Friday, April 22, 2022

EXPLAINER: What medical treatments do transgender youth get?

By LINDSEY TANNER

Barbara Dale, from Atlanta, mother of a transgender child, waves sign reading "Love Knows No Gender" at Gay Pride Transgender March at Piedmont Park in the city's Midtown District in Atlanta, Ga, Saturday, Oct. 12, 2019. Transgender medical treatment for children and teens is increasingly under attack in many states, labeled child abuse and subject to criminalizing bans. But it has been available in the United States for more than a decade and is endorsed by major medical associations. (AP Photo/Robin Rayne, File)


Transgender medical treatment for children and teens is increasingly under attack in many states, labeled child abuse and subject to criminalizing bans. But it has been available in the United States for more than a decade and is endorsed by major medical associations.

Many clinics use treatment plans pioneered in Amsterdam 30 years ago, according to a recent review in the British Psych Bulletin. Since 2005, the number of youth referred to gender clinics has increased as much as tenfold in the U.S., U.K, Canada and Finland, the review said.

The World Professional Association for Transgender Health, a professional and educational organization, and the Endocrine Society, which represents specialists who treat hormone conditions, both have guidelines for such treatment. Here’s a look at what’s typically involved.

PUBERTY BLOCKERS


Children who persistently question the sex they were designated at birth are often referred to specialty clinics providing gender-confirming care. Such care typically begins with a psychological evaluation to determine whether the children have “gender dysphoria,″ or distress caused when gender identity doesn’t match a person’s assigned sex.

Children who meet clinical guidelines are first offered medication that temporarily blocks puberty. This treatment is designed for youngsters diagnosed with gender dysphoria who have been counseled with their families and are mature enough to understand what the regimen entails.

The medication isn’t started until youngsters show early signs of puberty — enlargement of breasts or testicles. This typically occurs around age 8 to 13 for girls and a year or two later for boys.

The drugs, known as GnRH agonists, block the brain from releasing key hormones involved in sexual maturation. They have been used for decades to treat precocious puberty, an uncommon medical condition that causes puberty to begin abnormally early.

The drugs can be given as injections every few months or as arm implants lasting up to year or two. Their effects are reversible — puberty and sexual development resume as soon as the drugs are stopped.

Some kids stay on them for several years. One possible side effect: They may cause a decrease in bone density that reverses when the drugs are stopped.

HORMONES


After puberty blockers, kids can either go through puberty while still identifying as the opposite sex or begin treatment to make their bodies more closely match their gender identity.

For those choosing the second option, guidelines say the next step is taking manufactured versions of estrogen or testosterone — hormones that prompt sexual development in puberty. Estrogen comes in skin patches and pills. Testosterone treatment usually involves weekly injections.

Guidelines recommend starting these when kids are mature enough to make informed medical decisions. That is typically around age 16, and parents’ consent is typically required, said Dr. Gina Sequiera, co-director of Seattle Children’s Hospital’s Gender Clinic.

Many transgender patients take the hormones for life, though some changes persist if medication is stopped.

In girls transitioning to boys, testosterone generally leads to permanent voice-lowering, facial hair and protrusion of the Adam’s apple, said Dr. Stephanie Roberts, a specialist at Boston Children’s Hospital’s Gender Management Service. For boys transitioning to girls, estrogen-induced breast development is typically permanent, Roberts said.

Research on long-term hormone use in transgender adults has found potential health risks including blood clots and cholesterol changes.

SURGERY


Gender-altering surgery in teens is less common than hormone treatment, but many centers hesitate to give exact numbers.

Guidelines say such surgery generally should be reserved for those aged 18 and older. The World Professional Association for Transgender Health says breast removal surgery is OK for those under 18 who have been on testosterone for at least a year. The Endocrine Society says there isn’t enough evidence to recommend a specific age limit for that operation.

OUTCOMES

Studies have found some children and teens resort to self-mutilation to try to change their anatomy. And research has shown that transgender youth and adults are prone to stress, depression and suicidal behavior when forced to live as the sex they were assigned at birth.

Opponents of youth transgender medical treatment say there’s no solid proof of purported benefits and cite widely discredited research claiming that most untreated kids outgrow their transgender identities by their teen years or later. One study often mentioned by opponents included many kids who were mistakenly identified as having gender dysphoria and lacked outcome data for many others.

Doctors say accurately diagnosed kids whose transgender identity persists into puberty typically don’t outgrow it. And guidelines say treatment shouldn’t start before puberty begins.

Many studies show the treatment can improve kids’ well-being, including reducing depression and suicidal behavior. The most robust kind of study — a trial in which some distressed kids would be given treatment and others not — cannot be done ethically. Longer term studies on treatment outcomes are underway.

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Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content


LGBTQ leader is key in blocking Kansas ban on trans athletes

By JOHN HANNA

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Tom Witt, executive director of the LGBTQ-rights group Equality Kansas, follows a legislative committee meeting at the Statehouse Monday, March 7, 2022 in Topeka, Kan. For 18 years, Witt has used a variety of tactics to stymie conservative lawmakers' proposals, including a bill this year to ban transgender athletes from girls' and women's sports in schools and colleges. (AP Photo/John Hanna)


TOPEKA, Kan. (AP) — As state lawmakers moved to ban transgender kids from girls’ sports, Kansas’ most visible LGBTQ-rights lobbyist recently said during an interview in a Statehouse corridor that conservatives don’t mind if kindergartners “have their genitals inspected.”

The politically needling comment was bold enough to make Tom Witt’s point, and loud enough for a lobbyist supporter of the ban to hear as she walked by. It was also classic Witt: Boisterous. Engaged. And well-targeted.

Witt is a key reason Kansas is unlikely to join a growing number of states this year with a ban, despite Republican supermajorities in its Legislature. With lawmakers returning Monday from a spring break, supporters don’t yet have the two-thirds majorities to override Democratic Gov. Laura Kelly’s veto of their bill. They didn’t last year, either.

Witt, 60, is executive director of Equality Kansas and a Democratic consultant. During 18 years at the Statehouse, he’s spotlighted conservatives’ bills so that unwanted publicity prompts Republican leaders to disavow them or discourages GOP-led committees from even holding hearings. Others describe him as relentless in pursuing just enough “no” votes when it counts, and was influential enough in the state Democratic Party to help push it to the left.

He’s even let his health slide. In 2017, he ignored growing fatigue to successfully lobby against requiring transgender students to use facilities associated with their genders assigned at birth — then had a heart attack and bypass surgery.

As for this year’s bill, he said unnamed Republicans told him they “really hate” it before voting for it anyway. He said he’s bitter that they might have considered the political cost of voting no.

“This is life and death for some kids,” he said. “This is not trivial. This is not politics.”

Witt plans to retire from activism, lobbying and consulting by year’s end, having mentored younger, self-described progressive lobbyists.

Democratic state Rep. Stephanie Byers, the state’s first elected transgender lawmaker and a retired Wichita band director, credits Witt with connecting her to national groups and making media interviews easier to navigate during her 2020 campaign. Kari Rinker, a friend and American Heart Association lobbyist, said he taught her how to fundraise and work with a nonprofit board.

But Witt is sometimes profane and often pugnacious, even with friends. As for lawmakers, he said, party doesn’t matter: “If they vote against LGBT rights, I’m going to go after them.”

Brittany Jones, the conservative lobbyist who was walking by Witt’s recent hallway interview, begins her recollection of their Statehouse introduction in 2019 with, “I believe he’s made in the image of God just like I am.”

“As soon as he found out who I worked for, he dropped my hand, walked away and wouldn’t speak to me,” said Jones, policy director for the conservative group Kansas Family Voice. Witt doesn’t dispute that.

As Witt fights to keep Kansas from following at least 15 other states in banning transgender athletes from female school and college sports, some Kansas lawmakers are conflicted.

State Sen. David Haley, a Kansas City Democrat, voted no earlier this month but said “reasonable” constituents see the bill as common sense. He was the deciding vote last year against a veto override, giving a speech weighing both sides before voting no — as Witt sat in the main visitors’ gallery, visibly on edge.

“You know, it’s kind of like he’s a Marine Corps drill sergeant when he is committed to the advocacy for his ideology,” Haley said. “It’s like, ‘Everybody line up. This is the way it’s going to go.’”

The Kansas measures have applied to K-12 students, and a few lawmakers cite that as a problem. Witt said elementary schools would be forced to physically inspect children as young as 5 to settle disputes over transgender kids competing against other girls.

The bill’s text doesn’t says exactly how disputes would be resolved, and Haley called Witt’s argument “a little bit beyond belief.” State Rep. Barbara Wasinger, a Republican from western Kansas, said Witt’s argument is diverting attention from what she sees as the real issues, fair competition and scholarship opportunities for young women.

But Witt sees this year’s proposals triggering bullying and suicides. He pointed out a scar on his left cheek and said it’s from being attacked and cut with a knife in a high school bathroom in the 1970s.

“In some respects, not a damn thing has changed,” he said. “In the 70s, the things that trans people are being called today are what gays and lesbians were called then. The panic about bathrooms? We had the bathroom panic in the 70s.”

He also recalled how his activism began ahead of a 2005 statewide vote in favor of banning same-sex marriage in Kansas. A computer software writer and IT troubleshooter, he was living in Wichita with his future husband and their daughter.

“All I ever wanted in my life was a family,” Witt said. “And it felt like those people were coming after it.”

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Follow John Hanna on Twitter: https://twitter.com/apjdhanna

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