When the Affordable Care Act, also known as Obamacare, was being debated in 2009, it drew abundant criticism for alleged flaws — that it would mean socialized medicine, higher health care costs and even “death panels.” What drew little fire was a mandate that health insurance cover treatment for transgender people to align their bodies with their gender identity. It was just another form of medical care.
No longer. In 2020, not one state prohibited this sort of medical intervention for minors. But since 2021, 23 states have banned it outright.
Illinois, fortunately, is not one of them: Last year, Gov. J.B. Pritzker signed a law designed to protect access to gender-affirming care not only for state residents but also for people who come here from states where it is illegal.
In January, the Republican-controlled Ohio legislature enacted a ban by overriding the veto of Republican Gov. Mike DeWine. The measure forbids not only surgery but also puberty blockers and hormone therapy for transgender kids.
Ohio Rep. Gary Click, who sponsored the bill, insists that gender-affirming care is not “best medical practice. I do believe it is child abuse.”
Click, whose medical education apparently came from the Book of Leviticus, should not be treated as a credible judge. A Baptist pastor, he gave a sermon in 2019 arguing that transgenderism is part of a plot by Satan to destroy the family.
To transgender individuals, he declared: “You’re not born that way. God’s not going to curse you in the wrong body.” Would he tell a child born missing a leg that she should not get a prosthesis?
Hundreds of thousands of Americans who disagree with him have undergone treatment to resolve the awful mismatch between their bodies and their minds. Gender dysphoria is not a curious left-wing fad but a well-known syndrome recognized by medical and mental health professionals, from the American Academy of Pediatrics to the Mayo Clinic.
Much of the opposition to gender transition treatment rests on rigid ideology, not reasoned judgment. Republican U.S. Sen. Josh Hawley of Missouri writes, “To leftists, manhood is fake. Womanhood, too. Both are merely social confections that society made up and can remake at will.” Notions like those rest on a refusal to admit the existence of gender dysphoria, which is like denying the existence of left-handedness.
Supporters of these bans argue that children should not be empowered to act on feelings that may be temporary, that some adolescents who get such treatment later regret it and that some effects of hormone therapy can be irreversible, including infertility. Kids whose minds are not fully formed may make poor decisions that cause long-lasting harm.
All this happens to be true. Gender-affirming care has a real possible downside. It’s essential for physicians and parents to take a careful, deliberate approach, including thorough psychological assessments, before proceeding — which, as it happens, is customary practice.
But the existence of risk is no reason to ban it, even for minors. We allow them to go through pregnancy and childbirth, which carry serious health hazards, including death. We allow obese adolescents to get bariatric surgery, which may include removing part of the stomach and can have serious complications.
We allow puberty blockers and hormones to be administered to minors for conditions unrelated to gender transition. In each case, we agree that the potential value outweighs the possible harm.
For many youngsters, the upside of gender-affirming care is huge. Those with gender dysphoria are known to be especially vulnerable to psychological distress and self-harm. Transition treatments have been shown to reduce the incidence of depression and suicide. The proportion of transgender people who express regret over surgeries — a far more invasive treatment than puberty blockers or hormones and one rarely provided to adolescents — is in the neighborhood of 1%.
Those who want to deny gender-affirming care to minors exaggerate the potential dangers and dismiss the benefits, because many of them would rather not acknowledge human complexity.
But the problem isn’t just that they have the wrong answer. They’re asking the wrong question: whether such treatment is a good thing or a bad thing. The right question is: Who should decide?
We don’t know and can’t know if gender-affirming care will improve the life of young Emma or Ethan. But we do know that the people best informed on the matter are Emma, Ethan and their parents, acting in consultation with medical professionals. And we do know that the people making those decisions are the ones who will experience the consequences, for better or worse.
No medical treatment is infallible or devoid of risks. But to deprive minors of humane options is to condemn them to live with a choice that is not theirs.
Steve Chapman was a member of the Tribune Editorial Board from 1981 to 2021. His columns, exclusive to the Tribune, appear the first Thursday of every month. He can be reached at stephenjchapman@icloud.com.
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