By Jane M. Orient, M.D.
The Biden Administration is planning to reinstate rules withdrawn by the Trump Administration that add gender identity to nondiscrimination protections. It would also expand requirements to include any providers who accept Medicare Part B.
It’s not altogether clear what this will mean. There is no evidence that transgender or gender-nonconforming persons are failing to get prenatal care or delivery of babies, treatment for heart attacks, gall bladder surgery, trauma care, or other types of care that all types of patients might need—though it is possible that some caregivers might use the “wrong” pronouns. The issue seems to be “gender-affirming” care.
Physicians might be pressured to provide care they think is morally objectionable or harmful to a patient. This was the reason why the Association of American Physicians and Surgeons (AAPS) objected to the rule in the first place.
But exactly what kind of care? Language is the tool we use for thinking, and the meaning of words is critically important. “Affirming” sounds like a good thing, a positive thing. It’s replacing the term “sex change.”
Unarguably, it is impossible to change biological sex, to switch out the Y or the second X chromosome present in every cell of a person’s body. Also, advocates claim that people “know” themselves “really” to be of a gender different from the one “assigned at birth,” so the gender is essentially not being changed.
Puberty confirms and exhibits biologic sex, but in Newspeak this is not called “affirming.” After going through natural puberty, the vast majority of gender-confused children accept the biological reality that their bodies constantly manifest. So, many transgender activists insist that “affirming” therapy must be started before puberty, using a puberty blocker such as Lupron™ (leuprolide). It works by stopping production of the pituitary hormone that tells the testicles to make testosterone or the ovaries to made estrogen. Its main approved use is in cancer chemotherapy. It is also used in infertility treatments and to delay precocious puberty. Using it to suppress normal puberty is an unapproved, “off-label” use.
Lupron has numerous severe adverse effects. It stops the maturation of sex cells, and may result in sterility. It stunts growth and reduces bone density, among other consequences. It is not a harmless on-off switch that can delay a child’s development to give the child time to “explore” gender identity. While it may prevent or diminish irreversible changes such as a deepening voice, it causes its own, probably irreversible changes in many body systems.
The next step is cross-sex hormones to “affirm” (cause) the development of some secondary sex characteristics of the nonbiologic gender, such as facial hair, voice changes, and breast development. But sex hormones are not magic potions; many characteristics of the biological sex will persist despite years of therapy.
The next and clearly irreversible step is surgery.
Surgery does not affirm body parts. Surgery merely removes functional organs and replaces them with non-functional imperfect replicas. For example, a skin-covered wound that requires constant dilatation to remain open will never have the functionality of female genitalia.
Transgender extremists may try to steer a child into this course, even without the knowledge or consent of a parent.
Female-to-male transgender people might enjoy showing off their “top surgery”—if they had extremely expensive cosmetic surgery. If they haven’t, they will not look like the models shown on the internet, but will simply have a flat, deeply scarred, female-sized chest.
How many surgeons explain the possible urinary problems? Some patients will have to spend 10 minutes emptying their bladder and will constantly drip urine. “Bottom surgery” is complex, painful, and fraught with complications, while its results are typically far from the wishful expectations.
Are these interventions “affirming”–or denying?
Biological women are denied their prospects for femininity. They can lose their smooth skin, their breasts, their beautiful soprano singing voice, and their ability to bear children. They are likely to lose permanently their attractiveness to men who desire a lifelong female partner and wife and mother.
Biological men are denied their full height and strength and their potency, fertility, and attractiveness to women who desire a lifelong male partner and protector and father to their children. Post “transition” they will probably still have a distinctly male bone structure and other typically male coarser features.
“Affirmative treatment” negates the ability to experience intimacy in relationships in the way that normal women or normal men do. All patients will need lifelong medical care—continuous hormones and management of adverse effects.
But will the “affirmed” people be happy with their identity and less likely to commit suicide? We have very little long-term follow-up, and for now well-funded Woke activists are in control of research and treatment, and in a position to punish or cancel all non-affirming opinion. “Affirming” a delusion, and denying reality can only lead to harm.