Seattle Children’s Hospital is declining to provide gender-affirming surgery for transgender patients under 19 again, according to a patient and sources familiar with hospital policy.
Last week, a doctor at the hospital told a 17-year-old trans teen that the hospital wouldn’t perform his masculinizing top surgery until he turned 19, according to him and his family. The hospital did not respond to The Stranger’s requests for comment.
Back in February, The Stranger broke the news that the hospital decided to halt gender-affirming surgeries. A 16-year-old boy, who we called Ethan to protect his privacy, had gotten a call from hospital staff on his way home from school, indefinitely postponing his surgery half a day before it was scheduled.
The call was a shock, but the reason was clear. President Donald Trump had just issued an executive order that banned all trans care for people under 19. Trump’s government considers all medical intervention, puberty blockers, hormone replacement therapy (HRT) and surgery, to be chemical and surgical mutilation. The order threatened the federal funding of any hospital or research institution that defied it. Across the country, hospitals folded almost instantly. (As we’re all learning, a lot of stuff, including hospitals, states and universities, need federal funding the way cars need oil).
A major research institution, Seattle Children’s was no exception. According to a court filing in support of Attorney General Nick Brown’s later lawsuit to block Trump’s order, millions of dollars and potentially hundreds of jobs were on the line. At the time, that filing was not public and the hospital wasn’t saying much, only cancelling gender-affirming procedures and removing mentions of surgery from its website.
A week after Brown announced his suit with the Attorneys General of Oregon and Minnesota, a federal judge blocked Trump’s order. From the courthouse steps, AG Brown encouraged hospitals to go back to work. Seattle Children’s said in a statement that Brown’s suit gave it the “clarity it needed at this time to deliver on our mission while ensuring we operate within all applicable laws.” It started rescheduling surgeries, including Ethan’s the week, said his mother Sarah, whose name we’ve also changed to protect her privacy..
Last month, Brown’s office also alleged the National Institutes of Health disobeyed the judge’s order by cancelling a grant for the hospital’s research into gender-affirming care.. The judge didn’t see the connection, noting the grants at Children’s that Trump had left untouched.
Grey’s family had more warning than Sarah and Ethan, but the news was no less frustrating for him and his family.
Grey, 17, whose name we’ve changed for his protection, said on a phone call with The Stranger and his mother that he’d been on the waitlist for top surgery. But when he had his consultation last week, the surgeon and his staff told Grey the hospital couldn’t operate before he turned 19.
The surgeon delivered the news matter-of-factly and didn’t explain why Grey had to wait, he says. The surgeon may not have betrayed his feelings, but one employee later had, grumbling that Trump was responsible.
Then he says one employee handed him a sheet of paper that warned him about “the rare but serious risk of regret” and warned of “permanent physical changes.” While every surgery carries the possibility of regret, the risk is far lower for gender-affirming surgery compared to other procedures. A review of 27 studies that involved 8,000 patients from Europe, Canada, and the US found on average about 1 percent of teens and adults expressed regret.
The hospital did not respond to The Stranger’s questions about why it’s again drawing the line at surgery.
If it’s an attempt to shield funding, it’s a bad one. The hospital could stop these surgeries forever and its funding would still be at risk if it continued to prescribe hormones and puberty blockers, as was the case the last time the hospital halted surgeries. It still seems to be the case. Grey, who gets his testosterone from doctors at Children’s gender clinic, which operates separately from the gender affirming surgical program, says he hasn’t lost his prescription.
Surgery is by far the least common treatment for trans kids. Relatively few want or need surgery (and plenty are happy to call it a day with a new set of pronouns, a haircut, a name swap, and a shopping trip for new clothes—also called social transition). Those few who get it are usually trans boys and non-binary kids getting breast tissue removed, reducing their dysphoria and allowing them to stop binding their chests. Like an extremely tight sports bra, the compression hurts.
Trump’s order does not consider surgery to be any better or worse than hormones. By the government’s definition, all trans care is mutilation and castration. It’s about as measured as a stick of dynamite and surely designed to blow up the field as it exists today.
Doctors rarely operate on trans minors. A Reuters and Komodo Health Inc. analysis of insurance claims found that in the US, doctors performed 776 top surgeries on patients aged 13 to 17 between 2019 and 2021. Genital surgeries were even rarer, only 56 in the same time period (Seattle Children’s, like most US hospitals, doesn’t offer it to minors). Researchers at Harvard also found “little to no utilization” of surgery on minors–97 percent of breast-reduction surgeries on minors were on teens with gynecomastia, a hormonal condition that causes cis boys and men to grow breasts.
Republicans have exploited the fear they’ve stoked about transgender kids for the last five years, steadily introducing thousands of bills to ban or even criminalize their care, to keep them out of sports and to prevent them from being themselves at school. Speaking of school, during the campaign, Trump told voters that kids were going to class in the morning as one gender and coming home surgically altered that afternoon, a claim so plainly absurd it borders on confusing science with magic. But to an American who knows next to nothing about trans issues, it can sound at least plausible, even if it doesn’t really make much sense.
Study after study have found gender-affirming care improves the lives of children and adults. Claims that trans care has been “debunked” or is based on “low-quality evidence” are false. As are notions that gender-affirming care is less-regulated in the US, or that Europe has uniformly restricted such care. Gender-affirming care has a long history, but is regularly called “experimental.” Drugs used for gender transition are called dangerous when doctors regularly prescribe the very same medications to cisgender children for different medical reasons.
There is also no other known treatment for gender dysphoria and no evidence that waiting helps. There are those who say there’s no such thing as a trans kid, but they must be walking around with very dark sunglasses and cotton balls stuffed into their ears. These kids simply do exist. Still, the government crackdown continues. Last week, the Centers for Medicaid and Medicare Services, now led by famed charlatan Dr. Mehmet Oz, sent a letter telling State Medicaid agencies not to spend federal dollars on gender-affirming care for kids. Washington law protects access to gender-affirming care.
Sarah, mother of the boy in our first story, says top surgery has changed Ethan’s life for the better. After an uncomplicated recovery, he came out the other end less anxious and with a new freedom of dress. He used to pick clothes based on how well they could hide his chest, like baggy sweatshirts and unseasonably warm layers. He no longer has to worry about his chest outing him, a wonderful thing with summer weather on its way, she says.
It’s unclear why the hospital operated on her son but not on someone else’s. But Sarah couldn’t say the about face surprised her.
Grey is angry he has to wait.
Surgery isn’t intangible to him. Three years ago, doctors at Children’s fused Grey’s spine to correct his scoliosis. When he weighed his desire for top surgery against the reality of recovery, top surgery came out on top. Now he’s not sure what to do.
“only 1% regret”
That offensive tired old fake stat was meaningless from the beginning. Think about it. To admit to regret is a psychological suicide for one’s soul in and of itself. Nobody wants to admit that. It’s not about “regret”, it’s about the realization that for a good many the transition did not turn out so well medically or psychologically. The 1% retort is so flippant and cavalier. Nowhere else in medicine are people who have a hard time of it treated so disrespectfully.
To Grey: The next year or so will pass quickly. Years from now, It will seem like a just a day as you look back on this stressful time. That’s what growing up is all about. It’s painful. Everybody goes through pain.
You will make an adult decision that only adults should make and one that I hope takes you into a state of being as the gender that suits you in the pursuit of happiness, or, grateful for the time to determine that this is not the journey for you or even to postpone the decision.
It would be far better in the long run if kids could find peace in their original bodies, whether through counseling, religion or exercise. You can’t change your sex but it is possible to change how you feel about your sex. It’s sad so many young people are confused about this.
@1, can you tell me how many trans people you know who regret their decision? Can you show me any proof, anecdotal or otherwise, that 1% is a “flippant and cavalier” number? How about comparing it to something like bariatric surgery, which has a 50% rate of regret? You don’t just walk into an operating room – there’s a complex process of hormones and puberty blockers and a significant amount of therapy before surgery ever happens.
Meanwhile, su*cide rates for youth with gender dysphoria are as high as 31%. The American Academy of Pediatrics and The Society for Adolescent Health & Medicine support gender-affirming medical care for trans and non-binary youth, so I do, too.
@3: Youth includes young adults. It’s not a no, it’s just more time.
There is no such thing as hormone therapy and other gender affirming care for non-binary.
@3: “Meanwhile, su*cide rates for youth with gender dysphoria are as high as 31%.”
Particularly if you keep reminding young people of it as an option. Suicidal ideation is very contagious, particularly among youth. And it doesn’t really help if one of the primary providers of gender-affirming surgery has a TV ad flashing the word “Suicide” on the screen. There are a lot better ways to capture the attention of troubled or confused kids to seek help without leading them down that path.
Shame on them.
@3
There hasn’t been a spike in suicides over in Britain after the closure of the Tavistock gender clinic, as was predicted by the Mermaid trans advocate group.
@5: It’s a common misconception that talking about suicide heightens the risk of it happening. In fact, studies show that talking about it actually reduces risk. https://pubmed.ncbi.nlm.nih.gov/24998511/
I work with youth and have taken Youth Mental Health First Aid classes. They train you to explicitly ask young people in crisis if they have thought about harming themselves. You are much more likely to get an honest answer and be able to help them. My personal experience confirms this.
Not mentioning suicide increases the stigma and makes kids less likely to open up about their feelings.
@6: What is your source on that statement?
According to Jo Maugham, Executive Director of the Good Law Project, there’s been a massive increase in suicide rates among children on the NIH waitlist for gender-affirming care.
From 2013 to 2020, there was only 1 suicide among that population (still a tragic loss).
From 2020 to 2023 (after the Bell v. Tavistock decision), there were 16 suicides in the same group.
That’s a 16x increase in half the timespan. Withholding gender-affirming care has devastating effects on our children.
https://www.gendergp.com/transgender-suicide-rate-youth-explodes-in-uk/
Hi HannahD,
Nice day out there isn’t it.
Here you go.
Summary of conclusions
The data do not support the claim that there has been a large rise in suicide in young gender dysphoria patients at the Tavistock.
The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide.
The claims that have been placed in the public domain do not meet basic standards for statistical evidence.
There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care.
We need to ensure high quality data in which everyone has confidence, as the basis of improved safety for this at risk group of young people.
Suicide risk in gender dysphoria
The evidence on suicide risk in children and young people with gender dysphoria is generally poor. Most studies are methodologically weak, being based on online surveys and self-selected samples and coming from biased sources. However, there are good reasons to believe that their risk is high compared to other young people. They have often experienced prejudice and intimidation, isolation and family conflict. They may have mental health conditions such as depression and anxiety. There are high rates of autism. These are known risk factors – suicide in any group is usually the result of multiple risks acting in combination.
It therefore seems reasonable to assume that services offering non-judgemental support may contribute to lower risk. However, the evidence for “gender-affirming care” in the form of puberty-blocking drugs is unreliable. In contrast, a robust study from Finland published earlier this year (Ruuska et al, BMJ Mental Health 2024) reported that suicide risk was reduced after gender reassignment but that the improvement was explained by the treatment of co-existing mental ill-health.
https://www.gov.uk/government/publications/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust-independent-report
Didn’t Chase Strangio admit under questioning by the Supreme Court in the Skrmetti case that “gender affirming care” does nothing to reduce “completed suicides”?
Yes, that really did happen. Trust the science.
Can’t we all just try to be more accepting of others’ needs necessary, to be their best selves?
@2 Lovely thought, but it presumes a society in which one’s gender identity and expression have no bearing on how they are perceived or treated by others, in both positive terms (e.g., affinity, desire) and negative ones (e.g., stereotyping, discrimination). This is the essential blind spot of the trans-exclusionary feminist position. Perhaps if humanity survives another 10,000 years or so, such a utopian community might be realized. Until then, while it’s perfectly OK to wish gender didn’t matter, the fact is it does. Some gender-dysphoric people need medicalized solutions to live their best life in that reality, and others don’t. It’s a personal decision that really shouldn’t be anyone else’s business — especially not politicians and pundits who don’t even want to understand it.
Every time there’s a Stranger article related to trans people, all you ignorant bigoted dumbfucks feel it necessary to share your dumbfuck ignorant opinions on the lives of trans people. I sure as hell know all you ignorant dumbfucks aren’t doctors or therapists trained in gender care. But you love to play one on the Internet. You certainly don’t give a shit about children, you most certainly don’t give a shit about women, and you most definitely don’t give a shit about trans people. As usual, you ignorant dumbfucks just want to control how other people live their lives. It’s none of your fucking business you ignorant dumbfucks.
And a special call-out to resident concern-troll Phoebe in Dumbfucksland, who is always one of the first to chime in with their daily ignorant dumbfuck opinions on something they, as always, having absolutely no clue what the fuck they are talking about. Hey Phoebe in Dumbfuckland, do you have any sort of fucking life of your own to live? You’re always saying you’re not a transphobe (spoiler-alert: you are), and that you don’t have any issues with trans people, but every time trans people are mentioned, you seem to have issues with trans people, along with a list of made-up right-wing talking points. What you really mean to say is you don’t have a problem with trans people as long as they live their lives according to the opinion of Phoebe in Dumbfucksland. My god you’re a fucking ignorant tool. I mean, we all know WereBackDumbfuck is so ridiculous as to be a caricature of a MAGA-trolling dumbshit who only shows up here because he’s just another loser of thousands in the Fox News comments section. But what’s your excuse for being an ignorant dumbfuck, Phoebe from Dumbfucksland? If you could hear yourself from the perspective of a person knowledgeable on this subject, you’d call yourself an ignorant dumbfuck as well.
@14: Anyone who has differing opinions about gender care for minors is immediately cast as a transphobe is like saying gay teenagers under 18 shouldn’t buy booze is homophobic.
Viv posted this article at 9:26 and my comment was at 12:09, plenty of time for folks to “chime in” before I did.
@7 Yeah. But you have to get kids into a setting where trained professionals can talk to them. Not flash it up on a TV screen.
And, it’s just my opinion, but I’d rather see those kids making the initial contacts with an organization not a part of the Transgender Industrial Complex.
I still don’t get why any of us feel like we’re allowed or need to have an opinion on this. It should be up to the kid, their parents and the doctor. None of us have anything to do with it.
They’re still cutting off plenty of foreskins without waiting until the boys are old enough to decide if they want to keep it or not but nobody ever seems to care about that.
“I still don’t get why any of us feel like we’re allowed or need to have an opinion on this. It should be up to the kid, their parents and the doctor. None of us have anything to do with it.”
Social media has deluded many humans by convincing them their opinion is needed on everything. Too many people all up in everyone’s business.
“I still don’t get why any of us feel like we’re allowed or need to have an opinion on this. It should be up to the kid, their parents and the doctor. None of us have anything to do with it.”
Unless that kid’s parents happen to be some sort of social conservatives. And they put their foot down when they don’t approve of what their kid might be doing. Then, many will support “having an opinion” about how other people raise their kids. The doctor is a bit of a red herring in the equation. Because any number of doctors can be consulted with a wide range of medical opinions on the subject at hand. And any number of activists willing to provide a referral to a doctor or clinic that thinks “correctly”.
So much for not having anything to do with it.