More and more children feel that they are really males trapped in a female body or females trapped in a male body. In many quarters this sensation is no longer regarded as a form of mental illness, but as a legitimate dimension of sexuality.

Transgender advocates have a solution for these children’s psychological distress. The first stage is to affirm their chosen gender by allowing them to dress and groom themselves members of the opposite sex. The second is to administer puberty blockers, powerful drugs which suppress natural body changes. Later on, there are other drugs which will allow boys to develop breasts and girls to have facial hair  -- and so on.

But what if parents oppose these treatments – as they often do? Who should decide what is in the best interests of their son or daughter?

According to many bioethicists, it should be the government. Big Brother knows best. 

The latest issue of the American Journal of Bioethics offers a revealing insight into the outlook of the ethicists who help shape public policy. One of its leading articles, “Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm”, by Maura Priest, of Arizona State University, is followed by 12 shorter articles commenting on her arguments. About two-thirds of these are in broad agreement with her radical proposal to treat gender dysphoria as a medical emergency which requires government intervention.

To cut to the chase, Dr Priest and many of her bioethics colleagues believe that refusing to let your ten-year-old son or daughter access these life-transforming drugs is child abuse. She contends that:

... the law should clearly state that transgender youth (after having met appropriate diagnostic criteria) have a legal right to PBT regardless of parental approval. In addition to these legal parameters, the state should play a role in publicizing information about gender dysphoria and treatment via public schools, government-sponsored websites, and public service announcements. 

Priest is convinced that the harms of withholding puberty-blockers are too great to allow parents to stop their children from trying to change gender. Gender-dysphoric children who are not supported by their parents could commit suicide, suffer stigma and discrimination, become homeless, self-medicate in a dangerous way, and so on.

Just as it is the state’s duty to step in when naturalist parents are refusing insulin to their diabetic son or antibiotics to their daughter sick with meningitis, so is it the state’s duty to step in when the parents of gender-dysphoric children are avoiding medically recommended treatment. 

The idea that gender dysphoria and needing a blood transfusion are both medical emergencies is obviously catching on amongst paediatricians, psychologists and bioethicists. But has this been proven? Transgender science is a controversial area and establishing watertight proof of these harms is difficult. Priest claims that the need for PBT is “based on the best available science and expert professional consensus”.

However, as four of the comments to Dr Priest’s article demonstrate, there is far from being an “expert professional consensus” on the medical effects of PBT, let alone the consequences of government intervention.

Three American writers, Michael Laidlaw, Michelle Cretella, and Kevin Donovan, argue that “watchful waiting with support for gender-dysphoric children and adolescents up to the age of 16 years is the current standard of care worldwide, not gender affirmative therapy”.

Children and adolescents have neither the cognitive nor the emotional maturity to comprehend the consequences of receiving a treatment for which the end result is sterility and organs devoid of sexual pleasure function. To argue that all children who are self-declared as transgendered will be harmed psychologically and physically without puberty blocking treatments is false; the greatest number will be seen to not require this at all.

On the smoke-filled transgender battleground, these three doctors are regarded as “conservatives” and even “transphobic” because of their suspicions of the whole transgender narrative. But the three other comments come from experts who simply think that the need for puberty-blockers is not necessarily a medical emergency and that Dr Priest has overlooked the serious health risks involved.

Three scholars from the University of Melbourne agree that the wishes of gender dysphoric children should be supported and even that state intervention might be required. But they point out that the physical harms of PBT are hardly negligible. These include reduction in bone density, with risk of fractures; loss of fertility; fewer options for future genital surgery if the children persist; and damaging conflict with parents. “PBT is relatively new,” they caution. “It has not been shown to relieve gender dysphoria per se and more research is still required.”

Four scholars from medical schools at Harvard, New York University and Ohio State do not oppose state intervention as a last resort either. But they, too, warn that the risks are substantial, especially since puberty blockers might be needed for children as young as eight years old. Loss of fertility is particularly problematic, they point out, because a good number of transgender adults want biological children. They recommend that “Due to the uncertain long-term effects of PBT, the process of obtaining consent should be thoughtful and thorough.”

And three experts from the University of Cincinnati are sceptical of Priest’s proposals. “Absent an imminent risk of death or other serious harm, it is not clear that refusing medical transition necessarily constitutes medical neglect.” The issue of suicide is a murky one. “While transgender adolescents are at a substantially higher risk of suicide than their cisgender peers, the risk of suicide should not be overstated and used as a trump card.”

The American Journal of Bioethics is one of the leading publications for bioethicists. This special issue on parental rights and gender dysphoria demands that governments invade the family life of troubled gender dysphoric children. But this has to be resisted. Treating these children with powerful drugs is neither a settled science nor an expert consensus. Dragging the government into a debate to enforce so-called "medically recommended treatment" is the strong-arm tactic of transgender ideologues.     

Michael Cook is editor of MercatorNet.