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Transgender youth

Transgender youth are children and adolescents who are transgender and/or transsexual. Seeing that transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, and because most doctors are reluctant to provide medical treatments to them, transgender youth face different challenges compared to adults. Transgender issues manifest at different times in life in different individuals. In most cases of gender dysphoria, the condition is often apparent in early childhood, when such a child may express behavior incongruent with and dissatisfaction related to their assigned gender. Consequently, many of these children experience rejection as a result of their differences and quickly attempt to repress them. Stemming from this supression, people who see these children regularly may be unaware that they are unhappy as members of their assigned gender.

Vulnerability

Transgender youth are extremely vulnerable to a multitude of problems, including substance abuse, suicide, childhood abuse, sexual abuse/assault, and psychiatric disorders.^[1]

Healthcare

Lack of access to healthcare

Transgender youth potentially face many hardships in obtaining medical treatment for gender dysphoria. This lack of access may be due to doctors refusing to treat youth or youth fearing negative reactions from health care providers. Psychiatrists and endocrinologists are generally reluctant to provide hormone therapy to youths under 16, and obtaining sex reassignment surgery prior to the age of 18 is almost impossible in most countries. Many youth who have used hormones to develop desired secondary male or female sex characteristics have obtained these hormones illicitly. This can be potentially dangerous, and can result in a multitude of health problems for the youth, including improper pubertal growth and HIV due to contaminated needles. Sexually transmitted infections are a large health problem for transgender teens as well, as sexual partners often do not perceive these youth as health risks, especially since male-to-female youth cannot become pregnant. This trend of unprotected sex among the transgender population puts them at increased risk and has led to higher numbers of STIs among the group^[1] The latest revision of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People is amongst the first to address the needs of transgender children.

Existing healthcare options for transgender youth

When an individual is transitioning from female to male (FTM) or male to female (MTF), there are several avenues that are available to them pendant upon their financial capabilities, insurance's agreement to cover costs, and personal desire to utilize these options. While these options do exist, many of them are labeled off limits to minors (individuals under the age of 18). One of the options that does exist for minors is the use of puberty blockers, which in 2013 were officially stated as not damaging to bone health at the Endocrine Society's 95 Annual Meeting in San Fransisco. ^[2] In puberty, the mass of bones is built significantly, so this finding holds great importance in allowing transgender youth to keep from undergoing the psychological damage that may accompany their bodies going through a puberty that is not consistent with their gender identity. Puberty blockers are believed to put the succession of puberty on pause and can reverse any changes that had been made. Typically puberty blockers, which are reversible are first administered between the ages of 12-14 years of age, this is the age block because 16 years of age is believed to be too late. ^[2] For youth in Dutch nations, transgender youth are allowed to begin cross sex hormones at age 16, following their course of puberty blockers, allowing for successful transitions. ^[2]

Dr. Norman Spack, an endocrinologist who primarily has worked with intersex patients, has been a forerunner in helping youth navigate the transition process and educate others. His work is guided by his desire to see the suicide rates amongst untreated transgender individuals go down and to keep youth from undergoing psychological trauma that can accompany undergoing puberty for a gender they do not identify with. Dr. Spack is inspired by the research done in Dutch nations in their use of puberty blockers and affirms this choice, this affirmation stems from the fact that early administration of cross sex hormones causes stunts in growth, issues of infertility, and other health issues. When this procedure of puberty blockers and cross sex hormones are followed, transitional surgery is then granted upon turning 18 years old. ^[3] Dr. Spack boasts a number of successful and well known patients around the world, working with youth who cannot follow this prescription due to the height they may end up, one of these successes being a young woman named Jackie from England. ^[3]

For those who are above age 18 and do not require the consent of an adult, there is a myriad of options available if they wish to transition. For those wishing to transition from male to female, options consist of facial feminisation surgery, vaginoplasty, breast augmentation surgery, and cross-sex hormones. For those wishing to transition from female to male, options consist of penile construction surgery, breast reduction surgery, and cross- sex hormones. ^[4] In order for any individual to receive these medical treatments, they must have a written diagnosis of gender dysphoria and have undergone a year's worth of therapy if they are a United States citizen. If they are a citizen of Malta, there is a quick and relatively simple paperwork process to change their gender marker, in contrast, the United States has a difficult and extensive process that requires medical proof of need and returning to your home state to obtain various legal documents. In the United States to change an individual's existing gender marker and name, visits must be made to change the driver's license, social security card, banking documents, passport, the list trails on and extensive documentation must be presented in order to change each individual item. ^[5]

Homelessness and survival sex

According to the National Healthcare for the Homeless Council, 1 in 5 LGBT youth have unstable housing or lack housing altogether,^[6] as a result of that 1 in 5, it is estimated that between 20-40% of homeless youth are a part of the LGBT population.^[7] Some of the reasoning as to why LGBT youth are not able to have stable housing is family rejection/conflict, varying forms of violence, difficulty within various institutions such as school or the foster care system. ^[6] Even when LGBT youth find themselves in homeless shelters, they are not always having their needs met which can leave them at disproportionate rates on the streets compared to their heterosexual and cisgender peers, who fit within the gendered housing they are given and do not require additional services in their shelter placement. ^[7]

One practice that has resulted from transgender youth's inability to attain shelter that cares for their needs is to turn to survival sex for their money and shelter needs. Survival sex is the act of engaging in sexual activity with another individual or the act of selling sex in order to meet one's basic survival needs. ^[8] Transactions typically result in the youth receiving monetary value, but also can be utilized to gain a bed for the night, a meal, or clothing. While there is an awareness of the possible dangers associated with survival sex, it is often reported that a sense of pride in being able to support oneself accompanies the activity or the positivity of being able to eat and have somewhere to rest that night. Dangers do exist when it comes to the transaction of survival sex, one of them being the stigma that results from the transaction and another being the possibility of contracting an STI/STD (sexually transmitted infection/disease).^[8]

Suicide

Several studies have been conducted that estimate life-threatening behaviour for gay, lesbian, and bisexual youth, few have been done regarding transsexual youth, and thus comparable estimates do not exist. The few studies that have been done, however, have all concluded that transgender youth are at increased risk even over their gay, lesbian, and bisexual counterparts. A 2007 study of transgender youth found that, of the youth interviewed, about half had seriously contemplated ending their own lives. Of those who had thought about suicide, about half had actually made an attempt. Overall, 18% of all interviewed transgendered teenagers reported an attempted suicide that was linked to their transgender identity.^[9] A similar study was conducted with gay, lesbian, and bisexual youth, with results showing 15% had made a suicide attempt that was due at least partly to their sexual orientation.^[10] Both of these numbers are considerably higher than the 8.5% of high school students who had reported life threatening behavior.^[8] In a recent study, it is found that these statistics are even higher for those who are homeless or have been rejected from receiving medical care due to their gender identity, this brings the numbers up to 69% with a general statistic stating that around 40% of transgender youth have attempted suicide. ^[11]

Youth are generally predisposed to life-threatening behaviours due to a number of conditions, such as self-hatred, victimisation via bullying, substance abuse, etc. Transgender youth may also face victimization from peers and family members’ negative reactions to their atypical gender presentation, increasing their risk of life-threatening behaviors. Of the transgender youth who were interviewed and reported an attempt at taking their own life in the aforementioned study, almost all had been verbally abused by their parents, and a significant number had been physically abused as well. In comparing those transgender youth who had and had not attempted suicide, there were significant differences in family relations, peer relations, and school performance ^[9] Awareness of the suicide rates of LGBT youth spiked post-2010, as a result of significant publicity being given to the recent suicides of Leelah Alcorn, Skylar Lee, and Ash Haffner only being a few. ^[12]

Acceptance of transgender youth

On a global scale, transgender individuals face varying levels of acceptance or denial based on their location's climate. Factors that influence acceptance or denial of their identity tend to surround political interests, religious affiliations, and whether their identity is still labeled as a mental health disorder. Acceptance levels tend to predominantly be higher in countries located in the global north, Malta and the United States of America are two examples of countries where legislation and the social climate have curated a safer environment for transgender individuals.

Malta

In early April of 2015, Malta adopted a bill in Parliament titled the Gender Identity, Gender Expression and Sex Characteristics Act (GIGESC Bill). The bill allows youth to have their parents apply to have their gender marker changed for them or to have a gender marker held from their birth certificate until their gender identity has been discovered. The bill also keeps from having surgeries performed on intersex infants until their gender identity has been discovered, the parents are no longer required to make an immediate decision and medical personnel cannot override this decision.^[5] For individuals who are no longer a minor, they only need to request a notary for self declaration and cannot be asked for medical records when changing their gender marker or performing any other legal changes in conjunction to their gender identity. ^[10] In order to continue Malta's progress in LGBT protections and rights, the government has set up a council called the LGBTIQ Consultative Council, this action shows their commitment and dedication to actually enforcing the Bill. ^[5] While there are other European countries who have created allowances and encouraged acceptance of transgender individuals, most require compulsory sterilization^[13] and have lengthy legal proceedings.^[14]

United States of America

To be transgender in the United States of America (USA), whatever your age is to face hurdle after hurdle in attempting to transition and to be accepted. According to the Human Rights Campaign, in 32 states you can be fired for being transgender and in 33 states you can be refused housing. ^[15][16] In 2013, the state of California signed a bill in to legislation titled the School Success and Opportunity Act giving transgender students the full rights and opportunities that their cisgender peers are granted. ^[17] For individuals who are minors, if their parents consent, they are able to begin receiving puberty blockers at a young age and later receive cross sex hormones and then transitional surgeries upon turning 18 years of age. ^[3] For those who are not minors, they are able to participate in any body altering transitional experience that they desire if they are able to financially afford it and after going through a year of therapy to affirm this decision, but will have to jump over several hurdles for it to also be legally marked. ^[4]

Transgender youth leaders/activists

D.W. Trantham

At 13 years old, D.W. began the transition from male to female quietly for a year before coming out to her peers at her school, South Junior High in Boise, Idaho. ^[18]Upon coming out and deciding to use a women's bathroom in her school, one parent very publicly pulled their child out of anger that their child would have to share a bathroom with D.W. ^[19]In January of 2015, D.W. testified before the Idaho state courthouse on needing protections as a transgender youth and the need for transgender rights. While the Add the Words bill did not end up passing, the testimonies of D.W. and her father were felt throughout the crowd, whether positively or negatively. ^[20]

Jazz Jennings

At age 14, Jazz Jennings is a prominent figure in the transgender youth community after beginning to publicly transition at age 6 following a Barbara Walters interview, since then she has spoken on a national level for transgender youth. ^[21] Since then, she has gone on to star in a Clean&Clear commercial, write a book, and have a TLC show made about her viewpoint and daily life as a transgender youth.^{[22] [23]} In 2010, Jazz was named a youth ambassador by the Human Rights Campaign for all of the work she has done for the transgender community and for her prominence during Prop 8 in California. ^[24]At age 11, Jazz began using puberty blockers and will have to wait to begin taking cross-sex hormones and have gender affirmation surgeries completed until she is old enough. ^[25]

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