September 28, 2022

Some clinicians stress mental health care for kids questioning their gender

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Good morning, and happy Monday. I’m McKenzie Beard, your Health 202 researcher, filling in today for Rachel Roubein. Let’s dive in. 

On today’s edition: Some conservatives leaders are pushing to end abortion exceptions, and the federal government is trying to recoup $163 billion in unemployment pandemic fraud. But first…

These two psychologists say there’s a need for more gender-exploratory therapy

Some conservative-led states have responded swiftly and fiercely to the ballooning number of American children seeking medical intervention to change their sex. In Texas, Gov. Greg Abbott (R) has directed state officials to investigate gender-transition care for young people as child abuse.

Some experts argue that the pendulum of American opinion about sex reassignment treatments for young people has swung from one extreme to another: from completely averse to medical intervention to total affirmation without question. Laura Edwards-Leeper, a clinical psychologist, argues that the solution doesn’t begin in the law books, but in the doctor’s office.

The number of young people questioning their gender who request medical intervention is rising. Almost 2 percent of Americans under 18 identify as transgender, double the figure from five years ago, according to the Trevor Project

Erica Anderson, a psychologist who is transgender, said part of the reason more adolescents are identifying as transgender is because of increased LGBTQ representation in the media, broader access to information online and wider acceptance of the gender diverse community. 

She and Edwards-Leeper suggest another contributing factor is the ongoing mental health crisis among youth in America. Increasingly, patients are coming into Edwards-Leepers office wondering if the source of their anxiety or depression is an identity issue.

  • That’s certainly not the case for all youth, but it does explain why we’re seeing such a huge increase in young people identifying this way,” Edwards-Leeper said.
  • Edwards-Leeper and Anderson recently co-authored a Washington Post piece raising concerns that children aren’t getting sufficient mental health evaluations before being prescribed treatments that may not be reversible.

The standards of care for treating gender diverse youth crafted by the World Professional Association of Transgender Health recommend children undergo a full psychological evaluation by a mental health professional before medical intervention. 

And while the number of children questioning their gender is on the rise, Edwards-Leeper said most clinicians in the field hold a “negative view” of first encouraging their young patients to explore their newfound identity before moving forward with treatment. 

  • “It’s really seen as gatekeeping, inappropriate and pathologizing … but that calls into question: What are these assessments actually consisting of?” Edwards-Leeper asked.

It’s one thing for a child to explore changing their gender before puberty. Letting kids adopt a new name, pronouns, haircut or clothes is reversible, said Jason Rafferty, author of the American Academy of Pediatrics’ guidelines for treating transgender youth.

But the issue becomes trickier when a young person questioning their gender nears puberty. They may begin experiencing distressing dysphoria that’s “incongruent with who the child feels they are inside,” at which point Rafferty said health providers should start considering medical intervention.

Clinicians largely consider the effects of puberty blockers to be reversible, and Edwards-Leeper said they can be a helpful tool for adolescents to slow down their development and give them more time to figure out their identity. But hormones can be a different story.

“It’s more the hormones where we start talking about the irreversible effects,” she said. 

  • For minors on testosterone, that would consist of lowering of the voice, and facial and body hair growth.
  • For children on estrogen, a main effect is breast development.
  • Both groups may risk irreversible infertility if hormones are prescribed after delaying puberty.

On the political stage — and as November’s midterm elections heat up — the rhetoric is impassioned and polarized.

The Texas Supreme Court on Friday ruled the state’s child welfare agency could resume investigations of doctors and parents with transgender children for possible child abuse, but said Abbott nor state Attorney General Ken Paxton (R) had the authority to order such inquiries.

Ken Paxton, Texas attorney general:

In addition to Texas, laws banning sex-reassignment treatment in Arkansas and Alabama are pending before the courts. Thirteen other states are considering legislation restricting the use of hormone therapy or other types of treatment for transgender individuals, according to the UCLA Williams Institute

The state statutes are being promoted by conservatives as a way to protect children, but Edwards-Leeper said they largely go against recommendations by the federal government and major medical associations for how to treat transgender youth. 

  • “I am completely opposed to this legislation. It is not being done because of any concern about trans youth, this vulnerable population is being used as political pawns,” Edwards-Leeper said.

Anderson tweeted a similar sentiment:

The Biden administration and some liberal-led states are hitting back.

  • Last month, the Justice Department said in a letter to states that it is prepared to take legal action against lawmakers who are “intentionally erecting discriminatory barriers” blocking trans youth from care, a move they said might infringe on the 14th Amendment’s equal protection and due process clauses.
  • Meanwhile, a coalition of 19 Democratic-led states have introduced trans refugee bills to protect families traveling over state lines seeking gender-transition care for their children.

Jen Psaki, former White House press secretary: 

Xavier Becerra, secretary of Health and Human Services:

Abortion foes set their sights on narrowing ‘life of mother’ exceptions

As Republicans teeter on the cusp of a victory against abortion, some conservatives are pushing to narrow exceptions for terminating a pregnancy out of medical necessity, The Post’s Ariana Eunjung Cha and Emily Wax-Thibodeaux report.

What you need to know: Terminating a pregnancy to save a mother’s life has long been accepted as a moral imperative by those on both sides of the abortion debate. Doctors warn that eliminating the exception could drive up already high maternal mortality rates.

But now, with the U.S. the Supreme Court poised to overturn Roe v. Wade, some state officials are moving to further restrict the procedure, arguing that they create easily exploited loopholes in the law. Here’s a snapshot: 

  • Idaho Lt. Gov. Janice McGeachin (R) last week called for a special legislative session to remove most exceptions from that state’s “trigger law” banning abortion.
  • In Georgia, Pennsylvania and Wisconsin, leading Republican gubernatorial candidates have teamed up with antiabortion groups to push bans that would not allow the procedure even if the mother’s health is endangered.

Even in states where exceptions are written into the law, there is ambiguity about which decisions might be permitted, which doctors fear could open them up to liability and even criminal prosecution, Ariana and Emily write. 

  • Under the new trigger laws, which would take effect if Roe is overturned, some states would impose criminal penalties of $100,000 and prison sentences of 10 years or more for violations.

Nebraska Gov. Pete Ricketts (R) on CNN’s “State of the Union” on Sunday: 

Meanwhile, Oklahoma governor said there may be a loophole in state’s new abortion law

Gov. Kevin Stitt (R-Okla.) acknowledged the “possibility” that some Native American tribes in the state could create abortion safe havens to evade Oklahoma’s new near-total ban on the procedure. 

Key context: Nearly half of Oklahoma is within tribal lands, and in 2020, the Supreme Court ruled that crimes committed on reservations in the state that involve a Native American cannot be prosecuted by local law enforcement, only in tribal or federal court.

  • “The tribes in Oklahoma are super liberal. … They kind of adopt those strategies,” Stitt said on “Fox News Sunday.” “They think that you can be 1/1,000th tribal member and not have to follow the state law, and so that’s something that we’re watching.”

What else we’re reading on reproductive rights:

With fear and fury, thousands across U.S. rally for abortion rights (By Ellie Silverman, Kyle Swenson, Nicole Asbury and Karina Elwood | The Washington Post)

After decades defending abortion rights, Patty Murray readies for offense (By Mike DeBonis | The Washington Post)

In N.C., a Black Senate candidate talks abortion. Her rival doesn’t. (By Annie Linskey | The Washington Post)

An estimated $163 billion from pandemic unemployment benefits were misspent or stolen

State and federal law-enforcement agencies are working to uncover the true scope of fraud targeting the nation’s generous coronavirus aid programs, which siphoned billions from pandemic unemployment benefits while inflicting harm on unwitting victims, The Post’s Tony Romm and Yeganeh Torbati report. 

Earlier this spring, a top watchdog for the Labor Department estimated there could have been “at least” $163 billion in unemployment-related “overpayments” — which includes wrongly paid sums and benefits gained by criminals. 

  • So far, the United States has recaptured just over $4 billion of that, or roughly 2.4 percent of wrongful payments, raising the specter that Washington may never recoup the stolen funds.
  • Law-enforcement agencies are eying domestic criminals and gangs, as well as sophisticated networks based in Nigeria, Russia and Eastern Europe, for the fraud.
  • Meanwhile, the White House is moving to close gaps in the nation’s unemployment program — and ensure that other federal aid can’t be targeted in the same way again.

How they did it: In many cases, the unemployment funds were stolen by fraudsters who flooded states with thousands of applications using real Americans’ personal information. Investigators later discovered that criminals were openly plotting and sharing tips for defrauding the government online.  

But the tsunami of fraud came as little surprise to labor experts, who have warned about neglect and mismanagement for years. They say underfunded state offices with outdated systems, poor staffing and relaxed verification requirements for applications opened the door for waves of abuses.

Congress is gearing up for another busy week, and we’re watching for action on two bills in the House …

  • The House will bring up legislation from Rep. Robert C. “Bobby” Scott (D-Va.), chair of the Education and Labor Committee, to loosen some of the red tape associated with how people can buy baby formula to address shortages.
  • Chairwoman Rep. Rosa L. DeLauro (D-Conn.) of the Appropriations Committee ,will bring to the floor an emergency supplemental appropriation “to immediately address the infant formula shortage.”

And as for the rest of the week …

Tuesday: A Senate Appropriations subcommittee on the National Institutes of Health’s fiscal year 2023 budget request; the House select subcommittee on the coronavirus crisis on how the pandemic affected low-wage women workers

Wednesday: The Senate HELP Committee on health and education cybersecurity; the House Judiciary Committee on abortion care access; a House Homeland Security subcommittee on the Department of Homeland Security’s efforts to combat the opioid epidemic

Thursday: A Senate Special Committee on Aging on mental health care for older adults; a House Appropriations subcommittee on the Food and Drug Administration’s fiscal year 2023 budget request.

Thanks for reading! See y’all tomorrow.


https://www.washingtonpost.com/politics/2022/05/16/some-clinicians-stress-mental-health-care-kids-questioning-their-gender/