That’s mostly a very good article, but it seems to ignore the situation where the parents are unsupportive of their own trans children, or subscribe to those ideologies that the author acknowledges does exist.
‘Shared decision making’ is all very well when the child knows what they need, the doctor claims they’re ‘not an expert on trans people’ so they can’t offer a bridging prescription, the parents think it’s against their religion to acknowledge the existence of trans people in anywhere way besides a mental disorder that should not be given any credence. And even if they can find a decent doctor, there’s a 5 year waiting list - 5 years where they are given no treatment and continue to experience the wrong puberty, dysphoria, etc.
Hateful families are the elephant in the room for queer youth. The defensive approach taken in the States that is all but “let the parents and only the parents decide about their kids’ care” sacrifices those of us with hateful and unsupportive families. Trans youth will never thrive as long as minors keep being considered their parents’ property.
Yes, this is a major downside of the current medical and legal approach to minors (similar problems are found with abortion services, e.g. laws requiring parental consent for a minor to receive an abortion).
However, this article seems to have an intention and rhetorical goal of setting the record straight on the reality of trans gender affirming care in the context of a moral panic generated through misinformation and manipulation. The article’s intended audience is likely skeptical of trans identity and reflexively against gender affirming care for minors, and so it makes sense they emphasize how careful and conservative the current medical approach is to such care.
It’s a political asset that the gender affirming care is broken this way because it makes trans-skeptical people more comfortable with it, which should allow it to continue to exist in a world where people operate with the actual facts about the situation, even when they are ignorant or skeptical about the reality of trans identity.
Ultimately the medical establishment does have to be sensitive to the political and cultural context to avoid being shut down, so sometimes it’s a matter of making compromises to provide what they can even if it falls short of the ethical and clinical ideal (and let’s not mince words, this does mean people will die for political convenience, but the question is how many more would die if they were not conservative in their approach and were shut down completely?)
Naturally a common response to this is to reject the whole project of supporting or depending on the medical establishment’s flawed programs, but I think this critique tends to be hyper-individualist and assumes every trans person can overcome the social and financial context they are in and provide their own gender affirming care (or that alternatives to the medical stablishment would be able to fill everyone’s needs). Needless to say, rejecting gender affirming care from the medical establishment leaves behind the majority of people needing that care, and has obvious limits and problems such as not being able to realistically offer surgeries and risks legal trouble for everyone involved.
We need to realize how important this fight is for the long-term future of trans people and their health, and how that requires working with the medical establishment and investing in those compromised projects.
