As a physician, I know that doing no harm means listening to patients. So as the president of the nation’s largest association of LGBTQ+ health care providers, I am deeply troubled by the wave of anti-transgender bills sweeping across the country. Many of these bills are aimed at barring transgender youth from accessing health care to safely pause puberty.
On February 3, a Florida bill to criminalize providing this type of health care to transgender youth was shot down. After a similar bill soared through South Dakota’s House, a Senate committee rejected it 5-2 on February 10. Seven states have recently introduced such measures, despite an outcry from the communities they affect. The trend is alarming.
I’m a gay physician who trusts that transgender youth know what they need. I trust their families and my colleagues who support these young people to seek safe and necessary care. But one group is being left out of this discussion, and the issue is not whether to deny them the ability to make decisions about puberty in keeping with their expressed desires. For intersex children, the issue is allowing them to make their own decisions about whether to have significant, irreversible genital surgeries, which they may never want at all.
In all 50 states, doctors can offer parents surgery to change their child’s intersex traits, even though the United Nations, the World Health Organization, and the American Academy of Family Physicians identify these actions as human rights violations.
If politicians are really worried about irreversible alterations, I invite them to learn about the history of genital surgery forced on intersex infants. Procedures to move a working urethra, create a vagina, or reduce a clitoris are still offered to parents before a child turns 2. But this type of surgery has significant, proven risks to future sexual function, and it denies children their right to participate in these life-altering decisions. The South Dakota bill, in fact, created an exception to allow this kind of surgery.
All human bodies are different. Genitals and reproductive anatomy can develop along a spectrum, just like anything else. Intersex people are born with unique sex traits—for example, a person might have a large clitoris, smaller vagina, hormonal differences, or diverse combinations of internal reproductive anatomy.
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Because these surgeries are still happening before kids can speak, I work with interACT: Advocates for Intersex Youth, to raise up the voices of intersex kids who are fighting for change. Countless other organizations, such as Human Rights Watch, the ACLU, and Equality California, have called on providers to delay infant intersex surgeries.
A bill to delay interventions such as infant clitoral reduction in California was voted down last month, largely because of opposition from medical groups invested in continuing the surgeries. Proliferating bills like the one in South Dakota reinforce a dangerous double standard that assumes that transgender kids must be “saved” from the affirming care they need, and intersex kids must be “fixed” without their consent. This also leaves kids who are both intersex and transgender in medical and legal limbo.
We physicians are not allowed to take critical care away from patients, nor to force interventions on them, just because their bodies and needs don’t fit our personal expectations of “normal.” That’s not a part of our oath. Prioritizing patients means focusing on what they say they need, supporting each patient and their family in age-appropriate ways. The answer is very simple: Individuals must take the lead in making decisions about their own bodies.
Just because individuals are minors now does not mean they won’t have wishes for their bodies in the future. Transgender and intersex youth grow up. When they are denied their own choices, families bear the resulting stress and trauma.
If you don’t know any transgender or intersex kids, it may feel easy to shrug this off. But this is about more than just a few bad bills. Intersex and transgender children’s bodies are being used to uphold regressive ideas about gender’s being based on anatomy and fixed at birth, with medicine used to enforce rather than affirm.
It’s clear to me, as a physician who helps intersex and transgender children live healthy lives, that those who supported the South Dakota bill are putting youth at risk. Nearly 45 percent of transgender youth considered suicide in 2017, according to the Trevor Project. Those numbers are highest when children are not allowed to affirm their gender. Of intersex children who had infant clitoral surgery, 39 percent could not achieve orgasm as adults, compared to 0 percent in a control group. Many families are never told about these types of risks.
But the bill’s author, Representative Fred Deutsch, and I do agree on one thing. In defense of his bill, he wrote: “The solution is compassionate care, and that doesn’t include catastrophically and irreversibly altering [bodies].”
Deutsch is right: The solution is compassionate care. Puberty itself is an “irreversible alteration,” and it’s the biggest source of stress to many of the children I serve. For these kids, compassion is listening to their fear and providing generous social support for the whole family. The American Academy of Pediatrics strongly asserts that transgender youth must be supported and allowed a voice in health care decisions.
As the brilliant ACLU attorney Chase Strangio argues, scapegoating small transgender and intersex populations is a great way to quietly roll back rights for everyone. Many of the most significant political issues of our time are about individuals controlling their own bodies, and who gains or loses power as a result.
These bills set a dangerous standard for all future discussions of bodily autonomy, gender discrimination, and children’s rights. They do so on purpose. I will continue to fight against these bills, for the intersex and transgender children I serve, every step of the way. I hope you will join me.
