Sensible policymaking like that seems a long way off in America. On June 19th the International Swimming Federation voted to restrict transgender athletes from competing in elite women’s competitions (unless they took blockers as children). If female sports teams are forced to allow trans girls to join them, the era of female-only sports will be over. The lost ground this enabled women to make up in sport was one of the biggest achievements in the battle for sexual equality in America. When Title IX banned discrimination “on the basis of sex” in federally funded educational institutions in 1972, it resulted in the provision of separate programmes for girls.
The Biden administration has suggested it is considering changing Title IX, an amendment made to the Civil Rights Act, to include “gender identity” alongside “sex”. It has done so over sex and gender identity too. This is not the first time the administration has muddled its terms in an effort to embrace trans rights. Some gay adults who struggled with gender nonconformity in adolescence say they believe that encouraging children with gender dysphoria to consider themselves trans is in effect conversion therapy. Instead, they refer children to gender therapists, who are likely to affirm a trans identity and suggest drugs. Yet America’s focus on affirmation means many are wary of doing so. Most decent therapists should be able to help people with gender dysphoria, she says. But it will have a “chilling effect”, says Lisa Marchiano, a Jungian therapist and a co-founder of the Gender Exploratory Therapy Association. The order does not impose an outright ban on therapy for gender-dysphoric youth. Mr Biden’s order, by contrast, asks federal departments to expand access to “gender-affirming care”. Finland and Sweden have mostly stopped prescribing blockers to under-18s in favour of talking therapy, because the evidence base for them is thin. There is growing evidence that puberty blockers given to trans-identifying children from the age of nine, and the cross-sex hormones that often follow, lead to sterility and inorgasmia. Therapy has been dismissed as “gatekeeping”, even when applied to trans-identifying minors for whom gender-affirming drugs can be particularly harmful. That is now considered best practice in America’s booming trans health-care field. Increasingly, however, such talking therapy has clashed with “gender-affirmative” care, which accepts patients’ self-diagnosis that they are trans.