In late December, the Supreme Court of Texas decided it would take up the custody case of James Younger, a child from Texas whose mother insists the male child identifies as a girl. The child’s father, Jeff Younger, maintains his son is a boy. Should Jeff Younger lose custody of his kid, the boy will be subjected to surgeries mutilating the young child’s genitals in the mother’s pursuit of raising him as a girl.
Recent years have seen a “sharp rise” in the number of American youth ages 13 to 17 who say they identify as the opposite sex or as non-binary. This growing population of gender-confused adolescents is nearly double what it was just five years ago.
The sharp rise comes amidst a global and national debate around the correct standard of care for the treatment of gender confusion in minors. Some European countries were using an unproven protocol tried in the Netherlands referred to as “gender-affirming care.” This experimental approach treats children who express discomfort with their sex with drugs (such as puberty blockers and wrong-sex hormones) and surgeries (such as mastectomies). Although there is no evidence that these hormonal and surgical changes to a child’s body produce improved mental health outcomes, there is growing evidence of permanent physical damage, including loss of bone density, greater risk of disease, and infertility.
Recognizing the failure of the “gender-affirming” approach to achieve improved outcomes — and spurred by the lawsuit of a young woman who was prescribed puberty-blocking drugs at just 16 years old — countries such as Sweden, Finland, and England have made a clear U-turn away from some or all of these questionable protocols. After thoroughly reviewing the reliable evidence, these countries concluded that the risks of “gender-affirming care” far outweigh any potential benefits.
Instead, they are returning to psychological and psychiatric care as the starting point for addressing gender confusion in children — a model known as “watchful waiting” — noting that gender dysphoria in teens could be just a “transient phase” which should not be mishandled with radical, life-altering drugs and surgeries.
Nationally in the U.S., however, the “gender-affirming care” model is emphatically pushed as the only acceptable standard of care. Some states rely on recommendations from the World Professional Association of Transgender Health (WPATH), which is not a medical organization, but an ideologically driven advocacy group. And prominent medical organizations like the American Academy of Pediatrics (AAP) promote “gender-affirming care” despite the majority of its members supporting more review and discussion, noting the lack of evidence-based science, and raising persuasive findings that gender confusion has been clearly linked to other factors affecting children, including autism and social contagion.
Manhattan Institute Fellow Leor Sapir describes what is happening as an “exceptionalism” for “gender-affirming care,” exempting organizations like the AAP and the Endocrine Society from normal requirements in medicine that any recommended protocols be backed by objective evidence. The best evidence actually shows that the majority of children (61-98 percent) will “desist” (stop identifying with the opposite sex) if allowed to progress normally through puberty. It also shows that so-called social transition (using different names and pronouns) actually causes 97.5 percent of children to persist in cross-sex identification and that 96 to 98 percent of those who start on puberty blockers will move on to cross-sex hormones.
Fortunately, states like Florida are stepping up and leading by example in this national debate. In April 2022, the Florida Department of Health issued guidance (after a systematic review of available data and studies which revealed low-quality evidence to support “gender-affirming care”) that social transition, wrong-sex hormones, and surgeries should not be used to treat gender dysphoria in children under 18.
Then, in June 2022, the Florida deputy secretary for Medicaid issued a report concurring that “sex reassignment treatment” (which is the same as so-called “gender-affirming care”) is “experimental and investigational,” and “poses irreversible consequences, exacerbate[s] or fail[s] to alleviate existing mental health conditions, and cause[s] infertility or sterility.”
Finally, in November 2022, the Florida Boards of Medicine and Osteopathic Medicine voted to adopt a proposed standard of care prohibiting the use of “gender-affirming care” to address sexual confusion in minor children (with an exception made only for those who are already receiving such regimens).
The Florida medical boards’ thorough review of the best available evidence about how to treat gender dysphoria in children was much needed during a time when our nation’s most well-known medical associations have been captured by destructive ideology. States like Alabama, Arkansas, Arizona, and Tennessee have also sought to protect children from the lifelong harms caused by dangerous drugs and surgeries through legislation.
Not having a standard of care based on real science and real evidence is problematic for both parents and children. In child custody cases where parents may disagree on the best treatment for their sex-confused child, judges now defer almost exclusively to medical experts who support the activist-driven and unscientific standard of care. This deference affected child custody decisions in California, Texas, and Ohio, leading to the erasure of the rights of parents who do not support radical changes to their child’s body in order to affirm his or her perceived (and likely transient) incongruent gender identity.
Also, government officials like the Biden administration and California Gov. Gavin Newsom are embedding a politically driven standard of care into rules, guidance, and legislation like California’s SB 107, which allows California to take custody of a child away from parents in any state who disagree with attempts at “gender transition.” This undermines the rights of parents who prefer the watchful waiting approach to directing their child’s health care.
Further, youth who have undergone hormonal and surgical interventions are now “detransitioning” (reconciling with their sex) and experiencing deep regret at what they have lost. A growing number are sounding the alarm that they were too young to understand the consequences of what activists call “gender-affirming care” and that doctors and pharmaceutical companies sacrificed their health for profit. Chloe Cole, a California teenager, was put on puberty blockers and testosterone at age 13, and doctors removed her breasts at age 15. She has now filed a medical malpractice lawsuit against doctors and one of the nation’s largest insurance companies.
Following the lead of Florida, Arkansas, Alabama, and even western European nations, states should examine the best science and evidence rather than succumbing to harmful activist-driven ideology. This will not only preserve the constitutional right of parents to pursue non-invasive psychological treatment options, but it will also save children from the lifelong irreparable harms of being rushed down a direct pipeline from social transition to sterilization.