A major transgender health association has lowered its recommended minimum age to begin gender transition treatment, including sex hormones and surgery.
The World Professional Association for Transgender Health said hormones can begin as early as age 14, two years earlier than the group’s previous advice, and some surgeries at age 15 or 17, a year or longer than previous guidance. is done first. The group acknowledged the potential risks but said withholding early treatment is unethical and harmful.
organization An advance copy of its update was provided to the Associated Press ahead of publication in a medical journal expected later this year. The international group promotes evidence-based standards of care and includes more than 3,000 doctors, social scientists and others involved in transgender health issues.
The group said the update is based on expert opinion and a review of scientific evidence on the benefits and harms of transgender medical treatment in adolescents whose gender identity does not match the gender they were assigned at birth. Such evidence is limited but has increased over the past decade, the group said, with studies showing that treatments can improve psychological well-being and reduce suicidal behavior.
Starting treatment before transgender teens allows transgender teens to experience the same physical puberty changes as other teens, says Dr. Eli Coleman said.
But he insisted that age was only one factor for the measurement. Emotional maturity, parental consent, prolonged gender-related distress and careful psychological evaluation are among others.
“Certainly there are teens who don’t have the emotional or cognitive maturity to make informed decisions,” he said. “Therefore we recommend careful multidisciplinary assessment.”
The updated guidelines include recommendations for treatment in adults, but guidance for adolescents is set to receive more attention. This comes amid a rise in the number of children referred to clinics offering transgender medical treatment.With new efforts to stop or restrict treatment.
Many experts say more children are seeking this type of treatment because children who question gender are more aware of their medical options and face less stigma.
Critics, including some in the transgender treatment community, say some clinics are too quick to offer irreversible treatment to children who would otherwise escalate their gender-questioning.
Psychologist Erica Anderson resigned as a board member of the World Professional Association for Transgender Health last year after expressing concerns about “sloppy” treatment given to children without adequate counseling.
She is still a group member and supports the updated guidelines, which emphasize a comprehensive assessment before treatment. But she says dozens of families have told her that this is not always the case.
“They tell me scary stories. They told me, ‘Our baby spent 20 minutes with the doctor’ before offering hormones, she said. “Parents leave their hair on fire.”
Estimates of the number of transgender youth and adults around the world have varied, partly because of different definitions. The association’s new guidelines say that data from most Western countries suggest a range from a fraction of a percent in adults to 8% in children.
Anderson said she’s heard recent estimates that the rate in children is as high as 1 in 5 — which she strongly disputes. That number likely reflects gender-questioning children who are not good candidates for lifelong medical treatment or permanent physical changes, she said.
Still, Anderson said she condemns politicians who seek to punish parents. To allow their children to receive transgender treatment and those who say that treatment should be banned for those under the age of 18.
“It’s absolutely cruel,” she said.
Dr Marcy Bowers, the elected president of the transgender health group, has also raised concerns about hasty treatment, but acknowledged the dismay of those “forced by gatekeepers to jump through arbitrary hoops and barriers to seek treatment.” … and subject to investigation not applicable to any other medical diagnosis.”
Gabe Paulos, 22, had breast removal surgery at the age of 16 and has been on sex hormones for seven years. The Asheville, North Carolina, resident struggled with gender issues prior to her treatment.
Paulos said he was glad he was able to get treatment at a young age.
“Having the transition under the roof with your parents so they can go through it with you is really rewarding,” he said. “I’m so happy now.”
In South Carolina, where a proposed law would ban transgender treatment for children under the age of 18, Ellie Bundy has been waiting to have breast removal surgery since she was 15. Bundy, now 18, has graduated from high school and plans to have surgery before college.
Bundy, who identifies as non-binary, supports easier limits on transgender medical care for children.
“Those decisions are best made by patients and patient families and medical professionals,” he said. “It certainly makes sense to have fewer restrictions, because then the child and the clinician can figure it out together.”
Dr. Julia Mason, an Oregon pediatrician who has raised concerns about the growing number of youth receiving transgender treatment, said many people in the area are jumping the gun. They argue that there is not strong evidence in favor of transgender medical treatment for children.
“In medicine … the treatment has to be proven safe and effective before we can start recommending it,” Mason said.
Experts say the most rigorous research – studies comparing treated children with outcomes for untreated children – would be unethical and psychologically harmful to the untreated group.
The new guidelines include starting a drug called a puberty blocker in the early stages of puberty, which is around age 8 to 13 for girls and usually after two years for boys. This is not a change from the group’s previous guidance. Medications delay puberty and give children time to make decisions about additional treatments; Their effect ends when the drug is stopped.
Inhibitors can weaken bones, and starting them too young in children assigned to males at birth may impair sexual function in adulthood, although long-term evidence is lacking.
The update also recommends:
—the sex hormone—estrogen or testosterone—begins at age 14. This is often a lifelong treatment. Long-term risks may include infertility and weight gain, stroke in trans women, and high blood pressure in trans men, the guidelines said.
—Breast removal for trans boys at age 15. Previous guidance suggested this could be done after at least one year of hormone therapy, around age 17, although a specific minimum Ag was not listed.
—Most genital surgeries begin at age 17, including removal of the womb and testicles, a year earlier than in previous guidance.
The Endocrine Society, another group that provides guidance on transgender treatment, generally recommends Starting a year or two later, although it recently started updating its guidelines. The American Academy of Pediatrics And the American Medical Association allows children to seek transgender medical treatment, but they do not provide age-specific guidance.
Dr. Joel Frader of Northwestern University, a pediatrician and medical ethicist who advises the gender treatment program at Lurie Children’s Hospital in Chicago, said guidelines should be based on psychological readiness, not age.
Frader said brain science shows that children are capable of making logical decisions by age 14, but they are prone to risk-taking and take into account the long-term consequences of their actions only when they are very grow up.
Psychologist Colleen Williams of Boston Children’s Hospital’s Gender Multispecialty Service said treatment decisions are collaborative and personal.
“Medical intervention in any area is not a one-size-fits-all option,” Williams said.
Follow Associated Press Medical Writer Lindsey Tanner at @LindseyTanner.
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