It was obvious that gender transitions for minors were a bad idea. Why did it take so long for medical associations to say so?
As the Berlin Wall fell in 1989, many observers were shocked to see East German residents, once seemingly so loyal to their Communist government, cheering in the streets. Economist Timur Kuran dubbed the phenomenon a “preference cascade.” When people are pressured to conform, he wrote, they will hide their true beliefs for fear of censure or worse. And, since no one knows how many other people might share their heretical views, no one speaks up—until some rupture gives people the freedom to express their true preferences. Then the whole society seems to pivot at once; suddenly everyone admits the emperor has no clothes.
In recent weeks, a kind of preference cascade has begun sweeping through the thorny field of youth gender medicine. In her Free Expression column yesterday, Louise Perry told the story of Fox Varian, the young woman who recently won a landmark lawsuit against the psychologist and plastic surgeon who she believes rushed her into a double mastectomy at 16. At the time of surgery, Ms. Varian was convinced she would be happier as a boy. Those feelings passed, but too late to reverse the effects of her “gender-affirming care.”
For almost two decades, leading medical organizations have upheld puberty-blocking drugs, cross-sex hormones, and sometimes even surgery as appropriate care for young people suffering from gender dysphoria. Ms. Perry compares these drastic interventions with the lobotomies performed on mentally ill patients during the mid-20th century. In both cases, these treatments came to be accepted despite shockingly little evidence that their claimed benefits outweighed their harms.
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James B. Meigs is a senior fellow at the Manhattan Institute and a City Journal contributing editor.
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