New transgender standards remove age limits

Gigi LaRue’s daughter was 13 when she told her mom she was really a boy. The girl dealt with a host of mental health issues—anxiety, stress and depression. Like many of her peers, she attributed them to being transgender.

LaRue (who’s using a pseudonym to protect her daughter’s identity) says she and her husband soon made an appointment with a clinic that specialized in gender dysphoria. After the one-hour session, they walked out with instructions to buy their daughter a chest binder and consider hormone therapy. LaRue was flabbergasted.

“I was like, do you have any questions about her mental health?” she said. LaRue wasn’t sure the clinic would pay attention to her daughter’s underlying problems, so she sought out other doctors.

LaRue’s experience is not uncommon, but a new set of transgender health guidelines published last month might make the advice she received standard practice across the country.

The “Standards of Care for the Health of Transgender and Gender Diverse People,” published by the World Professional Association of Transgender Health (WPATH), now say children can receive puberty blockers, cross-sex hormones and possibly surgery all before they turn 18. The association removed age minimums from its recommendations for prescribing puberty blockers. It also suggested doctors prescribe hormones as soon as girls and boys notice their bodies changing.

Other medical organizations such as the Endocrine Society have made similar recommendations, but WPATH’s standards carry a particular significance because dozens of U.S.-based adolescent and children’s providers consider the organization’s recommendations the gold standard for youth struggling with gender identity issues. The Levine Children’s Center for Gender Health in Charlotte, N.C., for example, calls WPATH’s guidelines the “highest standards of care.”

But some doctors and parents are sounding the alarm about the recommendations.

Dr. André Van Mol is a family physician in California and co-chair of the American College of Pediatrician’s Committee on Adolescent Sexuality. He says the association’s recommendations ignore a large body of research, specifically studies done in Europe that directly challenge the assumption that puberty blockers and hormones improve a transgender patient’s quality of life. As an example, he pointed to a study published in 2019 that followed more than 2,000 Swedes for 10 years after their surgery to change their sex characteristics. The study found those who had surgery were no better off than those who had not. Additionally, independent reviews done in the U.K. by Hilary Cass and the National Institute of Health and Care Excellence likewise concluded little evidence exists showing the benefits of puberty blockers and cross-sex hormones in youth.

“Gender affirmation is not proven long-term safe, not proven long-term effective, not shown to improve mental health, and does not reduce suicides,” Van Mol said.

In the United States, neither puberty blockers nor sex hormones are approved by the Food and Drug Administration for children’s gender care. The National Institutes of Health said there’s limited evidence about long-term effects.

The WPATH policies also frown on family members who challenge a child’s newfound gender identity or encourage a child to conform to his biological sex. In a section discussing the timing of puberty blockers, the policy welcomes parents “unless their involvement is determined to be harmful or unnecessary to the adolescent.” In cases where parents are “too rejecting” of their child’s wishes, WPATH’s policy says “youth may require the engagement of larger systems of advocacy and support to move forward with the necessary support and care.”

All of this leaves parents like Erin Friday in a bind.

When Friday’s daughter announced that she was polyamorous in sixth grade and then transgender in seventh grade, she chalked it up to California’s aggressive sex education program. As a progressive Democrat, Friday initially accepted the trend. But she grew concerned when she heard recommendations that children as young as her daughter could receive puberty blockers and cross-sex hormones. Many of their recommendations, she said, had discounted the child’s overall needs and the parent’s voice.

“How is it medically necessary when the kid is in the driver’s seat?” she asked.

LaRue, whose daughter continues to struggle with gender identity, wishes all children realized that the natural changes that come with growing up are tough.

“I believe kids should have to go through puberty,” she said. “It’s not violence, it’s nature. The hubris that we can outwit nature is astonishing to me.”

Despite the transgender association’s recommendations, Van Mol, who’s also a member of the Christian Medical and Dental Associations, had some reassuring words for parents. He said the majority of kids who struggle with gender dysphoria will turn out OK without hormones or surgery. Most eventually move away or “desist” from those feelings, he said. Doctors who truly want to help these patients should prioritize their mental health concerns.

“If most of this goes away by adulthood, and there are underlying problems, then it stands to reason, addressing the underlying problems will help with the desistance,” he said.

That’s ultimately what happened to Friday’s daughter. After playing with the transgender label briefly, she is back to being a normal teenage girl.