Trends tend to take awhile to arrive in Maine, tucked away as we are in the far upper righthand corner of the map. And right now, a big trend among conservative politicians is using laws and state bureaucracies to pursue and punish transgender children, often by restricting their access to medical care.

I suspect it’s only a matter of time before this craze hits Maine, so I wanted to take this opportunity to talk a bit about what medical care for transgender kids looks like. Since transgender Americans make up less than 1 percent of the population, a lot of people are unfamiliar with their experiences.

First of all, the reason that going after trans kids is so in vogue right now is because Americans are actually widely supportive of trans rights: specifically the right for adults to transition, do what they want, and generally be left alone about it. This is because America has a libertarian streak. If you were to ask the average trucker in a midwestern diner, “Your friend Joe Schmo feels like they are a woman who was born in the wrong body. She wants to change her name to Jane Schmo, undergo hormone treatment, and shop in the ladies section of Carhartt. What do you say about that?” They’re probably going to reply, “Well, that’s Joe’s business. Uh, I mean Jane’s business.”

However, Americans are also prone to moral panics involving children. Remember that time in the 1980s that everyone was positive that day cares were filled with Satanic cults? This stems from the deep human instinct to protect children. It’s a good instinct, but like all strong feelings, it can become a runaway train.

Transgender children do not receive any transition-related medical treatment before the age of roughly 11. They don’t need it! Take it from me, a girl who was frequently mistaken for a boy before the age of 12. For young children, it’s all about the “social” transition  – letting the kid wear the clothes they feel represents who they are inside, allowing them to grow or cut their hair, maybe going by a different name. You will notice that this is what most loving, supportive parents tend to do regardless of what their child’s gender identity is.

The first medical step in transition is, often, the use of “puberty blockers.” These are usually prescribed for kids who experience precocious puberty (i.e., start going through puberty way too early). What they do for transgender children is buy them more time to make sure that they are comfortable and confident in their gender identity.


Let’s say you have a kid and you thought they were your daughter and when they are eleven they tell you that they are your son. You might say “OK, sweetie – uh, I mean, OK, sport.” But a lot of parents would want to make sure that their kid is really, truly positive they are a boy before they go through puberty, because while puberty blockers are reversible, puberty itself does involve permanent changes to the human body. Being the supportive parent that you are, you might also want to make sure that your son doesn’t go through the wrong puberty. Going through puberty sucks for everyone, even if you want the body you are gaining. I can’t imagine the horror that going through the wrong puberty would feel like.

If a child’s parents and medical team are in agreement that the child is “insistent, persistent, and consistent” in their gender identity, the next step for treatment is hormone replacement therapy, to bring their hormone levels in line with the gender they identify as, regardless of the reproductive bits they were born with. Transgender girls, like cisgender girls, will grow breasts; transgender boys will get deeper voices and grow those terrible little mustaches that teen boys the world over are so very proud of. It is not easy or quick to access hormone replacement therapy. This is mostly because in America, it is not quick or easy to access any sort of health care treatment.

The big worry people tend to have is in regards to surgery. First of all, if anyone tells you that children are undergoing genital reassignment surgery, please know that they are lying to you. “Bottom surgery” is not part of any current medical guidelines relating to the treatment of gender dysphoria in children and teenagers. Also, American doctors are all terrified of being sued; no surgeon is going to take the risk of being buried under lawsuits or thrown into jail for performing such a controversial operation on a minor.

“Top” surgeries – breast enhancement or removal – are very rare and, like any surgery, are on a case-by-case basis. In addition to the lawsuit fear, there’s also not much of a point in doing a procedure like that while the body is still growing, and a lot of adolescents don’t reach their full size and shape until around the age of 20. Breast implants are not approved for anyone under 18 by the FDA. Thousands of breast reduction surgeries are performed on adolescents every year in America, but not for the purposes of gender transition; they are usually performed to alleviate neck and back pain for teenage girls, or on teenage boys with gynecomastia –  overdeveloped breast tissue in cisgender males, usually caused by a genetic or endocrine issue.

When politicians try to make puberty blockers and hormone replacement therapy illegal for transgender youth, they are trying to force children to go through puberty in the wrong body. I hope you will keep that in mind whenever this particular moral panic arrives in Maine.

Victoria Hugo-Vidal is a Maine millennial. She can be contacted at:
Twitter: @mainemillennial

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