Transgender surgery versus female genital mutilation for minors

Here’s one of the more confusing anomalies in state laws — and in liberal woke-think. Forty-one states have laws prohibiting a practice known as female genital mutilation, or cutting, on minors, including nearly every state that is run by liberal Democrats. But only 27 states ban so-called “gender-affirming care,” including transgender surgeries, for minors. And they are all conservative-leaning states.

How can someone strongly oppose the practice of female genital mutilation — even if the under-age girl and her parents consent — yet still support transgender surgery on minors, which is arguably more invasive, disfiguring and life-altering?

Democrats lost the 2024 election in part because of their over-the-top support for gender-affirming care for minors, including puberty blockers, hormone therapies, and in some cases transgender surgery. With elections around the corner, Democrats don’t appear to have changed, though they may talk less about the issue.

But the country is changing, even if Democrats aren’t. For example, the American Society of Plastic Surgeons has become the first major medical association to recommend against permanent gender surgeries on minors. This follows the 2024 Cass Report, which found evidence for gender-affirming care for minors to be “remarkably weak.”

Another development: A detransitioning patient who had life-altering surgery as a minor recently won the first jury award of its kind — $2 million against her health care providers. And there are several similar cases moving through the courts. Most of these young people are victims of a medical system that failed them, and their stories will resonate with sympathetic juries.

Female genital mutilation is a cultural or ritual procedure practiced mostly in Africa, then Asia and the Middle East. The World Health Organization describes it as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.”

The Centers for Disease Control and Prevention estimates that more than 200 million women worldwide, and perhaps half a million girls and women in the U.S., have undergone the procedure.

Most states have passed legislation to stop the procedure, especially among minors, even with parental consent. Indeed, in most states, a parent or practitioner can be prosecuted for engaging in the practice. And most states also prohibit minors from traveling abroad to have the procedure done.

Depending on the extent of gender-affirming care on minor girls, they may be on medications for the rest of their life, become sterile, and those who have “top surgery” (i.e., mastectomies) will be disfigured forever.

Defenders claim the difference is that gender-affirming care for minors is medically necessary while female cutting isn’t. But gender-affirming care is not “medically necessary” in the sense that there is a physical problem such as cancer, diabetes, hernia or appendicitis. It’s a psychological condition known as gender dysphoria — a phase that most children with that diagnosis grow out of with time and proper counseling.

The fact that there has been a recent explosion of minors, mostly young girls, questioning their birth sex, implies that gender confusion has been a social-media-induced phenomenon that should have been easily recognized and carefully addressed.

But there have been numerous whistleblowers who have come forth claiming that there was very little pushback among certain health care providers treating minor girls, even to the point of telling the parents the child faced an increased risk of committing suicide if the parents didn’t consent to transitioning. Yet a recent paper in the Harvard Journal of Law and Public Policy effectively challenges such warnings.

For example, the mother of the woman who won the first lawsuit is quoted as saying, “This man [the attending psychologist] was just so emphatic, and pushing and pushing, that I felt like there was no good decision. I think it was a scare tactic.”

Then there is Jamie Reed, who worked for four years as a case manager at the Transgender Center at St. Louis Children’s Hospital. She decided to leave and speak out. “The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on,” she said. And she added, “Because what is happening to scores of children is … morally and medically appalling.

This isn’t to claim there’s no difference between female genital mutilation and transgender surgery. But both are life-altering decisions with no going back. Liberals understand why minors should be protected from genital cutting. They need to be just as clear on why minors should be required to wait until they become adults before proceeding with gender-affirming care, that includes puberty blockers, hormone therapies and especially transgender surgery.

Merrill Matthews is the Texas state chair of Our Republican Legacy.

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