MYTHS & fACTS
ABOUT CARE FOR TRANS YOUTH
MYTH: “Most Children Outgrow being Transgender” (aka: 80% Desistance).
FACT:
The most pervasive and damaging stereotype about transgender children is that they are merely going through a phase. The 80% figure comes from a 2013 study in Amsterdam conducted by Thomas Steensma, PhD and others. The study has been widely criticized for flawed methodology and the author himself has said that measuring desistance was never the intent of the study.
MYTH: those who receive gender affirming care will regret it.
FACT:
Fewer than three percent of those who receive gender-affirming medical care discontinue or regret that care.
THERE IS NO EVIDENCE THAT GENDER-AFFIRMING CARE IMPROVES MENTAL HEALTH.
FACT:
Gender-affirming care (GAC) is defined as any kind of medical care that people receive to align their body with their gender identity. This includes therapy, consultations with doctors, hormones, medication, or surgery for those over the age of 18. Gender-affirming care is life-saving medical care for the majority of people who receive it.
TEST YOURSELF!
What do you know about Gender Affirming Healthcare in OHIO?
What causes people to be trans?
Gender incongruence is not new. It is well-documented in ancient literature and by contemporary science as a naturally occurring phenomenon like intersex conditions. It is not caused by trauma or mental illness, though mental health challenges and PTSD can be comorbid conditions.
Does gender-affirming healthcare make kids more confused about their gender, leading to worsening depression, anxiety, and suicidal ideation?
When children have been insistent, consistent, and persistent in their feelings of severe gender dysphoria, have begun puberty, and are cared for and diagnosed by a multidisciplinary team of doctors as having gender dysphoria, gender-affirming care (which often does not include medical interventions) is shown to reduce depression, anxiety and suicidal ideation.
According to the Ohio Suicide Prevention Foundation, “Risk for suicide stems, in large part, from experiences of minority stress, such as discrimination, harassment, and rejection due to one’s identities.”
Efforts to remove gender-affirming care increase depression and anxiety in gender-diverse people.
What does gender affirming care look like for minor children in OHIO?
In Ohio’s pediatric hospitals, children are not given puberty blockers or cross-sex hormones until the onset of puberty. Evaluation for gender dysphoria is a lengthy process carried out by a multi-disciplinary team of medical and mental health professionals who evaluate the WHOLE child.
Prior to puberty, families and patients are offered therapeutic support. Families may choose to allow a child to wear clothing that makes them more comfortable or try a different name or pronouns. These accommodations for gender dysphoria are not taken lightly.
If a child is consistent, persistent, and insistent in their gender incongruence and dysphoria past the onset of puberty, puberty blockers and/or cross-sex hormones MAY be given.
Are puberty blockers dangerous with severe, permanent side-effects?
Puberty blockers have been safely on the market for precocious puberty since the 1980s and have been successfully used in gender-affirming healthcare since the 1990s.
In nearly all cases, they are completely reversible, meaning upon ceasing to take the medication, puberty begins.
There are risks with any medication. Physicians prescribing puberty blockers are aware of studies showing the possibility of bone density loss along with other potential side effects and monitor their pediatric patients similar to any other medication a child might be prescribed.
Some believe the high percentage of patients who progress to cross-sex hormones when placed on puberty blockers indicates that puberty blockers are not “reversible.” That they cement the idea of gender incongruence in a young patient’s head. This is pure speculation. Given the strict diagnosing protocols for gender dysphoria, it is just as likely that diagnoses of gender dysphoria are hightly accurate and those placed on on puberty blockers are indeed transgender.
Are children and parents being coerced into irreversible transitions with threats of suicide?
Threats of suicide should never be used to coerce a human being into physical or mental health treatment. Doctors do, and are required, to share the potential for serious outcomes of all treatment (or lack of treatment) options they present for any illness or condition. This can be disconcerting when the risk of suicide is real.
Quibbling over suicide statistics is, in itself, flawed thinking, because the implication is that the only valid reason for treatment of gender dysphoria is potential suicide. This completely dismisses other valid reasons for treatment: relief of mental anguish, success in life, school, and relationships, self-esteem, and feeling authentically human.
Children who are insistent, persistent and consistent with their gender identity through the onset of puberty, and have progressed through a systematic, whole-child plan of care, the vast majority (98%) who do choose surgical options as adults are satisfied with the outcome and report a significant decrease in anxiety and suicide ideation.
Isn't gender incongruence a social contagion that leads teen girls down a path toward sterilization?
This perception is highly sensationalized and false. There is no evidence that social influences are the cause of gender incongruence within the medically transitioned population.
Further, puberty blockers do not cause sterility. This claim is false. Reproductive sterility is not an automatic result of cross-sex hormones. The Standards of Care address relational ramifications with accommodations for patients to retain the ability to reproduce should they so choose to do so.
In Ohio, children do not make these decisions on their own. Parents and patients, in concert with their doctors, are best equipped to make these decisions.
SOURCES
For more information, see “What the Science on Gender-Affirming Care for Transgender Kids Really Shows” in the May 2022 issue of Scientific American.
References
Bao, A.M., & Swaab, D.F. (2011). Sexual differentiation of the human brain: Relation to gender identity, sexual orientation and neuropsychiatric disorders. Frontiers in Neuroendocrinology, 32(2), 214–226.
Bauer, G. R., et al. (2022). Do Clinical Data from Transgender Adolescents Support the Phenomenon of “Rapid Onset Gender Dysphoria”? Journal of Pediatrics, 243, 224-+.
Coleman, E., et al. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal Of Transgender Health, 23, S1–S258.
Olson, K. R., et al. (2022). Gender Identity 5 Years After Social Transition. Pediatrics, 150(2).
Olson, K. R., & Durwood, L. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3).
Phillip, A., et al. (2022). A Plausible Explanation of Increased Suicidal Behaviors Among Transgender Youth Based on the Interpersonal Theory of Suicide (IPTS): Case Series and Literature Review. Journal of Psychiatric Practice, 28(1), 3–13.
Rew, L., et al. (2021). Review: Puberty blockers for transgender and gender diverse youth—a critical review of the literature. Child and Adolescent Mental Health, 26(1), 3–14.
Steensma, T. D., et al. (2013). Factors Associated with Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study. Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 582–590.
Turban, J. L., & Ehrensaft, D. (2018). Research Review: Gender identity in youth: treatment paradigms and controversies. Journal of Child Psychology & Psychiatry, 59(12), 1228–1243.
Bustos,V. P., et al. (2021). Regret after Gender-affirmation Surgery: A Systematic Review and Meta-analysis of Prevalence. Plastic and Reconstructive Surgery, Global Open, 9(3), e3477–e3477.
Yildizhan, B. Ö., et al. (2018). Effects of Gender Reassignment on Quality of Life and Mental Health in People with Gender Dysphoria. Türk Psikiyatri Dergisi, 29(1), 11–21.