In our current political environment, the term gender-affirming care is highly stigmatized. It’s characterized as radical, dangerous, and experimental. Politicians and anti-trans activists promote false claims about young trans kids having their bodies permanently altered with hormone therapies and cosmetic surgeries. However, it’s remarkable that these lies have been effective at stirring up controversy, because as a society, we let families choose gender-affirming body modifications, hormone therapies, and cosmetic surgeries for their cisgender kids, even when those procedures are medically unnecessary and have risks of serious side effects and long-term complications.
We trust parents to work with their pediatric specialists to address hormone-related medical concerns in kids. Parents of a child who begins puberty too young (precocious puberty) can consent to their child taking puberty blocking medication, which suppresses sex hormone production and effectively pauses puberty. This medication is low risk, and the health consequences of untreated precocious puberty can be serious. However, pediatric endocrinology interventions aren’t always so straightforwardly safe and necessary. For kids who are shorter than average without a medical explanation (idiopathic short stature), treatment with human growth hormone (hGH) can result in several extra inches in height. Adding height has no medical benefit, and hGH may increase the patient’s risk of developing diabetes and certain cancers. Parents of boys are twice as likely as parents of girls to choose this hormone therapy for their kids.[1] This stark difference reflects the impact of gender-specific stigma regarding height: parents of shorter boys weigh the mental health and social benefits along with the medication risks, and opt to have their sons treated with medically unnecessary hormones.
We also trust parents to make choices about cosmetic surgeries for their children. For instance, when a teen boy develops excess breast tissue (gynecomastia), his parents can consent to have that perfectly healthy tissue surgically removed to reduce his mental anguish about having breasts. However, we don’t even require a mental health rationale for cisgender teens to access cosmetic surgery. The cosmetic procedure most commonly performed on minors is rhinoplasty: in 2020, over 44,000 rhinoplasties were performed on patients aged 13-19.[2] The vast majority of these cases involve female patients, and it’s not unusual for parents of teen girls to pay for rhinoplasty as a quinceanera, sweet 16, or high school graduation gift. All cosmetic procedures reflect gender-specific ideals: a girl undergoing rhinoplasty has her natural nose reshaped based on gendered beauty standards that prescribe thinner, smaller noses for women. Cosmetic surgeries performed on teens involve permanent changes, have significant risks, and are not medically necessary, yet it’s not controversial to let parents make these decisions.
Would these medical decisions be more controversial, and would politicians be more inclined to interfere with them if we used consistent language and called this gender-affirming medical care for cisgender kids? Because that’s what it is. It’s gender-affirming care to artificially delay puberty until a child’s brain and body are ready. It’s gender-affirming care to medically or surgically reshape a child’s body or part of their body to better align with gendered expectations and beauty standards. Further, whereas anti-trans activists spread lies and exaggerations about which interventions trans youth are able to access and at what ages, permanent gender-affirming interventions for cisgender kids are actually available to prepubescent children (in the case of hGH for boys) and adolescents as young as 13 (in the case of rhinoplasty for girls). In sharp contrast, gender-affirming care for trans kids is entirely limited to reversible interventions until late adolescence.
Today, families of transgender kids are scrambling to find medical care as hospital systems are caving to the Trump administration and closing their pediatric gender clinics. Trans youth are going to die by suicide because of these decisions. Many more will live with long-term mental health impacts. And they’re going to endure this cruelty while attending school with cisgender peers who are receiving medical and surgical gender-affirming care. Somewhere, there’s an 11-year-old trans girl unable to access puberty blockers sitting in class next to a cis boy on hGH for his idiopathic short stature. We grownups owe it to her to see through the manufactured outrage and abject hypocrisy of the anti-trans agenda. We give families broad latitude to seek pediatric medical care and make choices based on their unique needs; it is inhumane, harmful, and wrong to deprive trans kids and their families of this basic right.
[1] https://www.nature.com/articles/srep11099
[2] https://www.plasticsurgery.org/documents/News/Statistics/2020/plastic-surgery-statistics-full-report-2020.pdf/
