The ongoing conversation around gender dysphoria and “gender-affirming care” is deeply concerning, to say the least. Gender dysphoria is defined as a perceived misalignment between one’s biological sex and how they identify. Gender dysphoria has been linked to delusion and psychosis. Affirming a delusion or false belief is ethically questionable. Those who have a diagnosis of gender dysphoria are encouraged to socially transition and medicalize with cross-sex hormones and irreversible surgeries. Some might argue that they are engaging in self-harm.
Instead of helping patients accept reality, “gender-affirming” counselors affirm these errant beliefs. They should help these individuals move away from their desire to self-harm and address the real issues causing their distress. From a professional standpoint, doctors and therapists have an ethical responsibility to challenge destructive behaviors, not reward them. But the current model of care is affirmation-only.
Detransitioner Chloe Cole gives a speech about her experience with the affirmative care model
If mental health professionals affirmed a client's belief that they were Superman and should jump off a building to try to fly, they would be held accountable for putting the client in danger. How is this any different? By affirming a child's “gender identity,” professionals are violating the Hippocratic Oath to “do no harm.” This should not be taken lightly because it puts patients on a path to permanent self-harm. By not addressing the client's underlying issues like PTSD, traumatic life experiences, poor self-esteem, body dysmorphia, and autism, they may be doing them a disservice.
Even more insidiously, these issues are being pushed onto children by authority figures whom they are supposed to trust to keep them safe, such as parents and teachers. Affirming a child's belief that they are “trapped in the wrong body” and will never feel comfortable with themselves unless they get dangerous surgical procedures may traumatize them even further. It gives legitimacy to distorted thinking. The gender affirmation model is literally driving these kids crazy, and the only “treatments” they are offered have shown to do more harm than good.
Gender-affirming clinicians and their enablers are trapping children in a vicious cycle, perpetuated in the name of a pseudoscientific ideology. This cycle can only be broken through proper evaluation and therapeutic practices that allow them to explore these feelings. By helping clients face reality rather than encouraging them to dissociate from their bodies, we may be able to guide children away from self-harm and toward addressing the root causes of their distress. True mental health care should be grounded in material reality.
No child is trapped in the wrong body. Telling them otherwise is morally, ethically, and clinically indefensible.
References
American Psychiatric Association. What is Gender Dysphoria?
Barr, S. M., Roberts, D., & Thakkar, K. N. (2021). Psychosis in transgender and gender non-conforming individuals: A review of the literature and a call for more research. Psychiatry research, 306, 114272. https://doi.org/10.1016/j.psychres.2021.114272
X (Formerly Twitter), February 2025. Do No Harm.