20 years ago, Dr. Deb Thorp, now the medical director of gender services at Park Nicollet, started seeing a patient who was brought in by their mother. They had already figured out how to source their own hormones online for do-it-yourself therapy, so they were connected to Park Nicollet to make sure the process was instead done properly and under the care of a physician.
In a deep depression, the patient would not leave their bedroom except to use the bathroom. Through phone visits with Dr. Thorpe, along with a mental health specialist, they finally had access to the gender-affirming care they needed. Slowly, they were able to get their mental health to a place where they could get the gender-affirming surgeries they needed. Soon after leaving their bedroom far behind, her patient came into their own, later earning their doctorate in psychology. Today, they are a PhD-level therapist, running a gender program, doing podcasts and more.
“These are the kinds of successes I see every day,” says Dr. Thorp. “I see patients who were unable to function because their gender dysphoria was so bad. They were so uncomfortable going out in the world and they transition and they’re much more confident in their bodies.” In today’s Off the Charts, Dr. Thorp answers frequently asked questions about gender-affirming care and how essential and lifesaving it can be for youth and their families. Listen to the episode or read the transcript.
The difference between sex and gender
Many of the misunderstandings about gender-affirming care come from a big misconception around how sex and gender are defined. Sex relates to our physical bodies – our physiology. We are assigned a sex at birth according to the organs that we’re born with.
However, gender is “your personal experience of how you perceive yourself to be in the world.” A person’s gender can be categorized in many ways – including male, female, non-binary (someone who doesn’t identify as male or female) and agender (not identifying with any gender description). A person can also be gender-fluid, where they feel a bit more of one or the other, depending on circumstances. “To some degree, we’re all a little gender-fluid and we’re all a little gender non-binary,” says Dr. Thorp. “That’s kind of normal.” Rarely is one person on one side or the other.
Gender-affirming care as life-saving care
That identification with gender starts early in a child’s development. And with the visibility of trans and gender-diverse people in media as well as better access to information, children and teens are feeling more able to recognize how they identify, talking about it and working through it with their parents.
But when trans youth don’t receive support or affirmation from loved ones, the affects can be devastating. If parents of trans kids aren’t understanding, either for religious or nonreligious reasons, their children have twice the suicide-attempt rate as kids of affirming parents. As Dr. Thorp says during the podcast, “if they have even one affirming adult in their lives, that substantially cuts their risk of mental health problems, including the risk of suicide attempts.”
Very simply, as Dr. Thorp puts it, “gender-affirming care is lifesaving care in many ways. I think the current rhetoric around ‘it’s child abuse, it’s not proven’ is just plain wrong. There’s good data to show all of that. And in adults, there’s really good data as well that [with gender-affirming care] you cut their suicide risk [and] improve their mental health.
“You don’t go through this lightly. Nobody chooses to be transgender. You just are. Nobody chooses to be a gender different than what they were assigned at birth because that’s a really tough road to hoe. Nobody really wants to do that, but it is necessary, when that is the situation, to provide care as needed.”
Parental involvement, consent and protections
As transgender health is becoming more widely understood and standards of care among physicians have evolved over time, the process for adults to get gender-affirming care has become easier. And while that has also helped with the process for transgender youth, state laws in North Dakota, South Dakota and Iowa prohibit (and Wisconsin restricts) gender-affirming care of any kind under the age of 18.
Youth access to gender-affirming care is protected in Minnesota, with many safeguards that ensure involvement, thoughtful consideration and consent from all involved – including parents and healthcare professionals. Just like with surgery or other medical care, transgender youth under 18 need consent from their parents. Unlike reproductive care, substance abuse recovery or mental health therapy, as Dr. Thorp says, parents “have to be behind it, otherwise it’s not going to happen.
Before therapy can begin, including the prescription of hormone blockers or other medications, there’s a large amount of discussion and consideration encouraged from everyone involved. As Dr. Thorp describes, “you come in, you have a conversation, go home, talk about things as a family, you come back, you have another conversation and maybe you have a third conversation before you start.”
And still, before medication begins, a detailed and descriptive consent form has to be signed by the child, with both parents and their doctor confirming all topics regarding gender-affirming care has been covered in conversation. In addition, a mental health professional has to be involved at every step of the process. To sum it up, Dr. Thorp says “there are a lot of backstops along the way to prevent kids from accessing care, a portion of which might have irreversible changes, that their parents aren’t aware of. It’s almost impossible to do.”
That said, when trans youth do receive the affirming care they need, the results can transform, encourage and inspire. “It’s very gratifying to know that you’ve really helped give somebody their life by being able to give them affirming care. Really all of gender-affirming care is helping guide the patient in what it is that’s going to make them feel comfortable in their bodies and, therefore in the world, and that’s a different road for every single patient. And, in the case of younger folk, helping their parents and the rest of the family and setting them up for success to the best of our ability to do that.”
To hear more from Dr. Thorp, including her background as an OB-GYN physician, her views on transgender youth in sports, the importance of timing in gender-affirming care and how care protections in Minnesota are providing a lifeline to out-of-state families, listen to this episode of Off the Charts.