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Deciding to start estrogen or testosterone treatment is a more serious decision. They cause cosmetic changes that are difficult to reverse, including body fat redistribution and voice changes. For this reason, medical guidelines recommend that they generally not be provided until age 16, or at the earliest, 14. Though the evidence is still emerging, all existing data suggests that access to estrogen or testosterone is associated with improved mental health for these kids.
There has been growing attention to the idea that some youth who start estrogen or testosterone will later choose to stop it. That appears to be rare. Our group from Harvard Medical School recently published a case of an adolescent who started estrogen and chose to stop. That young person told us they did not regret the trial of estrogen and that it helped them to better understand their gender identity, even though they now have some cosmetic changes to their body (mostly body fat and hair redistribution). In other cases, kids “de-transition” because their communities place so much pressure on them to be cisgender that they feel they have no choice.
While conservatives highlight that youth may later regret the physical changes from estrogen or testosterone, the doctors who take care of these patients know it is far more likely that a young transgender person will have regrets when physicians refuse to provide the medical care to pause the puberty that is actively distressing them.
The potential benefits of providing gender-affirmative care typically outweigh the minor risks associated with treatment. These medications are administered only after thoughtful conversations between patient, family and physician. Medical interventions are not started without all three being on board and understanding the risks and benefits. Legislation that puts these decisions in the hands of the government instead of families and physicians is dangerous.
Conservatives also like to use phrases like “sex change surgery” to scare the general public. Under current medical guidelines, genital surgeries for transgender patients are never offered before adulthood. The only surgeries that are sometimes considered before the patient is an adult is the removal of breast tissue. It is something that requires careful evaluation before proceeding. Furthermore, youth who need this surgery are generally those who were not able to obtain puberty blockers, subsequently developed significant breast tissue, then had strong negative emotional reactions to their chest. Easier access to puberty blockers in the first place could eliminate the need for this kind of surgery.
State legislators need to educate themselves about these young people and their medical care before introducing legislation that will hurt them. They need to reach out to physicians and professional medical societies for input. They need to talk to the researchers in this area, and most important, they need to bring in the transgender youth themselves. If their bodies are going to be legislated, they should have the opportunity to be heard by the legislators who would do this to them. The medical profession has made it clear: This kind of legislation is dangerous and should not become law.
Dr. Jack Turban (@jack_turban) is a resident physician in child and adolescent psychiatry at the Massachusetts General Hospital, where he researches the mental health of transgender youth.
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