WPATH and USPATH Joint Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age
/WPATH and USPATH Joint Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age
Published: January 28, 2020.
Yesterday, WPATH and USPATH released a joint statement about a recent and troubling trend across various states in the US. The Gender Dysphoria Affirmative Working Group fully endorses what is written here.
A web link to the statement can be found here: https://listloop.com/wpath/mail.cgi/archive/adhoc/20200128125839/
Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age and to Penalize Professionals who Provide that Medical Care
The World Professional Association for Transgender Health (WPATH) and its US chapter, the United States Professional Association for Transgender Health (USPATH), vehemently oppose the legislation being proposed in Florida (HB 1365), South Carolina (HB 4716), South Dakota (HB 1057), Colorado (HB 20-1114), and similar legislation in other states. These bills seek to deny evidence-based care for transgender people under 18 years of age and to penalize professionals who provide that medical care. These bills will punish practitioners of gender affirming care with revocation of their medical license, or up to 15 years in prison in some states. These bills will treat health care providers as if they committed manslaughter or arson.
Many of the procedures mentioned by these bills are not even offered to transgender youth, revealing these bills to be alarmist expressions of ill-informed opinion. Guidance for the provision of medical care for transgender youth is outlined within the 7th edition of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender-Nonconforming People created by the World Professional Association for Transgender Health (Coleman et al. 2012). The guidelines differentiate between children and adolescents with regard to the provision of care.
Under the SOC, children do not receive any of the medical care identified within these bills, but mental health and social supports are provided to them along with their families. Surgeries on genitals and reproductive systems are considered for people who are typically over 18 years of age (depending on the age of consent and other relevant factors in the pertinent jurisdiction) and have been living in their affirmed gender for at least 12 months. Medical treatments that might be recommend for certain adolescents include puberty-blocking medication and – in carefully selected cases – hormone replacement therapies and surgery, most often non-genital. These treatments are not offered without conscientious medical attention and informed clinical evaluation.
Puberty suppression has been found to be very beneficial for transgender adolescents, and it is reversible (Mahfouda et al. 2017; Olson-Kennedy et al. 2018; Hodax et al. 2019; Salas-Humara et al. 2019). Further, a recently published study has concluded that transgender adults who had access to pubertal blockers had a lower risk of suicidal ideation compared to those transgender adults who did not have access to pubertal blockers (Turban et al. 2020).
We are disturbed by these attempts to legislate medical treatment without expert guidance from the relevant national medical organizations or even testimony from experienced, qualified local or regional providers and patients for whom these treatments have been beneficial, if not lifesaving. Given the climate in which these bills are presented, however, we can imagine that few young patients or their parents would be willing to present themselves for the scrutiny of potentially hostile legislators and the activists who are promoting these damaging bills.
All medical treatment is a crucial and very personal service that virtually everyone depends upon at some point in their lives, and it should not be delivered or restricted according to the whims of distant lawmakers who know little or nothing about the circumstances of an individual’s life. Proper medical care for any condition is a matter best negotiated between patients and their trained and qualified medical providers who are relying on clinical evidence and experience.
These bills attempt to criminalize treatments or at best restrict medical professionals from helping their patients and their families. Since transgender children, adolescents, or adults cannot be legislated out of existence, these bills seem to be a misguided attempt to prevent transgender people from coming forward for services they need in order to live healthy lives.
We urge you to reject these harmful bills and assure your transgender constituents and their families that their health and well-being is just as important as your own.
References
Coleman E, Bockting W, Botzer M, et al (2012) Standards of care for the health of transsexual,
transgender, and gender-nonconforming people, version 7. Int J Transgenderism 13:165–232
Hodax JK, Wagner J, Sackett-Taylor AC, et al (2019) Medical options for care of gender diverse and
Transgender youth. J Pediatr Adolesc Gynecol S1083-3188(19)30206–2.
https://doi.org/10.1016/j.jpag.2019.05.010
Mahfouda S, Moore JK, Siafarikas A, et al (2017) Puberty suppression in transgender children and
adolescents. Lancet Diabetes Endocrinol 5:816–826. https://doi.org/10.1016/S2213-8587(17)30099-2
Olson-Kennedy J, Okonta V, Clark LF, Belzer M (2018) Physiologic Response to Gender-Affirming
Hormones Among Transgender Youth. J Adolesc Health 62:397–401.
https://doi.org/10.1016/j.jadohealth.2017.08.005
Salas-Humara C, Sequeira GM, Rossi W, Dhar CP (2019) Gender affirming medical care of transgender
youth. Curr Probl Pediatr Adolesc Health Care 49:100683.
https://doi.org/10.1016/j.cppeds.2019.100683
Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal Suppression for Transgender Youth and Risk of
Suicidal Ideation. Pediatrics. 2020 Jan 23. pii: e20191725
Yadegarfard M, Meinhold-Bergmann ME, Ho R (2014) Family rejection, social isolation, and loneliness as
predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among
Thai male-to-female transgender adolescents. J LGBT Youth 11:347–363
CLICK HERE TO DOWNLOAD FULL POLICY STATEMENT
WPATH Board of Directors
USPATH Board of Directors
STAFF
President
Vin Tangpricha, MD, PhD
President
Erica Anderson, PhD
Executive Director
Sue O’Sullivan; sue@wpath.org
President-Elect
Walter Pierre Bouman, MD, PhD
President-Elect
Madeline Deutsch, MD, MPH
Executive Director of Global Education & Development
Donna Kelly; donna@wpath.org
Secretary
Randi Ettner, PhD
Secretary/Treasurer
Emilia Lombardi, PhD
Deputy Executive Director
Blaine Vella; blaine@wpath.org
Treasurer
Baudewijntje Kreukels, PhD
Immediate Past-President
Gail Knudson, MD, MEd, FRCPC
BOARD OF DIRECTORS
Tamara Adrian, JD Marci Bowers, MD
Tone Maria Hansen, MSN Ren Massey, PhD
Asa Radix, MD, PhD, MPH
Loren Schechter, MD Jaimie Veale, PhD
Immediate Past-President Joshua Safer, MD, FACP BOARD OF DIRECTORS
Dana (Thomas) Bevan, PhD John Capozuca, PhD
Lisa Griffin, PhD
Johanna Olson-Kennedy, MD, MS
Asa Radix, MD, PhD, MPH
Student Representative
Nova Bradford, BA
Communications Director
Jamison Green; jamison@veritasmeetingsolutions.com
EPATH Representative
Walter Pierre Bouman, MD, PhD
USPATH Representative
Erica Anderson, PhD
GEI Representative (Ex-Officio)
Lin Fraser, EdD
Student Representative (Ex-Officio)
Penelope Strauss, BA, MPH