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Trans Healthcare for Youth : What D o Doctors Have to Say About It? By Mark Flores The availability of gender -affirming medical care (GAC) for minors has taken a major seat in our nation ’s politics. Presently, according to the KFF feature “Policy Tracker: Youth Access to Gender Affirming Care and State Policy Restrictions” last updated on August 27, 2024 by Lindsey Dawson and Jennifer Kates , 26 states have enacted laws which limit youth access to GAC such as puberty blockers, hormone therapy, and gender -affirming surgeries. The U.S. Supreme Court has agreed to hear a case, United States v Skrmetti , this Fall 2024 session which will weigh the future of such bans with a decision to come next year . Thus , it is imperative to listen to the recommendation s of medical professionals in understanding the importance of such care in promoting the safety and welfare of trans youth. “children who are prepubertal and assert an identity of TGD [trans or gender -diverse] know their gender as clearly and as consistently as their developmentally equivalent peers ” – Jason Rafferty MD, American Academy of Pediatric ’s Policy Statement In the American Academy of Pediatric ’s policy statement “Ensuring Comprehensive Care and Support for Transgender and Gender -Diverse Children and Adolescents” reaffirmed on August 2023 authored by Jason Rafferty MD (lead author) , American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, Committee on Adolescence, and Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness , the AAP outlines the purposes and benefits of GAC. For instance, in the AAP’s policy statement Rafferty states that research supports “children who are prepubertal and assert an identity of TGD [trans or gender -diverse] know their gender as clearly and as consistently as their developmentally equivalent peers .” Rafferty also note s that the idea of “watchful waiting ” — waiting until a later age , usually after puberty , before considering a transgender kid’s gender assertion true — is outdated because it assumes that gender becomes fixed at an arbitrary age and treats gender diversity as an abnormality. Moreover, watchful waiting also withholds critical care from an already vulnerable population. For example, allowing children access to puberty blockers early on can diminish the need for future medical interventions as they prevent certain physiological changes like breast growth or vocal change s which will be harder to reverse later . If the child decides to come off puberty blocker s, then puberty will resume. Puberty blockers give children time to explore gender identity and decide with their family and pediatrician on a plan of care. Stacy Weiner , in the Association of American Medical Colleges News feature “States are banning gender -affirming care for minors. What does that mean for patients and providers?” released on Feb 20, 2024 , notes that trans youth who received access to puberty blockers or gender -affirming hormones were 70% less likely to contemplate suicide than those who hadn’t. The AAP advi se an integration of medical, mental health, and social services between the child’s pediatrician, a mental health provider, and potentially other professional s with expertise in the area (like an endocrinologist). The AAP also asserts GAC varies by individual and support from the child’s family and medical providers will be critical to their resilience. Some medical professionals have concerns . A mong them is Dr Hilary Cass , head author of “The Cass Review” an independent review of gender identity services for youth commissioned by the National Health Service in England finished April 10, 2024. The report concluded that the body of evidence supporting GAC for minors was unreliable, does n’t meet sufficient standards for care , and removes focus from individualized treatment for youth seeking gender services. As a result, the NHS cited the report in their emergency decision to criminalize providing puberty blocker s to any youth in England, Scotland, or Wales under 18. It has already been cited by multiple states in th e U.S. and is expected to be cited in the upcoming U.S. Supreme Court case according to “An Evidence -Based Critique of ‘The Cass Review’ on Gender - affirming Care for Adolescent Gender Dysphoria” released on July 1, 2024 co -authored by Meredithe McNamara MD and Anne Alstott JD, founders of Yale Law School’s The Integrity Project. In it, they conclude that The Cass Review does n’t follow established standards for evaluating evidence and that it fails to contextualize GAC with the evidence base for other pediatric care . Moreove r, The Cass Review only considers the possibility of GAC being given to youth who aren’t trans but gives no consideration to trans youth who are going through permanent and distressing physiological changes being denied access to care. In the American Psychological Association news feature by Kim I. Mills released on Feb 28, 2024 titled “APA adopts groundbreaking policy supporting transgender, gender diverse, nonbinary individuals ”, Mills notes that the APA ’s Council of Representatives voted 153 -9 reaffirming their policy statement , stating GAC as evidence based and critical to promoting positive mental health outcomes for trans and gender diverse youth and adults. According to the AAMCNews feature, the APA is only 1 of over 20 major U.S. medical groups to endo rse GAC for minors . It is crucial the U.S. government does the same.