Several states in the U.S. are considering banning access to gender-affirming care for young people. Alabama cited the Supreme Court's decision to support a law that makes GA care for youth a felony. Current laws in Alabama, Arkansas, and Arizona restrict or ban gender-affirming care for young people. Trans youth seem to be at the center of the conservative culture war. A majority of Americans support making gender-affirming health care illegal for people under the age of 18. State laws that prevent trans youth from accessing gender-affirming care are supported by a majority of Republicans.
The standard of care is GA medicine. GA care is not experimental according to the first part of the series. What is currently known about science-based GA care is presented by Dr. A.J. Eckert and Dr. David Gorski in the second part. Bullet points will be used to answer false and misleading claims in this post. The answers are meant to be a reference. In the future, we may publish more detailed posts about specific questions.
The standard of care for trans youth is set by the Endocrine Society and the World Professional Association of Trans Health.
The study found that socially transitioned trans youth had the same mental health as their peers. The cis gender control group was included in the study. They reported depression and self-worth that did not differ from their matched-control or sibling peers. Compared to previous work with children who had not socially transitioned, these findings are very different. A meta-study concluded that new research shows that socially transitioned prepubertal children are often well adjusted.
Poor mental health outcomes for trans youth can be linked to stigma, discrimination, and lack of family acceptance. Stigma and discrimination were found to be predictors of self-injury, suicide, depression, and anxiety among a sample of 923 Canadian trans teens. The negative outcomes for youth who are supported at home are caused by discrimination, stigma, and bully. Minority stress was found to be associated with depression. School belonging, family support, and peer support were found to affect lifetime suicide attempts and suicidality.
Positive outcomes are linked to acceptance at home and schools. The study found that using chosen names can reduce negative health outcomes and improve mental health outcomes. In a 2016 study, it was found that parental closeness was related to lower odds of all four mental health outcomes. Trans youth are more likely to be abused by their families than cis youth, which leads to worse mental health outcomes.
Doctors prescribe drugs that block puberty to give the child time to mature, to allow for exploration of gender identity, and to avoid an incongruent puberty. The drugs are not prescribed for prepubertal children until the second stage of puberty, which is the start of sex changes. Leuprolide is one of the most popular puberty-suppressing drugs used in youth. Since 1993, they have been approved by the FDA.
Since the mid 1990s, GnRHa has been used for the treatment of gender dysphoria. Delaying puberty was recommended by the Royal College of Psychiatrists in 1998 for adolescents who experienced strong and persistent cross-sex identification. The WPATH standards of care have been revised many times. The standard of care for adolescents entering the second stage of puberty should be blockers, according to the Harry Benjamin International Gay Dysphoria Association. When the US District Court for the Middle District of Alabama looked at the question of whether blockers and gender-affirming hormones for trans youth are experimental, they found no credible evidence. At least twenty-two major medical associations in the U.S. endorse transitioning medications as well-established, evidence-based treatments for gender dysphoria in minor children. Off-label use doesn't mean "experimental."
Concerns about puberty suppression have been studied. suppression doesn't have an effect on cognitive functioning The bone mineral density was covered within a year after the GnRHa treatment was stopped. Peak bone mass formation through bone mineral accretion during puberty is unaffected by GnRHa treatment. There was a long term follow up with the patient. The risk of fracture is still very low even though there is a decrease in bone density.
The conclusion of Henriette Delemarre-van de Waal's study on the safety and efficacy of puberty suppression was that it was effective and safe. There were studies that found minimal risks for young people who started hormones. The addition of GAHT restores bone density in both transboys and transgirls according to a meta-study. GAHT does not have a negative effect on BMD in trans women and trans men.
The harms of non-treatment are likely to be significant and permanent in the case of trans youth.
According to the Clinical Practice Guidelines of the Endocrine Society, suppression of pee can be completely reversed after cessation of treatment.
There are psychological tools that clinicians can use to assess the competency of patients. The standard is used to determine whether individuals can give informed consent. 74 trans adolescents between the ages of 10 and 18 were assessed using the macCAT-T. 89.2% of the people took the MacCAT-T tests. 87.8% of the time, the test agreed with the doctor's assessment. Mental health professionals and doctors are expected to evaluate patients' ability to give informed consent. The age of informed consent in the US is usually 14. It's not 18 or older in the U.S.
Treatments for gender dysphoria have been endorsed by a number of professional health organizations. Most of these groups have explicitly rejected insurance exclusions for healthcare related to gender dysphoria. It's quite the opposite in the case of the AMA. These are included.
| American Academy of Child and Adolescent Psychiatry | American Nurses Association |
| American Academy of Family Physicians | American Osteopathic Association |
| American Academy of Nursing | American Psychiatric Association |
| American Academy of Pediatrics | American Psychological Association |
| American Academy of Physician Assistants | American Public Health Association |
| American College Health Association | American Society of Plastic Surgeons |
| American College of Nurse-Midwives | Endocrine Society |
| American College of Obstetricians and Gynecologists | National Association of Nurse Practitioners in Women’s Health |
| American College of Physicians | National Association of Social Workers |
| American Counseling Association | Pediatric Endocrine Society |
| American Heart Association | Society for Adolescent Health and Medicine |
| American Medical Association | World Medical Association |
| American Medical Student Association | World Professional Association for Transgender Health |
The medical organizations that support restrictions on access to health care are mostly small, religiously based outfits.
The benefits of treatment to delay puberty, followed by hormone therapy, have been shown in dozens of studies. A study done in 2020 shows that suppression of puberty is associated with better mental health outcomes. The findings add to a growing evidence base suggesting that gender-affirming medical care is associated with better mental health outcomes in adulthood. A meta-analysis of 9 studies found that the benefits of GnRHa included decreased suicidality in adulthood, improved affect and psychological functioning, and improved mental health. In December 2021, a study was released that compared two groups of young people, one who wanted and one who didn't, with regard to gender affirming hormone therapy. The study found that people who received GAHT had a lower suicide attempt rate.
13 of the 16 studies that examined the benefits of puberty blockers and gender-affirming hormones in trans youth showed improvement in mental health, and none of them showed a decline. The two studies that found an improvement did not reach the level of statistical significance due to the small sample sizes. The study found that access to transition related care, including blockers and hormones, was associated with a lower risk of depression and suicidality over the course of a year. A 2020 longitudinal study of access to blockers and gender-affirming hormones found that youth scores and suicidal depression decreased over time while mean quality of life scores improved over time when given access to these treatments.
The study compared the psychological health of adolescents who had been referred for assessment for gender dysphoria at Amsterdam's VU University Medical Center and had not yet received puberty blockers or hormones, and adolescents who had been diagnosed with gender dysphoria and were taking puberty blockers but had not yet The group receiving puberty blockers had lower scores on measures of internalizing problems, suicidality, and problems with peer relations than the group who hadn't received any treatment. The group taking puberty blockers scored better than the cis control group in terms of internalizing problems.
There are other studies that have found the same thing. The combination of psychological support and puberty-delaying medication allowed subjects to reach levels of functioning comparable to peers. A study in the Netherlands found that psychological functioning steadily improved over the course of the study and these now young adults had global functioning scores similar to or better than their peers in the general population. A study of trans youth in Spain found that at baseline the trans adolescents had worse mental health than the cis adolescents, but that the difference was equal by the end of the study.
The best outcome in mental health care is to achieve the same results as the control group.
Opponents of gender-affirming medical care for trans people often point to a study as proof that they do not fare as well if they have access to care. The study only shows that suicide rates for people who had surgery before 1989 were higher than the general population. Rates are not shown to be higher for people who have surgery than for people who don't. The lead author of the paper stated that her research couldn't be used to make a conclusion about the harms of medical care for trans people.
All peer-reviewed articles published in English between 1991 and June of last year were reviewed by Cornell University. The majority of the 55 studies they identified found that gender transition improves the well-being of trans people. There was no evidence that the transition was harmful.
While access to medical care has not been shown to harm trans people, there are risk factors for suicide among them. Lack of government recognition of their identity is one of the key factors.
Many opponents of GA health care for trans youth and adults point out that the studies generally cited to support such care do not meet the "gold standard" of being double blind and RCT. It is impossible to prove this clinical question. Double-blind studies involving blockers or gender-affirming hormones can't be done because both the doctor and the patient will notice if puberty has not continued or if gender-affirming hormones are causing the patient to develop secondary sex characteristics.
A body of literature shows that those randomized to the treatment group are more likely to suffer mental health problems than those in the control group. The requirement that there be genuine uncertainty based on science and previous clinical studies as to which group in an RCT will do better is why the IRB wouldn't approve a randomized controlled trial at this time. The minimum requirement for an RCT to be ethical is clinical equipoise.
RCTs are not feasible, but they can be used to compare youth receiving treatment and those who haven't been done. The study found that the mental health of the young trans men who underwent chest reconstruction was better than that of the control group. The hormone therapy improved the mental wellbeing of 47 trans youth. Those who had received puberty blockers prior to hormone therapy reported lower suicidality than those who had not. In the largest study to date, researchers compared the number of adolescents referred to the gender clinic who had not yet received pubertal suppression with the number of adolescents who had already received pubertal suppression. People who received pubertal suppression had better mental health outcomes than people who didn't. In December 2021, a study was released that compared two groups of young people who wanted gender affirming hormones but didn't get them. The study found that people who received GAHT had a lower suicide attempt rate.
Dutch researchers who studied young adults over the age of 18 who had followed the protocol of blockers followed by gender-affirming hormones found that the Gender Dysphoria had been alleviated. Same-age young adults from the general population had the same wellbeing.
701 people have been assessed by the Royal Children's Hospital Gender Service in Victoria. The court found that almost all of the youth who received a diagnosis of gender dysphoria continued to identify as gender diverse into late adolescence. No patient who startedblockers wanted to return to their birth assigned sex. The long term study of trans youth by de Vries did not show a pattern of transition or regret. There were no Germans who expressed regret in the study. The study found that only 5 of the young people who started blockers ended up stopping treatment. Over a period of 2.6 years, 97.6% of the sample that was diagnosed with gender dysphoria continued to persist. By the end of the study, 87.1% of those who were living in their affirmed role were doing so. A long term study of 317 trans youth who socially transitioned found that almost all of them were identified as being of the same sex. Only 2.5% of people were identified as cis gender.
The Charing Cross, Tavistock, and Portman clinics had their records reviewed. There are only two people who have detransitioned due to regret or decision not to be trans. A Dutch study of 6793 patients who transitioned found only 7 who regretted it because they decided they weren't trans. Research shows that most adolescents don't regret having the chance to explore their gender after detransitioning. A study of youth who stopped puberty suppression found that many were happy to have the chance to explore their gender identity.
Trans teens who have chest reconstructions are very rare to have regrets. Less than 1% of trans men who had chest reconstruction before the age of 18 regretted it. Approximately 5% ofcis gender women who have had breast reduction regret, and this is considered by plastic surgeons to be very low.
The "watchful waiting" approach is used by most clinicians who care for trans people in the UK. The Center for Expertise on Gender Dysphoria in Amsterdam is the first clinic in the world to offer gender affirming medical interventions. The approach involves waiting until puberty to recommend transitioning to a different sex. The approach only applies to prepubertal children, who don't get medical interventions. The discussion of medical interventions for young people is not related to the watchful waiting approach. These interventions aren't offered before puberty begins.
The question of puberty suppression disrupting the formation of gender identity was posed in a qualitative study. They didn't observe puberty suppression to cause dysphoria in young people. Most of the endocrinologists in the study emphasized that they deliberately start treatment with puberty suppression only when the trans youth have reached stage two or three to give them at least a kind of "feel" with puberty before starting with puberty suppression.
The puberty suppression protocol is the best course of action to gain time for further assessment and prevent potential irreparable harms, as the standards of care recognize that if a youth still has a strong trans identification after puberty, it is unlikely to change. In adolescence, the most likely outcome is the persistence of gender dysphoria, according to Dr. Kenneth Zucker, the researcher most associated with the early studies.
Standards and clinicians have become better over time at identifying youth who are genuine trans people. The DSM-5 changed the criteria for determining a gender dysphoria diagnosis for young people who want to be of another gender. Researchers have known for almost a decade what factors are most likely to lead to adulthood.
The Dutch Protocol for treating minor was studied in 2006
Physical treatment outcome following interventions in adulthood is far less satisfactory than when treatment is started at an age at which secondary sex characteristics have not yet been (fully) developed… [They] Often have difficulties in connecting socially and romantically with peers while still in the undesired gender role, or the physical developments create an anxiety that limits their capacities to concentrate on other issues.
A follow-up study concluded, "Nonintervention is not a neutral option, but has clear negative lifelong consequences for the quality of life of those individuals who had to wait for treatment until after puberty" A clinical study published in 2020 compared the outcomes of youth who started medical transition at various points and found that older age and late pubertal stage are associated with worse mental health.
Recent studies show that trans youth receiving treatment have better mental health and should not be delayed in order to prevent unnecessary mental anguish. A large sample size study shows that trans people who begin treatment before the age of 18 are less likely to attempt suicide. A study found that youth with less congruous appearance were more likely to suffer from depression. It was found that prompt access to gender-affirming care was crucial to ensuring and improving the well-being of the young people who sought it. It was found that people who weren't able to get prompt access to care were more likely to have mental health problems.
The decision to give puberty blockers is not a child's decision. A team of specialists thoroughly evaluate each case before making a decision about treatment. The assessment process for the youth gender clinic in the Netherlands involves the adolescent, their parents, psychologists, and psychiatrists. Parents, psychologists, psychiatrists, social workers, and endocrinologists are included in the GeMS clinic at Boston Children's Hospital. WPATH, The Endocrine Society, and bioethicists who have studied the issue, consider young people who are able to give informed consent. The available scientific evidence does not support the view that adolescent medical transition is dangerous. Adolescent medical transition should be seen as ethical and available.
According to an article published in the year 2018, trans identity is a form of social influence. The article was flawed. The spokesman for the Endocrine Society stated that the author of the paper had written about the anxiety of parents who question an open approach to trans care and who frequent websites that cast doubt on current management approaches. There were no kids involved.
The publisher apologized after it was partially retracted. There is a statement on the subject.
The term “Rapid Onset Gender Dysphoria (ROGD)” is not a medical entity recognized by any major professional association, nor is it listed as a subtype or classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD). Therefore, it constitutes nothing more than an acronym created to describe a proposed clinical phenomenon that may or may not warrant further peer-reviewed scientific investigation.
Several follow-up studies looked at her hypotheses after she was diagnosed with RODG. In both studies they found the opposite of what they had been led to believe. A study found that trans youth wrestle with gender Dysphoria for years before coming out to their parents. It found that the parents understanding of their children was often flawed, and that the adolescents did not understand themselves as well. A better model was proposed by the paper for how the coming out process works.
The second study tried to verify the causes of gender dysphoria. A pathway of rapid onset gender dysphoria was recently hypothesised by the study. We tested a number of associations that were consistent with the pathway, but our results did not support the rapid onset gender dysphoria hypothesis. The conclusion of the study was that parents were wrong to think that dysphoria drives anxiety and depression.
We did not find support within a clinical population for a new etiologic phenomenon of rapid onset gender dysphoria during adolescence. Among adolescents under age 16 years seen in specialized gender clinics, associations between more recent gender knowledge and factors hypothesized to be involved in rapid onset gender dysphoria were either not statistically significant, or were in the opposite direction to what would be hypothesized. This putative phenomenon was posited based on survey data from a convenience sample of parents recruited from websites and may represent the perceptions or experiences of those parents, rather than of adolescents.
A second study found that trans youth generally wait months or years before coming out to their parents, resulting in the revelation suddenly to the child.
The wait time for a youth appointment at the UK's Tavistock gender identity clinic was over a year two years ago. Over two and a half years has passed since then. The waiting time for adults in the UK's national health system is 33 to 36 months. There must have been at least a year of gender incongruence for a young person to be seen. There are cases of youth waiting so long that they have to go back to the adult waiting lists. Teens generally take a long time to come out to their parents and seek treatment.
A UCLA report states that a small number of youth in the United States identify as trans. 700 in 100,000 youth may be trans. There are 1740 referrals who are assigned female at birth. There are 6 million females in the UK between the ages of 3 and 18 and only 29 in 100,000 of them are referred for evaluation. There could be many youth who would benefit from treatment but are not being seen. It doesn't support the idea that a lot of youth who are not trans are using the services of Tavistock.
The number of youth being referred is still relatively small compared to the expected number, despite the fact that the number of cases has increased.
The case of Bell in the UK is often cited by opponents of access to transition related care for minor. It is for the clinicians to exercise their judgement knowing how important it is that consent is properly obtained according to the particular individual circumstances.
There are studies suggesting a link between the two disorders. Other people have looked at the same data and found no correlation. There is no evidence that trans youth with ASD don't benefit from affirming care the same way other kids do.
The study looked at the harms of conversion therapy on young people. It found that people who had been subjected to conversion therapy as children were more likely to attempt suicide. Whether the therapy was religious or secular, this relationship was still there. Attempts to change a person's gender identity and expression to become more congruent with sex assigned at birth has been unsuccessful in the past. Such treatment isn't ethical anymore. A study in Korea found that people who had undergone conversion therapy were more likely to suffer from depression, panic disorders, and suicide attempts.
Conversion therapy attempts to change or suppress a person's sexual orientation. Sexual orientation is a pattern of attraction to people of the same sex or gender. Sexual orientation is who you like the most.
Changing who a person is attracted to is not a form of conversion therapy. When a person transitions, the label for their attractions may change.
A recent academic post online that has gained attention suggests that trauma can cause youth to have trans identities and that therapy can cause them to stop. The model and treatment proposed is the same as the one proposed by the most ardent proponents of sexual orientation change in the United States. A priori goal of entering therapy is to have them stop being who they are because of trauma that may be causing them to be homosexual or trans.
There is no proof that this approach works. A lot of evidence supports a more affirming one. According to recent peer-reviewed studies, children who are supported in their gender identity by their parents, schools, and peers are more likely to have better mental health outcomes. Efforts to change their gender identity can include coercing them into suppressing it or rejecting it altogether.
One of the false narratives about adolescent trans youth is that they are mostly young lesbians who are transitioning to male to appear straight or because of sexism. Data from large-scale studies don't agree with that view. According to the largest survey of trans men to date, only 23% of them identify as strictly heterosexual. The line of argument makes a mockery of the idea that being trans makes life easier. Only 16% of trans men in the UK think they're heterosexual.
The World Health Organization has a list of medical and mental health classifications.
The most places outside the US use this criteria. A diagnosis of a child's gender identity disorder requires more than just tomboyishness in girls. Not merely ambivalence towards one's gender is not enough.
The DSM-5 is used in the US to diagnose gender Dysphoria. It also requires a constant cross- gender identity. It is not enough for a gender dysphoria diagnosis to have a typically gendered interest and expression. Fears of gender non-conforming youth being railroaded into transitioning are not supported by the diagnostic criteria put forward by the ICD or the DSM.
Trans men and non-binary people use testosterone to suppress their menses. Studies show that people who have been taking testosterone for a long time retain their fertility if they stop. Their fertility rebounded to levels that were1-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-6556 was1-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-65561-6556 One of the side-effects of testosterone is permanent infertility. There is no evidence that puberty blockers cause permanent sterility.
The narrative that trans people can't have sex is false. People who receive treatment for gender Dysphoria are less likely to suffer from sexual problems. People who have undergone affirming gander are more likely to have sex. Most transfeminine people who go through gender affirming surgery report increased orgasms. People on testosterone have increased sexual desire. Trans people are more likely to suffer from sexual problems than the rest of the population. Reducing gender dysphoria can lead to a reduction in sexual aversions and an increase in enjoyment of sex.
The narrative that medical treatment for gender dysphoria leads to a life of sexual problems is not true. Lack of access to treatment increases the risk of being dissatisfied.
Some parents think that having a straight child is better than having a gay one, and that they are trying to get their child to transition. There are a lot of reasons why this is implausible. People with hostile attitudes towards lesbians and gays are more likely to be hostile to the trans community. Homophobia is likely to be the best predictor of transphobia, and these two constructs probably share a common foundation.
Being gay is a better outcome than being trans. The survey found that the families of trans youth made them feel bad about their identities more than the families of cis youth.
It would have to be assumed that these parents would be able to force their child into being a trans person. Then they would have to wait two years for an appointment. The youth would have to talk their way past therapists who see many genuine trans youths every year. It seems implausible.
The number of people seeking treatment in Western nations has grown over the years. Data from the Netherlands, Sweden, and New Zealand are included. Over time, the number of trans women and trans men presenting for evaluation and treatment increased.
The UK's Gender Identity Research and Education Society (GIRES) published a report with grant funding from the Home Office in 2009.
The sex ratio of trans men and trans women was found in Poland. The ratio of trans men to trans women was reported in Poland and Czechoslovakia. Okabe and his team. The ratio of trans men to trans women was found in Japan. Garrels and company The ratio of trans women to trans men in Germany was 2 in 1970 to 1 in 1994 but then fell to 1.2 after 1994. The number of people with a trans masculine of a trans feminine identity was the same as in the previous year. Sex ratios of trans people seeking transition treatment have varied across regions and time, with trans menconstituting a majority in several places, far longer than ten years ago.
There are cultural explanations for certain things. The head of trans inclusion at Stonewall said that parents and society are more tolerant of children who are assigned female at birth. Parents are less likely to act on feminine behavior when they assign a male at birth. The children come out later.
According to the data from the American Center for Disease Control, more than 10% of adolescents identify as lesbian or bisexual. Only a small percentage of adolescents identify as trans. It doesn't support the idea that youth find it easier to come out as trans. It has held true for close to a decade. The Williams Institute at the University of California Los Angeles found that 4% of US adults identify as lesbian, gay, bisexual, or transexual. The razor suggests that more people will come out as a result of society becoming more accepting.
There are a lot of myths surrounding the medical care of trans youth. Trans youth in the U.S. are losing access to potentially life-saving care due to the misinformation spread through mainstream media. Laws targeting access to care should not be used to guide the care of the marginalized population.
All Rights Reserved © 2024
