Senate Health, Education, Labor, and Pensions (Murkowski): Hearings to examine gender transition procedures on minors.

Education, labor and pensions will please come to order. As parents, children are often the greatest source of joy and the greatest source of worry. Their happiness and safety are a top priority and we collectively want to protect and also let them grow and flourish into successful and independent adults. Many parents have particular concern about transgender ideology taking over children's schools, social media feeds and monopolizing pediatric medical focus. Gender ideology is being pushed to convince children and parents that cross sex hormones and irreversible sex change operations are acceptable solutions to gender dysphoria. More children than ever are confused about gender. From 2017 to 2025, the number of children identifying as transgender increased about 383%. By the way, it seems to be more of an issue for children than adults. Nearly 25% of all transgender Americans are children. Given the number of individuals identifying as transgender decrease decreases as age increases. This suggests that oftentimes children grow out of gender confusion. With rare medical exception, a child should not have this ideology forced upon them by an over eager institution which often makes a significant amount of money from doing these procedures. These drugs and procedures leave children with long lasting life altering, irreversible psychological and physiological damage. Medical organizations claiming to care for children, namely the American association of Pediatrics and the Endocrine Society, alongside fringe discredited activist organizations like the World Professional association for Transgender Health, continue to advocate for irreversible gender transition procedures for children despite mounting evidence these are harmful. They defy science, the medical community and executive orders directing federal agencies to ensure children are not subjected to chemical and surgical castration. After years of help, investigations and public pressure, medical organizations like the American Society of Plastic Surgeons and the American Medical association have begun to change course. The ASPs or the American Society of Plastic Surgeons changed their position statement to recommend that, quote, surgeons delay gender related breast, child, genital and facial surgery until a child is at least 19 in agreement, the AMA told the New York Times the evidence for gender affirming surgical intervention in minors is insufficient for us to make a definitive statement in the absence of clear evidence. The AMA agrees with the ASPs that surgical interventions and minors should be generally deferred to adulthood. That should be obvious. Americans and their health care providers deserve to know that medical guidelines, especially for children, reflect the best scientific evidence and are not influenced by extreme ideology. The stories are heartbreaking. In a Supreme Court amicus brief, Layla Jane shared her experience of medical professionals confusing children about gender identity. She suffered from an array of complex mental health symptoms and was exposed to online transgender influencers who falsely led her to believe she was transgender at just 11 years old. Her parents sought guidance from various doctors who immediately promoted gender transition. In Layla's own words, I went straight from training bras to binders to a double mastectomy by 13. No doctor ever asked me about my past sexual trauma or why I thought I was transgender. After being prescribed and taking puberty blockers and testosterone, her breasts were surgically removed after a mere 75 minute mental evaluation. Layla Jane De transitioned when she was 17, but her medical procedures have left her with persistent nerve pain, poor self image and fertility complications. Unfortunately, there are a lot of stories like this and our witnesses today will speak more on this. Chloe Cole is a detransitioned 21 year old woman from California who went through the process of medical transition starting at age 12. Our other witness is Dr. Kurt Micelli, a psychiatrist and chief medical officer at do no Harm and and I thank you both for being here. If a doctor, teacher or therapist tells a concerned mom that if they don't agree to transition their child they will lose them to suicide, what is a parent going to do? First, there is zero evidence that gender transition procedures improve mental health. The opposite is often true. Second, the reality is that many of the children suffering from gender dysphoria will outgrow their diagnosis within a few years. Allowing minors to permanently change their body causes more significant harm to their overall health and well being long term. And we shouldn't confuse advisory boards. As a physician, I am part of professional organizations and understand how people who have got a certain viewpoint gravitate towards the advisory board within that organization. So we should not confuse advisory boards being overtaken by activists as if that is necessarily sound scientific evidence. We should be treating each child with the specialized care they need, not encouraging a nine year old boy to become a girl. It is our jobs as parents, as doctors, as teachers to protect children from harm. As senators, it is our job to stand up for what is right and against what is wrong, to support science and to speak out against quackery and to align public policy with the best interests of children and families. This includes not funding providers or organizations taking generous federal dollars and then promoting or performing gender transition services on minors. Let's put politics aside and first do no harm. Let's fulfill our duty to let kids be kids. With that I recognize. Senator Sanders, thank you very much Mr. Chairman.

And I have to say that this hearing is disappointing. It is disappointing in the sense as to why millions of Americans are giving up on the political process. They look to Washington at a Time when they are facing unprecedented crises and they're saying, who is responding to our needs? Today we are spending a hearing discussing, spending hours on a hearing that impacts an infinitesimal number of people. Now I'm wondering why, if you're concerned about children, why are we not dealing with the fact that the United States has the highest rate of childhood poverty of almost any major country on Earth? Now, here's the good news. We're not in last place. We're only in 35th place out of the 36 countries looked at by the United Nations. We're ahead of Uruguay. What about a hearing on that? What about a hearing on why in the richest country in the history of the world, millions of children today are going hungry and Republican policies have made that worse. What about a hearing, Mr. Chairman, to ask why it is that the United States remains the only major country on Earth not to guarantee health care to all people as a human right? What about a hearing to discuss what does it mean that 60,000Americans will die this year because they don't get to a doctor on time? 60,000Americans. What about a hearing talking about how our life expectancy is lower than other countries despite spending twice as much per capita on health care as the people of any other country? But what this hearing about is not about health care. It's not about children. It is about base politics. It is what my Republican colleagues do to get votes. You pick on a powerless minority. Today it's not undocumented immigrants. Today it's trans kids. And maybe we can get some votes getting everybody to kind of hate this powerless minority. Here are the facts when we talk about transgender kids. According to two peer reviewed studies published in the Journal of the American Medical association, the largest medical association in America, not a single child in our country under the age of 12 has received a transgender surgery. 0. A grand total of 85 transgender teenagers between the ages of 13 and 17 received a surgery to deal with their bodies. And most of these procedures was chest related. In other words, boys who had breasts. And they were concerned about that, et cetera, et cetera. Less than one hundredth of 1% of teenagers in America received medications for gender dysphoria. And none of these medications went to a child 12 years of age or younger. In other words, Mr. Chairman, we are using precious committee time dealing with an issue that impacts, at Most less than 100th of 1% of teenagers throughout America and zero kids under the age of 12. Let's be clear. The standard of care for transgender youth that my Republican colleagues are attacking today is supported by the American Medical association, the largest professional association of doctors in our country, and the American Academy of Pediatrics, the largest professional association of pediatricians in our country. What the medical and scientific community tells us is that gender affirming care is associated with a lower risk of depression, severe anxiety and suicidal thoughts. Bottom line, gender affirming care for youth should be between and a doctor, a patient and their parents, not politicians and the federal government. Not only would banning gender affirming care do nothing to protect kids, it will make it harder for them to get the health care they need and that would be a tragedy.

Thank you Mr. Chairman. First witness we'll go to our witnesses. We're joined by Dr. Kurt Maselli, Chief Medical Officer at Do no Harm. Dr. Miceli has extensive experience working in mental health crisis centers, drug and alcohol rehabilitation programs, and adolescent residential treatment facilities. He received his BA in Economics and BS in Biology at Villanova University, his MBA from UVA Darden School of Business, and MD from Drexel University College of Medicine. He is Board Certified in Psychiatry and Internal medicine. Thank you Dr. Marcelli for being with us.

Thank you Chairman Cassidy, Ranking Member Sanders and members of the committee. Thank you for the invitation to speak. My name is Kurt Maseli. I am a psychiatrist and Chief Medical officer of do no Harm, a diverse group of over 50,000 healthcare professionals and concerned citizens committed to keeping the practice of medicine grounded in scientific evidence. In line with today's hearing, my organization works to protect children from the dangers of gender transition procedures. I want to start by acknowledging an uncomfortable truth, which is that my profession, medicine, sometimes gets things wrong. From frontal lobe lobotomy to the opiate overprescribing crisis, medicine is riddled with examples of misadventure and even scandal. However, what earns doctors the public's trust isn't being mistake free, but rather our willingness to face up to those errors and and correct course. Do no Harm has identified nearly 14,000 minors who received gender transition procedures from 2019 to 2023, including over 5,700 surgeries. Yet nearly two dozen systematic reviews find no credible evidence supporting these interventions, not for overall mental health improvement and not for preventing suicide, which is, thankfully, very rare. Meanwhile, the known or expected harms include infertility, sexual dysfunction, bone density problems, cardiovascular disease, and markedly elevated mortality. Tragically, many of these youth will experience lifelong regret given irreversible effects of these interventions. Other countries have rightly reacted to this evidence. The United Kingdom has banned puberty blockers and the National Health Services has stopped Providing cross sex hormones for youth. In Sweden and Finland, medical professionals began a self correction under left leaning governments. In February, the American Society of Plastic surgeons, representing over 11,000 surgeons, appropriately responded to the scientific evidence by recommending against gender surgeries in minors. ASPS also warned about the risks of puberty blockers and cross sex hormones. One organization bears primary responsibility for my profession's failure to examine the evidence impartially and correct course, and that is the World Professional association for Transgender Health or or wpath. WPATH has positioned itself as the preeminent authority on gender medicine and has influenced other groups to adopt its recommendations favoring gender transition procedures on minors. In 2017, the Endocrine Society released its gender transition guidelines, authored almost entirely by individuals with clear ties to wpath. The American Academy of Pediatrics endorsement of Pediatric gender Transition explicitly cites WPATH's authority. To date, WPATH's recommendations for children have been adopted by insurers, hospitals and regulators. They've been invoked in legal briefs. In short, in the United States, pediatric gender medicine is WPATH and WPATH is pediatric gender medicine. But the foundation upholding WPATH's recommendations has effectively collapsed. In 2024, court proceedings revealed egregious misconduct in how WPATH developed its highly influential standards of care. First, WPATH commissioned systematic evidence reviews on treating minors, but suppressed them when the findings didn't support its approach. It then deceptively claimed that such reviews in adolescents were not possible. News of WPATH's misconduct was widely reported. One headline in the Economist read, research into trans medicine has been manipulated. The Washington Post editorial board wrote, the World Professional association for Transgender Health interfered with systematic reviews it commissioned, and the Atlantic concluded, this is not how evidence based medicine is supposed to work. No less egregious. Within hours of publishing its standards, WPEF deleted all age minimums for hormonal interventions and most surgeries. Under pressure from the Biden administration and the American Academy of Pediatrics, these revelations illustrate a troubling pattern. WPATH's recommendations are not driven by science but by ideology. And one of the most tragic aspects of this medical scandal is the overrepresentation of same sex attracted youth among those who are harmed by medically unnecessary drugs and surgeries. In the landmark Dutch study that launched this field of Medicine, 68 out of 70 were same sex attracted. Today, many young people who express regret and detransition say all they needed was help in accepting their homosexuality. Instead, they were affirmed as the opposite sex. This is not medicine. The public knows this as well. Support for gender transition Procedures for minors is rapidly declining among all voters. A New York Times poll last year found that only 10% of Americans supported allowing puberty blockers for minors as young as 10 years old. If we want to restore the American public's trust in the medical profession, we must start by admitting that we have made a grave mistake and the time to fix it is now. Thank you.

Thank you, sir. Next. Our next witness is. Chloe Cole, an advocate and d transitioner. She began the process of medically transitioning at age 12 and later underwent a double mastectomy at age 15 before detransitioning at age 16. Now, at 21 years old, Chloe is an advocate working to end gender transition procedures for minors and expose the institutions that have failed them. Of everyone here, you have the most courage. I look forward to hearing from you today. Thank you,

Chairman Cassidy, Ranking member Sanders and committee members. Thank you for your time. My name is Chloe Cole and I am. No, I am what is known as a detransitioner. I was diagnosed with gender dysphoria and given life altering drugs and irreversible surgery when I was only a child. As an adult, I've dedicated my life to making sure that my future children will not grow up in a world where they can be subjected to the same sex experimentation procedures that I and hundreds of thousands of children have suffered from. Despite what the doctors told me, I was not a sick boy trapped in a girl's body. I was a distressed girl. But the medical system treated my body as the problem. To any normal adult, my middle school insecurities would seem par for the course. But to my physicians, clearly they meant that I needed a scalpel to my breasts. My mom and dad, who never once believed that I was a boy, were told by psychologists and physicians that insignificant things like me wanting to become an athlete or having short hair meant that I actually was their son. The central thesis that attempts to justify child transitioning is transition your daughter or bury her. That's the lie my parents were told. And every parent of a trans identified child I know was told the same thing. Let me say that one more time. The entire premise of transgenderism is that I will take my own life if I don't transition. Yet here I am today. What they were told was that trying to change my sex would destroy my mental health. Or more importantly, that we had another much healthier option. Saying no to all of this and encouraging me to truly accept myself. Instead of honoring my parents instincts to keep me safe, the doctors put me on a chemical castration drug to stop my puberty, followed by massive doses of testosterone to induce a fake male puberty. And at 15, my breasts were taken from me. I had a double mastectomy while I was still developing and the surgeon confirmed with me that my breasts were perfectly healthy. I hadn't even had my first kiss or practiced driving before. How could they take away part of my womanhood before I was old enough to call myself one? The peace and self acceptance that I was promised never came. I'm almost 22 years old now. I have no breasts because they were replaced with scars because of Lupron, this drug that doctors lie is reversible. The first thing I feel when I wake up every day is the pain in my hips and knees. I have days, weeks, months, even when the post traumatic stress gets to me. Some days I'm not able to feel anything but numbness. Other days I'm having flashbacks where I see my scars bleeding and I'm having nightmares whether I'm awake or asleep. For me, the worst part is that nobody knows whether I'm able to have children now. I have no idea what my future is going to look like. No studies, surveys or numbers are ever going to be able to quantify just how heartbroken I am. This is not medicine. Medicine heals what is sick. But me being female was not a disease. The lie was the disease. Once doctors denied that boundary between male and female, they also denied the boundary between child and adult. That's how my confusion became evidence. My parents instincts became bigotry and a surgeon's knife became careful. When I detransitioned, the transgender cult responded by harassing me and my family, even stalking my grandmother. And it escalated into violence. Just a few weeks ago, I had hundreds of activists calling for me to be murdered. Why? Because I was going to speak on campus. This is how it is for those of us who detransition. The trans community tries to intimidate us into silence. But even worse is that we've all been left for dead by the same doctors who who promised to save our lives. I'm not alone. I have hundreds of friends who have been through the same thing. An entire generation of children were lied to. There is no such thing as a child being born in the wrong body. But there are physicians and medical bodies who prey on the confusion of perfectly healthy young boys and girls. Congress needs to ban these procedures on minors, protect parents who refuse them, investigate the medical institutions that promoted them, and make sure that children who have already been harmed are cared for. The American people have shown that they do not want this lie imposed on their children. Any member of Congress who defends this should have to look parents in the eye and explain why their child's body is now a commodity that they can sell to the gender industry. Do not wait until there are more children sitting in this chair crying to you about what was taken from them.

Thank you, Ms. Cole. I now defer to Senator Sanders to introduce his witness.

Thank you, Mr. Chairman. I'd like to introduce Shannon Minter, who is the legal director at the national center for LGBTQ rights. Mr. Minter is one of the nation's foremost experts on policies to protect LGBTQ youth. Mr. Minter, thanks for being with us.

Thank you so much. Chair and members of the committee, thank you for having me. I'm Shannon Minter, legal director of the national center for LGBTQ rights. For nearly 30 years, I've worked with transgender young people, their families, and their doctors. I would like to touch briefly on three points. First, that the government is attempting to rob families of the right and freedom to make medical decisions about their own children. Second, the government is baselessly attacking safe and effective medical care. And. And lastly, in a way we have never seen before in this country, the government is attempting to seize secretly the medical records of families to use private medical information about their children for an unlimited and unknown purpose. Few principles in American law are more settled than the right of parents to make medical decisions for their own children in consultation with their doctors. Parents exercise that right every day for every other medical condition their children may face. Parents, not politicians, know their children best. They see them every day. They sit beside them in exam rooms with their child's doctor making these decisions. Parents should not be robbed of the right to make decisions about their child's health just because that child is diagnosed with gender dysphoria. This care is not new. It has been available for more than two decades. It is supported, as Senator Sanders noted, by our nation's leading medical associations, the ama, the American Academy of Pediatrics, the American Psychological association, many others. The clinical standards require careful assessment. Reserve medical treatment only for adolescents with persistent, well documented gender dysphoria. Fewer than 1% of adolescents receive any medications. In fact, Fewer than 1/10 of 1% receive any medications. A substantial body of research has found those treatments to be safe, effective, and beneficial for those carefully screened young people. The Utah legislature actually commissioned. The most recent and largest review was published last May. It's more than a thousand pages, hundreds of studies, tens of thousands of transgender youth. It found the use of hormone therapy to treat gender dysphoria in adolescents to be safe and effective. And that, quote, there is virtually no regret associated with receiving the treatments, even in the very small percentage of patients who ultimately discontinued them. Scrametti. The supreme court upheld one state ban, but did not consider the question of parental rights. That was not before the court. If it had been, that case might have come out very differently. What we're talking about today is a proposal to rob parents across the country of the right to make health care decisions for their own children, something that could affect any family in any state. Right now, the federal government is taking unprecedented action, something that has never been done before in the history of our country, using subpoenas issued in secret to demand families private medical information without telling parents so that it can use their children's medical information in any way that it wishes with no limits. These actions are happening on the heels of multiple federal courts rejecting similar attempts by this administration. The judges rejecting those attempts were nominated by both democrat and republican presidents. One judge found that the demands contained, quote, more than a whiff of ill intent. Another concluded that they were motivated by, quote, extensive evidence of animus against transgender people. As a transgender person myself, who's benefited from a supportive family and church and from access to medical care, as a parent, recently a grandparent, I can tell you what is at stake for these families, Their rights and their freedom to make medical decisions about their own children. Thank you.

Thank you, Mr. Minter. I will defer and let coach tuberville go first.

Thank you, Mr. Chairman. Thanks for having this in this hearing, this very confusing hearing to most of us. While we even have to talk about something like this. Chloe, thanks for you being here today. Thank you for your testimony. After all your surgeries and things that you went through over the years, do you think now that with all the information out there, that a minor can make an informed decision about transition?

Thank you for your question, Senator. I do not think that children have the developmental capacity or worldly experience to make decisions like this that are very adult in nature, because this is not just a cosmetic change that these interventions cause through the body. Puberty is the only process through which a child can fully develop into adulthood, physically, psychologically, socially, and, of course, reproductively. I didn't know what was at stake. I didn't know how much it would mean for me to lose my ability to breastfeed and potentially my ability to have children at the time that I was allowed to go through this because I still very much was a child myself. I was still growing Up. No child can consent to being sterilized. Thank you.

You mentioned also that your parents were not fully informed about the alternatives like watchful waiting, counseling and long term risks, including infertility and sexual dysfunction. You know what improvements could be made in the informed consent process so that minors and their parents are fully aware of, of what their options are.

Thank you, Senator. I think that first of all, we need to stop allowing these treatments to happen in the first place, because frankly, they're dangerous for children, they're dangerous for the human body, regardless of how old you are. But the younger you go, the more damage results from this. But I think that parents need to be told that they have an option that isn't just medically experimenting on their own child. Their children don't need puberty blockers, they don't need cross sex hormones. They don't need surgery because the issue is not their body. This is completely psychological in nature. There is no gene, there is no structure in the body or brain that makes somebody transgender. These are feelings that these kids are experiencing that are real, but it doesn't mean that they are true because sex is not something that can be changed in human beings. Parents need to be informed of the risks of doing these procedures, especially the younger their child is, and also the fact that they can watchfully wait, how they can wait and watch to see how the child's feelings about their body progresses. And for the most part, most children with gender confusion will desist by the time they enter adulthood and reintegrate with their identity, with their sex. That's the information that parents need.

Thank you, Dr. Carl. Nearly two dozen reviews have found weak or no credible evidence supporting gender transition procedures for minors. Based on this evidence, why do you believe that major US Medical organizations continue to endorse this process?

Thank you for the question, Senator. I believe, unfortunately, many of our medical societies within the United States have been captured in some respect. I mean, we look at the American Medical association and it speaks to the quote, unquote, medical necessity of these gender procedures in minors. Yet they don't look at the evidence that is there. And that's very much in contrast to what the American Society of Plastic Surgeons has done in, in terms of looking at the systematic reviews, recognizing that there is very low evidence of benefit, understanding that the risks are significant, taking into account the ethical considerations as well as the issue of consent. And when medical societies start doing that, we'll find that more and more of them support the American Society of Plastic Surgeons statement as opposed to supporting the WPATH standards. Of care, which has clearly been quite scandalous, I would argue. And certainly in terms of taking off safeguards, taking off any sort of need for psychiatric assessment, just totally eliminating any sort of barriers and allowing a free fall access, it has been dangerous. And again, especially not in light with evidence. Again, we need to look at the evidence reviews. We need to look at what our European counterparts have done in the United Kingdom, in Sweden and Finland and elsewhere. And I think when we do that, we understand that these procedures are harmful and they come with very low evidence of any benefit.

Thank you. Thank you, Mr. Chairman.

Senator Sanders.

Thank you, Mr. Chairman. Thank you, panelists. As I think Ms. Cole has demonstrated, this is a sensitive issue. It's a difficult issue. And there are families all over this country who are dealing with it. Mr. Minter, who should be making those decisions? Do you think the members of the U.S. senate Committee on Health, Education, labor and Pension should be intervening in the decision process for families who are struggling with these issues? Or do you think that should be done by the parents, the young people and their physicians? Could you talk into the MIC a little bit?

Yeah, sorry. The entire premise of our legal system when it comes to parental control over decision making, medical decision making, is that it is parents who are the ones who best know their own children. That is also the entire premise of this care. Parents are involved at every stage of this care, from the initial evaluation and assessment to meeting with doctors and providers throughout the entire process. It is not the young person who who consents to this care. Just as with every other type of medical fair of care affecting youth, it is parents who have the legal responsibility and authority to consent to the care. And the standards of care require very specifically that parents are informed fully about all of the treatment options and the risks and benefits. So, Senator? No, I do not think there's any place for

as brilliant as the members of this committee are. You think maybe the decision should be left to parents and doctors and young people themselves?

Yes, sir, I do.

All right, let me ask you this. The Utah state legislature, which by the way has a Republican super majority, recently commissioned a report on the evidence for this care. Can you talk a little bit about what the Republican legislature found?

Yes, that is very significant. The legislature asked the University of Utah, which has one of the most well respected programs in the entire country, to evaluate the efficacy and safety of various medical treatments to perform an exhaustive review of the medical literature on treatments for gender dysphoria with transgender adolescents. It took the program a long time to complete it. They did the most comprehensive and exhaustive review that has been done to date. They concluded unequivocally that these treatments are safe, effective, that there's virtually no regret associated with those who receive these treatments, that they provide very significant benefits to these young people. Mental health benefits, physical health outcomes, and significantly reduced suicidality.

And can you remind us what the major medical associations in our country, what their position is? Like the ama?

Yes. Every major medical association in this country has endorsed the careful provision of these treatments for appropriately screened minors. Several of them have done their own independent analyses and developed their own practice guidelines. The Endocrine Society, the American Academy of Pediatrics, the American Psychiatric association, all have looked at the evidence and developed their own practice guidelines, all of which agree that this treatment can be beneficial for a small set of kids who have persistent severe gender identity into adolescence.

When you say a small set of kids, I mean, how many young people are we talking about here, do you think?

Extremely small number of young people. There was data analysis for a five year period from 2017 to 2021 that found that about 120,000 young people were diagnosed with gender dysphoria. This is over a five year period. Of that number, only about 14,700 received any medication. That is an incredibly small percentage.

Five year period.

Over a five year period, we're talking about fewer than one in a thousand young people. I mean, this is a very small group of young people receiving any type of medical treatment. It's only after the most careful screening.

Okay, Mr. Minto, thanks very much.

One out of a thousand. We've got a lot of kids in our country. One out of a thousand in an absolute number could be significant. I want to point out, by the way, there's a lot of peons to parental rights. But I will say Republicans are the ones who have stood up for parental rights on schools and asking a parent to be involved in a child's decision to have an abortion. And my colleagues here have always objected to those. I also want to point out that

your colleagues do not think it's a great idea for the federal government to tell every woman in this country what she could do with the body. That's correct.

So going back to and reclaiming my time, please, that's not appropriate. Now that said, and there's also evidence that the Biden administration was working with hijacked groups in the medical societies to promote this policy. And we have evidence of that. That said, Dr. Mazzelli, speak about this Utah study that Mr. Minter finds so important.

The Utah study was as Noted ordered by the Utah legislature and done by the Drug Regiment Review Committee of the University of Utah. I will say to start, this study was aimed to be a systematic review, and it is anything but that. In fact, there's no evidence of synthesis that is done by the Utah study. So when you do a systematic review, one of the key parts of it is to synthesize the evidence to look at the. Not just the risk of bias, but to look at the variation that's within studies, to look at studies based on their study size, to analyze them fully. None of that is done in the Utah report whatsoever. Another factor is that in the studies that the Utah review looked at, in the clinical studies, they only analyzed 40% of them, 60% of them weren't analyzed. What this becomes is a complete data dump into a report. And in fact, when they look at clinical practice guidelines, they. They take them at face value. There is no assessment of bias in the clinical practice guidelines that the Utah study takes. It just accepts them. It accepts the WPATH Standards of Care 8. It accepts the endocrine society. It accepts them as gospel. It has no critical analysis.

Has the Utah. What has the Utah legislature done with this study?

Well, the Utah legislature recently passed a bill to effectively end the moratorium and to issue a ban of these procedures.

So they banned it. They saw the shortcomings of the Utah

study that they did.

Now, Ms. Cole, Mr. Minter makes much of the fact that the parents are going to be presented as an option. I'm a physician. I am very aware that the doctor with the bias can coach language in a way which points a parent and a family in a certain direction. That's been recognized. Way back when, California legislature, a governmental body, required that all options be given to a woman with breast cancer because they feared there was a financial incentive for the physician to do a mastectomy instead of the lower cost, less profitable lumpectomy. So that was a governmental body intervening in quote, unquote, medical practice. And by the way, that was a good thing. So Mr. Minter makes much of this, but you point out that the way it was explained is if you don't do this, your child will die of suicide. Any comment upon Mr. Mentor, emphasizing that the parents are informed and the experience that you had.

Thank you for your question. I disagree with. I mean, there's been a lot of discussion in this hearing about parental rights and about parents consenting to this treatment for their children. But I think for the most part that parents are actually not being allowed to consent because they're not being given the information that they need in order to make a decision in the best interest for their child. If you're giving a parent an ultimatum of transition or your child is going to kill themselves, they're going to take what seems like the better of those two options, the only options that were given to them. Clinicians are using the single greatest fear that any parent could have, and that is outliving their own child. To make the parents consent is something that ultimately goes against their instincts. I agree that parents know their children best, but a doctor telling them to go against that instinct, to go against the way that they were made, that their child was made in their mother's womb because they will die otherwise, is not giving them the information they need in order to consent. This is coercion.

In your opinion, is there need for federal legislation banning the prescription of hormone therapies, puberty blockers, and surgical interventions in children with gender dysphoria?

We absolutely need federal legislation on this. We need to stop these treatments being used in children entirely because they are abuse. This is medical abuse.

Thank you.

And it's not just between. It's. This isn't just about disrupting conversations between a parent and their child's clinicians, because it doesn't matter who consents to this. This is child abuse. And we already have legislation that is making other forms of abuse in children illegal. This is no different. And we need to act now to ensure that the generation that comes after mine will never have to know what it is like to have their momentary confusion. These ultimately, for a lot of children, very normal confusion that comes around the time of puberty with these rapid changes in your body, in your life, to dictate the rest of their life and lead them into adult lives where they are miserable, they are sterile, they have no sexual function, and their health is compromised. Children deserve better than that.

Thank you, Senator Baldwin.

Thank you, Mr. Chairman. I want to start, as did the ranking member, by putting this hearing into some larger perspective. This week, Republicans are trying to ramp through a partisan funding bill that does nothing to address the issues that I hear about from Wisconsinites when I'm home. Meanwhile, we saw the President create a $1.8 billion slush fund to pay out to his supporters, some convicted felons with taxpayer money. That money could be used for so many better purposes, like medical research, access to health care, affordable child care. And now this morning, instead of addressing the issues that people really care about, like the high cost of things, the high cost of health care, Republicans are here to say that politicians should be involved in families health care decisions. Let me be clear. Health care decisions should be left to patients, their parents and their health care providers and doctors, not politicians. Once again, Republicans are trying to distract from the issues. They are not taking any steps to address exploding health care costs, coverage loss, high cost of groceries, skyrocketing costs of gas.

But we're here.

And Mr. Minter, thank you for being here. We've heard a lot of falsehoods today so far, and it is of great concern. As you said in your testimony, parents involvement in health care decisions for their children is a long established right. It is settled law and should remain free from political interference. It is not the place of politicians to insert themselves into these conversations which are so unique to each child and their families. Parents want to get their children the health care that they need and not be denied access just because a politician thinks they know their child better than they do. I think about a parent who comes to a pediatrician to seek health care for their child, who in the future the provider may have to say, I cannot help. The government has said I cannot help and do what's best. So can you discuss how the actions by this administration and Republicans that target medical providers, clinics and hospitals, how are they affecting the providers in the clinics and the hospitals, but they're preventing parents from being able to access the best care for their child. Talk a little bit more about that.

Thank you, Senator. Yes. The level of anguish that this administration's targeting of these health care providers and these families has created is really profound. I mean, over the past 30 years, I have met with dozens and dozens of parents across the political spectrum from every part of this country, many from very conservative backgrounds. And I hear the same experiences from these families over and over. You hear parents who said, my child would not get out of bed, my child stopped speaking, my child would not make eye contact with people, my child completely stopped interacting with their friends that doesn't want to go to school. These parents have worked hard, believe me, to understand what's going on with their child, to get accurate medical information. It is a process. It is a journey for these families. And. And then what you hear from them is that I got my child back. I recognize my child again. This is the happy, outgoing kid that we knew, and that is what is being taken away or threatened to be taken away by this body. And that has already been severely undermined by this administration's attacks.

I have limited time left, but I lament when I hear Ms. Cole talk about being protested. I Also lament when I hear about our doctors, our pediatricians, our clinics being protested and threatened their lives in many cases. This is the unfortunate atmosphere that has been created. Are you familiar with the level of threat that has been, that is happening right now with folks who are simply doing their jobs as medical professionals?

Yes. This administration has targeted medical providers across the country, demanding the seizure of these private medical records. It is really a blatant attempt to misuse now the criminal law. They're using now criminal subpoenas to intimidate these providers and, you know, treat them as, as though they're doing something that is, is going to lead to federal prosecution. I mean that it is a, it's just a blatant attempt to intimidate and harass them. And I will tell you Again, in my 30 years, these are providers who are dedicated to helping kids and families. They have done nothing wrong. They're following medical standards. They are helping young people who really need this care. And the actions of this administration and targeting them are so unfair and so cruel and so counterproductive to protecting these families and these young people. Thank you, Senator.

By the way, I want to point out that the committee has had several hearings on health care affordability and multiple Republicans have spoken out about the Senate Slush Weaponization Fund.

Just for the record.

With that, Senator housted.

Thank you, Mr. Chairman. Appreciate you holding the hearing today on this topic. And I do have great empathy for what children and teenagers are going through these days with the inundation that they get over social media and other platforms that affect their mental health, their well being, their ability to make judgments. And I also, I also know that there are a lot of things that the government does to protect children in law, from everything from smoking to alcohol to gun purchases, all kinds of things. And so it's very appropriate that we talk about how we would help protect children from life changing surgeries, particularly if they feel like they're not getting the right kind of information. And we also know that they're irreversible. And so Ms. Cole, I want to thank you for being here today. I'm interested in did you come to this conclusion on your own initially or was it suggested to you?

Thank you for your question, Senator. I started puberty a little bit earlier. I was about 8 or 9. I was one of the first in my class to start developing breasts and with that came a lot of attention on my body that I felt was very adult in nature for me being in elementary schooler at the time. And it was very uncomfortable I just wanted to crawl out of my skin at times and being a little bit more of a tomboyish girl. I liked having my hair shorter. I liked dressing like a boy. The person who I looked up to the most in my life was my oldest brother, and I modeled myself after him a lot. There were a lot of moments in my childhood when I thought for different reasons, that I was more like the opposite sex. I just related to them a lot more sometimes with my bodily insecurities. Going through puberty so young, I thought, I'm never going to be pretty enough. And I'm not sure that I want to be either, because this attention that I'm getting so young that eventually materialized into an assault was far too much to me at the time.

Okay.

But I didn't believe that I was a boy until I learned about the idea of transgenderism through social media.

And where did you read through on social media?

Yes.

And do you feel like the information that you were getting were leading you towards a transition of your gender?

Yes.

So what I was seeing in these online communities of other children who consider themselves to be the opposite sex, it was all very medically focused. Most of the discussion was oriented around the physical aspects of it. So before I even had a consultation, medicalization was already on my mind because these ideas were going around that this was an inherent medical condition I had, that somehow, on some level, I was actually a young man and I would not be able to survive, really, without going through this. Even a lot of the artworks and these posts that these other children would make, they would glorify even the scars that would result from what they called top surgery, which is actually a double mastectomy.

But I'm trying to. What was the moment? What was the moment that you and your parents decided that, gee, this is the right decision for our daughter?

Mom and dad were actually trying to protect me from this. They had no problem with me dressing differently, but they knew I wasn't a boy. They knew that I wasn't transgender and that this was something that very likely would pass over time. And even though I believed for years I was a boy, even though I went as far into this as I did, it turned out that that was true. This distress was something that was transient. I was going to grow out of it, but they only signed off on it when they were told that it was life or death for me.

So life or death. It was a life or death decision where you informed of the consequences, the long term health consequences, and what that would mean for you. And do you believe that you were fully informed of all of those consequences?

I was not fully informed of all of them. In fact, most of the complications that I experienced to this day, from the joint pains to the pelvic pains to the PCOS like symptoms, to my near lack of menses and these other unexplained complications I've had over the years, most of them I had no idea were going to happen to me until they did.

And so, two quick things. What would you suggest to parents and children who are going through these conversations right now?

I want every parent to know, every parent who is struggling with this, with their child, that they don't have to say yes to this. You don't have to. Your two choices are not between picking up your child from the morgue or putting them down this lifelong path of medical experimentation. You can love your child the way that they were made. You can love your child for who they are and tell them the truth, that, no, you are not the opposite sex. You are not a transgender boy. You are not a transgender girl. But I love you as you are. I see how you feel, and we're going to get to the bottom of it, but I am not going to allow you to get into harm's way.

And then finally, if I could. Mr. Chairman, do you believe the federal government has the responsibility to protect children from these therapies and surgeries?

Absolutely. I think that's whether you're a representative, whether you're an official in the government. As adults, we all have the responsibility to look after the children around us. That is our duty. And sometimes that involves saying no to a child's immature misgivings about their body, their confusion as they're going through this naturally very tumultuous time in their life. And that is part of our responsibility as adults, because children do not always know what is in their best interests. And the way that they feel about something, the way that they feel about themselves or sense of identity, is something that is naturally fluid because they are not adults yet. And we cannot expect them to have the appropriate judgment to influence decisions like this.

Thank you very much for being here. Thank you, Mr. Chairman.

Senator Kaine, Mr.

Chair, and first, a clarification. You earlier said that Democrats don't support parental involvement in children's reproductive decisions. That's definitely not the case. With respect to me, Virginia law has a parental consent requirement for abortion that I've long supported. And I suspect many of us on this side of the dais do believe parents should always be involved in medical decisions.

I Stand corrected. Thank you.

Ms. Cole, listen, I want to say this to you. Your story is tragic. It is a tragic story. It is a classic case as you tell of medical malpractice. And I know you have a medical malpractice claim pending. Being lied to, not being informed about consequences, having your parents told that if they did not consent to the surgery that you would likely commit suicide. That is outrageous. And similar cases have led to massive malpractice verdicts against physicians who did. What you are describing happened to you just recently in a state, a very blue state, New York. Someone with a case somewhat similar to Yours received a $2.6 million jury verdict. We have a legal system that is set up to compensate and then hopefully prevent people being treated the way you are being treated. And I think that system works. And I suspect it's going to work in your case. I know the, the pendency of the lawsuit, still a way off. But based on your description, you were horribly mistreated by the medical profession. And I believe there's going to be compensation. And compensation does not return you to the status that you would wish. But I have deep sympathy for that. I think the solution here is malpractice cases. I think the solution is standards of care by the AMA and the plastic surgeons and the pediatricians, which are evolving as more research is done. I don't think the right answer is a federal one. Size fits all. And Mr. Chair, I'd like to introduce for the record a letter from a Virginian who wrote me about being the parent of a 21 year old who's undergone gender affirming care. And I just want to read. It's a very long letter that is as powerful in many ways as Ms. Cole's testimony today. Here's a quote of it. We didn't make any decisions alone or in a vacuum. We. We worked closely with a wide variety of medical professionals and never felt pressured or coerced in any of our decisions. We always took time to research and explore alternatives before approving any medical intervention. Mr. Chair, I'd like to introduce that into the record without objection, and I'll say this, I can't. It's the first time I've introduced something in the record without the signature of the writer because the family is afraid of being exposed to publicity because of the animus against transgender people. And that's what I really want to focus on in my last two minutes. This hearing is in a context, as Senator Baldwin said, and it's in a context of intense hostility against Trans people. There was an election in Texas last week and we had a Democrat win a primary. And the President's right hand, chief adviser Steve Miller, decided to tweet out something negative about the winner of that primary. And he tweeted out that he's transgender. Now that's a lie. The guy who won the race isn't transgender. But the President's chief advisor was like, what is the most hateful thing I can say about someone to try to make others hate him too? He didn't say he wants to take your guns away. He didn't say he wanted to raise your taxes. He didn't say he was an extremist. He said he's transgender. We just had a governor's race in Virginia where our governor, Abigail Spanberg, won by about 15 points. The main attack against her on her opponent's ads was attacking her because she was pro trans. It wasn't really based on any vote or anything in particular, but again, there was a choice made. What is the group of people that we most want to kick around and can we connect this gubernatorial candidate to that group? There's a lawsuit that's pending right now about the DoD's decision to kick out anybody who is transgender and force them to retire. And that's bad enough, but guess what the Air Force did. The Air Force not only forced transgender members to retire, they then retracted the retirement order because, oh wait, if you retire, you get retirement benefits. And instead they classified the trans members not as retired, but separated in a way that they wouldn't get retirement benefits, even though most had served their country for 15 plus years. And the separation code was, you're a national security risk. You've served this country honorably. You're a national security risk because you're transgender. I worry that this hearing is in that context, the thing about Virginia. And I'm going to go a little bit longer if I can. Mr. Chair, I noticed that Senator Yustad got about a minute and a half extra. I thought it was interesting. Virginians rejected this campaign against the gubernatorial candidate because she was pro trans. Because Virginians had a memory. And the memory was this. Throughout Virginia politics after the founding era, where there was Jefferson and Madison and Monroe, who are the great leaders of our country, we went into about 150 year political eclipse on the national stage because we made our politics about kicking around marginalized, oppressed people, in Virginia's case, to African Americans. And that was the dominant feature in Virginia politics for about 150 years. Who can we kick around? Who can we direct hate towards. And that led, what did it get to? Virginia? I mean, we were bottom per capita income when I was born. Thankfully, we've turned the corner on that. And thankfully Virginians could see that for what it was. Okay. Attacking on trans people is sort of like the new version of kicking around who we used to kick around. Virginians rejected it. Last thing I'll just say is this. If you're a trans kid watching this hearing, if you have friends who are trans kids, if you have family who are trans kids, if you're not trans, but you're grappling, as Ms. Cole so accurately put it, like you're a teenager, you're an adolescent, your body's changing, you're confused, trying to figure it out. There is some intentional effort to make you feel bad about yourself. But you got a lot of people who love you. You got a lot of people who support you. You probably have more people who love and support you than you know, you might think. I can't talk to my parents about this. You know what? Parents understand a lot. And even if you can't necessarily find sympathy with your parents, you can find sympathy with an aunt or an uncle, with, or a sibling or a friend or a counselor. You're a beautiful, precious person. I agree with what Ms. Cole said. You know, the way you're made, you're made and you're precious and worthy of love as you are. You know, you got a lot of people who love and care about you and so don't believe that the issues you're grappling with are issues you grapple with in isolation. Because other kids, just like you, are grappling with just the same things. And there's a lot of people who want to help you. Thanks, Mr. Chair.

This Republican senator emphatically rejects the idea that we're trying to make a certain group of people an example of that which we should like, not like, for political purposes. I actually take offense at that. And Ms. Cole, your testimony is so powerful, that's who we should be concerned about. Anyway, Senator Marshall.

Well, thank you, Chairman, and appreciate our our guest today. Dr. Maceli, like you, I practiced medicine for 25 years. I saw hundreds, maybe thousands of adolescent girls. And as you could imagine, when a mom or an auntie is bringing in their 13, 15, 17 year old daughter, there's usually something going on. And you know, a lot of it was around STDs, pregnancy, family planning, those types of things. A lot of those young ladies had underlying things going on. I wouldn't necessarily classify it as a mental illness, but anxiety, anxiousness, maybe depression, suicidal ideation, all those types of things. But transgender was never a transition surgery or hormones was nothing anyone ever approached me about. What's different today than. And I was just practicing up till 10 years ago. This is a fad. It seems like it's something new. Any insight into that?

Thank you for the question, Senator. I think there's a lot that we can look at in terms of the Dutch protocol that came out in 2011 and 2014, studies that came out really in response to trying to see ways of helping folks who are seeking to transition and such. But I think the reality is that the evidence base is really quite different. And as you've noted, there's been considerable difference in the past 10 years just in terms of looking at the influence of social media, the comorbid existing psychiatric conditions, the other elements that people face. And I think one of the things that we can't forget is the need to focus on those conditions.

If.

If we look at a recent study that came out of Finland, we saw that the period from 1996 to 2010, about 24% of the individuals who presented to gender clinic had comorbid psychiatric illness. They were seeking psychiatric care. That number from 2010 to 2019 doubles to 48%, and that's compared to controls, where it's about 15%.

Okay, thanks. Certainly, we have a mental health epidemic in our youth. Ms. Cole, first of all, you're the bravest person I'm going to meet this week, and I want you to know that your courage to testify is just one of the most courageous things I've ever seen. Your testimony is very compelling. I think it's the most compelling testimony I've heard up here in a long, long time. So thank you for that sharing. Can you kind of help me? Where did you first get the idea that transgender was an option? That. That was something that. Go ahead.

Thank you, Senator. I learned about transgenderism and the definition of the word transgender through social media, and it was primarily through groups of young people who were talking about different things in the culture, from pop culture to politics. And from. From there, I just kept learning about these ideas, like that sex and gender are two separate things, that they both exist on a spectrum, and that there are some kids even who are born in the wrong body because they feel uncomfortable with the changes of puberty. And being a girl who was at a very uncomfortable point in her life moving to a new school, being the first in my class to really start physically developing in the Attention of that that was on my body rather than me as a human being. I thought maybe this is something that applies to me. Maybe I am a boy because I don't like this discomfort. Maybe I'm not just a tomboy, I'm actually transgender.

Okay. And certainly I want to express empathy too, like Senator Kaine did. I want to express empathy that we're not here to persecute anybody. We're here to help. But the studies would show that having these irreversible surgeries, medical treatments, don't really help the underlying mental health, mental challenge. And we could, I think that's well established now as well. You know, my big concern as a grandfather, a father, an obgyn, is just the irreversibility of the procedures, the side effects, infertility. I took care of hundreds of women that had a mastectomy from breast cancer. They, many of them suffer from lymphedema. They get swelling under their arms, they have chronic pain. I couldn't imagine the bottom surgeries, the chronic pain that that's going to lead to. But the infertility alone would be enough to stop this on minors. Ms. Cole, you used to just speak a little bit more about the informed consent that you did or didn't go through. Did they talk about those potential complications, the irreversibility, infertility, those types of things?

So I don't believe that I or my parents were properly informed of the consequences of these procedures from the puberty blocking joint drugs to the cross sex hormones of which I received massive increasing doses over the years and the surgery from every single one of those treatments. I still am to this day. It's been, I think over five or six years since I stopped taking these interventions. I'm still suffering the consequences. I still have chronic pain in my joints, in my back, in my pelvis. I don't know whether I am at risk of increased risk of reproductive cancers, which is a known side effect of these treatments. I don't know if I'm going to be able to have children of my own, which is part of the reason why I detransitioned in the first place. I got to about 16 years old and I learned that one day I wanted to become a mother. I wanted to be able to naturally have children of my own, to get married, to get pregnant, to be able to breastfeed them and experience that beautiful bond. But all of that might have been ripped away from me before I could even call myself a woman, before I was even an adult. And this hearings like this are not part of some coordinated attack on people who experience this discomfort around their gender. It's not hateful to question bad science or bad practices. We are simply looking out for the well being of children who are not equipped to make permanent decisions and whose parents are being told that they have no other choice. Thank you so much,

Mayor Markey.

Thank you, Mr. Chairman. I've heard from people across Massachusetts and the country sharing the real consequences of Trump and my Republican colleagues fear mongering and hateful rhetoric about trans people. One clinician who specializes in care for trans people shared with me how her clients are increasingly afraid to seek the care they need, worried about being targeted or exposed. She told me that she's afraid, too. Afraid of continuing to practice without threat to her licensure or even her own well being. A trans constituent shared having to make every health care decision with one eye on Washington, wondering whether politicians will cut off treatment options because politicians have decided that they know better than doctors and patients and we shouldn't be governing through fear. I issued a report last week outlining Trump's attacks on trans people in this country and the stories of our neighbors, real people who are being harmed by those policies and the politics on display in this hearing room today. Trump is limiting access to needed medical care, dehumanizing people by referring to them with the wrong pronouns, making fun of them, and ending critical discrimination protections. He's erasing references to trans people on government websites as if he could erase trans people from this country altogether. It is a downright obsession with him. But trans people have always existed and they cannot be erased. Mr. Chairman, I ask unanimous consent to enter into the record a compilation of more than 180 peer reviewed studies and evidence based clinical guidelines demonstrating that medical care for transgender people is safe, effective and life saving without objection. Despite what my Republican colleagues and some of our witnesses have claimed this morning,

the science is clear.

Major medical associations in this country overwhelmingly support this care because the evidence overwhelmingly backs it. Trump and MAGA Republicans are obsessed with getting between doctors and their children because when you cannot win on health care, on wages, on gas, on grocery prices, you look for someone to blame. And sadly, they've chosen the trans community. If Republicans truly cared about protecting children, they would reverse the nearly $1 trillion Medicaid cuts that are stripping coverage for millions of children and their families all across our country. If they really cared about children, they would extend the ACA premium tax credits so families aren't choosing between health insurance and groceries and gasoline, which is what they're doing right now they would lift up to more than one in five American children who live in poverty right now. But they're slashing all the programs for all those kids in America while they shed their crocodile tears. But that would rather substitute instead a program for tax breaks for their beat for their billionaire CEO buddies. That's what this is all about. And they want to cover that up, which is why they scapegoat. Mr. Minter, critics today have repeatedly cited a Trump Commission report on health care for trans youth which manufactured evidence to support cruel policies. I know you have mentioned the 1000 page review commissioned by the Republican controlled Utah legislature about safety and outcomes of providing health care to trans kids. We've also heard from Dr. Maseli claiming that that report was biased or flawed. Mr. Minter, do you agree with how Dr. Maseli categorized that report?

No, sir, I don't. As I mentioned that that program is one of the most well respected in the entire country with an enormous amount of experience doing the types of systematic reviews that were involved in this case. They had no prior involvement with this type of care, no interest in it one way or the other. And their methodology is spelled out in great detail in the report itself. I mean, this is one of the most, it is the most comprehensive systematic review that has been undertaken to date of this evidence. And I think the credentials of that program really speak for itself.

And I thank you. And I don't have time to go into all of the lies that we've heard today, but I want to end with this. Gender affirming care is health care. Health care decisions should be made between a child, their parents and their doctors, not by politicians in Washington. And finally, I just want to say trans rights are human rights. And we're just going to have to have this debate in America as to who's included in terms of all of the rights that our country provides. And I think that's what this year

is going to be all about.

Thank you, Mr. Minter. Thank you, Mr. Chairman.

Senator Hawley, thank you.

Mr. Chairman. Thank you for calling this hearing. Thank you to our witnesses for being here. Ms. Cole, I just want to start with something you said just a second ago. You said it's not hateful to question fake science. It's not hateful to protect children. It's not hateful to say that there are men and that there are women and those two things are different. It's not hateful to say that little girls shouldn't be told that they really ought to be boys. It's not hateful to do any of those things. And I just think it's time to speak a little truth to power because the fact of the matter is it is not bigotry to protect children in this country. I have sat here and listened to this side of the aisle say just a moment ago to compare protecting children and young people like you, Ms. Cole, to Jim Crow. We were just told a second ago, it is the new Jim Crow to say that boys shouldn't be in girls locker rooms. It is the new Jim Crow to say that men shouldn't be playing women's sports. I'm sorry, but that is the most ridiculous, outrageous thing I have heard in I don't know how long. And that is a real prize in the United States Senate. That is absolute garbage. And to hear these lies, and those are lies spewed in this hearing room is absolutely astounding to me. It is time to speak the truth. Protecting children is not wrong. It is our job. It is right. It is justice. It's what we are here for. And I think it's time that we start exposing the nonsense, the outrageous nonsense that has been foisted on our children. You've Testified to it, Ms. Cole. You said that you were pressured into transitioning. You were denied your full rights and the information that should have gone with your care. Your parents were not informed. You were kept in the dark. And the truth is, your case isn't a one off case. Your case is systemic. We're seeing it over and over and over. You know, we're seeing things like what you wrote, Mr. Minter, in your book from 1999. You wrote, let's just look at this, that children as young as 2 years old can have gender identity dysphoria and things like girls, boys rather, who want to avoid rough and tumble play in competitive sports or who show little interest in cars and trucks may be gender dysphoric. You said about girls. Let's look at the girls poster. You said about girls that little girls who have an identification with powerful male figures such as Batman or Superman or a lack of interest in dolls or any form of feminine dress may have gender dysphoria. You're a doctor.

You are quoting from the criteria from the dsm.

You're a doctor.

Those quotes are from the dsm.

You're a doctor.

I am a lawyer and those quotes are from the dsm.

You are your trained therapist.

I am a lawyer. And those quotes.

You're an advocate, in fact, is what you are. You're an advocate. You're an advocate for this ideology and that behind me is outrageously ridiculous. The idea that a two year old girl who doesn't want to play with dolls might be gender dysphoric is ridiculous. It is outrageous and it is time to say so. I don't care what labels you put on it. I don't care how many different titles you put on it in your books. It is absolutely outrageous. And I'll tell you one other thing, Mr. Chairman. There is no reason for this Congress to be funding outfits that perform transgender surgeries and force transgender therapies on minor children. And I have in mind Planned Parenthood. Planned Parenthood spends enormous sums of money, enormous sums of money trying to push transgender surgeries, hormone therapies on children. The Planned Parenthood League of Massachusetts, for example, advertises gender affirming hormone therapy to minors who are 16 years old. We've got it right here, in fact, urging them to come and participate in these studies and taking the hormones so that they can get compensated incentives for it. Here's the incredible thing. The United States is funding this. Do you know that Planned Parenthood got a billion and a half dollars, Let me say that again. A billion and a half dollars diverted from Medicaid and Medicare, taken from the poor, taken from our seniors so that they could do this. This is outrageous. This is absolutely outrageous. It is unconscionable. It's time for this Congress to act. I heard one of my friends on the other side of the aisle say a moment ago that malpractice cases really were the answer. You know what? I agree with that. They are the answer. And we ought to pass legislation right now in this Congress that will enable more malpractice suits for people like you. Ms. Cole, if that really is the answer, and if there really is nothing to hide, then good. Let's put power in the hands of the people and let's open up the courtroom doors for those who have had these gender hormone surgeries, these transition therapies forced on them, as you had. Ms. Cole, let's open up the courtroom doors. Let's stop funding with taxpayer money, hormone therapies, treatment surgeries for minor children without their parents consent. Let's reject the lies that this is somehow bigotry. Let's do our jobs and protect the children of this country. Thank you, Mr. Chairman.

Senator Banks.

Thank you, Mr. Chairman. Doctor, in Indiana we passed a law that bans gender transition procedures on minors. How important is it that we do that, pass a law like that nationally?

I would say, Senator, thank you for the question. I would say it's urgent. And it's urgent because medical societies, the practice of medicine, has not recognized the need to look at the evidence and to come to this conclusion itself. And that is. It's horrific, in my opinion. I mean, I look to my colleagues and again, many good colleagues trying to do the right thing. But the reality is that we have our medical societies sort of captured by an elite group that is pushing a message from wpath, which is completely bankrupt in terms of its issuance of guidelines related to the care of kids. And so I would urge, in that sense, if. If we as the medical profession can't govern ourselves appropriately, we need to make sure that kids are ultimately protected.

So this is about protecting kids. We require that kids have to be 18, or anyone has to be 18 before they can buy tobacco, 21 before you can buy alcohol, 16 before you can have a driver's license. How young are some children in America when they have a sex transition surgery?

As we noted, we put together a database based on claims data, the Stop the Harm database, and noted almost 14,000 kids less than the age of 17 and a half. And many of those, again, young teenagers who had these hormonal interventions and procedures for 5,700 surgeries. These are significant numbers when, you know, when we look at the number of children who've taken such medications. There is a study from the Journal of the American Medical association that looks at a rate of 1.4 out of 1,000 girls by the time they're 18 that have taken some form of medication related to gender transition. That's the same as the rate of diabetes in the population, type 2 diabetes. So I think there's great concern in that regard.

Ms. Cole, how old were you?

I was 13 years old when they put me on the first interventions, and I was 15. I didn't even have a driver's license yet. I didn't even have my first relationship when I had surgery to remove my breasts.

Lifelong issues, as you noted, complications that

you could have received.

Mr. Minter, how young is it appropriate, Is it appropriate to talk to a child about sexuality? At what age is it appropriate at 12? Is that appropriate?

It is. I'm not sure what that has to do with the medical care we're talking about here.

Is it appropriate at 12 to talk to a child about their sexuality?

You know who that decision belongs to? Parents.

Is it appropriate for a teacher to talk to a child about issues of sexuality at the age of 12?

No.

No. I've often wondered. I wasn't going to ask about this, Mr. Mentor, but this is Gay Pride month, I believe. The Gay Pride flag, the rainbow flag, what does that symbolize?

I am not an expert on the history of the gay pride flag, sir. I really can't answer that.

Is it a symbol? What does this symbolize? What does it mean?

I'm here to talk about whether parents or the government should make health care.

I'm asking you a question. You're here testifying before you notice.

I have no expertise on that.

Is it a political statement?

I have no expertise on that.

That's interesting that you would. That you would completely dodge that question. Is it appropriate for a Gay Pride flag to be in a kindergarten classroom?

You know, we're here to talk about an incredibly important issue that is.

You don't want to answer that question.

I just would. I hope that we give the attention before this committee.

So you do think it's appropriate for teachers to expose children as young as kindergarten age to issues of sexuality or political statements about sexuality?

I think it's important for this.

Would you defend that as a lawyer? Would you defend a teacher that places a gay pride flag in their classroom, in a kindergarten classroom?

What I do defend is the constitutional right of parents to make medical decisions for their own children.

You all see the absurdity of this, what these radicals are exposing children to, that they're entirely okay with a life altering sex change operation on a child. Mr. Chairman, is sickening to me. Ms. Cole, you're a hero for being here today to tell your story. I've heard you tell your story before. You're brave and. And I'm proud that my state, Mr. Chairman, passed a law to ban these types of operations on children. We need to do it. We need to do it nationally as soon as we can to protect more kids. Thank you. I yield back.

Thank you, Senator Banks. Now, Senator Kim.

Thank you, Chairman. Mr. Minter, I wanted to just talk to you. You've been working with transgender young people for more than 30 years. I guess I just wanted to ask you to tell me, tell us about the difference that this care has made in the life of a young person that you've worked with, in the lives of their family members. Just give us a sense of how you've kind of summed that up over the course of your experience.

You know? Yes, I had alluded to that earlier. I've talked with so many parents who describe the same trajectory of just, you know, the parents are so concerned when their child, a child that they, you know, has been happy and outgoing and healthy, you know, becomes Withdrawn, isolated, just won't interact with other kids. I just actually got a text yesterday from one of these moms who shared that exact story. Her. Her son, her transgender son became very angry, isolated, didn't want to leave his room. She and her husband went through the process of getting him the help that he needed. And she was writing to let me know that since that had happened, he has. He's excelling in school. He got scholarships, he joined the choir. I believe he got an award for his. His writing. And I was gonna see if I could find the quote really quickly. Yeah, here we go. She said she entered her text to me saying, before medical intervention, we were quite worried about him. Now we are watching him thrive and love life. And that. That is very representative of. Many of the other parents I've spoken to are just so relieved that their children are back that they recognize their child.

Hearing this from the parents themselves at work, I mean, I guess I want to zoom in on that a little bit more. If you can tell me, tell me what you have seen. When young people in particular are not able to get the care.

When young people are not able to get the care, it is so difficult for those kids, and it's excruciating for their parents to have to watch them suffer when they know there is care that could help them. I'm thinking of one mom I've worked with whose child was denied care because of some of these adverse laws that we're talking about. And that child is struggling, depressed, getting in trouble at school, angry, angry at their parents because kids expect their parents to help them get the care they need. And part of the damage caused by these negative campaigns and these laws is that it keeps parents from being able to do that. It's just the impact on families in the health and well being of these young people is truly devastating.

I guess I just wanted to point that out because, you know, I think that there is sometimes this discussion that, okay, you know, this ban on this type of care, that this is a neutral option. This is something that, you know, gives some more time until these decisions can be thought through more as they get older. But I guess I wanted to ask you, it doesn't seem like from your sense that there's neutrality here in terms of what these bans are putting into place. Is that correct?

No, no, no, of course it's not neutral. I mean, this is no different than any other type of health care and healthcare need. I mean, we don't deny care to minors and tell them to just wait till you turn 18 when you have an existing medical need and there are treatments that could help. It is. It's really cruel. These young people, this is a real medical condition characterized by very serious distress. And basically we're telling these kids and their families, you just have to live with that distress. And it's especially excruciating. Again, the treatments are designed reserved for kids who have persistent severe gender dysphoria over an extended period of time. You're asking them to go through physical changes that are agonizing to them and that will be very difficult to do anything about later. It will really. It impedes their ability to obtain effective care later. It is really, it is really quite cruel and it's unprecedented. This, we don't do this for any other type of health care.

And also that, you know, this is something where, again, the parents are involved. Right? The parents are part of this. Yet, you know, these bans would prevent the parents from the family from being able to seek that type of care.

Parents are at the heart of it all, every part of it, both legally and under the standards of care. The parents are the ones who have to. To consent to the care. And the standards of care require parents to be involved at every stage and to be fully informed of risk and benefits and treatment options.

Well, thank you for your testimony today. I yield back.

Senator Ashley moody.

Thank you, Mr. Cassidy, Chairman Cassidy, and thank you for calling this hearing, I dare say, under the last administration, shining light on something like this and folks that have regretted that decision after they matured and got older, I don't think this attention would have been paid its due or this issue would have been paid its due. And I think it's incredibly important. Mr. Mintner, you would say that once a child undergoes a transition, much of that's irreversible surgically.

It really depends on the specific treatment pathways, which is, you know, this is all a very individualized case by case assessment.

Many of those are irreversible.

It really does depend on their bodies change forever.

It does depend on the case.

Typically you're not answering this question. So when somebody's. A woman's breasts are cut off and their genitals are changed, you're not telling me that their body will be changed forever.

Surgeries are generally not recommended for minors.

What's the youngest that you would recommend it? What's the youngest age?

The standards of care are very clear. Surgeries are generally not recommended for minors. As with any other type of healthcare, there. There's a recognition that you have to look at the Individual circumstances of a child.

What's the youngest that you. You're aware of where a child has undergone surgery

there, I think.

I mean, you're acting like this doesn't happen, but it obviously happens. We're talking to somebody today who said her breasts were cut off before she ever even had a boyfriend. So, you know, it happens. What's the youngest that you've been involved with?

In my experience, surgeries are not generally recommended for minors. I am aware there's.

You don't know about it, you haven't been involved, and you don't even know if bodies are changed forever. So let me move on to somebody who can actually give me some information. Dr. Maseli, thank you for being with us. You had given some information that there are multiple scientific studies that a vast majority of minors. Grow out of a certain perception or status or gender dysphoria by a certain age. Can you give me some more information on that? Is that true? I think you said the vast majority of minors.

Sure, certainly. And thank you for the question, Senator. When we look at individuals who've had gender dysphoria before puberty, the vast majority do desist. And that is a recognized fact. In fact, oftentimes many of them may come out as homosexual and such. But I think it's just so important to recognize that we should not be treating their gender nonconformity or such with surgical or life altering procedures. I think we need to recognize the beauty of every individual and to give them any help that they need through the distress in terms of the psychotherapy or the psychosocial supports that could be offered. And again, not to engage in life altering procedures that will be with them forever.

And the information that I have is about at least 14,000. Around 14,000 minors have gone through this irreversible surgery.

5,700 in our database, more than 5,700 have surgeries. And about 14,000 from 2019 to 2023 had some sort of hormonal or surgical intervention related to gender transition.

Ms. Cole, you may not even remember, but I first met you when I was the Florida Attorney General many years ago. I remember our introduction like it was yesterday. I was physically moved. Your story was just heart wrenching. And some of the information I know you've already shared today shines a light on the fact that many children are being put through these irreversible practices and end up realizing that this was the worst thing that could have ever happened to them. I know you are part of that and you're also now experiencing in your quest not only to detransition, but to advocate on others, you're experiencing a lot of challenges, people coming after you, threatening you. Can you what is your response to the charge that this is not irreversible by an ex supposed expert in the field and what you're dealing with now, on the backside of a child that went through this and is now regretting that decision.

Senator, it's good to see you again. These treatments are absolutely irreversible. Not a single part of this, from the puberty blockers to the hormones and especially the breast and genital surgeries are reversible at all. I was on the puberty blockers for, I think, less than a year. This drug that these activists, these doctors often say is completely reversible, that a child can just resume puberty after stopping has made it so that my height is stunted. I wasn't allowed to fully go through puberty. And I have joint issues. I have pain every single day in my hips, in my knees, throughout my limbs the moment I wake up, because I was on it for less than a year. And I'm not the only person I know who has been through this and has to suffer the lifelong consequences of this. In fact, the youngest person I know who had surgery was 13 years old when she had her breasts permanently removed. And I think it's such a shame that this is being made out to be a partisan issue, because it's not. It's a shame that through four years of me working, trying to make sure that all children, all American children are protected, only one side of the aisle has worked with me to pass protections for them. You would think that the protection of children would unite people regardless of where they stand on the political continuum. And if you look at the polling across the country, this is something that lifelong Democrats and Republicans and people in between are concerned about, because this is a violation of human rights to sterilize, to mutilate, and to confuse a perfectly healthy young child who is simply going through puberty. There is no right.

That trend was given all of the information you needed at that time when you were making that decision with your parents.

Absolutely not. And I think the fact that I was even allowed to go through this so young in the first place just goes to show that this is a bad practice. This is not solved science. If the science is already solved, why are there so many? Why are there thousands of cases like mine that are passing through the cracks? The medical community has gotten it wrong before, they've gotten it wrong again. We've already gotten on them for doing things like lobotomies and unnecessarily sterilizations. This is just another case of that.

Thank you. Thank you, Mr. Chairman.

Senator Baldwin will have another statement.

I too regret that this has become unduly partisan. Share a little off topic story. But as a member of the LGBTQ community, equal opportunity is something that's really, really important to me. And I remember trying to achieve equal rights with regard to employment. There was a law called the Employment Non Discrimination act, enda. And there was long debate in the House when I served in the House and then when I came to the Senate about whether it should only include protections for members of the lesbian and gay community, but exclude protections for people in the transgender community because we weren't ready. Right. And so I was in the House when we passed an end that didn't include transgender people. And then I came to the Senate. And of course, in the Senate, you need a super majority to pass legislation. And we were right on the verge of having enough votes, but questionably, we might not make it. And I remember Senator Flake and I wouldn't tell this story and mention him by name if he hadn't already been public about what happened and he expressed his reservations. I voted for ENDA when it included just lesbian and gay protections, but I sexual orientation. But I'm not sure about including transgender protections in the end of Bill. And I remembered a Republican colleague we had in the House who had confided in me that he had a transgender son. And I called him up and I said, would you be willing to talk to Senator Flake? And he said yes. And so I asked Senator Flake, please remember him? Yeah, we were good buddies. Give him a call. They talked for three hours that night. And then Senator Flake called back and said, I'm voting for a Transgender Inclusive Employment Non Discrimination Act. It used to be non partisan,

But

the idea that the government would get involved and tell doctors that they can't treat patients who need help, There's a whole spectrum of things that fall under the category of gender affirming care. Dr. Maselli, you talked about the psychosocial aspects of that. I hope you wouldn't say that we should deny children those aspects of care. I hope we won't get to a place where the government says and intimidates doctors and hospitals to simply say no and refuse to see children with legitimate health needs, but that's where we're going, and that is dangerous. I agree with Senator Kaine that there are sometimes cases of malpractice in all sorts of parts of medicine. I know a close family member who deeply regrets having back surgery that made the pain chronic throughout her life. It made it worse. Those things happen. We have tools for dealing with it. But it's not for Congress and politicians to get involved and tell parents they can't seek the best care that their children need. So. We've had some of my Republican colleagues recoil at suggesting that there's an atmosphere of hatred towards transgender people. But I can't help but think that a transgender child watching the policy discussions that are happening on Capitol Hill, happening with this administration, don't feel under attack. We're adults and we need to be support hoarding our children. I yield back.

Thank you. I will end by quoting from an article which I'll submit to the Record with some others I'll list. Andrew Sullivan is an openly gay man who worked hard for the ability of gays and lesbians to marry. And he wrote an article, a very provocative blog poster, and he wrote a blog once, will Big Trans Be Held to Account? And he says, would anyone have predicted that the Democrats and the left in general would favor a vast, completely unregulated, for profit medical industry that would conduct a vast new experimental treatment on children with drugs that were off label and without any clinical trials to prove their effectiveness and safety? And then he goes on to say, and what if over 80% of the children subject to this experience were of a marginalized group, gay kids? I cannot imagine that any liberal or progressive would hand over gender nonconforming children, let alone their own children, to the pharmaceutical and medical industrial complex to be experimented in this way. I will submit this for the record as well as I ask for unanimous consent to enter statements into the record from the following organizations. The Family Research Council, Concerned Women for America, Alliance Defending Freedom, Ethics and Public Policy center, the American College of Pediatrics, a report from the Society for Evidence Based Gender Medicine, a report from do no Harm, a Supreme Court amicus brief, two New York Times articles, and a position statement from the American Society of Plastic Surgeons and a Health and Human Services literature review, without objection for any senator wishing to ask additional questions. Questions for the record will be due at 5pm Wednesday, June 17. I thank you all for being here. And gentlemen, I hope you don't mind, but I particularly thank you, Ms. Cole. Incredible courage. I can imagine that people come after you and attempt to counsel, but you are providing a service to our country and to children. With that, the committee stands adjourned.