It is estimated that approximately 1.4 million (0.6%) adults in the United States identify as transgender. Recent studies indicate that transgender and gender diverse (TGD) persons in the United States are vulnerable to adverse mental health outcomes, including higher rates of psychiatric illness and increased risk of suicide attempt. Research from Alex Keuroghlian, MD MPH, Director of the MGH Gender Identity Program, and other groups demonstrates that access to gender-affirming care alleviates psychological distress and improves mental health outcomes. In light of these findings, clinical guidelines established by professional medical organizations support the provision of gender-affirming care, and there is a growing number of medical programs dedicated to providing care to transgender individuals.
When it comes to gender-affirming care for teens, however, there are divergent and hotly debated recommendations. Last month, the World Professional Association for Transgender Health (WPATH) released a 350-page draft of new guidelines for the treatment of transgender and gender diverse (TGD) persons. In a new section addressing recommendations for adolescents, the guidelines state that adolescents must undergo comprehensive mental health assessment and must explore their gender identity for “several years” before receiving hormonal treatments or surgery.
In an interview in the New York Times, Dr. Keuroghlian discusses his concerns about the impact of these recommendations on transgender teens. Compared to their cisgender peers, transgender youth experience high rates of emotional distress and depression and are more likely to attempt suidide. Furthermore, there is evidence that earlier introduction of gender-affirming care is associated with better mental health outcomes. While mental health services should be offered as needed, requiring adolescents to pursue counseling for “several years” is likely to serve as yet another barrier to urgently needed care. Dr. Keuroghlian states, “Being trans isn’t a mental health problem.”
Expert guidelines, such as those issued by WPATH, would not only impact the medical care offered to adolescents but they would also determine what types of care insurance companies would be willing to cover. In addition, state legislatures look to these guidelines to make legal decisions regarding the care of transgender adolescents. Last year, 21 states introduced bills limiting or banning gender-affirming medical care for adolescents. While professional organizations and trans health specialists have universally condemned these legal actions, there is concern that conflicting opinions regarding the care of transgnedr adolescents may add fuel to this fire and may ultimately limit teens’ access to gender-affirming care.
Read More
Doctors Debate Whether Trans Teens Need Therapy Before Hormones (New York Times)
Almazan AN, Keuroghlian AS. Association Between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surg. 2021 Apr 28: e210952.
Beckwith N, McDowell MJ, Reisner SL, Zaslow S, Weiss RD, Mayer KH, Keuroghlian AS. Psychiatric Epidemiology of Transgender and Nonbinary Adult Patients at an Urban Health Center. LGBT Health. 2019 Feb/Mar;6(2):51-61. Free article.
Turban JL, King D, Kobe J, Reisner SL, Keuroghlian AS. Access to gender-affirming hormones during adolescence and mental health outcomes among transgender adults. PLoS One. 2022 Jan 12;17(1):e0261039.
Alex Keuroghlian, MD, MPH
Director, MGH Gender Identity Program
Director, Education and Training Programs at the Fenway Institute
Director, National LGBTQIA+ Health Education Center
Associate Professor of Psychiatry, Harvard Medical School
Alex Keuroghlian, MD MPH is the Michele and Howard J Kessler Chair and Director of the MGH Division of Public and Community Psychiatry and Associate Professor of Psychiatry at Harvard Medical School. In addition, he is the Director of the MGH Gender Identity Program, Director of Education and Training Programs at the Fenway Institute, and Director of the National LGBTQIA+ Health Education Center.
