Big Les

Virginia Medicaid (VA DMAS) recently started authorizing services, paid for by tax dollars, for the treatment of Gender Dysphoria (GD) in young people. The memo can be read here. Treatment includes the use of pharmaceuticals to suppress puberty followed by the introduction of “gender-affirming” hormones. Coverage also includes surgical treatment for the child’s chest and genitalia. This is not only disconcerting, its justification is horribly irrational. Four points are made to justify this abominable approach to treating a psychological condition with physical modifications.

1. They claim that “this population” (the young) has experienced “poor medical and behavioral outcomes.” This is a relatively new phenomenon with a new designation, so there is very little historical data. It simply hasn’t been studied enough.
2. They also claim that there exists an “outsized impact” on the young. It’s unclear what exactly is meant by this, but it seems to intimate that either there are many cases or that there is much need for treatment. If the former, it could simply be anomalous; if the latter the reasoning is circular as if to say, “The treatment is needed because it’s needed.” In any case, there’s still not enough data.
3. They go on to cite the “paucity of research.” They admit there’s not enough data concerning viable treatment, and they dare to use that as evidence of the need for this particular treatment modality.
4. The “stigma experienced” by pre-teens is the last point Medicaid makes in asserting treatment is “particularly important and complex.” This conclusion is horribly vague and reaffirms how little they know about this particular treatment now being covered. It seems to miss the mark entirely.

All kids struggle with myriad issues in those transformative years, and they need to learn how to handle those issues. Our children need us to teach them how to face the challenges life will bring their way, and we have the duty to equip them with the tools needed. Many parents are concerned and confused and may not understand that hormone therapy and sex change are quite extreme and often irreversible, but if we unpack the condition a bit, we should be able to see the current treatment philosophy is flawed.

Without delving too deeply into GD as I am no expert, it’s important to define some terms. Dysphoria is “a state of unease or generalized dissatisfaction with life.” As the term is used in GD it refers to being uncomfortable about how one feels about one’s gender. Not too long ago, such uncomfortableness was called Gender Identity Disorder, and treatment was ordered toward addressing the wrongful perceptions of one’s gender as it relates to one’s sex. Now, the language of incongruence is used to refer to a perceived lack of consistency or appropriateness. Again, this is horribly irrational. It’s a category mistake of the worst kind. Let’s draw distinctions and define terms.

1. Sex is a reproductive function of bilogy which qualifies how a species progenerates. Sexual creatures need partners, and these fall into two categories: male and female. Asexual creatures do not need partners.
2. Gender is a function of language and expresses the perceived dominance of a thing. Some things are perceived to be more dominant than others, and other things are considered neutral. The terminology used is masculine, feminine and neuter. When applied to biology the male is referred to as macualine and the female feminine, but there is no neuter unless the male is stripped of the ability to generate as in the case of a dog.

While it’s true sex and gender can be used synonymously, we must distinguish between the two in order to avoid confusion. In so doing we can easily identify the flaw in the reasoning which asserts that if a kid is uncomfortable with his/her gender, changing sex might solve the problem. Treatment of GD should focus on correcting misunderstandings about gender which are rooted in cultural perceptions and not one’s sex. This leads to a more healthy and reasonable approach to treatment that remains sympathetic to those who suffer from this condition. Without adequate “research meeting traditional objectivity standards” for this treatment modality, tax dollars should not be spent on procedures that are irreversible and may very well cause more long-term harm than short-term good.