Trans children need gender affirming care — and scientists say Republican bans hurt vulnerable kids

Republicans claim that the scientific evidence is weak for gender affirming care — actual scientists say otherwise

By Matthew Rozsa

Staff Writer

Published June 14, 2023 10:00AM (EDT)

Activists for transgender rights gather in front of the US Supreme Court in Washington, DC, on April 1, 2023. (ANDREW CABALLERO-REYNOLDS/AFP via Getty Images)
Activists for transgender rights gather in front of the US Supreme Court in Washington, DC, on April 1, 2023. (ANDREW CABALLERO-REYNOLDS/AFP via Getty Images)

The United States is an unbearably hostile place for transgender children, and the problem is only getting worse. At the time of this writing, there are 20 states where trans minors do not have access to medical experts who specialize in trans health, even though they previously had that right.

In states like Arkansas, Idaho, Iowa, Alabama, Oklahoma and Tennessee, new laws have been passed that prohibit trans children from using bathrooms that match their gender identities. In North Dakota, the House of Representatives is working on a bill that would fine institutions which receive state funding (like public schools) as much as $1,500 for using pronouns for trans people that match their authentic gender identities.

"I'm sickened by the way politicians all over the country are using ignorant soundbites to score political points and then literally write policy based on those same sound bites."

Naturally, supporters of these kinds of laws attempt to lean on some ostensibly "scientific" logic to rationalize their actions, and perhaps the most succinct summary of that defense comes from Florida surgeon general Joseph A. Ladapo: "While some professional organizations, such as the American Academy of Pediatrics and the Endocrine Society, recommend these treatments for 'gender affirming' care, the scientific evidence supporting these complex medical interventions is extraordinarily weak."

The cruel irony behind these types of arguments is that their exact opposite is actually true: The scientific evidence overwhelmingly demonstrates that gender affirming care is safe and effective.

Rebecca Jordan-Young, PhD., the chair of Women's, Gender and Sexuality Studies at Barnard College and co-director of Columbia University's Precision Medicine and Society Program, believes this is an especially important topic in light of the growing number of anti-trans policies sprouting up.

"I'm sickened by the way politicians all over the country are using ignorant soundbites to score political points and then literally write policy based on those same sound bites," Jordan-Young told Salon in an email.

"Gender affirming care is a very thorough, complex process of evaluating a child in the context of their own physical mental health"

Take the American Academy of Pediatrics, the largest association of pediatricians in the United States and a group whose collective assessment on the matter is being cavalierly tossed aside by Republicans. According to Michelle Forcier MD, a professor of pediatrics at Brown University's Alpert School of Medicine, the organization's 2018 guidelines provide "a very nice summary and overview" of the conclusions reached by most medical literature on the subject.

"Gender affirming care is a very thorough, complex process of evaluating a child in the context of their own physical mental health and their psychosocial supports and environment," Forcier pointed out. The recommended medical care does not — as many right-wingers seem to wish would happen — challenge a trans child's understanding of their own body, with the obvious goal of "convincing" the trans person that they somehow don't understand themselves as well as the anti-trans movement. As with any patient, doctors are encouraged to listen carefully to children and take their concerns seriously. Doing so is the only way to advocate for the child's best interest.

"There is no evidence that risk for mental illness is inherently attributable to one's identity of TGD [transgender or gender-diverse]," the guidelines explain. "Rather, it is believed to be multifactorial, stemming from an internal conflict between one's appearance and identity, limited availability of mental health services, low access to health care providers with expertise in caring for youth who identify as TGD, discrimination, stigma and social rejection."

If after empathetic listening a child is determined to be trans, the next step is gender affirming care. This is not — as conservatives claim — "a kid comes into clinic and says they're trans, and you say, 'Yes, and here's a bag of pills and hormones or surgeries!' That's just not how it works in real life," Forcier explained.

In fact, gender affirming care can look like any number of things. The main consideration is the patient's comfort and health, which can be as highly individualized as a person's fingerprints. For some children, all they will ever want is mental health care and a loving support network. Others will reach the age when doctors believe their bodies are ready to experience hormone treatments and other medical procedures and, if they wish to have them, their medical team will have their back. As it turns out, one of the reasons that conservatives are so adept at misleading the public into thinking that trans rights advocates want to perform sex reassignment surgeries on little children is because they wrongly lump in that specific procedure with all gender affirming care.

"One misconception about gender confirming medical care is that doctors are performing surgeries on young children for gender transition," explained Sahar Sadjadi, a medical anthropologist and assistant professor in the Department of Social Studies of Medicine at McGill University, in an email to Salon. "It has spread as a result of the disinformation produced by the media hostile to trans children, as well as the broadness of the word 'child.' If you call a 17-year-old who decides to have a surgical procedure a 'child,' and then claim that children are being operated on, you can create a climate of panic where people imagine genital surgeries are underway on 5-year-olds."

In fact, Sadjadi points out, to the extent that gender-related surgeries do occur on children, it is in contexts that the public finds generally acceptable, such as for children who are born intersex. This is in spite of the fact that those surgeries actually are opposed by many medical professionals, although the anti-trans laws in states like Texas and South Dakota explicitly allow them.

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Attacks on trans people are "part of a broader white nationalist ideology that promises the restoration of white patriarchal family."

"Early surgeries to 'correct' the genitals of those children are not medically necessary, but are actually highly invasive surgeries corrected to make the child aesthetically conform to what clinicians and parents feel is the child's gender," Jordan-Young pointed out. "These surgeries are still frequently performed across the US, in spite of medical protocols that officially suggest any genital surgeries should be delayed, and in spite of international human rights organizations identifying these surgeries as abusive (based on long-term follow up data on how the surgeries actually affect intersex people)."

Similarly, when children who choose to have physiological procedures performed are suddenly cut off from them — whether by political persecution or more mundane (but no less harmful) developments like poverty or health insurance frustrations — their bodies as well as minds suffer immensely. One does not need to look only at children to see this.

"Depriving someone of their hormone replacement therapy affects multiple organs of their bodies from the bones to the heart and skin," Sadjadi observed. "When it happens abruptly, drastic physiological and psychological symptoms could ensue. For many trans people, achieving a body that is socially recognized as the gender they identify with is psychologically vital, and in certain situations necessary for survival."

Of course, when all is said and done, the debate over trans children's medical care is not really about what is in the best interest of trans children. It is instead an attempt to effectively erase them from existence, to gaslight a generation of marginalized young people into believing their identities are lies — or else subject them to a world of overt persecution. For all of the talk from transphobes about wanting to protect children from bad science, the truth is that denying trans children gender affirming care makes no scientific sense except as part of a right-wing political agenda.

"Political abuse and scapegoating of trans children and adults by the far right to galvanize those afraid of the loss of familiar gender relations, have dire consequences for the well-being of individual and communities who now have to live under heightened threats of violence," Sadjadi explained. "Such political and legislative interference in scientific and clinical matters and bullying health-care providers will have a chilling effect on research on gender affirming care and more broadly, the scientific culture and practice. But this is the goal of those who launch these attacks." Sadjadi added that the attacks on trans people are "part of a broader white nationalist ideology that promises the restoration of white patriarchal family."

Jordan-Young confirmed Sadjadi's assessment, arguing that trans people of all ages "are being callously and viciously used as pawns in a game that's not at all about the well-being of children. As Sahar has noted, it's about protecting the white patriarchal family, by cultivating the fantasy that 'others' — anyone who violates those norms — can simply be eliminated."

If one wishes to approach the subject from a non-political perspective, then the best thing to do is look at the evidence from trans people themselves. As Forcier concluded, "I've had 20 to 25 years of experience in terms of providing medical care. A [trans] child is thinking about this long before they talk about it with their parents. Oftentimes not all the time, some kids are pretty quick and spontaneous, but many young people think about this for a while before they bring it up to their parents. And then typically they and their parents might say, 'Let's go talk to a medical provider, or a psychiatric or mental health provider, to find out what this means for you."

From there it is the beginning of a long journey that every child and their family must undertake together. It is a journey which people who care about trans children overwhelmingly agree should be regarded as private — meaning the government has no place inserting its subjective moral values into the equation.

The end result, very often, is a happy, healthy child who grows into a happy, healthy adult. If that is not the goal of medical care, then what is?

By Matthew Rozsa

Matthew Rozsa is a staff writer at Salon. He received a Master's Degree in History from Rutgers-Newark in 2012 and was awarded a science journalism fellowship from the Metcalf Institute in 2022.

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Gender Affirming Care Reporting Ron Desantis Trans Transgender