Transgender Treatments Distort the Purpose of Medicine

Physicians are supposed to promote patients’ health, not cater to their desires.

Transgender Treatments Distort the Purpose of Medicine

Physicians are supposed to promote patients’ health, not cater to their desires.

Farr Curlin - 23 juin 2025 - WSJ Opinion

https://archive.is/iGQtE

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The Supreme Court’s 6-3 decision in U.S. v. Skrmetti, upholding Tennessee’s ban on medical gender interventions for children, reflects a split in the Justices’ views of medicine: Is it about restoring patients’ health or satisfying their wants?

The court held last week that the Tennessee law permissibly distinguished between different medical uses of puberty blockers and hormones for children. Writing for the majority, Chief Justice John Roberts explained that medical treatments are defined not only by the drug used but by the purpose for which it is prescribed. Administering testosterone to a boy with delayed puberty is categorically different from giving it to a girl.

Justice Sonia Sotomayor wrote in dissent that the law impermissibly discriminates based on sex: “Male (but not female) adolescents can receive medicines that help them look like boys, and female (but not male) adolescents can receive medicines that help them look like girls.” In her view, the goal of testosterone for boys and girls is the same: it helps them “look more masculine.”

Behind the justices’ rift is a fundamental question: What is medicine for? In the traditional view, the purpose of treatment is the patient’s health—the well-working of the body. We don’t decide what health is. We observe health, recognize its goodness, and protect it.

Yet the rise of the “patient autonomy” model in the 1960s and ’70s directed physicians to administer treatment at their patients’ behest. This model led to a consumerist approach to medicine, which sees physicians as “providers” instead of healers. Providers of services fulfill customers’ wishes, regardless of whether doing so restores or compromises patient health.

Conflicts over “gender-affirming care” reveal how irreconcilable these models are. Tennessee’s law permits hormones and blockers for treating objective abnormalities of sexual development, consistent with medicine’s focus on health. Justice Sotomayor’s dissent collapses all uses of these drugs into one category: treatments that “help adolescents look and feel more” how they want.

Described in the American Psychiatric Association’s Diagnostic and Statistical Manual, gender dysphoria is a mental disorder. Those who suffer it perceive healthy secondary sex characteristics as disordered.

Traditionally, medicine treats a mental disorder by helping the patient align perception with reality—like the reality of a healthy body. Medicalized gender transition turns this norm on its head, “affirming” the child’s disordered perception and treating his healthy body as a diseased one. If a girl wants to take testosterone to change her body because of her perceived identity as a boy, in this view, the doctor should go along. Justice Sotomayor described a patient who was “terrified” of undergoing the “wrong puberty” and supposedly benefited from puberty blockers. She also cited statements by major medical associations claiming that treatments to suppress healthy sexual development are “medically necessary.”

In contrast, medicine traditionally takes the well-working human body as its standard. Justice Clarence Thomas pointed out in his concurrence that giving testosterone to a girl induces a disease state, hyperandrogenism, which increases her risk of heart disease and characteristically renders her infertile.

Justice Thomas’s concurrence aligns with longstanding principles of pediatric ethics that both doctors and parents have a fiduciary duty to promote children’s health-related interests. For pediatric patients, the ethical standard centers on their medical best interests, not their wish to suppress unwanted functions.

Medicalized gender transition has another glaring problem. Children can’t comprehend consequences such as sterilization or loss of sexual response. As Justice Thomas noted in his concurrence, members of the World Professional Association for Transgender Health have admitted that discussing fertility preservation with a 14-year-old is like “talking to a blank wall.” This problem is compounded by the high prevalence of anxiety, depression and other mental disorders in these children. Gender clinicians also admit that treatment ends when the child no longer wants it—unlike how medicine handles genuinely necessary interventions.

Front and center in the debate are the vulnerable children suffering from gender dysphoria. Their healthy bodies and future ability to experience sexual intimacy and have children are at stake, illustrated by stories of irreversible damage done to detransitioners—those who seek treatment and later regret it.

The integrity of the medical profession is also at risk. This isn’t the first time vulnerable patients have been harmed by physicians to alleviate mental distress. In the 19th century, thousands of young women had their ovaries removed to treat “menstrual madness” and “lunacy.” Lobotomies were performed in the 20th century on people like Rosemary Kennedy, whose family was told she’d be calmer afterward.

Today’s gender interventions for children are disturbingly similar. In trying to relieve mental suffering, they cause permanent harm. The Supreme Court was right to recognize this. It is past time for the medical profession to do the same.

Dr. Curlin is a physician and professor at Duke University and co-author of “The Way of Medicine.”