On Wednesday, the U.S. Department of Health and Human Services sent letters to several leading medical associations requesting information about their current position on youth gender medicine, and how the organizations reconcile their positions with the department's report on best practices for the treatment of gender dysphoria. The associations include the World Professional Association for Transgender Health (WPATH), the American Medical Association, the American Psychological and Psychiatric Associations, and the U.S. Endocrine Society. Despite medical practice reversals in Europe spurred on by the findings of systematic reviews of evidence, in the United States only the American Society of Plastic Surgeons and the American College of Pediatricians have broken with the artificial consensus largely propped up by WPATH and the U.S. Endocrine Society. “When medical organizations set standards that shape the care of children, they have a responsibility to explain the evidence behind those standards,” said HHS Secretary Robert F. Kennedy, Jr. For more details, see Leor Sapir's X thread.
England’s National Health Service has issued new guidance that patients should be treated on single-sex hospital wards according to their sex rather than their “gender identity.” The guidance also applies to staff facilities. To avoid charges of discrimination, however, the guidance recommends making gender-neutral and single-occupancy spaces available. While previous guidance by NHS allowed trans-identified patients to access facilities based on their “gender identity,” this guidance was rescinded following a Supreme Court case which determined that under UK equality law “sex” refers to biological sex, and women refers to biological females. The guidance does leave room for exceptions, however, in emergency units and urgent care settings.
In response to the Trump administration's final rule ending Medicaid and CHIP reimbursements for dysphoric minors, some Democrat-led states like Arizona and Virginia are quietly ending their coverage of “affirming care” despite the means at their disposal to maintain coverage. While the rule doesn't inherently prohibit state programs from covering “affirming care,” it does require states to fund these treatments themselves. States like California and Massachusetts have vowed to cover these treatments as litigation plays out, but states like Arizona and Virginia have opted not to follow suit. “Above all, both states’ compliance sends an important signal to the Trump administration: when it comes down to it, neither one is truly willing to take on the costs of protecting trans people—not even when those costs would almost certainly have a negligible impact on the state budget,” writes Aleksandra Vaca.
Oregon has temporarily paused its oversight of commercial insurers to ensure that these entities are not denying patients “affirming” interventions for the treatment of gender dysphoria. A provision in Oregon’s HB2002, which requires commercial insurers to fund gender transition procedures, empowers the Department of Consumer and Business Services to monitor these entities to guarantee compliance with the law. However, the state now maintains that enforcing HB2002 would require collecting detailed information about providers, patients, and procedures rendered that could be weaponized against providers and patients. According to data from the Williams Institute, there are over 9,000 transgender teens living in Oregon, which is nearly triple the number from its last estimate.
In City Journal, I wrote about the significance of a newly introduced federal bill, the Yaeli Martinez Child Protection Act, which would prohibit Child Protective Services from treating parents who raise their child as their birth sex as abusive and neglectful. As the article explains, the extended child welfare system has bought into the notion that parents who do not affirm the identity of a trans-identified minor are acting against the best interest of their child. This understanding has been used by CPS to justify separating otherwise loving parents from their trans-identified children, many of whom were originally transitioned at school without parental notification or consent. The bill would also defund trainings which promote the idea that non-affirmation is abuse. These trainings are used to train lawyers, forensic evaluators, and judges in the family court system. I go on to explain how these trainings undermine procedural fairness and parental rights.
Axios reports that Democrats are engaged in an "intra-party" feud over messaging on transgender issues before the midterms. During the last presidential election, Republican attack-ads highlighting Kamala Harris' stance on transgender issues were effective with voters, putting Democrats in a bind in terms of responding to critics—and not allowing them to set the terms of the debate—while keeping focus on a losing issue for Democrats. Rep. Marcy Kaptur of Ohio, and Democratic House candidates in New York, Iowa, and Alaska have put out ads coming out more forcefully against trans-identified boys competing in women's sports, which has left “LGBTQ+ friendly” colleagues feeling betrayed.
The Society for Evidence-Based Gender Medicine (SEGM) has spotlighted a new paper which explores how the concepts of “post-traumatic stress disorder” and “moral injury” may be useful for clinicians working with detransitioners. The article explains how previously desired physical changes associated with medical transition may come to be perceived as deeply traumatic by individuals who no longer identify as transgender, with the authors drawing an analogy between detransitioners and victims of female genital mutilation who later reappraise their situation. The authors also posit the role played by perceived “moral injury” in detransitioner experiences, which is a sense of destabilization stemming from felt betrayal by authority figures. The authors go on to surmise that for many detransitioners, psychotherapy alone will not be enough to alleviate their distress.
Joseph Figliolia
Policy Analyst
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