Transgender teenagers who begin gender-affirming treatments using puberty blockers are overwhelmingly unlikely to discontinue hormone replacement therapy moving forward, according to a new study published Thursday in )" href="https://urldefense.com/v3/__http://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/fulltext__;!!LsXw!UzWCmWe0242KsA57-FhcMRUwMU-i5r82jxnIA7GBUqcoHFl9HofNQft7nw126qkTCNRGpDl05tWqdHN9oQJzhEv6O3A$">according to a new study published Thursday in The Lancet)" href="https://urldefense.com/v3/__http://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/fulltext__;!!LsXw!UzWCmWe0242KsA57-FhcMRUwMU-i5r82jxnIA7GBUqcoHFl9HofNQft7nw126qkTCNRGpDl05tWqdHN9oQJzhEv6O3A$">The Lancet.
The gender identity clinic of the Amsterdam UMC hospital center in the Netherlands conducted the study, recruiting 720 adolescent patients who had been diagnosed with gender dysphoria and prescribed puberty blockers. Of the cohort, 98 percent (704 patients) reported continued use of hormone replacement therapy in a follow-up after starting.
“To our knowledge, this study is the first to assess continuation of gender-affirming hormones in a large group of transgender individuals who started medical treatment with puberty suppression in adolescence,” the study said.
ADVERTISEMENT
These results run contrary to one of the major political talking points against gender affirming care for transgender youth: that kids, when given time and space, largely move past gender dysphoria. This false narrative has been used to justify bans for gender affirming care, despite this study confirming past research about transgender youth who seek medical transitions for gender dysphoria.
Due to data collection limitations, there is no conclusive data that the patients stopped pursuing hormone treatment due to regret or desire to de-transition. The study’s authors speculated those who stopped could have done so due to non-binary gender identities, satisfaction in their medical transition, lack of knowledge about continued care following gender confirmation surgery, or cost.
“The key message [of the study] is that the majority of people, who went through a thorough diagnostic evaluation prior to starting treatment, continued gender-affirming hormones at follow-up,” Dr. Marianne van der Loos, a physician at Amsterdam UMC and a co-author of the study, told The Daily Beast. “This is reassuring regarding the recent increased public concern about regret of transition.”
Opponents of gender affirming care frequently cite a 2011 study that showed most adolescents followed in a cohort had gender dysphoria “desist” after time, or return to identifying as the gender they were assigned at birth rather than “persisting” in the gender they self-identify as, when advocating for a ban on gender affirming care until the age of 18. However, the study has routinely been criticized for its lax methodology, and flawed reporting thresholds and mechanisms.
Critics also point to supposed “social-contagion,” or a lack of oversight in prescribing hormone replacement therapy, when arguing against its prevalence. However, studies continue to show the “social-contagion” theory is a false narrative around transgender identities. Currently, the World Professional Association for Transgender Health suggests using a multidisciplinary approach of care that includes psychiatric assessments, and regular monitoring of hormone levels when determining when to offer transgender adolescents hormone replacement therapy and puberty suppression. This approach helps cut down on any medical complications that could arise from hormone therapy, while helping patients better understand what a medical transition can give them and if it is the right approach.
The authors of the latest Dutch study went to great lengths to highlight how patients received continued multidisciplinary assessments before starting—and when choosing to continue—hormone replacement therapy.
The study comes at a precarious time for the fate of gender-affirming care for minors in the United States and United Kingdom. Both countries have seen a rise in politicians seeking to use state intervention to limit the access of gender affirming care for transgender teenagers.
Arkansas was the first state in the U.S. to pass a law banning all gender-affirming care for minors. That law is currently being challenged in court. Several more states have followed suit with their own laws or executive actions aimed at barring transgender adolescents from receiving care.
In an especially pernicious move, Texas authorities have designated providing gender-affirming care as child abuse, leading to investigations from the state’s Department of Family and Protective Services into familes with transgender kids. The legality of the directives from the state’s Governor Greg Abbott and Attorney General Ken Paxton, is still being decided in the courts, although DFPS has confirmed investigations into at least 11 families.
Dr. Jack Turban, an assistant professor of child and adolescent psychiatry at The University of California, San Francisco who researches the mental health of transgender youth, told The Daily Beast the results from this study largely confirm past research into the usefulness of treatments like puberty blockers before hormone therapy, and that current guidelines requiring holistic assessments before beginning treatments are important in educating patients. With such guidelines in place, patient regret for these treatments remains low, despite misinformation from policymakers.
“I hope that studies such as these, and other past studies that had similar findings, will make their way to policymakers’ desks so we can have evidence-based public policy that promotes the health and wellbeing of young people,” Turban said.
Dr. Turban added that it’s important that those who are crafting laws about access to gender affirming care properly understand the landscape for adolescents and the mental and physical health risks they face when misinformation is prevalent.
“I worry that the recent political misinformation about trans youth, their medical care, and the reality of their lives, is creating psychological harm to these young people,” he said. “I suspect the mental health impacts of these media and political environments will be studied by psychiatric epidemiologists in future years, and I worry what the results will show in terms of the negative impact these conversations have had on public mental health.”
