“I hope our paper cools heads on this issue”. These are the words of Landon Hughes, lead author of a study into the prescribing of puberty blockers and cross-sex hormones to gender-distressed children between ages 13-17.

According to Hughes and his fellow researchers, fewer than one in 1,000 US minors received “gender-affirming medical care” during the period 2018-2022. This, he declares, is a reason for critics to calm down. “We are not seeing inappropriate use of this sort of care,” he claims. “And it’s certainly not happening at the rate at which people often think it is.”

I am not sure what rate Hughes thinks “people” have been imagining. Just how many children have been set on a path to lifelong medicalisation, facing consequences such as sterility and brittle bones, on the spurious grounds that they might have been born in the wrong body? Personally, I have never had an exact figure in mind.

The extent proposed by the new study is lower than in research from 2022, though some of the new framing hints at a desire to downplay things (emphasising, for instance, that “no patients under age 12 were prescribed hormones”, even though the criticism has always been that puberty blockers at that age lead to hormones later on). Yet even if the figures — based on commercial insurance plans, but not Medicaid, and excluding surgeries — can be trusted as far as they go, should the heads of critics really be feeling “cooled”?

I’ll be honest: one in 1,000 still sounds a lot to me. That would be at least one child in every secondary school in my area. Moreover, while I know it could be worse, the problem with “gender-affirming care” was never simply one of numbers. One vulnerable child being medically supported to self-harm is still one child too many. By suggesting that critics of gender medicine have been fixated on inflated figures (as opposed to actual harm), its advocates have found a new way to dodge the more important debate. They had to do this, now that the old tactics no longer work.

For many years now, anyone who criticised the ethics of giving puberty blockers to gender-distressed children would be accused of spreading misinformation and engaging in hyperbole. The hypocrisy of this would be witnessed in breathless headlines claiming that “moral panic about puberty blockers endangers the lives of trans kids”. We were told “gender-affirming care” was “life-saving”, on the basis that without it “trans kids” would kill themselves. If anyone became used to getting by on exaggeration and fear-mongering, it was those suddenly claiming to be on the side of limited access, honest counting and cool heads.

Following the UK’s Cass Review and the light shed by cases such as US v. Skrmetti, those supporting gender medicine have had to change tack. As the American Civil Liberties Union’s (ACLU) Chase Strangio was obliged to admit before the US Supreme Court, suicides among gender-distressed young people are “thankfully and admittedly rare”. Lifelong damage can no longer be defended on the basis that the alternative would have been death. New gotchas are required. A recent paper defending gender-affirming treatment for adolescents rather inventively suggests that we reframe our understanding of what “‘effective outcomes” are, getting away from “the linear narrative of improvement”. Now Hughes et al. have arrived to reassure us that whatever is happening, it isn’t happening to that many children, and given the numbers are so small, the doctors must surely have selected them very carefully. One has to wonder what the next sideways step will be.

Because whatever it is, it won’t be a step backwards. Not for those who have implicated themselves so much already. As for the rest of us, those vaguely defined “people”, I think most of us will come to see what has been done to far too many children as utterly barbaric.

“We are not seeing inappropriate use of this care.” Really? Please. There isn’t any other sort.

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Victoria Smith is a writer and creator of the Glosswitch newsletter.

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