How Not to Regulate Pediatric Gender Medicine | City Journal
As the 2023 24 legislative session gets underway, a number of states have resolved to make gender-affirming care a central focus. In red states, this means restricting the controversial practice or trying to eliminate it altogether. Some states, including Alabama and Arkansas, will be defending previously passed bans in the courts.
State efforts to restrict the use of puberty blockers, cross-sex hormones, and surgeries to address (apparent) gender-related distress in youth make for good public policy. Yet even lawmakers on the morally and scientifically correct side of an issue risk overstepping by unintentionally proposing harmful or strategically counterproductive regulations. We write to warn of three such mistaken efforts.
By way of background, European countries, including Finland, Sweden, and England, have conducted systematic reviews of evidence for hormonal interventions and found no evidence that the benefits outweigh the risks. In more specific terms, they found no evidence that drugs and surgeries (which, in Europe, remain almost unheard-of) are superior to the less invasive alternative psychotherapy. In addition, new research highlights how the social and political climate surrounding such aggressive treatment creates a placebo effect, making it impossible to know whether even the observed short-term benefits to mental health from hormones owe to the drugs themselves.
The Europeans have since reverted to the Dutch protocol, which requires, as conditions of eligibility for hormones, that patients experience prepubertal onset of symptoms, have no serious co-occurring mental-health problems, have familial support for their decision to use the drugs, and first undergo extensive (usually six-month-long) psychotherapy. This stands in contrast to the affirmative model, which takes a patient s gender identity at face value, relies on the minority stress framework to explain (or explain away) co-occurring mental health problems, and exhibits strong distaste for medical gatekeeping. (In her report to the NHS on the Gender Identity Development Service at the Tavistock Clinic, Hilary Cass, former president of the U.K. s Royal College of Paediatrics and Child Health, chose a more apt word, emphasizing the adoption of an affirmative model that originated in the USA as a main reason for the lack of patient safeguarding. )