Diane Grendell and Gary Click

State Representatives Diane V. Grendell and Gary Click are prime sponsors of a bill aimed at banning gender-affirming care in Ohio | via Ohio House of Representatives.

What do a lawyer and a pastor know that the American Academy of Pediatrics does not?

Two politicians are willing to sacrifice medical standards
in service to religious dogma.

State Representatives Diane V. Grendell and Gary Click have introduced HB-454 in the Ohio House. The bill titled Save Adolescents from Experimentation (SAFE) Act appears to be boilerplate from Alliance Defending Freedom and nearly identical to a similar measure in Arkansas. A federal judge has issued a temporary injunction prohibiting enforcement of the Arkansas bill.

Representative Click is a Baptist preacher. Representative Grendell is an attorney (a former judge) and a politician. Need I mention that both of these idiots are Republicans?

They are “idiots” because, with no qualifications whatsoever, they seek to substitute their judgment for that of medical science when it comes to the medical care of children. Moreover, to bolster an ideology they are willing to knowingly compromise the wellbeing of children that they know nothing about.

The principal “finding” of their malevolent adventure is this:

This state has a compelling government interest in protecting the health and safety of its citizens, especially vulnerable children;

I agree! The best way to “protect” the health and safety of children is to make sure that clinicians adhere to the best available medical science. There is a mountain of research in support of gender-affirming care.

Moreover, the research is expressed as the clinical practice standards of the American Academy of Pediatrics and the Endocrine Society.

Furthermore, in response to the Arkansas measure, the Endocrine Society stated that it “opposes legislative efforts that do not conform to medical evidence and clinical practice to prevent transgender and gender diverse adolescents from accessing gender-affirming medical care.”

“Mental health professionals and endocrinologists are not going to prescribe puberty blockers gratuitously.”

In order for HB-454 to be necessary to protect children, all of the following would have to be true:

  1. The Endocrine Society and the American Academy of Pediatrics are misguided.
  2. The evidence demonstrating the effectiveness of things like puberty blockers to allow gender-diverse kids to thrive is imaginary; fake.
  3. The parents of gender-diverse children are stupid and abusive. They make very bad decisions regarding the medical care of their offspring.
  4. The clinicians treating gender-diverse kids are greedy quacks.
  5. The (usually precocious1) kids, themselves, are incapable of understanding the medical treatment recommended by their doctors and parents.

The text of the bill includes the expected nonsense:

Studies consistently demonstrate that the vast majority of children who are gender non-conforming or experience distress at identifying with their biological sex come to identify with their biological sex in adolescence or adulthood, thereby rendering most medical health care interventions unnecessary;

The above is true and irrelevant. According to the CDC nearly 2% of kids experience some measure of gender incongruence (gender dysphoria). According to the research about 75% of those kids will see the condition resolve without medical interventions. That leaves us with 0.5% to 0.6% who are in severe distress.

The persistence of the condition is a function of its severity. The 75% that see the condition abate are not severely affected enough to transition. It is the remaining 0.5% to 0.6% who require gender-affirming care. In other words, none of the 75% will ever be candidates for the treatments that this measure seeks to ban.

Moreover, we must consider the skills and training of the doctors and other clinicians who treat kids with gender dysphoria. Mental health professionals and endocrinologists are not going to prescribe puberty blockers gratuitously.

“What these dishonest politicians are attempting to do is to re-tool anti-gay rhetoric supporting conversion therapy.”

Venturing further into the stupidity:

Scientific studies show that individuals struggling with distress at identifying with their biological sex often have already experienced psychopathology, which indicates these individuals should be encouraged to seek mental health care services before undertaking any hormonal or surgical intervention;

In a word: Bullshit! In fact, if you want kids to experience a lifetime of adverse mental health consequences, just subject them to gender identity conversion therapy.

Furthermore, children and adolescents do receive mental health counseling. It begins with a diagnosis and then an assessment of the severity of the condition.

Children are typically diagnosed with gender dysphoria if they have experienced significant distress for at least six months.

Furthermore, what these dishonest politicians are attempting to do is to re-tool anti-gay rhetoric supporting conversion therapy. It is based on pseudoscience that there is an “underlying cause” for the sexuality that the religious conservatives disapprove of. According to Christian lore, by identifying the underlying cause it can be treated with talk therapy. Voila! The alchemy changes LGBTQ persons into heterosexual, cisgender individuals.

The existence of underlying conditions (comorbidity) sounds coherent but it is not. First of all, we develop our gender identity and sexual orientation by about the age of two; long before a child could cognitively define a traumatic event which could be revealed in adolescence.

Secondly, gender identity has a “durable biological underpinning.” No amount of talk therapy is going to change someone’s biology.

Furthermore — in simplest terms — there is no evidence (despite the bill’s claims which are free of specifics) that anyone can be talked out of their gender dysphoria.

“These politicians are wholly unqualified to criticize medical treatment.”

Have another helping of bovine exhaust:

Suicide rates, psychiatric morbidities, and mortality rates remain markedly elevated above the background population after inpatient gender reassignment procedures have been performed;

Nonsense. Research demonstrates just the opposite in regards to puberty blockers.

Ah, the main course — Yum!

Some health care providers are prescribing puberty blocking drugs in order to delay the onset or progression of normally-timed puberty in children who experience distress at identifying with their biological sex. This is being done despite the lack of any long-term longitudinal studies evaluating the risks and benefits of using these drugs for the treatment of such distress or gender transition;

Puberty blockers (GnRHa) have been used — and researched — for decades to treat other conditions. They are deemed safe and fully reversible. Safety is not dependent upon the treatment for which a medication is prescribed.

Furthermore — at the risk of repeating myself — what do a lawyer and a preacher know about puberty blockers that is unknown to a board-certified endocrinologist?

“If this bill were enacted, they are going to literally murder children.”

The bill goes on to voice the same stupidity over hormones. It deserves the same response. The endocrinologists who treat these kids are highly trained specialists. These politicians are wholly unqualified to criticize medical treatment.

The bill goes on for many paragraphs to discuss the perils of surgery although I give them credit for writing that surgery is not generally recommended for minors. Then they state that such surgeries are on the rise. How the hell would they know?

For years now, Christian conservatives in defense of scripture, have been predicting a tsunami of malpractice suits. Admittedly the absence of evidence is not evidence of absence but I have been unable to find a single lawsuit based on gender-affirming care. Moreover, consent forms do not protect doctors from getting sued if they are reckless.

With respect to the operative text, the bill prohibits gender-affirming care for individuals under 18-years-of-age (under threat of license revocation). It is so broadly written that this could include counseling. Moreover, they seek to ban insurance policies from covering gender-affirming care. Furthermore — while they were meddling — the bill requires schools to out gender nonconforming kids to their parents.

I have no idea what the prospects are for this measure to be signed into law. If this bill were enacted, they are going to literally murder children. Furthermore, they are forcing doctors to violate their oath and to ignore the standards of their own professional organizations. The kids who survive will needlessly suffer.

1 I have discussed this with a few clinicians. No one has done a study that I know of but trans kids seem to have above-average intelligence. It might correlate to the fact that they are recipients of much more mental health counseling than their peers.

By David Cary Hart

Retired CEO. Formerly a W.E. Deming-trained quality-management consultant. Now just a cranky Jewish queer. Gay cis. He/Him/His.