The ethics of “gender affirming care” for minors

NICK EICHER, HOST: Coming up next on The World and Everything in It: Transgenderism for minors.

Last week, a congressional subcommittee clashed during a hearing on transgender policies for young people. The hearing featured testimony from a range of witnesses.

MARY REICHARD, HOST: One of the witnesses defending transgenderism was Myriam Reynolds. She’s the mother of a daughter now identifying as a boy. Reynolds contends her child’s life was saved by the transition, and the process wasn’t as manipulative as some have claimed.

MYRIAM REYNOLDS: I want to make it clear that the care we received was slow, very thoughtful, provided with the utmost care and consideration. There was no rush. Absolutely no coercion, lots of double-checking, and making sure we were all on the same page.

EICHER: But other witnesses argued that the core issue here isn’t process, but the legality of transgender procedures themselves. One of those witnesses was Chloe Cole. She underwent hormonal changes and a double mastectomy at age 15. Cole has since de-transitioned and become as she puts it an advocate for victims.

CHLOE COLE: I used to believe that I was born in the wrong body, and the adults in my life, whom I trusted, affirmed my belief and this caused me lifelong, irreversible harm. I speak to you today as a victim of one of the biggest medical scandals in the history of the United States of America.

REICHARD: Many states have grappled with how best to approach transgender procedures like the ones experienced by Cole. As of July, nineteen states have taken steps to curtail or ban transgender medical practices. But at the federal level there’s little consensus on what should be allowed.

EICHER: Opponents of the practices say there’s no way for minors to fully understand the implications. More concerning still, many in Congress fear minors may feel pressured. Louisiana Representative Mike Johnson opened the hearing by describing the dangers.

MIKE JOHNSON: Today we see adults inflicting unspeakable harms on helpless children to affirm the adult’s own worldview—that gender is somehow fluid, that sex can be surgically altered, that there are no lasting consequences to all this madness as a result of the sex change procedures.

REICHARD: New York Representative Jerry Nadler disagrees sharply with Johnson. He contends transgender procedures should not be curtailed because they limit parental choice.

JERRY NADLER: I trust parents and medical professionals, not politicians, to make decisions about their children's health when it comes to gender affirming care. And so does the Constitution.

EICHER: Shannon Minter, director of an LGBT group, made the same point in his testimony.

SHANNON MINTER: You know, parents should have the freedom to make health care decisions for their transgender children. Parents want what's best for their children. Americans differ about a lot of things, but there is one point on which we strongly agree and that is that parents, not the government, are best situated to make medical decisions for their own children.

REICHARD: But not everyone agrees that the so-called medical consensus is correct. Jennifer Bauwens of the Family Research Council says it’s politics, not medicine, that is driving the medical associations.

JENNIFER BAUWENS: The term evidence-based does not mean that this practice is standing on the merits of solid research findings addressing gender dysphoria. Instead it refers to a vote by those who are ideological supporters of the practice. Compared to other psychological disorders found in the DSM-5-TR, gender dysphoria is currently being treated with the most invasive invasive interventions connected to a psychological issue with the lowest quality of evidence to support that practice.

EICHER: At the core of the hearing was a debate over what counts as care and who gets to decide. Nadler pointed out what he thought was an irony: that Republicans traditionally oppose government intervention into family matters. Republicans, on the other hand, say there are some things even parents should not have the right to do. Chairman Johnson once again.

JOHNSON: Our American legal system recognizes the important public interest in protecting children from abuse and physical harm. No matter how liberated you may be, you still don't have the legal right to ignore seat belt safety laws or minimum driving age laws or drinking and smoking laws for your kids. No parent has a constitutional right to injure their children.

REICHARD: With a Republican-controlled House and a Democratic Senate, legislation on the issue is unlikely to go anywhere.

But the debate has begun.

JOHNSON: Without objection, this hearing is adjourned.

EICHER: Thanks to Leo Briceno in our Washington Bureau. He helped pull this story together. If you’d like to read more political stories free, you can subscribe to our politics newsletter we call The Stew. A fresh helping each week. You can find a link in today’s episode description.

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