Has Joe Biden any idea at all about the reality of transgender medicine?

With only two weeks to go before the mid-term elections in the United States, President Joe Biden has come out swinging in favour of trans rights. In a sit-down interview with trans TikTok star Dylan Mulvaney, the President said that he supported “every single solitary right” for trans-identifying people, “including use of your gender identity bathrooms in public”.  

Mulvaney, a 25-year-old actor who lives in California, has acquired 7.5 million followers on TikTok with her “Days of Girlhood” series, which documents her transition from male to female since March. She asked Mr Biden: “Do you think states should have a right to ban gender-affirming healthcare?”

“I don't think any state or anybody should have the right to do that,” the President responded. “As a moral question and as a legal question, I just think it's wrong.”

“Sometimes they try to block you from being able to access certain medicines, being able to access certain procedures and so on, none of that should be available, I mean, you know, no state should be able to do that in my view,” Mr Biden said.

The President is ill-informed, ill-advised, or ill -- or all three. He ought to at least know that gender-affirming healthcare is hugely controversial. Giving it a full-throated endorsement is more like Donald Trump endorsing bleach for curing Covid than sound public policy.

He appears not to have received the memo from the UK’s National Health Service. Across the Atlantic, the NHS has been busy critiquing the “Gender-Affirmative Care Model”.

The latest move is to declare that “social transitioning” for pre-pubertal children – using different pronouns, using a new name, dressing as the opposite sex and so on – may actually be harmful. In a discussion paper, the NHS stresses that the evidence for transitioning is weak.

“Early social transition”, says the document, “should not be viewed as a neutral act”. It should be regarded as an “active intervention” “because it may have significant effects on the child or young person in terms of their psychological functioning.”

It goes on to warn that there could be serious consequences if a child begins with social transition but desists later on:

In cases where a pre-pubertal child has effected, or is effecting, a social transition (or expresses a wish to effect a social transition) the clinical approach has to be mindful of the risks of an inappropriate gender transition and the difficulties that the child may experience in returning to the original gender role upon entering puberty if the gender incongruence does not persist into adolescence.

The NHS guidance is also discouraging the use of puberty blockers, since so little is known about their long-term effect. It will only allow them to be prescribed in a formal research setting. It strongly discourages teenagers from accessing these hormones on the internet.

Transgender care is far from being well-established healthcare. In the past two years, health authorities in one country after another in Europe have expressed their alarm, citing serious medical and psychological problems amongst people who have received “gender-affirming care”.

  • In France, the National Academy of Medicine declared on February 25: “great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects and even serious complications that can be caused by some of the therapies available”.
  • In Sweden, the National Board of Health and Welfare issued new guidelines for gender-affirming care in February. It said, based on current knowledge: “the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases.”
  • In the United Kingdom, the National Institute for Health and Care Excellence (NICE) published two systematic reviews of puberty blockers in March 2021. It found that they “lead to little or no change in gender dysphoria, mental health, body image and psychosocial functioning. In the few studies that did report change, the results could be attributable to bias or chance, or were deemed unreliable.”
  • In Finland, the Finnish Health Authority (PALKO/COHERE) reversed course in 2020. Its new guidance stated that “psychotherapy, rather than puberty blockers and cross-sex hormones, should be the first-line treatment for gender-dysphoric youth”.

In his interview with Mulvaney, President Biden declared that restrictions on transgender healthcare were “outrageous” and “immoral”. Perhaps his minders have kept him from listening to Chloe Cole, another Californian. She began to transition to a male at 13; she had a double mastectomy at 15; and she detransitioned at 17. The suffering she underwent is outrageous:

“The worst part about my transition would be the long-term health effects that I didn’t knowingly consent to at the time. I developed urinary tract issues during my transition that seem to have gotten worse since stopping testosterone. I have been getting blood clots in my urine and have an inability to fully empty my bladder. Because my reproductive system was still developing while I was on testosterone, the overall function of it is completely unknown. I have irreversible changes, and I may face complications for the rest of my life. I was failed by modern medicine.”

How can the President of the United States defend an atrocity like that?

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