GASBR Comments on HHS Rulemaking

Statement in Opposition to Proposed Regulations of the Department of Health and Human Services

The Green Alliance for Sex-Based Rights is a political association of Greens, feminists and other concerned persons who recognize that women and girls are oppressed on the basis of sex and who are dedicated to overcoming that oppression. By “sex,” we refer to biological sex, which is binary and immutable. It refers to the classification of male or female based on anatomic and chromosomal characteristics.

We strongly oppose the HHS proposal to include “gender identity” as a form of sex-based discrimination. “Gender identity” is NOT the same thing as sex.

“Gender identity” is a personal belief system that is not based in biology, science, or reality. Citizens and residents of our nation deserve a Department of Health and Human Services that relies on science, NOT political ideology, to define the word sex. 

Unlike “sex,” which is immutable, “gender” is a mutable social construct, a set of mostly learned or socially imposed behaviors and characteristics that our patriarchal society has associated with each sex. It can also describe a state of mind, such that a person might subjectively believe that he or she is of a “gender” that does not conform to his or her biological sex. Nonetheless, that subjective belief, no matter how sincerely held, and even if accompanied by various cosmetic and medical interventions, cannot and does not change the person’s sex.

Women and girls deserve protection against actual sex discrimination, and these protections are at significant risk if HHS were to adopt and implement rules which pretend that human sex is subjective or unknowable. For example, if both men and women can supposedly become pregnant, then discriminating against a pregnant woman could not possibly be a form of sex discrimination.

Healthcare providers, pledged to “first, do no harm,” should never be coerced into promoting or providing unnecessary “gender affirming” medical interventions, but these proposed HHS regulations will force doctors, nurses, and other healthcare practitioners to comply with the demands of gender identity ideology while ignoring the evidence, science, and the best interests of their patients.

Our tax dollars should not be spent on unnecessary, harmful, or ego-driven medical interventions.

The proposed regulations are especially dangerous to at-risk youth. The widely held belief that “gender affirming” medical intervention is the best course of action for children who identify as transgender is based on widely circulated dogma, not science or empirical evidence. The belief that such intervention is necessary to avert suicide is largely based on one or two studies that have been thoroughly debunked: See, e.g.,

What the evidence actually shows is that the vast majority of children who come to believe that they are transgender will desist – change their minds – as they mature. Iatrogenic disease is the result of diagnostic and therapeutic procedures undertaken on a patient.  And the adverse impacts of so-called “gender affirming” medical interventions undertaken before children  are allowed to mature, fits the definition of iatrogenic disease, leading to serious, often irreversible, consequences, depending on how far and how long they undergo medical intervention.

The promotion of “gender affirming” medical intervention is also deeply homophobic and an affront to the rights of gays and lesbians, since the majority of children and young people who medically transition are same-sex attracted and this “transing away of the gay” denies present and future lesbians and gay men the possibility of a healthy life with their bodies, and ability to experience sexual pleasure, intact. 

“Gender affirming” medical intervention is a euphemism for chemically and surgically altering children’s healthy bodies through three different avenues:

1) Children as young as 9 are put on gonadotropin-releasing hormone agonists (marketed by the gender medicine industry as puberty blockers for children, or for the chemical castration of sex-offenders to judicial and corrections officials). These are drugs that keep their bodies from maturing. It isn’t just the development of sex organs that are stymied by these drugs.  Brains, bones, and the entire body change radically via puberty.  Blockage affects the entire body, and interrupts the emotional and mental maturation process.  There are also major social and psychological risks associated with remaining a child as one’s peers grow up.

2) Puberty blockage virtually guarantees that children will move on to the second type of medical transition: wrong-sex hormones.  Young people are given hormones in concentrations for which their bodies are not designed.  In other words, they are given concentrations of hormones appropriate for someone of the opposite sex, not for their own sex.  (As a result, boys grow breasts, girls grow beards, etc.)

3) The third type of medical intervention is surgery: cutting off breasts, removing and/or massively altering genitals, shaving tracheas, and much more.  Children, as well as adults, regularly go under gender surgeons’ blades.  Double mastectomies are regularly performed on girls as young as 13.  Gender clinics provide other sex-reassignment surgeries for people under 18 as well, despite claims by some people that this doesn’t happen.

Gender identity ideologues and the so-called health-care providers who profit from medically transitioning people, use euphemisms to obscure the barbarity of what they are doing to healthy young bodies.  So-called “bottom surgery” is female or male genital mutilation.  So-called “top surgeries” are mastectomies.  The gentle-sounding term “cross-sex hormones” is used instead of the more accurate term “wrong-sex hormones.”  Puberty blockage is inaccurately depicted as a short and reversible “pause.” 

What’s in store for children who undergo gender medical transition?  All sorts of things that are never mentioned in the pretty picture books read in elementary schools or in the units on gender identity taught in middle school and high school.  Common outcomes of medical transition include

  • Infertility. This is a given for children who go on puberty blockers and then wrong-sex hormones, as it is for those who have gonads and other reproductive organs surgically removed or altered.
  • Sexual dysfunction, including inability to orgasm.
  • Girls who have mastectomies lose the ability to ever nurse an infant.
  • Weak bones that break easily. Inadequate bone density resulting from puberty blockage has serious lifelong implications.
  • Adverse impacts on the brain.  Puberty is crucial for brain development. Animal and some human data indicate that puberty blockers could pose risks for memory, IQ, and other aspects of cognitive function.
  • Vaginal atrophy and other menopausal problems in young women.
  •  Higher risk of cardio-vascular problems.  A woman taking testosterone has four times the odds of heart disease than one who is not taking it. Compared to men, her odds are two to one.  After about 5 years of taking estrogen, a man will develop blood clots and strokes at two to three times the rate of women and of men not taking estrogen.
  • Kidney damage.
  • Increased risk of certain cancers.
  • Post-surgical pain, and problems like incontinence.
  • Surgical complications, and the need to undergo additional surgeries.

Testimony from survivors of "gender-affirming care" strongly indicates that many live to regret decisions made FOR them when they were too young to understand the consequences – decisions often made WITHOUT parental consent, and at the behest of doctors and other medical personnel with a stake in advocating harmful treatments.

It’s bad enough that there has been an explosive growth in the number of children identifying as “transgender” and seeking such medical intervention, often without their parents’ knowledge or consent. It’s bad enough that growing thousands upon thousands of these children will end up suffering through the hell of “transition,” followed by regret and detransition, their bodies and emotional health scarred for life. It’s bad enough that thousands upon thousands of parents will experience years of hell with them, as they lose their children to the influences of the gender identity lobby, schools that promote gender identity ideology, the psychologists and physicians who promote “gender affirming” medical “transition,” peer group pressure, and other cultural and social influences.

It will become a lot worse if it becomes official federal policy to promote such transition and categorize those who resist it as practicing unlawful discrimination. It will become a lot worse if the nation’s taxpayers are forced to actually subsidize such horrific practices.  

The existing regulations are not perfect, but the proposed regulations compromise the ethical commitments of, and violate the rights of, health care providers, and will harm women and girls, children and parents, and society at large. We urge you, do NOT finalize these proposed rules.


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