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GENDER AFFIRMING CARE - Parents who seek treatment for a child with gender dysphoria argue that it is their right to consult with psychiatric and medical practitioners to attain the best care possible. In large measure, gender affirming care typically involves supporting the child’s gender through 1) the use of gender-affirming pronouns, dress, restrooms, etc.; 2) puberty blockers; 3) hormone therapy; and rarely, 4) gender-affirming surgeries that are done on a case-by-case basis in older adolescents. Discussions surrounding gender affirming care for youth have become increasingly divisive, with those opposed to the care likening the range of medical services provided to child abuse.
Legislators opposed to gender affirming care claim that legislative action is a just recourse to protect the wellbeing of children. If this is true, why have these same legislators in state after state across the country included text in anti-gender affirming care legislation that would undoubtedly harm young children, including infants? Take as one example Arkansas House Bill 1570, which includes a listing of exceptions when the surgical alteration of a child’s genitals would be permitted and warranted. Such instances include, but are not limited to, children born with typical female XX chromosomes and an enlarged clitoris (virilization) or children born with typical male XY chromosomes and a smaller than typical-size penis (under virilization). Both of these cited examples represent cases of intersex—an individual born with internal and/or external sexual and reproductive characteristics that are not typically male or female.
In many instances when children are born with virilized or under virilized genitals, surgical intervention serves no medical need; it is strictly done for cosmetic purposes in order to “normalize” the genitals to make them appear more typically male or female. Functionally and aesthetically, there is nothing wrong with a smaller than typical-size penis or a larger than typical-size clitoris; these variant genitals will still have the capacity to function and afford sexual pleasure. If the genitals a child is born with require surgical intervention because there is a medical necessity, of course surgery would and should be warranted. Because surgeries performed on the genitals of infants have a likelihood of causing dire outcomes, namely, the inability to achieve orgasm and a high incidence of urinary incontinence, pain, and other medical and psychological issues, there is a strong argument to be made to let intersex children, when old enough, decide for themselves if they want their genitals surgically altered for cosmetic purposes alone.
Allowing the time for an individual to make decisions about undergoing surgeries to alter their own genitals also provides time for one’s gender identity to become clearer. Case in point: a child born with XY chromosomes and under virilized genitals is subjected to surgeries that “normalize” the genitals to make them appear typically female. In such a scenario, it is not improbable that this same child could grow up to identify with a boy/man gender. Note: gender may not have even been fully considered prior to the surgical intervention.
Do the legislators who have drafted anti-gender affirming care legislation really want to protect all children, or do they only care about maintaining a paradigm built around a sex (male or female) and gender (boy/man or girl/woman) binary? This question is pressing, especially in light of the harm that can result from not only surgically altering the variant genitals of intersex infants but also from disregarding the idea that gender is distinct from sex.
(Maria Nieto, Ph. D is a Professor Emerita (Department of Biological Sciences, California State University East Bay) and the co-author of The Spectrum of Sex: The Science of Male, Female, and Intersex ((Jessica Kingsley Publishers, Hachette UK Book Group).
