Misinformation obscures standards guiding gender-affirming care for trans youth
Such laws and policies, and the statements used to justify them, reflect misconceptions and misinformation that conflate treatments and strip trans youth of essential care.
“Gender-affirming care” is a broad term for many distinct treatments provided to children, teens, and adults. Puberty blockers, for example, are medications that inhibit puberty by suppressing the body’s production of sex hormones, while hormone therapy is the administration of testosterone or estrogen to alter secondary sex characteristics.
One common misbelief heard when legislation is discussed is that gender-affirming medical interventions are provided immediately to any trans or nonbinary kid who walks into a gender clinic.
The reality is that the process informing these treatments is a long and intensive one. Before any medical or surgical interventions, kids must first be diagnosed with gender dysphoria, which involves experiencing significant distress for at least six months from at least six of a set of causes including a strong desire to be of the other gender and a strong dislike of one’s sexual anatomy.
Providers also abide by the standards of care set by the World Professional Association for Transgender Health. These standards encourage health care professionals to perform a comprehensive assessment of a child’s or teen’s “strengths, vulnerabilities, diagnostic profile, and unique needs” before providing any medical or surgical interventions. Without this assessment, other mental health issues “that need to be prioritized and treated may not be detected.”
The time it takes to perform this assessment varies from patient to patient, said Jack Turban, an assistant professor of child and adolescent psychiatry at the University of California-San Francisco. Turban may see someone who is 12 years old and asking for puberty blockers. This hypothetical patient has known they are trans since they were 5 years old and has already adopted a new name and pronouns that match their gender identity.
“That’s going to be a much shorter assessment to know that they are ready for treatment when compared to somebody who has only understood their trans identity for six months” and has other complex mental health conditions like schizophrenia, Turban said.
To receive puberty blockers, kids must also have experienced the onset of puberty, or Stage 2 on the Tanner scale of developmental change. This is marked by physical changes like the development of breast buds or testicle growth and tends to happen between the ages of 9 and 14 in kids with testes and 8 and 13 in those with ovaries. By pausing puberty, these drugs buy children more time to explore their gender identity before undergoing permanent and potentially unwanted pubertal changes.
The age at which trans minors receive gender-affirming hormone therapy depends on the patient’s ability to provide informed consent for the treatment, which can happen when they’re as young as 12 or 13 years old. The Endocrine Society notes that most adolescents have “sufficient mental capacity” to consent by the time they’re 16.
“We offer hormones to patients who are experiencing gender incongruence when patients and families are ready. This may be at an earlier age so that patients can go through puberty alongside their cisgender peers, or later, if they choose to,” said Mandy Coles, co-director of the Child and Adolescent Transgender Center for Health at Boston Medical Center. “If someone says, ‘I’m interested in estrogen,’ I say, ‘Great. What are the things that you are hoping to get out of that?’ Because it’s incredibly important to speak to patients and families about what medications can do, and what they can’t do.”
Coles said she also makes sure to talk continuously about consent with both the child and parents throughout the treatment process and lets her patients know they can stop taking hormones at any time.
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In a study of data from nearly 28,000 trans adults who responded to the 2015 U.S. Transgender Survey, Turban and fellow researchers found that people who received gender-affirming hormone therapy during adolescence had more favorable mental health outcomes than those who didn’t take hormones until they were adults.
Additionally, a study of 104 young trans and nonbinary patients at the Gender Clinic of Seattle Children’s Hospital found those who had started on puberty blockers or hormone therapy had 60% lower odds of depression and 73% lower odds of self-harm or suicidal thoughts than peers who hadn’t received those treatments.
There is so much misinformation claiming that providers of gender-affirming care are permanently harming vulnerable children, Coles said. “Denying access to care harms transgender and gender-diverse kids,” she said. “Gender-affirming care is not new. It’s the attacks on care that are new.”