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Why gender-affirming care for youth is important

False narratives on gender-affirming care harm transgender teenagers
Young diverse young people having fun together outdoor at city park.
Access to holistic, patient- and family-centered gender-affirming care must be considered a fundamental right for youth. (Getty Images) 

It’s normal and healthy for teenagers to question who they are, how they are perceived by their peers, and how the world understands them. Identity exploration is a critical stage in development for adolescents. It is time we allow teens to explore gender authentically, and for society to embrace gender expansiveness, not pathologize or politicize it.

We are pediatric endocrinologists who have collectively worked with thousands of gender-diverse youth and their families. Access to high-quality pediatric gender-affirming care is a testament to societal progress. But much work still needs to be done to further improve care.

Recent opinion pieces have argued youth identify as transgender or nonbinary as a way to address their underlying psychological distress or as a result of social pressure brought on by our eagerness to support gender exploration. These viewpoints claim that meeting with a pediatric transgender health provider catapults the adolescent into pursuing hormonal treatments or surgeries before they’re ready to make such decisions. This is simply inaccurate.

Such opinions fail to acknowledge the careful conversations and shared decision-making that most providers use to offer gender-affirming medical care. Endocrinologists like ourselves work with psychologists, social workers, peer and patient navigators, and community resources when caring for gender-diverse youth. Our visits with patients involve ongoing exploration of gender identity, as well as discussions regarding shifting identity and transition goals without shame or judgment. Medical interventions are only considered after having careful and thorough interdisciplinary discussions, and patients are closely monitored to ensure treatments continue to align with their goals and identity.

Like any aspect of medicine, the best evidence-based recommendations for diagnosing and treating health conditions come from established standards of care, not from politicians aiming to restrict the rights of trans youth. However, providers must also recognize the limitations of these standards and the need for individualized care. Mental health support is central to gender-affirming care, but the extent of support is highly individualized and should allow youth to explore gender authentically without needing to fit a mold or say the right thing in order to be believed.

Political efforts across the country are jeopardizing access to pediatric gender-affirming care. In mid-2021, Arkansas House Bill 1570 became law, blocking this care for youth and punishing health care professionals who provide it. This year, 32 similar bills have been introduced across 17 states. The Human Rights Campaign predicts a record high number of anti-trans bills will move through state legislatures this year. Recently, the Texas attorney general claimed providing gender-affirming care is child abuse under his state’s laws. In November 2021, one of the longest-standing interdisciplinary gender-affirming clinics, the GENder Education and Care, Interdisciplinary Support program in Dallas, Texas, was forced to close because of political pressures. This occurred despite a recent, peer-reviewed research study by the clinic that clearly demonstrated youth who receive gender-affirming hormone treatment have better mental health and are more satisfied with their bodies. 

In fact, many research studies demonstrate overwhelmingly positive outcomes from gender-affirming care. A 2021 study of 11,000 gender-diverse adolescents showed that access to hormones reduced depression and suicidality. Another showed gender-diverse youth receiving care in an interdisciplinary clinic experienced less depression, anxiety and suicidality compared with those without this care. As our patients grow older, they have repeatedly told us that gender-affirming care helped them survive adolescence and successfully transition into adulthood. They say early access to care allowed gender to simply be another aspect of identity, not the main focus. 

Yet concerns often surface about the risk of regret resulting from gender-affirming medical treatments. No large-scale research studies support that this is an actual trend. While acknowledging regret and grief as genuine experiences is important, this is not the typical experience for most youth. Grief and regret are complex and can result from a variety of factors, including family environment, societal influences, loss of support, unmet expectations, or shifts in gender identity and/or expression. Gender-diverse youth need providers who are curious and who invite curiosity from them, which allows an open exploration rather than fear-based responses.

Access to holistic, patient- and family-centered gender-affirming care must be considered a right for youth. Youth pay the heaviest price paid for lawmakers’ efforts to control, limit, pathologize or outright ban gender-affirming care.

Kara Connelly, an associate professor of pediatrics in the Oregon Health & Science University School of Medicine and medical director of the OHSU Doernbecher Children’s Hospital Gender Clinic.

Abby Walch, MD, is a pediatric and adult Endocrinology fellow at U.C. San Francisco (UCSF). Her views are her own and do not necessarily represent those of UCSF.

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