Few people understand the pressure we were under, back in 2019, if you had a trans-identified child in California and had Kaiser Permanente health insurance. We were expected to start our kid on puberty blockers and cross-sex hormones almost immediately after their 🏳️‍⚧️ declaration. I saved my records from Dr. Hoe, a Kaiser pediatric endocrinologist, who suggested I contact Gender Spectrum (an Oakland-based trans activist group) to get help in overcoming my fears. My daughter was 13 at the time. 🧵

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I asked Dr. Hoe what would be the next steps for a 14-year old, such as Ian, if they met with him. He said he would recommend that they speak with one of Kaiser’s Gender Specialists before proceeding. I told him that Ian already meets with a psychiatrist that is familiar with his mental/physical health. He said that Kaiser has found it is “easier for the (Kaiser) doctors to work directly with Kaisers own Gender Specialists” rather than with the teen’s psychiatrist outside of Kaiser system.

[ALWAYS THE SUICIDE RISK]
I voiced my concerns about medical risks. Dr Hoe said over and over again, that this is “an emerging field” and that “they don’t know the long term medical effects”, “but with any medical treatment there are benefits and risks”. When I asked him what would be the benefits he said, “it’s been shown that youths have a lower risk of suicide and less suicide ideation” if they are offered medical treatment, including hormone blockers and hormones.

When I asked him what are the studies that show the medical risks for 35 year olds that started hormone therapy at 14 or 15 years of age, he said there are "no studies of long term effects", and again said this is an “emerging field”. He said that what he does know is that “youths feel better" when they can take hormones that can "stop their periods or give them physical traits of the other sex”.

He said Kaiser has no handbook or set procedures in place for treating children or teens with hormones. I asked him to share with me his medical resources for treating teens in an email response. Below is his email. I have deleted the response from Ian’s Inbox, but it is still in Ian’s Kaiser records if you need access.

All of this was insane to me. I thought I was losing my mind. My daughter had never shown any signs of being unhappy as a girl (and what adolescent girl isn't terrified to go through puberty and enter womanhood??) How could I possibly follow the doctors' recommendation to block her puberty and put her on testosterone? Fortunately I followed my gut and pushed back and my daughter was never medicalized.

I saved records of every call and email around my daughter's trans-identification because my ex-husband was affirming and I wasn't so there was always this fear that I would lose custody if I didn't walk a fine line. (This is why I gave in to my daughter's request to use a male name - and avoided pronouns when speaking about her.)

Here are the links to the "guidelines" that Dr Hue sent me:

"I appreciate the conversation we had recently about Elisa.

As you requested, here's the online links for some guidelines from different professional medical organizations for providing transgender care:

Endocrine Society: academic.oup.com/jcem/article/1…

WPATH: wpath.org/media/cms/Docu…

I remember feeling a pit in my stomach when I read this section by the Endo Society:

"1.5. We recommend that clinicians inform and counsel all individuals seeking gender-affirming medical treatment regarding options for fertility preservation prior to initiating puberty suppression in adolescents and prior to treating with hormonal therapy of the affirmed gender in both adolescents and adults. (1 |⊕⊕⊕○)

2.0 Treatment of adolescents

2.2. We suggest that clinicians begin pubertal hormone suppression after girls and boys first exhibit physical changes of puberty. (2 |⊕⊕○○)

2.3. We recommend that, where indicated, GnRH analogues are used to suppress pubertal hormones. (1 |⊕⊕○○)

2.4. In adolescents who request sex hormone treatment (given this is a partly irreversible treatment), we recommend initiating treatment using a gradually increasing dose schedule after a multidisciplinary team of medical and MHPs has confirmed the persistence of GD/gender incongruence and sufficient mental capacity to give informed consent, which most adolescents have by age 16 years. (1 |⊕⊕○○).

And this about genital surgery:

5.4. We recommend that clinicians refer hormone-treated transgender individuals for genital surgery when: (1) the individual has had a satisfactory social role change, (2) the individual is satisfied about the hormonal effects, and (3) the individual desires definitive surgical changes. (1 |⊕○○○)"