‘Gender Affirming Care’ For Minors: Inside The Controversy

The modern American gay rights movement began in earnest in the mid 20th century when gay and lesbian individuals asked that their neighbors and governments afford them the same respect and opportunity given to straight individuals.

This movement was driven as much by courageous gay individuals living their lives the only way they knew how, as it was by activists, who advocated for better treatment of homosexuals.

Improvements in societal acceptance of gay individuals were slow but steady. Gallup polling data dating back to 1986 asking respondents whether they think homosexual relationships between consenting adults should be legal reflect this reality. In 1986, 33 percent of respondents believed homosexual relationships should be legal. A decade later that number rose to 44 percent, and by 2006 a majority – 56 percent of Americans – supported the idea.

While acceptance for homosexuals steadily increased, the issue was certainly still up for debate in the early 2000s. In 2004, Hillary Clinton characterized marriage as “the fundamental bedrock principle that exists between a man and a woman.” In 2008, Barack Obama said he believed “marriage is between a man and a woman.”

“I am not in favor of gay marriage,” he said.

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Meanwhile, then-senator Joe Biden stated neither he nor Obama supported “redefining from a civil side what constitutes marriage.”

Public perception of homosexuality continued to improve during the Obama administration, and states across the country enshrined the right of gay people to get married. By 2015, a total of 35 states – including South Carolina – were marrying same-sex couples (although many members of the S.C. General Assembly and state attorney general Alan Wilson fought the federal court order mandating the state certify gay marriage tooth and nail).

On June 26, 2015 the U.S. Supreme Court ruled in Obergefell v. Hodges that the due process and equal protection clauses of the Fourteenth Amendment to the U.S. Constitution protected the right of gay individuals to be married and enjoy the same legal protections as straight individuals.

This ruling refocused the efforts of the gay rights movement, which had by this time generated powerful lobbying and activist wings, to broader new goals.

For many activists the next frontier was transgenderism, as such these activists pushed for greater acceptance of transgender individuals with great success. In 2016 the U.S. military dropped its ban on transgender individuals serving in the armed forces, In 2017 the Boy Scouts of America dropped their century old ban on non-biological males. Earlier this week U.S. President Joe Biden invited numerous transgeneder influencers to the White House for a pride month celebration.

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The push for societal acceptance of transgender individuals has resulted in a rapid change in accepted medical practices. In 2013 the American Psychiatric Association’s (APA) board of Trustees voted to re-classify what had long been clinically referred to as “gender identity disorder” to “gender dysphoria” in the diagnostic manual used by American psychologists.

This shift was telling – the APA, an institution theoretically rooted in hard science, eschewed empirical evidence indicating that many transgender individuals very well may be definitionally psychologically disordered.

The APA defines a psychological disorder as “any condition characterized by cognitive and emotional disturbances, abnormal behaviors, impaired functioning, or any combination of these.”

A 2020 paper on suicidality in the transgender community published in Journal of Interpersonal Violence found that 82 percent of transgender individuals “have considered killing themselves” and 40 percent have “attempted suicide.”

This massive suicide/ suicidality rate – which is mirrored in numerous peer-reviewed publications, would be indicative to most ideologically neutral observers of “cognitive and emotional disturbances, abnormal behaviors, and impaired functioning.” Yet the APA chose to reclassify the disease a decade ago – paving the way for other medical institutions to treat gender identity disorder as something cured through gender transition. Since then, the “gender affirming care” market in the healthcare field has boomed – and the data show an outsized number of patients are adolescents.

The Williams Institute – a research center at the UCLA School of Law – produces reports on LGBTQ demographics and issues in the United States. A year ago, it released a report that aggregated CDC and Census Bureau data about transgender youth.

The report found that people aged 13-25 make up 18 percent of the nation’s transgender population despite comprising only 7.6 percent of the nation’s population. The institute’s estimation of the total number of transgender youth in the country grew from 150,000 in 2017 to 300,000 in 2022 – and estimated that 1.14 percent of South Carolinians aged 13-17 identified as transgender.

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These young people are treated at dozens of clinics throughout the country – with Mount Sinai, Johns Hopkins, Boston Children’s Hospital and other prestigious institutions on the vanguard of this movement.

What exactly happens at these clinics? Treatments range from talk therapy, to hormone altering medication, to surgical intervention. The latter two approaches – having gained popularity only within the last decade – are often experimental and medically controversial.

Of the two physical treatment methods, hormone therapy is less invasive and long lasting. Those who wish to transition hormonally are usually prescribed a combination of puberty blockers and the opposite gender’s sex hormones.

To understand how puberty blockers work, let’s look at what they do to male patients. Technically referred to as gonadotropin-releasing hormone (GnRH), the drug eliminates the body’s production of testosterone. As the name suggests, the drug is typically administered to adolescent boys going through puberty – and has the effect of preventing the natural development of the body including growth spurts and increases in muscle mass. It also blocks the development of body hair, the development of the penis and testicles, and the heightened libido pubescent boys experience.

The hormones contained in these drugs are also responsible for altering the growth of bones, and GnRH users often suffer from a precipitous drop in bone density.

According to the Mayo Clinic, if an adolescent child discontinues use of these drugs “puberty will resume and the normal progression of the physical and emotional changes of puberty will continue.” However, if boys begin these treatments too “early in puberty, they might not develop enough penile and scrotal skin for certain gender affirming genital surgical procedure” – and their fertility may be permanently destroyed.

This class of drug essentially pauses puberty, and if the “unpause button” is hit while the patient would still naturally be going through puberty – some of the damage can be undone. Still, it’s impossible to know how fully the patient might have developed had they never taken a puberty blocking drug in the first place.

If a male patient begins taking these drugs early in puberty, continues treatment throughout puberty and then – as an adult – decides they’d rather live life as a man, they are largely out of luck. By this point the body is no longer naturally pumping out the hormones that cause physical development, so the individual would likely have to live with an under-developed frame, a prepubescent penis, and an inability to have children.

Puberty blockers are only half of the hormonal equation. Should patients wish to develop characteristics unique to the other gender, they are also given “cross-hormone treatment.” For males, this means ingesting estrogen and for females it means ingesting testosterone.

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Males who take estrogen can expect fewer erections, less interest in sex, slower development of male pattern baldness, softer skin, smaller testicles, less muscle mass, more body fat, less facial hair and the development of breasts. Females who take testosterone can expect the cessation of menstruation, deepening of the voice, redistribution of body fat, enlargement of the clitoris, drying and thinning of the vaginal lining and an increase in muscle mass and strength.

Many of these effects are reversible, but some – such as the development of breasts for male patients or hair loss, voice deepening, clitoral enlargement and development of facial hair in female patients – are irreversible.

Male patients taking estrogen increases the risk of blood clots in deep veins (and in the lungs), heart issues, high blood pressure, type two diabetes, weight gain, nipple discharge and stroke. Female patients taking testosterone increase their risk of high cholesterol (and the associated heart issues), high blood pressure, overproduction of red blood cells, type two diabetes, as well as pelvic pain and clitoral discomfort. Also, both genders run the risk of obliterating their ability to reproduce even after the discontinuation of treatment.

For those seeking a more invasive and irreversible route, there is surgical intervention. For males seeking to feminize their appearance, many cosmetic surgeries are being offered including laser hair removal, hair transplants, Adam’s apple reductions, tummy tucks, butt lifts, liposuction, facial feminization plastic surgery and breast implants,

Other procedures, including vocal chord modifications, make serious alterations to the functioning of the body.

Unarguably the most impactful – and most controversial – surgeries are those designed to turn the male sex organs into female sex organs. These procedures range from removing the testicles (to prevent their production of male sex hormones) to full vaginoplasty – a procedure in which the penis is split, the urethra re-routed, and the remaining flesh shaped into a “neo-vagina.”

This surgery runs the risk of necrosis of the flesh, vaginal prolapse, and fistulas of the rectum – and patients must dilate their “neo-vagina” for a minimum of one year after surgery to prevent it from naturally healing shut. Since this manufactured opening does not contain mucus membranes like a real vagina, patients must perpetually clean and rinse out the surgical site to prevent the accumulation of bacteria.

Females looking to surgically become males also have options, starting with the removal of breast tissue and continuing with modification of the genitalia. The least invasive genital procedure – medically known as a metoidioplasty – creates a “penis” by removing the suspensory ligaments holding the clitoris in place and re-routing the urethra to flow through the new penis. This procedure typically still allows the patient to orgasm, and doesn’t require the removal of the vagina.

A phalloplasty and scrotoplasty create a completely new penis and testicles by taking large amounts of skin, blood vessels and nerves from other areas of the body including the arms, legs, and abdomen. This skin is turned into a cylinder through which the urethra is routed.

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(Female to male surgical scars – Via: Reddit)

Whatever you think about LGBT issues, everyone can agree these are serious medical interventions. The question is whether they are appropriate.

Numerous long term studies indicate many youths who identify as transgender do not retain this identity through to adulthood. The Medical Journal of Australia published a study in 1987 following up with eight children who were treated for “cross-gender behavior.” Zero of the eight still identified with the other gender.

A 2008 paper published in Developmental Psychology followed up with 25 girls diagnosed with gender identity disorder. These subjects were initially assessed as children around the age of eight. At that time, sixty percent of them met the APA’s criteria for gender identity disorder (the standard at the time). When these patients were followed up on in their early twenties, only three out of the 25 – or 12 percent – still met the threshold.

More scientific papers on this topic can be found here.

Since these studies take years to conduct, and since the field has progressed so rapidly, scientists must wait for today’s transgender youth to mature to develop an understanding of how new treatments change these statistics.

Members of the public don’t have to wait, as many transgender individuals have shared their stories online …

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(Via: Soft White Underbelly on YouTube)

One example is the above interview in which Mark Laita speaks with Laura – a woman who once transitioned from female to male.

Laura spoke of her return to femininity, saying “you can pass as the opposite sex but you can never really live as them, and you can never become the opposite sex, so I was never male – I was just having an identity crisis.” Laura isn’t alone in expressing the frustration that many transgender people feel at their inability to truly “be” the opposite sex in their own minds – even after medical intervention.

How should medical practitioners, policymakers and parents react to all of this?

The California House of Representatives recently amended a bill to include language which would hold parents liable for child abuse in custody disputes if they do not “affirm their child’s gender.’ Meanwhile, many European nations – including Norway, Finland, Sweden, and the United Kingdom – have taken the opposite approach and limited what “gender affirming care” is available to children.

A recently passed law in Washington State purports to “protect trans youth seeking life affirming care.” It does so by allowing youth shelters to not inform parents that their child is in the shelter’s custody if their child is seeking medical gender transition.

While some see this issue as little more than fodder for culture warriors – and indeed for many it is just that – the issue is more substantive than social. This is no Bud Light backlash, it is instead a discussion of whether children should be prescribed the same chemicals used to castrate sex offenders in order to “affirm” a gender identity that evidence indicates many wouldn’t carry into adulthood.

My view? If a mentally healthy adult wants to have surgery or take hormones nobody should have the right to stop them (heck, why not allow males who identify as “more male” to have the same easy access to exogenous testosterone as women who identify as males). But I believe children who can’t legally drink because they lack a fully developed prefrontal cortex run the risk of irreversibly damaging their bodies if their parents (or the state) encourage them to medically transition.

Transgenderism is here to stay – and federalism will likely dictate what that means on a state-by-state basis in our country. More than a dozen states have legislatively restricted transgender treatments – while about six have legislatively bolstered it.

South Carolina legislators passed a law preventing the state-sponsored transition of minors at the Medical University of South Carolina (MUSC) in December of 2022, much to the chagrin of local activists.

A South Carolina Senate bill, S. 623 – which didn’t make it out of committee this session – would ban gender-transition surgeries, hormone therapy and puberty blockers for people under the age of eighteen. A House bill – H.4047 – is similar to the Senate proposal but also would prevent school administrators from withholding information about student’s gender identity from parents.

That bill is also currently being debated at the committee level.

As more states address this issue, expect the heated partisan rhetoric to continue. Also, the (well-founded) belief that many of America’s once venerated medical institutions have been overtaken by political zealots has led to plummeting institutional trust. There is also growing resentment of the LGBTQ+ movement for forcing rapid change on society via corporate executives eager to hit ESG goals and avoid (what had for many years been one sided) cancellation campaigns.

The Bud Light and Target boycotts – which destroyed billions of dollars of each company’s value – demonstrated that things have changed. If Dylan Mulvaney, the TikTok influencer who partnered with Bud Light didn’t make videos primarily consumed by adolescents, and if Target – which saw a huge backlash after releasing girl’s bathing suits with room for young boys to tuck their penis in – had avoided bringing children into the mix, it is doubtful that the response would have been so swift.

But parents who support equality for LGBTQ+ individuals are often times disturbed that their children are exposed to these issues in ways that they deem inappropriate at school.

President Biden told a group of teachers in April 2022 that students are “not somebody else’s children. They’re like yours when they’re in the classroom.” Many parents understandably detest this sentiment, and know that whoever write’s Joe Biden’s script didn’t include this line by accident.

I believe as long as the LGBTQ+ movement is the de facto “state sponsored religion” of America’s governmental and corporate institutions – with its tenets forced upon a society still unsure of their wisdom – there will be major strife and backlash. I further believe it is hard to call this reaction unjustified.

I do not believe individuals angered at the alleged abuse of power on the institutional level should let their anger gestate into prejudice towards LGBTQ+ individuals – the vast majority of whom are Americans trying to find the same happiness and fulfillment as everyone else.

Those on the left must also not forget that many of those who oppose the normalization of transition don’t always do so from a place of hatred – that there very well may be legitimate bioethical concerns with the transition of children and adults who are not mentally well enough to make that decision.

We’re keenly aware this is a controversial topic, and would invite anyone who’d like their voice heard on it to submit a letter to the editor or an opinion-editorial. In fact, our founding editor Will Folks has been working on a draft expressing his views on the subject – along with several proposed policy planks for the consideration of elected officials.

Count on this news outlet to continue covering this important issue …

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ABOUT THE AUTHOR …

(Via: Travis Bell)

Dylan Nolan is the director of special projects at FITSNews. He graduated from the Darla Moore school of business in 2021 with an accounting degree. Got a tip or story idea for Dylan? Email him here. You can also engage him socially @DNolan2000.

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