Thankfully, the Louisiana legislature is again dealing with the subject of minor children presenting to the medical community with gender dysphoria. Now for those of you who may not be familiar with the term, gender dysphoria is the sense of unease or dissatisfaction between one’s biological sex and gender identity. This has most certainly become one of those “cultural wedge” issues about which our various political tribes ceaselessly argue, so let us throw some cold facts on the subject:

To bring everyone up to date, HB648, a bill introduced by Republican Representative Gabe Firment, prohibiting the use of certain treatments (the administration of puberty blockers, cross sex hormones, and surgery), easily passed the House but was narrowly voted down in the Senate & Governmental Affairs Committee. Fortunately, HB648 was resurrected by Senate leadership, and hopefully it will shortly be voted upon on the floor of the Senate.

I say hopefully, because time is running out as the session ends on Thursday. By way of information, all of our neighboring states have now or will shortly prohibit the administration of these procedures to youths, and unless Louisiana wants to become a destination for life-altering hormone therapy and genital mutilation surgery, the Senate must act swiftly.

Now opponents of HB648 frequently cite the fact that the American Academy of Pediatrics (AAP) has issued guidelines strongly favoring early medical treatment for gender dysphoria in minor children. To be clear, the AAP has indeed endorsed the use of puberty blockers, cross sex hormones, and ultimately irreversible surgery, for youths presenting with gender dysphoria. The  AAP’s endorsement of these treatments must mean that they were backed by rigorous science, right? Unfortunately, the AAP, like many American-based medical societies, has become highly politicized in recent years, and its recommendations and treatment protocols have become increasingly suspect, as we shall shortly see.

The fact is that these so-called “gender affirming” treatments are highly controversial and becoming more so as the realization sets in that there is little valid data and very poor follow-up to support the AAP’s conclusion. To be frank, as regards the treatment of minors presenting with gender dysphoria, the American medical establishment is increasingly out of step with its European counterparts, and evidence from other countries with less politicized medical establishments is coming in, and quickly.

Sweden’s National Board of Health and Welfare, noting the sudden and unexplained fifteen hundred percent increase (no, that is not a typo) of 13- 17 year old females presenting with gender dysphoria from 2008- 2018, decided just a few months ago that the risks of puberty blockers “currently outweigh the possible benefits” for minors.

In 2020, after a systematic review of the data, the Finnish Health Authority issued new guidelines which emphasized psychotherapy in lieu of puberty blockers and cross-sex hormones as the first line of treatment. The guidelines noted the growing international concern about the unexplained sharp rise in adolescents presenting with gender dysphoria, usually without a childhood history of gender-related distress. In Finland, surgery is not offered to those under eighteen years of age, and the guidelines warn of the uncertainty of providing “gender affirming” surgery to those patients twenty-five and under, due to the lack of neurological maturity.

The United Kingdom’s National Health Service, in 2022 commissioned an independent review of the The Tavistock Centre, which was then the only NHS facility providing gender identity services in the UK. The conclusions of the review, known as the Cass Report, were shocking, noting that some of the Tavistock staff had felt “under pressure to adopt an unquestioning affirmative approach” to children presenting with gender dysphoria, and this was “at odds with the standard process of clinical assessment and diagnosis” in all other clinical encounters.

The Cass Report concluded that the type of care provided at Tavistock was “Not safe or viable as a  long-term option for the care of young people with gender-related distress.” A law firm is in the process of filing hundreds of claims against the National Health Service for clinical negligence, and The Tavistock Clinic is scheduled to be closed next year, as the NHS attempts to devise an entirely different model for the treatment of gender dysphoria in the UK.

A common theme that investigators expressed when reviewing the work of gender dysphoria treatment clinics in these countries was the lack of valid studies and follow-up data on patients, as well as the unexplained huge increase in the number of youths presenting with gender dysphoria. It was also noted that a heavy predominance of these youths had associated mental health issues which for the most part were not adequately addressed.

Sweden, Finland, and the United Kingdom have now placed severe restrictions on the use of hormones, allowing them only in a very select, that is, much smaller cohort of patients. And there has been a growing realization among clinicians outside the United States (and very likely among American clinicians afraid to express themselves publicly), that the vast majority of youths with gender dysphoria will grow out of it and accept their gender if given time.

Note that all three of these countries were leaders, even pioneers, in advancing LGBTQ rights, so they cannot plausibly be faulted for seeking to reverse the advances made by the LGBTQ community over the last three decades. LGBTQ rights and community acceptance is not the issue before us, contrary to what the American left would have you believe. The real issue is whether children should be subjected to irreversible medical treatments on the thin and very controversial medical evidence currently available, even as contrary medical evidence mounts and other countries revise their medical standards and practices in the treatment of youths presenting with gender dysphoria.

Would that the American medical establishment were not so politicized as to see the writing on the wall, in time to save tens or perhaps hundreds of thousands of children from irreversible, life-altering treatments of dubious need or efficacy. Until the American Academy of Pediatrics and its ilk see the light of reason, we must rely on the Louisiana legislature for a sane response to the needs of these vulnerable children.

 

LOUIS GURVICH, Chairman
Republican Party of Louisiana