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State bills would curtail health care for transgender youth

Health care challenges for transgender youth
Health care challenges for transgender youth 13:42

Last month, Arkansas passed a law prohibiting doctors from treating transgender youth with puberty blockers, testosterone or estrogen, and surgery to assist their transitions. As part of a new culture war, similar bills have been introduced in at least 20 other states: in some cases, doctors could go to jail. Many physicians and therapists are appalled, like Erica Anderson, a highly respected gender psychologist at the University of California San Francisco who is transgender herself.

Dr. Erica Anderson: It's a very ominous development. It's a bad sign.

Lesley Stahl: Have you ever seen anything like that before in your lifetime?

Dr. Erica Anderson: No. No. And it's a clear overreach on the part of such legislatures. Clearly, they are demonstrating their ignorance and prejudice.

At least six major medical associations have weighed in against these bills, including the American Academy of Pediatrics of which Dr. Lee Savio Beers is the president.

Lesley Stahl: I'm gonna read you something that was said in support of this law in Arkansas. One of the Republican senators said gender-affirming treatments are, quote, " best, experimental, and, at worst, a serious threat to a child's welfare."

Dr. Lee Savio Beers: These are not experimental treatments. They're really based in scientific literature, they're based in decades and decades of expert experience, and they're backed by a number of major medical organizations.

Lesley Stahl: So let's say there's a young person and they're on hormones. Under the law in Arkansas, a doctor has to take those hormones away?

Dr. Lee Savio Beers: Yes. And if the doctor decides to move forward, they face significant penalty.

Lesley Stahl: Is there any medical rationale for this legislation, in your opinion?

Dr. Lee Savio Beers: No, there is not.

The field of transgender health care has grown rapidly. In 2007, there was one major youth gender clinic in the entire country. Today there are at least 50. The World Professional Association for Transgender Health, WPATH, issues guidelines that currently say to get medical treatments like hormones or surgery: those under 18 should have parental consent and have seen a therapist; to get hormones, those over 18 can sign an informed consent form after an initial assessment but for surgery they too need to have seen a therapist. Revised guidelines are expected by the end of this year.

  Dr. Lee Savio Beers

The process today is much easier than it used to be when patients who wanted to transition had to go through extensive therapy that many considered onerous and insulting. In some cases, doctors even tried to quote, cure them.

Dr. Erica Anderson: There's been a residue of trauma in the trans community. People tell the stories of feeling mistreated by the health care system that subjected them to all this extra scrutiny. So there's been a reaction, which is, well, if we actually accept that trans people exist and and deserve a right to be themselves and to have access to quality medical care, then let's give it to them.

Lesley Stahl: Is there an accreditation to work in this field?

Dr. Erica Anderson: So there is coming to be, yes.

But not yet. Dr. Anderson, who sits on the board of WPATH, says that their guidelines are not always followed by clinicians who are not well-trained.

Dr. Erica Anderson: There are health care providers who have jumped into this area because trans people are interesting. You know, they're unicorns. You know, "Oh, I have one of them now." And I think it's deplorable.

  Dr. Erica Anderson

The WPATH guidelines call for affirming but careful evaluation, which is how dr. Anderson says she has counseled hundreds of trans patients, including this 17-year-old, who she's been treating since he started the transition process at the age of 13, when he was diagnosed with gender dysphoria, a deep distress that his body did not match his gender identity.

Dr. Erica Anderson: Is your life better?

PATIENT: My quality of life has improved drastically. I very much believe if I hadn't done all these things, there's a high likelihood I would have tried to take my own life and I might have succeeded.

Dr. Erica Anderson: It's clear that there are many trans children who are helped by the kinds of interventions that we're talking about here that would be prohibited by these laws.

Lesley Stahl: Does it make a difference in how long someone has expressed gender dysphoria? I mean, you hear of parents who say, "Oh, I knew when my child was four years old." And then you also hear stories where someone said, "Well, I felt that way for three months."

Dr. Erica Anderson: Well, the formal diagnosis for gender dysphoria has this one criterion, that this conflict have existed for a minimum of six months.

Lesley Stahl: Okay. Well, six months. Is that…

Dr. Erica Anderson: I'm not satisfied with six months myself.

  Grace Lidinsky-Smith

While the vast majority of transgender youth and adults are satisfied with their transitions, not all are. In some cases, patients are choosing to reverse the process. It's called detransitioning. In her early 20s, Grace Lidinsky-Smith was seriously depressed and developed gender dysphoria. She began searching for answers in transgender communities on the internet.

Grace Lidinsky-Smith: And when I saw them being so happy and excited about doing this wonderful, transformative process to really, like, become their true selves I was like, have I considered that this could be my situation, too?

Lesley Stahl: Did this have any part of it, a sense that men had it easier in life than women did and that your road might be easier if you were male?

Grace Lidinsky-Smith: Yes. I just had this sense that if-- if I could inhabit life as, like, a trans man, as a man, then I wouldn't feel so self-conscious. I was thinking that it would make me feel very free.

Grace says she found a gender therapist on the internet and told her, "I'm thinking of transitioning." 

Grace Lidinsky-Smith: She thought it all sounded pretty good. 

Lesley Stahl: Did the therapist not question you about how deep the feeling was and what it was stemming from?

Grace Lidinsky-Smith: She didn't go - really go into what my gender dysphoria might've been stemming from. We only did a few sessions.

Because she was over 18 and didn't need parental consent, she says she merely signed an informed consent form at a clinic and got hormone shots.

Grace Lidinsky-Smith: They asked me, "So, why do you wanna go on testosterone?" And I said, "Well, being a woman just isn't working for me anymore." And they said, "Okay."

Lesley Stahl: So, that was that. You got your prescription for testosterone?

Grace Lidinsky-Smith: Uh-huh. Yup. 

Just four months after she started testosterone, she says she was approved for a mastectomy, what's called top surgery, that she told us was traumatic.

Lesley Stahl: You know, I'm kinda surprised because, based on everything you've said up to now, I would've thought you'd have a great sense of relief.

Grace Lidinsky-Smith: I started to have a really disturbing sense that like a part of my body was missing, almost a ghost limb feeling about being like, there's something that should be there. And the feeling really surprised me but it was really hard to deny.

And so she detransitioned by going off testosterone and then went back to the clinic and, she says, complained to the doctor that the process didn't follow the WPATH guidelines.

Grace Lidinsky-Smith: I can't believe that I transitioned and detransitioned, including hormones and surgery, in the course of, like, less than one year. It's completely crazy.

  Dr. Laura Edwards-Leeper

Dr. Laura Edwards-Leeper: It greatly concerns me where the field has been going. I feel like what is happening is unethical and irresponsible in some places.

Laura Edwards-Leeper was the first psychologist at the first major youth gender clinic in the U.S. at Boston Children's Hospital. She says she has helped hundreds of teens and young adults transition successfully after a comprehensive assessment.

Lesley Stahl: Do you have conversations with your colleagues about this whole area of accepting what young people are saying too readily?

Dr. Laura Edwards-Leeper: Yes. Everyone is very scared to speak up because we're afraid of not being seen as being affirming or being supportive of these young people or doing something to hurt the trans community. But even some of the providers are trans themselves and share these concerns.

There's no confirmed number of detransitioners in the U.S., though their percentage among the more than 1.4 million transgender Americans is assumed to be small. They are becoming more public though. We found a Reddit detransition support group with over 19,000 members worldwide, some saying they changed their minds because of family pressure or discrimination in employment and other areas or simply regret. We also interviewed more than 30 detransitioners, who say they also had experienced regret, including these four, who hadn't met before now.

Lesley Stahl: How many of you feel that you were blindly affirmed?

Garrett: I didn't get enough pushback on transitioning. I went for two appointments and after the second one I had, like, my letter to go get on cross-sex hormones.

Lesley Stahl: Two visits? That's it?

Garrett: Uh-huh. 

All four tell us they learned about transitioning on the internet where there are transformation videos on youtube, trans influencers and forums.

Transgender Influencer: I've just never been able to be me. But I can now.

For Daisy in Chicago, who says she started taking hormones at 18, everything was great in the beginning.

Daisy: After every step that you take, every milestone, feels like a million bucks. When I got top surgery I was elated. When I changed my name I was elated. But when everything that I had set out to do was done, I still felt incomplete.

Garrett from Baton Rouge, Louisiana, went from taking hormones to getting his testicles removed, he says in just three months, whereas the current guidelines call for continuous use for a year. He later got a breast augmentation. But, instead of feeling more himself, he says he felt worse.

Lesley Stahl: So more depressed after you transitioned than before.

Garrett: I had never really been suicidal before until I had my breast augmentation. And about a week afterwards I wanted to, like, actually kill myself. Like, I had a plan and I was gonna do it but I just kept thinking about, like, my family to stop myself. It kind of felt like how am I ever going to feel normal again, like other guys now?

Long before the anti-trans legislation was introduced across the country, the challenges facing the transgender community were daunting. LGBTQ advocacy groups like GLAAD and the Human Rights Campaign are worried that highlighting the stories of detransitioners could make things worse. Alfonso David is president of the Human Rights Campaign.

  Alphonso David

Alphonso David: We're talking about a community, transgender people, that are already marginalized, that are being further marginalized and victimized by elected officials, by anti-equality forces. They're being used as a political football. And these are real people. These are real lives that we're talking about.

Lesley Stahl: So what are some of the challenges right now facing the trans community?

 Alphonso David: The trans community is facing an epidemic of violence. We've had at least 44 transgender people killed last year. Transgender youth, in many cases, attempt suicide at a rate of four times that of their peers.

Lesley Stahl: There's worry that the idea that people regret the move can be used against trans people in this political environment.

Grace Lidinsky-Smith: I worry about it too. I think the kinds of things we advocate for don't hurt trans people. Like, we want there to be more help from therapists with dysphoria. We want there to be longer term tracking of health outcomes. Everyone benefits from that.

Dr. Anderson says the stories of detransitioners mean the trans community as a whole needs more and better health care, not bans on treatment. And she thinks it's a mistake to ignore their voices.

Dr. Erica Anderson: I think we cannot turn a blind eye to the needs of those trans people who have gotten less than adequate care or even poor care. My heart goes out to them. And their stories are important. And we can't deny them.

Earlier this month, the Biden administration, reversing actions taken by the Trump administration, said it will enforce protections against discrimination in health care for transgender people.

Produced by E. Alexandra Poolos. Associate producer, Collette Richards. Broadcast associate, Wren Woodson. Edited by April Wilson.

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