Pediatric Gender Affirming Care. Part 2
Perceptions of the European Approaches to PGAC
Pediatric Gender Affirming Care. Part 2
Perceptions of the European Approaches to PGAC.
To read the full Disclaimer: Click here | Last Updated: 8/10/24
“Humans see what they want to see.” Rick Riordan, The Lightning Thief
ABSTRACT
Pediatric Gender Affirming Care (PGAC) is the preferred by the Left Wing aligned American mainstream medicine treatment paradigm - used to manage pediatric patients with gender dysphoria (a marked incongruence between the experienced/expressed gender and the one recognized at birth). The goal of this method is to support (“affirm”-using the Left Wing PGAC advocates terminology ) by various measures an individual’s gender identity (different from the one recognized at birth). This modality is strongly criticized by the Right Wing associated organizations, physicians and public - as the method that is harmful to patients and society. The vituperative dispute over Pediatric Gender Affirming Care (PGAC) is one of the most active frontiers in the current cultural war. This article describe the FACTS related to astonishingly different partisan perceptions of the significance and substance of the recently revised European approaches to PGAC - in the CONTEXT of the deep partisan divide over the concept of Transgender Identity.
CONTEXT: The brief discussion of the broader context of the dispute over the PGAC is presented in this paper since those matters are frequently glossed over. Specifically:
The arguments for and against the reliance on the “pure science” versus using the religion or ideological approach to debate the validity of PGAC are discussed.
This discord over the PGAC is part of a broader disagreement on matters of gender identity. This standoff not only affects the debate’s substance but also the very language used to discuss these critical issues. Both sides reject each other’s terminology, leading to a language barrier that hinders communication and understanding. The dispute has led to a divergence in language, with each side interpreting terms like “sex,” “gender,” “female,” and “male” differently, and refusing to use the other’s vocabulary, viewing it as incorrect, harmful, or even evil. This barrier reflects their fundamental clash over reality’s nature, with what was once universally accepted now being highly contentious.The contentious terminology complicates unbiased analysis, as using politically charged terms can lead to accusations of bias, while avoiding them can sacrifice accuracy and misrepresent the strength and intentions of each side. The Right Wing asserts its correctness by claiming it has preserved traditional language, while the Left Wing accuses the Right of resisting progress.
The fundamental disagreements between the Left and Right Wings regarding transgender identity is centered around the essential tetrad containing the following questions:
Is the sex-gender distinction real?
The Left Wing accepts this distinction.
The Right Wing rejects it.
Is sex-gender binary?
The Left Wing views sex-gender as non-binary.
The Right Wing sees it as strictly binary.
Can sex-gender be changed?
The Left Wing believes sex-gender can be changed.
The Right Wing holds that sex-gender cannot be changed.
Are special accommodations necessary for the transgender and gender-nonconforming minority due to oppression?
The Left Wing advocates for special accommodations, such as participation in sports and access to gender-restricted spaces, due to oppression by the “cis-heteronormative” majority.
The Right Wing opposes special accommodations, arguing that they result in the oppression of women by what they describe as “men pretending to be women.”
These divergent views highlight the issue of changing one’s sex/gender as a central point of contention in the debate over transgender identity and rights.
The Left Wing views on the ability to change gender/sex are discussed in the context of the fact that Left Wing scientists rely on the relatively novel, still evolving and internally conflicted concept of sex-gender distinction.
Fact that Left Wing views on gender- sex distinction are evolving rapidly and many transgender concept advocates disagree with each other regarding details is emphasized. This creates the problem for the Right since it is difficult to debate the opponent who keeps altering his claims.
The Right Wing views on the inability to change gender/sex are discussed in the context of the fact that the Right Wing thinkers reject the concept of gender and assert that sex is immutable and cannot be changed by any medical intervention.
FACTS: Recently many European countries that have championed PGAC have modified their approach to this modality. The nature and implications of those changes have been perceived very differently by the American ideological camps. Right Wing side argues that Europe has “severely restricted and even banned Pediatric Gender Affirming Care due to “newly emerged scientific evidence”. Those claims are used as the vindication of the critical views on PGAC and the justification for legislative efforts to ban PGAC. Left Wing negates those opinions vigorously - asserting that the PGAC care was neither banned nor severely restricted in Europe but merely temporarily limited to research settings in order to gather more quality evidence about it. This paper provides links to the European sources allowing the readers to form their own opinion about this issue. Based upon those original materials it can be objectively asserted that:
The real changes in the delivery of PGAC were indeed introduced by the European Authorities - mainly because of the concerns about the quality of existing evidence. Those are unfavorable facts for the part of the American Left Wing that tries to minimize those occurrences.
However, in contrast to some Right Wing claims those adjustments were made not because new scientific evidence emerged and European scientists have adopted the negative stance on PGAC similar to those of American Right Wing. Rather, those modifications were brought about by the belated concerns about the low quality of existing evidence used to justify PGAC. To remedy this deficiency - the research studies examining efficacy and safety of PGAC has been incorporated to the changes in the European approach to PGAC. At this point the data are being collected and it is unknown if the results of those studies in the future will disfavor or favor the PGAC. Moreover, a vast majority of European physicians still follow the same Transgender Identity that is used by American Left Wing proponents of PGAC. Those are unfavorable facts for those American Right Wing activists who claim otherwise.
CONCLUSIONS: Based upon analysis of original sources - the recent shifts in European policies on PGAC are not favorable and do present problems for the Left Wing PGAC advocates. However, not to the extend that some very enthusiastic Right Wing PGAC skeptics claim. Still those changes can be used by the Right Wing to support their skepticism of PGAC - in a short term. However, the hopes that the long term successful strategy can be built based upon European examples are likely not justified. This tactic fails to meet several critical conditions necessary for the lasting success. One of those prerequisites is that science alone should be able to settle the PGAC dispute. Unfortunately, it is clear that the ongoing PGAC debate transcends science - as its core argument is fundamentally religious/Ideological, not scientific. But even if this would not be a case - the results of the forthcoming European scientific research may very likely contradict the current assertions of PGAC skeptics.
INTRODUCTION
As discussed in “Politicization, Polarization & Power Asymmetry”- the American public became severely polarized along the line separating two main ideological blocks: Left and Right. The deep ideological division between those two political camps is reflected by the ongoing culture war - that is being fought on numerous virtual battle fields. In the preceding article Pediatric Gender Affirming Care. Part 1 we have argued that the heated dispute over Pediatric Gender Affirming Care (PGAC) is one of the most active and most representative fronts of the current ideological war between Left and Right (Ref), (Ref).
In the current installment of our discussion of the battle over PGAC - we will describe the astonishingly different partisan perceptions of the significance, substance and the predicted consequences of the recently revised European approaches to PGAC. This topic will be discussed in the context of the roots and current status of the ongoing turbulent dispute over what the Left Wing refers to as “transgender/gender identity”.
The essential features of the therapeutic paradigm that is known by the endorsed by the Left Wing name as “ Pediatric Gender Affirming Care (PGAC)” have been discussed in details previously (Ref). In brief, PGAC is defined by its advocates - as “a range of social, psychological, behavioral, and medical interventions designed to support and affirm an individual’s gender identity - when it conflicts with the gender they were assigned at birth” (Ref, Ref, Ref). PGCA is one of the several therapeutic paradigms that can be used in the management of pediatric patients affected by the Gender Dysphoria i.e.: the serious distress caused by marked incongruence between the experienced/expressed gender and the one assigned at birth (Ref, Ref).
Those alternatives include (Ref, Ref, Ref, Ref, Ref, Ref, Ref):
reparative/conversion therapy,
redirection (decreasing cross gender identification) and
watchful waiting (watch-and-see) approach.
PGAC has been selected as the only preferred type of management by the Left Wing aligned American mainstream medicine. This preference is rationalized by the assertions that only PGAC can sufficiently alleviate psychosocial distress in gender dysphoric youth - to lower their typically high odds of depression, dysfunctionality, self-harm and suicidality (Ref, Ref, Ref, Ref).
This preference for PGAC, its very name and the rationale for it - have been strongly rejected by the predominantly Right Wing associated: organizations, physicians, scientists, advocates and general public. Those critics of PGAC consider it to be gender denying - not affirming care, that is harmful to the individual patients and to the society (Ref, Ref, Ref, Ref, Ref, Ref, Ref, Ref).
To demonstrate the immense depth of the partisan divide over this matter we have compiled previously the detailed Table containing the side by side comparison of partisan views on PGAC (Ref).
Due to the discussed previously Power Asymmetry favoring the Left - the concerns of the Right Wing PGAC-skeptics have not been accommodated by the mainstream medicine - despite many forceful PR campaigns directed against it (Ref, Ref, Ref, Ref, Ref, Ref). Therefore, the opponents of PGAC have turned into legislative strategies. In result, numerous states (including most of the Southern states) have enacted and continue to introduce laws banning PGAC (Ref, Ref, Ref, Ref, Ref, Ref, Ref). However, many of those laws have been and still are being legally challenged by the PGAC- proponents, frequently with the favorable for them results (Ref, Ref, Ref, Ref, Ref).
During the current PR, legal and legislative battles over the PGAC - many of the PGAC-skeptics started to point out the recent changes in the approach to PGAC that started to occur in Europe. They perceived those changes as the long awaited vindication of their critical views on PGAC and as the justification for the described above legislative efforts to ban PGAC (Ref, Ref, Ref).
However, the Left Wing has immediately negated those opinions vigorously - asserting that the PGAC care was neither banned nor severely restricted in Europe but merely temporarily limited to research settings in order to gather more quality evidence about it (Ref, Ref, Ref, Ref ).
Clearly, the American perception of the recent changes in European approach to PGAC - has been dependent upon the partisan affiliation of the sources describing it (Ref, Ref, Ref). This is not surprising. As discussed in “Politicization, Polarization & Power Asymmetry” most members of both Right and Left Wing dwell inside their own insulated Echo Chambers and Information Filter Bubbles (Ref, Ref, Ref). Consequently, they are receiving their news from the sources that are aligned with their political views. Therefore, this commentary that focuses on the original European sources and on the context of the partisan dispute over PGAC has been written - to provide more balanced view on this matter.
CONTEXT
Roots and Current Status of the Dispute over PGAC
Understanding the roots and familiarity with the current status of the Left versus Right debate on PGAC - provides the essential context - that is necessary for grasping the reasons of a stark contrast in how the Right and Left perceive the substance and significance of Europe's recent policy shifts regarding PGAC.
The Ideological Language Barrier
The acrimonious partisan discord over PGAC is a part of the larger schism about the CLUSTER of issues to which the Left Wing refers to as “transgender/gender identity” (terms adamantly rejected by the the Right Wing) and what the Right Wing calls “gender ideology” (terminology and approach vigorously repudiated by the Left Wing).
As shown above - already at the onset of the dispute - both arguing sides have used different names to describe the very topic of their conflict. Furthermore, they emphatically rejected those most fundamental labels - that were utilized by their adversaries. The intense antagonisms of the dispute combined with the ferocious attitudes of its participants has unavoidably resulted in a full divergence of the language and terminology used by the participants of this conflict. Left and Right interprets the concepts contained in the above CLUSTER such as “sex”, “gender”, “female”, “male”, etc. in a very conflicting ways - and it is reflected by their incompatible languages.
This divisive process has ultimately culminated in the creation of the virtual Language Barrier between those two sides. When describing matters related to the above CLUSTER - Left and Right Wing use the incompatible language and incongruent terminology. Each party adamantly rejects any compromise on terminology. Many activists from both sides defiantly refuse to employ terms or phrases that are typically used by their adversaries - even when describing the ideas of their opponents. This strong aversion to “the enemy’s vocabulary” is motivated by their conviction that the phraseology embraced by adversaries is not only incorrect but also delusional, harmful and even blasphemous and evil.
This Language Barrier has been self-erected between the two conflicted sides -because they clash over the true nature of the most basic aspects of reality. What was once universally accepted as obvious and indisputable is now viewed as highly contentious and debatable. In result, the participants of the debate don't merely dispute the choices of the solutions for the indisputable problems. Instead, they disagree even on what the problems actually are. What one party sees as the critical issue - the other one does not recognize as having any relevance, and vice versa. What one side describes as an objective verifiable reality - is being portrayed as the subjective delusions by the opponents. What is claimed to be as an objective verifiable reality by one side - is dismissed as mere subjective misconception by the adversary.
The conflicting and highly contentious terminology complicates the efforts to approach these issues from the unbiased standpoint. When the neutral analyst utilizes divisive political terminology strictly for the sake of accuracy, analysis, or education - this still could be immediately misconstrued as the endorsement and promotion of the side that is typically using such terms. Consequently, his objective analysis might be unfairly dismissed as politically biased propaganda. Conversely, an impartial researcher opting for less polarizing (hence less accurate) terminology to avoid offending politically biased readers - is in fact inadvertently replacing the intended objective analysis with yet another false narrative. The well intended avoidance of inflammatory terms - compromises the accuracy and veracity of the report. In result, his readers may form the incorrect opinions about the actual intentions, character and the strength of the other side.
It is important to note that Right Wing points out that they are correct since they did not change the language, neither introduced new terminology, nor changed the meaning of the old words - but their Left Wing opponents did that in what Right Wing describes as cultist fashion.
Left Wing rejects the accusation of being cult and claims that Right Wing refuses to accept progress.
The Alternative Realities
Neither side is willing to concede anything and currently those two groups seem to live within two completely alien to each other realities that contains their “own versions” of “language, science and culture”. Each side is certain that “their reality” and hence “their language, their science, their culture” are the only real and correct ones, as well as they deny and are irritated by what their opposing side purports to be their reality, language, science and culture.
This already very confusing and frustrating situation is made worse by the fact that Left Wing views on biological sex are still evolving and many transgender advocates disagree with each other regarding details (Ref). This creates the problem for the Right since it is difficult to debate the opponent who keeps altering his claims.
The Essential Tetrad
The contentious disagreement between the Left and Right over the concept of transgender identity is rooted in their different approach to the following tetrad of essential questions:
Is sex-gender distinction real or not?
Is sex-gender binary or not?
Can sex-gender be changed or not?
Are special accommodations necessary for what the Left Wing refers to as the “transgender and gender-nonconforming minority” because this group is oppressed?
Those questions are answered as follows:
LEFT WING:
Accepts the sex-gender distinction concept.
Asserts that sex-gender is non-binary.
Posits that sex gender can be changed.
Advocates for special accommodations for the transgender and gender-nonconforming minority (such as participation in sports and access to the gender restricted spaces) - because this minority still is oppressed by the “cis-heteronormative” majority (the term used by the Left Wing).
RIGHT WING:
Rejects the sex-gender distinction concept
Asserts that sex is strictly binary.
Posits that sex cannot be changed.
Advocates against special accommodations for what the Left calls “transgender and gender-nonconforming minority” - because according to Right Wing reasoning such accommodation results in the oppression of women by as the Right Wing describes “men pretending to be women”.
From those questions - the issue of the ability to change one’s sex/gender has a pivotal significance and therefore it will be discussed below in details.
Left Wing Views on the Ability to Change Biological Sex
Left Wing scientists when talking about terms such as “man”, “woman”, “male”, “female”, etc. rely on the relatively novel, still evolving and still internally conflicted concept of sex-gender distinction (Ref, Ref, Ref).
In general, sex-gender distinction has been and it is still used to justify providing the “gender affirming care” to patients suffering from gender dysphoria. This concept allows to make an assertion that person’s gender (being “man”, “woman” or “non-binary”) can be different from their biological sex that was determined at birth (based upon genetic makeup and phenotype that includes presence of male or female gonads, etc.). However, as discussed below - things are not as simple as they may appear at first glance.
As noted above, the idea of sex-gender distinction is quite new. Before the 20th century this notion was virtually unheard of. During those times the use of term “gender” was limited to linguistic - in reference to the grammatical gender system (Ref). During first half of 20th century the initial theoretical foundation for the sex-gender distinction has been formed (Ref). However, sex-gender distinction concept started to develop robustly only after 1950s - mainly within the scientific disciplines of psychology and sociology (Ref, Ref, Ref). It has been subsequently adopted by the feminist theory, permeated into demography, biology, medicine and other branches of science (Ref, Ref). Finally, it started to impact popular culture and has been acknowledged by the legal systems, national governments and international agencies such as WHO (Ref, Ref, Ref, Ref, Ref). As one of the researchers put it describing the advances of concept of “gender” - the “trickle had become a flood” (Ref).
At its inception sex-gender distinction proponents used term “gender” to denote the socially constructed facets of the differences between males and females, while term “sex” was applied to describe biologically determined aspects of those differences (Ref). Therefore, according to this initial approach the gender and biological sex were clearly and distinctly different from each other. There was an initially accepted but later criticized opinion that gender is fully “performative” that is can be changes at will by one’s actions, while biological sex was not (Ref). However, with time for the reasons discussed below - this clear sex/gender distinction has been blurred (Ref, Ref).
Some activists and organizations still employ the terms "gender" and "sex" according to their original definition (Ref, Ref). However, others use those terms in the variety of other ways (Ref, Ref). This spectrum of usage spans from extremely elaborated and convoluted models of gender-sex relationships to using gender as a simple synonym for sex - virtually in defiance to the original intentions of the founders of sex-gender distinction concept (Ref, Ref). This instability of terminology - creates the great deal of confusion for the critics of the sex-gender distinction who oppose the “gender affirming care”. That situation gives the advantage to the proponent of gender affirming care - either by the accident or by design.
However, that lack of cohesion can also hurt the proponents of the transgender concept in general and PGAC in particular. Recently, some newly emerged transgender advocates noted that many their colleagues started finally to worry the strict adherence to the traditional claim that gender is a social construct while sex is a biological reality can backfire (Ref). Namely, relying on this sociology-biology distinction may lead the transgender advocates to the unintentional acceptance of the"superiority" of biological sex over gender (Ref). That unwilling concession may lead to significant weakening of their main argument that a man can actually and truly become a woman and vice versa (Ref). This is because the reliance on the traditional gender/sex distinction leads to inevitable conclusion that gender is indeed changeable but biological sex just cannot be. Hence, man can become woman and vice versa only - from the perspective of the gender but not from the perspective of the biological sex. And that - as one of the younger transgender activist explains - makes the concept of transgenderism vulnerable to the attacks by “the anti-trans movement, which now hides its repressive goals behind the rhetoric of neutral biological fact” (Ref).
For this reason the bold opinion that sex (not just gender) can be truly changed is now being embraced by the prominent transgender researchers and advocates (Ref, Ref, Ref). According to this interpretation - neither gender nor sex are fixed and unchangeable attributes - but both represent changeable and fluid status. Consistently with this line of reasoning being male or being female is not an immutable trait - but the STATUS that can be changed in a way that the body parts may be modified by plastic surgery and legal name can be adjusted at will. Those clever analogies resonate well with other “changes of status” that are widely accepted by the society. Use of cometic surgery to modify one’s body parts for esthetic reasons occurs frequently (Ref, Ref, Ref). Changes of legal names are very common as well. In fact, traditionally - wives change their names to the name of their husbands at the time of the marriage (Ref).
The change of perspective on gender and sex is reflected by the following definitions contained in the most recent WPATH Standards of Care:
GENDER: Depending on the context, gender may reference gender identity (person’s deeply felt, internal sense of their own gender), gender expression (how a person enacts or expresses their gender in everyday life and within the context of their culture and society), and/or social gender role, including understandings and expectations culturally tied to people who were assigned male or female at birth. Gender identities other than those of men and women (who can be either cisgender or transgender) include transgender, nonbinary, genderqueer, gender neutral, agender, gender fluid, and “third” gender, among others; many other genders are recognized around the world.
SEX ASSIGNED AT BIRTH refers to a person’s status as male, female, or intersex based on physical characteristics. Sex is usually assigned at birth based on appearance of the external genitalia.
TRANSGENDER or trans are umbrella terms used to describe people whose gender identities and/or gender expressions are not what is typically expected for the sex to which they were assigned at birth. (Ref)
Since the goal of this paper is to discuss the European views on the sex and gender - it is important to note that as shown below the Council of Europe has gone even further that WPATH by explicitly stating that not merely gender but sex can be truly changed (Ref):
“Sex can be changed: in the case of transsexual people, who are born with the sex characteristics of one sex and gender identity of the other, sex reassignment surgeries are performed. This includes a change of sex organs and the administration of hormones.” (Ref, Ref)
Right Wing Views on the Ability to Change Biological Sex
Right Wing point of view does not recognize the concept of sex-gender distinction (Ref, Ref). According to this approach term “gender” is a contrived fallacy. It does not exist in real life. Being “man” or “woman” is fixed and unchangeable attribute (not “a status”) that cannot be different from their biological sex that was determined at birth (based upon genetic makeup and phenotype including presence of male or female gonads). One cannot change the biological sex just like one cannot change the biological age. In summary, the Right Wing thinkers reject the concept of gender and assert that sex cannot be changed by any medical intervention (Ref, Ref, Ref, Ref, Ref).
In accordance with this, the Right Wing aligned American College of Pediatricians (ACPeds) states that:
“Sex is a dimorphic, innate trait defined in relation to an organism’s biological role in reproduction. In humans, primary sex determination occurs at fertilization and is directed by a complement of sex determining genes on the X and Y chromosomes. This genetic signature is present in every nucleated somatic cell in the body and is not altered by drugs or surgical interventions.” (Ref)
FACTS
PGAC: European vs American Approach
It is evident that American mainstream medicine has maintained the same preferential stance on the PGAC in spite of the described above Right Wing backlash (Ref, Ref, Ref ). It is also indisputable that recently many European countries have modified their approach to PGAC. However, the nature and implications of those changes have been perceived very differently by the American ideological camps that are engaged in the ongoing cultural battle over PGAC. Just as beauty is in the eye of the beholder, the perception of the same event is strongly influenced by the ideological perspective of its observers. Consequently, the perception of changes in European approach to PGAC - depends on the sources describing it (Ref, Ref, Ref):
The RIGHT WING leaning journalists, activists and legislators claim that Europe has severely restricted and even banned Pediatric Gender Affirming Care due to “newly emerged scientific evidence” (Ref, Ref, Ref, Ref, Ref). Consequently, many Right Wing aligned organizations and legislators that are skeptical of the concept of Transgender Identity have been promoting those new European policies - as the long awaited vindication of their critical views on PGAC and the ultimate justification for their legislative efforts to ban PGAC (Ref, Ref, Ref). Some organizations concluded that those changes represent the acceleration of the already growing chasm between North American and European approach to PGAC (Ref).
The LEFT WING media sources assert that the Pediatric Gender Affirming Care was neither banned nor severely restricted but merely temporarily and cautiously limited - pending the results of research (Ref, Ref). Hence, the Left Wing associated activists and organizations have busy rebutting the described above claims of the Right Wing PGAC skeptics (Ref, Ref, Ref ).
The self-proclaimed CENTRIST pundits have applauded vigorously the new European PGAC approach - claiming that it is superior to any type of treatment used in the US (Ref). According to those rare in today’s polarized Worlds “middle of the road” commenters, the Europeans base their therapeutic paradigms on “the emerging scientific evidence” - while Left Wing Americans simply follow their ideology and Right Wing’s approach is guided by the equally “non-scientific” Christian theology. (Ref).
The original European sources should naturally provide the ultimate answer about the true nature of their novel approaches to PGAC. However, reading and understanding the original European materials may be challenging for many Americans due to language barrier and different from American legal and academic frames of references (Ref, Ref, Ref). After overcoming those obstacles - it becomes clear that the original European documents contain rather complex, sometimes equivocal and frequently conflicting explanations of the recently changed recommendations regarding PGAC (Ref, Ref, Ref, Ref). The links to the original European sources are enclosed as the references below for those readers who would like to analyze them directly - rather than to rely on their interpretations by others. However, the most pertinent objective observation about the European Approaches to PGAC can be summarized as follows:
For instance, frequently quoted British Cass Report is quite skeptical about quality of existing evidence supporting PGAC and hence limits it to the controlled research settings. However, it does not totally ban it and it does not reject the premisses of the embraced by the Left Wing concepts of transgender identity (Ref).
Similarly, other European National Health Agencies do not ban entirely PGAC nor reject its Transgender Identity based foundations. Instead, they recommend to be more cautious about PGAC. Those recommendations are made NOT because any “new scientific evidence has emerged” but due to the belated realization that such evidence are lacking and have to be collected. Therefore, the advice is given to limit the PGAC to controlled research settings - until the reliable evidence of PGAC effectiveness and safety are established by this research (Ref, Ref, Ref, Ref, Ref, Ref/Ref, Ref/Ref). As an example - in a contradiction to the narrative about “bans” - certain countries like Finland actually allow the initiation of hormonal interventions (use of cross gender hormones to alter secondary sexual characteristics) in a person younger than 18 years - on case-by-case basis and after careful vetting process (Ref/Ref Pages 9-10 Principle 4 ). Similarly, puberty suppression treatment may be initiated on a case-by-case basis after careful consideration and diagnostic examinations (Ref/Ref Page 9, Principle 2 ).
The Statement of European Academy of Pediatrics (EAP) explains that national approaches to PGAC within European Union vary and are in flux (Ref). EAP specifically recognizes the need for far more research into the PGAC related modalities as use of pubertal blockers and cross-sex hormones in pediatric patients. Furthermore, EAP acknowledges that there are deeply held societal beliefs about the premises and the nature of PGAC - that are based not only upon science but are rooted in conscience, culture, worldviews and social norms (Ref). This statement nullifies the mentioned above centrist fanciful claims about European “reliance on emerging science only”. In conclusion EAP advocates rather vague and open to interpretation management process that it describes as “child-centered individual rights-based analytical approach” (Ref).
Reasons for the interest in the European Approach to PGAC
Traditionally, Americans of the Right Wing persuasion have politely speaking rather unfavorable opinion about most European countries (Ref , Ref). They were consistently critical of European policies and rarely if ever they invoked them as worthy of emulation in the US (Ref, Ref, Ref). So what would explain the sudden outpour enthusiasm for following the European recommendations about PGAC - displayed by many Right Wing politicians, activists, journalists and medical organizations ( Ref, Ref, Ref, Ref, Ref)?
The most obvious answer is - that at least at the first glance, the recent situation in Europe allows to create seemingly very effective political narrative for the Right Wing Opponents of PGAC (Ref, Ref). Interestingly, even the most ardent Left Wing affiliated opponents of Right Wing PGAC skeptics point out that this is a case (Ref). Unlike the Right Wingers most members of the Left Wing faction have a lot of respect for the European policies - since they perceive those as much more progressive than traditionally more conservative American approaches.
Indeed, many European countries were way ahead of the USA regarding the acceptance of Transgender Identities, Transgender Medicine and Transgender friendly laws. Germany is considered to be the birthplace of “transidentities” in the early 20th century (Ref). Sweden was the first country in the world to allow people to legally change their gender in 1972 (Ref). Holland based physicians-scientists have first proposed in mid 1990s the use of the Puberty Blockers in the management of pediatric Gender Dysphoria - the approach known as the “Dutch Protocol” (Ref, Ref, Ref, Ref).
In the view of all the above the argument that the progressive European Countries whose scientists pioneered and maintained the robust PGAC are now reversing the course and abandoning the very concept they created - should cary the enormous significance (Ref, Ref ). Moreover, such a powerful assertion against PGAC could be presented using the language of the “objective science” that would resonate well - with both the Right Wing base of PGAC skeptics and with their Left Wing adversaries (Ref, Ref). This appears to be a perfect winning strategy for the Right Wing PGAC skeptics - to persuade the Left Wing PGAC proponents that they are wrong. However, the ultimate success of this ostensibly ingenious tactic depends upon fulfilling the following conditions:
that its underlying narratives are consistent with reality,
that European research that is being conducted as part of the changed approach to PGAC will not yield the unfavorable for the PGAC skeptics results,
that the science alone can settle the PGAC debate.
Veracity of the Narratives
The neutral observer has to acknowledge that vast majority of the PGAC skeptics who openly argue their opposition to this modality - in the face of the Power Asymmetry favoring their opponents - are courageous and well-meaning individuals. It is unlikely that they would deliberately misrepresent facts to fit their narrative. However, even the most ethical people are prone to making errors under the pressure of the heated disputes. Some of them may be misled by the deceptive characters whom they naively trust. Others may not be able to overcome their strong personal biases that can interfere with their perceptions of facts. Moreover, there will be always few bad actors - who would unscrupulously lie to advance their agenda. Due to all those circumstances the flurry of the inaccurate narratives can be created. It is hard to deny that this is precisely what has transpired during the debate about the significance and substance of changes in the European approaches to PGAC.
As shown above the veracity of certain obviously inaccurate claims that are being propounded by some PGAC skeptics - will easily crumble under the scrutiny. Contained in them false or exaggerated claims will be negated by the original European sources (Ref, Ref, Ref). The allegedly “perfect” strategy will fail.
The most dedicate followers of some prominent PGAC skeptics can still be energized by the well intended but not entirely truthful claim especially if it resulted from honest error. However, recklessly false statements that are repeated continuously - will have overwhelmingly negative impact. They will alienate many supporters - who will rightfully resent being lied to. They are bound to help not hurt Left Wing PGAC promoters - who will be able to easily discredit the PGAC skeptics as “bald face liars”.
Future Research Results
As discussed above, the changes related to utilization of PGAC in Europe have been introduced - not because European scientists decided suddenly to adopt the same views on Transgender Identity and PGAC that are expressed by the American Right Wing PGAC skeptics. Rather those changes were brought about by the belated concerns about the quality of evidence used to justify various aspects of PGAC. Those worries were certainly induced in part by the increasing questioning of the safety and effectiveness of the European PGAC by not-so-progressive European governments and the public. To remedy this lack of high quality evidence - the robust research studies with the collection of data related to the efficacy and safety of PGAC has been incorporated to the changes in the European approach to PGAC.
In such settings, the currently professed by the Right Wing PGAC skeptics strong reliance on the “European approaches to PGAG” does not appear to be wise -since it may backfire in the future. What if the data that are being collected now by European scientists will appear to be strongly supportive of the PGAC and therefore, the European scientists would be compelled to remove current restrictions and cautions related to PGAC? With such a research outcome - would the Right Wing PGAC skeptics - be still willing “to follow their European Colleagues” and hence join the camp of the PGAC promoters? The PGAC skeptics may feel overly confident that obtaining of such PGAC confirming data is simply impossible in the real world. But what if such data will be created by the honest error or deliberate hard to debunk fraud? What if the methods used for the European data analysis will give the answer that American PGAC skeptics may not like? Would the American PGAC skeptics abandon their hight confidence in the correctness of European approaches? And if so - how their flip-flopping on the trust in European Science - will be perceived by their supporters and enemies? Those are all important matters to ponder.
Limitations of Science
The success of the new strategy of PGAC skeptics based upon the reliance on the European approach to PGAC that is rooted in science - depends by default upon the ability of the science to decisively settle the PGAC controversy. Unfortunately, this does not appear to be a case. It is self-evident that in addition to purely scientific aspects - the political, cultural and especially religious and ideological factors play immense role in the current vituperative dispute over the PGAC. Many activists, authors and organizations on both Left and Right acknowledge that self-evident fact by stating that science alone will not settle the transgender dispute (Ref, Ref, Ref, Ref,Ref, Ref, Ref, Ref).
One of those authors summarized this situation as follows (Ref):
“Neither side is likely to concede because this is not a scientific argument, but essentially a religious one.
The one side believes that 1) God created man, male and female; 2) there is a universal divine Lawgiver; and 3) there are absolute moral principles, many of which are incorporated in the Oath of Hippocrates. Such precepts forbid harming individuals to serve an agenda.
The other side believes that 1) there is no God, or God is irrelevant; 2) the ultimate authority is Science; 3) morality and the law are determined by Science to serve the goals set by the authorities; and 4) religious people, especially Christians, are bigots opposed to enlightenment and to allowing oppressed and marginalized people to flourish.”
The expert who talks from the other side of the partisan divide - also expressed the sentiment that science will not provide the answer. However instead of religion he invoked the social justice (Ref):
“This is that social justice issue where science is just not going to satisfy everybody on this. I worry that scientific facts will be used to bludgeon each other and that we won't come to a consensus because our feelings are so heightened.”
Finally, the skepticism about science as the ultimate arbiter in this debate - is echoed by the scientist whose work was used to support arguments from the both political camps (Ref):
“I am a scientist whose work has been invoked—on both sides—in debates about equality for sexual and gender minorities, my reflections on these events has led me back to some basic questions about how scientific knowledge gets made in the first place. What I have come to conclude is that despite the fact that disputants on both sides wield claims about natural truths, the science we have now cannot settle the matter. (…) Debates about whether one is born with a pre-existing sex or assigned one at birth, as well as the legal disputes about whether sex is fixed and binary or complex and changeable, appear to be about scientific truthiness. But they are really part of the for-the-moment unsettled process of world-building.”
Interestingly, despite the presented above elegant arguments, there are still many groups and individuals on both sides of PGAC dispute - who still try to frame this debate as “purely scientific matter” that can be solved only by science (Ref, Ref, Ref, Ref, Ref, Ref, Ref).
Some proponents of “the scientific approach” believe that they can use science as the result oriented tool and that their opponents would not call them on this - but just capitulate. However, their adversaries will not surrender. Instead, they will use counter-arguments produced by their own result oriented tool that they will call “better science”. Consequently the line of the “scientific”arguments-rebuttals will go on forever.
Certain Right Wing advocates of “strict scientific approach” claim that it can guarantee a victory in the lawsuits by employees for being terminated due to non compliance with transgender identity affirming policies. They argue that reliance on the “religion freedom doctrine” in such cases will inevitably lead to the defeat due to “Religion Freedom Trap” (Ref, Ref). The implication here is that since this tactic can be effective in such legal cases - it should be used universally in all debates about Transgender identity. One of the critics of reliance on freedom of religion doctrine explains the danger of such approach - in the following way:
(There is a) danger in appealing to religious freedom as a defense against gender ideology. In framing the issue as one of religious discrimination, is granting the premise that the content of ones beliefs is something other than rational. (…) The only way to defeat gender ideology in the long term is thus not to ask permission of the state to practice “my truth” or, even, “our truth” on ever-shrinking islands of religious accommodation. (…) It is to declare to the commissars of this delusional social experiment that we are not asking for authorization to practice our religion. We are demanding that you leave our kids alone in the name of basic moral reality. (…) Get your ideology off their biology.”
The fragility of the constitutional provision of religious liberty has been well demonstrated - not only in cases involving Transgender Identity (Ref, Ref). Hence, the over-reliance on the religion freedom doctrine is not the best legal strategy in general. However, that does not mean that over-reliance on science either in courts or in general debate over Transgender Identity has to be automatically a winning paradigm. There is no persuasive evidence of it so far. In numerous legal cases involving issue of Transgender Identity and reliance on science the Right Wing side skeptical of Transgender Identity did not achieve the promised overwhelming victories (Ref). Having said that - the intentions of the author of the quoted above paper are clear - he certainly is sure that he means well. He wants his side to win, since he believes his side is right and good. However, there is an unfortunate problem here. He is a well credentialed and accomplished scholar in theology and ethics. Yet he is recommending using science, while not being bio-scientist or physician himself - in a contrast to the above quoted experts who do question usefulness of science while being bio-scientists/physicians. One of the problems, in this author passionate discourse is that his outwardly powerful argument “Get your ideology off their biology” can be easily neutralized by the counter-argument “Get your religion (cloaked in the arguments from obsolete invalid science) off their complex biology - that is confirmed by the modern real science.” Indeed, the “scientific claims” can be used to bludgeon each other without any chance for the consensus.
MUTUAL CRITICISM OF VIEWS ON PGAC
As expected - in the era of political polarization both sides of the PGAC debate are extremely critical of each other. As discussed above, both camps are annoyed, frustrated, and even angered by the opinions and actions of their opponent. Very serious accusations are relentlessly exchanged between those two opposing factions. Interlocutors frequently blame each other for the same transgressions. Neither side is willing to concede anything.
Full analysis of this contentious situation is beyond the scope of this article. However, a brief discussion of this reciprocal criticism is presented below.
Right Wing Criticism of Left Wing Endorsement of PGAC
The criticism of the PGAC by the Right Wing aligned skeptics is based upon their general rejection of the concept of the sex-gender distinction. Upon this foundation they have built their case against PGAC - by incorporating numerous aspects of PGAC that they consider to be extremely pernicious. According to those skeptics the unacceptably detrimental characteristics of PGCA include:
IDEOLOGICAL AND CULTIST ORIGIN: There is an avalanche of claims by the Right Wing aligned activists, physician, politicians and members of the public that PGAC is not a treatment modality based upon rational principles. Instead, they explain - it is a derivative of the sinister Transgender Ideology that gave birth to pseudo-religious cult that they call “transgender ideology” (Ref, Ref, Ref, Ref, Ref, Ref). Some authors point out that this ideology meets all the Lifton’s Criteria of brainwashing by cults (Ref). Some activists assert that the terminology used by promoters of transgender concept is not a scientific nomenclature but the cultish “newspeak”. This is consistent with the described by Lifton Loading the Language manipulative technique of creating the brand new neologisms and changing the meaning of the existing words (Ref, Ref). Likely for this reason many Right Wingers never use the Left Wing recommended terms such as “gender”, “cis”, “trans”, “assigned at birth”, “affirmation”, etc. They also tenaciously refuse to describe and/or to address the transgender individuals by their “preferred pronouns” and by “new legal names and gender” even when asked by those individuals to do so.
INSANITY/IRRATIONALITY: In keeping with the above assertions - the opponents of PGAC tend to describe PGAC and the concept of Transgender Identity as “intrinsically irrational”, “crazy”, “insane” and “delusional” since they are based upon the denial of the reality of biological sex. (Ref, Ref, Ref, Ref). To back up the claim of delusionality - the PGAC skeptics frequently point out to similarities between transgender identity and anorexia nervosa (Ref). To justify their arguments about denial of biological facts they invoke the biological concepts - that were widely accepted before introduction of sex-gender distinction (Ref, Ref)
IRREVERSIBLE HARM: PGAC skeptics express the opinion that contrary to Left Wing claims of safety and effectiveness of PGAC - this paradigm is the result of “toxic compassion” that leads to numerous severe and frequently irreversible harms. Namely, PGAC is:
Harmful to all pediatric patients since it causes the irreversible physical mutilation, infertility, impaired sexual function, abnormal bone formation and mental/psychological damages by the enhancement of delusional thinking and likely many long term side effects that we are not yet aware of. (Ref, Ref, Ref, Ref)
Harmful to girls by depriving them of the fairness in the athletic competitions and taking away their safe spaces (bathrooms, locker rooms) - by pretending that transgender girls are not different from biological girls (Ref, Ref)
Harmful to society by attacking the established societal order and harmony - while promoting delusions, degeneracy, immorality and destruction of traditional families and religious liberty (Ref, Ref)
CHILD ABUSE: Some PGAC contrarians claim that it constitute act of child abuse. They claim that it causes both physical abuse by treatment related mutilations and sexual abuse by sexualization of children that will ultimately lead to acceptance of pedophilia (Ref, Ref, Ref, Ref).
DECEPTIVE PSEUDO-SCIENCE AND BAD MEDICINE: many skeptics of PGAC propounds that its concept is based upon very flawed science and substandard clinical practices - since the strong political motivations caused lack of scientific rigor and objectivity among the researchers and clinicians who work in the field of PGAC. Those critics support those conclusions by pointing out:
Inadequate Research: Critics of PGACS argue that the evidence base for the effectiveness and safety of gender-affirming treatments is not robust enough to justify their use (Ref, Ref, Ref).
Integrity and Quality of Research. Since PGAC is driven by strong political agenda during times of severe politicization of medicine the scientific integrity of researchers is in question (Ref, Ref). Due to political pressure, studies may be biased (but performed in ways making difficult to detect such bias). The results of studies may be manipulated, suppressed, or even fabricated.
Inability of Obtaining Informed Consent. Children and adolescents do not have the maturity required to make decisions about undergoing significant medical treatments or participation in research (Ref). Critics suggest that young people may especially not fully understand the long-term implications of such treatment.
Other ethical issues. Additionally to issues with Informed Consent there are many other ethical issues in research and practice of PGAC. For instance tested intervention must be of potential benefit to the research subjects. If inadvertent harm occurs, researchers must provide for as much care as needed. Ethical physicians and scientists must not condition their approval on the results of clearly unethical research.
Willful ignorance of desistance and detransitioning: Some opponents of PGAC highlight in their opinion clear pattern of denial by the mainstream medicine of the high frequency of both desistance and detransitioning. Desistance occurs when child affected by gender dysphoria may spontaneously recover from it before reaching adulthood. PGAC critics use high frequency of desistance to argue against early medical interventions of PGAC, suggesting that allowing natural puberty might lead to better outcomes (Ref). Detransitioning is defined as the cessation or reversal of a transgender identification and gender transition through medical, social and legal means (Ref).
TRANS-HUMANISM. Trans-humanism is a philosophy and social movement that advocates using the transformative powers of technology and medicine to create a “post-human species (Ref). Certain activists claim that Transgenderism represents the First Wave of Trans-humanism that is hostile to humanity and contradicts religious faith (Ref, Ref,).
OTHER HIDDEN AGENDAS in addition to discussed above issues, there are numerous others less or more plausible critical hypotheses and theories critical of PGAC.
In the view of the above robust criticism - the PGAC skeptics demand that PGAC should be banned immediately and permanently. The ongoing legislative efforts are reflection of this position. The Left Wing PGAC proponents have neither conceded nor ignored any of the listed above critical arguments. They have provided lengthy and ardent rebuttals to their critics (Ref, Ref, Ref, Ref). Needlessly to say the Right Wing Skeptics were not convinced by any of those retorts.
Left Wing Criticism of Right Wing Resistance to PGAC
As described above the Right Wingers have been very vocal and active in their opposition to the endorsed by the Left Wing PGAC. Reciprocally, the Left Wing has been forthright in their robust disapproval of the Right Wing's opposing perspectives on this modality
According to the Left Wing experts and activists their endorsement of PGAC and the staunch criticism of the Right Wing’s negative opinions about that therapeutic paradigm is rooted in:
the validity of diverse forms of scientific evidence (Ref),
a broader understanding of ethical medical practice (Ref),
and foremost in the importance of providing the utmost compassionate care that supports the well-being of all transgender pediatric and adolescent patients (Ref).
According to such framed criticism, all the arguments made by Right Wing critics of PGAG are not valid since they are based upon:
the outdated and discredited old scientific theories (Ref),
irrational fear of the transgender individuals (Ref)
harmful lies, misconceptions and myths (Ref)
religious and cultural biases (Ref)
Therefore, the Right Wing objections against PGAC are not result of the benevolent desire to protect children - as the Right Wing activists deceptively claim. Rather, the backlash towards PGAC is driven by the multitude of religious and cultural motives disguised as “harm reduction” or “adherence to scientific evidence”.
In their examination of the motives behind the staunch opposition of Right Wing skeptics to PGAC, its Left Wing proponents have identified the following most pertinent factors contributing to this resistance:
SCIENTIFIC ILLITERACY. Many Left Wing PGAC advocates assert that the scientific illiteracy affecting certain Right Wing communities can further augment their already negative position towards PGAC and create the “local enclaves” that are highly adverse towards PGAC - via following mechanisms:
Misunderstanding of Medical Evidence: A lack of understanding of the result of scientific studies supporting PGAC - can lead to the spread of misinformation about the safety and efficacy of this modality. This can sway the public opinion against PGAC and in turn influence the elected official to enact the legal restrictions of PGAC to reflect - the will of their voters (Ref, Ref).
Rejection of the Mainstream Expert Consensus: Scientific illiteracy and innumeracy of the public can prevent its members from properly evaluating the quality of evidence that forms the basis of the consensus among mainstream experts. Consequently, the public might reject the validity of such consensus and renounce the authority of the mainstream experts - particularly when they contradict public’s long-held biases. This may be followed by the uncritical acceptance of the false claims based on incorrect premises that are presented by the “alternative experts’ - since the public’s limited scientific literacy hinders its ability to spot the errors underlaying these faulty assertions (Ref).
Promotion of Popular but Scientifically Invalid Solutions. Scientific illiteracy can taint the public opinion resulting in the acceptance and subsequent proliferation of the concepts that are scientifically incorrect but are favored by the public due to tradition or cultural preferences popular among the lay public (Ref).
“RELIGIOUS ZEALOTRY”. According to numerous Left Wing pundits the “religious zealotry” of the Right Wingers is one of the most pervasive and effective mechanism responsible for the opposition towards PGAC. (Ref, Ref). Religious zealotry undermines the acceptance of PGAC through numerous ways including:
Stigmatization: Left Wing PGAC advocates propound that extreme religious views contribute to the stigmatization of transgender youth, by portraying gender diversity as morally wrong, unnatural, sinful and blasphemous. Such framing of the transgender identity lead to increased discrimination and social ostracism for these individuals - while labeling the PGAC as “the sin and blasphemy enabling tool” (Ref, Ref).
Policy Influence: In certain states the religious zealotry can influence policymakers even more than secular public opinion. Under such influence the legislators enact laws that restrict access to PGAC typically based on moral/religious grounds rather than relying on scientific evidence. (Ref, Ref)
Healthcare Provider Bias: Left Wing proponents of PGAC worry that healthcare providers influenced by religious zealotry may refuse to offer PGAC or may provide substandard care due to their strong religious beliefs. (Ref, Ref)
Family Rejection: Left Wing PGAC advocates warn that families influenced by “extreme” religious beliefs may reject their transgender children or refuse to consent to PGAC (Ref, Ref).
Barriers to Education and Awareness: Many Left Wing pundits favoring PGAC have been recently sounding the alarm due to their concerns that recent outbursts of the reactionary religious zealotry create barriers to comprehensive education and awareness about transgender issues, perpetuates ignorance and misunderstanding about the needs and experiences of transgender youth. (Ref, Ref, Ref).
TRANSPHOBIA (TRANSMISIA) - Many Left Wing PGAC promoters claim the transphobia (now being renamed by the Left Wing experts as “transmisia”) is the common denominator of virtually all Right Wing false claims about that medical paradigm (Ref). Left Wing experts define “Transphobia” as “a prevalent and structural form of oppression and aggression against transgender and gender-diverse people, often based on fallacious or distorted claims from right-wing sources”(Ref, Ref, Ref, Ref). They further claim that transphobia manifests itself in various forms of stigma, prejudice, harassment, exclusion, and violence that negatively affect the well-being, dignity, and human rights of transgender and gender-diverse people including their access to PGAC. The PGAC advocates posit that transphobia undermines in the overt and latent way - the scientific validity and clinical efficacy of PGAC. Those activists make frequent calls about protecting and supporting transgender and gender-diverse individuals from being denied access to PGAC by their Right Wing transphobic persecutors (Ref, Ref, Ref). There are recent proposals to use the term Transmisia (the suffix -”misia”means “hatred”) in place of transphobia - because transphobia means literally “fear of the transgender people” and the Left Wing activists point out that this term became the misnomer - since it is currently used to denote primarily the hatred of transgender individuals and not the fear of them (Ref, Ref, Ref).
BIGOTRY. Next to transphobia - the “bigotry” is the second most commonly invoked by Left Wing PGAC advocates - factor that severely undermines the acceptance of PGAC. Left Wing PGAC advocates point out that vast majority of Right Wing political groups involved in legislative efforts aimed at banning of PGAC - typically cite concerns about the long-term effects and the irreversibility of such treatments. However, in opinion of those PGAC advocates such efforts are in reality rooted in bigotry and reflect a lack of understanding of transgender issues. (Ref, Ref, Ref).
RECKLESS CHILD ABUSE. Certain Left Wing PGAC advocates bring the attention to the following paradox: On one hand, many Right Wing associated groups critical of PGAC compare this modality to “child abuse” (Ref, Ref). However, ironically the mainstream medicine asserts that the prohibition of PGAC constitute a form of child abuse (Ref, Ref, Ref, Ref). This opinion has been echoed by the PGAC supportive legislator who stated that denying access to this treatment was "tantamount to torture" (Ref, Ref). This characterization of banning PGAC as a form of child abuse can be explained by highlighting the following consequences of such legislative efforts:
Denial of Essential Care: PGAC is considered essential by major medical organizations for the well-being of transgender youth. Denying this care can lead to significant psychological distress and increased risk of suicide and depression. Thus, the prohibition of access to PGAC is seen as a form of medical neglect, which is a recognized category of child abuse. (Ref)
Emotional Harm: The rhetoric used in campaigns against PGAC often involves language that delegitimizes the identities of transgender youth, which can contribute to stigma, discrimination, and emotional harm. This can be seen as a form of emotional abuse, as it directly impacts the mental health and self-esteem of these individuals. (Ref)
HYPOCRISY. The Left Wing PGAC advocates invoke quite eagerly the claim that the hypocrisy of Right Wing PGAC critics is simply unbearable. Those Left Wing commenters note that many Right Wing PGAC contrarians declare that they are motivated by the desire to adhere to the objective “truth”. The Left Wing pundits taunts activists who made such lofty declarations by arguing - that consistency with that self imposed rule - those Right Wingers should also call the married women ONLY by their birth not husband name - since the truth is that they were not born with this name. The usage of any nicknames shall be banned. Citizenships should never be changed. All plastic surgery should be outlawed as well. By following the “adherence to the truth” principle - all those scenarios constitute the “denial of reality”. Such sarcastic comments by the Left Wing Influencers are obviously rather satirical in nature. However, other more serious Left Wing pundits describe the negative impact of what they consider to be the Right Wing hypocrisy in much more sober and serious fashion. They claim that the hypocrisy of some Right Wing critics of PGAC are not a laughing matter. And that such shameless hypocrisy can negatively impact patients and healthcare practices in the following ways:
Contradiction with Personal Freedom: Some conservative values emphasize personal freedom and parental rights. However, efforts to ban PGAC contradict these principles by limiting the ability of parents and transgender youth to make decisions about their own healthcare. (Ref)
Inconsistent Application of Medical Standards: While some Right Wing PGAC adverse groups may advocate to “follow the science” by adhering to principles of evidence-based medicine - there is a selective dismissal of the substantial body of evidence supporting the benefits of PGAC. This obviously hypocritical “selective skepticism” undermines the credibility of medical professionals and organizations that endorse these treatments. (Ref, Ref)
Misrepresentation of Scientific Evidence: The portrayal of PGAC as experimental or harmful by some conservatives ignores the consensus among major medical organizations about its efficacy and necessity. This misrepresentation can lead to policies that are not grounded in the best interests of patients. (Ref)
Impact on Physician Autonomy: Efforts to legislate against PGAC can interfere with the physician-patient relationship by imposing legal constraints on doctors’ ability to provide care, despite their medical judgment and the established standards of care. (Ref)
In the view of the above robust criticism PGAC advocates demand that PGAC -skeptics should cease and desist immediately their opposition to this modality. As could be easily guessed - the Right Wing PGAC-skeptics were unfazed by this Left Wing criticism. They keep condemning PGAC without any compromise. Despite this discussed previously Power Asymmetry between Left and Right Wing - both sides are locked in the never-ending Stalemate.
CONCLUSIONS
Recently many European countries have modified their approach to PGAC. The changes in the European policies related to the PGAC have been perceived by some Right Wing affiliated PGAC skeptics as the opportunity to persuade their Left Wing opponents to change their mind about PGAC.
Outwardly the strategy builded around the claim that - the progressive European Countries whose scientists pioneered the PGAC concept are now abandoning it - appeared to be very promising to achieve the above goal.
Unfortunately, as it has been argued in this paper the several sine qua non conditions necessary for the success of this strategy have not been met. Specifically, the underlying narratives of this strategy were not aligned with reality. Moreover, the results of the European research studies that are being conducted as a part of the changed approach to PGAC will most likely yield the unfavorable for the PGAC skeptics results. Finally, the science alone cannot settle the PGAC debate - because the underlying it most essential argument is of the religious and not scientific nature.