Have you ever had a conversation with someone where it slowly became apparent that you were both using the same word, but meaning something entirely different? No matter how hard you try, you’ll make no headway on what you’re discussing until you understand what the other person actually means.

I bring this up because I’ve been thinking recently about the word “harmful”. I believe that it is often “harmful” to lie to people. It is harmful to encourage people to behave in ways which leave them at greater risk. And it is certainly “harmful” to conduct invasive and irreversible medical procedures on children which aren’t absolutely necessary. To the people on the other side of the divide, it is the act of expressing these beliefs which is “harmful”.

Herron claims to have regretted surgery almost immediately

This week a young man wrote about his experience falling down the gender rabbit hole. After years struggling with his mental health and sexuality, Ritchie Herron found a community online which pushed him towards the idea he might be trans. In his account he was sped him through psychiatric assessments and onto hormone treatment before eventually being referred to surgery. He turned it down, citing doubts. When it was offered again, he turned it down a second time, only to be told that if he did so he would be discharged. Believing he would lose his therapist otherwise, he signed up.

The surgery removed his penis and testicles, shaping a simulacrum of female genitals in their place. It also took his sex drive, any genital sensation, his ability to urinate without pain, and the potential to father children of his own. He claims to have regretted it almost immediately, and is now suing the NHS. 

Now, tell me: which part of the content of these paragraphs is harmful? To my mind, and possibly yours, it’s the role played in the damage done to a young man’s life by those people and institutions which had a duty to care for him. To the activists on the other side, it was the act of publishing his story in the first place. The tricky business of words, again.

Some activists believe that the idea of “detransition” generates stigma, or hinders progressive policies. It is certainly true that ideas can be harmful to those that hold them. Take a look at the graph below: the line in blue tracks google searches for “anorexia”; the line in red searches for “transgender”.

Now imagine that the response to the anorexia trend had been to open diet clinics across the country and put diet coaches in girls’ schools. We know that groups of teenagers can meme themselves out of the basic survival instinct to eat enough to stay well. At the same time, we are expected to believe that people feeling physically and socially ill at ease with puberty would never develop a false understanding of why that might be.

For those outside of trans rights advocacy, however, the sudden surge of interest is enough reason to pause and think carefully. This is particularly true when it comes to children, who are less capable of judging their own interests.

The number of children referred to the NHS’s gender identity clinic has grown exponentially, from 77 in 2009 to 2,590 in 2018. This is, for some, cause for celebration: the increase simply reflects a society which is more tolerant, allowing people to be who they truly are.

You should hope the NHS is taken to the cleaners

If on the other hand you have just the slightest, smallest doubt — the tiniest hunch that children may attach new and interesting labels to old issues of interaction and attraction — then this is deeply alarming.

If Ritchie Herron were the only person to have ever detransitioned after NHS treatment, then we could set these doubts aside. But he isn’t. Estimates of detransition rates vary widely, with numbers between one per cent and ten per cent cited. Some studies note that those who go through with surgery are less likely to find themselves regretting the process.

This is less comforting than it appears. “Harmful” outcomes are present throughout the process. Girls who take testosterone develop deeper voices and facial hair, traits which will persist after treatment ends. Boys who take oestrogen find themselves with breast tissue. Both may find they have decreased fertility and sexual function, particularly if treatment began at a young age. 

It was precisely these harms that caused Keira Bell to bring a request for judicial review against the NHS and its policy of providing puberty blockers to teenagers. A court initially agreed with this position, finding that children under 16 may not be able to give informed consent for their use. This decision was subsequently overturned. But for a brief period, the healthcare system did change its policies.

It’s for this reason that — depending, of course, on your definition of “harmful” — that you should hope the NHS is taken to the cleaners. Lawsuits (and the associated costs) are one of the few feedback mechanisms a state-owned health service has, beyond raw political pressure. If the greatest medical experiment of our time turns out to be deeply harmful, then it will be cases like Herron’s which bring it to an end.