Children with gender dysphoria in Denmark

In the Anglosphere you see things like this everyday: An IT contractor sues Nike for failing to protect them (the contractor) from misgendering harassment by coworkers who didn’t refer to them by the desired pronouns. Dozens of psychologists resign from a British clinic because they think it overdiagnoses gender dysphoria in children and they’re afraid of being labeled transphobic if they don’t conform.  With the arrival of 2020, there seem to be some signs of fatigue with aggressive transgender activism. Some people who might have been sympathetic to the issues are tiring of the dogmatism fueling the more questionable demands and judgments: their insistence on the right of biological males who self-identify as women to compete against cis-women in all sports, their branding as bigots heterosexuals who are not interested in dating transpeople, and their automatic approval of transitioning for pre-adolescents.

Below the statistical radar
Transgender issues also arise in Denmark. There has been a steady increase in requests for hormone treatment and surgery in the past few years. But the trend appears to be at a simpler, more exploratory stage, and issues concerning transgender rights, inclusion and pronouns are still rather novel. Schools are only beginning to adapt restroom and locker-room facilities (DK) to dysphoric children. Earlier this year professors were still surprised when students criticized the use of the categories “male” and “female.” One case involved a statistics course (DK) in the biology faculty, in which students were to analyze differences between the sexes in phenomena such as left-handedness and height. Some objected that the assignments were offensive to people who don’t identify with either category. They weren’t questioning the validity of the studies, only the conventional limitation to two sexes that made some people feel overlooked and left out. 

The professor couldn’t change he statistics, but he offered to use colors instead of the sexes, however that might work. After the evaluation meeting, he felt that his freedom of expression was being constrained and it made his teaching difficult. It seems rather quaint in comparison with what happens to American professors who run afoul of transgender activists. The same article tallies up the number of formal complaints about sexual harassment and offensive behavior at the University of Copenhagen: there were only five from 2016 to 2018. 

Taking the plunge
Last month the Denmarks Radio television network broadcast a documentary about the youngest child in the country, at age 11, to begin hormone treatment: “I don’t want to be a girl, Mom” (DK). It gave a sympathetic, sometimes moving account of the child’s situation and the difficulty of the decision. Altogether it offered a balanced treatment of the factors at play: the children’s discomfort in their innate sex; parents’ and doctors’ uncertainty about the best course and the timing; sex researchers’ and politicians’ caution about irreversible long-term effects of the treatment; and the possibility of regret and a desire for de-transitioning. There was widespread agreement about the need for better knowledge about the consequences of such treatment. 

And the process for determining whether to offer the treatment reflects those concerns. It consists of a referral to a sexology clinic, several interviews and tests, including psychiatric assessments and intelligence tests, consultations with school personnel, and a comprehensive evaluation by a group of psychologists and doctors. Contrast this with the position taken by American Academy of Pediatrics, whose guidelines for children who seek treatment for gender dysphoria recommend an immediate “affirmative” response, that is, a commencement of the treatment process. 

Whose interests are being served?
In a recent podcast with Quillette Magazine, Dr. James Cantor discusses his critique of these guidelines in a peer-reviewed article in which he cites several instances where the Academy misrepresented research. Among them was a dismissal of the previously accepted approach of “watchful waiting,” which was supported by replicated findings that after puberty two-thirds of children with gender dysphoria come to accept and prefer their natal sex. Most of them found that they were simply gay and not born in the wrong body.  

Like much of the transgender debate that goes beyond questions of fundamental civil rights, discrimination and equal protection, the Academy’s attitude is baffling in its apparent disregard for both science and common sense. Does it reflect a tendency toward overtreatment in American healthcare, a general trend toward ideological extremes and rigidity in American public debate, both? It's encouraging that Danish healthcare professionals and researchers maintain a more deliberative, agnostic approach to this fraught issue and the transition bandwagon.