In 2023, Oklahoma lawmakers enacted a law that prevents children from receiving sex-change surgeries and cross-sex hormones, citing concern that youth are not capable of making permanent, life-altering decisions of that magnitude.

The law is being challenged in court, but medical research continues to bolster the case made by the law’s supporters.

One of the latest examples, “Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery,” published in the medical journal Cureus, found that even adults who undergo so-called “gender-affirming” surgery have a 12.12-fold higher suicide attempt risk than those who did not.

Researchers examined data from TriNetX, a global health research network with a database that includes over 90 million patients from 56 healthcare organizations within the United States.

Researchers identified 15,609,864 adult patients from TriNetX who had a visit to an emergency department within the United States. They found 1,501 adult patients who had a visit to the emergency department and had undergone a sex-change surgery.

Based on the data, researchers found that adults who underwent sex-change surgeries had a 12.12 times greater risk of suicide attempts compared to patients who had no history of “gender-affirmation” surgery, a 3.35 times greater risk of being deceased, a 9.88-times higher risk of self-harm or suicide, and a 7.76 times higher risk of post-traumatic stress syndrome.

Researchers noted that based on self-identification, approximately 0.3 percent to 0.6 percent of the adult U.S. population claim to be transgender individuals who identify as members of the opposite sex, but the actual number may be even lower. When investigators examined only individuals with transgender diagnostic codes, hormone therapy, or sex-change surgery, those groups represented just 0.008 percent of the population.

In 2023, Oklahoma 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 like-minded 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.”

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.

The number of underage individuals subjected to puberty blockers, cross-sex hormones, or sex-change surgeries is significant.

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 so-called “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.

A database compiled by Do No Harm shows that 65 children were subjected to some form of sex-change procedure in Oklahoma from 2019 to 2023.

Numerous lawsuits have been filed nationwide by individuals who underwent gender-transition surgeries or cross-sex hormones as children and later regretted it. The lawsuits typically target the clinics and clinicians that participated in the procedures.

The U.S. Supreme Court has agreed to hear a case involving a challenge to a Tennessee law similar to Oklahoma’s SB 613. The court’s ruling in that case will determine the outcome of the challenge to Oklahoma’s law as well.