Shared from the 3/10/2022 San Francisco Chronicle eEdition

OPEN FORUM On Gender-Affirming Care for Transgender Youth

Don’t put politics ahead of science

Josie Norris / Hearst Newspapers

Demonstrators converge at the Texas Capitol in Austin on March 1 to protest state policies on transgender youth.

When it comes to health, if the past two years of pandemic life have taught us anything, it’s that following politics over science is dangerous, if not downright deadly. Unfortunately, when it comes to trans-gender kids, many states are repeating the same mistake.

On Tuesday, the Idaho Legislature passed a bill banning youth transgender treatment. This follows last month’s developments in Texas, where Attorney General Ken Paxton issued an opinion that said providing transgender youth with gender-affirming health care, treatment that brings an individual’s physical characteristics in alignment with their affirmed gender identity, could be considered child abuse under the Texas Family Code — a notion that ignores scientific evidence and the consensus of every major medical and mental health association in the U.S. Based on that opinion, Texas Gov. Greg Abbott then ordered state agencies to investigate such care as child abuse. And last year, Arkansas passed a law banning gender-affirming medical care to transgender youth — a law now being challenged in the U.S. Court of Appeals.

About 20 other states, including Florida and South Dakota, have similar proposed laws, some of which criminalize physicians who provide gender-affirming medical care to youth. As noted in a 2020 policy perspective in the Journal of Clinical Endocrinology and Metabolism, such proposed and enacted legislation aims to alarm the general public by inaccurately describing gender-affirmative youth care as “chemical castration” and “genital mutilation.”

But decades of scientific research show that gender-affirming care is nothing short of lifesaving for the people who need it. For example, a 2020 U.S. survey of transgender adults age 18-36 years found significantly lower risks of lifetime suicidal ideation in those who were treated in their youth with puberty blockers — one of the potential treatments within gender-affirmative care — compared to those who wanted but never received blockers. Gender-affirmative care is also the recommended standard of care by both the World Professional Association for Transgender Health and the Endocrine Society, the world’s oldest and largest organization of scientists devoted to hormone research.

For transgender youth, the story is similar. Close to 25 years of published data show that gender-affirming medical care, which includes both medical and mental health support, has clear mental health benefits. In fact, a study published just last month demonstrated 60% lower odds of depression and 73% lower odds of suicidality among youth who had initiated treatment with puberty blockers or gender-affirming sex hormones compared with youth who did not start such care.

Even with such compelling data, clinicians don’t take lightly the decision to embark on gender-affirming medical care with youth. While young people can certainly have a strong grasp of their own gender, they are also in the throes of a swift stream of development, exploring identity in multiple facets of life.

That’s why mental health specialists play a critical role in treatment, learning from a youth about their gender and weaving that information together with other aspects of the youth’s life, such as their home and school environments. Combined, this information becomes the foundation for developing a gender health plan unique to that youth that follows clinical practice guidelines. It’s an approach that has led to positive outcomes for thousands of transgender youth.

At the UCSF Child and Adolescent Gender Center, for example, we are an interdisciplinary team of medical providers — pediatric endocrinologists, adolescent medicine specialists, nurses, psychologists, social workers and school and legal specialists — who have worked together with over 2,000 patients and their families in the past 10 years. Among the approximately 1,200 of our patients who have embarked on gender-affirming medical care after careful consideration by the youth patient, their parents or caregivers, and medical and mental health providers, less than 1% have opted to discontinue care.

Fearmongering by lawmakers and others has no place in health care. Already, misinformation about gender-affirmative care for youth has had dire consequences. At the end of 2021, the Children’s Medical Center in Dallas was forced to close its program for gender-affirming medical care to new trans-gender patients. It was the only program of its kind in the state. And just this week, Texas Children’s Hospital announced it would stop providing hormone therapies for transgender children in the wake of Abbott’s recent directive.

Gender identity — one’s inner sense of self as male or female or somewhere on the gender spectrum — is, like sexual orientation, a fundamental dimension of the human experience. Major U.S. mental health associations, such as the American Academy of Child and Adolescent Psychiatry recognize that being transgender or gender diverse is not a mental illness, but instead reflects an example of human diversity.

Care of transgender adolescents should be led by trained health care teams in partnership with the patient and family, based on best available scientific evidence, not by politicians or legislators with no experience in our field.

Stephen M. Rosenthal is professor of pediatrics and medical director at the UCSF Child and Adolescent Gender Center. He is a National Institutes of Health-funded principal investigator on the Impact of Medical Treatment of Transgender Youth study and past president of the Pediatric Endocrine Society. Diane Ehrensaft is associate professor of pediatrics and director of mental health at the UCSF Child and Adolescent Gender Center. She is the author of “The Gender Creative Child” and is a NIH-funded principal investigator on the care of transgender youth.

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