It has been seven months since I first read in JAMA Pediatrics the article that made the transgender debate very real for me. I had seen several patients in office who received androgenic hormones or puberty blockers for questionably medical reasons, but when I read “Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults” in September, that was really the first time I realized that physicians right here in the United State were really cutting the breasts off underage girls.
I’ve always been dumbfounded by how any physician could do this to a child, as all of us were children once. I don’t understand how a physician can forget the awkward insecurity of being an adolescent and a teenager, and jumping at many fads, political viewpoints, clothing or hairstyles all in the quest of finding where one could “just fit in.” Peer pressure is an extremely powerful force. I’d be shocked to meet a person who’s never done something stupid on a dare, including drinking (possibly to excess), or ingesting drugs of one sort or another, all because of the insistence of friends or colleagues during this very impressionable period of life. Admittedly, while some days I am envious of the amazing full color “Gunz N’ Roses” tattoo that would now occupy my entire back if you had allowed me to make any decisions about my body that I desired at that age, I can’t understand how anyone fails to remember how dangerous giving freedom over permanent decisions would be during this time in a child’s life. Anyone who remembers what this is like knows this is NOT the time to make a lifelong decision like a double mastectomy.
In addition, anyone that understands the concept of “informed consent” knows where this problem comes from. “Informed Consent” dictates that for a child to receive a medical procedure at least one legal guardian must understand and consent as well. As we do not live in a perfect world, legal guardians do not always have the child’s best interest in mind. Whether the reason for that is a bad parent who just wants the child’s approval “at all costs,” a jealous parent who despises the wellbeing of the child, or just good old fashioned Munchausen by proxy, (a rare syndrome where parents poison or otherwise harm their children in order to gain the attention of having a “sick” child,) parents and guardians are not always going to make the best decisions for their children. This leaves the state to step in.
Usually that stepping in is in the form of CPS (Child Protection Services,) but sometimes it has to be the legislature. The Georgia Senate and House has now passed SB140, effectively banning hormonal treatments and surgeries for the purpose of “Gender Dysphoric Disorder” in children under 18.
In my opinion, however, this bill does not go far enough. It does block the obviously permanent reality of surgery on a minor, and also blocks hormonal treatments. Although some argue that hormonal treatments are reversible, as anyone who prescribes enough of them knows, they are not always reversible. I have plenty of female patients who suffer from facial hair from testosterone that was “needed” to restore libido at some point, and have no way of correcting this. But, what is left out is puberty blockers. Puberty blockers are compounds (usually leuprolide,) that work in the pituitary gland to delay puberty. While puberty can be brought on later, the exact effect of the delay, as far as changes in final body stature and secondary sex characteristics, are never known to be similar to what they would have been without the interruption. Put plainly, like a human heart, puberty is not something that can be easily stopped and restarted without complication.
In addition, I feel personally as an OBGYN that puberty blocker administration to a child is among the most evil acts a person can do to a child, especially a female. For a young girl, the idea of womanhood, with all of the massive changes, body fat distribution, growth of hair, and the resulting attention (or lack thereof) is a terrifying nightmare. Offering a way to “delay” these changes, for possible gender reconsideration or any purpose at all is a disgustingly attractive alternative, similar to offering a drowning man someone else to pull down with him for just “one more breath.” I feel that it’s a complete injustice that these medications were not included in this ban, and it’s a crime against children that an unscrupulous physician and deceived or uncaring parent can still effect these harms on a child.
Imagine for a moment a pharmaceutical company executive standing in front of a class of 5th grade girls, showing them pictures of what is about to happen to their bodies, including the curves, hair, smells, and acne. Then he asks them if they would like to delay them for a time with his proprietary drug. That’s the level of disgust I feel.
I’m bothered by the ever increasing volume of women I see experiencing regret in their late teens or early 20, now having irreversibly received male features from high dose testosterone, and with deep voices and absent breasts. I’m bothered by the physicians that are allowing this to happen, or worse, aiding and abetting these crimes. I’m appreciative the Georgia legislature has acted, but I will be the first to declare - this is not enough.
Dr. Greg Marchand is dual board certified in OBGYN and Minimally Invasive Gynecologic Surgery.