In this article Riki Wilchins draws attention to a specific group of trans teens: those who can’t get medical treatment because their parents refuse it. Although this article is about the situation in the USA, also in the Netherlands more and more concerns are voiced concerning hormonal treatment of transgender teens. Therefore Principle 17 publishes an extensive summary of Wilchins article below. (Click here to read the full article, with links.) Wilchins is one of the founders of transgender political activism in the 1990s, as well as one of its first theorists and chroniclers.

According to a study by Komodo Health, as reported in Reuters, from 2017 to 2022 at least 4,780 adolescents started puberty blockers and another 14,726 started hormone treatment. That’s about 20,000 kids[i].

Komodo Health found that over the same period, at least 121,882 children aged 6 to 17 were diagnosed with gender dysphoria. Since hormones aren’t prescribed until puberty around age 10 or 11, about half are ineligible for any kind of medical care.

So what is happening to the other 50,000 trans* kids who are not getting treatment?

Some may not be ready yet. Some aren’t seeking medical transition. Still others may have complicating medical issues. And many are in families who aren’t covered by insurance and simply can’t afford care.

But it’s a reasonable guess that many aren’t getting gender-affirming care, simply because their parents won’t let them. Even in cases where their doctor has recommended it. So why are we not talking about these kids? Why have we largely limited ourselves to vigorously defending the rights of trans kids to gender-affirming care – but only if their parents allow them to do so?

I have now read literally scores of new articles, blog posts, depositions, PR statements, and medical articles, patiently explaining affirming care for trans* teens and the need for it. However, none of them calls for gender-affirming care (GAC) to be recognized as a basic human right for trans* kids.

In addition, none of the them proposes any penalty for parents who deliberately and knowingly withhold GAC against medical advice. And none of them calls forcing kids to undergo what I call (for lack of a better term) Involuntary Natural Hormone Poisoning as child abuse. A term the right is increasingly using to describe providing such care.

If any parent dosed their child with hormones every day, so that their son grew breasts or their daughter grew a beard and chest hair, we’d naturally decry it as “child abuse.” But if that parent simply stands aside and lets the same trauma occur, because their kids’ own body does it to them it seems we have little to say. Even when that son or daughter is literally crying out for medical care and their own doctors has recommended it.

I’m not talking here of kids who show gender non-conforming behaviors, play-act another sex, or who loudly “wish” they were another sex. I’m talking about kids who consistently and insistently assert their true gender.

The Federal Child Abuse Prevention and Treatment Act defines child abuse and neglect as any “act or failure to act by parent or care taker, which results in death, serious physical or emotional harm…”. Similarly, the American Academia of Pediatrics defines it “failure to heed obvious signs of serious illness or failure to follow physician’s instructions…”

Both exactly fit what happens to trans* kids, when they are denied requested and recommend medical care and have to suffer the trauma of what one expert called a “natural disaster.” Just because we can’t see the wound, doesn’t mean psychological harm is any less damaging than physical harm.

The moral situation is less clear in those cases when parents are simply uninformed, are acting out of religious conviction, or otherwise believe they are acting in their child’s best interests. But even in cases where parents mean well but are causing vast harm, we should begin declaring as often and as publicly as possible: when it comes to their gender identity and the physical changes that will be wrought on them by puberty, transgender kids have an inherent and inalienable right to their own bodies.

This silent epidemic of GAC denial is set to accelerate the already catastrophic number of trans teen suicides. Suicide is already the second leading cause of death among adolescents, and probably the leading cause of death among transgender teens.

According to the same Komodo study, the number of kids diagnosed with gender dysphoria, increased from 25,000 to 42,000 (a 70% raise) from 2020 to 2021. And this just counts the number diagnosed, not those who couldn’t or didn’t get to a doctor. It is reasonable to assume that the number being denied care, went up by at least 70% as well.

So what do we reasonably expect is about to happen to the number of transgender teen suicides?

This is a mental health time bomb about to go off. And remaining silent about it only helps light the fuse. I’m aware that state courts do not yet let minors determine their own care, except in very narrow circumstances. And I’m also aware that courts remain reluctant to second guess parents on child-raising generally and on medical decisions specifically. But that’s where courts are today.

Encouragingly, the years since 2019 have witnessed a quiet flow of articles making the arguments for changing it, many of which draw on philosopher Maura Priest’s masterful 2019 paper published in the American Journal of Bioethics: Transgender Children and the Right to Transition: Medical Ethics when Parents Mean Well but Cause Harm.

And as far back in 2017, in deeply red Cincinnati, Ohio, a judge allowed a 17 year-old to transition. Even right-wing outlets like The Federalist recognized at the time that this “foreshadows the likely future in which minors will be granted the right, under state laws to decide their own gender identity treatments…”

Such statements are at least addressing the argument we should be making. So that one day, gender-affirming care and parenting will be recognized as a basic human right for EVERY trans* kid – not just those smart enough to choose the right parents.

[i] Komodo itself notes this is likely an undercount, since they do not account for kids who either were not covered by insurance or were not diagnosed with dysphoria.