Transgender Youth Health Care Restrictions
State governments are at it again
Just when you thought it might be getting at least a little easier to be transgender…
At the time of writing, this news is already three months old, but I just became aware of it this morning via a post from a Facebook friend and I feel the need to respond. Also, it’s been a while since I wrote a blog post, so this one will help get me back in the mood to keep writing.
What has aroused my need to write (and my ire), is a report by Alta Spells and Jen Christensen on the CNN website. Last updated on April 21, 2022, they reported on a set of guidelines from the Florida Department of Health that aim at making it more difficult (if not impossible) for parents of trans kids to find appropriate transgender health care for their children.
The CNN article is here (this is an external link):
The guideline publication from Florida DoH can be found by following this link:
https://www.floridahealth.gov/_documents/newsroom/press-releases/2022/04/20220420-gender-dysphoria-guidance.pdf
In case one or both of these URL’s eventually ‘disappear’ from the Internet, here are a couple of excerpts from the Florida guideline, and my take on them:
The first sentence in this excerpt that I take issue with is this one:
“A paper published in the International Review of Psychiatry states that 80% of those seeking clinical care will lose their desire to identify with the non-birth sex.
The 2016 paper by Ristori and Steensma quoted by the Florida Dept. of Health can be read here:
I don’t know the researchers who wrote that paper (one is based in Florence, Italy, the other in The Netherlands in Amsterdam), but in my personal opinion, I call BS on this conclusion. I am left to wonder if the Florida Department of Health has engaged in some kind of political spin-doctoring of the statistics in the paper (perhaps at the direction of virulently trans-phobic Republican Governor Ron DeSantis?).
I personally know at least 100 transgender women, and a couple of trans men, and I have not heard from any of them, any statement of ever, “losing their desire to identify with the non-birth sex”. Oh, it happens, but it’s extremely rare in people who have fully transitioned, maybe 1 in 10,000? I also know a fair number of part-time trans women who have not medically transitioned, and of that group, there are four or five who no longer actively pursue social events where they present as women; these are all people who are well past age 60 and are experiencing health issues that have made it too difficult to participate in our trans women’s support group social events.
But just because they no longer go out en femme to banquets, house parties, or GNO’s, they still know who they are, and they still embrace their “inner girl”, just not outside of their own minds and memories anymore. Getting old makes everything harder, and getting dolled up for a GNO when you are a part-time trans woman, of an age, where you carry a Medicare card in your purse, can be less appealing than it might have been 30 years ago, especially when even a walk to the mailbox halfway down the block sounds tiring.
In addition to the trans-feminine and trans-masculine people I know, I have several friends and acquaintances who fall into the non-binary, agender, gender-fluid, and gender-creative categories within the “Transgender Umbrella”. I mention them to reinforce the concept that transgender identity is a very complex thing, and that not every trans person’s gender can be pegged as being 100% feminine or masculine. Enby’s may or may not ever express a desire for medical transition services (generally HRT, gender re-assignment surgery, permanent removal of facial or body hair), but it’s not uncommon for Enby’s to file for a legal change of their name and an “X” for their gender marker.
Here’s another sentence from the Florida guidelines that I find execrable:
One review concludes that “hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact is generally lacking.”
Again, this is BS. Ask any transgender person who has completed at least social transition, of any age, whether they feel happier and more at home in their own skin, and you will almost always hear, “Yes!”. Yes, adolescents who are put on blockers and allowed to socially transition, are likely to experience negative feedback from some of their friends and schoolmates — 7th and 8th graders especially can be pretty brutal on each other, especially toward non-conformists — but if their home environment is good, with supportive parents and siblings, these kids will thrive.
As for “cognitive impact”: without regurgitating a bunch of personal history that I’ve already covered in several of my other posts here in Gender From The Trenches, let me just say that in addition to its other negative effects, gender dysphoria is a distraction. It usually manifests most noticeably as depression, along with a sense of uncertainty, which can be severe or mild, but it never quits. It’s emotionally painful. It’s a constant struggle, and struggles tend to tire you out. When children are constantly struggling with depression, stress, and fatigue, how well do you think they can perform, in school, athletics, or in their social life outside of school, in the first place? The happiness I now feel, post-transition, infuses every aspect of my life, every waking minute, with a wonderful sense of connectedness and “joie de vivre”, that I had never experienced before I married my wife Lynn in 1986, and that I thought had departed forever after she passed away in 2013. I smile a lot now. And when I look in a mirror, I see a sparkle in my own eye and realize, “Damn, it’s good to be Laura-Ann!” (contrast this photo with the selfie I shot in Death Valley in 1982, near the bottom of this blog).
Kids who have been struggling with gender dysphoria for years shouldn’t be belittled or scoffed at or told, “You are just going through a phase,” or made to feel abnormal. And most certainly they shouldn’t be brutally repressed and told, “You’re a boy, goddammit, and if I ever catch you wearing one of your sister’s dresses again, you’ll wish you’d never been born!” I can’t state exactly what language I might use in a conversation with my potentially transgender child (supposing I had one), and they were telling me they didn’t feel right about their assigned gender, but it’s critically important to realize that there is nothing “abnormal” about being trans. Your child will grow up with the same potential to be just as good and productive a member of society as any cis-gender kid, if you handle this situation calmly, supportively, and with love. Get your kiddo an appointment with a gender therapist who has experience helping trans children, and who knows how to have a conversation with kids of any age about gender issues.
…it’s critically important to realize that there is nothing “abnormal” about being trans.
Then there’s this gem, again from the Florida DoH guideline:
This just goes to show how ignorant some people — in this case, Florida politicians, and presumably even some employees at the Florida Dept. of Public Health — can be about health care.
Item #1: “Social gender transition should not be a treatment option for children or adolescents”.
This is just plain wrong-headed, transphobic, harmful to trans kids, and politically driven. Any decision to undergo social gender transition, belongs to the individual child and their parents, with guidance from a licensed therapist specializing in pediatric transgender care, and perhaps input and cooperation from the staff and faculty at the kid’s school, and no one else. If a child has been persistently expressing transgender identity for two or three years, they’re not likely to have this feeling of wrongness just “go away”, and the earlier you allow them to transition socially (if that’s what everyone involved decides is the best course of action), and re-integrate into their school’s social circles, the easier it will be for them. Little kids in K-4th grade will (I think) be far less likely to torment a trans kid than will 5th through 8th graders — this assumption is based on memories of my own childhood.
Item #2: “Anyone under 18 should not be prescribed puberty blockers or hormone therapy”.
There are only a very few states where under-age teens can even request full HRT, and only then if they are at least 16 years old, and with their parent’s and doctor’s full sign-off, so the idea of kids beginning “full medical transition”, meaning with HRT and GRS, is extremely rare to begin with, making item #2 a knee-jerk reaction to a situation that was about as rare as sightings of the Ivory-Billed Woodpecker. I disagree vehemently with the notion of a Government official, who is probably not a doctor and probably not even the parent of a transgender child, restricting puberty blockers. More on that below.
Item #3: “Gender reassignment surgery should not be a treatment option for children or adolescents”.
This statement was completely unnecessary: To the best of my knowledge, there has not been any state in the US in the last few years, where State health care laws would allow kids under the age of legal majority to get GRS for gender transition in the first place, not even in liberal California, let alone Florida. So this guideline comes across to me as a blatant attack on trans kids, just for the sake of incumbent right-wing Republican Florida politicians appealing to their transphobic voter base.
As for puberty blockers: THEY SAVE LIVES.
I’ve already beaten this issue to death in other comments I’ve made on this subject, but here goes anyway: Teenagers, in general, can be prone to very severe depression and suicidal ideation, with few of the life skills they will develop as adults to cope with stress. I think I can safely assume that almost everyone reading this, whether cisgender or transgender, male or female, was a teenager themselves at some earlier point in their lives, and can more or less remember how sucky being 14 years old can sometimes be.
Now, add into the stress of just being a teenager, a sense of hopelessness, low self-esteem, and fear that comes to someone coping with gender dysphoria, and the result is a shocking suicide attempt rate: until very recently, as many as 45% of trans teens reported at least one suicide attempt in situations where their families were unsupportive. When the parents are supportive, and everyone involved agrees that social transition and puberty blockers are appropriate and are administered, the gender-related suicide attempt rate in transgender 14 to 18-year-olds is practically zero. Puberty blockers are safe, and they’re reversible if the kid eventually decides that they don’t want to medically transition. The use of puberty blockers has not been shown to cause birth defects, cancer, or any other undesirable side effects in young trans adults who decide to either not transition medically, or who decide to conceive a baby naturally before they commit to full HRT and GRS.
For trans women, starting puberty blockers early enough will prevent the deepening of their voices, prevent the development of heavy facial hair, and prevent the thickening of the facial bones, and the development of a protruding Adam’s apple. If allowed to start blockers early enough, trans women will avoid the need for years of expensive and painful facial hair removal, avoid the need for facial feminization surgery, and they’ll have an easier time for the rest of their lives not having to explain to people why they have a male-sounding baritone voice, but a girl’s name. That deep voice is the #1 physical aspect that gets some trans women “clocked”, even when they are otherwise passable. Voice feminization surgery is risky, its overall success rate is no better than 70%, especially in older people, and it often leaves someone unable to sing musically, which for me, would really suck as I love Karaoke. The only downside of the use of puberty blockers for trans women is that it can make for a less successful gender re-assignment surgery later on since it blocks the growth and development of some tissues (the penis and scrotum) that the plastic surgeon will need for a full-depth vaginoplasty.
For trans men, the use of puberty blockers will stop, or at least slowdown, breast development, saving them the need for a double mastectomy after transition, or maybe years of having to wear a chest binder, which I can only imagine as being even worse than trying to squeeze into a 6-sizes-too-small bra. Blockers will also stop or slow down the development of other secondary female sexual characteristics. Blockers may stop, or at least delay, the onset of menses in trans masculine patients if begun early enough, but my understanding is that completely suppressing ovulation and the menstrual cycle permanently with just medication is not always possible. Some individuals will eventually need to have a hysterectomy to be completely free of menstruation. There is a research paper on the subject of blockers here that sheds more light on the issue (Krebs et al. 2022) (external link): https://www.karger.com/Article/FullText/524030
To you transphobes out there: ARE YOU DEAF?
We have been begging you for years to just listen to what we trans people have to say about ourselves. We aren’t crazy. Being transgender is something hard-wired into us that, so far, can’t be pointed to on blood tests or brain scans, but it’s as real as any other emotional or personality trait. You cis-gender people can take the fact of your gender for granted. You wake up in the morning, and go to the bathroom to pee, shave, brush your teeth, or whatever your routine is to get ready for your day, and you look in the mirror and see…yourself.
Your sense of yourself is in more or less smooth and happy alignment with what you see in that mirror as you comb your hair. Maybe you girls jazz up “the look for the day” with a sparkly barrette and earrings, or a cute light blue hair scrunchie to go with the white blouse and dark blue knit skirt you picked out, while you guys lather up to shave that overnight scruff off, trying not to cut yourself to shreds in the process, eh? Been there, done that, too many times. And over the years, I grew ever more aware that the face looking back at me out of the mirror was unhappy, and that the eyes were always looking at something off in the distance somewhere, and that they were reflecting something — my soul? — that belonged to someone else.
Every trans person I’ve ever talked to has told me that at some point in their lives, usually in early childhood, they woke up one day with the awareness that their sense of their own gender was in disagreement with the image in the mirror, in disagreement with the clothes that “society” told them they were supposed to be wearing, in disagreement with the name and gender marker on their driver’s license and birth certificate. And ultimately, that the pain and dissociation of having to fight this internal and never-ending war with themselves, was becoming intolerable. I have not ever encountered someone who transitioned and later regretted it. Not. Even. One.
By the time a trans person gets through the initial process of social transition, with at least a few therapy sessions, living as a full-timer for at least 6 months, then filing in Court for their legal name and gender marker change, and they’re on the verge of receiving hormone therapy and maybe GRS, almost all of them have already lived through at least a dozen years of battling gender dysphoria — it was 54 years in my case! — and for the love of God, we know who we are, and that gender transition is the only “solution” to our problem that will keep us out of a mental institution, if not an early grave.
It isn’t gender dysphoria or transition that marks us as crazy, it’s preventing us from transition that is driving us crazy.
If you cis-gender people, especially you transphobes who sneer at us, can’t comprehend why we subject ourselves to years of expensive, painful, and sometimes risky medical procedures, and to the likelihood of losing our marriages to divorce, and the necessity of putting up with your scorn and derision, maybe you can just take our word for it that gender dysphoria sucks! It’s painful, it’s debilitating, and gender transition is the most effective cure.
Have you ever lost someone you loved, a life partner or a child perhaps, to an early death? Cancer, a stroke, maybe a car accident, or a fatal injury at work? Remember how you felt a couple of months after the funeral? Like your life was meaningless, and that you could see little or no hope for any happiness in the future? You dragged yourself to work and went through the motions, but it was almost impossible to get through your shift without, at some point in the day, thinking about your pain, your grief, the empty place inside you that your departed loved one left behind?
I’ve been there. Lynn’s death eight years ago left a scar on my soul that will never fully heal, and I ask you transphobes out there to please take it from me, that gender dysphoria feels a lot like you are recovering from the death of a loved one, only the pain never gets better: it gets worse, month after month, year after year, until one day, for some of us, the knowledge of who you really are explodes into your consciousness, and the awareness that you are living a lie becomes a pain so intolerable that you either transition, or find some other way — all too often a permanent and irrevocable one — to make the pain stop.
Please just let us live in peace.
Let the parents and health care providers of trans kids care for them in a positive way, not by forcing them ever further into potentially catastrophic depression. You don’t “know best” what children need to “grow up right”, if you’re browbeating or threatening them about unconventional gender expression, instead of talking to them quietly and supportively. There are already too many kids dying every year from domestic violence, drug abuse, war, child trafficking, and all the other social ills plaguing the world; can we maybe not have a situation where America’s own government leaders are adding fuel to these fires that are consuming the lives of our children, by condemning the transgender kids to the hell-on-earth of unresolved gender dysphoria? Can we just have a world where every child has an equal chance at happiness and fulfillment?
References:
Krebs D, Harris R, M, Steinbaum A, Pilcher S, Guss C, Kremen J, Roberts S, A, Baskaran C, Carswell J, Millington K, 2022 ‘Care for Transgender Young People’, Horm Res Paediatr <https://www.karger.com/Article/FullText/524030#>
Ristori, J & Steensma, TD 2016, ‘Gender dysphoria in childhood’, International review of psychiatry (Abingdon, England), vol. 28, no. 1, Taylor & Francis, England, pp. 13–20.
