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Recently I took part in a virtual education session for trans youth. As participants introduced themselves, some using their names publicly for the first time, they welcomed one another with curiosity and openness. In response, bangs that initially obscured faces were pushed behind ears, camera angled to frame participants more prominently. Even the softest voices said hello. It was an example not only of what care looks like, but what gender affirmation is. These practices are at the core of health for all patients, trans youth in particular.
It’s vital for trans people, especially young trans people, to access the supportive, affirming health care they choose. Over the past several years, public support for respecting the rights of trans people has grown significantly. Large majorities of people across the political spectrum oppose discrimination against trans people in health care and other parts of public life. The recent passage of the Equality Act in the House of Representatives highlights an opportunity to establish federal protections in line with these widely-held values.
However, at the same time, state lawmakers across the country are advancing a coordinated legislative attack with dozens of bills focused on restricting our rights, including the right of trans minors to access gender-affirming health care. Some of these bills even criminalize parents’ support for their children’s decisions in medical settings.
These legislators are out of step with medical evidence and public opinion. And their bills are harmful — the risks of denying trans youth gender-affirming care are well-established. Among youth who identify as trans and gender nonconforming, those who access care at older ages present with higher rates of anxiety, depression, and suicidality. In other words, receiving care later in puberty is associated with worsened mental health outcomes. As a physician, it underlines the importance of helping patients access care early in puberty.
Fortunately, the rates of anxiety, depression, and suicidality that trans youth experience are not a foregone conclusion. When researchers examined trans youth who were supported in their identities, they were found to have similar rates of depression and suicidality as their cisgender peers.
These studies are essential to my understanding of this care, but, also, the positive impact of gender affirmation shows up in my office each week: more sincere eye contact from a previously guarded teenageer, a lingering hug between child and parent at the conclusion of a vulnerable conversation, tears as an expression of relief. Patients and their parents do not need politicians as gatekeepers for these moments. Rather than passing legislation interfering with life-saving care, legislators should listen to trans people and the medical professionals who work directly with them.
I practice gender affirming care using an informed consent model, which acknowledges the autonomy of trans people to make decisions for themselves regarding medical transition. I don’t need a therapist’s letter to offer this care. I can provide information to youth and their parents to inform healthy choices about gender transition, just as I do other consequential decisions they make in the clinical setting.
There isn’t a script for gender affirming care. Adolescence and puberty bring up questions about gender, and grappling with identity is an essential part of growing up. During some visits, I am a supportive presence during a conversation between family members. Other times, I prescribe hormones to delay puberty and/or facilitate a puberty that is more consistent with a person’s identity. Conversations about medical transition with youth and their parents lead toward greater mutual understanding and recognition.
The youth I meet are thoughtful. They have carefully considered their needs in relation to medical transition, both in relation to their individual futures and their important relationships. My goal in the exam room is to facilitate an environment where youth can speak freely and make healthy decisions.
Gender affirming care for trans youth is safe, backed by medical evidence, and life-saving. No child deserves to be targeted by politicians for who they are. Lawmakers cannot ignore the voices and stories of trans young people while also claiming to legislate in their interest. I urge the medical community to oppose legislation that seeks to withhold health care from trans youth, and learn more about how to care for gender diverse youth in their individual practice settings. In my experience, it’s life-affirming work.
Colton Wasserman MD (they/them) is a Family Medicine Physician, Fellow of Physicians for Reproductive Health and Associate Medical Director of Planned Parenthood Hudson Peconic.
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