Since the US Department of Health and Human Services released its report, Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, concerns have been raised, especially by the LGBTQ+, disability, and medical communities. We speak to a local expert to separate fact from fiction.
TRANSCRIPT:
Emyle Watkins: Hi. I'm Emyle Watkins, and this is the Disabilities Beat. Since the US Department of Health and Human Services released its report, Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices, concerns have been raised, especially by the LGBTQ+, disability, and medical communities.
Zoe Gross: So there are several really concerning things in the report.
Emyle Watkins: Zoe Gross is the director of advocacy for the Autistic Self-Advocacy Network, or ASAN. The report has brought up a lot of concern, because beyond not naming the authors, the report also pushes a type of controversial conversion therapy.
Zoe Gross: What they would like to do is what they call exploratory therapy. And what they mean by that is conversion therapy. So they mean talk therapy with the explicit goal of making a trans or gender-nonconforming kid become cis and gender-conforming.
Emyle Watkins: The renewed push for types of conversion therapy is especially concerning for the autistic community, as the roots of both conversion therapy and a controversial type of autism therapy are tied back to the same psychologist. Statistically speaking, trans and nonbinary people are also up to six times more likely to be autistic. And scientifically speaking, Dr. Elana Tal points out that conversion therapy is not an accepted medical practice. Atal is a local OBGYN who provides gender-affirming care and is a clinical assistant professor at the Jacobs School of Medicine.
Dr. Elana Tal: This is not something we talk about in the medical community because it is not evidence-based. It is harmful. So it is not something that we think about or talk about with our patients.
Emyle Watkins: Tal spoke to BTPM about her own personal perspective as a provider, not on the position of the university. The report also specifically mentioned autism in a way that ASAN and other advocacy groups have found particularly worrying.
Zoe Gross: They kind of implied that if you have a disability first and then become aware that you're trans, that invalidates the possibility that you're actually trans, which is absurd. And we know in the autistic community that we are more likely to be transgender and gender-nonconforming, but that's just a fact about us. Our being autistic doesn't invalidate our gender.
Emyle Watkins: Tal says that as a provider, to her it makes sense that there's an overlap between these two communities, but that does not invalidate their experience.
Dr. Elana Tal: I would say that what this tells us is that the experience of gender and sexuality is a deeply personal and complex experience that has neurologic and biological underpinnings that we don't entirely understand, which is similar for autism. So it makes sense to me that neurodivergence would overlap to some extent with the experience of being transgender. But I reject the notion that people with autism cannot make decisions for themselves. And I think that when we listen to autistic voices, they are telling us, "Please do not further marginalize us by denying us medical care that we feel is best for us." And that resonates with me a lot more than what feels like basically making an excuse to further marginalize an already marginalized group.
Emyle Watkins: And as the doctor points out, a good provider, no matter the discipline or the treatment being offered, evaluates a patient holistically and makes sure that the patient is able to make fully-informed decisions.
Dr. Elana Tal: For everything I do, patients with significant psychiatric comorbidities, it is important that they are plugged in with good mental health care providers who can maximize their mental health and make sure that that is not presenting a significant barrier to them accessing care.
Emyle Watkins: And decisions cannot be broadly applied to a group of people just based on a diagnosis alone.
Dr. Elana Tal: So this is something that absolutely comes up. It comes up not just in gender-affirming care, but in all types of medical care. But in my experience, it's pretty rare. And it, again, is in general not a great reason to further marginalize, especially when we know that denying someone necessary gender-affirming care further exacerbates mental health problems. So that is a very delicate balancing act that us as physicians are very attuned to and have a lot of nuanced understanding in how to approach those difficult conversations.
Emyle Watkins: You can listen to the Disabilities Beat segment on demand and view a transcript in plain language description for every episode on our website at btpm.org. I'm Emyle Watkins. Thanks for listening.
