Trans children have always existed. During the twentieth century, while some trans kids did socially transition, most had their gender identities disaffirmed, either by parents who disbelieved them or by doctors who subjected them to “gender reparative” or “conversion” therapies. The rationale behind the latter was a belief at that time that gender identity was flexible and subject to change during early childhood, but we now know that this is not true. Over the years, it became clear that these conversion efforts were not only ineffective, but they caused real harm — this is why most health professional organizations oppose them today.

Today we are experiencing an all-out moral panic against trans people that is occurring on many fronts: sports, public restrooms, banning books, school accommodations, drag performances, and so on. But arguably, anti-trans activists have made the most inroads in their attempts to undermine and restrict gender-affirming care for trans youth.

Their approach takes advantage of the mainstream public’s lack of awareness about trans experiences and trans healthcare. For instance, anti-trans activists will make it sound as though kids are adopting trans identities capriciously or frivolously, and that it’s just a phase they will simply grow out of. Or they will claim that the gender-affirming approach is new, experimental, and hasn’t been rigorously tested yet. Or they will make it seem as though children are being “rushed into hormones and surgeries” at a young age and with little to no assessment. All these claims are false, but they tend to strike the average person as feasible and alarming.

I’ve read countless trans-skeptical and “just asking questions” articles about the gender affirmative model, and they always have one glaring omission. Specifically, they focus solely on gender-affirming practices — social transition, puberty delay, hormone therapy, and surgeries — and portray them as “novel” and “active” interventions that require further scrutiny. This framing makes it seem as though the alternative approach (passively “doing nothing”) is an inherently neutral and less risky option. But “doing nothing” is not doing nothing! It involves actively disaffirming trans kids’ genders — and we have lots of research on the impacts of that approach.

Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, posttraumatic stress, and suicide ideation and attempts.

Emerging research indicates that children who are not permitted to express their gender freely within their key developmental contexts, including family and school, might be at risk of negative psychosocial outcomes, both in the short-term and into adolescence and adulthood. These include low self-esteem, low life satisfaction, poor mental health, lack of adequate housing, posttraumatic stress, and suicidal thoughts and attempts.

Canadian research indicates that one of the key areas of distress for trans and gender-diverse youth is lack of parental support. Young people whose gender identities are not strongly supported by their parents face an attempted suicide rate 14 times higher than their supported peers do. Trans youth without strong family support also reported less positive mental health, more depression, lower self-esteem, and lower life satisfaction. The authors concluded that “anything less than strong support may have deleterious effects on a child’s well-being.”

The supposedly passive and neutral “do nothing” approach forces trans adolescents into unwanted endogenous puberties. While anti-trans activists are quick to decry gender-affirming approaches as being “irreversible” and involving “a lifetime of medicalization,” they never discuss how restricting gender-affirming care will result in similar irreversible changes for trans youth and may require them to undergo additional medical procedures (e.g., electrolysis, top and other surgeries) at a later date that would not have been necessary if they had timely access to puberty blockers and gender-affirming hormones.

Whenever people argue that gender-affirming practices should be restricted or banned in order to protect the 1 or 2 percent of people who may later regret it, without considering how this would wreak havoc on the lives of the other 98–99 percent, what they are saying is that trans kids don’t “count” in their eyes. It doesn’t matter what happens to them because No Real Person Involved.