Science: Gender affirming care for minors risky
“First, do no harm.” The American medical community has strayed a long way from the Hippocratic ideal when treating gender dysphoria.
Instead of letting scientific evidence drive treatment protocols, the mainstream medical community in the United States has been driven by ideology with their “affirm-only/affirm early” gender affirming care policy.
These life-altering procedures have questionable benefits at best and well documented adverse health effects.
Research shows that by adulthood, many children will outgrow gender dysphoria, making these permanent procedures even more inappropriate.
We must protect children from the political beliefs of providers who push elective medical procedures on children that threaten their quality of life now and into adulthood.
Why I am sponsoring this legislation
I am sponsoring Senate Bill 1 to prohibit irreversible hormone treatments and surgeries for minors to change their gender identity to differ from their biological sex. The legislation is based on credible scientific studies that point to the dangers of treating children with gender affirming care.
Many on the left and in the mainstream medical community would have you believe that Senate Bill 1 is an example of extreme, right-wing conservatives inserting their political ideologies into medical practice without evidence. This couldn’t be further from the truth.
The science is far from settled. In fact, progressive European countries are reversing course on gender affirming care. Evidence of poor treatment outcomes has convinced these countries to change their protocols to restrict gender
affirming care practices.
The U.S. standard of care for gender dysphoria is based on low to very lowquality evidence. The most comprehensive study reviewing the scientific research on the efficacy of gender affirming care comes from the National Health Service (NHS) in the United Kingdom.
It concluded there was “limited evidence for the effectiveness and safety of gender-affirming hormones in children and adolescents with gender dysphoria, with all studies being uncontrolled, observational studies, and all outcomes of very low certainty.” The corresponding NHS study into the efficacy of puberty blockers found similar results. Even in the U.S., puberty blockers are not approved by the Food and Drug Administration to treat gender dysphoria due to the lack of evidence and risks.
How European countries are responding
While much of the American medical community seems to think puberty blockers are the “gold standard” for treatment, these drugs are being used off label.
As a result of the NHS research, the UK closed the world’s largest pediatric transgender clinic and reversed its
standard of care, abandoning the almost universal use of puberty blockers and crosssex hormones to treat gender dysphoria in children. The new primary treatment for gender dysphoria in the United Kingdom is psychotherapy and psychoeducation.
Likewise, both Sweden and Finland, following their own systematic reviews of the evidence, have significantly reversed their long-held pediatric gender affirming treatment protocols in favor of much more cautious treatment guidelines, prioritizing psychosocial interventions while sharply restricting hormone treatment and surgery.
When determining medical best practices, we must take into consideration that many of these children will outgrow gender dysphoria. Research from Dr. Michael K. Laidlaw, a medical doctor specializing in endocrinology who has been published in the peer-reviewed Journal of Clinical Endocrinology and Metabolism, shows that the vast majority of children with gender dysphoria will outgrow this condition by adulthood.
Authors writing in the peer-reviewed Journal of Sex and Marital Therapy document a spike in children who identify as transgender. They argue that this dramatic rise coupled with scant medical evidence of the long-term benefits of gender affirming care in children raise serious ethical concerns about the ability of trans-identified adolescents -and more importantly their parents -- to give true informed consent for procedures that have irreversible effects.
The legislation would press pause until adulthood
Finally, the evidence does not support that gender affirming care reduces adolescent suicide deaths. We heard testimony in the Senate Health and Welfare Committee from opponents of SB 1 contending that without puberty blockers and hormones, children would be more likely to die by suicide.
However, once again, the evidence simply does not bear this out. The most comprehensive study of its kind examined the suicide rates of 324 patients over a 30-year period who had taken cross-sex hormones and had undergone sex reassignment surgery. The authors of this Swedish study from 2011 found that “when followed out beyond ten years, the sex reassigned group had 19 times the rate of completed suicides and nearly three times the rate of all-cause mortality and inpatient psychiatric care compared to the general population of Sweden.”
To say “the science is settled” on the medical effectiveness of gender affirming care is intellectual dishonesty at best, and medical malpractice at worse. Given the permanency of puberty blockers, cross-sex hormones, and gender reassignment surgeries, there is not enough reliable evidence for doctors or parents to make informed decisions in favor of these practices, and children do not have the capacity to consent.
This information should give everyone pause – and that’s all this bill is asking, to press pause on physically transitioning a child until that child is an adult and can make a decision that will have life-long ramifications.
Sen. Jack Johnson, R-franklin, is the Senate Majority Leader in the Tennessee General Assembly.