The Missouri Senate passed legislation last week that would ban minors from receiving gender-affirming care. The bill would grant exceptions to children who begin treatment prior Aug. 28, when the bill would go into effect.
In states across the country, lawmakers have filed more than 430 billsthat would restrict LGBTQ inclusion, athletics, curriculum and healthcare — including more than 100 bills specifically concerning transgender individuals.
The restrictive trans legislation has commonly been introduced by Republican lawmakers, and Missouri's Attorney General is seeking an emergency regulation on gender transition, saying the medical care is "experimental and lack clinical evidence of safety or success."
"I think it's unclear exactly why there's such a widespread concerted effort to ban this type of care. It seems to have come out of nowhere," said Dr. Brandon Barthel, a Kansas City-area endocrinologist who joined Up To Date to explain what gender-affirming care consists of.
Gender-affirming care treats individuals experiencing gender incongruence or gender dysphoria through physician prescribed psychotherapy, puberty blockers, hormone therapy and for some, surgery.
The American Academy of Pediatrics and American Psychiatric Association are among the multiple medical organizations that have issued guidance related to the care of minors experiencing gender dysphoria.
Children as young as four have expressed feelings of gender incongruence, and the first course of treatment is understanding and exploration, according to Barthel.
"In the case of younger children like that, really the the only thing that you're going to be doing that would be considered treatment at that point, would be exploring those feelings with them, discussing what it what it means, how do they feel, whether they are just expressing themselves in a unique way or whether they truly have what I would think of as gender dysphoria," said Barthel.
"And there's no rush," he continued. "There's no treatment even available, medically speaking, for those patients because there's nothing to do. You're not going to put a 5-year-old or a 6-year-old on testosterone."
As the child ages, continued treatment may include puberty blockers, a physician prescribed treatment to suppress puberty, which Barthel describes as safe, "widely used medications."
Puberty blockers allow a patient and their care team more time to determine what's next, which may consist of hormone therapy.
"There's not an 11-year-old in an office somewhere, making this decision by themselves. The parents are involved. There's a multidisciplinary team typically involved. So that would be mental health professional, endocrinologist, ideally, both parents and then the patient themselves," Barthel said.
Hormone therapy results in more permanent physical characteristic changes, he explained.
An adult patient may follow up with an elective surgery to further align physical features with their gender identity, but for minors, he said, surgery is "extremely uncommon."
"Any kind of bottom surgery or genital reconstruction or anything like that, I've never heard of that happening under the age of 18," Barthel said.
- Dr. Brandon Barthel, Kansas City-area endocrinologist
