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Civilities: Some skeptical parents brought their questions to a national expert on transgender kids

Cayden McDonald, a transgender boy from Prince William County, Va., who was featured in a Washington Post story last year about transgender teens. (Pete Marovich For The Washington Post)

My most recent column, “Let’s remember when we talk transgender law, we’re talking about our kids,” stirred up a lot of controversy, especially among a Reddit group of parents who are worried about their tweens and teens with “gender identity issues.”

These parents, many of them affiliated with a site called 4th Wave Now (which describes itself as “a community of parents & friends skeptical of the ‘transgender child/teen’ trend”) claim that transgender experts are promoting “a contagion with a one-size-fits-all treatment [surgery and hormones] that is leaving casualties in its wake.” They add that there’s a “rush to affirm and celebrate” these kids’ decisions to transition.

With my regular chat on the calendar for earlier this week, a faithful reader sent me word of this announcement from the Reddit group (see above).

“Let’s get a good crowd of gender critical folks to show up for Petrow’s chat. Let’s let him know we are tired of the MSM [mainstream media] showing only one side of this debate. Let’s demand that the Washington Post cover the other side. Please feel free to share this call to action widely!”

A very good-sized crowd did join me — and my guest, Dr. Michelle Forcier, an associate professor of pediatrics at the Brown University Alpert Medical School, who is considered an expert on transgender, queer and questioning youth. (Chat questions and answers have been edited and condensed for clarity and length.)

The ethics of prescribing hormones

Q: How is it ethical to put children on a journey of lifetime hormone medication, plus endure the health risks of surgery, when — if those children are left to work their own life out — 80 percent will come to accept their biological sex?

Michelle Forcier: The bias inherent in the question is interesting and deserves a response. Not providing care seems to be more unethical and have worse health outcomes than providing care in this population. For example: How ethical is it to negate a person’s identity to tell them you know them better than they do? How ethical is it to deny a person access to medication that is very safe, effective and proven to help persons with gender nonforming/diverse brain/identity and body experiences? Additionally, transgender persons are never forced into surgical care. They need true understanding and consent to be able to engage in it. The 80 percent data is not representative or accurate for the bulk of children who move towards blockers or gender hormones.

Trans teen surgery

Q: Trans teens in this country now receive drastic surgeries, e.g. mastectomy, as young as age 14. How can such young kids truly give informed consent for such radical measures? There’s a good reason we don’t trust young teens with huge decisions — they are immature, by definition. Their brains have not fully developed.

Forcier: This “drastic surgery” again, such biased language! has really changed many trans boys and men’s lives, and has low risks and outcomes for complications and regret. Teens assent to surgery with parental consent. We are lucky that many parents understand that waiting for the arbitrary legal age of 18 for chest surgery for some young teens is cruel and harmful from a physical and psychiatric perspective. There is no one-size-fits-all . . . no one-time- or one-age-fits-all. There is listening to patients and the data, which suggests this surgery is safe, low risk and has low outcomes for regret.

Trans student staying in a field trip hotel room

Q: This April, a friend of mine who is a teacher will be accompanying a dozen students on a trip to Washington, and there will be four kids to a room. The students will be sharing beds. Among those students there is a young trans boy (female to male), and the teachers and staff are trying to figure out what is best for this boy. His female friends who are coming along are supportive of his transition. Her first inclination is to room this boy with the girls. She knows for sure that she can’t place him in a room with other boys because there are concerns about sexual assault. Does this make any sense? At the middle-school age, would it just be best to allow him to room with his female friends whom he is most familiar with?

Forcier: I would have open conversations with the parents and potential rooming parents involved. If this kid has friends who know and love him and who feel safe and want him to feel safe and all the kids and parents are okay to room together  great! If not, or if the patient wanted a single room for privacy, that is okay too. How terrible that we are worried about sexual assault just because there are cis boys in a room. Wow, we need to teach all our kids about respecting privacy, consent, what “no” means, and a whole host of ways to respect each person’s personal space and bodily integrity.

Puberty blockers

Q: How safe are puberty blockers such as Lupron for teens and preteens? They are often presented as harmless, reversible drugs that buy time for a young person. But they have a list of very well-known side effects in adults, including liver damage, osteoporosis and depression, including suicidal thoughts.

Forcier: The risk of not giving puberty blockers and the harm for continued development in the “wrong” gender far outweighs the minimal risks of totally reversible blockers. Please do not present “alternative facts” as data. There is no significant literature regarding liver damage, osteoporosis or severe depression in hundreds of youth on blockers.

Finally, I asked Michelle Forcier for her thoughts on the chat questions that had come in.

Forcier: There seems to be lots of bias, misinformation and making statements about “data” that are not supported in the actual medical literature. I am also always struck by how many persons without gender expertise, nor significant experience with a cohort of gender patients, have such strong, absolute opinions. Finally, I am hopeful that I can clarify many of the misstatements about our clinic’s care, approach and paradigm. At our clinic, we listen to kids for a whole host of medical and psychosocial issues and try to provide comprehensive holistic care. We apply very individualized (not one-size-fits-all) care to each youth and family, in the context of achieving their goals and with their safety, health and short- and long-term well-being in mind. Finally, we make no assumptions about patients, so [we] need to hear their stories, learn more about their experiences and retain humility, respect and a hopefulness that all youth deserve to be appreciated as their authentic selves, have a safe and loving home, and have caring, knowledgeable, and respectful providers helping them achieve their gender and other health goals.