Twenty-five years ago, when I was a young medical student on one of my first hospital rotations, the soft-spoken senior physician leading our team asked us one day on rounds, "what is all medication?" Met with blank stares, he then answered for us: "Poison. All medication is poison." He didn’t mean that the drugs we were giving our patients were killing them, but that we had a responsibility to be cautious when using them, as they also have the potential to harm.
It’s a lesson many of my physician colleagues are ignoring in their opposition to burgeoning legislation in several states that would prohibit "gender-affirming" therapies for children with gender dysphoria, including Ohio HB 454, currently the subject of contentious debate in my home state. Those therapies include hormones to stop puberty and change external sexual characteristics, and surgeries to alter anatomy to that of the opposite sex. As a doctor and a father, I have watched the role many in my profession have played in this debate with increasing concern and dismay. Physician involvement in this kind of therapy for children is horribly irresponsible and worthy of contempt.
The standard in medicine is that the onus is on those proposing any treatment to reliably demonstrate that treatment is safe and effective. In the case of children with gender dysphoria, the medical evidence for hormone therapy and surgery is weak and conflicting, with poor quality studies that are riddled with shortcomings and bias. Moreover, data supporting the safety of long-term hormone treatment in these children is largely non-existent.
BOSTON CHILDREN'S HOSPITAL DELETES REFERENCES TO VAGINOPLASTIES FOR 17-YEAR-OLDS AMID ONLINE FUROR
Infertility is common after hormone therapy, and bone and cardiovascular health are at risk as well. Crucially, there is also data to show that those who undergo surgical therapy are vastly more likely to suffer lifelong mental unrest and even commit suicide, and that those consequences may not surface until a decade or more after surgery. In recent years, an increasing number of accounts of children who "transitioned," then subsequently "detransitioned" in adulthood, have illustrated the difficulty of reversing the effects that hormones and surgery have on young bodies and minds.
Sadly, in a pattern that has become all too common in the COVID-19 era, U.S. physician advocates for these kinds of treatments have vastly overstated the results of their studies, downplayed any potential side effects, declared the issue "settled science," and then used that declaration as a cudgel to attack anyone who disagrees. In contrast, many of our European counterparts, including the United Kingdom, France, Sweden, and Finland, have recently hit the brakes on such therapy for children, recognizing that the data is poor and the long-term side effects are unclear.
What’s more, the ability of children to assent to any medical treatment is limited by the state of their brain development. It’s long been known that the prefrontal cortex, the area of the brain that is responsible for planning and making impulse-free decisions, is not fully developed until about age 25. That’s why we don’t let 10 year-olds eat ice cream all day long, why we don’t let 16 year-olds buy alcohol, and why rental car companies charge 21 year-olds a young renter’s fee. Physicians who treat children with gender dysphoria know this well, but many inexplicably suspend that knowledge when it comes to life-altering hormonal and surgical therapy. In doing so, they’re betraying the trust of the vulnerable children and parents who have come to them for help.
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There is even an increasing chorus of voices within the transgender community itself who, unlike my ostensibly judicious colleagues, recognize these issues with childhood decision-making, and have spoken against such therapies for children.
More fundamentally, the very notion of chemically and surgically altering a child because they feel like they are the opposite sex runs counter to some basic truths that humanity has traditionally taught its children. Namely, that their feelings sometimes don’t reflect objective reality, that there are some absolute constants in the world (one of them being their biologic sex), and that their physical existence is not a mistake. The idea that their body is somehow "wrong" is a message that should never be given to a child.
Like all who seek out medical care, children with gender dysphoria and their families deserve compassion and honesty from their physicians. What many are getting instead are misleading, ideologically driven recommendations, resulting in physical and psychological mutilation that is difficult or impossible to reverse. That’s true poison to our profession, and it needs to stop.
