Sex, Gender, Surgery and the West Virginia Legislature

The West Virginia House of Delegates Health and Human Resources Committee has approved a bill  (HB 2007) that would prohibit physicians from performing “gender reassignment surgery” on anyone under 18. Those are medical procedures that help individuals physically transition (or affirm) to their self-identified gender.

The Associated Press reported the bill passed “after little discussion.”

If there ever was a bill that demanded more than a “little discussion,” it would be this one. Where to begin?

First, sex and gender are different.  A person’s sex refers to their body parts, chromosomes and hormones. Gender refers to one’s internal sense of self as a man or woman, or a boy or a girl.  They match up most of the time, but not always.

Individuals whose gender differs from the sex assigned at birth are transgender. It is estimated that about one percent of teens aged 13 to 17 identify as transgender.

These individuals often struggle. According to the American Academy of Pediatrics, transgender youth have higher rates of depression, anxiety, substance abuse and self-harm. Nearly one-third report they have attempted suicide.

One option for transgender individuals is to transition, so their physical appearance matches their gender identity. This can be done through gender affirming nonsurgical procedures, such as hormone therapy and psychological counseling. However, individuals may also choose surgery that can include genital reconstruction, facial plastic surgery and breast surgery.

Clearly, surgery is a major life decision that requires extensive evaluation. For example, Medicaid will pay for gender affirmation surgery in West Virginia, but only for individuals who are at least 21 years old, only after a diagnosis of Gender Dysphoria, and only after thorough physical and psychological evaluations and a year of hormone therapy.

These procedures are medically approved… for adults, and after months of due diligence. A teenager is not mature enough to make that monumental irreversible decision, or even be able to consent if their parents are encouraging them to transition. But frankly, I’m still trying to educate myself on this very complicated topic.

This debate is occurring in other states. The Mississippi House just passed a bill that would prevent not only gender reassignment  surgery, but also hormone therapy and puberty blockers for minors.  It is unclear  to me whether the West Virginia bill goes that far.

It says a physician may provide [emphasis added] services to a minor “born with a medically verifiable disorder of sex development.”  I’m not sure what exactly that is supposed to mean, or whether it would prevent a doctor from providing hormone therapy. That is another reason why the bill deserves serious debate.

I don’t have any hard data, but it is my understanding that gender reassignment surgery for minors is not preformed now in West Virginia. If that is the case, then this bill is a solution looking for a problem.

But again, it does open the door for difficult discussions on the topic. It would help to call in medical and psychological experts to testify if legislators really want to educate themselves.

Notably, the bill includes separate and specific definitions for “gender” and “biological sex.” They are different, and that would be a good place to start the discussion to try to promote better understanding among lawmakers and the public about this complicated and controversial issue.

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