Why ‘Gender-Affirming’ Language is So Dangerous for Children

Earlier this month, the Department of Health and Human Services (HHS) issued its landmark review of the evidence and ethics behind sex change interventions to treat gender dysphoria in children. 

The review, among other things, makes the compelling case that the terminology employed by advocates for child sex change interventions implicitly assumes the benefits of these interventions. “Gender-affirming care,” for instance, has a positive connotation, whereas terms like “bottom surgery” obscure the grisly nature of the actual procedure, removal of the testicles with degloving and inversion of the penis.

This language, the HHS report argues, precludes an honest assessment of the harms associated with child sex change interventions, and leads to a dangerous clinical protocol.

Take the insistence of using “assigned sex” rather than simply sex. Here’s what the HHS report authors write:

“Assigned sex at birth” is not a harmless euphemism. It suggests an arbitrary decision— not unlike “assigned seating”—rather than the observation of a characteristic present long before birth, namely the child’s sex. Moreover, if the phrase “assigned sex” were intended merely as a gentler way of referring to sex in conversations with patients and families, one would expect more direct language to be used in the specialty medical literature. In professional contexts, where clarity is paramount, euphemisms are generally avoided. Yet “assigned sex” is ubiquitous in clinical and academic publications. Not only that: use of such terminology is now mandated by certain medical journals. The American Psychological Association (APA) style guide, for example, classifies “birth sex” and “natal sex” as “disparaging terms” which problematically “imply that sex is an immutable characteristic.” As law professor Jessica Clarke observes, “‘Sex assigned at birth’ is not a euphemism for ‘biological sex’ but a critique of the very concept.”

The logic is simple: by using language that “affirms” the patient’s belief that they are the opposite sex while avoiding language that accurately reflects biological reality, physicians are already accepting the initial premises of “gender-affirming care.” These terms reinforce the idea that medical intervention is necessary to “affirm” the patient’s self-conception, which need not be grounded in any physical truth.

This practice is a linguistic sleight-of-hand that is antithetical to honest scientific inquiry and, therefore, the actual interests of the patient. Instead, it uses ideological shibboleths to enforce a particular course of medical intervention.

Apparently, not everyone got the HHS memo. 

A new article published in the Journal of the American Medical Association (JAMA) argues that clinicians should use “affirming language” when treating patients experiencing gender distress, and that failing to do so can literally endanger their lives. These efforts include promoting “the use of pronoun-inclusive name tags, gender-neutral bathrooms, and ‘all are welcome’ signage”

“Affirming language is something all clinicians can use to honor patients’ experiences and protect their dignity,” the authors argue. “Every clinician can express empathy. No executive order can prevent a clinician from ensuring transgender patients seeking care feel heard and understood. Now more than ever, silence may be construed as support for antitransgender policies, stoking the fear patients are already experiencing.”

As it pertains to children, this is exactly backwards. 

Obscuring the actual nature of a child’s condition and using terms that implicitly assume medicalization and transition are the only acceptable courses of action is not “empathy” and does not “honor” patients’ experience.

Instead, using these terms constitutes a dereliction of duty and is incompatible with the foundational principles of medical ethics.

So-called “gender-affirming care” for minors is not supported by the weight of existing evidence. The Cass Review, an exhaustive review of gender medical services in the United Kingdom, found “remarkably weak evidence” to support the use of puberty blockers and hormone treatments for gender-distressed children. Reviews conducted in Finland and Sweden reached the same conclusion.

Additionally, many of the most frequently cited studies supporting so-called “gender-affirming care” for minors are rife with methodological limitations. Countries including the United Kingdom, Sweden, Belgium, France, Italy, Australia, New Zealand, Argentina, Brazil and Finland have each restricted minors’ access to these procedures.

Thus, using this coerced language that effectively begins the social transition and medicalization process is tacit encouragement of these dangerous and experimental procedures. 

The approach recommended by the authors of the JAMA commentary is reckless activism masquerading as empathy and inclusion.

Also, notice the phrasing: “silence may be construed as support for antitransgender policies.” Reminiscent of the “silence equals violence” refrain, the authors are effectively arguing that failure to affirmatively use “affirming language” is bigoted and even dangerous.

This seems like a statement from individuals more concerned with a political agenda than an honest and thorough examination of the evidence.

“Gender-affirming communication can preserve the sacredness of patient-clinician relationships and, although it does not replace the need for advocacy, this quiet intervention may save lives,” the authors continue, reinforcing this point.

In addition to these troubling statements, the authors of the JAMA commentary make several claims that reveal an agenda less concerned with scientific evidence and more concerned with ideology.

These include claims that there is “scientific evidence to the contrary” that there are two unchangeable biological sexes. Curiously, this claim is not supported by a citation pointing to the “scientific evidence” that would dispute this fact.

Moreover, the JAMA commentary makes the claim that the “empathy and validation of just one accepting health care professional can cut the risk of transgender youth suicide by more than 30%,” citing a 2023 study.

The method the cited study used to collect this information, however, was an anonymous online survey that did not collect identifying information, and participants were recruited through Facebook and Instagram ads “targeting those who interacted with LGBTQ-related content.” Additionally, “[y]outh who completed the survey were eligible to be entered into a drawing for a $50 gift card by providing their email addresses after being routed to a separate survey.” 

It’s plainly obvious that this recruitment method introduces significant selection bias, undermining the study’s validity.

Medicine should be grounded in scientific evidence, not ideology, and physicians should communicate with their patients in order to best meet their medical needs.

“Gender-affirming” language is hostile to this goal.