Engendering Gender Bending

A Call for a Moratorium

Gender “affirming” treatment has been on my mind lately. And it is out of control. For starters, my vitriol surrounds and stems from the intellectually challenged who can't distinguish between a biologic woman from a biologic man. And all too often, by extension, this same kind of absurd mindset exists where this same groupthink believes that minors (unusually so, as young as 7 or 8 yrs old) should be able to confirm a decision concerning genitalia altering surgery along with intensive hormonal therapy in the attempt to change their phenotype (and their brains to variable extents also) despite an immutable genotype.

Aside from a chronologic age as a line in the sand (ie, 18+), even IF a person is mature enough to ponder this life choice seriously, such radically altering procedures and treatment must absolutely involve rigorous and protracted psychologic evaluation prior to beginning any such plan. Parents should still be involved to help with any guidance, solicited or not, because overzealous clinicians are often too quick to move this treatment chain down the field. What further infuriates me is the idea that, in some states currently, lawmakers are trying to promulgate rules to exclude parents of minors from being involved in this kind of decision-making calculus. More outrageous yet are the lawyers penning statutes that read if parents do become involved in their own minor child's decision-making process regarding these radical and permanent treatments, whether by prevention or mitigation, parents could be legally liable and charged with child endangerment or even child abuse.

Equally, if not more, maddening are the physicians AND hospital systems who partake in catalyzing these procedures to make a fast buck. And the bucks in this area of medicine are big. These clinicians (physicians, psychologists, social workers) fast-tracking these surgeries and treatments should lose their licenses to practice. Adolescents, children especially, are highly susceptible to the current sociocultural demagoguery regarding sex change that is not only rampant on social media (where sadly most kids spend their time), but present in the mainstream media as well. Such groupthink is even becoming more prevalent in the school systems. Exposing children and adolescents to such a hive mind is particularly dangerous when promoting such reckless rhetoric due to the malleable minds of such cohorts. Changing one's sex today is made to look like merely getting a new hair style or having your vehicle's oil changed when it is nothing of the sort.

Biological sex, overall, is a clear dimorphic phenomenon where, overwhelmingly, one is born male or female. Conditions where genotypes are inconsistent with phenotypes are quite rare. Regrettably, yet so predictably, the left-leaning media of all stripes have flooded the common parlance with terms that tend to confuse and obfuscate the topic at hand. For example, the term “intersex”, according to the Cleveland Clinic’s website, is defined as “People who [are intersex] have genitals, chromosomes or reproductive organs that don’t fit into a male/female sex binary. Their genitals might not match their reproductive organs, or they may have traits of both”.

Too many prominent medical institutions are helping to muddy the gender waters by using inconsistent “definitions” of sex, gender, intersex, and gender identity as well as providing medical explanations for being “intersex” oftentimes using varying prevalence rates. For instance, it has been estimated that about 1.7% of the population as being intersex.¹ This percentage includes conditions such as Klinefelter syndrome, Turner syndrome, and late‐onset adrenal hyperplasia, all of which lack the clinical consensus to be recognized as “intersex” by the medical world at-large. Other disorders of sexual development are rare or exceedingly rare. And according to Sax, “If the term intersex is to retain any meaning, the term should be restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female. Applying this more precise definition, the true prevalence of intersex is seen to be about 0.018%”.²

Coercing children, either overtly or covertly, via peer pressure, media influencers, schools, medical institutions, or even by parents themselves, to undergo hormonal treatment and surgeries in order to change congenital phenotype is unconscionable given the great complexity of interaction between the neuroendocrine systems and the brain (psychologic) as well as the immunologic systems of the body. The brain possesses great neuroplasticity during its development which, by most estimates, is not complete until the mid- to late twenties. If exposed to various higher than normal physiologic concentrations of hormones (pharmacologic doses), such change to the human brain may worsen or unmask already underlying conditions such as early brain tumors or psychiatric conditions such as major depressive disorder, bipolar disorder, or schizophrenia.

Changing horses in the middle of the stream by gender altering hormonal treatments have, heretofore, unknown long-term consequences on the overall physiology of children undergoing such interventions. For example, it is known women are more easily subject to autoimmune disorders and that men tend to clear viruses more slowly and are more prone to bacterial infection. Androgens such as testosterone influence immune cells both in how these cells mature but also how they differentiate from bone marrow progenitor cells. There are scant data on cancer and non-cancer effects of longer term hormonal treatment, using androgenic or estrogenic compounds and their antagonists, in the setting of gender altering treatment of children and adolescents.

There must be a moratorium on gender changing surgeries (which have their own physical and psychologic burden) and hormonal ‘intrusion’ therapy until more precise standards of care can be established and safely followed. Such standards of care need to be founded on solid clinical data and outcomes studies concerning such treatment as these treatments are, for the most part, irreversible with long-term effects unknown. Because the population prevalence of true “intersex” children and adolescents is so low, extreme care must be exerted by the medical field to not allow the forced metamorphosis of sociocultural norms surrounding gender and potential profit motive to overtake the bedrock oath in medicine “primum non nocere” (or “First, do no harm”) when arbitrating whether medical practice will engender gender change treatments…or not.

1. Fausto-Sterling, A. (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books.

2. Sax, L. (2002). How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 39 (3): 174-8.