mcloudy.png
Tuesday August 16th, 2022 8:44PM

Trans kids' treatment can start younger, new guidelines say

By The Associated Press

A leading transgender health association has lowered its recommended minimum age for starting gender transition treatment, including sex hormones and surgeries.

The World Professional Association for Transgender Health said hormones could be started at age 14, two years earlier than the group’s previous advice, and some surgeries done at age 15 or 17, a year or so earlier than previous guidance. The group acknowledged potential risks but said it is unethical and harmful to withhold early treatment.

The association provided The Associated Press with an advance copy of its update ahead of publication in a medical journal, expected later this year. The international group promotes evidence-based standards of care and includes more than 3,000 doctors, social scientists and others involved in transgender health issues.

The update is based on expert opinion and a review of scientific evidence on the benefits and harms of transgender medical treatment in teens whose gender identity doesn’t match the sex they were assigned at birth, the group said. Such evidence is limited but has grown in the last decade, the group said, with studies suggesting the treatments can improve psychological well-being and reduce suicidal behavior.

Starting treatment earlier allows transgender teens to experience physical puberty changes around the same time as other teens, said Dr. Eli Coleman, chair of the group’s standards of care and director of the University of Minnesota Medical School’s human sexuality program.

But he stressed that age is just one factor to be weighed. Emotional maturity, parents’ consent, longstanding gender discomfort and a careful psychological evaluation are among the others.

“Certainly there are adolescents that do not have the emotional or cognitive maturity to make an informed decision,” he said. “That is why we recommend a careful multidisciplinary assessment.”

The updated guidelines include recommendations for treatment in adults, but the teen guidance is bound to get more attention. It comes amid a surge in kids referred to clinics offering transgender medical treatment, along with new efforts to prevent or restrict the treatment.

Many experts say more kids are seeking such treatment because gender-questioning children are more aware of their medical options and facing less stigma.

Critics, including some from within the transgender treatment community, say some clinics are too quick to offer irreversible treatment to kids who would otherwise outgrow their gender-questioning.

Psychologist Erica Anderson resigned her post as a board member of the World Professional Association for Transgender Health last year after voicing concerns about “sloppy” treatment given to kids without adequate counseling.

She is still a group member and supports the updated guidelines, which emphasize comprehensive assessments before treatment. But she says dozens of families have told her that doesn’t always happen.

“They tell me horror stories. They tell me, ‘Our child had 20 minutes with the doctor'" before being offered hormones, she said. "The parents leave with their hair on fire.’’

Estimates on the number of transgender youth and adults worldwide vary, partly because of different definitions. The association's new guidelines say data from mostly Western countries suggest a range of between a fraction of a percent in adults to up to 8% in kids.

Anderson said she’s heard recent estimates suggesting the rate in kids is as high as 1 in 5 — which she strongly disputes. That number likely reflects gender-questioning kids who aren’t good candidates for lifelong medical treatment or permanent physical changes, she said.

Still, Anderson said she condemns politicians who want to punish parents for allowing their kids to receive transgender treatment and those who say treatment should be banned for those under age 18.

“That’s just absolutely cruel,’’ she said.

Dr. Marci Bowers, the transgender health group’s president-elect, also has raised concerns about hasty treatment, but she acknowledged the frustration of people who have been "forced to jump through arbitrary hoops and barriers to treatment by gatekeepers ... and subjected to scrutiny that is not applied to another medical diagnosis.’’

Gabe Poulos, 22, had breast removal surgery at age 16 and has been on sex hormones for seven years. The Asheville, North Carolina, resident struggled miserably with gender discomfort before his treatment.

Poulos said he’s glad he was able to get treatment at a young age.

“Transitioning under the roof with your parents so they can go through it with you, that’s really beneficial,’’ he said. “I’m so much happier now.’’

In South Carolina, where a proposed law would ban transgender treatments for kids under age 18, Eli Bundy has been waiting to get breast removal surgery since age 15. Now 18, Bundy just graduated from high school and is planning to have surgery before college.

Bundy, who identifies as nonbinary, supports easing limits on transgender medical care for kids.

“Those decisions are best made by patients and patient families and medical professionals,’’ they said. “It definitely makes sense for there to be fewer restrictions, because then kids and physicians can figure it out together.’’

Dr. Julia Mason, an Oregon pediatrician who has raised concerns about the increasing numbers of youngsters who are getting transgender treatment, said too many in the field are jumping the gun. She argues there isn't strong evidence in favor of transgender medical treatment for kids.

“In medicine ... the treatment has to be proven safe and effective before we can start recommending it,’’ Mason said.

Experts say the most rigorous research — studies comparing treated kids with outcomes in untreated kids — would be unethical and psychologically harmful to the untreated group.

The new guidelines include starting medication called puberty blockers in the early stages of puberty, which for girls is around ages 8 to 13 and typically two years later for boys. That's no change from the group's previous guidance. The drugs delay puberty and give kids time to decide about additional treatment; their effects end when the medication is stopped.

The blockers can weaken bones, and starting them too young in children assigned males at birth might impair sexual function in adulthood, although long-term evidence is lacking.

The update also recommends:

—Sex hormones — estrogen or testosterone — starting at age 14. This is often lifelong treatment. Long-term risks may include infertility and weight gain, along with strokes in trans women and high blood pressure in trans men, the guidelines say.

—Breast removal for trans boys at age 15. Previous guidance suggested this could be done at least a year after hormones, around age 17, although a specific minimum ag wasn't listed.

—Most genital surgeries starting at age 17, including womb and testicle removal, a year earlier than previous guidance.

The Endocrine Society, another group that offers guidance on transgender treatment, generally recommends starting a year or two later, although it recently moved to start updating its own guidelines. The American Academy of Pediatrics and the American Medical Association support allowing kids to seek transgender medical treatment, but they don’t offer age-specific guidance.

Dr. Joel Frader, a Northwestern University a pediatrician and medical ethicist who advises a gender treatment program at Chicago’s Lurie Children’s Hospital, said guidelines should rely on psychological readiness, not age.

Frader said brain science shows that kids are able to make logical decisions by around age 14, but they’re prone to risk-taking and they take into account long-term consequences of their actions only when they’re much older.

Coleen Williams, a psychologist at Boston Children’s Hospital’s Gender Multispecialty Service, said treatment decisions there are collaborative and individualized.

“Medical intervention in any realm is not a one-size-fits-all option," Williams said.

___

Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.

___

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.

  • Associated Categories: Associated Press (AP), AP National News, AP Online National News, Top General short headlines, AP Health, AP Health - Children's Health
© Copyright 2022 AccessWDUN.com
All rights reserved. This material may not be published, broadcast, rewritten, or redistributed without permission.
Independent booksellers grew in number, diversity in 2021
Independent booksellers are growing in number and becoming more diverse
11:45AM ( 7 minutes ago )
US report: nearly 400 crashes of automated tech vehicles
Automakers reported nearly 400 crashes of vehicles with partially automated driver-assist systems, including 273 involving Teslas, according to new statistics from U.S. safety regulators
11:23AM ( 28 minutes ago )
Congo official: Rwanda will have war if it wants war
A spokesman for a top military official in eastern Congo said Wednesday that if Rwanda “wants war, it will have war."
11:19AM ( 33 minutes ago )
Associated Press (AP)
Israeli court finds Gaza aid worker guilty on terror charges
An Israeli court has found a Gaza aid worker guilty of several terrorism charges
11:00AM ( 52 minutes ago )
Floods leave Yellowstone landscape 'dramatically changed'
Historic floodwaters that raged through Yellowstone National Park may have permanently altered the course of a popular fishing river and left the sweeping landscape forever changed
10:51AM ( 1 hour ago )
Britain vows more Rwanda deportation flights after setback
The British government is vowing to organize more flights to deport asylum-seekers to Rwanda after a last-minute court judgment grounded the first plane due to take off
10:46AM ( 1 hour ago )
AP National News
Russia targets ammunitions depot in western Ukraine
The Russian military says it has used long-range missiles to destroy a depot in the western Lviv region of Ukraine where ammunition for NATO-supplied weapons was being stored
8:34AM ( 3 hours ago )
Biggest rate hike in years expected as Fed tackles inflation
The Federal Reserve is expected to announce its largest interest rate hike since 1994 — a bigger increase than it had previously signaled and a sign that the central bank is struggling to restrain stubbornly high inflation
8:17AM ( 3 hours ago )
US futures rise ahead of Fed rate hike decision
U.S. markets are poised to rebound ahead of expected action from the Federal Reserve to raise interest rates in its ongoing effort to cool inflation
8:17AM ( 3 hours ago )
AP Online National News
Laxalt's Nevada win sets up fierce race for Senate control
A former Nevada attorney general who has embraced lies about the 2020 election has won the Republican nomination for a pivotal U.S. Senate seat
6:12AM ( 5 hours ago )
Europe stocks up, Asia mixed ahead of Fed rate hike decision
Asian stock markets are mixed while Europe opened higher ahead of a Federal Reserve decision on how sharply to raise interest rates to cool inflation
5:53AM ( 5 hours ago )
Adam Laxalt wins Republican nomination for Nevada Senate
Adam Laxalt has won the Republican nomination for a pivotal Nevada Senate seat, fending off a challenge from a political newcomer and setting up a fierce November contest to topple incumbent Democrat Catherine Cortez Masto in a race that could swing power in the U.S. Senate
3:06AM ( 8 hours ago )
Top General short headlines
High court rules against government on drug reimbursement
The Supreme Court says the federal government improperly lowered drug reimbursement payments to hospitals and clinics that serve low-income communities
10:48AM ( 1 hour ago )
China city mayor apologizes over COVID-19 lockdown response
The mayor of a northeastern Chinese city on the North Korean border has apologized for unspecified failures related to its COVID-19 response
8:45PM ( 15 hours ago )
FDA advisers back Moderna's COVID-19 vaccine for older kids
A government advisory panel has endorsed a second brand of COVID-19 vaccine for school-age children and teens
7:09PM ( 16 hours ago )
AP Health
Lawsuit: Death of Black teen at juvenile center foreshadowed
A federal civil rights lawsuit alleges that the death of a Black teenager at a Kansas juvenile detention center was foreshadowed by a 2016 state inspection of the facility that noted systemic deficiencies in its handling of children with mental health issues
2:25PM ( 1 day ago )
US: Pfizer COVID-19 shot appears effective for kids under 5
A review by federal health officials says that Pfizer's COVID-19 vaccine appears safe and effective for children under 5, the only group not currently eligible for vaccination
9:45PM ( 2 days ago )
US: Pfizer COVID-19 appears effective for kids under 5
A review by federal health officials says that Pfizer's COVID-19 vaccine appears safe and effective for children under 5, the only group not currently eligible for vaccination
8:10PM ( 2 days ago )
AP Health - Children's Health
Independent booksellers grew in number, diversity in 2021
Independent booksellers are growing in number and becoming more diverse
11:45AM ( 7 minutes ago )
US report: nearly 400 crashes of automated tech vehicles
Automakers reported nearly 400 crashes of vehicles with partially automated driver-assist systems, including 273 involving Teslas, according to new statistics from U.S. safety regulators
11:23AM ( 29 minutes ago )
Congo official: Rwanda will have war if it wants war
A spokesman for a top military official in eastern Congo said Wednesday that if Rwanda “wants war, it will have war."
11:19AM ( 33 minutes ago )
Buffalo supermarket gunman charged with federal hate crimes
The gunman who killed 10 Black people in a racist attack at a Buffalo supermarket has been charged Wednesday with federal hate crimes and could face the death penalty
11:09AM ( 43 minutes ago )
Retail sales in May slip 0.3% amid surging inflation
Americans trimmed their spending unexpectedly in May compared with the month before, underscoring how surging inflation on daily necessities like gas is causing them to be more cautious about buying discretionary items
11:09AM ( 43 minutes ago )