With the U.S. Presidential election only a week away, there is a lot of misinformation spreading about a specific subset of health treatment: gender-affirming care. Our clinicians at Groundswell have worked with TGD* individuals for over fifteen years, in a settings ranging from in-home family therapy agencies to inpatient psychiatric hospitals. The issue of medical and mental health treatment provided to minors has become a political talking point by both sides, often without expert voices being invited into the discussion. So we thought it'd be an appropriate time to give an overview of the facts and myths about this effective and life-saving treatment.
Myth 1:
Gender-affirming care means doctors treat minors according to their whims or fleeting desires, without safeguards or parental consent.
Fact: Gender-affirming care is always delivered by doctors in age-appropriate, evidence-based ways; decisions about how to provide care are made in consultation with these doctors, therapists, parents and guardians of the AYA* patient if they are a minor. There are only a few exceptions to this, related to the youth's status as legally emancipated minor, if they are estranged from parents and/or unhoused.
Myth 2:
A child can go to a clinic and receive any level of treatment, from hormone therapy to surgeries.
Fact: Gender-affirming care consists of four stages, beginning with "social transitioning." This may include updating wardrobe or hairstyles, ascertaining what pronouns the patient would prefer to use, and potentially calling the patient by a different name. It's crucial to recognize that each of the four stages (as laid out by the Endocrine Society here: social, medical, surgical and legal) usually lasts for years, and individual patients may or may not continue through every stage. If they do, the surgical and legal stages will occur after the patient has reached adulthood.
Myth 3:
Medicines known as "puberty blockers" cause infertility and stop puberty in irreversible ways.
Fact: The main side effect of these medications, known as GnRH Analogues, is decreased bone density, which is easily treated with Vitamin D supplements. These drugs are safe and reversible, as they simply pause the progression of puberty. (They have been used since the 80s to treat precocious puberty, a growing problem in recent years due to youth inactivity, higher BMI*, increased stress levels, hormones in food, and overabundance of screen time.) As for fertility, it is possible that in some male-to-female trans youth, their sperm counts will be diminished, depending on the length and age of treatment. All of this is discussed in great detail beforehand with the patients and their families.
Myth 4:
Most people who undergo transitions in their youth regret or feel trapped by their choices later.
Fact: Recent studies have concluded that this just isn't the case. Only about 1% of patients report regretting any part of their transition, which is significantly less than those who report regretting cosmetic plastic surgery, tattoos, or knee surgery.
Finally, it's important to emphasize the overwhelmingly positive effects of gender-affirming care on the TNB* patients' mental health. Evidence shows that while these individuals were already suffering emotionally, after being affirmed and included in the treatment discussions, they cite a significant decrease in symptoms of depression, self-harm behavior, and suicidal ideation or attempts.
Sources:
Coleman, E. et al (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, Volume 23 (p.1-259).
Thornton, Sarah M. et al (2024). A systematic review of patient regret after surgery - A common phenomenon in many specialties but rare within gender-affirmation surgery. The American Journal of Surgery, Volume 234, (p. 68 - 73).
Tordoff , Diana et al (2022). Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Network Open. Volume 5, (p. 1-13).
A Note on Terminology
*All of these acronyms are used in our sources, and are defined as such by each source:
AYA - Adolescents/ Young Adults
BMI - Body Mass Index
TGD - Trans/ Gender Diverse
TNB - Trans/ Nonbinary
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