What is gender-affirming care?

Neerja Singh

In a growing trend the world over, there has been a significant rise in the number of teenagers openly identifying as transgender and seeking gender care. In countries that collect national data, like the Netherlands and Britain, the number of 13 to 17-year-olds seeking treatment for gender-identity issues has gone up from dozens to hundreds to thousands a year.

Gender-affirming care is an approach the medical community has adopted for embracing children and teenagers who come out as transgender. However, there has also been a contrary, right-wing backlash in some nations against allowing the young to medically transition from one gender to another.

The field of transgender care for youth has shifted in other ways too during the last decade or so. The big debate used to be about whether kids in preschool or elementary school should be allowed to live fully as the gender they identified with. Today, the debate is among clinicians on how to respond to the thousands of teenagers who are arriving at their doors. Some teens have questions about medication that suppresses puberty and others want to know about hormone-replacement treatments.

Just as striking, the types of cases have changed. The average age when a young person first comes to a clinic tends to be decreasing. Cases of teenagers coming out as trans aren’t new, their prevalence is. In addition, the current caseload is around two-thirds youths who were “assigned female at birth” and identify as trans boys or as nonbinary. In the past, by contrast, most patients at gender clinics were trans girls who were “assigned male at birth.”

But how does gender identity compare with sexual orientation? Sexual orientation refers to an individual’s enduring pattern of emotional, romantic, and/or sexual attraction to men, women, both genders, or neither gender. It is about who a person is attracted to, in terms of their gender. Common categories of sexual orientation include heterosexual (attraction to the opposite gender), homosexual (attraction to the same gender), bisexual (attraction to both genders), and asexual (lack of sexual attraction). Gender identity on the other hand refers to an individual’s deeply felt sense of their own gender, which may or may not align with the sex assigned to them at birth. It is about how a person identifies themselves in terms of their gender. Common categories of gender identity include male, female, and nonbinary (which encompasses genders other than exclusively male or female).

The key difference between the two therefore is that while sexual orientation relates to attraction, gender identity relates to self-identification. It’s important to note that everyone’s sexual orientation and gender identity can be unique and diverse, and individuals may experience fluidity or changes in both over time. Respecting and understanding these differences is crucial for creating inclusive and accepting societies.

What is the reason for this rise in trans-identified teenagers? Is it that the increased visibility of trans people in entertainment and the media has reduced the stigma attached and made it possible for many kids to express themselves in ways they would have previously kept buried? But is visibility the only factor at play? How about the “social influence,” absorbed online, peer to peer? In adolescence, peers and culture often affect how kids see themselves and who they want to be. To make matters more complicated, as a group, the young people coming to gender clinics have high rates of autism, depression, anxiety, and eating or attention-deficit disorders. Could some of these young people be trying to shed aspects of themselves they dislike? What if some are motivated by the support network and the need to have a cause to fight for?

There are acute ethical dilemmas involved. There is the principle of justice – which promotes access to care for trans youth – and there is the principle of doing no harm. For people who don’t know much about the issues, banning the care perhaps sounds more enticing than the idea that kids are dictating what treatment they should get.

But should teenagers seek sex change at all? For teenagers who are experiencing gender dysphoria (a condition where a person’s gender identity differs from the sex they were assigned at birth) and have a consistent and persistent desire to transition, seeking professional help is crucial. Mental health professionals with expertise in gender identity can provide counselling, support, and guidance to help teenagers explore their feelings, understand their options, and make informed decisions. Medical interventions for gender transition, such as hormone therapy and sex reassignment surgery, are typically not recommended for teenagers until they reach a certain age and demonstrate long-standing gender dysphoria. Ultimately, the decision to pursue any medical intervention related to gender transition should be made in consultation with healthcare professionals, the individual’s parents, or guardians (if applicable), and with the teenager’s well-being and best interests as the top priority.

The question is whether schools should play a role in gender affirmation. The opinions vary, depending on cultural, social, and individual beliefs. Advocates argue that schools should create a safe and inclusive environment for all students, including those who identify as transgender or gender non-conforming. By affirming students’ gender identities, schools can help reduce discrimination, bullying, and mental health issues. Schools can play a vital role in educating students, staff, and parents about gender diversity and promoting understanding and acceptance. By integrating gender-affirming education into the curriculum, schools can help reduce stereotypes, prejudices, and ignorance. As a matter of fact, schools may have legal obligations to provide gender-affirming resources, such as access to appropriate restrooms, changing facilities, and gender-neutral pronouns.

An extremely sensitive navigation is involved here, respecting parental rights while prioritizing the well-being of students. Some cultures may argue that schools should focus solely on academics and that gender affirmation should be the responsibility of families or medical professionals. The guiding principle in today’s world however is a universally accepted commitment to inclusivity, safety, and the well-being of all students.

In this new world of personal freedom and choices, adults are faced with poignant dilemmas. Many parents are surprised, even shocked into paralysis when their teenagers come out as trans. They may struggle to be both supportive and cautious. Some experience unease with medical transition and argue that although 18 is the legal age to vote, and consent to medical treatment, in this one area of medicine – gender-related treatment – the age of consent should be 25, when brain development is largely complete. There are the doubters who join support groups online, struggling with seeing themselves as the barriers to their child’s happiness.

Gender affirmation is an area where everyone involved must remain open to whatever comes. It’s important to note that it is an ongoing process, and each teenager’s journey will be unique. By providing support, resources, and understanding, we can help teenagers explore their gender identity and create a positive and affirming environment for them to thrive.

The author is a former teacher/journalist, published author and professional speaker on generational diversity with a background and training in media, having worked in advertising, public relations, documentary filmmaking, and feature journalism. She is a TEDx speaker and represents the Professional Speakers Association of India on the Global Speakers Federation Board. She can be reached at https://www.linkedin.com/in/neerja-singh/.

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