Should There Be a Minimum Age for Gender Transition?

Results from the 2015 United States Transgender Survey,¹⁶ conducted by The Williams Institute at the University of California Los Angeles School of Law, confirm that. Among the 27,715 transgender adults who responded to the questionnaire, researchers found that over 80% of respondents reported having had serious thoughts of suicidal behavior, with 40.4% who had attempted suicide at some point during their lifetime and 7.3% who had attempted suicide in the past year.¹⁶

According to Dr Klein, transgender children who are accepted by their families, peers, and physicians have rates of depression, anxiety, and suicidal ideation “nearly match[ing] their cisgender peers.”

So what can the medical community do to increase the acceptance of transgender children and prevent these poor outcomes?

“Transgender care absolutely should be part of the curriculum in medical school,” said Dr Klein. “I think that it is in some, but I do not think that it is in all.” Some topics, like reproductive embryology and endocrine development, are taught in a way that can be very gender- and sex-binary, which can be addressed by encouraging instructors to teach in a more gender-expansive way. “When I was a trainee, we did not discuss transgender care at all. It is not something that is on the pediatric endocrine boards. To be boarded in pediatric endocrinology, you do not need to know how to [treat] transgender kids or adolescents.”

One pediatric physician on Sermo added that they also did not receive training in transgender care during their time in medical school, suggesting that the creation of a specialty may be in order. “Although I have taken steps to educate myself on how to best manage these patients, there is definitely a need in the medical field,” the physician wrote.

Other physicians on Sermo added that both medical students and practicing clinicians should be “trained to recognize the long-term health outcomes associated with gender transition,” including providing the appropriate preventive care. Users also recommend offering supportive counseling aimed at helping adolescents make informed decisions about “everything that [the transition] process would entail.”

In the face of many available treatment avenues, one thing that Dr Klein advised against is watchful waiting.

“The whole consideration of watchful waiting…has been shown to be harmful. It is not doing nothing,” he said. “It is allowing a patient to potentially go further into an area of very high risk for unhealthy behaviors for the rest of their lives.”

“Many of the people who I see are not people who…were assigned male at birth and last week started to wear dresses,” Dr Klein added. “These are people who have known since they were 2 or 3 that they are female, that they are a girl, and that they are not the male that they were assigned at birth.”

In the case of Luna Younger, Dallas Judge Kim Cooks made her ruling at the end of October 2019: despite an 11 to 1 jury ruling in favor of Ms Georgulas, Judge Cook awarded joint custody to both parents and noted that the state could not require Mr Younger to affirm his child’s gender identity.^2,17 After the ruling, Ms Georgulas filed an appeal, and so the case continues.¹⁸

“We make our transgender kids jump through a lot of hoops already,” said Dr Klein, “and for many people in the public, that is still insufficient. [W]e are mandating that [transgender kids] should not go on [hormone] blockers, or they should not change their name, or they should not use their correct pronouns. We have to understand that these are not deviants, these are not crazy people, these are our kids.”

He added, “these are our future doctors or nurses or teachers, and we have to support them.”

References

1.  Zraick K. Texas father says 7-year-old isn’t transgender, igniting a politicized outcry. New York Times. October 28, 2019. https://www.nytimes.com/2019/10/28/us/texas-transgender-child.html. Accessed December 3, 2019.

2.  Dickson EJ. How a Texas custody case became a terrifying right-wing talking point. Rolling Stone. October 28, 2019. https://www.rollingstone.com/culture/culture-features/transgender-custody-case-dallas-anne-georgulas-mark-younger-904433/. Accessed December 3, 2019.

3.  Mendez M. Could transgender kids’ care be next ‘bathroom bill’ for Texas Republicans? Dallas Morning News. October 25, 2019. https://www.dallasnews.com/news/politics/2019/10/25/could-transgender-kids-care-be-next-bathroom-bill-for-texas-republicans/. Accessed December 3, 2019.

4.  Endocrine Society urges policymakers to follow science on transgender health [news release]. Washington, DC: Endocrine Society; October 28, 2019. https://www.endocrine.org/news-and-advocacy/news-room/2019/transgender-custody-statement. Accessed December 3, 2019.

5.  Endocrine Society. Transgender Health. https://www.endocrine.org/news-and-advocacy/position-statements/transgender-health. Published September 20, 2017. Accessed December 3, 2019.

6.  Saraswat A, Weinand JD, Safer JD. Evidence supporting the biologic nature of gender identity. Endocr Pract. 2015;21(2):199-204.

7.  Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014;99(12):4379-4389.

8.  Heylens G, De Cuypere G, Zucker KJ, et al. Gender identity disorder in twins: a review of the case report literature. J Sex Med. 2012;9(3):751-757.

9.  Dessens AB, Slijper FME, Drop SLS. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav. 2005;34(4):389-397.

10.  Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;102(11):3869-3903.

11.  Rafferty J; for the Committee on Psychosocial Aspects of Child and Family Health; the Committee on Adolescence; and the Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018;142(4):e20182162.

12.  Peters JW, Becker J, Hirschfield Davis J. Trump rescinds rules on bathrooms for transgender students. New York Times. February 22, 2017. https://www.nytimes.com/2017/02/22/us/politics/devos-sessions-transgender-students-rights.html. Accessed December 3, 2019.

13.  Green EL, Benner K, Pear R. ‘Transgender’ could be defined out of existence under Trump administration. New York Times. October 21, 2018. https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html. Accessed December 3, 2019.

14.  Goodnough A, Green EL, Sanger-Katz M. Trump administration proposes rollback of transgender protections. New York Times. May 24, 2019. https://www.nytimes.com/2019/05/24/us/politics/donald-trump-transgender-protections.html. Accessed December 3, 2019.

15.  Pediatric Endocrine Society statement against public discourse that risks the well-being of transgender and gender diverse youth and their families [news release]. McLean, VA: Pediatric Endocrine Society; October 28, 2019. https://www.pedsendo.org/education_training/healthcare_providers/consensus_statements/assets/PES_2019_Transgender_Statement.pdf. Accessed December 3, 2019.

16.  Herman JL, Brown TNT, Haas AP; The Williams Institute, UCLA School of Law. Suicide thoughts and attempts among transgender adults: findings from the 2015 U.S. Transgender Survey. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Transgender-Suicide-Sept-2019.pdf. Published September 2019. Accessed December 3, 2019.

17.  Smith L. Dallas child-custody battle hinges on 7-year-old’s gender identity, draws attention of Abbott, Cruz. Dallas Morning News. October 24, 2019. https://www.dallasnews.com/news/courts/2019/10/24/dallas-child-custody-battle-hinges-on-7-year-olds-gender-identity-draws-attention-of-abbott-cruz/. Accessed December 3, 2019.

18.  Burns K. What the battle over a 7-year-old trans girl could mean for families nationwide. Vox. November 11, 2019. https://www.vox.com/identities/2019/11/11/20955059/luna-younger-transgender-child-custody. Accessed December 3, 2019.

This article originally appeared on Clinical Advisor