A custody case in Texas has sparked heated debate and embroiled state policymakers in public discussions about the diagnosis and appropriate medical treatment of transgender children.
Unfortunately, many of the claims being made about gender-affirming care for transgender and gender-incongruent individuals are inaccurate. Policies concerning the diagnosis and treatment of transgender individuals should be based on science, not politics.
Claims that a transgender child would receive surgical or irreversible hormonal treatment do not reflect the reality of medical practice. The Endocrine Society’s Clinical Practice Guideline, which sets the standard of care for transgender individuals, recommends avoiding hormone therapy for transgender children prior to puberty. The guideline is co-sponsored by the American Association of Clinical Endocrinologists, American Society of Andrology, European Society for Paediatric Endocrinology, European Society of Endocrinology, Pediatric Endocrine Society and the World Professional Association for Transgender Health.
As noted in our evidence-based guideline, transgender individuals, both children and adults, should be encouraged to experience living in the new gender role and assess whether this improves their quality of life. Mental health care is recommended throughout this process, and only a mental health professional with training or experience in childhood and adolescent gender development should make a diagnosis of gender incongruence in a child or teenager.
Transgender individuals who are denied care from a healthcare provider are more likely to report having suicide thoughts and suicide attempts, according to an analysis of the 2015 U.S. Transgender Survey of adults released last month. Among individuals who were refused gender-affirming care in the previous year, 62 percent reported experiencing thoughts of suicide and 14.4 percent attempted suicide. Nearly half of transgender individuals who were rejected by their family have attempted suicide, while 33 percent who were not rejected attempted suicide.
Over the last few decades, understanding of gender identity has rapidly expanded. Considerable scientific evidence has emerged demonstrating a durable biological element underlying gender identity. There do not seem to be external forces that genuinely cause individuals to change gender identity. The Endocrine Society called for policies to reflect this reality in our position statement on transgender health.
The custody case has prompted a Texas state policymaker to announce plans to introduce legislation that would prohibit the use of puberty blockers for children under the age of 18. This proposal defies best medical practices.
Suppressing puberty is fully reversible, and it gives individuals experiencing gender incongruence more time to explore their options and to live out their gender identity before they undergo hormone or surgical treatment. Research has found puberty suppression in this population improves psychological functioning. Blocking pubertal hormones early in puberty also prevents a teenager from developing irreversible secondary sex characteristics, such as facial hair and breast growth.
It is critical that transgender individuals have access to the appropriate treatment and care to ensure their health and well-being.