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

[Since I'm the mad scientist proclaimed by myself]

https://www.scientificamerican.com/article/what-the-science-on-gender-affirming-care-for-transgender-kids-really-shows/

The truth is that data from more than a dozen studies of more than 30,000 transgender and gender-diverse young people consistently show that access to gender-affirming care is associated with better mental health outcomes—and that lack of access to such care is associated with higher rates of suicidality, depression and self-harming behavior.

And while some critics point to decade-old study and older studies suggesting very few young people persist in transgender identity into late adolescence and adulthood, Forcier says the data are “misleading and not accurate.” A recent review detailed methodological problems with some of these studies. New research in 17,151 people who had ever socially transitioned found that 86.9 percent persisted in their gender identity. Of the 2,242 people who reported that they reverted to living as the gender associated with the sex they were assigned at birth, just 15.9 percent said they did so because of internal factors such as questioning their experienced gender but also because of fear, mental health issues and suicide attempts. The rest reported the cause was social, economic and familial stigma and discrimination. A third reported that they ceased living openly as a trans person because doing so was “just too hard for me.”

A 2020 study of 300 gender-incongruent young people found that mental distress—including self-harm, suicidal thoughts and depression—increased as the children were made to proceed with puberty according to their assigned sex. By the time 184 older teens (with a median age of 16) reached the stage in which transgender boys began their periods and grew breasts and transgender girls’ voice dropped and facial hair began to appear, 46 percent had been diagnosed with depression, 40 percent had self-harmed, 52 percent had considered suicide, and 17 percent had attempted it—rates significantly higher than those of gender-incongruent children who were a median of 13.9 years old or of cisgender kids their own age.

Stop pushing policies that hurt us because of your discomfort with our existence.

[Since I'm the mad scientist proclaimed by myself]

And of course the anti-trans people are pretty much silent in this thread.

[Since I'm the mad scientist proclaimed by myself]

I look forward to seeing this thread locked because it “might start a controversial debate.”

It clearly won't considering that people like you don't have any decent arguments against the article so y'all have opted to mostly ignore it.

[Since I'm the mad scientist proclaimed by myself]

The truth is that data from more than a dozen studies of more than 30,000 transgender and gender-diverse young people consistently show that access to gender-affirming care is associated with better mental health outcomes—and that lack of access to such care is associated with higher rates of suicidality, depression and self-harming behavior.

Is it really a consistent finding?  Looking at the studies described in that link, it is at least a bit of an overstatement

     Study 1: De Vries, A. L., Steensma, T. D., Doreleijers, T. A., & Cohen‐Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow‐up study. The Journal of Sexual Medicine, 8( 8 ), 2276-2283.

This study from the Netherlands followed 70 transgender adolescents and measured their mental health before and after pubertal suppression. Study participants had improvements in depression and global functioning following treatment. However, feelings of anxiety and anger, gender dysphoria, and body satisfaction did not change.

Seems to be an improvement on depression in this study, but it's not related to body satisfaction. May be related to impacts of puberty on depression which is not limited to people with gender dysphoria.

Puberty blockers aren't for reducing current dysphoria, they're for preventing the body from changing in ways that make dysphoria much worse. This study doesn't have a control group, and simply shows that puberty blockers make things not get worse.

    Study 3: Costa, R., Dunsford, M., Skagerberg, E., Holt, V., Carmichael, P., & Colizzi, M. (2015). Psychological support, puberty suppression, and psychosocial functioning in adolescents with gender dysphoria. The Journal of Sexual Medicine, 12(11), 2206-2214.

This study is from the United Kingdom. They followed 101 adolescents who received pubertal suppression at the beginning of the study and 100 adolescents who, for a range of reasons, were deemed by the team not ready to start pubertal suppression and thus did not receive it over the course of the study. Both groups received supportive psychotherapy. Both groups saw improvement in mental health. While the pubertal suppression group had a 5-point higher mean score on the study's psychological functioning scale at the end of the study, the difference was not statistically significant.

No clear finding of difference between those who had puberty blockers and those who didn't. But the sample sizes were fairly small, and so may miss an effect if that effect isn't very large.

The problem is that kids not deemed ready for blockers aren't necessarily the same as kids that are granted it. Along with the mentioned problems.

    Study 8: Achille, C., Taggart, T., Eaton, N. R., Osipoff, J., Tafuri, K., Lane, A., & Wilson, T. A. (2020). Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youths: preliminary results. International Journal of Pediatric Endocrinology, 2020(1), 1-5.

This study was from Stony Brook Children's Hospital in New York. It followed 50 transgender adolescents longitudinally. Over the course of the study, 23 received pubertal suppression only, 35 received gender-affirming hormones only, and 11 received both. Three participants received no gender-affirming medical interventions. Over the course of the study, there was a statistically significant decrease in depression scores in one group: Male-to-female transitioners who underwent puberty suppression only.

In other words, those who had both hormones and puberty blockers didn't do as well as those who only had puberty blockers. Kind of complicates the narrative.

Small sample sizes, especially among those who had both.

Two more studies that can't find an impact of biomedical gender interventions:

    Study 11: Carmichael, P., Butler, G., Masic, U., Cole, T. J., De Stavola, B. L., Davidson, S., ... & Viner, R. M. (2021). Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One, 16(2), e0243894.

This is another study from the United Kingdom. Researchers presented data for transgender adolescents who had received pubertal suppression. They had data for 44 patients after 12 months of treatment, 24 patients after 24 months of treatment, and 14 patients after 36 months of treatment. They were unable to detect any changes on their mental health measures (positive or negative).

There wasn't a control group that got no treatment, so this doesn't say much since, as I said previously, puberty blockers are for keeping the body from getting any worse, not for making the body fit one's gender any more than it already did before puberty

Study 13: Hisle-Gorman, E., Schvey, N. A., Adirim, T. A., Rayne, A. K., Susi, A., Roberts, T. A., & Klein, D. A. (2021). Mental healthcare utilization of transgender youth before and after affirming treatment. The Journal of Sexual Medicine, 18( 8 ), 1444-1454.

This study utilized military healthcare data from transgender youth who received medical care through the U.S. military healthcare system. The researchers identified 963 transgender adolescents who had received some form of gender-affirming medical treatment. The mean age of starting any gender-affirming medical care was 18.2 (so this study may not technically qualify for our review of studies of adolescents). Their outcomes of interest were number of mental healthcare visits after gender-affirming medical care and number of days taking a psychiatric medication after starting gender-affirming medical care. In their adjusted models, there was no change in number of annual mental healthcare visits and an increase in days taking psychiatric medication from a mean 120 days per year to a mean 212 days per year.

Whether someone takes psychiatric medicine or not or whether someone goes to therapy is a pretty bad proxy for mental health. Especially the psychiatric medication part. There's no control group, so we don't know if this is any different from cis teens, there's no control group of trans youth who didn't get treatment, so we can't effectively compare, and there's no analysis of actual wellbeing, so we don't know if the psychiatric medication is even in response to new problems.

To add to this, I currently go to therapy every week, and do psychiatry once a monthish. This is pretty similar to the amount I was doing when I first started going to my current mental healthcare place. Hell, if this statistic counts social groups related to mental illness as "mental health visits", I'd actually be getting more of them in the past 6 months than ever before. I'm also on a lot more psychiatric medication then I was when I started. I was barely functional at the start of my time there, and I'm doing pretty well now.

Is there any tentative evidence that suggests these interventions can improve mental health for some with gender dysphoria?  Sure, as several of the other studies show.  But there are people who clearly have an interest in exaggerating what we know and the confidence with which we can know it. 

Only two of the studies linked actually show no difference(the others you cited are not evidence against puberty blockers effects as you seem to think), and one of them has a sample size of 3 for those that didn't get treatment. Most of them show a positive effect compared to not getting treatment(or just show positive effects). It is not as ambiguous as you're suggesting.

 And that has to be balanced against risks like this:

    Study 2: De Vries, A. L., McGuire, J. K., Steensma, T. D., Wagenaar, E. C., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2014). Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics, 134(4), 696-704.
...Of note, one patient in this study died from a surgical complication of vaginoplasty (necrotizing fasciitis), but little additional information is provided.

Risks of surgery are irrelevant to discussions about puberty blockers and hormones

[Since I'm the mad scientist proclaimed by myself]

I look forward to seeing this thread locked because it “might start a controversial debate.”

It clearly won't considering that people like you don't have any decent arguments against the article so y'all have opted to mostly ignore it.

It’s become clear that we’re not allowed to argue against it.

https://talkelections.org/FORUM/index.php?topic=538057.0
lol

[Since I'm the mad scientist proclaimed by myself]

Scientific American has become a joke, sadly.

Here's a great rebuttal to the most prominently cited recent "study" claiming that "gender-affirming care" for youth is effective:

https://jessesingal.substack.com/p/the-new-highly-touted-study-on-hormo

One journalist with a known anti-trans bent and no scientific background made claims that make one study seem vaguely suspect. From what digging I could do his claims seem a bit suspect. And that maybe suspect study was not one of the ones I even cited, which you would know if you actually read the stuff instead of just posting the first anti trans thing you found on google.

And no, I am not pushing policies because of my "discomfort with your existence." I am pushing policies that protect children who are too young to drink a beer or drive a car legally, let alone know what their "gender identity" is and be so sure of it that they want to undergo irreversible, experimental medical treatments that cut themselves off from fertility and orgasms for the rest of their lives. Back in the day, by which I mean like 2012 or so, this used to be known as "common sense."

Puberty blockers aren't irreversible and you'd know this if you followed actual science instead of whatever anti trans drek you listen to. And birth sex puberty is just as irreversible as cross sex puberty. If you're genuinely concerned about not letting kids make a mistake as opposed to just being uncomfortable with transness, then you should be a staunch supporter of puberty blockers. Their only problem is bone density, which can mostlybe counteracted with proper care, and is a much better problem to have then having to watch with a horror I don't know how to describe to you as your body twists into something horrific to you. I would be happier if I had access to blockers when I was younger. I might not be alive if I had to wait until 18 for HRT. And even if I was, my life would be much worse than it is now.

It is today in the UK, Finland, and Sweden, which have all rolled back their youth gender clinics. Funny how I don't doubt a "socialist" like OP would tout these countries' other policies as superior to America but conveniently ignore this one...

I do not evaluate a policy's validity based on what countries support it because I'm not a hack with zero critical thinking ability. Also I'm pretty sure the sweden thing was just one city forcing a clinic to stop providing it, UK government is a transphobic nightmare, and I don't trust the Finland thing because of the sweden thing being bs. Also:

Anecdotally, my mom has an trans friend from Norway(online) who said she got treated better in a rednecky part of the US than in Norway.

[Since I'm the mad scientist proclaimed by myself]

A lot of my skepticism with this "science" is that most of it revolves around patients reporting that they feel better. I can't imagine many worse ways to measure a moody kid's wellbeing than self-reported happiness.

How about every other way? I trust the scientists who universally accept the usefulness of these measures over some random guy who really doesn't want to believe that transition care is helpful to teenagers.

[Since I'm the mad scientist proclaimed by myself]

A lot of my skepticism with this "science" is that most of it revolves around patients reporting that they feel better. I can't imagine many worse ways to measure a moody kid's wellbeing than self-reported happiness.

How about every other way? I trust the scientists who universally accept the usefulness of these measures over some random guy who really doesn't want to believe that transition care is helpful to teenagers.

What do you mean by this?

How else are you going to measure someone's mood?

 ETA I'm pretty sure the scientific way of doing this is a bit more rigorous than asking "do you feel better than 6 months ago". I know it is for the questionnaires related to depression and anxiety I get sometimes from my mental health place