Last weekend shooting at a Colorado Springs bar has again highlighted
the danger and discrimination faced by many in the LGBTQ community,
including transgender people. In 2022 alone, 16 states are proposed
legislation that would restrict access to health care for transgender
patients.
Under the age of 18. That's as a study from U. C. L. A. S Williams
Institute says that since 2017 the number of youth or identify as
transgender has nearly doubled, Jeff Bennett spoke with Dr MEREDITH
McNamara from the Yale School of Medicine. She's an assistant professor
of pediatrics and specializes in adolescent medicine.
It's great to have you with us.
Thanks for having me so help us understand. First, what accounts
for the sharp increase in youth identifying as transgender? Is this
the matter of greater societal acceptance? Or is it a function of
more researchers conducting more transgender specific surveys?
Well, I would say it's probably a mixture of both. The number of
transgender people probably hasn't changed, but young people are
finding that it's safer to be who they are. So they are expressing
their identities more openly, now, sharing them with loved ones and
presenting for medical care.
We may be using better survey instruments to, um
To inquire about this as well. But I don't think that the narrative
that the number is sharply increasing as an accurate representation,
and it has been used to actually harm transgender people.
In what ways tell me more about that.
Well, if you suppose that, um the number of people is exponentially
increasing than that carves out the idea that there's some sort of
explosion or some sort of fearful social change, and that's given
cover to certain misinformation techniques that have allowed these
legislative bands that you mentioned to thrive.
So let's talk more about gender affirming care, which is an umbrella
term for many different services. What is the real spectrum of this
type of care? And how is it determined for each patient?
For transgender and gender, expansive people that it can include
a wide range of things, and it depends on the individual and that
can change over time. So for youth that may involve some elements
of social affirmation and transition, using their preferred pronouns,
or, um, a name that they have chosen for themselves, dressing a certain
way certain hairstyles that are from their gender.
And there are medical aspects of gender affirmation to which can
include and may include puberty blockers, or, um, exogenous sex hormones
such as estrogen and testosterone.
The National Institutes of Health has been doing research on the
long term effects of hormone blockers, which you mentioned on young
transgender people. They've been doing this research since 2015 as
I understand it, but they haven't released the findings yet what
is really known about the safety of that kind of treatment.
We know a lot about the safety of puberty blockers. We derived that
evidence based initially back in 2011, or so from studies done in
the treatment of precocious puberty. Precocious puberty is when a
young child develops, um into more of a an adolescent body at a rapid
rate, and we don't know why it happens.
Puberty blockers have been used successfully and safely in those
Children to allow them to develop socially in tandem with their peers.
And we've studied mineral density, psychosocial outcomes, among other
things, and it's been shown that that treatment is safe.
Now there is data on the safety of puberty, blockers and transgender
and gender, expansive youth. And while it would be great to see larger
studies, the evidence base is strong and the NIH is funding and producing
those at this very moment. But, um, we have to trust the clinical
investigators released their results when they're ready.
What about gender reassignment surgery, which is another form of
gender affirming care that's not recommended for people under the
age of 18. Why not? Well, that's actually um, Something is a little
bit of a mischaracterization. Gender affirming surgeries are very,
very rare. The number of mastectomies or top surgeries that have
been done
Um, within the past five years, the most recent data I saw averages
out to about 200 a year everybody is different, and everybody has
different desires for their gender affirmation, but
In the vast majority of times. Any form of gender affirming surgery
does not happen before the legal age of majority and I do want to
point out that in these politicized and misinformed debates on
gender firming care surgery is being overly represented to stoke
fear in the public and to convince people that
Politicians should be intervening in healthcare decisions between
parents and physicians and patients themselves. What are the leading
misconceptions about transgender youth? What do people fail to understand?
Well, first of all, um for my transgender and gender, expansive patients,
their gender identity is the least interesting thing about them.
They are
Vibrant young people who have so much to offer their our greatest
assets in society, and they deserve to feel safe and loved. I think
what people don't understand is that these bands have have harms
real harms not just within the jurisdiction where they're active,
but elsewhere.
When the state of Florida released their first practice bulletin
denouncing gender affirming care. We got a surgeon crisis calls at
our clinical centers in Connecticut. That is unconscionable. Um
What I also believe that politicians failed to understand, or at
least they don't care to understand is that there are real processes
that are scientifically informed that have developed the guidelines
that physicians use every day to provide gender for me care to young
people and that those processes are trustworthy and sound.
Dr. MEREDITH McNamara is an assistant professor of pediatrics who
specializes in adolescent medicine. That Gail School of Medicine.
Thank you so much for your insights and for your time.