AVA's Statement on Gender-affirming Care for Children and Adolescents
The Academy on Violence and Abuse strongly opposes the actions by the State of Texas, or any State, to withhold, or to criminalize, gender-affirming care for children and adolescents. Countless studies and peer-reviewed articles have shown the benefits of this care. To withhold it is medical neglect, and constitutes emotional child abuse, by the state's own definition; the emotional harm to persons denied care is well documented.
In addition, the assertion that genital reassignments before age of consent are frequent or commonplace is not correct. We request the Texas withdraw this misinformation, as well as the implication that persons are being treated against their will.
We concur with World Professional Organization on Transgender Health: "Standards of Care Regarding Surgery for Children and Adolescents, and the Consequences of Denying Care":
Genital surgery should not be carried out until (i) patients reach the legal age of majority to give consent for medical procedures in a given country, and (ii) patients have lived continuously for at least ”months in the gender role that is congruent with their gender identity. The age threshold should be seen as a minimum criterion and not an indication in and of itself for active intervention.
Chest surgery in FtM patients could be carried out earlier, preferably after ample time of living in the desired gender role and after one year of testosterone treatment. The intent of this suggested sequence is to give adolescents sufficient opportunity to experience and socially adjust in a more masculine gender role, before undergoing irreversible surgery. However, different approaches may be more suitable, depending on an adolescent’s specific clinical situation and goals for gender identity expression.
Risks of Withholding Medical Treatment for Adolescents
Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence (Nuttbrock et al.), withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents.
We also support the statements on gender affirming care of the American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Professional Society on the Abuse of Children the Pediatric Endocrine Society, the Ray E. Helfer Society, and other major medical and mental health professional organizations.