27 October 2023
Now, in 2023, at least nineteen states in the United States ban most medical forms of gender-affirming care for minors (1). The most utilized intervention, puberty blockers and hormone replacement therapy (HRT), provide families with early intervention options to treat gender-dysphoria. A study conducted by Stanford Medicine found that, for transgender adults, these treatments reduce mental distress and other psychological afflictions more when the treatments start in adolescence rather than adulthood (2). The American Medical Association and American Psychological Association support these early intervention treatments and have openly opposed restrictive gender-affirming care bills since their early stages (3). Many conservative legislatures argued they were attempting to curtail what they saw as “child abuse” with many bringing regretful detransitioners to testify at state hearings (4) (5). However, in an increasingly divisive and hostile political environment for LGBTQ+ issues, it is necessary that we explore the common arguments behind these recent legislative pushes and determine their validity.
One justification against widespread and early treatment availability state legislatures point to is the existence of regretful detransitioners—people who made the decision with parental consent to undergo either HRT or Gender Affirmation Surgery (GAS), or both, and later regretted the outcome because they realized they did not have gender dysphoria. Republican legislatures routinely host a detransitioner activist, mainly Chloe Cole, in hearings to voice support for gender affirming care restrictions. This group is smaller than the total number of people who regret treatment, which includes those who regret it for the societal response to their transition, those who wished they received less side effects, and those who wanted a different intensity of transition. While expansive longitudinal data does not exist on the subject, the total regret rate across studies sits around 2 percent, ranging from 0 to 10 percent depending on the measurement and sample (5). The experiences and issues facing those detransitioning are valid and should be taken seriously by the medical community; however, policy should not completely cut treatment for the over 90 percent of people whom the treatment helps in the name of protecting the few people who later regret their decision. It’s like a trolley problem where one hundred transgender people are tied to one track, but you still send the car down it because someone might step onto the other track.
While the detransitioner rate is a legitimate concern based on some medical research, the real purpose for broad Republican support seems nefarious. Many of these bills were amendments to or in combination with bills restricting drag performance, abortion, and other social issues (6). For example, Florida State Senator Clay Yarborough introduced the nationally renowned “Don’t Say Gay Bill” in a package with a bill that banned gender affirming care and revoked the business licenses to establishments hosting drag shows with any children in attendance (7). The Senator claimed each piece of legislation protects children and empowers parents, and Florida Governor Ron Desantis signed them all on the same day (7). Both sexual orientation and drag are unrelated to transgender identity, yet conservative politicians often link and push for these legislative priorities, seemingly because they support a cultural reactionary push within the Republican party. The same is seen in Montana’s law that bans social transitioning, which presents no harm to children (1).
Most of the bills also fixate on Gender Affirming Surgery (GAS), despite the small number of providers offering the service to minors (1). The procedure typically follows the use of other treatments, depending on individual considerations (8). While many of these bills restrict implants or double mastectomies for transitioning purposes, they allow similar procedures for cisgender women (8). The GAS regret rate sits below one percentage point, according to a metadata analysis from the National Institute of Health (9). This is substantially smaller than the regret rate for cosmetic surgery that cisgender people undertake, which can be as high as 60 percent, yet breast augmentation remains legal for minors across the U.S. (10) (11). If Republicans wish to save children from a procedure with a roughly 2 percent failure rate, they ought to save cisgender children from a procedure with a 60 percent failure rate. The hypocrisy behind ignoring data on cisgender healthcare and considering data on transgender healthcare displays a disproportionate Republican focus on the transgender population, and the party’s tendency to overinflate GAS negative effects is more of a public messaging push to label all gender affirming care as “mutilation” than an honest attempt at creating sound medical policy.
The policies restricting gender-affirming healthcare in all of these states should be reversed. Even according to the most restrictive views from medical literature, the remedies to reduce detransitioner numbers are longer assessment periods and stricter patient criteria before treatment, not a total treatment ban. These nineteen states will harm a generation of patients in exchange for cultural support, as the true purpose for these policies is supporting widespread transphobia—that even extends to the non-political realm where there was national hysteria over Dylan Mulvaney briefly marketing for a beer brand (12). Medical regulations should stick to medical purposes and patient safety goals.
Image via Pexels Free Photos.
References
(1) Choi, Annette, and Will Mullery. 2023. “19 states have laws restricting gender-affirming care, some with the possibility of a felony charge.” CNN, June 6, 2023. https://www.cnn.com/2023/06/06/politics/states-banned-medical-transitioning-for-transgender-youth-dg/index.html.
(2) Digitale, Erin. 2022. “Better mental health found among transgender people who started hormones as teens.” Stanford Medicine. https://med.stanford.edu/news/all-news/2022/01/mental-health-hormone-treatment-transgender-people.html.
(3) Madara, James L. 2021. “Dear Mr. McBride,” American Medical Associaion. Letter. ama-assn.org. https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-26-Bill-McBride-opposing-anti-trans-bills-Final.pdf.
(4) Vera, Amir, and Ashley Killough. 2022. “Texas AG declares pediatric gender-affirming procedures to be child abuse, legal opinion says.” CNN, February 23, 2022. https://www.cnn.com/2022/02/23/us/texas-attorney-general-gender-affirmation-child-abuse/index.html.
(5) Respaut, Robin, Chad Terhune, and Michelle Conlin. 2022. “Why detransitioners are crucial to the science of gender care.” Reuters, December 22, 2022. https://www.reuters.com/investigates/special-report/usa-transyouth-outcomes/.
(6) Cole, Devan. 2023. “Florida sued over bans on gender-affirming care for transgender youth.” CNN, March 23, 2023. https://www.cnn.com/2023/03/23/politics/florida-transgender-medical-ban-lawsuit/index.html.
(7) The Florida Senate. 2023. “Senator Yarborough Files Child Protection, Parental Empowerment Legislation.” President Office. flsenate.gov. https://www.flsenate.gov/Media/PressReleases/Show/4419.
(8) Conlin, Michelle, Robin Respaut, and Chad Terhune. 2022. “A gender imbalance emerges among trans teens seeking treatment.” Reuters, November 18, 2022. https://www.reuters.com/investigates/special-report/usa-transyouth-topsurgery/.
(9) Bustos VP, Bustos SS, Mascaro A, et al. “Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence” Plast Reconstr Surg Glob Open 9(3):e3477. 2021 March 19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/
(10) Jones HE, Cruz C, Stewart C, Losken A. “Decision Regret in Plastic Surgery: A Summary.” Plast Reconstr Surg Glob Open. 2023, 11(6):e5098. 2023 June 27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10299769/#:~:text=Decision%20regret%20has%20been%20self-reported%20by%20many%20patients.&text=A%20UK%20research%20poll%20revealed,were%20the%20most%20common%20reason.
(11) Zuckerman, Diana. 2005. “Teenagers and Cosmetic Surgery.” Virtual Mentor, 7(3):253-256 (March). 10.1001/virtualmentor.2005.7.3.oped1-0503. https://journalofethics.ama-assn.org/article/teenagers-and-cosmetic-surgery/2005-03
(12) Oliphant, James. 2023. “DeSantis’ Bud Light brawl marks his latest move in anti-corporate gambit.” Reuters, July 28, 2023. https://www.reuters.com/world/us/desantis-bud-light-brawl-marks-his-latest-move-anti-corporate-gambit-2023-07-28/.
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