The Cass report

Is the question: (1) Whether young people have enough information to properly decide about puberty blockers and hormone replacement therapy (and possibly, in some cases, top surgery); or (2) Whether they should be allowed to make such decisions at all (either because they lack the requisite decisionmaking capacity, or because those treatments are deemed unsafe or not appropriate for any young person); or (3) Whether anyone should be allowed to medically or surgically transition. My understanding is that by its terms the Cass report is relevant only to questions 1 and 2. But much of the narrative the report has generated reflects a deeper uneasiness about question 3. Undoubtedly in the wake of the report medical gatekeeping with regard to transition, about which trans people have been complaining for decades, will increase, at least for youth. If, as is sometimes claimed, the medical establishment has been aggressively marketing trans to vulnerable young people, this will be seen as a good thing. The history of the medical profession with regard to both trans and other behaviors that challenge sexual and gender norms does not suggest a strong tendency to encourage them – in fact, just the opposite. But there is money to be made, and even a further argument that medical interventions for trans people enforce those norms by representing gender as binary. I don’t favor increased medical gatekeeping for trans youth, because I argue that the youth themselves are the best judge of whether to avail themselves of existing interventions. This is not so much because they will necessarily make the best decisions. Young people are certainly capable of making bad decisions, of being inappropriately influenced by the agendas of the adults and professionals in their lives, and of acting compulsively and/or with inadequate information (though as to the latter its hard to imagine a topic more thoroughly vetted in the public square than trans). The main problem is how suspect the other possible decisionmakers – parents, doctors, and the state – are. Even if one or more of the latter three has a better claim to objectivity, which I doubt, I would favor letting the young person decide, on the basis that they will be the one to bear the consequences. (I don’t exactly consider myself a libertarian – I prefer the term “liberationist” – but one strength of the libertarian view is its reliance on bearing the consequences as a means of encouraging people to make intelligent choices.) As others have pointed out, the question whether puberty blockers are irreversible is a red herring. Puberty is irreversible. Trans kids have a choice, since the puberty and hormonal interventions exist. Puberty comes younger every year – maybe all kids, not just trans kids, should have the choice to delay puberty? Anyway, for trans kids at least, the choice exists, and who better to decide than themselves? hugzu ;-p