It is hard for most of us to imagine what it is like to have a child who is experiencing gender dysphoria. Even as the number of children expressing such feelings has been rising at a concerning rate across the country, such cases remain a tiny fraction of the total population.
The correct response from all people — regardless of their perspectives, whether scientific, faith-based or otherwise — is compassion and care for parents and caregivers trying to support a child during this time.
The wrong response, and one that stands to hurt the cause of more fully understanding and addressing gender dysphoria, is the one we are seeing now from Texas Attorney General Ken Paxton and Gov. Greg Abbott. Parents who are working through a child’s depression, fear and confusion don’t need the threat of being prosecuted for child abuse, a specter Paxton raised and Abbott joined in the lead-up to Tuesday’s primary election.
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 cross-gender hormones. One state employee with a 16-year-old transgender child was placed on administrative leave as a result. The family has sued and now a judge has blocked Abbott’s order, at least for now.
None of this is good, and we are left to wonder why Paxton and Abbott have focused so much energy on this tiny segment of the population now, and why parents and caregivers would be targeted even as they follow medical treatments that are prescribed by doctors, often in concert with therapists.
That is not to say we do not have concerns about the care being prescribed. But that is a scientific and medical question that needs 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 is certainly not a question that is so settled parents should face prosecution for following a doctor’s advice.
The standards come in part from the World Professional Association for Transgender Health. But as we have noted here before, those standards are unevenly applied and, just as important, are being challenged by health care systems worldwide.
Just days after Paxton announced his opinion that certain gender-affirming care could be considered child abuse, Sweden amended its treatment guidelines to dictate that minors should be given hormone treatments only in “exceptional cases.” The Swedish National Board of Health and Welfare issued a statement saying there are “no definite conclusions about the effect and safety of the treatments” and that “the risks outweigh the benefits at present.”
Nearby Finland altered its approach in 2020, emphasizing therapy as the best treatment and creating strict guidelines for medical interventions.
On Thursday, France joined the trend when its National Academy of Medicine issued a press release connecting the skyrocketing prevalence of transgender identity in young people with social media, and encouraging caution in treatment.
And a study by the National Institute for Health and Care Excellence in the United Kingdom found that gender-affirming care isn’t effective at reducing gender dysphoria or feelings of anger, anxiety or poor body image.
Meanwhile, a community of “detransitioners” is growing by the thousands, who say that gender-affirming care has let them down. A Reddit community for detransitioners includes 26,600 members.
An April 2021 study in the Journal of Homosexuality revealed that there are many reasons people regret undergoing gender-affirming care: 70% said they detransitioned after realizing their gender dysphoria was related to other issues, 62% cited health concerns, and half said that transitioning didn’t help their gender dysphoria.
Plainly, this is not a closed medical question. More research is needed, especially considering that puberty blockers and cross-gender hormones can have permanent biological effects.
The Finnish health agency wrote in its guidance, “Only limited research has been conducted on transgender identity and other gender identity conflicts, and comparative studies are very rare.”
And a paper in the Journal of Adolescent Health says, “more systematic interdisciplinary and (worldwide) multicenter research is required.”
Even if the research uniformly supported gender-affirming care, there is ample evidence that such care is being applied inconsistently. After our last editorial on this issue, we heard from many concerned parents with stories about their children receiving treatment without parents being well-informed, and about mental health practitioners writing referrals for puberty blockers with minimal screening.
The WPATH standards say that “hormone therapy should be provided only to those who are legally able to provide informed consent,” and that only in cases of persistent, well-documented gender dysphoria which time and therapy have failed to resolve. The standards say that psychotherapy is “highly recommended” though not required.
But many parents whose children have received gender-affirming care say that care was inadequate because it lacked either full consent, adequate therapy or both.
A study in the journal Archives of Sexual Behavior in October found that 55% of detransitioners studied felt that they did not receive an adequate evaluation from a doctor or mental health professional before beginning their transition.
A group of detransitioners has chosen March 12 as Detrans Awareness Day and organized an event sponsored by a parent group called Genspect with online panel discussions and networking opportunities.
“Many detransitioners believe that they were poorly advised, or even that they received inadequate or harmful medical treatment. Others believe that they should not have been able to make life-changing decisions at such a young age,” organizers wrote in a press release about that event. “Their voices are seldom heard, even though their numbers are growing.”
Gender-questioning children and their parents are desperately looking for help navigating the confusing world of gender dysphoria. What they need, as the scientific journals keep telling us, is more evidence that gender-affirming care actually works, or more effective treatment options to help them reach wholeness. Paxton and Abbott are only making that journey more fraught by criminalizing care that parents are often told their children need. No one seriously believes that these parents are intentionally harming their children. Every indication is that they are doing everything in their power to help them.
Texas shouldn’t criminalize gender-affirming care, or politicize kids. We should study gender dysphoria and protect our kids. We should lay off the gender-affirming witch hunt and let the doctors, not the politicians, take the lead.
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