5 myths about gender-affirming care for trans kids, debunked

Three states — Alabama, Arkansas and Texas — recently enacted a law banning gender-affirming care for trans children. Gender-affirming care includes puberty blockers, hormone therapy (testosterone for trans men and estrogen for trans women), and surgeries. But that’s not all. “It can be as simple as affirming their gender by using their name correctly and using the pronouns they identify with,” explains Dr. Abby Walchresearcher in adult and pediatric endocrinology at the University of California, San Francisco.

Research has repeatedly shown that gender-affirming care can save lives. In a study of trans and non-binary youth aged 13-21 receiving such care reduced rates of depression by 60% and suicidal thoughts by 73%. The medical consensus is that gender-affirming care should be provided to trans youth. In a February 23 statementthe Endocrine Society noted that she, along with the American Medical Association, American Psychological Association, and American Academy of Pediatrics, as well as clinical practice guidelines, supports “evidence-based medical care” for trans children. “Gender-affirming care benefits the health and psychological functioning of transgender and gender-diverse youth,” the statement noted.

Misconceptions are widespread about gender-affirming care for trans children — some propagated by anti-trans bills themselves. Here are the facts.

Myth 1: Young children take gender-affirming hormones.

Testosterone and estrogen “are not given to very young children. These are given to older adolescents who meet specific criteria for this treatment,” says Walch, whose opinions are his own and do not necessarily reflect those of UCSF.

The Endocrine Society recommends that trans youth wait until age 16 to start hormone therapy, but recognizes that some teens should be able to start earlier. A draft new standard of care from the World Professional Association for Transgender Health (WPATH) states that the recommended minimum age is 14 years.

Before starting hormones, a child can start puberty blockers once they enter puberty, with parental consent. Puberty blockers are completely reversible and simply press pause at puberty; they do not cause any sex-related changes in a child’s body.

And before that? “Before puberty starts, we wait. We don’t do anything but affirm them as individuals,” says Walch, for example supporting name, pronoun and style changes.

Myth 2: Many children will regret their transition.

“The data does not support this claim,” says Walch. “The studies that have been done show low regret rates and significant improvements in mental health outcomes for patients who can access gender-affirming medical therapies at a younger age,” she says.

For example, the first study of the mental health of children who made a social transition – changing their names, pronouns, clothing styles and hairstyles – showed that their rates of depression and anxiety were not higher than those of children in the two control groups. This despite the fact that the average rates of depression and anxiety among trans youth are more than double that of cisgender youthaccording to the Harvard TH Chan School of Public Health.

Myth 3: Children are pressured to become trans and transition medically.

Peer pressure can cause children to skip class or take up a new hobby. But the children are not at risk of being rejected by their families and being bullied, nor of seeking time-consuming medical care to integrate.

By the time trans children see a doctor to help them with their medical transition, they “have faced significant hurdles and challenges,” Walch says. Their own pediatricians may not know how to help them. Their schools may not meet their needs. Their friends and family may be confused or upset about their identity. “There is a lack of recognition in society and a lack of acceptance in our culture.”

The treatment of trans and gender diverse youth is not hasty, random or uniform. “It’s our job as medical and mental health professionals to do a thorough assessment,” Walch says. Providers take the time to determine if the child’s identity as transgender is persistent and if the child has gender dysphoria. The goal for the child, she says, is, “What do you need to be gender affirming?”

Myth 4: Without intervention, most children will “outgrow” being trans or gender diverse.

Children who identify as transgender are unlikely to later identify as cisgender. Children “whose gender identity persists and/or whose gender dysphoria worsens after the onset of puberty” are likely to “persist in their gender identity,” says Walch. “Some research has also shown that the younger a child is with a gender identity different from their sex assigned at birth, the more likely those people are to persist in that gender identity as well.”

Myth 5: Young children undergo gender-affirming surgeries.

Bottom surgeries, or genital surgeries, are not performed on anyone under the age of 18. The only type of surgery that trans teens typically have access to is top surgery for a flat chest. The draft new WPATH guidelines recommend the minimum age for surgery above 15 years. (To compare, breast reduction and augmentation surgeries are also performed on young cisgender people — sometimes for cosmetic reasons, according to teen vogue.) Facial feminization surgeries “are usually deferred until adulthood,” according to the Mayo Clinic.

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