Who uses gender-affirming care?
You, probably
The Trump administration started its blitzkrieg on American life with an executive order banning gender-affirming care for minors. The order’s first paragraph reads like a gruesome sequel to The Substance: “Across the country today, medical professionals are maiming and sterilizing a growing number of impressionable children… through a series of irreversible medical interventions.” Trans children undergo “chemical and surgical mutilation,” which “countless children soon regret.” This type of abuse, the order continues, is “sometimes referred to as ‘gender-affirming care’.”
The regret rate for gender transitions is exceptionally low, and gender care for minors saves lives1. But I’d like to talk about how this rich text paints gender-affirming care: as scary and deviant abuse, perpetrated on defenseless minors by woke adults and evil doctors. Actually, we all use gender-affirming care. You may have used it this week. Cisgender children and teens—those who identify with the gender they were assigned at birth—routinely undergo gender-affirming procedures and no one makes a fuss, or issues draconian executive orders.
The World Health Organization defines gender-affirming care as social, psychological, behavioral, or medical interventions that support a person's gender identity—which includes much of what we do daily. Women wear makeup, squeeze into shapewear and wax the hair on their legs while adding fake hair to their heads. Men guzzle protein shakes. Our Secretary of Health reportedly takes a testosterone replacement, which increases muscle mass (and loves to flaunt his shredded physique).
Ok, you may think, hormones and makeup are one thing; surgery is so much more extreme. But gender-affirming surgeries for cis people are legion, ranging from chin augmentation for men to vaginal surgery. Our president had hair transplants. And what about the children? Surely, operating on a child to alter their gender characteristics is wrong? If it is, we should also ban it for the thousands of cisgender minors who, according to data from 2021, surgically augmented their chins, got breast implants, or underwent vaginal plastic surgery.
Take chest reduction, a procedure performed on trans boys during gender transition and on cisgender boys suffering from Gynecomastia, which causes breast growth in men. A recent Harvard study found that 97% of teens who underwent chest reductions in 2019 were cisgender boys, while only 3% were transgender.
Gynecomastia is not life-threatening but can be socially mortifying, as Massachusetts congressman Barney Frank learned when he addressed the House of Representatives in 2011. Frank’s speech was on bank failures, but everyone focused on the lumps under his shirt. The Daily Mail screeched, “Congressman lacks support! Barney Frank gives the House a glimpse of his 'moobs' in revealing sweater.” A Ted Kennedy staffer reportedly joked that someone must have turned off the heating. No wonder boys go under the knife to escape such ridicule and humiliation.
It may seem like chest reduction for trans youth is a radical intervention, while for cis youth it’s simply a way to increase personal comfort. But this distinction is shaped more by politics than medicine. When a cisgender boy undergoes a chest reduction, he’s seeking to align his body with his internal gender identity and improve his mental health; the same goes for a trans boy. Gender-affirming care can be lifesaving for cis and trans boys alike.
If bans were truly meant to protect children from irreversible decisions they might regret, we’d also restrict breast implants, vaginal surgeries, and even puberty blockers prescribed to cisgender teens for conditions like endometriosis. Instead, the bans single out trans youth—not because their medical care is uniquely risky, but because their gender identity is politically contested. I’m not a lawyer, but that seems like discrimination to me.
Last December, a group of transgender minors, their parents, and healthcare providers argued before the Supreme Court that a 2023 Tennessee ban on gender-affirming care for trans minors violated the Equal Protection Clause, which mandates that the state grant equal treatment to people in similar situations: allowing care for cisgender minors but not for trans ones discriminates based on sex. Pediatricians cited in the plaintiff’s amicus brief reported that they provided such care to cisgender kids far more often than to transgender ones.
A study quoted in the amicus brief by Bioethicist Theo Schall and historian Jacob D. Moses argued that many procedures Republicans want to ban for trans people were actually invented for cis ones. Jean Zalon, a cisgender woman and the first U.S. patient to undergo mammoplasty - breast reconstruction after cancer treatment - described feeling ‘a void’ without her breasts. Testicular implants were first grafted in 1937 on a man who fell into a deep depression after a traumatic injury that required the removal of his testicles. Neither patient needed the procedure for physical health, only for emotional well-being.
Unsurprisingly, this conservative court upheld the ban. But that doesn’t mean we have to fall for propaganda. We all have a gender identity, and when our bodies deviate from what society tells us our gender should look like, we sometimes take measures to fix the discrepancy. It’s only trans people who get criminalized for it.