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A Nebraska Hospital Promotes Gender Transitioning Kids With Drag Performances

by Nate Grasz | Jun 30, 2022 | Gender Identity

This editorial first appeared in the National Review on June 24, 2022.

It’s June, which now means that “pride festivals”—featuring drag queens and overtly sexual content—are popping up nationwide. You can expect to see local LGBT organizations and large corporations attempting to “out-woke” one another by sponsoring and promoting these events, some even into July.

Though such celebrations are now commonplace, it’s still surprising to see a children’s hospital sponsor a drag show while pushing transgenderism and harmful hormone therapy on children at such an event. But Children’s Hospital & Medical Center in Omaha is indeed sponsoring a drag show at the 2022 “Heartland Pride Parade & Festival” in July. The event, which has a “kids corner,” features drag performers with names such as “Prince Poppycock” whose shows have promoted adult nudity and anal sex. The hospital will also have a booth at the event specifically marketed toward youth with the purpose of talking to children about “gender-affirming care.”

According to Children’s Hospital, gender-affirming care includes puberty blockers, hormone therapy, and gender-affirming surgeries, “which may involve ‘top surgery’ (creates a chest shape typical to males or enhances breasts), ‘bottom surgery’ (surgery on reproductive organs or genitals), facial feminization, or other procedures.” (The page containing this information has been removed from the hospital’s website.)   

Many Nebraskans are now rightly asking why a children’s hospital is sponsoring a drag show and promoting transgenderism to kids. Those who support and promote this type of “gender-affirming care” push the false notion that the complete and total, “no questions asked” acceptance of one’s chosen gender identity is necessary to prevent youth suicides. But the opposite is true.  A new research report  found that increasing access to so-called “gender-affirming care” not only failed to decrease youth suicide, but it likely also leads to  higher  youth-suicide rates. Nor is this about “buying time” for kids, as some may argue. It’s about a one-way road to transition. One study of children who started puberty blockers found that nearly 100 percent ultimately medically transitioned.

The simple truth is that hospitals—including those that provide high-quality care for children—can fall victim to the public and cultural pressures of the LGBT community. Moreover, hospitals can even profit from getting kids on puberty blockers and performing sex-change surgeries that remove healthy body parts—all under the guise of “gender-affirming care.”

But pushing puberty blockers, hormone therapy, and sex-change surgery on children violates the first duty of medicine: do no harm. Children who are struggling with their gender need compassion and real care, not hormones and surgeries that cause irreversible damage and lead to a higher risk of suicide. The overwhelming majority of children—up to 95 percent—will eventually outgrow gender dysphoria and embrace their biological sex without so-called gender-affirming care.

While most children grow out of dysphoria, those subjected to “treatment” suffer lasting harm. The most thorough long-term study on this issue, which for more than 30 years followed hundreds of individuals who underwent sex-reassignment surgery, found that mental-health challenges and suicide rates reached their highest levels ten to 15 years  after  surgery and were 20 times higher than those of comparable peers. And if a minor isn’t old enough to get a tattoo or buy cough syrup over the counter, why would we permit and promote dangerous hormones and drastic, life-altering surgeries that induce infertility?

As with abortion, proponents of radical gender ideology shield themselves and the reality of the aftermath of the procedures they promote behind euphemisms and slogans. Just as “choice” and “reproductive care” have become misnomers for the act of terminating the lives of innocent and defenseless children in the womb, “gender-affirming care” attempts to mask the brutal and devastating effects of permanently altering children’s bodies through puberty blockers, hormone therapy, and surgeries—including genital mutilation.

The heartache of those who struggle with gender dysphoria should motivate parents, lawmakers, and especially those in the medical profession to protect them from further harm. Children need meaningful help, not dangerous, permanent, and irreversible interventions that don’t solve the underlying problem. Which is why a children’s hospital should always heal, and should have no part in sexualizing and harming kids for ideological, political, or financial purposes.

While pride parades and drag shows rage on, we must teach and promote the idea that every person has inherent dignity and value, and help kids understand they can “be themselves” without needing to reject their bodies through harmful hormones and surgery.

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What is the difference between sex and gender.

Sex refers to the biological and physiological characteristics that define men and women. Gender refers to the socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women.

What is gender identity?

Gender identity is a person’s innermost concept of self as male, female, a blend of both or neither – how individuals perceive themselves and what they call themselves. A person’s gender identity can be the same or different from their sex assigned at birth.

What is gender expression?

Gender expression is the external presentation of one's gender identity, usually expressed through behavior, clothing, haircut or voice, and which may or may not conform to socially defined behaviors and characteristics typically associated with being either masculine or feminine.

What does it mean to be transgender?

Transgender is an umbrella term for people whose gender identity and/or expression is different from cultural expectations based on the sex they were assigned at birth.  Being transgender does not imply any specific sexual orientation.  Therefore, transgender people may identify as straight, gay, lesbian, bisexual, pansexual, asexual, and so forth.

What does gender transition mean?

Gender transition is the process by which some people strive to more closely align their outward appearance with their internal experience of gender. Some people socially transition which means they begin dressing, using names and pronouns and/or being socially recognized as another gender. Some people undergo physical transitions in which they modify their bodies through hormone therapy and/or surgery.

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Welcome to our one-stop hub for name and gender change information. Find out how to update your name and gender on state and federal IDs and records. 

Most courts and government offices have resumed normal operations with the formal end of the COVID-19 Public Health Emergency. Make sure to contact your local court or other government offices for details on their current operating hours and procedures, including if they require appointments for in-person visits.. You should keep dated copies of any materials you submit by mail or electronically. 

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Nebraska Name Change Laws

To obtain a legal name change in Nebraska, an applicant must submit a petition to the court and show reasonable cause for the name change. Applicants over the age of 19 must publish notice once a week for four weeks; applicants under the age of 19 must publish notice once a week for two weeks. (Neb. Rev. Stat. §§ 25-21,271 to 25-21,273)

For instructions on legal name changes for minors under 18 in Nebraska, see NCTE's Name Changes for Minors in Nebraska resource.

To obtain a legal name change in Mississippi, an applicant must submit a petition to the court. No publication is required. (Miss. Code. Ann. §§ 93-17-1 to 93-17-31).

For detailed instructions on adult name changes in Mississippi, see this LawHelp Interactive's Mississippi Adult Name Change resource.

For instructions on legal name changes for minors under 18 in Mississippi, see NCTE's Name Changes for Minors in Mississippi resource.

Nebraska Drivers License Policy & Procedures

In order to update name and/or gender on a Nebraska ID, the applicant must submit  (1) a  State ID Card Data Form ,  (2) a court order certifying the name change, if applicable  and/or (3) a form signed by a licensed physician certifying that the applicant has undergone the necessary sex reassignment procedures required for social gender recognition. The Nebraska Department of Motor Vehicles addresses name change here . Applicants must notify the DMV of a legal name change within 60 days of the name change.

Nebraska Birth Certificate Laws

Nebraska will issue a new birth certificate "upon receipt of a notarized affidavit from the physician that performed sex reassignment surgery on an individual born in this state and a certified copy of an order of a court of competent jurisdiction changing the name of such person." The record will be sealed and can only be accessed by a court order.  NE Code § 71-604.01.

To apply for an updated birth certificate, the applicant should submit to the Vital Records Office the following:

• An Application for Amendment , with your notarized signature
• A Physician's Affidavit, stating they performed gender reassignment surgery and the date the surgery took place, with the physician's notarized signature
• A copy of your current ID
• A check with the applicable fees

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Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Gender confirmation surgeries are also called gender affirmation procedures. These are both respectful terms.

Gender dysphoria , an experience of misalignment between gender and sex, is becoming more widely diagnosed.  People diagnosed with gender dysphoria are often referred to as "transgender," though one does not necessarily need to experience gender dysphoria to be a member of the transgender community. It is important to note there is controversy around the gender dysphoria diagnosis. Many disapprove of it, noting that the diagnosis suggests that being transgender is an illness.

Ellen Lindner / Verywell

Transfeminine Transition

Transfeminine is a term inclusive of trans women and non-binary trans people assigned male at birth.

Gender confirmation procedures that a transfeminine person may undergo include:

• Penectomy is the surgical removal of external male genitalia.
• Orchiectomy is the surgical removal of the testes.
• Vaginoplasty is the surgical creation of a vagina.
• Feminizing genitoplasty creates internal female genitalia.
• Breast implants create breasts.
• Gluteoplasty increases buttock volume.
• Chondrolaryngoplasty is a procedure on the throat that can minimize the appearance of Adam's apple .

Feminizing hormones are commonly used for at least 12 months prior to breast augmentation to maximize breast growth and achieve a better surgical outcome. They are also often used for approximately 12 months prior to feminizing genital surgeries.

Facial feminization surgery (FFS) is often done to soften the lines of the face. FFS can include softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. Each person is unique and the procedures that are done are based on the individual's need and budget,

Transmasculine is a term inclusive of trans men and non-binary trans people assigned female at birth.

Gender confirmation procedures that a transmasculine person may undergo include:

• Masculinizing genitoplasty is the surgical creation of external genitalia. This procedure uses the tissue of the labia to create a penis.
• Phalloplasty is the surgical construction of a penis using a skin graft from the forearm, thigh, or upper back.
• Metoidioplasty is the creation of a penis from the hormonally enlarged clitoris.
• Scrotoplasty is the creation of a scrotum.

Procedures that change the genitalia are performed with other procedures, which may be extensive.

The change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy (surgical removal of the breasts), hysterectomy (surgical removal of the uterus), and perhaps additional cosmetic procedures intended to masculinize the appearance.

Paying For Gender Confirmation Surgery

Medicare and some health insurance providers in the United States may cover a portion of the cost of gender confirmation surgery.

It is unlawful to discriminate or withhold healthcare based on sex or gender. However, many plans do have exclusions.

For most transgender individuals, the burden of financing the procedure(s) is the main difficulty in obtaining treatment. The cost of transitioning can often exceed $100,000 in the United States, depending upon the procedures needed.

A typical genitoplasty alone averages about $18,000. Rhinoplasty, or a nose job, averaged $5,409 in 2019.  

Traveling Abroad for GCS

Some patients seek gender confirmation surgery overseas, as the procedures can be less expensive in some other countries. It is important to remember that traveling to a foreign country for surgery, also known as surgery tourism, can be very risky.

Regardless of where the surgery will be performed, it is essential that your surgeon is skilled in the procedure being performed and that your surgery will be performed in a reputable facility that offers high-quality care.

When choosing a surgeon , it is important to do your research, whether the surgery is performed in the U.S. or elsewhere. Talk to people who have already had the procedure and ask about their experience and their surgeon.

Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a patient reference with whom you can speak.

It is important to remember that surgeons have specialties and to stick with your surgeon's specialty. For example, you may choose to have one surgeon perform a genitoplasty, but another to perform facial surgeries. This may result in more expenses, but it can result in a better outcome.

A Word From Verywell

Gender confirmation surgery is very complex, and the procedures that one person needs to achieve their desired result can be very different from what another person wants.

Each individual's goals for their appearance will be different. For example, one individual may feel strongly that breast implants are essential to having a desirable and feminine appearance, while a different person may not feel that breast size is a concern. A personalized approach is essential to satisfaction because personal appearance is so highly individualized.

Davy Z, Toze M. What is gender dysphoria? A critical systematic narrative review . Transgend Health . 2018;3(1):159-169. doi:10.1089/trgh.2018.0014

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature . Plast Reconstr Surg. 2016;137(6):1759-70. doi:10.1097/PRS.0000000000002171

Hadj-moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery . Sex Med Rev . 2019;7(1):141-155. doi:10.1016/j.sxmr.2018.06.004

Dowshen NL, Christensen J, Gruschow SM. Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information . Transgend Health . 2019;4(1):131-135. doi:10.1089/trgh.2018.0055

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

Rights Group: More U.S. Companies Covering Cost of Gender Reassignment Surgery. CNS News. http://cnsnews.com/news/article/rights-group-more-us-companies-covering-cost-gender-reassignment-surgery

The Sex Change Capital of the US. CBS News. http://www.cbsnews.com/2100-3445_162-4423154.html

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

Find a Surgeon

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Gender Surgeons in United States

Learn about Surgeons in the U.S. who offer Male to Female (MTF) and Female to Male (FTM) procedures, also known as Gender Confirmation Surgery (GCS), Sex Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS).

Dr. Charles Garramone

Dr. Garramone is one of the most experienced Top Surgery surgeons in the world, having performed thousands of Top Surgery procedures since 2005. With Dr. Garramone, you won’t have to worry about what your Top Surgery results will look like. His FTM Top Surgery technique is sought after by thousands of patients for its consistent and predictable results.

Dr. Scott Mosser

Dr. Mosser is an award-winning surgeon in San Francisco who has been helping transgender and non-binary patients for more than 10 years. He is board-certified by the American Board of Plastic Surgeons, co-founder of the American Society of Gender Surgeons (ASGS), Medical Director of the Gender Institute at Saint Francis Memorial Hospital, a member of WPATH, and co-chair of the Surgery and Beyond professional conference. Dr. Mosser is California’s FTN / FTM Top Surgery and Breast Augmentation expert.

Dr. Drew Schnitt

Dr. Schnitt is a board certified cosmetic, plastic, reconstructive and craniofacial surgeon who has been practicing in South Florida since 2002. His experience in cosmetic and craniofacial surgery makes him an excellent choice for gender-affirming facial surgery, as well as Top Surgery, Breast Augmentation and Body Sculpting.

Dr. Daniel Crane

Dr. Crane is a plastic surgeon who joined Dr. Drew Schnitt’s Inspire Aesthetics in 2022, expanding access to gender-affirming surgical care in South Florida. After completing a highly specialized aesthetic surgery fellowship where he performed countless breast, body contouring and facial surgeries, Dr. Crane worked with Dr. Schnitt to refine his skills with Top Surgery and Facial Feminization. His broad training in plastic and aesthetic surgery provides him with the knowledge and experience to help you achieve your transition goals.

Dr. Daniel Jacobs

Dr. Jacobs is an award-winning and board-certified plastic surgeon in San Francisco who joined The Gender Confirmation Center in July, 2022. Dr. Jacobs has more than 30 years of plastic surgery experience and provides outstanding surgical care for transmasculine, transfeminine and non-binary patients.

Dr. Josef Hadeed

Dr. Hadeed is a board-certified surgeon who specializes in Transgender Surgery, including chest/breast procedures, facial surgeries and body sculpting for both trans men and women. Dr. Hadeed’s practice now has two locations: Beverly Hills, California and Miami, Florida.

Dr. Michelle Lee

Dr. Lee is a fellowship-trained and board-certified plastic surgeon with deep expertise in aesthetic and reconstructive procedures for the chest/breast and face. Based in Beverly Hills, California, Dr. Lee is as well-known for her surgical precision as she is for the compassion, care and understanding that she has for all of her patients. She has the skill and artistry to help produce the aesthetic goals that transgender and non-binary patients seek with Top Surgery, Breast Augmentation and Facial Gender Confirmation Surgery.

Dr. Russell Sassani

Dr. Sassani is a board certified plastic and reconstructive surgeon who performs chest procedures, facial surgeries and body sculpting for both trans men and women in Florida. With unanimous 5 star reviews from his trans male patients, Dr. Sassani has quickly become one of the most popular Top Surgery surgeons in the Southeastern United States.

Dr. Angela Rodriguez

Dr. Rodriguez is a board-certified plastic surgeon in San Francisco who is dedicated full time to providing surgical care for transgender patients. Dr. Rodriguez had 14 years of craniofacial, aesthetic and pediatric plastic surgery experience before becoming a Gender Surgeon. She has a special interest in Facial Feminization and is also highly proficient in Vaginoplasty and Top Surgery.

Dr. Daniel J. Freet

Dr. Freet leads a multidisciplinary team at the University of Texas that performs both male-to-female and female-to-male surgery procedures, including facial and chest surgeries as well as Vaginoplasty, Metoidioplasty and Phalloplasty. Dr. Freet accepts both insurance and Medicare.

Dr. Alvina Won

Dr. Won is a board-certified surgeon who is committed to providing the highest quality of care in a welcoming environment for all patients. Dr. Won gained significant experience with gender-affirming surgery during a year-long cosmetic surgery fellowship. Finding this work to be extremely gratifying and interesting, Dr. Won now devotes part of her practice to serving the transgender patient population. Based in Washington state, just north of Seattle, she offers Top Surgery, Breast and Buttock Augmentation, and Body Sculpting.

Dr. Gabriel Del Corral

Dr. Del Corral is a double board-certified plastic and reconstructive surgeon who offers Gender Affirmation Surgery at the MedStar Center for Gender Affirmation in Washington D.C. and Baltimore, Maryland. He is an Assistant Professor of Plastic Surgery at Medstar Georgetown University Hospital. Dr. Del Corral is fellowship trained in microsurgery, and has expertise in reconstructive surgery, maxillofacial surgery and cosmetic surgery. He specializes in gender-affirming procedures with a special focus on Vaginoplasty, Facial Feminization and Phalloplasty.

Dr. Praful Ramineni

Dr. Ramineni is a board-certified plastic and reconstructive surgeon with over 15 years of experience. Based in Washington, D.C., Dr. Ramineni performs upwards of 600 surgeries a year and has a specialization in Gender Affirmation Surgery. Recognized for his exceptional surgical skills and natural-looking results, Dr. Ramineni’s patients also praise his friendly, compassionate and professional nature.

Dr. Cassie Nghiem

Dr. Nghiem is an Ivy League-educated, fellowship-trained plastic surgeon in Washington, D.C. who specializes in transgender surgery, including Chest Masculinization and Breast Augmentation. She believes in a shared vision and works closely with her patients to deliver the best quality care that is in line with their needs. Known for her surgical skill and artistry, Dr. Nghiem’s patients also love her kind and caring demeanor.

Dr. Curtis Crane

Dr. Crane is a board-certified plastic surgeon who performs Gender Affirming Surgery procedures in Austin, Texas. Dr. Crane is one of only a few surgeons in the world who is trained as both a plastic surgeon and urologist and has also completed fellowships in reconstructive urology and gender reassignment surgery. He has been performing gender surgery since 2005.

Dr. Dany Hanna

Dr. Hanna is a Urologist and fellowship-trained Gender Surgeon who works exclusively with transgender and non-binary patients at the Hanna Gender Center in Dallas, Texas. He completed a yearlong fellowship in gender-affirming surgery and also trained with the renowned Dr. Miroslav Djordjevic in Belgrade, Serbia. Dr. Hanna specializes in Vaginoplasty and also offers Nullification, Metoidioplasty, Top Surgery and Breast Augmentation.

Dr. Thomas Satterwhite

Dr. Satterwhite is a board-certified Plastic and Craniofacial Surgeon in San Francisco who is dedicated to offering the highest level of surgical care to the transgender community. Dr. Satterwhite works exclusively with trans women, trans men and non-binary patients seeking Gender Confirmation procedures such as Vaginoplasty, Facial Feminization, and FTM Top Surgery.

Dr. Dev Gurjala

Dr. Gurjala joined Align Surgical Associates in 2019, after five years of performing gender surgery, microsurgery, and general reconstructive and aesthetic surgery in the Kaiser Permanente healthcare network. He works exclusively with trans women, trans men and non-binary patients seeking gender-affirming surgeries, including Phalloplasty, Vaginoplasty and Facial Feminization.

Dr. Lorelei Grunwaldt

Dr. Grunwaldt is a double board-certified plastic surgeon who is recognized as one of the best plastic surgeons in the Pittsburgh area due to her exceptional skills and compassionate bedside manner. Dr. Grunwaldt has helped countless transgender and non-binary adults and teens by providing a safe and caring atmosphere throughout their Top Surgery and Breast Augmentation journeys. She is honored to be able to share her surgical talents and be a trusted member of her patients’ transition team.

Dr. Michael Safir

Dr. Safir is a board-certified urologist in Los Angeles who specializes exclusively in gender-affirming bottom surgery procedures. With subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery, Dr. Safir is one of a handful of urologists in the world with individual fellowship training and experience in both male and female genital reconstruction. He gained extensive experience over five years performing genital surgeries at one of the highest volume gender surgery centers in the world and is now affiliated with Align Surgical Associates out of Los Angeles. Dr. Safir’s vast experience in urology has made him a popular choice among transgender people from across the U.S. seeking bottom surgery.

Dr. John Henry Pang

Dr. Pang is a double board-certified plastic and reconstructive surgeon who performs gender-affirming genital, face and chest reconstruction surgeries. In 2019, Dr. Pang completed the intensive Transgender Surgery Fellowship training program at Mount Sinai. Now an associate surgeon at Align Surgical in San Francisco, Dr. Pang’s practice is dedicated to providing specialized care to the transgender and gender-nonconforming communities.

Dr. Drew Marano

Dr. Marano is a highly skilled plastic and reconstructive surgeon in New York City specializing in Gender Affirmation Surgery. Dr. Marano is fellowship-trained in gender-affirming facial, chest and genital surgeries, including Phalloplasty and Vaginoplasty. He is passionate about gender-affirming care and committed to providing a comfortable and supportive environment for his patients.

Dr. Paul Steinwald

Dr. Steinwald has performed FTM Top Surgery hundreds of times, and he’s well-known for having pioneered the Inverted-T procedure. Dr. Steinwald has the most experience with Top Surgery than any other surgeon in Colorado. Body Feminization and Breast Augmentation are also offered for trans feminine folks.

Dr. Kenan Celtik

Dr. Celtik is a Reconstructive Urologist who has dedicated his practice to gender-affirming genital surgery. He is fellowship-trained in Gender Surgery and has received 15 years of advanced education from some of the most highly regarded academic hospitals in the United States. With his elite training, deep expertise in complex genitourinary reconstruction, and a strong commitment to excellence, Dr. Celtik is uniquely positioned as a Gender Surgeon.

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Debate on Nebraska gender-affirming care bill gets combative

FILE - State Sen. Machaela Cavanaugh speaks before the Nebraska Legislature on March 13, 2023, at the Nebraska State Capital in Lincoln, Neb. Cavanaugh had followed through on her vow in late February to filibuster every bill before the Legislature — even those she supported — before reaching an agreement to debate a bill that would ban gender-affirming treatment for minors in Nebraska. (AP Photo/Margery Beck, File)

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LINCOLN, Neb. (AP) — Debate that began Tuesday on a Nebraska bill to ban gender-affirming care for minors, which led one lawmaker to stage an epic weekslong filibuster, quickly grew contentious, with supporters and opponents angrily voicing their frustration and admonishing each other for a lack of collegiality.

Sen. John Lowe, of Kearney, cited an activist group’s claim that gender dysphoria in youth “is just temporary,” while Sen. Brad von Gillern, of Omaha, compared gender-affirming treatment to shock treatments, lobotomies and forced sterilizations of years’ past. Bellevue Sen. Carol Blood countered that if lawmakers really cared about medical procedures affecting children, “how come we’re not talking about circumcision?”

And that was only the first three hours of an eight-hour Senate debate expected to stretch into Thursday.

The bill introduced by Republican Sen. Kathleen Kauth, a freshman lawmaker in the officially-nonpartisan state Legislature, would outlaw gender-affirming therapies such as hormone treatments, puberty blockers and gender reassignment surgery for those 18 and younger.

The proposal had already caused tumult in the legislative session, cited as the genesis of a nearly three-week filibuster carried out by Omaha Sen. Machaela Cavanaugh over her opposition. Cavanaugh had followed through on her vow in late February to filibuster every bill before the Legislature — even those she supported — declaring she would “burn the session to the ground over this bill.”

She stuck with it until an agreement was reached late last week to push the bill to the front of the debate queue. Instead of trying to eat time to keep the bill from getting to the floor, Cavanaugh decided she wanted a vote to put on the record of which lawmakers would “legislate hate against children.”

Lawmakers convened Tuesday to begin that debate with the understanding that the bill didn’t have enough votes to break a filibuster. But Kauth introduced an amendment to drop the restriction on hormone treatments, instead banning only gender reassignment surgery for minors. That amendment, she said, does have enough votes to advance.

Cavanaugh has said if the bill advances on a vote expected Thursday, she will resume filibustering every bill through the end of the 90-day session in early June.

The hard feelings by lawmakers on both sides of the bill emerged almost immediately Tuesday, with Kauth calling Cavanaugh’s filibuster “self-serving and childish.” Kauth said the purpose of her bill is to protect youth from undertaking gender-affirming treatments they might later regret as adults, citing research that says adolescents’ brains aren’t fully developed.

Omaha Sen. Megan Hunt called out that argument as hypocritical, noting that Kauth supports an abortion ban bill introduced this session that would also affect adolescents.

“In a couple of weeks, she’s going to turn around and vote for a bill that would force 12-year-olds to have a baby,” Hunt said. “She thinks they’re mature enough for that.”

Cavanaugh called the trans treatment bill “an assault on individuals that members of this body love,” and appealed to Republican members of the body to get back to their core principles of getting government out of people’s lives.

“So many of you have talked to me about government overreach time and time again,” she said. “This bill stands in opposition to the tenets that many of you have expressed to me are the foundation of why you are here.”

The Nebraska bill, along with another that would ban trans people from using bathrooms and locker rooms or playing on sports teams that don’t align with the gender listed on their birth certificates, are among roughly 150 bills targeting transgender people that have been introduced in state legislatures this year.

Bans on gender-affirming care for minors have already been enacted this year in some Republican-led states, including South Dakota , Utah and Mississippi . Arkansas and Alabama have bans that were temporarily blocked by federal judges. Other states legislatures have given final approval to measures similar to the Nebraska bill, with Georgia sending to the governor Tuesday a bill that would ban most gender-affirming surgeries and hormone replacement therapies for transgender minors.

The Gender Reassignment Controversy

When people opt for surgery, are they satisfied with the outcome.

Posted March 16, 2018 | Reviewed by Ekua Hagan

In an age of increasing gender fluidity, it is surprising that so many find it difficult to accept the gender of their birth and take the drastic step of changing it through surgery. What are their motives? Are they satisfied with the outcome?

Gender may be the most important dimension of human variation, whether that is either desirable, or inevitable. In every society, male and female children are raised differently and acquire different expectations, and aspirations, for their work lives, emotional experiences, and leisure pursuits.

These differences may be shaped by how children are raised but gender reassignment, even early in life, is difficult, and problematic. Reassignment in adulthood is even more difficult.

Such efforts are of interest not just for medical reasons but also for the light they shed on gender differences.

The first effort at reassignment, by John Money, involved David Reimer whose penis was accidentally damaged at eight months due to a botched circumcision.

The Money Perspective

Money believed that while children are mostly born with unambiguous genitalia, their gender identity is neutral. He felt that which gender a child identifies with is determined primarily by how parents treat it and that parental views are shaped by the appearance of the genitals.

Accordingly, Money advised the parents to have the child surgically altered to resemble a female and raise it as “Brenda.” For many years, Money claimed that the reassignment had been a complete success. Such was his influence as a well-known Johns Hopkins gender researcher that his views came to be widely accepted by scholars and the general public.

Unfortunately for Brenda, the outcome was far from happy. When he was 14, Reimer began the process of reassignment to being a male. As an adult, he married a woman but depression and drug abuse ensued, culminating in suicide at the age of 38 (1).

Money's ideas about gender identity were forcefully challenged by Paul McHugh (2), a leading psychiatrist at the same institution as Money. The brunt of this challenge came from an analysis of gender reassignment cases in terms of both motivation and outcomes.

Adult Reassignment Surgery Motivation

Why do people (predominantly men) seek surgical reassignment (as a woman)? In a controversial take, McHugh argued that there are two main motives.

In one category fall homosexual men who are morally uncomfortable about their orientation and see reassignment as a way of solving the problem. If they are actually women, sexual interactions with men get redefined as heterosexual.

McHugh argued that many of the others seeking reassignment are cross-dressers. These are heterosexual men who derive sexual pleasure from wearing women's clothing. According to McHugh, surgery is the logical extreme of identifying with a female identity through cross-dressing.

If his thesis is correct, McHugh denies that reassignment surgery is ever either medically necessary or ethically defensible. He feels that the surgeon is merely cooperating with delusional thinking. It is analogous to providing liposuction treatment for an anorexic who is extremely slender but believes themselves to be overweight.

To bolster his case, McHugh looked at the clinical outcomes for gender reassignment surgeries.

Adult Reassignment Results

Anecdotally, the first hurdle for reassignment is how the result is perceived by others. This problem is familiar to anyone who looked at Dustin Hoffman's depiction of a woman ( Tootsie ). Diligent as the actor was in his preparation, his character looked masculine.

For male-to-female transsexuals, the toughest audience to convince is women. As McHugh reported, one of his female colleagues said: “Gals know gals, and that's a guy.”

According to McHugh, although transsexuals did not regret their surgery, there were little or no psychological benefits:

“They had much the same problems with relationships, work, and emotions, as before. The hope that they would emerge now from their emotional difficulties to flourish psychologically had not been fulfilled (2)”.

Thanks to McHugh's influence, gender reassignment surgeries were halted at Johns Hopkins. The surgeries were resumed, however, and are now carried out in many hospitals here and around the world.

What changed? One likely influence was the rise of the gay rights movement that now includes transgender people under its umbrella and has made many political strides in work and family.

McHugh's views are associated with the religious right-wing that has lost ground in this area.

Transgender surgery is now covered by medical insurance reflecting more positive views of the psychological benefits.

Aspirational Surgery

Why do people who are born as males want to be women? Why do females want to be men? There seems to be no easy biological explanation for the transgender phenomenon (2).

Transgender people commonly report a lifelong sense that they feel different from their biological category and express satisfaction after surgery (now called gender affirmation) that permits them to be who they really are.

The motivation for surgical change is thus aspirational rather than medical, as is true of most cosmetic surgery also. Following surgery, patients report lower gender dysphoria and improved sexual relationships (3).

All surgeries have potential costs, however. According to a Swedish study of 324 patients (3, 41 percent of whom were born female) surgery was associated with “considerably higher risks for mortality, suicidal behavior, and psychiatric morbidity than the general population.”

1 Blumberg, M. S. (2005). Basic instinct: The genesis of behavior. New York: Thunder's Mouth Press.

2 McHugh, P. R. (1995). Witches, multiple personalities, and other psychiatric artifacts. Nature Medicine, 1, 110-114.

3 Dhejne, S., Lichtenstein, P., Boman, M., et al. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study of Sweden . Plos One.

Nigel Barber, Ph.D., is an evolutionary psychologist as well as the author of Why Parents Matter and The Science of Romance , among other books.

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Woman sues doctors who she says rushed her into gender surgery at 16

This is the 5th lawsuit of its kind.

By Gitanjali Poonia

Luka Hein, 21, is suing her health providers in Nebraska over the medical transition performed in her childhood.

The medical professionals at the University of Nebraska Medical Center rushed 16-year-old Hein into getting a double mastectomy after two visits to the gender clinic and didn’t offer her counseling or prescribe hormone therapy, the complaint alleges.

“I was going through the darkest and most chaotic time in my life, and instead of being given the help I needed, these doctors affirmed that chaos into reality,” Hein, who has since detransitioned, said in a press release .

This is the fifth lawsuit of its kind. The Center for American Liberty is representing Hein and two other women, Chloe Cole  and  Layla Jane , while Campbell Miller Payne began representing Prisha Mosley and Soren Aldaco in April this year. These women transitioned as young girls and have opted to reverse their surgeries, like Hein.

In recent years, detransitioning has become a part of the public discourse around gender reassignment procedures, especially for minors. Some advocates say the conversation around detransitioning portrays it “as much more common than it actually is, fueling misconceptions about the gender transition process and painting trans people as just temporarily confused or suffering from a misdiagnosed psychological disorder,” according to NBC News .

At least 19 states in the country have restricted minors from accessing gender reassignment surgery.

Utah was the first state to ban transgender surgeries for minors in January. At the time, Marina Lowe, the policy director at Utah’s LGBTQ advocacy group Equality Utah, said the bill is “essentially a ban on access to medical care for transgender youth,” as the Deseret News reported .

“Everywhere where one has been passed, there is litigation because it’s the government stepping in between parents and children and their doctors,” Lowe said.

A Reuters report that analyzed private and public health insurance data between 2017 and 2021 found that the diagnoses for gender dysphoria nearly tripled in the U.S., as more than 14,000 minors began taking hormones. A majority of diagnoses were made in female patients.

A study in The BMJ , a peer-reviewed medical journal, found that existing research and guidance about gender transitions focuses on initiating treatment rather than reversing it — something that the World Professional Association of Transgender Heath considers should be equally important .

“There’s a real need for more long-term studies that track patients for five years or longer,”  Dr. Kinnon MacKinnon, a gender studies professor at York University, told Reuters in 2022. “Many detransitioners talk about feeling good during the first few years of their transition. After that, they may experience regret.”

Shifts in identity may occur following transition, but these outcomes don’t represent the majority, the BMJ study said.

Sweden passes law to make it easier to change legal gender

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Some US troops set to depart Chad, at least temporarily

The United States is planning to temporarily withdraw some of its troops from Chad, U.S. officials said on Thursday, a move that comes just days after Washington was forced to agree to remove its troops from neighboring Niger.