Editorial: Gender-affirming care needs more research, not more politics | Remark

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It’s hard for most of us to imagine what it’s like to have a child with gender dysphoria. Even though the number of children expressing such sentiments has increased at a worrying rate across the country, these cases remain a tiny fraction of the total population.

The correct response from all people – regardless of their outlook, whether scientific, faith-based or otherwise – is compassion and care for parents and caregivers who are trying to support a child during this time.

The wrong answer, and the one that risks damaging the cause of a fuller understanding and resolution of gender dysphoria, is the one we are seeing now from Texas Attorney General Ken Paxton and the Governor Greg Abbott. Parents going through a child’s depression, fear and confusion don’t need the threat of being sued for child abuse, a specter that Paxton raised and Abbott joined in preparing for the primary elections on Tuesday.

This all became very real after Abbott ordered the Department of Family and Protective Services to investigate the use of hormone therapy, specifically puberty blockers and transgender hormones. As a result, a state employee with a 16-year-old transgender child was placed on administrative leave. The family sued and now a judge has blocked Abbott’s order, at least for now.

None of this is good, and we wonder why Paxton and Abbott have focused so much energy on this small segment of the population now, and why parents and caregivers would be targeted even as they undergo medical treatment. prescribed by doctors, often in collaboration with therapists.

This does not mean that we are not concerned about prescribed care. But it is a scientific and medical question that requires careful, honest, and open study that helps advance our understanding of the causes of gender dysphoria and the best standards of care to address it.

It is not a political question. And it’s certainly not such a cut-and-dried question that parents should face lawsuits for following a doctor’s advice.

The standards come in part from the World Professional Association for Transgender Health. But as we have already noted here, these standards are applied unevenly and, just as importantly, are challenged by health care systems around the world.

Just days after Paxton announced his opinion that some gender-affirming care could be considered child abuse, Sweden changed its treatment guidelines to dictate that minors should only receive hormone treatments in “cases exceptional”. The Swedish National Board of Health and Welfare issued a statement saying there were “no definitive conclusions on the effect and safety of the treatments” and that “the risks outweigh the benefits to the current time”.

Neighboring Finland changed its approach in 2020, emphasizing therapy as the best treatment and creating strict guidelines for medical interventions.

France joined the trend on Thursday when its National Academy of Medicine issued a press release linking the skyrocketing prevalence of transgender identity among young people to social media and urging caution in treatment.

And a study from the National Institute for Health and Care Excellence in the UK found that gender-affirming care is not effective in reducing gender dysphoria or feelings of anger, anxiety or poor body image.

Meanwhile, a community of “detransitioners” is growing in the thousands, who say gender-affirming care has let them down. A Reddit community for detransitioners has 26,600 members.

An April 2021 study in the Journal of Homosexuality found that there are many reasons why people regret having undergone gender-affirming care: 70% said they had detransitioned after realizing that their gender dysphoria was related to other issues, 62% cited health issues, and half said transitioning did not help their gender dysphoria.

Obviously, this is not a closed medical question. More research is needed, especially since puberty blockers and transgender hormones can have permanent biological effects.

The Finnish health agency wrote in its guidelines: “Only limited research has been conducted on transgender identity and other gender identity conflicts, and comparative studies are very rare.”

And an article in the Journal of Adolescent Health states that “more systematic interdisciplinary and multi-center (global) research is needed.”

Although research uniformly supported gender-affirming care, there is ample evidence that such care is applied inconsistently. After our last editorial on this issue, we heard from many concerned parents telling stories of their children receiving treatment without the parents being properly informed, and of mental health practitioners writing references for puberty blockers with minimal screening.

The WPATH standards state that “Hormone therapy should only be provided to those who are legally capable of providing informed consent,” and this only in cases of persistent, well-documented gender dysphoria that time and therapy do not allow. failed to resolve. The standards say psychotherapy is “strongly recommended” but not required.

But many parents whose children received gender-affirming care say the care was inadequate because it lacked either full consent, adequate therapy, or both.

A study published in October in the journal Archives of Sexual Behavior found that 55% of detransitioners studied felt they did not receive an adequate assessment from a doctor or mental health professional before beginning their transition.

A group of detransitioners chose March 12 as Detrans Awareness Day and hosted an event sponsored by a parent group called Genspect with online panel discussions and networking opportunities.

“Many detransitioners feel that they have been given bad advice, or even that they have received inadequate or harmful medical care. Others believe they shouldn’t have been able to make life-changing decisions at such a young age,” organizers wrote in a press release about the event. “Their voices are seldom heard, though their numbers are growing.”

Gender-questioning children and their parents are desperate for help to navigate the confusing world of gender dysphoria. What they need, as the scientific journals keep telling us, is more evidence that gender-affirming healing actually works, or more effective treatment options to help them achieve wholeness. Paxton and Abbott only make this journey more difficult by criminalizing the care parents are often told their children need. No one seriously believes that these parents are intentionally harming their children. Everything indicates that they are doing everything in their power to help them.

Texas should not criminalize gender-affirming care or politicize children. We should study gender dysphoria and protect our children. We should end the gender-affirming witch hunt and let doctors, not politicians, take the lead.

The Dallas Morning News

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