Denial of Gender-Affirming Care Could Result in Suicide

Source: Lonny Meinecke / This image was generated with the assistance of AI

What We Believe

Once when I was a child, my dad came home in a terrible state. He told us the story. He had gone to a wealthy man’s mansion to work on his plumbing. But while my dad was talking to him, the man busied himself by cleaning his shotgun. This made my dad nervous, so he courteously asked the man to please point the barrel a different way. The man scoffed at my dad, reassuring him it wasn’t loaded. He even pulled the trigger to prove it—and blew a big hole in his own ceiling.

I learned something that day—that what a man believes does not alter what eventually happens. What a man believes can blind him to the way things are.

Like the story about the shotgun, I can assume gender is a binary thing (that the shotgun isn’t loaded) and let that be the end of it. But what if it isn’t? What a man believes can blind him to the way things are. Someone could get hurt.

A Few Plain Facts

• Nearly 1.4 million Americans do not identify with the sex assigned to them at birth. This is called gender dysphoria (Anderson and colleagues, 2023)
• About 64 percent of Americans favor protecting these persons from discrimination (Parker, Horowitz, and Brown, 2022)
• Americans are fervently split over whether to allow gender assignment surgery (for example, male to female; Parker and colleagues, 2022)
• Although Americans are undecided about adults, most vehemently oppose letting children under 18 surgically change their gender (Parker and colleagues, 2022)

Are Children Too Young to Understand the Consequences?

Should transgender youth have the right to determine their gender? Pronouns are reversible. Surgery is not. Sometimes, gender dysphoria happens because a child's current state isn't congruent with their eventual state (after puberty). But his or her dysphoria (extreme malaise) is real. Self-harm is possible if we close the door on a child because we know better. But some children still take their own lives, even after gender-affirming treatment (Jackson, 2023).

Why do children need the right to determine their gender? To answer that question, I think about what I know. I know that they are in crisis (Marcia, 2006). I know that the failure to overcome this childhood crisis could be disastrous or fatal (Jennings, 2015). I also know that—if they are asking for such a right—it’s because they don’t have it yet. This determines my next question. Why don’t our children have the same rights as grown-ups do? What must children do to be treated equally?

Americans have been asking that question for over two centuries. That same question has been asked by Americans who happen to be called Black by birth. We treated them like children. That question has been asked by Americans who happened to be called female at birth. We treated them like children. In fact, pretty much every minority we have decided to call a “minority” has asked this question. "Why don’t we have the same rights that you have? What must we be to be equal? How White must we be? How male must we be? How old must we be? How 'able' must we be? We just want equal treatment under the law" (Meinecke, 2017).

I am not a political scientist or a human rights activist, but I am a psychologist. I don’t really ask myself things that experts in those fields address. But I do ask myself, what will this (clearly) differential treatment do to the mental health of a child? What will the longitudinal denial of such a right do to a prepubescent child’s feelings of inescapable hopelessness or despair? The very labels we use in society to try and guarantee equality (Black American, special needs, minor) already summon the need for differential thinking—to reason how a Black American differs from an American, or how an underage American (who cannot vote until it’s too late) differs from an eligible voter (who on average will not comprehend the crises of these urgent minorities).

My education did not equip me to ponder the complexities of individual liberties, nor how to distribute something fairly even though everyone needs it but only some will get it while others will not (Meinecke, 2017). My education did prepare me to worry about how such non-universal liberties will impact a child’s sense of self-regard (Rogers, 1961). My training does urge me to gently apply universal liberty to all persons—not because it’s merited or fair, not because it's reasonable, but because its absence may result in a child in an identity crisis taking his or her own life. While we the eligible voters are busy arguing over which voters get to decide what ineligible voters need, our children are in chat rooms weighing the advantages of secret suicide (Jennings, 2015; Marcia, 2006). Does this sound like the wealthy man with the shotgun? Assume the gun is loaded.

Their Agony Matters

My goal is to get children out of this crisis and into a safe space. My job is to agitate for their survival—not to constrain the need to survive to a group of individuals old enough to decide how. My education (for which I am very grateful and probably undeserving) trained me to put the psychological needs of another person ahead of my personal beliefs. First, I let them know their agony matters to me; their despair matters to us all. I don’t tell them they aren’t feeling what they are feeling just because I can’t feel it, or that what they believe isn’t valid because it’s unusual or uncustomary. Carl Jung once observed that even the strangest beliefs are actually facts (so far as that individual’s belief system is concerned; Cummings Center for the History of Psychology, 1957). Yes, they will stand in front of the barrel of a loaded gun if they think it isn’t loaded.

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Grown-ups, treat what your child is telling you as a fact. Treat your child’s crisis like a potentially loaded gun. Because for him or her (or whatever pronoun we need to carefully put here), to the best of my knowledge in psychology, it is loaded and it might go off. Just in case, if we all point it the other way, no one will get hurt (no matter which of us was right). Which opinion was more ethical or moral will not console the mother of a dead child. Do not close every door on a child’s hope for acceptance. Leave one outlet ajar and he or she will go through it when no other choice remains but to pull the trigger.