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New US guidelines put trans youth at higher risk of mental illness

New guidelines are being drafted in the US that touch on the current debate within the medical community: how accessible should gender-affirming care be for transgender teens? These recent recommendations may seem more prudent, but hold very real dangers.

Last spring, Arkansas enacted the first law in the United States to ban transgender youth from receiving proper care while still under the age of 18.

The law made the two main procedures administered to underage trans people illegal, namely, gender-affirming hormone therapy and puberty blockers.

Over the past year alone, over 20 laws were put forward in state legislatures attempting to restrict care for trans teens. Within this hostile context, the World Professionals Association for Transgender Health (WPATH) seeks to publish their new recommendations for transgender care standards this spring.

The draft of this document, which will serve as guidance for healthcare providers, was available to the public and open to comments until last week.

Some of the proposed recommendations were received with widespread appraisal, such as the removal of a longstanding requirement that adult patients receive psychiatric assessment before any gender-affirming procedures may take place.

Debate among professionals, however, concerns one measure in the draft. This recommendation makes it necessary for underage transgender people to receive psychiatric assessment prior to requesting a specific procedure.

It also requires that a transgender person must have been questioning their gender identity for ‘several years’ in order to access care in the form of hormones or surgeries.

The argument made for a minimum waiting period before receiving hormonal therapy or surgery rests on the notion that more transgender people are seeking medical care now than in the past.

An increase that some doctors believe is linked to peer influence on social media sites, such as TikTok.

While LGBTQ+ communities on social media have larger followings now than ever before, the notion that people would undergo consequential medical procedures because of ‘internet trends’ is laughable.

Considering the continued marginalized position transgender people are relinquished to in society, it seems more likely that growing awareness and acceptance of transgender existence has simply made it possible for many people to openly claim their identity.

At first glance, it does not sound like a radical proposition, but this provision has been vehemently opposed by medical experts and trans rights activists who were quick to remind the WPATH that transgender youth are among the most vulnerable to mental illness.

Current societal and systemic pressures on transgender and non-binary people already lead to shockingly high rates of suicide attempts and mental illness.

Experts feel that any additional waiting time or barriers to sometimes life-saving healthcare will inevitably lead to worse mental health outcomes for an already vulnerable group of people.

Other arguments for caution when treating transgender teens surrounds the dangers associated with hormones or hormone blockers – so, what does the science say on this matter?

Although the main effects of gender-affirming hormones are reversible, they can in fact have long term side-effects, the main one being loss of fertility.

As for puberty blockers, if taken at the right time of adolescence, they have totally reversible effects. They can also enable a smoother transition if a patient decides to go forward with gender-affirming hormones later on, according to recent studies. They are a perfect tool to safely allow time for patients and their parents to make a decision while potentially avoiding some of the psychological dangers of gender dysphoria.

The new recommendations make the case that teens need to be dealt with differently than adults, and this makes sense. There needs to be extra attention given to young trans people and they need to be provided with the help they need.

We know for a fact that lack of access to care for trans teens can lead to worse mental health, an existential threat to trans youth in the United States. So, when airing on the side of caution, it would be less harmful to prioritize puberty blockers rather than endangering them with procedural loopholes and an elongated waiting period.

When weighing out the risks associated with giving care to trans teens, the most recent data must guide our decision-making.

The WPATH’s new policies will not be able to protect transgender youth in the way they may think it will. Additional hurdles to proper care will cement already existing mental health disparities between transgender and cisgender people, and lead to worsening the situation for trans teens when there are safe ways of offering them life-saving treatments.

Mental health resources for trans, NBs

The Trevor Project (USA):

Mind Out (UK):

Stonewall (UK):


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