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1/ THREAD: evidence surrounding healthcare for #trans young people, particularly focussed on puberty blockers, none of which was considered during the judicial review or NHS decision today*
This is a huge thread, and it's only a selection of the research. I pared down, HARD
This is a huge thread, and it's only a selection of the research. I pared down, HARD
2/ Kelly, 2016; ‘The Court Process Is Slow but Biology Is Fast’: Assessing the Impact of the Family Court Approval Process on Transgender Children and Their Families
link: https://doi.org/10.2139/ssrn.2793664 (this one is particularly salient right now)
link: https://doi.org/10.2139/ssrn.2793664 (this one is particularly salient right now)
3/ Key findings: "Australian adolescents experiencing gender dysphoria must obtain Family Court approval before they can commence cross-sex hormone treatment that will enable them to develop the pubertal characteristics of their chosen sex.
4/ The Court approval process imposes a significant and harmful burden on children and their families that far outweighs any risks associated with permitting parents to consent to treatment."
5/ Costa et al, 2015; Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria
link: https://doi.org/10.1111/jsm.13034
link: https://doi.org/10.1111/jsm.13034
6/ Key findings: "GD adolescents receiving also puberty suppression had significantly better psychosocial functioning after 12 months compared with when they had received only psychological support "
7/ Turban et al, 2020; Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation
link: https://doi.org/10.1542/peds.2019-1725
link: https://doi.org/10.1542/peds.2019-1725
8/ Key findings: "There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment.
9/ These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes."
10/ Ehrensaft, 2017; Gender nonconforming youth: current perspectives
link: https://doi.org/10.2147/AHMT.S110859
link: https://doi.org/10.2147/AHMT.S110859
11/ Key findings: "The minimal age for being eligible for [puberty blockers] may vary among approaches and indeed among clinics adopting the same approach, but there is common agreement that these treatments are in the best interests of the child"
12/ Rosenthal, 2016; Transgender youth: current concepts
link: https://doi.org/10.6065/apem.2016.21.4.185
link: https://doi.org/10.6065/apem.2016.21.4.185
13/ key findings: "This treatment [puberty blockers] is fully reversible and allows additional time for gender exploration without the pressure of ongoing pubertal development. The physical changes of puberty, once completed, cannot be reversed."
14/ Panagiotakopoulos et al, 2020; The effect of early puberty suppression on treatment options and outcomes in transgender patients
link: https://www.nature.com/articles/s41585-020-0372-2
link: https://www.nature.com/articles/s41585-020-0372-2
15/ Key findings: "Most if not all of the non-genital surgeries are redundant for patients who have had access to puberty suppression in early adolescence."
16/ "Benefits of puberty blockade on mental health include the absence of unwanted secondary sexual characteristics, many of which are irreversible and require surgery for even partial reversibility once they have developed.
17/ Prevention, if possible, is preferable to treatment, as these unwanted, dysphoric secondary sexual characteristics can contribute to the psychosocial sequelae of untreated gender dysphoria"
18/ Agana et al, 2016; Caring for the transgender adolescent and young adult: Current concepts of an evolving process in the 21st century
link: https://doi.org/10.1016/j.disamonth.2019.07.004
link: https://doi.org/10.1016/j.disamonth.2019.07.004
19/ Key findings: "Therapies that suppress puberty allow the patient to further explore their gender dysphoria/incongruity, and prohibit the development of undesirable secondary sex characteristics.
20/ The progression of secondary sex characteristics can cause further psychological distress and require more invasive measures in the future if this person pursues gender confirming surgery."
21/ Ashley, 2019; Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth
link: https://doi.org/10.1177/1359104519836462
link: https://doi.org/10.1177/1359104519836462
22/ Key findings: "Unbounded social transition and ready access to puberty blockers ought to be treated as the default option, and support should be offered to parents who may have difficulty accepting their youth."
23/ Hembree, 2013; Management of juvenile gender dysphoria
link: https://doi.org/10.1097/01.med.0000436193.33470.1f
Key findings: "Protocols and results of treatment of early adolescents have demonstrated that the harmful effects of persistent gender dysphoria can be prevented.
link: https://doi.org/10.1097/01.med.0000436193.33470.1f
Key findings: "Protocols and results of treatment of early adolescents have demonstrated that the harmful effects of persistent gender dysphoria can be prevented.
24/ Pubertal suppression in early puberty not only prevents the severe distress, but also allows healthy adolescent development living in the appropriate gender."
25/ Schagen et al, 2016; Efficacy and Safety of Gonadotropin-Releasing Hormone Agonist Treatment to Suppress Puberty in Gender Dysphoric Adolescents
link: https://doi.org/10.1016/j.jsxm.2016.05.004
Key findings: "Triptorelin effectively suppresses puberty in gender dysphoric adolescents.
link: https://doi.org/10.1016/j.jsxm.2016.05.004
Key findings: "Triptorelin effectively suppresses puberty in gender dysphoric adolescents.
26/ These data suggest routine monitoring of gonadotropins, sex steroids, creatinine, and liver function is not necessary during treatment with triptorelin."
27/ Hembree et al, 2017; Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline
link: https://doi.org/10.1210/jc.2017-01658
link: https://doi.org/10.1210/jc.2017-01658
28/ key findings: "We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists"
29/ Kreukels & Cohen-Kettenis, 2011; Puberty suppression in gender identity disorder: the Amsterdam experience
link: https://doi.org/10.1038/nrendo.2011.78
link: https://doi.org/10.1038/nrendo.2011.78
30/ Key findings: "[denying puberty blockers] is irreversible: the adolescents will never know how puberty in accordance with their gender identity will be, because that is made impossible by the effects of their own sex hormones.
31/ "Transsexual adolescents often consider not experiencing the puberty of their desired sex more harmful than missing their natal puberty."
32/ "As puberty suppression therapy generally results in a physical appearance that makes it possible to live unobtrusively in the desired gender role, withholding GnRHa treatment is also harmful because of the potential life-long social consequences (such as stigmatization)."
33/ Cohen-Kettenis et al, 2008; The Treatment of Adolescent Transsexuals: Changing Insights
link: https://doi.org/10.1111/j.1743-6109.2008.00870.x
link: https://doi.org/10.1111/j.1743-6109.2008.00870.x
34/ "In judging the desirability of hormonal pubertal suppression as a first but reversible phase in the sex reassignment procedure, one should not only take consequences of the intervention into account. Rather, one should also consider the consequences of nontreatment.
35/ Nonintervention is not a neutral option, but has clear negative life‐long consequences for the quality of life of those individuals who had to wait for treatment until after puberty. This implies that “in dubio abstine” may actually be harmful."
36/ Panagiotakopoulos, 2018; Transgender medicine - puberty suppression
link: https://doi.org/10.1007/s11154-018-9457-0
link: https://doi.org/10.1007/s11154-018-9457-0
37/ Key findings: "successful early puberty blockage has been demonstrated to allow time for the proper psychological evaluation of patients as they first present to medical care, improve functioning in several cognitive and social domains in gender dysphoric adolescents…
38/ …undergoing treatment, and facilitate achieving more desirable cosmetic results after full physical transition."
39/ de Vries et al, 2014; Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment
link: https://doi.org/10.1542/peds.2013-2958
Key findings: "A treatment protocol including puberty suppression leads to improved psychological functioning of transgender adolescents.
link: https://doi.org/10.1542/peds.2013-2958
Key findings: "A treatment protocol including puberty suppression leads to improved psychological functioning of transgender adolescents.
40/ While enabling them to make important age-appropriate developmental transitions, it contributes to a satisfactory objective and subjective well-being in young adulthood."
41/ de Vries et al, 2011; Psychiatric comorbidity in gender dysphoric adolescents
link: https://doi.org/10.1111/j.1469-7610.2011.02426.x
Key findings: "Delayed eligibility for medical interventions is associated with psychiatric comorbidity although other factors are of importance as well."
link: https://doi.org/10.1111/j.1469-7610.2011.02426.x
Key findings: "Delayed eligibility for medical interventions is associated with psychiatric comorbidity although other factors are of importance as well."
42/ Vance et al, 2014; Psychological and Medical Care of Gender Nonconforming Youth
link: https://doi.org/10.1542/peds.2014-0772
link: https://doi.org/10.1542/peds.2014-0772
43/ Key findings: "Providing sensitive health care, optimizing physical transitions that enable GN youth to live more comfortably as their true gender selves, and promoting societal gender acceptance are 3 goals we can work toward to help these youth thrive"
44/ van der Miesen et al, 2020; Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers
link: https://doi.org/10.1016/j.jadohealth.2019.12.018
link: https://doi.org/10.1016/j.jadohealth.2019.12.018
45/ Key findings: "Adolescents show poorer psychological well-being before treatment but show similar or better psychological functioning compared with cisgender peers from the general population after the start of specialized transgender care involving puberty suppression."
46/ Turban & Keuroghlian, 2018; Dynamic gender presentations: Understanding transition and “de-transition” among transgender youth.
47/ link: https://doi.org/10.1016/j.jaac.2018.03.016
Key findings: "The risk of preventing social and/or medical transition for those with significant gender-related distress almost always outweighs the risk of regret in a small minority of patients who receive gender-affirming medical care.
Key findings: "The risk of preventing social and/or medical transition for those with significant gender-related distress almost always outweighs the risk of regret in a small minority of patients who receive gender-affirming medical care.
48/ The process of going from he-series pronouns to she-series pronouns and back again is not inherently dangerous. Puberty blockers can be stopped, and natal puberty will progress."
49/ Turban & Ehrensaft, 2017; Research Review: Gender identity in youth: treatment paradigms and controversies
link: https://doi.org/10.1111/jcpp.12833
link: https://doi.org/10.1111/jcpp.12833
50/ Key findings: "These youth suffer disproportionately high rates of anxiety, depression, and suicidality... affirmative treatment protocols may improve the high rates of mental health difficulties seen among these patients"
51/ Jessen & Roen, 2019; Balancing in the margins of gender: Exploring psychologists’ meaning-making in their work with gender non-conforming youth seeking puberty suppression.
52/ link: https://doi.org/10.1080/19419899.2019.1568290
Key findings: "Participants deploy affirmative and exploratory therapeutic strategies in their work, in order to enable gender non-conforming youth to make informed decisions regarding puberty suppression.
Key findings: "Participants deploy affirmative and exploratory therapeutic strategies in their work, in order to enable gender non-conforming youth to make informed decisions regarding puberty suppression.
53/ Participants emphasized the importance of therapeutic approaches that explore non-binary gender discourses, alongside the use of puberty suppression"
54/ Clark et al, 2020; Hormone therapy decision-making processes: Transgender youth and parents
link: https://doi.org/10.1016/j.adolescence.2019.12.016
link: https://doi.org/10.1016/j.adolescence.2019.12.016
55/ Key findings: "Health care providers should be aware of the deliberation and information-seeking in which youth engage prior to seeking care as well as the temporally misaligned decision-making processes of youth and parents.
56/ Understanding the challenges trans youth experience due to insufficient parental support and system barriers can provide important context for health care providers striving to provide accessible, gender-affirming care and decision-making support for trans youth."
57/ Daley et al, 2019; Decision-Making About Gender-Affirming Hormone Therapy.
link: https://doi.org/10.1016/j.jadohealth.2019.02.018
link: https://doi.org/10.1016/j.jadohealth.2019.02.018
58/ Key findings: "Ultimately, for both parents and adolescents, the benefits of treatment outweigh any concerns, and they are in agreement about the goals of personal confidence, comfort in one's body and happiness."
59/ There are so many more studies than just these, I've really narrowed it down to puberty blockers alone. If you want to see more, a large and easy to navigate database is kept at http://bit.ly/transpapers
