Trans Kids' Healthcare: Are We Getting It Wrong?

This episode critically examines the current state of healthcare for transgender children, focusing on the validity of the research supporting common treatments such as puberty blockers and hormones.

1. Social transitioning may be beneficial, but it comes with challenges, particularly bullying, which significantly impacts mental health.
2. The CAS review criticizes the lack of strong evidence for puberty blockers and hormones, yet other studies suggest these treatments can improve mental well-being.
3. Recent bans on puberty blockers might worsen mental health outcomes for trans youth, opposing the therapeutic goals.
4. The episode highlights a critical gap between clinical practice and emerging research, emphasizing the need for supportive, evidence-based care.
5. Discussions around gender identity and medical treatment must consider both the potential benefits and the socio-political context affecting trans youth.

1: Introduction to the Topic

Wendy Zuckerman opens the episode by setting the stage for a discussion on trans kids' healthcare, highlighting recent political actions and scientific reviews that question the efficacy of gender-affirming care. Cal Horton: "Idaho and Indiana are officially banning gender affirming care for transgender youth."

2: The Impact of Social Transitioning

The chapter explores the mixed results of studies on social transitioning, with new research indicating potential risks to mental health, which contrasts with previous findings. Cal Horton: "The science here is mixed."

3: The Science of Puberty Blockers

A deep dive into the controversies and research surrounding puberty blockers, examining how they're used and their debated impact on mental health. Ada Chung: "It's a pause. So the idea is that you temporarily stop your body from going through puberty."

4: Hormonal Treatments and Mental Health

This segment discusses the use of hormones in trans healthcare, including a significant new study showing dramatic improvements in mental health from hormone therapy. Ada Chung: "Testosterone therapy for someone who has gender dysphoria can, you know, save lives."

5: Concluding Thoughts

The episode wraps up with a discussion on the need for more comprehensive and supportive research in trans healthcare, opposing views that dismiss the current evidence as insufficient. Cal Horton: "They're the UK researcher that we heard from earlier. It's really disheartening."

1. Support Social Transitioning: Encourage supportive environments that respect chosen names and pronouns to significantly reduce risks of mental health issues.
2. Educate on Bullying: Implement anti-bullying programs focusing on LGBTQ+ issues to protect trans youth from harassment.
3. Promote Inclusive Healthcare Policies: Advocate for policies that support access to gender-affirming treatments like puberty blockers and hormones.
4. Stay Informed: Keep up-to-date with the latest research to make informed decisions about care.
5. Seek Specialized Care: Consult healthcare providers who specialize in transgender health to ensure competent, compassionate care for trans youth.

Health care for trans kids has been in the spotlight, with battles over what the science says and tons of U.S. states restricting the care that children can get. And then there’s a new report out of the UK, called the Cass Review, saying that a bunch of the evidence that doctors have been relying on to treat trans kids is “remarkably weak.” So what’s going on here? What is the best health care for trans kids? We sort through the science with Professor Stephen Russell, Dr. Cal Horton, and Dr. Ada Cheung.

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Cal Horton, Ada Chung, Stephen Russell

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Content Warnings:

Discusses suicide and self-harm; content warning for sensitive topics

Wendy Zuckerman
Hi, I'm Wendy Zuckerman, and you're listening to science versus.

Before we get started, this episode discusses suicide and self harm a little bit. So please take care while you're listening, and we'll put some resources in the show notes today on the show, kids who are transgender. It's a topic we've covered before, but there's new research, a new battle amongst researchers, and a new election, which is all putting transgender healthcare into the spotlight like never before. Texas, now the largest state to block. Gender affirming care for transgender children.

Cal Horton
Idaho and Indiana are officially banning gender affirming care for transgender youth. So called gender affirming care. Ridiculous. If you are forcing a trans child to go through puberty when they are. Trans, that is tantamount to torture.

Wendy Zuckerman
Some politicians even want to make it harder for kids to do things like changing their pronouns or names to fit their gender. And they say that all of this talk of being trans, it's just a phase that they'll grow out of. And so all of this politics has been bubbling away. But then, just a few months ago, a nearly 400 page scientific report for the UK government called the CAS review came out and it kind of sounds like it agrees with many of those politicians. It said that supporting a kid who's trans could actually be harmful for them, and that the evidence behind medicines like puberty blockers or hormones, which are sometimes given to trans teens, is basically garbage.

Well, they called the evidence remarkably weak. The report has found no good evidence for giving puberty blockers to adolescents. These clinicians gave puberty blockers to these children. But what is that if not experimenting? It is a medical scandal.

In the UK. The government just announced an emergency ban on puberty blockers. So today on the show, we are diving back into this topic to find out what is going on. What is the new science telling us about? One, if your kid says that they want to use different pronouns or change their name, what should you do?

Two, is the evidence behind puberty blockers and hormones actually crappy? And three, whats the chance that this is just a phase that your kid will grow out of? With more and more kids coming out as trans and gender diverse, the stakes of getting this right are higher than ever. And its all coming up just after the break.

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Wendy Zuckerman
Welcome back. Today on the show, we are asking, when a kid is trans, what is the best thing that we can do for them? Should we let them change their name and pronouns, give them medicines to help us wade through the research? Here we have senior producer Meryl Hoard. Hey, Meryl.

Cal Horton
Hey, Wendy. Oh, my gosh. When this cast report first came out, you know, this scientific report, I pretty much called you right away. Right. And I guess I'm just like, did we get the science wrong here?

Wendy Zuckerman
Because last time, when we reported on this several years ago, I mean, we were basically saying the exact opposite thing of what this report has found. Right. I know. It was like, what? We got this all wrong.

What did they like? In a nutshell, you read that 400 page report. I didn't read, like, all of appendix six, but I read a lot of it. Did you read. Did you read appendix five?

Cal Horton
I think I might have, yeah, I think that was a good one. Good, good. All right, so as you were rating. As you were rating it, what did strike you? Well, overall, they just kept saying that the evidence is really weak for all of this stuff, for puberty blockers, for hormones, that we just don't have good research on a lot of this stuff.

Wendy Zuckerman
Okay, so let's start not with medicines like puberty blockers and hormones. We're gonna get into all of that. But first, let's start with actually kind of the first thing that your kid might need to do. It's called social transitioning. Mm hmm.

So this is a situation where you've got a kid saying, you know, don't call me by a girl's name because I'm a boy. Don't put me in a dress. Don't use the pronouns she, I'm a boy, use he. And when we talked about this last on the show, it seemed like the science was pretty clear like that. If your kid wants to do this, you should support them in doing that.

Cal Horton
Yeah. Okay. But it's been a couple of years. So what is the research telling us now? Yeah, so this was something that really surprised me when I read the CAS review, because they were basically like, the science here is mixed.

And they even pointed to some research that really seemed to show that if you let your kid do this, that it can actually make things worse for them. Like, it could be harmful to their mental health. Oh, wow. And that was just really different, like you said, from what we thought when we last looked at this. Yeah.

Wendy Zuckerman
So what, I mean, is it true? What's the truth here? What do you think of the sciences? Yeah. So they really kind of pointed out one study in particular, which seemed to show that this could be bad for kids.

Cal Horton
So I wanted to start there. So what these researchers did is they surveyed thousands of trans and gender diverse adults, and then they asked them about when they socially transitioned and also about their mental health. And what they found was that for the people who said, like, I socially transitioned when I was an adolescent, they were more likely to have attempted suicide at some point in their lives compared to people who socially transitioned as adults. Oh, and the cast review says that this basically means that social transitioning could be bad for adolescents. And that's what the study concluded, or the cast review.

Well, what was weird was that when I looked at the actual study, they said it wasn't actually the social transitioning itself that was making these kids feel crappy. It was the bullying that can come along with that. Oh. So they could tell from the data that it was the kids who got bullied more. They were the ones who were more likely to be attempting suicide years later.

That's what was driving this increased risk in suicide attempts. The paper. So they said, quote, social transition itself is not harmful, unquote. But if you're getting harassed, be like, because of it, then that is the thing that can make you feel horrible. And I actually talked about this with Professor Steven Russell.

He's at the University of Texas in Austin. Yeah. What that study suggests is that the critical factor there is discrimination and stigma. We know, like, a lot of trans kids do face a lot of bullying, and this can be really brutal, like, especially if you're trying to figure out all this stuff when you're pretty young, like, around, like, middle school. That's scary, being the target of homophobia and transphobia, not when you're 24, but when you're 14, and you've got to deal with that, which is totally different story than when we used to come out when we were in our twenties and thirties and figure it out, then.

Wendy Zuckerman
We'Re all our nastiest little tears when we're in middle school, right? Yeah, exactly. And so I talked to Steven about what we make of all of this. How does it make you feel when you see that kind of study being used to say, you shouldn't let your kid socially transition when they're young, because then they'll get bullied more, and that will increase their suicide risk? Well, there are so many layers of that.

Stephen Russell
And I understand the anxiety. I understand where it comes from. I totally get it. I raised a gay kid. I was not interested in someday safety for him.

I was interested in safety that afternoon, you know, like, sending him to school that morning and him being safe then. So all of my great ideas about, like, averages and statistical properties and, like, who cares? What about my kid today? I bet there are a lot of parents who have this anxiety. And now we have this study sort of suggesting, like, if a kid does want to socially transition, they should wait until, you know, at least after middle school, maybe after high school, when it's less likely that they'll get bullied.

Wendy Zuckerman
What do you think? I mean, that's the question, right? Like, would it be better to kind of discourage this, or should we just, like, support kids anyway? And Steven actually did this study that really helps answer this. It focuses on this one specific part of social transitioning, which is changing your name.

Cal Horton
So this is like, you know, if your parents named you Michael, but you're realizing that, like, no, actually, I am a girl. You probably want to change your name right, into something that fits you better. And so this can be a big step. And Steven wanted to look at what might happen after someone decides to do this. So he did this study a few.

Stephen Russell
Years ago, and so this was before we were talking about pronouns, even. And so I just thought, well, we should just ask about whether kids can use the name they want. Oh, so how did he study this? All right, so he surveyed almost 130 trans and gender nonconforming teens and younger adults, and he asked them, do you have a preferred name that's different from the name that you were given at birth? And if they said yes, then the survey asked them, and this is the important part, how many people in your life actually use that name?

I was like, well, are you able to use it at home, at school, at work, and with your friends? And he also asked them about their mental health, and he wanted to know if there are people in the person's life that are using that name, is their mental health better? And he wasn't really expecting that he'd see much in the data, but then his colleague knocked on his door. She came in with the results and was like, stephen, you're not gonna believe this. Oh, my gosh.

Oh, my gosh. It worked. It's like, it's real. The people who said, yes, I get called my chosen name in at least just one place. That lowered their risk of suicidal behavior by 56%.

Wendy Zuckerman
Oh, my gosh. 56%. I talked to Stephen about that. Whew. Yeah, it's dramatic.

Cal Horton
So it could mean the difference between life and death for someone. Well, yes, absolutely. Absolutely. The more people in their lives used the person's chosen name, the more their risk for suicidal behavior dropped. That's so.

Wendy Zuckerman
That's such a dramatic finding. I don't know. It's a bit surprising. I don't think it is, actually. Like, Steven was like, no, this makes sense.

Stephen Russell
I feel like it's that amazing possibility to be seen or heard. Like, and maybe for the first time, you know, it's so deep when you think about it that you can imagine that if you're queer, trans kid, that, you know, feels like Susan is not who you are, but Steven is. And you get to. There's at least one place where people will call you Steven. It's gotta be amazing when kids can use their name.

It transforms them. Another study has actually since backed that up. They found something really similar. And then we also have a study that looks at younger kids who socially transitioned when they're around seven years old. And that one also found that the kids had better mental health after they socially transitioned.

Cal Horton
And the researchers thought that this would just generally be true of kids that are in support of families. So zooming out, it really feels like for a kid who's decided to socially transition, and that's what they want to do. The studies say that you should support them. So then, I mean, it feels like, other than the messiness with the bullying study, it feels like the research isn't that mixed, that it's really pointing to, like, if your kid is transitioning, you should support them. Why was the cast review so, so down on this?

I mean, they did seem to put a lot of stock in that bullying study. Like, that was kind of their big conclusion. They said that, like, look, when kids get called by their chosen name, it helps them. But then there's this study that finds that suicide attempts go up. It's almost like those all canceled each other out.

And so we just don't know what to do. I mean, it feels like the actual answer is try to stop bullying and then support your kids to socially transition. Yeah, exactly. And also this idea of waiting until you're out of high school to come out as trans for some kids, it's just not really an option. Here's Steven and I think that what.

Stephen Russell
So many trans and gender diverse people will tell us, just like so many LGB people will tell us, just like many straight people would tell us if we told them not to be straight and just wait, they would tell us. I can't just wait. It's inauthentic and it's undermining my well being to just put an entire part of myself on hold for 510. 15 years. After the break.

Wendy Zuckerman
Puberty blockers and hormones. We're giving them to some trans kids. But is it the right move? Coming up.

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Wendy Zuckerman
Welcome back. Today we're looking at the new science on transgender health care. And now we're going to go to the most controversial part of this debate. We brought Ada Chung into the studio to discuss it. She's an endocrinologist and head of the trans health research group at the University of Melbourne.

All right, we're gonna jump right into the controversy. We've been looking at your twitter, and it seems like you're a swiftie. Oh, yes, of course. So what do you think of the new album? I love it.

Ada Chung
Yeah, I unashamedly love Taylor Swift. I can't get into it. I love that people love it, but I cannot get through it a whole album. Oh, Wendy, how do you not like Taylor Swift? Come on.

Wendy Zuckerman
She's fine. I just don't. I feel nothing in my soul when. I listen to it. Anyway.

Anyway, okay, so we, Meryl and I chatted with Ada together, and we're here to talk about some of the medicines that we're using for trans kids. Now, Ada treats trans adults. She gives them hormone therapy, but she knows a lot about this space in general. And so let's start by talking about the first medication that a trans kid might go on. And I talked with ADA about the basis.

Okay, so these are called puberty blockers. So they might start these when some of the first signs of puberty kick in. So think when the kid is like. Around eleven, what they do is they block the pituitary gland hormones so that it pauses puberty. So it's temporary.

Ada Chung
It's a pause. So the idea is that you temporarily stop your body from going through puberty, because if you're, let's say, a trans girl assigned male at birth, you may really not want to go through male puberty. That would mean growing hair on your face, having your voice drop. On the other hand, in a trans. Boy, we can prevent the development of breasts that otherwise might require invasive surgery down the track to correct.

Wendy Zuckerman
Okay, so in our past episodes on puberty blockers, we've mainly talked about the side effects. And these drugs are pretty safe. They've actually been used for decades for something called precocious puberty, which is when kids go through puberty early. And we've never really dug into this question of do they improve mental health or not? So, Meryl, what did that big science report from the UK say about this?

Cal Horton
Yeah, they did not think the evidence was great. They came down pretty hard on puberty blockers. They said that, like, when it came to whether or not being on puberty blockers helps kids mental health, the results were insufficient and inconsistent. So what is the evidence? Why did they think that?

Okay, one of the things that they point out is that we don't have the highest quality of evidence for puberty blockers. So we all know what you'd really like is a randomized controlled trial. So that's where you get a group of people, split them into two groups. One gets the drug, one group doesn't at random, and then you compare the two. Love a randomized controlled trial.

Yeah, right. Love them. But a lot of researchers have said that that would basically be impossible for this area because there's no kids that would want to sign up for a trial where they might get a puberty blocker or they might get a placebo, and then their bodies will go through all of these irreversible changes. But we do have these other studies, observational studies, that look at kids who get puberty blockers and then checks what happens to their mental health after they go on them. But what the cast review noticed is that the results are kind of mixed.

And that's true. Some of the studies will find that when they look at trans adolescents mental health after they go on puberty blockers, it'll get better. But then other studies don't find an improvement. I can see then why people are then questioning these meds. Yeah, I mean, that's what I thought, too, when I first looked at this, but then I spoke to researchers about it, like Cal Horton, so their research fellow at Oxford Brookes University in the UK, and they've done a bunch of studies on trans kids and their families.

So I asked them about puberty blockers. One of the things that surprised me when I read it was this idea that there's not good evidence that they improve mental health. So the purpose of puberty blockers is to block puberty. They are very successful and effective at blocking puberty. What they're meant to do is stop well being decreasing.

Quinnehtukqut McLamore
So they're preventing something from happening. And what we would hope to see is a. Is just a kind of keeping on the same, even, you know, just mental health being as it was before puberty. Yeah. So, okay.

Cal Horton
It feels like what the Cass report is saying is that they're kind of expecting kids to get this big, like, boost to their mental health after on puberty blockers. And, like, sometimes we do see that. But the thing is, what you really wanna know is what happens when people don't get puberty blockers at all. Right? Yes.

Wendy Zuckerman
Because that's ultimately what would lead to potentially depression. Right. Like, if you don't get the blockers and you start growing boobs or getting a period and you are a boy and people. Yes. Okay, so do we have a study then that looks at the kids who did not get them, like, and what happened to their mental health?

Cal Horton
We have a study like that. Oh, okay, great. So, okay. They looked at mental health of over 200 trans kids who were around 14 years old and they were not on puberty blockers. So probably had started to go through some puberty that they didn't want, and they had pretty terrible mental health compared to just cisgender kids who are around the same age from the same population, they had more stuff like self harm, suicidality, depression, anxiety.

It looked like they were really struggling. That's awful. So from that, we could see that kids, trans kids who are not on puberty blockers, their mental health is not great. And then if you look at the kids who were on the puberty blockers, they were doing better. Like, they were doing better than the kids that didn't get them.

And in fact, they were actually doing basically as good as the kids who weren't transparent.

Wendy Zuckerman
Okay, so all of this seems to be saying that if you don't let kids access puberty blockers, like, the exact situation that is happening in more and more states around the US and now in the UK as well. Yeah. Those kids have the worst mental health compared to everyone. Yeah, that's where we're at. Yes, this stuff really matters.

So now onto perhaps the most controversial side of all this, which is giving hormones. So for lots of trans folks, after they go on puberty blockers, if they want to then physically transition, they might take hormones, right? Yeah. A lot of trans people might go on to take testosterone or estrogen to help their bodies match their gender better. Yes, yes, exactly.

And so hormones, that's actually a big part of Ada Chung, our swifty and endocrinologist research. So she just did this randomized clinical trial. It was published this year in this space. So she got more than 60 trans and gender diverse folks who were mostly in their early twenties, and she gave half of them testosterone therapy immediately while the others were on a waitlist. And then after three months, she looked to see what was going on with their mental health.

So did the group that got hormone therapy do better? And here's what she found. We found a marked reduction in depression and most significantly, this marked reduction in suicidal ideation. So half the people had complete resolution of their suicidal ideation. Whoa.

From a result of testosterone therapy? Yep. From that first three months of testosterone therapy. That's huge. Huge.

Ada Chung
How did you feel? Was really affirming, because this is mirroring what we are seeing clinically. Testosterone therapy for someone who has via gender dysphoria can, you know, save lives. And I can just sort of see the. I don't know, like the emotion in your eyes, which I don't get from when I talk to most academics about most things.

Cal Horton
Can you tell me a little more. About how you're feeling as you're thinking about your patients? You know, I see patients who have quite severe mental health conditions. I see people who are struggling, you know, in hospital with various conditions, and then they affirm their gender, and then I see people thrive, people are happy, and it is a pure joy when I see people so well. And although Ada's research was on people who were mainly in their twenties, there is another study which involved more than 150 trans teens getting testosterone therapy.

Wendy Zuckerman
And it also found that their depression and anxiety scores dropped after the treatment, which Ada says is exactly what she'd expect. I personally, I actually think the effects of testosterone on a 22 year old compared to an 18 year old are pretty similar, or even a 16 year old. Like, it causes the same physiological effects. So I would expect similar effects of testosterone therapy on gender dysphoria, on psychological functioning, on suicidality. It's also important to point out that some of the benefits that Ada saw in her study might have been due to the placebo effect, because there wasn't a placebo control.

And also, Ada's study was specifically on people taking testosterone. Right. So, Meryl, what do we know about trans women taking estrogen? We do know that with estrogen, the effects on the body might be a little bit more slow or subtle, at least in the beginning. Cause, like, with testosterone, you can start getting facial hair pretty much like, you know, within months, pretty quickly.

Cal Horton
But with estrogen, it could take years to grow breasts. Yes, I remember my own. Those titties don't grow out of nowhere. No, exactly. It takes like, years.

Wendy Zuckerman
You got that awkward budding thing going on. Okay, so do we have research on estrogen and trans teens? Yeah, there is some. So there's this study that looked at young trans feminine people. So basically, teens taking estrogen, and they tracked them for two years and still didn't see clear improvements to their mental health.

Oh, right, right. And the researchers said it could be because they just didn't follow them long enough. Like, maybe they were actually still in that, like, awkward budding phase. And we're not really sure, like, why it didn't help them. Because we do have a handful of studies in adults that has shown that estrogen therapy can help.

Cal Horton
Even in the CAS reports review on hormone therapy, most of those studies showed mental health benefits to younger kids, like adolescents taking hormones.

Wendy Zuckerman
Okay, so the last thing that we wanna look at, which is this big question that's kind of like sitting like an elephant in all of this talk, trans kids and how to best help them, which is this idea that they're gonna regret any medicine that they've been on, that this is just a phase. Yeah. And I remember from previous episodes that we've done on this, we would talk about how there are, like, these strands of evidence pointing to an answer here, but we really wanted more data in this space. Yes. Now it feels like we finally have studies on this question of, like, how many people identify as transformers and then stop identifying that way later on, including one that just came out a couple weeks ago by this guy.

Stephen Russell
Hi there. Steven Russell. So he just did this study where they followed hundreds of people. They were 15 to 21 years old for over three years, and they asked them again and again and again, how do you identify to see whether their gender identities shifted over time? And what he found was that it was actually super common to see all sorts of things, people going from cis to trans to cis, just all sorts of different things.

And I was like, oh, my gosh, that's amazing. And who knew? I'm constantly amazed by the data that tells me how old I am or. How out of touch. Out of touch, that there's that much change happening in gender.

Cal Horton
And so were you surprised when you saw that there were a big chunk of kids who identified as trans at one point, but then ultimately identified as cis by the end of the study? Yeah, I was. I wasn't expecting as much change. So if you took everyone who identified as trans at the start of the study and then looked at what happened, half of them still identified as trans by the end of it, but half of them identified as cis. Oh, interesting.

Wendy Zuckerman
So then, I guess, then, what does this mean for this big fear that kids are gonna be on medicines that they don't need to be on? Like, is that happening? Right. Yeah. So that's the question.

Cal Horton
Right. But Steven looked at that. He asked everybody whether they were on hormones or puberty blockers. Great. He saw that while most of the people who identified as trans the whole time were taking hormones, it was actually really rare.

For the people who started identifying as trans and then later switched to identifying as cis, it was really rare for them to be taking hormones. Oh. It was actually only one person out of 32. Oh, interesting. And none of them were on puberty blockers.

And the results from Stevens study were actually remarkably similar to another study looking at this, which came out earlier this year. So that one was from a pediatric gender clinic in Western Australia. So in that study, there were 29 people who switched from identifying from trans to cis, and only two of them were on any kind of medication. Mmm. I mean, it is fascinating because it does show that when people say things like, you know, oh, they're just kids, this is just a phase.

Wendy Zuckerman
I mean, for some kids, there is kind of. There is some truth in that. I mean, you're saying it's just a phase. Might feel derogatory, but they're just exploring who they are. But then what the data is telling us is to take that argument further and to say, like, therefore, we should not allow any trans kids to be on medication.

That is wrong. Right. Like, according to these two studies, at least, that we have the trans kids that are going on medications far and away. They're not in that, like, exploratory phase. Like, they are sticking with that identity.

Cal Horton
Yeah, exactly. And then, like, if we do look at that group of people who are changing things, like, identifying as trans first and then Cisco, the vast majority of them are not taking any of these meds. Over 90% of them. Right, right. And while that study was on teens, there's actually data from younger kids that seems to show that if you socially transitioned when you're, like, around eight years old, you're much less likely to be switching up your identity.

So, yeah, the data does not seem to be backing up this idea that there's all these people who are, you know, taking these meds and then later not identifying as trans anymore. Right. Yeah. Yeah. Okay.

Wendy Zuckerman
So then, you know, I feel like the cast review might have highlighted some places where we want more research. More research is always good, but it still feels like if you look at the data that we have, it is supporting social transitioning, puberty blockers, and the use of hormones. That's what it looked like to me. By the way, I reached out to the cast review people to ask them about why it seemed like they overlooked a bunch of the stuff that we talked about today, and they never got back to me. But the thing is.

Cal Horton
So what it feels like to me is that the cast review has set this really high bar of evidence that we need to show that affirmative care works, and it's good to demand good quality evidence. But then they kind of ignore, like, the fact that if you don't do any of this stuff, a kid could really suffer. I mean, like, that's what we see in the data. Like, when kids don't get puberty blockers, their mental health is worse. That's right.

Wendy Zuckerman
That's right. I mean, that's what these. When people make these arguments of, like, the evidence base isn't perfect, so let's do nothing. Like, they're not able to acknowledge that doing nothing is doing something. Like, you're actively saying no to a child.

You're actively saying, like, no, we will not support you, we will not give you the medicines that you need. And we have evidence that that is harmful. Yeah. And now, as a result of this report, there are these huge implications for all these kids. So, like, here is Cal Horton.

Cal Horton
They're the UK researcher that we heard from earlier. It's really disheartening. Disheartening is the wrong word. I was kind of, you know, pretty much unable to function for, like, a week afterwards. And I speak to trans people and I speak to parents of trans kids around the country.

Quinnehtukqut McLamore
And, you know, we've all been absolutely devastated by the impact of the. Of the cash report because it was a car crash we could see coming, but we're unable to in any way influence. And we know the impacts that the impacts it's already having are devastating, and the impacts it's going to have are just. Just heartbreaking. And, you know, knowing and caring about trans kids, it's just.

It's devastating that we've got to where we are, and it's devastating that this harm is being veiled in a banner of evidence based policy that really, like, cuts to my core because it's not evidence based.

Cal Horton
Yeah. And it's not just Cal. Other big science y groups in this space have, like, looked at all this and said, if you follow the evidence, it still leads to gender affirming care being the best thing for kids like the American Academy of Pediatrics and the Endocrine Society. And so, yeah, when it comes to this argument that the evidence here is weak, here's what Steven thinks. I mean, we really, we have just started and, you know, for what it is, we have really good data rich community samples that follow kids over time using multiple methods from different areas of the world and the country asking similar questions to come up with the same kind of results.

Stephen Russell
It's insulting to say that it's weak. It's not weak. So, you know, we know a lot.

Wendy Zuckerman
Thanks, Meryl. Thanks, Wendy. That's science versus. And how many citations are in this week's episode? We have 81 citations.

And if people want to see them, where should they go? To our show notes and then follow the links to the transcripts. And we'll also put a link there to our last episode that we did on trans kids healthcare. And that one we go in some more detail about stuff like the side effects of puberty blockers and hormones. Yes.

And on Instagram this week, which is science versus, we're going to have a video of me chatting to Doctor Ada Chung. I'll also pop it on my TikTok which is Wendysookerman. See you, Meryl. Bye, Wendy.

Cal Horton
This episode was produced by me, Daryl Horn and Wendy Zuckerman, with help from Michelle Deng and Rose Rimmler, were edited by Blythe Terrell. Fact Checking by Eva Dasher consulting by Rebecca Kling Mix and sound design by Bobby Lord music written by Bobby Lorde, Bumi Hidaka, and Peter Leonard. Thanks so much to all the researchers we spoke to for this episode, including Blake Cave, Doctor Doug van der Lohn, and Doctor Quinnitucket Macklemore. And a very special thanks to all of the trans folks in their family that we spoke to, Christopher Souter, the Zuckerman family, and Joseph Lavelle Wilson. Science versus is a Spotify studios original.

Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. See you next week.