By Jack Turban
March 1, 2022 at 11:43 a.m. EST
Post)
Jack Turban is a chief fellow in child and adolescent psychiatry at Stanford University School of Medicine.
I’m a physician who has dedicated his career to improving the mental health of transgender youths. I’ve treated kids so uncomfortable with their chests that they bind them until they can barely breathe. I’ve seen cases of teens so distressed by their genitals that they don’t go to the bathroom and wind up suffering intestinal damage; they’re often so hunched over it looks as if they want to disappear into themselves.
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The dual traumas of their bodies developing in ways that don’t match their gender identity and the relentless harassment from their communities are overwhelming. A recent study by the Centers for Disease Control and Prevention found 35 percent of transgender teens had attempted suicide in the past 12 months.
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Yet last month, Texas Gov. Greg Abbott and state Attorney General Ken Paxton worked together to label as “child abuse” standard-of-care medical practices for transgender youths that have been endorsed by major medical organizations, including the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry. They also directed the Texas Department of Family and Protective Services to investigate parents who help their children access such care.
This tragic mistake is on par with putting children with diabetes into foster care because their parents gave them their insulin.
Over decades, the medical profession has developed protocols to help young people align their bodies with who they know themselves to be. We start with fully reversible interventions (temporary puberty blockers) and move toward less-reversible interventions (e.g., testosterone or estrogen) while providing psychotherapy so teens can better understand themselves and make informed decisions. With this approach, we’ve seen young transgender people thrive. Abbott and Paxton want to undo that progress.
Paul Waldman: The Texas GOP attack on trans kids reaches a horrifying new level
It’s clear Paxton hasn’t conferred with medical experts. He claims in a statement that “the medical evidence does not demonstrate that children and adolescents benefit from” gender-affirming care. In reality, at least 14 studies have examined the impact of gender-affirming care on the mental health of youths with gender dysphoria and have shown improvements in anxiety, depression and suicidality.
Paxton repeats commonly parroted misinformation about transgender youths. He falsely implies that most transgender adolescents will grow up to be cisgender (i.e., to identify with the gender they were assigned at birth). These data, hotly contested, apply to children who haven’t yet hit puberty, who are not candidates for gender-affirming medical interventions. Once a transgender child reaches the earliest stages of puberty, the point at which medical interventions are considered, it’s rare for them to later identify as cisgender. Studies of gender-affirming surgeries show regret rates between 0.3 and 0.6 percent. Of adolescents who start puberty blockers, only 1.9 percent choose to stop gender-affirming care.
Among the few adolescents who begin and then end gender-affirming interventions, some highlight the treatment as a necessary part of their journey to understand themselves. While some people might “de-transition” and regret gender-affirming interventions, these numbers are extraordinarily small in the context of the estimated 1.4 million transgender people in the United States. As with all medical interventions, potential risk of regret is weighed against potential benefit on a case-by-case basis. But this decision should be up to doctors and families, not politicians.
Paxton also claims that gender-affirming care for adolescents results in “sterilization.” This is false. Puberty blockers have been used for decades, and they don’t impair fertility. It’s possible — though not fully established — that estrogen and testosterone might impair fertility, and for that reason, guidelines recommend fertility-preservation counseling before starting these medications. While genital surgeries would of course have more dramatic implications for fertility, under current guidelines these procedures aren’t recommended for people younger than 18.
Voices Across America: I’m the mother of a trans son in Texas — and no, I’m not a ‘child abuser’
Another common misconception is that teens are rushed thoughtlessly into gender-affirming care. This couldn’t be further from the truth. Guidelines require that any minor undergoing gender-affirming medical interventions first work with a mental health professional (with very specific training requirements) to explore the nature of their gender dysphoria and ensure they understand the implications of pursuing treatment. And this process begins only once a family makes it to the clinic. Generally, families have had a long series of conversations about gender identity before they even call a clinic, and waitlists for gender clinics can be up to a year.
Parents helping their children through these transitions love their children. Yet Paxton, in seeking to label parents abusers, threatens to remove children from loving homes. Such separation results in trauma, along with physical and mental health issues, including depression, suicide attempts, decreases in IQ and even shorter life expectancy.
No parent should have to decide between going to prison and withholding necessary care from their child. Health policy needs to be driven by data and expertise, not misinformation and political rhetoric. I hope Paxton and Abbot will not let their political ambitions cloud their responsibility to protect the welfare of children in their state, and I pray they will change course immediately.
March 1, 2022 at 11:43 a.m. EST
Post)
Jack Turban is a chief fellow in child and adolescent psychiatry at Stanford University School of Medicine.
I’m a physician who has dedicated his career to improving the mental health of transgender youths. I’ve treated kids so uncomfortable with their chests that they bind them until they can barely breathe. I’ve seen cases of teens so distressed by their genitals that they don’t go to the bathroom and wind up suffering intestinal damage; they’re often so hunched over it looks as if they want to disappear into themselves.
Sign up for a weekly roundup of thought-provoking ideas and debates
The dual traumas of their bodies developing in ways that don’t match their gender identity and the relentless harassment from their communities are overwhelming. A recent study by the Centers for Disease Control and Prevention found 35 percent of transgender teens had attempted suicide in the past 12 months.
ADVERTISING
Yet last month, Texas Gov. Greg Abbott and state Attorney General Ken Paxton worked together to label as “child abuse” standard-of-care medical practices for transgender youths that have been endorsed by major medical organizations, including the American Academy of Pediatrics and the American Academy of Child & Adolescent Psychiatry. They also directed the Texas Department of Family and Protective Services to investigate parents who help their children access such care.
This tragic mistake is on par with putting children with diabetes into foster care because their parents gave them their insulin.
Over decades, the medical profession has developed protocols to help young people align their bodies with who they know themselves to be. We start with fully reversible interventions (temporary puberty blockers) and move toward less-reversible interventions (e.g., testosterone or estrogen) while providing psychotherapy so teens can better understand themselves and make informed decisions. With this approach, we’ve seen young transgender people thrive. Abbott and Paxton want to undo that progress.
Paul Waldman: The Texas GOP attack on trans kids reaches a horrifying new level
It’s clear Paxton hasn’t conferred with medical experts. He claims in a statement that “the medical evidence does not demonstrate that children and adolescents benefit from” gender-affirming care. In reality, at least 14 studies have examined the impact of gender-affirming care on the mental health of youths with gender dysphoria and have shown improvements in anxiety, depression and suicidality.
Paxton repeats commonly parroted misinformation about transgender youths. He falsely implies that most transgender adolescents will grow up to be cisgender (i.e., to identify with the gender they were assigned at birth). These data, hotly contested, apply to children who haven’t yet hit puberty, who are not candidates for gender-affirming medical interventions. Once a transgender child reaches the earliest stages of puberty, the point at which medical interventions are considered, it’s rare for them to later identify as cisgender. Studies of gender-affirming surgeries show regret rates between 0.3 and 0.6 percent. Of adolescents who start puberty blockers, only 1.9 percent choose to stop gender-affirming care.
Among the few adolescents who begin and then end gender-affirming interventions, some highlight the treatment as a necessary part of their journey to understand themselves. While some people might “de-transition” and regret gender-affirming interventions, these numbers are extraordinarily small in the context of the estimated 1.4 million transgender people in the United States. As with all medical interventions, potential risk of regret is weighed against potential benefit on a case-by-case basis. But this decision should be up to doctors and families, not politicians.
Paxton also claims that gender-affirming care for adolescents results in “sterilization.” This is false. Puberty blockers have been used for decades, and they don’t impair fertility. It’s possible — though not fully established — that estrogen and testosterone might impair fertility, and for that reason, guidelines recommend fertility-preservation counseling before starting these medications. While genital surgeries would of course have more dramatic implications for fertility, under current guidelines these procedures aren’t recommended for people younger than 18.
Voices Across America: I’m the mother of a trans son in Texas — and no, I’m not a ‘child abuser’
Another common misconception is that teens are rushed thoughtlessly into gender-affirming care. This couldn’t be further from the truth. Guidelines require that any minor undergoing gender-affirming medical interventions first work with a mental health professional (with very specific training requirements) to explore the nature of their gender dysphoria and ensure they understand the implications of pursuing treatment. And this process begins only once a family makes it to the clinic. Generally, families have had a long series of conversations about gender identity before they even call a clinic, and waitlists for gender clinics can be up to a year.
Parents helping their children through these transitions love their children. Yet Paxton, in seeking to label parents abusers, threatens to remove children from loving homes. Such separation results in trauma, along with physical and mental health issues, including depression, suicide attempts, decreases in IQ and even shorter life expectancy.
No parent should have to decide between going to prison and withholding necessary care from their child. Health policy needs to be driven by data and expertise, not misinformation and political rhetoric. I hope Paxton and Abbot will not let their political ambitions cloud their responsibility to protect the welfare of children in their state, and I pray they will change course immediately.
