A new study confirms what experts in transgender medicine have known for years: The overwhelming majority — 98% — of adolescents who begin gender-affirming treatment continue that treatment into adulthood.
The research, published in the prestigious medical journal the Lancet, adds to a large and ever-growing body of evidence that gender-affirming care, a broad term that includes physical and mental health services, is critical health care for transgender youth. That evidence is compelling enough that a laundry list of medical societies, including the American Medical Association, the American Academy of Pediatrics and the Endocrine Society, have affirmed their support of access to this kind of care.
It’s a body of evidence that Republicans cynically ignore when introducing state-level bans on transgender care — bans that tend to target transgender youth. They claim to be protecting kids, but families and scientific research say they are causing them harm.
This week, proceedings began in a lawsuit brought by families in Arkansas to challenge the “SAFE” (Save Adolescents From Experimentation) Act. Passed last year, but on hold while the case winds through the courts, the law bans doctors from performing or making referrals to gender transition care, including hormones that block puberty or gender reassignment surgeries.
Judges have blocked enforcement of similar laws in Alabama and Arizona. Other proposed bills targeting access to health care for trans youth are proliferating as midterm elections approach. Some proposed laws go so far as to criminalize prescribing or helping an adolescent access gender-affirming care. Others would define gender-affirming care as child abuse.
The sponsors of these bills claim they are withholding health care from trans kids to protect them. Arkansas Attorney General Leslie Rutledge told Time that the law will protect children from making “life-altering, permanent decisions that they may desire to make as an underage child but could regret as an adult.”
The science clearly proves this argument wrong. On a fundamental level, Rutledge and the many others who promote this line of thinking misconstrue how puberty blockers work. The effect of these drugs can be reversed by ending treatment. And in the Lancet study, Dutch researchers asked whether adolescents who began gender-affirming care — in this case puberty blockers followed by hormones (either estrogen or testosterone) — continued that care into adulthood. Nearly all of them did.
The results “are consistent with what those of us who actually take care of transgender people think we are seeing in our clinical practices,” says Joshua Safer, the Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery. Of the very few patients in his practice that have voiced regrets about gender-affirming therapy, any doubts were related to a lack of support for their transition, not because they questioned their gender identity. In a similar vein, a recent survey found that familial pressure and social stigma were among the main reasons a small fraction of transgender people choose to go back to living as their sex assigned at birth.
In other words, gender-affirming care is not harming kids. The harm comes from a society that can’t support their mere existence. Republicans who use false claims about the dangers of health care for trans youth to fire up their base seem more than happy to nurture that type of society.
Blocking access to gender-affirming care comes with impossibly high stakes for some children and their families. Studies show that gender-affirming therapy can significantly lower the risk of suicidal thoughts and overall improve the well-being of transgender youth. For families with children using these drugs, those benefits far outweigh the potential health risks associated with taking them.
This is “literally a do or die situation,” says Karen Young. When in middle school, transgender child cycled through depression, acts of self-harm, and hospitalizations. Puberty blockers, which her child began at 12, and the more recent introduction of estrogen, helped pull them out of that terrifying stage.
But Young also lives in Florida, where Governor Ron DeSantis recently ended gender-affirming coverage for Medicaid recipients. His decision came two days after her now 14-year-old child was approved by the state insurance to receive an implant that delivers puberty-blocking drugs steadily over the course of a year. Young had the medical device, but no one to implant it. She spent weeks looking for a hospital in another state that had availability, then more time negotiating with the hospital in Florida, which feared legal consequences of mailing it across state lines.
That procedure and everything related to it will be out-of-pocket costs for Young’s family. So will all of her child’s routine visits to an endocrinologist, their estrogen treatment, and much more.
Young feels privileged to be able to navigate the increasingly difficult system and afford — though it’s tough — the care her child needs. She worries about the families who don’t have that luxury — and of course fears for people in states where such care could be barred altogether.
Several families have come forward to sue the state of Florida over the ban. As judges there, the one in Arkansas this week and others around the country weigh the evidence, they should be paying attention to the stories of families like Young’s. And they should recognize that these aren’t just anecdotes — these lived experiences are reflected in the science.
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(With assistance from Elaine He.)
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ABOUT THE WRITER
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
