The Science Behind Gender-affirming Care for Children

Research found that respecting a young person’s pronouns is linked to a reduction in suicide risk. In this List23 article, Mindpath Health’s Leela Magavi, MD, discusses why gender-affirming care for LGBTQIA+ youth saves lives.

Gender-affirming healthcare is a topic of discussion that has gained more attention recently after being polarized by the so-called Don’t Say Gay measure (HB 1557). The new law in Florida prohibits instruction and discussion about gender identity and sexuality in K-3 classrooms.

Gender identity is basically an individual perception of having a particular gender, which may not be compatible with his, her, or their birth sex. It is the internal, intuitive sense of being male, both, or neither, according to Dr. Leela Magavi, a Hopkins-trained psychiatrist and regional medical director for Mindpath Health.

If their gender identity does not match their sex assigned at birth, some people may wish to receive gender-affirming treatment.

An estimated 1.4 million people in the United States are transgender, but another 1.2 million adults aged 18 to 60 are nonbinary.

By the age of 3, children have already established awareness of gender identity and gender-specific behaviors. According to Dr. Magavi, children can identify and recognize gender groups between the ages of 18 and 24 months, and the majority can identify their own gender by age 3.

Different care for different ages

Gender-affirming healthcare comes in many forms. It isn’t a one-size-fits-all approach; like many medical therapies and treatments. It’s dependent on the person’s age, condition, and even the individual’s ability to perform it.

Different age groups may choose the genre and method of gender-affirming treatment. Gender-affirming therapy may be as simple as using a different name and the correct pronouns for children. It may involve taking medications to postpone puberty or receiving hormone therapy. Later in life, these individuals may want surgery.

“I encourage parents to use their children’s preferred name and pronoun, as well as their family members, friends, and neighbors to do the same. This could halt social isolation, depression, and suicidal thoughts in children and teens,” Dr. Magavi says.

Dr. Magavi believes that trans-affirming abilities can alleviate patients’ worries by validating them and encouraging them to clarify their beliefs, goals, strengths, weaknesses, and concerns.

Gender-affirming care is not purely medical

Dr. Jonah DeChants, a research scientist at The Trevor Project, said it was important to note that gender-affirming medications aren’t prescribed to prepubescent children. Gender-affirming care for kids focuses on the social and psychological aspects. Such changes are also easier to implement for individuals.

According to Dr. Magavi, parents can help their children feel more secure and comfortable when discussing bathroom remodels or modifications to wardrobes to fit nonbinary requirements.

Research has found that respecting a young person’s pronouns is linked to a reduction in suicide risk and that transgender and nonbinary youth with access to binders, shapewear, and gender-affirming clothing have reported lower rates of suicide in the past year compared to transgender and nonbinary youth without access.

The mental toll of restricting care

Transgender individuals are two to three times more likely to have depression or anxiety, and they have a greater risk of depression and self-harm.

According to a 2019 transgender teen survey, 45% of those surveyed had suicidal tendencies before starting hormone therapy.

The American Academy of Pediatrics is advocating gender-affirming care. It recognizes that restricting or prohibiting access to healthcare for transgender and nonbinary individuals may cause these individuals” mental health to decline.

Timing of care can save lives

One of the greatest benefits of gender-affirming healthcare is that it may be lifesaving.

According to Dr. DeChants, a peer-reviewed study by The Trevor Projects researchers published in the Journal of Adolescent Health found that gender-affirming hormone therapy is significantly linked to lower rates of depression, suicidal thoughts, and suicide attempts among transgender and nonbinary youth.

The permanency argument

People who support anti-transgender legislation argue that individuals may express their displeasure after receiving medical treatment, and hormonal therapies may also affect their bone health or fertility.

Existing evidence suggests that bone growth catches up as people stop taking puberty blockers. Doctors prescribe vitamin D and calcium supplements to alleviate this side effect and recommend weight-bearing exercises to keep bones strong.

Individuals typically begin hormone therapy when they are between 14 and 16. Although breast development and voice deepening are permanent from hormone therapy, muscle mass and body fat distribution changes may be reversed when the therapy ends.

Read the full List23 article with sources.