How Not to Regulate Pediatric Gender Medicine

Leor Sapir and Colin Wright
city-journal.org
2023-01-24

As the 2023-24 legislative session gets underway, a number of states have resolved to make "gender-affirming care" a central focus. In red states, this means restricting the controversial practice or trying to eliminate it altogether. Some states, including Alabama and Arkansas, will be defending previously passed bans in the courts.

State efforts to restrict the use of puberty blockers, cross-sex hormones, and surgeries to address (apparent) gender-related distress in youth make for good public policy. Yet even lawmakers on the morally and scientifically correct side of an issue risk overstepping by unintentionally proposing harmful or strategically counterproductive regulations. We write to warn of three such mistaken efforts.

By way of background, European countries, including Finland, Sweden, and England, have conducted systematic reviews of evidence for hormonal interventions and found no evidence that the benefits outweigh the risks. In more specific terms, they found no evidence that drugs and surgeries (which, in Europe, remain almost unheard-of) are superior to the less invasive alternative - psychotherapy. In addition, new research highlights how the social and political climate surrounding such aggressive treatment creates a placebo effect, making it impossible to know whether even the observed short-term benefits to mental health from hormones owe to the drugs themselves.

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