Calls for “diversity and inclusion” are right to insist on compassion for everyone, including those who identify as transgender. But genuine inclusion requires more than slogans; it demands open debate about medical risk, long‑term outcomes, and the rights of religious citizens to uphold biological reality without being vilified.
For decades, gender dysphoria has been understood as a behavioral health condition. Earlier diagnostic manuals used “Gender Identity Disorder,” emphasizing significant distress and functional impairment. When the term shifted to “gender dysphoria,” it stayed within a mental health framework, focusing on distress.
Historically, clinicians responded with thorough psychological assessment, exploring co‑occurring conditions such as autism spectrum traits, depression, trauma, and internalized homophobia before any medical intervention. Robust psychosocial evaluation should be the foundation of care for minors with gender distress.
This context matters because, in many cases, gender dysphoria in youth appears to be temporary. Follow‑up studies of children once diagnosed with gender dysphoria have repeatedly found that a substantial majority—often in the 60–80 percent range—no longer identify as transgender by late adolescence or adulthood when supported with watchful waiting and therapy rather than early medicalization.
A systematic review reported desistance rates averaging above 80 percent in earlier cohorts. Registry data from Europe similarly suggest that many youth diagnosed with gender dysphoria later discontinue transition‑related care, indicating that for a significant portion, the condition is transitory.
When a condition is often temporary, the ethical bar for permanent interventions must be extraordinarily high. Yet the prevailing “gender‑affirming” pathway for minors often includes puberty blockers, cross‑sex hormones, and sometimes surgeries.
Puberty blockers halt normal puberty and can reduce bone density. Cross‑sex hormones create irreversible secondary sex characteristics and frequently result in infertility. Surgeries remove healthy tissue or permanently alter genitalia.
Evidence reviews by multiple health authorities conclude that the quality of long‑term evidence for benefits in minors is low to very low, while potential harms—sterility, impaired sexual function, cardiovascular risks, surgical complications, and regret—are serious.
If many gender‑distressed youth would naturally come to accept their biological sex as they mature, placing them on a path that leads to permanent infertility and lifelong medicalization risks turning temporary distress into a permanent affliction.
Accounts from detransitioners— young adults who reverse or regret prior transition—underline that some choices were made during periods of confusion, mental illness, or social pressure that they later deeply regret. Ethical pediatric practice usually follows a clear hierarchy: reversible before irreversible, conservative before radical, strong evidence before irreversible harm. That hierarchy should apply here as firmly as in any other field of medicine.
History offers sobering lessons when enthusiasm outpaces evidence. In the mid‑20th century, lobotomy was praised as a humane, modern treatment for severe psychiatric illness and performed on tens of thousands of patients, only to be later recognized as a profound ethical failure that left many permanently disabled. Thalidomide, marketed as a safe remedy for morning sickness, was widely prescribed before its devastating effects on unborn children became undeniable.
These examples are not offered to equate all aspects of gender medicine with those tragedies, but to show that professional consensus and compassionate intentions can coexist with serious, unrecognized harm. Prudence in the face of weak evidence and irreversible interventions is not bigotry; it is responsible medicine.
Any honest conversation about “diversity and inclusion” must also reckon with religious pluralism. Many Christians, and members of other faiths, believe that biological sex is created, innate, and immutable, and that physically altering a healthy child’s body to resolve psychological dissonance is morally wrong. In a free society, citizens must be able to express such views in civic debate, raise concerns about school policies and pediatric protocols, and decline to endorse speech that violates conscience without being branded hateful.
A genuinely inclusive community can do two things at once: protect children who identify as transgender from bullying and mistreatment, and protect families—Christian, Muslim, or others—who see rapid medicalization of minors as unsafe and unethical. It can insist on civility from all sides while refusing to treat disagreement over contested medical practices as a moral crime.
The call, then, is not to abandon compassion but to widen it—to include the child in distress, the detransitioner with regrets, the cautious clinician, and the religious neighbor whose faith teaches that bodies matter and that irreversible decisions should never be rushed onto the young.
Mary Davis is a resident of Alpine and a member of the Alpine Community Planning Group. She also serves on the San Diego County Commission for the Status of Women and Girls.
