Gender issues have been an understandably controversial topic for a long time. Recent achievements and highlights in clinical, psychological, and social research greatly expanded our understanding of the matter and offered new ways of coping with the situation for people suffering from gender dysphoria. Several interventions were developed to provide solutions for people who feel the necessity to align their physical gender characteristics with their perception of gender, with hormone replacement therapy (HRT) being among the leading practices. Unfortunately, a growing body of evidence suggests that HRT may have several adverse effects. Specifically, a relationship is established between the administration of hormones and the increased suicide rate among teens suffering from gender dysphoria (LeVay et al. 91). This suggestion has led to the debate on whether eligibility for HRT should be regulated more strictly. Despite the obvious ethical implications, I believe that a more rigorous evaluation of eligibility should take place before the permission for hormone therapy may be acquired.
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The main reason for such a decision lies within the gap between the perceived benefits and the real positive outcomes. The initial assumption is that the physical changes of secondary sexual characteristics will aid the perception of transition and, by extension, result in psychological improvements. However, that means that transgender individuals support the social construct they intend to oppose. For as long as the practice is proven to be safe, there is little reason for reconsideration. However, since gradually more studies support the presence of negative effects, the unrestricted access to hormones becomes an unjustified risk (Simonsen et al. 241). What’s more, the actual psychological improvements are questionable. A meta-analysis of studies on the outcome of patients who underwent hormonal therapy shows only short-term improvements and no statistically significant long-term benefits (White Hughto and Reisner 21). In my opinion, such results confirm the necessity of prior evaluation.
My position is only strengthened by the fact that most of the teens that identify as transgender are not “persisters” (LeVay et al. 90). I admit there is another controversy involved here of the amount of freedom versus control that an individual at a young age should have. However, it should be mentioned that the current level of scientific knowledge is such that it becomes difficult and in many cases impossible for a layperson to follow using only conventional wisdom. Therefore, in the situation such as this, it would be better to rely on evidence and prioritize physical and psychological health rather than pursue the ultimate freedom of choice.
I must admit that I find the factor of irreversible physiological changes relatively unimportant beyond the issue of a low number of persisters. For as long as the practice remains safe there is no reason to worry about the changes in physical characteristics. On the other hand, as soon as we figure out the adverse health effects (which we did in this case), we have reasons to introduce regulations and establish evaluation procedures to determine eligibility for the practice. In other words, it is not the irreversibility of change we should be concerned with – it’s the ultimate effect (which, in our case, is negative).
In conclusion, hormone therapy can only be considered a viable solution as long as it does not contradict the established medical ethics and a philosophy of doing more good than harm. For as long as we have reasons to suspect the opposite, I suggest prior evaluation as a necessary element of hormone therapy access.
LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. 3rd ed., Sinauer Associates, 2015.
Simonsen, Rikke Kildevæld, et al. “Long-term follow-up of individuals undergoing sex reassignment surgery: psychiatric morbidity and mortality.” Nordic Journal of Psychiatry, vol. 70, no. 4, 2016, pp. 241-247.
White Hughto, Jaclyn M., and Sari L. Reisner. “A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals.” Transgender Health, vol. 1, no. 1, 2016, pp. 21-31.