OPINION:
Does the truth matter?
This is the most important question as the Supreme Court heard arguments in U.S. v. Skrmetti on Dec. 4. The state of Tennessee argued that it has a right to restrict children’s access to sex-change treatments, including puberty blockers, cross-sex hormones and surgery. Opponents assert that children can make these decisions independently and that government oversight is unnecessary.
Yet as a practicing pediatrician and state health regulator, I can attest that there’s no good evidence showing that sex-change treatments benefit children. The 26 states that have banned them protect children from activism masquerading as medicine.
This debate ought to start with a simple fact: Sex-change treatments are the Wild West of medicine, treated differently from every other type of care. In less than a decade, they have been rushed into widespread use on an experimental basis without being held to the same standards as other medical interventions.
Data shows that between 2019 and 2023, about 14,000 minors in the U.S. were transitioned, including nearly 5,700 who underwent surgery. While the doctors providing these treatments may be well intentioned, the onus remains on them to prove that novel and risky treatments are beneficial. Sex-change treatments can cause infertility, loss of sexual function and other serious harms. No youth can fully appreciate or consent to these risks.
Where is the evidence justifying this trend?
The catalyst was a 2014 Dutch study purporting to show that children benefit from attempts to change their sex. Yet it has since been proved that this study suffers from severe methodological flaws while involving patients that are in no way like the children being transitioned now. The Dutch children had early-onset gender dysphoria, often present as toddlers; the study also excluded youth with mental health problems.
In the U.S., however, children with late-onset dysphoria and mental health problems are routinely transitioned. More recent studies are also flawed, and when European countries have analyzed the evidence over the past few years, they have rapidly begun to restrict children’s access to sex-change treatments.
To date, Britain, Finland, Sweden, Norway and Denmark have concluded that transition puts youth at a greater risk of physical and mental harm while benefits remain uncertain. The European Society of Child and Adolescent Psychiatry, representing more than 30 countries, made it crystal clear. Medicine must not “promote experimental and unnecessarily invasive treatments with unproven psychosocial effects” and adhere to the principle of “first, do no harm.”
Most recently, the British Parliament, led by the liberal Labor Party, has extended a ban on puberty blockers in the U.K. — reflecting the evidence that children are in danger from such interventions.
Remarkably, many of those who advocate sex-change treatments know that the evidence is poor and that children are at great risk. Earlier this year, another federal trial revealed that World Professional Association for Transgender Health had hired experts at Johns Hopkins University to comb the medical literature, hoping to find the evidence to support youth transition.
Johns Hopkins told the association, known as WPATH, and federal authorities that they “found little to no evidence about children and adolescents.” WPATH prevented Johns Hopkins from publishing this discovery, intentionally leaving the medical profession, parents and patients in the dark.
As if evidence suppression were not enough, WPATH also succumbed to demands from the Biden administration to reject the lack of evidence and remove any age limits on treatment guidelines. Federal officials were concerned that “devastating legislation” might result and impair their ideological agenda. They were not concerned about protecting youth from unproven treatments.
Denying the lack of evidence and suppressing this information is a defining trait of those pushing transition on vulnerable youth. In October, Dr. Johanna Olson-Kennedy — one of the most prominent activist physicians in the space — refused to publish her taxpayer-funded research on puberty blockers. She admitted that her research failed to show that puberty blockers improve youth mental health but continues to defend their use.
Meanwhile, the U.S. is witnessing a growing number of de-transitioners — young people who regret what medical professionals like Dr. Olson-Kennedy did to them as minors. They have been left physically and mentally harmed, often permanently and with limited medical and legal recourse.
Children should not be subjected to such unsupported and dangerous treatments. While activists argue that state restrictions infringe on children’s rights, children have a greater right: the right to be protected from those who would harm them.
States have an obligation to follow the evidence that activists won’t, hence the restrictions that so many have passed. The truth matters — and the Supreme Court should recognize the unmistakable conclusion that sex-change treatments are a direct threat to children’s health.
• Dr. Patrick Hunter, a practicing pediatrician and bioethicist, serves on the Florida Board of Medicine. His views are his own.
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