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What Is Transgender Child Abuse and Neglect?

The polarization in the medical field regarding what is the proper care and treatment of young people who are struggling with respect to their identity is reaching an epic level.  There is seemingly no middle ground: either one believes that a person’s identity is determined by their biological characteristics (chromosomes, genitals, etc.) or one believes that identity is determined by what the person chooses or feels.  Consequently, a person experiencing dysphoria about their natal sex should either receive assistance in increasing their identity with that biological reality, or they should be affirmed in their notion that they were ‘born in the wrong body’ and provided interventions that will approximate their ideas and feelings about who they are.  Thus, when an adolescent presents to one of the ever more prevalent gender clinics and requests hormone treatments and surgery, is a parent behaving in an abusive or medically neglectful manner if they (a) support the teens request or (b) refuse the teens request?

In “Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm,” the author Maura Priest argues, “(1) transgender adolescents should have the legal right to access puberty-blocking treatment (PBT) without parental approval, and (2) the state has a role to play in publicizing information about gender dysphoria.”1 Her argument stems from the premise that as a society we believe parents should provide medical care for their children, and to fail to do so is a form of medical neglect or child abuse.  Further, given that children who are not comfortable living as their biological sex dictates are ‘vulnerable’ – a point which no one on either side of the argument seems to dispute – the state has an interest and responsibility in protecting these vulnerable teens from parents who refuse to seek hormonal or surgical interventions to change the sex of their child.  Sadly, this is not merely a theoretical issue, parents have lost custody of their children as a result of their decisions.  And the age of consent is seemingly dropping.  Recently in Canada, courts have ruled against a father who refused to support his daughter’s doctor’s plan to inject her with testosterone when she was 14 years old. The healthcare team deemed the youth “capable to consent to [her] own medical care,” despite her developmental history of depression and self-harm, multiple suicide attempts, and parental separation. From a clinical perspective, any doctor presented with a young adolescent with this cluster of symptoms would recommend individual and family therapy focused upon coping with loss and dysphoria, not radically changing one’s identity. Yet in the current culture of gender ideology, there has been a drastic increase in the number of child-focused gender clinics putting forth the message that “puberty blockers and cross-sex hormones may be the only way to prevent teen suicides”.  And what could be more abusive and neglectful to a child than to interfere with an intervention that could prevent their demise?

The Alternative Conception of Transgender Child Abuse and Neglect

The argument can alternatively be made that it is abusive and neglectful to accede to a youth’s feelings about their identity, and expose them to interventions which will delay their adjustment to their biological sex, which is the only identity in which they will flourish. 

First, the research is clear that people who identify as transgender are 10 times as likely to attempt suicide at some point in their lives, and this rate almost doubles among those who have had transition surgery. Consequently, the notion that affirming transgender feelings by providing pharmacological interventions is damaging to the young person, not only psychologically, but physically [1] as well. Puberty blockers or cross-sex hormones are known to place these adolescents at greater risk for bone density problems, cancer, metabolic abnormalities, and impaired fertility. Another consistent finding that calls into question the practice of intervening with hormones for children who are in critical stages of their natural development is that the vast majority of those who identify as transgender do not persist in this identification.  Therefore, the administration of hormones might interfere with a healing process that would naturally occur, or at least delay a person’s realization that changing the gender by which they are living will not be a panacea for the burdens they experience. 

As has been previously asserted children need the guidance and direction of parents who are willing to stand firm, with love.  Children experiencing confusion regarding their sex need parents who are willing to be with them lovingly and compassionately through the struggle—even when that love and compassion are resisted—and withstand the cultural pressure to accede to that which much more often than not is a temporary answer to a problem that needs a comprehensive, caring solution. This is the non-abusive, non-neglectful, attentive and respectful stance that a child needs from a parent in the time of their greatest need.

  1. Priest, Maura, “Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm,” The American Journal of Bioethics, Volume 19, 2019 – Issue 2.