Gender Dysphoria Treatment for Children Needs Some Rules in Virginia

by James C. Sherlock

Virginia needs, for the protection of children, parents, and physicians, a law to specify minimum age requirements and require court orders for voluntary medical intervention in child sexual development.

When there are physical abnormalities involved, the court can order those treatments as well.

On the other hand, I propose a ban on voluntary sex reassignment surgery in minors.

A court order is already required in Virginia for non-therapeutic sterilization of children. Virginia law makes no reference to the treatment of gender dysphoria in children.

Some will try to parse the differences, but it seems almost axiomatic that consent to puberty blocking and hormone replacement therapy (HRT) for minors should be treated the same as consent to sterilization.

A modification to existing state law on voluntary sterilizations of children to set minimum age limits and require a court order for medical treatments of gender dysphoria in children seems the right approach if such treatments are not to be banned altogether for minors.

Sex reassignment surgery on minors, on the other hand, should be banned outright.

I have pursued through the Freedom of Information Act (FOIA) discovery of the rules for gender dysphoria medical treatment of children at UVa Medical Center and its Transgender Youth Health Services clinic at the UVa Teen and Young Adult Health Center. I have not yet inquired about gender reassignment surgeries in children.  

I am not singling that center out. I chose it because it is covered by FOIA and I could get the information I sought. The institution was very responsive.

The overall UVa Medical Center policy for informed consent is

The attending physician who proposes a treatment plan or procedure or the attending’s designee is responsible for obtaining consent prior to provision of care.

The general rule for treatment of a patient under the age of 18 in Attachment B of its Informed Decision-making policy is:

Consent must be obtained from at least one of a minor’s biological or adoptive parents, a legally appointed guardian, or an attorney-in-fact authorized by a properly executed power of attorney pursuant to Virginia Code 20-167 to consent to medical treatments for the minor. Legally appointed guardians are required to provide documentation of guardianship.

The rules for initiating puberty blocking medicine/hormone replacement therapy (HRT) for children at UVa Medical Center from Attachment A of its Informed Decision-making policy, “Procedures requiring informed consent forms”:

Puberty Blocking Medication/Hormone Replacement Therapy (HRT)

A new puberty blocking medication/HRT consent form must be obtained from the minor’s parent/guardian upon initiation of treatment, and validated, at a minimum, annually thereafter in patient’s electronic health record. A new written consent is not required unless there is a lapse in care, a change in the patient’s provider, or change in the patient’s condition where the risk, benefit, alternatives to treatment and anticipated outcomes differ from the current patient authenticated consent.

That’s it.

University of California San Francisco (UCSF) Benioff Children’s Hospitals are nationally ranked in pediatric endocrinology (puberty blockers and hormone therapy) at 29th. The University of Virginia Children’s Hospital is ranked 49th in that same specialty.

The UCSF Child and Adolescent Gender Center accepts new patients ages 3 through 17. UVa starts accepting patients into its Transgender Youth Health Services program at age 11. The Commonwealth has no age rules. UVa Medical Center has imposed the 11-year-old minimum age standard on itself.

Which is something, I suppose. Perhaps that accounts for UCSF’s higher ranking. If so, they are welcome to it.

I refer the reader to the web page of the UCSF Gender Affirming Health Program to get a caring view of the effects of hormone therapy as information/warning to patients. I find no such information on the website of UVa Medical Center, though I am sure it is provided to patients or their parents/guardians.

Click on either testosterone therapy or estrogen therapy for unvarnished looks at the effects of each. They are brutal at best.

I do notice that the procedure rules at UVa Medical Center require a court order to perform non-therapeutic sterilization procedure on minors 14-18. It is the law in Virginia.

Code of Virginia § 54.1-2975. Sterilization operations for certain children incapable of informed consent.

It shall be lawful for any physician licensed by the Board of Medicine to perform a vasectomy, salpingectomy, or other surgical sexual sterilization procedure on a person fourteen years of age or older and less than eighteen years of age when:

3. The court has determined that a full, reasonable, and comprehensible medical explanation as to the meaning, consequences, and risks of the sterilization operation to be performed and as to alternative methods of contraception has been given by the physician to the child upon whom the operation is to be performed, to the child’s guardian, if any, to the child’s spouse, if any, and, if there is no spouse, to the parent who has custody of the child;

4. The court has determined by clear and convincing evidence that the child’s mental abilities are so impaired that the child is incapable of making his or her own decision about sterilization and is unlikely to develop mentally to a sufficient degree to make an informed judgment about sterilization in the foreseeable future;

5. The court, to the greatest extent possible, has elicited and taken into account the views of the child concerning the sterilization, giving the views of the child such weight in its decision as the court deems appropriate;

Add puberty blocking therapy, hormone replacement therapy and sexual reassignment surgery provisions to this law and you have it.

“Surveys” of the satisfaction levels of adults who had the treatments as children are typically conducted by advocates. Regardless:

  • As adults some patients are still satisfied with the transition.  If so, they could have waited (and perhaps did wait under similar rules) until the law I propose made it legal.
  • If they are regretful, the path back is dangerous, expensive, long and incomplete.  And family relationships are shattered.

I propose a minimum age of 14 for puberty blockers and HRT, which will make me an outlier among conservatives and most parents. It will in many cases make the use of puberty blockers moot. I add the court order requirement.

I propose a ban on voluntary sex reassignment surgery in minors, which I should think will have 90% approval among Virginia voters.

Personally, I would not object if the puberty blocker and HRT treatments were banned for minors in all cases that were not accompanied with a diagnosis of physical abnormalities.

I make this more modest proposal as an attempt at a compromise that may be able to get enacted into law on a bipartisan basis.

Bottom line. Virginia law should set minimum age limits and require a court order for puberty blocking medication and hormone replacement therapy for minors.

It should ban voluntary sex reassignment surgery on minors.

Share this article


(comments below)


(comments below)


39 responses to “Gender Dysphoria Treatment for Children Needs Some Rules in Virginia”

  1. James Kiser Avatar
    James Kiser

    The idiots in the democratic crazy party (Berkley professor says men can get pregnant) took too literally the Kinks song “boys will be girls and girls will be boys. Want to change your self and fantasize about being other than what you born than make the ban apply to 21.

  2. JayCee Avatar

    This novel of unredeemed guilt, trauma, dominance and degradation pairs childhood suffering with pleasure has its roots in a Nazi SS hygiene institute who in their cocaine filled leisure hours produced and enjoyed pornographic films casting men as women and vice versa. Too many parallels between this novel and todays fringe left fascination with a projection of redefinition of moral terpitude on a younger generation.

  3. JayCee Avatar

    This novel of unredeemed guilt, trauma, dominance and degradation pairs childhood suffering with pleasure has its roots in a Nazi SS hygiene institute who in their cocaine filled leisure hours produced and enjoyed pornographic films casting men as women and vice versa. Too many parallels between this novel and todays fringe left fascination with a projection of redefinition of moral terpitude on a younger generation.

  4. No, it can not always wait. What about a transgender girl who wants to swim? New rules prohibit those who went beyond Tanner 2 male puberty from competing.

    Certain body structures change during puberty. Broader shoulders, wider hips, voice changes.

    You are eager to talk about kids who go on to detransition, but what legal recourse would there be for kids forced to undergo a puberty they didn’t want to go through and now are adults with bodies they never wanted and can’t resolved medically either at all or at great expense? Who had parental consent but were forbidden from starting puberty blockers until 14, which for most of children will be in Tanner Stage 4, almost completely through puberty?

    Or do they not matter?

    1. LarrytheG Avatar

      well… it’s change…. we didn’t use to have to deal with this kind of stuff… heckfire, not even acknowledge it… those type of folks were just “abnormal” and not up to us to figure out now to actually deal with the issues… that’s what those freak shows were for… right?

    2. WayneS Avatar

      So what sex-differentiating body structure changes occur at or around the age of three?

      1. Cite where it says there are medical interventions for three year olds.

        Hint: Your hindquarters are not a citation source.
        Hint2: Psychologists are also at hospitals.

        1. WayneS Avatar

          Once again, if you are not going to answer my question, please just say so.

          I have not made any claims about how “gender dysphoria” in 3-year-old children is treated. I simply asked you to provide evidence as to what the actual treatment regimen consists of.

          1. It’s literally on the website:

            Over the past five years, it has become increasingly common for families with young children to request advice about the best way to approach their gender non-conforming child. Children as young as 18 months old have articulated information about their gender identity and gender expression preferences. Most parents are at a loss as to how to best help their child, and may seek the advice of a professional; commonly a psychiatrist or pediatrician. At this stage of development, no medical intervention is warranted or necessary. For young children, decisions must be made to create safe environments that promote healthy growth and development. For some children this may include a social transition – changing of external appearance (clothing, hairstyle) and possibly name and pronouns to match one’s internal gender.

            Emphasis mine.

  5. WayneS Avatar

    The University of California San Francisco (UCSF) Child and Adolescent Gender Center accepts new patients ages 3 through 17.

    Three years old? That is nothing less than legally-sanctioned child abuse. At 3 years, old children have no real understanding of the differences between males and females, or what being a ‘boy’ or a ‘girl truly means.

    As far as I am concerned, any parent who puts their 3-year-old child on the gender dysphoria path is doing so because of their perception of the child’s ‘gender’, not the child’s.

    1. James C. Sherlock Avatar
      James C. Sherlock

      Of course, but I am pointing our that the Commonwealth has no rules. UVa Medical Center has imposed the 11-year old minimum age standard on itself.

      1. WayneS Avatar

        I understand. UCSF’s policy actually shocked me, though, and I have reached a point where it takes a lot for something to genuinely shock me.

        I mean, offering “gender dysphoria” treatment for 3-year -old children?

        As you know, very young children have very active imaginations, but short attention spans.
        A three 3-year-old boy telling his parents he’s a girl every day for a few months is not sufficient reason to jump on the transsexual bandwagon.

        He’s just as likely to wake up one morning and tell his parents: “I’m not a girl anymore, I’m really a dragon”. What will the helicopter parents do then? Will they seek “species dysphoria” treatment? Will they schedule surgery to haves wings and scales grafted on to their son’s body? Or maybe they’ll find a surgeon to install a propane burner in the back of the kid’ throat so he can breathe fire like a ‘real’ dragon. I’m sure there is a doctor somewhere in California who’d be willing to give it a try.

        1. At three years old treatment is entirely social. Different name, pronouns, possibly dress, everything would be the child’s preference.

          It’s the perfect time to address a little boy insisting they’re a girl. If they’re still adamant about it by age 10 right at the cusp of puberty, any medical intervention will have a lot more confidence backing it. If it was a phase or maybe they just like dresser or whatever, then seven years is a lot of time to let them work things out.

          1. WayneS Avatar

            At three years old treatment is entirely social.

            Please provide evidence that is the case.

            Different name, pronouns, possibly dress… do not require visits to a UCSF Benioff Children’s Hospital.

          2. Do you know what a psychologist is?

          3. WayneS Avatar

            Yes. I just don’t believe that the only treatment being administered to young children at UCSF is “social”.

            If you are not going to provide the evidence I asked for why don’t you just say so?

          4. Matt Adams Avatar
            Matt Adams

            A Ph.D not an M.D.

          5. They…they exist in hospitals. Do you not know what a Rehabilitation Psychologist is? Grief and Trauma? These are roles within a hospital.

            I know you all like flaunting your ignorance, but let’s settle down a notch.

          6. Matt Adams Avatar
            Matt Adams

            “I know you all like flaunting your ignorance, but let’s settle down a notch.”

            You should probably put the bottle down before you comment on someone’s knowledge. A Physcologicst is a Ph.D and a Psychiatrist is an M.D. who’s attended medical school.

            I would know my siblings a Physcologist.

            I don’t think you know what goes on ina hospital you weren’t a patient in, so drop the tude.

          7. James McCarthy Avatar
            James McCarthy

            Please follow your own advice with respect to ad hom criticism. What is a Physcologist??

          8. Matt Adams Avatar
            Matt Adams

            It’s called a typo Jimmy, something you, yourself are guilty of as well. Yet, people don’t feel the need to make that the crux of their comments.

            I made a joke, to which the poster replied with a comment that wasn’t even close to the mark.

            Both of you need to learn it’s a joke not a di*k, don’t take it so hard.

            Beyond that if you’re going to quibble over ad hom attacks, maybe you should talk to your pal as well. After all they started with one, but this again plays to your utter hypocrisy on your posts.

        2. James C. Sherlock Avatar
          James C. Sherlock

          It is both B.S. crazy and inhuman.

          1. WayneS Avatar

            Subjecting a young boy or girl to a ‘gender affirmation’ program is legalized sexual abuse of a child as far as I am concerned.

    2. Chrissy Taylor Avatar
      Chrissy Taylor

      As a Transwoman myself…… I totally agree Wayne! 💯 That is definitely legally sanctioned child abuse!! Leave it up to the crazies in California to think that pushing gender nonsense on to 3-year-old children as being normal

  6. JayCee Avatar

    This novel of unredeemed guilt, trauma, dominance and degradation pairing childhood suffering with pleasure has its roots in a Nazi SS hygiene institute who in their cocaine filled leisure hours produced and enjoyed pornographic films casting men as women and vice versa. Too many parallels between this novel and todays fringe left fascination with a projection of redefinition of moral terpitude on a younger generation.

    1. That’s fiction and even in your very link mentions accusations of revisionism.

      The exact opposite happened, with Nazis persecuting LGBT citizens and even burning transgender research.

      1. James Wyatt Whitehead Avatar
        James Wyatt Whitehead

        You know you have found the Holy Grail of liberalism when the left invokes the imagery of Nazis.

        1. LarrytheG Avatar

          cuz only Conservatives can claim Nazi things about the left? 😉

  7. LarrytheG Avatar

    The interesting thing to me is when we think the govt should dictate on these issues and when not.

    I’m no fan of this in general (but have a live and let live attitude) and even less so for children who, as has been pointed out, Parents are making irrevocable lifetime decisions that may well be regretted later.

    And as we know, more and more, not every parent is fit to be a parent.. given some of them propensity to providing deadly weapons to their offspring and worse.

    There are thousands of children the state has taken over responsibility for because the state, yes… the GOVT ….HAS DETERMINED that the child is at risk if left to the care of their parent(s). The govt has usurped the authority of the parents. NO two ways about it.

    Happens every day at social services where a child is “removed” from the parent for cause.

    So that’s my question – On what basis do we do this for this issue? What is the fundamental reason why the state takes this authority from the parent?

    Oh, and I DO give credit to Sherlock for being forthright enough to come right out with his recommendations rather than play the culture war game with it.

    But again – what is the fundamental reason that the State should remove authority from the parent? Is it moral or religious or what?

    1. James C. Sherlock Avatar
      James C. Sherlock

      Child protection. So stated in the opening sentence.

      1. LarrytheG Avatar

        You could say that about almost anything , right?

        Every day, child social services take a child away from the parent – for specific reasons – they can’t just say “child protection”.

        what sets this apart?

        What makes the govt a better decider than a parent on this issue?

        1. James C. Sherlock Avatar
          James C. Sherlock

          Another set of eyes on the situation, a judge who is not emotionally involved, before irreparable change is imposed on a child. Exactly the law we have on sterilization.

          1. LarrytheG Avatar

            As I said at the top, I have reservations about doing something that cannot later be undone but at the same time to take a position that ALL of this is wrong and should be stopped is a simple-mans answer to something he can’t understand and calling him a Judge and having a one-side-fits-all law don’t fix it.

            We are dealing with issues we never had to deal with before – not that the issues did not exist – just that we chose to pretend that there were no such people and even if there were – (and there were) – we chose to ignore it.

            Much like we used to do with kids with other issues like autism – we just told parents to keep them at home, there was no place for them at school.

            Times change.

            This is just one aspect of transgender that is not going to go away by just refusing to acknowledge it as real.

  8. walter smith Avatar
    walter smith

    Reality time. Pile the hate on. Just because we CAN do “sex re-assignment” surgery, doesn’t mean it should be done. I think the doctors performing this should lose their medical licenses. 3.5 billion cells all can’t be one way by mistake. The unhappiness is a mental issue and mutilating your body to not function the way it is designed will not be a real or lasting “cure.”
    Guess I just disqualified myself for that Berkeley Law professorship…

    1. Cancer Cells like this post.

      1. walter smith Avatar
        walter smith

        Please tell how the expression of my opinion is cancerous.
        Why should your opinion be regarded as correct? I take it you disagree. Why am I wrong besides “feelings?”

        1. You said 3.5 billions cells can’t all be one way by mistake. So cancer cells are just fine, right? No mistakes there.

          1. walter smith Avatar
            walter smith

            That’s not an argument, and it is also incorrect. The human body has 3.5 billion cells and they are all coded XX or XY. One or the other, not a mixture. Cancer cells are a mutation and are not fine. Try again.

  9. Clarity77 Avatar

    It was not long ago that it was established and consensus fact in the mental health field that full mental maturation does not exist in males till the late 20’s and in females the mid-20’s. Gender reassignment is an irreversible, profound and an obviously not to be taken so lightly decision. Mind boggling that this very abusive and heinous procedure is being promoted and encouraged on our nation’s under age children, the very future of our nation, with virtually a complete lack of any reasonable safeguards.

Leave a Reply