#DayofSilence

#DOS to end bullying of LGBTQ students

Lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth and those perceived as LGBTQ are at an increased risk of being bullied. Results from the 2017 Youth Risk Behavior Survey show that, nationwide, more U.S. high school students who self-identify as lesbian, gay, or bisexual (LGB) report having been bullied on school property (33%) and cyberbullied (27.1%) in the past year, than their heterosexual peers (17.1% and 13.3%, respectively).

Bullying puts youth at increased risk for depression, suicidal ideation, misuse of drugs and alcohol, risky sexual behavior, and can affect academics as well. For LGBTQ youth, that risk is even higher.

All of the recent transphobic legislation amid at youth including Idaho #HB509 further traumatizes gender diverse youth and sends the message that they are to be excluded. It also confuses families of gender diverse youth turning a medical situation into a political one. Like so many political issues inflammatory language is used to engage people’s feelings over their reasoning. Such has been done in the recent legal case filed in Britain against the NHS’ GIDs clinic. They have been accused of over-prescribing and/or unsafely prescribing puberty blockers to adolescents.  All of this news can feel stressful and confusing for gender diverse young people and their families. 

Let’s take a minute to look at the details. Important key points:

Regarding the potential increased risk in suicide and self harm (the reason the lawsuit was filed)

• The study that is referenced in the British case with increased rates of suicidal ideation and self harm is UNPUBLISHED
  • “Experts on clinical trials criticised the design of the study,” but do think the data should be explored further
• Other studies have shown improved safety and mental health, including decreased suicidal thoughts:
  • Ethical Issues in Gender Affirming Care for Youth
  • The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): Trends in Prevalence, Treatment, and Regrets
  • Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation
  • Puberty suppression in transgender children and adolescents
  • Medical Options for Care of Gender Diverse and Transgender Youth

Regarding concerns around brain and neurologic development being delayed by puberty blocking medications:

• Leuprolide, the most commonly used puberty blocker in the US, has been used in children since the 1980s
  • It received FDA approval in 1998
  • It is used in much younger children to treat Precocious Puberty for a duration of up to 3-5 years with long-term outcome data from adults previously treated show an excellent safety profile and minimal long-term effects

Regarding concerns that providers treat underage youth without consent:

• The standard practice currently in gender affirming care is MORE conservative than in sexual health, reproductive health, mental health, and substance use treatment
  • Most providers REQUIRE SIGNED consent from all parties with medical decision making rights prior to any gender affirming care under the age of 18
    • The exception being immediate risk to life due to suicide or self-harm
  • MANY states allow minors to consent to their own sexual, reproductive, and mental health without any parent involvement: https://www.schoolhouseconnection.org/state-laws-on-minor-consent-for-routine-medical-care/

Many Medical Societies support gender affirming medical care for adolescents going so far as to say not offering care is maleficent. These societies include, but are not limited to:

• American Academy of Pediatrics
• The Endocrine Society
• The Pediatric Endocrine Society
• American Academy of Child and Adolescent Psychiatry
• American Academy of Family Physicians
• American College of Obstetricians and Gynecologists
• American College of Physicians
• American Medical Association
• American Osteopathic Association
• American Psychiatric Association
• American Public Health Association