Mehmet Oz, a physician and former television host of “The Dr. Oz Show,” serves as the administrator of the Centers for Medicare and Medicaid Services. Stephanie Carlton, a nurse, is deputy administrator of CMS.
America’s children aren’t lab mice. They deserve quality care backed by sound evidence and should not be conscripted as test subjects in risky experiments that cause irreversible harm.
That’s why the federal government has proposed two rules today banning the use of Medicaid and Children’s Health Insurance Program funds to subsidize sex-rejecting medical interventions for minors and prohibiting hospitals participating in Medicare and Medicaid from performing them. Extraordinary interventions such as cross-sex hormones and double mastectomies require extraordinary evidence, especially when children are involved. In this case, the evidence is lacking.
Comprehensive independent reviews — including by the Department of Health and Human Services, Sweden, Finland and Britain — conclude that the evidence that these treatments produce lasting benefits is “remarkably weak,” “low quality” and “insufficient” to determine “long-term outcomes.”
The risks, however, are substantial:
• Puberty blockers can reduce bone density, alter brain development and disrupt sexual maturation.
• Cross-sex hormones cause irreversible changes, including infertility, loss of sexual function and cardiovascular issues.
• Surgical interventions remove healthy organs, permanently alter appearance and can lead to decades of painful, costly complications.
Too many medical professionals have ignored these findings. Reasonable, evidence-based objections — that a child’s gender confusion might resolve over time or that hormones and surgeries might not bring lasting relief — are denounced as bigotry.
This is not how clinicians respond to any other case of pediatric or adolescent mental distress. The accepted approach is to begin with the least invasive interventions, including psychotherapy, family counseling, evaluation for autism or attention-deficit/hyperactivity disorder (ADHD), treatment for anxiety and depression, and trauma-informed care.
Many adolescents presenting gender distress have co-occurring conditions. A widely discussed study by researcher Lisa Littman found 63 percent had at least one prior mental health disorder or neurodevelopmental disability.
The consequences of ignoring mental health and jumping straight to medicalization aren’t theoretical. A growing number of people — who underwent these interventions as minors but have returned to accepting their biological sex — have filed lawsuits saying that clinicians pushed them toward blockers, hormones and surgeries without adequately addressing their psychological issues.
Doctors do a grave disservice to these young patients when they treat expressions of gender distress as infallible declarations of “true identity” instead of addressing them in their broader psychological and cultural context.
Three trends, which arose in the 2010s, seem particularly relevant:
First, diagnoses of adolescent gender dysphoria surged — particularly among girls, for whom the condition was previously uncommon. One gender clinic in the United States reported a fivefold increase in the average monthly number of minor patients referred to the clinic between 2015 and 2018. Nearly three-quarters of those children were “assigned female at birth.” This reverses historic trends for the transgender population, in which biological males outnumbered biological females. International data show the same pattern: Between 2009 and 2018, Britain saw a 12-fold increase in gender treatment referrals for boys, while referrals for girls grew by a factor of 44.
Second, teens got smartphones, and social media use exploded. Studies show that they now spend an average of nearly five hours per day on social media. The Littman study found that 87 percent of parents “reported that, along with the sudden or rapid onset of gender dysphoria, their child either had an increase in their social media/internet use, belonged to a friend group in which one or multiple friends became transgender-identified during a similar time frame, or both.”
Third, youth mental health deteriorated sharply. According to the Centers for Disease Control and Prevention, the suicide rate for 10- to 24-year-olds increased 57 percent between 2007 and 2018, with teenage girls experiencing the steepest declines in emotional well-being.
Definitively establishing causal links between social media, mental health and gender dysphoria will require more research, but the correlation alone should be enough to justify ending this experiment.
Proponents of the current approach demand that we “believe trans kids” and insist that blockers, hormones and surgeries are the most effective way to save gender-confused children from suicide. If they’re wrong — as studies increasingly suggest — then “gender-affirming care” for kids will have earned its place in the medical malfeasance hall of shame, right next to lobotomies.
With the risks so great and the evidence so weak, CMS had a duty to reevaluate what kind of care it ought to fund. After reviewing the data, we believe that Medicaid and CHIP should not pay for experimental interventions that leave distressed children frail and sterile without offering them any clear long-term benefits — especially when less invasive options exist.
CMS estimates that cutting federal funds for sex-rejecting interventions performed on minors would save taxpayers more than $250 million over the next decade.
These proposed rules aren’t about scoring political points. They’re about grounding our health policy in science — and protecting our kids.
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