Allow children to transition, or they will kill themselves. For more than a decade, this has been the strongest argument in favor of youth gender medicine—a scenario so awful that it stifled any doubts or questions about puberty blockers and cross-sex hormones.
允许孩子过渡，否则他们会自杀。十多年来，这一直是对青年性别医学的最有力的论点 - 这种情况非常可怕，以至于扼杀了有关青春期阻滞剂和跨性别激素的任何疑问或疑问。
“We often ask parents, ‘Would you rather have a dead son than a live daughter?’” Johanna Olson-Kennedy of Children’s Hospital Los Angeles once explained to ABC News. Variations on the phrase crop up in innumerable media articles and public statements by influencers, activists, and LGBTQ groups. The same idea—that the choice is transition or death—appeared in the arguments made by Elizabeth Prelogar, the Biden administration’s solicitor general, before the Supreme Court last year. Tennessee’s law prohibiting the use of puberty blockers and cross-sex hormones to treat minors with gender dysphoria would, she said, “increase the risk of suicide.”
“我们经常问父母，‘你宁愿有一个死儿子，也不愿意一个活着的女儿吗？’”洛杉矶儿童医院的约翰娜·奥尔森·肯尼迪曾经向美国广播公司新闻解释。影响者，激进主义者和LGBTQ组的无数媒体文章和公开声明中的短语变化。去年在最高法院之前，拜登政府总检察长伊丽莎白·普雷格尔（Elizabeth Prelogar）提出的论点伊丽莎白·普雷格尔（Elizabeth Prelogar）在最高法院提出的论点中表达了同样的想法。她说，田纳西州的法律禁止使用青春期阻滞剂和跨性别荷尔蒙以性别烦躁不安治疗未成年人，她说：“增加自杀的风险。”
But there is a huge problem with this emotive formulation: It isn’t true. When Justice Samuel Alito challenged the ACLU lawyer Chase Strangio on such claims during oral arguments, Strangio made a startling admission. He conceded that there is no evidence to support the idea that medical transition reduces adolescent suicide rates.
但是这种情感表述存在一个巨大的问题：这不是真的。当塞缪尔·阿利托（Samuel Alito）大法官在口头辩论期间对此类主张提出挑战时，奇怪的人令人震惊。他承认，没有证据支持医疗过渡会降低青少年自杀率的想法。
At first, Strangio dodged the question, saying that research shows that blockers and hormones reduce “depression, anxiety, and suicidality”—that is, suicidal thoughts. (Even that is debatable, according to reviews of the research literature.) But when Alito referenced a systematic review conducted for the Cass report in England, Strangio conceded the point. “There is no evidence in some—in the studies that this treatment reduces completed suicide,” he said. “And the reason for that is completed suicide, thankfully and admittedly, is rare, and we’re talking about a very small population of individuals with studies that don’t necessarily have completed suicides within them.”
起初，Strangio躲过了这个问题，称研究表明阻滞剂和激素减少了“抑郁，焦虑和自杀性”，即自杀思想。（即使这是有争议的，根据研究文献的评论。）但是，当Alito引用了为英格兰的CASS报告进行的系统审查时，Strangio承认了这一点。他说：“有些人没有证据表明这种治疗可以减少自杀。”“而且，诚然且公认的自杀原因很少见，我们正在谈论的是，很少有研究的人不一定已经完成了他们的自杀。”
Here was the trans-rights movement’s greatest legal brain, speaking in front of the nation’s highest court. And what he was saying was that the strongest argument for a hotly debated treatment was, in fact, not supported by the evidence.
这是跨权利运动最大的法律大脑，在美国最高法院面前讲话。他所说的是，实际上，最激烈的辩论待遇的论点不是证据的支持。
Read: The Democrats need an honest conversation on gender identity
阅读：民主党需要就性别认同进行诚实的对话
Even then, his admission did not register with the liberal justices. When the court voted 6–3 to uphold the Tennessee law, Sonia Sotomayor claimed in her dissent that “access to care can be a question of life or death.” If she meant any kind of therapeutic support, that might be defensible. But claiming that this is true of medical transition specifically—the type of care being debated in the Skrmetti case—is not supported by the current research.
即使那样，他的承认也没有向自由大法官注册。当法院以6-3投票以维护田纳西州法律时，索尼亚·索托马约尔（Sonia Sotomayor）在她的异议中声称“获得护理可能是生死问题”。如果她的意思是任何类型的治疗支持，那可能是可以防御的。但是，特别是对医疗过渡是正确的（在SKRMETTI案中辩论的医疗类型）的情况，这是当前研究的支持。
Advocates of the open-science movement often talk about “zombie facts”—popular sound bites that persist in public debate, even when they have been repeatedly discredited. Many common political claims made in defense of puberty blockers and hormones for gender-dysphoric minors meet this definition. These zombie facts have been flatly contradicted not just by conservatives but also by prominent advocates and practitioners of the treatment—at least when they’re speaking candidly. Many liberals are unaware of this, however, because they are stuck in media bubbles in which well-meaning commentators make confident assertions for youth gender medicine—claims from which its elite advocates have long since retreated.
开放科学运动的拥护者经常谈论“僵尸事实”，即使在反复抹黑的情况下，人们仍然会叮咬公众辩论。为捍卫青春期阻滞剂和荷尔蒙的许多普通政治主张符合这个定义。这些僵尸事实不仅与保守派，而且是著名的倡导者和待遇者都平淡无奇地矛盾，至少在他们坦率地讲话时。但是，许多自由主义者并没有意识到这一点，因为他们被困在媒体泡沫中，在这种媒体泡沫中，善意的评论员对青年性别医学发表了自信的主张，这是其精英倡导者自从撤退以来就早已撤退的。
Perhaps the existence of this bubble shouldn’t be surprising. Many of the most fervent advocates of youth transition are also on record disparaging the idea that it should be debated at all. Strangio—who works for the country’s best-known free-speech organization—once tweeted that he would like to scuttle Abigail Shrier’s book Irreversible Damage, a skeptical treatment of youth gender medicine. Strangio declared, “Stopping the circulation of this book and these ideas is 100% a hill I will die on.” Marci Bowers, the former head of the World Professional Association for Transgender Health (WPATH), the most prominent organization for gender-medicine providers, has likened skepticism of child gender medicine to Holocaust denial. “There are not two sides to this issue,” she once said, according to a recent episode of The Protocol, a New York Times podcast.
也许这种泡沫的存在不足为奇。许多最热心的青年过渡的拥护者也在记录下贬低了应该对其进行辩论的想法。奇怪的人是该国最著名的自由言论组织的工作，他一条推文说，他想破坏阿比盖尔·索里尔（Abigail Shrier）的书不可逆转的损害，这是对青年性别医学的怀疑待遇。Strangio宣称：“停止了这本书的发行，这些想法是100％我会死的山丘。”世界上最杰出的性别医学医学提供者组织的世界跨性别健康协会（WPATH）的前负责人马西·鲍尔斯（Marci Bowers）将儿童性别医学的怀疑比喻为大屠杀的怀疑。她曾经说：“这个问题没有两个方面。”
Boasting about your unwillingness to listen to your opponents probably plays well in some crowds. But it left Strangio badly exposed in front of the Supreme Court, where it became clear that the conservative justices had read the most convincing critiques of hormones and blockers—and had some questions as a result.
吹嘘自己不愿听你的对手可能在一些人群中表现良好。但是，这使奇怪的事物严重暴露在最高法院的面前，在那里很明显，保守派法官读了对激素和阻滞剂最具说服力的批评，因此有一些疑问。
Trans-rights activists like to accuse skeptics of youth gender medicine—and publications that dare to report their views—of fomenting a “moral panic.” But the movement has spent the past decade telling gender-nonconforming children that anyone who tries to restrict access to puberty blockers and hormones is, effectively, trying to kill them. This was false, as Strangio’s answer tacitly conceded. It was also irresponsible.
跨权利的活动家喜欢指责怀疑论者对青年性别医学以及敢于报告其观点的出版物，引起了“道德恐慌”的影响。但是，在过去的十年中，这一运动一直在告诉性别不合格的孩子，任何试图限制进入青春期阻滞剂和荷尔蒙的人的人实际上都是试图杀死他们的。这是错误的，正如Strangio的回答默认承认的那样。这也是不负责任的。
After England restricted the use of puberty blockers in 2020, the government asked an expert psychologist, Louis Appleby, to investigate whether the suicide rate for patients at the country’s youth gender clinic rose dramatically as a result. It did not: In fact, he did not find any increase in suicides at all, despite the lurid claims made online. “The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide,” Appleby reported. “One risk is that young people and their families will be terrified by predictions of suicide as inevitable without puberty blockers.”
英格兰在2020年限制了青春期阻滞剂的使用后，政府要求一名专家心理学家路易斯·阿普比（Louis Appleby）调查该国青年性别诊所的患者自杀率是否急剧上升。它没有：实际上，尽管在网上提出了Lurid的说法，但他根本没有发现自杀。Appleby报道：“在社交媒体上讨论这个问题的方式不敏感，令人沮丧和危险，并违反了关于自杀安全报告的指导。”“一种风险是，年轻人及其家人将因自杀的预测而感到恐惧，因为没有青春期阻滞剂。”
When red-state bans are discussed, you will also hear liberals say that conservative fears about the medical-transition pathway are overwrought—because all children get extensive, personalized assessments before being prescribed blockers or hormones. This, too, is untrue. Although the official standards of care recommend thorough assessment over several months, many American clinics say they will prescribe blockers on a first visit.
当讨论红色状态禁令时，您还会听到自由主义者说，对医疗过渡途径的保守恐惧是劳累的，因为所有儿童都会在被开制的阻滞剂或激素之前接受广泛的个性化评估。这也是不真实的。尽管官方护理标准建议在几个月内进行彻底评估，但许多美国诊所表示，他们将在首次访问时开处方阻滞剂。
This isn’t just a matter of U.S. health providers skimping on talk therapy to keep costs down; some practitioners view long evaluations as unnecessary and even patronizing. “I don’t send someone to a therapist when I’m going to start them on insulin,” Olson-Kennedy told The Atlantic in 2018. Her published research shows that she has referred girls as young as 13 for double mastectomies. And what if these children later regret their decision? “Adolescents actually have the capacity to make a reasoned logical decision,” she once told an industry seminar, adding: “If you want breasts at a later point in your life, you can go and get them.”
这不仅仅是美国卫生提供者浏览谈话疗法以降低成本的问题。一些从业者认为长期的评估是不必要的，甚至是光顾的。奥尔森·肯尼迪（Olson-Kennedy）在2018年告诉《大西洋》（Atlantic）。她的出版研究表明，她将年轻的女孩称为13岁，即双乳腺切除术。如果这些孩子后来后悔他们的决定怎么办？她曾经对一个行业研讨会说：“青少年实际上有能力做出合理的逻辑决定，并补充说：“如果您想在生活中的稍后时刻乳房，就可以去买它们。”
Perhaps the greatest piece of misinformation believed by liberals, however, is that the American standards of care in this area are strongly evidence-based. In fact, at this point, the fairest thing to say about the evidence surrounding medical transition for adolescents—the so-called Dutch protocol, as opposed to talk therapy and other support—is that it is weak and inconclusive. (A further complication is that American child gender medicine has deviated significantly from this original protocol, in terms of length of assessments and the number and demographics of minors being treated.) Yes, as activists are keen to point out, most major American medical associations support the Dutch protocol. But consensus is not the same as evidence. And that consensus is politically influenced.
但是，自由主义者认为的最大的错误信息可能是，这一领域的美国护理标准是基于证据的。实际上，在这一点上，关于青少年医疗过渡的证据（所谓的荷兰议定书，而不是谈话疗法和其他支持），最公平的话是薄弱且尚无定论。（另一个并发症是，就评估的时间和未接受治疗的未成年人的数量和人口统计而言，美国儿童性别医学已经与该原始方案显着偏离。）是的，正如激进主义者渴望指出的那样，大多数美国主要的医疗协会都支持荷兰协议。但是共识与证据不同。这一共识在政治上受到影响。
Rachel Levine, President Joe Biden’s assistant secretary for health and human services, successfully lobbied to have age minimums removed for most surgeries from the standards of care drawn up by WPATH. That was a deeply political decision—Levine, according to emails from her office reviewed by the Times, believed that listing any specific limits under age 18 would give opponents of youth transition hard targets to exploit.
乔·拜登（Joe Biden）卫生与公共服务助理部长雷切尔·莱文（Rachel Levine）成功游说，从WPATH得出的护理标准中，大多数手术都取消了年龄的最低年龄。这是一个严重的政治决定 - 根据《泰晤士报》审查的办公室的电子邮件，院子里认为，列出18岁以下的任何特定限制将使对抗青年过渡的艰难目标的反对者利用。
More recently, another court case over banning blockers and hormones, this time in Alabama, has revealed that WPATH members themselves had doubts about their own guidelines.
最近，这次在阿拉巴马州禁止阻止者和激素的另一个法院案件透露，WPATH成员本身对自己的准则有疑问。
Read: Young trans children know who they are
阅读：年轻的跨性别孩子知道他们是谁
In 2022, Alabama passed a law criminalizing the prescription of hormones and blockers to patients under 19. After the Biden administration sued to block the law, the state’s Republican attorney general subpoenaed documents showing that WPATH has known for some time that the evidence base for adolescent transition is thin. “All of us are painfully aware that there are many gaps in research to back up our recommendations,” Eli Coleman, the psychologist who chaired the team revising the standards of care, wrote to his colleagues in 2023. Yet the organization did not make this clear in public. Laura Edwards-Leeper—who helped bring the Dutch protocol to the U.S. but has since criticized in a Washington Post op-ed the unquestioningly gender-affirmative model—has said that the specter of red-state bans made her and her op-ed co-author reluctant to break ranks.
2022年，阿拉巴马州通过了一项法律，将激素和阻滞剂的处方定为19岁以下的患者。在拜登政府起诉阻止法律后，该州的共和党总检察长向法律进行了传唤文件，表明WPATH已知道一段时间以来，一段时间以来，青少年过渡的证据基础很薄。“我们所有人都痛苦地意识到，研究中有很多差距来支持我们的建议，”主持团队修改护理标准的心理学家埃利·科尔曼（Eli Coleman）在2023年写信给他的同事。但该组织并未公开表明这一点。劳拉·爱德华兹·莱珀（Laura Edwards-Leeper）（他帮助将荷兰议定书带到美国），但此后在华盛顿邮报（Washington Post）批评的是毫无疑问的性别肯定的模式中，他说，红色状态禁令的幽灵使她和她的专家同事不愿意休息。
The Alabama litigation also confirmed that WPATH had commissioned systematic reviews of the evidence for the Dutch protocol. However, close to publication, the Johns Hopkins University researcher involved was told that her findings needed to be “scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender health care.” This is not how evidence-based medicine is supposed to work. You don’t start with a treatment and then ensure that only studies that support that treatment are published. In a legal filing in the Alabama case, Coleman insisted “it is not true” that the WPATH guidelines “turned on any ideological or political considerations” and that the group’s dispute with the Johns Hopkins researcher concerned only the timing of publication. Yet the Times has reported that at least one manuscript she sought to publish “never saw the light of day.”
阿拉巴马州的诉讼还证实，WPATH已委托对荷兰议定书的证据进行系统的审查。但是，接近出版物，约翰·霍普金斯大学的研究人员被告知，她的发现需要“审查和审查，以确保出版物不会对跨性别医疗保健的提供不会产生负面影响。”这不是循证医学应该如何工作的方式。您不会从治疗开始，然后确保仅发表支持该治疗的研究。在阿拉巴马州案件中的法律申请中，科尔曼坚持认为，《 WPATH指南》“开启了任何意识形态或政治考虑”，并且该组织与约翰·霍普金斯研究人员的争议仅涉及出版时间。然而，《泰晤士报》报道说，至少她试图出版的手稿“从未见过一天”。
The Alabama disclosures are not the only example of this reluctance to acknowledge contrary evidence. Last year, Olson-Kennedy said that she had not published her own broad study on mental-health outcomes for youth with gender dysphoria, because she worried about its results being “weaponized.” That raised suspicions that she had found only sketchy evidence to support the treatments that she has been prescribing—and publicly advocating for—over many years.
阿拉巴马州的披露不是这种不愿承认相反证据的唯一例子。去年，奥尔森·肯尼迪（Olson-Kennedy）说，她没有出版自己的关于性别烦躁不安青年的心理健康成果的广泛研究，因为她担心其结果“武器化”。这引起了人们的怀疑，她只发现了只有粗略的证据来支持她开处方并公开倡导多年的治疗方法。
Last month, her study finally appeared as a preprint, a form of scientific publication where the evidence has not yet been peer-reviewed or finalized. Its participants “demonstrated no significant changes in reported anxious/depressed, withdrawn/depressed, somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing problems or externalizing problems” in the two years after starting puberty blockers. (I have requested comment from Olson-Kennedy via Children’s Hospital Los Angeles but have not yet heard back.)
上个月，她的研究终于以预印本出现，这是一种科学出版物的一种形式，尚未经过同行评审或最终确定证据。在开始青春期阻滞剂后的两年中，它的参与者“表现出报告的焦虑/沮丧，撤回/沮丧，抑郁，抑郁，躯体抱怨，社会问题，思想问题，侵略性行为，内部化问题或外在问题的重大变化”。（我已通过洛杉矶儿童医院向奥尔森·肯尼迪（Olson-Kennedy）发表评论，但尚未回音。）
The reliance on elite consensus over evidence helps make sense of WPATH’s flatly hostile response to the Cass report in England, which commissioned systematic reviews and recommended extreme caution over the use of blockers and hormones. The review was a direct challenge to WPATH’s ability to position itself as the final arbiter of these treatments—something that became more obvious when the conservative justices referenced the British document in their questions and opinions in Skrmetti. One of WPATH’s main charges against Hilary Cass, the senior pediatrician who led the review, was that she was not a gender specialist—in other words, that she was not part of the charmed circle who already agreed that these treatments were beneficial.
对精英共识而不是证据的依赖有助于理解WPATH对英格兰CASS报告的敌对反应，该报告委托系统的审查并建议对使用阻滞剂和激素的使用极为谨慎。该评论是Wpath将自己定位为这些治疗方法的最终仲裁者的能力的直接挑战 - 当保守派法官在Skrmetti的问题和观点中引用英国文件时，这变得更加明显。领导该评论的高级儿科医生希拉里·卡斯（Hilary Cass）的主要指控之一是，她不是性别专家，换句话说，她不是魅力的圈子的一部分，她已经同意这些治疗方法是有益的。
Read: Britain is leaving the U.S. gender-medicine debate behind
阅读：英国正在离开美国性别 - 医学辩论
Because of WPATH’s hostility, many on the American left now believe that the Cass review has been discredited. “Upon first reading, especially to a person with limited knowledge of the history of transgender health care, much of the report might seem reasonable,” Lydia Polgreen wrote in the Times last August. However, after “poring over the document” and “interviewing experts in gender-affirming care,” Polgreen realized that the Cass review was “fundamentally a subjective, political document.”
由于WPATH的敌意，许多美国人离开了，现在相信CASS的评论已被抹黑。莉迪亚·波格林（Lydia Polgreen）在去年八月的《泰晤士报》上写道：“一读时，特别是对于对跨性别医疗保健历史有限的人来说，大部分报告似乎是合理的。”但是，在“浏览该文件”和“采访性别肯定护理专家”之后，Polgreen意识到CASS的评论是“从根本上讲是一个主观的，政治文件”。
Advocates of youth gender medicine have reacted furiously to articles in the Times and elsewhere that take Cass’s conclusions seriously. Indeed, some people inside the information bubble appear to believe that if respectable publications would stop writing about this story, all the doubts and questions—and Republican attempts to capitalize on them electorally—would simply disappear. Whenever the Times has published a less-than-cheerleading article about youth transition, supporters of gender medicine have accused the newspaper of manufacturing a debate that otherwise would not exist. After the Skrmetti decision, Strangio was still describing media coverage of the issue as “insidious,” adding: “The New York Times, especially, has been fixated on casting the medical care as being of an insufficient quality.”
青年性别医学的拥护者对《时代》和其他地方的文章做出了巨大反应，这些文章认真对待了CASS的结论。的确，信息泡沫中的某些人似乎相信，如果可观的出版物将停止写这个故事，所有疑问和问题以及共和党试图在选举上利用它们的试图消失。每当《泰晤士报》发表一篇关于青年过渡的文章不那么挑剔的文章时，性别医学的支持者都会指责该报纸制造一场辩论，否则就不存在。在SKRMETTI决定之后，Strangio仍将媒体报道描述为“阴险”，并补充说：“尤其是《纽约时报》，人们一直致力于对医疗保健的质量不足”。
Can this misinformation bubble ever be burst? On the left, support for youth transition has been rolled together with other issues—such as police reform and climate activism—as a kind of super-saver combo deal of correct opinions. The 33-year-old democratic socialist Zohran Mamdani has made funding gender transition, including for minors, part of his pitch to be New York’s mayor. But complicated issues deserve to be treated individually: You can criticize Israel, object to the militarization of America’s police forces, and believe that climate change is real, and yet still not support irreversible, experimental, and unproven medical treatments for children.
这个错误信息泡沫可以爆发吗？在左边，对青年过渡的支持与其他问题（例如警察改革和气候行动主义）一起融为一体，这是一种超级保证的合作交易。现年33岁的民主党社会主义者佐兰·曼达尼（Zohran Mamdani）进行了资助性别转变，其中包括未成年人，他成为纽约市长的一部分。但是复杂的问题应该受到分别的治疗：您可以批评以色列，反对美国警察部队的军事化，并认为气候变化是真实的，但仍然不支持对儿童的不可逆，实验性和未经证实的医疗治疗。
The polarization of this issue in America has been deeply unhelpful for getting liberals to accept the sketchiness of the evidence base. When Vice President J. D. Vance wanted to troll the left, he joined Bluesky—where skeptics of youth gender medicine are among the most blocked users—and immediately started talking about the Skrmetti judgment. Actions like that turn accepting the evidence base into a humiliating climbdown.
在美国，这个问题的两极分化对于让自由主义者接受证据基础的粗略性是无益的。当副总统J. D. Vance想拖延左派时，他加入了蓝调人（青年性别医学的怀疑论者是最受阻碍的用户之一），并立即开始谈论Skrmetti的判断。这样的行动将接受证据基础变成了屈辱的攀登。
Acknowledging the evidence does not mean that you also have to support banning these treatments—or reject the idea that some people will be happier if they transition. Cass believes that some youngsters may indeed benefit from the medical pathway. “Whilst some young people may feel an urgency to transition, young adults looking back at their younger selves would often advise slowing down,” her report concludes. “For some, the best outcome will be transition, whereas others may resolve their distress in other ways.”
承认证据并不意味着您还必须支持禁止这些治疗方法，或者拒绝某些人过渡会更快乐的想法。卡斯认为，一些年轻人确实可以从医疗途径中受益。她的报告总结说：“尽管有些年轻人可能会感到过渡的紧迫性，但年轻人回顾自己的年轻自我通常会建议放慢脚步。”“对于某些人来说，最好的结果将是过渡，而其他人可能会以其他方式解决他们的困扰。”
I have always argued against straightforward bans on medical transition for adolescents. In practice, the way these have been enacted in red states has been uncaring and punitive. Parents are threatened with child-abuse investigations for pursuing treatments that medical professionals have assured them are safe. Children with severe mental-health troubles suddenly lose therapeutic support. Clinics nationwide, including Olson-Kennedy’s, are now abruptly closing because of the political atmosphere. Writing about the subject in 2023, I argued that the only way out of the culture war was for the American medical associations to commission reviews and carefully consider the evidence.
我总是反对对青少年医疗过渡的直接禁令。实际上，在红色国家制定的方式无视和惩罚性。父母受到儿童虐待调查的威胁，以寻求医疗专业人员保证他们是安全的治疗。严重的心理健康问题的儿童突然失去了治疗支持。包括奥尔森·肯尼迪（Olson-Kennedy）在内的全国诊所，由于政治氛围，现在突然关闭了。我在2023年写道，我认为，《文化战争》中唯一的途径是使美国医学协会委托审查并仔细考虑证据。
From the July/August 2018 issue: When children say they’re trans
从2018年7月/8月发行：当孩子们说他们是跨性别的时候
However, the revelations from Skrmetti and the Alabama case have made me more sympathetic to commentators such as Leor Sapir, of the conservative Manhattan Institute, who supports the bans because American medicine cannot be trusted to police itself. “Are these bans the perfect solution? Probably not,” he told me in 2023. “But at the end of the day, if it’s between banning gender-affirming care and leaving it unregulated, I think we can minimize the amount of harm by banning it.” Once you know that WPATH wanted to publish a review only if it came to the group’s preferred conclusion, Sapir’s case becomes more compelling.
但是，Skrmetti和Alabama案的启示使我对保守派曼哈顿研究所的Leor Sapir等评论员更加同情，他支持禁令，因为美国医学不能信任警察本身。他在2023年对我说：“这些禁令是完美的解决方案吗？可能不是，但归根结底，如果这是在禁止性别肯定和不受监管之间，我认为我们可以通过禁止它来最大程度地减少伤害。”一旦您知道Wpath只有在该小组的首选结论中才想发布评论，Sapir的案子就会变得更加引人注目。
Despite the concerted efforts to suppress the evidence, however, the picture on youth gender medicine has become clearer over the past decade. It’s no humiliation to update our beliefs as a result: I regularly used to write that medical transition was “lifesaving,” before I saw how limited the evidence on suicide was. And it took another court case, brought by the British detransitioner Keira Bell, for me to realize fully that puberty blockers were not what they were sold as—a “safe and reversible” treatment that gave patients “time to think”—but instead a one-way ticket to full transition, with physical changes that cannot be undone.
尽管努力抑制证据，但是在过去的十年中，关于青年性别医学的情况变得更加清晰。因此，更新我们的信念并不是屈辱：在我看到自杀证据的限制之前，我经常用来写医疗过渡是“救生”。由英国批评者凯拉·贝尔（Keira Bell）提出的另一个法院案件，使我完全意识到，青春期阻滞剂并不是他们被出售的东西 - 一种“安全且可逆的”待遇，使患者“有时间思考”，但相反，是一张完全过渡的机票，有着无法进行的身体变化。
Read: The attack on trans rights won’t end there
阅读：对跨性别权利的攻击不会结束
Some advocates for the Dutch protocol, as it’s applied in the United States, have staked their entire career and reputation on its safety and effectiveness. They have strong incentives not to concede the weakness of the evidence. In 2023, the advocacy group GLAAD drove a truck around the offices of The New York Times to declare that the “science is settled.” Doctors such as Olson-Kennedy and activists such as Strangio are unlikely to revise their opinions.
荷兰协议的一些倡导者在美国应用，在其安全性和有效性上都享有其整个职业生涯和声誉。他们有强烈的激励措施不承认证据的弱点。2023年，倡导组织格拉德（Glaad）在《纽约时报》（New York Times）办公室驾驶一辆卡车宣布“科学已经定居”。奥尔森·肯尼迪（Olson-Kennedy）和激进主义者等医生不太可能修改他们的观点。
For everyone else, however, the choice is still open. We can support civil-rights protections for transgender people without having to endorse an experimental and unproven set of medical treatments—or having to repeat emotionally manipulative and now discredited claims about suicide.
但是，对于其他所有人来说，选择仍然开放。我们可以支持对跨性别者的民权保护，而不必认可实验性和未经证实的医疗治疗组，或者必须重复情感上的操纵性，并且现在对自杀的主张。
I am not a fan of the American way of settling political disputes, by kicking them over to an escalating series of judges. But in the case of youth gender medicine, the legal system has provided clarity and disclosure that might otherwise not exist. Thanks to the Supreme Court’s oral questioning in Skrmetti and the discovery process in Alabama, we now have a clearer picture of how youth gender medicine has really been operating in the United States, and an uncomfortable insight into how advocacy groups and medical associations have tamped down their own concerns about its evidence base. Those of us who have been urging caution now know that many of our ostensible opponents had the same concerns. They just smothered them, for political reasons.
我不喜欢美国解决政治纠纷的方式，因为他们将他们踢到一系列不断升级的法官中。但是，就青年性别医学而言，法律制度提供了否则可能不存在的清晰度和披露。得益于最高法院在Skrmetti和阿拉巴马州的发现过程中的口头询问，我们现在更清楚地了解了青年性别医学在美国如何真正运作的方式，以及对倡导团体和医疗协会如何抑制其对证据基础的关注的不舒服见解。我们当中一直敦促谨慎的人现在知道，我们许多表面上的对手都有同样的担忧。出于政治原因，他们只是窒息了他们。
