Youth record

New Arkansas Law and Similar Bills Put Transgender Youth at Risk, Research Finds

This week, Arkansas became the first state to ban doctors from giving hormones or puberty-delaying drugs to transgender people under the age of 18. Doctors who do so could be forfeited and sued. The law is called the Law on the Safeguarding of Adolescents from Experimentation (SAFE). This became official Tuesday afternoon, when the Republican-controlled state legislature voted to overturn Gov. Asa Hutchinson’s attempted veto.

Nineteen other states have introduced similar legislation, and some of the bills provide for strict penalties. Under the one passed by the Alabama Senate in March, doctors who administer treatment to minors face up to 10 years in prison.

Arkansas bill sponsor Alan Clark said puberty blockers and hormone treatments are “experimental at best and a serious threat to a child’s well-being at worst.” But medical and scientific organizations say his claim is false. They include the American Medical Association, the American Psychological Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry (AACAP), and the Endocrine Society. These groups represent thousands of clinicians and researchers nationwide. Among them, AACAP recently argued that “state legislation regarding the treatment of transgender youth that directly opposes evidence-based care… is a serious concern” that puts young people at risk.

Experts say claims that gender-affirming medical treatments are experimental or risky are wrong on several levels. Puberty blockers, a class of drugs called GnRH agonists that dampen the effects of sex hormones, have been used safely for decades to delay puberty in children who start it too early. In transgender youth, drugs are used to prevent the development of permanent sex characteristics such as breasts and voice changes during the onset of puberty, usually at age nine or older. Gender-affirming hormones (testosterone or estrogen) are usually not given until adolescence. These hormones promote the development of sex characteristics different from those assigned to an individual at birth.

Data is beginning to emerge on the long-term effects of these treatments in young people diagnosed with gender dysphoria, defined as distress resulting from a difference between gender identity and the sex assigned to the individual at birth. , based on a few studies. Teams in the Netherlands and the United States followed groups of transgender adolescents from the start of treatment. So far, this research has shown that hormone treatments and drugs that block puberty are safe.

Importantly, the therapies also reduce the high rate of suicide attempts and mental illness among transgender youth. Such evidence suggests that withholding treatment is not an ethical option, according to Guy T’Sjoen, an endocrinologist at Ghent University in Belgium, who collaborates with the team in the Netherlands. ” It does not matter ; it’s very harmful, ”he says.

The Dutch group was the first to study puberty blockers in transgender children. And Annelou de Vries, a child and adolescent psychiatrist at VU University Medical Center in Amsterdam, says she hasn’t seen major side effects in the 1,500 or so adolescents treated at her clinic. Last June, her team published a study showing that 178 transgender adolescents given blockers had better psychological functioning and fewer suicide attempts, compared to 272 transgender youth who had not received early care.

This is an important finding, says Joshua Safer, an endocrinologist at Mount Sinai Hospital in New York City, given that about 40% of transgender teens consider suicide, according to a national survey. Delaying puberty, he says, is a cautious approach that allows doctors to slow the development of sex characteristics without giving gender-affirming hormones to young adolescents. State laws banning the practice could cost lives, Safer says. “If we really refused to treat people, they would suffer,” he says. “Tackling puberty blockers sounds like sabotage to me.”

The US research team, which is funded by the National Institutes of Health, finds similar results. Its study, which is the largest to prospectively follow transgender youth from the start of treatment, was launched in 2015 and recruited nearly 400 people. About 100 of them are early teens who receive puberty blockers at the average age of 11. And over 300 are late teens receiving hormones. treatment at the average age of 16. In an article published last year, the team found that young people who received treatment at a younger age were in better mental health than those who received it later.

American researchers recognize some confounding factors in the study. Young teens who take puberty blockers tend to have support from their parents, which also helps improve mental health. And it will be many years before they can see effects that don’t appear until old age. Still, “everything we’ve looked at so far is incredibly encouraging,” says Johanna Olson-Kennedy, a pediatrician at Children’s Hospital in Los Angeles, who is leading part of the NIH-funded study.

As their investigation progresses, Olson-Kennedy and her colleagues are trying to get as much information as possible about how gender-affirming treatments affect the body, which will help doctors better target treatment on individuals and what to watch out for. A major medical concern with puberty blockers is their effect on bone growth. Medicines prevent the build-up of bone minerals in growing children, which is why doctors try not to give them to adolescents for a very long time. But a study by the Dutch team found that the bone density of transgender boys returned to normal within a few years. And more recently, the NIH-funded study found that transgender girls tended to have lower bone density before starting treatment, possibly because they were less physically active than cisgender boys their age. .

“It’s true, at the moment there is still a lot of things that we don’t know for sure,” says de Vries. “But if we’re going to wait until we find out everything, we’ll never be there.”

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