Children are victims in the latest identity-driven culture war

THE first question asked of any new parent is: “Boy or girl?” Across the developed world, the answer matters far less than it used to. Both girls and boys are less constrained by their sex than ever before. Women can not only vote and own property, but stand for election and run companies. Men can care for children—and for their appearance. Both sexes are free to love, and in many countries marry, whomever they wish.

But for some, even today’s capacious gender roles do not fit. The number of transgender adults—those who do not identify with the sex on their birth certificates—seems to be rising (see article). More are changing their names, clothing and pronouns, taking cross-sex hormones and seeking gender-reassignment surgery. Their rights and status have become the casus belli for the latest culture war.

The fiercest fire is left-on-left. Some feminists reject the claim that trans women (people registered male at birth who have made the transition to a female identity) are indeed women, rather than men who eschew stereotypically male behaviour. But to trans people being thus “misgendered” feels downright cruel. Such feminists are called “transphobes” and accused of hate speech. The hard words fly both ways: witness Germaine Greer declaring that “just because you lop off your dick” does not make you a woman.

None of this is edifying. What is unforgivable is that children are caught in the crossfire. Soaring numbers are seeking help for gender dysphoria—the distressing conviction that the sex on their birth certificate is the wrong one. If they are unlucky, what happens next will have more to do with an adult battle over identity than with what is right for them.

Gender reassignment is a momentous choice, since it causes irreversible physical changes and, if surgery is done to reshape the genitalia, perhaps also sterility. For gender-dysphoric children the clock is ticking, since puberty moulds bodies in ways no drugs or scalpel can undo. Waiting until adulthood to start the transition therefore means worse results.

Some clinics buy time with puberty-blockers, which suppress the action of sex hormones. But these may have harmful side-effects. Furthermore, most gender-dysphoric children will probably not become transgender adults. Studies are scarce and small, but suggest that, without treatment, a majority will end up comfortable in their birth sex, so treatment would be harmful. Unfortunately, no one knows how to tell which group is which. Yet some trans activists have thrown caution to the wind. Specialists who start by trying to help gender-dysphoric children settle in their birth identities, rather than making a speedy switch, risk being labelled transphobes and forced out of their jobs. Few are willing to say that some such children may actually be suffering from a different underlying problem, such as anorexia or depression.

Won’t someone think of the children?

It is bad enough that doctors, parents and gender-dysphoric children must make high-stakes choices against time without good evidence about what will happen. Worse is that children’s plight is being used by adults as an opportunity for moral grandstanding. The child’s interests depend not on the feelings of transgender activists—nor those of feminists—but on facts that still need to be established. Doctors need to know more about how to tell when gender dysphoria is likely to persist. Until they have that information, they should not rush in with drugs. Before acting, doctors should have reasonable grounds for thinking that they are doing good.