I'm very happy to see you making distinctions between surgeries, drugs, and talk therapy!
I always have. Europe is generally quite stringent about the requirements for having sex-reassigning hormone therapy and surgery for individuals younger than 18, but more than one European country allows people to change their gender in official documents without even needing a medical diagnosis or sex reassignment. (Whether I agree with this is a separate topic, and it's also unrelated here.)
What is happening in the US with the bans targeting gender-affirming care goes well beyond medically sound stringency. Banning non-invasive interventions seems to me rooted in a theocratic and overly socially authoritarian, anti-scientific political inclination, not medical concerns. There's also the hyperbole of trying to dismiss all gender-affirming care as "child mutilation" or "castration" even though a lot of it—most of it that's recommended for children by medical guidelines—is neither surgical nor irreversible.
In many cases, one of the ways of ensuring there's no need for surgery, hormone therapy, or any other irreversible physical intervention until a minor diagnosed with gender dysphoria reaches adulthood is to let them live as a member of their identified gender wherever and whenever possible. How many of those who want to ban gender-affirming care do you think would be willing to accept this entirely non-surgical, reversible, and medically approved course of action? How many of them even acknowledge that not all people fit into a gender binary?
I do have a side question though, and I think it's quite relevant: In this discussion how are we defining "gender" and "sex"? I ask because I think the phrase "gender affirming" is logically incoherent with what it means. It seems to actually mean "sex change", correct?
The excerpts below mostly match how I'm defining "gender" and "sex," with the clarification that I believe there's an overlap between biological sex and gender. How much of gender expression comes down to nature versus nurture is a different question, though. I think it could be about 30% to 70% or 35% to 65%, respectively, although that's a very rough estimate that could be off by a bit. Still, I definitely believe there's a biological component to gender, in addition to the sociological one.
Sex' and 'gender' are often used interchangeably, despite having different meanings:
Sex refers to a set of biological attributes in humans and animals. It is primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex is usually categorized as female or male but there is variation in the biological attributes that comprise sex and how those attributes are expressed.
Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender identity is not confined to a binary (girl/woman, boy/man) nor is it static; it exists along a continuum and can change over time. There is considerable diversity in how individuals and groups understand, experience and express gender through the roles they take on, the expectations placed on them, relations with others and the complex ways that gender is institutionalized in society.
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cihr-irsc.gc.ca
Gender-affirming care doesn't always have to do with changing sex, no. Usually, it includes thorough evaluation of a person to assess whether they meet diagnostic criteria for gender dysphoria, social support for them if they do, and talk therapy that addresses any sociologically challenging conditions they may be facing due to their gender identity. Sex reassignment surgery and hormone therapy are only a subset of gender-affirming care in some cases.