THE MEDICAL COMMUNITY once supported treating patients suffering from mental illness by hammering a sharp instrument through the eye socket into the brain’s prefrontal cortex. The inventor of this crude surgery even received a Nobel Prize.
Despite severe complications of brain hemorrhage, disability and death — and lack of long-term evidence that the procedure was beneficial — the press touted the surgery as groundbreaking, fueling false hope for families of suffering loved ones.
Tens of thousands of lobotomies were performed in the U.S. before a critical analysis of complications and measured “success” led to its disrepute.
Similarly, as evidence mounts discrediting “gender-affirming” medical treatments for children with gender distress, it is perplexing that the medical community has not established guardrails to protect minors from irreversible surgeries that they may come to regret later in life.
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Enter HB 619.
HB 619 prohibits gender reassignment surgeries — such as the creation of an artificial penis or vagina — in patients under the age of 18 who do not otherwise have a disorder of sexual development.
It is natural for clinicians to want to alleviate a child’s gender distress since providing relief and comfort are instincts that feed compassionate medical care. However, evidence-based medicine is the most compassionate care there is. Evidence exposes whether or not treatments are beneficial, and current evidence does not support medicalization of gender-distressed children. In fact, research shows that patients may do worse after gender-affirming procedures, as some studies reveal that overall risk of suicidality increases significantly after these interventions.
In April, British pediatrician Hilary Cass released the largest systematic review of gender medicine research to date commissioned by the United Kingdom’s National Health Service. (Systematic reviews are the gold-standard analysis of evidence that guide best clinical practices.) The Cass Review found no way to know which children will maintain a lasting transgender identity and no reliable evidence that medical treatments help most children with gender distress.
Despite claims that hormones are “lifesaving,” evidence did not demonstrate that hormones reduce the risk of suicide in these children. The Cass Review’s conclusions match findings reached by experts in multiple other countries who have recommended pumping the brakes on “gender-affirming” treatments for children.
A minor in New Hampshire is considered to lack the mental capacity to enter into legal contracts because children are not cognitively mature and may not understand the terms. Likewise, HB 619 protects children from undergoing permanent surgeries on healthy body parts when they likely cannot comprehend the long-term consequences. We know that the frontal cortex, the part of the brain that determines personality and executive function, is underdeveloped until the mid-20s, limiting a child’s ability to make informed decisions. Children are not static but rather have an evolving personality and understanding of themselves, necessitating time and space to grow.
Good medicine isn’t political, yet politics has muddied the waters surrounding gender-distressed children. Opponents of HB 619 argue the legislation antagonizes the transgender community, but the reverse is true. Minors exploring their sexuality and gender are, first and foremost, children with the same cognitive limitations as all children, and they deserve the same protections.
Others point to prominent U.S. medical organizations that support youth medical transition as justification for this approach, but the U.S. has become an outlier among other countries that have shifted practice away from medicalization of gender-dysphoric youth after analyzing the evidence.
HB 619 has bipartisan support because the human instinct to protect children crosses party lines. Labeling children based on their temperament or sexual orientation doesn’t erase their vulnerabilities — all children need the same protections, and medicine must prioritize this responsibility.
Governor Chris Sununu can underscore the importance of protecting New Hampshire’s most vulnerable and precious resource — children — by signing HB 619.
Aida Cerundolo, M.D., is a physician living in Lebanon.
