Trans kids need rights, whether or not their parents or doctors agree

Of the approximately 300,000 trans kids in the US between the ages of 13-17, only about 1,000 of them get access to HRT in any given year.

By Jane Migliara Brigham

In the wake of what might be an imminent ban on youth access to HRT, self-proclaimed trans allies are voicing support for trans youth in numbers I have not seen in many years.  It is heartening to see, as they are finally realizing the imminent risk that trans people have been warning about for many years.

That being said, there is a particular line of defense that I see used over and over that sounds accepting on its face, but fails to support the vast majority of trans kids in practice.  It goes like this: “a ban on trans youth healthcare infringes on the rights of parents and doctors to make decisions about their children”.

This framing was the primary defense of trans rights used by opponents of the healthcare bans which passed the US House last week (HR 3492 and HR 498).  In their speeches and public statements, these self professed allies stressed how the Republicans were stripping away the rights of legal guardians, and how the government was acting as a doctor, when only doctors had that right.

Curiously rare in all these discussions was the idea that trans kids themselves had the right to control their own bodies.  There were a few speeches by legislators themselves that implied this, such as those by representatives McBride and Randall, but these were notable outliers.  The assumption is that since trans kids can’t vote, they have no rights that legislators need to take seriously.

This line of defense is - strictly speaking - true.  The proposed bans on trans youth healthcare would take away from the monopoly of medicine that parents and doctors currently have over children in their care.  It also does not levy direct legal punishments onto the trans kids that are being deprived of medicine.  In effect, this would be a net loss for trans kids.  However, because those losing healthcare can't vote, they have no right to have their wellbeing considered directly. That right is reserved for the (adult) parents and doctors who control their healthcare.

The problem with this defense is not that it isn't true, it's that it completely misses the point of why children’s access to trans healthcare is important in the first place.  Access to youth trans healthcare isn't important because it protects the rights of parents and guardians to administer the lives of their kids, it’s important because it protects the right of the trans kids who need it to live dignified lives.

The standard line of defence by these self-professed allies would protect the rights of trans kids with both supportive families and doctors, but would do nothing to help the vast majority of trans kids who do not have supportive parents or access to supportive doctors.  It also does nothing to expand the pool of trans kids who can get ahold of HRT from those who can get it now.  

Trans Youth Healthcare Today

Let’s take a look at the state of trans youth healthcare in the United States.  Right now, 27 states have laws or statutes banning youth trans healthcare, composing 39.4% of the US population.  The kids there are already deprived of the right to control their own body.  

As for the kids that live in the other states, their healthcare isn't banned, but is so thoroughly restricted that for most of them, it might as well be banned.  If they want HRT, they have to go through massive persuasive and bureaucratic hurdles that most will never be able to overcome.  They are forced to go through the very transmedicalist system that has been discarded for US adults.

First, they have to come out to their parents, get them to accept that their kid is trans, and that they will need to permanently alter their body in order to have a decent shot at a dignified life.  If the parent says no, the kid is fucked.  Parents have the ultimate say over what medication goes into their children’s bodies, so kids will need the approval of their parents.

Next, the kid needs the consent of a psychotherapist who can verify that they are trans.  This step is not required for adults, but since it is perfectly legal to discriminate against children on the basis of their age, we still make them go through this bigoted, demeaning, and asinine process.  The therapist could be supportive, but they can also make the kid do “gender exploratory therapy”, a process that is meant to distract the child for as long as possible.  There is no set time when a therapist has to verify that a child is “truly trans”, and that they should get access to HRT or puberty blockers.  It is - in effect - a more subtle form of conversion therapy.

After that, the child is sent to either a pediatrician or an endocrinologist.  These tend to give the kid either puberty blockers or the bare minimum amount of HRT, as recommended by WPATH.

Assuming that everyone involved is acting in the kid's best interest - as most self-proclaimed allies do - is to engage in wishful thinking.  The parents, therapists, and doctors of trans kids are not noticeably more likely to understand the plight of trans children (and be willing to act to fix it) than the general population are.  All these people can be prone to bigotry, ignorance, or simple laziness when confronted with the suffering of a trans kid, just like anyone else.  There is little compelling evidence that the parents and doctors of trans kids are any less likely to hold bigoted assumptions than the general population.  Therefore, there is no reason to assume that these people will act in the interests of trans kids any more than the general population.

While all of this is going on, the trans kid is still going through puberty, watching their own body mutate as those who are meant to take care of them sit on their hands and bicker.  This is unacceptable.  If any person along this chain decides to not help the kid, or delays in helping them, the child has no one to appeal their case to.  The whole system of trans youth healthcare is broken from top to bottom.

No wonder that of the approximately 300,000 trans kids in the US between the ages of 13-17, only about 1,000 of them get access to HRT in any given year.  Now, we don't know how many of the total number of trans kids actually want HRT.  I haven’t found any research where people bothered to ask them.  Assuming they all want HRT (unlikely), that means that only one in 300 are getting HRT in a given year.  Assuming that half of the trans kids are aspiring transsexuals and want HRT (more probable), then only 1 out of 150 people who want it will get it in a given year.  Since we don't know how many trans kids are aspiring transsexuals who want to change their bodies, we cannot get numbers which are any more precise than this.

This is a system of care so horribly inefficient that it would never be tolerated for a group of people that society at large actually wanted to exist.

How to Actually Help Trans Kids

If you want to help trans kids, rather than the parents of trans kids and the doctors they choose, you cannot defend the system as it currently exists.  You also cannot defer to the “medical experts” on this matter, as many of them support the gatekeeping of healthcare resources for trans kids until they are evaluated by psychotherapists and pediatricians.  You have to think bigger than maintaining the status quo.  You need to give more power to the kids directly.

The most obvious improvement would be to move trans youth healthcare onto the informed consent model that adults use to access HRT.  This would mean that they can approach a relevant doctor, ask for HRT, and then get it.  This would be an instant massive improvement.  It would mean that therapists and doctors could no longer act as gatekeepers for kids, and kids would not need to be diagnosed with gender dysphoria to get care.  They could ask for it and get it.  

While this would be a massive improvement, it does nothing to address the first source of gatekeeping that the kids will run into; their own parents.  Since children are the legal wards of their parents, the parents get final say over what kids can put in their body.  In other words, they get to gatekeep what medicine their kids get.

This also underestimates that most kids wouldn’t even know how to make a doctor’s appointment on their own, and would lack the transportation to get there if that was not provided by their parents.  Most kids in the US live in places where you need a car to go anywhere, meaning that they only get to go places when their parents or someone else with a car is willing to take them.

The best policy for trans kids to access the same care as adults is to have that care made available in places that kids can reliably have access to.  While doctors are locked behind bureaucratic hurdles that kids likely have no experience navigating, that is hardly the only place to distribute medicine.

Children already have access to a place where they know how to get access to medication, and which typically comes staffed with people who can answer questions about how to use that medication safely.  I am talking about pharmacies.  They can be found in virtually every small town in the country, and are stocked with every medication that people frequently use.  Since the vast majority of people taking estrogen and testosterone are cissexuals, there would be little stigma associated with stocking “trans products”, any more than there is stigma around stocking condoms or birth control, which as of writing are available almost everywhere.

As I have advocated for in a separate article, HRT should be available over-the-counter.  This would allow for greater freedom in who has access to hormones.  It would be especially useful for trans kids, as it would greatly reduce the number of people who can gatekeep them from their care.

No one has the right to control their bodies, not even their legal guardians or doctors.  If you want a system that allows all trans kids to get hormones, and not just the fortunate few, you need a system where kids can go around the backs of parents and doctors if needed.  Until this is enacted, access to care will always be a lottery of who is lucky enough to have truly supportive parents and doctors, and who has to watch puberty deform their bodies, potentially leading to a lifetime of dysphoria.

The Idiocy of Defending Trans Care as it Exists Today

If you want a better life for trans kids, give the power to the kids, not to the parents and doctors.

When people say that trans care should be decided on between parents and doctors, they are defending a system so wildly inefficient that it will never serve the vast majority of people who ask for its services.

Most trans kids today can’t get access to HRT, even where it is perfectly legal.  For most kids, the only difference between trans youth care today - and what the Republicans are proposing - is that the current system offers the hope of getting care at some unknown future time, whereas the Republican plan takes away that hope.  In terms of how many kids actually get care, the two systems aren't that far apart. 

Most trans kids already live under a de facto trans healthcare ban, whether they know it or not.  Let’s change that.