Since the first pediatric gender-affirming care clinic opened in the United States 15 years ago, the number of youth identifying as transgender and the number of clinics serving them have exploded. A New York Times investigation of puberty blockers that suppress estrogen and testosterone by Megan Twohey and Christina Jewett found growing concerns from some parents and doctors about the drugs' potential negative impact on bone density and brain development. This class of drugs, gonadotropin-releasing hormone agonists, are also used to treat adults with prostate cancer and endometriosis. Republican lawmakers are using doctors' concerns about the drugs' longterm effects to justify state restrictions on care. Wedge issue: In the U.S., the medical debate isn't as heated as the political one. "Republicans in 2022 midterm races are embracing more anti-transgender rhetoric than in any year that LGBTQ+ experts can remember," wrote Orion Rummler for The 19th. GOP state lawmakers have introduced more legislation this year than ever that would restrict transgender youths' ability to participate in sports, access care and change their name or gender on forms of identification, The Washington Post's Anne Branigin and N. Kirkpatrick reported. The psychological impact: "The language of medicine and science is being used to drive people to suicide," said Rachel Levine, HHS' assistant secretary for health and the first openly transgender person to win Senate confirmation to an executive branch post, at the Out for Health Conference, organized by health science students in Texas on LGBTQ health issues. And a 2022 study suggests that those who receive hormone therapy in adolescence have better mental health outcomes than those who receive it in adulthood. The study was conducted by psychiatrist Jack Turban, who at the time worked at Stanford Medicine, and colleagues at Boston's Fenway Institute, which advocates for the health care needs of transgender people. Consensus and dissent: Levine said there was "no argument" among medical professionals "about the value and the importance of gender-affirming care." In Finland and Sweden, doctors are more cautious about treating transgender young people with hormones or surgeries than the country's politicians are, reported Lisa Selin Davis, a journalist who covers gender nonconformity. The U.K.'s National Health Service plans to shutter its only youth gender-affirming clinic next year in favor of a distributed network of comprehensive medical care. The health service's statement on the decision emphasized the need to answer questions about puberty blockers and integrate mental health services into models of care for transgender youth. A dearth of long-term research: The FDA hasn't approved puberty blockers for treating gender dysphoria, the feeling of discomfort or distress some transgender people experience when their bodies don't align with their gender, so doctors prescribe the medicine off-label. The journal Pediatrics published one of the only long-term studies of transgender youth this summer. It followed 317 people for five years after they transitioned. The study found that 2.5 percent of the participants returned to the gender identified for them at birth. Another 3.5 percent identified as nonbinary, while 1.3 percent detransitioned before transitioning again. In 2015, the National Institutes of Health gave $5.7 million to four U.S. gender-affirming clinics to study the effect of puberty blockers, but the clinics haven't published the results. The American Academy of Pediatrics and the American Medical Association support gender-affirming care for adolescents. Gender-affirming care can include changing social components like name, pronouns and dress, using puberty blockers and hormone therapy, and undergoing gender-confirmation surgery.
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