Why gender-affirming care is good, evidence-based medicine

hands in various colors to symbolize the transgender flag
(Image: Adobe Stock/Illustration: Dave Chrisom, Boston Children's Hospital)

Recently, some states have attempted to classify gender-affirming medical treatments for transgender youth — such as puberty blockers and hormone therapy — as “child abuse.”  They also seek to penalize doctors and nurses who provide this care, and teachers and other professionals who fail to report such cases.

While these orders do not apply at all to Massachusetts and are being challenged in state courts, the potential harm they could cause trans youth has families and clinicians concerned. Boston Children’s stands with our pediatric clinician colleagues across the country who make themselves available for patients and families who seek gender-affirming care.

We spoke with members of Boston Children’s Gender Multispecialty Service (GeMS) to learn more.

What could this mean for transgender kids and their families?

The most obvious consequence of these rules is that children who receive gender-affirming medical care could risk being investigated for child abuse by state agencies. Several children’s hospitals are no longer able to provide this care for their patients as a result.

“We know that higher rates of depression, anxiety, and suicidal thinking in transgender youth are largely influenced by feelings of discrimination and a lack of support,” says GeMS associate director and psychologist Kerry McGregor, PsyD. “If that support is removed, we would expect to see increased distress in gender-diverse kids and teens.”

What about for transgender kids and families in Massachusetts?

These days, we’re so connected through technology that what’s happening across the country can feel like it’s happening next door. So even though families in Massachusetts may not technically be affected by what’s happening elsewhere, they can still feel the stress.

“We have to remember that kids are always watching and listening,” explains GeMS psychologist Col Williams, PsyD. “And witnessing their identity, health care, and well-being become politicized and devalued can be harmful no matter where they live.”

How does Boston Children’s support gender-diverse kids and teens?

As the first pediatric and adolescent transgender health program in the United States, GeMS has long provided gender-affirming care. That care can come in several different forms: It can mean supporting kids who are exploring their gender identity, transitioning socially (for example, changing their pronouns, using an affirmed name, or modifying their clothing), or pursuing medical care.

“Everyone is different and there’s no single path,” says GeMS endocrinologist Jessica Kremen, MD. “We always prioritize the needs of the person in front of us.”

At GeMS, the decision to prescribe medical therapies like puberty blockers and hormones comes after a patient meets with the program’s mental health and medical providers. If the youth, parents/guardians, and interdisciplinary team determine that the youth would benefit from medical care — for instance, if they are experiencing gender dysphoria — then such therapies are an option. “We recommend medical therapies to patients we know well and who we know will benefit from them,” says Kremen. “Gender-affirming medical care can be lifesaving because it helps people’s bodies develop in ways that align with their gender identity.”

Why is gender-affirming care important?

Gender-affirming care can have profound positive effects on a child or teen’s well-being — something that’s been confirmed by research. In fact, study after study shows that gender-affirming care is linked to a lower risk of depression, anxiety, suicidal thoughts, and substance abuse in transgender children, teens, and young adults.

“This is an established, evidence-based model of care,” explains McGregor. “We know that it can be extremely effective in treating gender dysphoria and helping trans kids live healthier, happier lives.”

Williams agrees. “Being affirmed in one’s gender — whether with the help of medical therapies or not — is associated with reductions in dysphoria and improved quality of life,” they say. “So many families have told us, ‘We feel like we’ve got our kid back’ when they’ve received gender-affirming care. It’s hard to dispute that.”

How can families help support transgender kids?

The best thing families can do to support their children is to help them feel safe, affirmed, and heard. One way to do that? Start the conversation. “What’s going on in the world can feel scary and upsetting,” says Kremen. “Don’t pretend it isn’t happening or that it’s not a big deal. It’s important to acknowledge it and talk about it as a family.”

“Meet your child where they are,” says McGregor. They should feel safe expressing themselves both at home and in the community — if they don’t, what can you do to help better support them?

And follow your child’s lead. “Some kids want to get involved in sharing their stories, protesting, or taking other action, and they may ask you to advocate with them. Others might not, and that’s okay, too,” explains Williams. If your child or teen is active on social media or constantly checking the news, find collaborative ways to help them take some much-needed breaks so that they can unplug and recharge. “You can help them find balance and time for self-care so they don’t get emotionally exhausted or traumatized — and can keep being the resilient kids we know they are,” Williams says.

Learn more about Gender Services at Boston Children’s Hospital.

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