Resources for why denying gender-affirming care is child abuse?

June 23, 2022 1:59 PM

I (trans man) have been asked by a couple of cis people to explain the problem with the Texas/Florida laws surrounding gender-affirming care for kids. I tend to answer fairly forcefully, that denying trans kids gender-affirming care is a form of child abuse. There are lots of resources online that aren't this strong. What are your favorite resources on this topic for people to read? Do you have any that are similarly strongly worded?

Apologies for a question that is a bit of asking the community to do my homework, but I'm feeling exhausted from life and would appreciate some support in having more resources at my fingertips since people have asked me. I don't need them all to be quite that strong, but I would rather not pass along articles that undermine my point. The audience is ignorant but likely well-intentioned people, who seem to be genuinely asking for more information (not total crazies). (Although in the age of information, ignorance is a choice).

Note, I'm not asking for advice on how to frame my responses myself, though am certainly not trying to minimize other forms of abuse and so if I'm doing something like that feel free to let me know.

posted by lab.beetle to Human Relations (15 answers total)

Growing Up Transgender. The point I've shared with some hesitant adults is quoted in this piece: "Doing nothing is not a neutral decision. Puberty for trans adolescents causes significant harm."

Doing nothing allows puberty to progress, and some pubertal changes are irreversible. Puberty is itself is a kind of hormonal transition, from androgynous child body to an adult body with secondary sexual characteristics. Puberty blockers just keep things as-is and give the child time. Doing nothing is what actually forces the body change.
posted by nouvelle-personne at 2:05 PM on June 23, 2022 [9 favorites]

It’s worth keeping in mind that gender-affirming care is considered best practice by mental health and medical professionals who care for trans youth. I don’t want to seem combative towards your premise, but I do want to suggest that it’s worth challenging the (outrageous) media narrative that puts experts in trans healthcare on equal footing with fringe groups who want to hurt and eliminate trans people. One way to start pushing back would be to say, “You can understand that medical neglect is child abuse, right? Medical and mental health experts who care for trans kids agree as a field that trans kids need gender-affirming care. It’s not controversial within that field. So we can talk about why it’s harmful to deny trans kids gender-affirming care—we can talk about suicide statistics and that kind of thing—but let’s start with an understanding that the people who study this and develop best practices for these kids say that denying gender-affirming care harms kids. The people suggesting this is debatable are not part of this community of experts.”
posted by theotherdurassister at 2:24 PM on June 23, 2022 [21 favorites]

As a child protective services professional, I love both answers above. I am fortunate enough not to be in a state considering this appalling legislation, and it is sickening-especially as many of us in child welfare work to confront our history as a systemically racist agency and try to move forward in a different way-to see our system once again weaponized against communities.

But yes, I’d frame it like medical neglect. If a doctor tells me my child has to take insulin or they will have sever harm that could include death, or if a therapist tells me my child needs immediate counseling or they are at risk of suicide-it is neglectful not to do those things, even if I don’t believe diabetes exists. I have encountered so many cases of suicide attempts-some completed-in my work with trans youth. This is absolutely an urgent medical need.
posted by purenitrous at 2:35 PM on June 23, 2022 [2 favorites]

My friend co-wrote this excellent brief connecting the fight for trans rights to other abolitionist movements, includes lots of data about how carceral systems (including child welfare systems and legislation denying access to gender affirming care) are harmful, abusive, and oppressive.
posted by sleepingwithcats at 2:38 PM on June 23, 2022 [1 favorite]

I would ask them why they think legislative professionals with backgrounds almost universally not in medicine are better at deciding what options parents have for supporting their childrens’ medical issues than, say, the parents themselves, or the doctors themselves.

I’m not sure you need to convince them why gender affirming care is good. You can use the language of conservatives in how vaccination hesitation is presented - why should the government be inserting itself in between the relationship of a parent/kid and their doctor?
posted by saeculorum at 2:58 PM on June 23, 2022 [1 favorite]

Response by poster: I appreciate all of the advice on how to frame the discussion but am also, or primarily, looking for articles to send after the fact. So, first I make all these good points, and then I send them a few links to reinforce my points. What should those links be? Is there a nice, well-written article that explains how it is medical neglect, for example?
posted by lab.beetle at 3:23 PM on June 23, 2022 [1 favorite]

AMA's position on anti-transgender bills

“Decisions about medical care belong within the sanctity of the patient-physician relationship,” he added. “We believe it is inappropriate and harmful for any state to legislatively dictate that certain transition-related services are never appropriate and limit the range of options physicians and families may consider when making decisions for pediatric patients.”

It also includes a link to an amicus brief from AMA and theAmerican Academy of Pediatrics on why banning transgender minors from youth athletics undermines accepted approach to treat gender dysphoria.
posted by kschang at 3:34 PM on June 23, 2022 [4 favorites]

A possible parallel to present as a question: if these cis people had a cis son with gynecomastia *and their son was seriously distressed about it*, would they refuse to take him to the doctor? If their son was being bullied for having a body that was not perceived by his peers as “male”, would they refuse to seek medical, therapeutic, institutional, or social support?

Management of adolescent gynecomastia: an update
Gynecomastia and psychological functioning: A review of the literature

I am neither a lawyer nor a doctor, but I imagine it might be difficult to find authoritative resources that would define non-provision of gender-affirming care as child abuse. Federal law looks pretty broad, and a quick skim of state laws also turns up language like ~failure to provide adequate medical care - where what constitutes “adequate medical care” is up to judges and juries, not set out in defined terms.
posted by rrrrrrrrrt at 3:44 PM on June 23, 2022 [1 favorite]

Williams Institute's brief on this issue:

Research shows that gender-affirming care improves mental health and overall well-being for transgender people, including youth. A 2020 study published in Pediatrics found that access to pubertal suppression treatment was associated with lower odds of lifetime suicidal ideation among transgender adults. Similarly, research conducted by the Williams Institute concluded that risk of past-year suicide attempts was lower among transgender people who wanted and received gender-affirming medical care. More generally, research indicates that efforts to support transgender youth in living according to their internal sense of gender is associated with better mental health and feelings of safety at school, while efforts to change the gender identity of transgender people (i.e., conversion therapy) are associated with suicidality.

posted by kschang at 3:44 PM on June 23, 2022 [1 favorite]

This Scientific American article does a nice job of demonstrating how consistently medical experts support gender-affirming care and how well documented the negative outcomes are when kids are denied this care. I like how clear it is that there is broad consensus within the medical community. It has a section on the harms of denying gender-affirming care, with links to studies published in several reputable sources. They include a link to this editorial in The Lancet, which could also be a good quick primer on the topic for someone who doesn't know much about trans healthcare.
posted by theotherdurassister at 5:29 PM on June 23, 2022 [2 favorites]

This is an article from February 2022 published by JAMA Network Open, a subsidiary journal of the Journal of the American Medical Association, one of the most respected journals in the biomedical field.

The article describes a yearlong study of trans and nonbinary teenagers. The findings are summarized at the beginning:

Question: Is gender-affirming care for transgender and nonbinary (TNB) youths associated with changes in depression, anxiety, and suicidality?

Findings: In this prospective cohort of 104 TNB youths aged 13 to 20 years, receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.

Trans and NB kids die when they are denied gender affirming care.
posted by cubeb at 6:17 AM on June 24, 2022 [3 favorites]

Here's another peer reviewed article that surveyed almost 35,000 LGBTQ young people. Once again, it finds that gender affirming health care -- SPECIFICALLY hormone treatment -- significantly reduces depression, suicidal ideation, and suicide attempts among trans/NB youth. Table 4 in particular lists outcomes of gender affirming care (or lack thereof) for 13-17 year olds. 28% of the surveyed trans kids who did not get hormone therapy actually attempted suicide. For the kids who did get hormone therapy, that fraction dropped to 16%.

That means that for every hundred trans teenagers, providing hormone treatment can help stop at least twelve of them from literally trying to commit suicide. If you find yourself wanting to argue about that point, pause for a moment and think about what you're arguing for and exactly why you're arguing for it.
posted by cubeb at 6:47 AM on June 24, 2022 [3 favorites]

In my teens in Midwest 1970s, another teen I barely knew, son of a well-known family in my town, people my parents knew, did serial, severe self-harm. I have avoided asking about her because I'm pretty sure she didn't eventually survive. She was AMAB. There was no support system, it was rare for people to be out, she could not get understanding, to say nothing of treatment. I think of her and her pain when this topic comes up. I don't have the stats, but people who are unable to transition are at vastly higher risk for self-harm. The pain that leads to self-harm isn't always really given weight.

For devil's advocaters, the rate of people who have transitioned going back to their birth-assigned gender is extremely low.
posted by theora55 at 10:05 AM on June 24, 2022

I watched a really good episode of Oprah about 15 years ago and there was a mother on there who had supported her child to transition and it was SO GOOD. She was crying as she explains how she just kept hoping it was a phase and dismissing her child until one night she found her child in the bathroom at 4 or 5 trying to cut off their penis with finger nail scissors. And she GOT it. I did to. I don’t think if I had not seen that episode of Oprah that I would have understood or had empathy in the way I do, because it’s something foreign to me… I grew up very sheltered! But it was very powerful… maybe you can find it on YouTube. I think also the fact that it’s such an old episode might be good because this is such a charged subject that it’s proof that this has been happening for people and families for a LONG time. Maybe it’s the episode “transgender families” from 2007? But you’d want to screen it first?
posted by catspajammies at 12:31 PM on June 24, 2022

I just want to clarify that in the episode I am talking about, the mom accepted that her child was meant to be female and did not go through male puberty! That’s what I meant
posted by catspajammies at 12:35 PM on June 24, 2022