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Why Is the U.S. Still Pretending We Know Gender-Affirming Care Works?

Imagine a comprehensive review of research on a treatment for children found “remarkably weak evidence” that it was effective. Now imagine the medical establishment shrugged off the conclusions and continued providing the same unproven and life-altering treatment to its young patients. This is where we are with gender medicine in the United States. It’s been three months since the release of the Cass Review, an independent assessment of gender treatment for youths commissioned by England’s National Health Service. The four-year review of research, led by Dr. Hilary Cass, one of Britain’s top pediatricians, found no definitive proof that gender dysphoria in children or teenagers was resolved…

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  Plastic surgeons society recommends delaying gender-affirming procedures until age 19

The American Society of Plastic Surgeons (ASPS) recommends that gender-affirming surgeries be delayed until a patient is at least 19 years old, the group announced in a statement Tuesday. The statement, made by the group’s board of directors, represents a break from major U.S. medical groups that have supported the care, and applies to facial, chest, and genital procedures performed for transgender and nonbinary patients.

 It’s Official: No Consensus Among Medical Groups on “Gender-Affirming Care” for Minors

Notably, the ASPS statement raises strong concerns about not just surgeries but also the use of puberty blockers and cross-sex hormones, though it limits itself to advising its members on surgeries. As such, it directly challenges other medical associations, including the American Academy of Pediatrics, the Endocrine Society, and the American Psychiatric Association, that have endorsed hormonal “treatments” for children and teens distressed about their developing bodies.

Articles of Interest

Doctors’ Group Endorses Restrictions on Gender-Related Surgery for Minors

The A.M.A.’s announcement followed a similar recommendation from the American Society of Plastic Surgeons. Other medical groups argued for a more personalized approach.

Position Statement on Gender Surgery for Children and Adolescents

Consistent with ASPS’s August 2024 statement that the overall evidence base for gender-related endocrine and surgical interventions is low certainty, and in light of recent publications reporting very low/low certainty of evidence regarding mental health outcomes, along with emerging concerns about potential long-term harms and the irreversible nature of surgical interventions in a developmentally vulnerable population, ASPS concludes there is insufficient evidence demonstrating a favorable risk-benefit ratio for the pathway of gender-related endocrine and surgical interventions in children and adolescents. ASPS recommends that surgeons delay gender-related breast/chest, genital, and facial surgery until a patient is at least 19 years old.

The Battle Over Gender Therapy

More teenagers than ever are seeking transitions, but the medical community that treats them is deeply divided about why — and what to do to help them.

Youth and gender-affirming care: let’s start with ‘do no harm’

No decent person wants to hurt children. Yet as pediatricians and longtime public health practitioners, we’ve both seen how children can be harmed by adults’ poor decisions. Efforts to block gender-affirming care for trans children have been more about politics than about health, and kids are paying the price: More than 90% of LGBTQ+ youths say recent politics has harmed their mental health.

Youth Gender Transition Is Pushed Without Evidence

Psychotherapy, not hormones and surgery, is increasingly the first line of treatment abroad. Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

“Wait Until You’re Older”

Last year, a staggering 22 states across the U.S. banned gender-affirming care for minors. The conservative politicians behind this wave of legislation didn’t care that it went against the near-unanimous medical consensus that parents and doctors ought to be able to decide, on a case-by-case basis, whether puberty blockers, hormones, or other interventions are what’s needed for a given teen to flourish and live their life authentically. These lawmakers felt the consensus was wrong, that the government should take medical transition entirely off the table, at least until the kids grow up and can make “informed,” adult decisions.

'It helps me be myself': trans kids on the healthcare Republicans want to deny them

Proponents of the healthcare bans argue that kids are too young to consentto treatments like hormone therapy and puberty blockers and that the bills aim to prevent “medical experimentation” on children. Some bills claim that trans kids “will outgrow” their identities.

A Medical Frontier

Doctors who provide gender-affirming care are split on how to evaluate teens.

A Rare Reversal on Gender Transition Policy

The ‘vast majority of children’ receiving care shouldn’t be treated with hormones or surgery, says the American Academy of Pediatrics

An English ruling on transgender teens could have global repercussions

Worries grow over treatments that can leave children sterile.

Conservative justices lean toward allowing Tennessee’s ban on gender affirming care

A conservative U.S. Supreme Court appeared ready to side with Tennessee Wednesday in upholding the state’s ban on gender affirming care for minors, a case likely to set legal precedent on equal protection for transgender children. A decision from the court isn’t expected until June 2025, but Republican-appointed justices such as Samuel Alito, Clarence Thomas and Brett Kavanaugh tipped their hands on how they would rule during three hours of oral arguments in Washington, D.C.

Doctors Debate Whether Trans Teens Need Therapy Before Hormones

Clinicians are divided over new guidelines that say teens should undergo mental health screenings before receiving hormones or gender surgeries.

Doctors Who Provide Gender-Affirming Care Prepare For Growing Restrictions

More than a dozen states have drafted or voted on restrictions to critical healthcare for trans youth. But it's not just trans youth that are being targeted. The livelihoods of doctors and pediatricians who provide this care are at stake too.

Everything You Need to Know About Getting Top Surgery

In our increasingly anti-trans environment, it can be difficult to find affirming, inclusive information related to gender-affirming care. But if you know people who have had top surgery or have ever browsed an online group of people sharing photos of their first day wearing a favorite shirt with their new flat chest, you know that the possibility of gender euphoria is out there.

Experts Say Gender-Affirming Medical Care Can Be Lifesaving for Youth

Research shows that limiting gender-affirming medical care for young people can have a negative effect on their health.

For Transgender Youth, Stigma Is Just One Barrier to Health Care

Discrimination, delays and systemic hurdles prevent young trans people from reaching the care they need, a new study finds.

Gender Affirmation For Minors Is Child Abuse, Not Treatment

Interviewing therapists, academics, and transgender people in pursuit of the elusive answer to the question, “What is a woman?” Walsh uncovers a number of professionals whose objections to the trans party line have resulted in being cut out of the discussion altogether.

Gender-Affirming Care Doesn’t Just Help Trans Youth Survive. It Allows Them to Flourish

Transgender people suffer from disproportionately poor lifelong health outcomes and lower life expectancy. This problem is commonly attributed to the gender dysphoria that many transgender young people feel about their bodies. But the truth is that gender dysphoria is treatable when transgender young people are able to access gender-affirming health care and live authentically as themselves.

Gender-affirming care should be embraced, not met with vitriol and bomb threats

Those three words, “gender-affirming care,” indicate a thoughtful approach to individuals whose gender identity — feelings of self — doesn’t correspond to the sex assigned them at birth. I am appalled that delivering this kind of care has caused well-publicized incidents of bigotry and threats of violence...

Gender-Affirming Hormone Therapy for LGBTQ Youth Can Help Save Lives, Study Finds

The use of gender-affirming hormone therapy (GAHT) is significantly related to lower rates of depression, suicidal ideation and suicide attempts among transgender and nonbinary youth, according to a study published in the Journal of Adolescent Health...

Gender-affirming hormones can improve teens’ mental health and life satisfaction

The research is one of the longest studies to study the psychological effects of gender-affirming care.

Hm, No One Had a Problem With Puberty Blockers When Only Cis Kids Took Them

“Puberty blockers have been used for decades in cisgender kids who either are going through puberty too early, or, in some instances, kids who are going through puberty very quickly,” Jason Klein, a pediatric endocrinologist and Assistant Director of the Transgender Youth Health Program at Hassenfeld Children’s Hospital at NYU Langone, told VICE. “Their use has been FDA approved, well-studied, well-documented, and well-tolerated for a long time now. And it’s the exact same medication that we use in trans or nonbinary children to basically put a pause on pubertal development. Exactly the same medications, at exactly the same doses.”

How Medical Care for Transgender Youth Became ‘Child Abuse’ in Texas

A custody battle in the Dallas suburbs amplified a growing conservative cause and helped fuel a move to treat transgender medicine as abuse

In just a few years, half of all states passed bans on trans health care for kids

Transgender people under 18 face laws that bar them from accessing gender-affirming health care in 25 states — just a few years ago, not a single state had such a law. The Supreme Court has agreed to consider a case from Tennessee in its next term that challenges that state’s gender-affirming care ban for young people. “Pressure had been mounting for the Supreme Court to weigh in here,” says Lindsey Dawson, director for LGBTQ Health Policy at the health research organization KFF.

It’s okay to let your transgender kid transition — even if they might change their mind in the future

It’s possible that many prepubescent transgender children will, in fact, change their minds about transitioning medically. We don’t have great research to know. Luckily, the interventions that doctors would recommend for kids this young are completely safe and reversible. Medical guidelines advise that prepubescent children not be offered any hormonal interventions. What a psychologist or psychiatrist might recommend is allowing the child to “socially transition” if the child so desires.

Medical Group Backs Youth Gender Treatments, but Calls for Research Review

The American Academy of Pediatrics renewed its support of gender care for minors while commissioning a fresh look at the evidence.

Mental health benefits of gender-affirming hormones for teens persist for two years in new study

Trans and nonbinary teenagers who receive gender-affirming hormones experience less depression and anxiety and more satisfaction with life than before the treatment, according to a new study published Wednesday in the New England Journal of Medicine

More Trans Teens Are Choosing ‘Top Surgery

Small studies suggest that breast removal surgery improves transgender teenagers’ well-being, but data is sparse. Some state leaders oppose such procedures for minors.

Most teens who start puberty suppression continue gender-affirming care, study finds

Researchers found that a whopping 98% of people who had started gender-affirming medical treatment in adolescence continued to use gender-affirming hormones at follow-up. The finding is significant because of ongoing political debates over whether young people should receive gender-affirming treatment, with some opponents arguing that many transgender children and teens will realize later in life that they aren't really trans.

New research finds trans teens have high satisfaction with gender care

Only 4% of participants — nine kids — expressed regret with some aspect of their care. When the researchers asked more about these regrets, she says, “often the regrets they were expressing had to do with [wishing] they hadn't done blockers and they'd gone straight to hormones, or they maybe had a negative side effect related to the blockers.” For instance, having an implant that got irritated.

New standards of transgender health care raise eyebrows

Controversial recommendations on everything from transition to castration.

New York Times Admits That Hundreds of ‘Top Surgeries’ Are Being Performed on Children

The legacy media has changed its mind. We are now informed that life-changing transgender surgeries on minors are real, and that they’re spectacular.

Parents say gender-affirming health care is ‘life-affirming care’ for their trans children

WPATH is an international organization of health professionals whose mission is to “promote evidence-based care, education, research, public policy, and respect in transgender health.” They are joined by other major medical organizations in concluding that age-appropriate gender-affirming care is evidence-based and medically necessary, including the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, and the Endocrine Society.

Puberty blockers: why some young people need help exploring their gender identity

Young trans people face numerous challenges in life. These can include social discrimination, bullying, harassment and family rejection. It’s maybe not surprising then that trans youth are also at much higher risk of self-harm and suicide attempts than their peers. Research shows that for some young trans people, puberty blocking drugs can help while they explore their gender identity. Puberty blockers are medications that temporarily cause the body to stop producing sex hormones and so delay puberty.

States are banning gender-affirming care for minors. What does that mean for patients and providers?

More than 20 U.S. states have banned or severely limited treatment to align a young person’s body with their gender identity. That leaves some doctors caught between breaking the law and providing what they say can be lifesaving medical care.

Surgery for Transgender Youths Becomes a Political Issue

Readers discuss whether teens are too young to undergo gender-affirming surgeries.

The Myth That Fuels the Panic Over Surgery for Trans Teenagers

For many, getting top surgery is a long and onerous proc

The real threat to gender-diverse children is the politicization of care issues like puberty blockers and detransition

Gender-affirming care is riddled with ethical dilemmas that have spilled over into an explosive political situation. The changing landscape of transgender health care, debates about puberty blockers and detransition are all low-hanging fruit for opportunistic politicians like Poilievre.

The Travesty of Transgender Surgery for Kids

We should allow children to become who they are destined to become, not what adults believe they should become.

U.K. Study Criticizes Puberty Blockers for Gender Dysphoria in Minors

Four-year study says there is no good evidence for giving transitioning drugs, adding to growing caution in U.S. and Europe.

U.S. Study on Puberty Blockers Goes Unpublished Because of Politics, Doctor Says

The leader of the long-running study said that the drugs did not improve mental health in children with gender distress and that the finding might be weaponized by opponents of the care.

We Need to Change the Terms of the Debate on Trans Kids

Sadjadi, who was a physician before she became an anthropologist, has written that puberty blockers are not as medically inconsequential as they are often portrayed. Although they appear to have no long-term physical effects if they are used for a short time (a year or less), some studies suggest that they can have long-term detrimental effects for the musculoskeletal system if they are used for three or four years.

What Are Puberty Blockers?

Recent conservative legislation has targeted a class of drugs used to treat transgender adolescents. But what do these drugs actually do?

What does gender-affirming care for transgender children involve? Let’s clear up some misinformation

This care runs the gamut from treatment that is socially affirming and support-based to medical care that follows the guidelines laid out by the World Professional Association for Transgender Health.

What the Science on Gender-Affirming Care for Transgender Kids Really Shows

Laws that ban gender-affirming treatment ignore the wealth of research demonstrating its benefits for trans people’s health.

What to Know About Gender-Affirming Care for Children and Adolescents

“People may assume that gender care means that you’re going to do surgery, or you’re going to put them on hormones. While that might be part of it, that’s really not the focus,” says Dr. Chang. “It’s a lot of continual checking in and seeing where the child is on their journey. It’s about love and support and affirmation.”

What We Owe Children Contemplating a Gender Transition

Hormones and surgery, affirmation as ‘trans kids’ or therapy? Experts and readers debate.

When Children Say They're Transgender

Hormones? Surgery? The choices are fraught—and there are no easy answers.

When Students Change Gender Identity, and Parents Don’t Know

Educators are facing wrenching new tensions over whether they should tell parents when students socially transition at school.

Resources

4 out of 5 kids who question gender ‘grow out of it’: Transgender expert

A psychiatrist who has presided over youth gender transition treatments for more than a decade says “four out of five” gender-questioning children eventually accept their bodies if no medical interventions are carried out.

The Trevor Project

Gender-affirming care has been shown to reduce suicide ideation and attempts in transgender individuals, along with social support, familial support, and reduction of discrimination.