Updated Mar 6, 2022 - Health

Culture war around care for transgender kids heats up

Illustration of a child in silhouette holding a transgender pride flag over their shoulders like a cape
Illustration: Annelise Capossela/Axios

The confrontation over gender-affirming care for transgender youth hit a boil this week as Texas Gov. Greg Abbott doubled down on his call for state officials to investigate "transition care" for minors as "child abuse."

Driving the news: Even as Abbott's team called the issue a political "winner," major medical groups including the American Academy of Pediatrics condemned the stance, saying it trampled on the doctor-patient relationship and injected politics into medical care.

Why it matters: Research has demonstrated transgender kids are more prone to anxiety, depression, and suicide than their peers, adding a high degree of urgency to the issue, experts say.

State of play: Legislation to block gender-affirming care for minors was introduced in at least 21 states in the last year alone, according to the UCLA Williams Institute.

  • In Idaho, legislation was introduced in a state House committee last month to ban gender-affirming surgery on minors.
  • In Arkansas last year, lawmakers banned administering puberty blockers or hormones to transgender youth. The law is being challenged in court and has not taken effect.
  • Tennessee also banned "gender-confirming" care for minors last year.

The big picture: HHS Secretary Xavier Becerra released a statement Wednesday calling the Texas government's actions "unconscionable," saying "at HHS, we listen to medical experts and doctors, and they agree with us, that access to affirming care for transgender youth is essential and can be life-saving," he said.

Between the lines: The field of transgender healthcare is rapidly evolving. Doctors are divided, for instance, over whether teens should receive counseling before receiving care, such as hormones, the New York Times reported.

  • In the gender-affirming care model, the AAP says "pediatric providers offer developmentally appropriate care that is oriented toward understanding and appreciating the youth's gender experience."
  • "There are a lot of conversations" over time with the child, family and other clinicians, such as mental health professionals, to carefully assess the best way to proceed, Kathryn Melland Lowe, a pediatrician and a member of AAP's executive committee on LGBT health and wellness, told Axios.
  • For instance, if a child is distressed over body appearance and has begun puberty, a doctor may prescribe "puberty blockers" to pause sexual development in order to offer more time to consider the options.
  • If the patient, family and medical care team decide to move forward, the patient may be taken off the puberty blockers and prescribed hormones for sexual development that matches their identified gender, Lowe said. While surgery generally isn't recommended for kids, their doctor may find it appropriate based on the individual patient, she said.

Yes, but: As with any treatment, there are potential risks involved. For instance, there are some side effects that accompany the use of hormones and well as concerns for longer-term impacts such as infertility.

But, but, but: Those risks must be weighed against the risks of foregoing therapy, which can cause a great deal of mental distress and harm, Lowe said.

  • A study published in JAMA Network Open last week found rates of depression and suicidal thoughts dropped significantly among transgender or nonbinary teens within a year of receiving puberty blockers or gender-affirming hormones.
  • "I've seen a number of kids go on gender-affirming medications and truly just come to life and thrive and they can move on with their life. They aren't just stuck in their inner turmoil. Their inner gender now matches their physical body," Lowe said. "And that is supported in the research."

Editor's note: This story originally published on March 3.

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