Gender-affirming medication could help save transgender kids’ lives.

That’s my main take-away from a new study published in the journal Pediatrics. While the results conform to what I already suspected, medical practice should be based on evidence rather than supposition. Having this new evidence is important to determine how best to provide care for young trans patients.
The question the study investigates is whether access to medications that suppress the development of puberty for trans youth has a positive effect on their mental health, with a focus on measures that indicate a risk for suicide. The authors note that a prior study found 40 percent of trans adults it surveyed had attempted suicide within their lifetimes, and that the increased risk of suicidality is likely due to a combination of intense discomfort with their own bodies (dysphoria) and the stress of being a minority in an often-hostile society. Would access to medications that halt the progression of the physical changes that come with puberty mitigate some of these risks?
Using data from a 2015 survey conducted by the National Center for Transgender Equality, the authors compared answers between respondents who wanted access to medications to suppress pubertal development but weren’t able to get it, and those who were able to receive the medication they sought. Because these medications only became available in the United States starting in 1998, only answers from people who might have been able to access them while still experiencing puberty were included in the analysis.
One of the things that jumped out at me: of the thousands of trans people who reported wanting this kind of treatment, only 89 (2.5 percent) were able to receive it. Among those who were able to receive it, 11 percent had to travel over 100 miles for it.
Of the trans adults who were able to access the pubertal suppression therapy they sought during adolescence, about 75 percent reported suicidal thoughts over their lifetime. For those who wanted it but did not receive it, the number rose to about 90 percent. While both percentages are alarmingly high, the ability to access this kind of care substantially reduced the risk.
Access to appropriate care has the potential to save some trans people’s lives.
One of the most common (and inaccurate) criticisms leveled against gender-affirming medical care for trans kids is that it makes irreversible changes to their bodies at too young an age. The authors of the new study make clear that the interventions they included in their analysis do not result in permanent changes, and if stopped, puberty advances as it otherwise would have.
“It is important to note that pubertal suppression, with appropriate medical monitoring, is fully reversible,” Dr. Alex Keuroghlian, Director of the National LGBT Health Education Center at The Fenway Institute, Director of the Massachusetts General Hospital Psychiatry Gender Identity Program, and one of the paper’s senior authors, told me in an email. “It is a safe way to mitigate negative health outcomes that can result from undergoing puberty that does not align with a transgender youth’s gender identity.”
This new study comes as medical care for trans youth has come under attack. Legislators in numerous states seek to place bans on the kinds of care the study participants sought. In an article about why these bans have the potential to do lasting harm to trans people, Katelyn Burns points out that, while the effects of the treatment are reversible, the physical changes they prevent often are not.
“While the proposed bills are new, the ideology behind them is old. Bill proponents appeal to the fallacy that natal puberty is natural and therefore necessary for all kids,” she writes.
But this approach would force trans girls into male puberty and trans boys into female puberty without their consent, and brings along its own permanent changes, which could partially be reversed only with painful and expensive medical treatments in adulthood. Trans women forced through male puberty would have to undergo electrolysis to remove facial hair and may be left with a body frame (shoulder and hip width) that would be unchangeable surgically. Trans men would need surgery to remove their breasts and, like trans women, be forced to live in an unwanted body frame for their entire lives.
Burns is trans herself, and spoke to me in 2017 about her own experience of dysphoria as she entered puberty.
“My doctors just assumed that I was cis and wanted a normal male development, and I didn’t,” she told me. “Nobody ever just asked, ‘I see you started growing facial hair. How do you feel about that?’”
A ban would force trans kids into cis development, presumably with the goal of preventing them from living according to their gender identity at all. These efforts are not only likely to fail, but to do damage to those they target.
“The more we collect and analyze data, the more we come to a consistent conclusion: affirmation of transgender identity is associated with good mental health outcomes and trying to force someone to be cisgender is associated with bad mental health outcomes,” Dr. Jack Turban, resident physician in psychiatry at The Massachusetts General Hospital and McLean Hospital, and lead author of the study, told me via email.
“Doctors tried for decades to force transgender people to be cisgender,” he continued. “It didn’t work, and it caused irreparable damage. Psychiatry has learned from its mistakes and all major professional guidelines now recommend gender-affirming approaches for transgender youth.”
Among the professional organizations offering such guidelines is the American Academy of Pediatrics, and as a pediatrician myself, I take the needs of my trans patients very seriously. Over the past couple of years, I’ve made questions about gender identity part of routine screening for all my adolescent well visits. (To date, the number of patients who have reacted negatively to being asked is zero. The kids, as they say, are alright.) This new study is a reminder of why it’s important to include these questions as part of routine care, and to ask them sooner rather than later.
All medical providers for trans patients need to assure that their patients have access to treatments that can measurably and durably improve their mental health and well-being, and affirm their ability to live according to their gender identity. And everyone needs to understand that the lives of trans people, including trans kids, are important.
Efforts to deprive them of the care they need will not make them something they are not. And the evidence continues to demonstrate it will only do them harm.