As a 43 transgender woman who began developing intersex traits in adolescence and began medical treatment at age 23, I began studying the effects of hormones and contemplating the spiritual implications of undergoing medical treatment decades before this topic entered state and national politics. I was raised as a Christian and was taught that the thoughts I was having were the result of sin as opposed to biology, which made coming to terms with such a heavy decision a years-long process combining personal reflection, prayer, and research.

This policy is the culmination of that lifetime of experience, combined with my strong objection to how both politics and religion have mishandled this subject. Too often, the debate has been reduced to two extremes: either unrestricted medical intervention for children, or defamation and rights violations against transgender people. Neither approach serves us.

For years, voices like mine—adult transgender women with lived experience—have been excluded from this conversation. That absence has led to misrepresentation, even by allies, and left us vulnerable to political backlash from platforms crafted without our necessary input.

This proposal is grounded in personal experience, scientific evidence, and constitutional reasoning. It affirms youth while safeguarding long-term autonomy by establishing age 16 as the minimum for irreversible medical interventions—except in rare cases involving medically verified intersex traits.

I want to begin by expressing deep gratitude to everyone who has advocated for transgender safety and dignity—especially those who risked reputations and careers to do so. But I also urge my allies to carefully consider what I’m presenting here, because crucial facts which have not entered into the public conversation very much need to be brought into the debate.

To Democrats: many in the party mean well, but when our voices are excluded, even good intentions can cause harm.

To Republicans: I urge you to recall the spirit of Abraham Lincoln and the early Republican movement, which was built on protecting minorities—particularly Black Americans—with compassion and conviction. The politicians your party has put forth in recent years, I believe, have strayed far from those foundational principles. The defamation and callous disregard directed at transgender women—the deliberate incitement of harassment against a small minority already facing immense challenges—are reckless, unjustifiable, and demand restitution as well as remorse. If you would like to engage in respectful discussion on this topic, or help support my campaign, I welcome the dialogue: SondraWilson4Governor@gmail.com.

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Why This Policy Is Needed
Lessons From Jazz Jennings and Dr. Marci Bowers

Caution: This section contains graphic medical information about surgical procedures and complications, which may not be suitable for all readers.

Jazz Jennings, one of the most visible transgender youth in America, grew up starring on the reality TV show I Am Jazz. Her story illustrates a critical medical and developmental principle: allowing nerves and tissue to mature before irreversible interventions can significantly affect long-term outcomes.

At age 11, Jazz began puberty blockers. By the time she sought gender-affirming surgery at 17, her surgeon, Dr. Marci Bowers, found that early suppression had left insufficient genital tissue to complete the procedure safely. Surgeons substituted abdominal tissue, leading to multiple corrective surgeries and reduced sensation (Corinthios, 2020; Delott, 2019; Jennings, 2025).

Dr. Bowers—a preeminent gender surgeon, trans woman, and current President of WPATH—has since publicly stated:

“My concerns regarding puberty blockade and its negative impact upon later genital surgery remain and are not allayed by new techniques of vaginoplasty including peritoneal pull through. Complications and challenges for these patients are without a doubt, increased.” (Bowers, n.d., para. 3)

Genital tissue, unlike abdominal skin, contains dense networks of sensory nerve endings that are essential for long-term sexual function and quality of life (Gray & Mann, 2024). When surgeons must substitute abdominal or intestinal tissue, outcomes often involve reduced sensation and higher complication rates (Regenexx, 2019; UpToDate, 2024).

Jazz’s experience is not unique; it reflects a broader medical reality. Early puberty suppression can limit surgical options, increase the likelihood of corrective procedures, and lead to suboptimal results. Research confirms that preserving genital tissue into mid-adolescence improves surgical outcomes and erogenous sensation compared with abdominal “pull-through” methods (Gray & Mann, 2024; Remy et al., 2024).

This experience underscores the rationale for waiting until at least age 16 before administering hormone replacement therapy. By mid-adolescence, young people have more physical maturity, expanded surgical options, and greater legal autonomy—translating into more choices, less risk, and better long-term results.

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Erring On the Side of Caution

I understand the urgency many youth feel about their identities and bodies—I have lived that urgency myself—but it must be balanced with wisdom. Even if only a small percentage later regret irreversible medical decisions, their experiences carry immense weight. Grounding protections in evidence, empathy, and constitutional safeguards ensures every trans youth’s path is shaped by safety, dignity, and the best possible future.

The reality is that most 12- and 14-year-olds cannot fully imagine what life will feel like decades down the road. Decisions made in adolescence can shape an entire lifetime. Too often, though, the political battles over youth transition have sidelined adult transgender women’s voices—the very people who live with the long-term outcomes. As a result, laws have been written about us, without us, and we’ve borne the harm. My goal is to change that by building protections grounded in evidence, empathy, and constitutional principle.

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A Final Thought Before We Dig Into My Rationale for the Policy

Before we turn to the details of this proposal, I want to remind readers that my campaign is built on a comprehensive platform designed to uplift all Iowans and strengthen every part of our economy.

As a transgender woman, I have endured harassment, physical attacks, sexual assault, poverty, and systemic violence. Yet I remain hopeful that through humanitarian work, Iowans—and eventually humanity—will reevaluate how transgender people are seen and treated. I know that deeply held religious views persist, and that some cultures and states would prefer we not exist at all. In the midst of this, I am grateful to live in a country where I can stand up for what I believe, try to make a difference, and even run for public office. Sincerely, thank you, Veterans.

My campaign is not centered on identity politics; it is grounded in humanitarian vision. My Christian upbringing remains part of who I am: it informs a platform that helps the homeless, feeds the hungry, and heals the sick, while also addressing environmental concerns in ways that create jobs and grow our GDP.

It is my hope that after I am gone—or preferably long before—people will see that what I am trying to do is not simply political, but humanitarian. I want this campaign to touch hearts and help change the world. Deep down, that is what drives me. I do not want other LGBTQ+ people to suffer as I have, and I have dedicated my life to using my gifts to help all people. Although I firmly believe in the separation of church and state, I also believe this work is my calling.

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Evidence-Based Medical Rationale

APA Framework: The American Psychiatric Association recognizes gender dysphoria as a real and serious condition that deserves compassionate, evidence-based care. This policy aligns with the APA’s framework while placing constitutional and medical safeguards on timing and irreversibility.

Sexual Function & Sensation: Genital tissue contains highly sensitive nerve endings. Preserving this tissue into mid-adolescence significantly improves the chances of maintaining long-term sexual function.

Surgical Options: If puberty is halted too early, there may not be enough tissue for certain procedures. In those cases, surgeons must turn to alternatives (like intestinal tissue), which carry higher complication rates and reduced sensation.

Overall Outcomes: Waiting until at least 16 allows for better surgical results, reduced medical risks, and decisions made with greater mental and legal maturity.

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Minimum Age and Constitutional Rationale

Minimum Age: 16 years old
Rare Exceptions: Age 14 in medically necessary cases involving intersex traits
Override Provision: Below age 14 only in severe intersex cases, with doctor and parental discretion, supported by independent medical and legal review

Legal Basis: This policy is grounded in due process, equal protection, and bodily integrity under Iowa law (Iowa Code §§613.16; 599.1–2) and the U.S. Constitution. The minimum age floor is non-negotiable; it cannot be overridden by advocacy, political pressure, or reinterpretation of community feedback.

Non-Negotiable Legal Protections: The minimum age of 16 for hormone therapy, and the strict, medically verified exceptions for intersex traits, are fixed. These may not be altered by constitutional review, shifting medical consensus, or community feedback. Only procedural refinements (documentation, review processes, educational materials) may evolve.

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Medical Requirements

• Persistent, well-documented gender dysphoria, in line with APA diagnostic standards

• Independent mental health evaluation

• Parental involvement with legal and medical safeguards

Definition Clause: “Intersex traits” refer to medically verifiable conditions involving atypical chromosomal, gonadal, or anatomical sex development. Exceptions must not be used to circumvent age thresholds based solely on gender identity.

Iterative Clause (procedural only): Policy procedures—documentation, review processes, and educational materials—may be refined through constitutional review, medical consensus, and community feedback. These refinements cannot alter the minimum age of 16 or the strict exception framework.

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Why Not Younger?

While puberty blockers may offer temporary relief (de Vries et al., 2011), they are not equivalent to hormone therapy. The latter involves permanent physiological changes and lifelong medical oversight.

Children under 16 may not fully grasp the long-term impacts on fertility, sexual function, or lifelong medical needs. Parents play a critical role in providing guidance without exerting pressure either way. Even at 16, youth require careful counseling about the lifelong implications, and hormone therapy should generally be avoided if gender dysphoria has only recently appeared. Medical science now provides the tools to help young adults make informed decisions while minimizing unnecessary risks.

“If young people are mature enough to make life-altering decisions, they’re mature enough to understand the value of waiting. Patience isn’t punishment—it’s protection.”

— Sondra Wilson

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Why Not Wait Until 18?

Whenever possible, waiting until 18 is ideal. Altering natural hormone levels is a serious, permanent decision that demands medical justification and thoughtful reflection. That said, for youth experiencing persistent, long-term dysphoria, delaying care until adulthood can allow irreversible physical changes to occur, which may intensify lifelong distress. Evidence shows that starting hormone therapy after age 16 is associated with lower rates of depression and suicidality among trans adults (Turban et al., 2020). This policy seeks to balance early support with protective caution—offering timely care while safeguarding long-term health and well-being.

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Addressing Common Concerns

Concern: “Puberty blockers are completely reversible.”

Response: The assertion that puberty blockers are “completely reversible” is medically misleading and oversimplifies the long-term physiological consequences of prolonged suppression. While puberty may resume upon cessation of blockers, the developmental trajectory does not rewind. Years of halted gonadal, neurological, and skeletal maturation cannot be recovered in full. The body does not reinitiate puberty as if those years had not passed—it compresses or bypasses key stages, often with lasting effects.

Prolonged suppression has been shown to:

• Reduce genital tissue development, which can limit surgical options and increase reliance on abdominal or intestinal tissue for vaginoplasty—tissue that lacks the sensory nerve density of native genital structures, resulting in diminished erogenous sensation and sexual function (van de Grift et al., 2020; Gray & Mann, 2024).
• Impair bone mineral density, with long-term risks for skeletal health (Klink et al., 2015; Staphorsius et al., 2015).
• Alter neurological maturation, including executive function and emotional regulation, with insufficient data to confirm reversibility (Chew et al., 2021).
• Delay or distort sexual development, affecting reproductive capacity and lifelong intimacy outcomes (Remy et al., 2024).

Even the Mayo Clinic (2023) notes that while puberty blockers halt secondary sex characteristics, they do not guarantee full restoration of physical or neurological development. The Endocrine Society (2022) acknowledges these effects but continues to use the term “reversible,” despite mounting evidence that the reversibility is partial at best and context-dependent.

To describe puberty blockers as “completely reversible” is not only scientifically inaccurate—it risks misleading families, clinicians, and policymakers into underestimating the long-term implications of early medical intervention. This language should be reconsidered in all clinical and policy contexts.

Concern: “Just wait until 18.”

Response: Waiting risks irreversible physical changes causing lifelong dysphoria.

Concern: “Youth aren’t mature enough to decide.”

Response: If young people are mature enough to make life-altering decisions, they’re mature enough to wait a little longer. Patience isn’t punishment—it’s protection.

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Why This Policy Matters

This is not a denial of identity—it is a safeguard for long-term autonomy and safety. By protecting youth under 16 and ensuring that interventions occur only when legal and medical thresholds are met, we uphold constitutional principles while promoting mental and physical well-being.

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Related Policy: Schools to Remain Neutral, Bully-Free Learning Environments

Policy Disclaimer

This document is a constitutional policy proposal authored by Sondra Wilson, independent candidate for Iowa Governor 2026. It is intended for public education, civic dialogue, and legislative consideration. It does not constitute medical advice, legal counsel, or enforceable law.

All medical references are based on publicly available research and case studies as of August 2025. Readers are encouraged to consult qualified professionals for individualized guidance.

The age thresholds and exception clauses outlined herein are grounded in Iowa Code §§613.16 and 599.1–2, and reflect constitutional principles of due process, equal protection, and bodily integrity. These thresholds are non-negotiable and may not be altered by reinterpretation, advocacy, or community feedback. Only procedural elements—such as documentation formats, review protocols, and educational materials—may evolve through iterative refinement.

This policy is protected under the First Amendment and may be cited, critiqued, or republished with attribution. Feedback is welcome and may inform future procedural updates, but shall not override the fixed age protections or legal safeguards.

Contact: 📬 SondraWilson4Governor@gmail.com