"The presumption that gender-diverse identities are not real — that young people will eventually come to accept their birth assigned gender as their minds catch up to their maturing bodies..."

"... is not supported by the evidence and is likely harmful...."

Writes Marci L. Bowers, a gynecologic and reconstructive surgeon and president of the World Professional Association for Transgender Health, in "What Decades of Providing Trans Health Care Have Taught Me" (NYT).

I was surprised to see the term "birth assigned gender." What's "assigned" at birth isn't "gender" but sex. Earlier in the column, the doctor does refer to "gender identities [that] do not match... sex assigned at birth."

But what is the science of this "matching"? Is it a medical problem not to "match"? 

Most of this column is about the medical practices that have been taking place for decades and statistics showing that adults who have received drug and surgical treatments have felt better off.

It seems that Bowers' answer to my question — Is it a medical problem not to "match"? — is that if the solution works, the thing worked on is to be understood as a problem. This is the more general doubt that we often see with respect to new psychiatric drugs. 

Here's a 2008 NYT article (which I blogged at the time), "Psychiatrists Revise the Book of Human Troubles":

“This is not cardiology or nephrology, where the basic diseases are well known,” said Edward Shorter, a leading historian of psychiatry whose latest book, “Before Prozac,” is critical of the manual. “In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial.

“What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”...

This article, addressing the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders," anticipates coming debates about gender identity:

Soon after the psychiatric association named the group of researchers working on sexual and gender identity, advocates circulated online petitions objecting to two members whose work they considered demeaning.

Transgender people are themselves divided about their place in the manual. Some transgender men and women want nothing to do with psychiatry and demand that the diagnosis be dropped. Others prefer that it remain, in some form, because a doctor’s written diagnosis is needed to obtain insurance coverage for treatment or surgery.

15 years ago, there were 2 camps, one of which stressed insurance coverage for drugs and surgery. 

“The language needs to be reformed, at a minimum,” said Mara Keisling, executive director of the National Center for Transgender Equity. “Right now, the manual implies that you cannot be a happy transgender person, that you have to be a social wreck.”

Have to be... because that ties to reimbursement of medical expenses? There's more pragmatism and economics to this than science, and Bowers is a gynecologic and reconstructive surgeon. This must be a field that is lucrative and highly dependent on insurance. But she is presented as the expert who knows the most, because of decades of practice.

To stay with the 2008 NYT article:

Dr. Jack Drescher, a New York psychoanalyst and member of the sexual disorders work group, said that, in some ways, the gender identity debate echoed efforts to remove homosexuality from the manual in the 1970s.

After protests by gay activists provoked a scientific review, the “homosexuality” diagnosis was dropped in 1973. It was replaced by “sexual orientation disturbance” and then “ego-dystonic homosexuality” before being dropped in 1987.

Ego-dystonic homosexuality? I don't remember that term, but it seems to mean homosexuality that you feel bad about. 

“You had, in my opinion, what was a social issue, not a medical one; and, in some sense, psychiatry evolved through interaction with the wider culture,” Dr. Drescher said.

Compare that to the current controversy over transgenderism. Is it a social issue? How did it come to be regarded as a medical problem as opposed to a social issue? I would like Dr. Bowers to show us the science of how that happened and to be forthcoming about any financial conflict of interest.

Bowers opposes legislation that limits treating children:

Anti-treatment bills will not protect children, and they will not help the medical community provide better care for patients in need. We should instead take anti-transgender legislation for what it is: thinly veiled cruelty to a specific minority population of the country....

To say this is "what is is" is not to speak like a scientist, but another politician. The meanies are always on the other side.

The field of transgender medicine is evolving rapidly, but it is every bit as objective- and outcome-driven as any other specialty in medicine. Allow the remaining scientific questions to be answered by knowledgeable researchers, without the influence of politics and ideology.

Please scientifically demonstrate that you and those in your group — the World Professional Association for Transgender Health — are free of "the influence of politics and ideology" (and financial incentives). It really doesn't work anymore to simply claim to be the science. Where did you establish that your field is "as objective- and outcome-driven as any other specialty in medicine"? And does that phrase elicit the kind of trust it once had? I think, post-pandemic, people are going to expect a lot more showing of one's work and a lot less demanding that we leave it to the experts.

Sure, it's annoying and complicated to have legislators meddling in your business, especially if you believe you're an empathetic helper of humanity and you have highly developed knowledge and skill, but you haven't built the trust, you haven't demonstrated the science, and people are powerfully motivated to rescue children from what may be harm.