The Real Issues in the Transgender Debate: Really, there are three issues. This one is the most important

In light of the U.S. v. Skrmetti Supreme Court case, about the Tennessee law that protects children with gender dysphoria from destructive hormone treatments and surgery, it is helpful to consider the actual issues involved.  The transgender debate is not a single issue, but three issues, which to some degree bear on one another but are logically separate questions.

The first issue is the broad logical, philosophical, and biological questions at the root of transgender ideology.  What is a woman?  What is a man?  Can a man become a woman, and a woman become a man?  What is gender?  What is sex?  When is sexual identity fixed, if it is fixed?  What is the relationship between gender and sex?  What is the biological definition of male and female?  Is the human species sexually binary (male or female) or bimorphic (a continuum between male and female)?

These issues are of enormous importance for our culture, and they bear on questions of biology, medical care, and ethics, but they are not the same thing as the issues of medical care and ethics and should not be conflated with them.

The second issue is the effectiveness of transgender medical care.  Do children who are given puberty-blockers really benefit from the treatment?  What are the short-term and long-term risks of puberty-blockers?  What are the effects of cross-sex hormones in patients, especially children?  What effect do cross-sex hormones have on fertility, metabolism, bone strength, cancer risk, and long-term psychological health?  What are the medical and psychosocial consequences of lifelong dependence on powerful mind- and body-altering drugs?  Do castration and the surgical fashioning of fake genitals really make mentally ill children and adults psychologically healthier?

All of these “second issue” questions are straightforward science, unlike the “first issue” questions, which are heavily laden with metaphysics.

The third issue is the ethics of transgender treatments, irrespective of the philosophical and scientific rationale for the treatments.  Is it ethical to destroy normal body parts and functions with drugs and surgery?

Note that this ethics question is distinct from the questions about the logical coherence of transgender ideology and the scientific effectiveness of transgender treatments. Even if transgender ideology made sense (it doesn’t), and even if transgender medical care helped people (it doesn’t), is it ethical to damage a healthy body in service to these goals?