“The most insidious source of the anti-trans movement in this country,” writes Andrea Long Chu in her provocative cover story, “is, quite simply, liberals.” As one of those liberals, I’ve advocated in these pages for some of the ideas that Chu’s essay is aimed at. I support trans rights in general, but, like many liberals, I believe the medicalization of children is being carried out in many cases recklessly and dangerously. Chu, by contrast, argues for a sweeping, unconditional right for children to transition their sex rapidly. And yet I am gratified it was published and find the piece to be an important contribution.
The quality I most admire is its honesty. Chu dispenses with the tiresome misdirection found in the talking points hurled constantly against my position, instead clearly stating several important truths: first, that the critics of the orthodox trans-rights view are not all reactionaries and many are liberals. Second, that there are important differences of opinion between various critics. Conservatives dismiss trans rights altogether, while liberals completely support trans rights as it pertains to employment, housing, public spaces, and other adult matters, disagreeing mainly in how it is applied to children (as well as, in limited cases, addressing the problems raised by trans female athletes competing against natal females).
Trans-rights activists and their allies have relentlessly presented their entire agenda as a take-it-or-leave-it block, attacking anybody who criticizes any piece of it as a transphobe. Chu does not stoop to that propagandistic move.
Third, and most important, Chu dispenses with the activist-group mantra that gender-affirming care for youth is simply a matter of life-saving science. Instead, she argues for gender-affirming care, including puberty blockers, cross-sex hormones, and surgery, as a matter of right: “In principle, everyone should have access to sex-changing medical care, regardless of age, gender identity, social environment, or psychiatric history.”
The last item on the list is especially crucial. An important source of controversy within the field of gender-care experts is the problem of treating kids with mental illness. There’s no consensus among practitioners (in the U.S., anyway) on whether a child with autism, trauma, dissociative disorder, or other mental-health issues is capable of providing informed consent to treatment that will have irreversible effects. Many trans-rights allies have insisted this inconvenient debate is a sideshow or not really occurring. Chu addresses it squarely and argues from first principles that neither age or mental-health status ought to prevent a child from undertaking a sex change.
Arguments about rights are difficult. Most people form intuitive views about absolute rights and use them as the foundations from which other arguments grow. Some contested views of rights are whether everybody has a right to gun ownership, or the right to vote (which some conservatives describe as a privilege), or a right to health care, or that market income distribution is morally sacrosanct. When we argue about gun control, voter-suppression laws, Obamacare, or taxing the rich, we are frequently shadowboxing over different beliefs about rights. Empirical arguments can settle questions like whether a specific law will work. But if, say, you consider firearm ownership an absolute right, then no evidence about how many lives any particular gun-control reform is likely to save is going to make you support it. Or if you believe adult citizens ought to have the right to vote, then any plan to restrict the franchise is simply a nonstarter.
Chu isn’t shadowboxing. She makes clear her support for letting kids undergo sex-change procedures is absolute and in no way predicated on any measurable outcome. She explicitly denies that transitioning a child needs medical guardrails of any kind:
The right to change sex includes the right to receive counseling, to understand the risks, or to be treated for comorbidities; in fact, society has a duty to make these resources freely and widely accessible to trans kids. But these are practical options, not obligations. To make “thoughtfulness” a requirement of any universal right is to taper that right into an exclusive privilege.
As a matter of a priori logic, this is perfectly sound. Your principles are your principles. Importantly, the sweeping nature of this claim makes it impervious to any set of facts. Even if it were the case that (to take an extreme hypothetical) 99 percent of the kids undergoing sex-change procedures will eventually regret their choice and face unpleasant side effects, Chu’s argument would be unaffected.
Since the efficacy of youth gender medicine has no bearing on her position, it follows that the debate over the efficacy of youth gender medicine is pointless and even cruel. Chu blames liberal critics of youth gender medicine for emphasizing disagreements and uncertainty among providers. Their reporting, she laments, “took what was threatening to become a social issue, hence a question of rights, and turned it back into a medical issue, hence a question of evidence; it then quietly suggested that since the evidence was debatable, so were the rights.”
Of course, it is not just the skeptics of gender-affirming care who turned the matter into one of evidence. The advocates have adopted the same frame. As the GLAAD truck protesting the Times for its coverage of youth gender medicine claimed, “The science is settled.”
The science is actually unsettled and growing more so. Health services in England, Sweden, Finland, Norway, and France have all pulled back on youth gender transition care in the face of evidence reviews casting doubt on the gender-affirming practice. A study in Finland published last month did not find that gender-reassignment interventions reduce the risk of suicide, and just in the last week, the National Health Service stopped routinely prescribing puberty blockers for gender transition in England. (The former study is especially important, given that large numbers of parents provided consent for medical transition after being told refusal would put their child at risk of suicide.)
In the U.S., the major organizations representing providers have held firm, hence the boast by the activist group GLAAD that “every major medical association supports gender-affirming care as best practices care that is safe and lifesaving and has widespread consensus in the medical and scientific communities.” But this consensus is the product of a power struggle between advocates of unmediated gender-affirming care and their more cautious colleagues.
The primary clinical standards for transitioning the sex of children were developed in the Netherlands and involve extensive evaluation and screening for mental health. In 2022, Reuters surveyed doctors and other staff at 18 gender clinics in the U.S. and found that none of them — zero out of 18 — employed “anything like” the medically proscribed level of caution. Providers like Laura Edwards-Leeper, the founding psychologist of the first pediatric gender clinic in the U.S., and Erica Anderson, former president of the U.S. Professional Association for Transgender Health, have been marginalized after warning, “A flood of referrals to mental health providers and gender medical clinics, combined with a political climate that sees the treatment of each individual patient as a litmus test of social tolerance, is spurring many providers into sloppy, dangerous care.”
An important source of this pressure is the very belief system Chu articulates. As one psychiatric researcher noted in a recent editorial in the journal Acta Paediatrica, “Unfortunately, the discourse surrounding the use of puberty blockers in gender dysphoria is often framed as a political human rights issue rather than as a medical issue.” When England shut its main youth gender clinic, decentralizing its functions, the government issued a report in which doctors stated that they had experienced “pressure to adopt an unquestioning affirmative approach.”
Many trans-rights activists believe the cautious procedures recommended by the Dutch protocols for guiding youth gender transition are immoral. That belief grows out of bitter experience trans people have had with a medical profession that long pathologized them, extending their opposition to medical gatekeeping to children. The rights-based approach put it in conflict with medicine’s “do no harm” ethos, which tends to demand evidence for interventions. (Doctors who support, say, abortion as a right for minors do so within the context of evidence showing that abortion can be done safely — which is established through science, not merely because of appeals to bodily autonomy.)
Marci Bowers, WPATH president, put the matter more delicately. The organization, she told Reuters in 2022, was trying to find a middle ground between “those who basically would have hormones and surgeries available at a vending machine, let’s say, versus others who think that you need to go through all sorts of hoops and hurdles.” The youth gender status quo that activists have presented to the public as the clear consensus of experts in the field is, in reality, the product of a political struggle between practitioners who believe something like Chu’s case for sex-change-as-human-right against those who believe medical evidence calls for more caution.
It’s hardly uncommon for activists to define their stance as the obvious, singular moral truth and any critic of any degree as a moral monster to be shamed and shunned. (Just, uh, look around.) This tactic is especially likely to prevail in deep-blue pockets, like gender clinics and coastal journalism. Trans-rights activists have applied it with notable success in both areas.
Jesse Singal reported for New York’s social-science vertical on an episode in Canada where activists targeted a researcher at a gender clinic who they believed had engaged in “conversion therapy” with wild false accusations, resulting in a Kafkaesque firing. Two years later, he wrote a cover story for The Atlantic on the rise in gender-questioning youth, presenting both positive stories about youth transitioners alongside the concerns of detransitioners and providers in the field. As a result, Singal himself became the target of wild smears. For several years after, some journalists in the mainstream media understood that covering this story in a way that deviated even slightly from the narrative promoted by trans-rights activists would bring a terrible personal and professional cost.
Chu’s essay lists Singal, along with several other writers, as one of many dissident cranks who “live in self-imposed exile on Substack, the newsletter platform, where they present themselves as brave survivors of cancellation by the woke elites.” I’m not closely familiar with the work history of every writer she names, and they all have different motivations. But if you think the best explanation of this fact pattern is every one of these journalists chose independently and without pressure to abandon secure, coveted positions at influential outlets to gamble on self-published newsletters and then falsely claimed they had been hounded from their jobs, then you have a different understanding of human motivation than I do.
Whatever the cause, the fact that journalistic skeptics of the practice of gender medicine worked almost entirely outside established journalism, and the supporters worked inside it, made it very easy to dismiss the former as cranks and bigots.
The dam broke when the New York Times plunged into the subject. Having spent years insisting only transphobes had any questions about the efficacy of pediatric gender medicine, it was a catastrophic reversal for these questions to be aired in the news pages of the paper of record. Activists pulled out the familiar playbook, targeting the Times with letters denouncing its bigotry and street protests.
But the main letter criticizing the paper’s coverage did not identify any errors of note. Indeed, the letter criticizing the Times, as Washington Post media reporter Erik Wemple found in a careful analysis, was itself riddled with misrepresentations. That its signatories have not acknowledged or withdrawn their false claims shows that the Times’ real offense was not misreporting on the state of the youth gender science but reporting on it.
Chu’s essay indicts the Times for subscribing to a viewpoint she calls “trans-agnostic reactionary liberal,” or TARL. I reject the epithet — just plain liberal works for me, thanks — but I embrace her description. “The TARL’s primary concern, to hear him tell it,” she writes, “lies in protecting free speech and civil society from the illiberal forces of the woke left, which, by forcing the orthodoxy of gender down the public’s throat and viciously attacking anyone who dares to ask questions, is trafficking in censorship, intimidation, and quasi-religious fanaticism.”
Chu concedes that these liberals also oppose the vicious conservative attack on trans rights, but she believes the extremes of the right and left feed into each other: “the ‘overheated political moment,’ inflamed by both right-wing backlash and the strident tactics of trans activists, is preventing the medical Establishment, which is trusted implicitly, from coming to a sober consensus.”
Well … yes. That is the nub of it. Not that the Establishment is always wise, or that ideas located at the extreme at any given moment are always wrong, but that censorship and intimidation in service of quasi-religious fanaticism is a poor way to advance justice. History is filled with fanatics who were certain they possessed a monopoly on truth and were therefore justified in using any methods needed to vanquish their enemies.
Some of those fanatics were acting on behalf of the genuinely oppressed. But the sobering historical lesson liberalism offers us is that even the noblest intentions are not enough to create actual justice. I don’t accept the notion that to value empiricism and universal rights, even for our political enemies, is tantamount to a lack of concern about trans rights or the rights of any other oppressed group.
Liberalism may not offer final permanent solutions to all our moral dilemmas. That is often frustrating, but there is nothing insidious about it.
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