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Deutsch Transgender-Child-Operation Ban Useless; Standards of Care Already Prohibit Genital Surgery on Minors

When South Dakota legislators discuss transgender issues, they tend to ignore facts and experts. For instance, chiropractic Rep. Fred Deutsch (R-4/Florence) is so bent out of shape over transgender kids that he is thinking about proposing a bill to ban doctors from doing sex-change operations on kids. But if Deutsch spent our tax dollars attending real informational conferences rather than conservative rage fests, he’d know that real doctors are way ahead of him: medical professionals don’t operate on children’s genitals to deal with gender dysphoria.

The World Professional Association for Transgender Health (WPATH) publishes standards of care covering all aspects of health issues transgender people face. Dr. Anne Dilenschneider, one of only three mental health providers in South Dakota recognized by WPATH as capable of including transgender care in their scope of practice, tells me that Version 7 of the WPATH standards of care include age of majority as one of the criteria for performing surgery:

Genital surgery should not be carried out until (i) patients reach the legal age of majority to give consent for medical procedures in a given country, and (ii) patients have lived continuously for at least 12 months in the gender role that is congruent with their gender identity. The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention [World Professional Association for Transgender Health, Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7, 2012, p. 20].

The only surgery allowed on minors by the WPATH standards of care is chest surgery for adolescent females transitioning to males:

Chest surgery in FtM patients could be carried out earlier, preferably after ample time of living in the desired gender role and after one year of testosterone treatment. The intent of this suggested sequence is to give adolescents sufficient opportunity to experience and socially adjust in a more masculine gender role, before undergoing irreversible surgery. However, different approaches may be more suitable, depending on an adolescent’s specific clinical situation and goals for gender identity expression [WPATH, 2012, p. 20].

This exception exists due to the demonstrated health risks of chest-binding; nonetheless, many insurance companies do not cover chest surgery for transgender minors.

South Dakota legislators have rejected WPATH standards of care before. The South Dakota High School Activities Association originally wanted to use WPATH standards to inform the enforcement of its rules on transgender youth participation, but dropped WPATH from its policy to placate legislators who think WPATH advocates too much for transgender youth.

The Legislature has very few practicing medical experts (I can think of one doctor and one nurse*). Medical experts have laid out the WPATH standards of care to ensure that transgender patients are treated properly. Those standards restrict almost all surgery on minors, with only one exception for adolescents transitioning from female to male under specific criteria designed to prevent greater harm. Representative Deutsch, how about we just trust the doctors on this matter and focus on real public policy issues?

*Update 12:51 CST: Multiple attentive readers raise our Legislative nurse count to two: Rep. Jean Hunhoff (R-18/Yankton) is also an RN.


  1. grudznick 2019-11-11 09:09

    I thought of another nurse for you, Mr. H. Young Ms. Hunhoff, she of the curly hair, is purported to be a nurse. And that’s not counting the bone-cracker caucuses.

  2. Michael L. Wyland 2019-11-11 12:06

    I think the prompting issue is a court decision in another state that forbade a father from intervening to stop the mother of a minor child from receiving sex-change treatments and/or surgeries (the parents seem to be divorced).

  3. Gideon Oakes 2019-11-11 12:29

    Someone needs to help poor Fred out with his definition of “small government”.

  4. Cory Allen Heidelberger Post author | 2019-11-11 12:38

    Gideon, I think your Libertarian Party is well-positioned (philosophically, if not financially and numerically) to lead a statewide conversation about exactly that point. We Democrats will try, but we come at the matter from the perspective of “smart government,” and our Republican friends pretend to have seizures when presented with either word. Libertarians could do a great job of asking South Dakotans to consider the true meaning of conservatism and liberty. Help us get the fake-Republicans out of our bathrooms and our doctors’ offices and off our backs

  5. Cory Allen Heidelberger Post author | 2019-11-11 12:44

    Michael, our legislators sure like leaping into frays that aren’t happening in South Dakota. We’d get better legislation if they stopped watching Fox News and just read our local papers and research from the LRC.

    If they are reacting to a lawsuit involving a divorced couple, then it’s all the worse, probably just another excuse for the Pishcke angry-dads mob to gripe about their oppression at the hands of the matriarchy they imagine is responsible for all their sufferings. Another fake “mens’ rights” debate will be as detrimental and distracting from real problem-solving as another transgender debate.

  6. Porter Lansing 2019-11-11 12:45

    Rep. Fred Deutsch (R-4/Florence pop. 378) – “bent out of shape” chiropractor. (priceless)

  7. mike from iowa 2019-11-11 14:01

    Deutsch, like many another wingnut all over America has waaaaaaaaay too much free time on his blood stained hands. Remember, moar women die during childbirth than abortions. Moar kids die due to lack of food and healthcare, all because of fauxknee gawd fearing kristians can’t keep their noses out of women’s lady bits.

  8. Debbo 2019-11-11 16:51

    ” legislators who think WPATH advocates too much for transgender youth.”

    Can’t have anyone being too reasonable and compassionate towards trans people. Can’t humanize them!

  9. Debbo 2019-11-11 18:23

    Mike, I just read that and was going to offer the link. Instead, I’ll offer encouragement.

    The article is kind of long, but that’s because it’s so stuffed with solid info. It corrects many misconceptions about transgenderism.

    Small children do have a sense of their gender at a young age and the rate of giving that up is very low. An old study that put the number quite high was filled with errors.

    People like Deutsch are either ignorant or cruel, like Texas governor Abbott and senator Oozy Croozy. Abbott, Croozy and others are using one small child and her family for their own political gain. That is cruel.

    I hope Deutsch just doesn’t know any better. He should by now.

  10. Certain Inflatable Recreational Devices 2019-11-11 19:09

    Deutsch DOESN’T know any better. He’s also mean.

  11. Adam 2019-11-11 21:32

    Rep. Fred Deutsch is just a rural legislator with a very rural agenda.

    We’ve got A LOT of those in South Dakota and it’s what holds us back.

  12. Robin Friday 2019-11-11 21:48

    Every time I think of the 600-pound convicted rapist Ted Klaudt from Walker, SD representing anyone in the SD legislature, I despair for rural SD.

  13. happy camper 2019-11-13 08:02

    The rates of children claiming to be Trans have ballooned astronomically and the Trans Activists are desperate to invalidate studies that show desisting, or reversal of perceived gender identification are commonplace.

    This young woman’s words from Atlantic link help to explain: Claire believes that her feeling that she was a boy stemmed from rigid views of gender roles that she had internalized. “I think I really had it set in stone what a guy was supposed to be like and what a girl was supposed to be like. I thought that if you didn’t follow the stereotypes of a girl, you were a guy, and if you didn’t follow the stereotypes of a guy, you were a girl.” She hadn’t seen herself in the other girls in her middle-school class, who were breaking into cliques and growing more gossipy. As she got a bit older, she found girls who shared her interests, and started to feel at home in her body.

    In my view it’s a phenomenon that has become way too politicized. Their pain is real and wanting others to be comfortable with themselves is a worthy goal but adolescence is simply a time of great change and uncertainty as they mature. If parents of the above child had listened to prevailing thought they would have started a physical transition and regretted it later (their words).

  14. happy camper 2019-11-13 09:11

    Consider the following statement from the link below, which better explains the position I’ve long felt in my gut: Rather than doing away with the constrictions of gender, which limit and harm both men and women, transgender ideology serves to further reify these socially constructed stereotypes and roles and even to demand that we change our bodies in accordance with them.

    Instead, we ought to accept the material reality of the body while encouraging people to express themselves and their gendered feelings in whatever way they like. Boys and men ought not to be limited to wearing masculine clothes or pursuing “masculine” interests, and neither should women and girls be limited by sex. We ought to be trying to change society, not children’s bodies.

  15. bearcreekbat 2019-11-13 11:56

    The article linked by happy was eye opening to me. I highly recommend carefully reading it and considering the author’s observations and perspective.

    The author, Lisa Marchiano, appears to be a credible source with no readily identified religious or trans-phobic bias and she makes some factually compelling points about whether taking steps to physically change a child is potentially more harmful than beneficial to children in general.

    I was particularly impressed with Marchiano’s suggestion, echoed by happy, that it makes sense to “accept the material reality of the body while encouraging people to express themselves and their gendered feelings in whatever way they like,” rather than physically altering a child’s body or trying to change the child’s physiological development.

    A legislative focus on medical treatment for transgender children, rather than such treatment for all children, however, seems inappropriate. Rather than addressing treatment to physical alter only transgender children, it would make more sense to address all cosmetic surgery and similar treatment altering children. And rather than a blanket prohibition, it would be more appropriate to permit consideration of each individual’s child’s particular circumstances, since in some cases, what might be considered cosmetic surgery is is reality factually necessary to correct a serious physical problem. For example, breast reduction surgery is often the best way to deal with severe back pain and other physical symptoms due to breast size.

    Bottom line, happy’s criticism of transgender surgery has considerable support in the research and experiences described by Marchiano. A “one size fits all” law that fails to deal with an individual’s unique circumstances, however, does not seem an appropriate solution.

  16. Debbo 2019-11-13 16:21

    I support the use of hormone therapy to delay pubertal physical changes because that’s an easily reversible action if necessary. I also believe newborns with ambiguous genitalia should not be altered until the child is old enough to declare their gender.

    I want to quote a line from HC’s article: “I am particularly concerned about the number of teens and tweens suddenly coming out as transgender without a prior history of discomfort with their sex.”

    I share that concern with the author. Those are not the ones I’ve been talking about. My topic is the children who have consistently regarded themselves as a specific gender that does not match their genitalia.

    One thing about HC’s source. Mercatornet refers to itself as supportive of “traditional family values.” Those words have long indicated a decidedly conservative slant. In addition, their article about NY’s new law that increases women’s rights to control their bodies and health care, called Gov. Cuomo and the law “pro abortion.” This again shows the conservatism of the Mercatornet organization.

    I’m taking the cited article with a bucket of salt.

  17. happy camper 2019-11-13 17:24

    It’s good to be skeptical, but that skepticism must go in all directions. I’ve read a lot since this conversation started but my concern is only what is healthy for these kids. In my own adolescence I felt ambiguous and confused (a very late bloomer) think back to those times yourself some kids starting dating early if you didn’t fit in, you wanted to, didn’t really understand what was all changing, and kids don’t have the confidence and strong sense of identity that naturally develops over time as you have now. This article brought together many of the concerns I’ve read from various sources. The Transgender label now given and accepted so easily sends kids down a path, they’re encouraged to pick a lane, start hormone therapy which is not without risks, and every step they get in deeper. They become invested in their new identity monetarily and dependent on their new support system. At the point they might want to reverse there’s very little acceptance or even outright hostility.

    I’m the gay one you just ain’t gonna get me to buy this. I’ve known lots of people and asked them lots of questions. I think it’s a sickness caused by an unaccepting society with a cure much worse then the short term pain that will in many cases work themselves out. I’ve been there turned out gay but as time progressed become quite happy with my plumbing. This is a sickness caused by a binary society looking for a cure and what a wonderful cure it is cut off your given body parts to make the rest of society (and you in turn) feel comfortable with how fluid sexuality and gender actually is over time. No way I ain’t buyin it.

  18. happy camper 2019-11-13 18:00

    In a way I think it’s caused by people unwilling to accept the breadth of sexuality after being imposed by Victorian standards, religion, or what have you. Do all cultures have the same high rate of Transgender? Or is it just an internal reaction to ignorance and repression. I tend to think the latter.

  19. Debbo 2019-11-13 18:29

    “I think it’s a sickness caused by an unaccepting society.”

    You’re probably right in some cases, perhaps even most of them. But not all. That’s my point. Thanks for your research.

  20. Cory Allen Heidelberger Post author | 2019-11-13 19:57

    On reversals: the WPATH Standards of Care note (see p. 11) that the vast majority of pre-pubescents experiencing gender dysphoria do not continue to experience that condition into adulthood:

    An important difference between gender dysphoric children and adolescents is in the proportion for whom dysphoria persists into adulthood. Gender dysphoria during childhood does not inevitably continue into adulthood. Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children…. Boys in these studies were more likely to identify as gay in adulthood than as transgender…. Newer studies, also including girls, showed a 12–27% persistence rate of gender dysphoria into adulthood.

    In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty-suppressing hormones, all continued with actual sex reassignment, beginning with feminizing/masculinizing hormone therapy [WPATH, 2012, p. 20]


  21. happy camper 2019-11-14 10:26

    That author writes some good stuff on her blog. I do understand Deb’s point, but Marchiano does a very thoughtful job (which I can’t do) of explaining how we should listen to painful experiences and not necessarily seek an immediate solution, but understand they are opportunities for deep learning. “One of my concerns about the way that gender dysphoria is being addressed in a clinical context is that curiosity and exploration are foreclosed. There is no space to wonder about what these feelings might mean, or discover their complexity. Instead, we are encouraged to believe that they mean we are transgender and need to be treated with medical intervention.” Her blog post is worth a read imo. She’s expansive. Wants you to learn from your feelings, be curious not self-critical, and has good poetry too.

    “Be patient toward all that is unsolved in your heart and try to love the questions themselves, like locked rooms and like books that are now written in a very foreign tongue. Do not now seek the answers, which cannot be given you because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps you will then gradually, without noticing it, live along some distant day into the answer.” Rainer Maria Rilke

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