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PaperclipPerfector  1yr ago (text post)   6132 thread views

Small-Scale Question Sunday for May 21, 2023

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

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Thank you. I'm mostly able to follow this, but there's one thing I'm still unsure of. Under v8, puberty blockers can start at Tanner Stage 2 (so around age 12), but does hormone therapy still start around 16?

It's... not really clear. On top of none of the WPATH standards really binding, v8 (and to a lesser extent v7) have largely framed especially the adolescent treatment section as a discussion of research for more controversial sections, rather than strict 'you must have this characteristic'. From v8:

Previous guidelines regarding gender-affirming treatment of adolescents recommended partially reversible GAHT could be initiated at approximately 16 years of age (Coleman et al., 2012; Hembree et al., 2009). More recent guidelines suggest there may be compelling reasons to initiate GAHT prior to the age of 16, although there are limited studies on youth who have initiated hormones prior to 14 years of age (Hembree et al., 2017).

And that :

The skills needed to accomplish the tasks required for assent/consent may not emerge at specific ages per se (Grootens-Wiegers et al., 2017). There may be variability in these capacities related to developmental differences and mental health presentations (Shumer & Tishelman, 2015) and dependent on the opportunities a young per son has had to practice these skills (Alderson, 2007). Further, assessment of emotional and cognitive maturity must be conducted separately for each gender-related treatment decision (Vrouenraets et al., 2021).

(Referencing a study here, which finds that "Most research suggests that MDC is reached little before the age of 12 years.")

But the summary section just says:

Reached Tanner stage 2.

Soc cons have read this to only require Tanner Stage 2 (note: especially for XX-chromosoned, this can be much earlier than 12; it's not unheard of to occur closer to 10 or even 9). And I don't doubt there's some practitioners that have tried to read it that way. I think a more honest read of the full standards is generally going to be at least 12 and normally closer to 14, but it's not actually spelled out, and that's true for both surgical and hormonal interventions.

I'm not sure if this reflects aggressive retreat from restrictions under active pressure, wanting to be vague out of concerns related to long duration puberty blockers (a lot of the data re bone growth problems seems tied to very high doses not used for trans-adjacent therapy, but there's certainly space for issues), or just wanting to avoid being use for/legitimizing statutes or other strict bans (eg, a UK's court holding 16 as a required minimum age for informed consent including for puberty blockers, later overturned, referenced WPATH at length).

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