XPost: alt.transgendered, alt.society.mental-health, sac.politics   
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   From: yourdime@outlook.com   
      
   N THE U.S., 23 states have passed legislation to ban medicalized care for   
   minors with gender dysphoria, or the experience of distress that can occur   
   when a person’s gender identity does not match the sex they were assigned   
   at birth. On the other hand, 12 state legislatures have introduced laws to   
   protect access to youth transgender care. Such care can include puberty   
   blockers, which are medications that suppress the body’s production of sex   
   hormones, and cross-sex hormones like testosterone or estrogen that alter   
   secondary sex characteristics. It also may include sexual reassignment   
   surgery in rare instances.   
      
   U.S. policies on both ends of the spectrum are not science-driven but   
   rather emanate from polar-opposite ideologies. Unlike in Europe, there   
   doesn’t appear to be room for a non-ideological process for determining   
   what the best care is that weighs the emerging clinical evidence and   
   adjusts policies accordingly.   
      
   As reported in Axios, state efforts to restrict various forms of   
   transgender medicine are being fueled by religious groups that aim to   
   shape policy based on their strongly held beliefs around the immutability   
   of gender and family. Faith-based objections to transgender care come from   
   a worldview in which God created humans as male or female. Here, the role   
   of parents’ rights features prominently, as well as a conviction that   
   adolescents are insufficiently mature to decide on trans alterations to   
   their bodies. Moreover, lawmakers point out that some young people later   
   regret having had irreversible body-altering treatment.   
      
   The bans on care can be driven by extreme religious views. In one example,   
   The Associated Press reported last year that Oklahoma state Sen. David   
   Bullard introduced what he called the “Millstone Act” — a bill that would   
   make the act of providing gender transition procedures to anyone under the   
   age of 26 a felony — by citing a Bible passage that suggests those who   
   cause children to sin should be drowned. The age limit was later lowered   
   to 18.   
      
   Proponents, however, see the idea behind gender-affirming care as offering   
   medical treatment so that a person can live as the gender with which they   
   identify. A frequently heard argument is that children who can’t access   
   care are at significantly higher risk of worse mental health outcomes.   
   There is evidence that gender-affirming care for youth yields short-term   
   improvements in terms of less depression and suicidality. However, a   
   review of the literature shows it suffers from a lack of methodological   
   rigor by not adequately controlling for the presence of other   
   psychological conditions, substance use, and factors that enhance or   
   reduce suicide risk. This greatly enhances the possibility of   
   misinterpreting the data, leading researchers to cite significant   
   differences between groups being compared when in fact there are no   
   differences.   
      
   U.S. policies on both ends of the spectrum are not science-driven but   
   rather emanate from polar-opposite ideologies.   
      
   A critique in The Economist assessed apparent political motivations   
   underlying the presumed consensus among U.S. health care providers,   
   including groups like the American Academy of Pediatrics, or AAP, that   
   gender-affirming care is invariably beneficial and should be made as   
   accessible as possible. But an empirical basis for relatively easy access   
   is lacking. In 2020, the British National Institute for Health and   
   Clinical Excellence published two systematic reviews — one on puberty   
   blockers, the other on cross-sex hormones — which indicated no clear   
   clinical benefit of such treatments regarding gender-dysphoria symptoms.   
   The review found that analyses regarding the impact of puberty blockers   
   were “either of questionable clinical value, or the studies themselves are   
   not reliable.” On cross-sex hormones, the institute identified short-term   
   benefits but said these “must be weighed against the largely unknown long-   
   term safety profile of these treatments.”   
      
   Furthermore, based on a four-year review led by Hilary Cass, the National   
   Health Service in England declared in March that puberty blockers will not   
   be available to children and young people, unless they’re enrolled in   
   clinical research trials. In April, the final report was released which   
   reinforced the NHS policy change.   
      
   To take a more rational approach, the U.S. ought to adopt the European   
   perspective and look to the forerunners in gender care — the Dutch.   
   Caution is at the heart of the Dutch model of care for those presenting   
   with gender dysphoria. Over a period spanning two decades, gender   
   specialists in the Netherlands methodically compiled a comprehensive set   
   of guidelines for providing trans care for minors, known as the Dutch   
   protocol. The protocol outlines prerequisites for care, which include   
   documented onset of gender dysphoria during early childhood, an increase   
   of the experience of gender incongruence after puberty, the absence of   
   other significant psychiatric illnesses, and a demonstrated knowledge and   
   understanding of the consequences of medical transition.   
      
   After a youth enters a clinic, they undergo a diagnostic phase that lasts   
   at least six months, during which time there’s an intensive work-up   
   involving detailed questionnaires and dialogue between the young person   
   and a mental health support team. After that, youths who want to pursue a   
   medical transition are prescribed puberty blockers, and it may be a couple   
   more years before they become eligible for cross-sex hormones.   
      
   Treatment with puberty blockers typically begin around age 12.   
   Irreversible and partially irreversible interventions, which include   
   cross-sex hormones and surgery, cannot be given until the person reaches   
   16 and 18, respectively. Patients who go through with the transitioning   
   process are provided with psychotherapy throughout.   
      
   To take a more rational approach, the U.S. ought to adopt the European   
   perspective and look to the forerunners in gender care.   
      
   This watchful waiting approach to helping gender-diverse children is   
   rejected by the AAP, psychologist James M. Cantor wrote in an analysis of   
   the AAP’s policy. U.S. clinicians have criticized the Dutch process for   
   being too slow and erecting unnecessary obstacles on the path of gender   
   transition. They tend to favor quicker access to puberty blockers, cross-   
   sex hormones, and even surgeries for young people. Although sex   
   reassignment surgeries are relatively rare in the U.S., recent research   
   using data from 2016 to 2020 show that 3,678 (7.7 percent) of them were in   
   the 12 to 18 age group. In Europe, such surgeries for youth are mostly   
   inaccessible.   
      
      
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