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Treatments for gender dysphoria/gender-affirming care for transgender youth have been a hot topic of discussion lately, with some states moving to limit or ban such treatments for youth. This led to an internal discussion at AllSides as to whether or not we should use the phrase “gender-affirming care” or another term when writing about transgender treatments and interventions.

The qualifier “gender-confirming” or “gender-affirming” to describe treatments such as puberty blockers, cross-sex hormones, and sex reassignment surgery is polarizing. Those with a favorable view of such interventions typically use the term “gender-affirming” or “gender confirming” because they believe such treatments are necessary, life-saving, or helpful for transgender individuals; others object to this terminology, because they see the treatments — for youth especially — as harmful, irreversible, and/or carrying the potential for long-term risks or regret.

The polarization over the term reveals word choice bias, a type of media bias in which the words a reporter uses to describe something can reveal their perspective or opinion on it.

RELATED: Unpacking Media Bias in Coverage of Rand Paul, Rachel Levine Exchange Over Treatments for Transgender Youth

At the crux of the controversy is: Do these treatments affirm someone’s experienced gender identity, or disaffirm an objective reality? Some believe such treatments are necessary and beneficial for transgender individuals to embody the gender they identify with; others believe the procedures are harmful, and unethical to conduct on youth.

The AllSides team — which includes people on the left, center, and right — had an internal exchange debating this terminology, which you can jump to here. We also had team members on the left and right write about both sides of the issue, which you can jump to here.

 

AllSides Opts Not to Use the Term “Gender-Affirming Care”

Due to the polarization around the term “gender-affirming care,” AllSides will use the terms gender transition procedures or gender transition treatments to describe such interventions.

Where possible, we will include descriptive detail about what specifically is being discussed — for instance, if a bill seeks to ban cross-sex hormones or surgery for youth, we will note that specifically.

AllSides Team Debates Transgender Terminology

When this issue was raised internally, some on the AllSides team felt that this was not a partisan issue at all— that we ought to use the terms “gender affirming care” and “gender confirming treatments” because those are the terms used by medical professionals and the trans community. Others argued that the term is slanted toward a specific viewpoint and that not all medical professionals are in agreement about the treatments.

One team member on the left said that the issue with the term gender transition treatment is that it implies someone is changing their gender, whereas “nonbinary or gender-neutral people also use gender-affirming care.” They noted that the term includes not only medical procedures that alter sex characteristics, but describes aspects of social transitioning such as hairstyles, clothing, name, and pronouns. Meanwhile, a team member on the right argued that for AllSide to use the term gender-affirming care implies that we endorse the procedures and process, which are currently highly controversial.

Here’s a snippet of a Slack exchange the AllSides team had internally. We wanted to showcase this conversation because it seemed to be a good example of the left/right thinking on this issue:

Julie:

So, the term “gender confirming treatment” used in our headline is a biased term that we should probably avoid. We should just say “treatment” or “procedures” without a qualifier. We even mention this word-choice bias in our last sentence in the Headline Roundup, in which we say “Coverage tended to use the phrase “gender-affirming care” in left-rated outlets, “gender confirming treatments” in center-rated outlets, and “gender transition procedures” in right-rated outlets.” 

I am going to remove that qualifier from our mentions of the treatment/procedures

Joseph:

Strongly disagree

Julie:

Maybe just “gender treatments” is more neutral

The debate is this: some people say that such treatments affirm one’s “true” gender. Others say that it is actually harmful to do these treatments, that they are not affirming. It’s a huge debate.

Whether we like it or not, or whatever side we personally fall on, it is disputed. That’s why we see the differences among the left and right media word choice on this

​​Joseph:

I intentionally used the term most commonly used by center-rated outlets to avoid bias. This language is also what is advocated for by trans organizations. The Trans Journalists Association actually uses stronger language with “gender affirming care”

Julie:

Center doesn’t mean unbiased, though. We’re very clear that center outlets can show bias. So defaulting to their standards is not what AllSides does. I think you did a great job on the Headline Roundup. We just have to be careful about qualifiers.

Joseph:

Defaulting to your solution is defaulting to the conservative approach, is it not?

Julie:

No, it’s neutralizing it. People can still understand what procedures we are referring to when we simply use the term “treatments” and describe them. We don’t want to tell people whether the treatments are “gender affirming” or “gender disconfirming” (which is the crux of the debate — we want to avoid partisan framing). I mean, there wouldn’t be a bill about this at all if it weren’t highly partisan and controversial.

Joseph:

Times like these are when I hate the word “partisan”

Julie:

:grimacing emoji: partisan disputes are definitely not fun lol

Joseph:

The dividing line isn’t about democrats or republicans, it’s about transphobia or trans allyship.

We shouldn’t concede medically appropriate language at the behest of people who just don’t think trans people are right about themselves.

Julie:

AllSides isn’t here to be allies to one side or the other — we’re helping people to understand both sides, and that means helping people to understand the objections to transgender treatments and the arguments in favor of such treatments. We’re not here to say who is right or who is wrong, or to take a position on whether these controversial treatments are affirming or harmful. Of course, we can all have our personal opinions, but our Headline Roundups need to avoid qualifiers so that we don’t implicitly endorse one side or the other. 

Joseph:

Trans people aren’t a “side,” they’re a vulnerable community who face heightened risks of suicide, abuse, and discrimination because many people don’t see their identities as valid.

Julie:

Yeah, I hear that argument. But there are “sides” to the debate regarding the best way to treat trans individuals, whether we like it or not. Being the type of company we are, we have to be sensitive to those perspectives. Again, I think you wrote this Headline Roundup perfectly and did an awesome job — we just have to be careful about qualifying adjectives.

Joseph:

Thanks for the praise on the [Headline Roundup], but the debate here isn’t at all about how to treat trans people. That might be the point of the Arkansas bill, but that’s not your issue. Your issue is with the phrase “gender confirming treatments,” from what I can tell, because some people don’t think trans people are valid in the gender identities they claim. The phrases “gender confirmation” and “gender-affirming” aren’t some partisan talking point, they’re accepted and used by organizations like Johns Hopkins University, the American Psychiatric Association, and even health insurers like Aetna.

https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-nonsurgical-services

https://www.psychiatry.org/psychiatrists/cultural-competency/education/transgender-and-gender-nonconforming-patients/gender-affirming-therapy

http://www.aetna.com/cpb/medical/data/600_699/0615.html 

It is scientifically and medically accurate to call these treatments by their widely accepted name. It is wholly inappropriate to not do so because some people don’t like the medical community’s conclusion.

For a similar example, would we publish an article discussing “both sides” of whether vaccines cause autism? No, because that isn’t a political debate, it’s a misconception based on bad data that the scientific community almost unanimously disavows. With the issue of “gender confirmation” phrasing, we aren’t even discussing anything substantive, merely the phrasing used by doctors. This shouldn’t be an issue.

Julie:

I get that perspective, but there are also a lot of medical professionals who disagree with the elite institutions on these treatments. The elite medical institutions used to be pro-tobacco use, for example, or in favor of other medical treatments that were commonly accepted in the past and are no longer endorsed (like lobotomy or bloodletting!) Just because an authority says something doesn’t mean it is right or will always be accepted. It can mean that, but other times, things are not settled. There’s huge debate over these treatments in our society, despite elite endorsement. AllSides implicitly endorses one side when we use qualifying adjectives. Saying “treatment” or “gender treatment” allows people to know what treatments we are talking about, without us appearing to take a stance on whether it is helpful/necessary or harmful.

Understanding Both Sides of the Issue of Transgender Treatments

Transgender people identify with a gender other than the one determined by or assigned to their biological sex, and it can cause great discomfort. This can lead to interventions such as hormone blockers to delay puberty, top surgery, bottom surgery, and hormone replacement therapy. 

The treatments applied to transgender individuals have become controversial lately, particularly when it comes to youth. Here’s some background about both sides of the issue.

Argument 1: “Gender-Affirming Care” Is a Misnomer

Some argue that “gender-affirming care” is a misnomer, because medical interventions like hormone treatment, puberty blockers, and surgery are really gender disaffirming care. In this view, gender is largely determined by our biology, so medically altering our bodies disaffirms the gender we naturally embody. While men and women differ in their temperaments — there are masculine women and feminine men —  gender is by and large a term that refers to the psychological and cultural characteristics associated with biological sex. While gender dysphoria is very real, the route to healing would not be to affirm the disconnect by permanently altering the body, but to use psychotherapy or other modalities to help the patient to assess and heal underlying trauma that leads to the disconnect, with the goal of creating mind-body harmony. People who hold this view argue that the goal should be to make the mind match the body, rather than to make the body match the mind.

Because they view gender dysphoria as largely psychological, people with this perspective would argue that young people should not be given medical interventions to change their gender. They say that children often outgrow or heal their gender dysphoria without medical intervention, so young people are at risk of making permanent changes to their bodies that in the coming years they might wish they could reverse, and will be unable to. They argue that medical transition is expensive, and has come to represent a predatory industry that seeks to exploit people and turn them into lifelong medical patients. They point to people who have detransitioned who say medical professionals rushed to give them hormones and other medical interventions without conducting due diligence. 

In this view, gender dysphoria can be resolved with therapy, and medical procedures can be risky, irreversible and unnecessary. People with this perspective may note that the most thorough follow-up of people who underwent sex reassignment surgery — extending over 30 years — found the suicide rate actually rose among them.

Argument 2: “Gender-Affirming Care” is an Appropriate Term 

Those who prefer to describe transgender medical interventions as “gender-affirming care” differentiate between “sex” and “gender,” with the former referring to one’s biology and the latter referring to the social roles and experiences constructed around it (a man’s “sex” means he has male reproductive organs, but his “gender” means he wears suits to formal events and doesn’t wear makeup). In this view, pursuing gender affirmation — social, legal, medical, and surgical interventions that would allow them to live as the gender they identify with — is beneficial. 

This side argues such interventions alleviate the discomfort that accompanies gender dysphoria by helping trans people feel accepted and validated in their experienced gender. Those who defend these procedures argue that opponents are invalidating trans people’s experiences and identities, thereby directly contributing to trans people’s discomfort and keeping them from living full lives. They may point to a study that found over half of transgender and non-binary youth considered suicide in 2020, and found that “transgender and nonbinary youth who reported having pronouns respected by all or most people in their lives attempted suicide at half the rate of those who did not have their pronouns respected.”

People with this view argue that sufficient safeguards are in place to ensure that transgender individuals are equipped for such treatments, such as being required to show a long-lasting and intense pattern of gender nonconformity or gender dysphoria and to address any psychological, medical or social problems that could interfere with treatment before undergoing medical changes. Withholding social and medical affirmation makes gender dysphoria worse, not better, they argue, and assumes that transgender people’s identities aren’t valid. 

From this view, sex is arbitrarily assigned at birth, but someone’s inner world — how they feel, think and act — is how their gender is truly experienced, and thus one can feel “trapped” inside the wrong body. Someone’s self-perception can be disconnected from their biology, and bringing the two into harmony via biological intervention can be life-saving. People with this view may also point to a study that showed​​ the longer ago a sex assignment surgery, the less likely the patient was to suffer anxiety, depression or suicidal behavior during the study period.

Conclusion

There are very divergent views on the merits of medical intervention for transgender individuals, and the issue will continue to be a way that media outlets reveal their bias when reporting on such issues. 

To further understand the left/right divide over transgender issues, visit our Red Blue Translator.

Julie Mastrine is the Director of Marketing and Media Bias Ratings at AllSides. She has a Lean Right bias.

This piece was reviewed by Joseph Ratliff, Daily News Specialist (Lean Left), AllSides Managing Editor Henry A. Brechter (Center bias).