Why We Should Stop Comparing "Sex Changes" to Tattoos

Tattoos don't leave 18 year olds sterilized, shave years off their lifespan, or increase suicidality while being championed as "medically necessary, life-saving care"

As someone who has spent about a year advocating to expose the malicious practices of gender medicine and the harms of transgender ideology, I often hear the following sentiment:“if you have to be 18 to get a tattoo, you should have to be 18 to ‘change’ your gender.” This phrase has been uttered so often that it has become a thought-terminating cliche.

Most Americans agree that “sex changes” for minor children should be off the table. However, the question of how to handle the issue of gender transition for adults, especially for those under 25, seems to perplex just about everyone. Even though the culture war has exposed so many Americans to the lack of evidence underpinning the efficacy of ‘gender affirming care’ for resolving symptoms of gender dysphoria, while having robust evidence that risks to long-term physical and mental health are severe (both for kids and for adults)- so many are satisfied to use libertarian frameworks to understand the issue of adult transition.

One common argument made in favor of legal and unrestricted access to gender transition procedures is that if legal adults are allowed to get tattoos, they should also be allowed to undergo “gender-affirming” surgeries and hormone treatments. This argument is based upon a libertarian worldview, aimed at minimizing government intervention so as to maximize individual rights, and it goes a little something like: if people can modify their bodies through tattoos, piercings, or plastic surgery, why should gender transition be treated any differently?

I see the comparison between 18 year olds getting tattoos and 18 year olds getting “sex changes” as a deeply flawed one. The irreversible and medically complex nature of gender transition, the poor patient outcomes of many of those who undergo these procedures, the ideological capture of medicine, and the broader societal consequences of promoting medical transition all make it clear that "sex changes" are not even remotely comparable to getting a tattoo.

Here are just a few reasons why we should stop making this comparison:

1. Tattoos Do Not Alter Biological Function or Require Lifelong Medical Maintenance

One of the most obvious reasons gender transition should not be compared to tattoos is that tattoos are purely cosmetic and do not require lifelong medical intervention. A tattoo does not alter a person's hormones, disrupt bodily functions, or require ongoing pharmaceutical dependence. In contrast, gender transition involves hormone therapy, surgeries, and other interventions that have permanent effects on bodily function.

For individuals undergoing medical transition, the use of cross-sex hormones often results in irreversible changes such as sterility, loss of sexual function, osteoporosis, cardiovascular risks, and other long-term health complications. Additionally, many transgender-identifying individuals who undergo gender transition surgeries such as mastectomies, vaginoplasties, and phalloplasties face lifelong medical complications, including infections, nerve damage, and painful scarring. Despite the activist-clinical claim that gender transition body modifications are suicide prevention, a Swedish study has shown that rates of suicidality actually increase following sex-reassignment procedures¹. None of these risks apply to tattoos.

While tattoos may fade, stretch, or require touch-ups, they do not fundamentally alter a person’s biological function or require an ongoing relationship with the medical industry. Gender transition, on the other hand, by design creates a state of permanent medical dependency that requires regular hormone treatments, surgeries, and post-operative care for life. Gender medicine sees endless interventions in pursuit of a desired aesthetic outcome to be the best treatment protocol for resolving psychological distress, regardless of how many bodily functions must be sacrificed in order to achieve this goal. Tattoo parlors know they are doing a cosmetic body modification for the sake of the cosmetic body modification, without calling it “suicide prevention.”

2. Tattoos Do Not Cause High Rates of Regret Leading to Further, More Dangerous Medical Reversal Attempts

Another major flaw in the tattoo-transition comparison is that tattoos have a relatively low rate of regret compared to gender transition. Studies on tattoo regret indicate that while some individuals eventually choose to have their tattoos removed, the vast majority of tattooed people do not experience deep psychological distress over their decision². Tattoo removal is also a relatively simple and increasingly effective procedure, with no significant long-term health consequences.

By contrast, studies have shown that a significant portion of individuals who medically transition experience regret, often after realizing that their gender dysphoria was linked to underlying mental health issues, trauma, or social influences. The rise of detransitioners—individuals who regret their transition and attempt to restore their biological sex—demonstrates that many people are being funneled into irreversible medical interventions without fully understanding the consequences.

The process of detransitioning is not even remotely as simple as tattoo removal. Individuals who have undergone hormonal or surgical interventions may face permanent damage, including sterility, loss of natural hormone function, and irreversible changes to their bodies. Even breast binding and genital tucking, which appear on the surface to be easily reversible ‘gender affirming care’ interventions, carry risks of significant, permanent damage to the body.

Many detransitioners report significant distress³ at the realization that they cannot fully regain their pre-transition physiology. Unlike a tattoo, which can often be removed with laser treatment, the effects of gender transition are not so easily reversed.

3. Unlike Tattoos, the Medical Industry Promotes Gender Transition Body Modifications as ‘Healthcare’

The decision to get a tattoo is typically made freely, without institutional or ideological pressure. Tattoo parlors do not engage in psychological evaluations, recruit clients through activist organizations, or frame tattoos as a medically necessary intervention to prevent suicide. By contrast, gender transition is heavily promoted by the medical industry, activist groups, and political organizations, often targeting young and vulnerable individuals⁴.

Hospitals and clinics across the U.S. actively advertise gender-affirming treatments as “life-saving care,” despite the lack of long-term studies proving their efficacy in treating gender dysphoria⁵. Activist organizations push the narrative that transition is the only solution for gender-distressed individuals, by actively suppressing alternative treatments such as psychotherapy. Additionally, individuals seeking gender transition are often given fast-tracked access to hormones and surgeries without meaningful medical oversight—a stark contrast to the process of obtaining a tattoo.

In the case of tattoos, reputable artists often warn clients about tattoo placement, long-term implications, and potential regret. In gender medicine, by contrast, doctors, activists, and medical organizations suppress discussions of regret, complications, and alternative treatments, effectively steering individuals toward transition rather than allowing them to make a fully informed decision.

4. Gender Transition Has Broader Societal Implications

Another key distinction between tattoos and gender transition, is that gender transition does not just affect the individual—it has significant consequences for society as a whole. Tattoos are a personal aesthetic choice with no impact on legal definitions, sex-based rights, or medical policy. Gender transition as a medical practice, on the other hand, directly affects laws, language, and the way society is structured.

The widespread normalization of gender transition has led to policy changes in schools, workplaces, prisons, and public accommodations, often forcing institutions to redefine sex-based categories in ways that disadvantage biological women. The inclusion of trans-identified males in women’s sports, shelters, and medical research has created significant conflicts that do not exist in the realm of tattoo culture.

Additionally, the rise of gender transition requests—particularly among adolescent girls and young adults—suggests that gender transition is not simply a matter of individual choice but a broader cultural trend that influences vulnerable people in ways tattoos do not⁶. While people do sometimes make impulsive decisions about tattoos, there is no widespread movement pushing minors or young adults toward full-body tattooing under the claim that it will save their lives. Gender transition, however, is frequently framed as a necessity for youth, with activists promoting medical intervention as the only treatment option for the psychological issue of gender distress.

5. Pediatric Transition Only Exists Because of Poor Outcomes for Adult Transitioners

An often-overlooked reason gender transition cannot be compared to tattoos is the fact that the industry of gender medicine, has itself only expanded to children due to the poor outcomes seen in adult transitioners⁷. The original Dutch clinicians who pioneered the gender-affirming, medicalized model as a treatment for ‘gender incongruence’ began intervening in children’s bodies not because transition had a strong success rate in adults, but because adults who transitioned later in life often had poor outcomes, regret, and persistent distress⁸. The Dutch approach assumed that by transitioning children earlier—before male puberty had permanently shaped their bodies—better aesthetic outcomes could be achieved, which the Dutch clinicians assumed would lead to better quality of life outcomes.

However, this model was never based on large-scale, long-term research, and it ignored the reality that most children with gender dysphoria would have naturally outgrown their distress without medical intervention⁹. Instead of concluding that transition itself may not be the correct solution for gender dysphoria, clinicians pushed the process to younger and younger ages¹⁰, effectively experimenting on children in the hopes that early intervention would reduce regret. In other words, when the adult transition experiment failed to make their patients better, Dutch clinicians began experimenting on kids.

This historical progression further illustrates why transition cannot be compared to tattoos. The fact that medical transition was moved to younger age groups due to poor outcomes in adults proves that it is not a straightforward, freely made choice, but rather, a medicalized life trajectory built on uncertainty, trial-and-error, and ideological motivations of activists rather than on sound science. Tattoos have never required such justification, nor have they been moved from an adult-only space to minors in a desperate attempt to correct for the flaws of one experiment, with an even more invasive experiment done at younger ages.

Tattoos and Gender Transition Are Not Comparable, So Why Are We Comparing Them?

The perspectives of those who are critical of pediatric transition have successfully pervaded the zeitgeist because of the culture war. The culture war approach was necessary in order to mobilize the public to elect leaders who are hell-bent on ending medical brutality of minor children. However, one major downside of this ‘culture war’ approach is that many people fail to think critically about the nature of this phenomenon for what it actually is; not merely a set of body modifications, but a medical ethics disaster that carries complex social and legal consequences for all of society.

The comparison between tattoos and gender transition falls apart under the slightest bit of scrutiny. Tattoos are a cosmetic, non-medical, and low-risk form of body modification that can be removed or covered up with minimal impact on physical health. Gender transition, by contrast, involves invasive medical procedures, lifelong pharmaceutical dependence, high rates of regret, and significant physical risks that cannot be easily undone, or undone in any capacity.

Furthermore, the systemic pressure pushing individuals toward transition, the lack of informed consent, and the wider societal consequences of normalizing medical transition make it clear that this is not just a matter of individual choice. Tattoos exist purely within a framework of personal self-expression, whereas gender transition has become an institutionally enshrined and ideologically driven movement with profound social and medical implications.

Ultimately, the argument that “if people can get tattoos, they should be able to transition” ignores the complexity, risk, and irreversible nature of gender medicine. While libertarian arguments about bodily autonomy may apply to tattoos, they fail to account for the broader consequences of medical transition. Given the lack of long-term evidence supporting transition’s benefits, the rising number of detransitioners, and the medical industry's complicity in pushing demonstrably harmful interventions despite a stunning lack of evidence, it is clear that gender transition should not be treated as a simple cosmetic choice on par with getting inked.

Libertarian frameworks will never adequately solve for the complex interactions of society with techno-medicine and political activism. While the culture war got us to the position that medical transition for minors is severely restricted, we must understand that the issue of adult transition being treated as something which is best addressed with libertarian logics as opposed to through the logic of medical ethics is a downside of letting the culture war dictate our policies.

Knowing that gender transition is nothing like a tattoo, either in the extent to which it is actually an freely-made, informed individual decision, or in the realm of the lifelong medical consequences which result from the said body modification— we must at the very least drop the pretense that the many social and ethical problems which have resulted from scandalous medicine (turned into a full blown medical scandal)- will be resolved by treating the issue of adult transition as if it were anything like an adult getting a tattoo.

1. Dhejne, C., et al. (2011). Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLOS ONE, 6(2), e16885.

2. Kluger, N. (2020). Tattooing and Tattoo Regret: Clinical and Epidemiological Aspects. Current Problems in Dermatology, 54, 1-16.

3. Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior, 50, 3353–3369.

4. Levine, S. B., et al. (2022). Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults. Journal of Sex & Marital Therapy.

5. Cass, H. (2023). Independent Review of Gender Identity Services for Children and Young People: Final Report. NHS England.

6. Littman, L. (2018). Rapid-Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports.PLOS ONE.

7. Biggs, M. (2022). The Dutch Protocol for Juvenile Transsexuals: Origins and Evidence. Journal of Sex & Marital Therapy, 49(4), 348–368. https://doi.org/10.1080/0092623X.2022.2121238

8. Abbruzzese, E., Levine, S. B., & Mason, J. W. (2023). The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed. Journal of Sex & Marital Therapy, 49(6), 673–699. https://doi.org/10.1080/0092623X.2022.2150346

9. Singh D, Bradley SJ, Zucker KJ (2021). A Follow-Up Study of Boys With Gender Identity Disorder. Front Psychiatry. Mar 29;12:632784. doi: 10.3389/fpsyt.2021.632784. PMID: 33854450; PMCID: PMC8039393.

10. de Vries, A. L. C., et al. (2014). Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics, 134(4), 696–704.