What just happened?
In Nebraska, lawmakers recently approved a law that combines restrictions on abortion and gender-affirming care. The bill, LB 574, bans abortions after 12 weeks of pregnancy, with exceptions for medical emergencies, sexual assault, or incest, and restricts so-called gender-affirming care for transgender minors younger than 19.
The law defines “gender-altering procedures” as any medical or surgical service and prescribed drugs related to gender alteration. The state’s chief medical officer, appointed by Nebraska’s Republican governor, is also given the power to regulate nonsurgical gender-altering procedures for minors, such as puberty blockers and hormone therapy.
In Texas, a similar bill headed to Governor Greg Abbott would make Texas the largest state to ban such procedures for minors. The bill cleared the GOP-controlled legislature over the objections of Democrats.
What is ‘gender-affirming care’?
The term “gender-affirming care” is a euphemism for the range of medical interventions provided to both children and adults to conform to the ideology of transgender identity.
The Biden administration defines it as a “supportive form of healthcare” that “consists of an array of services that may include medical, surgical, mental health, and non-medical services for transgender and nonbinary people.”
The government also claims, “For transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being as it allows the child or adolescent to focus on social transitions and can increase their confidence while navigating the healthcare system.”
Despite the misinformation presented on the topic, such medical interventions are neither evidence-based nor necessary for the mental and physical health of human beings. Children are often asked to make decisions that will affect their bodies and fertility before they are developmentally capable. Any concerns about the potential for regret in the future or the irreversible nature of some gender-affirming procedures are waved away by LGBT+ advocates as being unimportant or trivial. As Reuters found in a special investigative report, “Hard evidence on long-term outcomes for the rising numbers of people who received gender treatment as minors is very weak.”
While the evidence against such interventions is ignored in the United States, many countries in Europe are still hesitant about experimenting on the bodies of children. As The Economist notes,
Almost all America’s medical authorities support gender-affirming care. But those in Britain, Finland, France, Norway and Sweden, while supporting talking therapy as a first step, have misgivings about the pharmacological and surgical elements of the treatment. A Finnish review, published in 2020, concluded that gender reassignment in children is “experimental” and that treatment should seldom proceed beyond talking therapy. Swedish authorities found that the risks of physical interventions “currently outweigh the possible benefits” and should only be offered in “exceptional cases”. In Britain a review led by Hilary Cass, a pediatrician, found that gender-affirming care had developed without “some of the normal quality controls that are typically applied when new or innovative treatments are introduced”. In 2022 France’s National Academy of Medicine advised doctors to proceed with drugs and surgery only with “great medical caution” and “the greatest reserve”.
What medical procedures are classified as ‘gender-affirming care’?
Gender intervention procedures are based on three categories: puberty blockers, cross-sex hormones, and surgery.
Puberty-blockers. The medications most commonly used to suppress puberty are known as gonadotropin-releasing hormone (GnRH) analogues. GnRH analogues suppress the body’s release of sex hormones, including testosterone and estrogen, during puberty. These sex hormones affect primary sex characteristics (the sexual organs present at birth, including the penis, scrotum, and testicles and the uterus, ovaries, and vagina), and secondary sex characteristics (the physical changes in the body that typically appear during puberty, such as breast development and growth of facial hair).
Hormone therapy. Treatments that lead to the development of certain secondary sex characteristics. Depending on what the person is trying to achieve, they might include anti-androgens, estrogens, progestogens, or testosterone. According to The Economist, data suggests around 5,000 teenagers were prescribed puberty blockers or cross-sex hormones in America in 2021, which is double the number from 2017.
Surgeries. Surgical procedures are attempts to change the person’s body to more closely match the body of someone of the opposite sex. This may include chest and genital surgeries, body sculpting, facial feminization, and hair removal, among other treatments. Currently, few states allow surgeries for children younger than 16.
Genital surgery. A range of procedures are used to remove the genitals and reproductive organs to change the bodies people were born with. (“Bottom surgery” is slang for genital surgery.)
Chest surgery. Surgery to remove or construct a person’s chest, either removing the breasts (for women and girls) or breast augmentation (for men trying to look like women). (“Top surgery” is slang for gender-affirming chest surgery.) As Yale Medical points out, one surgical procedure used to masculinize the chest—called a bilateral mastectomy—involves removing most of a person’s breast tissue, accompanied by chest contouring. This is often offered to teens at the age of 16.
Facial surgery. For a man trying to look like a woman, treatments may include Adam’s apple reduction and procedures to reshape the nose or other areas of the face. Surgeries for a woman trying to look like a man might include jaw augmentation or enhancement of the Adam’s apple.
Some treatment options are potentially reversible (e.g., puberty-suppressing hormone treatment can be stopped before other hormones are given), while others are semipermanent or fully permanent (like hormone treatment and surgical interventions).
Which states currently ban such procedures for minors?
The states that restrict or ban such interventions on minors include the following: Alabama, Arkansas, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Mississippi, Montana, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Utah, and West Virginia.
Some of the laws being enacted are facing legal challenges and may be struck down as unconstitutional.
What should Christians do on this issue?
Unlike many culture war issues in America, this issue is likely to be largely resolved in the next 10 to 15 years. By then, the results of today’s harrowing experiment on children’s bodies will be widely seen by the public. Adults who were pushed to mutilate their bodies to conform to an ideological agenda will begin to express their regret and anger and will want—and deserve—to hold someone accountable for their pain and loss.
One way we might bring that future into the present is to adopt an approach taken in Arkansas. Lawmakers in that state are trying to make it easier to file malpractice lawsuits against doctors who provide such care. The law allows someone who received gender-transition medical interventions as a minor to file a malpractice lawsuit against his or her doctor for up to 15 years after the patient turns 18. (The current ban prohibits doctors from providing gender-confirming hormone therapy or puberty blockers to anyone younger than 18 or referring him or her to other doctors who can provide that care. No gender-affirming surgery is performed on minors in Arkansas.)
This right to sue should be expanded to include lawsuits against medical associations, such as the American Academy of Pediatrics, who have misrepresented, ignored, and suppressed the evidence showing the harms of gender interventions in children. Many physicians who provide “gender-affirming care” to minors claim, without sufficient evidence, that the rate of those who regret such interventions is extremely low. But if they’re held accountable by being financially responsible for their medical malpractice, they might reconsider their willingness to prioritize LGBT+ ideology over medical science.
The Gospel Coalition