In 2023, Oklahoma lawmakers voted to make it illegal to provide children with puberty blockers, cross-sex hormones, or sex-change surgeries as a treatment for gender dysphoria.

Opponents of the law sued, arguing that puberty blockers, cross-sex hormones, and sex-change surgeries are the standard of medical care for children who express discomfort with their sex.

But a notable share of medical officials appears to be shifting to positions that align with those of the Oklahoma lawmakers who voted to restrict the provision of permanent, life-altering acts to child patients who express feelings that are often short-term in nature.

In April 2024, the Cass Review, conducted by Dr. Hilary Cass for the National Health Service England, was released. That report reviewed treatments for children who question their gender identity.

The associated overview of key findings in the Cass report noted that the “rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health,” and that the “use of masculinising/feminising hormones in those under the age of 18 also presents many unknowns …”

The report overview stated, “For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress.”

After the Cass Review was issued, officials in both England and Scotland banned the use of puberty-blocking hormones for minors.

Leor Sapir, a fellow at the Manhattan Institute, reported that in July the American Society of Plastic Surgeons, a medical association representing 11,000 members and over 90 percent of the field in the U.S. and Canada, told Sapir that it “has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria.”

Sapir said ASPS acknowledged that there is “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions” and that “the existing evidence base is viewed as low quality/low certainty.” 

An analysis by the Manhattan Institute, using an all-payer national insurance database from 2017 to 2023, found evidence of 5,288 to 6,294 “gender-affirming” double mastectomies for girls under age 18. The patients included 50 to 179 girls who were 12.5 years of age or younger at the time of their procedure.

Sapir noted that individuals who underwent gender-transition surgeries as children and later regretted it have filed almost two dozen lawsuits against clinics and clinicians that are currently underway.

‘Harmful Lifelong Consequences’

Medical providers’ views are shifting even as the State of Oklahoma is defending its law in federal court.

In 2023, state lawmakers passed and Gov. Kevin Stitt signed into law Senate Bill 613, which states, “A health care provider shall not knowingly provide gender transition procedures to any child.”

The law defines “gender transition procedures” to include surgical procedures that alter or remove physical or anatomical characteristics or features that are typical for the individual’s biological sex, or the provision of puberty-blocking drugs and cross-sex hormones. The restrictions apply to patients younger than 18.

The American Civil Liberties Union and likeminded groups sued, seeking to have the law overturned.

The plaintiffs in Peter Poe v. Gentner Drummond included five youth who claim to be transgender, their parents/guardians, and one doctor previously paid to make youth of one sex physically appear as members of the opposite sex.

U.S. District Judge John F. Heil, III, denied plaintiffs’ motion for a preliminary injunction that would prevent enforcement of the law.

“Where, as here, there is robust scientific and political debate concerning a significant public-policy question, a court should be loath to step in to end the debate and thereby suggest it is all-knowing,” Heil wrote in his opinion and order. “The record in this case amply demonstrates that there is no consensus in the medical field about the extent of the risks or the benefits of the Treatment Protocols.”

Heil denied the plaintiffs request for a preliminary injunction that would keep the state law from being enforced, writing that the plaintiffs “have failed to show a likelihood of success on the merits of each of their constitutional claims.”

The Oklahoma Council of Public Affairs (OCPA) joined with Do No Harm, a group of medical professionals, to defend SB 613 in an amici curiae brief filed in the case.

“No reliable scientific evidence justifies the use of puberty blockers, cross-sex hormones, and surgeries to treat gender dysphoria in minors. To the contrary, such treatments carry harmful lifelong consequences, including infertility, total loss of adult sexual function, and increased risk of several other serious medical conditions,” OCPA and Do No Harm’s brief stated.