Empathy in Disagreement: The Steel Manning Exercise

Today’s disagreement is about transgender health care for young people and the future of the trans rights movement.

Gender Affirming Care is a method of treating gender dysphoria by affirming a child’s gender identity and tailoring medical and social interventions around this identity. This might begin with a social transition and often leads to a medical protocol that involves puberty blockers and then cross sex hormones.

Almost a year ago, we had a conversation with leading national clinicians, Dr. Jack Drescher and Dr. Erica Anderson about the state of gender affirming care for young people in the United States. If you haven’t listened to that episode, I highly recommend it as a helpful primer for this conversation. Since then, a lot has changed in the conversation about trans care for young people.

In April 2024, the Cass report came out in the UK. It is one of the most thorough reviews of the evidence base for gender-affirming care. It also called into question the limits of what we know and don’t know about care for minors. Right now, 27 states have enacted laws to ban or restrict the practice and the supreme court will be ruling on it later this year. And the United States has a new presidential administration who recently issued the executive order: “Protecting Children from Chemical and Surgical Mutilation," which attempts to put forth a national ban on gender affirming care.

We ask some important questions around gender affirming care and the trans rights movement. Have trans advocates and medical practitioners overstated the quality of the evidence base for gender-affirming interventions for minors?

Brianna Wu is a political commentator and trans rights activist. She is executive director of the progressive Rebellion PAC.

Dr. Marci Bowers is a pelvic and gynecological surgeon with more than three decades of experience in healthcare. Dr. Bowers was most recently the president of the World Professional Association for Transgender Health (WPATH). She was the organization's first transgender president.

Thank you to Brianna and Marci for coming together to have this critical conversation. It's a difficult topic and as you’ll hear, a difficult conversation. But we need more of this. We need more people willing to come together and have hard conversations out in the open, and we really appreciate you both.

This conversation is pretty “in the weeds” when it comes to youth gender medicine and the state of the research. If you have the context, that’s great – you can skip ahead. If you don’t, here is a highly efficient glossary:

• WPATH is the leading trans health organization in the world. Its “Standards of Care” or SOC - have served as the national guidelines for youth gender medicine in most gender clinics.
• The Standards of Care have evolved a great deal over time: SOC 6, published in 2001, required multiple psychological assessments and a period of Real Life Experience (RLE), living as the preferred gender, before any medical interventions. The most recent SOC, SOC 8, was published in 2022. It removed many of these requirements which activists have described as “gatekeeping.”
• The Dutch Protocol, also known as “watchful waiting”, is a more conservative alternative to gender-affirming care. It focuses on providing large amounts of psychological support and monitoring during childhood. If the dysphoria continues to persist, then putting young people on puberty blockers and cross sex hormones in late adolescence.
• Language around gender identity is constantly evolving. Brianna uses the term FTM (or Female to Male) to describe females who transition. For the same demographic, Marci uses “transmasculine.”
• We also talk about Hormone Replacement Therapy (HRT) and Facial Feminization Surgery (FFS).
• Okay, that will hopefully create a solid foundation. Take a deep breath. Open your mind as far as it’s willing to go. And prepare for a different kind of conversation on gender affirming care and the future of the trans rights movement.

Recommended Reading and Listening

• WPATH Standards of Care Version 8
• Last year’s episode of The Disagreement about gender-affirming care: https://podcasts.apple.com/si/podcast/12-gender-affirming-care-for-children-and-adolescents/id1735027795?i=1000658885782

Questions or comments about this episode? Email us at podcast@thedisagreement.com or find us on X and Instagram @thedisagreementhq. Subscribe to our newsletter: https://thedisagreement.substack.com/