Teens in Distress: Gender Dysphoria

Are We Being Kind?

What does it mean to be nice/kind/caring? Is every act that makes someone happy for a moment an act of kindness? I think we can agree that it would not be nice to give a young child lots of candy and several desserts a day, even though the child might enjoy this, at least for a while. It would not be nice to give a teenager as much pot as they wanted to smoke, let them stay home from school whenever they didn’t feel like going, or let them stay out until all hours every night, even on school nights, doing whatever they want. The teen might enjoy these things, at least for a while, and probably wouldn’t complain. However, a parent doing those things would not be acting “nice.”

Quite obviously, what may be enjoyable in the short-term is not always enjoyable in the long-term. The long-term may be a few days, a few weeks, a few months, or a few years. Either way, giving a child or a teen something that is perceived as enjoyable in the short-term may often be quite the opposite of “nice.”

Let’s consider a scenario where a teen is actually in distress. Let’s say that the teen is having trouble completing homework on time, and is feeling overwhelmed. (Note that I am not in favor of unreasonable amounts of homework, but a reasonable amount of homework can help a teen learn the subject-matter.) There are several things that might be done to help the teen overcome this problem. One possibility would be to do the work for the teen (assuming the parent was capable of this). Let’s say the parent did that, and the teen always came to school with all homework completed. Now the teen would be getting better grades, and would not be stressed out by the homework. Is this “nice?” Is this really helping the teen? Of course not. The teen would not learn how to do the work, and ultimately would be unable to progress at school or in life. This would be a terrible idea.

What if, instead of the parent doing the work for the teen, the teachers simply stopped giving this particular teen any homework assignments? Again, the distress associated with the homework would disappear. The teen could finally relax! No more late night tears, no more early morning embarrassment. Yet, this too would ultimately be a huge disservice to the teen.

If the only choice was one of these two ways of relieving the teen’s distress, or allowing the teen to “suffer,” what should be done? Wouldn’t it be cruel to simply leave the teen in such a state?

Luckily, there are other ways of helping a teen in this situation. There are often after school tutoring hours at school. Parents can also help their teen focus on the assignments and perhaps answer a few questions about the work. Of course, the teen would still have to suffer some distress to accomplish the work, but that distress - in manageable amounts - is actually good for the teen. It will enable the teen to figure out how to be organized, how to be efficient, how to focus - all skills useful not only in their school career, but throughout life. Doing the work will also help the teen learn the subject-matter. This type of assistance will make the teen not feel so overwhelmed as to give up, but also won’t make the teen feel helpless and useless, or remove all obstacles in front of the teen.

The big question here is, when it comes to a young person suffering from gender dysphoria, what is the “nice” thing to do? First, let’s consider what “gender dysphoria” really is. It is a feeling of extreme discomfort with respect to one’s primary and/or secondary sexual characteristics. It is, in essence, emotional and psychological pain in connection with one’s sexed body.

So how do we deal with extreme discomfort with one’s sexed body? We don’t want to ignore such suffering. Shouldn’t we deal with this in the same way we would deal with any other form of body dysmorphia, or disgust with the appearance of particular body parts? (We distinguish based on there being a so-called “gender identity,” but please read my essay entitled Gender Identity, wherein I explain why there is no such a thing.) Why aren’t we helping people suffering from gender dysphoria to become comfortable with their healthy bodies? Would it not be nice to assist people in relieving their distress through counseling and physical activities that put them in touch with their bodies? Isn’t it better to be comfortable with your body than to try to deny its existence, and chemically and surgically alter it, suffering the inevitable side effects and dangers of surgery? Yet any attempt to assist someone in becoming comfortable in their own skin is now considered a form of “CONVERSION THERAPY,” and, in many places, this is banned. We have actually made it illegal to be nice to people suffering from gender dysphoria.

Instead of helping people who are in deep emotional and psychological pain to alleviate the pain by helping them to become comfortable in their own skin, society has decided that the ONLY way to be nice is to alleviate their emotional and psychological suffering in the short-term by assisting them in delusional thinking (ie. telling them they really are the opposite sex) and chemically and surgically altering the appearance of their bodies so they can live in a delusional state, satisfied that they are “really” the opposite sex. Is this nice at all? The chemical and surgical alterations will surely sterilize their bodies, will surely have many long-term side effects, will most likely shorten their life-spans and cause lessened quality of life at some point, and the efforts to support the delusion that they are the opposite sex and, for those who decide to go “stealth,” the efforts to convince other people that they are the opposite sex, will surely deplete a large amount of their energy and cause cognitive dissonance. And, despite headlines touted by the media, there are no studies proving or even strongly suggesting that these chemical and surgical interventions are at all necessary to prevent those struggling with gender dysphoria from committing suicide or suffering severe depression. Rather, these interventions represent a quick fix, not very different than allowing a stressed out teenager to skip school and smoke pot - but with even greater negative long-term implications.

In discussing the question - how can we help people suffering emotional and psychological pain? - we must consider other questions, such as - why are we so quick to stop people from feeling pain? Some have made the analogy between the affirmation model and the medicalization of “gender dysphoria” on the one hand, and the opioid crisis on the other. They are both “medical scandals” in which the medical community is too quick to give out medications with strong side effects and potential for huge profits, justified by a misplaced notion that the medication is an appropriate treatment for gender dysphoria, on the one hand, and physical pain on the other.

While it was not initially known - at least by the public - that opioids are highly addictive and affect patients for longer than, and in more ways than, anticipated, nobody is even hiding the fact that cross-sex hormones are supposed to be used for a life-time, with a life-time of side effects. Further, most people are, or should be, aware that surgical interventions associated with transition contain additional risks, potential for infection, etc. Thus, it should be more obvious to a layperson that “gender dysphoria” treatments are inappropriate than it ever was that opioids were inappropriately over-prescribed.

Further, while there is little to no value in physical pain, we must consider whether a certain amount of emotional and/or psychological pain may actually be beneficial. Art, true art, comes from pain. The pain of a broken heart allows us to love again, with greater intensity. The pain and disappointment of losing at a game causes us to strive to do better, to win the next time. The saying “no pain, no gain” may be a bit too simplistic, but isn’t it true? In the movie “Oh, God,” when “God” (played by George Burns) is asked why there has to be so much pain in the world, he answers that there is no up without a down, no in without an out. We need pain, for, without it, there is no pleasure.

This is not to say that we should cause pain. We should not. There is enough of it in the world without anyone ever having to purposely induce it. The extreme excess of pain caused by man’s inhumanity to man must stop, and should be prevented whenever possible. However, the pain inherent in becoming a teenager and then an adult is valuable and builds character. The pain of discomfort with one’s body during this transition to adulthood usually results in acceptance, and, when things go well, ultimately leads to enjoyment of physical pleasures, including sex and other intimate activities with another human being, one of the greatest pleasures on Earth. The pain of identity confusion can, and usually does, lead to an understanding of who one is, which can also lead to great accomplishments, and to understanding and relating to others on a very high psychological and emotional level, beyond childhood friendships. This is another of life’s great pleasures.

This all having been said, I think we need to re-visit our approach to the “epidemic” of “gender dysphoria.” We need to look at doing something other than medicating it away, and surgically dissecting it out of existence. We need to treat the pain of adolescence the way it has always been treated until about ten years ago - as a necessary rite of passage into adulthood.

Logically, it should sound somewhat questionable and desperate to suggest alteration of healthy body parts to alleviate discomfort with them. Granted, many people undergo plastic surgery to alter the appearance of body parts with which they are dissatisfied. However, this is recognized as a purely aesthetic choice, and is not considered, in any way, shape or form, to be medically necessary or an expression of one’s true authentic self. Society would never congratulate the parents of a teenage girl complaining that her nose is too big or her breasts are too small for immediately signing her up for plastic surgery. Society certainly tolerates this, and understands that, in a shallow world, these cosmetic alterations may have some benefits, but again, nobody with any reason would congratulate a girl for “realizing” she needed a rhinoplasty or breast enlargement, and then prioritize our limited medical resources to immediate surgery for such a teen. Keep in mind that the side effects from a rhinoplasty or breast enlargement are significantly less than those associated with puberty blockers, followed by a life-time of cross-sex hormones, a double mastectomy and a phalloplasty - and yet we push these cosmetic surgeries on vulnerable young people and pressure their parents to go along. One must ask what the distinction is that elevates the chemical and surgical alterations associated with transition so far above all other forms of cosmetic surgery. (And again, it cannot be the “suicide card,” the subject of another essay, because there is no proof that these treatments actually prevent suicide.)

Now I have digressed. My point in writing this was to ask why we believe the kind and decent thing to do in response to emotional and psychological pain associated with discomfort with primary and/or secondary sex characteristics, whether organic or induced by society, is to lie to these vulnerable people and alter their sex characteristics. I would suggest that the kind and decent thing to do is to gently guide those suffering gender dysphoria into becoming more comfortable in their bodies. This may involve talk therapy, or exercises to get in touch with the body, or a combination of the two, and it must always involve compassion and respect. While these vulnerable young people might have to go through some immediate pain and confusion, such gentle guidance will help these individuals to navigate the natural discomfort (sometimes heightened by society) they are experiencing, will help them to be grounded and stronger in the long-run, and will avoid any physical harm, and the need to spend psychological energy pretending to be the opposite sex. Am I missing something, because this just seems like common sense to me?