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.

[freepcrusher]

answer this for me - you need to be 18 to get a tattoo, fake t--s, drink (21 actually), vote, buy a gun etc. So why is it not unreasonable to have the same standards for gender affirming care, which is a highly novel/recent treatment?

[Lexii, harbinger of chaos and sexual anarchy]

answer this for me - you need to be 18 to get a tattoo, fake t--s, drink (21 actually), vote, buy a gun etc. So why is it not unreasonable to have the same standards for gender affirming care, which is a highly novel/recent treatment?

Other than getting a gun, those age requirements are lower in other countries, so why strictly 18?

[Warren 4 Secretary of Everything]

answer this for me - you need to be 18 to get a tattoo, fake t--s, drink (21 actually), vote, buy a gun etc. So why is it not unreasonable to have the same standards for gender affirming care, which is a highly novel/recent treatment?

Other than getting a gun, those age requirements are lower in other countries, so why strictly 18?

I guess cause in this country, the legal age is 18.

[afleitch]

answer this for me - you need to be 18 to get a tattoo, fake t--s, drink (21 actually), vote, buy a gun etc. So why is it not unreasonable to have the same standards for gender affirming care, which is a highly novel/recent treatment?

Gender affirming care isn't novel or recent.

Gender affirming care does not necessarily mean surgery or medical transition.

Corrective surgery and other treatments absolutely can and does happen for people under 18 where there are specific reasons for it both medical, physical and psychological. You can debate the merits of it, but the idea it's not a 'thing' is disingenuous.

Not engaging with the points raised by the OP is poor form.

[Born to Slay. Forced to Work.]

answer this for me - you need to be 18 to get a tattoo, fake t--s, drink (21 actually), vote, buy a gun etc. So why is it not unreasonable to have the same standards for gender affirming care, which is a highly novel/recent treatment?

Even before anyone was openly trans they were performing “corrective” surgery on people born intersex without their knowledge or consent when they were new borns.

As others said this almost always isn’t surgery but more likely puberty blockers or just simply therapy.

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

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

[🐒Gods of Prosperity🔱🐲💸]

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.

    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.

    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.

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).

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.

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.   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.

[Ferguson97]

One of the core arguments against the abundance of evidence showing that gender-affirming care produces positive is that there is some sort of coordinated effort to silence the truth. If you're at the point where you're shouting conspiracies like this, it's time to take a step back. It's no different from those anti-vaxxers who scream about how Phizer and Moderna are hiding evidence about the negative side effects of the vaccines. It's insane.

[John Dule]

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

[OSR stands with Israel]

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

[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

[EastwoodS]

My whole life motto, speaking to toxic, religious, incel bigots is  “I’m not here to make your toxic existence comfortable , I’m going to live how I want and advocate against and support the destruction of any societal barrier or insitituion and that holds me back or advocates against  my rights whether or not your snowflake, fragile heteronormative culture likes it or not.

[Sirius_]

I don't think that minors should have access to all of the same gender treatment options as adults, and I don't think anyone was really arguing for that, but clearly the hardline "no transing our kids" people are wrong. It's silly to make policy around ~2% of ~2% of the population, to the detriment of a much larger group of people. Especially when we allow people to make all sorts of choices they end up regretting, some of which have much worse consequences.

[John Dule]

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.

[bagelman]

Most people hear "doctors injecting kids with hormones and preforming major irreversible surgery" when the read the phrase "Gender-Affirming Care for Transgender Kids" so opposition seems to be default.

I'm not one to argue with scientific studies, as long as those studies were conducted in an unbiased matter.

[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

[Born to Slay. Forced to Work.]

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.

The first amendment still applies to vehement hate mongers

[🐒Gods of Prosperity🔱🐲💸]

Most of those studies, whether they found a benefit or not, did not have a control group. That is a limitation of most research in this are, so you can't just use that as a way to dismiss the ones that don't find a difference between before and after. In fact, it often happens that you find a difference between before and after even if there is no actual therapeutic benefit, simply because severe psychological distress is often short-lived. 

[🐒Gods of Prosperity🔱🐲💸]

One of the core arguments against the abundance of evidence showing that gender-affirming care produces positive is that there is some sort of coordinated effort to silence the truth. If you're at the point where you're shouting conspiracies like this, it's time to take a step back. It's no different from those anti-vaxxers who scream about how Phizer and Moderna are hiding evidence about the negative side effects of the vaccines. It's insane.

It doesn't need to be a coordinated effort at all if you have people who have similar ideological biases and motivated cognition.

[John Dule]

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.

The first amendment still applies to vehement hate mongers

There are no "hate mongers" on this site, and the First Amendment does not apply here. Not sure what this non-sequitur is about.

[Alben Barkley]

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-hormones

And here's a great article (including an affadavit to the Missouri AG) from someone on the inside of a youth gender clinic exposing the horrific lack of proper "care" there:

https://www.thefp.com/p/i-thought-i-was-saving-trans-kids

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." 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...

[7,052,770]

And here's a great article (including an affadavit to the Missouri AG) from someone on the inside of a youth gender clinic exposing the horrific lack of proper "care" there:

https://www.thefp.com/p/i-thought-i-was-saving-trans-kids

Do we have any independent confirmation on these claims? Any response from the clinic and its leadership? These allegations are outside the bounds of the nationally established medical ethics and should be thoroughly investigated.

[John Dule]

And here's a great article (including an affadavit to the Missouri AG) from someone on the inside of a youth gender clinic exposing the horrific lack of proper "care" there:

https://www.thefp.com/p/i-thought-i-was-saving-trans-kids

Do we have any independent confirmation on these claims? Any response from the clinic and its leadership? These allegations are outside the bounds of the nationally established medical ethics and should be thoroughly investigated.

Missouri is "conducting an investigation" as of two days ago, so maybe we should wait to see what they find. I wish this had happened in a state where we could be more sure of an unbiased investigation, but to be honest, I doubt that any result to this situation could possibly lead to contrition or soul-searching among the gender crowd.

As for the whistleblower herself, she clearly works in this industry and is thus sympathetic to transgender people. She is also apparently "married to a trans man," and she made a sworn affidavit-- if she perjured herself in making it, she can be fined or even imprisoned. I sincerely doubt that someone who is clearly this far left would make these statements under oath unless she had legitimate reason to believe they were true. It's either that or she's an attention seeker on the level of George Santos-- which is possible, but I wouldn't say it's likely.