Who Must Transition?
A philosopher examines the uses of science and his love for his son amid the Texas legislature’s debate over appropriate health care for trans kids.
When my son Max was five, we’d put his little step stool in front of the bathroom mirror and he’d shave with me. He’d paint his face with shaving cream and follow my every move. Then he would put on his Spiderman jammies and we would roughhouse for a while before bed. Max is 13 now. He’s taller than his mom and he’s starting to get the best of me in our wrestling matches. He’s a gymnast, has a black belt in taekwondo, hates math but loves geography, and plays the ukulele and cello. He is a Minecraft master and TikTok connoisseur. He likes his pancakes burned, with extra chocolate chips. He is also transgender.
For Max, his sister Lulu, and his friends, that last identity is the least interesting aspect of who he is. Yet it is the one that has thrust us into the turmoil of state politics. It started in 2015, which was the year Max turned seven and socially transitioned with pronoun and name changes. It was also the year legislators in our home state of Texas attempted to make it illegal for transgender people to use bathrooms aligned with their gender identity. In 2017, “bathroom bills” appeared in state after state in a wave of anti-transgender legislation. The bills were purportedly about safety and privacy, yet there was never evidence of a problem.
This year 21 states are considering legislation to prohibit trans youth from receiving gender-affirming health care, including drugs that temporarily delay puberty, hormones for the development or suppression of secondary sex characteristics (such as breasts or facial hair), and gender-affirming surgeries (which are extremely rare in minors, as standards of care recommend deferring surgery until the age of 18 years). Arkansas passed a bill prohibiting gender-affirming health care. Texas is considering more of these bills than any other state: SB 1311 and HB 1399 would strip the licenses and insurance from any doctors who provide gender-affirming care. SB 1646 and HB 68 would classify parents like me and my wife Amber as child abusers if we seek gender-affirming care for Max.
Once again, trans-inclusive families must publicly defend our private lives. It is not enough to say, “leave us alone,” because we are being accused of harming our children. So we are forced into a debate in which both sides trade what they call scientific evidence. As a philosopher who has spent a career thinking about how science is framed and used in politics, I find myself in territory that is both familiar and newly harrowing.
The proponents of these bills use a handful of studies showing that most gender-questioning youth “desist” once they go through natal puberty (that is, puberty of the sex they were assigned at birth). We point out the flaws in these studies. The studies highlight cases where children were rushed into decisions they later regretted. We note that that is a failure to follow existing guidelines. Proponents of these bills emphasize the health risks of hormone therapies and their unknown long-term risks. We emphasize the benefits of these therapies and point out that all medicines have risks. They say that children don’t have the cognitive capacity to make major decisions. We say that kids know their gender identity from a young age. They say that kids should wait before making decisions. We argue that waiting is also a decision; indeed, there is no possibility of not choosing.
The debate is absurd, pitting some legislators with minimal understanding of the issues against families and health professionals who live and breathe this world. The debate won’t change hearts and minds because both sides see things in a certain way and find and use the evidence that supports that view. This observation is not to assert a false equivalency; for each topic, we can distinguish better claims from worse ones and from falsehoods. But I want to look beyond what appears to be a debate about science and medical practice to reveal the deeper values at play.
This ongoing debate about transgender youth gives “the science” more agency than it deserves. For those behind these bills, the driving force is mostly outrage politics or religion. For parents like us, the driving force is our kids. Max was trying to tell Amber and me who he was at the age of two. He kept trying for years as we persistently misgendered him in our cluelessness, until by the time he was six he became despondent and started acting out in ways that frightened us. Amber and I couldn’t find much information at that time. What we did find often told us that there was something wrong with us, with our parenting, or with our child. But being a boy sure didn’t feel wrong to Max. To her enormous credit, Amber really listened to him and she got me to do the same. It feels right to us too. It is right. That is the truth that matters. The science didn’t get us there. Max did.
As Søren Kierkegaard wrote, “truth is subjectivity.” We will only move beyond these political attacks when we succeed in communicating this kind of truth about being transgender. Yet, because it is so intimate, so unique to each person, and so contrary to fundamental cultural assumptions, it is virtually impossible to convey the fullness of this truth. We don’t have the shared ground that aids with understanding propositions of fact. There will be a space between the sides that we cannot bridge. For that, we need people willing to transition, to take a leap of faith. In what follows, I hope to make that leap a little less frightening.
There is a central question at stake with the current round of bills: How do we best promote the health and flourishing of our children? The word euphoria means carrying well, or the power of enduring easily. More simply, it means being well and happy. This is the value shared by all people of good faith.
The question of how to raise happy and healthy children is partly empirical. Nutritional sciences, for example, can inform eating habits. Parents should make use of this type of evidence. Yet we should also follow the evidence we get from our children. Even before they can talk, a child with a food allergy, for example, will “tell” their parents what kind of diet brings them euphoria. Similarly, most people are right-handed, but a left-handed child will let their parents know that they don’t fit that mold. Let’s call these two kinds of intertwined evidence: the evidence-of-science and the evidence-of-self.
There are also two kinds of love to consider. The theologian William F. May wrote that parenthood, more than other relationships, teaches an “openness to the unbidden.” Our children are gifts, each of them unique. Parents do not “make” children according to their designs. Humans are engendered and engendering creatures; like other living organisms, we come into being through procreation, not construction. Yet parents do shape their children according to their best sense of euphoria. This requires balancing what May calls “accepting love” and “transforming love.” He writes, “Accepting love, without transforming love, slides into indulgence and finally neglect. Transforming love, without accepting love, badgers and finally rejects.”
When it comes to gender and euphoria, we must wrestle with a tangle of two kinds of evidence and two kinds of love. The proponents of these bills invoke only scientific evidence, which is of varying qualities, invariably uncertain, and selectively cited. What they do not cite is the evidence-of-self from the transgender experience, which is evidence that must be considered for a complete picture. Indeed, this truth of subjectivity, in Kierkegaard’s terms, is the heart of the matter.
And this, I believe, is where May’s two types of love help us understand what underlies this debate: In their zeal to transform children according to one static view of how the world should be ordered, the proponents of this legislation seek to prohibit the accepting love necessary for a child’s euphoria. For parents like me, this is the maddening part. Do they think they know our children better than we do?
That is the real problem, and I will return to it later.
However, as so much of the debate is conducted through references to science, let’s start there. Science is not a photographic film reproducing an objective world picture. If this were the case, science would churn out a string of unrelated observations that would be confusing. As Francis Bacon, the godfather of modern science, put it, “Truth emerges more readily from error than confusion.” You first need some direction, a target to aim for. Then you can better know, from failure or success, whether you are on the right track. Or as the polymath Jacob Bronowski explained four centuries after Bacon, science and art both entail the creative, synthetic acts of meaning-making.
To guide their investigations, scientists must frame reality in some way. Where should we look and what facts are relevant? The historian of science Thomas Kuhn called these world-pictures paradigms. These are frameworks that make sense of individual observations. What do we see: the sun rising or the Earth turning? Which way of picturing the world explains reality and our experience of it the best? Is combustion a matter of phlogiston leaving substances, or is it a matter of oxygen combining with substances? Oxygen is real, to be sure, but it is only discoverable and understandable as a piece of a world picture composed of elements with different properties.
Paradigms interact with the observations that scientists make. Bronowski noted that this interaction holds scientific creativity to account in a way that is different from art. Science must test its world pictures. Sometimes experiences do not fit the picture—they don’t behave the way our paradigm would expect them to behave. These anomalies eventually can trigger a crisis and then a revolution—or paradigm shift to use Kuhn’s terminology. Other times, observations and examples keep fitting into the picture, bringing it into sharper focus and further confirming the paradigm. Heliocentrism and thermodynamics, to mention two examples, are very well confirmed.
When it comes to transgender children, what do we see? Or, rather, who do we see? Science often unthinkingly derives its paradigms from its cultural context in ways that import biases. The historian Allen Brandt, for example, chronicled how racism structured the world-picture of the government scientists who conducted the Tuskegee syphilis study. Black people were pictured as less than human, a threat to white civilization, and incapable of controlling their sexual urges or understanding a scientific study. This justified a 40-year experiment on Black men with syphilis. Scientists lied to these men and immorally withheld treatments such as penicillin.
Just as racism has infected science, so has transphobia. It was—and largely still is—a cultural “certainty” that transgender people were disordered and delusional. Our vocabulary, with words such as “transvestite,” carried stigmas around mental derangement and sexual deviance. It is little wonder then, that science first pictured trans folks as diseased. Paradigms exist in medical and psychological science as official guidelines or standards of care (e.g., the Diagnostic and Statistical Manual of Mental Disorders, or DSM). Early versions of the DSM pictured transgender people through the lens of “gender identity disorder.” As with gay people for so long, trans people were pictured as cases in need of conversion therapy to “set them straight.” For children, the idea was to teach them to “live in their own skin” through interventions (e.g., enforcing “gender-appropriate” toys, clothes, and activities) designed to get them to accept the sex assigned to them as birth as their gender identity. This approach was thought to be the path to euphoria.
Truth can change over time and this is part of the wonder. Paradigms shift. In this situation something even bigger than a paradigm is moving. The immutable gender binary has been fundamental in our culture: “Male and female created he them” (Gen. 5:2). Its movement is like plate tectonics, sometimes slow and imperceptible and other times violent and quick. Some parts might remain anchored as other parts crash and subduct, melting into something new.
What forces move our cultural plate tectonics? The scientific and the social are intertwined, pushing and pulling at one another. As early as 1918 there has been an alternative paradigm, gender-affirmation, that pictures trans identities as valid and healthy. This viewpoint was not some purely scientific discovery born from the crushing weight of scientific evidence. Rather, it started with the evidence-of-self and something more like that leap that Amber made with Max. The science had to catch up to the knowledge held by transgender people. Scientists and doctors had to stop, listen, and wonder, “what if I looked at you this way?” Then a coevolutionary process happens as the transgender self and the emerging science shape one another and in turn influence and are influenced by wider social and technological changes, especially media.
The new paradigm coproduced by our two kinds of evidence (science and self) ushered in a world-picture finally capable of bringing transgender people into focus, allowing them to exist—a word that means to stand out, emerge, or be visible. In other words, as mainstream culture slumbered in its transphobic dogmatisms, trans folks were teaching not just their parents but science and medicine how to see their truth.
In 1979, the World Professional Association for Transgender Health (WPATH), a nonprofit organization led by medical doctors and an interdisciplinary group of other specialists, issued the first standards of care (now in its seventh version) for the gender-affirming paradigm. Over the next 40 years, this model gained traction in the scientific, medical, and psychological communities. In 2016, the University of California, San Francisco (UCSF) also issued guidelines. Every major medical association in the United States has issued statements supporting gender-affirming care for youth who meet the diagnostic criteria laid out in these standards of care and guidelines.
By 2013, the year Max turned five, the fifth edition of DSM recategorized transgender people in terms of gender dysphoria rather than disorder. The World Health Organization is moving its entire discussion of gender incongruence out of the chapter on mental disorders to a new section on sexual health, stating that “this reflects evidence that trans-related and gender diverse identities are not conditions of mental ill health, and classifying them as such can cause enormous stigma.” A stigma, it must be emphasized, that was previously legitimated by science. Add to this the burgeoning presence of transgender people in media (the animation studio Pixar is casting its first-ever transgender character), and we can feel the truth of our cultural plate tectonics moving. At different rates of change, some things are subsiding and others are rising up.
The current round of bills is being justified by the old paradigm. For example, the expert witness called to testify in favor of the Texas bills was Dr. Clifford Alan Hopewell, a neuropsychologist and 2004 past president of the Texas Psychological Association (TPA). This is “settled science,” he argued. “The human brain is programmed with either XX or XY chromosomes and that simply cannot be changed.” He described the existence of transgender children as a “hysterical phenomenon that has exploded in the past few years.” But Hopewell is hopelessly out of touch with the state of the science. Any undergraduate genetics student knows that gender is not determined by a rigid chromosomal binary criterion. And historians know that transgender people, including children, have always lived in the United States, although they have historically had to hide their truth.
Yet Hopewell is certain that being transgender is a mental disorder. The affirmative care model, which means “validating what the person is presenting,” is wrong, Hopewell continued. “We don’t do that with any other diagnosis. If an individual is depressed, I don’t treat them and make them more depressed and affirm their depression.” Later in the same hearing, there was a twist that captures the paradigm shift perfectly. The 2020 past president of TPA, Dr. Megan Mooney, testified: “Unfortunately, Dr. Hopewell is not up on the current data and is not in step … with the Association and our support of gender-affirming care for youth and their families.” The very organization from which Hopewell claimed his authority in fact repudiated him.
To understand the full context of this legislation, we need to leave the legislature behind and reconsider what it means to be human and to be among other humans. Humans are political animals because we perform our unique identities in the spaces of appearance created when people come together. To exist is to be and also to be recognized. Cyndi Lauper is the best philosopher for explaining this truth. As she sang, “I see your true colors shining through.” Meaning, for the colors to shine, they must be seen. The spaces of appearance through which the colors must shine, though, are usually ruled by the categories that allow only some ways of being to be seen. As the philosopher Maggie Brown notes, the word category originally meant an accusation (kata,to harangue) made against someone in public (the agora). “True Colors” is a song about how sometimes we will truth into being. Lauper believed in the true colors even when they were hidden by the dominant categories. Her belief allows them to shine.
Sometimes accessing evidence of truth depends first on adopting a belief in that truth. As the philosopher William James argued, it can be rational to have unsupported faith in your ability to perform a task that requires confidence. You would succeed only if you first believed in yourself: the belief made a new truth possible. Or consider how acting friendly toward a stranger is required to become friends. If you stand aloof waiting for objective evidence of friendship, James notes, the friendship will never come.
Being transgender, like any identity, is a social as well as a personal phenomenon. The new medical categorization of dysphoria is rooted in this existential point. Etymologically dysphoria means “hard to carry.” The DSM-5 defines gender dysphoria as a “marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months.” This incongruence is both an internal struggle about one’s body and a social mismatch between a person and societal expectations. Notably, these expectations are based on the assignment of gender at birth, a snap judgment that is made on radically incomplete knowledge and an outmoded binary. Yet this pseudoscientific judgment captures a person in a rigidly false category that defines them for the rest of their life.
Folks who are recognized by the dominant categories can easily fit expectations. They carry each other’s identities, which make them light, euphoric. But for those who are rendered invisible, their identity is “hard to carry,” because they bear that burden all on their own. This is where the pathology enters. The dysphoria that trans people experience is the responsibility of the rest of us. We have a gender dysphoric culture. We have been deranged by centuries of gender stereotypes, binaries, and hierarchies. Our gender categories—these abstractions—prevent us from seeing the living, unique person right in front of our eyes.
The cure for our pathology is obvious. Dr. Diane Ehrensaft is director of mental health of the Child and Adolescent Gender Center at UCSF and author of a 2017 literature review of gender-affirming practices for trans youth. The research has a simple message: when trans children receive support affirming their identities, their mental health improves. “That’s where the radical shift is,” Ehrensaft said, noting that past research focused on what was wrong with transgender kids. “It looks like the pathology lies in the culture, not inside the child.”
Amber and I put it this way: we were the ones to transition, not Max. He already knew who he was. We had love but lacked comprehension; we could not encompass or include his way of being, because we had never seen—or had never recognized—an example of it before.
Kai Shappley, a transgender girl who is in fourth grade, testified along with other transgender children at a Texas Senate hearing. “God made me,” Shappley said, “God loves me. And God does not make mistakes.” The Senators supporting bills that target Kai were not there to listen. They had left the room to attend other meetings presumably more important than this one about whether children will be deprived of medical care and removed from their families. After her testimony, Kai looked at a mostly empty chamber. The few Senators remaining had no questions. “Seriously?” Kai asked, “None of you wants to know more about me?” Kai later received death threats for speaking her truth. A fourth grader.
Those seeking to use the power of the state are so certain that they are right that they feel entitled to wield their power without listening to the people sitting in the crosshairs. Are they afraid of Kai, of what she could teach them?
Evidence of the heart forms the foundations of our worldview and our deepest convictions. It’s how we know who we are and what we should do. And while this nation is deeply divided over many issues, both evangelicals and social liberals hold evidence of the heart in high esteem: It’s long been seen as a singularly authentic way to navigate the bewildering landscape of American life.
Senator Charles Perry, the author of SB 1646 (the bill that would classify parents as child abusers), offered his own evidence of the heart during another Senate hearing: “I am answerable to one thing and one thing only, and that is a sovereign creator.” Perry admitted that his real motivation was not grounded in scientific evidence of health risks. If this were about risks, these bills would target other uses of the medicines. Perry has no problem, for example, with puberty blockers for children with precocious puberty, presumably because that use reinforces his sense of normal or natural development as God intends.
The first command, Perry said, “is you shall place no Gods before me.” We are trying to “reverse his creations,” but “we don’t have the right to be God.” The medical profession has “decided that they’re smarter than our creator.” These were among the last words spoken before his bill was passed by the full Senate on a party line vote.
Perry loves his God and we love our son. Perry’s theology, like much of science, fell into the trap of abstract categorizing. The Catholic thinker Ivan Illich wrote about this tendency to forget the incarnation of God: “Take away the fleshy, bodily, carnal, dense, humoral experience of self, and therefore of the Thou, from the story of the Samaritan and you have … the basis on which one might feel responsible for bombing your neighbor for his own good.” Perry feels responsible for depriving trans kids of healthcare and loving families for their own good.
I wonder what would happen if Perry had a transgender grandchild. What if he really had to listen to someone he loved? Would he make that transition like Amber and I did? The problem with evidence of the heart is believing that inner voice is actually the voice of God, especially when you justify state power based on that belief. And the problem with the evidence of science is believing that we can objectively define people, as if a who could be turned into a what. Stripped bare of the shelters of God and science, we are left with each other. I am left with Max, that little boy with cheeks slathered in shaving cream, grinning at me in the mirror and through the years. He is all I need.
We are all in transition, moved by our technological and cultural tectonics. It can be jarring and disorienting. Like many, Perry is frightened and confused. Kierkegaard would tell him that he has a choice. We all have a choice. We cannot escape our freedom! How to react? Do we close in, box out, and hold tight to our truths with righteous certainty? Or do we take a leap, open our hearts, listen to the people who are struggling to carry their existence, and help?