Three states — Alabama, Arkansas and Texas — have recently enacted legislation banning gender-affirming care for trans kids. Gender-affirming care includes puberty blockers, hormone therapy (testosterone for trans men and estrogen for trans women) and surgeries. But that isn’t all. “It can be as simple as just affirming one’s gender using their name correctly and using the pronouns that they identify with,” says Dr. Abby Walch, an adult and pediatric endocrinology fellow at the University of California in San Francisco.
Research has repeatedly demonstrated that gender-affirming care can be life-saving. In a study of trans and non-binary youth ages 13 to 21, receiving such care reduced depression rates 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 statement, the Endocrine Society noted that it, along with the American Medical Association, the American Psychological Association, and the American Academy of Pediatrics, as well as clinical practice guidelines, supports “evidence-based medical care” for trans kids. “Gender-affirming care benefits the health and psychological functioning of transgender and gender-diverse youth,” the statement notes.
Misconceptions are prevalent about gender-affirming care for trans kids — some spread by the anti-trans bills themselves. Here are the facts.
Myth 1: Young children are taking gender-affirming hormones.
Testosterone and estrogen “are not given to very young children. Those are given to older adolescents who meet specific criteria for that treatment,” says Walch, whose opinions are her 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 it recognizes that some teens should be able to begin it sooner. A draft of the new Standards of Care from the World Professional Association for Transgender Health (WPATH) states that the minimum recommended age is 14.
Before starting hormones, a child may start puberty blockers once they enter puberty, with their parents’ consent. Puberty blockers are completely reversible and merely press pause on puberty; they do not cause any sex-related changes in a kid’s body.
And before that? “Prior to the onset of puberty, we wait. There’s nothing we do other than affirming them as an individual,” Walch says, such as by supporting name, pronoun, and style changes.
Myth 2: Many children will regret their transition.
“The data does not back this claim,” Walch says. “The studies that have been done show low rates of regret and significant improvements in mental health outcomes for patients who are able to access gender-affirming medical therapies at younger ages,” she says.
For instance, the first study of mental health of children who have socially transitioned — changing their names, pronouns, dress styles, and hairstyles — showed that their rates of depression and anxiety weren’t any higher than those of children in two control groups. That’s despite the fact that the average rates of depression and anxiety in trans youth are more than double those of cisgender youth, according to the Harvard T.H. Chan School of Public Health.
Myth 3: Kids are pressured into being trans and medically transitioning.
By the time trans children see a doctor to aid in their medical transition, they “have faced significant barriers and hardships,” Walch says. Their own pediatricians may not know how to help them. Their schools may not accommodate their needs. Their friends and family may be confused or upset about their identities. “There’s a lack of recognition in society and a lack of acceptance in our culture.”
Treatment of trans and gender-diverse youth isn’t hasty, haphazard, or one-size-fits-all. “It’s our job, as medical and mental health professionals, to do a thorough assessment,” Walch says. Providers take time to determine whether the child’s identity as transgender is persistent and whether the child experiences gender dysphoria. The focus for the child, she says, is, “What is it that you need to affirm your gender?”
Myth 4: Without intervention, most children will “outgrow” being trans or gender-diverse.
Kids who say they’re trans are unlikely to later identify as cisgender. Children “whose gender identity persists and/or they have worsening gender dysphoria after the onset of puberty” are likely to “persist in their gender identity,” Walch says. “Some research has also shown that the younger a child presents with a gender identity that differs from their sex assigned at birth, that those individuals too are more likely to persist in that gender identity.”
Myth 5: Young children are undergoing gender-affirming surgeries.
Bottom surgeries, or surgeries on the genitals, aren’t performed on anyone under age 18. The only type of surgery that trans teens can usually access is top surgery for a flat chest. The draft of the new WPATH guidelines recommends the minimum age for top surgery as 15. (For comparison, breast reduction and augmentation surgeries are also performed on cisgender youth — sometimes for cosmetic reasons, according to Teen Vogue.) Facial feminization surgeries “are typically deferred until adulthood,” according to the Mayo Clinic.
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