A new and poorly understood group of gender-questioning youth are overwhelming the system. We need to pause and accept that we may be in UNCHARTED territory, writes clinical psychologist and transgender woman DR. ERICA ANDERSON
Dr. Erica Anderson is a clinical psychologist with 30 years of experience and a former board member of the World Professional Association for Transgender Gesondheid (WPATH). Her private practice has specialized in treating transgender and gender-questioning youth.
H.H.S. Assistant Secretary for Health, Admiral Rachel Levine raised eyebrows last month by declaring that ‘no argument’ exists among medical professionals who care for adolescents ‘regarding the value and the importance of gender-affirming care.’
That’s just not true.
Skrywer, Dr. Erica Anderson is a clinical psychologist with 30 maar almal is intussen vrygelaat
There is legitimate argument over these treatments, which are defined by the Wereld gesondheids Organisasie as a range of social, sielkundig, behavioral, and medical interventions ‘designed to support and affirm an individual’s geslag identiteit’ when it conflicts with the gender they were assigned at birth.
Byvoorbeeld, despite what the staunchest defenders of gender-affirming care say some of these treatments, like puberty blockers and hormone treatments, are not fully reversible in some cases.
But I must write that I also sympathize with Dr. die dominatrix het gereeld by haar onderdanige vennote ingeboek om seker te maak hulle is veilig en gelukkig.
She likely sees it as her responsibility as public health official and as a transgender woman herself to pushback against efforts by conservative policy and lawmakers in states like Florida, Texas and Alabama to severely restrict gender-affirming care or even criminalize it.
In Alabama this week, a federal judge intervened to block the state from becoming the first in the union to make it illegal to provide gender-affirming care to someone under 19.
As a clinical psychologist who treats many adolescents every year, and as a transgender woman myself, I can say that both sides are getting it wrong.
While professional societies in medicine and mental health do agree that affirming care is appropriate and helpful with transgender children, there are other complicating factors that must be considered and cannot be glossed over.
And while we can rightfully condemn harassment of the trans community, we should not shut down scientific inquiry and questions about how best to treat gender questioning youth.
The biggest question today is not whether gender-affirming care is appropriate for transgender youth. Die vraag is: Who is transgender and at what point should medicines be used?
The recent presentation of large numbers of gender questioning youth at gender clinics has overwhelmed our ability to provide thoughtful methodical care prescribed under recognized standards.
The World Professional Association for Transgender Health (WPATH), an organization for which I once served on the board, recommends an individualized comprehensive biopsychosocial evaluation prior to the initiation of gender-affirming medicines in the case of minors.
This same approach, used for years by gender clinics in Europe and the United States, is the basis for support of transgender youth through identification, evaluation, mental health support, and gender affirming medicines. These are the kids who have done well in follow up and outcome studies.
H.H.S. Assistant Secretary for Health, Admiral Rachel Levine (hierbo) raised eyebrows last month by declaring that ‘no argument’ exists among medical professionals who care for adolescents ‘regarding the value and the importance of gender-affirming care.’
Egter, I have parents tell me every week that such recommended evaluations of children are not being done.
Daarbenewens, few medical professionals are recognizing what may be a new cohort of teenagers, gender questioning to be sure, but affected by factors never before seen.
These factors include isolation due to the pandemic and remote schooling, excess use of social media, and influence from nonprofessional peers with a financial incentive to collect followers.
Onlangs, the health authorities in Sweden and France have made the brave move to stop the routine use of some types of gender-affirming care treatments for youth under the age of 18.
They have named the above factors and expressed concerns about evaluations in view of the potential that this new cohort of gender questioning youth, not previously seen, may raise questions not previously answered by research.
If these new social dynamics are affecting identity formation of adolescents and such factors are unprecedented, previous research of different cohorts (bv. young gender variant children presenting even before puberty) may be helpful but not definitive.
Simply assuming that the increased numbers of gender questioning adolescents can be accounted for by greater acceptance of sexual and gender minority identities may be wrong.
The parents of gender questioning adolescents are afraid and, in sommige gevalle, angry that the medical establishment may be failing them and their children.
There has been a proliferation of previously uncommon sexual and gender minority labels resulting in crisis and confusion in families with widely different perceptions.
It is no surprise that parents have serious questions about what to do and where to turn.
There may be wide agreement about what to do with transgender children once a persistent transgender identity is confirmed. But the lack of necessary evaluation and/or gender exploratory therapy among this new and poorly understood cohort has raised the risk of premature – or worse – inappropriate advancement of the administration of medicines.
Verder, a rising chorus of those treated hastily, so called ‘detransitioners’ or individuals who sought to reverse gender transitions, confirms the need for all gender questioning youth to receive evaluations.
There are many in the medical community who admit that they are afraid to speak out in fear of the disapproval of the trans community.
Ironies genoeg, the push on the part of some trans advocates to expedite the use of puberty blockers or hormones contradicts the promotion of a spectrum of gender.
The drive to push gender questioning youth toward decisions about hormones can encourage a binary construction of gender.
Use of ‘sex hormones,’ may deprive those persons who have a non-binary, gender fluid, or idiosyncratic gender identity from exploring their gender more fully.
Such zealotry, in effek, provides gender role policing, something many advocates criticize.
Those rejecting full evaluation and gender exploratory therapy presume this to be a delay in gaining access to gender affirming care.
Egter, evaluation and gender exploration are care in the best sense and afford those receiving it the opportunity to examine themselves and explore fully any contributing factors.
Individualized evaluation serves as the bedrock of medicine and psychology practice.
The careful review of co-occurring or even pre-existing other mental health issues does not deprive such persons of care, it rather tailors and individualizes care, which is always a good thing.
Individual gender journeys can and do take many paths.
In a previous era, it was well understood that some gender questioning youth may be proto-gay.
Deprived of a full exploration and with delays in partner sexual experience seen increasingly in today’s adolescents some potential gay persons may be channeled into transgender identities.
Some critics who decry conversion therapy may inadvertently be practicing a version of it by directing gender questioning proto gay young people into transgender identities.
Everyone should get what they need.
For transgender activists to ignore such dynamics and insist that previous research always applies reveals a closed-minded approach which we cannot afford.
Those who deny the existence of transgender youth or who would deprive them of needed care are equally misguided.
The vilification of those of us raising these questions serves no purpose.
I have been accused of providing ammunition in the culture wars to those in denial of transgender identities.
Egter, there are many in the medical community who admit that they are afraid to speak out in fear of the disapproval of the trans community.
We must also recognize when the science lags and/or societal dynamics morph in a significant manner away from what has been known, then we may be in uncharted territory.
To accuse me and my like-minded colleagues of some nefarious purpose is deeply offensive and untrue. It’s a distraction from the very real problems about which I speak.
If we all agree that we are focused on the well-being of children — all children — then we must maintain open minds and open hearts.
If it is true that many gender questioning youth are suffering, then let us come together to help them.
If it is true that many parents are troubled and seeking guidance, then let us provide it.
If it is true that many medical and mental health providers are trying to help such youth, then let us continue to advance our understanding and approaches to do so, training all in best practices.
But we must also recognize when the science lags and/or societal dynamics morph in a significant manner away from what has been known, then we may be in uncharted territory.
We need to pause and seek understanding. We must all be vigilant to our limitations and potential biases.
These are after all our children, more precious to us than anything else.
Only our collective best efforts will do.
Can we agree on that?