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Saturday, November 25, 2017

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A rational approach to transgender discussion


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Issues of morality are thorny because people disagree on the fundamental precepts. People rank moral values in different orders. Some place individual freedom above all, while others value peace as the paramount moral end.

Such discrepancies are why people often regard those with whom they disagree as morally inferior. How could a good person want to legalize drugs or prohibit abortion?

Judgment of this sort arises only when one cannot empathize with people who view the world from a different moral lens. Despite widespread disagreement in all things moral, all rational actors can agree on brute facts, here defined as contextual information, with or without a concomitant explanation.

For example, while people weigh the competing values of human prosperity and environmental change, incontrovertible facts show that the prevalence of undernourished people decreased by 42 percent from the years 1990 to 1992 and 2012 to 2014, and the planet’s average surface temperature will rise about two degrees Celsius by the end of the 20th century.

Brute facts, especially coupled with the correct explanation, augment the moral adjudication of all rational actors.

The topic of transgender children has recently risen to the public consciousness. In 1989, the Gender Identity Development Service received two referrals. In 2015, that number grew over two orders of magnitude, and included 300 children under 12. Differing moral vantage points result in the judgments described above. 

In one case, conflict arose over a 14-year-old girl adopting a male name in an effort to move toward a new gender identity. While the child’s mother disapproved, the relevant authority supported the girl’s decision.

“The rights of the parents are being eroded, especially those who have traditional Christian values. It is leaving parents to feel intimidated,” the mother said.

On the other hand, Dr. Norman Spack, a pediatric endocrinologist, urges that society give self-identifying transgender children hormone-blockers after puberty, and eventually cross-sex hormones. He said the current suggested minimum age to be given such strong hormone doses, 16, is cruel.

This tension between the conservative wait-and-see perspective and the liberal do-it-now attitude can be resolved.

Once brute facts and their proper explanation are understood, we will know exactly which children should be given the appropriate transgender treatments. The positions of both the parent and the doctor would give way if we completely understood the basis of transgender people. It would be easy to vindicate or refute the Christian mother’s resistance to her child’s name change and Spack’s claim that delayed hormone treatment is cruel.

There would be no room for moralizing in the face of certainty. Just as we have progressed in treating physical ailments by understanding their underlying causes and explanations, so too will the proper medical solutions for transgender children depend on understanding the genetic and neurological basis of transgender people.

In the meantime, uncertainty implies that at least one of two errors are inevitable: Some individuals will inappropriately receive transgender treatment, and some individuals will face pressure to remain unchanged despite their genuine transgender status. While the suffering incurred by each of these errors is a problem, the former is surely far worse.

To claim that mistaken gender transition is of the same magnitude as facing obstacles — not including discrimination —  in implementing such a transition is moral relativism of the worst kind. As we acquire more and more brute facts, both errors can be diminished, and eventually they will be eradicated entirely with correct explanations.

Until then, we face the uncomfortable truth that catastrophic mistakes will be made. But there is a trade-off between the two errors. An overly rash approach will result in children facing the rest of their lives mistakenly altered. An overly conservative approach will bring suffering to those children who are genuinely transgender for a few additional years until they are deemed old enough to make such a life-changing decision. The latter option is the mistake society must bear.

Guest columnist Logan Chipkin is an ecology and evolution graduate student and can be reached at [email protected]

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  • Michelle Heinrich

    Not to beg the question but why are you assuming that someone accessing transition care and then regretting it is “far worse” then someone wanting to access transition care and then being denied. Both lead to the same supposed outcome- an adult with a body they now wish they had/hadn’t altered, so why aren’t the outcomes of equal severity. One could also argue that the act of withholding something that someone truly desperately wants is less ethical than giving someone something that they mistakenly desperately want.

    Therefore it would appear in the absence of other factors as though letting someone mistakenly transition of their own volition is preferable to nullifying an individual’s bodily autonomy in case they’re mistaken.

    • Logan Chipkin

      The outcomes are not the same. One is a postponing of a solution, the other is a creation of a problem.

      • Michelle Heinrich

        2 Cases:

        Person A is a trans woman who would have liked to have been able to access transition care when she was an adolescent, but was kept from doing so.

        As such she has the permanent marks of testosterone puberty (i.e. increased height, a deepened voice, body hair, facial hair, narrow hips, wide shoulders) even though she would like to have the traits more typical of an estrogen puberty. Sadly these are unobtainable through transition care administered after puberty.

        Person B is a cis woman who received transition care during adolescence at her request, but now regrets doing so.

        As such she has the permanent marks of testosterone puberty (i.e. increased height, a deepened voice, body hair, facial hair, narrow hips, wide shoulders) even though she would like to have the traits more typical of an estrogen puberty. Sadly these are unobtainable through transition care administered after puberty.

        Both person A and B underwent a testosterone puberty that they wish hadn’t happened. Both now possess the same traits that they wish they didn’t have, and both wish they had the traits more associated with an estrogen puberty. So how are the outcomes not the same? Forcing trans people to go through a puberty that they don’t want, leads to the outcome that you’re so desperate to prevent for cis people.

        • LetMyPplGo

          You’re absolutely right. Either way someone gets “mistakenly altered” as the author says. It’s an incredibly false and short sighted assumption to think that doesn’t have a serious and detrimental effect.

          On top of that, the author’s standard for treatment doesn’t at all coincide with modern medical practices. There is more regret found in prostate cancer surgeries than transition.

          And on top of that, what medical test is 100% accurate? Few to none. Many even have false positives. You can’t eliminate human error unless you eliminate humans. But the author suggest we need a higher standard for trans people alone — a double standard in fact.

      • LetMyPplGo

        Michelle Heinrich is right. Denying care to a trans person creates many new problems for them. What happens when you fail to treat medical conditions in a timely manner? They get worse, the cure becomes more expensive, and there is far more likely to be permanent damage.

        You can’t just “postpone a solution” and not expect that postponement to create issues as well. In fact it does create many problems.

        No one should have to go through puberty twice. Whatever reason a person has to go through it twice doesn’t matter — it still leaves you with the same problems in the end. You’re still mistakenly altered. That is a fact.

        The best outcomes for trans people, like any other medical condition, are found when it is treated early.

        I would also add that already the vast majority of people who transition do so appropriately. There is more regret to be found after prostate cancer surgery than transition. Yet we still do prostate cancer surgeries.

        Human error will always be a factor so long as we continue to be human. In fact, tests for other medical issues do not come with a 100% success rate. Many even produce false positives.

        So why should anyone be expecting certainty for transgender people? That is a double standard. Why should there be a double standard for the treatment of transgender people? That isn’t rational.

        • Logan Chipkin

          Which error do you consider worse for an individual? Delayed treatment or irreversible treatment that is later regretted?
          Remember, at least one of the two above-described errors is inevitable until we have the relevant understanding and technology.

          • LetMyPplGo

            They are the same error. Delayed treatment is irreversible. It also causes regret. What is so hard to understand about that? It is a false assumption that a cisgender person’s situation is worse than a transgender person’s. Both will suffer similarly.

            What I tried to explain (and that you ignored) is that with our current understanding and technology, the rate of transition regret is actually really low. Your “rational” approach is to make 100 trans people suffer irreversible harm and regret because of 5 cisgender people. That isn’t actually rational.

            It’s especially irrational when you consider the facts. A 95% success rate is actually really good in modern medicine. 10% of deaths in the US are attributed to medical error, the third highest cause of death here, but it would be wholly irresponsible to stop or delay treating people as a result. That isn’t how it works.

            You would be setting a double standard — a discriminatory standard even — by withholding treatment from transgender people and only transgender people when you consider how other medical treatments work as well as their success rate.

            Even now doctors and researchers are improving on the already high rate of success for transgender transition (and other medical treatments). But they do that through learning and treatment — not by doing nothing or making false assumptions. That is how modern medicine works.

          • Logan Chipkin

            The younger the child, the more uncertain is the correct option, given that individual “agency” matures with age.

            A delayed solution is not equivalent to the creation of a new problem.

            Note – I did not choose the title of this article. Nonetheless, simply declaring something as irrational does not make it so.

            Also, calling something discriminatory is not in itself an argument.

            All assertions require explanations.

          • Michelle Heinrich

            But in what way are the delayed solution and the new problem different in the 2 cases I offered above? Both individuals have been physically masculinized (one through bodily puberty the other through induced) and both wish they hadn’t. They would also probably both be gendered as male in neutral gendered clothing by society.

            Furthermore, transition care at that point for the trans women will be as effective in reducing the physical changes brought on by a testosterone puberty as detransitioning would for be for the cis women. I just fail to see how these aren’t incredibly similar outcomes

          • LetMyPplGo

            I am getting the feeling that Chipkin doesn’t understand what transition involves or what transgender youth go through.

          • LetMyPplGo

            I did give explanations. I even pointed out that it is the double standards that are discriminatory. You are requiring a higher standard of treatment of trans people than any other medical issue, and you advocate sacrificing 95 transgender people for 5 cisgender people.

            What is missing are the explanations for your assertion that delaying treatment doesn’t create new issues. Even the most basic research into transgender transition would show you that delayed treatment causes major issues. It is also one of the biggest sources of regret among transgender people — that they couldn’t or didn’t transition when they were young.

            Considering that, I get the feeling you have failed to do the research on the transgender side of your argument.

            I wrote a longer response wherein I explained the details of the transition process, but it is caught in the “pending” moderation queue. Maybe you will get to see it soon?

            Regardless, you should be responding to Michelle Heinrich. It speaks volumes that you ignore so many arguments and respond with such baseless assertions.

  • Dianne S

    This whole article has nothing to do with rationality. It puts decades of science and clinical research on the same footing as a religious opinion in a deceitful attempt to sound “balanced”.

    • Logan Chipkin

      With all due respect, that is not an argument.

    • Michelle Heinrich

      You should talk about what that science and clinical research is. Also religion doesn’t seem to factor into his analysis.

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