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The right of transgender minors to receive gender-affirming care has sparked debate in many parts of the United States and is now headed to the US Supreme Court.
The court will hear oral arguments. Wednesday In testing, transgender youth and their families; to the law Tennessee prohibits sex-affirming medical care for minors.
It is one of 26 states that have banned gender-affirming health care services for transgender children and adolescents. analysis From the data Activity Development Project, A non-profit think tank that advocates for LGBTQ rights.
Gender-affirming care is a multifaceted approach that includes medically necessary and scientifically evidence-based practices to help a person safely transition from their assigned gender—the gender a clinician assigned at birth based on most physical characteristics—to the gender they identify with—what gender the individual is. He wants to be known.
Although the term gender-affirming care has only recently entered the public lexicon, Dr. Madeleine Deutsch, Director UCSF's Gender Affirmative Health Program in San Francisco says the practice is long-standing and well-established. In decades Scientific research.
Major medical associations – incl American Medical Associationof American Psychiatric Associationof Endocrine Societyof American Psychological Associationof American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry – They confirm the practice of gender verification and agree that it is the gold standard Clinically suitable Care that can be provided Life saver Treatment for children and adults.
“While we are always evaluating the strength of the evidence for this type of care, every major US medical association recognizes that the medical evidence is strong and supports centers that provide this type of care and have been doing so for decades,” said Dr. Kellan Baker. Director General The Whitman-Walker Institute, a healthcare organization working on LGBTQ+ issues.
A wide-ranging but controversial review of research in the UK this year questioned the use of anti-puberty drugs, saying the cause of early puberty was “unclear” and that any benefits for mental health were supported by “weak evidence”. The assessment is known as – Cass review For Dr. Hilary Cass, a pediatrician, it has prompted providers in the United Kingdom to reduce their use of the drug. However, his method has come under Sharp criticism From some scholars and experts.
The process usually begins with a conversation between a medical professional and the individual. If the patient is a child, the discussion includes the family as much as possible.
“It's really about better understanding what they're bringing to the clinic,” Licensed said. Clinical psychologist Dr. “We are also looking to understand the child's understanding of their own gender, gender expression and the history associated with that.”
After the experts decide what the person needs, a multidisciplinary team of medical professionals makes a plan for them. Depending on the person's age, care may include mental health and support groups, legal help, and sometimes medical help, such as hormones or surgery as a person goes through puberty.
“This is individualized care, not a one-size-fits-all plan,” Baker said.
A transition plan can be as simple as providing support when someone starts using different pronouns, changes their hairstyle or clothing, or uses a different name.
“When we support and allow people to do these things, their lives are better,” Deutsch said.
mental health care; Gender-affirming care often includes counseling. A 2018 study He found that the prevalence of mental health problems among transgender youth It was seven times higher than their cisgender peers.
Mental health problems Not necessarily a stem From one person's identity; growing one No Studies show They often They happen Due to what is known as social discrimination and minority stress. alienation, IsolationDiscrimination, bullying, harassment and Violence It can cause feelings of isolation and isolation.
People who identify as transgender may need mental health help just to find out who they are, come to terms with it, and find self-acceptance. Mental health care can help people come out to their families and friends and develop coping mechanisms so they can be who they are in a world that is not always friendly or accepting.
Gender-affirming care; Studies show, It reduces a person's risk of depression and suicide and is associated with improved well-being.
Medicine and Surgery; Some people may receive age-appropriate medical care, such as hormone therapy, adolescent partners, voice and communication therapy, gynecologic and urologic therapy, and reproductive medicine. Normally, surgeries are given only to adults.
World Professional Association for Transgender Health InstructionsWhat you think. Gold standard For gender-affirming care around the world, they say that this type of care should provide a person with safe and effective ways to achieve lasting personal comfort with their gender identity with the goal of improving their overall physical health, psychological well-being, and self-esteem. fill out”
What are puberty blockers and hormones?
When children reach a certain stage of puberty – when diagnosed by a medical provider – and still have a persistent and well-established feeling that their gender does not match the gender assigned at birth, doctors and families can decide. Moving forward with reversible AdolescenceIt is commonly called Adolescent defenses.
Although not all patients choose this treatment. Some research It shows that gender non-conforming youth may experience anxiety when they begin to develop secondary sexual characteristics.
These gonadotropin-releasing hormone drugs were used for the first time Delayed puberty For people known as Pre-adolescenceAs the baby's body quickly turns into an adult.
Adolescents prevent the development of secondary sexual characteristics for a few years, giving the child time to find support, explore their gender identity and develop coping skills, according to the American Academy of Pediatrics. If a patient decides to stop treatment, puberty will resume.
“This basically puts everything on hold, and kids can stay on that for two years with no ill effects, and it's completely reversible,” Deutsch said. “If you stop, everything will continue where you left off.”
Studies have shown that puberty blockers can reduce the stress that can occur when a child changes secondary sexual characteristics such as breasts, Adam's apple or voice. Studies show Transgender teens who use puberty blockers are less likely to commit suicide than those who seek treatment but don't. Adolescent barriers can ease the transition later in life because the person has not developed these secondary sexual characteristics.
In this process of gender maintenance care, after a thorough evaluation by a medical professional, a patient can take hormone therapy which will result in a gender-affirming physical change.
Adolescent contraceptives may carry some risks, and more long-term studies are needed Pediatric Endocrine Society. According to the American Academy of Pediatrics, long-term studies on fertility and bone health are limited and provide “varied results.”
The World Professional Association for Transgender Health guidelines state that before prescribing puberty blockers, the provider must confirm that the person has a persistent and persistent gender disorder or gender nonconformity. They must have the emotional and cognitive maturity to give informed consent; Any co-occurring mental health problems that interfere with treatment or consent need to be addressed. The person should tell you that there may be reproductive consequences, and contraceptive options should be discussed; And the child should reach Tanner stage 2 during puberty, which is when a girl starts to develop breast lumps and a boy's scrotum and testicles start to increase in size. Pediatric endocrinologist should agree with this decision.
Professional medical guidelines, with some exceptions, do not recommend puberty blockers, hormone therapies, or surgery for prepubescent children. If such treatment is indicated, the medical professional will first conduct a thorough evaluation in collaboration with the patient and their caregivers to understand the child's unique needs.
I think one of the biggest myths is that kids feel rushed into medical decisions like hormone therapy or surgery. This is not the only issue; said Wald.
Deutsch agreed: “Kids don't do anything about it, because they want to be trans because it's trendy or something,” she said. “Trans youth and trans people in general do not have access to hormone vending machines.”
Some critics suggest that young people who take puberty blockers may change their minds about their gender identity later in life. Many studies show that most people choose gender-affirming care. Don't regret their choice later. – including Research conducted in October 2022 In the Netherlands, they found that 98% of transgender youth who started gender-affirming treatment as teenagers continued to use those hormones into adulthood five or six years later. Among the 3,306 UK Gender Identity Development Service patients included in the Cass Review analysis, less than 10 patients registered at birth had transitioned to their gender.
Questions about the benefits of birth control pills have received new attention, the author of a federally funded study said in October. Delayed publication Some of her results are feared to be “armed” in a heated political climate.
According to Johanna Olson-Kennedy, medical director of the TransHealth and Developmental Center at Children's Hospital Los Angeles. In the studyPuberty blockers, which she helped lead, followed 95 children ages 8 to 16 for two years to help them improve their mental and physical functioning, and when the drugs were used to slow the physical changes associated with puberty, they didn't seem to improve mental health.
Some advocates for…