Jonathan Chait's Fantasy Football

Just Why Do These People Have So Many Opinions About Trans Youth in the First Place?

[An AI rendering of Jonathan Chait in football pads.]

Last week, Jonathan Chait published an essay called “Helping Trans Kids Means Admitting What We Don’t Know.” I’m all for Jonathan Chait admitting what he doesn’t know, but the piece is actually about other people’s ignorance, not his own. He criticizes trans activists and their lefty allies for “shut[ting[ down internal criticism by treating any criticism of their position as either identical to, or complicit with, the far right.” By contrast, Chait contends that a debate about gender affirming care (GAC) is raging among medical professionals and that the disagreement is stoked by the fact that “the science is genuinely murky and embryonic, making the struggle to identify a humane and effective solution both difficult and necessary.” Critics from within the medical community, Chait argues, harbor serious enough doubts that it is pernicious to assert there is no “credible debate” about gender affirming care.

The thesis of this issue of The Strong Paw of Reason is that Jonathan Chait has a mistaken confidence in his ability to adjudicate whether debate on this issue is reasonable. Whether he is aware of it or not, Chait’s views of the underlying issue are badly distorted by his unacknowledged attachment to a narrow vision of masculine development. When behavior confirms his vision, even if the behavior risks irreversible and significant bodily harm, Chait dismisses concerns about those risks as trivial, misplaced, patronizing, and even hysterical. By contrast, as his recent essay showcases, Chait treats risk quite differently when the behavior in question does not fit his narrow script of gendered development. Rather than handwaving those safety concerns away, he treats them with respect and deference, arguing that uncertainties about GAC make them reasonable. The point, as we will see, is not that Chait is correct about risk in the one case and wrong in the other—though, in fact, I think he is—but that his contradictory treatment of risk indicates something else is afoot and that he is not well situated to render opinions about what “the science” says and which debates, medical or otherwise, are credible.

In short, according to Chait, it’s good to encourage boys to risk grave bodily injury in the pursuit of becoming manly men, but it’s eminently reasonable to doubt that youth and their parents can be trusted to decide in consultation with clinicians about the risks involved in becoming trans adults. They require edification from journalists. Chait’s view is emblematic of something bigger. In American culture, we tend to respect the autonomy of young people only when they confirm our own sense of what is normal, and we tend to brutally dismiss and violate the autonomy of young people who challenge it. This is an unfortunate tendency and one that intelligent people should guard against, particularly as they age, but it structures many public discussions of GAC and trans and gender nonconforming youth.

To illustrate this tendency, I’m not going to extensively parse Chait’s opinions of GAC. Those opinions are neither particularly educated nor relevant to my point. Instead, I’m going to look closely at Chait’s opinions about something else entirely. For you see, Chait takes a very favorable view on an activity that significantly increases the risk of irreversible and grave bodily injury to millions of young people in America every year. And he takes a very dim view of people who question the safety of that activity, deeming them “enemies” beset by “moralistic hysteria” who refuse to understand why the activity is so beloved by its fans in the first place. The activity, and the major topic of today’s issue, is youth football!

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I. Dear Cissy, You Don’t Have to Mind Your Own Business, But You Probably Should

The larger question we are navigating is about who you should listen to if you have uncertainties about GAC. To that end, I want to disclose my beliefs about the issue in broad strokes. You may disagree with some of those beliefs. But I’m not trying to convince you the things I believe are true; I merely want to put my cards on the table about what I believe. If this isn't something you care about, skip this section, although, by the end of it, I think you’ll see why it’s relevant to the broader point about Chait, his critics, and the journalistic coverage of GAC. To the point:

1) I believe that there is very little disagreement among relevant medical experts and clinicians that, for most patients seeking GAC, the benefits of GAC vastly outweigh the harms. This calculus accounts for some uncertainty about the long term health effects of pharmaceutical treatments such as puberty blockers and most clinicians work with patients to proactively manage those risks rather than using them to restrict treatments that would be net beneficial. Clinicians, patients, and parents are together best situated to assess the relevant factors and identify those instances where a course of treatment would not be net beneficial. In general, many trans and gender noncomforming people contend that clinicians, hospitals, and insurance companies make obtaining care difficult and costly and that those practical obstacles are a major source of suffering for trans and gender nonconforming youth. Furthermore, they point out that a common reservation about GAC voiced by critics is not about unintended and uncertain consequences, but about the intended and certain consequences: critics doubt that patients will be happy with transition, a doubt that goes against the stated and persistent judgment of the patients seeking care.

2) I believe that little mainstream journalism on the topic appropriately conveys the complexity of that clinical reality. For that matter, little of it helps to illuminate the relevant trade offs for clinicians, patients, and family members. Put differently, to the extent “medical debate” exists about GAC, I see no evidence that any of the journalism Chait mentions provides any added value to the debate for the parties most directly affected by it. The idea that clinicians specializing in GAC are educated by this genre of journalism is farcical, and the idea that patients and parents should seek out Jesse Singal’s treasured wisdom is little better. We should be candid about who is likely to be educated by this sort of journalism and who seeks it out: it is often consumed by and produced for an audience of people who fear they may one day be affected and they want institutional and sometimes political responses to help deal with that possibility.

3) I believe that trans people and GAC clinicians are vociferously critical of the type of journalism Chait defends because they correctly recognize that it has little social value and because it may make accessing, studying, and improving GAC more difficult. Safely delivering GAC in the current political climate is already difficult, and it is made more difficult by popular journalism that strips medical care from the clinical context where it occurs and drops it into lurid and sensationalistic narratives that fan the anxieties of readers who care more about the symbolic stakes of the “trans” issue than the material benefits of expanding access to GAC. Which pieces do this and how is, of course, open to interpretation and not a scientific question that I, Chait, or anyone else can answer. We’re going to have to argue about it, and those arguments are going to get heated and people are going to lose their tempers. But to the extent that there is any uncertainty about GAC, restricting access to GAC makes it more difficult to study GAC, which, in turn, intensifies the very uncertainty used to justify its restriction. Asking—or even angrily demanding—that journalists consider how their coverage adversely impacts clinical access matters not just to the people directly seeking GAC now; it also shapes how we can come to know anything empirical or scientific about GAC in the future and, as a result, improve clinical outcomes.

Those are my opinions, but should you rely on my authority? No, you should not! Yes, I know far more about GAC than the average bear (and probably Chait). And, yes, as a professor, I do write about the history of endocrinology and sometimes direct students doing qualitative research on GAC. Yes, I’m also one of the primary investigators (the least primary, if I’m being honest!) on a grant with colleagues in Duke’s medical school and global health clinic to study the “long-term mental and physical health questions” of GAC. What I’m not is a medical doctor, much less a clinician who specializes in GAC, nor am I a person who has sought GAC in the past or plans to in the future. Some of the knowledge that informs my opinions comes from reading scientific literature on the topic, but most of it comes from me speaking with colleagues who I trust and to my friends who have, in fact, received some form of GAC. I find that talking to more knowledgable people is educational when I am ignorant. Listening to those people is even more so.

I must confess now that I could be wrong about any of the things I have written above, though I don’t think I am and I would put my certainty as high. If you care about these issues and wish to become better educated about them, however, you must do your own research. Before you embark on such a journey, you should ask yourself why you care. And be honest with yourself about the answer! 

Have you experienced any of the following symptoms? 

• Frustration with all the new letters now included in the LGBTQIAA+ abbreviation.

• A horny desire to better understand the trans people you are trying to fuck.

• A concern about the malign influence of “gender ideology,” gnosticism, or transhumanism on America’s young adult literature.

• Discomfort with how often the kids these days have pink hair and weird pronouns and did you see the “friend” cousin Sarah brought home from Bryn Mawr at Thanksgiving?!

• The fact that all the pretty they/them twinks have been ignoring you on Grindr, which definitely doesn’t have anything to do with the fact that you may be getting up there just a bit, darling.

• The haunting anxiety you just can’t shake that your own child, despite never actually mentioning it to you, may be trans or gender nonconforming or perhaps just not all that interested in playing high school football.

If any of these symptoms persist, please desist! Knowing more about GAC is not going to quell any of these fears, and it won’t make you a happier or more thoughtful person. You need a therapist, not another Jesse Singal essay, and the best course of action would be for you to leave trans people and the topic of GAC alone.

Meanwhile, if you are interested because someone you care about, say your child or a juvenile sibling, has expressed interest in accessing GAC or has expressed distress about their gender identity, I am begging you—absolutely begging you, down on my knees imploring you—talk to a clinician who specializes in GAC. Then talk to a second one and a third one and a fourth one. And then talk to the parents of other people who have accessed GAC. Talk to a therapist who has worked with similar minors and another therapist who has worked with their adult loves ones. And definitely talk to people you know who have accessed GAC and are trying to access it currently, including the person trying to access it now in this hypothetical. And above all else, when you talk to that person, actually listen to them without presumption or patronizing condescension.

There is a third category you may fall into. Maybe you want to know more about GAC because of pure intellectual curiosity, the worthy desire to be educated about controversies, or a belief that you are professionally obligated to offer opinions about matters of public interest. If that’s the case, have at it. Do your research, draw your conclusions, write your essays if you must. But tread lightly and take care not to grip too tightly. The issues are not abstract intellectual games to many of the primary interlocutors, nor one of the many topics that make up their “beat.” They may honestly believe the stakes are life and death to themselves and people they care about. They may not want to be patient with you. Your poking and prodding may piss them off. They may get angry and say mean things about you. Tough. Suck it up, buttercup, and welcome to the working week.

The broader point I’m trying to make here is that while journalists have a particular view of their profession that they believe empowers them to unilaterally decide what qualifies as a matter of public interest and what are credible debates in the various communities they cover, there’s no reason why other people have to defer to their judgments. And they don’t. To the contrary, there are many people who disagree that what Chait calls the “medical debate” about GAC is even appropriately public in the same way that tax policy and electoral politics are matters of general public concern. They question why there needs to be a large public debate about it at all, whether on Twitter or in the pages of New York Magazine, especially if it is to be organized by people who lack any scientific expertise or material interest in the issue. Indeed, many of Chait’s critics believe that whatever debate exists about GAC should be primarily defined and conducted by the communities most impacted by it, not by a general audience of journalists attracted by another opportunity to showcase their very important takes on hot-button culture war issues. If a minuscule fraction of minors seek GAC, general interest in it is poised to be, at best, Monday morning quarterbacking and gawking from the bleachers. At worst, such coverage will be used as the basis to deny people access to care they seek.

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II. Concussion Discussion

[Tfw the uniform says 18, but the hairline says 38.]

Of course, sometimes journalists do have skin in the game. Sometimes they are writing about something that matters to them personally and, when they are, they may use their own personal experience in lieu of more conventional empirical evidence. Take, for example, Jonathan Chait’s 2014 essay, also in New York Magazine, “In Defense of Male Aggression: What Liberals Get Wrong About Football.” The premise of the essay is that football “is actually pretty great” because it gives boys and young men a structured and relatively safe way to work out aggression and violence. In making that argument, Chait both pooh-poohs concerns about the elevated risks of concussion football players face and he cites his own experience playing high school football as a generalizable example about why it is so great. In other words, the essay downplays the risks of concussions and then counter-poses those risks to respect for the autonomy of boys who wish to participate in what Chait cherishes as an important form of “male socialization.”

As policy analysis, the essay is badly flawed but instructively so. It simply doesn’t have the goods to deliver a cogent cost-benefit-analysis of youth football, which is probably why so much of the essay is dedicated to Chait’s maudlin and meandering reminisces. Chait stipulates what the broader literature on traumatic brain injuries confirms: playing football carries an elevated high risk of injuring your brain through concussions. Chait puts football’s concussion numbers at “6.4 times per 10,000 athletic events'' compared to “sports like girls’ soccer (3.4 times per 10,000), boys’ lacrosse (4), and ice hockey (5.4)"  Chait writes that this is only “an incrementally higher risk.” True! By the same token, since 25.2 miles is also an increment, a marathon is only incrementally longer than a one-mile jog. Meanwhile, the “data gives [sic] us no reason to consider high-school football a dramatically riskier activity.” “Drama” isn’t a term of statistical analysis, so save the drama for your mama, Jonathan. However, significance is, and those data definitely show significant differences in concussion risks between football and other sports.

Chait’s article is from 2014, so it is worthwhile to consider what we’ve learned in the 8 years since it was published. A 2016 systematic review in British Journal of Sports Medicine found American football with the third highest concussion rate after rugby and hockey, with .53 concussions per 1000 athlete exposures. A 2022 meta-review in Sports Medicine, found 0.78 concussions/1000 per athlete exposures for high school football (ages 13-19) and 1.15 concussions per 1000 athlete exposures for minor football players (ages 5–15). That meta-review also found that limiting contact in practice reduced but did not eliminate concussion rates, as did Heads Up Football, a program focused on coach education and contact training. Meanwhile, the CDC currently suggests there is a relationship between the frequency of tackles in football and elevated concussion risk and it notes that tackle football tallied 15x times as many concussions as non-tackle football. Finally, research on whether the “age of first exposure” (AFE) matters to the severity of adverse health consequences is mixed. A 2017 study in Translational Psychiatry, found that “Younger AFE predicted increased odds for [later] clinical impairment,” while a 2019 study in Sports Health found “that timing of onset of football exposure does not result in poorer functioning in adolescence and young adults and may contribute to resilience through decreased levels of physically related psychological distress.” 

What can we conclude from all this? 1) Young people who play football run a significantly elevated risk of being concussed. 2) Sports with lower frequency of contact, such as soccer and basketball, and non-contact sports, such as tennis or volleyball, carry significantly lower risks of concussions with frequency of contact the controlling factor. 3) Earlier exposure to concussions may generate even more serious long term adverse consequences for cognitive functioning and health. 4) Concussion risks can be proactively managed through mitigation and education strategies, but they cannot be eliminated and they remain elevated above activities with less or no contact even after mitigation. 

In short, playing football exposes young people to the significant risk of irreversible and serious brain injury. Failure to recognize and manage the risks of those injuries leads to significantly worse health outcomes for players. The presumptive case for reducing access to youth football is strong indeed. Proponents of youth football would need to identify a unique and powerful benefit. Can Chait do it? (Spoiler: No.)

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III. Jonathan Chait’s Moving Defense of (Cisgender) Youth Autonomy

[A Portrait of the Author as a Young Very Large Potato.]

That won't stop him from trying! What benefits does Chait cite to offset the risks of concussions? He contends that football can structure and safely manage the effects of something he calls “testosterone poisoning” in boys and young men, a condition that impairs their impulse control, emotional regulation, and increases their tendency towards violent and aggressive behavior.¹ Football offers afflicted boys a disciplined path to manhood that is less destructive to themselves and to others than what they would likely do if football was unavailable. The evidence he cites to support these (rather sweeping) claims is anecdotal and vague. The essay references no peer reviewed studies on this point, nor does Chait conduct any tendentious readings of statistics that burden quantities with non-statistical qualifiers such as “dramatic” or “incremental.” Half-baked and underdeveloped references to Friday Night Lights and Teddy Roosevelt abound, yes, and Chait drags out bromides from the work of Stephen Pinker and Jonathan Haidt and then ponderously links them to youth football.

The main evidence, however, is Chait’s own experience, which he weaves throughout the essay but summarizes nicely in the final two paragraphs:

Football’s enemies have an accurate sociological observation, but their conclusion is backward. Nothing else pumped so much adrenaline through me that I couldn’t feel my feet underneath me as I ran and could barely remember my name, or made me weep or scream uncontrollably. It is the adventure of your life, a chance to prove yourself as a man before other boy-men who, even if you never see them again, you will always regard as brothers-in-arms.

This is an increasingly antiquated conception of male socialization. George Orwell, the old socialist, was well ahead of his time when he scribbled out an angry rant against the sporting ethic, which, he wrote, “is bound up with hatred, jealousy, boastfulness, disregard of all rules and sadistic pleasure in witnessing violence: in other words it is war minus the shooting.” That is all more or less true. But shooting is precisely the problem with war. War minus the shooting is actually pretty great.

One could warn Chait that concussions are precisely the problem with football, but I fear he’d still miss the point. If you want to make an objective case for football, you need to show not just that football has some developmental benefit for boys—something he assumes but does not show in the essay—but that those benefits are unique and powerful. It can’t just be that football gives boys the taste of “war minus the shooting”; it’s that soccer or flag football can’t. Or, for that matter, that competitive debate and chess club don’t also direct youthful masculine aggression into good habits and healthy personal development without, at once, significantly elevating risks of traumatic brain injuries. I suppose it’s possible—unproven but possible—that football offers a marginal benefit in terms of managing teenage masculine aggression over debate and chess. But you’d have to be an absolute laughable rube to assume without evidence that it’s superior on that score to soccer, cricket, and basketball, sports that are vastly more popular throughout the rest of the world with boys and young men and that provide exactly the vital “male socialization” Chait is crowing about.

But now I’m trying to measure the distance to a first down in Chait’s fantasies and that, my friends, is a fool’s errand. While Chait is happy to hand-wave objective concussion risks as merely the “bien pensant” worries of “a safety-reform movement mutating into a culture war,” the benefits of football are, on the other hand, presented as so ineffable they can’t be documented with statistics and peer-reviewed studies. They are, however, quite clear from Chait’s own personal experiences.

What’s more striking is that, despite the weakness of his evidence, Chait engages in precisely the rhetorical tactic that he chastises leftists for in his recent week’s piece about GAC when he describes people worried about football’s effects. “We prefer to alternate between ignorant bliss and spasms of moralistic hysteria,” Chait intones, “and as the moral panic around football has spread, it has not only expanded beyond the NFL, a well-deserved target, but has at times left that target behind.” When he summarily dismisses the concerns of “football’s enemies,” he doesn’t bother to distinguish between people who would like to create programs to manage and reduce concussion risks and people who would simply like to ban football outright. There is obviously a meaningful difference between harm reduction and abstinence—the safety programs mentioned in the last section are financed by professional football—but Chait isn’t interested in practical ways to make youth football safer and the article doesn’t mention any of them. It is, rather, an effort to dismiss those safety concerns entirely, a partisan’s dogged defense of an activity he venerates. Expressions of concern about football, he writes, represent “one part of America ris[ing] in visceral, often-uncomprehending revulsion against the values and mores of another.” Football only has enemies and advocates, people who believe it elevates the risk of concussions and those who are apparently statistically illiterate.

Charitably put, what Chait is saying is that high school football was incredibly meaningful to him, that it helped him become the man he is, that he is happy being the man he is, that he wants to give boys the chance to become men in the same way he did, and that this path to manhood is worth the risks. Fine, fine. These claims are not meaningfully open to scientific scrutiny in the normal sense nor does Chait make even a passing effort to scrutinize them empirically. But, to read them and to be moved by them as Chait intends, you must treat Chait’s narrative of his own masculine identity formation with respect and deference. You must, in short, believe that young Jonathan deserved the autonomy he wielded in choosing to play football. Whatever his shortcomings and immaturity at the tender age of fifteen, those choices made him the author of “the adventure of [his] life” and he does not regret them. Football was essential to his masculine development—it gave him access to critical “male socialization” and bound him to his “brothers-in-arms”—even though, and especially because, it exposed him to a shared risk of bodily injury.

Indeed, in Chait’s argument, the boys who are the least rational and mature, those most captivated and dominated by surging hormones, need the discipline of this “male socialization” the most. Respect for their autonomy, even when the subjects are not rational or mature, is vital and this kicker follows: it’s condescending, patronizing, and not a little bit offensive for liberals to meddle in the tempestuous and sensitive processes by which other people’s sons win their manhoods. It intrudes on “the adventure of [their] life.”  Boys and young men, even those too addled by “testosterone poisoning” to think clearly or judge risk, should be able to decide which games they will play and which dangers they will face; the bearing of the risks is the adventure itself and to have the opportunity to prove yourself requires a risk of failure (and concussions, apparently).²

The passage is an earnest, if overwrought defense of the autonomy of immature and impulsive boys over and against the caution of pansy “bien pensant” liberals. It correctly recognizes that one of the distinctive pleasures of youth abides in the experience of grasping new autonomy that most adults grow to consider banal—think of a first kiss, car, beer, cigarette, or joint. Those experiences are cherished sources of nostalgia even when they are objectively mediocre or worse and even when they may lead to painful outcomes. They are vivid parts of what makes a rich life even when they suck. This is why people such as Chait wistfully recall their mediocre football careers, why others smile at pictures of tragic high school haircuts and gaudy parachute pants, why others tap their feet and hum along to “Closing Time,” and why still others choke up at the passing memory of an awkward, fumbling kiss with a high school sweetheart that dumped them ages ago. Chait is correct that we are educated by life into what passes for adult maturity, and the instrument of education is often childish failure, embarrassment, and pain. When we deny young people autonomy, we deny them not only their will, but the thrills and pleasures that, while distinctive to youth, as experience and memory will help us to bear the hardships of adulthood yet to come. We should, in the best version of Chait’s position, be hesitant to deny young people autonomy precisely because it robs them of the thick and variegated experiences they need to develop into healthy adulthood.

As should be obvious, I have some measured sympathy for this perspective, even if I disagree with Chait’s ultimate conclusion about the relative value of high school football. In fact, like Chait, I played high school football and I understand its attractions well enough, arguably better than he. Unlike Chait, who by his own admission was mediocre, I played for four years, was good enough to crack the starting lineup in my sophomore year, and earned three varsity letters. I found football deeply meaningful, pleasurable, and thrilling. But I was also concussed playing football, and, on at least one occasion, I was concussed seriously enough that I had to be taken to the hospital. No one warned me about the long term risks associated with concussions, but my coaches spent quite a bit of time telling me that football would shepherd me into manhood, making claims that sounded remarkably similar to the ones Chait makes in the article.

I don’t think football did an effective job of teaching me how to be a good man, even though I think most of my football coaches were well-intentioned and good people. To the extent that it taught lessons of discipline, preparation, humor, dedication, camaraderie, restraint, and poise, it tended to do so unevenly and with no more success than my other serious adolescent passions—my various friendships and romances, computer games, science fiction books, violin, and speech and debate tournaments. Football also introduced some very bad personal habits that did, indeed, circle the orbit of what people sometimes call “toxic masculinity.” It would be many years before I would see that with clarity. As Chait is happy with the man he has become, I am also quite fond of the person I am, but I candidly recognize that person is one who would terrify my football coaches and teenage self. I spent many years thinking about what had been incomplete and damaged in the earlier vision of manhood I had clung to like a raft as a teenager. What I discovered was that I needed to learn how to be a good person before I could learn what it might mean to be a good man, and that this was a lesson all the bluster about manhood in football obscured more than it revealed.

All of that said, if you had told me at the age of fifteen that I could not choose to play football, that I was not entitled to decide for myself how I would blaze a trail to manhood, I would have deeply resented it. I would have hated you for saying it and I would have worked tirelessly to thwart your efforts to deny my juvenile passion. For the truth is that we all decide precisely what sort of person we will be and no other can choose for us. It is not that it is merely wrong for other people to decide for us; it is that they cannot decide for us. They cannot decide for us any more than they can breathe, eat, or sleep for us. They can, however, make life hell in the deciding, make the choices we make more or less painful. That is precisely what is hard about adolescence for everyone, gender conforming or not: there is doubt, fear, and pain that comes with becoming what we have not been. It is a process that sometimes violates the expectations of those we love and confounds and surprises even our selves. This is why there is a profound, if intangible moral good in a measured defense of the autonomy of young people.

Even in this articulation, the autonomy of young people is not a trump card to be wielded outside of context and consequence. But it does require us to treat willful identity statements—I am this or I wish to become this—with respect and care and it does obligate us to help young people safely navigate growth without substituting their preferences about who or what they will become with our own. When we do that, we do not choose for them, we merely make their choice more painful. In any case, how one navigates that process in schools, clinics, and homes is rarely easy, but it is not made easier by framing what should be a conversation as a debate, much less a debate to be enjoined in heated digital spaces by culture war combatants speed-reading studies they aren’t trained to understand.

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This returns us to gender affirming care and a conclusion. Advocates of GAC often point out that concerns such as “bone density” only seem to be considered serious and unmanageable risks by journalists when the bones in question belong to trans kids thinking about transition. When the sex hormones and antagonists are administered to a patient in a way that confirms assigned sex, various unmanageable risks are, well, managed (as they can and should be) and there is no second-guessing patient choice. Perceptions of risk for GAC do, however, seem to pivot between “blissful ignorance and moral hysteria,” at least outside of more sober clinical discussions. This is the frustration that trans and nonbinary people express when risk is bandied about in this selective, divorced as it is from the specificity of who is doing the risking, who is permitted to do the deciding about the risking, and what other risks all the parties ought to consider relevant to that deciding. These inconsistencies illustrate exactly how the “medical debate” about GCA cannot be detached from the “political debate,” no matter how much Chait wishes it were so, since both debates would hinge less on the unintended consequences of GCA and more on a differing evaluations of the benefits of the intended consequences as well as who is best situated to decide whether the benefits outweigh the costs. To whatever extent one could separate a medical debate from a political debate in theory, it is pure fantasy to believe one could do it in practice in the current environment.

As we have seen, however, fantasies do weigh heavily when it comes to Chait’s thinking about the gendered development of youth and so we should not be surprised to find it here. It is undoubtedly some sort of fantasy about gender that explains Chait’s vastly different treatments of risk when it comes to GAC and youth football. Teenage boys deserve the autonomy to pursue masculinity through football even if it brings elevated risks of concussions. The least rational and developed boys, the ones most afflicted by “testosterone poisoning,” need it the most. People who doubt this are hysterical moralists who exaggerate the risks of concussions and refuse to recognize that they are denying boys not just access to a fun game but to the very means to become the men they desire to be.

I wish that Chait would treat the autonomy of young people seeking gender affirming care with the same level of empathy and compassion that he treats teenage boys seeking to prove their manhood on the football field. The risks of irreversible bodily injury for those boys are not a “murky and embryonic” thing, despite what Chait seems to believe, and the benefits of GAC are every bit as meaningful to the young people seeking them as football was to Chait. At the very least, Chait must recognize that the path to adulthood is no less treacherous for trans and gender noncomforming youth, and almost certainly considerably more so, than the pathways available to most American boys. There is no equivalent of soccer in our GAC analogy, no second path that confers the same benefits without the risk. If trans adults and their allies are impatient with these niggling doubts and uncertainties selectively raised by journalists for their audiences of Monday morning quarterbacks, it reflects a sense that the path to trans adulthood is already dangerously perilous and that the access to life-saving care is already too restricted.

There is, to be sure, a time and a place for people to discuss whether the public rhetorical choices of trans and gender nonconforming people and GAC clinicians adequately serve their own desired outcomes and the wellbeing of trans youth. That discussion, in fact, is already happening amongst trans and gender nonconforming people and GAC clinicians. That discussion is not enriched by Chait’s presence, who has neither the education nor interests to be a credible participant. But that is where Chait now intrudes. He should not be surprised that many trans and gender noncomforming people are not interested in what he has to say, not edified by his considered opinions. They are, quite understandably, irritated by his pretense. And if they learn about his opinions of youth football, I suspect they may well be furious that he regards the autonomy of the boy he once was as vastly more precious than the autonomy of trans youth who actually breath and dream today.

1. To my knowledge, testosterone poisoning is not an actual clinical diagnosis but a slippery way of describing the unattractive behaviors common to some adolescent boys and young men. It is, in this sense, a term invented to make the incidences of those behaviors seem somehow more clinical, biological, and scientific, and thus to make the speaker themselves sound like they’re an educated and erudite expert. This form of low-grade scientism I find creepy, distasteful, irritating, and slightly pathetic. I would, I hope, be humiliated to discover I had ever used this term in any way that was not facetious.

2. Chait’s argument is so muddled that he implies but doesn’t really articulate what might be a marginally stronger claim: football attracts more aggressive boys, boys who are so aggressive and violent that they couldn’t be satisfied with chess or whatever, so they would turn to street brawling if they didn’t have football. The risk of bodily injury from football is less than the risk of bodily injury from street brawling, right? [Editors Note: Is it?] In which case, it’s a classic opportunity cost argument: when it comes to violent and aggressive boys, football is still safer than anything else. I think this argument is evidence-free trash, but it also misses the example of Chait’s own experience: He says he “lacked natural ferocity.” Maybe football is somehow better than soccer for hyper-aggressive toughs who would be getting traumatic brain injuries no matter what, but plenty of mellow, abiding boys just like Chait have access to the activity and they wind up getting concussed when otherwise they would have been running cross-country and singing in show-choir.