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What IS Gender Affirming Health Care For Kids Anyway, Because Texas Is Super F*cking Lying About It Right?
If you ask many a Republican these days, Vladmir Putin invaded Ukraine because some people on Twitter put their pronouns in their bio. If you ask many a know-it-all white guy supposedly "liberal" pundit, they will tell you that one of the only chance we have of winning elections in the future is to "drop all of this culture war stuff" and just throw reproductive rights and trans people under the bus, or just at the very least agree that they should not be allowed to play sports.
Then there are of course the conservatives who try to play like they are reasonable . They don't "hate" trans people, they say, they just think it's not right to just immediately pump every child who questions their gender identity full of hormones and immediately hack off their genitalia, no questions asked. That would, indeed, be an entirely reasonable tack to take if that were actually happening, but it's very definitely not. There is a massive difference in what these people imagine is happening versus what actually is happening.
It would be reasonable if that were the case, but in this particular instance, the mass hysteria has been calling from inside the house.
In actuality, the Gender Affirmative Model is an extremely nuanced approach based on an understanding of human psychology and taking into account what is actually damaging to a child's psyche and what is not. Affirmative therapy has long been the standard of care for LGBTQ patients in general, and did not come out of thin air. It's been especially helpful for TGE (transgender and gender expansive) children as they explore their gender identity and figure out who they are. As it turns out, it can actually be damaging for children to be told, "I don't care what you say, you are a girl!" or "You are a boy!"
The model also draws a distinction between gender expression and gender identity, acknowledging that there are cisgender girls who enjoy activities frequently coded as "for boys" and vice versa. Not only that, it acknowledges that there are trans children who may go the opposite route, desperately trying to force themselves to act like the gender they were assigned at birth.
It's complicated. So it's understandable, to a degree, that people want things to be simple. Everyone would prefer if everything were simple. A big part of the reaction towards the Gender Affirmative Model and trans acceptance in general is "it's just too complicated and I don't like it." People think it would be easier to just tell kids "No." But this can be damaging to them in the long run, and we know this because those who have actually been through it have told us so. This isn't coming out of nowhere.
In this model, gender health is defined as a child’s opportunity to live in the gender that feels most real or comfortable to that child and to express that gender with freedom from restriction, aspersion, or rejection. Children not allowed these freedoms by agents within their developmental systems (e.g., family, peers, school) are at later risk for developing a downward cascade of psychosocial adversities including depressive symptoms, low life satisfaction, self-harm, isolation, homelessness, incarceration, post-traumatic stress, and suicide ideation and attempts.
What this means is that if a kid wants to present as another gender and be known by a name that suits that gender, that's better for them in the long run even if they later turn out to be a desister.
Contrary to popular belief (i.e., shit people just made up), the GAM does make distinctions between "desisters" (those who are just exploring their gender identity and may go through phases) and "persisters," those for whom this is a fixed aspect of their identity. And at this point, they've become pretty good at differentiating between the two.
The major premises informing our modes of practice include: (a) gender variations are not disorders; (b) gender presentations are diverse and varied across cultures, therefore requiring our cultural sensitivity; (c) to the best of our knowledge at present, gender involves an interweaving of biology, development and socialization, and culture and context, with all three bearing on any individual’s gender self; (d) gender may be fluid, and is not binary, both at a particular time and if and when it changes within an individual across time; (e) if there is pathology, it more often stems from cultural reactions (e.g., transphobia, homophobia, sexism) rather than from within the child.
There's a lot of nuance here. It really isn't this bizarre conservative fantasy nightmare — one that Texas Attorney General Ken Paxton claims is happening and is not happening — where doctors say, "Oh, your four-year-old says they're a different gender than they were assigned at birth, so we're going to hack off their genitalia and pump them full of hormones." Rather, health care for trans children involves allowing them to express themselves and their gender in whatever way they feel is appropriate — a haircut, a name change, different clothes — without enacting any major changes. The most "extreme" thing that might be offered to children who are likely to be "persisters" are puberty blockers, which are entirely reversible and just give them time to figure out who they are before going through puberty and developing the secondary sex characteristics of what may be the wrong gender. Under current guidelines, hormone therapy, if started, is not prescribed until age 16 and that happens if and only if it is clear that the child is a persister. Statistically, only about 10 to 30 percent of children who experience gender variance "persist" after puberty.
Studies have shown that those who have received puberty blockers and, later, those who have received hormone therapy, have been happy with their decision, experience improvements to their mental health — and most importantly, do not regret their decision.
In their longitudinal study on the first 70 adolescents to receive puberty blockers, de Vries and colleagues reported an improvement in general functioning after two years, along with a decrease in depression and behavioural and emotional difficulties. Fifty-five of these 70 individuals were assessed later in early adulthood, after cross-sex hormones had been administered and gender reassignment surgery had been performed. Depressive symptoms had decreased, general mental health functioning had improved and no regret about transitioning was found.
The Gender Affirmative Model is based both on what psychologists understand are the best practices for care of individuals as well as conversations with adult transgender people about what would have helped them in childhood and what they needed from those whose job it was to care for them. It did not come out of nowhere.
Rightwing culture warriors are threatening to take children from their parents for the foulest kind of politics, declaring without any basis in law that healthcare for children is "abuse," so they can rile up their base with terrible libels and lies. And they need to stop.
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