It was recently announced that the Oregon Health Plan, which provides healthcare coverage to low-income residents of Oregon, will cover “medical care” for “transgender” children starting October 1, 2014. 
The official text of the Oregon Health Plan guideline reads:
“Hormone treatment is included on this line only for use in delaying the onset of puberty and/or continued pubertal development with GnRH analogues for gender questioning children and adolescents. This therapy should be initiated at the first physical changes of puberty, confirmed by pubertal levels of estradiol or testosterone, but no earlier than Tanner stages 2-3. Prior to initiation of puberty suppression therapy, adolescents must fulfill eligibility and readiness criteria and must have a comprehensive mental health evaluation. Ongoing psychological care is strongly encouraged for continued puberty suppression therapy.”
Under this guideline, services covered by the State of Oregon will include:
- Mental health counseling
- Evaluation by a pediatric specialist
- Procedures, medication, and follow-up monitoring related to pubertal suppression
You might think from this language that there is ample scientific support for such a momentous decision. One would hope that the state and medical establishment had taken great care with something that may permanently affect children and families. But this radical change is not based on recent medical breakthroughs. There is no amazing new science suggesting that state-run medical plans serving the most needy and vulnerable people should now put children as young as 10 years old on puberty-blocking hormones if they are “diagnosed” as “transgender.”
In fact, even the endocrinology experts who commented on this decision had this to say about this so-called therapy:
“There is very poor evidence of the benefit of puberty suppressing therapy for transgendered youth, based on the existing literature.” 
Rather than following guidelines from well-researched medical science, Oregon’s decision is based on trans* political activism and social normativity. The activist (and deeply regressive) trope behind this is that children who report “feeling” like the opposite sex must therefore be the opposite sex and should therefore have the opportunity to physically mimic the superficial appearances of the opposite sex with state-funded medical intervention.
This represents nothing less than the politicization of a public healthcare decision, one that affects every citizen of Oregon who depends on the state-run healthcare plan. A state bureaucracy is financially supporting significant medical intervention for children because trans* activist adults and their medical enablers have constructed a “disorder” – and the life-altering “cure” – for their own political purposes, personal opinions, and needs.
By abetting this, the state is supporting the pathologizing of normal childhood behavior, as well as setting the stage for standardizing sex role stereotypes in public policy. If that isn’t chilling enough, the proposed “cure” legitimizes artificial hormone treatments for children who can’t possibly know the difference between sex and gender, the complexities of what we call “gender identity,” or the long-term consequences of these decisions. As a result, and as a legal matter, children cannot consent to this “treatment” in any meaningful way.
Conflating sex with gender
It is a scientific fact that we cannot change our biological sex. A female taking puberty-suppression hormones will still be female, and a male taking puberty-suppression hormones will still be male. These hormones can only influence the expression of secondary sex characteristics (i.e., body hair, voice, breast or testicle development, and menses). They can not change the primary aspects of a person’s sex (i.e., the presence of a specific type of gonad, chromosomes, and the innate ability to impregnate another human being or gestate a child).
These are the facts about biological sex and artificial hormones. But Oregon’s mandate is about “gender questioning children and adolescents.” In other words, a state bureaucracy and medical professionals are conflating the biological realities of sex with the social fiction of gender. There is no verifiable medical evidence that these drugs work for what they’re being proposed for: “aligning” one’s sex with their “abnormal” gender. The bottom line is that state-paid doctors may now prescribe untested drugs for the sole purpose of helping a child or teen “pass” (be read by other people) as the opposite sex.
Think of what that means in terms of state support, what that means in terms of medical and political institutions. These powerful, influential bulwarks of society are putting their full weight behind the story that these drugs will make gender non-conforming children feel better because they are “in the wrong body.”
The truth is, selling the idea that people can change their sex, with the promise that they will then feel better about themselves, their bodies, and their sexual orientation, is tantamount to lying. It is fiction.
Unproven medical treatments
The treatment referenced in the Oregon guideline involves injections of gonadotropin-releasing hormone antagonists.  These powerful artificial hormones were developed and are normally prescribed for fertility and prostate problems in adult females and males, respectively. Treating children with these drugs because they have been diagnosed as “transgender” appears to be an off-label use of the drugs.  The effectiveness of these drugs for this purpose is in significant doubt – even if we accept the fantasy of a “transgendered” medical condition – because these drugs haven’t been tested and approved for this use.
The United States Food and Drug Administration has this to say about off label use of approved drugs:
“Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment. If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, and to maintain records of the product’s use and effects.” 
There is no “sound medical evidence” or “firm scientific rationale” for using puberty blockers to treat a psychiatric condition.  And contrary to the suggestion that these drugs are perfectly safe, recent studies show that the use of puberty blockers in girls results in a greater risk of polycystic ovary syndrome, which itself can cause obesity and acne.  Additionally, 20-30% of girls taking puberty suppressing hormones will experience side effects that include headaches, weight gain, nausea, and hot flashes.
This is obviously not a harmless proposal by any measure, nor is it demonstrably effective, so it is hard to imagine why anyone would put a child through this.
But the supporters of this guideline give us clues to what is going on. Trans* activists using children to make another inroad into what they hope to “prove” about and gain for themselves. Medical professionals adapting to pressure from these activists and the constant social pressure around gender conformity. Policy-makers responding to the constant haranguing by trans* activists and the advice of medical professionals. This may not be intentional collusion, only acquiescence to pressure and social conformity. But the result for children is the same.
All of these people seek a “solution” to a child’s preference for the behavior and trappings of the stereotypical gender role of the opposite sex. They want to turn that into something medically correctable. Through treatment with artificial hormones, the tomboy girl who rejects the trappings of stereotypical femininity becomes a “normal” boy and the princess boy becomes a “normal” girl.
Being socially acceptable
Even adults struggle with the negative reactions from society when they defy gendered norms of behavior and appearance. It is much harder for a child to overcome the pressure of these rigid social demands. And if that message is all they ever hear from parents, friends, teachers, other adults, the media, and now even medical professionals, they will have no other way to conceptualize their feelings and create their own path.
Under ideal conditions, a gender non-conforming child does not internalize the stereotypes associated with either her own or the opposite sex. That child simply non-conforms without defining the essence of her individual self by reference to binary gender stereotypes. This gender non-conforming child does not misunderstand her biological sex or pathologize her own body parts. That is the healthiest possible experience for a child and demonstrably creates the healthiest adults.
Compare this to a child who has internalized the stereotypes associated with the opposite sex and fantasized those as defining the essence of her individual self. This child comes to understand who she is because of her non-conformity with the gender role “proper” for her sex. She creates a social persona demanding that others validate the “gender-related identity” she has modeled after the stereotypes associated with the opposite sex. She then declares her “human right” to be “treated as” the sex associated with her self-selected “gender identity.”
It is not hard to see the problems this could create for the child during all stages of development. And this on top of what the child has already experienced. It is not hard to understand the feelings of wrongness or intense physical and mental discomfort that such a child experiences, or to feel sympathy and empathy for her. But it is not at all uncommon for children to struggle with their gender role(s) at some point.
Persistently gender non-conforming children are on the farther end of the continuum for that experience. Their discomfort is not different in kind, but in degree. Among those children, there is also wide variability in the ability to cope, with some children being righteously indignant of gender roles and others being utterly miserable.
For the latter child, the problem is exacerbated by being labeled with a misnomer (“transgender”) and diagnosed for a very specific medical intervention. Rather than investigating and addressing the full scope of the child’s experience, bringing the best professional knowledge and methods to bear on the situation, people are accepting the trans* activist frame as a given: that children can be “born in the wrong body” (the heart of the “transgender” claim).
Conflating gender non-conformity with this fictional medical anomaly obviously has wide-ranging ramifications for children and adults. A side effect of this rush to accept the trans* activist framing is the confusion between “gender identity” (the new term that encapsulates the conflation of gender non-conformity with the need for medical intervention) and sexuality (the simple fact of sexual preference that is now well-understood by professionals and most of society).
There is compelling evidence that a large percentage of gender non-conforming children grow up to be gay or lesbian adults.  Conflating gender non-conformity with a trans* medical condition, puts homosexual boys and girls at risk, yet again, of being pathologized and medically treated for something that much of society has come to accept as normal and healthy.
Medicating lesbian and gay children into conformity
Breaking the norms of sex roles, as many lesbian and gay children do, is a very difficult path for the children themselves and for the adults in their lives. Any family can struggle with what that means and how to cope. The child or adolescent is not only breaking out of gender stereotypes, but is exploring an alternative sexuality that has long been vilified. Parents know that their children are likely to have fewer legal rights as adults and struggle against prejudice their whole lives. Any additional political conformity by the parents can make their anxiety that much worse.
In conservative families, where institutional hierarchies depend on gender stereotypes and conformity around sexuality, a non-conforming child is a problem to be solved. The pressure on the child in that family to find a way to fit in and be loved could be very painful. In a situation like that – with additional incentives and pressure from the church, conservative peers, and the staid and traditional medical establishment – it is no wonder that the family and the child would strongly consider the possibilities of having/being a “normal” son who was heterosexual instead of a lesbian daughter.
In this way, the conservative view of gender inherently supports gender-transitioning for the purpose of aligning a child’s behavior and appearance with the secondary sex characteristics of the child’s body, as re-created with puberty suppressing drugs. But even liberal parents can fall prey to the social pressures of gender stereotypes, with the additional mandate to be politically correct. And there is plenty of that kind of social pressure right now.
There are now a significant number of online liberal political spaces where the trans* activist narrative is taken as fact. Anyone who doesn’t go along with this orthodoxy is vehemently denounced as “transphobic,” harangued, shouted down, and/or shunned. Many well-known and popular liberal blogs and other liberal social media spaces will ban anyone who questions trans* orthodoxy around “gender identity” and being “born in the wrong body.” We’ve even recently seen in-person versions of this with the outraged reactions to Christine Benvenuto’s book about her ex-husband’s sex change. 
This is further supported by what appears to be a wider social acceptance of the transitioning phenomenon. Chaz Bono – a female who identified as being a lesbian for years, but who is now living as a heterosexual man — is a good example. When on the very popular prime time television program, Dancing With the Stars, Chaz was paired with a female partner and received significant support from the program throughout the experience. Yet Martina Navratilova, an out lesbian, was paired with a male partner.
The message is very clear in reinforcing not only mainstream society’s heteronormativity, but the trans* narratives of “born in the wrong body” and the possibility of full blown sex and sexuality transitions. All of these messages simply amount to claiming that a child who doesn’t conform to the sex role stereotypes and sexuality of the typical male has a female “gender identity” and should actually be female bodied, while a female child who doesn’t conform to the sex role stereotypes and sexuality of the typical female simply has a male “gender identity” and is actually male bodied.
With powerful puberty blocking drugs and a lot more pressure to conform to gender stereotypes, adults are putting kids in a terrible position.
Gender non-conforming kids, for real
Most of us know how painful and difficult it can be to grow up being different from the accepted norm. Gender non-conforming kids can experience the worst of this, growing up being socially ostracized, bullied, and harassed by other children and adults for how they look and behave. Additionally, many lesbian girls and gay boys are pathologized for their sexuality. Kids have all kinds of reactions to this, including feeling suicidal and acting on those feelings.
We have known as a society what the answer to this is, to “be free to be you and me.” That now sounds quaint. Somehow we lost the plot. Instead of creating that world, we’re now facing a world where gender non-conforming kids are pressured toward puberty suppressing “therapy” that doesn’t acknowledge or address underlying social structures.
Puberty suppression does not solve the actual problem – the pain of living in a society with rigid gender roles – it just attempts to suppress what bothers other people – the gender non-conformity. In so doing, we tell the child, her parents, and wider society that discomfort with what you are bullied about must be medically treated.
Bullies do not have to change their behavior, because the bullied will be medicated so the bullies aren’t uncomfortable with them anymore. If Jane is “actually a boy” then it’s ok that she wanted to play with trucks and wear jeans and t-shirts all the time; she just needs to be understood as a “boy” and have no outward signs that she’s actually a female.
Suppressing the puberty of a child in order to make other children and adults more comfortable with that child’s “gender expression” must not be understood as a victory for human rights. The fight against gender stereotyping and the abolition of sex-based social roles is derailed by these celebrations of “gender identity.” Further, pathologizing gender non-conformity is the opposite of freeing women and girls from the shackles of compulsory femininity.
For that reason, feminists especially have every reason to take up this fight on her behalf, regardless of what we agree or disagree on around what “gender identity” in adults might mean. This impacts all girls and women, lesbians and gay men. If the concept that there are correct and incorrect bodies vis a vis “gender” gains significant medical support, no one outside the stereotypical gender expression will escape unharmed.
Selfish devotion to trans* activism
None of what is described here seems to matter to the trans* activists who are forcing this issue. They are using this moment to push rhetoric to normalize their own preferences (which happen to perfectly match society’s conservative adherence to gender roles), use families that receive state-funded medical care to promote a political agenda that normalizes and standardizes insurance payments for trans-related conditions, and to put people to sleep (how much energy does the average person have for this issue, after all).
Their propaganda around this decision by the state of Oregon makes clear what their intentions are: 
“The $1,000 ‘out-of-pocket’ monthly cost of pubertal suppression treatment is out of reach for most families,” said TransActive Executive Director, Jenn Burleton.
“Pubertal suppression provides transgender adolescents the option of avoiding unwanted, irreversible and deeply distressing changes that come with birth-sex pubertal development,” Burleton said. “Far too often trans adolescents experience increased suicidal ideation as a result of these changes and the indifference of others about the impact these changes have on trans youth.”
“Thanks to this common sense, safe and medically recommended action by the Oregon Health Plan, lives will be saved and TransActive is extremely grateful to have been able to play a part in this victory and to be a regional and national center for providing the care needed by these kids and their families.”
This statement lays the groundwork for assuming that being deeply disturbed by pubertal changes is a stable, quantifiable state and that blocking those changes is something we can reasonably consider as medical “treatment.” It is also stated as if this is commonly experienced and that anyone should be able to see how “unfair” pubertal development can be. The reference to “indifference” is telling; who is indifferent exactly? And who is supposed to care about children? The shaming is very clearly directed at adults who would make decisions on behalf of children.
The next phrase is designed to sound as if this is a settled medical reality, not pure conjecture and what appears to be medical experimentation on children. “Common sense,” “safe,” “medically recommended” – who could argue with those weighted words? Who wants to go up against any of those claims? Certainly not parents who are confused and anxious already. Not the bureaucrats for whom this issue is more of a nuisance than something they can focus on. Obviously not the medical specialists who signed off on this.
But we know we must do something about this, because children’s lives are on the line.
Not only can someone as young as 10-years old not discern between what is a socialized gender role and what is biological sex, she cannot bring political or social analysis to bear on her problem. The greatest travesty of all is that children are not going to understand the long term ramifications to degree that adults and medical professionals should.
So what can we do about this?
There are many avenues to pursue and we need the communities of mothers, lesbians, gay men, feminists, and others to work against the normalizing of prescribing artificial hormones to gender non-conforming children. One avenue is to discuss and implement real solutions for the children who are gender non-conforming and who struggle with their sense of “gender identity.” So-called mommy blog communities are probably excellent places for that discussion.
Another thing we can be doing is to look at the medical community behind the Oregon decision and start efforts to engage them about this issue. In addition to the trans* activists, these are the people – who have professional obligations not to build health policy with no scientific basis – behind the policy change: Heidi Allen, Ph.D. (Columbia University); Carol Blenning, M.D. (Family Practice-Oregon Health & Science University); Bruce Boston, M.D. (Chief-Pediatric Endocrinology, Oregon Health & Science University; Karin Selva, M.D. (Pediatric Endocrinology, Randall Children’s Hospital). 
It’s reasonable to believe that if there were more open discussion of this issue, some or all of these professionals would feel somewhat more pressure to listen to concerns other than those of just trans* activists. The credentials behind these people’s names can intimidate people into silence. But we have only to remember that medical science has been wrong about prescription drugs and thousands of people with credentials have made deadly mistakes with them. Highly-credentialed people are not immune to social pressures toward conformity, from both inside and outside their professional communities.
Medical professionals, health plan administrators, and legislators and other policy makers in other jurisdictions will be under the exact same kinds of pressures that those in Oregon have been. If the proliferation of anti-discrimination “gender identity “ legislation is any indication, Oregon will not be the last state to implement such a rule. Trans* activists are well ahead of the curve on this issue. By becoming more active now we will be able to put everyone on notice that we also want our voices heard on this issue.
It will take some focused community work on our part to bring common sense and medical ethics to bear on behalf of gender non-conforming children. But there are many people who are concerned about this issue and a critical mass of push back is foreseeable; we just want to be on the leading edge of that work.
This post was made possible through significant input from and research by Elizabeth Hungerford.
up  New Guidelines for the October 1, 2014 ICD-10 Prioritized List
GUIDELINE XXX, GENDER DYSPHORIA
Hormone treatment is included on this line only for use in delaying the onset of puberty and/or continued pubertal development with GnRH analogues for gender questioning children and adolescents. This therapy should be initiated at the first physical changes of puberty, confirmed by purbertal levels of estradiol or testosterone, but no earlier than Tanner stages 2-3. Prior to initiation of puberty suppression therapy, adolescents must fulfill eligibility and readiness criteria and must have a comprehensive mental health evaluation. Ongoing psychological care is strongly encouraged for continued puberty suppression therapy.”
On page 42 of this PDF archived on the oregon.gov site here: http://www.oregon.gov/oha/OHPR/Pages/herc/Past-Material.aspx; http://www.oregon.gov/oha/OHPR/HERC/docs/P/A-VbBS1-10-13.pdf
up  The Endocrine Society summarizes their recommendation this way:
“There is very poor evidence of the benefit of puberty suppressing therapy for transgendered youth, based on the existing literature. Use of puberty suppressing therapy is based on expert opinion. The Endocrine Society recommends treatment of transgendered youth be treated with puberty suppressing medications at the first physical changes of puberty with GnRH analogues.”
In other words, this professional organization can find no reason to use this treatment, but suggests it anyway, based on other expert advice (that of psychologists).
On page 225 of this PDF archived on the Oregov.gov site here: http://www.oregon.gov/oha/OHPR/Pages/herc/Past-Material.aspx; http://www.oregon.gov/oha/OHPR/HERC/docs/P/A-VbBS12-13-12.pdf
up  Treatment of precocious puberty by GnRH agonists.
“The side effects observed during treatment such as headaches, asthenia or hot flushes, are related to sex steroid deprivation and are observed in 20 to 30% of cases. Questions remain concerning the impact of these treatments on intellectual development and body composition.”
up  “While the medication is approved by the Food and Drug Administration for children who start puberty prematurely, it is currently unapproved for transgender adolescents.
Only a small number of clinics in America serve transgender children, and it was only a few years ago that doctors began treating them with puberty-blocking drugs.”
up  “Off-Label” and Investigational Use Of Marketed Drugs, Biologics, and Medical Devices – Information Sheet. Guidance for Institutional Review Boards and Clinical Investigators.
up  Gender Interrupted: Controversy & Concerns about Gender Identity Disorder (GID), by Kate Richmond, Ph.D. & Kate Sheese, B.A. Muhlenberg College York University
up  GNRH analog therapy in girls with early puberty is associated with the achievement of predicted final height but also with increased risk of polycystic ovary syndrome, Eur J Endocrinol July 1, 2010 163 55-62
up  Id.
up  From ‘Gender Variance: An Ongoing Challenge to Medico-Psychiatric Nosology’, by Rosario, Vernon A.(2011) Journal of Gay & Lesbian Mental Health, 15: 1, 1 — 7
“Green’s prospective study of gender-variant boys (1987) followed into adolescence and young adulthood found that 75% of those who could be reassessed had developed a gay or bisexual orientation, and only one was primarily transsexual. Subsequent studies of girls and boys have continued to find that the majority of gender-variant children grow up to have a homosexual or bisexual orientation rather than identify as transsexual” (Drummond et al., 2008; Wallien & Cohen-Kettenis, 2008)
From: Sexual orientation and childhood gender nonconformity: evidence from home videos. Rieger G, Linsenmeier JA, Gygax L, Bailey JM. Dev Psychol. 2008 Jan;44(1):46-58. doi: 10.1037/0012-1618.104.22.168. http://www.ncbi.nlm.nih.gov/pubmed/18194004
“Prehomosexual children were judged more gender nonconforming, on average, than preheterosexual children, and this pattern obtained for both men and women.”
From A follow-up study of girls with gender identity disorder. Drummond, Kelley D.; Bradley, Susan J.; Peterson-Badali, Michele; Zucker, Kenneth J. Developmental Psychology, Vol 44(1), Jan 2008, 34-45. doi: 10.1037/0012-1622.214.171.124 http://psycnet.apa.org/journals/dev/44/1/34/
“… girlhood cross-gender identification is associated with a relatively high rate of bisexual/homosexual sexual orientation in adolescence and adulthood.”
up  Article about Benvenuto and her experience with the her husband’s “sex change” and trans* and other activists’ attempts to silence her story.
up  Burleton’s statement.
up  TransActive’s press release about Oregon’s decision.