Politics and Money

[lesgetrich]

Again, Republicans think they can make better health care decisions than medical doctors. As usual, they invent issues that really aren't problems. Where are the hordes of people who have been harmed by gender dysphoria treatments who are demanding change? The fact is, sex change involves castration in males and mastectomy in females and most doctors agree that there should be a minimum age for people deciding about their permanent sexual identity. Like abortion, patients and their doctors, not republicans, should be able to decide what happens to their bodies...

Should There Be a Minimum Age for Gender Transition?

Despite scientific evidence and existing clinical practice guidelines, critics also remain in the medical community. According to results of a poll hosted on Sermo, a global social platform for physicians, 94% of physicians think that an age minimum is an appropriate benchmark for patients who wish to transition: more than half (62%) of these respondents said that the minimum age should be 21 years, while nearly a third (32%) said that age 18 years would be an appropriate minimum.

While many countries recognize 16-year-old patients as legally competent to make medical decisions, others believe that abilities such as good risk assessment do not develop until after age 18 years.10 The Endocrine Society guidelines state that gender-affirming treatment in the form of sex hormones may be initiated “after a multidisciplinary team…has confirmed the persistence of [gender dysphoria]/gender incongruence and sufficient mental capacity to give informed consent,” which is typically around age 16 years.10 Some research suggests that there are risks associated with waiting until as late as age 16 years, and more long-term studies are needed to determine the optimal age for treatment.

On Sermo, one endocrinology physician shared a belief that children and adolescents do not possess the capacity to make informed decisions about fertility or permanent body alterations. “Affirming a child’s false gender identity, instead of providing exploratory counseling to help resolve the dysphoria, is astonishingly negligent.”

Another physician, specializing in physical medicine and rehabilitation, agreed. “Children [do not] know enough about themselves to be trusted to make the correct, irreversible decisions, and generally do not have the maturity to handle it. More kids question their gender now due to it being popular socially, or more in the news and social media. We cannot allow them to be potentially permanently harmed for a potentially temporary condition.”

This is a sentiment with which Dr Klein strongly disagrees.

“Trans people have been around forever,” he said. “This is not an invention of the aughts. People have been [providing] care in trans communities for decades now…and finally there are formalized guidelines…and people are feeling more comfortable expressing their gender truthfully and are feeling comfortable enough to do something about it.”

Although transgender people may now feel safer to publicly express their gender, some lawmakers are creating policies that have the opposite effect. Since taking office, President Donald J. Trump has made efforts to roll back many of the steps undertaken by the Obama administration to bring equality and protection to the transgender community under federal law.

In 2017, this included the removal of protections that allowed transgender students to use bathrooms that corresponded with their gender identity.12 In 2018, it took the form of the Trump administration attempting to narrowly redefine the concept of gender as “a biological, immutable condition determined by genitalia at birth,”13 or essentially, as one New York Times article stated, defining the word transgender “out of existence.”

Most recently, the Trump Administration moved to repeal Obama-era protections that banned discrimination against transgender patients in medical settings and as health insurance customers.14

These legislative maneuvers, coupled with the recent statements from Texan legislators about the Younger case, have left some within the medical community concerned. The Pediatric Endocrine Society, for example, has called out the recent “public discourse” as potentially harmful to the wellbeing of both transgender and gender-diverse children and their families — and in opposition to the current standard of care.

“We strongly oppose public discourse that misrepresents and contradicts evidence-based standard of care recommendations and risks the wellbeing of transgender youth and their families,” the statement read in part.

According to the American Academy of Pediatrics, those risks can range from depression and anxiety to eating disorders, self-harm, and suicide.

“We know that our transgender kids, especially children and adolescents, have a much higher risk for and rate of self-harm and of suicidal thoughts or suicidal attempts, and of depression and anxiety — especially those who are not affirmed within the home or school, ” said Dr Klein. “It is not so much being transgender that causes depression…alcohol and drug abuse, anxiety, or things like that. It is really being unaccepted that does that.”