Mindpath Health’s Leela Magavi, M.D. helps to discuss the life-saving science behind gender-affirming care.

The 'life-saving' science behind gender-affirming care for children

Medical News today spoke to several mental health professionals and a suicide prevention group for LGBTQ people to see if science supports gender-affirming treatment for trans and nonbinary youth.

*The 31st International Transgender Visibility Day, an annual event designed to increase awareness of the discrimination faced by transgender and gender nonconforming individuals and their contributions to society.

Gender-affirming healthcare is a topic of discussion that has gained more attention recently after being polized by the so-called Don’t Say Gay measure (HB 1557). The new law in Florida prohibits instruction and discussion about gender identity and sexuality in K-3 classrooms.

Gender-affirming care can be referred to as the psychological, social, and medical care that is designed to honor individuals” gender identity.

Gender identity is basically an individual perception of having a particular gender, which may not be compatible with his, her, or their birth sex. It is the internal, intuitive sense of being male, both, or neither, according to Dr. Leela Magavi, a Hopkins-trained psychiatrist and regional medical director for Mindpath Health.

If their gender identity does not match their sex assigned at birth, some people may wish to receive gender-affirming treatment.

An estimated 1.4 million people in the United States are transgender, but another 1.2 million adults aged 18 to 60 are nonbinary.

People are unaware of their gender identity until later in life. By the age of three, children have already established awareness of gender identity and gender-specific behaviors.

According to Dr. Magavi, children can identify and recognize gender groups between the ages of 18 and 24 months, and the majority can identify their own gender by age three.

Different Care for Different Ages

Gender-affirming healthcare comes in many forms. It isn’t a one-size-fits-all; like many medical therapies and treatments, it depends on the person’s age, condition, and even the individual’s ability to perform it.

Different age groups may choose the genre and method of gender-affirming treatment. Gender-affirming therapy may be as simple as using a different name and the correct pronouns for children. It may involve taking medications to postpone puberty or receiving hormone therapy. Later in life, these individuals may require surgery.

I encourage parents to use their children’s preferred name and pronoun, as well as their family members, friends, and neighbors to do the same. This could halt social isolation, depression, and suicidal thoughts in children and teens, according to Dr. Magavi.

Dr. Leela R. Magavi believes that trans-affirming abilities can alleviate patients” worries by validating them and encouraging them to clarify their beliefs, goals, strengths, weaknesses, and concerns. [It is crucial for clinicians to understand LGBTQIA individuals and their needs in order to individualize treatment.

Gender Affirming Care is Not Purely Medical

Dr. Jonah DeChants, a research scientist at The Trevor Project, the world’s largest suicide prevention and crisis intervention organization for LGBTQ youth, said it was important to note that no gender-affirming medications are prescribed to prepubescent children.

Gender-affirming care for kids focuses on the social and psychological aspects. Such changes are also easier to implement for individuals.

According to Dr. Magavi, [Parents] can assist their children feel more secure and comfortable when discussing bathroom remodels or modifications to wardrobes to fit nonbinary requirements.

Dr. DeChants emphasized that there are many ways in which individuals may assist and support transgender youth without undergoing medical therapy.

Our research has found that respecting a young person’s pronouns is linked to a reduction in suicide risk, and that transgender and nonbinary youth with access to binders, shapewear, and gender-affirming clothing have reported lower rates of suicide in the past year compared to transgender and nonbinary youth without access.

Gender Affirming Care is Multi-Faceted

Almost all research has shown that a multidisciplinary approach, which includes questions about fertility, mental health support, and hormone therapy, if necessaryis required, while providing gender-affirming treatment.

The Dorm, a full-service treatment community for young people in Washington, D.C., has a licensed independent clinical social worker and director. She claims that gender-affirming care may be used throughout an individual’s lifespan.

According to the survey, most gender-segment individuals benefit from support for their social transition, as well as family support, education, and mental health.

Harte emphasized that the family must be supported and educated.

Parents, siblings, and others need and deserve their own help in navigating social transition and gender diversity. The more support and resources the family has in their system, the better equipped they will be to assist their gender diverse family members, according to MNT.

The Mental Toll of Restricting Care

Transgender individuals are two to three times more likely to have depression or anxiety, and they have a greater risk of depression and self-harm.

According to a survey published in the journal Pediatrics in 2020, 2.8 percent of transgender adults in the United States were diagnosed with puberty blockers, despite almost 17% saying their wish. The adults who received therapy were 70% less likely to have considered suicide.

Both the societal stigma and the signs of gender dysphoria can exacerbate overall issues with mental health, which often go untreated due to a lack of willingness to seek treatment. Sarah Harte, the director of The Dorm D.C.

A study by the Netherlands found that kids and adolescents who had not received puberty blockers were more likely to die by suicide than their non-transgender peers. When kids started taking puberty blockers, their mental health improved and was comparable to or worse than their non-transgender peers.

According to a 2019 transgender teen survey, 21 out of the 47 surveyed had suicidal tendencies before starting hormone therapy. Likewise, that figure slowed to 6.

The American Academy of Pediatrics is advocating gender-affirming care. It recognizes that restricting or prohibiting access to healthcare for transgender and nonbinary individuals may cause these individuals” mental health to decline.

According to Dr. DeChants, 85% of transgender and nonbinary youth and two-thirds of all LGBTQ youth are reporting that recent discussions about anti-trans legislation have harmful effects on their mental health.

73% of transgender and nonbinary youth said it made them feel angry, sad, 47% stressed, and more than one in three felt hopeful, helpless, and/or nervous. Dr. Jonah DeChants reveals that while discussing proposal to prohibit doctors from prescribing gender-affirming medical therapy, she said.

Timing of Care Can Save Lives

When it comes to gender-affirming treatment, timing is also crucial.

Consensus among scientists in this field is that transgender and gender-diverse people of all ages benefit from trauma-informed and evidence-based care, and that the earlier the treatment is administered, the greater the benefit to the patients” overall health, both mentally and physically.

One of the greatest benefits of gender-affirming healthcare is that it may be lifesaving.

According to Dr. DeChants, a peer-reviewed study by The Trevor Projects researchers published in the Journal of Adolescent Health found that gender-affirming hormone therapy is significantly linked to lower rates of depression, suicidal thoughts, and suicide attempts among transgender and nonbinary youth.

Wider Implications

According to Harte, research continues to demonstrate the benefits of gender-affirming and trauma-informed care for mental health and overall wellbeing and functioning.

Transgender and gender nonconforming individuals are more likely to experience mental health problems, but they also are at greater risk than the general population to experience trauma related to poverty, homelessness, and violence, according to the narrator.

According to Harte, the negative impact of restricting access to gender-affirming care might be classified into two main effects:

Further barriers to safe, well-informed care will result in higher levels of dangerous and unsafe self-care practices, where people seek out medications and procedures in unregulated and unsafe environments.

Harte reaffirmed that the healthcare received, and the attitudes expressed toward the patient early in life have profound implications for the individual life.

It is particularly important that early healthcare experiences, both affirming and discriminatory, have the potential to influence a patient’s attitudes toward healthcare for the rest of their lives. This impacts all areas of health, not only gender-affirming procedures, but the frequency of individuals actively seeking medical and psychological treatment for all areas of health, such as heart health, sexual health, and mental healthcare.

The Permanency Argument

People who support anti-transgender legislation argue that individuals may express their displeasure after receiving medical treatment, and hormonal therapies may also affect their bone health or fertility.

Existing evidence suggests that bone growth catches up as people stop taking puberty blockers. Doctors also prescribe vitamin D and calcium supplements to alleviate this side effect and recommend weight-bearing exercises to keep bones strong.

Individuals typically begin hormone therapy when they are between 14 and 16. Although breast development and voice deepening are permanent from hormone therapy, muscle mass and body fat distribution changes may be reversed when the therapy ends.

Dr. DeChants reveals that puberty blockers are reversible, and therefore they are frequently prescribed as a first step to provide transgender and nonbinary young people, their families, and their doctors with the possibility to determine if other forms of gender-affirming healthcare are required.

Blockers used in marijuana are not intended to be a long-term therapy, according to a new generation.

While GHT may have irreversible effects, Dr. DeChants recognizes that many people do not consider the same consequences as trans and nonbinary youngsters experiencing the puberty of their assigned sex at birth.

Potential side effects must be considered with the positive effects for many youngsters, families, and doctors. Even though severe dysphoria and distress are considered essential to achieving optimal health and well-being for a young person, according to MNT.

Trans and nonbinary young people may be prevented from receiving GAHT, thus making it more probable that their bodies will change irreversibly in ways they feel terrible. Dr. Jonah DeChants

Before an individual undergoes medical visits, doctors consider all outcomes and perform a risk-benefit analysis with the patient. Regardless of the individual’s age, communication throughout is also crucial as they may postpone treatment.

Harte insisted on the importance of having a trusting and collaborative relationship with healthcare professionals in order to ensure that both the trans or nonbinary individual and their families are aware of any side effects or other risks, both due to intervention or their absence of such activities.

To view the complete article with sources and learn more about the science behind gender-affirming care, click here.

Leela R Magavi, M.D.

Newport Beach, CA

Dr. Leela Magavi is a native Californian and Hopkins-trained psychiatrist committed to providing compassionate, evidence-based care to individuals of all cultural, political, religious, sexual, and socioeconomic backgrounds. She completed her adult psychiatry residency at Georgetown University Hospital, during which time she also had the invaluable experience of caring for veterans at Washington, D.C. VA. As a resident, she was awarded ... Read Full Bio »

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