Grey Matter Episode 6: Transitioning Minors Part 1: Decision-Making Capacity Under Age 18

“Transitioning Minors Part 1: Decision-Making Capacity Under Age 18”
by Kaitlin Puccio

When discussing transgender issues, “harm” is understood in precisely opposite ways by those on either side of the debate. Where there are calls for children under the age of 18 to be able to transition, one side argues that “harm” would be preventing minors from doing so, and the other side argues that “harm” would be allowing minors to do so. Action is being taken on both sides to prevent their perception of what is “harm” coming to pass, but these actions leave us no closer to an understanding of what is objective harm, which may be the most harmful of all.

The age of legal majority is 18 in most countries and most U.S. states. The question of harm to transitioning individuals in the current debate involves minors. One argument for preventing minors from gender transitioning is that they are too young to make that kind of permanent, life-changing decision, and they therefore must wait until they have reached the age of legal majority to make such a decision, with the assumption being that by age 18 they will be prepared and mature enough to make permanent, life-changing decisions.

One counterargument deals with the concept of maturity in an alternative fashion, such that if children don’t transition before puberty, they will in fact develop into biologically mature males or females, which later transitioning will not be able to reverse even with the use of hormones. Further, the argument continues, “forcing” natural maturation upon biological males or females who wish to transition—for example, by inhibiting access to puberty blockers—may be harming those children mentally due to the fact that their level of body dysmorphia likely exceeds normal levels of dissatisfaction with one’s developing body because of their “untreated” gender dysphoria—the treatment being gender reassignment surgery, puberty blockers, or similar.

While there may be persuasive arguments on both sides, the current cultural and political approach to the debate—which turns on the age of legal adulthood—falls short of providing a reasonable path forward. If an argument rests on the idea that minors should be prevented from transitioning due to their being too young to make that kind of decision, we must then ask if 18 is substantially different from 17 or 19 in this regard. Does an 18-year-old have much more capacity for making such a decision than a 17-year-old? (Though this doesn’t address the concern of some individuals who advocate for transitioning before puberty.) The response may be that it doesn’t in fact matter if an 18-year-old’s capacity for making such a decision is not significantly different from that of a 17-year-old, because 18 is the age of legal majority and we can’t prevent 18-year-olds from making such decisions as adults. The question would then be: Why is the legal age 18 and not 17 or 19, or any other age?

Even if we accept that the legal age is 18, we stagger our ability to make certain types of decisions as legal adults; should we not do the same with gender transitioning? For example, we reach the age of majority at 18 and can go to war then, but cannot have a beer until age 21. And yet, we can earn a driver’s license before reaching the age of 18, and the decisions we make when driving not only affect us, but everyone around us. Perhaps some of these age restrictions are based on brain development studies and are not as random as they seem. In that case, perhaps it would make sense to base the age of gender-transition-decision-making on mental capacity at a certain age during brain development than on the age of legal majority.

While there is a need for both sides to come together to have a conversation about these types of questions, there is an urgency on both sides as well, which is why the conversation has not happened and why political shouting has taken its place instead. There is an urgency on one side to put an immediate prohibition on what it views as irrevocably harmful gender reassignment surgeries. There is an urgency on the other side to protect what it views as the best interests of a transgender child by allowing and even encouraging that child to transition, thus preventing the harm of gender dysphoria. But actions taken on both sides as a result of this urgency leave the group of individuals in question at a greater risk of harm overall.

Instead of immediately brandishing picket signs and legislative pens, we must think about how to approach the issue as it applies to minors, which might allow us to find a solution in less time than it takes to try to pass insecure laws that will only give rise to more opposition. Perhaps we begin not by analyzing the age of legal adulthood, but by asking what is the right action to take that will result in the least harm for the greatest number of people. If we approach the question from a psychology perspective and use numbers as our guide, we will be able to evaluate how many individuals actually suffer from gender dysphoria, the age at which decision-making capacity ripens, at what age allowing children to transition might be abusive (the analysis may be different for a 17-year-old and a 7-year-old, for instance), the long-term harms of youth transitioning, and whether something like this emerges in waves in society. That is, for example, does zeitgeist play a part in the emergence and disappearance of certain disorders simply by virtue of it being widely in the public consciousness? Some psychiatrists will point to evidence showing that this is a possibility. If this is true, how many children are we harming by—to a degree—normalizing gender dysphoria when it’s actually a minority of people who suffer from it?

These questions will be further explored in “Transitioning Minors Part 2: Gender Dysphoria Zeitgeist.”