This past week has been particularly rough for me. Not because of what’s going on in Washington, DC, but because of what’s been happening in state legislatures across the country. In South Dakota, Florida, Colorado, South Carolina, and a number of other states, bills have been introduced which would make it illegal for medical providers to give transition-related medical care to transgender youth. Some of these bills even threaten to turn parents who support their transgender children over to child protection agencies as potential child abusers!
As an adult (whose child is cisgender), these bills don’t directly threaten me or my immediate family, yet I am feeling attacked. Why? Because I was a transgender youth at one time, and if I’d had access to the information that is available now, I would have likely come out and tried to transition while still young. Even without these bills, I’ve long had a strong sense of needing to protect transgender youth – it is in them that our greatest promise lies.
What medical care do transgender youth need?
This answer assumes that the transgender youth are in affirming families and communities. The timelines I give are general/typical, but as every person is different, the processes and timelines for individual youth may also deviate from what I outline below.
Childhood (0 to 11-13 years)
For the first 11-13 years of their lives, the answer is none. Until a child reaches puberty, no medical care is offered in support of transition. Until puberty begins, there are no appreciable medical differences between male and female children – no hormones, no sex-specific biological processes (such as menstruation), not even differences in growth or muscle mass.
During this pre-puberty period, a child’s transition is social (and possibly legal – name change); the child may use a different name, different pronouns, and might dress in clothing associated with their experienced gender. They might use the restrooms in alignment with their experienced gender – if the school/schools system they attend supports them in doing so.
Onset of Puberty (11-13 years old)
Upon reaching puberty (typically around 11-13 years old), the typical care offered is puberty blockers. These are the same blockers used if a child entered precocious puberty. They are reversible and do not endanger the youth or their potential for future reproductive capability. The blockers are used to simply pause the progress of puberty and to give the youth more time.
Many transgender youth feel pressure and anxiety from the threat of a puberty which would take their bodies in a direction out of alignment with their gender, and puberty blockers safely relieve that pressure. The youth is granted extra time to develop mentally and to further explore and investigate their feelings about their gender.
If at any point, the youth determines that they would prefer to proceed with the puberty their body would naturally take them through, they simply stop using the puberty blocking medications and natural puberty resumes with no permanent effects.
14-16 years old
Puberty blockers can be used safely for a few years, but at some point, puberty must begin. This can either be a puberty driven by the hormones the body would naturally produce, or – for transgender youth who are continuing to transition – one driven by exogenous hormones. Once the youth is around 14-16 years old and agreement is reached by the youth, their parents, their medical providers, and their psychological providers, the youth is provided hormones – estrogen for transgender girls, and testosterone for transgender boys. Under the influence of these hormones, their bodies develop in the same manner as their same-gender peers – secondary sex characteristic develop and they follow typical growth patterns for their gender.
These changes are more difficult to reverse, and may result in future infertility. This is why the use of puberty blockers is so important – to give the youth as much time as they safely can before these decisions must be made.
The youth can expect to be on these hormones for the rest of their lives, and to have no ill effects from the hormones – they have the same potential as their same-gender peers for all aspects of their lives, except reproduction.
So what about reproduction? Does this mean that transgender youth can never have children?
The answer is, perhaps surprisingly, “no”. If a transgender youth decides that it is important for them to preserve their ability to have genetically-related offspring, there are multiple options available.
The easiest options is to stop puberty blockers and let natural puberty run its course. The youth will have the same reproductive capacity as if the puberty blockers were never used.
Another option which some transgender youth utilize is to allow natural puberty to progress just long enough for their gonads to become fertile, then retrieve zygotes from them and cryogenically preserve them. In other words, harvest eggs or sperm, and then freeze them. In the future, they could work with a partner to fertilize eggs and implant embryos in a partner or surrogate, or inseminate a partner or donor.
And then there’s always the option of adoption – it’s truly a beautiful way to build and grow a family!
Aha, but what about surgery? We can’t be performing irreversible surgeries on our children, right? The reality is, we aren’t. At least, we aren’t performing gender confirming surgeries on children; tonsils are still removed and congenital defects are repaired on children all the time – these are also irreversible, but there’s no controversy about those surgeries, is there?
Here’s what happens for most transgender youth: if they decide to get Gender Confirmation Surgery (that’s a big if – many decide not to), that surgery typically doesn’t happen until they’re at least 18 years old; at that point, they’re legally adults and fall outside of the scope of transition care for minors.
But there are a small few transgender youth who get GCS before turning 18. This can only happen with the unanimous agreement of the youth, their parents, and their medical and psychological providers. Jazz Jennings is an example of a transgender woman who had her surgery when she was 17 – she was 3 1/2 months shy of turning 18 when she had her surgery in June 2018, and this part of her transition is well documented in the fifth season of her TV series I Am Jazz on TLC.
Then why is this legislation being proposed?
Whatever reasons are being given, they are not being proposed with the best interests of transgender youth at heart.
The proposed bills are being proposed/sponsored by conservative legislators, and marked similarities between bills proposed in various state legislatures is evidence that these bills are being pushed by anti-transgender lobbying groups.
Over the past few years, transgender people have become popular and frequent targets for conservative politicians and organizations. On the federal level, we’ve seen policies which protect transgender people and grant them access to medical care eviscerated and reversed, transgender people barred from serving our country (despite nearly all the heads of the different branches saying that transgender soldiers are capable and good members of the military – and not a burden), and mentions of our very existence literally erased from government websites. We are awaiting decisions from the Supreme Court which will tell the country whether it is legal to fire transgender people from their jobs – just for being transgender. At the state level, we’ve seen numerous bathroom bills proposed and even passed – stripping transgender people of the dignity of being allowed to safely pee! And now we are seeing legislation proposing to block access to medical care from transgender youth – among our most vulnerable populations!
I’ll close with some sobering statistics: in a 2018 study from the American Academy of Pediatrics, over 50% of female-to-male adolescents reported having attempted suicide. The same study revealed that nearly 42% of non-binary adolescents and almost 30% of male-to-female adolescents have attempted suicide. Other studies have shown that family rejection increases the rates of suicide attempts, while family acceptance can cut those rates in half. And yet more studies have shown that the passage of laws which discriminate against LGBTQ+ people causes a significant negative impacts on the physical and mental health and well-being of LGBTQ+ youth.
This much is clear: laws which prevent transgender youth from accessing medical care are not in the best interest of those transgender youth.
If you live in a state which is considering laws which would make it illegal to help transgender youth medically transition, please call your lawmakers and tell them just how damaging these laws would be and urge them to vote against them.
With reports continuing to come in of yet more states taking up these kinds of bills, is it any wonder I’m feeling under attack?
Battered, bruised, but not beat,