Law & Principles

OCPA defends ban on child sex-change surgeries

June 28, 2023

Ray Carter

The Oklahoma Council of Public Affairs (OCPA) has joined with medical professionals to defend a new state law that prevents children younger than 18 from being subjected to sex-change surgeries or given puberty blockers or cross-sex hormones.

“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,” states an amici curiae brief by the Oklahoma Council of Public Affairs and Do No Harm.

The brief was filed in Peter Poe v. Gentner Drummond, a case in the U.S. District Court for the Northern District of Oklahoma.

Do No Harm is a group of physicians and healthcare professionals who believe “healthcare should be free from experimental procedures that place political agendas ahead of patient well-being.”

OCPA believes it is “important to protect children and families from medical treatments that are wholly unproven, that cause known harm, and that carry lifelong and irreversible consequences.”

Earlier this year, 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 American Civil Liberties Union and likeminded groups have sued, seeking to have the law overturned, and have asked for an injunction to prevent the law’s enforcement.

The brief filed by OCPA and Do No Harm notes the extensive harms that can occur to children subjected to the banned procedures, and notes there is no significant research indicating any benefit that would offset those harms.

The brief notes that puberty blockers have been linked to “life-altering side-effects, including decreased bone density, cognitive impairment, polycystic ovarian syndrome, metabolic syndrome, and greater risk of infertility.”

For males, the brief notes that use of cross-sex hormones is associated with “numerous health risks, such as thromboembolic disease, including blood clots; cholelithiasis, including gallstones; coronary artery disease, including heart attacks; macroprolactinoma, which is a tumor of the pituitary gland; cerebrovascular disease, including strokes; hypertriglyceridemia, which is an elevated level of triglycerides in the blood; breast cancer; and irreversible infertility.”

For females, the use of cross-sex hormones is associated with “risks of erythrocytosis, which is an increase in red blood cells; severe liver dysfunction; coronary artery disease, including heart attacks; depression; hypertension; infertility; and increased risk of breast, cervical, and uterine cancers.”

The known risks of various sex-change surgeries include “fistulas, chronic infection, atrophy, need for colostomy, and complete loss of sexual sensation.”

In addition, there is reason to think use of puberty blockers can lead to increased mental distress and even suicide.

The OCPA/Do No Harm brief notes that “delaying a child’s natural puberty while his or her peers continue to develop the characteristics that come from puberty can actually worsen a minor’s gender dysphoria” (emphasis in original).

Use of puberty blockers for gender dysphoria has never been approved by the U.S. Food and Drug Administration, and no clinical trial has ever established the safety of using them for that purpose.

The brief notes that it remains unknown the extent to which puberty blockers impact brain development and cognition, but that authors in one study were concerned puberty blockers “may prevent key aspects of development” during adolescence—“a sensitive period of brain organization”—and the study authors did not know whether a patient would “catch-up” to otherwise resume developmentally normal brain functioning.

“Even more worrying, some have raised concerns that the use of puberty blockers may contribute to suicidal ideation and behavior,” the brief notes (emphasis in original), pointing to a study that found a “statistically significant increase in self-harm after a year of puberty suppression.”

“No treatment can be deemed safe and effective when it remains unknown whether its application could permanently stunt patients’ cognitive development or may lead them to suicide,” OCPA and Do No Harm stated in their brief.

The brief also notes that many children and adolescents seeking experimental gender medicine today concurrently suffer from depression, anxiety, autism spectrum disorder, or attention deficit hyperactivity disorder.

“Without properly understanding the relationship between gender dysphoria and other comorbid psychiatric diagnoses, minor patients are put at risk of receiving experimental and risky treatments in place of those that may effectively and safely mitigate their real underlying mental-health problems,” the brief states (emphasis in original).

OCPA and Do No Harm also noted that there is now a growing number of “individuals who have come to regret irreversible physical changes made to their bodies to treat gender dysphoria. These individuals are commonly referred to as ‘detransitioners.’”

Yet there are no reliable, long-term studies on rates of regret and detransition among the cohort of children and adolescents treated under the “gender affirming” model.

Defenders of putting child patients through sex-change measures have pointed to studies that purport to show short-term benefits. But the OCPA/Do No Harm brief notes that “the effects are so minimal as to be immaterial, and the studies do not control for the confounding effects of psychotherapy or the placebo effect.” When a recent study controlled for mental-health comorbidities, the differences in suicidality rates between gender-dysphoric and non-dysphoric children “were either miniscule or non-existent,” the brief states.

While some medical organizations are opposed to SB 613, OCPA and Do No Harm noted, “Although these groups claim to offer objective analysis, an even cursory glance at the positions these groups have taken elsewhere reveals that they peddle nothing more than political ideology dressed up as ‘science.’”

The brief notes that many medical groups that support subjecting children to sex-change procedures have also issued statements in favor of Critical Race Theory, gun control, immigration, climate change, and affirmative action.

“And if anyone has ever wondered what the American Academy of Family Physicians thinks about nuclear weapons or biological warfare, the Medical Interest Group Amici have that covered too,” OCPA and Do No Harm’s brief states.

The brief notes that some medical groups have taken self-contradicting stances depending on the issue.

For example, the American Academy of Child & Adolescent Psychiatry (AACAP) claims children and adolescents can provide informed consent to gender-transition procedures, but that same organization has argued in another case that those same children should not be subjected to lifetime prison sentences because “adolescents as a group, even at later stages of adolescence, are more likely than adults to engage in risky, impulsive, and sensation seeking behavior. This is, in part, because they overvalue short-term benefits and rewards, and are less capable of controlling their impulses, making them susceptible to acting in a reflexive rather than a planned voluntary manner. Adolescents are also more emotionally volatile and susceptible to stress and peer influences. In short, the average adolescent cannot be expected to act with the same control or foresight as a mature adult.”

The American Medical Association has made similarly self-contradictory arguments in different cases, the OCPA brief notes.

Through their brief, OCPA and Do No Harm state that “one is left with the distinct impression that something more than ‘science’ is driving the bus here. Indeed, the Medical Interest Group Amici … consist almost entirely of repeat players who issue public policy statements on issues that bear no relation to their purported expertise. Name a hot-button social issue, and they have it covered.”

Furthermore, SB 613 puts Oklahoma in line with medical standards across much of the world.

“Health authorities in Sweden, Finland, and the United Kingdom have conducted systematic reviews of evidence and, having found that the evidence of benefits is too uncertain to outweigh the risks, have decided to place severe restrictions on medical transition procedures—generally limiting the use of these treatments to research studies,” OCPA and Do No Harm stated in their brief (emphasis in original). “Oklahoma has now reached the same reasonable conclusion.”