It can be fun. Children do it often. Let’s pretend to be doctors and nurses. You get to be our patients. These games can become rather elaborate, with costumes and various props. It is (usually) harmless and educational – a trying out of potential roles. Very rarely these games turn dangerous. Perhaps some of mother’s pills are found and prescribed to a patient. Perhaps an operation is attempted. These have real consequences – life altering or ending consequences.

Consequences

Should such a tragedy occur, we do not blame the children (primarily), but the parents. The adults have a duty to prevent children from harming themselves and each other. For very young children, all the blame belongs to the adults. As they age, the lines become less defined. Still, when teenagers are supplied with dangerous weapons by their parents and proceed to use them in school, there are rightly calls to hold the parents responsible as well.

Age of responsibility

Modern science has demonstrated that the human brain is not fully developed until a person is in their early 20’s; this largely affects the areas of the brain which deal with longer term consequences. Societies have empirically recognized this by limiting both the rights and responsibilities for young people. The actual calendar age of “majority” varies from country to country and at different times. The age for marriage, for alcohol consumption, for the purchase of cigarettes, for voting, for treatment as an adult in criminal processes, and for many other things are all set in law (mostly well below that suggested by the science).

Transsexuality

I think that we are in a comparable situation with the issue of transsexuality. If a young person wants to explore various roles by dressing and acting as the opposite sex, I think that, while it may be unwise, it is a matter between them and their families and friends. However, encouraging and offering drugs and surgery to make these changes permanent is criminal and should be outlawed. Let me be clear here, I am only talking about doing these things with minors. If legal adults wish to make these changes (at their own expense), they live with the consequences of their choice; it is their responsibility.

A counter argument is that medical changes should be instituted early, ideally before the onset of puberty to have “the best effect”. At one level, this is undisputable. An early neutering (surgical removal of sexual organs) and the administration of the desired hormones will cause the child to develop the appearance (if not the actuality) of the desired sex.

Humans have a long history of gender modification. One example: young boys were castrated so that their voices would not break and they could become “male sopranos”. It always worked in that they did not develop adult male appearance or behavior – but they did not always become successful singers. Similarly, others were castrated (at various ages) to increase docility or to create “safe” guards for women. Neutering of females was rarely done purposely for what should be obvious reasons. In our current society such practices are considered cruel and barbaric. We now routinely do this only to animals.

Criminalization?

Earlier in this essay, I used the terms “criminal” and “outlawed” regarding the encouragement of sex changes and use of drugs and/or surgery on transsexual minors. It will be argued that this will harm those who are truly “in the wrong body” by forcing them to pass through puberty as the wrong gender and thus be inflicted with irreversible changes to their bodies. This is true; but how can you really be sure of who is “in the wrong body”? What if we are wrong? It used to be one of the precepts of medicine was “first, do no harm”.

I recognize that some may agree with my basic argument, but consider criminalizing such actions to be a step to far. Therefore, let me offer a compromise. Criminalize the receiving of any compensation for the performance of these actions. If you, as a medical professional, really believe that it is in the best interests of the young person to receive this treatment, surely you can agree to do this entirely without charge.