A case for much-needed care for transgender kids

Unless you, a family member, or a close friend are transgender, you likely don’t know much about transgender health care. My teenage son came out as transgender nearly six years ago, so let me tell you a bit about the process.

It’s long and thoughtful and involves a team of professionals, from family physicians and endocrinologists to therapists and psychologists. You don’t just walk into a doctor’s office and get a prescription for puberty blockers or schedule surgery. (I think most of us understand that health insurers don't like to approve treatment that doesn’t have at least some science behind it.)

Lots of factors are considered before gender-affirming medical interventions are deemed appropriate. In our family’s experience, that meant our son needed to live with his gender identify for more than one year and have a recommendation on file from his mental health provider. Let me add that this care is far from cheap — and our family has one of the most generous health insurance policies in the state. It’s hard to imagine families paying for it without thoughtful consideration about what is best for their child.

As a parent, I did a lot of research and spoke with many different medical and mental health providers. I also met with parents who I knew had similar experiences with transgender or nonbinary children. I discovered there is an organization called the World Professional Association for Transgender Health, or WPATH, which collects science from more than 100 medical professionals and experts around the globe and issues Standards of Care for the Health of Transgender and Gender Diverse People. These are evidence-based guidelines for health care professionals.

Gender-affirming medical care, I learned, is based on decades of clinical experience; it is not considered experimental. In fact, it is supported by the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American College of Physicians, the Endocrine Society, and the American College of Obstetricians and Gynecologists, among others.

While there may not be a one-size-fits-all model for transgender health care, every major medical and mental health organization in the U.S. supports access to individualized gender-affirming care for both youth and adults. Iowa legislators seem to think this is not significant enough and that a parent’s rights end at the door to the doctor’s office. How come we can challenge school curricula — even what books circulate in school libraries — but we can’t make health care decisions based on long-established medical guidelines and years of personal experience?

Identifying as transgender is not an easy path, but my son has never wavered. In fact, a longitudinal study published last year in the journal Pediatrics found that five years after transitioning, some 94 percent of youth still identified as transgender. Thanks to a supportive community and the option to receive the health care he deserves, my son has persevered. He maintains a GPA over 4.0 and is involved in many extracurricular activities. He is 18 now and soon will be leaving this state to attend college.

My hope is that research will continue — we absolutely need more data. But until people start listening and learning from what we do know, I will worry about the children and families in Iowa who no longer have access to this care.

Sara Epstein Moninger and her family live in Iowa City.

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