Sex-changes for 15-year-olds without parental consent

[+ Gar1eth]

I don't think I can be for this. I realize gender dysphoria is a real illness. I just think 15 is too young for this kind of irrevocable decision.

 

 

NOW PLAYING

Sex-changes for 15-year-olds without parental consent?

 

 

 

The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo -- even go to a tanning bed.

 

But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notification -- and the state will even pay for it through its Medicaid program, the Oregon Health Plan.

 

 

 

"It is trespassing on the hearts, the minds, the bodies of our children," said Lori Porter of Parents' Rights in Education. "They're our children. And for a decision, a life-altering decision like that to be done unbeknownst to a parent or guardian, it's mindboggling."

 

In a statement, Oregon Health Authority spokeswoman Susan Wickstrom explained it this way: "Age of medical consent varies by state. Oregon law -- which applies to both Medicaid and non-Medicaid Oregonians -- states that the age of medical consent is 15."

 

While 15 is the medical age of consent in the state, the decision to cover sex-change operations specifically was made by the Health Evidence Review Commission (HERC).

 

Members are appointed by the governor and paid by the state of Oregon. With no public debate, HERC changed its policy to include cross-sex hormone therapy, puberty-suppressing drugs and gender-reassignment surgery as covered treatments for people with gender dysphoria, formally known as gender identity disorder.

 

 

HERC officials refused repeated requests by Fox News for an interview and even gave Fox News inaccurate information about the medical director's work schedule.

 

Oregon Health Authority officials directed Fox News to their website. It shows transgender policy was discussed at four meetings in 2014. It was passed without any opposition or even discussion about teenagers' new access to undergoing a sex change.

 

Gender dysphoria is classified by the American Psychiatric Association as a mental disorder in which a person identifies as the sex opposite of his or her birth. It is rare, affecting one out of every 20,000 males and one out of every 50,000 females.

 

According to a 2008 study published in the Journal of the American Academy of Child and Adolescent Psychiatry, "most children with gender dysphoria will not remain gender dysphoric after puberty."

 

Dr. Paul McHugh, who led the Johns Hopkins Psychiatry Department and still practices, said Oregon's policy amounts to child abuse. "We have a very radical and even mutilating treatment being offered to children without any evidence that the long-term outcome of this would be good," McHugh said.

 

Dr. Jack Drescher, a member of the APA who worked on the Sexual and Gender Identity Disorders Work Group, says treatment for gender dysphoria has received a lot more attention in recent years. He said this year New York changed its policy to cover cross-sex hormone drugs and sex-reassignment surgery for Medicaid recipients who are at least 18 years old. He thinks Oregon is offering the treatment too early.

 

"Children age 15 may not fully understand all the consequences of the procedures they are undergoing," he said.

 

Jenn Burleton disagrees. She underwent a sex-reassignment surgery and started the Portland non-profit group TransActive. She said requiring parental consent would lead to more suffering and teen suicide attempts.

 

"Parents may not be supportive," Burleton said. "They may not be in an environment where they feel the parent will affirm their identity, this may have been going on for years."

 

The science is unsettled. A 2010 Murad study concluded "very low quality evidence suggests sex reassignment ... improves gender dysphoria and overall quality of life." The authors admitted the evidence was "sparse and inconclusive."

 

Lisa Maloney, a parent and Scappoose, Ore., School Board member, is outraged.

 

"To know that taxpayers are now on the hook for that, that a child can do that without their parent's knowledge or information or consent, parents have absolutely no say, that's appalling," Maloney said.

 

The Oregon Health Authority could not say how many Medicaid recipients have been treated for gender dysphoria since the new policy took effect in January. Oregon has 935,000 people enrolled in the Oregon Health Plan. HERC assumes between 14 and 112 of them may be gender dysphoric. It estimates the total cost of adding cross-sex hormone therapy, puberty-suppressing drugs and sex reassignment surgeries to the coverage will be no more than $150,000 per year.

 

But HERC also believes the state will save money due to fewer suicide attempts. It estimates there will be one less suicide attempt per year. The Centers for Disease Control and Prevention estimates the average cost per suicide attempt in the U.S. is $7,234.

 

But Dr. McHugh says a sex-change operation, especially for young people with gender dysphoria, is never appropriate.

 

"We can help them if we begin to explore with them and their families what they're fearing about development, what they're fearing about being a young boy, a young adolescent appropriate to themselves."

 

Gman

[OneFinger]

I still have a home in Oregon and am SHOCKED by this law. I had no idea this was legal.

 

I fully support those that want sex change operations. But, until the age of 18, that decision should be made by an adult, IMHO.

[+ deej]

I still have a home in Oregon and am SHOCKED by this law. I had no idea this was legal.

 

I fully support those that want sex change operations. But, until the age of 18, that decision should be made by an adult, IMHO.

 

I actually agree with the need for adult involvement. But there's a big BUT here.

 

If I had a kid together enough to want sex reassignment I'd probably be thrilled the state's Medicaid program will cover the costs! I'd walk hand-in-hand with the kid to the (many) appointments with doctors and mental health counselors.

 

(Why do people think this is a one-and-done thing? It's a long process!)

 

If the whole deal came as a surprise to me I *SHOULD* be ashamed that I didn't know it was coming. I'd be a failed parent. People in that boat, though, won't consider themselves failed parents. They'll just think they have a broken child, which is actually a good reason for this law. Kids from that family need the protection and may actually survive childhood.

 

Yes, adults should be involved. But not the ones that don't believe it's a thing.

[+ Gar1eth]

I actually agree with the need for adult involvement. But there's a big BUT here.

 

If I had a kid together enough to want sex reassignment I'd probably be thrilled the state's Medicaid program will cover the costs! I'd walk hand-in-hand with the kid to the (many) appointments with doctors and mental health counselors.

 

(Why do people think this is a one-and-done thing? It's a long process!)

 

If the whole deal came as a surprise to me I *SHOULD* be ashamed that I didn't know it was coming. I'd be a failed parent. People in that boat, though, won't consider themselves failed parents. They'll just think they have a broken child, which is actually a good reason for this law. Kids from that family need the protection and may actually survive childhood.

 

Yes, adults should be involved. But not the ones that don't believe it's a thing.

 

 

I understand your point. But I just can't accept doing irrevocable surgery at 15. I realize there might be some who need it. But psychiatry is a very inexact 'science'. In the middle of adolescent hormonal surges on top of people just really developing the tools for abstract thought. I just don't know. My main answer is that the world isn't perfect. And sometimes we can't make it better as much as we want.

 

Gman

[+ pdxleo]

If this is like any other treatment done under the OHP, it'll take three years to get plan approval and all the necessary appointments, so they will be 18 by then anyway!

[+ deej]

If this is like any other treatment done under the OHP, it'll take three years to get plan approval and all the necessary appointments, so they will be 18 by then anyway!

 

Exactly. This isn't like getting a tattoo while drunk at a party.

 

There will be medical and psych professionals involved at every step of the way and it takes a long time. And some kids in this country have rotten parents and NEED the outside help just to live through puberty. There's just too much teen suicide because they don't think there's any other way.

 

If this helps, that's a good thing.

[Lookin]

I found this recent Frontline program Growing Up Trans a real eye opener. Some gender-dysphoric kids are making decisions as early as twelve and taking drugs to delay puberty so that irreversible changes like deepening voice or breast development don't occur. They can get off the drugs and continue through puberty, should they choose to, but most stay on the drugs and use the extra time to prepare for sex-reassignment surgery.

 

Most of the kids featured in the program have no doubts where they belong, although I recall one who later regretted having the surgery.

 

This is an area of medicine which is growing quickly and several of the pioneer doctors were looking forward to the day when the field is more mature. Which it sounds like it will be, and maybe sooner than we think.

 

One thing I learned for sure: it's not my place to put my feelings ahead of those who are living with gender dysphoria. As of today, it's a tough road to travel and only a deep commitment will get someone through safely, no matter her or his age.

[mike carey]

Some gender-dysphoric kids are making decisions as early as twelve and taking drugs to delay puberty so that irreversible changes like deepening voice or breast development don't occur. They can get off the drugs and continue through puberty, should they choose to, but most stay on the drugs and use the extra time to prepare for sex-reassignment surgery.

I'm uncomfortable with the idea of irreversible procedures being undertaken when people with gender dysphoria are so young but totally agree that hormones to prevent the onset of puberty should be available. From all I've read children with gender dysphoria realise as much when they are quite young and puberty typically does not change anything.

 

That said, as others have noted the path to gender reassignment surgery is slow, so the likelihood of somone undertaking it at 15 is vanishingly low. What is important is the age of medical consent. At 15 a teenager is capable of making spectacular mistakes but they are also quite capable of making mature decisions on how their lives will progress. If a 15yo has supportive parents it's not an issue, they can receive the counselling and treatment they need or want for their dysphoria. Having that age of consent at 15 means that if the parents are not supportive, a doctor can tell them they are entitled to their opinion but are cannot override their child's decision to, say, go onto hormone therapy, or indeed to force the child to end the consultation with the GP. I may not like 15 being the age at which surgery can be undertaken, but having different ages for different medical interventions would be unmanageable.

 

Continuing on the consent theme but away from the gender dysphoria one, I read yesterday that anti-vaxxer parents in Ontario had complained that their 16yo had received free publicly-funded vaccinations and used her babysitting money to pay for others that weren't covered by the public system. They wanted to sue the provincial government for vaccinating the girl without their consent. The Ontario Ministry of Health refused to provide the parents with any information about what may or may not have happened because that would breach the daughter's right to medical privacy!

[+ Gar1eth]

I'm uncomfortable with the idea of irreversible procedures being undertaken when people with gender dysphoria are so young but totally agree that hormones to prevent the onset of puberty should be available. From all I've read children with gender dysphoria realise as much when they are quite young and puberty typically does not change anything.

 

That said, as others have noted the path to gender reassignment surgery is slow, so the likelihood of somone undertaking it at 15 is vanishingly low. What is important is the age of medical consent. At 15 a teenager is capable of making spectacular mistakes but they are also quite capable of making mature decisions on how their lives will progress. If a 15yo has supportive parents it's not an issue, they can receive the counselling and treatment they need or want for their dysphoria. Having that age of consent at 15 means that if the parents are not supportive, a doctor can tell them they are entitled to their opinion but are cannot override their child's decision to, say, go onto hormone therapy, or indeed to force the child to end the consultation with the GP. I may not like 15 being the age at which surgery can be undertaken, but having different ages for different medical interventions would be unmanageable.

 

Continuing on the consent theme but away from the gender dysphoria one, I read yesterday that anti-vaxxer parents in Ontario had complained that their 16yo had received free publicly-funded vaccinations and used her babysitting money to pay for others that weren't covered by the public system. They wanted to sue the provincial government for vaccinating the girl without their consent. The Ontario Ministry of Health refused to provide the parents with any information about what may or may not have happened because that would breach the daughter's right to medical privacy!

 

Well I can't complain about getting vaccinations. But that's qualitatively different then irreversible surgery. But another case, I wouldn't let a 15 year old decide to quit cancer treatment for a curable cancer (or allow their parents either). Now if the cancer was incurable, and the treatments only prolonging pain without much gain in life expectancy, then I'd definitely discuss with the child depending on the developmental age whether to stop treatment or not.

 

Gman

[+ quoththeraven]

More specifically, there's a long haul of counseling and psychological services before anyone ever gets approved for hormone therapy, let alone surgery.

 

This may also respond to the situation with children who are intersex or otherwise have ambiguous genitalia, who have had their parents and doctors make decisions for them when they were young that they later on wanted to reverse. They are lobbying to change medical practice so nothing irrevocable is done until the children are old enough to make the decision. Age 15 doesn't strike me as too young, given sexual development. Surgery is surgery, irrespective if it's to deal with trans issues or gender ambiguity.

 

There was a boy whose penis was mangled in a botched circumcision who was given hormone therapy and "converted" to a girl. It never took. He always felt something was wrong. (That he had a male fraternal twin didn't help matters.) His parents had him see John Money at Johns Hopkins, who pioneered sex reassignment surgery but whose writeups of the case were close to fictional. The patient eventually had treatment to revert to male as best he could. He still wound up killing himself.

 

In addition, many, many transgender teens kill themselves if they see no way out. I'd rather see 15 year olds get surgery with medical but not parental approval than see 15 year olds kill themselves. Taking unsupportive parents out of the equation is, imo, not much different from outlawing conversion therapy for minors.

[mike carey]

Taking unsupportive parents out of the equation is, imo, not much different from outlawing conversation therapy for minors.

Couldn't agree more, QTR.

[+ deej]

Continuing on the consent theme but away from the gender dysphoria one, I read yesterday that anti-vaxxer parents in Ontario had complained that their 16yo had received free publicly-funded vaccinations and used her babysitting money to pay for others that weren't covered by the public system. They wanted to sue the provincial government for vaccinating the girl without their consent. The Ontario Ministry of Health refused to provide the parents with any information about what may or may not have happened because that would breach the daughter's right to medical privacy!

 

Anti-vaxers are stupid, and directly responsible for the recent measles outbreak in the US. Measles is a disease that is 100% preventable by way of a vaccine that has no credible science against it (NONE!), and it is a potentially deadly disease. But, you know, PERSONAL FREEDOM (to see your children -- or someone else's -- die).

[mike carey]

But, you know, PERSONAL FREEDOM (to see your children -- or someone else's -- die).

Having cited the story, I realised I did so with no actual comment about what I thought. Of course there is no crefible science against vaccines. I agree with the sentiments in the twitter post:

1. Kudos to the kid for reading up and getting the vaccinations on the DL, and

2. More power to Ontario Health for giving her the shots and then telling the parents that the kid was old enough to decide for herself, and that moreover what had happened was none of their business because .. privacy.

Recently the Australian Government changed the rules for Federal child-care subisdies, so that no vaxx means no subsidy (there had previously been a conscientious objection excemption). PersonalFreedom™ isn't the primary reason here as much as it is in the US. There are two demographics here that have health authorities worried, alternative lifestyle communities and prosperous leafy suburbs in major cities. The former populated by people in tin-foil hats who believe the anti-vaxxer nonsense, and the latter where mummy and daddy were far too busy to take little Johnny to the doctor for his shots.

[+ deej]

There are two demographics here that have health authorities worried, alternative lifestyle communities and prosperous leafy suburbs in major cities. The former populated by people in tin-foil hats who believe the anti-vaxxer nonsense, and the latter where mummy and daddy were far too busy to take little Johnny to the doctor for his shots.

 

Here, the tinfoil hat-wearers tend to be the mummy and daddy living in leafy (or sun-dried) suburbs. (I'm thinking of YOU, Orange County.)

 

California just repealed the "conscientious exemption" for vaccinations. So many foil hat-wearers were preventing their kids from being vaccinated that herd immunity was in jeapordy. The measles outbreak was a wake-up call and, fortunately, it was heeded. Unfortunately, it will be a generation before the vulnerability dies off.