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Explainer: Arkansas bans gender transition procedures for minors

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April 9, 2021

On Tuesday, Arkansas became the first U.S. state to prohibit doctors from providing gender transition procedures for children. 

The legislation, known as the Arkansas Save Adolescents from Experimentation (SAFE) Act, prohibits any physician or other healthcare professional from providing gender transition procedures to any person under the age of 18. Additionally, it prohibits any public funds from being given directly or indirectly to any doctor, hospital, or other entity that provides gender transition services for minors.

In March, the bill passed the state House by a vote of 70-22, and was approved in the state Senate by a vote of 28-7. But earlier this week, Republican Gov. Asa Hutchinson vetoed the legislation, saying, “This was one step way too far and I couldn’t abide by it.” On Tuesday, the state’s Republican-controlled legislature voted to override the veto.

What does the law mean by “gender transition procedures”?

For the purposes of the Arkansas law, gender transition refers to the process in which a person goes from identifying with and living as a gender that corresponds to his or her biological sex to identifying with and living as a gender different from his or her biological sex, and may involve social, legal, or physical changes.

Gender transition procedures mean any medical or surgical service, related to gender transition that seeks to alter or remove physical or anatomical characteristics or features that are typical for the individual’s biological sex. It also includes efforts to instill or create physiological or anatomical characteristics that resemble a sex different from the individual’s biological sex, including providing puberty-blocking drugs, cross-sex hormones, or other mechanisms to promote the development of feminizing or masculinizing features in the opposite biological sex, or genital or nongenital gender reassignment surgery performed for the purpose of assisting an individual with a gender transition.

What procedures are prohibited by this law?

The primary effect of the law is that it prevents healthcare providers from giving puberty-blocking drugs and cross-sex hormones to minors.

Puberty-blocking drugs are used to delay the onset or progression of puberty in children who experience distress at identifying with their biological sex. Cross-sex hormones refer to testosterone or other androgens given to biological females in amounts that are larger or more potent than would normally occur naturally in healthy biological sex females, and to estrogen given to biological males in amounts that are larger or more potent than would normally occur naturally in healthy biological sex males. 

Genital and nongenital gender reassignment surgeries are also prohibited, even though they are generally not recommended for children. However, the law points out that “evidence indicates referrals for children to have such surgeries are becoming more frequent.” Such procedures can include irreversible changes such as mastectomy, hysterectomy, thyroid cartilage reduction, and voice surgery. 

How does this affect children who are born intersex?

Intersex is a statistically rare variation in sex characteristics including chromosomes, gonads, or genitals that do not allow an individual to be distinctly identified as male or female. Intersex is a physical condition while transgender is a psychological condition, and the vast majority of people with intersex conditions identify as male or female rather than transgender or transsexual.

The legislation does not prohibit medical procedures to persons born with a medically verifiable disorder of sex development, including a person with external biological sex characteristics that are irresolvably ambiguous. 

What are the dangers of providing gender transition services to minors?

According to the American Psychiatric Association, “For natal adult males, prevalence [of gender dysphoria] ranges from 0.005% to 0.014%, and for natal females, from 0.002% to 0.003%.” But a study published in 2018 in the medical journal Pediatrics found that young people are 329% more likely than adults to identify as transgender, and that there are almost as many transgender teens as there are adult men and women who identify as gay and lesbian.

Prior to 2012, there were few reported cases and little to no research studies about adolescent females with gender dysphoria first beginning in adolescence. But parents have recently been reporting that their children are experiencing what is described as “rapid-onset gender dysphoria,” appearing for the first time during puberty or even after its completion. According to another study published in 2018,

The onset of gender dysphoria seemed to occur in the context of belonging to a peer group where one, multiple, or even all of the friends have become gender dysphoric and transgender-identified during the same timeframe. Parents also report that their children exhibited an increase in social media/internet use prior to disclosure of a transgender identity.

In 36.8% of the friendship groups described in the study, the majority of the members became transgender-identified. As the study notes, “The description of cluster outbreaks of gender dysphoria occurring in pre-existing groups of friends and increased exposure to social media/internet preceding a child’s announcement of a transgender identity raises the possibility of social and peer contagion.” Peer contagion describes a process of mutual influence between a child or adolescent and their peers that includes behaviors and emotions that potentially undermine one’s own development or cause harm to others. Peer contagion has been known to influence suicide, eating disorders, and bisexuality. 

Previous studies have shown that anywhere from 65 to 94% of children who express gender dsyphoria eventually ceased to identify as transgender by late adolescence or adulthood. But by giving them gender transition procedures, the medical profession is causing such children to be permanently affected by a condition most will grow out of by adulthood. 

The health effects of taking cross-sex hormones can also be deadly. In biological women it can lead to severe liver dysfunction, heart disease, strokes, and irreversible infertility. In biological men it can cause such conditions as blood clots, strokes, and breast cancer.

What does the Bible say about sex and gender?

Katie McCoy has helpfully defined gender this way: “We believe that gender is God-given, not socially constructed or self-determined; that gender distinctions are rooted in creation and manifested in biological differences, transcending social customs and cultural stereotypes; that being created as a [man or] woman is an essential aspect of our identity (Gen. 2:18-25; Matt. 19:4; Mark 10:6).” Similarly, biological sex, that is, whether a person is male or female, is determined by God long before that person is born. God made each person as either male or female, and this is a physical and genetic reality (Gen. 1:27). 

Christians understand that sex is tied to biology and that gender is tied to sex. Our gender is not something we choose; it is tied to the biological reality of sex. And our sex, gender, and bodies are permanent features of our identities as created by God.