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Example: [Collected via Twitter, July 2015] You’ve got to be kidding me! Oregon 15-yr-olds are now allowed to get sex-change operations—w/o parental notification https://t.co/Ldu0p2z3X7 — Franklin Graham (@Franklin_Graham) July 10, 2015 COMING UP: Oregon allowing 15 yr olds to get state-subsidized sex-change operations w/o parental consent-thoughts?@genemarks @DrDanielBober — Gretchen Carlson (@GretchenCarlson) July 10, 2015 Origins: On 9 July 2015 Fox News published an article titled Oregon allowing 15-year-olds to get state-subsidized sex-change operations, (accompanied by several broadcast segments) claiming that a recently approved policy in the state enables minors as young as 15 to undergo gender reassignment surgery without the knowledge or consent of their parents. The article (subsequently aggregated to a number of web sites without additional investigation) stated: The list of things 15-year-olds are not legally allowed to do in Oregon is long: Drive, smoke, donate blood, get a tattoo — even go to a tanning bed. But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation. Many residents are stunned to learn they can do it without parental notification — and the state will even pay for it through its Medicaid program, the Oregon Health Plan. A Portland transgender advocate addressed the claims made in the article, indicating that the assertions were implausible with respect to the mechanics of gender reassignment surgery: Jenn Burleton, the executive director of TransActive Gender Center in Portland, said the idea a 15-year-old can walk into a doctor’s office, say they want gender affirmation surgery and get it done without a parent’s consent is unrealistic. It’s irrational, she said. It’s laughable. The Oregon Health Authority also released a statement about the such claims, explaining that the age of medical consent in Oregon (15) and coverage of gender dysphoria as a medical condition in no way suggested that teens of that age were in actuality undergoing surgery without the knowledge or consent of their parents: In Oregon, the age of medical consent is 15 or older. Patients should be able to demonstrate the capacity to make a fully informed decision and to give consent to treatment, regardless of age. However, nothing in Oregon law requires a health care provider to provide medical services to a minor or safeguard the confidentiality of a minor. In most cases, providers will encourage (and in some cases require) family engagement and supports unless it would endanger the patient. The documents to which Fox News referred (which purportedly quietly approved gender reassignment for teens) in actuality assessed aligning Oregon's public health coverage (for patients of all ages) with the general standard of treatment for gender dysphoria. Surgery was listed as one of several options available to patients under later revised guidelines and was not specific to minors: Updating Oregon’s policy and bringing it into line with current major international treatment guidelines, the Health Evidence Review Commission (HERC) has voted to move gender dysphoria into the covered portion of the Prioritized List with the publication of the next biennial review List. Services already approved for this new, covered line include psychotherapy, medical visits, and medications to suppress puberty in gender questioning youth. The only portion of the documents in question pertaining to minors did not mention parental consent and simply referenced medications to suppress puberty in gender questioning youth. In terms of utilization estimates in the June 2014 document, Oregon's Health Evidence Review Commission stated that 175 total Oregonians (not specifically or even primarily teens) would likely be covered under the inclusion each year: HERC staff estimate a utilization rate (of all treatments for gender dysphoria) in OHP of 175 persons in any 12 month period. HERC staff estimates that the total cost of adding all treatments for OHP will be less than $150,000 per year. The numbers provided are not insignificant with respect to an estimated number of surgeries performed each year. A 2015 Washington Post article quoted two medical experts who estimated that a woman who chooses the full range of surgical procedures available would spend $75,000 or more to transition to a male, but surgically transitioning from male to female might cost in the $40,000 to $50,000 range. So even factoring in the lowest cited cost of $40,000 per individual surgery (and the fact that the estimates included all Medicaid patients in Oregon treated for gender dysphoria, not just minors), the less than $150,000 per year estimated spending would cover just three patients — with hardly anything left over for non-surgical treatments such as counseling and medication. The Fox article also cited a 2008 study that stated most children with gender dysphoria will not remain gender dysphoric after puberty, implicitly suggesting that children in Oregon who might opt for gender reassignment surgery (without any input from their parents regarding the serious health decision) would invariably come to regret their hasty course of action later in life. However, Fox elided the portion of the study that indicated the children presenting as gender dysphoric had an age range [of] 5-12 years, meaning all study participants were well under the threshold age of medical consent in Oregon. That omission was in contrast to the wording of Fox's headline, which specifically cited minors aged 15 and over (none of which were included in the cited study). It's true that the age of medical consent in Oregon is 15 (whether or not a minor is transgender), and in early 2015 the state of Oregon's HERC did opt to include gender dysphoria in a list of conditions covered by the state's Medicaid plans. But publicized claims misled readers and viewers into thinking that a new guideline had approved sex changes for teenagers by conflating extant Oregon state policies that were largely unrelated. In fact, the age of medical consent in Oregon has been 15 since 1971, and gender dysphoria Medicaid coverage changes applied to all residents of the state (not teens specifically). The Fox article (and subsequent iterations) failed to consider the lengthy, arduous process gender reassignment entails or the likelihood that any medical provider would agree to begin such a process on a minor who lacked parental consent. Moreover, the policy change was not enacted quietly (i.e., without notice or disclosure), as the Associated Press had published an article announcing Oregon Medicaid to Cover Gender Reassignment nearly a year earlier. We've asked out HERC whether additional details are available to determine whether any 15- to 17-year-olds have been affected by the policy update or have undergone gender reassignment in Oregon following the change.
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