Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment
Transgender Youth Using Puberty Blockers
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FM","link":"/"}},"futureofyou_370142":{"type":"posts","id":"futureofyou_370142","meta":{"index":"posts_1591205157","site":"futureofyou","id":"370142","score":null,"sort":[1491930057000]},"guestAuthors":[],"slug":"transgender-clinics-see-surge-in-demand-from-youth-seeking-early-treatment","title":"Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment","publishDate":1491930057,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Los Angeles pediatrician Dr. Johanna Olson-Kennedy uses a stethoscope and otoscope, of course. But running a clinic for transgender youth means her pediatric medical supplies also include a selection of silicone penises and chest-flattening binders.\u003c/p>\n\u003cp>Thanks to the openness of \u003ca href=\"https://www.statnews.com/2016/06/29/caitlyn-jenner-trangender-health/\" target=\"_blank\">Caitlyn Jenner\u003c/a> and others, public awareness of transgenderism — and demand for trans-specific medical care like counseling, hormone treatments, and genital surgery — is exploding, even for the youngest of patients. At the \u003ca href=\"http://www.hrc.org/resources/interactive-map-clinical-care-programs-for-gender-nonconforming-childr\" target=\"_blank\">30-plus clinics\u003c/a> for transgender youth across the US, doctors like Olson-Kennedy can barely keep up with the demand.\u003c/p>\n\u003cp>Chicago’s Lurie Children’s Hospital, for example, opened its trans clinic just four years ago but already has 500 patients — and a four-month waiting list. Seattle Children’s Hospital opened its clinic in October and immediately got scores of calls. Olson-Kennedy’s clinic, the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, is the country’s largest, treating 725 trans youth from across the western US. Five hundred of those patients are Olson-Kennedy’s.\u003c/p>\n\u003cp>Her youngest patient is 3.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I’ve had mothers call me who say their child tries to kill themselves every time they have their period.'\u003ccite>Los Angeles pediatrician Dr. Johanna Olson-Kennedy, who treats transgender youth\u003c/cite>\u003c/aside>\n\u003cp>What her patients share is the strong, almost certain, belief that they have been born into the wrong body. Their brains tell them they are one gender, their bodies another. Too often, Olson-Kennedy said, these kids have no one to help guide them or ease their pain or even offer routine medical care without disparaging them. “You sit in this room with these young people and see their distress so clearly,” said Olson, a 47-year-old California native. “It’s not OK to do nothing.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So Olson-Kennedy battles. She fights with insurance companies, tangles with pediatric colleagues who think children are too young to transition, and persuades reluctant parents to help their distressed kids. She’s even taken on the authors of “What to Expect When You’re Expecting” for not including a section on transgender children. And now, just as her fledgling field is beginning to gain medical and mainstream acceptance, she’s got a new adversary: President Donald Trump, who many fear will erode the recent gains of the transgender community and cut access to the health care they need to transition.\u003c/p>\n\u003cp>“It’s my number one concern right now,” Olson-Kennedy said. “I’m very worried.”\u003c/p>\n\u003cp>But there are also signs of hope. Olson-Kennedy is helping lead the first National Institutes of Health grant for research on transgender youth, now in its second year. And she and others hope that data will help win out over discrimination.\u003c/p>\n\u003cp>Olson-Kennedy’s clinic sits on the fourth floor of a bank building on a busy stretch of Sunset Boulevard. In her office with a view of the iconic Hollywood sign, she counsels patients and their parents — a good many of whom have driven or flown from distant states to see her. She can spend hours getting to know a patient before beginning any medical treatment.\u003c/p>\n\u003cp>The youngest patients receive no medical interventions, just counseling. Olson-Kennedy describes one 18-month-old, born a girl, who understood her gender before her grammar. “I a boy,” she repeatedly told her parents. Many young children who experiment with gender roles end up reverting to their birth gender.\u003c/p>\n\u003cp>But when the gender discomfort persists into adolescence, said Olson-Kennedy, it’s usually there to stay. And puberty, when secondary sex characteristics develop, can be a dangerous trigger.\u003c/p>\n\u003cp>“I’ve had mothers call me who say their child tries to kill themselves every time they have their period,” Olson-Kennedy said. “Parents come in saying, ‘My kid tried to cut off his penis with dental floss.’”\u003c/p>\n\u003cp>Olson-Kennedy’s first line of treatment for adolescents is stopping puberty so children and their parents can buy time to sort out what they want to do. Puberty blockers, GnRh agonists like the injectable Lupron or the implant Supprelin, suppress puberty by modifying hormone release. Such drugs have been used off-label safely for more than 30 years to stop early puberty.\u003c/p>\n\u003cp>Trans doctors say it’s critical to stop puberty before the body morphs in ways that are difficult to change — the broadening of shoulders for men, for example, or the rounded hips of women. “Even 14 or 15 is too late,” said Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital.\u003c/p>\n\u003cp>Once children are ready to make a permanent change, they can stop puberty blockers and use masculinizing or feminizing hormones. Some trans youth go on to have surgery to remove breast tissue or add breast contours or alter their genitals. Others forego surgery and use binders and packers to alter their body shape.\u003c/p>\n\u003cp>While some religious groups oppose the process of transitioning — and radio host Laura Ingraham, in the running to be Donald Trump’s press secretary, told her listeners to wear adult diapers rather than use public bathrooms with people who are trans — Olson-Kennedy and her colleagues mostly ignore the flack. They say the care they are providing is not only reducing emotional distress but saving lives. Without support and treatment, Olson-Kennedy said, trans kids are a risk for almost everything: depression, self harm, substance abuse, homelessness, HIV and \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\">suicide\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>A Sense of Urgency \u003c/strong>\u003c/p>\n\u003cp>Athena Fenstermacher was born male, but identified as a girl from her earliest days. “As soon as she could pick colors. As soon as she could talk,” said her mother, Jill. “There are pictures of me with a buzzcut and plastic heels and a Barbie,” Fenstermacher said. “I just knew I wasn’t born into the right body.”\u003c/p>\n\u003cp>Now 18, Fenstermacher is a petite and pretty blonde, demure, graceful and mature beyond her years. Living in nearby Long Beach, she found Olson-Kennedy at 15, after years of confusion and deciding she must be a gay male. “I didn’t even know transitioning existed until I was 14,” she said. “Everyone told me, ‘We don’t know what to do.’” Her treatment was further delayed by counselors who told her she had to undergo months of therapy before they would give her a referral to Olson-Kennedy. (While Olson-Kennedy said therapy is important, she said it should not be used as a roadblock to seeing a physician.)\u003c/p>\n\u003cp>Fenstermacher’s transition was excruciating. She attempted suicide, she said, after enduring extended bullying through high school and dealing with issues like trying to find a bathroom she could use comfortably. A 2015 study by the National Center for Transgender Equality found a majority of transgender Americans avoid using public bathrooms, even going so far as to limit their food and water intake when away from home. For 8 percent of people surveyed, this led to urinary tract or kidney infections.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are pictures of me with a buzzcut and plastic heels and a Barbie. I just knew I wasn’t born into the right body.'\u003ccite>Trans youth Athena Fenstermacher, who was born male\u003c/cite>\u003c/aside>\n\u003cp>It all took a toll: Fenstermacher went from an honors student with a stellar GPA to barely passing. She ended up earning her degree at home. Now, she fights constant loneliness and a sense she’s always being stared at and appraised. She hasn’t been swimming in seven years and says her slightly wider shoulders make her feel like a linebacker. She’s wistful when she describes watching her younger sister develop into the body she wishes she could have had. And she’s angry at her own genetics and a world that won’t accept her.\u003c/p>\n\u003cp>Fenstermacher is willing to discuss her experience and care because she’s so appreciative of Olson-Kennedy and because she wants people to understand the intense pain that comes with struggling with your birth gender. But she flinches every time her physician says the word “trans.” That word, Fenstermacher said, sets people to gawking, making judgements, and scrutinizing.\u003c/p>\n\u003cp>“I don’t feel like a trans woman.” Fenstermacher said. “I feel like a woman.” The word trans, she said, conjures up extremes: the flamboyant models of “Strut” or wealthy trans women like Caitlyn Jenner who order up any medical or cosmetic treatment they want. “The battle is a little different when you can just walk out the door and get facial feminization surgery,” said Fenstermacher, who dresses simply in jeans and T-shirts and, with her mother, has struggled to pay for therapy, treatment, hormones, and the surgery she recently underwent at a private clinic in San Francisco.\u003c/p>\n\u003cp>Athena’s mother fully supported the transition. “When you see their pain, you do what you have to do,” she said. Divorced and a waitress, Jill Fenstermacher literally had to scrape and borrow to get the money for Athena’s care, which was only partially covered by insurance. The costs of getting a legal name change, changing Athena’s driver’s license, it all adds up. “I told her, ‘I don’t care if I have to sleep in my car, I’m helping you do this.’” She’s battled so much: school districts, insurance companies, therapists, doctors. “I’m like the front line for her,” Jill Fenstermacher said. “I try to protect her, but there’s so much discrimination.”\u003c/p>\n\u003cp>Not all doctors agree with the approach of Olson-Kennedy and her colleagues. Some think young patients will grow out of their gender dysphoria, or that children should wait until they are 18 to make critical gender decisions. Many would simply like to see data on whether delaying puberty and allowing children to transition at younger ages is safe and healthy for them in the long run.\u003c/p>\n\u003cp>Olson-Kennedy is hoping to oblige. In 2015, she and three other leading trans youth doctors received the first NIH grant given to study transgender youth. The $5.7 million, five-year study will look at nearly 300 youth, some who received puberty-blocking hormones and others who took masculinizing or feminizing hormones after puberty. Teams at children’s hospitals in L.A., San Francisco, Boston, and Chicago have recruited patients and are now collecting data to evaluate the effect of treatment on mental health and determine how safe the treatments are.\u003c/p>\n\u003cfigure id=\"attachment_370177\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-370177\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Trans-teen.jpg\" alt=\"Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan.\" width=\"594\" height=\"400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-160x108.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-240x162.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-375x253.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-520x350.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan. \u003ccite>(Allison Long/Kansas City Star/MCT via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctors think the study will prove that early treatment and puberty-blocking lead to far better long-term outcomes, making it easier for doctors and parents to accept that approach.\u003c/p>\n\u003cp>“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.\u003c/p>\n\u003cp>And the researchers are hopeful that more data will help to combat misconceptions, both publicly and within the medical profession itself.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Even 14 or 15 is too late.'\u003ccite>Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital\u003c/cite>\u003c/aside>\n\u003cp>Olson-Kennedy points to the stories she hears of pediatricians who say they don’t believe in providing trans care. “You don’t have people opting out of diabetes care because they don’t believe in treating diabetes,” she said.\u003c/p>\n\u003cp>Insurance companies also prove a roadblock for many of her patients. But with California law making it illegal to deny care for gender dysphoria and with her healthy appetite for a fight, Olson-Kennedy usually gets her way. “I have template letters for 100 different denials,” she said. “I just fax in a 100-page appeal and tell them if they deny me, I’m going to fax in 200 pages.”\u003c/p>\n\u003cp>The most counterintuitive end goal of such specialized transgender youth clinics may be to eventually not even need them.\u003c/p>\n\u003cp>“My goal is to make this absolutely mainstream,” said Dr. Cora Breuner, an orthopedist and pediatrician at Seattle Children’s Hospital who chairs the American Association of Pediatrics committee on adolescence. “People should not have to drive 17 hours for this care.” She thinks more kids would get the care they need if pediatricians — usually the first doctor parents seek out — were more comfortable with trans patients. Sensing urgency, the AAP is currently fast-tracking a statement on care for transgender kids, Breuner said.\u003c/p>\n\u003cp>Many physicians have a long way to go. The Twitter hashtag #transhealthfails chronicles a litany of frustrating experiences, from trans women being forced to take pregnancy tests before X-rays despite their not having uterus, to a doctor saying he couldn’t put a cast on a broken arm because he wasn’t versed in trans health care.\u003c/p>\n\u003cp>Sixteen-year-old Shay Sullivan, a Montana resident, had a series of frustrating medical experiences before the family found Olson-Kennedy four years ago. For years, the Sullivan family had tried to find care closer to home and dealt with a palpably uncomfortable local pediatrician. All the while, Shay was becoming increasingly anxious. The clock was ticking as puberty approached.\u003c/p>\n\u003cp>After the family’s first meeting with Olson-Kennedy, Sullivan’s mom, Shelley, said, “We just looked at each other. We were so relieved. We finally found someone who was going to help us find our way.”[contextly_sidebar id=\"WEqHfKvtKe7dW3iHsSIXRQ0Crw5Vzu9w\"]\u003c/p>\n\u003cp>The family’s insurance covered all but $200 of the cost of Shay’s $17,000 hormone blocking implant and helped cover the gender confirmation\u003cstrong> \u003c/strong>surgery she had at 16. (Most doctors wait until patients are over 18 for such surgery, but Shay was considered exceptionally mature, her mother said.) The family paid for the travel to see Olson-Kennedy and for staying in Arizona for nearly two weeks for the surgery. “We’re fortunate,” said Shelley, a physical therapist. “We both have good jobs and are able to afford it.”\u003c/p>\n\u003cp>Today, Shay is a driven high school junior, earning an International Baccalaureate degree in high school as well as learning several languages and is planning to study abroad during college. She doesn’t travel as much to the Los Angeles clinic now because her pediatrician has agreed to work with Olson-Kennedy to provide her care. Shay volunteers to help other trans teens in Missoula and is having a “pretty good year socially,” she said. One low point: Since entering high school, she’s not allowed to play on girls’ sports teams.\u003c/p>\n\u003cp>\u003cstrong>Federal Policy Changes Afoot? \u003c/strong>\u003c/p>\n\u003cp>Doctors on the front lines of transgender youth care say they are heartened that children are coming in at younger ages and that transgender youth clinics are opening in suburban areas. But they’ve also nervously got their eyes on what Trump may do.\u003c/p>\n\u003cp>“I don’t know if it will be any worse, but I don’t think things will get better,” said Boston Children’s Spack, 73. “I’m old enough to remember when homosexuality was considered a disease. Those ideas die hard.”\u003c/p>\n\u003cp>Garofalo, a self-described optimist, said he hopes medical care for trans kids won’t suffer greatly under the new administration. But he said, “I’d be naive not to be worried.” He said he is definitely “poised to fight,” if needed, to protect his patients and families.\u003c/p>\n\u003cp>Olson-Kennedy already has her sleeves rolled up. She’s worried about policy changes, like a dismantling of the Affordable Care Act, that might remove the insurance coverage trans youth need. But she’s also worried about an emerging ethos that may allow open discrimination and violence against transgender youth and adults.\u003c/p>\n\u003cp>“We’ve made such incredible strides,” she said. “We don’t want to see people going underground again.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2016/12/20/transgender-youth-doctors-clinics/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery\u003c/em>.\u003c/p>\n\n","blocks":[],"excerpt":"Clinics for transgender youth are surging with patients who want to transition, even as President Donald Trump rescinds protections for transgender students. ","status":"publish","parent":0,"modified":1491851188,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":47,"wordCount":2917},"headData":{"title":"Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment | KQED","description":"Clinics for transgender youth are surging with patients who want to transition, even as President Donald Trump rescinds protections for transgender students. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment","datePublished":"2017-04-11T17:00:57.000Z","dateModified":"2017-04-10T19:06:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"370142 https://ww2.kqed.org/futureofyou/?p=370142","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/04/11/transgender-clinics-see-surge-in-demand-from-youth-seeking-early-treatment/","disqusTitle":"Transgender Clinics See Surge in Demand From Youth Seeking Early Treatment","nprByline":"\u003cstrong>Usha Lee McFarling\u003cBR />STAT\u003c/strong>","path":"/futureofyou/370142/transgender-clinics-see-surge-in-demand-from-youth-seeking-early-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Los Angeles pediatrician Dr. Johanna Olson-Kennedy uses a stethoscope and otoscope, of course. But running a clinic for transgender youth means her pediatric medical supplies also include a selection of silicone penises and chest-flattening binders.\u003c/p>\n\u003cp>Thanks to the openness of \u003ca href=\"https://www.statnews.com/2016/06/29/caitlyn-jenner-trangender-health/\" target=\"_blank\">Caitlyn Jenner\u003c/a> and others, public awareness of transgenderism — and demand for trans-specific medical care like counseling, hormone treatments, and genital surgery — is exploding, even for the youngest of patients. At the \u003ca href=\"http://www.hrc.org/resources/interactive-map-clinical-care-programs-for-gender-nonconforming-childr\" target=\"_blank\">30-plus clinics\u003c/a> for transgender youth across the US, doctors like Olson-Kennedy can barely keep up with the demand.\u003c/p>\n\u003cp>Chicago’s Lurie Children’s Hospital, for example, opened its trans clinic just four years ago but already has 500 patients — and a four-month waiting list. Seattle Children’s Hospital opened its clinic in October and immediately got scores of calls. Olson-Kennedy’s clinic, the Center for Transyouth Health and Development at Children’s Hospital Los Angeles, is the country’s largest, treating 725 trans youth from across the western US. Five hundred of those patients are Olson-Kennedy’s.\u003c/p>\n\u003cp>Her youngest patient is 3.\u003c/p>\n\u003caside class=\"pullquote alignright\">'I’ve had mothers call me who say their child tries to kill themselves every time they have their period.'\u003ccite>Los Angeles pediatrician Dr. Johanna Olson-Kennedy, who treats transgender youth\u003c/cite>\u003c/aside>\n\u003cp>What her patients share is the strong, almost certain, belief that they have been born into the wrong body. Their brains tell them they are one gender, their bodies another. Too often, Olson-Kennedy said, these kids have no one to help guide them or ease their pain or even offer routine medical care without disparaging them. “You sit in this room with these young people and see their distress so clearly,” said Olson, a 47-year-old California native. “It’s not OK to do nothing.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So Olson-Kennedy battles. She fights with insurance companies, tangles with pediatric colleagues who think children are too young to transition, and persuades reluctant parents to help their distressed kids. She’s even taken on the authors of “What to Expect When You’re Expecting” for not including a section on transgender children. And now, just as her fledgling field is beginning to gain medical and mainstream acceptance, she’s got a new adversary: President Donald Trump, who many fear will erode the recent gains of the transgender community and cut access to the health care they need to transition.\u003c/p>\n\u003cp>“It’s my number one concern right now,” Olson-Kennedy said. “I’m very worried.”\u003c/p>\n\u003cp>But there are also signs of hope. Olson-Kennedy is helping lead the first National Institutes of Health grant for research on transgender youth, now in its second year. And she and others hope that data will help win out over discrimination.\u003c/p>\n\u003cp>Olson-Kennedy’s clinic sits on the fourth floor of a bank building on a busy stretch of Sunset Boulevard. In her office with a view of the iconic Hollywood sign, she counsels patients and their parents — a good many of whom have driven or flown from distant states to see her. She can spend hours getting to know a patient before beginning any medical treatment.\u003c/p>\n\u003cp>The youngest patients receive no medical interventions, just counseling. Olson-Kennedy describes one 18-month-old, born a girl, who understood her gender before her grammar. “I a boy,” she repeatedly told her parents. Many young children who experiment with gender roles end up reverting to their birth gender.\u003c/p>\n\u003cp>But when the gender discomfort persists into adolescence, said Olson-Kennedy, it’s usually there to stay. And puberty, when secondary sex characteristics develop, can be a dangerous trigger.\u003c/p>\n\u003cp>“I’ve had mothers call me who say their child tries to kill themselves every time they have their period,” Olson-Kennedy said. “Parents come in saying, ‘My kid tried to cut off his penis with dental floss.’”\u003c/p>\n\u003cp>Olson-Kennedy’s first line of treatment for adolescents is stopping puberty so children and their parents can buy time to sort out what they want to do. Puberty blockers, GnRh agonists like the injectable Lupron or the implant Supprelin, suppress puberty by modifying hormone release. Such drugs have been used off-label safely for more than 30 years to stop early puberty.\u003c/p>\n\u003cp>Trans doctors say it’s critical to stop puberty before the body morphs in ways that are difficult to change — the broadening of shoulders for men, for example, or the rounded hips of women. “Even 14 or 15 is too late,” said Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital.\u003c/p>\n\u003cp>Once children are ready to make a permanent change, they can stop puberty blockers and use masculinizing or feminizing hormones. Some trans youth go on to have surgery to remove breast tissue or add breast contours or alter their genitals. Others forego surgery and use binders and packers to alter their body shape.\u003c/p>\n\u003cp>While some religious groups oppose the process of transitioning — and radio host Laura Ingraham, in the running to be Donald Trump’s press secretary, told her listeners to wear adult diapers rather than use public bathrooms with people who are trans — Olson-Kennedy and her colleagues mostly ignore the flack. They say the care they are providing is not only reducing emotional distress but saving lives. Without support and treatment, Olson-Kennedy said, trans kids are a risk for almost everything: depression, self harm, substance abuse, homelessness, HIV and \u003ca href=\"http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf\" target=\"_blank\">suicide\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>A Sense of Urgency \u003c/strong>\u003c/p>\n\u003cp>Athena Fenstermacher was born male, but identified as a girl from her earliest days. “As soon as she could pick colors. As soon as she could talk,” said her mother, Jill. “There are pictures of me with a buzzcut and plastic heels and a Barbie,” Fenstermacher said. “I just knew I wasn’t born into the right body.”\u003c/p>\n\u003cp>Now 18, Fenstermacher is a petite and pretty blonde, demure, graceful and mature beyond her years. Living in nearby Long Beach, she found Olson-Kennedy at 15, after years of confusion and deciding she must be a gay male. “I didn’t even know transitioning existed until I was 14,” she said. “Everyone told me, ‘We don’t know what to do.’” Her treatment was further delayed by counselors who told her she had to undergo months of therapy before they would give her a referral to Olson-Kennedy. (While Olson-Kennedy said therapy is important, she said it should not be used as a roadblock to seeing a physician.)\u003c/p>\n\u003cp>Fenstermacher’s transition was excruciating. She attempted suicide, she said, after enduring extended bullying through high school and dealing with issues like trying to find a bathroom she could use comfortably. A 2015 study by the National Center for Transgender Equality found a majority of transgender Americans avoid using public bathrooms, even going so far as to limit their food and water intake when away from home. For 8 percent of people surveyed, this led to urinary tract or kidney infections.\u003c/p>\n\u003caside class=\"pullquote alignright\">'There are pictures of me with a buzzcut and plastic heels and a Barbie. I just knew I wasn’t born into the right body.'\u003ccite>Trans youth Athena Fenstermacher, who was born male\u003c/cite>\u003c/aside>\n\u003cp>It all took a toll: Fenstermacher went from an honors student with a stellar GPA to barely passing. She ended up earning her degree at home. Now, she fights constant loneliness and a sense she’s always being stared at and appraised. She hasn’t been swimming in seven years and says her slightly wider shoulders make her feel like a linebacker. She’s wistful when she describes watching her younger sister develop into the body she wishes she could have had. And she’s angry at her own genetics and a world that won’t accept her.\u003c/p>\n\u003cp>Fenstermacher is willing to discuss her experience and care because she’s so appreciative of Olson-Kennedy and because she wants people to understand the intense pain that comes with struggling with your birth gender. But she flinches every time her physician says the word “trans.” That word, Fenstermacher said, sets people to gawking, making judgements, and scrutinizing.\u003c/p>\n\u003cp>“I don’t feel like a trans woman.” Fenstermacher said. “I feel like a woman.” The word trans, she said, conjures up extremes: the flamboyant models of “Strut” or wealthy trans women like Caitlyn Jenner who order up any medical or cosmetic treatment they want. “The battle is a little different when you can just walk out the door and get facial feminization surgery,” said Fenstermacher, who dresses simply in jeans and T-shirts and, with her mother, has struggled to pay for therapy, treatment, hormones, and the surgery she recently underwent at a private clinic in San Francisco.\u003c/p>\n\u003cp>Athena’s mother fully supported the transition. “When you see their pain, you do what you have to do,” she said. Divorced and a waitress, Jill Fenstermacher literally had to scrape and borrow to get the money for Athena’s care, which was only partially covered by insurance. The costs of getting a legal name change, changing Athena’s driver’s license, it all adds up. “I told her, ‘I don’t care if I have to sleep in my car, I’m helping you do this.’” She’s battled so much: school districts, insurance companies, therapists, doctors. “I’m like the front line for her,” Jill Fenstermacher said. “I try to protect her, but there’s so much discrimination.”\u003c/p>\n\u003cp>Not all doctors agree with the approach of Olson-Kennedy and her colleagues. Some think young patients will grow out of their gender dysphoria, or that children should wait until they are 18 to make critical gender decisions. Many would simply like to see data on whether delaying puberty and allowing children to transition at younger ages is safe and healthy for them in the long run.\u003c/p>\n\u003cp>Olson-Kennedy is hoping to oblige. In 2015, she and three other leading trans youth doctors received the first NIH grant given to study transgender youth. The $5.7 million, five-year study will look at nearly 300 youth, some who received puberty-blocking hormones and others who took masculinizing or feminizing hormones after puberty. Teams at children’s hospitals in L.A., San Francisco, Boston, and Chicago have recruited patients and are now collecting data to evaluate the effect of treatment on mental health and determine how safe the treatments are.\u003c/p>\n\u003cfigure id=\"attachment_370177\" class=\"wp-caption aligncenter\" style=\"max-width: 594px\">\u003cimg class=\"size-full wp-image-370177\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/04/Trans-teen.jpg\" alt=\"Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan.\" width=\"594\" height=\"400\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen.jpg 594w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-160x108.jpg 160w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-240x162.jpg 240w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-375x253.jpg 375w, https://ww2.kqed.org/app/uploads/sites/13/2017/04/Trans-teen-520x350.jpg 520w\" sizes=\"(max-width: 594px) 100vw, 594px\">\u003cfigcaption class=\"wp-caption-text\">Isaac Barnett, a transgender 18-year-old, left, talks with his doctor, Jill Jacobson, Jan. 20, 2014, at Children's' Mercy South in Overland Park, Kan. \u003ccite>(Allison Long/Kansas City Star/MCT via Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The doctors think the study will prove that early treatment and puberty-blocking lead to far better long-term outcomes, making it easier for doctors and parents to accept that approach.\u003c/p>\n\u003cp>“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.\u003c/p>\n\u003cp>And the researchers are hopeful that more data will help to combat misconceptions, both publicly and within the medical profession itself.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Even 14 or 15 is too late.'\u003ccite>Dr. Norman Spack, an endocrinologist who founded the country’s first transgender youth clinic at Boston Children’s Hospital\u003c/cite>\u003c/aside>\n\u003cp>Olson-Kennedy points to the stories she hears of pediatricians who say they don’t believe in providing trans care. “You don’t have people opting out of diabetes care because they don’t believe in treating diabetes,” she said.\u003c/p>\n\u003cp>Insurance companies also prove a roadblock for many of her patients. But with California law making it illegal to deny care for gender dysphoria and with her healthy appetite for a fight, Olson-Kennedy usually gets her way. “I have template letters for 100 different denials,” she said. “I just fax in a 100-page appeal and tell them if they deny me, I’m going to fax in 200 pages.”\u003c/p>\n\u003cp>The most counterintuitive end goal of such specialized transgender youth clinics may be to eventually not even need them.\u003c/p>\n\u003cp>“My goal is to make this absolutely mainstream,” said Dr. Cora Breuner, an orthopedist and pediatrician at Seattle Children’s Hospital who chairs the American Association of Pediatrics committee on adolescence. “People should not have to drive 17 hours for this care.” She thinks more kids would get the care they need if pediatricians — usually the first doctor parents seek out — were more comfortable with trans patients. Sensing urgency, the AAP is currently fast-tracking a statement on care for transgender kids, Breuner said.\u003c/p>\n\u003cp>Many physicians have a long way to go. The Twitter hashtag #transhealthfails chronicles a litany of frustrating experiences, from trans women being forced to take pregnancy tests before X-rays despite their not having uterus, to a doctor saying he couldn’t put a cast on a broken arm because he wasn’t versed in trans health care.\u003c/p>\n\u003cp>Sixteen-year-old Shay Sullivan, a Montana resident, had a series of frustrating medical experiences before the family found Olson-Kennedy four years ago. For years, the Sullivan family had tried to find care closer to home and dealt with a palpably uncomfortable local pediatrician. All the while, Shay was becoming increasingly anxious. The clock was ticking as puberty approached.\u003c/p>\n\u003cp>After the family’s first meeting with Olson-Kennedy, Sullivan’s mom, Shelley, said, “We just looked at each other. We were so relieved. We finally found someone who was going to help us find our way.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The family’s insurance covered all but $200 of the cost of Shay’s $17,000 hormone blocking implant and helped cover the gender confirmation\u003cstrong> \u003c/strong>surgery she had at 16. (Most doctors wait until patients are over 18 for such surgery, but Shay was considered exceptionally mature, her mother said.) The family paid for the travel to see Olson-Kennedy and for staying in Arizona for nearly two weeks for the surgery. “We’re fortunate,” said Shelley, a physical therapist. “We both have good jobs and are able to afford it.”\u003c/p>\n\u003cp>Today, Shay is a driven high school junior, earning an International Baccalaureate degree in high school as well as learning several languages and is planning to study abroad during college. She doesn’t travel as much to the Los Angeles clinic now because her pediatrician has agreed to work with Olson-Kennedy to provide her care. Shay volunteers to help other trans teens in Missoula and is having a “pretty good year socially,” she said. One low point: Since entering high school, she’s not allowed to play on girls’ sports teams.\u003c/p>\n\u003cp>\u003cstrong>Federal Policy Changes Afoot? \u003c/strong>\u003c/p>\n\u003cp>Doctors on the front lines of transgender youth care say they are heartened that children are coming in at younger ages and that transgender youth clinics are opening in suburban areas. But they’ve also nervously got their eyes on what Trump may do.\u003c/p>\n\u003cp>“I don’t know if it will be any worse, but I don’t think things will get better,” said Boston Children’s Spack, 73. “I’m old enough to remember when homosexuality was considered a disease. Those ideas die hard.”\u003c/p>\n\u003cp>Garofalo, a self-described optimist, said he hopes medical care for trans kids won’t suffer greatly under the new administration. But he said, “I’d be naive not to be worried.” He said he is definitely “poised to fight,” if needed, to protect his patients and families.\u003c/p>\n\u003cp>Olson-Kennedy already has her sleeves rolled up. She’s worried about policy changes, like a dismantling of the Affordable Care Act, that might remove the insurance coverage trans youth need. But she’s also worried about an emerging ethos that may allow open discrimination and violence against transgender youth and adults.\u003c/p>\n\u003cp>“We’ve made such incredible strides,” she said. “We don’t want to see people going underground again.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2016/12/20/transgender-youth-doctors-clinics/\">story\u003c/a> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery\u003c/em>.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/370142/transgender-clinics-see-surge-in-demand-from-youth-seeking-early-treatment","authors":["byline_futureofyou_370142"],"categories":["futureofyou_1"],"tags":["futureofyou_1244","futureofyou_1020","futureofyou_1018"],"featImg":"futureofyou_370174","label":"futureofyou"},"futureofyou_226462":{"type":"posts","id":"futureofyou_226462","meta":{"index":"posts_1591205157","site":"futureofyou","id":"226462","score":null,"sort":[1471639239000]},"guestAuthors":[],"slug":"transgender-youth-using-puberty-blockers","title":"Transgender Youth Using Puberty Blockers","publishDate":1471639239,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Puberty is no picnic, even in the best of circumstances. Once the sex hormones estrogen or testosterone kick in, there’s no turning back: Here come breasts and periods, Adam’s apples and acne. It’s a tough passage for many kids, but for some — transgender youth whose bodies don’t match their gender identity — puberty can be unbearable.\u003c/p>\n\u003caside class=\"pullquote alignright\">Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable.\u003c/aside>\n\u003cp>For one Oakland family, their daughter’s path was clear from the time she was three. Her birth certificate said “male,” but the child would always say she wanted to be a girl, and that soon became, “I AM a girl,” said the mother, who asked that her family’s name not be used to protect her daughter’s privacy. She recalled a day when the girl wept in frustration trying to fashion a skirt out of some t-shirts.\u003c/p>\n\u003cp>“Finally I just said, ‘Honey, do you want a dress?’’ and they went to a store and bought one. “I literally thought she was going to faint or hyperventilate,” said the mother. “She couldn’t sit still, she was so excited and so happy. It was a moment of pure joy for her, and also a turning point,” she said.\u003c/p>\n\u003cp>She was happy growing up and attended a progressive school in the San Francisco Bay Area as a girl. But when she was approaching puberty, she became very nervous, “worried about getting facial hair or watching her shoulders get broader. It was all very painful for her,” her mother said.\u003c/p>\n\u003cp>The child was experiencing what’s known as \u003ca href=\"http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf\" target=\"_blank\">gender dysphoria\u003c/a>, a DSM-5 diagnosis of significant ongoing distress, with the feeling of being assigned the wrong gender at birth. Researchers at Harvard \u003ca href=\"http://www.jahonline.org/article/S1054-139X%2814%2900693-4/abstract\" target=\"_blank\">recently found\u003c/a> that transgender youth are at a much higher risk for mental disorders, including depression, anxiety, suicidal thoughts and self-harm. They are more than twice as likely as non-trans youth to be diagnosed with depression (50.6 percent vs. 20.6 percent) or suffer from anxiety (26.7 percent vs. 10 percent).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“These kids are saying to the world, ‘I was born in the wrong body, and there’s something just not right about living this way,’” said Scott Leibowitz, head child and adolescent psychiatrist at the Ann & Robert H. Lurie Children’s Hospital of Chicago.\u003c/p>\n\u003cp>\u003cstrong>Blockers ‘Safe and Effective’\u003c/strong>\u003c/p>\n\u003cp>Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable. By taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed, so that the body does not develop secondary sex characteristics. This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids and prostate cancer.\u003c/p>\n\u003cp>It was only in 2008 that \u003ca href=\"https://endocrine.org/\" target=\"_blank\">the Endocrine Society\u003c/a> approved puberty suppressors as a treatment for transgender adolescents as young as 12 years old. The Society, with members in more than 100 countries, has \u003ca href=\"https://www.endocrine.org/news-room/press-release-archives/2013/medical-intervention-in-transgender-adolescents-appears-to-be-safe-and-effective\" target=\"_blank\">since declared\u003c/a> that the intervention appears to be safe and effective. In 2011 the \u003ca href=\"http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1347&pk_association_webpage=4233\" target=\"_blank\">World Professional Association for Transgender Health\u003c/a> (WPATH), also issued Standards of Care for the treatment of patients with gender dysphoria, which include puberty suppression.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As soon as he got breast buds, it was like the panic button was hit. He was quickly and very intensely uncomfortable and afraid.'\u003c/aside>\n\u003cp>There are few reported side effects to this off-label use of sex hormone suppressors. Despite early concerns that blocking sex hormones might harm bone development, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25427144\" target=\"_blank\">recent study\u003c/a> from the Netherlands found no evidence of long-term effects on bone mineral density. If the suppressors are halted, puberty resumes as if there had been no treatment.\u003c/p>\n\u003cp>Data on the use of puberty blockers is scarce, but in the past decade or so, it’s believed thousands of transgender youth and their families have chosen to suppress puberty to give adolescents a time-out while they figure out the next step in their development.\u003c/p>\n\u003cp>A St. Louis, Mo., child was classified as female at birth, one of a set of twin girls. But the parents had been discussing puberty blockers with him since he was seven years old, after he had begun dressing as a boy and showing more masculine traits.\u003c/p>\n\u003cp>“I remember watching a documentary where he learned what blockers were and we talked about it and he was sure that’s what he wanted when the time came,” said his mother, who also asked that the family’s names not be used to protect her child’s privacy.\u003c/p>\n\u003cp>“As soon as he got breast buds, it was like the panic button was hit,” the mother said. “He was quickly and very intensely uncomfortable and afraid. He would cry, knowing that this was the beginning of something that he didn’t want, that he knew wasn’t right for him,” she said.\u003c/p>\n\u003cp>In March, after the boy turned 11, a pediatric endocrinologist prescribed the sex hormone suppressor Eligard, an injection that he receives every four months. According to his mother, because they intervened early, the unwanted breast buds receded quickly, along with her son’s depression and anxiety. “I don’t know what we would have done if we were not able to stop puberty so he doesn’t have to feel in constant conflict with his own body,” she said.\u003c/p>\n\u003cp>So far, according to the mother, the biggest problem their family has faced has been trying to get insurance coverage for her son’s treatment. She said they have been lucky to obtain the injections at cost — $500 per shot — rather than the $1,500 to $2,000 per shot that the therapy typically costs. Her husband’s employer, which self-funds its medical insurance plan, chose a clause that excludes transgender care.\u003c/p>\n\u003cp>That kind of exclusion could change, especially since the Obama Administration recently issued \u003ca href=\"https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-11458.pdf\" target=\"_blank\">final regulations on Section 1557 of the Affordable Care Act\u003c/a> that ban the denial of health care on the basis of gender identity in programs that receive federal funding. The rule could help people who feel they have been discriminated against to bring complaints or lawsuits, according to the \u003ca href=\"http://transgenderlawcenter.org/archives/12908\" target=\"_blank\">Transgender Law Center\u003c/a> in Oakland, Calif.\u003c/p>\n\u003cp>In 2014, Oregon became the first state to provide Medicaid coverage for adolescents receiving puberty blockers. Medicaid programs in other states, including New York and California, have also expanded transgender healthcare coverage, although that does not mean that puberty blockers always are covered.\u003c/p>\n\u003cp>\u003cstrong>How Early is Too Early?\u003c/strong>\u003c/p>\n\u003cp>Treatment with puberty blockers gives transgender children a breather so they can continue to mature and decide whether they will pursue treatment with cross-sex hormones or gender reassignment surgery. For many families, the question is not whether to intervene with blockers, but how early to start.\u003c/p>\n\u003cp>Because the onset of puberty varies so widely — as early as age 9 for some — suppression can begin at different ages. And that’s prompted some disagreement within the field — the “age versus stage” debate — about when to begin, according to Leibowitz. Most often blockers are initiated at the first visible signs of development as measured by the \u003ca href=\"http://www.childgrowthfoundation.org/CMS/FILES/Puberty_and_the_Tanner_Stages.pdf\" target=\"_blank\">Tanner Stages\u003c/a>, a scale of sexual maturation developed by pediatrician James Tanner. The trigger for suppression is usually Tanner stage 2, when pubic hair and breast buds appear.\u003c/p>\n\u003cp>“If you are able to suspend puberty as soon as it happens you’re optimizing the benefits that it can bring physically,” said Leibowitz. Starting early may alleviate the need for surgical breast removal or voice modification therapy later on. It also makes it far easier for transgender teens to fit in. “That ability to blend in and be perceived as the gender that they identify with is associated with long-term psychological benefits,” said Leibowitz.\u003c/p>\n\u003cp>But does that mean that 9- or 10-year-old transgender kids should be started on puberty blockers? Even though the treatment is reversible and is considered safe, Leibowitz said some clinicians argue the age issue is important because less is known about very early interventions. How long can puberty be safely suppressed? And if the next step is transitioning with cross-sex hormones, at what age should that begin?\u003c/p>\n\u003cp>Of course, there is no treatment at all unless the parents of transgender children agree. “For most of my clients [who are minors], the issue revolves around whether they can start hormones or puberty blockers without parental consent, and the short answer is ‘No,”’ said Danielle Castro, a psychotherapist and project director at the Center of Excellence for Transgender Health at the University of California, San Francisco.\u003c/p>\n\u003cp>Castro said families of some transgender youth refuse the intervention because they believe their children are “just going through a phase.” A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18981931\" target=\"_blank\">study\u003c/a> in 2008 found that 43 percent of very young children who experienced gender dysphoria no longer felt that way after adolescence. The 27 percent who remained dysphoric were the ones who had felt that way most strongly when they were young.\u003c/p>\n\u003cp>Young children may indeed change their minds, but gender identity seems to be fixed by the time kids have reached puberty. The Endocrine Society finds that transgender adolescents grow up to be transgender adults “100 percent of the time.” Dr. Stephen Rosenthal, director of the Child and Adolescent Gender Center at UCSF, \u003ca href=\"http://press.endocrine.org/doi/pdf/10.1210/jc.2014-1919\" target=\"_blank\">agrees\u003c/a>: “Children who meet the mental health criteria for gender dysphoria in adolescence are likely to be transgender for life.”\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20646177\" target=\"_blank\">recent study\u003c/a> of 70 participants all the adolescents who had been given puberty blockers went through with sex reassignment.\u003c/p>\n\u003cp>\u003cstrong>The Standard of Care\u003c/strong>\u003c/p>\n\u003cp>Even though the Oakland family had agreed in advance that their daughter would start on blockers at the right time, “we had to reassure her constantly that we wouldn’t let it go too far,” she said.\u003c/p>\n\u003cp>When she turned 13, the girl started receiving monthly injections of Lupron, a widely prescribed sex hormone suppressor. “As soon as she started, you could just see the relief in her,” said the mother. “You could see it in her demeanor, in her mood; it was just a huge weight off her shoulders,” she said.\u003c/p>\n\u003cp>The family’s insurer, Kaiser Permanente, covered the treatment. Puberty blockers are considered “standard of care in the appropriate clinical circumstances,” said Erica Metz, medical director for Transgender Health at Kaiser Permanente Northern California. According to Metz, the treatment “gives patients and their families time to work with their mental health and medical providers to determine if it is appropriate to start transitioning.”\u003c/p>\n\u003cp>When the girl was 14, she started taking estrogen — the next step in her male-to-female transition. Instead of growing facial hair and a male physique, she developed breasts and some curves. Her voice didn’t deepen, and she doesn’t have an Adam’s apple.\u003c/p>\n\u003cp>The mother described her daughter as a social, outgoing and well-adjusted teenager. She knows the \u003ca href=\"http://williamsinstitute.law.ucla.edu/research/suicide-attempts-among-transgender-and-gender-non-conforming-adults/\" target=\"_blank\">grim mental health statistics\u003c/a> for transgender people — 41 percent have attempted suicide, nearly nine times the national average — and she doesn’t want to imagine a world where her daughter would be without puberty blockers, a medical intervention that she called a “lifesaver.”\u003c/p>\n\u003cp>“The thought of her having had to go through male puberty, I think it would have destroyed her mental health and well-being,” the mother said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Transgender adolescents are more frequently making off-label use of a hormone agonist that suppresses puberty.","status":"publish","parent":0,"modified":1471881260,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":2027},"headData":{"title":"Transgender Youth Using Puberty Blockers | KQED","description":"Transgender adolescents are more frequently making off-label use of a hormone agonist that suppresses puberty.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Transgender Youth Using Puberty Blockers","datePublished":"2016-08-19T20:40:39.000Z","dateModified":"2016-08-22T15:54:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"226462 http://ww2.kqed.org/futureofyou/?p=226462","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/08/19/transgender-youth-using-puberty-blockers/","disqusTitle":"Transgender Youth Using Puberty Blockers","source":"Future of You","nprByline":"Elaine Korry\u003cbr />California Healthline","path":"/futureofyou/226462/transgender-youth-using-puberty-blockers","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Puberty is no picnic, even in the best of circumstances. Once the sex hormones estrogen or testosterone kick in, there’s no turning back: Here come breasts and periods, Adam’s apples and acne. It’s a tough passage for many kids, but for some — transgender youth whose bodies don’t match their gender identity — puberty can be unbearable.\u003c/p>\n\u003caside class=\"pullquote alignright\">Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable.\u003c/aside>\n\u003cp>For one Oakland family, their daughter’s path was clear from the time she was three. Her birth certificate said “male,” but the child would always say she wanted to be a girl, and that soon became, “I AM a girl,” said the mother, who asked that her family’s name not be used to protect her daughter’s privacy. She recalled a day when the girl wept in frustration trying to fashion a skirt out of some t-shirts.\u003c/p>\n\u003cp>“Finally I just said, ‘Honey, do you want a dress?’’ and they went to a store and bought one. “I literally thought she was going to faint or hyperventilate,” said the mother. “She couldn’t sit still, she was so excited and so happy. It was a moment of pure joy for her, and also a turning point,” she said.\u003c/p>\n\u003cp>She was happy growing up and attended a progressive school in the San Francisco Bay Area as a girl. But when she was approaching puberty, she became very nervous, “worried about getting facial hair or watching her shoulders get broader. It was all very painful for her,” her mother said.\u003c/p>\n\u003cp>The child was experiencing what’s known as \u003ca href=\"http://www.dsm5.org/documents/gender%20dysphoria%20fact%20sheet.pdf\" target=\"_blank\">gender dysphoria\u003c/a>, a DSM-5 diagnosis of significant ongoing distress, with the feeling of being assigned the wrong gender at birth. Researchers at Harvard \u003ca href=\"http://www.jahonline.org/article/S1054-139X%2814%2900693-4/abstract\" target=\"_blank\">recently found\u003c/a> that transgender youth are at a much higher risk for mental disorders, including depression, anxiety, suicidal thoughts and self-harm. They are more than twice as likely as non-trans youth to be diagnosed with depression (50.6 percent vs. 20.6 percent) or suffer from anxiety (26.7 percent vs. 10 percent).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“These kids are saying to the world, ‘I was born in the wrong body, and there’s something just not right about living this way,’” said Scott Leibowitz, head child and adolescent psychiatrist at the Ann & Robert H. Lurie Children’s Hospital of Chicago.\u003c/p>\n\u003cp>\u003cstrong>Blockers ‘Safe and Effective’\u003c/strong>\u003c/p>\n\u003cp>Full-blown puberty is irreversible, but for transgender children, it’s no longer inevitable. By taking a gonadotropin-releasing hormone (GnRH) agonist, secretion of the sex hormones can be stopped and the onset of puberty suppressed, so that the body does not develop secondary sex characteristics. This has been done safely for decades to suppress sex hormones in children who develop too early, a condition known as precocious puberty. Suppressors have also been used to treat endometriosis, uterine fibroids and prostate cancer.\u003c/p>\n\u003cp>It was only in 2008 that \u003ca href=\"https://endocrine.org/\" target=\"_blank\">the Endocrine Society\u003c/a> approved puberty suppressors as a treatment for transgender adolescents as young as 12 years old. The Society, with members in more than 100 countries, has \u003ca href=\"https://www.endocrine.org/news-room/press-release-archives/2013/medical-intervention-in-transgender-adolescents-appears-to-be-safe-and-effective\" target=\"_blank\">since declared\u003c/a> that the intervention appears to be safe and effective. In 2011 the \u003ca href=\"http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1347&pk_association_webpage=4233\" target=\"_blank\">World Professional Association for Transgender Health\u003c/a> (WPATH), also issued Standards of Care for the treatment of patients with gender dysphoria, which include puberty suppression.\u003c/p>\n\u003caside class=\"pullquote alignright\">'As soon as he got breast buds, it was like the panic button was hit. He was quickly and very intensely uncomfortable and afraid.'\u003c/aside>\n\u003cp>There are few reported side effects to this off-label use of sex hormone suppressors. Despite early concerns that blocking sex hormones might harm bone development, a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25427144\" target=\"_blank\">recent study\u003c/a> from the Netherlands found no evidence of long-term effects on bone mineral density. If the suppressors are halted, puberty resumes as if there had been no treatment.\u003c/p>\n\u003cp>Data on the use of puberty blockers is scarce, but in the past decade or so, it’s believed thousands of transgender youth and their families have chosen to suppress puberty to give adolescents a time-out while they figure out the next step in their development.\u003c/p>\n\u003cp>A St. Louis, Mo., child was classified as female at birth, one of a set of twin girls. But the parents had been discussing puberty blockers with him since he was seven years old, after he had begun dressing as a boy and showing more masculine traits.\u003c/p>\n\u003cp>“I remember watching a documentary where he learned what blockers were and we talked about it and he was sure that’s what he wanted when the time came,” said his mother, who also asked that the family’s names not be used to protect her child’s privacy.\u003c/p>\n\u003cp>“As soon as he got breast buds, it was like the panic button was hit,” the mother said. “He was quickly and very intensely uncomfortable and afraid. He would cry, knowing that this was the beginning of something that he didn’t want, that he knew wasn’t right for him,” she said.\u003c/p>\n\u003cp>In March, after the boy turned 11, a pediatric endocrinologist prescribed the sex hormone suppressor Eligard, an injection that he receives every four months. According to his mother, because they intervened early, the unwanted breast buds receded quickly, along with her son’s depression and anxiety. “I don’t know what we would have done if we were not able to stop puberty so he doesn’t have to feel in constant conflict with his own body,” she said.\u003c/p>\n\u003cp>So far, according to the mother, the biggest problem their family has faced has been trying to get insurance coverage for her son’s treatment. She said they have been lucky to obtain the injections at cost — $500 per shot — rather than the $1,500 to $2,000 per shot that the therapy typically costs. Her husband’s employer, which self-funds its medical insurance plan, chose a clause that excludes transgender care.\u003c/p>\n\u003cp>That kind of exclusion could change, especially since the Obama Administration recently issued \u003ca href=\"https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-11458.pdf\" target=\"_blank\">final regulations on Section 1557 of the Affordable Care Act\u003c/a> that ban the denial of health care on the basis of gender identity in programs that receive federal funding. The rule could help people who feel they have been discriminated against to bring complaints or lawsuits, according to the \u003ca href=\"http://transgenderlawcenter.org/archives/12908\" target=\"_blank\">Transgender Law Center\u003c/a> in Oakland, Calif.\u003c/p>\n\u003cp>In 2014, Oregon became the first state to provide Medicaid coverage for adolescents receiving puberty blockers. Medicaid programs in other states, including New York and California, have also expanded transgender healthcare coverage, although that does not mean that puberty blockers always are covered.\u003c/p>\n\u003cp>\u003cstrong>How Early is Too Early?\u003c/strong>\u003c/p>\n\u003cp>Treatment with puberty blockers gives transgender children a breather so they can continue to mature and decide whether they will pursue treatment with cross-sex hormones or gender reassignment surgery. For many families, the question is not whether to intervene with blockers, but how early to start.\u003c/p>\n\u003cp>Because the onset of puberty varies so widely — as early as age 9 for some — suppression can begin at different ages. And that’s prompted some disagreement within the field — the “age versus stage” debate — about when to begin, according to Leibowitz. Most often blockers are initiated at the first visible signs of development as measured by the \u003ca href=\"http://www.childgrowthfoundation.org/CMS/FILES/Puberty_and_the_Tanner_Stages.pdf\" target=\"_blank\">Tanner Stages\u003c/a>, a scale of sexual maturation developed by pediatrician James Tanner. The trigger for suppression is usually Tanner stage 2, when pubic hair and breast buds appear.\u003c/p>\n\u003cp>“If you are able to suspend puberty as soon as it happens you’re optimizing the benefits that it can bring physically,” said Leibowitz. Starting early may alleviate the need for surgical breast removal or voice modification therapy later on. It also makes it far easier for transgender teens to fit in. “That ability to blend in and be perceived as the gender that they identify with is associated with long-term psychological benefits,” said Leibowitz.\u003c/p>\n\u003cp>But does that mean that 9- or 10-year-old transgender kids should be started on puberty blockers? Even though the treatment is reversible and is considered safe, Leibowitz said some clinicians argue the age issue is important because less is known about very early interventions. How long can puberty be safely suppressed? And if the next step is transitioning with cross-sex hormones, at what age should that begin?\u003c/p>\n\u003cp>Of course, there is no treatment at all unless the parents of transgender children agree. “For most of my clients [who are minors], the issue revolves around whether they can start hormones or puberty blockers without parental consent, and the short answer is ‘No,”’ said Danielle Castro, a psychotherapist and project director at the Center of Excellence for Transgender Health at the University of California, San Francisco.\u003c/p>\n\u003cp>Castro said families of some transgender youth refuse the intervention because they believe their children are “just going through a phase.” A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/18981931\" target=\"_blank\">study\u003c/a> in 2008 found that 43 percent of very young children who experienced gender dysphoria no longer felt that way after adolescence. The 27 percent who remained dysphoric were the ones who had felt that way most strongly when they were young.\u003c/p>\n\u003cp>Young children may indeed change their minds, but gender identity seems to be fixed by the time kids have reached puberty. The Endocrine Society finds that transgender adolescents grow up to be transgender adults “100 percent of the time.” Dr. Stephen Rosenthal, director of the Child and Adolescent Gender Center at UCSF, \u003ca href=\"http://press.endocrine.org/doi/pdf/10.1210/jc.2014-1919\" target=\"_blank\">agrees\u003c/a>: “Children who meet the mental health criteria for gender dysphoria in adolescence are likely to be transgender for life.”\u003c/p>\n\u003cp>In a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/20646177\" target=\"_blank\">recent study\u003c/a> of 70 participants all the adolescents who had been given puberty blockers went through with sex reassignment.\u003c/p>\n\u003cp>\u003cstrong>The Standard of Care\u003c/strong>\u003c/p>\n\u003cp>Even though the Oakland family had agreed in advance that their daughter would start on blockers at the right time, “we had to reassure her constantly that we wouldn’t let it go too far,” she said.\u003c/p>\n\u003cp>When she turned 13, the girl started receiving monthly injections of Lupron, a widely prescribed sex hormone suppressor. “As soon as she started, you could just see the relief in her,” said the mother. “You could see it in her demeanor, in her mood; it was just a huge weight off her shoulders,” she said.\u003c/p>\n\u003cp>The family’s insurer, Kaiser Permanente, covered the treatment. Puberty blockers are considered “standard of care in the appropriate clinical circumstances,” said Erica Metz, medical director for Transgender Health at Kaiser Permanente Northern California. According to Metz, the treatment “gives patients and their families time to work with their mental health and medical providers to determine if it is appropriate to start transitioning.”\u003c/p>\n\u003cp>When the girl was 14, she started taking estrogen — the next step in her male-to-female transition. Instead of growing facial hair and a male physique, she developed breasts and some curves. Her voice didn’t deepen, and she doesn’t have an Adam’s apple.\u003c/p>\n\u003cp>The mother described her daughter as a social, outgoing and well-adjusted teenager. She knows the \u003ca href=\"http://williamsinstitute.law.ucla.edu/research/suicide-attempts-among-transgender-and-gender-non-conforming-adults/\" target=\"_blank\">grim mental health statistics\u003c/a> for transgender people — 41 percent have attempted suicide, nearly nine times the national average — and she doesn’t want to imagine a world where her daughter would be without puberty blockers, a medical intervention that she called a “lifesaver.”\u003c/p>\n\u003cp>“The thought of her having had to go through male puberty, I think it would have destroyed her mental health and well-being,” the mother said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/226462/transgender-youth-using-puberty-blockers","authors":["byline_futureofyou_226462"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1019","futureofyou_1020","futureofyou_1018"],"featImg":"futureofyou_226658","label":"source_futureofyou_226462"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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