If you’ve attempted discussions with fellow Democrats about medical interventions for gender distress, you’ve probably run into well-worn slogans and unfounded claims—the result of successful misinformation campaigns, a polarized political climate, and heightened emotions around “gender.” Read on for ideas about how to decrease confidence around some common claims.

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If you question “gender-affirming care,” it’s because you’re transphobic.

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The medical interventions known as “gender-affirming care” (GAC)—puberty blockers, opposite-sex hormones, and cosmetic surgeries—run a high risk of harming vulnerable patients, and create lifelong dependence on medication in people who were previously physically healthy. The evidence that such interventions relieve distress is low quality and/or completely lacking as demonstrated by the WPATH Files, the Cass Review, and the HHS Gender Dysphoria Report. All people deserve evidence-based medical care.

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Questions to ask:

• If you learned that GAC lacked evidence and did not result in good outcomes, would your thinking change?

• Should politics play a role in the quality of care certain people receive?

• How is the concern that GAC might be substandard a sign of being “transphobic?”

• What does it mean to be “transphobic?”

• Are there reasons someone might be concerned that aren’t due to “transphobia?”

• What if there were other ways of addressing gender distress that have better outcomes and fewer risks? Would it be “transphobic” to pursue those?

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People who object to “gender-affirming care” are all right-wing bigots.

 

Concerns about medical interventions that affect brain development, bone density, fertility, sexual function, risk of stroke and cancer, and overall quality of life are not right or left issues. People across the political spectrum are concerned about the lack of evidence for these interventions, and understand that promoting the belief that we each have an innate “gender” (known as “gender identity”) that may be different from our sex is an idea that has more in common with religion than science. People understand that gender ideology compromises hard-fought women’s rights and is dismissive of gay, lesbian, and gender non-conforming people.

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Questions to ask:

• What are some reasons I might object to GAC other than that I am bigoted? 

• How could we talk about quality of care for those with gender distress without bringing in politics?

• What evidence makes you think that skepticism of GAC is a right-wing position? How do you tell who is a bigot and who is genuinely concerned about quality of care?

• How do you make sense of the fact that countries with strong social-democratic or progressive health systems—like Sweden, Finland, Norway, and the U.K.—have restricted youth medicalization based on evidence rather than politics?

• If this were primarily a right-wing position, why would center-left governments in Europe be leading the policy changes?

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If “gender-affirming care” is so harmful, why does every major medical association support it?

 

Doctors and medical associations in the U.S. have been following the lead of  the World Professional Association for Transgender Health (WPATH), an organization exposed for violating the core tenets of medical ethics. U.S. medical associations are now outliers on this issue. Many countries have placed strict limitations on GAC due to a lack of evidence starting with uber-progressive Finland in 2020. In 2024, England and Wales banned puberty blockers outside clinical trials and recommend extreme caution for other interventions for youth. The Cass Review made clear there is little to no evidence for these medical practices. ​

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Questions to ask:

• What about the other times medical professionals have  been wrong about medications or surgeries? 

• How confident are you that these medical associations are always right? How confident are you that countries who have banned or limited these interventions are wrong?

• Democrats were once the party most skeptical of big pharma. To what extent might the profit motive be influencing the stance of major medical organizations?

• How should clinicians balance a teen’s stated wishes with developmental factors like impulse control, identity exploration, and susceptibility to peer influence?

• What do you think “informed consent” should look like for a minor when the long-term risks and benefits are still uncertain?

• How should we differentiate between reversible, partly reversible and irreversible interventions when making health decisions for youth?

 

Some people have always been uncomfortable in their bodies. Shouldn’t we help them?

 

Most liberals have long been in favor of abandoning sex-based stereotypes and are comfortable with children participating in a wide range of activities or wearing clothing or hairstyles that are atypical for their sex. However, children go through developmental phases and can (and should) change their minds often. Evidence demonstrates that most gender-distressed children reconcile themselves to their sex by going through puberty, and the majority of these children grow up to be same-sex attracted. Being uncomfortable is part of the human condition and puberty is not a disease to be cured. 

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Questions to ask:

• What does it mean to be “born in the wrong body?” 

• What evidence do we have that medical interventions permanently resolve feelings of discomfort?   

• How might medicalizing adolescents with sex-atypical gender expression promote regressive sex stereotypes? 

• How is identity formed? Do children’s identities arrive as fully developed or are they always evolving—tested, constructed, rejected, and integrated over time?

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Shouldn’t we, as liberal Democrats, respect pronouns and preferred names, and embrace the gender spectrum?

 

The Cass Review states that social transition should be treated with great caution. If we are to be the “party of science,” Democrats need to hold the line on reality, and not allow feelings to replace facts. Agreeing to call men women and vice versa erodes hard won rights and safeguarding for children and women. Accepting a request to use a child’s opposite-sex pronouns may appear kind or benign but is almost always the first step onto the medical pathway. It is not respectful to manipulate language to negate biological truths. We accept gender non-conformity, but sex is binary.

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Questions to ask: 

• What are some possible negative outcomes of allowing people to choose their pronouns and requiring others to use them?  

• How will the lost meaning behind “he/she” impact crime statistics, census data, health care data, etc.? What are the implications if institutions don’t record biological sex?

• How does using wrong-sex pronouns compromise sense perceptions, especially of young children?

• Are there ways to support gender non-conformity without negating biological reality or compelling speech?

• If a youth strongly identifies with something that could be transient, should clinicians act immediately or explore possible underlying factors first? 

• How do you think clinicians should differentiate between a deeply rooted identity and distress stemming from unrelated issues—like trauma, autism, or internalized homophobia?

 

Isn’t trans just like being gay?

 

Gay and lesbian people ask to be accepted for who they are. They demand no rights beyond those every person enjoys. Trans activists insist that trans-identified people be accepted for who they are not.  Being gay has to do with sexuality—being attracted to members of the same sex. Those experiencing gender distress wish to be perceived as a member of the opposite sex. These are very different phenomena.

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Questions to ask:

• What does it mean to be same-sex attracted if anyone can self-identify as male or female? 

• What is the impact of gay and lesbian kids being told that gender nonconformity means they are in the wrong body?  

• What are the consequences of teaching kids that there is something wrong with their bodies if they don’t conform to sex stereotypes?

 

People regret getting tattoos sometimes, but we aren’t trying to outlaw tattoos. Adults should be free to make their own choices. 

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Tattoos, unlike puberty blockers, opposite-sex hormones, and surgical sex-trait modification, do not cause bone loss, interfere with brain development, increase risk for stroke, blood clots and heart attack; do not cause sterility, vaginal atrophy, or anorgasmia; nor do they involve removing healthy body parts. All people deserve evidence-based care.

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Questions to ask: 

• Is regret about the permanent loss of sexual function, reproductive capacity, and body parts like breasts and genitals comparable with tattoo regret? 

• If exploratory therapy was shown to help gender-distressed people more than surgeries, would it change your mind about what such people need?

• We know some adults regret tattoos but manage fine. How do you think regret might differ when the decision involves irreversible anatomical changes rather than a surface modification?

• When a procedure affects fertility, sexual function, or long-term health, does that place it in a different ethical category from things like piercings and tattoos?