The American Medical Association says gender transition-related care for minors can be “medically necessary.” But some Republican lawmakers, including several in Michigan, want to place those doctors, and the parents of those children, in prison for life.
But debates in which the medical and political spheres collide can often leave the actual people involved more as an abstract discussion, without insight into why such care would be undertaken and the benefits it provides.
Fawn Rost of Grandville is the mother of Zahna, her 12-year-old trans daughter. She wants lawmakers to know her child is not a theoretical pawn to be played on a political chessboard.
“It’s just heartbreaking,” she told the Michigan Advance about efforts to criminalize what she calls “life-affirming care” for her daughter. “And in a way too that makes it feel like it’s very political and it definitely feels like it’s a bargaining chip to try to get more voters.”
What Rost calls “life-affirming care” for Zahna is more generally referred to as “gender-affirming care” by the medical community.
However, House Bill 6454 introduced on Oct. 11 by state Rep. Ryan Berman (R-Commerce Twp.), never uses the word “affirming.” Instead, it refers to “gender transition procedure” in seeking to redefine first-degree child abuse and provide a maximum penalty of life in prison to any parent or guardian, as well as any medical professionals, involved in such care.
One of the Michigan bill’s co-sponsors, Rep. Beau LaFave (R-Iron Mountain), told The Hill he believes it is “logically incoherent” to provide gender-affirming care to youth unable to legally consent to have sex.
“The idea that we would be making potentially life-altering changes to 11-, 12-, 13-, 14-, 15-year-old kids when it is illegal for them to have sex is insane,” he said. “I mean, they’re not responsible enough to smoke a cigarette until they’re 21.”
However, LaFave’s comparison erroneously conflates sexuality with gender, two different concepts that are often confused with one another.
And with the current level of GOP-sponsored intolerance and bigotry toward the LGBTQ+ community, it should be no surprise that providing any affirmation to the very idea that gender isn’t fixed at birth would be avoided.
But Rost believes her experience with Zahna demonstrates the reality that this type of legislation doesn’t acknowledge: Gender identity is not fixed solely to the reproductive organs one is born with.
“She knew when she was 3 and would try to tell us,” said Rost. “You know when you ask kids, ‘What do you want to be when you grow up?’ I have other kids and they would say things like, ‘Oh, I’m going to grow up to be a firefighter,’ or ‘I’m gonna go up to be a Power Ranger.’ But Zahna was always, ‘I’m gonna grow up to be a girl.’ And she would say things like, ‘When can I grow my hair out long like a big girl?’ She just really thought at a young age that when you got to be older as an adult, you got to choose your gender.”
Rost says like many parents of trans children, her first inclination was that her child was going through a phase, as was suggested by their pediatrician at the time.
“Well, that wasn’t true,” she said. “She was very persistent. So when you have a very persistent child, you go, ‘Hmm, that’s different.’ And while I was doing research, I was realizing that there’s no way it was just a phase for a kid to be that persistent and insistent from the ages of 3 to 5. It wasn’t going to go away and it wasn’t going to change.”
At that point, Rost said she and her husband realized that it was not a phase, so they told her that it was okay to be a girl if that’s what she wanted.
“And it took her probably about a month or so of thinking about it before she really came to us and said, ‘Yes, mom, I am a girl, and I would like to tell that to people,’” said Rost.
That’s when they decided to let Zahna transition publicly, having her choose a female name, get a female haircut, wear female clothing and use female pronouns. Rost said the change in her child was almost immediate.
“When she was presenting as a boy, she was this very quiet, shy little boy,” she said. “But the minute we decided as a family that we were going to support her, she emerged as this wonderful, happy, bubbly, enthusiastic kid. It was amazing.”
Looking back, Zahna says coming out to the world was really just about being who she always thought she was.
“It was kind of weird at first because all of my friends had a difficult time understanding,” she said. “But I feel like once they got used to it, it was just almost relieved to finally let everyone know that I was a girl and I wasn’t a boy.”
While some in the public might disagree with letting a 5-year-old child make that type of decision, medical experts have a different perspective.
“If there are persistent and strong indications that gender dysphoria is present, a comprehensive evaluation by clinicians skilled in the assessment and treatment of gender dysphoria is essential, irrespective of the patient’s age,” states the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC).
WPATH is an international organization of health professionals whose mission is to “promote evidence-based care, education, research, public policy, and respect in transgender health.”
They are joined by other major medical organizations in concluding that age-appropriate gender-affirming care is evidence-based and medically necessary, including the American Academy of Pediatrics (AAP), the American Academy of Child and Adolescent Psychiatry, and the Endocrine Society.
One of WPATH’s Certified Transgender Health Providers is Amy Ver Wey, a limited licensed psychologist and vice president of River City Psychological Services in Grand Rapids.
“When people say that this is a phase, that’s just not the true authenticity for these kids,” Ver Wey told the Advance. “This is not the reality of the situation. This isn’t something that kids wake up and just want to do. They don’t choose this unfortunate discrimination. So there are these insistent, persistent and consistent feelings of incongruence with their gender assigned at birth through their experience and their affirmed gender identity.”
That incongruence is a hallmark of gender dysphoria, defined by the American Psychiatric Association as the “psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.”
Ver Wey says trying to avoid that psychological distress is what motivates so many parents to seek affirming care for their kids.
“Now it’s like, ‘OK, what do we do next? How do we support this kid so that they can obtain the medical care that’s necessary, and in some cases, life saving?,” she said.
And that is no overstatement, considering statistics showing nearly one in five transgender and nonbinary youth attempted suicide in the past year.
“Being able to access gender-affirming care allows a person to be able to explore in a healthy way,” Ver Wey said. “When a kid comes into my office, it’s not like a snap of a finger or magic wand and then all of a sudden, they get to transition.”
The process always begins with talking to the child and hearing about how they feel while evaluating them, she said.
“We explore and it’s not just gender related, but it’s all mental health stuff,’’ she said. “So I think that gender-affirming care can look very scary and specific to some people who don’t know and don’t have a lot of information. My role as a clinician is to work with caregivers and work with a kid, to be able to assess where to go on the journey and follow the kid, next to the kid. There’s no leading the kid.”
But when the child leads them to a specific conclusion of gender dysphoria, the normal changes in their bodies leading into adolescence may require medical interventions such as puberty blocking agents.
That is exactly where Zahna found herself, said her mother.
“Without puberty blockers, Zahna will start progressing as a boy,” said Rost. “Her voice will get deeper. Her physical features like her Adam’s apple, hair on her face and other parts that women do not have. There are things that could be not changeable by the time she makes it to an adult to have these conversations. So having the puberty blockers, I can’t imagine a world without them for her.”
Technically referred to as gonadotropin-releasing hormone (GnRH) analogues, the blockers essentially pause the normal progression of puberty’s physical and emotional changes, giving time for children and families to explore the various issues involved. If a decision is made to stop treatment, puberty can then resume.
Having that choice is vital, according to Rost.
“Being a teenager and going through puberty is hard enough, going through the wrong puberty could be, would be, beyond scary,” she said. “It would be detrimental, I think, to her health.”
If a decision is made to progress beyond puberty blockers, the next stage of care could involve hormone treatments, also referred to as gender-affirming hormone therapy (GAHT). This involves sex hormones, including testosterone or estrogen, being administered so that patients secondary sexual characteristics, such as enlarged breasts in females or facial hair in males, will more align with their gender identity.
GAHT, which in most circumstances isn’t initiated until age 16, can have side-effects, including an increased risk for heart disease and loss of fertility.
However, in all cases, they are administered under the supervision of a medical doctor and include regular screenings and lab tests. They have also been associated with lower rates of depression, suicidal thoughts and suicide attempts.
Beyond that in the process are surgical interventions, which can span everything from body-contouring procedures to complete transition. These almost always occur after age 18.
Jazz McKinney, executive director of the Grand Rapids Pride Center, which provides services and support for the LGBTQ+ community in West Michigan, is already seeing anxiety over the legislation.
“At this point, everything is so up in the air that it’s very hard to comfort folks,” they said. “We’re getting folks reaching out to us in tears, saying things like, ‘Man, this would be absolutely devastating to my family.’ I think folks aren’t understanding the consequences that these things could have. Like I said, I’ve had folks calling me crying, just in tears, confused, especially the youth. They don’t understand. ‘You could potentially be taking my parent away and putting them in jail for what? For them allowing me to be myself?’’’
For those families that are committed to the emotional well-being of their children, it is hard not to engage in “What if?” scenarios.
For Rost and others, should HB 6454 ever become law, there would be no other option but to leave Michigan.
“We would not stay here and have our tax dollars go to a state that will not allow me to provide care, life-affirming care for my daughter,” said Rost. “So yes, there is always the thought that we would not stay. Now that being said, we are very concerned about how safe it is in the entire country with bills being proposed nationally.”
Zahna would just like people to know that she is not an isolated case, nor really that different than anyone else.
“I feel that if children weren’t able to get this care, it would be really bad, like really, really bad,” she said. “And I don’t know what would happen, but it’s more than just 10, 15 families. It’s thousands, maybe even millions of families that would be affected by some of these bills that would go into effect if they did go into effect.”
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