Gender Studies, Triota Honors Society host panel on care for gender-diverse youth in response to SCOP event

The Gender Studies Program and Triota Honors Society hosted a panel of four experts on transgender health from Indiana University (IU) in a Tuesday night discussion.

The panel explored the best clinical ways to assist children and adolescents struggling with their gender identity. It was organized in response to an event held by Students for Child Oriented Policy (SCOP) in the fall.

At the time, Pamela Butler, associate director and director of undergraduate studies in the Gender Studies Program said the work presented at the SCOP event was “discredited and debunked widely by every legitimate medical organization that’s ever responded to their claims.”

In an email, SCOP co-president Ellie Gardey, a junior, defended the SCOP-invited panelists to the fall event.

“Student for Child-Oriented Policy offered a panel discussion with a professor of endocrinology and a medical doctor which brought attention to the serious side-effects of cross-sex hormones and puberty-blockers on children,” she said.

The first panelist to speak on Tuesday was Stephanie Sanders, provost professor of gender studies at IU and associate director of the Kinsey Institute, which studies questions of human sexuality. Describing a number of ways in which a person’s birth-assigned sex might not match their own conception of their gender, she said the determination process is inherently social.

“I just want to point out that you might think the first step is pretty straightforward, right?” she said. “That it’s just biology there — putting a person in a category. But it’s actually a social process. Authorities come to an agreement about what size phallus constitutes a penis versus a clitoris. And then estimates are made about how your gender will be classified according to that phallus.”

Defining “gender identity” as the “inner sense of who we are,” Sanders said this concept does not necessarily match a person’s sex assigned at birth. She dispelled the idea that gender identity is a matter of choice.

“We know from the literature that gender identity is established fairly early, and it’s resistant to change,” she said.

Sanders also discussed ways to “affirm” those who do not think their gender matches their birth-assigned sex. The four categories of intervention were “social affirmation,” in which a person modifies their appearance and pronouns, for example, to match their gender identity, “legal affirmation,” in which the person has their gender changed on legal documents, “medical affirmation,” which involves hormonal treatments to either suppress puberty or introduce the other sex’s hormones to the person’s systems and “surgical affirmation,” which involves surgical modifications to the body.

“In terms of what the experts actually say, the experts actually say that developmentally appropriate gender affirmation interventions are recommended,” she said.

Sanders turned the floor over to James Dennis Fortenberry, professor of pediatrics and chief of adolescent medicine at IU School of Medicine. He talked about his firsthand experience treating youths and adolescents who did not feel their gender identity matched their sex.

For Fortenberry, one of the most important actions people can take to make sure everyone feels accepted is addressing people the way they want to be addressed.

“The topic here is affirming care,” he said. “You may think I’m assuming this has to do with what we do in the clinics. I’m talking to you. You work in the world. You live in the world. You interact in all sorts of places with people.

“There are two things on this slide that help you be affirmative if you do them every time with every person you encounter. If you get my name right and get my pronouns right, I’m giving you from me what you need to do to treat me in an affirmative way.”

Talking about specific treatment strategies utilized in his clinics, Fortenberry said the method used depends on the age of the patient. For example, he said treatment for pre-pubescent children involves making the child feel accepted and does not involve hormones.

“There are no hormones, there is no surgery, this is just supporting this child to express themselves as they experience themselves,” he said. “It doesn’t sound really complicated. But if you think about the excitement, the intense investment our culture invests in ‘Is it a boy or a girl? Do we do pink or do we do blue?’ A gender reveal party — there’s a concept — that’s why this is important.”

For such patients, puberty is a critical time. As bodies start to change, gender dysphoria — or the distress a person feels from the seeming mismatch between their biology and their gender identity — becomes acute, leading to mental health problems. Fortenberry spoke of this problem in the context of a someone assigned male at birth who identifies as female.

“Puberty is a big thing … for kids with gender dysphoria, it’s particularly challenging because all of the sudden this particular kid — think about them — they’re going along, they want breasts. They’re going to get breasts. They’re going to have a period. Except that’s not what they get … and the dysphoria goes up hugely,” he said. “ … We often see increases in suicidal ideation behavior, cutting, other kinds of self-harming behavior at that time.”

Puberty blockers can help manage this problem, he said. While they do not stop puberty, they buy time.

“[Puberty blocking hormones] help reduce this kind of dysphoria,” he said. “It doesn’t make it go away because it doesn’t change what’s here, but it does suspend it for a while and lets this young person come into a place where they’re better ready to work through some of these other things, especially the initiation of hormones if that’s where they’re going.”

The next speaker was Richard Brandon-Friedman, an IU professor, as well as the social work services supervisor for the Gender Health Clinic at IU’s Riley Hospital for Children. He spoke about the psychological toll young people face as they come out as gender nonconforming.

Drawing a parallel with past ideas about homosexuality, Brandon-Friedman debunked the common societal misconception that gender nonconforming people might just be confused or searching for attention.

“This is not a choice … If you’ve grown up as gender diverse or a sexual minority, it is not fun,” he said. “Nobody says, ‘I want to be that gay kid in the high school who always gets picked on.’ That’s not what people want to do. They may say, ‘This is who I am, and I am that person who identifies as gay. It’s not going to get me a lot of popular press. It’s going to be mostly difficulty.’”

Continuing on that point, he said while gender diversity is more visible in the contemporary world, it is not new.

“Gender diversity has been around forever, pretty much. We can see historical documentation … all the way through contemporary times of different people with different presentations and different understandings of gender,” he said.

Talking more specifically about treatment options, Brandon-Friedman sought to dispel the fear that a gender diverse individual might undergo treatment, only to find out they were “wrong” about who they thought they were. He said social transition is fully reversible, and high standards and numerous assessments required for medical treatments make an irreversible error highly unlikely.

In lieu of focusing on the low probability negative consequences of treatment, Brandon-Friedman said people should focus on the positive.

“What about if they are right? Instead of saying that they might be wrong, what if they’re right? Well, we know that if we help them their psychosocial functioning improves,” he said. “We know they have increased authenticity.

“We know they have enhanced understanding of themselves. They really have this opportunity to live as who they are and achieve their life goals as they feel they are. We know this keeps them from having that significant dysphoria. It gives them the life that they want.”

The final speaker was Liana Zhou, the director of library and special collections at the Kinsey Institute. Her library includes 2,000 years’ worth of artifacts and archives related to gender diversity issues. She said her archives are designed to celebrate the empowering stories of gender diverse people throughout history.

“What we are trying to say is affirming your sexuality and your identity through self-empowerment,” she said. “I think everyone is so resilient, and I think the stories at the Kinsey Institute … it’s about the struggles, and overcoming those struggles … and to voice your stories.”