Hi everyone,
I was really struck by the article “Affirmative practice with transgender and nonconforming youth: Expanding the model.” It was perhaps one of the most thorough examinations of the complexities of providing care to transgender and gender nonconforming (TGNC) folks that I’ve read, including examining what the social worker’s role might be in this situation and the research on various aspects related to care. I really appreciated the multidisciplinary perspectives and completely support the idea that there is no one-size-fits-all model for working with TGNC youth, and that the clinician’s role is to provide affirming care and empathetic support.
What really stood out to me, however, was the discussion about how “clinicians are being sought to assist parents in deciding whether or to what extent a child should be supported in social gender transition” (p. 167). In particular, the research on persistence rates was interesting. The 12-50% persistence rates was lower than I’d thought it might be. Without really delving into the research, I wondered what the sample sizes were and how prevalent gender dysphoria is in children. Reading that “most childhood gender dysphoria desists” (p.167), definitely complexified the role that social workers might play for me as advisors to youth and parents. This was especially true around the three approaches for clinicians of support, discouragement, and wait-and-see. This seems like a really important consideration to me, given how much of the national discourse is caught up in LGBTQ+ rights, care, and liberties right now, especially for youth.
This discussion was very nuanced from my perspective and addressed a lot of good points. One thing I was skeptical about was this statement: “Given that pubertal suppression is fully reversible (i.e., one’s natural puberty will resume upon discontinuing the medication) and has no significant side effects.” Of course, the prevention of suicide and the child/youth’s mental health should be the first priority. I am a bit skeptical, though, that blocking a developing youth’s puberty has “no significant side effects”. The article cited came out in 2009 and the full article is hidden behind a paywall, and this seems wrong to me. How long can one hold off puberty to make decisions about gender? Is there “too long” one can wait and miss important developmental windows? Does the individual have to take hormones at a certain point to simulate puberty, even if they don’t choose to transition from their gender-at-birth? Have long-term medical effects of this treatment been examined in empirical studies in a way that allows the authors to confidently suggest no harm is being done or could result?
These questions arise from a desire that, if I were to have a TGNC client, I could truly provide them with all the information regarding treatment options and talk through all the risks and benefits in a way that I did think the authors provided thoughtful commentary on around hormone therapy in the next section. This is in no way coming from a desire to refuse puberty blockers, simply to better understand the effects of these decisions. This said, I know this is a controversial topic, and so if I’ve said or raised anything distressing or offensive, this was not my intention. I would have liked to see more research in this area discussed by the authors.
In looking up more on this topic, I did find one really interesting article here: https://doi.org/10.1016/j.jadohealth.2020.09.028, entitled "No One Stays Just on Blockers Forever: Clinicians' Divergent Views and Practices Regarding Puberty Suppression for Nonbinary Young People." It's an interesting read on clinicians thoughts and feelings about "short term" vs. "long term" use of puberty blockers and the complexities therein.
Best,
Melissa