Roger Marshall wants the government, not families, to make choices for trans youths | Opinion

The 2024 elections are over. Many voters are happy with the results and just about as many are disappointed. Either way, it is now time our elected officials in Washington, D.C., and our state houses develop and approve policies to attack the challenges and issues we the people want to be addressed. I believe we all can agree that there are many important priorities. To name a few, climate change, immigration, gun violence, the national debt, the mental health epidemic, violence against women and all the destructive “-isms.”

Despite this, Kansas Sen. Roger Marshall, as reported recently The Kansas City Star, wants to take rights away from vulnerable transgender youth. Quoting from the Star:

“In the coming weeks, Marshall said, he’d be introducing a Senate bill that would try to prevent gender-affirming care by going after doctors, nurses and mental health professionals who provide it with fines up to $100,000. It is just one pillar of Marshall’s sweeping agenda to restrict the rights of transgender Americans, specifically transgender youth.”

Purely from a viewpoint of national impact, this makes no sense as a priority. A 2022 report from the Williams Institute at the University of California, Los Angeles, estimated that among Americans age 13 and older, there are only 1.6 million transgender people, representing 0.6% of that population. The estimate for the 13- to 17-year-olds targeted by the legislation is 300,000. For various reasons, not all of those 300,000 will seek gender-affirming care. Thus, we have a proposed Senate bill attacking the rights of well under 300,000 people, among a U.S. population of nearly 350 million.

These attacks target kids whose existence isn’t threatening or hurting anybody. Contrast this with climate change, which impacts all of us, or violence against women, which impacts many millions of Americans every year.

Increased risk for suicide attempts

Getting back to the meat of Marshall’s proposed bill: What is the compelling reason the federal government provides us before taking away citizens’ rights? Marshall and other elected officials across the country justify their efforts with the concern that puberty delaying medication has potential long-term risks, and therefore should be banned. Marshall is correct that treating gender dysphoria with puberty-delaying drugs is associated with risk, as is taking a baby aspirin to prevent blood clotting. This represents risk from action. Another form of risk is from inaction. Imagine a transgender or nonbinary teenager with severe gender dysphoria who was denied puberty-delaying medicine because of this proposed legislation. After being denied treatment, the teen commits suicide. Suicidal attempts are increased by up to 2.5 times among young transgender people, according to the Trevor Project.

For those interested in learning more about the potential risks and benefits from puberty-delaying care, I refer you to a guest commentary, “Is puberty delaying treatment ‘experimental treatment?” published in the April 2020 International Journal of Transgender Health. It is an objective, thoughtful review discussing multiple issues associated with the care of transgender youth and adults. The commentary takes a deep dive into all the risk and benefit issues. The unique complexities surrounding care of transgender people is explained in detail. Paraphrasing the authors’ conclusions, treating gender dysphoria is not experimental. The gender dysphoria treatment community has established solid treatment standards, and this community has struck a good balance between risk and benefit.

Truth about regret after surgery

A second concern — regret after gender-affirming surgery — is rarely an issue for transgender youth. Nonetheless, what does the data show? A systematic review of patient regret after surgery was published in The American Journal of Surgery in August 2024. The authors’ highlights were “regret after gender-affirming surgery was less than 1%; regret after elective plastic surgery operations was significantly higher; regret after major non-surgical life decisions was significantly higher; patients with regret should receive multidisciplinary care.” I honestly don’t see any support that provides a legitimate and compelling reason to delete the families, physicians and the rest of the medical team from the decision and replacing them with elected officials.

Again, the foundation for Marshall’s bill is to prevent harm to transgender youth by removing risk and care. His chosen method is to threaten physicians, nurses and mental health professionals with fines up to $100,000. This means Marshall wants politicians to manage medical risk. The senator is a physician, and knows full well that a physician’s day is full of risk-versus-benefit decisions ranging from minor to life-and-death. The government does not interfere in these day-to-day risk-benefit decisions, and it should not be interfering in risk decisions related to gender affirming care.

Many, if not most, gender clinics for youth are located and staffed by the top children’s hospitals in the country. These wonderful and important hospitals are universally admired. The clinics are staffed by specialized adolescent physicians, pediatric endocrinologists, psychologists, psychiatrists, social workers, nurses, nurse facilitators and specialized surgeons when needed for consultation and explanation in cases of severe gender dysphoria. The medical team, the family and the patient make the decisions most appropriate for each individual. These dedicated and experienced professionals put their hearts and souls into helping these kids and their families navigate an extremely difficult path to happiness and well-being. Medical professionals know the risks and benefits, know the medical literature, know the kids, know the family and know when an individual’s transgender identity is insistent, persistent, consistent. The other political team doesn’t possess this. Their plan is a one-size-fits-everybody — and nobody gets treatment. I find it very disappointing that a physician is leading this effort.

Whose safety in restrooms?

There is another reason I hesitate to accept the stated justification for this effort to ban gender-affirming care. Another pillar of the proposed bill is a ban on trans youth using the bathroom that matches their gender identity. If I were the father of a transgender girl, I would be far more concerned about her safety in the boys’ restroom at school than in the girls’. Think about it. My trans daughter walks into the girls’ restroom. She is fully clothed and walks by a few cisgender girls at the sinks. She goes into a stall and secures the door. After emptying her bladder, she leaves the stall, again fully clothed, and goes to the sink to wash her hands before leaving the restroom. Banning her from that restroom has nothing to do with protecting my daughter from harm. If anything, it is trying to protect the cisgender girls — but from what? How is this different from banning my trans daughter from walking past other girls in the cafeteria or the library?

I wrote this diatribe because I was concerned that only one side of the coin was being shown. On this side is a physician without expertise in gender-affirming care who wants the government to take this care away from a very small percentage of our youth. On the other side is a physician without expertise in gender-affirming care who wants that care to be available to those who need it. A physician who wants the patient, family and the medical team to freely make the needed decisions, just like what happens in other clinics all over this country every day.

I will end with one line from a prayer recently said in my church, and two lines that are all mine.

Like Jesus, we want to bring signs of peace and freedom, justice, truth and love. God, help us embrace the other and the different. Lord, help us end any attempt to erase the other and the different.

This story was originally published December 18, 2024 at 5:07 AM.