The GOP crusade against trans youth health care is built on lies, medical experts say


'It felt like my life was being signed away,' an Arkansas teenager told the New York Times in January.

As part of their broader campaign attacking transgender rights, conservative lawmakers are now pushing inaccurate and misleading information about transgender youth whose families want them to be able to seek the potentially life-saving care they deserve.

With a slate of bills that would outlaw gender-affirming care for minors, Republican governors and state lawmakers are targeting health care professionals who provide their patients with gender-affirming care such as hormone treatments, puberty blockers, and in some cases, gender-affirming surgery.

So far this year, GOP lawmakers in 11 states have already introduced bills restricting gender-affirming care for transgender youth, adding to at least 35 similar bills that Republican lawmakers introduced last year. Arkansas passed a gender-affirming care ban last year, but a federal judge temporarily blocked the law from going into effect.

"It felt like my life was being signed away," Sabrina Jennen, a transgender teenager living in Arkansas, told the New York Times in January, adding that if the Republicans' law does go into effect, "it would truly be the death of Sabrina ... I wouldn't be able to live and be myself."

In 2018, the American Academy of Pediatrics published a policy statement outlining best practices for health care providers to follow when giving gender-affirming care to minors. According to the medical group, puberty blockers are reversible and hormone treatments are partially reversible. Gender-affirming surgeries are typically given to adults and are rarely recommended for minors.

The medical group further explained that prepubertal "kids who identify as transgender and gender diverse" (TGD) understand their gender as well as cisgender kids of the same age, and said that the approach of "watchful waiting" — where caretakers assume their child's "notions of gender identity become fixed at a certain age" and therefore withhold "critical support" — is outdated.

"More robust and current research suggests that, rather than focusing on who a child will become, valuing them for who they are, even at a young age, fosters secure attachment and resilience, not only for the child but also for the whole family," the group's authors wrote.

Still, Republican lawmakers have continued to insist that it is inappropriate for health care providers to treat gender dysphoria in children, which can lead to higher levels of depression and anxiety if left untreated. To make their argument, these lawmakers often rely on one of the following three misleading claims that medical experts have repeatedly debunked.

Misleading Claim No. 1: Health care providers are casually giving gender-affirming care to minors

An Ohio bill, H.B. 454, sponsored by Rep. Gary Click (R), said physicians can't provide gender transition procedures, surgical or not, to minors. Nationwide Children's Hospital in Ohio, which treats trans youth in its THRIVE program, opposes this type of legislation. In a House hearing held on Feb. 17, Click referred to what he sees as a "lack of professional curiosity" about transition-related care among physicians and recommended a "watchful waiting" approach.

Dr. Andrew Fisher is a gynecologic surgeon at UChicago Medicine's Trans CARE clinic, which provides reproductive health care to transgender and gender-nonconforming patients. While he is not a pediatrician, Fisher said he has helped younger patients and their families navigate the gender-affirming care system. He said he hasn't seen patients accessing this care casually and with relative ease as lawmakers have suggested. Fisher said he has seen firsthand what patients go through to get access to this care.

"They would typically talk to their pediatrician first, who would then refer them to an experienced hormone prescriber or multidisciplinary clinic, especially in the pediatric and adolescent and population," Fisher told the American Independent Foundation. "These clinics are staffed with a multidisciplinary group of people that includes pediatricians, therapists, pediatric psychiatrists and psychologists, and endocrinologists, and there's a long informed-consent process and a long conversation that has to do with a lot of things, first and foremost, identifying, 'Is this a true gender dysphoria diagnosis? Is there another mental health diagnosis at play ruling out 'medical causes' for what a patient might be experiencing?'"

Even after that point, Fisher said there's another long process involving patients being informed on what kinds of puberty-blocking medications and hormone medications there are and how they could affect their body, which could take anywhere from weeks to months. When asked about Click's comment that young people could wait until they are adults to make medical decisions, Fisher said that for most patients, only having the option of social transition does not "ameliorate the severe depression and the anxiety."

Fisher, whose clinic provides some gender-affirming surgeries, described surgery, particularly bottom surgeries, as "not common at all" for minors.

Misleading Claim No. 2: 'Rapid-onset gender dysphoria' is responsible for kids' gender identity

Click also referred to the term "rapid-onset gender dysphoria" when he argued in favor of his legislation in Ohio. This term refers to a 2018 study that describes a supposed "social and peer contagion" phenomenon. The idea is that kids, often those assigned female at birth, who have friends who say they experience gender dysphoria and are influenced by what they see on social media, have experienced "sudden or rapid" gender dysphoria. This term has been embraced by individuals and groups who oppose trans rights in recent years, as well as conservative media, as BuzzFeed News has reported.

The board of directors for the World Professional Association for Transgender Health has said the term is "not a medical entity recognized by any major professional association" and that it is "nothing more than an acronym created to describe a proposed clinical phenomenon that may or may not warrant further peer-reviewed scientific investigation."

Fisher said, "It's a biased term at a minimum."

Misleading Claim No. 3: Transition regret is prevalent

Although people do transition and decide to transition again to the gender assigned to them at birth, the overrepresentation of transition regret stories during discussions about whether young people should be able to receive this care is a problem, Fisher said. Researchers have also found that gender-affirming care is associated with better mental health outcomes for trans and/or nonbinary youth and that transition regret is rare.

Trans minors rarely receive gender-affirming surgery. A 2021 study in the medical journal Plastic and Reconstructive Surgery found there is an "extremely low prevalence in regret" among patients who do receive such procedures. A 2020 study found that people who were provided puberty blockers in adolescence were less likely to think about committing suicide compared to peers who wanted this health care but did not receive it.

Jack Turban, a researcher whose work focuses on the mental health of transgender youth, wrote in an article for Vox addressing concerns around kids transitioning, "If a child has hit puberty and identifies as transgender, they are much less likely to later stop identifying as transgender." Turban also referred to a large study in the Netherlands that found only 1.9% of adolescents decided to stop taking puberty blockers.

"Just looking at a couple of cases isn't sufficient to say that our whole systematic approach for how we treat these patients is flawed. Certainly, people can grow and people can evolve, but everything we do in medicine is risks versus benefits," Fisher said.

He added, "It's our duty as health care providers to provide those things as long as we feel certain that we're keeping them safe."

Published with permission of The American Independent Foundation.