Intolerance is Poor Public Health Policy

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Transgender and gender diverse youth face bullying at every turn: at home, in school, at the doctor’s office. Few books on parenting address the complexities of sex and gender. Research on how to raise healthy kids also neglects this crucial aspect of identity. These gaps leave young people who struggle to define and express their gender to cope with near universal negative reactions on their own. They face skepticism, derision and even violence — simply because of who they are.

Now, the Trump administration’s Health and Human Services Department is poised to add to this confusion and prejudice by proposing to redefine gender as an immutable characteristic dependent on a person’s biological sex assigned at birth.

Trans persons are individuals whose assigned sex at birth does not match their internal awareness of their own gender. According to the Williams Institute at UCLA Law School, about 1.4 million, or .06 percent, of U.S. adults identify as transgender or gender-diverse, with a slightly higher percentage among younger age groups. Trans people live in nearly every neighborhood in our country.

Medical science knows that biologic sex cannot always be predicted by a quick inspection of a baby’s genitals in the delivery room (the basis of many birth certificates) or even a chromosome count. Up to 1.7 percent of the time, biologic sex defies typical male-female categorization, as reported in a 2000 study in the American Journal of Human Biology.

Gender — the awareness that you are female, male, a combination of both or not exactly either — is even more complex because it involves the interplay of anatomy, brain development, the impact of hormones and the social environment. Understanding how these factors contribute to gender development continues to evolve as research expands.

Research data document that, like other groups facing discrimination, trans folks are more often victims of prejudice and violence, have lower access to needed medical care and are disproportionately burdened with depression, anxiety and risk of suicide. In fact, the U.S. Transgender Survey revealed that 40 percent of trans adults have attempted suicide.

But we also know that gender diverse children who are affirmed in their gender identity at home and at school do not display increased pathology and have no more anxiety or depression than their siblings. Similarly, transgender and gender-diverse adults raised in highly accepting families have dramatically better mental health outcomes that those whose families rejected them.

At the UCI Health Pediatric Gender Diversity Program, our mission is to promote the best health outcomes for transgender and gender-diverse youth, many of whom have been referred to us by primary care physicians who feel ill equipped to help.

All our clinic staff members are trained in how to show respect for our patients. We listen and work with them to help alleviate their anxiety and that of their parents, and we provide individualized counseling and medical care. This may include puberty-blocking medication, which can give a young person time to further explore gender identity without the stress and inevitable permanent changes that (an undesired) puberty brings. Hormones may be provided to help the body align more closely with the gender experienced by the patient.

We also reach out to other physicians, schools, public health officials and the broader community to improve education. By speaking up and educating our colleagues, we hope more support and resources will become available for all of California’s youth.

Each of us can change our approach to our transgender neighbors and colleagues even if we don’t completely understand their experiences. We can all advocate for acceptance. As parents, we can ensure our child’s school has accommodations for trans students to help reduce depression, anxiety and health problems (including documented urinary tract infections from avoiding bathroom use).

A new policy statement by the American Academy of Pediatrics notes that while transgender and gender-diverse children face challenges in life, they can grow into happy, healthy adults when supported and loved throughout their development.

Above all, we should never accept a government policy that would erase the very existence of trans people.

Lynn Hunt is Professor of Pediatrics at the University of California, Irvine School of Medicine and Director of the UCI Health Pediatric Gender Diversity Program.


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