Photo by Alexander Grey on Unsplash
Photo by Quick, without looking it up, tell me roughly how many transgender minors receive gender-affirming surgeries in the United States each year.
Five thousand? Nope. One thousand? Lower. Five hundred? Not quite.
The correct answer? Somewhere in the ballpark of 300, based on an analysis of health insurance claims. Of those surgeries, the overwhelming majority of them were mastectomies or breast reductions, followed by breast augmentation, and the data set found claims for somewhere around 18 genital surgeries a year in minors ages 13-17 with a prior gender dysphoria diagnosis. Currently, the clinical guidelines from the World Professional Association for Transgender Health only recommend genital surgery for minors after an intensive decision-making process in which the patient’s care team, including doctors, therapists and caregivers, all agree that it would be more detrimental to the patient’s quality of life, health and safety to delay the surgery until they reach the age of majority, and the patient is determined to be capable of giving informed consent.
Next question: How many cisgender minors receive similar procedures each year? Based on a review of statistics from the American Society of Plastic Surgeons, roughly 7,000 cis patients ages 13-19 receive the same type of health care each year for primarily cosmetic purposes, encompassing mastectomies, breast reductions and breast augmentation. That’s a 2233.33 percent difference between the two demographics.
If you found those numbers surprising, I don’t blame you. After all, the current political and legal zeitgeist would lead any logical person to think those numbers were reversed. Lately, it seems like we can’t go a single day without hearing about the dangers of trans health care preying on unsuspecting children, permanently destroying their bodies and turning them into blue-haired liberals. Most people don’t spend large parts of their day pouring over statistics to get a strong sense of how a niche type of medical care actually happens, so people trust what they’re being told. But these numbers are important, not just because they give us a better picture of reality, but because they tell us a lot about the true purpose of bans on gender-affirming care.
Gender-affirming care bans are written in a very specific manner to ensure that they only apply to the treatment of gender dysphoria. As long as the patient does not have a gender dysphoria diagnosis, minors are only restricted by standard health care guidelines and laws surrounding informed consent. Concerns about regret, complications, future fertility and any other potential issues are addressed in the privacy of the doctor’s office, not by the legislature. If gender-affirming health care was as dangerous to youth as some people claim, why wouldn’t we ban these procedures across the board? How could it possibly be that it is magically safe for every other application, but a national crisis only in the case of gender dysphoria?
I’ll give you the answer to that one, too: It’s because these laws aren’t actually about safety.
Gender-affirming-care bans, along with other anti-trans political projects and the associated moral panic, are a key piece on the Christian nationalist chess board. Much like the Satanic Panic of the ’80s and ’90s, the fears surrounding gender-affirming care have been manufactured in order to encourage the public to view those who do not conform to the conservative societal standard as dangerous and predatory.
Transness and gender nonconformity in general are some of the greatest threats to the Christian nationalist project, because conservative and fundamentalist Christianity rely on strict gender hierarchies to function. Pick any fundamentalist family and you’ll see this in practice, with the father being the ultimate authority over the family, his wife expected to be fully submissive to him, and the children’s education centering around becoming “biblical men and women.” A child’s life path is determined at birth by their genitals, with boys expected to be the breadwinners, typically working in construction or other “masculine” fields, and girls being raised to take on the domestic labor to the point of often becoming substitute parents for their younger siblings at a young age. In addition to aiding the general logistics of the home, the strict insistence on these sex-based gender roles also serves as a form of psychological control within these communities, creating binaries that limit a person’s ability to question authority and stifle their ability to see the world complexly.
Fascist regimes, religious or otherwise, use the exact same tactics of logistical and psychological control on a much larger scale through the strict enforcement of gender, race and class-based hierarchies. But like any political structure, it can only last as long as the people under it buy into those hierarchies. Trans and gender nonconforming people directly contradict this system, making their arbitrary nature increasingly obvious, even to people who are comfortable with their assigned social roles.
The current systematic effort to eliminate transness from the public eye is also an intentional effort by the Christian nationalist movement to acclimatize the general public to government intrusion in our doctors’ offices, our pharmacies, our homes, and ultimately our bodies. It works hand-in-hand with efforts to ban abortion and limit access to birth control and other reproductive health care to create an environment where personal liberty is no longer a core cultural value, and our bodies (especially women’s bodies) become government commodities. When the government can tell you, on a completely arbitrary basis, what health care is acceptable, what clothing is acceptable, what haircuts are acceptable, and what names and forms of address are acceptable, it can also control every other aspect of your life. It can force you to have children, or sterilize you if you are deemed “socially undesirable.” It can require you to go to church and make public declarations of faith. It can bar you from voting, running for public office or being employed for simply refusing to conform to its chosen standard. And we know this because it has happened time and time again in every part of the world.
We are experiencing a dangerous moment in the history of American secular democracy. There is no justification for the flood of anti-transgender laws that does not lead us further down the path of Christo-fascism. Trans rights are a state/church issue because the Christian nationalist movement made it one, so now we have no choice but to fight back. It is not too late to stop this, but our window of opportunity is shrinking. The more people who stand up against these laws, the less effective they become. The more we speak up to defend bodily autonomy, medical privacy and best-practice health care for trans people, the more we defend these rights for everyone regardless of gender identity. Whether you’re bringing the fight to Congress, your state legislature or your kitchen table, every time you defend trans rights you defend the United States from Christian nationalism.
Disclaimer: The views in this column are of the author and do not necessarily reflect those of the Freedom From Religion Foundation.
2 Responses
Thought-provoking piece. I appreciate how it explains the wider impact of these laws beyond just one group and shows how interconnected these issues really are. It made me stop and think about the long-term social consequences, not just the immediate political arguments. Articles like this are important for encouraging more empathy and awareness.
These are interesting numbers, I did not suspect cis kids were actually getting top surgeries and that they were even more of them than trans kids getting those procedures.