Common Myths Around Gender-Affirming Care
And How Cis People Can Help Respond
So much of mainstream media coverage of gender-affirming care for kids starts from the incorrect premise that gender-affirming care is something to be publicly debated. Cis writers, like Emily Bazelon at the New York Times, treat trans kids like a puzzle to solve, a two-sided argument that we are obligated to treat with a both-sides approach.
What’s missing from many if not all of these stories is that trans kids are first and foremost human beings who have real feelings and are cared for by their parents, who also have real feelings.
Gender-affirming care is not happening in a vacuum, and it is not happening quickly. Following are some of the most common arguments you’ll see around gender-affirming care for trans kids, along with the truth about how affirming care happens and simple answers to people who question the need for gender-affirming care, as well as those who work to actively ban this care.
1. Puberty blockers are hormones. We shouldn’t be giving kids hormones.
First, a quick refresh of how puberty works (which trans kids receiving gender-affirming care must learn as part of informed consent before being prescribed puberty blockers.)
When puberty starts, the hypothalamus starts cranking out a hormone called gonadotropin-releasing hormone (GnRH). This hormone is sent to the pituitary gland, stimulating this gland to produce two additional hormones — luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
For bodies with testes, LH triggers the release of testosterone. For bodies with ovaries, FSH triggers the release of estrogen. These messenger hormones are the start of puberty.
Here is a more in-depth but simple discussion of puberty.
Puberty blockers are gonadtropin-releasing hormone analogues that, as their name suggests, block the release of sex hormones, effectively delaying puberty. They are not hormones.
2. We don’t know the long-term affects of trans kids using puberty blockers.
It’s true that using puberty blockers for gender-affirming health care is an off-label use of the medication. But, puberty blockers are used in kids experiencing precocious puberty (as well as people with breast cancer and prostate cancer, among other health conditions).
Most of the common risks for all populations who use puberty blockers involve potential adverse affects on bone density, which is closely monitored during gender-affirming care.
The Dutch have been working with trans youth for decades and have shared results.
Here is a concise list along with brief descriptions of each of 16 studies that provide evidence on the benefits of puberty blockers and other gender-affirming care.
3. Puberty blockers are irreversible and cause infertility in trans kids.
Lots of people unfamiliar with gender-affirming care for trans kids (both well-intentioned and openly hateful) believe this is true, and there simply is no scientific evidence to support this claim.
The affects of puberty blockers are wholly reversible. If a kid decides not to continue transition and instead go through a puberty that aligns with their assigned sex at birth, blockers are stopped and puberty begins.
For trans kids who decide to continue transitioning, puberty blockers are stopped when hormone replacement therapy (HRT) begins and they start the puberty that aligns with their gender.
Many trans kids begin puberty blockers at around age 10 or 11, before puberty begins, so they don’t have to experience any development of the primary and secondary sex characteristics associated with their assigned sex.
Blockers do not affect fertility. (HRT can have implications for fertility, and we talk more about that here).
This study from Boston IVF shows trans men can have children biologically related to them even after hormonal transition, when some believe fertility may be irreversibly affected.
This policy statement from the American Academy of Pediatrics lists puberty blockers as reversible.
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4. Too many kids are coming out as trans and are being influenced by peers.
This is patently false. What’s true is that more kids are exploring their identities in ways that weren’t previously available. What does this mean?
Trans people have always existed, and likely existed in larger numbers in the past but were not free to come out or live their truth in the same way kids are able to today either because they lived in unsupportive environments where transition would have been dangerous or social stigma kept them closeted.
Still, there are people who insist trans kids are a “social contagion.” Often, people will reference “Rapid-Onset Gender Dysphoria (ROGD)” in this argument, which is meant to describe kids who haven’t expressed any dysphoria as young children but “suddenly” come out as trans as they approach puberty.
ROGD has been heavily debunked. In their essay “A Critical Commentary on ‘Rapid-Onset Gender Dysphoria,’” Florence Ashley, a transfeminine jurist and bioethicist based in Toronto, says:
“The thesis of social contagion is allegedly supported by the stark rise in teenagers referred to gender identity clinics, as well as patterns of LGBT+ friend groups, internet usage and social isolation. However, none of these corroborate the existence of social contagion or psychic epidemic.”
More to the point, as Ashley notes, trans kids are likely seeking gender-affirming care more readily because of the increase in trans visibility, supportive parents, as well as the very real phenomenon that puberty — the start of bodily changes — is what initiates some kids’ understanding of themselves as trans.
“Puberty is known for its role in intensifying or unearthing gender dysphoria in part due to changes and development in secondary sexual characteristics.”
The truth is that how trans people — and trans kids especially — come to know they are trans is not a uniform, homogenous experience.
Florence Ashley’s essay explaining how ROGD is not an accurate description of how some trans kids experience transition later in adolescence.
A rebuke of Dr. Lisa Littman’s, who coined the term rapid-onset gender dysphoria in her work, detailing why ROGD is problematic.
Gender diversity is well-established and has a long history in many cultures. This map details several cultures across the globe who recognize — and respect — more than two genders.
Julia Serano shares a timeline of how “social contagion” and “ROGD” entered the conversation around trans kids.
5. Trans kids are having gender reassignment surgery. No kid should be allowed to have irreversible surgery!
First of all: No child is having gender reassignment surgery! None. Not one. Zero. People who are actively anti-trans or who may be unfamiliar with how gender-affirming health care for kids works often make this outlandish claim to scare people and motivate them to vote against trans-positive legislation and call for the banning of gender-affirming care.
More and more, these completely false claims are causing trans-supportive parenting to be criminalized, like we see in Texas today.
NO MINOR CHILD IS HAVING GENDER-AFFIRMING SURGERY! (Sorry for the all caps, but this is serious business!)
(For more on what gender-affirming health care really looks like for trans kids, you can start with how puberty blockers are prescribed.)