Treating gender dysphoria for kids needs some rules in Virginia

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by James C. Sherlock

Virginia needs, for the protection of children, parents and doctors, a law specifying the minimum age and requiring court orders for voluntary medical intervention in the sexual development of the child.

In case of physical abnormalities, the court can also order these treatments.

On the other hand, I propose a prohibition of the voluntary change of sex operation among minors.

A court decision is already obligatory in Virginia for the non-therapeutic sterilization of children. Virginia law makes no reference to treating gender dysphoria in children.

Some will try to parse out the differences, but it seems almost axiomatic that consent to puberty blockage and hormone replacement therapy (HRT) for minors should be treated the same as consent to sterilization.

A change to existing State Law on voluntary sterilizations of children to set minimum age limits and require a court order to medical treatments for gender dysphoria in children seem the right approach if such treatments are not to be totally prohibited for minors.

sex change operation on minors, on the other hand, should be purely and simply prohibited.

I pursued through the Freedom of Information Act (FOIA) the discovery of the rules of medical treatment for gender dysphoria in children at UVa Medical Center and its Health of transgender youth service clinic UVa health center for adolescents and young adults. I haven’t asked about child sex reassignment surgeries yet.

I did not distinguish this center. I chose it because it’s covered by FOIA and I was able to get the information I was looking for. The establishment was very responsive.

The entire UVa medical center Politics for informed consent is

The treating physician proposing a treatment plan or procedure or the person designated by the treating physician is responsible for obtaining consent prior to the provision of care.

The general rule for treating a patient under 18 in Attachment B of his Informed decision making the policy is:

Consent must be obtained from at least one of the biological or adoptive parents of a minor, a legally appointed guardian, or an attorney authorized by a power of attorney duly executed in accordance with Virginia Code 20-167 to consent to medical treatment for the minor. Legally appointed guardians are required to provide guardianship documents.

The rules for initiating puberty blocking drug/Hormone Replacement Therapy (HRT) for children at the UVa Medical Center in Schedule A of its Informed decision making Policy, “Procedures Requiring Informed Consent Forms”:

Puberty blocking drugs/hormone replacement therapy (HRT)

A new consent form for puberty blocking drugs/HRT must be obtained from the parent/guardian of the minor at the start of treatment, and validated, at a minimum, annually thereafter in the patient’s electronic health record. New written consent is not required unless there is an interruption of care, a change in the patient’s provider, or a change in the patient’s condition where the risk, benefits, treatment alternatives and the expected results differ from the patient’s current authenticated consent.

That’s it.

Benioff Children’s Hospitals at the University of California, San Francisco (UCSF) is nationally ranked 29th in pediatric endocrinology (puberty blockers and hormone therapy). The University of Virginia Children’s Hospital is ranked 49th in this same specialty.

The UCSF Child and Adolescent Gender Center is accepting new patients ages 3-17. UVa begins to accept patients in its Health services for transgender youth program at age 11. The Commonwealth has no age rules. UVa Medical Center has self-imposed minimum age standard of 11 years.

Which is something, I guess. Perhaps this explains UCSF’s higher ranking. If so, they are welcome.

I refer the reader to the UCSF web page Gender-Affirming Health Program to get a care view of the effects of hormone therapy as information/warning to patients. I cannot find any such information on the UVa Medical Center website, although I am sure it is provided to patients or their parents/guardians.

Click either on testosterone therapy Where estrogen therapy for an unvarnished look at the effects of each. They are brutal at best.

I notice that the procedure rules at the UVa medical center need a court order perform non-therapeutic sterilization procedure on minors aged 14 to 18. It’s the law in Virginia.

Virginia Code § 54.1-2975. Sterilization operations for some children unable to give informed consent.

It will be legal for any doctor licensed by the Board of Medicine to perform a vasectomy, salpingectomy or any other sexual sterilization surgical procedure on a person fourteen years old or more and less than eighteen years of age when:

3. The court determined that a full, reasonable and understandable medical explanation as to the meaning, consequences and risks of the sterilization operation to be performed and as to the alternative methods of contraception was given by the physician to the child on whom the operation is to be performed, to the child’s guardian, if applicable, to the child’s spouse, if applicable, and, if there is no spouse, to the parent who has custody of the child;

4. The court has determined by clear and convincing evidence that the child’s mental capacity is so impaired that the child is unable to make his own decision regarding sterilization and is unlikely to develop mentally to a degree sufficient to make an informed judgment about sterilization in the foreseeable future;

5. The court, to the fullest extent possible, has heard and considered the views of the child regarding sterilization, giving the views of the child whatever weight it deems appropriate in its decision;

Add to this law provisions on puberty blocking therapy, hormone replacement therapy and sex reassignment surgery and you have it.

“Surveys” of the satisfaction levels of adults who received the treatments as children are usually conducted by advocates. Regardless of:

  • In adulthood, some patients are still satisfied with the transition. If so, they could have waited (and may have waited by similar rules) until the law I am proposing made it legal.
  • If they regret, the road back is dangerous, expensive, long and incomplete. And family relationships are broken.

I propose a minimum age of 14 for puberty blockers and HRT, which will make me an outlier among conservatives and most parents. In many cases, this will make the use of puberty blockers unnecessary. I add the requirement for a court order.

I propose a ban on voluntary sex change operation in minors, which I think will be 90% approved by voters in Virginia.

Personally, I would not object to puberty blockers and HRT treatments being prohibited for minors in all cases not accompanied by a diagnosis of physical abnormalities.

I make this more modest proposal as a compromise attempt that could be enacted into law on a bipartisan basis.

Bottom line. Virginia law should set minimum age limits and require a court order for puberty-blocking drugs and hormone replacement therapy for minors.

It should ban voluntary sex reassignment surgery on minors.

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