Gender-Affirming Care Ignores Human Physiology

By Aida Cerundolo

Monday, December 29, 2025

 

Physician leaders keep crusading for the freedom to disrupt healthy children’s natural puberty and physiology despite state bans shuttering pediatric gender clinics, executive orders threatening federal funds, and now a proposed rule from the U.S. Department of Health and Human Services blocking Medicare and Medicaid payments to hospitals providing pediatric sex-change interventions. Human physiology hasn’t changed, yet medical elites trumpet a revised paradigm of health when it comes to gender procedures that prioritize patients’ beliefs over the preservation of normal bodily functions.

 

On the one hand, traditional Hippocratic oath medical principles seek to conserve established physiological processes in support of physical health. On the other hand, “gender-affirming” clinicians aim to liberate patients from their own natural bodily functions with interventions that artificially produce physical characteristics more closely aligned with gender aspirations.

 

And the medical community is dead set on the latter. The Supreme Court’s U.S. v. Skrmetti decision supporting state bans of pediatric gender interventions exposed medical organizations’ intent to keep these interventions on life support.  The American Academy of Pediatrics condemned the ruling, proclaiming it “strips patients and families of the choice to direct their own health care.” The American Psychiatric Association released an almost identical statement. Each legal blow to pediatric gender interventions has only strengthened rhetoric from physicians championing care they believe is unfairly denied to gender-nonconforming patients.

 

Yet reimagining ethical medical care as that which allows a patient rights to certain medical interventions that alter normal human physiology is legal window dressing on an illogical concept. Modern therapies are developed and administered based on studies demonstrating efficacy and safety for a given condition, not legal scholarship. For example, a patient does not have a right to receive chemotherapy if there is no medical reason to give it.

 

The U.S. v. Skrmetti oral arguments showcased this legal reframing of medicine. Justice Sonia Sotomayor downplayed the risks of gender interventions with “every medical treatment has a risk, even taking aspirin.” This argument doesn’t consider that aspirin is given to correct a physiological abnormality, thereby improving outcomes for most patients, despite a small risk of side effects in some. Conversely, “gender-affirming” interventions universally interrupt normal physiology in all patients, introducing health risks that were previously absent. Justice Ketanji Brown Jackson similarly overlooked the foundational concept of healthy physiology as it relates to biological males and females by decrying perceived sex discrimination when a patient of one sex does not receive the same medication that would be given to a patient of the opposite sex.

 

These mental gymnastics can only be accomplished by decoupling gender from biological sex, thereby creating a new model of health untethered to physiological standards of physical wellbeing. Subsequently, a patient’s gender ambitions, not normal physiology and bodily functions, spawn a fresh definition of wellness that every patient has the right to achieve.

 

But putting patients in the driver’s seat to achieve a perception of health that is not supported by science can be dangerous. It requires a higher tolerance for harm because the end goals deviate from what decades of research have shown to be healthy.

 

Predictably, there is an emerging cohort of young people who have suffered adverse effects from irreversible gender interventions. Many of these “detransitioners” deal with loss of bodily functions, sterility, and life-long medicalization.

 

Even so, the response from the medical community has been indifference. While treatment injuries usually trigger caution, in this case, advocates got louder while victims were shunned. It seemed that gender ideology — not patients — needed protection. The surgeon and president of the World Professional Association for Transgender Health admitted that “acknowledgement that de-transition exists even to a minor extent is considered off limits for many in our community.”

 

This avoidance strategy worked. A glance at resources for clinicians reveals a world untouched by systematic reviews and ethical concerns surrounding “gender-affirming” interventions for children. UpToDate, one of the most frequented online medical platforms in the country for clinical information offers a chapter explaining why children should have access to puberty blockers and cross-sex hormones. The authors omit the newly released Department of Health and Human Services’ gender dysphoria report concluding that the evidence for such interventions in minors is inadequate. The influential Cass Review finding “poor” quality of evidence for puberty blockers and cross-sex hormones — as well as extreme uncertainty in predicting which children will maintain a lasting transgender identity — is barely mentioned and its key takeaways are absent.

 

UpToDate is not alone in portraying pediatric gender interventions as proven and necessary. Leadership from the Association of American Medical Colleges claims the legal limitations on gender interventions are an “attack” on gender diverse patients and vows to continue challenging state and federal laws. The American Medical Association provides big money in grants to academic medical centers for trainees to become advocates and providers of “gender-affirming” care. And medical schools are lockstep with gender interventions for all ages. A journal article authored by three medical students and one educational psychologist outlines ways that medical school curriculum must embed gender ideology in order to “preserve” the “rights” of patients to receive these interventions.

 

Still, history has not been kind to belief-directed medicine. Doctors guided by beliefs rather than science have committed ethical and moral transgressions, like forced sterilizations of the “feeble-minded” and the Tuskegee experiment. These are just some examples of ideology causing human suffering.

 

That’s because the human body knows no ideology. While beliefs come and go, human physiology is unchanging, and ignoring its rules will make people feel unwell or worse. The body’s memo on how to practice ethical medicine is decades of research and clinical experience. The medical community need only take heed of it.