Akash Vaid
- May 2, 2021
- 6 min read

The Case for Trans Youth Healthcare Rights

Trans youth require the right to gender affirming care:

One very common argument against trans healthcare rights is that minors cannot truly understand their gender identity, and so undergoing permanent transitions should not be allowed (people often seem to think all gender affirming treatment is permanent or involves surgical alterations). The negative physical side effects of the process are also brought up, which still stands even when talking about reversible treatment. Another talking point is the fact that certain, contested studies show minimal effectiveness of gender affirming surgery in treatment of gender dysphoria. Let’s refute these claims.

What is trans healthcare for minors?: The vast majority of gender affirming treatment, particularly among minors, is not permanent. There is Gender Confirming Surgery (permanent), Hormone Replacement Therapy (partially/minimally permanent, depending on dose and length of time), and puberty blockers (completely reversible). Even among the broader adult trans population, only 25-35 percent undergo GCS (gender confirming surgery). Currently, minors do not have access to GCS in the US, and even lesser treatment like HRT is not attempted by those under 16 years of age (1)(2). The common form of gender affirming care for minors is puberty blockers, which are not used until around age 10, and general psychiatric care. The point being made here is that when thinking about gender affirming care for minors, the common image people tend to have is where kids are undergoing intensive sexual reassignment surgery; this perception is inaccurate. There is evidence to suggest that even some forms of GCS should be available to teenagers (1)(2)(3), but the main discussion about trans youth healthcare revolves around the completely reversible puberty blockers (available to kids directly prior to pubescence, if allowed by a medical professional after extensive evaluation/diagnosis/therapy) and the mostly reversible HRT (available to teenagers if allowed by a medical professional, after adequate time on puberty blockers and further evaluation/diagnosis/therapy) (1).

Refutations:

A good way to refute the arguments about minors being too young to undergo gender affirming care is by applying that same logic to psychiatric care for mental illness:

There is a significant amount of evidence suggesting that puberty blockers have equal or greater safety than many widely administered psychiatric medications. The Endocrine Society and FDA both support the use of puberty blockers for kids. From all the conducted research, the overwhelming scientific consensus is that despite having some minor side effects, puberty blockers are safe and do not cause long term harm, only some effects on bone density which can be alleviated with exercise and proper nutrition. Other long term effects follow a similar pattern of creating minor abnormalities in a patient, but nothing that threatens health (1)(2)(3)(4). The aforementioned sources and studies also show the clear effectiveness of puberty blockers in the treatment of gender dysphoria. Meanwhile, numerous SSRIs are administered to children of various ages, despite the fact that they carry a FDA black box warning about an increased risk of suicidality for people under the age of 25. In addition, many children are prescribed antidepressants only officially approved for adult use (this is a fairly common pharmaceutical practice called off label use). Antidepressants have an extensive list of common side effects, as well as evidence that the more serious effects like aggression and suicidality are more common than the records show. There is also evidence indicating a negative effect on lifespan and predisposition to life threatening conditions. ADHD medication is even more widely prescribed to children, despite having numerous side effects, mostly in the first few months of taking it. More seriously, numerous research efforts have discovered a significant effect on brain development in children, particularly boys (1)(2)(3). It should be noted, though, that these findings don't necessarily reflect any distinctly negative long term consequences from the medication. If someone believes puberty blockers shouldn’t be administered to children, they should also be against prescribing the majority of common psychiatric medications to children as well.
“Minors are too young to understand their own gender identity”: once again, this logic should realistically also apply to children who undergo treatment for any psychiatric conditions where the diagnosis mostly or entirely involves symptom reports from the patient (for example, ADHD would generally be disanalogous to dysphoria because the diagnosis includes cognitive tests and exercises as opposed to just psychoanalysis). I see no reason why a child can feel symptoms of depression, anxiety, BPD, bipolar, etc and work through them with a medical professional, but can’t do the same with symptoms of dysphoria or gender nonconformity. The process is exactly the same; the child and/or family notices the symptoms and goes to a professional, who then evaluates the child and diagnoses them. The Standard of Care requires incredibly exhaustive evaluation and non-physical therapy relating to a whole host of different potential causes of the dysphoria before any intrusive physical therapy is considered. Even the use of puberty blockers (which are completely safe and reversible) typically are accompanied by specialized procedures to fully maximize how informed and confident the family’s decision is. Thus, the argument that the child can’t know their own identity is ignoring the fact that the large majority of decisions for whether the child needs the treatment is done by medical professionals and the legal guardians. This is compounded by the fact that the consequences for someone who doesn't have depression or ADHD being misdiagnosed and taking medication is significantly more detrimental than a person who doesn’t have dysphoria taking puberty blockers; if the gender affirming treatment isn’t necessary, then the child can just stop taking them and continue on with their normal puberty, the only consequence being lack of development compared to peers. However, a person being misdiagnosed with ADHD or depression and taking medication generally has brain altering, addictive consequences.
Effectiveness of trans healthcare: Pages 113-115 of the Standards of Care Book detail the history of research on the outcomes of trans healthcare in a fairly comprehensive manner. There are a few well known studies, most notably the Newfield study, Swedish study, and the first Netherlands study, which show negligible or negative outcomes in mental health among trans people post surgery. However, each of these studies has their fair share of issues. The Newfield study recruited its 384 participants by a general email rather than a systematic approach, and the degree and type of treatment were not recorded. Study participants who were taking testosterone had typically been doing so for less than 5 years. The Swedish and Netherlands studies did not use control groups of trans people who had not undergone surgery, instead using the national populace and a select group of cis people as respective control groups. This is because neither study was even designed to question the efficacy of gender affirming surgery, the conclusions of the studies simply stated that trans people require extensive psychiatric support both before and after surgery, since they still had higher suicidality than the general population (1). Even beyond these studies being misinterpreted, the fact remains that the general scientific consensus is that gender affirming surgery absolutely improves the lives of trans individuals. The aforementioned Standards of Care book shows this; looking through the various studies I used as evidence for different points throughout this document, you will see that most or all of them mention the efficacy of trans surgery, even when the specific topic of the study is not related to that. This meta analysis of dozens of studies revealed that quality of life definitively and significantly improved post surgery, despite still being lower than that of the general populace (largely due to a variety of extenuating societal factors). Other studies proving this point include 1, 2, 3, and virtually any recorded scientific research that isn't one of the aforementioned debunked and misinterpreted studies that get parroted around by people who aren't bothered to do their due diligence when it comes to research. The literature also seems to go against the idea that many trans folks are simply confused, and in this confusion end up taking drastic measures that they regret later on. A recent study found that out of the over 27,000 surveyed trans individuals, 13 percent of them had “detransitioned” at one point in time, but 82.5 percent of those who had detransitioned did so due to external factors including harassment, familial pressures, financial reasons, going back on wanting children, etc. Only around 16 percent of those who detransitioned had done so because of internal conflict with gender identity. It is also important to note that these types of external factors greatly influence trans people’s struggles with mental health post surgery; to make that shift in identity is to fully out yourself and it sets an expectation for those around you to respect this new identity. Naturally, this would open someone up to harassment and result in friends/family needing to adjust, which is often very messy. This is especially notable for studies on trans mental health which were conducted in a less tolerant time period.