Regular readers of this space know that whenever I write about social or cultural issues, I like to reach out to those with “lived experience” — people with direct, intimate knowledge of the topic at hand, so that it’s not just me pontificating.
When I recently heard a conservative lawmaker opine that transgender youth in Texas need to “wait until they’re 18” to receive gender-affirming care — sounds reasonable, right? — even I as a mere layperson knew this statement was woefully misguided, if not dangerously ignorant.
The lawmaker’s comments sought to justify a new law, set to start on Sept. 1, that makes Texas the largest state to ban gender-affirming care to minors with gender dysphoria, a psychologically distressing condition in which a person’s interior sense of gender doesn’t match their sex assigned at birth.
The science around gender-affirming care for minors, which can include the use of puberty blockers and hormone treatments (but not genital surgery) is evolving, but evidence already exists that such care is crucial for the wellbeing of many transgender youth. That’s why every major medical group endorses it.
I wanted to delve into why the lawmaker’s assertion is so boneheaded, and I wanted to talk to parents of local transgender youth and the doctors who care for them to help explain why.
That’s where I came up empty.
One parent I reached out to said her attorney advised her not to be interviewed — it is simply too dangerous to talk about her child’s experience in the current climate in Texas. Another said her now-adult trans child implored her not to participate, even with a promise of anonymity.
Even health care providers who treat children and youth with gender dysphoria declined to speak out — not that surprising, given the new law could cause them to lose their licenses for bestowing gender-affirming care.
Such is the culture of fear surrounding transgender youth in Texas that parents are too afraid to talk about it.
It’s a level of anxiety that is causing some transgender youth and families to flee the state. Hospitals and clinics are ceasing to provide treatments that enable trans youth to grow into vibrant, well-adjusted young adults.
In the absence of real voices, here’s what the facts say:
Transgender youth have a much greater risk of suicide, according to the Centers for Disease Control and Prevention. However, access to puberty blockers and hormones significantly decreases the chances of suicide and depression in the immediate term and down the road, one study finds.
Puberty blockers, used for decades in children with precocious puberty, forestall the development of biological sexual characteristics like facial hair in males and breasts in females. This gives trans youth more time to explore their gender identity through social transitioning, using their preferred pronouns and dressing as their felt gender.
It allows time for minors and their parents to access counseling and other means of psychological assessments, to help minors with gender dysphoria to better understand what they’re going through and to decide which, if any, medical interventions they might desire.
Puberty blockers also mean trans youth don’t have to endure the pubertal physical changes that don’t align with their gender identities, which can be extremely psychologically distressing, and it means they can avoid more extreme gender-correcting surgeries down the road.
Hormone treatments, usually given in later adolescence — testosterone for trans males and estrogen for trans females — means trans youth can develop the outer sexual characteristics that are in sync with their interior sense of gender.
There are a number of studies proving the benefits of gender-affirming care for minors, including one by the American Medical Association, which found trans minors and young adults who received puberty blockers and hormone therapy had 60% lower odds of moderate or severe depression and 73% lower odds of having thoughts of suicide.
Yet another study suggests that the earlier children can have access to gender-affirming care, the better. Some smaller studies have shown that trans people who have undergone puberty-blocking treatments early in life, along with psychological support, have better mental health outcomes later in life.
To be sure, there are valid concerns over the use of puberty blockers in youth.
Some evidence suggests their use, particularly timing and duration of that use, can affect bone density. There might also be deleterious effects on brain development and later fertility.
Data show some of these effects may be reversible when the blockers are stopped and hormone treatment begins.
And studies and medical guidelines suggest that the potential downsides of puberty blockers or hormones outweigh the risks of not addressing the despair of minors with gender dysphoria — of claiming, as some conservatives have, that such youth are simply falling prey to TikTok influencers or cultural trendiness.
The recent explosive growth in youth coming out as transgender has been attributed by medical experts to be less a result of “social contagion” and more a byproduct of a growing acceptance and language that expresses a need that has long existed and is finally being addressed.
Still, a scarcity of studies exists regarding the long-term effects of medical gender-affirming care on trans youth.
That’s another reason why bans are so harmful: the new Texas law is going to create a chilling effect on research and the overall accrual of knowledge about best practices when it comes to the care for minors undergoing transition.
Texas is hardly alone in stigmatizing and outlawing care for this fragile population. Around 30 states have outright banned or restricted access to gender-affirming care for minors or are considering doing so, most of them in the South or Southwest.
Forever in search of a problem that doesn’t exist, Texas Gov. Greg Abbott has described gender reassignment surgeries in children as “genital mutilation” and “child abuse” — which of course is absolutely true, except for the small problematic fact that it simply never happens, not in Texas or anywhere in the U.S.
While some doctors might perform “top surgery” — mastectomies to remove breasts in trans males — at the age of 16 in certain circumstances, genital surgery is not recommended by any medical group supporting gender-affirming care and, according to my research, no legitimate doctor will perform it.
There have been reports of trans youth later “detransitioning” — reverting back to their biological gender identity — but they make up a distinct minority, and studies show most said they felt compelled to do so by outside pressure, such as criticism from family.
The new law is just one in a long line of legislation, here and elsewhere, that seeks to frighten the families of transgender children, from bathroom bills to laws that bar the ability of transgender athletes from competing on youth sport teams that match their internal identity.
Our impeached and scandal-plagued attorney general, Ken Paxton sought to sic the state child welfare system on parents of transgender youth, seeking to investigate them over charges of child abuse, until a judge halted his ambitions.
The number of kids who will be harmed by this new state interference is not insignificant.
Almost 30,000 youth, ages 13-17, who identify as transgender live in Texas. Almost 300,000 such youth are estimated to live in the U.S.
The National Institutes of Health will soon release more guidance in the treatment of youth with gender dysphoria, which may provide more evidentiary ballast for parents and doctors seeking to stop the political assault on transgender kids.
In 2015, four U.S. gender clinics were awarded $7 million to examine the effects of blockers and hormone treatment via a longitudinal study. The researchers seek to address the fact that the United States had produced little data on the use of puberty blockers, particularly among transgender patients under 12.
The findings are coming soon.
And new guidelines from an international group dedicated to trans adolescents suggests that such youth should undergo mental health assessments and must have questioned their gender identity for “several years” before receiving drugs or other medical intervention.
That makes sense.
What doesn’t make sense is meddlesome politicos like Paxton and Abbott inserting themselves into very private decisions that are best kept between young people, their parents and their doctors.
Using transgender youth as a pawn in the culture war — because that’s what this is — is unconscionable. The new Texas law is going to cause untold harm and suffering.
Bring on the lawsuits.
