Opinion: Gender-affirming care is essential to letting kids be kids—a physician’s perspective

As a white, cisgender woman and a pediatrician and child/adolescent psychiatrist practicing for more than 25 years, I feel the national conversation surrounding gender-affirming care for children loses sight of the realities of childhood. Gender-affirming care is essential to letting kids be kids.

Adolescence is the time when most start to face life’s biggest questions: Where do I fit in? What do I stand for? What do I believe in? Who am I, really? The answers are rarely simple and never come easily. Kids attain clarity and growth through experimentation and this developmental process can be difficult for those exploring questions regarding their gender identity. Many transgender and gender-nonconforming adults recall manifestations of gender dysphoria during early childhood. Few young people are equipped to manage the backlash that comes with this exploration, making the already thorny task of finding oneself even more painful. The last thing kids need are restrictions on their access to support.

Texas is among 20 states with laws or policies banning gender-affirming care; seven additional states are considering bans. Transgender and gender-nonconforming kids experience diagnoses of depressive disorder at rates four to seven times higher than their cisgender peers and are more than seven times as likely to attempt suicide. However, gender-affirming care statistics indicate gender non-conforming youths who received gender-affirming care are 60% less likely to experience depression as compared to those who do not; and are 73% less likely to experience suicidality.

Activists protested Senate Bill 14 at the Texas Capitol, May 12, 2023. The bill, later signed into law by Gov. Greg Abbott, bans gender-affirming medical care for transgender children.
(Credit: Mikala Compton/American-Statesman/File)
Activists protested Senate Bill 14 at the Texas Capitol, May 12, 2023. The bill, later signed into law by Gov. Greg Abbott, bans gender-affirming medical care for transgender children. (Credit: Mikala Compton/American-Statesman/File)

Just let kids be. That’s what gender-affirming care is about: talking to kids, their families, and loved ones, and working together to provide the support everyone needs, whatever that support might look like. Medications and surgery may become a part of the conversation later, but it is not the foundation of gender-affirming care.

Between the ages of 12 to 18, teenagers begin to build a stable sense of self, usually through trial and error. By test-driving different identities, they find what works, what’s comfortable, and how they want to move through the world. Without completing this phase, kids do not have a consistent sense of self on which to build their adult lives. This often manifests in insecurity, ineffectuality, and disappointment in self and in life.

There has long been a tacit acknowledgment of childhood, especially adolescence, as a proving ground for identity. What you learn about yourself in adolescence is fundamental to your development as an adult; it sets the stage for your relationships throughout life. The response of your support system, including healthcare providers, reinforces how, or if, you'll get the help you need.

The concept of the gender binary, however, is new. Its proponents often put a great deal of emphasis on its traditional roots, suggesting that spectrums of gender and sexuality are potentially dangerous ideas. But this is false. It is only in the early 20th century that the idea of “gender” as we are familiar with it today began to take shape. Recent years have seen tighter bounds placed on acceptable gender expression.

Why are we allowing new, poorly founded notions about the gender binary to unseat long held and clinically supported ideas about how we should respectfully treat, and meet, children where they are?

Our government should not be in the business of designing legislation to manage a child’s deeply personal journeys of self-actualization and discovery. It is not possible to legislate identity any more than to legislate taste in movies or favorite pizza toppings. These are conclusions people need to come to on their own terms, in their own way, through unfettered exploration.

Can’t we just let kids be kids? Childhood should be a time of limitless curiosity. Caregivers should meet that curiosity in kind. By joining them in the spirit of inquiry rather than limitation, we allow teens not only to survive adolescence, but thrive through it. To disallow exploration and discovery, in any facet of identity, denies children the vital gifts of childhood. The consequences can be lasting, dire, and even fatal.

O'Melia is Chief Medical Officer and Chief Clinical Officer for Eating Recovery Center and Pathlight Mood & Anxiety Center

This article originally appeared on Austin American-Statesman: Opinion: Gender-affirming care is essential to letting kids be kids—a physician’s perspective