October 4, 2023 - 10:30am
The state of Nebraska is cracking down on the medical experiment currently being run on gender-questioning youth. New regulations will require adolescents seeking medical transition to undergo therapy before and after initiating puberty blockers or cross-sex hormones, impose a seven-day waiting period before new prescriptions can be filled, and require medical providers to assess and address co-morbidities. Each step effectively pumps the brakes, slowing down a process many young patients have sped through as demand for these interventions surged.
The Nebraska Department of Health and Human Services emphasises the need to “allow for sufficient therapeutic treatment time” to “develop a thorough understanding of a patient’s needs and determine appropriateness for treatment” that has “life-changing effects”. Surgical interventions for gender-dysphoric youth under the age of 19 are now banned in the state, under a new law that took effect the same day.
Activists warn that delays — whether in the form of therapeutic requirements, waiting periods or blanket bans on surgical interventions for youth — put young patients at risk. But as State Senator Kathleen Kauth, who introduced the bill, said, “everyone believes they’re acting in the best interests of children; we’re just looking at it from very different sides.”
Nebraska is just the latest state to defect from the wide-open “gender-affirming care” model that spread across the US over the past 16 years in the absence of regulation. When it comes to hormonal and surgical interventions for gender-dysphoric youth, the map of the United States now looks like a patchwork quilt: access hinges on state politics.
Twenty-two red states — from Idaho and Montana down to Texas and Florida — have now restricted or outright banned access to puberty blockers, cross-sex hormones, and surgeries for gender-questioning patients under the age of 18. Meanwhile, blue states like California, Colorado, Illinois, Maryland, Minnesota, New Mexico, Oregon, and Washington have passed legislation to ensure access to hormonal and surgical interventions for youth, expand insurance coverage for these procedures, and shield medical providers from legal liability.
Court challenges criss-cross the country, too, with outcomes uncertain. Just last week, the Sixth Circuit Court of Appeals cleared the states of Tennessee and Kentucky to enforce new laws banning youth medical transition, with Chief Judge Jeffrey Sutton warned that, “[u]ntil more time has passed, it is difficult to gauge the risks to children — whether by physically transitioning as a child or not — making it reasonable for accountable democracies to consider, reconsider, and if need be reconsider again the best approach to these issues.” Lawmakers and advocates on both sides of the issue appeal to the values of protecting children to support their political agendas.
The parallels with abortion restrictions and bans are clear. Republican lawmakers and trans-advocacy organisations alike are keen to draw comparisons between the two issues, with Nebraska Republicans packaging abortion restrictions together with regulations on youth medical transition, and organisations such as the American Civil Liberties Union and Planned Parenthood framing both issues as examples of “bodily autonomy” under assault.
Whether “gender-affirming care” is in fact “life-saving healthcare” is not a matter of mere assertion: either the evidence will support such a claim or refute it. Countries like Finland and Sweden that once pioneered transition for gender-dysphoric youth have recently changed course, backing away from experimental and often irreversible hormonal and surgical interventions and favouring psychotherapeutic approaches instead. But while evidence may be able to resolve conflicts abroad, political polarisation prevails in the US, where every state has now become a battlefield.
Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.
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SubscribeMedical providers being given protection from legal liability is a red flag that the supports know deep down that it is wrong to do this to children.
The fact that trans-affirming medical providers are shielded from legal liability says it all really.
I’ve heard of the Movement Advancement Project before. It’s a group of rich patrons and corporations that appropriate fashionable causes to further their own agenda. They state that they are politically independent when that quite clearly isn’t true.
You’re right. And they’re misusing the LGB movement to further the alphabet soup causes. They don’t care about LGBs.
Agreed, and the feeling is very much mutual. The sex part, of same sex attraction became the roaring jumbo jet in the room.
The upside, is that the LGB community are closer and growing stronger. Homosexual men and women are working together, to rid the homophobic poison hiding behind the late and unwanted abbreviations!
The LGB Aliance have been amazing inspiration for the community, a beacon of light, indeed!
Must be nice! You can slice up the children to your heart’s content and know ahead of time that you’ll never be prosecuted for it. Business is good.
Good to see some reflection before launching into often unnecessary and pretty dangerous affirmation surgery.
I’m concerned that, yet again, issues are being merged. Plenty of people who support access to abortion are still dismayed at gender reassignment surgery to minors. These two issues have nothing in common, except that they’ve become unduly politicised.
I do so agree with you about the forced teaming of the issues. It’s a shame that the motivations are so obviously political rather than truly principled.
In effect women are being forced to vote away their own rights to protect their children. However I think many will recognise that fighting for the vulnerable who have only our voices to speak for them is the responsible choice even if it means that we then have to fight again for our own rights. We’re the adults and in a healthy society we must protect children ahead of ourselves.
The real change is going to come as more and more kids suit their doctors, hospitals and even social services or teachers and schools for damages.
I think anyone with sense and any kind of life experience could see that this was a situation ripe for abuse and regrets. These are situations where the children are objects to be exploited for political purpose and financial gain by adults.
Well, children cannot really provide informed consent.
And…it is a situation ripe for some very expensive and, for lawyers, lucrative lawsuits.
Once the lawsuits started, you knew the insurance companies and their lawyers were going to be all over the medical providers and all over schools that intervened by supporting transition without informing parents. At some point I expect that we will see individual teachers and counselors suited as well.
No medical malpractice coverage? No way a doctor or hospital will do the procedures.
Settlements with school systems? Major crackdowns on schools involving themselves. They will want to put any blame back on the parents.
Individual teachers get suited without financial support from the school system? Even if they win the suit they will go broke on lawyers fees. Only the most rabid and risk tolerant will intervene then.
I’m sensing a general shift too, a combination of a rise in gender critical thinkers, political footballers, ruffled medical communities, and the involvement of courtrooms.
Either all, are making real differences with real changes. We can hope so, at least.
Thanks Eliza, great post!
It is getting better, I agree. Even Gavin Newsom recently vetoed a bill that would instruct judges to take into consideration a parent’s support for a child’s gender identity when making a decision on custody rights. He might still have his veto reversed but, as a possible presidential contestant, he’s seen which way the wind’s blowing.
A delusion is a belief that is contrary to reality, unshakable, and drives behavior. The belief that a male is a woman, or a female is a man, is such a belief. But it is the only delusional belief I am aware of for which medical professionals have recommended that rather than helping the person relinquish the belief, we medically and surgically alter them to make them fit somewhat more closely with the delusion. It is worth wondering why this belief has been given this special status.
At the beginning of the 20C many of the great and good supported eugenics, they thought it was for the greater good of humanity and they were uniquely able to divine what was right. We will look back on the current era of mutilation of children to suit fashionable ideas with the same horror.
If your genitals do not define your gender, why do you need to remove them to assert your gender choice?
This is classic cognitive dissonance. Follow the money.
The Unherd obsession with trans continues. Averaging about three articles a day I’d estimate on an issue that impacts a tiny minority of peole.
Good to see we have so many experts on the subject here though, always happy to dive in with their considered opinions!
The issue impacts all of us, especially women, who are being defined out of existence. In Australia lesbians are not allowed to advertise gatherings for female-only lesbians, since the trans movement insists on redefining the word “lesbian” to include men who say they are women who want to relate to women. The trans issue affects anyone who wants to use a single-sex space, whether a hospital ward, a women’s refuge or a public or school toilet. This “tiny minority” seems to want, and also to have, the power to redefine us all.