LB 574: Do no harm

Reasonable people would agree that proponents and opponents of Legislative Bill 574 all want what’s best for the children and adolescents that this bill addresses. The division comes over deciding what’s “best,” which is based on our personal experiences and our interpretation of available information.

I began treating and advocating for transgender individuals in 1988 as the physician member of the only group in Omaha who provided that service, which was quite unpopular at that time. I wasn’t sure what I was getting into or if it was even the right thing to do. My experiences and relationships with transgender people and their families over the next 30 years taught me that it was absolutely the right thing to do.

Those same experiences and relationships now tell me that passing LB 574 is absolutely the right thing to do.

First: Kids (and many adults) who believe that they are transgender may or may not actually be transgender, and there’s no way to predict who among these kids will continue their transgender journey into adulthood and who will not.

“Follow the science” is a popular motto. But when science isn’t unanimous, people often choose whichever “science” supports their belief. The leading organization in the transgender field worldwide is the World Professional Association for Transgender Health (WPATH). Their latest version of Standards of Care for the Health of Transgender and Gender Diverse People was published in September 2022. They rightfully included precautionary statements in those Standards. To name a few: no reliable means of predicting an individual child’s gender evolution; diverse gender expressions in children cannot always be assumed to reflect a transgender identity or gender incongruence; few outcome studies that follow youth into adulthood; some adolescents may regret the steps they have taken.

Second: The long-term effects of gender-affirming interventions are unknown.

Again, WPATH’s Standards of Care says that we have limited data on the optimal timing of gender-affirming interventions as well as the long-term physical, psychological and neurodevelopmental outcomes in youth.

Third: Medical and surgical treatments carry risks in everyone, but gender-affirming interventions pose particular risks to children and adolescents.

Puberty blockers, often presented as safe and reversible, have been linked to problems with bone growth, bone weakening, abnormal blood clotting, high blood pressure, diabetes mellitus, decreased white blood cells, paralysis, convulsions, emotional instability, and suicidal ideation and attempts. Hormone therapy can leave a child or adolescent with irreversible effects if they change their mind (detransition or desist) — e.g., lower voice, male pattern hair, and enlarged clitoris in transmasculine youth; breast development in transfeminine youth; difficulties with having children in some. And surgery, of course, brings about permanent changes that cannot be undone.

LB 574 respects all of these.

The most basic of principles taught in medicine is “first, do no harm.” It tells us that given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good.

A few children may well continue their transgender journey into adult life, and medical treatment — even with these attendant risks — might be arguably defensible. But studies show that most will not, and even WPATH says that we have no way of knowing who among them will continue and who will turn back. As such, “first, do no harm” precisely applies in this situation because initiating gender-related medications or surgery in someone at any age who is not clearly transgender subjects that person to unwarranted risks.

Parents and at least most legislators who oppose LB 574 undoubtedly believe in their hearts that their opposition is what’s best for the children and adolescents that the bill addresses — opposition that’s based on their personal experiences and their interpretation of available information. No one can fault them for that. My concern is simply that the information that they are working from is flawed and, therefore, what follows is misdirected.

Some opponents of LB 574 describe those of us who support it as “hateful” and “anti-trans.” I didn’t spend 30 years treating, supporting, caring and advocating for my transgender friends because I hate them. Just the opposite. After decades of first-hand experience, dealing with the ramifications of medical and surgical management and a deep respect for the potential consequences of these interventions, I support for LB 574 because I care enough to keep them safe.

Please don’t let misdirected beliefs place the lives of children and adolescents at risk.

Please… do no harm… let them grow.