WE LOVE YOU JUST THE WAY YOU ARE:

How should we respond when someone adopts an identity at odds with reality, and then asks us to "affirm" that identity, especially if they seek technical interventions in the forms of hormonal or surgical alterations to their bodies? How should we respond when it's a child or teenager caught up in this craze?

First, it is neither loving nor compassionate to affirm someone in a mistaken identity. Whether it be a new name or new pronouns, hormones or surgery, if the intention behind the intervention is to endorse the new identity, we're failing in our duties to love--to will the authentic good of another. It is not good to attempt to live detached from reality. Consider medical technologies that could be used to "affirm" a false identity. The purpose of medicine is to bring about human health and wholeness, human flourishing in the physical and psychological domains. Here health is understood not as the subjective satisfaction of desires but as the objective well-functioning of the mind and body, where our various bodily systems achieve their ends--the circulatory system to circulate blood, the digestive system to digest nutrients, the respiratory system to absorb oxygen--and where our thoughts and feelings achieve their ends of bringing us into, and keeping us in, contact with reality. The use of hormones or surgery to redesign a body according to beliefs at odds with reality profoundly violates this norm.

Second, it is never loving to mutilate bodies at the service of affirming false identities. When it comes to medical interventions--so-called "medical transition" or "gender-affirming 'care'"--physicians are deploying bad means (mutilation) in the service of bad ends (affirming falsehoods). Administering high doses of estrogen to a man who rejects his male reality for some alternative identity (whether as a woman, non-binary, gender-ambidextrous, etc.), or administering high doses of testosterone to a woman who rejects her female reality for some alternative identity (whether as a man, non-binary, etc.), or removing reproductive organs and using plastic surgery to create orifices or appendages that resemble those of the other sex (or neither, or both), mutilates the body in an effort to reinforce beliefs at odds with reality. This is a misdirection of the medical profession, a violation of sound medical ethics--and thus a failure of love on our part if we support it. (It is also worth mentioning, at least in passing, that "sex-reassignment" is literally impossible, and that the best evidence, as I document in When Harry Became Sally and subsequently, continues to show that "gender-affirmation" procedures do not bring about psychological wholeness.)

Third, things get worse with children, especially when it comes to puberty blocking drugs. It is a profound failure of love--indeed a profound injustice--for an adult to interfere with the natural development of a child's body to alter its appearance based on gender ideology. To intervene in a child's physical development, to block the child from going through normal puberty--all in an attempt to "affirm" a "gender identity" that rejects bodily reality--is profoundly unethical. Likewise, to tell a child (or anyone, for that matter) that he or she is the opposite sex (or both, or neither), or to encourage a child's mistaken belief that he is something other than a boy, or she something other than a girl, is deeply unjust to that child.

Children who feel deep discomfort with their bodily sex should be treated with kindness, respect, compassion, and love. They need to be protected from bullying, teasing, and any form of mistreatment. But they deserve to know the truth and to be guided to embrace the truth with whatever assistance we can give to help them feel comfortable with their bodies.

This includes providing counseling for any underlying trauma or for social dynamics at home or school that may play a role in the dysphoria. And it includes helping them to break down misguided sex stereotypes or cultural expectations that may underlie their dysphoria. But it must also entail a resolute refusal to go along with ideologies that reinforce sex stereotypes. Preferring the color pink or playing with dolls does not make someone a girl. Rather than teaching children to understand themselves based on how well they fit prevailing cultural expectations on sex, we should be teaching them that the truth of their sexual identity is based on their bodies--sexual identity is received, not self-determined--and that sometimes cultural associations attached to the sexes are in fact misguided or simply too narrow. 

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