The Supreme Court in early March reprimanded California for forcing schools to hide students’ gender changes from their parents.
The legal stakes in this case are significant, but it also exposes a deeper divide about how society should respond when children experience gender issues—and how public health officials like us can shape policies to help these children thrive.
Until recently, this debate has been dominated by radical gender ideologues, who insist on affirmation at all costs.
From their perspective, a girl who thinks she’s a boy is a boy. According to them, failure to confirm this new identity will cause more damage than irreversible surgery or lifelong treatment with cross-sex hormones.
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A transgender rights advocate takes part in a rally outside the U.S. Supreme Court as the justices hear arguments in a case involving the health rights of transgender people in Washington, DC, on December 4, 2024. (Kevin Dietsch/Getty Images)
In California, the pipeline to these drastic interventions begins in the classroom, where state law requires teachers to hide children’s gender confusion from their parents, even if that means sitting across from them at parent-teacher conferences and negligently lying to the people most responsible for those children’s care and well-being.
Children’s social transition at school puts them on a collision course with sex-averse medical interventions that cause lower bone density, infertility, cardiovascular problems and other painful, costly health problems.
There is no exit. California’s ban on “conversion therapy” applies not only to the abusive practices most people associate with that term, but also to any form of counseling that might reduce children’s gender issues without converting them. (Multiple states have similarly broad bans on their books, though the Supreme Court just struck down Colorado’s.)
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That policy is rooted in academic queer theory rather than science, but after a long campaign of infiltration and intimidation, activists have managed to align the medical profession with their ideology. Just a few years ago they could claim that “[e]A very large medical association deemed sex-averse interventions for trans-identifying youth “safe and life-saving.”
But that confidence was never matched by strong evidence.
Fortunately, the tide has turned. There is a growing international consensus that the gender activists were wrong. Scientific reviews in Sweden and Finland, as well as the rigorous Cass report from Britain, have convinced these countries to dramatically scale back sex-averse interventions for children and adolescents.
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Last fall, the U.S. Department of Health and Human Services (HHS) published a comprehensive overview titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” who came to the same conclusion: that minors undergoing medical transition do not bring any proven benefits.
The choice between “a trans son or a dead daughter” convinced thousands of parents to approve interventions that irreparably damaged their children. It turned out to be a false dichotomy.
Children’s social transition at school puts them on a collision course with sex-averse medical interventions that cause lower bone density, infertility, cardiovascular problems and other painful, costly health problems.
There is also mounting evidence that trans-identifying children are not simply “born in the wrong body” but instead struggle with deeper issues.
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The recent spike in gender dysphoria among young people has coincided with a massive decline in teen mental health (likely caused by smartphones and social media). Both trends were more pronounced among girls.
One influential study found that 63% of gender-challenged adolescents have at least one additional neurodevelopmental or mental health disorder.
These children do not need puberty blockers and hormones. They need psychotherapy, family counseling, thorough clinical evaluation, and perhaps treatment for anxiety or depression – no rush to irreversible medical interventions.
Based on these findings, CMS and HHS took action in December by proposing two new rules to ensure that taxpayer-funded health programs are guided by evidence, not ideology. The first prevents taxpayer dollars from subsidizing sex-averse interventions for children through CHIP and Medicaid; the second prohibits hospitals that perform these interventions from participating in Medicare and Medicaid, given the significant safety risks to children.
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In January, CMS convened all major medical associations involved in sex rejection interventions for minors and conducted a “grand tour” of the available evidence. A month later, the American Society of Plastic Surgeons issued a courageous and principled statement recognizing that there was “insufficient evidence demonstrating a favorable risk-benefit ratio for… gender-related endocrine and surgical interventions in children and adolescents.”
That policy is rooted in academic queer theory rather than science, but after a long campaign of infiltration and intimidation, activists have managed to align the medical profession with their ideology.
The American Medical Association quickly followed suit. The false “scientific consensus” in favor of children undergoing medical transition has finally shattered.
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Not long ago, parents who opposed California would have been alone. But not anymore. This government stands behind them.
We will continue to defend scientific rigor and genuine compassion against the bullying dogmatism of radical gender ideologues. We will free this country’s institutions from the long captivity to which activists and their allies have subjected them. And we will always put parents and children first.
Stephanie Carlton is deputy administrator of the Centers for Medicare & Medicaid Services.
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