By Jessica Weissman and Jessie Ford
When it comes to gender and sexuality, we believe it is important to take an affirming, positive, and holistic approach. This means understanding that identities and attractions are diverse, complex, and very important to people. Gender affirming care has the potential to be just this, and includes a robust array of healthcare (most frequently talk therapy) that is designed to support and affirm a person’s gender identity. Such gender affirming care is important for the health and wellbeing of gender diverse, transgender, and nonbinary youths and adolescents. It is also recognized as safe, effective and medically necessary by all major medical organizations in the US, including the American Academy of Pediatrics and the American Medical Association.
Yet, in the last year, more than 100 bills preventing trans youth from accessing gender affirming healthcare have become laws across the US, leaving 35.1% of transgender youths in states banning safe and medically necessary care.
How did we get here? At present there are a lot of tensions and misconceptions around gender affirming care. This care is often inaccurately portrayed as irreversible, hastily done, and dangerous. In practice, this care is flexible, careful, deliberate, and even suicide-preventing. We would repeat—the majority of gender affirming care is talk therapy, not sex changes. Yet, all these myths around gender affirming care for trans or gender non-conforming (TGNC) youths are adding to stress and misunderstandings. Moreover, gender affirming care bans have been cast as a form of protection for TGNC youths, when in reality, these bans can have harmful effects.
TGNC youths are among the most vulnerable in our population. TGNC youths experience unique distress when their gender identity is incongruous with their sex assigned at birth. Accumulating evidence proves that TGNC youths have especially high rates of negative mental health outcomes such as depression, anxiety, and suicidal ideation in the US. A study done by the University of Minnesota found that suicidal ideation was reported by 61% of TGNC youths, more than three times what is reported by their cis-gendered peers. Another study, which included 371 transgender youths, found that 82% had considered suicide, and 40% had attempted.
Healthcare guidelines for TNGC youths are informed by decades of research and are ever evolving as we better understand care. Gender affirming care is commonly misconceived as being rushed and entirely surgical. On the contrary, the World Professional Association for Transgender Health outlines standards of care which include thorough investigation of an individual’s psyche, family, and social issues before moving onto additional interventions. Psycho-social care (e.g. talk therapy) focuses on promoting resilience, addressing stigma, palliating internalized transphobia, strengthening social support, and improving body image.
When further measures are deemed necessary, less common interventions such as puberty blockers make it possible for young people to take more time to discern their gender identity prior to the onset of permanent sex characteristics. Additional hormone therapies allow adolescents to achieve sex characteristics that align more closely with their gender identity. Puberty blockers and hormone therapies have been safely used for decades, and the irreversibility of these interventions is a common misconception. The effects of puberty blockers are entirely reversible, and additional hormone therapies are fully or partially reversible depending on the length of use.
There is also widespread belief that gender affirming surgery for TGNC youths is common practice; however, gender affirming surgery is performed on less than 1% of TGNC youths seeking care, and only when deemed clinically necessary by parents and doctors. Just to reiterate, surgery is very, very rare. As for those who do decide to receive gender affirming care, there is mounting evidence to suggest that detransition among transgender youth is rare.
A growing body of evidence on the positive effects of gender affirming care further contradicts the misinformed, fear-inducing character of the bans. The positive health effects associated with timely gender affirming care are vast. A Stanford University study found that adolescents who received timely hormone therapy experienced less suicidal ideation, decreased rates of substance abuse and fewer mental health disorders. A similar study revealed 60% lower odds of depression, and 73% lower odds of suicidality among TGNC youths who initiated puberty blockers or gender-affirming hormone therapy, compared to those who had not.
Legal and societal shifts in the United states have threatened the safety of trans people who, in the face of these restrictions, are left more vulnerable than ever. Eliminating these protections for transgender youth not only affects access to suicide-preventing care, but also reinforces the notion that TGNC people are undervalued by society and the healthcare system.
It is our hope that by debunking myths around the safety and necessity of gender affirming care we can increase people’s awareness and understanding. We’ll conclude by stressing a few things we know for certain; gender affirming care is safe, medically necessary, and can prevent suicide. Myths surrounding gender affirming care perpetuate the harmful misconceptions of care bans as protection for trans youths. Gender affirming care is protection for trans youths, and can save lives wherever lawmakers allow.
Jessica Weissman is a master’s student at Columbia University Mailman School of Public Health. Jessica studies in the Sociomedical Sciences Department and is obtaining a certificate in Sexuality, Sexual and Reproductive Health. Jessica is a member of the Sexual Health Action Group and the Queer Health Task Force at Mailman. While Jessica is still honing in on her specific research interests, she aspires to contribute to an evidence base that informs programs and policies aiming to enhance the health outcomes of sexual and gender minority populations.