I am truly disheartened and frustrated that politics are criminalizing evidence-based medical care for transgender youth. At least seven states proposed anti-trans bills in the first week of 2022, and due to political pressure, some hospitals are closing their doors to new patients. I worry about not being able to see my patients and about their treatment being disrupted. Transgender youth could lose access to the care they need because their health is up for political debate. Due to restrictions in some states, transgender youth may need to travel long distances to receive care. This is not a feasible option for everyone. Last summer, I was surprised to meet a mother and her child who traveled from Florida to New York to seek help and counseling.
Almost 2 percent of high school students identify as transgender, and these numbers are rising. These students experience bullying and feel unsafe at school, and 35 percent attempt suicide. Anti-transgender legislation legitimizes violence against transgender people. Suicide is a result of living in a transphobic society. When transgender teens are denied care, their rates of suicide are much higher. Research shows having access to gender-affirming care and hormone therapy could reduce the risk of suicidal thoughts in transgender youth.
The government, public and, unfortunately, some health care professionals have misconceptions about gender-affirming care. They question whether the mental health evaluations are sufficient and if puberty-delaying medications are safe. There are also misconceptions that surgery is the first line of therapy for transgender children. We prescribe puberty-delaying medication to give our patients time to explore their gender identity and avoid the distress of going through puberty in the wrong gender.
Prescribing puberty-delaying medications is the most conservative approach to managing gender dysphoria in transgender youth. These medications are reversible and are only recommended if the patient meets the diagnostic and treatment criteria of the Endocrine Society Clinical Practice guidelines. Puberty-delaying medications have been used for decades to treat children with early-onset puberty. These medications’ safety is only being questioned now that they are being used as part of gender-affirming treatment for teens with gender dysphoria.
When transgender children and adolescents do not have access to regulated gender-affirming care, they will seek unregulated gender-affirming care. This has actually come up in my practice when adolescents were cut off from their medical providers. When people do not have safe access to care, they will be forced to make unsafe choices.
Gender-affirming care improves the mental health and wellbeing of transgender youth, however, politicians continue to propose policies that block access to care and disregard widely accepted medical evidence and Clinical Practice Guidelines. The Endocrine Society’s guideline and position statement reflect the consensus of more than 18,000 endocrinologists worldwide and a thorough review of the scientific evidence behind transgender health.
We are in alignment with major international medical and scientific organizations such as the American Medical Association, the Pediatric Endocrine Society, the American Psychological Association, and the American Academy of Pediatrics on gender-affirming care.
Many other organizations have strongly opposed discriminatory policies against transgender youth, including the American Psychiatric Association, the American Academy of Family Physicians, the American College of Physicians, the American College of Obstetrics & Gynecology, the American Osteopathic Association, and GLMA: Health Professionals Advancing LGBTQ Equality.
Politicians are ignoring the medical evidence and keeping physicians from providing the best care possible to our transgender patients. I feel uneasy about the future of my patients’ care and saddened that they face several obstacles and discrimination from the political system.
We need to stand together to fight efforts that block gender-affirming care for trans youth. The Endocrine Society has developed resources to advocate for transgender policy changes in your state.
Siham Accacha is a pediatric endocrinologist.
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