Sex-Change Surgeries for Kids: A-OK With Biden

The Biden administration recently sent a letter to the attorney general of each state, warning the top law enforcement officials that they could be violating civil rights law if they don’t comply with “gender-affirming care” procedures for children. 

But just what is this gender-affirming care promoted by President Joe Biden, and how does it affect kids? 

Jay Richards, a senior research fellow at The Heritage Foundation’s DeVos Center for Religion and Civil Society, says the term is a euphemism for giving hormones to children and, in many cases, performing irreversible surgery on them. (The Daily Signal is Heritage’s multimedia news organization.)

These hormones and surgeries have long-term consequences for a child. 

“If you give a girl heavy doses of testosterone for several years, this causes her uterus to atrophy. It can effectively sterilize her,” Richards says. “And the same thing if you’ve got a boy, especially these pre-pubescents: So you delay puberty and then you give him estrogen. This can not only sterilize the child, it can actually make them so they can’t even function sexually.”

Richards joins “The Daily Signal Podcast” to discuss gender ideology and reveal how the Biden administration is pushing it on America’s children.

We also cover these stories: 

• Consumer prices rose by 8.5% in March, the highest level since December 1981, the Labor Department says.
• New York’s lieutenant governor resigns in the face of bribery and other charges in a federal corruption probe.
• A new law in Oklahoma makes abortion illegal. 

Listen to the podcast or read the lightly edited transcript below.

Doug Blair: My guest today is Jay Richards, the William E. Simon senior research fellow in The Heritage Foundation’s DeVos Center for Religion and Civil Society. Jay, welcome to the show.

Jay Richards: Thanks. Good to be with you.

Blair: Great. You recently wrote an article for The Daily Signal headlined “Biden Doubles Down on Radical ‘Gender-Affirming Care’ for Kids.” Let’s define our terms before we start here. What does that mean? What is gender-affirming care?

Richards: OK. So, gender-affirming care, according to [President Joe] Biden’s Health and Human Services Department, refers to something that people that follow this gender ideology call the Dutch protocol.

So it’s essentially based on a single study in the Netherlands with 54 subjects and no control group that basically argues that the proper standard of care for children who have gender dysphoria is this four-step process that starts with social transition—so pronoun-changing, referring to a boy as a girl, her gender identity as female—followed, if they’re not in puberty, by puberty blockers to delay the onset of puberty, followed by cross-sex hormones. So for girls that would be testosterone, followed by surgical intervention.

So it’s that four-step process that gets called all sorts of euphemisms, transition or whatever, but according to President Biden and his administration and his HHS, that is called gender-affirming care, where you, just to be clear, where you set a child on the pathway starting in school and ending in sterilization.

Blair: You mentioned that this was based off of one study out of the Netherlands. Is it really based on such, to me, flimsy evidence, that it’s just one thing?

Richards: It is. That what’s so bizarre about this, is if you dig into it—now, we’re told that is sound science. It’s this one study in which they did this. And the study itself, I mean, we could spend five minutes on it, is really, really weak. But even if it was good, it would be a single study.

So you don’t take one study in a foreign country with very few subjects and use that to implement a draconian nationwide medical intervention, which is what we’re talking about.

This is how bad it is, that countries that are sort of over this cliff, farther than us, countries like Sweden and Finland and the U.K., they have now put the breaks on. So they were following the Dutch protocol. Sweden was way ahead of us on this. They’ve since noticed that, actually, this doesn’t seem to have any positive outcomes.

If you’re imagining that the child’s psychological health will improve, that presumably would be why you would do this, well, you can track that. They’ve been doing it long enough to notice. Actually, this doesn’t seem to have any sort of positive effect. By the way, there are also some very severe costs on the other side.

And so they’re slowing down just as President Biden has decided to hit the accelerator.

Blair: You’ve mentioned that this study did have some problems. What are some of those issues?

Richards: Well, it was very small, so it’s not powerful. You have 54 subjects, which is really not surprising, if you think about it. You’re in one small country. You’re not going to have thousands of subjects to do this. But there’s also not a control group.

So in other words, you need to have—let’s say you’re going to have 54. So you have a group that you run the tests on, right? So you do these interventions and then [have] another group that’s comparable in every way, same age, demographics. In this case, it’d be teenagers presenting with gender dysphoria. And then you’d track both groups.

And so if this was going to be positive, you’d say, “Well, it turns out, when we can pair these groups, say, five years out, the kids who have been put through the Dutch protocol are much better off. They’re much better adjusted socially. They’re much happier.” Those sorts of things.

We don’t have anything like that. And so you don’t even know, OK, what are we comparing this with? And so it ends up being, well, it would be their kind of their self-report previously versus afterward, which might be something, but when you dig into it, it’s really not even clear what that is.

This very much looks to me like this was agenda-driven research. And unfortunately, the problem with a lot of this is that to actually get empirical data on these things is tough because it ends up being activists and activist funders that push the research itself. And so knowing that, to figure out that actually even then the research is very, very sparse, that’s very telling.

Blair: Returning to your piece. You mentioned a letter that the Biden administration sent out to all state attorneys general, that they needed to allow minors to go through these procedures, otherwise, they might face some consequences. Can you go a little more in-depth about that?

Richards: Absolutely. So, again, what the Biden White House is doing is following radical left activists on this, radical gender activists on this stuff. And they were told, “Well, there’s some states that are actually putting the breaks on this.”

And so Texas, for instance, the attorney general, it wasn’t legislation, he just ruled that their laws that were in place gave them all the authority they needed to be able to say that at least in some cases, like putting a girl on heavy doses of testosterone or giving her a double mastectomy, not because she has breast cancer, but for gender-affirming purposes, that could, under certain circumstances, constitute child abuse. So … you could go in and arrest a doctor presumably for doing this.

And so that’s terrified the White House and gender activists, because other states are doing this now. Alabama has just passed a bill that’s sort of comparable to that. There’s discussion in Idaho and some other places. Last year, actually, Arkansas passed the SAFE Act, really good, designed basically to protect kids from the procedures.

So the White House has not only sort of issued directives defining gender-affirming care “by HHS,” but now telling states “OK, you can’t prevent doctors from doing this,” effectively.

Like, if you prevent doctors from doing this, this is like telling doctors that they can’t give a child a blood transfusion to save her life. It’s effectively that, so that states could actually be in violation of federal law or civil rights laws if they try to prevent these procedures.

Blair: Does the Biden administration have a constitutional or legal framework to do this? You said that they’re doing it sort of like, “Oh, you’re refusing a child a blood transfusion.” Is that the framework that they use?

Richards: The framework is essentially civil rights. So obviously, I mean, states have regular police power. States generally have jurisdiction over health and welfare, but of course, the federal government has long been involved in this, right? And so whether it has to do with health insurance or whatever, there’s always a sort of federal hook on this. So that’s essentially the justification.

What we’re seeing is a lot of rule-making and on the sort of regulatory side through HHS to try to enforce this. And so the same time that that letter from the attorney general went out to state attorneys general, HHS, this other department, issued this sort of description really describing the Dutch protocol. And then the president even had a corresponding video address on the same thing.

So not very good at exiting Afghanistan, but remarkably well-coordinated when it came to pushing gender ideology.

Blair: I hear this refrain from the left a bunch where they basically say this isn’t actually an issue, where kids aren’t being subjected to these surgeries until they’re old enough. Is that true?

Richards: No, that’s a lie.

Different states have different rules for the final step of the Dutch protocol. So for instance, surgical intervention in many cases won’t happen until 18, but in California and some of the Western states, it can happen as young as 16. We know of girls that had mastectomies at 16.

And even if you just don’t talk about the surgeries, let’s just talk about the hormonal interventions. If you give a girl heavy doses of testosterone for several years, this causes her uterus to atrophy. It can effectively sterilize her.

And the same thing, if you’ve got a boy, especially these pre-pubescents. So you delay puberty and then you give him estrogen. This can not only sterilize the child, it can actually make them so they can’t even function sexually. I don’t want to be too graphic, but essentially, they could never have a satisfactory sexual life even after they’re married, nor could they ever have children.

I mean, … other than killing someone, it’s hard to think of a more dramatic effect that a medical intervention should have. And so the idea that we’re going to just kind of rush this based on a very narrow base of evidence is, I think, unconscionable.

Blair: Back to that sort of topic. One of the things that I’ve noticed a lot is this story of a detransitioner, somebody who goes through the procedure, finds out later that they were in a bad place in their life and that they made a hasty decision, and then they go back. How does the Biden administration react to those types of stories? Have they acknowledged that being a thing?

Richards: No acknowledgement whatsoever. That’s what’s strange about this, because we’re getting more and more of these stories. You call them detransitioners, others are desisters. So this would be someone that may be socially transitioned and then changed their mind.

There are these heartbreaking stories, though, often of girls that go through this in their teenage years. They may get double mastectomies, years of testosterone, which changes their facial structure, their voice, and things like that, and then realize it was all a terrible mistake.

And they’re mad because not just their parents not only went along, but the doctors and the schools and the therapists all went along on the so-called affirmation side, rather than just helping them deal with manifest psychological problems that they were having, one of which manifested itself in terms of gender dysphoria. And so that’s what’s so bizarre about this.

If you knew that even 5% of kids that were gender dysphoric resolved that by the time they were 18 or 20 years old, you’d want to be really careful, right?

But what the Biden administration’s policy is, essentially, assume anyone, any child, as soon as he presents, shows up at a Planned Parenthood clinic and says that she wants testosterone, that she is permanently in that state. When in fact, we know that’s not the case.

We know that between 60% and 90% of kids that are gender dysphoric early in their teen years actually do work their way out of it and become comfortable with their bodily sex by the time they’re adults. In fact, for many people, puberty itself seems to be the cure for gender dysphoria. So the idea that we’d interfere with that is just really bizarre.

Blair: Prior to this letter going out from the Biden administration and HHS, how had the administration been handling these types of topics?

Richards: Well, we’ve been tracking this since, honestly, a year ago. So one of the very first things President Biden did was issue an executive order sort of weighing heavily in favor of gender ideology.

There was an attempt to revive so-called Section 1557, which is a provision in Obamacare. This is a provision that had to do with nondiscrimination. And they said, “So, by ‘sex discrimination,’ we will include sexual orientation and gender identity.” Gender identity, that’s the sort of term of art for the transgender issue.

That was actually struck down. There was a permanent injunction placed on that by, I think, the 6th Circuit [Court of Appeals] back in August.

So you’d think that that strategy would be dead, but HHS is continuing to go forward with this. And in fact, we’re waiting any day now for a rule to drop that will essentially add sexual orientation and in particular gender identity to those provisions having to do with discrimination.

And so what that means, that’s a lot of regulatory speak, but what that means is that effectively, if a health care plan or a hospital declined to perform these gender-affirming procedures, they could be in violation of the law. That’s what this means. Simply by essentially a word change, a redefinition of a term that’s on the books, you as a doctor might not be free to decline, say, to give a young girl a double mastectomy who doesn’t have breast cancer.

Blair: Do we see there’s a future sort of campaign from the Biden administration? We’ve seen what they’re doing now with this letter. We’ve seen what they’ve done in the past. Do we have any idea what the future holds for this type of policy?

Richards: Well, certainly there’s an interest in this being funded. So it’s one thing to say, “OK, this is sort of permissible.” It’s another thing to say, “States can’t prohibit it.” It’s still another to say, “Private insurance companies can cover it, must cover it. Medicare, Medicaid coverage.”

So you could see, essentially, if you think, OK, if your goal was to make sure that as much of this kind of thing was happening as possible, assume that is the goal of the Biden administration, and pretty much everything they’re doing on this subject will make perfect sense. That sounds like an exaggeration, but it’s staggering how much of a priority this is for this administration.

Blair: We spoke a little bit about some of those state efforts, like in Texas, to push back against this stuff from the Biden administration. Could you go into a little more detail about what those efforts look like?

Richards: Absolutely. Look, I’m all for states doing whatever they need to do within the bounds of the law to prevent this from happening. But there are better and worse ways to deal with this. And so in Idaho, this almost passed, and then I think it died in the Senate. And in Idaho, they were making these procedures a felony.

Here’s the problem, is that the way it was framed, it wouldn’t just go after the doctors that did it, but it might go after the parents. And this is our worry really with what’s happened in Texas, by defining these procedures as child abuse, well, the parent, of course, could be guilty of child abuse.

Now, yes, there are probably a few radical parents—and I see them online, you can read about them online—who are basically recruiting their children into this. But I’m telling you, I talk to parents every week. And what’s happening is that parents are really, other than the kids, the primary victims of this.

So parents get shell-shocked. They have a child. They have a daughter, right? They know they have a daughter, and their daughter comes home one day when she’s 13 years old and says she’s nonbinary or says that she’s really a girl or wants to be a boy or really a boy.

And then the parent goes to the principal. They go to the therapist, right? They go to the pediatrician. And all of them say, “Yes, if you want to have a live son rather than a dead daughter, you’re going to do this.” And so parents are stuck in a bind.

And so what the states need to be doing is protecting the parents from the agents of transition, which includes physicians and medical clinics and therapists. And it also includes the schools.

So lawmakers need to focus both on what’s happening in the schools, which is, frankly, the kind of recruiting ground for this stuff, and then focus on the standards of care. You got to do both of those things.

So you got to fight the ideas, the way they’re percolating, especially through the school authorities, and then you’ve got to prevent the agents, which in this case are wearing white coats, from actually perpetrating these things.

Blair: And what does that legislation look like? Does that look like state-level laws being passed against the rules? Or what does that look like?

Richards: Well, I honestly, at the moment, I think the best example is probably what’s been done in Arkansas, which is called the SAFE Act. Essentially, it gives the parents the right to sue. So you could go after doctors who try to do this stuff.

So it empowers the parents. So parents know they might be being told by their principal they’re supposed to do this, but the state’s telling them, “Oh, no. Actually, you can go after a doctor who does this.” And then the state also goes after doctors’ medical licenses, and that puts a stop to it.

And then add to that something like the Parental Rights in Education bill that Gov. [Ron] DeSantis just signed in Florida, which insists on transparency so that parents know what their kids are being taught and then prohibits the introduction of sexual topics, sexual orientation, and gender identity, especially in the young grades.

Because they’re getting recruited with these ideas at school, and then that’s the start of this school-to-sterilization pathway. And then they find their way, eventually, to Planned Parenthood clinics and to medical clinics.

Blair: That does bring to mind, I’m trying to imagine what a parent should do if their child, their son or daughter, comes home and says, “Mom, I’m not the gender, the sex that I say I am or that you said I am. I am the opposite sex.” How do you respond to that? What’s an appropriate way to respond?

Richards: Well, the parents that help their kids get through this, first of all, you want to help your child work through it. Very often kids, especially girls that are on the autism spectrum, will have these very rigid ideas of what it means to be a boy or a girl.

So it’s one thing to say, “We’re sexually binary and our genders correspond to our sex.” It’s another thing to say, “Well, if you don’t like playing football, you’re a girl. And if you like playing musical instruments, you’re a girl.” Right? Or, “If you like playing baseball, you must be a boy.” Right? So very often what we’re dealing with is overly narrow and rigid gender stereotypes.

So what we really want to help people realize is, look, we’re a sexually binary species. We’re all either male or female. Our genders are our social expression of that. But the way in which we express our gender, it falls along a bell-shaped curve, right? There’s a spectrum. And so there’s gender atypical behavior.

You may be a girl that’s gender atypical. You may be a tomboy. That doesn’t mean you are a boy, right? It means you’re a girl that likes some things that more typically boys like. That’s all it means, and we used to know this. It’s only in the last 10 or 15 years that we managed to forget this obvious lesson.

Blair: That does bring to mind an interesting idea. Because a lot of people have almost said that gender shouldn’t exist as a concept anyway, because sex is really all that matters, right? When you look at a boy or a girl, it’s, “You are a boy biologically. You have all the sexual characteristics of a boy.” “You are a girl.” Is gender even relevant anymore?

Richards: Here’s the problem, is that the word gender and sex used to be more or less synonyms. We dropped the word sex when referring to male and female at some point in my childhood and it became gender, right?

And then that would’ve been OK if gender was still connected to sex, but gender then there was a total body replacement so that now when we’re talking about gender, we’re talking about gender identity.

And gender identity is this entirely subjective idea, right? Just whatever your impression is in your head of your gender, not of your sex, right? So it’s actually a circular definition.

So some conservatives say, “Well, let’s just not use gender at all.” I think it’s overly draconian. What we need to say, I think the precise way of saying it is that sex is male or female. Gender is masculine and feminine. We still have that category.

And so your gender is the social expression of your biological sex. So just that there’s two sexes. There’s two genders. You don’t have to throw the baby out with the bath water.

What you have to be careful of is making sure that when people are talking about gender, they’re not really replacing the sexual binary with gender identity. Because what gender ideologists want to do is they want to replace biological sex as a thing we discover about each other with an entirely subjective social construct or with something that’s entirely inside a person’s head. And the only way you can find out what somebody’s gender is, that is their gender identity, is by asking them. And at that point, gender has been entirely separated from bodily reality.

Blair: Right, right. As we wrap-up here, I’m curious, for those of us who maybe are not parents, who don’t have to deal with this directly, what should we be doing to push back against things like the Biden administration is doing or congressional representatives who are pushing transgender ideology?

Richards: Honestly, I think a lot of the fight is going to happen around the dinner table. So I think everyone that’s a parent needs to inform themselves. If you don’t, you need to know how to explain this.

Read Ryan Anderson’s book “When Harry Became Sally.” Read Abigail Shrier’s book “Irreversible Damage.” And then find out what’s happening in your school board, in your local districts. Because a lot of these fights, I think they’re going to take place not necessarily at the national or even the state level, they’re going to happen at the level of school board.

So find out what’s being taught in your local schools, especially in the younger grades. If they don’t want to tell you, that means they’re doing something bad.

And if you find out more often than not, unfortunately, just because you live in Florida or Texas, doesn’t mean it’s not happening there, too. This stuff isn’t just happening in California. It’s happening all over the country.

But most of it’s happening because parents don’t know. They’re not paying attention and they haven’t been told. And so honestly, I think once parents wake up, I think this has a very short half-life at that point.

Blair: Knowledge is power. My guest today was Jay Richards, the William E. Simon senior research fellow in Heritage’s DeVos Center for Religion and Civil Society. Jay, very much appreciate your time.

Have an opinion about this article? To sound off, please email letters@DailySignal.com and we’ll consider publishing your edited remarks in our regular “We Hear You” feature. Remember to include the url or headline of the article plus your name and town and/or state.