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Their sense of self can consolidate, or they can try on a way of being that doesn’t prove right in the long run as the brain further develops the capacity for thinking long-term. The draft mentioned the very small group of people who detransition (stop identifying as transgender), saying that some of them “have described how social influence was relevant in their experience of their gender during adolescence.” In adolescence, peers and culture often affect how kids see themselves and who they want to be. At the same time, the authors acknowledged that they weren’t sure that visibility was the only factor at play.Īs they wrote in their December draft chapter, part of the rise in trans identification among teenagers could be a result of what they called “social influence,” absorbed online or peer to peer. Leibowitz and his co-authors thought that the timing of the rise in trans-identified teenagers, as well as research from Britain and Australia, suggested that the increased visibility of trans people in entertainment and the media had played a major - and positive - role in reducing stigma and helping many kids express themselves in ways they would have previously kept buried. Some are asking about medication that suppresses puberty or about hormone-replacement treatments. In the past, by contrast, most patients at gender clinics were trans girls who were “assigned male at birth.”Īs they worked on a draft of the adolescent chapter of the Standards of Care, the big debate among clinicians was how they should respond to the thousands of teenagers who are arriving at their doors. In addition, the current caseload is around two-thirds youths who were “assigned female at birth,” in the current parlance of the field, and identify as trans boys - or as nonbinary, in a smaller but growing number of cases. Cases of teenagers coming out as trans aren’t new. The average age when a young person first comes to a clinic tends to be around 14 or 15, according to some clinicians I talked to. Many of the current group of teenagers haven’t told their families, from a young age, that they feel they are a different gender, though they often say they internalized such feelings for years. Just as striking, the types of cases have changed. The few doctors and therapists who worked in them knew one another, and the big debate was whether kids in preschool or elementary school should be allowed to live fully as the gender they identified as when they strongly and consistently asserted their wishes. A decade ago, there were a handful of pediatric gender clinics in the United States and a dozen or so more in other countries. What Leibowitz and his co-authors didn’t foresee, when they began, was that their work would be engulfed by two intersecting forces: a significant rise in the number of teenagers openly identifying as transgender and seeking gender care, and a right-wing backlash in the United States against allowing them to medically transition, including state-by-state efforts to ban it.ĭuring the last decade, the field of transgender care for youth has greatly shifted.
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The guidelines are meant to set a gold standard for the field of transgender health care, and this would be the first update since 2012.
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It was for all these reasons that Leibowitz was selected, in 2017, to be a leader of a working group of seven clinicians and researchers drafting a chapter on adolescents for a new version of guidelines called the Standards of Care to be issued by the World Professional Association for Transgender Health (WPATH). “umbrella,” as he put it, aware of the overlap as well as the differences between gay and trans identity. As a child and adolescent psychiatrist who is gay, he found it felt natural to work under the L.G.B.T. issues for the American Academy of Child and Adolescent Psychiatry. He has directed or worked at three gender clinics on the East Coast and the Midwest, where he provides gender-affirming care, the approach the medical community has largely adopted for embracing children and teenagers who come out as transgender. Scott Leibowitz is a pioneer in the field of transgender health care.
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