The risks outweigh the benefits.
Gasps came from the audience behind retired Rexburg physician, Jud Miller, as he sat before the Idaho House Judiciary, Rules, and Administration Committee. The facts he’d relayed did not sit well with many transgender activists in attendance. Miller had come to Boise to testify in favor of a bill that would have banned medical interventions for transgender minors, including genital surgeries, mastectomies, puberty blockers and cross-sex hormone therapy.
The bill passed the House in March this year but died in the Senate soon after.
Even as the protection of children from harmful medical practices failed in Idaho, it succeeded in Florida as medical leaders made the correct choice last month when they voted to ban gender-affirming care for minors.
Following hours of testimony from several experts on medical interventions for gender dysphoria, the Florida Boards of Medicine and Osteopathic Medicine voted on Nov. 4 to ban gender-affirming care for minors — medical interventions that change one’s physical appearance to match their preferred gender identity.
Given the success of this bill in a more populous and less conservative state, Idaho should feel empowered to resurrect this bill and protect minors.
The long-term risks and the poor evidence for the effectiveness of gender-affirming medical interventions outweigh the benefits.
The American Psychiatric Association defines gender dysphoria as the psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.
Children diagnosed with gender dysphoria may undergo puberty blockers to arrest the development of secondary sex characteristics, this would be followed by cross-sex hormones at adolescence enabling the child to develop their desired gender characteristics. This can lead to sexual organ removals and mastectomies.
In a letter to the National Governors Association last year, the American Medical Association said, “Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people.”
But as more children begin these medical interventions, more are facing lifelong health risks.
In a research article published in September, Michael Biggs, an associate professor of sociology at the University of Oxford who testified before the Florida Boards, scrutinized the origins and evidence of the original Dutch study published in 2006 that is the basis for gender-affirming medical interventions today.
According to the article, puberty blockers, which are GnRHa drugs that prevent the creation of sex hormones, are not approved for cases of gender dysphoria as there have never been clinical safety trials for this specific usage.
They are approved for treating prostate cancer and precocious puberty.
The risks of taking these are not completely known, but studies from Amsterdam and London gender clinics have shown they can inhibit the development of bone mass. Other studies show that they possibly affect brain development. One measured a drop of 7 IQ points after two years among 25 children while another found a gap of 8 points between 15 treated children and a matched control group.
The latter is of particular concern because of the effect it can have on a minor’s ability to make decisions regarding gender identity.
The studies that show decreased IQ scores in minors who take GnRHa have been small, but a randomized control trial cited by Biggs found that in sheep, GnRHa impairs spatial memory.
The same drugs are used to chemically castrate men with sexual obsessions.
The effects of hormone therapy are better understood: they can reduce fertility, the risk increasing the longer it occurs.
Puberty blockers have been framed as a benign diagnostic tool to allow pubescent children the chance to explore gender identity without the pressure that would supposedly come from puberty and the development of secondary sex characteristics.
Biggs, in his article, says it is plausible that giving puberty blockers to children can essentially make their gender dysphoria a self-fulfilling prophecy, causing it to persist longer than it otherwise would.
Two psychiatrists from Johns Hopkins University and a professor from the Washington University School of Medicine agreed by saying, “It seems equally plausible that the interference with normal pubertal development will influence the gender identity of the child by reducing the prospects for developing a gender identity corresponding to his or her biological sex.”
Since the children would not develop many of the characteristics of their biological sexes, they would not have the chance to know whether they are comfortable in their natural bodies.
Also, both puberty blockers and cross-sex hormones reduce sexual desire and function, which, according to Biggs, could affect patients’ understanding of their bodies and their future relationships.
The data do not support the claim that puberty suppression is diagnostic either.
Biggs says that almost all children, 96-98%, who receive puberty blockers continue onto cross-sex hormones.
Almost the opposite is true of adolescents who undergo no transitional treatments.
One of the statements by Miller that provoked gasps from audience members during his testimony was that most children with gender dysphoria grow out of it.
Psychologist David Schwartz concluded that 80% of gender-dysphoric children who receive no interventions stop insisting that they are a different gender by late adolescence. This occurrence ranges from study to study but is always the majority of cases.
A large portion of gender-dysphoric children become homosexual adults.
Given these facts, the question remains as to how wise it is to provide medical interventions to any transgender child, especially since there is no way to know who will persist.
In the world of gender-affirming care, life-long health decisions for a child are made almost entirely based on feelings rather than rational evaluations of whether they are truly necessary, effective and safe.
Parents who would likely approach this more rationally are naturally pressured into consenting to medical interventions by the prospect of their children committing suicide.
Part of the bill that excited additional controversy was a provision that would make it a felony for parents to take their children out of state to receive gender-affirming care. While parents who risk the health of their children in this regard should not be rendered completely blameless, it seems unreasonable to place complete legal blame on them, considering the claims from the medical establishment that affirmation is necessary as well as the alarming statistics on suicide.
Attributed primarily to stigmatization, the Trevor Project’s 2022 National Survey on LGBTQ Youth Mental Health found that 45% of LGBTQ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth.
However, there is no evidence that medical interventions reduce suicides among transgender individuals in the long run.
Adults who underwent surgical transition were 19 times more likely than their age-matched peers to die by suicide, according to a Swedish longitudinal study that covered more than a 30-year span.
A report from the Heritage Foundation also found that teen suicides are higher in states where there is easier access to medical interventions.
As far as using gender-affirming medical interventions as a treatment for gender dysphoria, the evidence is of “very low certainty,” according to a review commissioned by the National Institute of Health and Care Excellence in the United Kingdom.
The issues include the lack of randomized control trials, small sample sizes, short follow-ups and inadequate scales to measure gender dysphoria.
The results of the original Dutch study could not be replicated.
Despite the risks, the transience of gender dysphoria, and the lack of evidence, the American medical establishment continues to promote gender-affirming care.
Idaho lawmakers need to stand up and bring a ban to the floor again.
In an interview with Scroll, Miller said that the governor’s office and Idaho senate leadership will kill any bill that is too controversial. Undoubtedly the litigation will be a headache. But Idahoans should ask them, is a child’s health worth the political fallout?