Utah Rep. Nicholeen Peck submitted a bill for consideration on Feb. 18 that would prohibit the use of public funds for gender-affirming care for transgender Utahns. This proposed legislation would effectively ban Utahns on state medical insurance from receiving care that the American Medical Association argues is medically necessary.
As a physician specializing in LGBTQ+ health, I am privileged to maintain a practice where transgender Utahns are extremely overrepresented in my patient panel. Transgender Americans make up approximately 0.6% of the US population, though, so the vast majority of my patients are cisgender (people whose sex assigned at birth aligns with their gender identity).
Like my transgender patients, cisgender individuals often seek gender-affirming care because they are suffering. Gender-affirming care refers to all medical interventions that enhance your primary and secondary sexual characteristics and, by proxy, affirm your gender identity, which is important to cisgender and transgender individuals alike. Though Utah legislators are not currently trying to restrict cisgender access to gender-affirming care, it will be increasingly possible for them to do so if Rep. Peck is successful in her efforts to insert herself into the healthcare decisions of a vulnerable minority of Utahns.
Gender-affirming care for cisgender children and adults often lacks rigorous scientific study, but this medical care has been widely offered across the United States for decades without restriction. Girls who exhibit precocious puberty or hirsutism (facial hair) have been routinely treated with hormone blockers to delay puberty or decrease testosterone levels. Boys of short stature can be treated with growth hormone to grow taller. Women entering perimenopause commonly take estrogen and progesterone to help with a host of unpleasant symptoms like insomnia, brain fog and fatigue. Middle-aged men may supplement with testosterone for their muscle mass and sex drive — and some cisgender women do this, too.
These are just a few examples of gender-affirming care my cisgender patients routinely seek, and many of us can implicitly understand why such care would be sought by individuals. Advocates who aim to restrict transgender access to gender-affirming care often cite the lack of rigorous medical study as an important reason for their ideology. If medical evidence is their concern, then we should expect these activists to eventually limit cisgender access to similar therapeutics. More broadly, if the electorate accepts that politicians can limit the reasonable medical care of some adults, then cisgender citizens should expect that they, too, may one day face their own restrictions per the whims of whomever we happen to elect to public office.
That said, I suspect that the activists seeking to restrict transgender access to gender-affirming care use the slogan of “protect our children” as a loincloth for their own “gender ideology.” On the first day of his term, President Donald Trump proclaimed through executive order that there only exist males and females, and the text of the order demagogues transgender individuals by relying on old, bigoted tropes alleging transgender people have nefarious, ulterior motives to terrorize cisgender people. As a specialist in transgender care, I can say with certainty that transgender people exist, contrary to the president’s recent declaration. Moreover, doctors have long known that nearly 1-in-75 individuals are born intersex, which is an umbrella term that captures a multitude of sexual genetic code that goes beyond XX and XY and sometimes includes ambiguous genitalia. Gender satisfaction is markedly lower among intersex individuals, further questioning the dogma that gender and sex are always synonymous and only male or female.
As an aside, in a contradiction that truly makes my head spin, the same ideology that promulgates the lie that transgender care advocates for sex-reassignment surgery for transgender minors — which is not recommended by leading medical associations and not practiced — simultaneously advocates for genital surgeries for infants with ambiguous genitalia. In the second half of the 20th century, this “only male/female” ideology fostered such a robust sense of shame for parents who produced intersex children that tens of thousands of these children were legally and surgically assigned an often-arbitrary gender and the details of their early developmental history was often left unsaid. Once direct-to-consumer genetic testing became ubiquitous, the practice of absconding intersex identities with forced surgery and silence largely fell out of favor, but this recent history is a cautionary tale for what’s to come if we blindly accept Trump and Peck’s gender crusade.
If you would prefer to live in a world where the personal preferences and individual ideologies of people like Rep. Peck are not inserted into the medical care of adults with decisional capacity, then I urge you to call your representatives and let them know that adult medical care ought to be decided by patients and their doctors, not fanatical politicians.
(Sean M. Udell) Sean M. Udell, M.D., is an attending physician and adjunct professor of medical education in Park City, Utah.
Sean M. Udell, M.D., is an attending physician and adjunct professor of medical education in Park City, Utah. Dr. Udell completed both psychiatric residency and medical school at the University of Pennsylvania.
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