In April, Children's Minnesota launched its pediatric Gender Health Program. In apparent response, a recent commentary in the Star Tribune ("We may look back and ask: What were we thinking?" June 21) contended that gender programs promote risky, unnecessary and experimental treatments. As medical professionals and researchers with expertise in adolescent health, we strongly disagree.
Transgender and nonbinary youths experience persistent and significant distress when forced to conform to the gender they were assigned at birth. They face substantial health disparities, with higher rates of depression, suicide attempts, substance use, bullying and unprotected sexual encounters than their cisgender (i.e., not transgender) peers. However, research shows that these health outcomes are related to stigma, rather than the simple fact of being transgender or nonbinary. This is a subtle, but critical, distinction: Negative health outcomes are not intrinsic to being trans and nonbinary. Rather, daily experiences of discrimination and harassment lead to poor health outcomes.
Yet, transgender and nonbinary youths are not destined to suffer from depression or suicide. In fact, when supported in their gender identity, they do well, with levels of depression similar to their cisgender peers. This presents a wonderful opportunity: If families, schools and health care providers support young people in their gender identity, we can help transgender and nonbinary youths do more than simply survive. We can help them thrive.
In some cases, supporting children and adolescents in their gender identity includes medical interventions. This is not taken lightly, and providers who offer these services follow recommendations established by leading medical organizations, such as the World Professional Association for Transgender Health. The American Academy of Pediatrics, the largest professional organization of pediatricians in the U.S. and which represents more than 67,000 pediatricians, also supports medically appropriate interventions for gender affirming care. Children and adolescents who are interested in gender affirming care are evaluated by a multidisciplinary team, including mental health and medical professionals, to help families prepare for and understand what this care may look like. We start with reversible interventions, such as changes in gender expression, including clothing choice or makeup, and sometimes using different names or pronouns. Reversible interventions can also include medications called puberty blockers. Puberty blockers have been used for decades in pediatrics, primarily for precocious (early) puberty, and since the early 2000s have also been used to "pause" puberty for young people who experience gender dysphoria.
For adolescents who are experiencing significant distress from the onset of puberty, puberty blockers give families time to explore gender identity without the added stress of progressing through unwanted body changes. Pediatricians agree that puberty blockers are safe and reversible medications. The majority of side effects are mild and transient. The most significant side effect, slower accrual of bone density, should resolve once an adolescent progresses through puberty. If an adolescent decides not to pursue gender transition, they can stop puberty blockers, and puberty will resume at its previous pace.
If an adolescent does want to pursue gender transition, gender affirming hormones are an option. These are considered partly reversible: some, but not all, of the effects of hormones reverse when an individual stops taking them. As with all medications, gender affirming hormones do carry certain risks. However, the risks are minimal, especially compared to the known effects of untreated gender dysphoria, i.e., depression or suicide. We take special care to ensure that adolescents and their parents or guardians are aware of the benefits, risks, and alternative treatments available to them. Nonreversible interventions, such as surgical interventions, are not routinely offered to adolescents under age 18.
The medical and research community supports gender affirming medical care as a powerful tool to improve the lives of children and adolescents who are transgender or nonbinary. There is ample and growing evidence that children and adolescents have better health outcomes when they are supported in their gender, which includes access to medical interventions when appropriate. As clinicians and pediatric researchers, we firmly support expanding access to gender affirming care for youth. When we look back on the decision to open gender affirming clinics, we will say thank you for giving adolescents the support they need to become thriving adults.
Kathleen Miller is a board-certified pediatrician and current fellow in adolescent medicine in the Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. She is also a member of the Minnesota chapter of the American Academy of Pediatrics. Marla Eisenberg is an associate professor and the director of research in the same division at the university. Amy Gower is a research associate there. G. Nic Rider is an assistant professor and licensed psychologist at the Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School.
