... No, We Definitely Want to Use Medical Arguments to Defend Trans Children

your fetish for counterintuitivity is not going to help trans kids

Andrea Long Chu, a  writer who has made a living nibbling around the edges of profound-seeming ideas but never rises to the occasion of actually taking a bite, has written a meandering thinkpiece about medical transition for trans youth, which among other problems troubles the core definition of youth trans medicine - she in fact believes that we should stop thinking of medical care for trans children in medical terms at all. I think this is a terrible idea for trans people and their advocates, and I think Chu’s relentless efforts to be interesting have made her essay effectively contrary to the effort to defend the right of everyone to live in a way that’s consistent with their sincerely-felt gender identity. I also think that a lot of well-meaning people are praising her essay because it’s “pro trans,” which means nothing.

Chu writes

The right to change sex that has been enjoyed for decades by their parents, friends, teachers, coaches, doctors, and representatives, especially if those people are white and affluent — this right belongs to them, too. We should understand this right as flowing not from a revanchist allegiance to an existing social order on the perpetual verge of collapse but from a broader ideal of biological justice, from which there also flows the right to abortion, the right to nutritious food and clean water, and, crucially, the right to health care.

Well, that’s swell. However I must note that the right to abortion, to nutritious food and clean water, and crucially, the right to health care have proven remarkably fragile in the face of something we call politics, by which we mean the steady course of ritualistic combat between warring tribes who vie for control of society, most certainly including its apparatus for dictating life and death. And so I think your essay here sucks, Andrea, because it speaks to those rights with nothing resembling a plan to secure them. It seems designed, instead, to flatter the moral vanity of the kind of people who read New York magazine.

Chu thinks physiological or hormonal or anatomical transition for minors should not be subject to the influence of parents or doctors. Trying to subtract parents and doctors from medical care for children is like trying to subtract the state from the “free market”; whether you believe it would be better or worse to do so, the debate is pointless, because you can’t. Like so much else of what Chu advocates for, I can refute it simply by saying “that will not occur.” Any attempt to do so, meanwhile, will have potentially terrible political consequences. It’s difficult to think of a policy stance more likely to enflame otherwise disengaged parts of the electorate than the notion that we should cut parents out of medical decisions about their children. And when it comes to physiological transition for children, these are medical decisions, both in terms of basic reality – surgeons perform gender confirmation surgery, doctors prescribe hormone therapies, sorry – but also in terms of political necessity. The entire edifice of trans medicine rests on the fact that it is in fact medicine, which is a domain of human life that’s afforded special independence. Doctors have been able to help trans adolescents transition because they are doctors and because doctors practice medicine; that is the special space in which certain core elements of our halting efforts to advance trans rights have grown. Why give that up? To be the smartest kid in class? To impress the kind of people who read Bookforum? Please.

We will never be able to defend the rights of transgender kids until we understand them purely on their own terms: as full members of society who would like to change their sex…. We must be prepared to defend the idea that, in principle, everyone should have access to sex-changing medical care, regardless of age, gender identity, social environment, or psychiatric history.

But, you see, they are in very direct and material terms not full members of society. We operate not just in America or in Western society but in literally every known human culture as if those under a given age of maturity (which can vary substantially) are the wards of their parents. This is, I’m afraid, another of my annoying assertions of an “is” statement that comes before a “should” statement. I understand that there is a certain precious tendency among affluent anarchists to want to change the reality of parent-child relationships, but wishes aren’t horses, are they? The notion that we can cut parents out of consequential medical decisions for their children, even if that notion is morally correct, is absurd nonsense that will hurt trans children and their advocates. We aren’t there; we can’t get there; a large portion of our political spectrum would like very much to deny even adults the right to live according to their gender identity or expression. When the wolf is at the door, you don’t go outside to draw in the dirt with a stick. Is there really no room to ask what types of engagement will actually defend actually-existing trans people who live on planet Earth, not in the land called Honah Lee?

And not for nothing, but New York is publishing this shit because it’s counterintuitive and thus likely to farm clicks, not because it’s strategic or correct. (Never take political advice from an editor.) No, arguments to medical privacy and medical autonomy are exactly the right arguments to defend trans children. They come with a certain degree of legal force, they have a longstanding presence in American parenting culture, and they don’t depend at all on actual respect for trans identities. You don’t need to appeal to people’s often-nonexistent compassion for trans people to say, “My child’s medical care is nobody else’s business.” Is the need for such arguments somewhat discouraging? Perhaps. Do we still need them? Yes. And playing games with that reality is so fucking bamboozling to me, so absolutely senseless and maddening, that I got genuinely mad while reading that piece, which is rare.

I don’t expect anyone to take my opinions on these matters seriously; you have no reason to. But I think Chu is dead wrong about this particular point, dead wrong to trouble the most meaningful source of trans autonomy we have in pursuit of an intellectualized lark, and I think people who care about protecting the rights of trans kids should continue to make the same basic argument I’ve advocated for here. We respect the rights of patients, parents, and doctors to make medical decisions in every other domain. Why not this one? Why violate that basic social expectation? Who are you to tell me what my kid can and can’t do with their body, under the supervision of their doctor? That can work. Whatever Lacanian horseshit Chu is pulling this out of will not work. It will not help trans youth.

Nor is Chu helping anyone by dismissing the value of standard medical investigations prior to transition.

As for transition-related care itself, 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.

Obligations? I guess not. But please, apply this to any other medical context: is there any obligation to receive an EKG if you’re having chest pains? No. Does it help people seeking good cardiac health to write essays about how not everyone needs an EKG to know that they need care? No. Does abandoning any standard of prior evaluation and rigor before medical transition help us in the current political moment? No, it does the exact opposite. It does the exact opposite! This is the fucking conservative fever dream! If you must think out loud, for Christ’s sake, think carefully.

I read Chu’s book Females, and I though to myself… golly! It’s a kind of ontological meditation on the status of being female that doesn’t, I’m afraid, ever get around to effectively defining what she means by female. The female is the one who receives, I guess, the female is the hole, which is the kind of thing you come up with while waiting for the campus shuttle to take you to the parking garage. (Chu has always struck me as the kind of person to make fun of going to grad school while in grad school.) The essential vibe of the book is the sort of thing I can get into, lazy and digressive, but at some point you have to actually say something. I’m guessing she was offered a book deal because her work was hot at the time and turned that heat into an advance check of indeterminate size; good for her, get that bread. But Females is one of those rare examples of Goodreads reviewers really having an author’s number; its pages are suffused with the palpable sense that she didn’t actually want to be writing that book at that moment. The result is both a lack of length (106 pages!) and a lack of sense.

What’s particularly frustrating for me is that Chu nods towards a point I’ve been making for a long time, that justifying trans rights through reference to those rare cases of biologically indeterminate sex categories is a mistake. I see defenders of trans rights habitually referring to intersex people, a genuinely very rare condition, and I think… that is exactly what we’re saying gender is not. The whole argument is that one’s gender identity need not comport with any given anatomical reality. So why make tendentious claims about the prevalence of anatomically indeterminate individuals to justify trans rights? Gender identity is not conditional on anatomy, there, done. If there had not been a single intersex person born in the history of the world it would not undermine trans rights at all. I wish Chu had spent more time on that rather than on pass-the-bong speculative trans epistemology. Trans reality is decidedly corporeal.

The only question that ultimately matters is, does Andrea Long Chu’s New York essay actually further the cause of preserving the rights of trans adolescents to medically transition? And the answer to that, it seems to me, is clearly no.

Chu says that public sentiment on trans people might be changing, and I think that’s true, but in the opposite direction that she implies. I think the backlash has arrived. We’re in a new era of trans politics, and the age of reflexive deference in some parts of the media is over, stamped out by the same broad and vague vibe shift that has brought both good and bad changes to contemporary political culture. I am even brigand enough to suggest that this backlash was driven in part by the rhetorical excesses of some trans advocates. Even more, I think it was helped along by a journalist class that deferred to those advocates out of fear rather than principle. We’re now seeing opponents of trans rights take the offensive in many domains. Which means that we must be effective advocates, if we want to oppose them well, not members of the professionally clever class. What’s more, if the long fight to recognize the equal rights and dignity of trans people is to proceed, we need to move beyond for and against, beyond pro and con. People need to drop their reflexive assumption that any criticism of an essay like Chu’s is necessarily transphobic and consider the possibility that Chu is a bad advocate for a cause that desperately needs effective advocates.

I believe that trans children and their parents and their doctors should be empowered to pursue whatever medical recourse they believe is best. I’m not criticizing Chu for advocating for trans people, a concept so nebulous that it’s like advocating for goodness or justice. I’m criticizing Chu for being a tiresome edgelord and I’m criticizing the team at New York for publishing this and revealing themselves to be totally disengaged from the actual material state of trans politics, a trendy topic which they had hoped to throw on their cover in just the exact same way Vogue might throw a waifish model on theirs.

This is a question that’s so simple and profound, I’ve brought many “gender critical” types to a standstill with it: if trans children, their parents, and their doctors are not the right people to make medical decisions for those children… who is? The government? Joe Rogan? You? This is not an easy question for many critics of adolescent trans medicine to deal with, in part because they tend to be small-government types who hate the idea of being told how to raise their children. It reminds me very much of sensitivity regarding the GOP’s assault on IVF, a sensitivity felt even by many people who oppose abortion. Because Americans don’t want anyone making medical decisions with them but their doctors! And it’s insane to reject that compelling reasoning on behalf of pure abstraction, on academic faff, on precisely the kind of preening self-absorption that led Kay Gabriel to say of Females, “Your argument is a front for your tone.” That is exactly it, here, that is the thing. Chu’s piece was not an essay on trans identity; it was the careful arrangement of affect, a series of broad waves towards a particular self-satisfied approach to writing, a game of appearance. This is all far too serious for that shit and I think New York’s editors could do with a great deal of introspection about what they’re up to. We are past the point of good vibes leading to good outcomes. To defend trans people you must think.

And, yes, Chu is trans and I’m not. I don’t give a fuck. She’s wrong and I’m right.