The Washington PostDemocracy Dies in Darkness

Opinion Restricting care for transgender teens would be a terrible mistake

Demonstrators at the Supreme Court on Oct. 8, 2019. (Michael S. Williamson/The Washington Post)

Tey Meadow is an associate professor of sociology at Columbia University and author of “Trans Kids: Being Gendered in the Twenty-First Century.”

Lawmakers in at least six states — South Dakota, Florida, South Carolina, Colorado, Oklahoma and Missouri — are seeking to make it a criminal offense for physicians to provide gender-confirming medical care, including puberty suppressors and hormone therapy, to transgender children and adolescents. Others, such as in New Hampshire, are attempting to classify affirming a child’s gender identity as “child abuse.”

As a sociologist who has spent the past decade researching the families of trans and gender-nonconforming children, their physicians, psychologists and advocates, I’ve heard arguments like these before from other well-meaning people. But I can say with certainty that restricting care for these young people would be a terrible mistake.

Those who feel uncomfortable with the concept of such treatment should know this: It’s not new. Medical transition for adults has been available in the United States since the late 1960s. The drugs used to suppress puberty in children have been under study since the 1970s. Contrary to what the legislators assert, we do know how they work. And as successive generations of trans people have earlier access to care and support, we have increasing evidence that the earlier they are delivered, the better.

The movement to criminalize transgender medicine relies on fundamental misunderstandings of the kinds of care actually offered to children and adolescents. And it ignores the evolving consensus among physicians and psychologists that active facilitation of the gender identities of trans youths — acknowledgment, support, associated medical care — is the single biggest predictor of the physical, psychological and emotional well-being of these youths. This is why nearly every major medical governing body in the United States — the American Medical Association, the American Academy of Pediatrics, the American Psychological Association, the Endocrine Society and the American College of Obstetrics and Gynecologists — all recommend the “affirmative” model of care for transgender young people.

The accepted standard of medical care for transgender youths is managed by the World Professional Association for Transgender Health, which does not recommend medical treatments for pre-pubertal children. They do, however, receive psychological and social supports aimed at helping both the child and their family understand and navigate the child’s gender identity.

Puberty suppression is often the first step in medical care for transgender adolescents. Longitudinal research demonstrates that adults who had early access to puberty suppression — which is reversible — fare far better psychologically than those who did not. As the WPATH statement on the proposed legislation outlines, hormone therapy and non-genital surgical procedures are — in carefully selected cases — administered to transgender children in later adolescence. It is only after legal adulthood (age 18) that genital and reproductive medical treatments become an option.

These treatments make the lives of trans youths better. Research measuring the long-term effects of psychological and medical supports, administered under these and previous WPATH guidelines, show a near-universal efficacy. Transgender children who are supported in their affirmed genders are every bit as psychologically healthy as their cisgender peers. While some trans youth exhibit a slight elevation in self-reported anxiety, this is consistent with what psychologists call “minority stress” — the cumulative psychological impact of stigma and nonacceptance from family, peers or the larger culture, which includes our government.

While stigma hurts them, it does not make them cisgender. Late adolescents and early adults who make full medical and social transitions almost never change their minds. They may learn to “cover” — a term sociologists use to describe the downplay or hiding of a stigmatized part of one’s identity. But that is very different from no longer feeling trans, and covering can be psychologically costly.

Conservative lawmakers often paint transgender children as “vulnerable” to abusive treatment, but if they are vulnerable to anything, it is the disastrous social, psychological and bodily effects of nonacceptance. Trans youths who lack parental and community support exhibit higher levels of depression, early substance abuse and suicidal ideation.

This elevated risk appears to be directly proportional to their victimization by others. The Centers for Disease Control and Prevention’s Youth Risk Behavior Survey found that suicidal ideation was nearly three times higher in trans youth, but that those same youth were five times as likely to be threatened or injured with a weapon at school and more than four times as likely to fear that environment as a whole. These are not inconsequential matters: A number of gender nonconforming young people have taken their lives in recent years rather than face rejection from family and school communities.

These lawmakers are right to stress that we as adults hold responsibility to ensure the well-being of trans and gender nonconforming youth. We most certainly do. But the best way to help them thrive is to demonstrate to these young people that we love, support and affirm them everywhere — including in the clinical consulting room.

Read more:

Ruth Marcus: We’re at war over gender pronouns. Can’t we all just show some respect?

Aimee Stephens: I was fired for being transgender. The Supreme Court should make sure it doesn’t happen again.

Chase Strangio: I’m a transgender attorney fighting for my community. Will that make a difference to the Supreme Court?

Jennifer N. Pritzker: Why should I support a political party that is marginalizing me out of existence?

Henry Olsen: California wants to teach kindergartners about gender identity. Seriously.