New bill targets gender doctors

A draft law in Chile proposes criminal charges against health professionals who transition minors and forbids the use of a false diagnosis to hide these procedures

The city of Santiago, Chile. Photo by Chalo Gallardo on Unsplash

No time limit

Opposition politicians in Chile have announced plans for a bill to prohibit hormonal and surgical interventions for gender-distressed minors.

If enacted, the bill would apply criminal penalties and deregistration to health professionals who ignore the ban, with enforcement action still possible 50 years after an injured minor reaches the age of 18.

On August 5, the bill’s author, Karen Medina, an independent member of Chile’s Chamber of Deputies, said the aim was to “protect our children and adolescents from irreversible interventions that, to date, do not have sufficient scientific backing.”

“Since 2012, hormone treatments have been performed on minors in Chile under clinical criteria, despite the lack of specific technical regulations.

“Some data indicate that in the last two years, 1,174 children have undergone treatment. Six hundred of them with pubertal blockade, 400 cases of cross-hormone therapy. Of every five children treated, four are girls.

“In Chile, there is no registry [of consolidated treatment data] or real control over these procedures. International evidence shows that they can cause permanent and irreversible damage.”

Ms Medina presented the bill with fellow deputies Diego Schalper and Mauro González (both of the liberal-conservative party National Renewal) and Francesca Muñoz of the Christian Social Party.

Journalist Sabine Drysdale, whose coverage of unregulated paediatric gender change last year helped galvanise opposition to the “gender-affirming” treatment model in Chile, said she expected the bill would be debated by the new parliament after November’s elections. The left-wing government led by President Gabriel Boric is lagging in opinion polls.

“The good news is that this bill has been signed by right and centre-left members of parliament, which shows that the well-being of children who suffer dysphoria is a cross-party matter of interest that is starting to be taken seriously,” Ms Drysdale told GCN.

Unlawful?

The new draft law follows a special investigative commission of the Chamber of Deputies, the lower house of Chile’s parliament, which recommended the suspension of the government’s Gender Identity Support Program (PAIG), which is open to children from the age of three and promoted as non-medical support.

The commission noted the doubtful legality of medical referrals enabled by the PAIG, the inadequate scientific evidence for hormonal and surgical interventions, and the lack of a national registry tracking basic patient data on minors.

The commission also drew attention to the fact that the Ministry of Health had in its possession an unpublished 2023 review of the scientific literature confirming the weak quality and uncertain nature of the evidence for gender medicalisation of minors.

“[This means] the government that was defending the transition of minors had evidence against the gender-affirming medical treatments—and still kept providing them,” Ms Drysdale said.

“Children in Chile today keep receiving blockers, hormones and top surgery [double mastectomy].”

She likened the ministry’s silence to the American scandal involving the withholding of inconvenient research data on puberty blockers by the US gender clinician Dr Johanna Olson-Kennedy because it might be “weaponised” by opponents of “gender-affirming care”.

Ms Drysdale said the new Chilean bill was “important because it sets some facts straight.”

“Pro-trans advocacy groups and many doctors have been saying loudly that no children receive gender-affirming hormone treatment or reassignment surgery in Chile and/or that these treatments are reversible and do no harm.”

She said this misinformation had persisted, despite media coverage and the special investigative commission having documented the fact of paediatric medical transition in Chile.

“Children as young as 9 years old have received puberty blockers and surgeons are chopping healthy breasts from teenage girls to ‘affirm’ their identification with the opposite sex in the public and private sector.”

Irreversible damage

The Chilean parents’ group Kairós has welcomed the bill, noting that 15 per cent of the gender-distressed children in their members’ families had desisted and re-embraced their birth sex, thereby highlighting the risks of medicalising unstable transgender or non-binary identities.

“This bill seeks to regulate medical interventions that are based on weak evidence and that would have led our children to make irreversible changes to their healthy bodies,” the group said.

“We would like to see support for this initiative come from across the political spectrum and reflect genuine concern from all sectors, as we are families from all over the country and from a wide range of political backgrounds.”

In its preamble, the bill sets out the nature, timing and potential harms of hormonal and surgical interventions; the weak evidence base as confirmed by the Cass review; the (very limited) data on treatment in Chile; the shift away from gender-affirming medicalisation in the UK, Nordic countries and Republican-run US states; as well as landmark court decisions in the US (Skrmetti) and Australia (re Devin).

The bill would prohibit puberty blockers, cross-sex hormones and surgery “whose direct or indirect objective is to affirm [a minor’s] identification with the opposite sex,” according to an unofficial text sighted by GCN. (It does not mention medical interventions with the supposed purpose of affirming a minor’s “non-binary” identity.)

Civil and criminal penalties could apply to “castration, mutilation or injury caused to minors” by these hormonal or surgical interventions. The bill also targets the use of false diagnoses or prescriptions to disguise gender-affirming treatment, as well as clandestine supply of hormonal drugs.

Detransitioner Nicolás Raveau, a former trans rights activist who has researched the rise of the gender-affirming model in Chile, said he would like to see more attention given to treatment alternatives and the welfare of young adults aged 18-25.

“I agree with the general ban, but I still think it is only an initial step, and that alternatives in health and support need to be presented which do not refer only to the clinical sphere,” he told GCN.

He thought it a tactical error for Deputy González to stress the unconditional freedom of adults to do, as the deputy put it, “what they deem appropriate with their bodies in the event of a sex change”.

Mr Raveau said: “The 18-25 age range is the one that is undergoing a massive [gender] transition in Chile and is being left out of the debate and any possible assistance. The Chilean detransitioners I know are in that age range, and their physical and mental health is in poor condition.”

“It is sad and worrying to see. I think it is important that they are not left out of the public eye.”

Some social media reaction to news of the new draft law claims that a ban on surgery in Chile is a political stunt in defiance of the facts.

Prominent architect Sebastián Gray retweeted news of the bill with the comment: “Lying as a permanent tactic of the far right, a troop of liars: There is NO sex-reassignment surgery for minors under the age of 18, nor are hormones prescribed before puberty.”

In fact, the bill says nothing of pre-pubertal hormone treatment. It is international gender-affirming practice to start hormone suppression at the outset of puberty, which may be as young as 9. And the bill’s discussion of under-18 surgery cites data from the government itself, which supports trans rights.

In June 2024, Deputy Schalper had petitioned Health Minister Ximena Aguilera for data on mastectomies, vaginoplasties and genitoplasties in minors.

In reply, the minister said the records could not give a precise answer, but she had ordered a search using the diagnosis of “gender identity disorder”, which is coded as F64 in the UN International Classification of Diseases (ICD).

The ministry’s search terms included surgical procedures such as “unilateral orchiectomy, partial or total amputation of the penis in men, and penile prosthesis implantation, partial or total mastectomy, hysterectomies and vulvectomies in women.”

The results, reported by the minister, were 42 cases in the 20 years to 2024. Six of these surgeries were said to involve 17-year-olds in public hospitals, the rest were in the private sector. The minister said she could not give more detail about these procedures because the small numbers involved created a privacy risk.

It is unlikely that the ICD F64 diagnosis shows the true scale of paediatric gender surgery in any country because there is evidence internationally of activists and clinicians using other diagnoses. The purpose of this tactic appears to be to gain health insurance coverage, to avoid the “pathologising” nature of the F64 diagnosis, or to conceal procedures known to be controversial from public scrutiny.