Why There's a Medical Crisis for Transgender Youth (Guest Column)
The head of Los Angeles' only clinic dedicated to young trans patients at Children’s Hospital Los Angeles talks scarcity of providers, lack of resources and the ethics involved with prescribing puberty-blockers.
Transgender visibility has increased dramatically in the past five years in the United States. Viewers are exposed to transgender characters through TV shows like Transparent and Orange Is the New Black and even youth-oriented shows like TeenNick’s Degrassi: The Next Generation and TLC’s I Am Jazz. Public figures like Caitlyn Jenner, Chaz Bono, Janet Mock and Laverne Cox are humanizing trans experiences.
But there is a huge disparity when it comes to available transgender medical care. With no reliable data on how many trans people are in the U.S., the health-care community is not prepared to provide adequate and appropriate trans-related services for those in need. Children’s Hospital Los Angeles has the only dedicated clinic for transgender youth in Los Angeles. San Francisco, Chicago, Boston and a few other large cities have centers, but in most other places around the country, there’s a dearth of providers. After Caitlyn’s Diane Sawyer interview, a parent of a young transgender child in the Midwest called me looking for help and a referral. Unless a family can get to one of the few existing centers, there’s practically nothing in the way of services available. Sometimes this is true even for people within 50 miles of our center.
There’s a huge shortage of medical professionals who are comfortable and willing to prescribe puberty-blocking medication or hormones for trans youth. Physicians in the United States first began using puberty-blockers, an innovative strategy for preventing the development of unwanted secondary sex characteristics, in 2007. Puberty-blockers have been lifesaving for many trans youth. By simply delaying puberty with this reversible intervention, blockers prevent youth from growing into a body that they don’t identify with, alleviating what can be devastating anxiety and giving youth and their families time to explore, cope and learn. And if they’ve not yet gone through puberty, blockers can make a big difference. You can’t “ungrow” unwanted breasts if you identify as male. Nor can you reverse a deep voice or "ungrow" an Adam’s apple if you identify as female. Early transition with blockers and later, hormones, can be extremely beneficial both physically and psychosocially.
Most people who posit ethical issues with early intervention aren’t actually working with gender-variant or transgender youth. They aren’t sitting with these children and their families witnessing what they’re going through. Transgender-youth care is undertaken with thoughtfulness. Most of the young people who are going on blockers have been in care for a considerable amount of time with a mental-health professional. There’s an implication that we, as medical providers, don’t consider the ethical issues that arise. Standing around and watching a child suffer when we have proven, safe means to intervene — that’s unethical.
Unlike in other areas of medicine, providers are allowed to opt out of gender-related care, citing personal beliefs. We don’t allow physicians to refuse diabetes care because they don’t believe in treating diabetes. This lack of medical and mental-health services for trans people is a crisis that continues to result in significant negative outcomes, including isolation, homelessness, unemployment, HIV and suicide.
There’s a predominate misconception that the worst possible outcome for a human being is that he or she is transgender. Skeptics are critical of early intervention, asking the question, "What if they aren’t transgender, and they’ve undergone hormone treatment?" Every trans individual’s story and experience is unique, so great care and consideration is taken by providers who specialize in this extraordinary field of medicine.
A physical-gender transition does not eradicate every single challenge that trans people might face. What does change is the opportunity for transgender individuals to be seen in the world as their authentic selves, experience less anxiety going into public spaces and have fewer symptoms of depression and thoughts of suicide. Transitioning earlier gives transgender individuals the power to choose whether or not to disclose their trans experience. It keeps people healthier, it keeps people safer, and it improves their chances of thriving in the world. And that is what the health-care community should strive for, for everyone.
Ultimately, what’s the solution to this crisis? Legislation can help with resource allocation. Philanthropy and grants can help fund direct care and research. Formalized medical and “culture competency” training is critical for educating providers about the trans experience and that medical intervention is a necessity. The first step for the medical community is learning how to use correct names and pronouns and to treat transgender people with dignity and respect.
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