Democrats once billed themselves as defenders of the powerless against the oppressive forces of industry. Last week, Arizona’s Democratic governor, Katie Hobbs, protected the politically powerful gender-medicine industry from its victims.

Hobbs vetoed legislation that would have made insurers and health-care providers financially liable for costs associated with reversing or mitigating the harms inflicted on patients in the name of “gender-affirming care.” Currently, young people who have variously undergone surgical castration, mastectomies, and endocrine disruptions, only to realize that what they needed instead was mental-health support, are often left to shoulder the resulting medical bills themselves.

Those who detransition do so for a range of reasons. A survey of detransitioners cited in the influential Cass Review found that the most common were respondents’ acceptance that their dysphoria was “related to other issues” and having experienced “health concerns.” Detransitioners face significant challenges, not least scorn and ostracism from the “community” that once vowed to be their “chosen family.”

Despite growing attention to the phenomenon of detransition from researchers and medical authorities, the International Classification of Diseases, used by most public and private insurers, offers no billing codes for the process—despite having codes for medical transition and even for obscure events such as being bitten by an orca. This critical gap in insurance coverage results in the revictimization of those who were betrayed by doctors in their hour of need.

A young gay man is suing the Fenway Health clinic in Boston after doctors inappropriately approved him for feminizing hormones, surgical castration, and breast implants. Now, he must live with those implants and endure their side-effects because their removal is expensive and not “gender-affirming” per his insurance policy.

A young woman, Katie, underwent testosterone “treatment,” a double mastectomy, and a hysterectomy—all procedures covered by insurance as “gender-affirming.” She soon realized that she had been misdiagnosed and mistreated but could not get the estrogen regimen she needed to cope with early menopause (at age 25) because no billing code existed for her condition.

Prisha Mosley, who was put on a medical transition pathway at age 16 after having experienced sexual assault, severe depression, and eating disorders, was quoted $11,920 for breast reconstruction, which assumes no complications and which would involve two or three surgeries. Mosley would have to pay for  the procedures out of pocket, with knowledge that she can never regain her ability to breastfeed.

There is a twisted irony in the fact that the ICD lists billing codes for physically healthy young patients to undergo invasive procedures but no codes to undo the resulting damage. This is discrimination—the sort of thing Democrats profess to stand against.

Unfortunately, many doctors either don’t know how or would prefer not to treat detransitioners, who frequently mention having lost trust in the medical establishment. A 2021 survey of 100 detransitioners found that three-quarters never told their doctor of their decision to reverse course. Detransitioners, some scarred and sterile, embody the inherent dangers of “gender medicine.” They are seen as a threat by the lucrative gender industry and its protectors. They are the last people that gender clinicians want to meet in their exam rooms.

Arizona Senate Bill 1511 would have been a small and sensible step toward helping detransitioners. Hobbs, however, vetoed the bill. Her veto statement included a single line, laconically explaining that SB 1511 is “unnecessary and would create a privacy risk for patients.”

Her privacy concern is nonsensical. The legislation would not publicly identify or otherwise compromise the personal information of patients who receive transition or detransition services. As for the legislation being “unnecessary,” a word Hobbs seems to have borrowed from a statement on the proposed law by the Human Rights Campaign, this claim is misleading. While detransitioners in Arizona can have their procedures covered if they retain a “gender dysphoria” diagnosis—the mismatch between one’s actual and perceived sex—coverage is unavailable for those who come to terms with their sex and thus lose the diagnosis. This is an increasingly common experience around the globe. A recent study from Germany found that nearly two-thirds of individuals ages five to 24 who received a gender dysphoria diagnosis had lost it within five years.

Another salutary effect of the vetoed law: it would have required insurers to document detransition information. Officials don’t know how many individuals medically detransition, partly because the absence of corresponding billing codes means that insurers and regulators don’t collect comprehensive data. Still, there are good clues that the number is not trivial and may be rising. One study observed that 30 percent of patients who started hormonal treatment ceased doing so within four years. And in the United Kingdom and Sweden, health officials who radically scaled back pediatric gender services cited clinicians’ concerns about detransitioners in their decisions.

A charitable explanation of Governor Hobbs’s veto is that, like other Democrats, she has been misled by groups like the American Academy of Pediatrics, the Endocrine Society, and, above all, the World Professional Association for Transgender Health. Documents made public this week as part of the ongoing litigation over Alabama’s age-restriction law reveal that WPATH suppressed scientific evidence, wrote its “standards of care” with a view toward litigating them in the courts, and was pressured by Rachel Levine, the transgender assistant secretary for health at the Department of Health and Human Services, to eliminate age minimums for endocrine and surgical interventions. WPATH and its allies in the medical establishment have refused to heed numerous warnings from European health agencies and physician Hilary Cass about the uncertainties and dangers of pediatric gender transition.

Democrats like Governor Hobbs who have deferred uncritically to the WPATH-based consensus on youth gender medicine have put themselves in a bind, but whether they are aware of the broken chain of trust in this area of medicine is another question.

More plausibly, Hobbs’s decision was driven by electoral incentives. Powerful lobby groups like the Human Rights Campaign have shifted their focus from gay rights to trans issues on the pretense that the two subjects are connected. While the detransition bill initially had bipartisan support in the Arizona Senate Health and Human Services committee, one Democrat pulled support after state transgender groups publicly opposed it. Democrats who recognize the harms of sex “change” procedures on young people vote their conscience at their own electoral risk.

A final and potentially more disturbing possibility is that Hobbs was influenced by her husband’s (Patrick Goodman’s) reported involvement as a therapist at the Phoenix Children’s Hospital Gender Support Program, a transgender clinic that offers kids the type of procedures that eventually produce detransitioners. (While the hospital seems to have scrubbed the information from its website, it listed Goodman as a “provider” as of December 16, 2023).

Regardless of her motivations, Hobbs has stymied a critical effort to improve care for those who have met with misfortune at the hands of “gender affirming” clinicians. While Arizona’s governor failed, other states considering similar bills have a chance to do what’s right for a suffering population.

Photo by PATRICK T. FALLON/AFP via Getty Images


City Journal is a publication of the Manhattan Institute for Policy Research (MI), a leading free-market think tank. Are you interested in supporting the magazine? As a 501(c)(3) nonprofit, donations in support of MI and City Journal are fully tax-deductible as provided by law (EIN #13-2912529).

Further Reading

Up Next