What is gender-affirming care?

June 21, 2023 6:39 AM

"So what is gender-affirming care, exactly? And why is it important? The 19th spoke with health care professionals who provide gender-affirming care to adults and adolescents — as well as trans young adults who were comfortable sharing their experiences — to answer those questions."
posted by bwerdmuller (17 comments total)

It is essential to understand the misleading claims and flat out lies that the right is using to demonize trans people. This is an attempt to villainize and control an internal group as fascist ideologies are pressed forward.

Children are not undergoing surgeries. Plain and simple.

Although some (not all) young children will have body dysmorphia, young children have no medical intervention of any kind. They may change cothing, pronouns, want their hair cut, etc. They may also begin to receive gender identity therapy to help them process their feelings.

As they age, these children may be eligible for puberty pausing horomones, so long as they have been going to therapy, clearly understand the consequences (as discussed with therapist and medical professionals), and realistically have been living as their preferred gender for an extended time. If the child changes their mind (exceptionally rare), the horomones are removed, and puberty resumes.

Let's be clear: children are not being brought in willy-nilly off the street to start getting horomones. This is a long, drawn out, intense process to vet who is eligible.

Let's even put it more simply: if a child has been living as one gender for their entire childhood, then puberty begins - do you really want to put that child through the distress of puberty as the opposite gender?
posted by WildMuffin at 7:19 AM on June 21, 2023 [40 favorites]

The linked article was helpful, and helped dispel some of my ignorance on the subject. Thanks.
posted by Artful Codger at 8:03 AM on June 21, 2023 [2 favorites]

The Sawbones podcast had a great recent episode on this as well.
posted by chuke at 8:11 AM on June 21, 2023 [4 favorites]

Puberty blockers are also sometimes used for children with intellectual disabilities in order to delay puberty, because if puberty happens before these young people are mentally and socially ready, it’s extremely disruptive. Making these medications less available helps no one.
The rightists like to stick their noses in everyone’s business but can’t take when they face a little regulation.
posted by Katjusa Roquette at 9:14 AM on June 21, 2023 [10 favorites]

As they age, these children may be eligible for puberty pausing horomones, so long as they have been going to therapy, clearly understand the consequences (as discussed with therapist and medical professionals), and realistically have been living as their preferred gender for an extended time. If the child changes their mind (exceptionally rare), the horomones are removed, and puberty resumes.

I have seen this sentiment coming up a lot in this kind of discussion, and I think it is giving up too much. Why can't a kid pop up at fifteen and say "The changes happening to my body are giving me dysphoria, and I want it to stop," and just be given puberty blockers or even HRT without going through some kind of real world experience hazing and long term therapy first? This seems to carry a presumption that cis bodies are "better" than trans bodies, that a cis person who starts HRT and later regrets it has damaged their body while a trans person who spends a little longer going through the wrong puberty has not. I reject this framing.
posted by eruonna at 9:28 AM on June 21, 2023 [32 favorites]

Although it does mention the World Professional Association for Transgender Health, this article seems to be U.S. focused. In particular, it says "Puberty blockers are a typical step for minors receiving gender-affirming care." But in Britain, the National Health Service is shifting to a model in which puberty blockers will not be routinely proscribed. Policies to limit provision of puberty blockers have also been introduced in Sweden and Finland.
posted by Mr.Know-it-some at 9:49 AM on June 21, 2023 [1 favorite]

As ever, the policies wilfully throw hordes of trans people under the bus in order to protect a much, much smaller number of hypothetical confused cis people. They withhold treatment for trans people for all kinds of reasons, all kinds of hoops you have to jump through (age, "real life experience", etc) just in case someone might be cis. Protecting that one cis person from some sex hormones is worth denying them to dozens and dozens of trans people (which in practice means allowing them to be subject to the wrong hormones).
posted by Dysk at 10:07 AM on June 21, 2023 [21 favorites]

But in Britain, the National Health Service is shifting to a model in which puberty blockers will not be routinely proscribed.

In Britain, most politicians regardless of ideology are transphobic pieces of shit.
posted by Glegrinof the Pig-Man at 10:26 AM on June 21, 2023 [20 favorites]

Most media outlets too.
posted by Dysk at 10:46 AM on June 21, 2023 [8 favorites]

Why can't a kid pop up at fifteen and say "The changes happening to my body are giving me dysphoria, and I want it to stop," and just be given puberty blockers or even HRT without going through some kind of real world experience hazing and long term therapy first?

I am not saying the current accessibility, or lackthereof, is correct. My point is that the right-wing framing gender affirming care as a free-for-all and/or forced upon children, which is not.

I don't want to speak for your experience of a social transition and therapy as hazing. In my experience, kids are tough on each other, and for some, teenage years themselves are a form of hazing even without identity complexities. It's important for everyone to have access to therapy, especially while they are going through something that can influence significant social changes.

I pass no judgement when someone understands, processes, comes out, verbalizes, or anything else about their gender identity. I've personally seen it happen with a four-year-old in my care, and to hear the ongoing, reapeated suggestions by the right-wing that this is brand new, that it's not thought out, and that it's detrimental are all blatantly false. Gender affirming care takes many forms, has been thoroughly considered, and is unique to each individual's experience and needs (at least when care is actually accessible).
posted by WildMuffin at 10:56 AM on June 21, 2023 [3 favorites]

Viagra & boob jobs are gender affirming care for cis people.
posted by mike3k at 11:15 AM on June 21, 2023 [17 favorites]

I think that even doing this as describing the current state of gender care for children is buying into the transphobic framing. It is saying that they are right to be concerned and tries to reassure them that serious people have taken these concerns seriously and put strict protections in place. But the concern itself is fundamentally transphobic.

I pass no judgement when someone understands, processes, comes out, verbalizes, or anything else about their gender identity. I've personally seen it happen with a four-year-old in my care, and to hear the ongoing, reapeated suggestions by the right-wing that this is brand new, that it's not thought out, and that it's detrimental are all blatantly false. Gender affirming care takes many forms, has been thoroughly considered, and is unique to each individual's experience and needs (at least when care is actually accessible).

This is a take that feels much better to me. It moves the focus away from the supposed danger of gender-affirming care while also showing that the fear is unfounded.
posted by eruonna at 11:17 AM on June 21, 2023 [5 favorites]

Funny thing is, I'm pretty sure a greater understanding and tolerance of gender as a continuum with a range of expressions has reduced the number of gender-related surgeries in young children, not increased it.

Why? In one word: intersex. It used to be that a gender-nonconforming anatomy often would be operated on, to resemble (as well as surgery could establish) what was deemed the most appropriate anatomy, and usually in early childhood. That has become a lot less common with a greater visibility of intersex people and a greater dialogue on how gender is construed and expressed.
posted by jackbishop at 12:21 PM on June 21, 2023 [9 favorites]

Although it does mention the World Professional Association for Transgender Health, this article seems to be U.S. focused. In particular, it says "Puberty blockers are a typical step for minors receiving gender-affirming care." But in Britain, the National Health Service is shifting to a model in which puberty blockers will not be routinely proscribed. Policies to limit provision of puberty blockers have also been introduced in Sweden and Finland.

posted by Mr.Know-it-some

eponysterical, and not in a good way.

Assigned Media: What’s Going on With Gender-Affirming Care in Europe?

The Stranger: The GOP’s War on Trans Kids Relies on Myths about a “Progressive” Europe

The American Prospect: Trans Rights in Finland

tl;dr:

re:

• the UK: people often refer to something called the Cass Report, saying that it recommended shutting down the Tavistock Centre which managed almost all of the Gender Identity treatment in the UK for anyone under 18; however, they often don't mention the reason the report recommended shutting it down was because there were 5+ year delays in receiving any treatment (Abigail Thorne has a 90m video explaining how difficult it is as an adult obtaining treatment) and that the recommendation also included creating multiple clinics providing regional support, and increasing the number of staff, thereby reducing the long delays and improving levels of care. in this particular case, this is not really a shift in care model. trans kids under 18 already were not receiving puberty blockers because the time gap between being referred and obtaining any sort of treatment would often place them outside of when puberty blockers would be effective.

• Sweden: the idea that it's a super progressive place is difficult to disabuse, but there's been an upswing in right-wing political parties gaining influence, and their shift in restricting trans youths' healthcare is entirely due to the same fearmongering present in the us/uk. the primary hospital providing care (Karolinska) ceased much of it in the wake of the uk's original decision on keira bell (which revolved around something called "gillick competence", and the lawsuit was led by a barrister who is closely linked with the American ADF (Alliance Defending Freedom, the same group involved with numerous anti-trans and anti-LGBT lawsuits); the reason for this was to make it easier to remove gillick--and make it easier to prevent teen girls and teens with uteruses from accessing birth control or abortion care). while the bell decision was overturned in the uk (allowing the resumption of treatment) the swedish hospital didn't revisit its decision.

• Finland: was actually never that supportive of trans kids. this isn't really a change.

---

also, it's wild that you reference SEGM in your third link. That's the "Society for Evidence-Based Gender Medicine", which sounds awfully nice, except that it's an anti-trans organization. it's frequently cited by anti-trans groups and people, and is closely linked with Genspect, another anti-trans organization led by noted bigot Stella O'Malley.

Both SEGM and Genspect endorse the facile and erroneous theory of ROGD (Rapid Onset Gender Dysphoria), which is a diagnosis that does not exist and was proposed by Lisa Littman, who only interviewed parents of trans children; these parents were opposed to their children's gender identity, and so frequented anti-trans websites, of which three were used to harvest bigots for the "study". unfortunately, even though it and subsequent studies purporting to show evidence for ROGD keep being written, every single time those studies are retracted or corrected due to violations of consent, methodological flaws, and even the simple fact that not a single one ever spoke with a trans child. ROGD is about as legitimate as Wakefield's autism-vaccine study, and has become just as difficult to disabuse people of.

Stella O'Malley herself recommends "exploratory therapy" for trans kids, which is conversion therapy; she describes herself as gender critical, and her organizations work closely with the Alliance Defending Freedom, a right-wing Christian organization that's working to outlaw abortion and curtail Queer rights.

additional sources re: SEGM, which reference its support for inhuman clinical trials to be performed on trans youth and tendency to misrepresent data.

Yale School of Medicine:

it cites a biased source – the website of the so-called Society for Evidence-Based Gender Medicine (“SEGM”). SEGM is not a recognized scientific organization, and in Appendix A we document the bias that infuses its medical claims. The SEGM website badly mischaracterizes the underlying source that it cites for the 61-98% figure.

The study SEGM cites is Steensma et al. (2013). But the Steensma study was not designed to (and the lead author has acknowledged) does not provide a basis for calculating what percentage of prepubertal children diagnosed with gender dysphoria persist with that diagnosis into adolescence. Rather, the Steensma study was designed only to study the characteristics of those who persisted. Among other limitations, in Steensma (2013), former patients who opted to not participate in the study (either refused to participate or did not respond to an offer to participate) were categorized as “desisters,” i.e., patients whose gender dysphoria resolved without transition or treatment. Patients can fail to respond to a study request for many reasons, including having moved away, receiving treatment elsewhere, or being uninterested in participating in a study. Thus, SEGM misuses the Steensma data by counting nonresponding patients as having “desisted” in experiencing gender dysphoria. Indeed, in published correspondence, Steensma emphasizes that the 2013 study should not be used to calculate the percentages of “persisters” and “desisters.” The misrepresentation of Steensma on the SEGM website constitutes a major violation of the scientific method and the accepted conventions of research.

BuzzFeed:

Newer groups are also playing a role, including the Society for Evidence-Based Gender Medicine. Last year, SEGM was cited in an Idaho bill barring trans people from changing the sex on their birth certificate. A federal court has since struck down the law. (In an email, a SEGM spokesperson said they never expressed support for the Idaho bill and that they “object to the politicization of healthcare.”) SEGM member William Malone told a Christian news site in 2019: "No child is born in the wrong body, but for a variety of reasons some children and adolescents become convinced that they were."
...
Opponents, including members of ACP and SEGM, have called for “hypothesis-driven randomized controlled clinical trials” to evaluate care models for treating gender dysphoria in children, but those techniques aren’t realistic or ethical, said Turban. Given the existing evidence for providing trans youth with gender-affirming care, and the fact that it’s already widely accepted in the medical field, no institutional review board would permit a randomized trial of puberty blockers or gender-affirming hormones, he said. Moreover, the study could never remain blind, since the effects of being given the medication would be impossible to hide.

---

please, if you think you're an ally, reconsider how you engage with these and whether you truly understand the context and organizations in play.
posted by i used to be someone else at 3:25 PM on June 21, 2023 [7 favorites]

if the phrasing in the first half seems like it is referring to other things, that's because i'm basically just cutting and pasting it from the actual work that i've done where i've had to explain that multiple times.
posted by i used to be someone else at 3:33 PM on June 21, 2023 [2 favorites]

I also want to underscore that the use of puberty blockers is only being questioned when it comes to trans youth. for the cis kids out there, nobody complains when they're prescribed; suddenly, all of the erroneous concerns about bone density and fertility aren't discussed at all.

it's also not like puberty blockers are prescribed for trans kids much at all (the reuters article isn't great, but it has the info): between 2017 and 2021, only 122k children in the entire us, between ages 6-17 were diagnosed with gender dysphoria. of those, only 17.7k received puberty blockers or hormone replacement therapy.

in 2021, statista places the number of children between 6-17 at 50.7M.

so we're talking about 0.2% of all youth who have been diagnosed with gender dysphoria, which is likely an undercount, and of those who have the diagnosis, only 14.5% got HRT or puberty blockers.

which means only 0.03% of all youth in the united states received that care.

and yet it's a big fucking deal that needs the attention of state houses every-fucking-where.
posted by i used to be someone else at 3:47 PM on June 21, 2023 [10 favorites]

even when we talk about affirming surgery for teenaged transmascs, the numbers imply there's a staggering moral panic against trans healthcare.

because i'm not linking to the nytimes about anything re: Queer people, the advocate points this out explicitly:

in 2021, only 203 procedures were done on transmascs.

in 2020, 3,200 cis girls 18-19 received augmentations; 4,700 13-19 received reductions.
posted by i used to be someone else at 4:03 PM on June 21, 2023 [9 favorites]