Amid rising rates of suicide in transgender and nonbinary youth, healthcare professionals say gender-affirming care may be a possible solution, but recently passed state legislation has created barriers to receiving treatment.
Healthcare providers discussed the current landscape of gender-affirming healthcare for transgender and nonbinary youth in North Carolina during a community forum hosted by Charlotte Trans Health, a local LGBT+ nonprofit, on Tuesday evening.
Gender-affirming healthcare is a supportive form of healthcare consisting of medical, surgical, and mental health services for transgender and nonbinary people.
“[Gender-affirming care] may be clothing, hair, maybe hormones and maybe surgery,” Rhett Brown, a board-certified family physician and panelist at the forum said. “There is no fixed destination, and when you feel complete and feel authentic, your dysphoria is controlled.”
Some of these services include social affirmation, such as using gender-affirming names and pronouns, reversible puberty blockers, and reversible hormone therapy like taking testosterone for those who were assigned female at birth.
Other gender-affirming services can include surgeries, like “Top” surgery, which creates a male-typical chest shape or enhance breasts, or “Bottom” surgery, which is surgery on genitals or reproductive organs.
A need for gender-affirming care
Healthcare providers say with rising rates of suicide among LGBT+ youth, gender-affirming care can be “lifesaving.”
Rates of suicide have increased since COVID-19 due to isolation, panelist Beverly Moss, a licensed clinical mental health counselor said.
Nearly 1 in 5 transgender and nonbinary people attempted suicide between September and December 2022, according to a 2023 survey by the Trevor Project.
Access to gender-affirming care lowers rates of depression, anxiety, suicidal ideology and suicide drastically, panelist Hayden Nielsen, a clinical social worker said.
Roughly half of transgender and nonbinary youth found their school to be gender-affirming, and those who did reported lower rates of attempting suicide, according to the Trevor Project.
Reservations
During the forum, one mother of a young transgender child asked about having reservations about gender-affirming care. She shared that she wanted to make the right decision for her child and consider lasting effects.
“It’s a huge decision for any 13, 14-year-old or parent to make,” Brown said. “It’s an impossibly hard decision to make.”
A total of 27 studies, pooling 7,928 transgender patients who underwent any type of gender-affirming surgeries, 1% – around 77 patients – expressed some form of regret over having the procedures, according to a 2021 study from the National Institute of Health.
Brown explained that some treatments are reservable, while others are not.
Some treatments, like puberty blockers, which are only used in later stages of puberty to ensure the endocrine system is functioning normally, are reservable. If a transgender or nonbinary child stopped taking puberty blockers, eventually the typical course of cis-gendered puberty development would continue.
On the other hand, if puberty blockers are used before sperm development has occurred, that person will be infertile for the rest of their life, Brown said.
Some other treatments, like hormone therapy, are partially reversible and depend on what stage the patient is in.
Hormone therapy, like testosterone and estrogen, can lower voices and cause hair growth, which can’t be undone, but progression can be halted.
Roadblocks to treatment
Recently, new laws preventing gender-affirming care for transgender and nonbinary youth have passed in the state, including N.C. House Bill 808, which passed in August.
N.C. House Bill 808 bans any gender-affirming care for transgender and nonbinary minors, including puberty blockers, hormone therapy and surgery.
Some healthcare providers fear the bans will have adverse effects on transgender and nonbinary youth.
The bill does allow minors currently on puberty blockers or receiving hormone therapy to continue.
Healthcare providers said gender-affirming care can be complicated to navigate, but encouraged parents facing these decisions to continue seeking care for their children.
