The Supreme Court rebuked California early in March for forcing schools to hide students’ gender transitions from their parents.
The legal stakes in this case are significant, but it also exposes a deeper divide over how society should respond when children experience gender distress — and how public health officials like us can shape policy to help those children flourish.
Until recently, this debate was dominated by radical gender ideologues, who insist on affirmation at any cost.
From their perspective, a girl who thinks she’s a boy is a boy. Failing to affirm this new identity, they believe, will cause more harm than irreversible surgeries or a lifetime regimen of cross-sex hormones.
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In California, the pipeline to these drastic interventions begins in the classroom, where state law requires teachers to hide kids’ gender confusion from parents, even if that means sitting across from them in parent-teacher conferences and lying by omission to the very people most responsible for those children’s care and wellbeing.
Socially transitioning children at school puts them on a collision course with sex-rejecting medical interventions that cause lower bone density, infertility, cardiovascular problems and other painful, costly health issues.
There is no off-ramp. California’s ban on “conversion therapy” applies not just to the abusive practices most people associate with that term, but to any counseling that might reduce children’s gender distress without transitioning them. (Multiple states have similarly broad bans on their books, though the Supreme Court just struck down Colorado’s.)
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Those policies are rooted in academic “queer theory” rather than science, but after a long campaign of infiltration and intimidation, activists managed to align the medical profession with their ideology. Just a few years ago, they could claim that “[e]very major medical association” considered sex-rejecting interventions for trans-identifying youth to be “safe and lifesaving.”
But that confidence was never matched by strong evidence.
Thankfully, the tide has turned. There’s a growing international consensus that the gender activists were wrong. Scientific reviews in Sweden and Finland, as well as the U.K.’s rigorous Cass report helped convince those countries to dramatically scale back sex-rejecting interventions for children and adolescents.
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Last fall, the U.S. Department of Health and Human Services (HHS) published a comprehensive review titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” which arrived at the same conclusion: that medically transitioning minors conveys no proven benefits.
The choice between “a trans son or a dead daughter” convinced thousands of parents to approve interventions that irreparably damaged their children. It turned out to be a false dichotomy.
Evidence also increasingly suggests that trans-identifying kids were not simply “born in the wrong body” but may instead be struggling with deeper issues.
The recent spike in youth gender dysphoria coincided with a massive decline in teen mental health (likely driven by smartphones and social media). Both trends were more pronounced among girls.
One influential study found that 63% of adolescents presenting with gender distress have at least one co-occurring neurodevelopmental disability or mental health disorder.
These kids don’t need puberty blockers and hormones. They need psychotherapy, family counseling, thorough clinical evaluation and perhaps treatment for anxiety or depression — not a rush toward irreversible medical interventions.
Based on these findings, CMS and HHS took action in December by proposing two new rules to ensure that taxpayer-funded health programs are guided by evidence, not ideology. The first stops taxpayer dollars from subsidizing sex-rejecting interventions for children through CHIP and Medicaid; the second bans hospitals that perform these interventions from participating in Medicare and Medicaid, given the considerable safety risks to children.
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In January, CMS convened all the major medical associations involved in sex-rejecting interventions for minors and held a “grand rounds” on the available evidence. A month later, the American Society of Plastic Surgeons issued a courageous and principled statement acknowledging that there was “insufficient evidence demonstrating a favorable risk-benefit ratio for … gender-related endocrine and surgical interventions in children and adolescents.”
The American Medical Association quickly followed suit. The fake “scientific consensus” in favor of medically transitioning children has finally shattered.
Not long ago, the parents who stood up to California would have stood alone. But not anymore. This administration has their back.
We will continue to champion scientific rigor and genuine compassion against the bullying dogmatism of radical gender ideologues. We will free this country’s institutions from the long captivity to which the activists and their allies have subjected them. And we will always — always — put parents and children first.
Stephanie Carlton is deputy administrator of the Centers for Medicare & Medicaid Services.
