Recently, the Department of Health and Human Services (HHS) released a peer-reviewed report, previously released in draft form, that confirms what Independent Women and others have been saying all along: So-called “gender-affirming care” does not cure gender dysphoria, but instead medically mutilates and psychologically manipulates minors.
This report follows on the heels of an executive order, as well as of other countries that are retreating from the “gender affirming care” model for minors, including the United Kingdom, New Zealand, Brazil, Chile, the province of Alberta in Canada, and the state of Queensland in Australia. This report is the first comprehensive federal review of the gender medicine industry and provides evidence for multiple harms caused to patients
First is infertility and sexual dysfunction. Delaying the normal timing of puberty interrupts the development of reproductive anatomy and be irreversible, especially if puberty blockers are followed immediately by cross sex hormones. For males, the report states that this “could permanently damage the immature gonadal tissues, leading to sterilization,” and that “there is no proven physiological mechanism by which fertility can reliably be reestablished.” For females who start with puberty blockers and then take testosterone, it says that “the reproductive tract makes the likelihood of conception, pregnancy, and birth uncertain.” It also highlights atrophy of the testicles for males and of the vaginal inner lining for females..
Puberty blockers also lead to weaker bone density that puts patients at higher risk for osteoporosis and dangerous fractures of the hips or spine later in life. Puberty is a critical time when the body gains much of its bone mass. If puberty is delayed, a person may never reach that peak. The report discussed studies that used “Z-scores” as a measure for bone density, where a decrease in the Z-score means weakened bones. The report says that “multiple longitudinal, observational studies on pediatric patients undergoing medical transition have consistently demonstrated decreases in Z-scores” with use of puberty blockers. A re-analysis of U.K data “found that one third of the puberty-blocked patients had a Z-score of below -2 (indicating osteoporosis) for hip, and more than one quarter of patients had low Z-scores for spine.”
Cognitive decline and psychiatric disorders are another consequence of gender medicine. Testosterone is an anabolic steroid that has the potential to be misused and lead to serious adverse reactions, reported in both men, women, and adolescents. The report says that “anabolic steroid misuse has demonstrated associations with severe psychiatric problems, including mood instability, psychosis, and dependence,” with the most common symptoms being “irritability, aggression, euphoria, inflated self-perception, impulsivity, and risk-taking behaviors.”. The idea that medical transition reduces suicide is called into question with a study from Sweden finding that “adults who had undergone medical and surgical transition had 19 times the rate of suicide deaths,” and other studies also reported elevated suicide rates.
The use of puberty blockers and cross-sex hormones can also lead to future surgical complications. The report specifically mentions that males starting estrogen in pre- or early stages of puberty may have limited genital development. This can make a standard vaginoplasty surgery (which uses existing tissue) impossible. Instead, patients may decide to do an intestinal vaginoplasty—a more complex and riskier procedure. One report described the tragic case of an 18-year-old who died from a severe bacterial infection (necrotizing fasciitis) after undergoing this surgery. Although this complication was noted in a 2006 study, no further research has been done since.
Finally, regret was a consequence discussed in the report. First, it says that the “claim that the detransition and regret rates are vanishingly low is unsupported by the evidence.” A U.K.-based study, which was not focused on minors, found that about 20% of patients stopped taking hormones, and half of those experienced regret. With two studies that did focus on children, one found fewer than 5% stopped hormones and reidentified with their biological gender, the other study found a much higher rate of 25%. Regret can be incredibly painful, given the number of irreversible physical changes experienced. Males experience breast growth and infertility, and females grow facial and body hair, develop a deeper voice and male pattern baldness, and lose the ability to breastfeed with a mastectomy.
Looking at the evidence, what’s clear is that too many vulnerable children and their families have become victims of a medical establishment that mutilates them in the name of care. The patients and families deserve to receive accurate and evidence-based information to guide their decisions surrounding the treatment of gender dysphoria, and this report will hopefully be a first step in making that a reality.