Abstract
This book review is actually a Letter to the Editor from the Editor. In January/March 2021, Volume 10, Issue 1, we at Journal of Pediatric Surgical Nursing published a special issue on transgender issues. The issue contained articles on firsthand family experiences, puberty-blocking drugs, surgeries to change external gender appearance, school issues, and health provider guidance. This was the second time I had published a series on transgender. Back in 2010 and 2011, with colleague Bethany Gibson, I wrote a three-part series on transgender published in both journals Pediatric Nursing and Urology Nursing. As a nurse ethicist, I also served as a contributor and reviewer for the Parents Manual for Children Born with Ambiguous Genitalia. Therefore, I thought I knew quite a bit on the topic of gender and transgender. As I wrote in 2010, my idea of transgender related to the child who at the age of 2 years was already declaring that they wanted to dress a certain way and play with certain toys and acted from the earliest days of childhood to be born in the wrong body. My idea of a transgender person came from the Jazz Jennings interview on newswoman Barbara Walter's 2007 broadcast. “I'm a girl,” Jazz declared, “and I always have been.”
Thus, it was with interest that I began to read this most interesting book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, by Abigal Shrier, an attorney and columnist for the Wall Street Journal. Shrier describes what, unknown to me, has become a raging movement in American junior high and high schools. Preteens and teens, who are not able to find their place among peers, have decided that they were trans. Scores of children daily leave school, perhaps without knowledge or permission from parents, to receive puberty-blocking or gender-reversing hormones. Teens fill out forms, without need for parental notification, changing their names and gender for in-school use. TikTok support groups, high school clubs, and medical clinics exist, all dedicated to supporting teens, mostly those born in female bodies in their transition to male. Shrier contends that the girls were unable to find a home among the preppies, the cheerleaders, the goths, the lesbians, or the fast girls, and when they reached out to the transgender folks, they were welcomed with open arms. They are encouraged to feel the high of the self-administered testosterone injection, apply for top surgery (the bilateral mastectomy), and speak only with those in support of this new life choice.
I have to say I did not think that was what we were writing about. I thought we were publishing about a fairly rare condition and how to support it, as the good nurses that we are. Shrier conducted hundreds of interviews for this book. She describes how the American Academy of Pediatrics and many other medical organizations have come out in support of this treatment. And she talks about the few physicians that said, “Hey, wait a minute, before we pass out these prescriptions, we need to meet these individuals and understand their thoughts, their reasoning. These drugs are not harmless and prior to dispensing them, we need to know the history and development of the teen patients.” Both members of the dissenting physician group and Shrier have been ostracized, had contracts canceled, and been fired from professional positions. They are now accused of being anti-LGBTI, biased and bigoted. Wow! This is an explosive topic, and my naiveté in thinking it was about a rare set of surgeries was quite off base. Shrier discusses parents who are trying to be loving and supportive, but whose daughters played with Barbies, wore dresses, went to proms, and never indicated a gender dysphoria. What to do now when they are binding their breasts and responding only to a new name?
This book will be interesting to you whether you support or oppose the idea that any child should be able to request and receive puberty-blocking or sexual characteristic reversal drugs, with or without parental support. The psychological assessment, which would look into whether a teen had a long history of feeling, acting, dressing, and living as an alternative gender, is opposed by the new trans supporters, who refer to the mental health team as “gate blockers.” I find that I, like Shrier, always a liberal writer and supporters of patients’ rights, now have a hard time exactly understanding this current movement. I invite readers to write to us at the Journal of Pediatric Surgical Nursing and help to inform.