smac97

Could you elaborate on the irony you see here? First, could you clarify what you mean by "a disciple of Joseph Smith"? Also, the PDF document characterizes "secret non-monogamy" as "{a} relationship model that is at least as common as monogamy, if not more so, is secret non-monogamy, generally taking the form of affairs or infidelity." You raise a fair point about irony, and it’s one worth addressing directly. I acknowledge that Joseph Smith practiced plural marriage secretly in many cases, including without Emma’s full knowledge or consent for most of the sealings. Faithful scholars like Brian and Laura Hales document this openly in their research (Joseph Smith’s Polygamy). They acknowledge that the secrecy caused real pain, especially to Emma, and that Joseph’s approach was imperfect. That said, there are some distinctions work addressing: Joseph and early church leaders taught that plural marriage was a divine commandment introduced gradually under difficult circumstances (legal persecution, mob violence, and the threat of destroying the young church). Public announcement would have invited immediate destruction. The Hales and other LDS scholars argue the secrecy was primarily pragmatic necessity, not deception for personal lust. Most of the women involved later spoke positively of Joseph and the principle. By contrast, the BACP guidance is a modern professional standard for therapists that explicitly frames non-monogamy (including in the context of discussing “secret non-monogamies”) as “equally valid” to monogamy, with “blurred boundaries.” It instructs therapists to avoid focusing on the “non-normativity” of going against monogamous commitments. I think the two situations are not equivalent: Joseph claimed divine direction for a religious practice in a hostile 1840s environment. The BACP is a secular therapy organization telling counselors in 2023 to treat secret infidelity through an “affirming lens.” One can recognize that Joseph’s secrecy was a flawed approach to implementing a very difficult divine commandment in an extremely hostile environment, without imputing lust or deliberate unfaithfulness as the primary motivation. The six-year gap between his marriage to Fanny Alger and the next recorded plural marriage (Louisa Beaman), along with the repeated “angel with a drawn sword” accounts and Joseph’s own reluctance, provide substantial grounds to view his actions as driven by religious conviction rather than personal desire. Faithful scholars like Brian and Laura Hales document these challenges openly while defending Joseph’s prophetic calling. Similarly, one can critique modern therapeutic guidelines that downplay the harm of betrayal in marriage without it being “ironic.” The two situations are not equivalent: Joseph claimed revelation for a religious practice under threat of destruction; the BACP is a secular professional body instructing therapists in 2023 to treat non-monogamy (including in discussions of secret non-monogamies) as “equally valid” to monogamy with “blurred boundaries.” Thanks, -Smac

We appear to be talking past each other. Thanks, -Smac

I wonder if this misses the point. The concern is less about "enforcing religious laws" and more about whether therapists should treat secret infidelity (non-consensual betrayal) with the same “affirming" lens they apply to other behaviors. Look at the document’s own wording in Section 4.4: This does not seem to be neutral. It explicitly tells therapists to de-emphasize the harm of going against monogamous commitments and to view non-monogamy (even in the secret context being discussed) as equally valid. Compare that to how therapists likely handle cutting, bulimia, or anorexia. Those are not “affirmed” as equally valid coping mechanisms. They’re recognized as harmful and addressed with the goal of reducing them. Can you help me identify why the different standard arises when the behavior involves betraying a partner’s trust? I suspect non-religious people (and many secular therapists) also worry about this. Healthy relationships require honesty, consent, and accountability. When professional guidelines tilt toward affirming secrecy or blurring boundaries around infidelity, it can undermine trust, attachment, and emotional safety — outcomes that have real, measurable harm. So I think the issue isn't really about religion, but rather about whether therapy prioritizes client autonomy above all, even when that autonomy harms others, or whether it maintains ethical guardrails around destructive relational behaviors. I also wonder if there are quasi-religious ideological underpinnings for some of these guidelines. I think the article is not misrepresenting the document — it’s quoting it directly. Here’s the actual wording from BACP’s GSRD guidance (Section 4.4 on “Secret non-monogamies”): The guidelines explicitly discuss secret non-monogamy and then instructs therapists to view non-monogamy as “equally valid” to monogamy while downplaying the importance of boundaries. Even if some poly/ethical non-monogamy communities condemn cheating (which many do), professional therapy guidelines shouldn’t blur the line between consensual arrangements and betrayal. Fidelity and trust are foundational to most marriages, and therapists should be able to name harm when secrecy and deception are involved — without being told to treat it as just another “valid” way of relating. This is not, I think, a "political" issue. Plenty of secular relationship experts, attachment researchers, and everyday people (religious or not) recognize that secret affairs usually cause deep relational damage. The concern is whether therapy guidance should prioritize “affirmation” over acknowledging that harm. I agree that therapists should not harangue clients or impose personal moral judgments. The role is to help people understand their behavior and its consequences, not preach. The problem with the BACP guidance is that it goes beyond neutrality. It explicitly tells therapists to adopt a GSRD affirmative approach, under which non-monogamy (even when discussed in the “secret non-monogamies” section) is framed as “equally valid” to monogamy, with “blurred boundaries” between them. That’s not just “don’t judge.” It’s an instruction to de-emphasize the normativity of monogamy and the harm of secrecy. A truly neutral therapist could say: “Secret affairs often destroy trust and cause significant pain to the betrayed partner — let’s explore what’s driving this and what you want for your relationship.” An affirmative approach risks minimizing that harm in order to validate the behavior as just another valid way of relating. This is not the same as helping the client examine self-defeating patterns. It can enable them by softening the ethical reality of betrayal. Helping people improve does not require unending moral neutrality on issues like deception in committed relationships. Good therapy can acknowledge harm while remaining compassionate and client-led. I don't think that analogy works. A defense attorney’s job is to zealously advocate for their client’s legal interests within the adversarial court system. Their role is not to act as a moral counselor or relationship repair expert. In contrast, a therapist’s job is to promote psychological health, emotional well-being, and healthier functioning, including in relationships. When a client is engaging in secret infidelity, a good therapist should be able to help them examine the consequences (broken trust, attachment damage, guilt, impact on children, etc.) without being instructed to treat non-monogamy as “equally valid” to monogamy and the boundaries as “blurred anyway” (direct language from the BACP guidance). No one is asking therapists to “berate” clients. The concern is whether professional guidelines should push an affirmative stance that downplays the harm of betrayal in favor of validating the behavior as just another valid relational choice. Therapists are not defense attorneys. Their ethical duty includes addressing self-defeating and relationally destructive patterns, not softening them under the banner of affirmation. The article is a bit more histrionic than I'd like, but we can and should discuss professional therapy guideline that explicitly tells counsellors to treat non-monogamy (including in the context of secret non-monogamies) as “equally valid” to monogamy and that “the boundaries between them are blurred anyway.” When a major therapy organization (BACP) frames secret infidelity through an “affirmative lens” and downplays the importance of fidelity and trust in relationships, that’s worth discussing, including in a religious setting. Many people — religious and non-religious — recognize that betrayal in marriage causes real, measurable harm. Therapy should help people address that, not soften it under the banner of diversity affirmation. If the roles were reversed and a guideline encouraged therapists to affirm cutting or anorexia as “equally valid coping mechanisms,” most people would rightly push back. Why is relational betrayal treated differently? Thanks, -Smac

British Association for Counselling and Psychotherapy: Gender, Sexual, and Relationship Diversity (GSRD) "{U}nder a GSRD affirmative approach, nonmonogamy is an equally valid form of relating to monogamy, and the boundaries between them are blurred anyway." "{T}he key issue with secret non-monogamy is its non-consensual nature and the secrets, lies, and deception which are involved." "Thus the goal of therapy is not to stop the non-monogamous person or people from being non-monogamous – just as we would not attempt to stop a gay or trans person from being gay or trans – rather it is helping them navigate their relationship..." "It can be hugely helpful, with secretly non-monogamous people, to normalise how incredibly difficult lifelong monogamy is ... and how many diverse ways there are of navigating non/ monogamy." Section 4 of the PDF is eye-opening (alongside several other sections): This seems like a substantial step toward supposedly credentialed "experts" straight-up ratifying hedonism. Thanks, -Smac

Here: "'Secret non-monogamy.'" "'{T}he goal of therapy is not to stop the non-monogamous person.'" Therapists are supposed to "'normalise'" this. A salient point, this. From The Family: A Proclamation to the World: Thanks, -Smac

New numbers reveal the child sex-change mania is worse than we knew This is an opinion piece, but the factual allegations are troubling. d

The bill referenced is the “Protection of Women and Girls in Sports Act” or more relevantly a related measure on civil liability for gender-transition procedures on minors. As of the reported committee approval, it would: Create a federal cause of action allowing individuals (or their representatives) who underwent certain gender-transition medical interventions (puberty blockers, cross-sex hormones, or surgeries) as minors to sue the medical providers, institutions, or others involved. Allow recovery of actual damages, and in some versions, punitive damages, attorney fees, and costs. Potentially include a look-back period (reviving claims that might otherwise be time-barred under state statutes of limitations). Aim to hold providers accountable for procedures performed on minors, arguing they involve irreversible harm and insufficient evidence of long-term benefit. Malpractice lawsuits are already available under state tort law in every U.S. jurisdiction. Plaintiffs can (and have) sued providers for: Lack of informed consent. Medical negligence (deviation from standard of care). Battery (if procedures lacked proper consent). Fraud/misrepresentation. However, this federal bill would do several important things beyond ordinary state malpractice: Federal Cause of Action: It creates a uniform federal right enforceable in federal court. This bypasses state-law barriers such as: Short statutes of limitations (many states have 2–3 years from discovery or majority). Damage caps on medical malpractice. Sovereign immunity or protections for state-funded providers. State laws that might shield gender clinics or define “standard of care” to include these procedures. Presumed Harm / Easier Proof: The bill likely includes findings or presumptions about the experimental nature of these interventions on minors, potentially easing the plaintiff’s burden on causation or negligence compared to fighting prevailing medical association guidelines in state court. Attorney Fees and Punitive Damages: Many versions provide for fee-shifting (loser pays plaintiff’s fees) and enhanced damages, making cases more viable for plaintiffs’ attorneys. National Reach: A minor (or now-adult) in a blue state with strong protections for gender clinics could still sue in federal court or under federal law, avoiding hostile state doctrines. Ordinary malpractice claims exist but face significant practical and legal hurdles (statutes of limitations, expert testimony battles, sympathetic juries in some areas, evolving “standard of care” debates). This bill would create a stronger, federally-backed private right of action specifically targeting these procedures on minors, with pro-plaintiff features. It is designed to deter providers and give detransitioners/parents a clearer path to compensation, especially where state law is unfavorable. If passed, the bill will likely face immediate legal challenges on federalism, retroactivity, or First Amendment grounds. Thanks, -Smac

An update: House Judiciary Approves Bill Establishing Right to Sue for Damages on Trans Surgery I think this is an excellent idea. I have, for quite a while now, been posting and re-posting a set of bullet points as to the most acute concerns about pediatric sex trait modification treatments. I anticipate some or all of these will be heavily litigated: Comorbidities. Informed consent. Compromised assessments of the best interests of the child. Irreversibility. Sterilization. Cutting off healthy body parts. Longitudinal studies essentially absent. Lifelong medical regimens. Massive ideological/sociopolitical influences/pressures on medical care. Massive social contagion risks. Massive risk of financial devastation for the individual (and burden on society). I guess we'll see. Here is a Grok summary of this EO: Adults can continue to do as they please, but even then I think comorbidities, lack of informed consent, etc. will remain viable grounds for adults to file these sorts of lawsuits. We have had ample discussion about these issues, which I think needs to be an ongoing thing. I acknowledge that many people have strong feelings of all sorts about this topic. I hope Ms. Cole humanizes and puts a face to the children who have been adversely affected by PSTMs. Thanks, -Smac

I just checked the federal court docket. The lawsuit is still in place, with a "Third Amended Complaint" filed on June 1. Multiple motions to dismiss have been filed, but most claims against most of the defendants have been denied. There are currently four motions to dismiss filed on June and July, none of which has been adjudicated. Here is a Grok summary of the Third Amended Complaint: More Grok-generated detail: Thanks, -Smac

I don't think what I have said speaks to privileging religious views. Yes, I think we can do this. We have done it in the past. Schools can and should focus on core academics: reading, writing, math, science, history, the arts, stuff like that. These prepare kids for life without substituting institutional preferences for parental ones on deeply debated topics. No, that’s not what I’m saying at all. I want no child isolated or unsupported. Every kid deserves kindness, safety, and the ability to talk with trusted adults (especially their parents) about hard things. Reducing bullying and fostering basic human decency is worthwhile. What I oppose is public schools and libraries using their authority and proximity to children to proactively affirm contested moral and sexual viewpoints as equivalent or normative, especially for young kids. That crosses from neutral education or anti-bullying into ideological formation, which many parents (of all backgrounds, including faithful Latter-day Saints) see as undermining their primary stewardship. Acknowledging that families come in different forms is one thing. Framing same-sex relationships as morally interchangeable with the husband-wife pattern taught in scripture and the Family Proclamation is another. The latter is not neutral — it’s a particular worldview on sexuality, marriage, and family that not all families share. Parents, not institutions, should guide their children’s moral formation on deeply personal and religious questions. Transparency, age-appropriate boundaries, and viewpoint diversity protect pluralism better than one-sided normalization. Kids can be supported without public resources becoming tools for advocacy on adult-level controversies. Is exposing children to such sexualized material anywhere appropriate? I think the issue is sufficiently common/widespread that it deserves some public discussion and debate. This is particularly so where there are people openly advocating that children be exposed to such sexualized events/venues. No, that misrepresents my position. I am not calling for isolation of any child, nor equating anyone with pornography. Every minor deserves safety, kindness, and support — including queer youth. Reducing bullying is good. My concern is public institutions (schools/libraries) using tax-funded resources and authority over minors to proactively normalize contested moral views on sexuality and family as equivalent to the husband-wife pattern taught in scripture and The Family Proclamation. That’s not neutral education; it’s ideological formation on topics many parents want to handle at home according to their own values and faith. This isn’t “Christian Nationalism” or undoing the First Amendment. It’s defending parental rights and viewpoint neutrality — the same principle that would prevent public schools from teaching Joseph Smith’s First Vision as fact or pushing any particular religious or political orthodoxy on other people’s children. Pluralism means public institutions don’t get to pick winners on deeply divisive moral questions involving minors. Latter-day Saint teachings on chastity and eternal marriage come from scripture and modern revelation, not nationalism. Shielding children from premature sexualization (regardless of orientation) and respecting parental stewardship is reasonable, not extreme. I have repeatedly condemned public displays of sexual licentiousness of any sort, including Mardi Gras. Here, here, here, here, here. I am not sure if Mardi Gras is "coded" as a "straight" event. Moreover, I am not seeing anyone justifying/rationalizing exposing children to sexualized stuff at that event, whereas there is plenty of such advocacy relative to "Pride" events. The difference here is context and advocacy. I don’t see widespread efforts to bring explicit or sexualized Mardi Gras content into children’s libraries or classrooms as “age-appropriate” or “inclusive.” With some Pride-related materials, I do see that push — including non-graphic books that normalize contested views on sexuality and family for minors. From scripture and the Family Proclamation, I draw qualitative distinctions between opposite-sex marital intimacy (unitive + procreative within husband-wife covenant) and same-sex behavior. These distinctions are rooted in biology, doctrine, and observed patterns — not Christian Nationalism, not bigotry. Just reasoned disagreement. Attraction isn’t sinful; behavior is. These beliefs do not justify unkindness. The Church's teachings in this area are quite good. Public institutions shouldn’t function as co-parents or ideological tools on deeply contested moral issues. Parents hold primary stewardship. Age-appropriate boundaries, transparency, and viewpoint diversity protect pluralism better than one-sided normalization for children. Thanks, -Smac

I agree with much of what you said above in your post in terms of standards. I have a problem with the second sentence though as if presenting same sex relationships is inherently superseding parents. That's not quite what I intended to say, but I can see how you could surmise that. I apologize for creating confusion. It is also "normal" for people to have affairs, get abortions, and do other things that reflect ongoing controversies in society. I don't think teachers and schools should be using their positions of trust to ideologically influence/instruct children toward one side of hotly-contested social issues, particularly when they do so obliquely or secretly (sometimes even deliberately subversively). Again: Literature often depicts behaviors that conflict with my religious beliefs. I view sex outside marriage, adultery, and abuse within marriage as wrong. While such things occur, I oppose materials that proactively endorse or normalize them—especially for young children. I no longer have children in elementary school, but I quite understand the sentiments of parents who send their kids to school expecting teachers to teach them the Three Rs, history, science and other topics intended to help them become functioning and productive members of society. I think many parents dislike the idea of activists and idealogues using schools and their "captive audience" students to endorse one side or the other of controversial social/moral issues, particularly when this is done so secretively and/or subversively. This video comes to mind: And this: And this: And this: Many more like this. I agree that public institutions should remain viewpoint-neutral and not favor one ideology. That's exactly why schools shouldn't be in the business of endorsing contested moral or social views, whether on family structure, sexuality, religion, or politics, by integrating them into required reading or classroom discussions for young children. "Representing the public" is best served by sticking to core academics: reading, writing, math, science, history, and the arts. These prepare kids without substituting institutional preferences for parental ones on deeply debated topics. Neutral, age-appropriate exposure to the real world's variety is one thing; proactive normalization or equivalence as part of moral formation is another. Parents, not public employees, hold primary responsibility there. A demographic quota approach (nationwide percentages for race, family structure, LGBT+ representation, etc.) sounds straightforward but quickly becomes problematic as a standard for public schools and libraries. It turns curators into social engineers, forcing subjective judgments: How much does a "minor" subplot or side character “count”? Do we weight by protagonist, page count, or implied endorsement? Older classics get penalized for reflecting their era, while newer books are prioritized for activism over literary quality. This shifts the focus from excellence, truth, and age-appropriate education to engineered outcomes. Public institutions funded by taxpayers should prioritize core skills over mirroring fluid cultural or ideological demographics, especially on morally contested issues like sexuality and family formation. Parents, not distant statisticians or librarians, should guide their children’s exposure to these topics. Viewpoint neutrality and parental rights serve pluralism far better than rough proportional representation that risks becoming one-sided advocacy. Neutral, high-quality literature reflecting human experience is valuable. Mandated demographic balancing in children’s materials is a different project entirely. I agree with much of this. For young children, literature should emphasize positive virtues, such as kindness, sharing, honesty, respect, rather than criticism or shaming. Protecting self-esteem and avoiding material that promotes disrespect is a good baseline. The challenge arises when “positive” portrayals cross into proactively normalizing contested moral or relational behaviors as equivalent to the traditional family pattern. For me as a Latter-day Saint (and many others), same-sex relationships aren’t simply another “normal” variation but fall outside the divinely ordained husband-wife pattern taught in scripture and the Family Proclamation. Presenting them as interchangeable in books for young kids can function as implicit (and, in many circumstances, explicit) moral instruction on a topic where parents hold primary stewardship. We can show realistic diversity in families without turning public schools and libraries into venues for ideological affirmation on sexuality and marriage. Focus on universal character traits and let parents guide the deeper worldview conversations. That approach better respects pluralism and keeps the emphasis on positive development rather than settling adult-level debates. Fair point. Older materials, especially in history, politics, and culture, do get far more layered and context-dependent. I appreciate you keeping the focus on civility and mutual respect. That is a strong foundation we can all agree on. I’m happy to leave it there for now or pick up the conversation later if you’d like. Thanks for the thoughtful exchange. Thanks, -Smac

This makes it sound like you’re very much against a book that shows a child with two moms being read in a child’s class. But a book with opposite gendered parents would be ok. Correct? See this prior exchange: Broadly, yes. Not quite a simple "correct," because there is some important nuance here. I apply broadly similar standards to non-graphic, age-appropriate portrayals of family life—whether a child going home to a mom and dad, or (less commonly in traditional literature) to two moms. A passing, neutral description of a child's lived reality isn't the core issue for me. Literature can and does reflect the diversity of family situations children actually encounter. Where I start to draw the line is when public schools or libraries use such books to proactively normalize and equate and advocate for same-sex relationships as being morally or functionally interchangeable with the divinely ordained pattern of husband-and-wife marriage taught in scripture and The Family Proclamation. For young children especially, this crosses into premature moral formation on a topic where faithful Latter-day Saints (and many others of good will) have reasoned, principled disagreements rooted in biology, theology, and sociology. I wouldn't support school materials that endorse Joseph Smith's First Vision as historical fact, affirm Muhammad's theophanies, take a position on abortion, or push other contested religious or ideological claims—precisely because public institutions aren't equipped or authorized to settle those matters for other people's children. Parents hold primary stewardship for their children's moral and religious upbringing. Schools act in loco parentis in a limited way for safety and basic education, not as surrogate ideologues. When teachers or librarians quietly/secretly advance one contested view on marriage and sexuality (while sidelining others), it undermines parental rights, viewpoint diversity, and trust. Children benefit from shielding against early immersion in adult-level controversies, especially when the material tilts toward advocacy rather than neutral reflection of reality. I am fine with age-appropriate literature that fosters kindness, reduces bullying, and acknowledges that families come in varied forms. But public resources shouldn't function as ideological magnets that substitute institutional/teacher preferences for parental ones. Transparency, opt-outs, and balance serve pluralism better than ideologically curated equivalence. Thanks, -Smac

Broadly, yes. Literature often depicts behaviors that conflict with my religious beliefs as a Latter-day Saint. I view sex outside marriage, adultery, and abuse within marriage as wrong. While such things occur, I oppose materials that proactively endorse or normalize them—especially for young children. I draw qualitative distinctions between healthy opposite-sex marital intimacy (unitive and procreative, within the covenant of husband and wife) and other expressions. My perspective on same-sex behavior is rooted in scripture (Genesis 1-2), The Family: A Proclamation to the World, doctrines of eternal marriage and chastity, and empirical patterns. Some key differences include: Biological/Procreative: Opposite-sex complementarity enables natural reproduction and fulfills the command to multiply (Genesis 1:28). Same-sex lacks this capacity. Eternal Purpose: Opposite-sex marriage aligns with exaltation and eternal increase (D&C 131-132). Same-sex does not fit this revealed pattern. Societal Role: Opposite-sex unions form the historical bedrock for stable, biologically intact families with measurable child-rearing advantages. Same-sex homes can be loving but differ in modeling complementarity and generational continuity. Moral Framework: Marital opposite-sex intimacy is sacred; same-sex behavior falls outside the law of chastity. Attraction is not sinful, but behavior is. These distinctions affirm the divine worth and agency of all as children of God. They do not justify coercion or unkindness. In civil contexts (e.g., children's libraries), parents hold primary stewardship for their children's moral formation. Public institutions are not co-parents, but I think some folks within them want to be, or even want to supersede parents in some ways. Explicit sexual content—regardless of orientation—risks premature sexualization and violates "let virtue garnish thy thoughts" (D&C 121:45). Even non-graphic materials that normalize same-sex relationships as equivalent for minors can undermine parental values and doctrinal family teachings. Consequently, I support age-appropriate boundaries, transparency, viewpoint diversity, and parental rights. Literature aimed at reducing bullying is worthwhile, but libraries should not serve as one-sided ideological tools. Latter-day Saint principles favor shielding children from explicit content and premature ratification of behaviors outside God's ordained pattern, while respecting pluralism for adults. Thanks, -Smac

And yet it is being made available to children. As I noted previously: "It seems to be happening (and not just descriptions of 'gay' sexual behavior). But why?" Yes, but it is being made available to children. What are your thoughts about the propriety of this? Yes, and the question itself clearly comes from a perverted mind. THIS IS DISGUSTING! Seriously, this is sick. I think sexually explicit material of any sort should not be provided to children. It looks like we agree on that. I am glad we agree on that. Yes. Hence my opposition to any sexually explicit materials being provided to children. Because school libraries get batches of donated books and don’t have the manpower to read all of them. That is an interesting theory. Okay, that is not a specifically LGBTQ book either. My opposition to sexually explicit materials in children's libraries is not limited to "LGBTQ" materials. Perhaps we agree on some things, then. The topics include all sorts of sexual matters. Okay. I think graphic sexual material is perhaps difficult to define with precision, but that does not mean it cannot be defined at all. Here is the question I posed: "Do you think it is possible to have literature that addresses and acknowledges that 'gay and other queer people exist' while not exposing children to graphic and explicit descriptions of sexual acts and behaviors?" Your comments seemed to have been characterizing sexually explicit "LGBT" materials as equivalent to acknowledging that "gay and other queer people exist." I found that to be an unusual perspective, so I asked a measured question about it. No. I am, and would in fact very much prefer to be, indifferent to the sex lives of other people. As it is, though, the "community" that per se defines itself by its members' sexual proclivities often injects "images of sex" into their most visible and public demonstrations. Hence we get sexually explicit stuff at Pride parades, drag queen story hours, and so on. Some "heterosexual" folks are likewise engaging in public displays of perversion, including exposing children to sexually explicit displays. All of these things ought to be condemned. Thanks, -Smac

I'm interested in the substance of what he said. I don't think particularized credentials are needed to examine "a literature review." I'm not sure. I read the review and it seemed to be both substantive and persuasive. You are not addressing the substance of what the author wrote. I think his critique is substantive. I think there is substantial evidence of it existing. From the article: I also think there is ample evidence of ideological incursions into academic/professional assessments of this theory. I think opposition to it is based on it telling ideologues what do they do not want to believe, namely, that Gender Dysphoria may, in some instances, have a social contagion element to it. See, e.g., here: Evidence Backs the Transgender Social-Contagion Hypothesis The eye-popping numbers here (5,000% increase in the UK, 1,500% rise in Sweden, etc.), plus other evidences, and also just generalized observation, provide ample justification to consider ROGD and "social contagion" as possible contributing factors to what is happening here. The vitriolic responses to it, such as those experienced by the author here and as demonstrated by you in this thread, are ideological, not clinical or evidence-based, assessments. There are ideological and political and emotional reasons for the vitriol. I think the topic deserves a more objective analysis. "{T}he share of college students identifying as transgender fell 50% between 2023 and 2025." "{T}ransgender identification among 18- to 22-year-olds declined by nearly 50% between 2022 and 2024." I think these points deserve some attention and discussion. The bolded bit above deserves some discussion and evaluation. The ideological narrative has a lot to do with legal arguments, in a tail-wagging-the-dog sort of way. That is, advancing legal arguments for people who identify as "trans" relies heavily on analogizing "trans" identity to race or sex or other constitutionally-protected classes. This really gets into some deep philosophical questions for people who invest a lot of value and importance in sexual and/or gender "identity." But I don't think the answers to these questions are what ideologues want them to be, hence the reliance on vitriolic reactions. These are some solid points, IMO. Thoughts? Hence the value of examining data. "The notion that transgender identity is biologically hard-wired can’t explain why there has been a more than 20-fold surge in those identifying as transgender in the U.S. since 2010." I am reading materials and seeking to have a discussion. One of the reasons I hold the position I do is because I so frequently encounter advocates who label anyone who disagrees with them as bigots, who rely on ad hominem and other logical fallacies, who resort to vitriol and shaming censorship to stifle voices and discussions rather than engage in measured and evidence-based discourse. "That is right-wing propaganda designed mostly to assuage the consciences of bigots who want to imagine they are supporting lesbians in their hate." "Getting bigots to donate to them to applaud their (real or imaginary) fight against the transgender menace probably has the money rolling in." "She played transphobes by telling them a carefully curated story that flattered their bigotry and they swallowed it with no critical analysis whatsoever." "It is contested primarily on flimsy religious grounds and an appeal to the bigotry of the past as being something that must be preserved for the good of society." "You want a society in which transgender people are marginalized or kept out of sight and in which you cannot be called a bigot for wanting things this way." "Also quit hating on puppyboy outfits you bigots." "If/When that fails who will be the next target of conservative bigotry’s compulsive need for a moral panic?" "They have been fed propaganda and view the term as applying primarily to transgender people because propagandists like to simplify the concept to avoid ambiguity and to focus bigotry." "I think people are just uncomfortable with transgender people so they find justifications to back up their bigotry." "This is just blatant bigotry and a massive double standard." "Then they can purge all mention of queer people as obscene because they’re bigots." "You seem to agree entirely that queer people are themselves graphically sexual just by existing with your disgustingly bigoted question above." These are just from the last three pages of this thread. This stuff is found in the beginning, middle and end of virtually every interaction with you. Thanks, -Smac

Seems like it is happening: Hearing Recap: Explicit Children's Books Edition School system pulls 2 books with graphic sex from libraries Parents Objecting to Pornographic Material in School Libraries Aren’t “Book Banners” From Facebook: And on and on and on. Do you think it is possible to have literature that addresses and acknowledges that "gay and other queer people exist" while not exposing children to graphic and explicit descriptions of sexual acts and behaviors? That's a good question. What are your thoughts about it? It seems to be happening (and not just descriptions of "gay" sexual behavior). But why? This seems to be a legitimate summary of books found in libraries: https://docs.google.com/.../16kXOBblHt1EeNHQu0v-a.../edit Blaine County School District libraries offer pornographic books to children as young as elementary school (NSFW) I actually won't quote this article, as it quotes the books being offered in libraries for children, and those book quotes and illustrations (some shown in the article) are quite sexually explicit. This stuff seems to be happening. When it comes to having sexually explicit materials in children's libraries, I think we ought to work to avoid this cyclical pattern: Thanks, -Smac

From this study: From 97 identified historical patients (1970–1990), only 15 (about 15%) participated in the follow-up survey/phone interview. This introduces strong selection bias—participants were likely those doing well enough (and willing) to respond years later. High loss to follow-up is a well-documented issue in GAS outcome studies and often inflates positive results. Also, this study has weak controls. It relies on old charts and self-recall. There is no control group (e.g., dysphoric individuals who did not pursue surgery). Preoperative/postoperative comparisons are limited, and confounding factors (e.g., therapy, social changes, natural resolution of dysphoria) are not well isolated. The study contributes anecdotal-style long-term data from a surgical perspective, but it appears that it is not considered robust evidence by standards applied in systematic reviews or bodies like the Cass Report. From this article: These are emblematic of the "abundance of evidence" upon which you base your position? About this "study": The flaws go on from there. As you are apparently not willing to present the evidence on which you rely, I will go ahead and look for data supporting it. What you have presented so far does not seem very good. And the data shows that it is. That does not seem to be the case. But I will go look. I am happy to evaluate data. You provided some, and I found it not very good. You are declining to provide more which supports your perspective, so I will go look. I think there are ample grounds for reasoned and principled disagreement with many facts of trans ideology and the trans movement. I appreciate you sharing your perspective on the history of segregation—it's a complex chapter with legal, social, economic, and moral dimensions. However, I don't think the analogy holds for the current debate over pediatric gender medicine in places like the UK, Sweden, Finland, and Norway. Segregation was a system of racial separation imposed despite clear, consistent evidence of harm (psychological, educational, economic) and in the face of a strong scientific consensus that racial categories did not justify differential treatment under the law or medicine. The shift away from it wasn't primarily because judges "couldn't find a biological difference"—biology was never the core justification for equal rights under the Constitution. It was about fundamental principles of equality and dignity, backed by overwhelming documentation of harm. In contrast, the recent changes in Europe (e.g., the Cass Review and aligned systematic reviews in multiple countries) stem from independent evidence reviews finding the evidence base for puberty blockers and cross-sex hormones in minors to be weak: low-quality studies, high risk of bias, uncertain benefits for mental health/gender dysphoria, and known risks (bone density, fertility, sexual function, etc.). These are not fringe sources. They are commissioned by national health services using standard evidence-based medicine methods. That's why several countries have moved toward restricting routine use in children, prioritizing psychotherapy, and calling for better research. This is a standard medical caution when data are insufficient, not an ideological campaign. Reasonable people can disagree on how to weigh the evidence or balance distress in gender-dysphoric youth. But comparing evidence-based clinical caution to Jim Crow segregation strikes me as a false equivalence that doesn't advance understanding. I'm happy to discuss specific studies or reviews if you'd like—my goal is careful, individualized care grounded in solid data, especially for kids. I appreciate the link—I've read critiques of ROGD, including this one. Let's clarify what I'm actually saying. "Rapid-onset gender dysphoria" (ROGD) isn't a formal DSM diagnosis or "junk science." It is a descriptive, hypothesis-generating term for a real epidemiological pattern observed by clinicians and documented in multiple sources: a sharp post-2010s rise in adolescent-onset (especially natal female) gender dysphoria, often with minimal childhood history, peer clusters, heavy social media influence, and high psychiatric comorbidities (autism, trauma, anxiety, depression, etc.). This isn't based on one parent survey (Littman's 2018 study, which had limitations but was explicitly exploratory). Supporting observations include: Dramatic shifts in sex ratios and age of presentation at gender clinics worldwide (e.g., UK GIDS data, Dutch, Finnish, Swedish clinics). Reviews by Kenneth Zucker and others noting the change from predominantly early-onset male cases to adolescent-onset female cases. The Cass Review and European systematic evidence reviews acknowledging the unexplained surge and the role of social influences as one plausible contributor among multifactorial causes. Major health bodies in the UK, Sweden, Finland, and Norway didn't restrict youth medical transitions because of "pseudoscience"—they did so after their own independent reviews found the evidence for puberty blockers/hormones in minors weak, with uncertain long-term benefits and known risks. They emphasize holistic assessment, addressing comorbidities, and caution around social contagion/peer influence. I'm not claiming ROGD explains every case or justifies blanket denial of care. Many with gender dysphoria benefit from support. But dismissing the documented shift in presentation as "unproven" ignores clinical reality and the reason for caution in pediatric care. The debate exists because the evidence is contested. I found the hullabaloo about this article interesting. See also here: More here: The Rapid Ideological Retraction of a Scientific Article on Rapid Onset-Gender Dysphoria Some excerpts: "{A} 5,000% increase in adolescent girls." I am sure this is operative in some instances. But then, I think the next one is also: I think this is a valid point. It's a new theory. I think this is the more prominent source of opposition. But that's a guess. Concerns focused on methodological limitations, such as the study’s intentionally biased recruiting method (to see if a sample could be recruited that would show the ROGD phenomena–a “proof of concept” demonstration). These limitations reflected intentional trade-offs rather than mistakes, and they were addressed at length in the article. Nevertheless, the journal required an unnecessary “correction” by the author (Jussim, 2019; Littman, 2019). My retracted article also addressed, and found support for, ROGD. The article’s data were collected by Suzanna Diaz, through the website ParentsOfROGDKids.com. Suzanna is the mother of a young adult whom Suzanna believes has ROGD. “Suzanna Diaz” is a pseudonym adopted for privacy concerns–I don’t even know her real name. That she felt it necessary to publish under a pseudonym is interesting. And unfortunate. Our article’s large sample size allowed detection of many strongly significant effects, and our findings were generally consistent with the ROGD hypothesis. Most (75%) of the gender dysphoric youth reported on by their parents were natal females, who appear especially susceptible to ROGD. The gender dysphoric youth had a high rate of preexisting mental health problems, and those problems predated announcement of transgender status by nearly four years. Most children knew other youth who had become transgender around the same time, and this was especially common for females. Most females had taken steps to socially transition; this was half as common among males. Medical gender transition steps were much less common, with about 7% of youths having taken cross-sex hormones (and similar rates for boys and girls). Disturbingly, youths with more mental health problems were especially likely to have socially and medically transitioned. The strongest predictor of both kinds of transition was family referral to a gender specialist. Parents who consulted with specialists usually felt pressured to transition their gender dysphoric children. "Parents who consulted with specialists usually felt pressured to transition their gender dysphoric children." That seems to be a common phenomenon. Activism seems to be playing a big role in "scholarship" in this area. The entire article is worth a read. Thanks, -Smac

Thank you for sharing your thoughts. A few further comments: Hormones trigger and regulate gamete production, but they don’t create the underlying developmental pathway or redefine sex. The binary is established at conception by genetics (XX vs. XY) and the SRY gene on the Y chromosome, which directs the undifferentiated gonad to become testes (leading to testosterone and sperm pathway) or ovaries (leading to eggs). Hormones are downstream effectors, not the root cause. Altering hormones later (cross-sex hormones) changes secondary traits and suppresses gamete production, but it does not rewire the body to produce the opposite gamete. A biological male on estrogen doesn’t produce eggs; a biological female on testosterone doesn’t produce sperm. That’s not a “skill issue” — it’s immutable reproductive biology. Disorders of sexual development (DSDs/intersex) are variations or malfunctions within the binary, not a third sex. They don’t produce a third gamete type. No human reproductive system produces both functional sperm and eggs, or a novel gamete. That’s why biologists define sex by the binary gamete system: small (male) or large (female). Variations don’t erase the binary any more than birth defects erase the fact that humans are bipedal. The core point stands: gynecomastia surgery corrects a deviation toward typical male physiology. Gender-affirming mastectomy alters healthy female physiology away from it. One is corrective; the other is not. I am curious about your perspective on this point. If sex is so malleable, why can’t medical transition produce functional opposite-sex gametes or reproductive capacity? Reducing suffering and increasing flourishing is exactly the goal — which is why evidence matters so much. If “gender-affirming” medical interventions reliably worked long-term with acceptable risks, that would be a strong argument. But the data (Cass Review, European health authorities, recent HHS evidence summary, and long-term studies) shows weak evidence of sustained mental health benefit, persistent elevated suicide risk, significant irreversible harms (sterility, sexual dysfunction, bone loss, cardiovascular issues), and growing reports of regret/detransition — especially in the rapid-onset adolescent cohort with high comorbidities. "Whether the treatment works" is a pivotal concern. That said, we do not evaluate treatments solely by short-term self-reported happiness. We weigh net outcomes, desistance rates, and whether we’re addressing root causes or entrenching a perception by altering healthy bodies. That’s why we don’t affirm anorexia with starvation, amputate healthy limbs for BIID, or perform other body-modifying procedures for psychological conditions despite reported relief. The ethical standard is “do no harm” plus strong evidence, not just subjective flourishing. The binary isn’t my personal idea, it is observable reproductive biology (two gametes, two sexes). Interventions can approximate secondary traits, but they do not change that underlying reality. Prioritizing caution for minors isn’t sacrificing happiness to ideology; it’s protecting vulnerable kids from experimental paths with poor evidence. European countries reached the same conclusion based on the data, not theology. If the long-term evidence robustly supported net benefit, I would reassess. Right now, it doesn’t for most youth. That’s the ethical heart of the disagreement. Increased quality of life is the goal, not the data. Self-reported short-term satisfaction or “quality of life” improvements exist in some studies, but that’s not the same as robust, long-term evidence of net benefit. The Cass Review, European systematic reviews, and other analyses found the overall evidence base for puberty blockers, cross-sex hormones, and surgeries in minors to be remarkably weak — poor study quality, short follow-up, failure to account for comorbidities, and no good control groups. Suicide rates remain elevated post-transition, desistance is common (especially pre-pubertal), and regret/detransition data is underreported but growing. We don’t accept “it makes them feel better short-term” as sufficient for other irreversible interventions on healthy bodies (e.g., BIID amputations, anorexia affirmation). The ethical threshold requires strong evidence that benefits outweigh harms long-term. If you have high-quality, long-term studies showing clear, sustained reductions in suffering, improved functioning, and minimal regret for the current cohort of mostly adolescent females, I would genuinely like to see them. The existing data drove multiple European countries to restrict these interventions. That’s not ideology — it’s following the evidence. Where specifically do you see the strong data for medicalizing healthy adolescent bodies? Except that medical (and other forms of transitioning) does often relieve the symptoms. You continue to ignore this. That is the point. When it relieves the symptoms it means the treatment is working. Starvation doesn’t help with anorexia. Transitioning works very well in most cases. It helps. Talk therapy has minimal benefits. You want to get rid of the treatment that seems to be the most successful in favor of the one that doesn’t. You are the joke in a lot of transgender memes that go along the lines of: ”Wow, I am happier now and more comfortable in my own skin. I hope this lasts forever.” ”But aren’t you worried this might be irreversible?” I’m not ignoring reported relief. Some people do experience short-term improvement in dysphoria after transition. The issue is whether it’s sustained, net positive long-term, with acceptable risks. So far, the evidence for this is poor. The Cass Review, European health authorities, and systematic reviews found the evidence for puberty blockers, hormones, and surgery in minors to be low-quality: short follow-ups, weak controls, failure to address comorbidities, and no clear proof of lasting mental health gains. Suicide rates often remain elevated, desistance is common (especially with therapy/watchful waiting), and regret/detransition is understudied but real. “Works very well in most cases” is not supported by the rigorous data. We do not judge treatments by short-term self-report alone. Anorexia patients can feel temporary “relief” from restriction, but we don’t affirm it because long-term outcomes are disastrous. I submit that the same caution applies, or should apply, when irreversibly altering healthy bodies (sterility, sexual dysfunction, bone loss, surgical complications). Exploratory therapy isn’t “minimal benefit,” it is the approach recommended precisely because it addresses root causes (trauma, autism, social contagion, mental health) rather than rushing to medicalization. Multiple countries shifted to this model after reviewing the evidence. The meme framing assumes the premise (transition = happiness forever). The data shows it’s more complicated, especially for the recent surge in adolescent females. Prioritizing evidence over ideology ought not be mocked, as it is responsible medicine. Again, if you have high-quality, long-term studies showing clear superiority of medical transition over therapy-first for this cohort, I’d like to see them. That is all nonsense. The relief is usually not short term and doesn’t introduce serious medical harms. What I am referencing is not "nonsense." It is what systematic evidence reviews show. The Cass Review (2024), Swedish, Finnish, and other European analyses concluded that the evidence for sustained long-term benefit from puberty blockers, cross-sex hormones, and surgeries in minors is weak to very low quality. Many studies have short follow-up, high loss to follow-up, poor controls, and fail to account for comorbidities. Suicide rates frequently remain elevated post-transition. Desistance is common with therapy and time, especially in pre-pubertal children. Regret and detransition, while understudied, are documented and appear higher than earlier claims suggested. Serious medical harms are well-established: sterility, loss of sexual function/orgasm, bone density loss, cardiovascular risks, surgical complications (stenosis, fistula, need for lifelong dilation), and unknown effects on brain development. These are not trivial. Short-term relief in dysphoria or body image is reported by some, but that doesn’t prove net long-term flourishing. The same pattern occurs in other conditions where affirmation entrenches the issue (anorexia, certain body dysmorphias). This is why multiple countries have sharply restricted youth medical transitions in favor of therapy-first approaches. It’s not denial of relief for some — it’s recognizing that the evidence does not support routine medicalization, especially for the recent surge in adolescent females with high rates of mental health issues. And these countries did not do so based on religious sentiment, but rather based on the evidence. If you have robust, long-term studies showing clear, sustained benefits outweighing those harms for most cases, I’d genuinely like to see them. The existing data drove the policy shifts in Europe. Reality-based care is the care that works the best at treating the symptoms. You just don’t think it is real. You aren’t basing this on data. It is a religious dogma that the Church came up with a few decades ago. I have repeatedly noted substantial shifts in both Europe and the U.S., the former of which obviously is not acting based on "a religious dogma that the Church came up with a few decades ago." The Cass Review, European systematic reviews (Sweden, Finland, UK, Norway), and the recent HHS evidence summary all concluded that the quality of evidence for puberty blockers, cross-sex hormones, and surgeries in minors is very weak. These countries are shifting to a therapy-first, exploratory approaches and restricted routine medicalization — especially for the recent surge in adolescent females with high comorbidities (autism, trauma, mental health issues). This approach is following the evidence, not dogma. The Church’s teachings on sex and the body predate modern gender medicine by millennia and align with observable biology (binary gametes, reproductive roles). But the clinical reasoning stands independently. We don’t generally treat psychological distress by permanently altering healthy organs when less invasive options exist. That principle applies whether the distress is gender-related, anorexia, BIID, or species dysphoria. If the high-quality, long-term data robustly showed medical transition as clearly superior for most youth, the European reversals wouldn’t have happened. Where specifically do you see the strong evidence that justifies routine permanent alteration of healthy adolescent bodies? The Cass Review is not a “politicized TERF island” outlier — it is one of the most comprehensive independent systematic reviews ever conducted on this topic. It examined hundreds of studies and concluded the evidence for puberty blockers, hormones, and surgery in minors is of poor quality, with weak long-term data on benefits and significant risks. Multiple other developed countries reached similar conclusions based on their own evidence reviews: Sweden, Finland, Norway, UK — all sharply restricted youth medical transitions in favor of therapy-first approaches. The WPATH Files and leaks from major gender clinics revealed internal doubts about the evidence and rushed care. Long-term studies (e.g., Swedish and Dutch cohorts) show elevated suicide rates post-transition, high comorbidity, and incomplete resolution of mental health issues. If the “overwhelming evidence” showed clear, sustainable benefit with low regret, those countries wouldn’t have reversed course (and you would be presenting that evidence). These things are not happening. Short-term relief in dysphoria is reported, but that doesn’t equal long-term flourishing or outweigh the irreversible harms (sterility, sexual dysfunction, bone density loss, etc.). The consensus you mention was largely driven by advocacy-influenced guidelines (WPATH, Endocrine Society). The shift in Europe came from looking at the actual data more rigorously. That’s how science should work. If you have specific high-quality, long-term studies showing sustained net benefit for the current cohort of mostly adolescent females, I’d genuinely like to see them. Cost/benefit analysis is central to medical ethics — which is exactly why the evidence matters so much. If “gender-affirming” interventions showed clear, sustained net benefit with low regret and manageable harms, that would justify them. But systematic reviews (Cass Review, Swedish, Finnish, and others) found the evidence quality low to very low: weak long-term data, high loss to follow-up, failure to address comorbidities, and no good controls. Harms are substantial and irreversible (sterility, sexual dysfunction, bone loss, cardiovascular risks, surgical complications). Suicide rates often remain elevated. Desistance is common with therapy and time, especially in pre-pubertal kids. That’s a poor cost/benefit profile for routine use on healthy minors. Consistency with similar conditions (BIID, anorexia, species dysphoria) is not “scripture,” but is rather a basic safeguard against confirmation bias. We don’t amputate healthy limbs for BIID despite reported relief, or affirm starvation for anorexia, because the body is healthy and the distress is psychological. The principle is the same here: we should be extremely cautious about permanently altering healthy adolescent bodies for a condition with high comorbidity and weak evidence. European countries applied exactly this cost/benefit lens and restricted these treatments. These countries are not being influenced by the particularized teachings of the Church. They are following the data. If you have high-quality, long-term studies showing strong net benefit for the current cohort (mostly adolescent females with comorbidities), I’d like to see them. The existing evidence drove the policy shifts. It is contested because people hate transgender people. That is like arguing that segregation must be necessary because if getting rid of it was so good it wouldn’t be contested. Plus I have seen a lot of the stuff contesting it and it often comes down to nothing. Opposition isn’t driven by “hate for transgender people.” It’s driven by legitimate concerns about weak evidence, risks to minors, and the medicalization of healthy bodies. The surge in adolescent females (a demographic shift unlike anything in prior history), very high rates of comorbidities (autism, trauma, mental health issues), social contagion factors, and desistance rates make this different from prior cases. European countries (UK via Cass Review, Sweden, Finland, Norway) didn’t restrict youth transitions because they “hate trans people” — they did so after systematic evidence reviews found the data for puberty blockers, hormones, and surgery in minors to be low-quality, with uncertain benefits and known harms (sterility, sexual dysfunction, bone loss, etc.). Europe as been the epicenter for medicalized approaches to Gender Dysphoria, and their approach is clearly secular/clinical, not religious, so developments there should matter. Your segregation analogy doesn’t fit. Segregation was overturned with overwhelming evidence of harm and no medical controversy. Here, multiple independent reviews (not fringe sources) raised serious questions about safety and efficacy for children. That’s why the debate exists. Dismissing concerns as “hate” or “nothing” avoids engaging with the actual data: Cass, WPATH Files, detransitioner testimonies, and the policy reversals in Europe. If the evidence were as strong as claimed, those countries wouldn’t have changed course. What specific high-quality, long-term studies convince you that routine medicalization is the right first-line approach for most of today’s youth cohort? I favor bodily autonomy in general. So do I, but that was not my question. Do you see any ethical "stopping point" at all? Well, that's an interesting perspective. Could you elaborate? They aren’t performed lightly. The medicine behind it was built up slowly over decades. I am curious why you think so much of Europe has radially altered course on this. Yep, meets that criteria. It does not meet the criteria for most cases. There is no clear physical pathology in the breasts, genitals, or endocrine system of gender-dysphoric minors — the organs are healthy and functioning as designed for their sex. The distress is psychological. Evidence reviews (Cass, European systematic analyses, HHS) show the quality of data for long-term benefit is low, while harms (sterility, sexual dysfunction, bone loss, cardiovascular risks) are substantial and irreversible. Less invasive options (exploratory therapy addressing comorbidities) are often bypassed. That’s why multiple countries restricted these interventions. The ethical bar for operating on healthy adolescent bodies is (and should be) high. Rapid-onset gender dysphoria (ROGD) is not pseudoscience. It’s a descriptive term for the well-documented epidemiological shift: a sharp increase in adolescent-onset cases (especially natal females) with little or no childhood history, often in clusters, after heavy social media exposure, and with high rates of comorbidities (autism, trauma, mental health issues). This pattern was noted in clinical practice and parental reports, then studied (Littman 2018 and follow-ups). The Cass Review and European evidence summaries explicitly acknowledged social influence and peer contagion as plausible contributors to the surge. That’s why those countries moved away from routine affirmation toward therapy-first models. Dismissing it as “discredited” doesn’t erase the data: the demographic flip, explosion in referrals (thousands of percent in some clinics), friendship-group clustering, and the timing with social media. These are observable facts needing explanation. “Social contagion” is a neutral hypothesis for part of the increase — not a claim that all trans identities are fake. The medicine here is contested precisely because the evidence for medicalization in this new cohort is weak. That’s not ideology — it’s what systematic reviews found. It is you meddling in things you don’t understand and showing a lack of compassion by doing so. I am not meddling. I am engaging with the actual evidence and clinical reality. The Cass Review, European systematic reviews, detransitioner testimonies, and whistleblowers from gender clinics all raised serious concerns about rushed affirmation, weak long-term data, comorbidities, and harms to minors. Those aren’t fringe opinions; they drove policy changes in the UK, Sweden, Finland, Norway, and elsewhere toward therapy-first approaches. Caring about protecting kids from experimental medicalization on healthy bodies (especially with high desistance rates and comorbidities like autism and trauma) is not a lack of compassion. It is caution grounded in the data. Dismissing those concerns as “meddling” or “incomprehension” avoids the substance. Genuine compassion means following the best available evidence, not ideology. If the long-term outcomes were clearly positive with minimal risk, the European retreats would not have happened. It is not rushed medicalization. Again, that you just recently found out about this does not mean there isn’t data about it. And yes, you are infantilizing them. From the previously-cited article: Two hours seems rushed. I would be happy to consider the data you are referencing here. The evidence is that therapy DOES NOT provide more than a minimal benefit. Again, I am happy to consider whatever data it is you have which you feel supports your position. I don't think you have such data, though, as you would have posted it by now. Thanks, -Smac

A cleft palate is a good example of a structural deviation that often requires correction for both function and normal development. But even milder congenital variations illustrate the principle. A sixth finger (polydactyly) is excess tissue/bone deviating from normal human anatomy. Surgery to remove it is common, even when it’s not severely dysfunctional, to restore typical hand structure, improve function and "cosmesis" (just learned that word recently), and avoid social/psychological issues. We treat it as a correctable anomaly, not something to affirm as a valid variation. Gynecomastia is analogous: excess glandular tissue in a male chest is a deviation from normal male development. Surgery removes the abnormal tissue to restore typical male anatomy. It’s corrective. By contrast, gender-affirming mastectomy removes healthy, normal female breast tissue to oppose female development based on identity. The tissue isn’t excess or anomalous — it’s standard for the sex. That’s the ethical and clinical difference: one aligns with biological sex reality; the other rejects it by altering healthy organs. We don’t generally amputate healthy body parts to match a subjective perception (BIID, species dysphoria, etc.), even if distress is real. The same caution applies here, especially in minors. The birthmark/mole comparison is weaker because those are usually superficial and don’t involve substantial glandular/structural change. Would you support removing healthy breasts in a dysphoric adolescent female the same way we remove a sixth finger? Thanks, -Smac

I acknowledge that cultural beauty standards influence many cosmetic decisions, but that doesn’t erase the clinical distinction for gynecomastia. The surgery addresses a physical deviation from normal male chest anatomy — excess glandular breast tissue in a male body, often triggered by puberty/hormones. It’s not just “unwanted fat” or subjective aesthetics; it’s abnormal glandular development that deviates from typical male secondary sex characteristics. Medical guidelines recognize it as a condition warranting evaluation and potential correction, similar to other sex-atypical developments (e.g., certain cases of macromastia in females or precocious puberty). Compare to your examples: Outlier height/strength in athletes is within normal male variation — extremes of the male bell curve, not a departure from male physiology. Gynecomastia is excess female-like tissue in a male body. Correcting it aligns the body toward typical male development, not an arbitrary beauty ideal. In cultures prizing higher weight, obesity-related pseudogynecomastia might be less stigmatized, but the underlying glandular issue in true gynecomastia is still a biological anomaly. We don’t refuse cleft palate repair because some cultures might view it differently. The parallel to gender medicine is that one corrects a deviation from sex-typical biology; the other removes healthy sex-typical tissue to oppose it. This is not mere subjectivity. It is grounded in observable anatomy and reproductive biology. Thanks, -Smac

Autism is a neurodevelopmental disorder (per DSM-5 and medical consensus), characterized by challenges in social communication, restricted interests, and repetitive behaviors. For many, it involves significant difficulties — sensory sensitivities, executive function issues, higher rates of anxiety/depression, and support needs that can range from mild to profound. Yes, autistic people often have unique strengths (pattern recognition, focus, honesty, etc.) and see/process the world differently. That’s worth celebrating and accommodating. But calling it “not a disorder, just different” downplays the real struggles and comorbidities that many face. It’s both: a different neurotype and a condition that frequently impairs functioning in a neurotypical world. We accommodate and support people with autism without pretending the challenges don’t exist — just as we do with other neurodevelopmental conditions. The same principle applies to gender dysphoria in autistic youth: high comorbidity rates deserve careful assessment and therapy, not rushed affirmation that may overlook root issues. Thank you for sharing your thoughts. In my view, that analogy doesn’t hold. Again, autism is a neurodevelopmental disorder involving measurable differences in brain structure/function, social communication challenges, sensory processing issues, and higher rates of comorbidities (anxiety, depression, epilepsy, GI problems). These can range from mild to severe and often impair functioning in a neurotypical world. Recognizing that isn’t misogyny or pathologizing normal variation. Rather, it is clinical reality backed by genetics, neuroimaging, and decades of research. We accommodate strengths (focus, pattern recognition) while addressing deficits through therapy, education, and support. Historical views of women as “defective males” or menopause as purely mental were wrong because they ignored objective biology and imposed cultural bias. Autism’s challenges are not imaginary or solely cultural. Studies have shown high heritability, and interventions (behavioral therapy, occupational therapy, etc.) demonstrably help many. Dysfunctional masculinity or personality disorders are separate issues of behavior/character, not equivalent to a neurodevelopmental condition present from early development. We treat the latter because it often involves genuine impairment, not to enforce conformity. The same caution applies to gender dysphoria in autistic youth: high comorbidity rates warrant thorough assessment, not assuming affirmation is always the answer. Dismissing concerns as outdated prejudice avoids engaging with the data. What specific evidence leads you to view autism as primarily “different, not disordered”? Thanks, -Smac

Emotional distress is a factor in many surgeries (including gynecomastia), but it’s not the sole or defining criterion. The key difference, then, is the underlying condition: Gynecomastia involves excess glandular tissue in a male body — a physical departure from normal male development (often hormonal/pubertal). Surgery removes abnormal tissue to restore typical male chest anatomy. It’s corrective, similar to other procedures addressing congenital or acquired deviations (cleft palate repair, gynecomastia is medically recognized for this reason). “Gender-affirming” mastectomy removes healthy, normal female breast tissue in a female body to align with a subjective identity. The breasts are not excess or pathological; they are standard female development. The intervention works against biological reality rather than restoring it. Both can relieve distress, but one treats a deviation from sex-typical physiology while the other alters healthy sex-typical physiology. That’s an objective clinical distinction, not pure subjectivity. Medical ethics weighs risks/benefits differently when operating on healthy organs versus correcting abnormalities. I’m open to nuance on adolescent gynecomastia (I noted skepticism for purely cosmetic pseudogynecomastia cases earlier). But equating the two ignores the biological grounding. What makes removing healthy female breasts equivalent to correcting excess male breast tissue, in your view? Thanks, -Smac

Thank you for sharing your thoughts. My understanding is that biological sex is not primarily determined by hormones. Hormones influence secondary characteristics (like breast development), but they don’t redefine the fundamental binary. Rather, in biology, sex is defined by the type of gamete (reproductive cell) an organism’s body is organized to produce: Male: Small gametes (sperm). Female: Large gametes (eggs/ova). There are only two sexes because there are only two gametes. This is the standard, unambiguous definition used in evolutionary biology, developmental biology, and genetics. No third gamete exists, so no third sex. Disorders of sexual development (intersex conditions) are variations within the binary, not evidence against it — they don’t produce a third gamete type. Hormones (testosterone, estrogen, etc.) are important regulators, and we can alter their levels. But changing hormone profiles doesn’t change the underlying reproductive anatomy or gamete-producing design. A biological male (XY, testes designed for sperm) on estrogen still has a male reproductive system at the chromosomal and developmental level. The body isn’t “malleable” into the opposite sex; interventions create approximations of secondary traits, often with significant trade-offs (infertility, health risks). Gynecomastia surgery removes excess tissue to align with normal male physiology. “Gender-affirming” mastectomy removes healthy female tissue to oppose normal female physiology. That’s the core difference. I don’t think you have a good grasp of the ethics behind all of this. You are putting the ethical line where your religion sets it, not based on medical ethics. I appreciate you raising the ethics question, but I think you’re mischaracterizing where my line comes from. My view is not rooted in religion setting an arbitrary boundary (moreover, I think the Church's doctrines, though fundamentally "religious" in nature, do not support the notion of "an arbitrary boundary," but rather boundaries that reflect reality, which corresponds to the designs of the Almighty). It comes from medical evidence, biological reality, and standard ethical principles in medicine: primum non nocere (“first, do no harm”), informed consent, and avoiding irreversible interventions on healthy tissue when less invasive options exist. We as a society do not affirm anorexia by helping patients starve, amputate healthy limbs for body integrity dysphoria, or surgically alter people who identify as another species — even if it relieves distress. I think this is not in dispute. The ethical line is whether we’re treating a mental health condition by permanently altering a healthy body in ways that introduce sterility, sexual dysfunction, bone density loss, cardiovascular risks, and uncertain long-term outcomes. Evidence reviews (Cass Review, European reversals, the recent HHS report) show the quality of evidence for “gender-affirming” surgeries/hormones in minors is remarkably weak, while harms are substantial. I also think the ethical line is, or ought to be, drawn relative to the intended purpose of medical procedures which align physiology toward biological sex reality versus away from it. My faith aligns with protecting kids from experimental medicalization, but the reasoning I have presented here stands on its own from the data, desistance rates, comorbidities, and regret/detransition patterns. If the evidence were stronger for net benefit and low risk, I would reassess. Where do you draw the ethical line, and what data supports medicalizing healthy adolescent bodies for psychological distress in this specific case? That’s exactly the point. In anorexia, we do not affirm the distorted perception by helping the person starve or surgically alter their body to match the delusion. We treat the underlying psychological condition with therapy, nutritional rehabilitation, and support — even when the patient experiences intense distress and insists the thin ideal would “relieve” their symptoms. The parallel with gender dysphoria is that we are often affirming a distorted perception of the body (by hormones and surgery on healthy tissue) rather than primarily addressing the psychological distress through therapy. Both involve body-image/identity issues where the “relief” from affirmation can be short-term and comes at the cost of entrenching the problem and introducing serious medical harms. If the goal is genuine well-being, why would medical personnel treat one as a mental health issue requiring reality-based care and the other as something that justifies permanent medical alteration of a healthy body? I agree that some people report short-term relief from gender-affirming treatments for body dysphoria — that’s not in dispute. The deeper questions are: Net long-term benefit — Does it resolve the distress sustainably, or does it often mask comorbidities (autism, trauma, mental health issues) while introducing irreversible harms (sterility, sexual dysfunction, bone loss, cardiovascular risks, regret/detransition)? Evidence reviews like the Cass Review found the quality of studies claiming benefit to be very low, with weak follow-up data. Ethical consistency — BIID (body integrity dysphoria) patients also report profound relief from amputation, and some “otherkin” or species dysphoric people seek extreme cosmetic alterations. We don’t generally affirm those by amputating healthy limbs or performing radical surgeries because the body is healthy and the distress is psychological. The principle is the same: treating a disorder of perception by mutilating a functional body is ethically fraught, especially in minors where desistance is common. If the treatments were clearly safe, effective, and curative with strong evidence, this wouldn’t be so contested. The surge in adolescent females, high comorbidity rates, and European retreats from routine affirmation suggest caution is warranted over affirmation-as-first-line. Where do you see the ethical stopping point for medically altering healthy bodies to match subjective identity? Many medical treatments are irreversible — that’s why the ethical bar is high. We don’t perform them lightly on healthy tissue for psychological conditions. Also, the line is not "weird." Rather, it is standard medical ethics: primum non nocere (first, do no harm) and proportionality. We accept irreversible interventions in particularized circumstances: There’s a clear physical pathology (e.g., cancer, severe injury). Benefits demonstrably outweigh harms with strong evidence. Less invasive options have been exhausted. Removing healthy breasts/testicles/penis in a minor (or adult) with gender dysphoria fails that test for many cases. The body parts are functionally healthy. Evidence for long-term mental health benefit is weak (per Cass Review and others), while harms (sterility, loss of sexual function, bone density issues, surgical complications, regret) are substantial and permanent. Comorbidities like autism, trauma, or social contagion are common, especially in rapid-onset adolescent cases. Compare all this to to BIID (amputating healthy limbs), anorexia (endorsing starvation), or species dysphoria. We reject those despite reported distress relief because altering a healthy body to match a subjective perception is ethically problematic. The same principle applies here. Again, if the data showed clear, sustained benefit with minimal risk, I would reassess. Right now, it doesn’t for most youth. That’s why European countries have sharply restricted these interventions. What makes this case different enough to justify the exception? No — quite the opposite. People with autism, trauma, or other comorbidities deserve the highest standard of care, not rushed medicalization that may entrench problems or create new ones (sterility, sexual dysfunction, surgical complications). Exploratory therapy and comprehensive assessment aren’t “infantilizing” — they are responsible medicine. We do this for other conditions with high comorbidity (e.g., eating disorders, self-harm, OCD) because adolescents’ brains are still developing, desistance rates can be high, and long-term data on these interventions is weak. The Cass Review and European shifts highlighted exactly this: Many gender-distressed youth have co-occurring issues that should be addressed first. “Bodily autonomy” for minors doesn’t mean affirming every request for irreversible procedures on healthy organs. Parents and doctors have a duty to protect kids from decisions they may regret when older — especially when social contagion, peer influence, and mental health factors are prominent in the recent surge of adolescent females. Supporting therapy-first isn’t denying autonomy or compassion. It’s prioritizing evidence-based care over ideology. Dismissing concerns as “yikes” doesn’t address the data on comorbidities or outcomes. What evidence convinces you that immediate medicalization is the prudent path for these complex cases? Exploratory therapy isn’t “LOL." It is the approach increasingly recommended by systematic reviews because the affirmative model has weak evidence. The Cass Review (UK, 2024) and similar European analyses found that routine therapy was often inadequate or bypassed under the affirmative model, with poor assessment of comorbidities (autism, trauma, same-sex attraction, social influence). Many clinics moved to “informed consent” or very brief evaluations. Long-term studies on medical transition show mixed or modest mental health benefits, persistent high suicide risk, and significant regret/detransition rates in some cohorts. We have not seen evidence supporting the supposed slam-dunk “it works” narrative. Countries like Sweden, Finland, UK, and Norway didn’t shift to restrictions because therapy “doesn’t work” (or because of religious sentiments). They did so because the evidence for puberty blockers/hormones/surgery in minors is low-quality, risks are substantial, and desistance is common with watchful waiting + therapy. The sharp rise in adolescent females (post-social media) particularly suggests many cases involve social/contagion factors or underlying issues therapy can address. I’m not saying stop all medical transition forever. I’m saying don’t rush irreversible interventions on healthy minors when exploratory therapy, addressing root causes, and time often lead to better outcomes. That’s not anti-compassion — it’s evidence-based caution. The “transphobes screaming” line is a strawman; serious concerns come from clinicians, detransitioners, and reviews showing the affirmative approach failed many kids. If the data robustly showed medicalization as clearly superior long-term, the European shifts would not have happened. What specific high-quality evidence convinces you it’s the best path for most youth? The distinction isn’t “icky/sinful vs. not” or an ad hoc religious invention. It’s grounded in clinical medicine and biology, which I have presented consistently. Gynecomastia/pseudogynecomastia surgery corrects a physical deviation from normal male chest anatomy (excess glandular tissue or fat in a male body). The intervention restores typical male secondary sex characteristics. Emotional distress is a common reason for many reconstructive procedures — that doesn’t make the underlying issue subjective identity. “Gender-affirming” mastectomy removes healthy, normal female breast tissue to oppose female physiology and approximate a male appearance based on felt identity. The tissue is not pathological; the body is functioning as designed for its sex. This is not corrective in the same way. Scripture informs my broader worldview (including the sanctity of the body and sex as part of God’s design per the Proclamation on the Family), but the clinical distinction stands on its own: one aligns with biological reality, the other rejects it by altering healthy organs. That’s why European reviews (Cass, etc.) and medical ethics emphasize caution with the latter, especially in minors. If the evidence showed equivalent outcomes and low risk for both, the comparison might hold. It doesn’t. Dismissing the biological line as mere religion avoids engaging with the data on desistance, comorbidities, and long-term harms. What makes the two cases ethically equivalent in your view? Thanks, -Smac

I see the distinction differently. Gynecomastia surgery corrects a physical abnormality — excess glandular breast tissue in males, often triggered by puberty, hormones, or medication. The goal is to restore a typical male chest contour, addressing a condition that deviates from normal male physiology. It’s corrective, like fixing a cleft palate or removing a benign tumor causing distress. The body is being aligned toward biological sex reality, not away from it. In contrast, "gender-affirming" mastectomy in adolescent females (or "top surgery") removes healthy female breast tissue to approximate a male appearance based on a subjective identity. The breasts are not pathological; they are normal, healthy organs developing according to female biology. The intervention denies rather than affirms biological reality. Both can relieve psychological distress, but that doesn’t make them equivalent. We don’t amputate healthy limbs for body integrity dysphoria, affirm anorexia by endorsing starvation, or surgically alter someone who believes they’re a different species. The ethical line is whether we’re treating a disorder of the mind by altering a healthy body in ways that are irreversible and carry known risks (infertility, sexual dysfunction, skeletal issues, potential regret). I am not opposed to compassion or mental health support for gender dysphoria. But the evidence (Cass Review, European shifts, weak long-term data) increasingly questions whether rushing to remove healthy organs in minors is the right response — especially with the sharp rise in adolescent females and high rates of comorbidities like autism or trauma. Exploratory therapy to address root causes seems more prudent than immediate medicalization. What do you see as the key difference (or non-difference) here? I appreciate you sharing those links. I have looked into gynecomastia and pseudogynecomastia. The key distinction remains: gynecomastia (and pseudogynecomastia) involves excess tissue in males that deviates from normal male physiology. Surgery removes abnormal or unwanted male breast tissue to restore a typical male chest contour. It’s corrective — aligning the body toward biological sex reality. Emotional distress is often a factor (as it is with many cosmetic or reconstructive procedures), but the underlying issue is a physical departure from the male norm. In contrast, “gender-affirming” mastectomy in females removes healthy female breast tissue to create a male-appearing chest based on subjective identity. The breasts are not excess or abnormal; they are normal organs of female development. The surgery denies biological reality rather than correcting a deviation from it. On liposuction for pseudogynecomastia in adolescent males: If it’s true pseudogynecomastia (mostly fat, often tied to obesity/puberty), I am more skeptical of routine surgery in minors for purely cosmetic/psychosocial reasons. But it’s still fundamentally different from removing healthy female breasts. One case addresses excess tissue in a male body; the other amputates normal tissue in a female body to affirm a perceived identity incongruent with biology. Again, I am all for compassion and mental health support for body image distress in any minor. But we should be very cautious with irreversible surgeries on healthy minors. The evidence for benefits vs. harms in gender medicine (especially rapid-onset cases) is much weaker than for standard gynecomastia correction. Therapy exploring root causes seems preferable to jumping to the scalpel. I am curious where you draw the line on medicalizing psychological distress in healthy bodies. Thanks, -Smac

I’m a little unclear. Are you against all gender affirming surgery or just against it for minors? Under past, and somewhat ongoing, medical regimes, I am overwhelmingly against medical interventions for minors which are intended to address Gender Dysphoria. This is largely due to the various factors in the above bullet list pertaining to and centering on minors. I likewise have concerns about adults, and I think comorbidities, informed consent, etc. must be meaningfully addressed. In the end, though, adults have greater autonomy. I just came across an interesting article that lays out some concerns reflective of my own, and also lays out additional factors to consider: On the disaster of transgender medicine I agree that some advances in the trans movement, particularly "medicalized gender transitions for adolescents," have been politicized across the spectrum. That is a big part of the problem. The linked article above is from Pew Research. Very much worth a read. This is an important point, and I want to better understand it. I think recent years have exhibited a substantial "social contagion" component to this phenomenon: Demographic Shifts: Referrals to gender clinics have exploded (e.g., 4,000%+ in some places), with a reversal from mostly young boys to predominantly adolescent girls (often with no childhood history of dysphoria). This pattern coincides with widespread social media use and increased visibility of transgender identities. Peer Clustering: Littman’s study and others noted "cluster outbreaks" in friend groups, where multiple teens (sometimes a majority) identified as trans around the same time, far exceeding baseline prevalence. Social Media & Online Influence: Many parents have reported sudden onset teen emphasis on this issue after heavy Tumblr, TikTok, YouTube, or Reddit exposure to transition narratives. Social media can amplify identity exploration, provide echo chambers, and frame dysphoria as a solution to other distress (anxiety, depression, autism, trauma, bullying, same-sex attraction). Comorbidities: I have spoken about this a lot. High rates of prior mental health issues, neurodiversity (e.g., autism), and social difficulties. Gender dysphoria may serve as a maladaptive coping mechanism for underlying problems, with transition presented online as a "cure." International Reviews: The Cass Review and similar European analyses acknowledged social influences and peer contagion as plausible contributors to the surge, noting weak evidence for medical interventions and recommending caution/therapy-first approaches. Several countries (Sweden, Finland, UK, Norway) restricted youth medical transitions partly for these reasons. Analogies: I have seen quite a few comparisons to past contagions like eating disorders, self-harm, or Tourette-like tics spread via social media. Regarding the concept of “true transsexuals,” I continue to struggle with it. The author uses the term for the small, distinct subgroup of children who: Exhibit clear, consistent, insistent cross-sex identification from early childhood (not sudden adolescent onset). Likely have lifelong gender dysphoria without intervention. May suffer severe, persistent distress if not allowed to transition. These are contrasted with the recent surge of mostly adolescent-onset cases (often influenced by peers/social media), which he sees as the core of the "disaster." He argues this tiny "true" group has been harmed or overlooked amid the broader backlash and politicization. The piece calls for better research and nuanced care that doesn't abandon them. I struggle with "nuanced care" for these kids including puberty blockers, cross-sex hormones and surgical interventions. These cases, though legitimate psychologically, are not reflective of biological/physiological reality. A child who well and truly thinks (“consistent, insistent and persistent”) that he is a dog or a space alien certainly deserved compassion and attention, but not medical intervention to designed to make him have some sort of physiological approximation to looking like a dog or a space alien. Indeed, even affirming his subjectve-but-clearly-delusional belief that he is a dog or space alien seems quite problematic for me. The position I am trying to articulate here — compassion for genuine distress without endorsing or medically reinforcing a mismatch with biological reality — apparently aligns with a growing number of clinicians, researchers, and reviewers (e.g., the Cass Review in the UK, European reversals, and the recent HHS report). Gender dysphoria is real psychological distress. For a small subset of children ("consistent, insistent, persistent" from early childhood, as the article puts it), it can be profound and lifelong. Desistance rates are high overall (especially with watchful waiting + therapy), but some cases persist. However, the subjective belief ("I am the opposite sex") does not alter objective sex (chromosomes, gametes, skeletal structure, etc.). Sex is binary and immutable in humans for reproduction. Interventions (blockers, hormones, surgery) do not change sex; they approximate secondary characteristics, often with sterility, sexual dysfunction, bone density loss, cardiovascular risks, and unknown long-term brain effects. Treating this condition like other body/mind mismatches (such as anorexia — where we don't affirm starvation; or body integrity dysphoria — where we don't amputate healthy limbs) prioritizes psychological approaches first: exploratory therapy addressing comorbidities (autism, trauma, same-sex attraction, social contagion in adolescent-onset cases, family dynamics). The dog / space alien analogy is a common reductio in the literature. If a child persistently believes they are another species or entity: We offer compassion, therapy, and support for the distress. We do not affirm the delusion as reality or pursue veterinary/cosmetic interventions to "match" it. Doing so would likely entrench the delusion rather than resolve underlying issues. Critics of the "affirmative" model argue the same logic applies here: social/medical transition can lock in a pathway with high regret/detransition risks for some (especially rapid-onset adolescent cases), while foreclosing natural resolution. Persistent early-onset cases are rarer and deserve careful, individualized evaluation. But even then, many experts now favor therapy over immediate medicalization due to weak evidence of net benefit. So, what does "nuanced care" mean for this small subset of minors? Apparently: Comprehensive mental health assessment (ruling out/exploring comorbidities). Therapy focused on distress tolerance and reality-testing, not immediate affirmation. Watchful waiting for most (high natural desistance in pre-pubertal kids). Very rare, highly restricted medical steps only after exhaustive evaluation, in clinical trials, for the most severe persistent cases. My discomfort with blockers/hormones/surgery as "treatment" for a psychological condition is, it seems, shared by the Cass Review, multiple European health authorities, and the HHS evidence summary — they highlight poor evidence quality and significant risks. The surge in adolescent females (post-social media) particularly suggests social/contagion factors in many cases, not a sudden biological revelation. In saying this I do not deny the suffering of genuinely dysphoric kids. Rather, this perspective questions whether chemically/surgically altering healthy bodies is the ethical or effective response, versus addressing the mind and environment. The data increasingly supports caution. Back to the article: Several items in my bulleted list center on poor data. I'm not sure this is correct. I think the following should be the foundation of all treatments (noted above) : Comprehensive mental health assessment (ruling out/exploring comorbidities). Therapy focused on distress tolerance and reality-testing, not immediate affirmation. Watchful waiting for most (high natural desistance in pre-pubertal kids). The last bullet point is, I think, where there is the most contention: Very rare, highly restricted medical steps only after exhaustive evaluation, in clinical trials, for the most severe persistent cases. I still struggle with the notion of "medical steps," but I'm willing to listen and pay attention to meaningful and clear and strong data. I just don't think we are anywhere close to having that at present. This point is addressed in the article: "A two-hour appointment." The mind reels. I think the correlation noted here ("{t}he swift expansion of this new medical field coincided with the onset of ... the 'phone-based childhood'") has strong indicia of causation. We don't let minors get tattoos, or drink, or vote, etc., mostly under the rubric of minors not really being prepared for such things. And yet "transgender kids know their gender" has been a rallying cry. Social contagion concerns. Informed consent. Compromised assessments of the best interests of the child. Longitudinal studies essentially absent. Ideological/sociopolitical influences/pressures on medical care. These concerns come up over and over. I am very much on the periphery of this topic, and have only raised it occasionally on this board. And I have been excoriated for doing so. We're apparently not allowed to even voice these concerns. The censorious proclivities of the ideologues advancing this stuff are potent and wide-ranging. I'd like to see data on this. Frankly, if meaningful and reliable data were available, I think we would have seen it by now. There have been huge incentives to find it, and yet it's not just here. And more than that. Medicine should be evidence-based. As it is, this sector of medical care has been dominated by ideologues, politics and poor data. Interesting stuff. Thanks, -Smac