As a Catholic Doctor, I Know Gender-Affirming Care Is Essential for Transgender Youth.

!chasers !cuteandinvalid

I am a pediatric endocrinologist who works in a gender clinic at a major U.S. teaching hospital. I am writing this article anonymously because medical providers who take care of transgender youth are being targeted by those who oppose what we do. My safety and that of my colleagues is at risk. Unfortunately, many of us have received vicious emails and we have experienced a few incidents of individuals coming to our clinics to disrupt our work. Many gender programs in this country have been forced to close due to laws that ban transgender care of persons under 18 years of age.

Because I am a Catholic physician, I spent many hours discerning whether it was morally acceptable to treat these children. I view relieving suffering as my duty as a physician. These children are clearly suffering. They have an extremely high incidence of depression, suicide, and self-harm. Eighty-two percent of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth. This risk is significantly reduced with supportive care and medical/mental health intervention. I have seen this turnaround repeatedly in my practice. The work that I do is affirmed by prominent medical societies including the Endocrine Society, the Pediatric Endocrine Society and the World Professional Association for Transgender Health.

Many misconceptions circulate about caring for youth with gender dysphoria, which is defined as distress due to a mismatch of the person's assigned gender and the gender identity they affirm. For example, despite a common rumor that floats around these discussions, prepubertal children are never treated with puberty blockers or hormones. Those who propagate these rumors need to know that these children and their parents are supported by mental health professionals. The children often continue to socially transition by dressing in the clothing of the gender they affirm and changing their pronouns and names. To support these children, it is important that home and school situations enable them to feel comfortable with their clothing and pronouns.

When pubertal changes are first noted, generally at age 10 to 11 years of age, puberty blockers can be started after a thorough mental health assessment. By blocking puberty for a few years, these children have the time they need to consider their gender identity without the stress of allowing puberty to progress. Puberty blockers are reversible so the child can stop them at any time and continue with biological puberty if they decide that their gender identity aligns with their biological s*x.

Many people may not know that irreversible hormone therapy (estrogen or testosterone) is only offered after another complete mental health assessment and no earlier than 14 years of age. Children are carefully monitored for side effects of the hormone therapy and are supported with mental health services throughout their gender journey. Parental consent is always required for any treatment in youth under age 18.

The possibility of detransitioning (i.e., affirming the biological gender after having been treated) is often stated as a reason to withhold treatment. This possibility should not prevent treatment. The use of reversible puberty blockers until at least age 14 is specifically prescribed to allow teens to be confident in their gender identity. Moreover, prior to starting on gender affirming hormone therapy, the teen must pass a full mental health assessment that confirms a persistent and consistent gender identity. Regrets after treatment are rare. An extensive literature review from Cornell University's Public Policy Research Center found a regret rate ranging from 0.3 to 3.8 percent with regrets most likely resulting from a lack of social support after transitioning, such as family rejection, lack of affirmation of gender identity in school, stigmatization, violence, and sexual assault. Ninety-three percent of treated individuals reported an increase in overall well-being.

It is important to know that detransitioning and regret are not synonymous since most individuals who detransition do not regret their treatment but are either pressured to detransition or over time reconsider their gender identity. In a large study from the Netherlands, most participants who started gender-affirming hormones in adolescence continued this treatment into adulthood, thus diminishing the possibility of detransition as an area of concern.

Another concern regarding the treatment of gender dysphoria in children is the concept “rapid onset of gender dysphoria” or what is called transgender social contagion. It is unlikely that this phenomenon exists to any significant degree. Children generally have gender dysphoria for years before they divulge this to their parents and the “rapid onset” may represent the perceptions or experiences of their parents rather than social contagion. Since all children will have thorough mental health evaluations prior to treatment, those without true gender dysphoria will be offered supportive care only.

Treating gender dysphoria in children in our society has unfortunately become political. However, treatment of these children does not “groom” them to affirm a gender identity contrary to their biological s*x. Instead, this treatment is a support for them through an exceedingly difficult period in the path to affirming their authentic selves.

I consider the work that I do essential for the health and well-being of children who are struggling with their gender identity. Children should be evaluated and treated in centers that have medical staff and behavioral health providers who are trained in providing gender care. Long term studies of treated children are underway and are necessary to ensure proper treatment and monitoring. For now, treating these children alleviates the suffering they experience when their gender identity is not affirmed.