The cause of transgender rights received a moral boost this week when US President Joe Biden again proclaimed March 31 as Transgender Day of Visibility. In an emphatically worded statement the President said: “Transgender people are some of the bravest Americans I know, and our Nation and the world are stronger, more vibrant, and more prosperous because of them. To transgender Americans of all ages, I want you to know that you are so brave. You belong. I have your back.”

Backing up its words with deeds, the Biden Administration announced a dizzying number of initiatives for transgender people in a “fact sheet”. Especially prominent is gender-affirming care for adolescents. It says that “for transgender and nonbinary children and adolescents, early gender-affirming care is crucial to overall health and well-being”. This includes, on a case-by-case basis, “top” surgery, “bottom” surgery, and facial feminization. Bioethics writer Wesley J. Smith recast the announcement by the Office of Population Affairs as “Castrations/Mastectomies Okay for Transgender Minors”.

Demedicalising gender identity. The CEO of Transhealth Northampton, Dallas Ducar, argues in an essay in STAT that a diagnosis of gender dysphoria should not be required before health insurance companies pay for transgender medical treatment. While some trans people suffer from gender dysphoria, other do not, Ducar says. “To better serve all patients, insurers should decide medical necessity not by a diagnosis but by reported identity.” Ducar compares reimbursements on the basis of transgender “medical necessity” to mammograms or colonoscopies on the basis of age.