Updated: May 15, 2022
Last Wednesday, Florida’s Department of Health outlined new guidelines to end gender-affirming healthcare for trans youth. In a statement, the state’s surgeon general Joseph A. Ladapo cited “a lack of conclusive evidence”, as well as a study claiming most trans youth “will lose their desire to identify with the non-birth sex.”
According to the Williams Institute, more than a third of trans youth in the US are at risk of losing gender-affirming care. Florida’s decision reflects the debate raging between trans youth and state legislatures throughout the United States. One side argues early gender-affirming care could improve mental health outcomes for trans children. The other argues that gender-affirming healthcare could lead to damaging, irreparable effects for gender-nonconforming children. Both sides invoke research to confirm their respective viewpoints. But who’s right?
What is Gender-affirming Healthcare?
Gender-affirming care is any clinical care that aids a trans person in his or her gender transition. This includes gender reassignment surgery, hormone therapy, and puberty suppression. This article will focus on the lasting effects of hormone therapy and puberty suppression in trans youth.
Hormone medicines use synthetic or naturally derived hormones to stimulate a person’s gender transition. Hormone medications are approved by the Food and Drug Administration for menopause and other conditions, but hormone therapy for gender dysphoria is an off-label use.
Puberty blockers or gonadotropin-releasing hormone agonists suppress the production of testosterone and estrogen. They are FDA-approved to treat precocious puberty.
The Argument Against
The opposition claims that research behind pediatric gender-affirming healthcare ignores the potential health risks. Some research does show a slight relationship between depression and hormone therapy. It’s also worth noting that these same studies also point to improved mental health outcomes—lessening anxiety, depression and suicidal thoughts—for trans people after beginning hormone therapy.
Moreover, other members of the opposition assert that gender dysphoria is a fleeting phase in many children. These people, including Ladapo, frequently cite a doctor named Thomas D. Steensma. A 2011 study of his claimed approximately 80% of trans youth will grow out of gender dysphoria. However, the study lumped together all gender-nonconforming youth with trans youth. That is, all boys perceived to be feminine or all girls perceived to be masculine were conflated with trans kids.
The Argument in Favor
Those in favor argue that early treatment for gender dysphoria with hormone therapy and puberty blockers could prevent the trauma associated with puberty. In fact, a 2006 Dutch study showed “a decrease in behavioral and emotional problems” following puberty suppression in trans children 12 and older.
A more recent study at Stanford in 2022, drawing from the largest survey of trans adults in history, found that suicidal ideation was 135% lower in trans adults who began hormone therapy in their adolescence.
However, less research exists to confirm the positive impact of hormone therapy and puberty suppression for children younger than 12. Additionally, research has yet to sufficiently explore the impact of these drugs on mineral bone density and cognitive development.
Despite the ever-growing evidence for the efficacy of gender-affirming care and despite the flawed studies from the opposition, research on pediatric gender-affirming healthcare is still in its infancy. Regardless, the push to deny gender-affirming healthcare to trans youth seems to be more motivated by bigotry than scientific evidence. Florida’s Department of Health dismissed a growing body of research as “low-quality evidence.” Whether you agree or not, two words surely can’t encapsulate years of successful outcomes and devotion to the subject.