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Amanda Jette Knox @MavenOfMayhem
, 22 tweets, 4 min read Read on Twitter
THREAD: Because there are so many genuinely concerned people (and not just trolls) who worry about medically affirming trans kids, here’s a thread explaining some of the reasons why this kind support is sometimes necessary. And why it’s not as scary as some lead you to believe.
First, if a child feels safe enough to tell you they’re trans or think they might be, that’s a big deal. We, as parents, need to take that role & responsibility seriously. Your child just revealed something that likely took a LOT to say and are putting their trust in you to help.
But HOW do we help? That’s where some parents get stumped. Some fringe groups with loud voices warn against affirming a child in any way. Some are strictly against medical transition. Wasn’t there that video going around about the dangers of blockers?
The good news is many of the world’s leading medical organizations believe in the affirming model for trans people, including kids. These include the American Academy of Pediatrics, the World Health Organization and even journals like The Lancet.
Why? Because the affirming model has been proven to be the safest. This sometimes includes medical support for trans youth. But what does that look like, and how can that possibly be safe? Some of these changes aren’t reversible, right?
First, medical support isn’t needed for all trans youth. But for those who DO need it, it’s critical. It’s also carefully guarded, often to the point of frustration for many youth. It’s not a “Hi, I’m trans!” “Ok, here are some blockers & hormones!” situation. At all.
There are often several appointments with doctors before a youth can access hormone blockers. These block puberty changes caused by estrogen or testosterone. This isn’t administered to youth until they’ve reached puberty.
Blockers hit the pause button on puberty, so a child has some breathing room to figure things out. How do they feel now that their body is no longer rapidly changing? Does it alleviate any gender dysphoria? (Usually, yes. Very much.)
If a child hits that pause button and decides “you know, I think I’m comfortable with my initial puberty progressing” blockers are stopped and the process resumes. This doesn’t often happen, but it does happen. That’s why this is the first medical step.
Are there risks to blockers? Yes. As with any medication, there are risks. The biggest one, by far, is a weakening of bones. Kids on blockers take vitamin D, calcium and sometimes other supplements to counter this. Bone scans are also done to check on bone health.
The weakening of bones is caused largely by growth continuing to happen without estrogen or testosterone to support that growth. So, once a teen reaches the age of informed consent (which is dependent upon where they live) or slightly later, they can often start hormones.
By the time hormones are given, teens have usually been on blockers for a good while. Hormones produce some changes that are more permanent, so this step should be taken seriously. But it also can’t wait too long because of bone health – AND mental health. Both are important.
This is where some folks will argue trans kids shouldn’t make ANY of these life-impacting changes until 18. No blockers, no hormones. Why can’t we just support them in other ways until they’re adults? With just clothes and names and pronouns? Isn't that enough?
Other than suicide risk, one big reason we need to provide medical support (when necessary) is NOT doing so in the teen years can cause a lifetime of changes in a trans person’s body that can’t be undone easily, or at all. Once someone hits 18, most of their growth is done.
Things like height, skeletal growth, facial hair, facial bone structure, breast development, voice, Adam’s apple, hand and foot size, etc, all occur during puberty. Some of these things can be corrected with treatments or surgeries (at a cost), some cannot.
Medically supporting trans kids is relatively new, so we don’t have a lot of data on outcomes yet. But here’s what we know so far: Most go on to live HAPPILY as trans adults, with suicide rates dropping from 8-10 times HIGHER than average to the societal average. That's huge.
But what about regret? Today's gender identity clinics report relatively low instances, as do people within the trans community. It can happen, but that’s why this is a slow process for tweens & teens. A long pause button, a slow, measured increase in hormones.
Regret is a tricky thing to measure anyway. Does the person regret transitioning because it’s not who they are, or is society/their families not being supportive of who they are causing their unhappiness? Without that data, we don’t have a good idea.
We do know most cases of “de-transition” in adults are because they’re unhappy with how society treats them. The problem isn’t generally being trans, it’s being trans in a society that doesn’t value or respect you. We need to change society, not trans people.
We also don’t know how many kids/teens “desist” (stop saying they’re trans) and then transition later in life, perhaps once it’s safer to do so, away from families/schools that are less than supportive. Many of the old studies on “desisting” kids don’t provide any reasons.
In short, what we know is MOST kids who medically transition lead happier lives. That medical transition, like ALL medical treatments, carries risk, but that the risk is carefully weighed against the benefits. Good parents do their homework on this while listening to their kids.
Personally, I have a thriving 15-year-old girl in my home today who was barely limping along through life when she came out to us at 11. Affirming her in ALL the ways she needs us to has been a life-saving decision. Her future is looking much brighter today.

Thanks for reading!
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