If a trans person decides to receive gender-affirming surgery, clinics require that the individual receive letters from one or more providers stating they have persistent and well-documented gender dysphoria, any significant mental health concerns they have are sufficiently controlled, and they can consent to the surgery. However, breast growth from estrogen or a deepening of the voice caused by testosterone are not reversible. For example, decreased muscle strength and body fat redistribution caused by estrogen can reverse once a person stops taking the hormone - though these changes become more fixed the longer someone stays on the hormone. Some physical changes brought about by gender-affirming hormone therapy are reversible. What are the things that you are hoping to get out of that?' Because it's incredibly important to speak to patients and families about what medications can do, and what they can't do."Ĭoles said she also makes sure to talk continuously about consent with both the child and parents throughout the treatment process and lets her patients know they can stop taking hormones at any time. "If someone says, 'I'm interested in estrogen,' I say, 'Great. This may be at an earlier age so that patients can go through puberty alongside their cisgender peers, or later, if they choose to," said Mandy Coles, co-director of the Child and Adolescent Transgender Center for Health at Boston Medical Center. "We offer hormones to patients who are experiencing gender incongruence when patients and families are ready. The Endocrine Society notes that most adolescents have "sufficient mental capacity" to consent by the time they're 16. The age at which trans minors receive gender-affirming hormone therapy depends on the patient's ability to provide informed consent for the treatment, which can happen when they're as young as 12 or 13 years old. By pausing puberty, these drugs buy children more time to explore their gender identity before undergoing permanent and potentially unwanted pubertal changes. This is marked by physical changes like the development of breast buds or testicle growth and tends to happen between the ages of 9 and 14 in kids with testes and 8 and 13 in those with ovaries. To receive puberty blockers, kids must also have experienced the onset of puberty, or Stage 2 on the Tanner scale of developmental change. Puberty blockers, hormone therapy and surgical options "That's going to be a much shorter assessment to know that they are ready for treatment when compared to somebody who has only understood their trans identity for six months" and has other complex mental health conditions like schizophrenia, Turban said. This hypothetical patient has known they are trans since they were 5 years old and has already adopted a new name and pronouns that match their gender identity. Turban may see someone who is 12 years old and asking for puberty blockers. The time it takes to perform this assessment varies from patient to patient, said Jack Turban, an assistant professor of child and adolescent psychiatry at the University of California-San Francisco. Without this assessment, other mental health issues "that need to be prioritized and treated may not be detected." These standards encourage health care professionals to perform a comprehensive assessment of a child's or teen's "strengths, vulnerabilities, diagnostic profile, and unique needs" before providing any medical or surgical interventions. Providers also abide by the standards of care set by the World Professional Association for Transgender Health. Youth who have gone through puberty must meet two of the criteria for a diagnosis. Before any medical or surgical interventions, kids must first be diagnosed with gender dysphoria, which, for prepubescent youth, involves experiencing significant distress for at least six months from at least six of a set of causes, including a strong desire to be of the other gender and a strong dislike of one's sexual anatomy. The reality is that the process informing these treatments is a long and intensive one. One common misbelief heard when legislation is discussed is that gender-affirming medical interventions are provided immediately to any trans or nonbinary kid who walks into a gender clinic.
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