The Price of Affirmation
Unmasking the Motivations Behind Modern Standards of Care
When Medicine Forgets Its Soul
Something essential has gone missing in the corridors of modern healthcare: the soul. Nowhere is this more visible than in the latest standards of care regarding transgender and gender diverse youth. Behind the polished language of inclusivity, empowerment, and affirmation lies a machine—cold, ideological, and frighteningly self-assured.
This piece is not an argument against humanity, dignity, or self-expression. It is a dissent against how original frameworks of care have been surgically warped into outcome-driven dogma, repackaged as progressive science. It is a plea to slow down, to listen, and to feel into what has been lost in the race to affirm at all costs.
What began as a compassionate turn—creating safety for gender nonconforming individuals—has mutated into a totalitarian insistence: that all expressions of gender distress, at any age, must be affirmed without question. That anything less is abuse. That to doubt is to do harm. This is not the evolution of understanding; it is the narrowing of it.
The Warping of Original Work: From Exploration to Prescription
The early work in gender care was exploratory. Clinicians were careful, slow, and curious. They understood that identity is a complex, developmental process, especially in children. They recognized the entanglements of trauma, neurodivergence, familial dysfunction, and social contagion. They knew that what appears as gender dysphoria can sometimes be a placeholder for something deeper.
These early pioneers were not in a rush. Their responsibility was to hold space—not to project outcomes. They knew that for many young people, gender questioning was a necessary portal through which other psychological and existential truths could emerge. There was no assumption that discomfort with one’s body automatically pointed to a lifetime of medical transition.
But that nuance has been eroded. In the latest WPATH Standards of Care, what was once an open-ended question has become a preordained answer. Affirmation is not one path among many; it is the only path. Medical intervention has moved from last resort to first reflex. The clinician has been repositioned—not as a guide, but as a facilitator of a predetermined journey.
No one dares to ask, anymore, what we might be missing beneath the diagnosis. Because to ask is to be accused of cruelty. Or worse, transphobia. The result? Entire psychological histories left unexamined. Developmental trauma dismissed. The deep soul work—ignored.
And the cost of that? The silencing of doubt, the erasure of caution, the medicalization of childhood.
The Disappearing Middle: When Skepticism Becomes Heresy
We are told that to question is to hate. That to pause is to harm. That to suggest a child might be confused is to erase them. This absolutism is not science. It is doctrine.
The effect is chilling. Reasonable clinicians are silent. Concerned parents are vilified. Nuanced researchers are ignored. And the children? They are swept into a current they cannot possibly understand, let alone consent to.
WPATH's own document reveals this tension. Read closely and you will find quiet admissions: lack of long-term data, developmental unknowns, ethical grey zones. But these concerns are footnoted, not foregrounded. They are acknowledged to satisfy the ghost of rigour while the policy machinery moves full speed ahead.
What happens in a culture when the middle ground collapses? When discernment becomes danger? We lose the ability to think. We lose the courage to feel. And we enter the realm of moral panic, where questioning consensus becomes a threat to the very identity of the collective.
And so the standards of care become less about care and more about enforcement. Less about human dignity and more about ideological purity. Professionals are no longer asked to listen. They are asked to agree. Compliance becomes compassion. And silence becomes survival.
The Burden of Irreversibility: What We Cannot Undo
To intervene medically in the life of a child is to assume the weight of irreversibility. Puberty blockers, cross-sex hormones, surgeries—these are not neutral acts. They rewire the body, suppress fertility, fracture identity, and sometimes embed regret.
And yet, the language surrounding these interventions has been sanitized. Blockers are “pause buttons.” Hormones are “gender-affirming.” Surgery is “life-saving.” These euphemisms anesthetize the public. They obscure the lived realities of those who come to regret their transition, whose deeper issues were never truly addressed, whose bodies now carry the cost of cultural haste.
In clinical terms, this is known as iatrogenesis: harm caused by the healer. And yet, the system refuses to name it. Even when the evidence accumulates. Even when stories pour in from those who followed every step, believed every promise, and now feel betrayed by the very institutions that once claimed to see them.
Detransitioners are the inconvenient truth. Their stories disrupt the tidy narrative. And so they are sidelined, erased, or dismissed as statistical anomalies. But anomalies do not organize online. They do not form networks of support. They do not write memoirs, give testimony, or beg that we “slow down.”
They exist because something has gone deeply wrong. And they speak not only for themselves—but for all the children who may follow.
The Return to Soul: What Healing Actually Demands
Real healing is not about affirmation. It is about truth. It is about holding space for the full complexity of the human condition—the confusion, the pain, the longing, the trauma. It is about guiding someone through their suffering, not helping them bypass it.
This demands time. Patience. Depth. It demands practitioners who can hold uncertainty, families willing to face discomfort, and institutions brave enough to admit what they do not know.
To truly support a gender-questioning child is to be willing to sit in the storm without needing to resolve it. To listen without assuming. To ask questions without fearing what might emerge.
It is not affirmation that heals. It is the slow, sacred work of integration. Helping someone piece together the fragments of themselves. Making room for grief. For joy. For contradiction. For change.
Affirmation may feel loving in the short term. But when it becomes a mandate, it risks becoming a betrayal—of the very complexity it claims to honour.
A New Kind of Courage
To dissent today takes courage. Not the courage to speak against people—but to speak for them, when the systems claiming to help them have lost their way.
The WPATH document, in its current form, is not a neutral map. It is a highway without exits. It is a narrative too afraid to ask real questions. It reflects a world more interested in outcomes than origins, more loyal to ideology than to soul.
But this can change. It must. The children deserve better. So do the parents. So do the practitioners who went into this work to serve, not to conform.
Let us recover the art of listening. Of wondering. Of staying with the question a little longer. Let us remember what medicine once meant—to heal, not to rush; to support, not to direct; to honour, not to overwrite.
Because affirmation without inquiry is not care.
It is abandonment dressed as compassion.
It is haste dressed as certainty.
It is ideology wearing the mask of healing.
And our children are paying the price.
Take Heart,
Jason
Well said. The harm to my son, to my family is a living nightmare. All at the hands of those who took an oath to do no harm. Yet it goes on and continues to destroy lives unchecked. Wake up world.
This is incredibly kind and truthful. I pray for open minds and open hearts to allow that space for healing and understanding. I am resisting affirmation for my daughter because I see and love her for who she really is and will be.