You might assume if you’re listening to a qualified, experienced and well-respected psychiatrist, such as Dr Lucy Griffin, that what she has to say about an area of healthcare would be well informed and correct. Especially when the points she makes sound like common sense. [See Daily Mail article here]
But without working regularly with high numbers of transgender patients over a period of time, it’s impossible to have full insight into the difficulties this patient group experience and therefore how best to successfully treat those patients.
First off my warning bells were alerted by the fact she is calling trans-women men and trans-men women. Mistakes such as these are often the first tell-tale signs of someone with little knowledge or experience of this patient group.
Here is an analogy that I hope will help people understand why you need to be a gender specialist to comment on the care of transgender patients.
If it appears someone has broken their back, medical advice is not to move them. Common sense, yes? Then we see a group of Dr’s who start quickly pulling the injured away from the scene of the accident, risking paralysis! Other Dr’s publically chastise these actions, sighting their many insights from their professional knowledge and training as to why this is wrong and is ‘risking harm’ to the patient. The public agree with what seems like common sense coming from a qualified source.
Without the full picture, what the chastising Dr’s, and the public, don’t realise is that in these particular cases the patient needs to be moved quickly because of a greater risk. For example, maybe they are in a car which is on fire – one risk can outweigh another.
Transgender people can be harmed immensely by having to live the wrong life year after year. By waiting until they are 18 for medical intervention, not only have they already experienced great distress at seeing their bodies change in ways that is not correct for them but they then have permanent physical changes that are either difficult or impossible to correct.
To ‘do nothing’ is not always the best way to ‘do no harm’. Early intervention for a transgender patient is often life changing with very positive long-term outcomes.
Gender transition is a big step and certain questions do need to be asked and addressed. But the reasons against hormone blockers that Dr Griffin sights are not an informed view – she hasn’t seen the fire, so to speak!
So let’s take a look at some of the issues:
Age of consent
Many people still believe that a child is too young to make such a life affecting decision.
Gender dysphoria is not something that develops, it is something you are born with. Gender specialists are trained and experienced in diagnosing true gender dysphoria and distinguishing it from a passing phase. They also see the possible devastating consequences suffered when treatment can’t be accessed or is delayed.
The problem with waiting until transgender patients are adults is that irreversible changes have already happened to the body by going through the wrong puberty and these changes usually have a very negative affect on quality of life.
What if it’s a phase?
Children can go through phases of cross-gender play and dressing, many girls are tom-boys etc. This is very different to gender dysphoria although the two can be confused if you don’t know what to look for. So any treatment for gender dysphoria does need to be carefully considered.
Normal Spack is a US endocrinologist with vast experience of treating transgender patients with hormone blockers. He states that if a child is going through a phase they will almost certainly have grown out of the phase by the time they reach puberty.
You can watch Norman Spack’s very informative Ted Talk on this topic here
Stringent assessments performed by trained gender specialists ensure that before patients can access any irreversible treatment that they do indeed have true gender dysphoria and are not simply going through a phase.
The use of hormones blockers provides a safety net and ensures no harm is done. Rather than induce the patient’s desired puberty at the age puberty would normally be experienced, blockers temporarily hold off or slow any form of puberty. This is fully reversible and buys time. While on hormone blockers professionals can assess the patient who can also receive counselling. When they reach the age of consent for treatment if they still feel gender transition is right for them they can start treatment and begin their desired puberty. If at any point the patient or the gender professionals decide that transition is not the right step, the blockers can be stopped and the patient will go through their biological puberty with no harm done. They will develop just as they would have, just at a later time. And to address Dr Griffin’s concerns over fertility, they will still be fertile.
Benefits of blockers
When we reach puberty our body starts developing secondary sex characteristics and many of these changes are irreversible. Some changes can be corrected with surgical procedures, but of course this means undergoing that procedure, which isn’t pleasant, and then living with the scars it leaves behind.
Unfortunately some of the changes can’t be altered at all, and the transgender person has to live for the rest of their lives with sexual characteristics that are not in keeping with their gender identity.
Some of these changes include:
- Voice breaking
- Width of hips
- Size of hands
- Size of feet
- Breast growth
- Body and facial hair growth
- Bone structure (including facial)
Other than being distressing and triggering, many of these irreversible characteristics also hinder the transgender person’s ability to pass in their acquired gender. This plays a huge role in quality of life due to how society perceives and accepts them. It can make life highly challenging, and is something they have to deal with day in, day out for the rest of their lives. Yet such distress is preventable with the use of hormone blockers.
Hormone blockers are an effective way to slow down the changes that happen at puberty. There is a safety net because they are reversible and buy time while the patient and the gender specialists work out what the best course of treatment, if any, is for the patient.
By preventing the distressing and irreversible changes that occur during puberty hormone blockers can greatly improve long term quality of life. They enable a transgender person to develop in a way that is correct for their internal gender. This can reduce distress and allows them to live the rest of their lives in the ‘right’ body. The benefits they bring help with passing and therefore to alleviate problems that still occur in today’s society’s due to misunderstanding and non-acceptance.