A submission to the Vine Review
On the intractable problem of calculating harms if one assumes Gender Affirming Care to be the only appropriate treatment for Gender Dysphoria in minors.
What follows is a submission I have made to the Queensland Government commissioned Independent Review into Queensland Health’s use of puberty suppression drugs and gender affirming hormones for minors suffering from gender dysphoria. This is an evidence-based evaluation which is being directed by the eminent Melbourne Psychiatrist, Professor Ruth Vine, aided by a panel of eminent experts.
In my view, there are intractable philosophical questions around what an evidence-based inquiry could actually be if one takes gender to be real and sex to be a construct. The terms of the review seem to indicate that this intractably difficult approach to evidence is likely to be assumed by the Review. But hopefully this will not be the case.
Effective ‘Balance of Harms’ calculations are Prevented by Gender Affirming Care
By Paul Tyson
Abstract:
This essay looks at the medical ethics calculation that should be made when balancing the harm of the loss of a child’s future reproductive integrity against the harm of the suffering produced by juvenile and teenage gender dysphoria. The argument presented explains that whilst treatment education will be routinely done with the gender dysphoric minor, a genuine ‘balance of harms’ calculation is effectively not done by therapists, endocrinologists, and surgeons. The reason it is not done is because the permanent disabling of a self-identified trans minor’s reproductive integrity is not understood by the Gender Affirming Care principle as a harm, but rather, as the only moral and identity-realizing cure pathway available for the trans-identifying gender dysphoric minor.
Significantly, natural reproductive integrity damage in trans-identifying minors is considered to be necessary and good for philosophical rather than medical or mental health reasons. That is, the philosophical foundations of Gender Affirming Care are not evidence-based medical science or evidence-based psychological or psychiatric science. The justifying foundation of the therapeutic practice of Gender Affirming Care is Queer Gender Theory. This is not an evidence-based theory. Indeed, Queer Gender Theory explicitly denies the validity of objective scientific knowledge. Here, all scientific knowledge claims as regards a person’s sex are interested and interpreted claims that concern normative social governance structures. Here, there are no objective facts about a person’s sex, regardless of their gender-identity. Instead, sex is defined by gender-identity. Hence, a transwoman is deemed to be a person of the female sex because of their gender-identity, regardless of their male chromosomes and male reproductive physiology.
The explicitly sex-anti-realist and anti-science philosophy of Queer Gender Theory has captured our therapeutic environment. Thus, Gender Affirming Care prescribes that minors who are persistently certain that they are trans-gendered should proceed along a reproductive integrity disabling treatment pathway, for this alone is authentic care.
In sum, Gender Affirming Care entails the negation of standard bio-ethical evidence-based balance of harms calculations, and does not seriously consider the irreversible harms such treatments may do to a child’s reproductive integrity.
4,938 words
Dr Paul Tyson is an Honorary Fellow at the School of Historical and Philosophical Inquiry, University of Queensland
Dr Tyson’s philosophical specialities are metaphysics, epistemology, and ethics.
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In medical practice, complex calculations which balance harms are routinely performed by doctors.
Balance of harms calculations in medical practice
Many medical treatments entail risks and harms. Considering whether to surgically remove a breast because it is cancerous, is to contemplate surgically inflicting a serious physical harm (the loss of a breast) such that if there is any way of effectively treating the cancer without removing the breast, that is preferable. The cancer is a harm and removing the breast is a harm, but a sufficient prospect of escaping death at the cost of losing a breast, if other treatments are deemed unlikely to work, is a viable ‘balance of harms’ reason to undergo a mastectomy.
Balance of harms logic applied to Gender Affirming therapeutic practices for Minors
As I understand Australian medical practice, there is no discretionary or cosmetic reason why minors can elect to undergo cross-sex hormonal and surgical sex-presentation transition treatments that will permanently disable the reproductive integrity of their adult bodies. Adults can elect to undergo such medically non-necessary treatments – at their own cost – because they are assumed to be in a position to judge whether they wish to become unable to sexually reproduce or not, as they are mature and have had the opportunity to reproduce. But the argument as to why minors should receive Gender Affirming hormonal and surgical therapies is not an adult discretionary or cosmetic argument. Rather, the justifying argument is that the psychological harm of not undergoing sex-presentation altering treatments for minors overwhelmingly outweighs all medical harms to the reproductive integrity of the minor that are produced by such treatments. However, in practice, infertility harms are typically not considered to be real harms for trans-identifying minors, so there is no need to demonstrate an evidence-based balance of harm justification for minors undergoing sex-presentation reassignments. But let us ask, is the damaging or permanent disabling of a minor’s naturally sexed reproductive integrity a harm?
Reproductive integrity damage in minors is a medical harm
When gender dysphoria is not present, treatments that damage or permanently disable the adult integrity of a healthy minor’s reproductive biology – for no medically necessary reason – are unambiguously deemed to be harmful. This is not disputable. Let us take it as given that the permanent disabling of the reproductive integrity of a physically healthy minor is a real harm. Hence, when puberty blockers and other hormonal and medical interventions are performed on physically healthy minors, there must ordinarily be a bio-ethical argument about why the presence of gender dysphoria in minors over-rides the physical harm to the natural reproductive integrity of the minor.
The two premise ‘balance of harms’ argument
I see no reason why bio-ethical arguments in favour of authorizing puberty blockers for minors should not follow normal medical good-practice models as ‘balance of harms’ arguments. Here, Gender Affirming Care (GAC) advocates maintain that the harm of not perusing hormonal and medicalized sex-presentation transitions for gender dysphoric minors is greater than the harm of damaging or permanently disabling the reproductive integrity of the minor.
The argument goes like this:
Premise One: Gender Affirming treatments cause serious medical harms to the minor, for such treatments often damage or permanently disable the minor’s adult reproductive integrity.
Premise Two: Gender dysphoria is such a severely distressing psychological condition that it justifies treatments that cause irreversible physical harm to the adult reproductive integrity of minors.
Conclusion: Hormonal and surgical treatments that damage or permanently disable the reproductive integrity of gender dysphoric minors, and cure them of gender dysphoria, are justified because the phycological harm of not curing them of gender dysphoria is greater than the physical harm produced in treating gender dysphoria by hormonal and surgical means.
Problems with the Gender Affirming Two Premise balance of harms argument
There are a range of serious problems with the above argument that I shall not here pursue in any detail. But to indicate some of these problems, the below four observations can be made:
1. If a Watchful Waiting psychotherapeutic approach rather than a GAC approach was taken, and gender dysphoria resolved itself naturally over time without damaging the reproductive integrity of the future adult, this would undeniably be a better balance of harms outcome than affirming and transitioning the same child, who has then lost their reproductive integrity as an adult.
2. If there are other reasons why a minor wants to embrace a trans-gender identity than that they really and essentially are trans – such as being ASD and struggling with puberty, online persuasion, peer contagion, social alienation, anxiety, depression, the normal identity flux of youth, and a broad cultural environment of mental ill-health for our youth[1] – then they will very likely regret the irreversible loss of their reproductive integrity in later life.
3. Since the only GAC criteria for being trans are a self-reported gender dysphoria and a self-determined trans-gender identity, there is no objective clinical means of identifying which minor claiming to be trans really is trans, and which minor claiming to be trans only thinks they are trans at the time of claiming this gender-identity, but may want to change back to their natural sex identity (de-transition) later in life. GAC influences the minor to determine a future for themself that they cannot properly appreciate as a minor, and that they cannot undo as an adult (de-transitioners remain reproductively damaged). These are very serious ethical problems as GAC has no evidence-based way of determining whether the minor really is trans or not before proceeding down a hormonal and medical transition pathway.
4. If gender dysphoria is a severe suicide-inducing mental anguish harm, why is it not considered to be a dangerous self-harming mental health disorder, like anorexia? There is a serious conceptual incongruence here in the way we are presently trying to understand what gender dysphoria is. Either: gender dysphoria is a life-threatening and pathological body dysmorphic mental disorder experienced in the mind, and caused by the mind (the body is healthy), and requiring a mental health treatment, or; gender dysphoria is a natural and benign psychological condition that is perfectly normal in trans people, which should require no treatment at all (like being same-sex attracted). But somehow there is nothing wrong with the suicidal gender dysphoric trans mind, yet it is their healthy body that is wrong, and the only effective treatment for the life-threatening anguish of gender dysphoria is to damage the natural reproductive integrity of the healthy body so as to conform it to the body dysmorphia of the gender dysphoric trans mind. No other mental health condition or disorder is treated by damaging the healthy body. A person with the psychological condition of an amputation fetish is not treated by amputating a healthy limb, for example. ‘Do no harm’ is a fundamental principle of ethical therapeutic care. None other than the senior US psychiatrist Professor Allen Frances finds this all very confusing. And really, it is confusing, and our present gender dysphoria treatment models are obviously confused.[2]
Leaving the above matters to one side, let us proceed with the Two Premise Gender Affirming balance of harms calculation.
How harm balancing judgements are calculated
Harm balancing arguments where medical therapies are applied to mental health problems presuppose that medical and psychological harms can be compared and evaluated as in some manner commensurate. This is quite common in psychiatry where some mental illnesses – say schizophrenia – are not so much cured by medical means, but certain drug treatments (which may have unwanted side effects) have been found to effectively assist with the management of the distressing effects of this psycho-neurological disorder. Thus balance of harm calculations can be meaningfully made between medical drug treatment risks/harms and the risk/harms to the patient of a psychiatric illness. But the harms have to be properly identified and weighed.
Using the Two Premise balance of harms argument, careful and properly conducted clinical evidence showing that gender dysphoria is indeed permanently well managed or cured by hormonal and surgical sex-presentation transition treatments would be supportive of the GAC stance. Evidence showing that the psychological distress of gender dysphoria in minors does not respond to psychotherapeutic treatments would also be supportive of a GAC stance. On the other side of the ledger, proper clinical evidence showing the existence of regret and detransition in later life, where there were no identified indicators of trans-identity-transience when they were minors, would undermine the GAC stance. Also, evidence showing that psychotherapeutic Watchful Waiting cautions at least do no harm, and – in a statistically significant manner – do assist sufferers, would powerfully undermine the single path of Gender Affirming hormonal and medical sex-presentation transitioning treatments for minors.
If the Two Premise balance of harms calculation was informed by measurable clinical evidence both for GAC, and against it, then, if the evidence sided with GAC, this would be a bio-ethically justified sole treatment pathway. But this is not what happens.
Why credible harm balancing calculations are not applied to Gender Dysphoria treatments for Australian minors
There is a reason why proper bio-ethical balancing of harm calculations are not credibly done in weighing the psychological harm suffered by gender dysphoric minors against the harms of reproductive integrity disabling treatments. This is the same reason why the cost and benefit of Watchful Waiting psychotherapeutic treatments verses Gender Affirming hormonal and surgical treatment pathways is not pursued as well.
The calculative clarity of the ‘balance of harms’ argument for pursuing Gender Affirming hormonal and surgical treatments of gender dysphoria in minors is routinely confused or simply not done because of the presence of an assumed Third Premise, which is not a ‘balance of harms’ or bio-ethical premise.
The non ‘balance of harm’ premise
Premise Three: it is natural and good for children and youths to be trans.
‘Balance of harm’ incalculability
If this Third Premise is tacitly inserted into the ‘balance of harms’ calculation weighing the physiological harm of Gender Affirming hormonal and medical treatments against the psychological harm of gender dysphoria, any meaningful balance point is removed. That is, the insertion of the Third Premise will make it appear as if damaging the natural reproductive biology of the physically healthy minor suffering from gender dysphoria – who it is assumed must be trans – is not a harm.
The iPhone generation spends an enormous amount of time online which parents can no longer effectively monitor. Due to strong online peer-to-peer trans-activism targeting gender nonconformism in our kids, minors who are socially atypical, such as ASD children, can easily come to believe that they are different because they are ‘wrongly-sexed.’ This non-scientific and counter-factual identity belief – being ‘wrongly-sexed’ – is affirmed by GAC. GAC thus dispenses with evidence-based thinking, as what empirical evidence could there be that a person has been born into a wrongly sexed body? Once GAC affirms that the problem the minor faces is that they are indeed wrongly sexed, no calculation as regards competing harms is entered into in the Gender Affirming treatment model; their body must be sex-presentation altered to conform to their true gender. The only harm now present for the GAC model is not pursuing hormonal and surgical transition to the ‘rightly sexed body’ as soon as possible. This is the opposite of the Watchful Waiting psychotherapeutic treatment model for minors that was normal in this domain until around 2010.[3]
The philosophical problem with allowing this Third Premise to appear within a balance of harm ethical calculation is that once we have inserted this premise we have moved away from any evidence-based calculation of competing treatment harms which is normal in many medical contexts, and there is now no calculation to be made, and no treatment options to be had. In effect the physical harm to the natural reproductive integrity of the minor caused by GAC has been excluded from ethical consideration. Premise One has been functionally removed and replaced by Premise Three, and the treatment decision-maker is no longer making a rational and evidence-based ‘balance of harms’ assessment about whether a minor should or should not receive reproductive integrity disabling hormonal and surgical treatments. There is only ‘should.’
Queensland parents seeking professional help for their gender confused children are often astonished and shocked to discover that the only treatment path offered to their child is one of hormonally and medically enabled transition.[4] This is because all Queensland Health gender clinics offer GAC only, and there is no balance of harms calculation made as regards the cost to their child’s adult reproductive integrity by such clinics. Indeed, should a parent not be on board with GAC, therapists will treat the concerned parents as a significant cause of the child’s suffering, and treat such parents as if they are preventing the only and obvious cure for their child’s gender dysphoria (being the permanent damage to their child’s future reproductive integrity). Put yourself in the parent’s place. Would you agree to your child having the very possibility of becoming a parent removed because they are going through a juvenile or adolescent identity crisis?
What type of claim is Premise Three?
Premise Three is a normative and interpretive claim. On the normative front, being trans is deemed to be good. On the interpretive front, being trans is interpreted as a naturally occurring identity type. Both of these claims are complex and difficult to justify, and their truth is not decidable on the basis of normally recognized empirical evidence. As such, Premise Three is not, in itself, tied to empirical facts which could reasonably be taken to illustrate objectively compelling competing observable harms.
The question of whether damaging the physical integrity of a minor’s natural reproductive integrity is justified by medical treatments that purport to cure the psychological anguish of gender dysphoria is an evidence-based and testable question. This is a question that a ‘balance of harms’ treatment calculation should be able to process. But this is the very question that the normative and interpretive assumption of the goodness and naturalness of ‘being trans’ removes from any meaningful harm balancing calculation.
Bearing Premise Three in mind, there are now a range of options down which this argument might proceed. The concept of “true trans” – of an essential gender-identity that is trans – is incongruent with key Queer Gender Theorists, who are typically anti-essentialists about everything, let alone something as subjective and contextually influenced as ‘identity.’ To Judith Butler, gender-identity is created and performed by the individual, it is not an essential reality.[5] To queer transwoman Sandy Stone, the point of being transsexual is to confuse and undermine normative heterosexual assumptions about sex and gender, in aid of sex and gender anarchy; it is not about realizing one’s true identity.[6] Being ‘born in the wrongly sexed body’ is incompatible with Butler’s entirely performative and poetic conception of gender and sex. Equally, the notion of ‘good’ and ‘natural’ are entirely constructed notions in postmodern Gender Theory, and – following the work of queer pioneer Michel Foucault – they are essentially political notions. Here anything that undermines the normative influence of conventional ‘heteronormativity’ is good, and anything that assumes the validity of sex realism and traditional gender roles is bad. But this is an explicitly amoral and pragmatic theory of ‘the good’ where the individual liberty to self-define all norms and identities is considered ‘good’ for explicitly ‘governance’ based reasons.[7] But I will not go directly into a critique of Premise Three. Rather, let us look at Queer Gender Theory’s approach to scientific facts. For significantly, queer gender theory denies that there are any fixed and objective facts about the human reproductive sex binary.[8]
Sex and Gender as performative co-constructions
In Judith Butler’s most recent book she explains that:
…even though certain feminists have distinguished between [“sex” and “gender”], associating “sex” with either biology or legal assignment at birth, and “gender” with sociocultural forms of becoming… feminists and other scholars in gender studies disagree among themselves about which definitions and distinctions are right. The myriad, continuing debates about the word show that no one approach to defining, or understanding, gender reigns.[9]
To Butler there can be no right or wrong definition of either “sex” or “gender”[10] because her gender theory is a linguistic performative theory about cultural and political power. To Butler, the only meaning of all words is what different users of those words give them, and what normative power linguistic assertions exert. Further, Butler denies any real distinction between “gender” as shifting sociocultural conventions and “sex” as biological reality.
Consider the following quotes illustrating Butler’s linguistic, performative, and constructivist account of both gender and sex:
…gender is made through certain structures of power, which means… that gender is constructed. As power is contested and challenged, gender also changes…[11]
The closest definition of social gender we get from Butler is a malleable construction of words and usages which express structures of cultural and relational power.
Whatever else gender means, it surely names for some a felt sense of the body, in its surfaces and depths, a lived sense of being a body in the world in this way.[12]
This is the closest thing we get from Butler as to the personal identity meaning of gender; it is a subjective “felt sense” about one’s body, which cannot be objectively determined.
Sexuality, then, is a form of power. Gender, as socially constructed, embodies it, not the reverse. Women and men are divided by gender, made into the sexes as we know them, by the social requirements of heterosexuality.[13]
To Butler the social and personal construct of gender embodies and defines male and female sex – as oppressive heterosexual “requirements” – so the reproductive sex binary (which she does not believe in) is not a natural reality which is in any manner prior to gender. This is a complete denial of the object facticity of one’s actual sex, and a denial of the facts of reproductive human biology. Butler here – in an act of astonishing magical thinking – asserts that the only valid meaning of one’s sex is defined not biologically, but rather subjectively, socially, performatively, politically, and poetically, through gender.
Butler’s Gender Theory is overtly and bluntly anti-science as regards sex. And because – according to Butler – a person’s sex is not an objective biological fact about them, their reproductive integrity is not an objective biological fact either. Butler is what philosophers call a sex anti-realist.
…gender is not to culture as sex is to nature: co-construction is a better way to understand the dynamic relation between the social and the biological on matters of sex.[14]
…sex and gender constitute one another.[15]
Sex and gender are co-constructions, but gender, power, and ‘felt sense’ are the primary drivers of this co-construction, and biological ‘facts’ are only ever named and only ever known through culture, gender, and power. The simple facts of biological reality are deemed unknowable in themselves, and all such “facts” are deemed secondary to cultural and personal gender performativities.
Bodies as objects of knowledge are material-semiotic generative nodes. Their boundaries materialise in social interaction: “objects” like bodies do not pre-exist as such.[16]
The objective reality of one’s biological sex – regardless of one’s gender, regardless of one’s relation to power and linguistic and performative meaning constructions – is denied by Butler. Hence, doctors should not think that the reproductive integrity of a female or male sexed body objectively exists. Hence, there is no harm done to the reproductive integrity of any trans-identifying minor should they require sex-presentation transformations (that sterilize them) once they decide that their gender determines their sex to be other than their actual biology. This is tragic magical thinking dressed up as profound philosophy. But it is not actually philosophical at all. For philosophy is truth concerned. Butler’s Gender Theory is, as the philosopher Martha Nussbaum points out, power concerned and poetic: this is sophistry not philosophy.[17]
It mystifies me how experience endocrinologist, surgeons, psychotherapists, and psychiatrists – who must have the utmost respect for scientific reality in the performance of their vocations – were ever seduced into accepting the obfuscating and tangled sophistry of Queer Gender Theory as true. Queer Gender Theory denies that objective scientific truth can be known. Queer Gender Theory denies the true and objective scientific knowledge of any person’s sex.
GAC is premised on the anti-scientific rejection of the factual physiological realities of human reproductive sex. Why we let GAC practitioners anywhere near our sexual identity confused ASD children is very hard to understand. It puts our children at enormous risk of being taken advantage of in their confusion.
Queer Theory denies the scientific facts of the objective sex and reproductive integrity of the trans-identifying minor
To Queer Theory, there is no factual scientific objectivity about one’s sex, but sex and gender are co-constructed, with the primary driver of co-construction being the at once political, cultural, and subjective category of “gender.” Further – we shall not go into it here – gender is poetically performed. One’s gender-identity becomes ‘true’ by being performed. Thus a transwoman is truly a real woman because this male performs being female through their feminine dress, feminine manners, feminizing sex-presentation hormones and surgeries, and female birth certificate. In this manner the objective biological reality of a person’s sex is entirely denied, and performative gender-identities are considered real. Fantasy here displaces reality.
In 2013 the Gillard government was manoeuvred by Queer Theory advocates to amend the Sex Discrimination Act (1984) and remove definitions of men as biological males and women as biological females from the Act. I can only put the success of this sex-anti-realist legislative reform down to the philosophical naivety of our then parliamentarians, and a long-game, highly effective legislative lobbying campaign conducted by ACON, Equality Australia, and other QT+ influencers. Thus did a science denying radical social reform movement, inherently opposed to the heterosexual cultural norms upon which the reproductive family and long customs of sexual safety depend, gain legislative leverage in Australia.
Evidence-based balance of harms calculations are denied by Gender Affirming Care
In GAC the biological reality of a minor’s future reproductive integrity is not considered to be real, but rather, their subjective, performative, poetically generated, and political “gender identity” is considered to be real. Hence, there is no meaningful balance of harms calculation that can be made between the (supposedly unreal) physical harms of trans-gender identity treatments and the (supposedly devastating and life-threatening) psychological harms of not transitioning gender dysphoric minors.
But the actual facts of the matter are that medically transitioning a sex-identity confused minor on the grounds of performing their ‘true’ trans-sexual gender-identity, requires the permanent damaging and disabling of the child’s reproductive integrity. For the scientific facts of the matter are that the only way one can become a hormonally and medically fully transitioned transwoman or transman is to permanently disable one’s natural reproductive integrity.
In reality, there are no medical means of actually making a XY chromosome reproductively capable male into an XX chromosome reproductively capable female. All that transition surgeries and hormonal treatments do is change a person’s visible sex-presentation. These are cosmetic yet sterilizing transformations. This is the objective fact of the matter. One cannot actually ‘perform’ gestating and birthing a child if one is male, no matter what opposite-sex hormones one takes, what sex-presentation altering surgeries one undertakes, or how sincerely one gender-identifies as female. There is a clear and non-fungible distinction between the objective facts of human reproductive biology and the gender-defined identity wishes of transwomen and transmen. I have no idea how endocrinologist and surgeons who perform sex-presentation procedures on minors claiming to be trans go along with the reproductive disabling fiction that the minor is actually becoming a person of the opposite sex.
Note further, unlike being same-sex attracted, Gender Affirming medical and hormonal treatments actually create the transitioned trans-gender person. This is a performed identity that requires hormonal and surgical ‘performance’ to be fully realized. As such it cannot be a natural state. There is no natural “true trans.” We are not, after all, a hermaphrodite species naturally capable of changing our sex.
If the aim of Gender Affirming Care is to make every minor who presents with gender dysphoria and claims to be trans into a transitioned and reproductively compromised trans-person, then GAC is working very well. But GAC as a therapeutic governance structure makes the normal balance of harms calculation which seriously biologically disabling medical treatments routinely entail, impossible.
Significantly for Queensland Health, therapeutically treating real physical harms to the reproductive integrity of Gender Affirmed minors as if they do not exist, does not make those harms go away. And according to key queer theorists, gender identity is not a fixed and essential fact in the world anyway, so de-transition (or at least endless sex and gender presentation re-configuration) seems consistent with postmodern gender-identity theory.
Anti-essentialism in gender-identity is entirely consistent with Queer Gender Theory, but it is not what many “wrongly-sexed” gender-essentialist ASD minors believe they are signing up for. They believe they are becoming the opposite sex, and that they are aligning their wrongly-sexed body with their essential intrinsic gender-identity via hormonal and surgical means. These gender distressed ASD children and young adults are being led on in a sterilizing performative delusion by GAC. This is wrong. This is serious mal-practice. We need to re-calibrate objective sex as real and objectively important, and gender identity as constructed and malleable, for this is the actual reality of the situation.
It seems unavoidable to me that there will come a terrible day of reckoning for therapists, endocrinologists, and surgeons who have used Gender Affirming Care to exclude a proper balance of harms calculation and to rule out any Watchful Waiting psychotherapeutic approach to minors experiencing gender dysphoria. Hence, the quicker GAC is revoked, the less overall harm minors in the Queensland Health system will undergo.
Conclusion
Balance of harms calculations need to be done when a medical treatment has serious disabling consequences to the physically healthy body. In normal medical ethics there needs to be a demonstrably good reason why one harm is outweighed by another. But I have seen no evidence-based balance of harms argument showing that the healthy body is ever ‘wrong’ or that its disabling is ever a good and natural treatment for mental health distress.
That the body dysmorphia of gender dysphoria is no longer considered a mental health disorder, and is considered treatable by medical means that damage the natural form and reproductive function of the healthy body, cannot be explained scientifically or logically. Like GAC, this is best explained philosophically, as sophistry. History is likely to show non-medical reasons why the present therapeutic environment assumes that it is natural and good for minors to irreparably damage their future reproductive integrity because they are trans. Those reasons will likely be tied to the powerful lobbying influence of queer activists on our legislators and therapeutic professions in recent years.
The above leads me to ask three concluding questions:
1. Could it be that the determination to normalize and valorise being trans, at whatever reproductive integrity cost to gender distressed minors, is a politically and ideologically driven imperative, not a medical or psychological evidence-based imperative?
2. Are we sacrificing the reproductive integrity of our vulnerable children to an anti-science ideological cause?
3. Could it be that political and ideological imperatives that prevent a normal balance of harms calculation for gender confused minors in Queensland implicates Queensland Health in a serious medical mal-practice scandal?
[1] See Jonathan Haidt, The Anxious Generation. How the Great Rewiring of Childhood is Causing and Epidemic of Mental Illness, Doublin: Allen Lane, 2024.
[2] See this long and fascinating recent discussion between Professor Allen Frances and Irish psychotherapist Stella O’Malley: Beyond Gender, Episode #8, 11 April 2025.
[3] See Hannah Barnes, No Time To Think. The Inside Story of the Collapse of the Tavistock’s Gender Service for Children, London: Swift, 2023.
[4] I speak from personal experience, and from discussions I have had with other parents who have found themselves in the same situation.
[5] See Judith Butler, Gender Trouble, London: Routledge, 1990.
[6] See Sandy Stone, “The “Empire” strikes back: A Posttransexual Manifesto,” 1993: https://sandystone.com/empire-strikes-back.pdf
[7] See Michel Foucault, The History of Sexuality, 4 volumes, London: Penguin Classics, 2020. Note, this reference, and the above two references broadly locate central queer theory texts illustrating my points. Specific textual citations will follow shortly.
[8] I am aware of Anne Fausto-Sterling’s “sex is a spectrum” arguments seeking to dismiss the reality of the human sex binary. I do not find her arguments persuasive. With Oxford biologist Richard Dawkins – and with obvious scientific fact – the reality is that when it comes to human reproduction, only the successful mating of a fertile and reproductively normal male with a fertile and reproductively normal female actually works; reproductive sex – as distinct from certificated sex, or recreational sexual identity – is a natural male/female binary, not a many coloured spectrum.
[9] Judith Butler, Who’s Afraid of Gender?, Dublin: Allen Lane, 2024, 3.
[10] Butler often puts “sex” and “gender” in quotation marks, indicating that she does not understand these words to refer to realities in the world that are independent of language. She is an anti-essentialist about meaning itself, such that human language is understood by her as a human invention expressing desires and interests, rather than a viable means of communicating objective truths about objective reality. She is a very consistent anti-realist and anti-positivist when it comes to her rejection of scientific truth claims.
[11] Butler, Who’s Afraid, 139.
[12] Butler, Who’s Afraid, 29. Butler’s emphasis.
[13] Butler, Who’s Afraid, 140. Butler’s emphasis.
[14] Butler, Who’s Afraid, 188.
[15] Butler, Who’s Afraid, 207.
[16] Butler, Who’s Afraid, 206. Butler’s emphasis.
[17] Martha C. Nussbaum, “The Professor of Parody. The hip defeatism of Judith Butler.” The New Republic, 23 February 1999. https://newrepublic.com/article/150687/professor-parody