How Gender-Affirming Care Is Like Infant Circumcision
Five arguments against gender-affirming interventions and how they apply to infant circumcision.
Transgender identification among Americans is up from 0.2% and 0.1% among traditionalists (<1946) and baby boomers (1946 - 1964), respectively, to 2.1% among Generation Z (1997 - 2003) (Jones, 2022). This explosion in trans identification and acceptance has come with a number of controversies, including whether trans people should be fully integrated into what were once sex-segregated spaces such as prisons, bathrooms, sports leagues, and so forth. Others have expressed concern about the massive increases in transgender identification among children and adolescents, especially young girls (see: Shrier, 2020).
Many outspoken critics of gender ideology express concern about what is referred to as gender-affirming care, which consists of social affirmation, puberty blockers, hormone therapy, and gender-affirming surgeries (OASH, 2022). Some of these concerns are:
Most minors lack the cognitive ability, knowledge, and life experience to make important medical decisions that have irreversible side effects.
Minors are making decisions that are permanently altering their sexual organs prior to ever having sexual intercourse or possibly even having sexual experiences whatsoever.
Minors are not fully developed in their physical appearance, and major aesthetic changes may not be necessary if they come to enjoy their future physical appearance.
Gender-affirming hormone treatment and surgeries are less than perfect and may result in unwanted complications.
Minors may not want this treatment if enough time passes.
Generally, we expect parents to promote their own children’s welfare, and there is a warranted societal norm of permitting parents to make choices for their children. However, in extreme circumstances, it is morally justified for the government to intervene to prevent a parent from harming their children. Almost everyone accepts that parents should not be allowed to abuse their children severely. The issue is that the extent to which you view puberty blockers, hormone treatment, and surgical interventions as harm depends on contentious moral and empirical assumptions. Some believe this treatment is life-saving, and some believe it is life-ruining.
If you share the above concerns about gender-affirming care, you should be sympathetic to some of the worries of intactivists—“people who campaign against involuntary, nontherapeutic genital modification, such as infant male circumcision.” Almost everyone in the Western world has moral objections to the non-consensual cutting of female genitals. Still, most seem relatively indifferent to the non-consensual cutting of infant male genitals or support it for reasons of hygiene, aesthetics, health, culture, or religion.1
Intactivists’ concern about non-consensual infant genital cutting is an even more extreme example of the first concern about minors lacking cognitive ability; infants cannot consent to circumcision, which has irreversible side effects. Adults can voluntarily undergo circumcision and trans-affirming surgery if they do decide they want to at a later point in life. While there are some benefits to intervention sooner in the case of circumcision, it seems morally dubious to perform a procedure non-consensually earlier for what could be regarded as minor benefits.
A common argument among those opposed to gender-affirming interventions is that children and adolescents may be losing sexual function prior to having the legal right to engage in sexual intercourse. It would be hard to imagine that truly informed consent could be obtained for a procedure that may reduce sensations that a young person has never experienced. While many men are happy that they were circumcised as an infant, they do not know what it feels like to have a foreskin. These men cannot compare sexual sensitivity with and without their foreskin. Perhaps they would not consent if they could feel both. Some men try to restore their foreskin or try retaining skin over their glans and find it increases their sensitivity considerably, but it is worth noting that this is not a random sample.
Similar to concerns about gender dysphoria desisting with the passage of time. Most adult men who were not circumcised as children don’t go on to undergo circumcision as an adult voluntarily. Most come to accept or even enjoy that they have a foreskin. If the counterfactual is that an infant will likely grow up and be okay with his foreskin, it is reasonable to suspect that if the infant had increased cognitive ability and was provided with the full knowledge of the future, it would likely not actually consent to undergo the procedure. Regardless, we can imagine some would. However, it seems immoral to force a large number of people to undergo a procedure that has lifelong effects to merely save some the convenience of having to do it as an adult. Analogously, this seems somewhat akin—although not as harmful—to putting everyone on puberty blockers involuntarily to ensure that a minority of the population can transition genders more easily. Medical interventions ought to be targeted at the population in need of the intervention.
Even if we accepted the idea that both circumcision and gender-affirming surgery had no negative side effects, we should take seriously the possibility of complications. Not all surgeries are going to go according to plan—there is a risk of error and infection. People have different personal preferences for risk, and it seems unethical to decide what is an appropriate level of risk unless the benefits overwhelmingly outweigh the downsides, like in the case of vaccines. Many believe that transgender youth do not understand the risks and complications associated with trans-affirming interventions and that they should make these decisions when they are adults and have a full understanding of the risks and their own risk aversion. Why not take a similar attitude with regard to circumcision?
I am not suggesting that both interventions are equally harmful, but I do believe that the arguments made against trans-affirming surgery on adolescents and children could also be made against circumcision. Of course, there are other arguments for infant circumcision that were not addressed here such as religious ceremony. I will need to address these at a later time. Regardless, I hope that this article at least encourages those who are anti-affirmation and pro-circumcision to reconsider their pro-circumcision stance to some extent.
An interesting implication of the intentional blurring of the boundary between male and female humans is that perhaps circumcision of the penis could be regarded as female genital mutilation within the framework of trans rights activists.
It's simple: I'd ban both.
"Gender affirming care" is an attempt to institutionalize Munchausen by Proxy.
We used to put people in the psychiatric ward for that. With luck, we will soon again.