Transing California Foster Children & Why Doctors Like Us Opposed It

California’s AB2119, “Foster care: gender affirming health care and behavioral health services,” was signed into law by Governor Jerry Brown on September 14, 2018. We called it the transgender foster child bill. The law assures that trans-identified foster children will have the legal right and full support of the state to go as far down the path of medical and surgical transition as each vulnerable child chooses. It is the removal of protection from sexually confused minors couched in a deep parlance of ideology, not science. The proposed therapies enrich hospitals, drug companies, tech firms, and medical personnel at the expense of misled children. It’s the foster kids that need affirming, not mistaken identities and propaganda terms. Nouns have gender, people have sex.

Preparing for the Fight

I was part of a very small team that opposed the bill under the coordination of the California Family Council (CFC), headed by CEO Jonathan Keller and Director of Capitol Engagement Greg Burt. Endocrinologist Michael Laidlaw and I, a full-time family physician, led the witness team. While both of us have busy family, community and professional obligations, and neither of us had any lobbying or testifying experience, we agreed to work against this bill because it was so detrimental to at-risk kids. Michael and I have both written about gender dysphoria at Public Discourse before: see here and here.

To fight and win would benefit sexually confused foster children in California and beyond. To fight well and lose would provide a pathway made of research, presentation, influencing, and honor-filled protocol for allies in other states to follow and perhaps succeed.

Sacrificing several Fridays, Mike and I, along with a CFC leader, met with legislative aides—preferably chiefs of staff—for the Assembly members or senators on the next committee assigned the bill. We presented tightly written and signed testimonials: organizational letterhead, bullet points on page one, and a few added pages expounding on the points, including professional literature citations.

We went out of our way to meet with members of the LGBT caucus, who, interestingly enough, gave us the most time. We addressed them with respect and kind directness, and they usually responded with the same, plus curiosity. In almost every office we visited—regardless of position on the political spectrum—we were their initial exposure to the bill, and we hoped that the law of first mention would help us. We eventually sent copies of our signed testimonies to nearly every member of the Assembly and Senate. These documents would also form the basis of our opposition presentations before committee.

The Stage

California Assembly and Senate public hearings are like Kabuki theater. There is a lot of lovely and rehearsed presentation, but decisions are made before bills are introduced. Rules are presented, but they bend smoothly for favored groups, which we were not. A bill’s sponsor opens the floor, two or three proponents are granted two-minute testimonies (their two minutes seem longer than ours), then microphone time is given for any citizens to come up, give their name, home city, organization, and one sentence to offer their support. The process is repeated for the opposition. The bill’s sponsor will close, then the vote is taken.

We learned from our first testimonies in Assembly committees—my wife Evelyn and I were the initial bill opponents—that staying on message was key, particularly when the other side’s points are distractingly in error. You are there to make your case. Correcting the errors and ad hominems of the opposition does not achieve that. Mike and I were joined as witnesses by two courageous men—Rene Jax and Hacsi Horvath—who greatly regretted having pursued the path of so-called male-to-female transition. Rene Jax was the first transsexual to be sworn in as a police officer before becoming an author and lecturer. His latest book is aptly titled, Don’t Get on the Plane! Sex change surgery will ruin your life. Hacsi Horvath is a UC San Francisco epidemiology researcher whose chaotic childhood included a brief, desperate foster period. Come Senate committee time, we were battle-tempered.

Opposing AB2119

In the Senate Human Services Committee, my brief introduction included a description of my profession, the fact that I was representing the American College of Pediatricians, and that I had been a nine-time foster parent. The two minutes’ clock was running.

“Please oppose AB 2119. The state is mandating that foster children must exclusively be affirmed into dangerous treatment protocols that lack proven records of benefit or safety because of a condition that usually goes away on its own.” Having their attention, I engaged the main points.

1. Transgenderism/gender dysphoria has an overwhelming probability of desistance, resolving on its own 80 to 95 percent of the time by adulthood, according to professional literature.
2. Underlying issues need addressing first; there can be many, and foster children are more likely to have them. The APA Handbook of Sexuality and Psychology specifically warns against a rush to affirm or transition because it risks neglecting underlying psychological issues. Yet this bill encourages rushing. Endocrine Society guidelines state that psychological intervention is all that is needed in some forms of gender dysphoria. Yet this bill says the opposite.
3. The risks and permanent consequences of a minor undergoing transitioning are sobering. It makes someone a patient for the rest of his or her life, and kids don’t grasp this.
4. There is no medical proof of the long-term benefits or safety of a child undergoing hormonal therapy and surgical transitioning. So it is impossible to scientifically recommend these to minors. The hormones are not FDA-approved for this use. This bill is not pro-science, it’s no science. (I included the following evidence in Assembly Human Services Committee testimony and ran out of time, so I did not verbalize it all in the Senate hearing.)

• The NIH in 2016 began the largest-ever study of transgender youth, and it is the first to track medical effects of delaying puberty and only the second to follow its psychological impacts. That study began in 2016. We have no results.
• WPATH (World Professional Association for Transgender Health) Standards of Care confirms, “To date, no controlled clinical trials of any feminizing/masculinizing hormone regimen have been conducted to evaluate safety or efficacy in producing physical transition.”
• The UC San Francisco Center of Excellence for Transgender Health states, “the impact of GnRH analogues [puberty blockers] administered to transgender youth in early puberty and less than twelve years of age has not been published.”
• A September 2017 JAMA Clinical Guidelines Synopsis on hormone treatment of gender dysphoria offered six major recommendations, three of which encouraged hormone administration (starting in adolescence) and surgery (post-hormone treatment), despite these three being supported by “low” or “very low” evidence.

5. Regret is not rare, poor outcomes are not rare, but what is gone is gone. Two pro-LGBT groups (YouthTransCriticalProfessionals.org and 4thWaveNow.com) oppose transitioning therapy for minors due to high rates of regret and de-transitioning. A 2011 Swedish study showed that post-gender-reassignment adults were nineteen times more likely to commit suicide than the general population. Affirming transition is not proven to reduce suicides. It appears to worsen the outcomes.
6. Children have developing brains; their minds change often, and they don’t grasp long-term consequences. Kids should not be making permanent decisions about altering their bodies.
7. People of faith help keep our troubled foster systems afloat. Driving them out of foster parenting is a blow the system doesn’t need.

In the Assembly committee, the UC San Francisco family physician supporting the bill was brought back up to refute my testimony, an apparent violation of committee rules. She made glancing reference to a recent Dutch study allegedly showing low transition regret, and told the panel I likely was unaware of it. I shook my head but had no time to point out the Amsterdam Cohort study’s flaws: It only counted regret for those having gonadectomies, had a 36 percent rate of failed follow-up, stated hospital registry data were often unavailable, and it admitted that the average time to regret was 130 months but that they might have been premature in assessing it, among other study shortcomings. The Dutch study was classic advocacy, not a scientific refutation.

Michael began his testimony to the Senate Judiciary Committee by thanking the sponsoring Assemblyman for his concern regarding foster children. He then made the clearest and most concise case his two minutes afforded:

Let’s be clear. This “affirmative care” that [the UCSF physician] is talking about includes the following:

1. Powerful, dangerous hormones to block kids’ normal puberty.
2. High-dose, high-risk sex hormones with deadly blood clot and cancer risks.
3. Hazardous surgeries for boys to turn the intestine into an imitation vagina while destroying their penis and removing their testicles.
4. Breast binders and mastectomies to destroy teenage girls’ healthy breast tissue, and ovary and uterus removal, ensuring infertility forever.

This is all being done in the name of reducing child trans suicide. But we can reduce child trans suicide—by providing proper mental health care. Seventy percent of trans people have a mental health disorder now or in their lifetime leading to the suicide risk. Trans suicide after reassignment surgery and hormones is proven nineteen times higher than the population, so it worsens the suicide risk.

Michael then discussed the difference between trans children and gay-identified children:

The doctors at UCSF and everywhere else in the world have absolutely no way of diagnosing with certainty who is a true “trans” and who has gender dysphoria and underlying mental health and endocrine problems. They are certainly not born that way. Multiple recent studies have proven 80-95 percent will grow out of their gender confusion.

Proper treatment for foster kids with gender dysphoria involves psychological counseling and endocrine care.

Then Michael lowered the boom with what would become an ongoing project.

Please do not pass this bill. Instead I call for a formal investigation into ethical violations and violations of federal law regarding human experimentation on minors at UCSF and Children’s Hospital Los Angeles. I have specific details of the laws being violated if you wish to ask.

Children are being sterilized. Their sexual function is being permanently destroyed. They are being exposed to lifelong health risks for this “affirmative” therapy, without being given the needed psychological therapy. AB2119 is a mistake. Please strike it down.

The legislative aide of our champion Republican senator on the committee took Michael up on the challenge and requested written details of the human experimentation consent violations, and the efforts to make a legal case of this continue.

The tragedy of “gender-affirming health care” for minors mirrors the calamities of the lobotomy movement and California’s former eugenics sterilization program. AB2119 is a triumph of ideology posing as science. But again, it isn’t pro-science, it’s no science. Language control aims at thought control, and the terms of ascendancy in “transgender” activism are cleverly engineered. “Gender-affirming health care” is a case in point. Human beings should be affirmed, not false identities and sexual confusion. Proper health care should be directed at underlying problems, especially when 70 percent of transgender-identified people have mental health issues being neglected and left to fester.