Article Gender affirming care: science doesn’t have the answers - yet

[C C]

https://www.acsh.org/news/2025/08/29/gen...-yet-49700

INTRO: With the Supreme Court’s ratifying Tennessee’s ban on trans-care for youth despite conflicting science and international discord over their safety, society is faced with a broader concern: who decides these morally-fraught issues: politicians or physicians– especially when science hasn’t accumulated enough evidence to provide an answer... (MORE - details)

[Syne]

Simple, "do no harm." In medicine, you simply don't destroy healthy physiology, endocrinology, etc. without solid scientific justification. Although I doubt such justification can ever exist for destroying healthy bodies.

[Yazata]

https://www.acsh.org/news/2025/08/29/gen...-yet-49700

INTRO: With the Supreme Court’s ratifying Tennessee’s ban on trans-care for youth despite conflicting science and international discord over their safety, society is faced with a broader concern: who decides these morally-fraught issues: politicians or physicians– especially when science hasn’t accumulated enough evidence to provide an answer...

I think that the Supreme Court ruled that the laws governing "trans-care" should be a matter for the states to decide. In the face of "conflicting science and international discord", there would seem to be justifiable cause for disagreement. And that in turn would seem to justify the coexistence of different regulatory regimes.

After all, aren't we told over and over that we must "celebrate diversity"? So why isn't diversity of opinion on these culture war issues ever included?

That said, I agree with Syne's view that from the physicians point-of-view, the governing medical-ethics principle should be "do no harm".

That's why I'm exceedingly skeptical about the whole idea of "gender affirming care". It just seems wrong to me to permanently mutilate healthy young bodies, whether surgically and/or hormonally/developmentally, because a child either suffers from a psychiatric condition (gender dysphoria) or worse, is being manipulated by adults, whether parents or public schools, into undergoing "care" that will irreversibly eliminate their possibility of ever living a normal life.

[Magical Realist]

That said, I agree with Syne's view that from the physicians point-of-view, the governing medical-ethics principle should be "do no harm".

Should we then ban cosmetic surgery, liposuction, hair transplants, breast augmentation, hysterectomies, and the lap band for weight loss? Who exactly is defining "harm"?

[Syne]

That said, I agree with Syne's view that from the physicians point-of-view, the governing medical-ethics principle should be "do no harm".

Should we then ban cosmetic surgery, liposuction, hair transplants, breast augmentation, hysterectomies, and the lap band for weight loss? Who exactly is defining "harm"?

In children? Absolutely. Adults can consent and decide for themselves, including living with any permanent repercussions.
No one has banned anything for adults.

[Magical Realist]

I see. So your "Do no harm" argument has nothing to do with doing no harm really. It's just about children. You should change your argument then.

[Syne]

While I think any amount of medically unjustifiable harm is against the Hippocratic Oath, a free society does allow adults a certain degree of self-harm, like smoking, alcohol, overeating, etc..
Although I wouldn't really say that "liposuction, hair transplants, breast augmentation" are destroying healthy physiology. Some cosmetic surgeries might, and some hysterectomies are medically necessary.

[Yazata]

That said, I agree with Syne's view that from the physicians point-of-view, the governing medical-ethics principle should be "do no harm".

That's why I'm exceedingly skeptical about the whole idea of "gender affirming care". It just seems wrong to me to permanently mutilate healthy young bodies, whether surgically and/or hormonally/developmentally, because a child either suffers from a psychiatric condition (gender dysphoria) or worse, is being manipulated by adults, whether parents or public schools, into undergoing "care" that will irreversibly eliminate their possibility of ever living a normal life.

I'm inclined to believe that in the future, this period today will be viewed as one of the biggest biomedical ethics scandals in history. It's up there with the period in which psychiatric patients were routinely lobotomized and involuntarily sterilized.

Just as with lobotomies, surgical and endocrine mutiliation remove any chance the patient can live a normal life in the future. Stealing a human being's future almost certainly qualifies as "harm" in my view.

That's how genital mutilation differs from cosmetic surgery. Cosmetic surgery can have very beneficial effects in later life, when it is used to address birth defects of the face and similar things. I can support its use on children in those kind of cases where its benefits are clear and unequivocal.

Certainly many celebrities abuse it as adults, and we have all seen the photos of celebs who destroyed their appearance by too much cosmetic surgery. In those cases, I do think that surgeons bear ethical responsibility for performing unnecessary and potentially harmful surgeries just because they are being offered money to do it. The "do no harm" principle can be and sometimes is violated.

But again, I think that it's an entirely different level of ethical violation when it's adults subjecting children to irreversible destruction of normal body function. That really needs to stop.

If adults choose "gender affirming care", then that will still present ethical issues for the physician, but at least it can be argued that the principle of personal freedom allows adults to make those kind of perhaps ill-advised choices for themselves. 

(I see that I basically said the same thing as Syne in the post immediately above, except in far more wordy fashion.)

[Syne]

I'm inclined to believe that in the future, this period today will be viewed as one of the biggest biomedical ethics scandals in history. It's up there with the period in which psychiatric patients were routinely lobotomized and involuntarily sterilized.

Just as with lobotomies, surgical and endocrine mutiliation remove any chance the patient can live a normal life in the future. Stealing a human being's future almost certainly qualifies as "harm" in my view.

That's how genital mutilation differs from cosmetic surgery. Cosmetic surgery can have very beneficial effects in later life, when it is used to address birth defects of the face and similar things. I can support its use on children in those kind of cases where its benefits are clear and unequivocal.

Certainly many celebrities abuse it as adults, and we have all seen the photos of celebs who destroyed their appearance by too much cosmetic surgery. In those cases, I do think that surgeons bear ethical responsibility for performing unnecessary and potentially harmful surgeries just because they are being offered money to do it. The "do no harm" principle can be and sometimes is violated.

But again, I think that it's an entirely different level of ethical violation when it's adults subjecting children to irreversible destruction of normal body function. That really needs to stop.

If adults choose "gender affirming care", then that will still present ethical issues for the physician, but at least it can be argued that the principle of personal freedom allows adults to make those kind of perhaps ill-advised choices for themselves. 

(I see that I basically said the same thing as Syne in the post immediately above, except in far more wordy fashion.)

As usual, you said it better.
I really do think that the term "barbaric" will be used in the future to describe much of this "gender-affirming care" madness.
I think abortion is barbaric, but that doesn't condemn children to deal with a life in a mutilated body. It's odd that transing the children is fearmongered as preventing suicide, but these are the same people who want assisted-suicide.
Exploring assisted dying policies for mature minors: A cross jurisdiction comparison of the Netherlands, Belgium & Canada
If you're a mature enough minor to opt for trans hormones, puberty blockers, and/or surgeries, certainly you'd be mature enough for assisted suicide too.
But probably can't let children kill themselves while they're such useful political puppets.