Is all gender-affirming care for children ‘experimental’? Experts say no

The word "experimental" can trigger fear of the unknown and may suggest unforeseeable consequences or complications.

Lawmakers aiming to restrict access to gender-affirming care have embraced the term, arguing that their proposals will protect children from such "experimental" treatments.

A Jan. 1 Instagram post echoed that alarm.

"All ‘gender affirming care’ for children is 100% experimental," read the Instagram post featuring a screenshot of a tweet. "There are zero long term studies on the effects the drugs and surgeries will have on them."

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(Screenshot from Instagram.)

Gender-affirming care is an individualized approach to health care that centers, encourages and supports a person’s gender identity, experts said. 

The World Professional Association for Transgender Health’s standards of care noted that gender-affirming care is more than just transition-related medical treatments such as hormone therapy or surgical procedures.

Gender-affirming care for children might include allowing a child to wear whatever clothes they like or encouraging the use of the name and pronouns that align with the child’s gender identity, said Dr. Michelle Forcier, a pediatrics professor who specializes in gender and sexual and reproductive health at The Warren Alpert Medical School of Brown University.

Those types of emotional and social affirmation — which also include creating a safe space to explore gender identity — are important elements of pediatric gender-affirming care, said Dr. Jason Rafferty, a pediatrician and child psychiatrist at Hasbro Children’s Hospital in Providence, Rhode Island. 

Forcier and Rafferty emphasized that gender-affirming care for children is based on individual needs and goals. Social support is the only type of gender-affirming care recommended for children before puberty, said Shane Diamond, a World Professional Association for Transgender Health spokesperson. As children reach adolescence, medical treatments might become part of their care.

Dr. Renata Arrington-Sanders, an adolescent and young adult medicine associate professor at Johns Hopkins University School of Medicine, said there is "an extensive body of evidence-based, peer reviewed research on gender-affirming care" that informs current standards set by organizations, including the Endocrine Society, the American Academy of Pediatrics, and the World Professional Association for Transgender Health. 

Puberty-blocking medication might be an element of gender-affirming care for children who reach puberty and experience gender dysphoria — a feeling of distress when their bodies don’t align with their gender identity.

Puberty blockers "help delay unwanted physical changes that don’t match someone’s gender identity," according to St. Louis Children’s Hospital. They were first used in the U.S. for gender-affirming care in 2007, Rafferty said. But they have been prescribed in Europe at least since the mid-1990s to treat adolescents with persistent gender dysphoria.

The medication gives children time to explore their identities and consider additional treatment options. Research, including a 22-year follow-up study, shows that medication helps alleviate psychological distress in adolescence and supports a child’s development into adulthood.

Puberty blockers contain gonadotropin-releasing hormone (GnRH) analogs, which suppress the body’s release of sex hormones such as estrogen and testosterone. 

Although puberty blockers weren't designed for gender-affirming care, their use for this purpose has been studied and isn't considered "experimental" by experts.

"‘Experimental’ in this context is a political term designed to create drama, confusion, and terror," said Forcier. "Medical care is always being evaluated and studied so we can provide the best care."

Every medication has side effects, Arrington-Sanders said, but doctors monitor the side effects of medications used to suppress puberty.

Studies demonstrate the long-term efficacy and positive impacts that gender-affirming care such as puberty blockers has on transgender youth, said C.P. Hoffman, senior policy counsel at the National Center for Transgender Equality. Hoffman pointed to a gender dysphoria research overview by doctors and researchers at the Yale School of Medicine, the University of Alabama at Birmingham, Children’s Medical Center Dallas and other institutions. 

The researchers noted that studies in 2015 and 2022 found that puberty blockers helped young people with gender dysphoria.

California state Sen. Scott Wiener, D-San Francisco, discusses his proposed measure to provide legal refuge to displaced transgender youth and their families on March 17, 2022, at a news conference in Sacramento, California. (AP)

Feminizing or masculinizing hormone therapies might be another element of gender-affirming care that may be recommended when a patient is capable of giving informed consent —  around age 16, according to the Endocrine Society.

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Like puberty blockers, gender-affirming hormone therapy medications aren’t approved specifically for gender affirmation use, and instead are approved and commonly used for contraception, managing menopause, for male pattern baldness and more.

But the hormones themselves are "considered safe (and) effective, especially when medically monitored," said Forcier of Brown University.

Substantial evidence shows that access to gender-affirming hormone therapies when young reduces the long-term risk of suicide, anxiety, depression and gender dysphoria.

Gender-affirming surgeries are typically recommended for and provided to adults. 

Certain gender-affirming surgeries, such as masculinizing chest surgery, are sometimes provided to teenagers, though this is rare. There is not much research on the long-term impact they have on adolescents, Rafferty said.

Some things about gender-affirming care, such as how it affects fertility, are still being researched. But experts said this is the nature of medicine and pediatrics. 

Rafferty said, "When most people hear ‘experimental’ they feel it means that providers do not know what they are doing or (are) guessing when making clinical decisions." But additional studies and research happen routinely to learn more about a topic and to develop better practices and standards of care.

An Instagram post claimed, "All ‘gender affirming care’ for children is 100% experimental. There are zero long term studies on the effects the drugs and surgeries will have on them."

Experts said it is inaccurate to call all gender-affirming care for children "experimental," because the approach, including the use of puberty blockers, is evidence-based. Research also shows that gender-affirming care reduces the risk of suicide, anxiety, depression and gender dysphoria.

For prepubescent children, gender-affirming care does not involve medication or surgeries; instead, it’s about social affirmation such as allowing a child to wear gender-affirming clothes or adopt a gender-affirming hairstyle. 

There’s an element of truth to the claim: There aren’t many long-term studies on the effects of gender-affirming surgeries for youth, but that’s because they aren’t done on children and rarely on teenagers.

We rate this post Mostly False.

PolitiFact researcher Caryn Baird contributed to this report.

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