The Transgender Family Handbook

October 11, 2023 8:55 AM

There is plenty of rhetoric out there that might encourage a parent to question their child in this moment that’s designed to scare them into inaction or, worse, outright rejection. There is less guidance for those who choose to believe their children. This is a handbook for the trans-affirming family; it presumes you love your child and want what’s best for them. And while it’s their journey alone, you have the opportunity, and obligation, to help them to become who they are.
posted by latkes (49 comments total)

Ooooh thank you for posting this! Looking forward to diving in and reading!
posted by brainwane at 9:01 AM on October 11, 2023

The handbook sections are:

➼ So They Just Came Out
➼ Telling People (When Your Child Is Ready)
➼ A Shopping Guide
➼ Dealing With the School
➼ Puberty Blockers and Hormones Don’t Have to Be Scary
➼ When to Move (And When to Stay Put)

A ton of links to resources, such as children's books to read with one's kid, a gender support plan "to get families, teachers, and administrators on the same page and help them map out responses to a number of situations a child might encounter at school", and anecdotes...... I can tell this will be so useful to so many people!
posted by brainwane at 9:09 AM on October 11, 2023 [2 favorites]

On the topic of trans resources, I just came across the Rainbow Railroad. "We help at-risk LGBTQI+ people get to safety. In countries around the world, LGBTQI+ people face violence and oppression simply because of who they love or who they are. We help them get to safety."
posted by aniola at 9:35 AM on October 11, 2023 [7 favorites]

Thanks for this.
posted by OHenryPacey at 9:37 AM on October 11, 2023

I think this is the thing that I shockingly didn't hate when someone posted it in the work slack. I'll have to go back and look because I had some things to add.
posted by hoyland at 9:41 AM on October 11, 2023 [1 favorite]

the "When to Move (And When to Stay Put)" section is sobering
posted by elkevelvet at 10:31 AM on October 11, 2023

You know, they say "never read the comments". Well, I did.

In the comments - beyond the frothing-mouthed - there are people who disagree with article's stated consequences and risks associated with some aspects of gender-affirming care for kids.e.g. this comment . This commenter identifies as trans, and does not write in the style of a classical transphobe screed.


We know that calm, sober, well-put-together writing on topics affecting marginalized groups does not preclude bigotry error or misinformation. But (unlike almost all screedlike writing) this style does not guarantee it either.

Is there a place or resources for someone who wants to act and learn in good faith to address the veracity of comments like these?
posted by lalochezia at 10:43 AM on October 11, 2023 [2 favorites]

I'm glad this exists. I will say, the doctors we've seen have been handling kids with hormone issues (not just trans kids) for years, and were totally unworried about prescribing puberty blockers, etc, because those meds are known and tested. Hormonal therapy has been around a long time for straight people, after all. So all the conservative attempts to make it scary or call it unproven should not frighten you.

Two years in, my kid is thriving, and she really is starting to look very different, and I'm so happy for her.

Though I would still kill for a company that makes cute girl shoes (not just drag heels) to do them in larger sizes so she had more options.
posted by emjaybee at 10:48 AM on October 11, 2023 [16 favorites]

This commenter identifies as trans, and does not write in the style of a classical transphobe screed.

This very much looks like midbrow columnist transphobia talking points to me, your Signal and the like. This may or may not be a trans person talking, but they absolutely sound like they’re getting their talking points from The NY Times, Atlantic or Guardian.
posted by Artw at 11:04 AM on October 11, 2023 [10 favorites]

Though I would still kill for a company that makes cute girl shoes (not just drag heels) to do them in larger sizes so she had more options.

Have you come across Hot Chocolate? Not cheap, and skews very cutesy-goth, but they do very cute flats and low heels up to a US women's 13, if that's any good.
posted by BlueNorther at 11:11 AM on October 11, 2023 [2 favorites]

Yeah (seconding Artw); it would be a surprisingly confused or misinformed understanding of the details of various forms of transitioning coming from an actual trans person and physician. Which isn’t to say impossible, but definitely odd enough to be suspicious. To save this thread, memail me if you want a more detailed breakdown or rebuttal - I’m certainly no expert, but even so can see several glaring issues.
posted by eviemath at 11:13 AM on October 11, 2023

Yeah I wouldn't pay much attention to comments like that. Look at the assumptions they're making: that puberty blockers are harmful, that transition should be a last resort, that medical intervention is experimental, that puberty is natural (implied: we should let it progress without intervention) and terrifying for everyone (implied: what kids are telling you is dysphoria is some other feeling masquerading as dysphoria). Transphobic commenters (some of whom are trans!) have a history of "just expressing concerns" on everything from preserving gender-nonconforming subcultures to optimizing neovaginal depth, and it always boils down to: hmmm have you thought about *not* transitioning
posted by knuckle tattoos at 11:16 AM on October 11, 2023 [10 favorites]

lalochezia, that comment is full of TERF/Gender Critical talking points and ideas, and is almost certainly not the work of a trans person. For example,

Puberty blockers are called "reversible" but the reality is over 97% of kids who go on puberty blockers go onto cross sex hormones and are permanently sterilized thereafter (see NHS study).

The point of this particular phrasing is to imply that taking puberty blockers causes or "leads to" medical transition, when the much more plausible reason virtually everybody who goes on puberty blockers goes on to medical transition is the same reason you don't get a lot of casts applies to non-broken arms. You're meant to take away from this that going on puberty blockers is ultimately the same as getting gender-affirming care, which the author of that comments wants you to understand as harmful and bad.

Puberty is a natural part of life that is terrifying for everyone, trans or cis.

This is true! It's also true that the experience of going through the wrong puberty is catastrophically awful and having been through the wrong puberty saddles you with traits that cause painful dysphoria, make it harder to pass, and require expensive treatments and/or surgeries to change. Transphobes absolutely love forcing trans kids through the wrong puberties for all these reasons, because it's a way of torturing and abusing us. The point of this sentence is to hide that pain and suffering, and the deliberate infliction of that pain and suffering, behind the normal tribulations of puberty.

Youth gender medicine is developing field with many unknowns. There is much we don't know. Many of the European countries are changing course and now catergoize medical/surgical transition for youth as experimental, because that is the truth. Google "A systematic review of hormone treatment for children with gender dysphoria and recommendations for research" to learn more from experts in Sweden on this topic.

Utterly false. The idea that gender-affirming care is "experimental" and that we don't understand any of it is nonsense. The first gender-affirming vaginoplasty happened 90 years ago! Transphobes love to repeat these talking points but the idea that Europe is suddenly making gender-affirming care less available to young people is nonsense and anybody trying to get you to believe that doctors are just performing novel procedures and prescribing experimental drugs with unknown effects is a liar who wants to hurt trans people and wants to recruit you into doing so.

-Seemingly innocuous gender affirming interventions such as tucking or binding have physical and sometimes permanent consequences (ex. permanently deformed breast tissue in transmascs is well documented in the community).

Another distortion. You can in fact hurt yourself by tucking or binding if you do it wrong, but the answer to this is to give education on how to do it right as well as making the correct tools for doing so (proper breast binders, for example) available.

-Lastly, transtion should be a LAST RESORT. all other avenues should be explored thoroughly and exhasutively before transitiong. This used to happen, but not any more with the gender affirmative approach. If you want to transition now, you will be met with a warm welcome from gender care specialists.

This is pure, venomous hatred for trans people trying to disguise itself as the "moderate" position. The actual history of medical gatekeeping of trans healthcare is a horror show; most of the doctors who've been involved in the provision of healthcare to trans people over the past 50+ years have been monsters whose primary goal was to prevent transition if at all possible and provide it only to trans people who a) would likely kill themselves without it and b) be a "passable" member of the gender they were transitioning to, complete with socially-normative sexuality and gender roles. Modern informed consent and affirming care came out of the endless list of horror stories from that era, and anybody advocating to return to it hates trans people, full stop.

The modern "last resort" thing is a form of conversion therapy called Gender Exploratory Therapy, in which a person who wants to transition is sent to a "therapist" who will want to explore every possible reason they might think they're trans. This never actually ends in transition, of course- the point is to string the trans person along as long as possible. It's especially popular as a means of forcing trans kids to go through the wrong puberty while dangling gender-affirming care and social transition just out of reach, a carrot they'll never actually get to. It's similar to the crisis pregnancy centers which try to string pregnant people along until they're past the local legal deadline for abortion- an act of violence pretending to be an act of care, perhaps the ultimate obscenity.

Look, it's possible that this is a trans woman posting this. There's a small population of trans people for who being trans is the worst fucking thing that ever happened to them, and they're dealing with it by being transmedicalists or outright transphobes, but they're extremely rare and are eternally at odds with the larger trans community. TERF shit doesn't become more valid or reasonable or worthy of consideration because it comes out of their mouths.

It's much, much more likely, however, that this is some TERF piece of shit reciting TERF talking points and doing it from behind a mask that they think will make their garbage more credible.
posted by Pope Guilty at 11:17 AM on October 11, 2023 [53 favorites]

Thanks, Pope Guilty (and everyone else in the thread who responded)
posted by lalochezia at 11:32 AM on October 11, 2023 [1 favorite]

Completely agree with Pope Guilty's analysis of that comment. In particular, the use of the word "medicalized" as a descriptor of trans people is a real tell. Not something you would expect to here from a trans person, but ubiquitous in TERF talking points.
posted by Shellybeans at 11:45 AM on October 11, 2023

Thank you for this resource, and for the wonderful comments here. I started the day in kind of a very bad place, and between this and the Yo Yo Ma video, I am much better. I love this community.
posted by xedrik at 12:32 PM on October 11, 2023 [3 favorites]

I think we should avoid trying to determine if someone is "really" trans or not, and instead focus on what they actually say. There's enough content to disagree with to avoid needing to invalidate someone's gender identity on top of that.
posted by saeculorum at 12:36 PM on October 11, 2023 [5 favorites]

I don’t even think you should assume they’re a real doctor.
posted by Artw at 1:35 PM on October 11, 2023 [5 favorites]

that's fair. and they may well be trans for all I know. but I don't have a lot of patience for this kind of stuff, and when the terf dogwhistles come out that's when I really lose my enthusiasm for engaging with someone's argument.
posted by Shellybeans at 1:52 PM on October 11, 2023 [6 favorites]

In particular, the use of the word "medicalized" as a descriptor of trans people is a real tell. Not something you would expect to here from a trans person,

I'm not clicking through to read the context, but trans people raging against medicalization is as old as time. Medical transition has always been something of a devil's bargain, in that the only way for us to have access to it is through medicalization and pathologicization of transness.
posted by hoyland at 2:03 PM on October 11, 2023 [7 favorites]

Can I gently ask/suggest that we re-focus on the family handbook from the FPP? There are more than enough other Metafilter threads and places on the internet more broadly to discuss and take down terf talking points, but relatively few places to celebrate trans kids having affirming and supportive families and communities.
posted by eviemath at 2:37 PM on October 11, 2023 [23 favorites]

I wish there was a handbook like this for families where someone transitioned later in life, in their 30s, 40s, 50s...
posted by Miko at 4:31 PM on October 11, 2023 [6 favorites]

I wish there was a handbook like this for families where someone transitioned later in life, in their 30s, 40s, 50s...

The still-around classic is the PFLAG booklet (Our Trans Loved Ones?). Going back 15+ years, the recommendation used to be Trans-Forming Families, but it was hard to get your hands on it even then. (I've never actually seen a copy.)
posted by hoyland at 5:11 PM on October 11, 2023 [4 favorites]

While I do sometimes find the focus (of cis people in particular) on trans kids/youth tiresome because it often comes with this tinge of saviourism (save them from the "wrong body"!), this sort of guide is particularly necessary because kids really have very little control over their lives and very little access to transition (medical or social) without, at a minimum, parental support and, when you're talking about kids, without parents being able to do the research and advocacy themselves. A fifteen or sixteen year old can do a lot of the legwork themselves; a ten year old can't. When you're talking about people who transition when they're well into adulthood, their family (beyond partners anyway) aren't really entitled to details.
posted by hoyland at 5:21 PM on October 11, 2023 [4 favorites]

Transphobes love to repeat these talking points but the idea that Europe is suddenly making gender-affirming care less available to young people is nonsense

This really depends where you are in Europe, sadly. It certainly seems to be happening here in the UK.
posted by Dysk at 6:03 PM on October 11, 2023 [1 favorite]

Transphobes love to repeat these talking points but the idea that Europe is suddenly making gender-affirming care less available to young people is nonsense

Seems like they are

Sweden decided in February 2022 to halt hormone therapy for minors except in very rare cases, and in December, the National Board of Health and Welfare said mastectomies for teenage girls wanting to transition should be limited to a research setting.

Other countries are weighing the same questions.

Neighbouring Finland took a similar decision in 2020, while France has called for "the utmost reserve" on hormone treatments for young people.

posted by L.P. Hatecraft at 6:08 PM on October 11, 2023

I think it's great something like this exists and I also think it's the job of parents to question their children, about everything. It's how they learn to think for themselves. Young people can be very susceptible to social pressure and often don't make good decisions. We don't trust children to make good decisions about drinking and driving, having children, or voting* and so its hard for me to believe that every decision about sexual identity is 100% accurate and unquestionably correct. Questioning your child's decisions from a place of curiosity is supportive and loving, in case anyone needs to hear it.


* these are just examples of decisions that young people aren't trusted with, no equivalence of any kind is implied
posted by Mr. Gunn at 6:10 PM on October 11, 2023

hear you, I do, but worry it implies that we shouldn't trust young children with their cis or hetero feelings too...I suppose I'm on with that but like don't badger them about it either way

accepting what people say face value about how they feel about their bodies and sexuality, at any age, is fine with me
posted by tiny frying pan at 6:27 PM on October 11, 2023 [3 favorites]

When you're talking about people who transition when they're well into adulthood, their family (beyond partners anyway) aren't really entitled to details.

It’s not about being entitled to details. It’s about helping a family reorganize and come to terms with their relationships with one another as adults. I will look at the PFLAG resources. In the meantime I’d just say that humans and their relationships don’t stop developing and changing when they reach adulthood, and family relationships can remain very significant to many people.
posted by Miko at 6:44 PM on October 11, 2023 [1 favorite]

It’s not about being entitled to details. It’s about helping a family reorganize and come to terms with their relationships with one another as adults. I

Where I was going was that this guide is fairly practical and a lot of the practical stuff doesn't fall on family when adults transition, simply because they're adults.
posted by hoyland at 6:51 PM on October 11, 2023 [1 favorite]

Yeah I got that. This is a nice guide. I wish there was a different one for adults. Which this is not, so that's enough said about it, yeah.
posted by Miko at 6:59 PM on October 11, 2023

We don't trust children to make good decisions about drinking and driving, having children, or voting*

Do you regard a child's cissexuality as somehow less of a decision? If not, then why do we trust them with that choice?

Do you think children experience less pressure to be cis than to be trans? If not, then why is a supposed choice to be cis driven by external pressures less worth questioning than a supposed choice to be trans?

Seems like you're suffering from a good old-fashioned failure to recognize that the default is not the same as the natural.

Also...there are takesies-backsies allowed on wearing dresses and nail polish, or even on taking puberty blockers. Not so much on killing someone or bringing someone into this world.

Parents in a hostile environment may feel they have little choice but to encourage their children to be secretive or guarded about their gender identity. I can't say they're always and everywhere wrong. But that's quite different from considering their gender identity not a "good decision."
posted by praemunire at 7:16 PM on October 11, 2023 [14 favorites]

The shopping guide from The Cut's Transgender Family Handbook links to a more detailed Shopping Guide for Trans Kids and Teens, According to Trans Families that covers clothing, swim and underwear, and skin care and beauty. Today I Learned that, instead of binders,

Some people prefer using tapes, like TransTape or kinesthetic tape, to bind — they offer a fuller range of movement and can be worn for days at a time.

posted by brainwane at 8:37 PM on October 11, 2023 [1 favorite]

Mr. Gunn, taking your concerns as well-intentioned, the thing is, transitioning for lols or a whim is not a thing. It just isn't. Even the most accepting systems will still require talking to multiple medical and behavioral professionals. And there are many steps with many off ramps between initial coming out and any kind of permanent body changes, over months and years. We have so many studies on this, truly. Kids allowed to transition and who are supported thrive.

Meanwhile if we had any drug that cut suicide rates the way allowing kids to transition does, we'd throw parades for it.

But talk to people who have transitioned, don't listen to this internet rando. You will hear amazing and heartbreaking stories of people who suffered so much from being denied this care, starting at a young age.

It can be hard to understand being a trans kid if gender identity is not something you've ever struggled with. But it is real. These kids aren't doing it for attention.

Feel free to message me if you want to ask more questions, I have tons of resources if you want them.
posted by emjaybee at 9:56 PM on October 11, 2023 [16 favorites]

social pressure

PROTECT CIS CHILDREN
posted by sharktopus at 6:59 AM on October 12, 2023

In addition to what emjaybee said, I figured I'd throw in my two cents as someone who transitioned "young", but not all that young.

I came out age 19 (I think), so young enough to have been "trans youth", but without the minefield that comes with living with parents (though I was financially dependent on them) or being a minor. It took me six years to start medical transition (the timeline of my social transition is extremely murky, but it was pretty clearly underway by the two year mark). I didn't have access problems, so much as that I wasn't ready. But could I have been ready much sooner had I had better family support, better access to therapy? Probably. My mom really tried, and was great in some ways and deeply unhelpful in others.

Do I regret not coming out or transitioning sooner? No, not for a minute, it happened when the time for me was right. So sometimes it hard for me to hear "these kids lives will be ruined if they don't transition!!!11!!!" because what does that say about me? However, I can't say enough how painful those six years were. I would plot a timeline in my head and just miss it entirely (to think I thought I'd have top surgery in undergrad!). I can't imagine a parent choosing not to try and save their kid that pain. I reconnected with my best friend from high school a couple years ago and, at some point, we talked about whether it was obvious I was trans. He said it was obvious something was really, really wrong and he hadn't known what it was (neither did I!). Again... imagine your kid figuring it out and you deciding to do nothing.

I think the one negative repercussion of not transitioning sooner for me is that I grew up without the idea that there was an "adult" me. It wasn't that I thought I'd kill myself (though I was pretty sure in high school the world would end before I graduated), but rather the idea of me as an adult just did not compute, there was a total blank. Couple that with just being in survival mode for years and years and it's like... I'm supposed to have wants? I can be happy?

so its hard for me to believe that every decision about sexual identity is 100% accurate and unquestionably correct. Questioning your child's decisions from a place of curiosity is supportive and loving, in case anyone needs to hear it.

Honestly, this was my mom at her least helpful (and other than one disastrous fight caused by her shitty partner, she never questioned me being trans--she'd throw out ideas of "things that might help", none of which were... actually transitioning, which is what I needed). By the time I said anything to her, I was pretty sure I was trans. There are certainly ways parents can support their kids exploring gender without expressing an "opinion", but by the time your kid is telling you, they already did the soul searching.
posted by hoyland at 7:02 AM on October 12, 2023 [10 favorites]

every decision about sexual identity

Sigh. Since the comment is still up, may as well ensure that the important point is made.

Setting aside the homophobia implicit in this, and the issue around the degree to which any of this stuff is a conscious choice (it isn’t), we’re talking about gender here, not sexuality. The two are quite different things - especially in the case of prepubescent kids.

The conflation of gender identity with sexuality or the claim that having a non-cis gender is somehow inherently a sexual thing is part of the both trans- and homophobic talking points being used to attack the human rights and existence of trans people (of all ages) currently, and shouldn’t really be parroted here on Metafilter.
posted by eviemath at 7:04 AM on October 12, 2023 [14 favorites]

Mod note: Sigh. Since the comment is still up, may as well ensure that the important point is made.

I've left the comment up because there were several excellent responses and pushback to it.

Otherwise, that derail has been well handled by the community and folks should not attempt to derail this post again. One comment removed for being snarky, by the commenter's own admission.
posted by Brandon Blatcher (staff) at 7:53 AM on October 12, 2023 [3 favorites]

I had the good fortune of knowing a young woman at my last job who, given her age, must have transitioned pretty early. And, look I don't want to minimize the existence of people who's gender identities aren't even going to fit the mainstream, or imply that "passing" is a goal everyone's supposed want. But if you're going to live life on the other side of the gender binary than you got started out as, that's the way to do it. I wish I'd lived in a world where I even knew that was an option at that age, because she was just, like, a normal young lady.*

That's what all these transphobes are afraid of here. They are afraid that if society lets people make the choice to physical transition steps at a medically appropriate age, then trans people will be too normal for even them to notice.

And that terrifies them.



*And yes, there is so much to unpack with using the word "normal" and all of its moral insinuations and emotional implications, but I want to actually finish this post, so I'm not going to go on that digression.
posted by Zalzidrax at 8:05 AM on October 12, 2023 [3 favorites]

And, just in general, as an older queer person, it's heartening to see kids these days viewing gender as a space for self expression and personal joy rather than a binary one has to conform to. The kids are pretty alright.
posted by Zalzidrax at 8:16 AM on October 12, 2023 [11 favorites]

(Thanks for the explanatory note, Brandon Blatcher!)
posted by eviemath at 9:51 AM on October 12, 2023

Transphobes love to repeat these talking points but the idea that Europe is suddenly making gender-affirming care less available to young people is nonsense
Seems like they are
Sweden decided in February 2022 to halt hormone therapy for minors except in very rare cases, and in December, the National Board of Health and Welfare said mastectomies for teenage girls wanting to transition should be limited to a research setting.

Other countries are weighing the same questions.

Neighbouring Finland took a similar decision in 2020, while France has called for "the utmost reserve" on hormone treatments for young people.

they're not:

https://www.thestranger.com/queer/2...ds-relies-on-myths-about-a-progressive-europe
https://prospect.org/podcasts/05-20-2023-trans-rights-lgbt-finland/
https://apnews.com/article/fact-check-norway-not-ban-gender-affirming-care-956221436313

the tl;dr:
re: 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

re: 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 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 (paul conrathe) 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.

re: finland/norway:
it was actually never that supportive of trans kids.
posted by i used to be someone else at 10:15 AM on October 12, 2023 [8 favorites]

re: the UK, it's more complicated than that. There have been a number of contractions in service availability in recent years, from the GenderGP debacle to the recent controversies about the "permissive" Tavistock Centre's approach to treating kids - this is also part of the Cass report. To say nothing is the way its become an increasingly prominent culture war political football, which is only just starting to ramp up for an election year.

Whatever would be politically convenient for those of you in the US and elsewhere, it isn't fucking pretty over here.
posted by Dysk at 12:05 PM on October 12, 2023 [2 favorites]

(yeah, tbh, i see so many versions of the "but europe/sweden/finland is banning care so there's a real discussion to be had" bullshit that i'm just copypasting that same thing over and over again.

i did it in an internal work chat that's focused on trans care; i did it on ars technica's forums. i did it on other social media; i did it in a slack; i think i've done it here before already.

the fun part of this shit is so many "allies" and "liberals" will echo those same talking points ad infinitum because they're so well-read and didn't you know, it showed up in that nytimes article or that atlantic article or that guardian article or that bbc article.

you'd have more success stopping climate change by dropping ice cubes into the sargasso sea.)
posted by i used to be someone else at 12:54 PM on October 12, 2023 [4 favorites]

Mod note: Several comments removed. If you're at a point where you're arguing with people that you're not convinced about what they're saying, it's probably time to take a break from the thread.

MeFi and its community is firmly pro-trans, so please keep that in mind if the topic gets heated.
posted by Brandon Blatcher (staff) at 6:23 AM on October 13, 2023 [2 favorites]

Is there a country that should be emulated in their approach to gender affirming care?
posted by Selena777 at 10:34 AM on October 13, 2023 [1 favorite]

Is there a country that should be emulated in their approach to gender affirming care?

It's... complicated. The US tends to lead the way in terms of minimizing hoop-jumping (e.g. pioneering informed consent models*), but that's because private insurance has historically meant access is abysmal, so people got creative.** An awful lot of the research comes out of the Netherlands (we were fighting about Dutch puberty blocker studies on Metafilter a decade ago), but my understanding is that one or two university clinics have a stranglehold on care there and you're in for a hard time if you can't fit into their boxes. Much of Europe is like that--there's a bureaucracy that's reasonably good at serving people who conform to their expectations (or can fake it). These things come and go, too. Access in the UK has completely gone to shit, but I remember being envious of the GIC system, bullshit and all.

*In trans contexts, "informed consent [model]" means "not requiring a letter from a therapist to start hormones". This came about not as a matter of principle but because people couldn't afford therapy.
**The sex non-discrimination provision of the ACA was interpreted by the Obama administration HHS to require insurance cover transition-related care and that kicked in in 2017, IIRC. This was a sea change in access in the US, particularly to surgery.
posted by hoyland at 5:36 PM on October 13, 2023 [4 favorites]

I’d pretty much assume the NHS, even in its current underfunded state, is vastly superior to American healthcare in all areas except this, where they can have an opinion that they don’t need to do something vs America where you just pay them and tell them to do it. The flaw becomes an advantage.
posted by Artw at 5:58 PM on October 13, 2023 [1 favorite]

Yeah, the situation over here is much better if you can afford to go private (for adults, at least - a lot of private providers got a lot more conservative after Bell v Tavistock, and haven't all come back to where they were after the appeal.)
posted by Dysk at 8:37 AM on October 14, 2023