Last week wasn’t a good one in Missouri for those who believe that government should keep its nose out of private medical decisions best left to patients, their families and their doctors.
A judge on Friday declined to halt a new state law that prohibits transgender medical care for minors, clearing the way for it to go into effect this week.
Days earlier, a poll found widespread support across the state for the new law. It also showed strong support for another new law that prohibits transgender high school athletes from competing in sports outside the gender they were assigned at birth.
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Public opinion isn’t the only factor to consider in policy decisions, especially on the fast-evolving issue of gender. Still, the polling should provide LGBTQ activists with some guidance regarding what’s feasible in Missouri right now in terms of policy goals — and where they should pump the brakes. Attempting to push a generally conservative state too far too fast is a recipe for irrelevance.
The St. Louis University/YouGov statewide poll found that 63% of Missourians support banning puberty blockers and other hormone therapy for patients younger than 18, with just 24% opposed. The gap was even wider regarding gender-transition surgery for minors, with 73% favoring the new ban and just 14% opposed.
In contrast with those numbers, organizations like the Mayo Clinic, the American Psychiatric Association and many others widely recognize gender dysphoria as a form of serious psychological distress for adolescents who identify as a gender other than the one they were born with.
It’s easy to see why people whose families aren’t directly impacted by the issue could find the very idea of gender-affirming treatment for minors disturbing. That’s obviously true (according to this and other polls) on the issue of surgery.
But some context is necessary: Genital transition surgery on minors is virtually non-existent. And even the most common form of surgery for minors — breast removal for biological females — is exceedingly rare.
The roughly 200 such surgeries logged in the entire country in 2021 (according to a New York Times analysis last year) are dwarfed by the thousands of cosmetic breast surgeries that non-trans adolescent girls undergo every year, prompting none of the political histrionics from red-state legislatures.
For the overwhelming majority of the young patients in this debate, the issue isn’t surgery but hormone treatments. And those treatments aren’t offered to just any rebellious teen going through a phase. The American Academy of Pediatrics and other professional organizations strictly observe standards requiring counseling and analysis to separate actual gender dysphoria from the usual dramas of adolescence.
The stakes are real; elevated depression and suicide rates among gender-dysphoria youths have been well documented. One study last year published in the Lancet Child & Adolescent Health medical journal found that hospitalized trans and nonbinary youths had attempted-suicide rates seven to 13 times higher than non-trans youths.
Depriving trans youths of all treatment under all circumstances, as Missouri’s new law does, will undoubtedly cost young lives. That alone makes the case for activists to continue the legal fight to overturn that particular law.
Yes, public opinion is clearly against such a campaign, but on this issue, public education could be a crucial tool in changing those views. Proponents should also press the philosophical argument — once embraced by conservatives, now selectively rejected — that Big Government doesn’t belong in people’s personal lives.
The second new law, banning trans participation in high school sports, strikes us as a fundamentally different issue than banning trans medical treatment — and a far more defensible one.
You don’t have to be an anti-trans bigot to question the fairness of forcing biologically female athletes to face opponents who are, in terms of their musculature, male. And unlike the debate over medical treatment, this isn’t a strictly private issue, but one that affects all those participants.
There are nuances, to be sure. But activists who want to make substantive political progress in protecting adolescent trans rights would do better to focus on ensuring they can make their own medical decisions rather than fighting for them to get on the school track team.
Of course, it’s no coincidence that Missouri’s ruling Republicans have front-burnered divisive cultural issues like these, which affect slivers of the populace, while neglecting more pressing issues like education, general health care and gun violence. That political cynicism, too, should be part of the debate, especially in next year’s elections.