The NY Times magazine has a long piece by Emily Bazilon on “gender therapy” and the controversies around it. The language is so shaped by the current ideology that clarity is all but impossible. Like the first sentence for instance:

Scott Leibowitz is a pioneer in the field of transgender health care.

But what is transgender health care? Is it ordinary health care, for trans people? Or is it health care specific to transness? If the latter, what does that include? Blockers, cross-sex hormones, surgeries? If so, is that really health care, or is it something else? Given the drastic nature of it, and the disconnect from actual disease or injury, isn’t it more like attempted psychological care rather than genuine health care? That’s a real question, not a snark. Given the fact that being trans is in the head, and blockers & hormones & surgeries change the body, it’s reasonable to ask if changing the body is really medically advisable.

He has directed or worked at three gender clinics on the East Coast and the Midwest, where he provides gender-affirming care, the approach the medical community has largely adopted for embracing children and teenagers who come out as transgender.

That hints at the problem right there. Medical care is supposed to fix illness or injury. It’s not supposed to “embrace.” It’s certainly not supposed to “embrace” new and peculiar ideas about trying to change one’s sex. When and how and why was it decided that “the medical community” has to “embrace” people who “come out as transgender”? Maybe the medical community doesn’t have to do that. Maybe it ought not to. Maybe it ought to be a lot more cautious about all of this. Maybe it ought to recognize that it’s more political than medical, and decide to stay out of it.

He also helps shape policy on L.G.B.T. issues for the American Academy of Child and Adolescent Psychiatry. As a child and adolescent psychiatrist who is gay, he found it felt natural to work under the L.G.B.T. “umbrella,” as he put it, aware of the overlap as well as the differences between gay and trans identity.

Yes, well again that just underlines the problems. There is no such “umbrella.” It’s doubtful that there is much “overlap.” The differences are a lot more consequential than the overlap.

In short all of this buys into the ideology in the act of trying to report on it. It’s more careful than most such reporting, but it still buys in.

So, Leibowitz is leading “a working group of seven clinicians and researchers drafting a chapter on adolescents for a new version of guidelines called the Standards of Care to be issued by the World Professional Association for Transgender Health (WPATH).” It’s the first update since 2012. A lot has happened in those ten years.

What Leibowitz and his co-authors didn’t foresee, when they began, was that their work would be engulfed by two intersecting forces: a significant rise in the number of teenagers openly identifying as transgender and seeking gender care, and a right-wing backlash in the United States against allowing them to medically transition, including state-by-state efforts to ban it.

It’s not just “right-wing” though, and some or much of the reason for the relative absence of the left is the crazed bullying that greets any resistance to this novel and reckless idea that it’s “medical care” to surgically alter people’s genitals because they have “come out as transgender.”

As they worked on a draft of the adolescent chapter of the Standards of Care, the big debate among clinicians was how they should respond to the thousands of teenagers who are arriving at their doors. Some are asking about medication that suppresses puberty or about hormone-replacement treatments. Leibowitz and his co-authors thought that the timing of the rise in trans-identified teenagers, as well as research from Britain and Australia, suggested that the increased visibility of trans people in entertainment and the media had played a major — and positive — role in reducing stigma and helping many kids express themselves in ways they would have previously kept buried.

Or, that increased visibility played a major and destructive role in nudging kids to think being trans is cool.

As they wrote in their December draft chapter, part of the rise in trans identification among teenagers could be a result of what they called “social influence,” absorbed online or peer to peer. The draft mentioned the very small group of people who detransition (stop identifying as transgender), saying that some of them “have described how social influence was relevant in their experience of their gender during adolescence.” In adolescence, peers and culture often affect how kids see themselves and who they want to be.

Ya think???

To make matters more complicated, as a group, the young people coming to gender clinics have high rates of autism, depression, anxiety and eating or attention-deficit disorders. Many of them are also transgender, but these other issues can complicate determining a clear course of treatment.

But what does “are also transgender” mean? How can these purported experts even know there is such a thing? Is it ever really a matter of actually being transgender as opposed to thinking one “feels like” the opposite sex? Is it ever anything but a feeling in the head?

From what I can tell the answer is no, and if that’s the case, how are medical people so confident that it’s their job to reify this feeling in the head by drastically altering the bodies? If people start saying they feel like birds will surgeons start altering their arms into crude wings?

To be continued.