0:00

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

0:02

Science Versus. Before

0:06

we get started, this episode discusses

0:08

suicide and self-harm a little bit.

0:11

So please take care while you're listening and we'll

0:13

put some resources in the show notes. Today

0:16

on the show, kids who are

0:18

transgender. It's a topic

0:20

we've covered before, but there's new

0:23

research, a new battle amongst researchers,

0:25

and a new election, which is

0:28

all putting transgender healthcare into the

0:30

spotlight like never before. Texas,

0:33

now the largest state to block

0:36

gender-affirming care for transgender... This morning,

0:38

Idaho and Indiana are officially banning

0:40

gender-affirming care for transgender youth. So-called

0:43

gender-affirming care. Ridiculous.

0:46

If you are forcing a trans child to

0:48

go through puberty when they are trans, that

0:51

is tantamount to torture. Some

0:53

politicians even want to make it harder for

0:55

kids to do things like changing their pronouns

0:57

or names to fit their gender. And

1:00

they say that all of this talk of being

1:02

trans, it's just a phase that

1:04

they'll grow out of. And

1:06

so all of this politics has been bubbling

1:09

away. But then, just a few months

1:11

ago, a nearly 400-page scientific

1:13

report for the UK government called

1:15

the Caster of UK MOUNT, and

1:18

it kind of sounds like it agrees with

1:20

many of those politicians. It

1:22

said that supporting a kid who's trans could

1:24

actually be harmful for them, and

1:27

that the evidence behind medicines, like puberty

1:29

blockers or hormones, which are sometimes given

1:31

to trans teens, is

1:33

basically garbage. Well, they

1:35

called the evidence remarkably weak.

1:38

The report has found no good

1:40

evidence for giving puberty blockers to

1:42

adolescents. These clinicians gave puberty blockers

1:45

to these children. But what is

1:47

that if not experimenting? It is

1:49

a medical scandal. In

1:56

the UK, the government just announced an

1:58

emergency ban on puberty blockers. So today

2:01

on the show, we are diving back into

2:03

this topic to find out what is going

2:05

on. What is the new science telling us

2:08

about, one, if your kid says

2:10

that they want to use different pronouns or change

2:12

their name, what should you do? Two,

2:15

is the evidence behind puberty blockers

2:17

and hormones actually crappy? And

2:20

three, what's the chance that

2:22

this is just a phase that your kid will

2:24

grow out of? With

2:26

more and more kids coming out as trans

2:28

and gender diverse, the stakes of

2:31

getting this right are higher than ever. And

2:34

it's all coming up just after the break. There's

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way at New balance.com/running. New

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Balance. Run your way. Welcome

3:46

back. Today on the show we are asking,

3:48

when a kid is trans, what is

3:51

the best thing? Something that we can do for them. Should

3:53

we let them change their name and pronouns?

3:56

Give them medicines? To help

3:58

us wade through the research here? brutal,

8:00

like especially if you're trying to figure

8:02

out all the stuff when you're pretty

8:04

young, like around like middle school. That's

8:07

scary. Being the target of

8:10

homophobia and transphobia, not when

8:12

you're 24, but when you're 14. And

8:15

you've got to deal with that, which is totally

8:17

different story than when we used to come out

8:19

when we were in our 20s and 30s and

8:21

figure it out then. We're

8:24

all our nastiest little turds when we're in

8:26

middle school, right? Yeah, exactly. And

8:29

so I talked to Stephen about like what we make of

8:31

all of this. How does it

8:33

make you feel when you see that

8:35

kind of study being used to say,

8:37

you shouldn't let your kid socially transition

8:39

when they're young because then they'll get

8:41

bullied more and that will increase their

8:43

suicide risk? Well, there

8:46

are so many layers of that. And

8:48

I understand the anxiety. I understand where it comes

8:51

from. I totally get it. I raised

8:53

a gay kid. I

8:56

was not interested in someday safety for

8:58

him. I was interested in safety that

9:00

afternoon, like sending him to school that morning

9:02

and him being safe then. So all

9:04

of my great ideas about like averages

9:06

and statistical properties and like, who cares?

9:08

What about my kid today? I

9:11

bet there are a lot of parents who have this anxiety. And

9:15

now we have this study sort

9:17

of suggesting like if a kid does want

9:19

to socially transition, they should wait until, you know,

9:22

at least after middle school, maybe after high school when it's

9:25

less likely that they'll get bullied. What

9:27

do you think? I mean, that's

9:30

the question, right? Like, would it be

9:32

better to kind of discourage this or

9:34

should we just like support kids anyway? And

9:37

Stephen actually did this study that

9:39

really helps answer this. It

9:42

focuses on this one specific part of

9:45

social transitioning, which is changing your name.

9:48

So this is like, you know, if your parents named you

9:51

Michael, but you're realizing that like, no,

9:53

actually, I am a girl,

9:55

you might you probably want to change your name,

9:57

right? And so something that's you better. And

9:59

so. So this can be a big step. And

10:02

Stephen wanted to look at like, what

10:04

might happen after someone decides to do

10:06

this? So he did this study a few

10:08

years ago. And so this was before

10:10

we were talking about pronouns even. And so I

10:12

just thought, well, we should just ask about

10:16

whether kids can use the name they want. Oh,

10:18

so how did he study this? All right, so

10:21

he surveyed almost 130 trans and

10:24

gender nonconforming teens and younger adults.

10:27

And he asked them, do you have a preferred

10:29

name that's like different from the name that you

10:31

were given at birth? And

10:33

if they said yes, then the survey asked them,

10:36

and this is the important part, how

10:39

many people in your life actually use

10:41

that name? It's like, well, are

10:43

you able to use it at home, at school,

10:45

at work and with your friends? And he also

10:47

asked them about their mental health. And he wanted

10:49

to know like, if there are people in the

10:51

person's life that are using that name, is their

10:53

mental health better? And

10:55

he wasn't like really expecting that he'd see

10:57

much in the data, but then

10:59

his colleague knocked on his door. She came

11:02

in with the results and was like, Steven, you're not

11:04

gonna believe this. Oh my gosh, oh my gosh, it

11:06

worked. It's like, it's real. The people

11:08

who said, yes, I get called my chosen name

11:11

in at least just one place, that

11:13

lowered their risk of suicidal behavior by

11:15

56%. Oh

11:18

my gosh, 56%. I

11:20

talked to Steven about that. Yeah,

11:23

it's dramatic. So it could mean the difference between

11:25

life and death for someone. Well,

11:27

yes, absolutely. The

11:30

more people in their lives used

11:32

the person's chosen name, the more

11:35

their risk for suicidal behavior dropped.

11:37

That's such a dramatic finding. I

11:40

know, it's a bit surprising. I don't think

11:42

it is actually. Like Steven was like, no,

11:44

this makes sense. I feel like

11:47

it's that amazing possibility to be seen

11:49

or heard. Like, and maybe

11:51

for the first time. You know, it's

11:53

so deep when you think about it that

11:55

you can imagine that if you're a

11:58

trans kid that, you know, feels. It's

14:00

inauthentic and it's undermining my wellbeing

14:02

to just put an entire part

14:04

of myself on hold for

14:08

five, 10, 15 years. After

14:12

the break, puberty blockers and hormones. We're

14:14

giving them to some trans kids, but is

14:16

it the right move? Coming

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15:10

Welcome back. Today we're looking at

15:12

the new science on transgender healthcare. And

15:14

now we're going to go to the

15:16

most controversial part of this debate. We

15:18

brought Ada Chung into the studio to

15:21

discuss it. She's an endocrinologist and head

15:23

of the Trans Health Research Group at

15:25

the University of Melbourne. Alright,

15:27

we're going to jump right into the controversy. We've

15:30

been looking at your Twitter and it seems like you're

15:32

a Swifty. Oh yes, of

15:34

course. So what do you think

15:36

of the new album? I

15:38

love it. Yeah,

15:41

I unashamedly love Taylor

15:44

Swift. I can't

15:46

get into it. I love that

15:48

people love it, but I cannot get through

15:50

it all out. Wendy,

15:53

how do you not

15:55

like Taylor Swift? Come on. She's fine.

15:57

I just don't. I feel nothing in

15:59

my life. don't

18:00

have the highest quality of evidence

18:03

for puberty blockers.

18:06

So we all know what you'd really

18:08

like is a randomized controlled trial. So

18:11

that's where you get a group of

18:13

people, split them into two groups. One

18:15

gets the drug, one group doesn't at

18:18

random, and then you compare the two.

18:20

Love a randomized controlled trial. Yeah, right.

18:24

Love them. A lot of researchers have

18:26

said that that would basically be

18:28

impossible for this area because there's

18:31

no kids that would want to sign up

18:33

for a trial where they might get a

18:35

puberty blocker or they might get a

18:37

placebo and then their bodies will go through all of

18:39

these irreversible changes.

18:42

Right. But we do have these

18:44

other studies, so like observational

18:46

studies that look at kids who

18:48

get puberty blockers and then

18:51

checks what happens to their mental health after they

18:53

go on them. But

18:55

what the CAST review noticed is that the

18:57

results are kind of mixed. Oh. And

19:01

that's true. So some of the studies

19:03

will find that when they look at

19:05

trans, adolescence, mental health after

19:07

they go on puberty blockers, it'll

19:09

get better. But then other studies

19:11

don't find an improvement. I can

19:14

see then why people have been

19:16

questioning these meds. Yeah.

19:18

I mean, that's what I thought too when I

19:20

first looked at this. But

19:22

then I spoke to researchers about it

19:25

like Cal Horton. So they're a research

19:27

fellow at Oxford Brookes University in the

19:29

UK and they've done a bunch of

19:31

studies on trans kids and their families.

19:33

So I asked them about puberty

19:35

blockers. One of the things

19:37

that surprised me when I read it

19:40

was this idea that there's not good

19:42

evidence that they improve mental health. So

19:47

the purpose of puberty blockers is

19:49

to block puberty. They

19:52

are very successful and effective at

19:54

blocking puberty. What they're meant

19:56

to do is stop wellbeing

19:59

decreasing. So they're preventing something

20:01

from happening. And what we would hope to

20:03

see is just a kind of keeping

20:06

on the same, even, you

20:08

know, just mental health

20:10

being as it was before puberty. Yeah,

20:13

so, okay, it feels like what the CAS

20:15

report is saying is that they're kind of

20:17

expecting kids to get this big, like, boost

20:19

to their mental health after they're

20:21

on puberty blockers. And like, sometimes we do

20:23

see that, but the thing

20:25

is, like, what you really want to know

20:28

is, like, what happens when people don't get

20:30

puberty blockers at all? Right, yes, because that's

20:33

ultimately what would lead to

20:35

potentially depression, right? Like, if you don't

20:38

get the blockers and you start growing

20:40

boobs or getting a period and you

20:42

are a boy and people are, you

20:44

know, yes, okay. So do we have

20:47

a study then that looks at

20:49

the kids who did not get them? Like, and

20:52

what happened to their mental health? We have a

20:54

study like that. Oh, okay, great. So, okay, they

20:57

looked at mental health of over 200 trans

20:59

kids who were around 14 years old, and

21:02

they were not on puberty blockers. So

21:05

probably had started to go through, you know,

21:07

some puberty that they didn't want. And

21:10

they had pretty terrible mental health compared

21:12

to like, just cisgender kids who are

21:14

around the same age from the same

21:17

population. They had more stuff

21:19

like self-harm, suicidality,

21:21

depression, anxiety. It

21:23

looked like they were really struggling. Yeah, that's awful. So

21:26

from that, like, we could see that

21:28

kids, trans kids who are not on

21:30

puberty blockers, their mental health is not

21:32

great. And then if you

21:34

look at the kids who were on the

21:37

puberty blockers, they were doing better. Like, they

21:39

were doing better than the kids that didn't

21:41

get them. And in fact, they were actually

21:43

doing basically as good as the kids who

21:45

weren't trans. Okay,

21:50

so all of this seems to be

21:52

saying that if you don't let

21:54

kids access puberty blockers, like the

21:56

exact situation that is happening in

21:59

more... I

30:00

mean, it is fascinating because it does

30:03

show that when people

30:05

say things like, you know, oh,

30:08

they're just kids, this is just a phase. I

30:11

mean, for some kids, there

30:13

is kind of, there is some truth in

30:15

that. I mean, saying it's just a phase

30:17

might feel derogatory, but they're just exploring who

30:19

they are. But

30:21

then what the data is telling us is to take

30:24

that argument further and to say,

30:26

like, therefore we should not allow any

30:28

trans kids to be on medication. That

30:31

is wrong, right? Like according to these

30:33

two studies, at least, that we have,

30:36

the trans kids that are going

30:39

on medications far and away, they're

30:41

not in that, like, exploratory phase.

30:43

Like they are sticking with that

30:46

identity. Yeah, exactly. And

30:48

then, like, if we do look at that

30:50

group of people who are changing things, like

30:53

identifying as trans first and then cis, the

30:56

vast majority of them are not taking any of

30:58

these meds, over 90% of them. Right,

31:01

right. And while that study was on

31:03

teens, there is actually data from younger

31:05

kids that seems to show that if

31:07

you socially transitioned one year, like, around

31:09

eight years old, you're much less likely

31:11

to be switching up your identity. So

31:14

yeah, the data does not seem to

31:16

be backing up this idea that there's

31:18

all these people who are, you know,

31:20

taking these meds and then later not

31:22

identifying as trans anymore. Right, yeah. Yeah.

31:25

Okay. So then, you

31:27

know, I feel like the CAS review might

31:31

have highlighted some places where we

31:35

want more research. More research

31:37

is always good. But

31:41

it still feels like if you look at

31:43

the data that we have, it

31:45

is supporting social transitioning,

31:48

puberty blockers, and

31:51

the use of hormones. That's what it looked like to

31:53

me. By the way, I reached out

31:55

to the CAS review people to ask them about

31:57

why it seemed like they like overlooked. bunch of

31:59

the stuff that we talked about today. Yeah. And

32:01

they never got back to me. But

32:05

the thing is, so what

32:07

it feels like to me is that

32:09

the CasterView has set this really high

32:11

bar of evidence that we need to

32:14

show that affirmative care works. And it's

32:16

good to demand good quality

32:18

evidence, but then they kind

32:20

of ignore the fact that

32:23

if you don't do any of this stuff, it

32:26

could really suffer. I mean, that's

32:28

what we see in the data. And

32:30

I think when kids don't get puberty blockers,

32:32

their mental health is worse. That's right. That's

32:34

right. I mean, that's what these, when

32:37

people make these arguments of like,

32:40

the evidence base isn't perfect, so

32:42

let's do nothing. Like,

32:44

they're not able to acknowledge that doing

32:47

nothing is doing something. Like, you're actively

32:49

saying no to a child. You're actively

32:51

saying like, no, we will not support

32:54

you. We will not give you the

32:56

medicines that you need. And

32:59

we have evidence that that is harmful. Yeah,

33:02

and now as a result of this

33:04

report, there are these huge implications for

33:06

all these kids. So

33:08

like, here is Cal Horton. They're the UK researcher

33:10

that we heard from earlier. It's

33:13

really disheartening. Disheartening is the wrong

33:15

word. I was kind

33:18

of pretty much unable

33:20

to function for like a week afterwards. And

33:23

I speak to trans people, and I speak

33:25

to parents of trans kids around the country.

33:27

And we've all been absolutely devastated by the

33:29

impact of the cash report, because

33:32

it was a car crash we could see coming,

33:35

but were unable to in any way

33:38

influence. And we know

33:40

the impacts that the impacts it's already

33:42

having are devastating, and the impacts it's

33:45

going to have are just heartbreaking. And

33:48

knowing and caring about trans kids,

33:52

it's devastating that we've

33:54

got to where we are. And it's devastating that

33:57

this harm is being. failed

34:00

in a banner of evidence-based

34:03

policy. That really cuts to

34:05

my core, because it's not

34:07

evidence-based. Yeah,

34:12

and it's not just Cal. Other big,

34:14

sciencey groups in the space have looked

34:16

at all this and said, if

34:19

you follow the evidence, it still leads

34:21

to gender-affirming care being the best thing

34:23

for kids, like the American Academy of

34:25

Pediatrics and the Endocrine Society. And

34:28

so, yeah, when it comes to this argument, the

34:30

evidence here is weak. Here's

34:32

what Stephen thinks. I mean,

34:34

we really, we have just started. And,

34:36

you know, for what it is,

34:38

we have really good data. Rich

34:40

community samples that follow kids over

34:42

time. Using multiple methods from

34:45

different areas of the world in the country,

34:48

asking similar questions to come up with

34:50

the same kind of results, it's

34:52

insulting to say that it's weak. It's

34:54

not weak. So,

34:57

you know, we know a lot. Thanks,

35:00

Meryl. Thanks, Wendy. That's Science

35:02

Versus. And how many citations are in this

35:04

week's episode? We

35:07

have 81 citations. And if people want

35:09

to see them, where should they go? To

35:12

our show notes and then follow the links to the transcripts.

35:14

And we'll also put a link there to our

35:17

last episode that we did on trans kids' healthcare.

35:21

And we'll also put a link there to our

35:23

last episode that

35:25

we did on trans kids' healthcare. And

35:28

that one we go into more detail about

35:30

stuff like the side effects of puberty blockers

35:32

and hormones. Yes. And on Instagram this week,

35:34

which is science underscore VS, we're

35:37

going to have a video of me chatting to Dr.

35:39

Ada Chung. I'll

35:41

also pop it on my TikTok, which is

35:43

at Wendy Zuckerman. See you, Meryl. Bye, Wendy.

35:55

This episode was produced by me, Meryl Horne. And Wendy

35:57

Zuckerman with help from Michelle. Del

36:00

Dang and Rose Rimmler were edited by

36:02

Blythe Terrell. Fact checking by

36:04

Eva Dasher, consulting by Rebecca Clang, mix

36:06

and sound design by Bobby Lord. Music

36:09

written by Bobby Lord, Bumi Hidaka, and

36:11

Peter Leonard. Thanks so much to all

36:14

the researchers we spoke to for this

36:16

episode, including Blake Cave, Dr. Doug VanderLon,

36:18

and Dr. Quinnitucket Macklemore. And

36:21

a very special thanks to all of the

36:23

trans folks and their families that we spoke

36:25

to, Christopher Suter, the Zuckerman family, and Joseph

36:27

LaVell Wilson. Science Versus is a Spotify Studios

36:30

original. Listen for free on Spotify or

36:32

wherever you get your podcasts. Follow

36:34

us and tap the bell for episode notifications.

36:37

See you next week.