In the US, around 1.4% of adolescents aged 13-17, or roughly 300,000 youths, identify as transgender or gender-diverse (TGD),
meaning their gender identity or expression does not align with their assigned sex's traditional roles or stereotypes.
US military base health providers advocate for children diagnosed with gender dysphoria to be given gender-affirming care such as puberty blockers and affirming hormones. In an article published in the American Journal of Public Health, the providers argue that children have an inherent right to consent to gender-affirming therapy and even come up with the idea that 7-year-olds can make their own medical decisions.
They claim that a “watchful waiting” approach to treatment is unethical and urged the Department of Defense to train all its providers on gender medical interventions for minors
The article recommends that the Uniformed Services University, a military institution, take the lead in pushing forward “gender-affirming care” training within the Pentagon health system.
(To read and listen the full source -here)
The number of new patients seeking such care in the MHS increased from 109 individuals a year in 2010 to over 600 a year in 2016.
In 2017, when gender-affirming medical care was included in TRICARE benefits for about a year, at least 2,500 children actively sought care for gender dysphoria through TRICARE Prime insurance at military or civilian treatment facilities, and 900 received GnRH-a or gender-affirming hormones. These numbers reflect a growing need for accessible gender-affirming care for TGD individuals, particularly for those within the military community. ( read the full report here)
The Department of Defense (DoD) responded that it would train its healthcare providers in keeping with current science and best medical evidence, and that medical decisions are made in consultation between a minor and their guardians.
The DoD also emphasized that it does not support rushing anyone into taking drugs. The DoD providers criticized clinicians who pause before changing a minor’s gender to see if they would grow out of the dysphoria, calling it “unethical”. They also criticized laws that ban transgender drugs, saying that they assume adolescents and their parents are incapable of understanding the risks and benefits of gender-affirming medical care.
The article recommends that the DoD consider the legal ramifications of telehealth options and help facilitate long-term puberty-blocking implants for minors. The DoD should also provide legal services to health providers in states which have banned gender meds for minors, according to the providers. They argue that clinicians may be forced to choose between withholding treatments to act by state law, and providing ethical and evidence-based treatment while facing legal or financial persecution, dishonorable military service, or allegations of child abuse. If those clinicians face criminal ramifications, the providers urge the DoD to defend them from prosecution under state laws or policies that criminalize gender-affirming care.
However, some medical professionals have criticized the article. Dr. Stanley Goldfarb of Do No Harm, an organization of physicians seeking to restore the medical profession to the Hippocratic Oath, disputed the claims made by the DoD doctors, calling them “laughable”.
He argued that the notion that 7-year-old children can make decisions about their medical treatment is beyond laughable. He also pointed out that a large cohort of “detransitioners” suggests the folly of assuming the soundness of childhood decisions.
The debate over gender-affirming care for minors will continue, with proponents advocating for immediate treatment and opponents calling for caution and further research.
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