Decisions About Gender-Affirming Care

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Credit…Rhiannon Adam for The New York Times

To the Editor:

Re “Tennessee’s Trans Case Is About Age, Not Sex,” by David French (column, Dec. 9):

As a trans woman in her late 30s who could not begin transition until my late 20s, I wish every day that I had been able do so before puberty. The amount of pain, energy and money I have had to spend to undo the effects of puberty — both to be comfortable in my body and to pass as a cisgender woman — is demoralizing.

I was able to leverage my considerable education into a decent paying job, save money for surgeries that have alleviated society’s discomfort with my appearance and then hustle my way into a successful career in an industry that is tolerant of someone like me. Yet even with a good income, many in the trans community still turn to sex work to afford such gender-affirming care, and laws that limit choice will guarantee that more do so. To live as my authentic self, would I walk this profoundly painful path again? Yes, but children in 2025 should not have to suffer through a similar struggle.

To leave these weighty decisions to legislators instead of parents, their children and the medical community is dooming youngsters to, at best, hundreds of thousands of dollars in medical expenses in an effort to achieve a normal life. At worst, they will struggle with unemployment, homelessness, suicidality and death by their own hands or those of another.

I understand the fears people have: “Well, what if a child undergoes some type of intervention and regrets it later?” But in reality, the overwhelming majority of trans people who receive gender-affirming care, including minors, do better. Very few regret transitioning. I certainly don’t.

Most parents and doctors have good judgment when it comes to the various interventions available. Are we talking about performing vaginoplasty or phalloplasty on toddlers? Absolutely not. Puberty blockers are a remarkably safe option that will help give trans kids, their parents and doctors more time than biology normally allows to make the right decision about the deeply nuanced and personal journey that is transition. I know plenty of adult cisgender women whose parents let them get breast implants at 16 for purely cosmetic reasons. Shouldn’t a trans girl and her parents be granted the same latitude?

To those who rail about the lack of studies on gender-affirming care, should there be more? Yes, please; trans medicine is deeply underfunded because it does not yield a product that turns a profit. Where is the outrage about that?