Last week, the Department of Health and Human Services shared a report titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” The report claims to “summarize, synthesize, and critically evaluate the existing literature on best practices for promoting the health and wellbeing of children and adolescents with distress related to their sex or to social expectations associated with their sex.” In reality, the report spreads dangerous and inaccurate information about gender dysphoria and gender affirming healthcare. At a time when transgender and gender diverse (TGD) youth and adults are the target of increasing legislation restricting their ability to fully participate in society, including access to the healthcare they need, it’s important to understand the science surrounding gender affirming health care. Let’s answer some of the common questions and myths surrounding this topic.
Q: Sex vs. gender – what’s the difference? Someone’s sex is made up of their biological characteristics, such as hormones, chromosomes, and reproductive organs. Based on these biological characteristics, people generally are determined to be male or female when they are born, but there are also people who have both male and female biological characteristics and are intersex. Gender is someone’s internal sense of being male, female, a blend of both, or neither. Transgender is a broad term for people whose gender identity and sex are different.
Q: What is gender dysphoria? Gender dysphoria is the distress someone may feel when their sex and gender identity are not the same. While gender dysphoria is also a medical diagnosis, being TGD is not a mental illness. Not all TGD people experience gender dysphoria and it occurs because society’s expectations of what a man or woman should be does not align with how someone feels about themself. Gender dysphoria can contribute to other mental health challenges, like depression and thinking about suicide.
Q: What is gender affirming care? Gender affirming care (GAC) means a bunch of different things! It can include using preferred names and pronouns, to having access to appropriate psychotherapy, hormone therapy, cross-sex hormones, and surgery.
Q: Can children be given hormone therapy? Children who are TGD and have not gone through puberty are not given any medical GAC. As youth approach and go through puberty, they may be given puberty blockers, cross-sex hormones, and surgery, though surgery among youth is very rare. A diagnosis of gender dysphoria is required to access gender affirming medical care, and children’s doctors, therapists, and parents all have to agree before this care is provided.
Q: Does gender affirming care help with treating gender dysphoria? All major medical associations consider access to hormones, surgery, and other medical interventions to be the highest standard of care. There are over a hundred studies showing the benefits of gender affirming care for TGD youth and adults that have taken place over many decades.
Now that we’ve answered some key questions, let’s address some myths found in the HHS Report.
Myth: Children and youth under 18 can access medical GAC whenever they want. This is not true. The process to accessing medical GAC for youth is extensive. Youth undergo thorough screening, meet with therapists, both alone and with their parents / caregiver(s), and multiple medical doctors before they can begin any sort of medical GAC. No GAC is given to youth without the consent of their parent or guardian. Adults over 18 must also meet with therapists and multiple doctors before accessing GAC. The process can often take many months or sometimes years.
Myth: Youth who identify as transgender or gender diverse are in a “phase.” The HHS report suggests that with therapy, youth will “come to terms with their body” no longer identify as transgender. The report promotes “exploratory therapy” which seeks to change someone’s gender identity. It is otherwise known as “conversion therapy” or “reparative therapy.” This type of therapy has shown to be psychologically damaging, does not ultimately change someone’s gender identity, and is banned in multiple states.
Myth: The science supporting gender affirming care is “low-quality.” The HHS report argues against GAC because the evidence supporting it is “low-quality,” This is misleading. The “gold standard” for scientific studies is the randomized-controlled trial, when patients are randomly selected to receive a treatment or program and others do not. The HHS Report uses the lack of randomized-controlled trials to argue that GAC is unsafe, but it does not consider the strengths of the current science or the moral issues related to using the “gold standard.” The reason why RCT’s aren’t common for GAC is because we know that GAC is beneficial based on hundreds of other studies and there are serious moral issues that come up if we enroll someone into an RCT that is experiencing severe mental distress and then deny them care. This is especially the case with children and youth. And at the same time the Department of Health and Human Services states there is not enough evidence to support GAC, funding to support research for LGBTQ+ has been slashed.
Myth: Patients will regret their decision to access GAC. This is very misleading. A small number of people do regret their decisions around GAC, however the most recent US Trans Survey found that 98% of over 90,000 respondents were satisfied with their hormone treatment. This is significantly lower than other more common procedures, such as breast enhancements or a rhinoplasty. Regret among a few people should not make GAC inaccessible for everyone.
Access to GAC is a politically charged topic with significant amounts of misinformation and disinformation, but the scientific evidence points to the benefits of this care. As with other medical care, the decision of when and how to pursue GAC should be left to the individual patients, their families, and their doctors.