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wishIwere t1_iuan4bz wrote

It's gender dysphoria and the standards of care are set by a multidisciplinary organization that includes psychologists, endocrinologists, pediatricians, researchers and other medical and non-medical stakeholders called World Professional Association for Transgender Health (WPATH). The most recent standards of care can be found here. The recomended standards of treatment are thus:
>6.1- We recommend health care professionals working with gender diverse adolescents:
6.1.a- are licensed by their statutory body and hold a postgraduate degree or its equivalent in a clinical field relevant to this role granted by a nationally accredited statutory institution.
6.1.b- receive theoretical and evidenced-based training and develop expertise in general child, adolescent, and family mental health across the developmental spectrum.
6.1.c- receive training and have expertise in gender identity development, gender diversity in children and adolescents, have the ability to assess capacity to assent/consent, and possess general knowledge of gender diversity across the life span.
6.1.d- receive training and develop expertise in autism spectrum disorders and other neurodevelopmental presentations or collaborate with a developmental disability expert when working with autistic/neurodivergent gender diverse adolescents.
6.1.e- Continue engaging in professional development in all areas relevant to gender diverse children, adolescents, and families.
6.2- We recommend health care professionals working with gender diverse adolescents facilitate the exploration and expression of gender openly and respectfully so that no one particular identity is favored.
6.3- We recommend health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner.
6.4- We recommend health care professionals work with families, schools, and other relevant settings to promote acceptance of gender diverse expressions of behavior and identities of the adolescent.
6.5- We recommend against offering reparative and conversion therapy aimed at trying to change a person’s gender and lived gender expression to become more congruent with the sex assigned at birth.
6.6- We suggest health care professionals provide transgender and gender diverse adolescents with health education on chest binding and genital tucking, including a review of the benefits and risks.
6.7- We recommend providers consider prescribing menstrual suppression agents for adolescents experiencing gender incongruence who may not desire testosterone therapy, who desire but have not yet begun testosterone therapy, or in conjunction with testosterone therapy for breakthrough bleeding.
6.8- We recommend health care professionals maintain an ongoing relationship with the gender diverse and transgender adolescent and any relevant caregivers to support the adolescent in their decision-making throughout the duration of puberty suppression treatment, hormonal treatment, and gender- related surgery until the transition is made to adult care.
6.9- We recommend health care professionals involve relevant disciplines, including mental health and medical professionals, to reach a decision about whether puberty suppression, hormone initiation, or gender-related surgery for gender diverse and transgender adolescents are appropriate and remain indicated throughout the course of treatment until the transition is made to adult care.
6.10- We recommend health care professionals working with transgender and gender diverse adolescents requesting gender-affirming medical or surgical treatments inform them, prior to initiating treatment, of the reproductive effects including the potential loss of fertility and available options to preserve fertility within the context of the youth's stage of pubertal development.
6.11- We recommend when gender-affirming medical or surgical treatments are indicated for adolescents, health care professionals working with transgender and gender diverse adolescents involve parent(s)/guardian(s) in the assessment and treatment process, unless their involvement is determined to be harmful to the adolescent or not feasible. The following recommendations are made regarding the requirements for gender-affirming medical and surgical treatment (All of them must be met):
6.12- We recommend health care professionals assessing transgender and gender diverse adolescents only recommend gender-affirming medical or surgical treatments requested by the patient when:
6.12.a- the adolescent meets the diagnostic criteria of gender incongruence as per the ICd-11 in situations where a diagnosis is necessary to access health care. In countries that have not implemented the latest ICd, other taxonomies may be used although efforts should be undertaken to utilize the latest ICd as soon as practicable.
6.12.b- the experience of gender diversity/incongruence is marked and sustained over time.
6.12.c- the adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.
6.12.d- the adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed.
6.12.e- the adolescent has been informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility, and these have been discussed in the context of the adolescent’s stage of pubertal development.
6.12.f- the adolescent has reached tanner stage 2 of puberty for pubertal suppression to be initiated.
6.12.g- the adolescent had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated

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Mordcrest t1_iubnble wrote

Two parts of this confuse me

>6.1.c- receive training and have expertise in gender identity development, gender diversity in children and adolescents, have the ability to assess capacity to assent/consent, and possess general knowledge of gender diversity across the life span.
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>6.12.c- the adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.

So if they are treating a minor, someone under the age of 16 even, why is their consent possible for a procedure like this, or hormone therapy, even though they can't legally consent to sex, drinking alcohol, smoking, or gambling? Why are they considered mature enough, or able to be assessed for consent, if they cannot, at that same age, consent to many other things with life altering consequences less severe in some cases, than these treatment procedures?

Genuine question, since I am confused what separates them.

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iam666 t1_iubsm9b wrote

Because the law requires an arbitrary limit in order to apply it to everyone equally. It’s not like on your 18th birthday you’re magically a mature adult who can be trusted to sign a mortgage. But medical care requires a much more individual approach which varies person to person. Someone who is 16 could be evaluated by a professional (who has “the ability to assess capacity to assent/consent”) to determine if they understand the situation and are of sound mind to make the decision.

This is by far a more effective way of determining one’s ability to consent. But they’re not going to have you get a professional examination every time you go to the bank for a loan. They just make sure you’re 18+ and assume you’re capable.

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Greyswandir t1_iubpb7k wrote

Informed consent and legal ability to make certain decisions are different concepts. And in the cases you list the key difference is giving consent for a medical procedure which may have drawbacks but which may have upsides too, and asking the patient to weigh those aspects before deciding. Whereas the things you listed that a teenager cannot do are generally not seen as having a benefit to the teen.

Informed consent is more or less exactly what it sounds like. It’s the idea that a thing is explained to you in a manner you can understand and then you agree to it. It’s a thing that can be given even by very young children for example. It’s also a thing that an adult may not be able to give, for example if they have certain developmental disabilities. A large chunk of medicine and medical research is built around the idea of informed consent. The idea that the patient needs to have medical procedures explained to them in a manner they can understand before they agree so that they can make their own judgements about if the risk is worth the potential gain.

The other things you mention have to do with legality, which is a policy rather than scientific construct. For the examples you listed the idea is that those are things we generally don’t want children doing because they are 1) addictive and 2) bad for you. The age cutoff is the age at which we as a society will let you make your own self-destructive choices.

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overlordpotatoe t1_iubsgko wrote

It's a cost/benefit thing. There's no benefit to a teen smoking, drinking alcohol, gambling, etc. and no professionals trained to assess which teens are and aren't mature enough to make decisions about those things. This would be better compared to other medical treatments than to things that have no benefit other than personal enjoyment and no professional oversight. Teenagers are often allowed input on their medical treatment.

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finalmantisy83 t1_iuboclz wrote

The most basic answer would be that individuals are generally able to come to conclusions about their identity before they are about drug or alcohol use.

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wolfie379 t1_iubn2gs wrote

Don’t forget that the doctors have to operate under laws made by politicians with zero medical knowledge but plenty of fossilized opinions, so that in some jurisdictions following what panels of experts have decided are best practices can get a doctor thrown in jail and/or banned from practicing medicine. Recent law in Florida is a prime example.

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libertyandfreedom22 t1_iubezwf wrote

Any reason a lot of doctors don’t seem to follow this protocol?

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MeiNeedsMoreBuffs t1_iubg3ey wrote

Keep in mind that doctors are still human, and humans are susceptible to biases, misinformation, and politics. A lot of doctors chose not to treat patients suffering from AIDS in the 80s for example.

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aphilsphan t1_iubtsxf wrote

But the protocol seems to indicate they SHOULDN’T treat trans adolescents. Because most family doctors won’t have the right training. What most doctors should actually do is refer their patients to someone with proper training.

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[deleted] t1_iublf9r wrote

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hmantegazzi t1_iubtfjq wrote

the WPATH standards have been very recently updated in a very comprehensive fashion, so there might be a number of assessments about the previous version still circulating, that point at weaknesses that don't exist anymore.

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[deleted] t1_iublvtq wrote

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LupinKira t1_iubrcd2 wrote

This suggests a narrative that is both inaccurate to the reality of the situation and disingenuous to the data we have. Regret rates are very low (<5%) for individuals who undergo hormone replacement therapy or other gender affirming therapies: https://www.genderhq.org/trans-youth-regret-rates-long-term-mental-health

Furthermore, doctors aren't hesitant to prescribe gender-affirming care because it's "forefront" or "experimental" and they don't want the risk. Doctors who don't want to provide gender affirming care are uncomfortable with it because they're uncomfortable with the concept of trans people to begin with. Trans people in the US get refused not only gender-affirming care, but also general care at a staggering rate (>40%): https://www.americanprogress.org/article/protecting-advancing-health-care-transgender-adult-communities/

This narrative frequently parroted about how minors shouldn't have access to gender affirming treatments because they're going to regret it later is also indicative of a lack of understanding of trans people as a population. People don't just "trans their gender" on a whim. Even as an adult who openly identifies as transgender and is socially accepted the act of going on hormones can be extremely difficult. People don't change their entire social identity and open themselves up to mass discrimination and bigotry for a kick, they do it because it's the only way for them to live.

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ReplyingToFuckwits t1_iubsw81 wrote

> You don’t want be the doctor standing in court in 5-10 years when the child turns into an adult and happens to regret their choice of undergoing surgery or hormone therapy.

Very few people regret it. Of those who do, they predominantly talk of social issues such as bullying, violence and discrimination. Only a tiny fraction of people stop identifying as trans.

This is something that has been studied and shouldn't be handwaved away so you can make a point on social media.

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aLittleQueer t1_iubpczu wrote

> it’s on the frontier

It’s not, though. There is nothing new or experimental about any medical care being offered to trans kids or teens, It’s just newly present in the broader cultural awareness.

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[deleted] t1_iubmkql wrote

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iam666 t1_iubrlf9 wrote

What do you mean “advocacy group”? They’re medical professionals who construct guidelines on how to treat patients with a certain condition. There’s a bunch of groups just like this who make guidelines for a bunch of different conditions.

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SnortingCoffee t1_iubompq wrote

First off, there's no such thing as an "objective organization". All organizations have profit motives and/or missions that preclude objectivity. But WPATH exists to facilitate an interdisciplinary understanding of gender dysphoria and transgender health issues.

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Justintime4u2bu1 t1_iuavsrf wrote

So basically outlines the philosophy of medical practice requirements to apply them as needed on a case by case basis.

Not the specifics of care given, which the people asking are looking to be defined, yet for it to be defined would lead to a ‘fascistic’ medical ruling.

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KittensInc t1_iuazj2n wrote

Section 6.12 make the specifics quite clear?

The entire document is 260 page, with 24 pages dedicated to adolescents and 13 more to children. Each of the items listed in u/wishIwere's post is an entire section.

What a lot of people seem to be struggling with, most likely including OP, is that gender dysphoria is not a trivial physical ailment with a one-size-fits-all treatment. Forcing unwanted treatment on anyone, especially children, is completely unacceptable.

The standards of care focus on reducing harm and delaying permanent decisions, and making sure that the adolescent fully understands the impact of their decisions. Making them more specific than they currently are would lead to a worse outcome.

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[deleted] t1_iub2ksn wrote

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[deleted] t1_iub2xet wrote

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[deleted] t1_iub3xf3 wrote

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swine09 t1_iub03by wrote

There are guidelines and statements from, among others, the APA, AMA, and the Endocrine Society.

They are all generally in agreement about how practitioners should treat young people with gender dysphoria (with respect, nonjudgment, and supportive treatment if indicated, including potentially hormone treatment).

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regular_modern_girl t1_iubedte wrote

It’s “gender dysphoria”, actually, you might be mixing it up with Body Dysmorphic Disorder (an entirely separate thing).

In terms of consensus, this is p much it right here, there’s nothing binding a given physician to these particular standards, but I’d say a majority of the medical community (at least here in the US) largely agrees that these are the best guidelines for handling anyone of any age dealing with gender dysphoria (or who might be), although obviously with minors, especially pubescent minors, there are additional considerations, but the general consensus seems to be that with proper counseling and consideration, making sure that the patient understands the weight of making permanent decisions about their body, and of course parental consent, giving minors who’ve been determined to likely benefit from medical transition (or even just treatment with puberty blockers, if nothing else) should not be barred from access to it, that proper care for people suffering from gender dysphoria can be potentially life-saving, and that trans youth especially should not be denied the care they need due to the political machinations of people who aren’t even related to them (and likely don’t actually have their best interests in mind).

Anyway, trans people medically transitioning has been occurring for well over a century now, it is not a new phenomenon, just one that has recently been noticed by the mainstream a lot more, and the statistics over that long period of time generally suggest that it is very important for the well-being of a substantial minority of the population.

The idea that is circulating in some circles currently that parents are somehow forcing their children to not conform to gender expectations based on their birth sex, or somehow inducing “gender confusion” in them, has no psychological or medical basis, and if it were to occur in some case, I’m sure the extensive counseling that youth undergo as per the standards of care would be able to find evidence of it (to my knowledge, I have never actually heard of a case like this, unless you count the tragic story of David Reimer being forcibly raised as a girl against his will after a botched circumcision, but that case was entirely one doctor’s unethical social experiment, and if anything actually demonstrates why gender dysphoria should be properly treated, as David always asserted he was a boy even against being told otherwise and forced to dress and behave as a girl, something that I’m sure many trans men can deeply relate to).

Doctors who oppose these standards of care (usually on almost solely political grounds) make up a minority of the medical community. It’s always important to remember that trans people people of all ages have existed for a long time without society falling apart at the seams, and will continue to do so. Don’t let the latest politicized othering of a vulnerable group confuse you.

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PrimeGuard t1_iuawm83 wrote

Mental health treatment doesn't usually have a consensus on how to treat anything. Generally your providers will use whatever methodologies they were trained in, found to be useful, and are themselves comfortable using.

That is not to say that best practices don't exist or standards aren't enforced organization to organization, but mental health treatment is too young a science and people are far too complex to use overly generic techniques.

Additionally, not every patient will want the same things, and not all patients will be be successful with the treatments they are working towards. Some patients will come in for support with gender affirmation and realize that neither gender fits well enough to stop their symptoms, while others don't need anything other than the world around them to stop losing their minds over their choices.

The job of the therapist is to help the patient realize their best possible baseline, and if that involves lifelong issues, prepare them to meet their challenges effectively. It is always a dialogue and a moving target for the patient.

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jeffersonairmattress t1_iuaywbc wrote

Yes. The only constructive consensus for healthcare is that every person is an individual with unique strengths and challenges. There cannot be a universal solution for nor should there be over- broad categorization of individual struggles.

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[deleted] t1_iubeq60 wrote

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Eric-Ridenour t1_iubs96o wrote

No. ALL doctors is flat out false. All doctors don’t agree on anything and there are several who vocally oppose these recommendations.

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Azudekai t1_iuboxh9 wrote

Hard to say all when you have dipshit doctors writing books about how germ theory is wrong of vaccines are evil.

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[deleted] t1_iub2r0j wrote

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