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Support trans youth, say pediatricians

On September 17, the American Academy of Pediatrics (AAP) released a policy statement declaring that "The Academy stands against stigmatization and marginalization of [transgender and gender-diverse (TGD)] youths and emphasizes the need for their acceptance as members of our families, communities, and workforce. A new policy statement, Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescentsuses strengths-based concepts to outline the role of pediatricians in addressing the needs, challenges and resilience of TGD youths and their families."

The AAP is the largest professional organization of pediatricians in North America, representing over 64,000 members in both primary care and related specialties.The AAP's recommendations are:

"1. that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;

"2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;

"3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;

"4. that insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions;

"5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;

"6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all children without fear of harassment, exclusion, or bullying because of gender expression;

"7. that pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;

"8. that the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and

"9. that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD..."

This important statement comes at a time when fearmongering about the acceptance and accommodation of trans youth has reached a fever pitch in the Western world. In the U.S., fears raised about trans kids in public washrooms continue to constitute an unwarranted panic used to justify attacks on the public school system and teachers unions as much as the kids themselves.

In the UK, tabloids have targeted a children's charity with false claims and called medical access into question, while predominantly anti-trans websites have attempted to portray an increase in trans youth coming out of the closet as a "social contagion." In Canada, acceptance of trans kids is typically rephrased as "transgender [or even "liberal"] ideology" (it makes it easier to generate alarm when the kids are erased entirely), and used as one of the main objections to age-appropriate sex education. The phrase "gender ideology" has been used by the Vatican for longer, and is also sometimes a dog whistle encompassing any combination of feminism, reproductive freedoms, sex education, and/or LGBTQAI2 rights.

Much of this fearmongering has been made possible by flawed or distorted data, such as the often-cited statistic that 84 per cent (or 90 per cent, because rounding up sounds better) of trans kids desist, that is, grow out of it, in much the same way people used to view being gay as "just a phase". These false claims are made possible by looking at studies that failed to distinguish kids who actually had a strong and persistent identification with the gender that does not match their birth assignment, from kids who simply experimented with gender, or were even just arbitrarily thought of as gender non-conforming by their parents or doctors.

The AAP statement also comes at a time when Canadian media outlets are starting to jump on a study purporting to show a social contagion-style phenomenon that proponents call Rapid Onset Gender Dysphoria (ROGD). If anything clearly demonstrates why the AAP's statement this week was necessary, it is the panic over ROGD.

Rapid Onset Gender Dysphoria is not recognized by any medical body or institution, but is rather a theory generated by a group of trans-exclusionary feminists and parents who refuse to accept their kids' admissions of experiencing gender dysphoria, and instead blame trans awareness and activism for making being trans seem trendy. It is essentially a retooling of the "gays recruit" myth, but it has proven so effective in UK tabloids that British Conservative politician and Equalities Minister Penny Mordaunt is launching an investigation into why the number of kids accessing the medical system has risen from 97 to 2,519 over the past eight years.

Of course, the answer to that should be obvious. Eight years ago, trans-affirming treatment existed only at major metropolitan centres, few doctors would help trans kids, and finding those who did was hit-and-miss. Eight years ago, human rights protections were tenuous for adults, let alone youth who had much less legal autonomy, and schools were unprepared for accommodating them. Eight years ago, awareness, support options and the assurance of being accepted were much less, but the certainty of opposition was overwhelmingly intimidating. Eight years ago, parents could even have custody of their children taken away if they affirmed and supported them. As the stigma decreased and acceptance increased, people simply started coming out earlier in life. Which means that only now is society beginning to realize the real prevalence of trans* people.

 ROGD was given a veneer of legitimacy by a recent "study" that media outlets everywhere eagerly jumped on. The Littman "study" claims that "parents have described clusters of gender dysphoria outbreaks." I put study in quotation marks, because its methodology was a total mess. It was published in a journal that speeds papers to publication, and then lets you "peer review" them.

The study itself acknowledged that its methodology was to take a voluntary survey of visitors to three websites (4thwavenow, Transgender Trend and youthtranscriticalprofessionals, which I will not link to directly), a cursory glance at which would be more than enough to ascertain exist only to discredit trans youth anecdotally and demonize their supporters. The survey didn't talk to trans kids at all, but rather asked parents if their child's coming out was sudden (i.e. it can seem to be "rapid onset" when one doesn't live with it and is unaware of it for years), without prior signs (any trans person can tell you that before coming out, they sometimes go to great lengths to hide it), and were received with any sort of peer or educational support (from which they are assumed to have contracted transgenderism, I guess). The methodology was so flawed that the journal PLOS ONE decided to conduct a "post-publication re-review," and the researcher's university, Brown University, withdrew its support almost as quickly as it was published, stating:

"As a research institution, we feel we must ensure that work that is featured on the University website conforms to the highest academic standards. Given the concerns raised about research design and methods, the most responsible course of action was to stop publicizing the work published in this particular instance. We would have done this regardless of the topic of the article..."

In the end, the only thing that was "rapid onset" was the process from fearmongering to theory (the few months in which the aforementioned three websites grew) and from published "study" to media event (which can be measured in days). The National Post and Globe and Mail should be embarrassed.

In fact, attempts to pass off transphobia and homophobia as science are not new: a discredited 2012 study attempting to prove that parenting by same-sex couples harmed their kids touched off a new wave of anti-LGBTQAI2 junk research, and an astroturf organization calling itself the American College of Pediatricians (identified as a hate group by the Southern Poverty Law Center) has repeatedly tried to pose as an authoritative pediatrics organization in order to fight LGBTQIA2 equality and reproductive rights. But the speed with which ROGD was heralded shows that there is a real appetite for misinformation about trans youth.

So this week's policy statement by the American Academy of Pediatrics is vital. After years of ongoing research and evidence, the AAP has put its support behind the Gender-Affirmative Care Model (GACM):

"The GACM is best facilitated through the integration of medical, mental health, and social services, including specific resources and supports for parents and families.24 Providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.5 A specialized gender-affirmative therapist, when available, may be an asset in helping children and their families build skills for dealing with gender-based stigma, address symptoms of anxiety or depression, and reinforce the child’s overall resiliency.34,35 There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.24,36,37

I have written before about medical accommodations for trans youth, and what is involved:

"It's important to recognize that the process for trans youth that I'm speaking of is not "sex change" and surgery. This is often the conclusion that people jump to, but the reality is that newer treatments merely delay puberty until it is certain whether further changes like hormone therapy must be undertaken... typically after age 14...

"Youth transition does not start simply because a child wants to crossdress on occasion or because they like dolls or trucks. It happens when there is a strong and persistent identification that clearly indicates that there is something deeper than the usual experimentation phase which most kids go through..."

Dr. Norman Spack, who pioneered affirmative treatments, has a TED Talk on how they are scaled to be age-appropriate, and why he came to develop his course of care. It should be acknowledged that the policy statement does not specifically embrace Dr. Spack's treatment, but does stand behind gender-affirmative care, of which his medical process is one example.

The AAP statement also condemns reparative (or conversion) therapy:

"In contrast, “conversion” or “reparative” treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions. The Substance Abuse and Mental Health Services Administration has concluded that any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate. Reparative approaches have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice. The AAP described reparative approaches as “unfair and deceptive.” At the time of this writing, conversion therapy was banned by executive regulation in New York and by legislative statutes in 9 other states as well as the District of Columbia."

Ontario banned reparative therapy for youth in 2015, noting that kids are often coerced or forced into the treatment by unaccepting parents and churches. This year, reparative therapy for all ages has been coming into question, with legislation being proposed in Nova Scotia, considered in Alberta, passed in the City of Vancouver, and being lobbied for nationwide.

The AAP's statement mirrors guidelines issued earlier this year by The Canadian Paediatric Society, and are informed by a growing body of evidence that accepting, affirming and supporting trans children and youth leads to better long-term outcomes:

"Many kids who are transgender have chosen a name that is different than the one that they were given at birth," said author Stephen T. Russell, professor and chair of human development and family science. "We showed that the more contexts or settings where they were able to use their preferred name, the stronger their mental health was.... I've been doing research on LGBT youth for almost 20 years now, and even I was surprised by how clear that link was..."

Whether or not the rhetoric subsides, the science is clear.

This article also appears on Dented Blue Mercedes.

Image: Ted Eytan/Flickr

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