Even with a suppressed puberty, being transgender is extremely hard with high rates of depression and suicide. Any responsible analysis of the aggregate benefits of prescribing blockers needs to factor in the rates of desistence with and without blockers, but proponents of blockers almost always try to frame this discussion as though all kids with gender dysphoria persist in a cross sex gender. And indeed many try to claim that desistence is a "myth", despite most research into the topic.
The DSM criteria for gender dysphoria aren't particularly useful when you are diagnosing kids that play with dolls despite not expressing a trans identity or wish to switch sexes by themselves.
In addition to that, when you are dealing with a conversion therapist it is only natural to depress, but this doesn't mean that it's healthy for you eeither mentally or physically. This is something that was forced onto me as well.
Finally, you seem to be considering transitioning to be inherently something that should be avoided, otherwise why would less kids desisting be considered a negative?
Transition is indeed something that should be avoided if a patient can become comfortable in a same sex gender identity, because even with a suppressed puberty trans people have negative health outcomes across a variety of measures. To say that transition is best avoided if possible isn't a moral judgment against trans people, it's an accurate statement about the disparities in health outcomes.
This is a simplistic model, but imagine trans people have 10% risk of suicide if they don't get blockers, 5% if they do, and cis people have 1%. If I have a cohort of 10 patients with gender dysphoria 8 will desist and 2 will persist without prescribing blockers. And if you do prescribe blockers all of them will persist and transition. The former achieves the optimal health outcomes for the group as a whole. Again this is hugely simplistic, as suicide is not the only healthcare outcome we care about, but it illustrates that desistence rates are relevant to measuring whether blockers improve overall health outcomes.
Of course ideally we'd be able to know which patients will and won't persist. Psychologists attempted to do this for decades, but were never able to reliably predict which patients would and would not persist. People like to point to the extremely low rates of desistence among people prescribed puberty blockers as proof that psychiatrist are predicting correctly. But of course it's also consistent with blockers serving as a determining factor in persistence, and not merely offering "time to think".
Most people who pass by a bus stop don't get on a bus, but if they stop and wait at a bus stop then the probability they soon get on a bus is above 90%. Do you think standing at a bus stop caused them to get on a bus?
It's more like I have two different buses. When kids get on bus A, ~80% of them arrive at destination X and 20% at destination Y. When kids bet on bus B, 2% of them arrive at destination X and 98% of them arrive at destination Y. It sure looks like bus B isn't merely affording the kids "time to think" but is in fact altering their destination, does it not?
The patients in the study are diagnosed with the same criteria for gender dysphoria in the DSM. Heck, the author in the study I linked wrote the criteria for gender dysphoria in the latest iteration of DSM. I'm always puzzled by people who insist that the study was including patients that weren't actually experiencing gender dysphoria.
I don't get your bus analogy. Surely the people who get on bus B which goes to destination Y do so because they want to get to destination Y? The act of getting on the bus doesn't cause them to want to go its destination.
And how does that choice seem to affect the outcome? When gender dysphoric children are met with a neutral model of care that primarily seeks to observe the child, about 4 in 5 desist by young adulthood. When they're affirmed, and especially if put on chemical treatment to suppress puberty, 98% or more persist with a trans identity. Even with a suppressed puberty, transgender people experience worse health outcomes than cis people across a variety of measure. To say that the former approach is a better healthcare outcome in aggregate is not a denigration of trans people but a recognition of the challenges they face. To justify affirmation, the improvement has to be demonstrated not only against an adult transition, but also against the population that desist and live life as cis people.
The studies presented above took a sample of the patients that visited a a clinic that voiced distress of their gender over the span of a period of time - the majority of them meeting the criteria for gender dysphoria in the DSM - and tracked which of them desisted or persisted in expressing a non-cis gender identity decades or more after the fact (average time from first visit to last follow up was 13 years). The lowest rate of desistance was 70%, 3 out of the 4 were above 80%.
To call the results of a study "unrealistic" indicates that one already knows a "realistic" result would be. This is essentially admitting to bias approach to the data: if it doesn't conform to your predetermined "real" result, and your criticism is solely based on that and not any methods in the study. By comparison, the studies that show extremely low rates of desistance are either studies with kids on blockers, or they are not cohort studies. E.g. studies recruiting respondents from the internet is vastly more susceptible to reporting bias than taking the group of patients visiting a gender clinic over the course of a year.
If you want to actually post and discuss a study finding high rates of persistence under a neutral model of care, I'd be very interested in reading. But my approach towards deciding what a realistic result is leans more heavily towards published research than anecdotal claims.
You say "most research" shows this. From which source(s) do you draw these claims? If I recall correctly there were a lot of methodological issues with drawing this type of conclusion from those studies.
The desistence rate for this study was 87%. Most other studies fall in the range of >70%
> At the time of follow-up, using different metrics (e.g., clinical interview, maternal report, dimensional measurement of gender dysphoria, a DSM diagnosis of GID, etc.), these studies provided information on the percentage of boys who continued to have gender dysphoria (herein termed “persisters”) and the percentage of boys who did not (herein termed “desisters”).2 Of the 53 boys culled from the relatively small sample size studies (Bakwin, Davenport, Kosky, Lebovitz, Money and Russo, Zuger), the percentage classified as persisters was 9.4% (age range at follow-up, 13–30 years). In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3
You can find studies that find a very low rate of desistence, in the single digits. But those are among children that were put on puberty blockers.
Treating people as 'a politically losing issue' is weird to me. There are certainly some nuances to <18 transgender care, but that statement doesn't address any of them and just suggests we embrace political cowardice.
> When policies around it changed, that tipped the scales from the public ignoring trans women or seeing them as victims, towards many members of the public seeing them as monsters who are out to get their children.
This is worse. It wasn't because politics around it changed, it was because republicans (upset that they could no longer target gay people), reused the same crappy arguments against trans people, and then wrapped it in a pedophilic flag.
The change in policy is just effective propaganda making people concerned that random doctors are allowing their children to get sex change operations without consent, when that isn't how ANY of this works. Children <18 can socially transition, get puberty blockers, and MAYBE get hormone treatment. WITH parent consent.
The fact that the media and comments like yours continues to pretend its a reasonable 'discussion' perpetuates the nonsense.
Discussions like this often end up at WW2 and that's not what I'm saying here, but Germany in the 1920s was essentially the Gay/Trans hub of the world until it wasn't: https://www.netflix.com/title/81331646.
But even that's not the beginning of 'trans'.
The reason trans isn't 'flying under the radar', isn't because trans people got too proud. Its because one political party decided to shine the magnifying glass to turn trans into a political issue.
How many do consider reasonable to sacrifice in the name of political expedience?
Trans women until VERY recently were forced to go into prostitution and were excluded by the wider society. Trans people were not force teamed into any war, or rather, this is partially right, they were forcefully forced to pick a team by the side that aims to take away their bodily rights, protections, and mark them as undesirables again.
Imagine trying to make the same argument about forcing cis women to go through male liberty to "understand men better". It's ridiculous.
Further, studies show that the main predictor of bone structure is whether you started HRT before or after the beginning of puberty, and that outcomes get worse the more it progresses. At 18 you still get some change, but you really need to either block puberty or start HRT before it for optimal outcomes.
And if you don't want to give HRT to trans children, at least get them on puberty blockers. There's pretty much zero evidence suggesting they do anything worse than temporary and reversible reductions in bone density.
The effects are only partially reversible, and only after tens or hundreds of thousands of dollars in surgeries, hair removal, voice training, other treatments.
I understand it's a politically losing issue now, but I believe it's due to misinformation, outrage porn, and unfair application of rigor, from mostly the anti-trans side but even allies and trans folk themselves sometimes. To that end I hope this does not feel like an attack - let me know if you have any questions that you think my perspective would help.
This is the key point, imho.
In the transgender rights discourse no margin for error is admitted, but there is like in any other human field (of course).
There have been several cases of people being given a "gender disphoria" blanket diagnosis (eg: the case of Chlementine Breen[1]), which later caused issues. And of course some of those people are transitioning back and started doing activism against the trans rights movement.
It's weird that minors are not allowed to do something trivial as drinking a beer or driving a car yet they're allowed to take on irreversible changes (sometimes involving surgery) to their bodies.
This is hurtful to all people involved, and until this point is not understood, the attrition will continue.
[1]: that case is a textbook example of "no margin error admitted" because in order for their voice to be heard they had to resort to talking to the extreme opposite political side.
The wrong puberty is irreversible mutilation. It's not weird at all given that kids are being given treatment for cancer.
Complete nonsense. The ratio is generally the inverse: there are 100 cis people and 1 trans person. Those are just the numbers, otherwise trans people wouldn't be a considered a minority.
Actually you're the one arguing that the convenience of one trans person is worth more than the life of 100 cis people.
Damn the social consequences, it's who we are. If transitioning were available as a minor it would greatly reduce suffering.
Don't get me wrong, trans issues do need more study, but this is also an example of isolated demand for rigor. Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
In addition, trans healthcare in Sweden has historically been behind the US. Trans people were forcibly sterilized up until 2013, and trans healthcare underfunded. In Finland the sterilization was required until 2023!
The UK, Italy, Denmark, and Sweden all stopped prescribing puberty blockers to gender dysphoric children following the Cass review. Other countries, like Finland, has stopped earlier. It's not possible to continue insisting that this is settled science, when much of the developed world has broken with the US's approach towards gender care in minors.
> Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
Such as? Furthermore, there were RCTs conducted studying the effects of puberty blockers. They didn't decrease gender dysphoria.
Also, put the evidence (or lack thereof) in the context of the certainty and urgency that proponents of gender medicalization were conveying: People were claiming that gender dysphoric children were going to kill themselves if they don't get blockers. Doctors like Joanna Olson-Kennedy repeatedly claimed that parents had the choice of a dead son or alive daughter, a statement parroted by politicians.
This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers [1]. And now she's trying to argue that no benefit is actually a good result because the patients would have fared even worse absent blockers. But of course, without a control group there's no substance to that claim.
1. https://www.nytimes.com/2024/10/23/science/puberty-blockers-...
> "“They’re in really good shape when they come in, and they’re in really good shape after two years,”"
So a treatment that causes a change to not happen does not cause those who are doing well to do even better? Is this the evidence that's supposed to make me want to ban a widely-accepted medical treatment?
Here's a study showing evidence that gender dysphoria treatment in children improves well-being and mental health: https://pubmed.ncbi.nlm.nih.gov/25201798/
There's loads more.
Neither the discussion nor the conclusion mention this, so maybe I'm misinterpreting something?
> We did not detect a difference in the odds of lifetime or past-year suicide attempts or attempts resulting in hospitalization. It is possible that we were underpowered to detect these differences given that suicide attempt items were less frequently endorsed than suicidal ideation items (Table 3). Given this study’s retrospective self-report survey design, we were unable to capture information regarding completed suicides, which may have also reduced the number of suicide attempts we were able to account for. Given that suicidal ideation alone is a known predictor of future suicide attempts and deaths from suicide, the current results warrant particular concern.
Yes, we're at a juncture. But my point is I don't think bans for adult care are inevitable, nor that strict prohibitions for minors need be permanent. If trans advocates and their supports took a breather and figured out how to reframe things, the backslide (such as it is) could be arrested and even reversed. But that will require, at a minimum, taking back the microphone from the most radical "advocates". And probably to depoliticize it. The issue has become highly politically polarized, but that's a relatively recent thing. I was gobsmacked by the generally tame and sympathetic conservative response to Caitlyn Jenner among conservatives 10 years ago. The turn was avoidable and, arguably, reversible.
I agree with your assessment, and I am suspicious of anyone (on either side) who claims that there is an obvious “correct” answer to this issue.
It's the same medicine from the same medical professionals and the only difference is your gender identity.
Even if you were to convince me of this legal fiction that gender identity has nothing to do with idemitiy and is in fact just a medical condition the Supreme Court doesn't care to treat, I still would call it a life threatening attack.
If the Supreme Court denied chemotherapy for cancer patients, it'd be perfectly justified to call it life threatening denial of care. The fact that it's available for cancer patients with other diseases that are treatable via chemotherapy is irrelevant.
It should be up to a doctor to decide if a prescription makes sense for a particular patients symptoms and diagnosis. The Supreme Court should not concern itself otherwise.
At least with Roe v Wade there's an argument to be made about it involving a second hypothetical person. But this? This is strictly between patients, their medical care, and their parents.
But I guess what you’re saying is why is the state passing these laws, which is a fair enough question. The Supreme Court says they are allowed to, and they are the authority on which laws are allowed, so I expect the states will keep doing this sort of thing until the voters tell them not to.
Plato did try to warn us that democracy was a terrible idea.
https://www.npr.org/2025/06/18/nx-s1-5421276/scotus-transgen...
At the national level, The One Big Beautiful Bill Act as passed by the House cuts all federal funding for transgender care for adults via Medicaid [3], though that's still pending what the Senate does.
[1] https://apnews.com/article/florida-transgender-health-care-a...
[2] https://www.pbs.org/newshour/health/missouri-governor-signs-...
[3] https://www.politifact.com/article/2025/jun/02/medicaid-bill...
Given that a number have prohibited it from being paid for by the state Medicaid program for adults when it previously was, that is, maybe, a glass quarter full take. (There is also the issue that wrong-gender puberty is a particularly significant suicide risk factor for trans youth, so restricting gender affirming care for youth is a particularly strong assault on trans lives.)
And even then, its not strictly true, as while most states with restrictions that have passed have only restricted care to minors, Nebraska did so for persons under the age of 19, which includes some adults.
> Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.
They have not only sought to do so, they have actually done so (as mentioned above). They have not yet implemented broad prohibitions (except Nebraska's for adults under 19), but "limit" and "broad prohibition" are not the same thing, and mere limitations can have the same practical effect as broad prohibitions, as many states demonstrated by making it nearly a practical impossibility to provide (and therefore access) abortion services, even before the Supreme Court overturned Roe; conservative states are following the same playbook with gender-affirming care.
> Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
No, legally-imposed waiting periods for adult (or even youth) gender affirming care were not present (and still are not present) in the most liberal states. That's a very strange thing to invent to minimize the restrictions being imposed by conservative states.
If you are equating the fact that it can take time, for some services beyond HRT, to save up money and/or jump through whatever hoops are established by your insurance, and find and schedule time with the required provider(s) with legislatively imposed waiting periods and other access restrictions, that's incredibly dishonest (for one thing, the legislative restrictions don't overlap the other ones, they add on top, and, by making it more difficult for providers to operate and thereby reducing the number of providers, make the other issues worse as well.)
Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.[1] Which is not nothing considering how many were so quick to ban abortion.
Also, it's not just the U.S.; plenty of "liberal" Western European countries have reversed course on care for minors. Even the Netherlands, the origin of the WPATH protocol, has pulled back on the reigns for minors, though they haven't yet instituted any prohibitions.
IMO, the trans advocacy rhetoric that equivocated hurdles to gender affirming care for minors as murder backfired. The fact there seems little motivation to limit treatment for adults suggests substantial openness to the issue among even conservative populations. And there are many in the LGTBQ community, include trans community, who share similar sentiments, at least regarding the rhetoric.
[1] Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.