President Joe Biden declared his support for allowing children and adolescents with gender dysphoria to undergo body mutilating surgeries or use puberty blockers and cross-sex hormones to look more like the opposite sex despite unknowns about longterm side effects.
In multiple documents released Thursday, which is observed by some as the Transgender Day of Visibility, the Biden administration backed what it described as “gender-affirming health care" for children.
The U.S. Department of Health and Human Services’ Office of Population Affairs released a document titled “Gender Affirming Care and Young People."
The document states that “early gender-affirming care” for non-binary or trans-identified minors “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.”
The document lists “top” surgeries — elective mastectomies and breasts enhancements — and “bottom” surgeries — removal of genitals — as “gender-affirming care.”
The document states that the surgeries are “[t]ypically used in adulthood or case by-case in adolescence.”
“Gender-affirming care is a supportive form of healthcare. It consists of an array of services that may include medical, surgical, mental health, and non-medical services for transgender and nonbinary people,” stated OPA.
“Medical and psychosocial gender affirming healthcare practices have been demonstrated to yield lower rates of adverse mental health outcomes, build self-esteem, and improve overall quality of life for transgender and gender diverse youth.”
HHS’ Substance Abuse and Mental Health Services Administration’s National Child Traumatic Stress Network released a document titled “Gender-Affirming Care Is Trauma-Informed Care.”
The network’s document defined gender-affirming care as including so-called “evidence-based interventions such as puberty blockers and gender-affirming hormones” and proclaimed that “gender-affirming care is neither child maltreatment nor malpractice.”
The statement comes as officials in Texas have defined administering puberty-blocking drugs on children who question their gender as “child abuse” and experimental since the Food and Drug Administration has not approved such drugs for that use.
“There is no scientifically sound research showing negative impacts from providing gender-affirming care,” the network’s statement adds. “[Transgender, gender diverse, and intersex] youth can thrive when they are supported and affirmed in their identities and their identity development.”
An entry on Mayo Clinic's website states that drugs aimed at blocking puberty “might” help reduce depression among youth. “However, puberty suppression alone might not ease gender dysphoria,” said the clinic, adding, Using medication to delay puberty “beyond one’s peers can be stressful,” and thus, a child “might experience lower self-esteem.”
The conservative American College of Pediatricians, an association of physicians and healthcare professionals “dedicated to the health and well-being of children,” has long voiced its opposition to using puberty-blocking drugs on children suffering from gender dysphoria.
“There is not a single long-term study to demonstrate the safety or efficacy of puberty blockers, cross-sex hormones and surgeries for transgender-believing youth,” the organization said in a statement.
“This means that youth transition is experimental, and therefore, parents cannot provide informed consent, nor can minors provide assent for these interventions. Moreover, the best long-term evidence we have among adults shows that medical intervention fails to reduce suicide.”
“Temporary use of puberty blocker Lupron has also been associated with and may be the cause of many serious permanent side effects including osteoporosis, mood disorders, seizures, cognitive impairment and, when combined with cross-sex hormones, sterility,” the American College of Pediatricians added. “In addition to the harm from Lupron, cross-sex hormones put youth at an increased risk of heart attacks, stroke, diabetes, blood clots and cancers across their lifespan.”
The American Academy of Pediatrics has issued medical guidelines that support the surgical and hormonal transition of trans-identified children and adolescents.
“Often, pubertal suppression creates an opportunity to reduce distress that may occur with the development of secondary sexual characteristics and allow for gender-affirming care, including mental health support for the adolescent and the family,” an October 2018 AAP guideline states.
Supporters of puberty blockers have long claimed that puberty blockers' impact on children is reversible and are designed to give children with gender dysphoria more time to decide which gender they identify as. Proponents also claim that once adolescent users stop taking puberty blockers, their puberty resumes.
The new OPA document claims that puberty blockers are reversible.
However, the United Kingdom’s National Health Service reports that “[l]ittle is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”
“Although GIDS advises this is a physically reversible treatment if stopped, it is not known what the psychological effects may be,” the NHS website explains. “It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones. Side effects may also include hot flushes, fatigue and mood alterations.”
As teens who are 16 or over and have been on puberty blockers for at least a year are eligible to start cross-sex hormones in the U.K., the NHS warns that those “hormones cause some irreversible changes,” such as breast development and deepening of the voice.
“Long-term cross-sex hormone treatment may cause temporary or even permanent infertility,” the NHS website added. “There is some uncertainty about the risks of long-term cross-sex hormone treatment.”
The state of Texas has made headlines in the last year as Gov. Greg Abbott, Attorney General Ken Paxton and the state’s child services agency have questioned whether prescribing puberty-blocking drugs and cross-sex hormones to minors could constitute “child abuse.”
In February, Paxton issued a formal opinion stating that prescribing puberty blockers or conducting sex-change surgeries on children with gender dysphoria “can legally constitute child abuse under several provisions of chapter 261 of the Texas Family Code.”
Texas is also investigating whether AbbVie Inc. and Endo Pharmaceuticals, Inc., manufacturers of puberty blockers, have been engaging in deceptive advertising practices.
Paxton’s office had issued Civil Investigative Demands against the two companies, seeking to determine “whether these manufacturers of puberty-blocking drugs deceptively advertised and promoted hormone blockers for unapproved uses without disclosing the potential risks to children and their parents.”
“Companies should never promote or supply puberty blockers for uses that are not intended or approved,” stated Paxton. “I will not allow Big Pharma to misleadingly promote these drugs that may pose a high risk of serious physical and psychological damage to Texas children who cannot yet fathom or consent to the potential long-term effects of such use.”
The Biden administration has challenged Texas, with the president claiming that his administration is putting “Texas on notice that their discriminatory actions put children’s lives at risk.” The administration issued guidelines saying that it may violate federal law for Texas to charge doctors who administer gender reassignment surgeries or puberty blockers on children with “child abuse.”
Earlier this month, Paxton sued the Department of Health and Human Services and argued that the federal government is misinterpreting federal law and that Texas law does allow him to label such acts as “child abuse.”
A state appellate court struck down Abbott’s directive instructing the Texas Department of Family and Protective Services to “conduct a prompt and thorough investigation of any reported instances of these abusive procedures.”
The attorney general’s office has asked the Texas Supreme Court to reverse the lower court decision blocking the directive.
As a result of the governor’s directive and attorney general’s opinion, the Houston-based Texas Children’s Hospital stated earlier this month that it will pause “hormone-related prescription therapies for gender-affirming services.”