A parent of a trans child breaks down myths and facts of gender-affirming care, as told to Parents editor De Elizabeth.
Medically reviewed by Varuna Srinivasan
The following was told to Parents editor De Elizabeth, by the mother of a trans teen. This parent wanted to protect her family's identity and remain anonymous, while sharing some of the crucial things she's learned about gender-affirming care from her experience. Below, you can find her story.
My daughter came out to me as transgender almost two years ago, when she was 15. It has been an emotional journey for us both, and sometimes a bumpy one. I have always supported her living as her authentic self and transitioning socially, but once we began having discussions about visiting doctors for medical care, I had some concerns. I will admit that I began this journey woefully uneducated about gender-affirming care for kids.
As time has gone on, I've learned that so much of the information out there about gender-affirming care is full of misconceptions and falsehoods, many of which are harmful for LGBTQ+ youth and their families. So often as I’ve moved through this process with my daughter, I’ve been struck by how completely different the actual lived experience of receiving gender-affirming medical care is from the way it’s often depicted.
As such, I want to share some of the top misconceptions about gender-affirming care for youth, what it’s really like from my perspective, along with commentary from experts in the field.
Myth 1: It’s a Quick and Easy Process
So often, I’ve seen people say things like “Oh, you know, kids are walking into doctor’s offices, just getting hormones and puberty blockers on the spot,” as though receiving gender-affirming medication is some kind of immediate thing. In my experience, and in the experience of so many others, this could not be further from the truth. In fact, my daughter often complains about how slow the process has been!
“Support for gender identity exploration is by definition a slow process that happens over time,” explains Angela Kade Goepferd, MD, chief education officer and medical director of the Gender Health program at Children's Minnesota. Dr. Goepferd says that care for trans and non-binary youth always involves a combination of mental health care and medical care—usually multiple appointments with both mental health and medical professions.
In many cases, children can’t begin to receive any kind of medical treatment until they have been diagnosed by a mental health professional with gender dysphoria, and most of that time, medical care won’t be offered unless a child has been solid in their identify for at least a year or more, Dr. Goepferd describes.
Moreover, the bulk of gender-affirming care for minors doesn’t involve medications like puberty blockers or hormone replacement therapy (HRT). According to the 2023 U.S. National Survey on the Mental Health of LGBTQ Young People from the Trevor Project, only 11% of trans and non-binary youth between age 13-24 reported being on HRT, and only 2% reported taking puberty blockers.
Furthermore, it’s not even that easy to get an appointment for gender-affirming medical care in the first place. Personally, several of the places I called for my daughter had a six month waiting list.
“Based on the rhetoric we hear from some anti-trans politicians, one would think that gender-affirming care was readily accessible for anyone who wanted it—but that could not be farther from the truth,” says Casey Pick, director of law and policy at The Trevor Project.
Over 50% of respondents to the 2023 Trevor Project survey said they weren’t able to receive mental health care that they wanted, and over 65% of youth on gender affirming hormones were afraid of losing access to that care.
Myth 2: Gender-Affirming Care for Minors Usually Involves Surgery
Contrary to popular anti-trans talking points, it is very, very rare for anyone under the age of 18 to receive gender-affirming surgery.
“Surgical transition is not often a part of gender-affirming care for those under 18,” Dr. Goepferd affirms. “The place where I practice at Children's Minnesota—we don't provide any gender-affirming surgeries at all. It's not a part of our clinic.” This has also been the case for every medical professional I’ve contacted on the journey with my daughter. Surgeries aren’t on the table yet, and aren’t a common trait of gender-affirming care for kids.
When surgeries do happen, they are usually top surgeries, for trans masculine youths, Dr. Goepferd says. And even then, this is still very uncommon. For example, according to JAMA, of the 48,019 gender-affirming surgeries that took place between 2016 and 2020, only 3,678 (7.7%) were performed on minors under the age of 18—and that’s over a four year period. The majority of those surgeries were breast or chest surgeries.
Myth 3: Gender-Affirming Medical Care is Harmful to Kids’ Health
I’ve heard many people talk about the medications that some trans kids receive as harmful, with irreversible, long-term health risks.
First of all, as Dr. Goepferd explains, most of the gender affirming care that trans youth receive is actually not medical in nature at all, and thus completely reversible, with no physical health implications. This includes aspects like social transitioning, supporting youth at school and home, helping kids make decisions around hair and clothing, and gender-affirming items like compression tops for trans masculine youth.
Most of the medications offered to kids are also reversible, such as suppressing a menstrual period or suppressing puberty via puberty blockers. Interventions like HRT, including estrogen and testosterone, are partially reversible, and HRT is only offered to adolescents aged 15-16 or older. These adolescents have gone through mental health assessments to make sure they are ready, Dr. Goepferd adds.
As for any long-term effects of gender affirming medications, Dr. Goepferd notes that any time you give a child medication for any reason, you are doing a risk-benefit calculation. That includes common medication we’ve all given our kids. In addition, when it comes to HRT, trans and non-binary kids aren’t the only ones receiving this medication.
“We use hormones like testosterone and estrogen on young people who are not transgender,” Dr. Goepferd says. For example, conditions like polycystic ovarian syndrome and hypogonadism (where your sex organs make little or no hormones) are treated with synthetic hormones.
"From my perspective, it is an issue of equity and fairness," Dr. Goepferd says. "If we are going to offer medications to kids who are not transgender, that come with risks and benefits, there is no reason that we should not offer those same medications to transgender youth."
Further, it's worth noting the potential harm that can be caused if a trans child is denied access to resources to help them feel comfortable in their bodies. Given the high rate of depression and suicidal ideation among transgender youth, it's imperative to equip young people with ways to comfortably express their gender identity and live authentically.
Myth 4: Being Trans Is a Trend
You’ve probably heard this one—that the reason that so many trans and non-binary kids are coming out these days is due to “social contagion,” or that they are doing so because it’s some “cool” trend. “There isn't scientific evidence to support this,” says Rebecca Minor, MSW, LICSW, psychotherapist and gender specialist. “Instead, the increasing visibility and acceptance of trans individuals in society have likely made it safer for trans kids to come out.”
In the past, many kids suppressed their true identities due to fear, stigma, or lack of information. “Now, with more understanding and resources available, they're finding the courage to express their true selves,” Minor describes. “It's not about a trend; it's about society becoming more understanding and accepting, allowing individuals to live authentically.”
Being a trans or non-binary kid is nothing new—these kids have always existed. “As social acceptance and a greater understanding of the trans experience has grown in recent years, trans and nonbinary people feel more comfortable being out and living openly as their authentic selves,” Pick says. Moreover, it’s crucial that we all continue to work to create environments where trans and non-binary youth feel safe and supported.
Supporting this population isn’t just about being kind and compassionate—though that sure goes a long way. It’s also about saving lives. “A new report published by The Trevor Project found that trans and nonbinary young people who were out and felt their sexual orientation or gender identity was accepted by a parent or caregiver had approximately 40% lower odds of attempting suicide than those who did not,” Pick notes.
In my experience with my daughter, coming out gradually to friends and family and receiving gender-affirming care has been vital for her mental health. Imagine having to hide an important piece of your identity. Imagine needing important medical care and not being able to access it.
Seeing my daughter receive the care and love she needs—seeing the heaviness of her heart begin to lift, and joy return to your face—has been nothing short of miraculous. This is what I want people to know most about gender affirming care for kids: Above all else, it’s necessary, meaningful, and incredibly healing.
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