January 10, 2024 - 4:00pm

Over the past two years, trans activists and gender clinicians in the United States have been pushing back against state restrictions and bans on youth gender transition while desperately trying to control the public conversation. In the process, activists and clinicians have demonstrated their willingness to deceive the public in service of their cause, covering the full spectrum from evasiveness to bald-faced lies. 

This is all coming to a head in Ohio this week — as the governor, state legislature, and activists clash over whether and how to regulate youth gender transition. The way the debate over youth gender transition has unfolded in the state has been misleading at best, with gender-affirming clinicians, the Ohio Children’s Hospital Association, and activists insisting that — in attempting to ban gender surgeries on minors — legislators are effectively trying to ban the free circulation of unicorns by legislating a non-issue. 

The status of youth gender transition in Ohio is currently in flux. Late last year, the legislature passed a bill that would have banned hormonal and surgical interventions for minors. Governor Mike DeWine vetoed it, describing the issue as one for doctors and parents, not politicians, to decide. (Today, the Ohio House is expected to vote to override DeWine’s veto.) Governor DeWine also issued an executive order last Friday banning gender transition surgeries for minors, effective immediately. 

But for something that’s emphatically not happening, activists certainly don’t want a ban on youth gender surgeries signed into an executive order or written into the law. The advocacy organisation TransOhio denounced the new rules as “unnecessary and harmful”, and plugged an “emergency fund” to help Ohioans seek “gender-affirming care” out of state.

If you suspect activists may be protesting a bit too much, you’re right. Yesterday, an Ohio parent shared screenshots with me from a private Facebook group for “parents of transgender youth” being treated at Cincinnati Children’s Hospital’s Transgender Health Clinic. This Facebook group contains frank discussions of mastectomies for girls as young as 14, and is a place where parents swap tips on navigating the surgical referral process for gender-questioning teens, naming — and praising — Ohio surgeons willing to operate on patients under the age of 18. 

Deception by gender-affirming clinicians and trans activists takes many forms. 

Jamie Reed, the whistleblower from the St. Louis Children’s Hospital’s gender clinic, noticed that doctors from her clinic lied in their testimony to the Missouri legislature, claiming that gender surgeries for minors were “off the table”. What they meant, apparently, was that gender surgeries for minors were off the discussion table — not the operating table. While St. Louis Children’s Hospital itself did not perform such surgeries, clinicians handed out lists of surgeons who were ready and willing to operate on underage patients. Giving patients and their parents lists of surgeons allowed clinicians to claim they weren’t referring young patients for surgeries. 

Others try to obscure the paper trail, burying controversial procedures under vague billing codes like endocrine disorder (not otherwise specified) or downright dishonest ones, like billing double mastectomies for teenage girls as breast reductions, as surgeons in Indiana and other states have done. 

What we’re seeing here is a strategy playbook being put into action. At the recent US Professional Association for Transgender Health conference in Denver, Colorado that I attended, presenters shared ways to mislead policymakers and the public about the substance of “gender-affirming care”. Naturally, they didn’t put it in those terms. Instead, presenters spoke of the need to push back against “Right-wing disinformation” by avoiding giving details about patients, ages, and procedures to “dinosaurs”, as health policy wonk Kellan Baker put it. 

What Baker meant was: “the dinosaurs” aren’t ready for “the full expansiveness of gender”. Too many details about double mastectomies at 14 may lead the public, policymakers, and the media to draw the wrong conclusions: that trans healthcare has gone off the rails and will not — or cannot — regulate or reform itself. 

Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.