[AMENDED] UUA Business Resolution: Embracing Transgender, Nonbinary and Intersex People is a Fundamental Expression of UU Religious Values

General Assembly 2024 GA Business
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*The paragraph on “transgender youth” assumes that youth ( < 18) who declare themselves to be transgender are both capable of making such a decision and are correct in doing so. But the actual data from Europe (UK, Finland, etc.) has shown that such decisions are often being made in the manner of a “contagion” or fad, especially among girls, not with extensive counseling and other safeguards. Many medical personnel are very concerned about the permanent effects of puberty blockers and the like. Many also question whether such youth have the physical, emotional, and intellectual maturity to make such decisions. And parental rights and responsibilities may be abrogated. Key findings from the recent Cass report include (Final Report – Cass Review):

  • “While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices.

  • The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate.

  • The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services.

  • The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown.

  • The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

  • Clinicians are unable to determine with any certainty which children and young people will go on to have an enduring trans identity.

  • For the majority of young people, a medical pathway may not be the best way to manage their gender-related distress. For those young people for whom a medical pathway is clinically indicated, it is not enough to provide this without also addressing wider mental health and/or psychosocially challenging problems.”

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Hi Dick,

Just curious. How many transgender children and youth do you regularly interact with? Are you a youth group leader at your church working with them week to week? Do you currently have young trans kids? What’s your direct experience like?

Because it sure sounds like you’re choosing to go with questionable studies rather than direct experience.

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I’ve been attending conferences with medical and mental health experts from around the world for the best possible care for transgender people, youth and children for many years. I can not stress enough how affirming and validating people’s experience and expertise on their own identities including children is life saving.

As people who say we are for social justice and equity, we can not do less than side with transgender, nonbinary and intersex people and support the fight for equality. I have always had many friends who are transgender and/or nonbinary and I have been in community with children who are all kinds of beautiful gender creative, transgender, and nonbinary for my entire adulthood. The first time I met a transgender person was over 45 years ago. My diverse LGBTQIA2S community and friendship circles include so many folks outside the binary. One of my favorite organizations is https://transfamilies.org/ and of course I love our UU UPLIFT Programs for Trans/Nonbinary+ UUs

My sincere apologies and regret to all my transgender and nonbinary siblings who may see transphobic misinformation and unloving posts and remarks in this thread. Please know you are loved, valued and precious. If like me you love transgender, nonbinary and intersex people and children and you experience harm reading this thread of comments, please take care of yourselves. Please find our allies and accomplices. Please take breaks or let us with cis privilege like myself who love you stay in this conversation.

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Our denominational philosophies of religious education generally center around the idea that children have souls, spirit, and a conscience. We don’t plant stuff (or dogmas) in them, but water them with love and watch as they emerge from themselves. It follows, then, that we honor our youth, believe them when they tell us what they know to be the truth about themselves, and recognize that they are the leaders of today.

I’m a Religious Educator, and I support this resolution, including the paragraph about youth, because it is actually part of our faith and the culture of our denomination that we assume that people younger than 18 are competent, autonomous, thoughtful, human beings.

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Also, gender identity, much like sexuality, isn’t something that one “decides”. That language is kind of insulting, because it externalizes and treats as superficial something which is actually deeply personal and intrinsic to one’s sense of self. I decided to play violin, I decided to keep chickens; I didn’t decide to be a cis woman. Nor did my friend decide to be a trans woman.

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Hi Dick, I’m a transgender person who is also a biologist and I do advocacy work for my community.

No reputable medical agency supports your claims, the social contagion theory, or the “dangers” of puberty suppression. Studies have been published, yes, but you have to look at the author’s biases, accreditation, and the journal’s status. The UK in particular has been pushing vehemently transphobic laws and guidelines, as there is a large push to say that trans women aren’t real women. (Many of those people also deny the existence of non-binary people, and think that trans men and transmasculine people are just confused girls.) None of this is true.

The Cass report in specific is extremely under-researched, uses junk data and junk science, and contains many inconsistencies. You can read more about those errors here: https://www.gendergp.com/response-to-the-cass-review/

These US and worldwide health organizations directly support transgender children, youth, and adults. These are all legitimate organizations based in science and well-studied medicine.

The following have issued statements in support of health care for transgender people and youth:

American Academy of Child and Adolescent Psychiatry

American Academy of Dermatology

American Academy of Pediatrics

American Academy of Physician Assistants

American Medical Association

American Nurses Association

American Association of Clinical Endocrinology

American Association of Geriatric Psychiatry

American College Health Association

American College of Nurse-Midwives

American College of Obstetricians and Gynecologists

American College of Physicians

American Counseling Association

American Heart Association

American Medical Student Association

American Psychiatric Association

American Society of Plastic Surgeons

American Society for Reproductive Medicine

American Urological Association

Endocrine Society

Federation of Pediatric Organizations

GLMA: Health Professionals Advancing LGBTQ Equality

The Journal of the American Medical Association

National Association of Nurse Practitioners in Women’s Health

National Association of Social Workers

Ohio Children’s Hospital

Pediatric Endocrine Society

Pediatrics (Journal of the American Academy of Pediatrics ) and Seattle Children’s Hospital

Texas Medical Association

Texas Pediatric Society

United States Professional Association for Transgender Health (USPATH)

World Health Organization (WHO)

World Medical Association

World Professional Association for Transgender Health

I have several written and highly researched pieces on these topics that I will post for you to read, including sources. I will put them in separate comments after this first piece on puberty blocking.

Puberty Blockers:
Puberty blocking is not permanent and can be stopped and started safely! Puberty blockers have been safely used with cis (or assumed cis) children to treat precocious puberty (the medical term for early puberty) or to treat puberty that is happening too fast for decades. In the US, which is where my experience comes from, puberty blockers are regulated and approved by the FDA, and are extremely well studied.

Adults can take the same drugs labeled as puberty blockers (medically called called GnRH analogues) and are used to treat some forms of breast and prostrate cancer, polycystic ovary syndrome, and endometriosis (with varying results and very different risk profiles for adults than for children). These GnRH analogues were prescribed off label since the early 1980’s to treat precocious puberty, and the US FDA officially approved them for on-label puberty development since 1993.

And they are just as safe and effective for trans and non-binary youth. Potential side effects for children are a slight loss in bone density, which is treated by vitamin D and calcium supplements and physical activity; weight gain or loss, hotflashes (especially if puberty wasn’t suppressed before the onset), and headaches. But for most people, puberty blockers save lives, and most adults who were on puberty blockers as children report that the benefits outweighed the risks.

Many trans adults feel like they went through a horrible process with their first puberty, and are stuck with features that would not have developed had they had been given access to puberty blockers early on. Puberty blockers for trans and non-binary youth are used to halt puberty until the youth is of a sufficient age to start making safe decisions for themselves. And if that youth later determines that they aren’t trans or don’t want to have an alternative puberty, the puberty blocker is stopped and the youth proceeds as typical through puberty for the given driving hormone (estrogen or testosterone).

When a youth reaches teenager status then they and their guardian have a discussion with their doctor to determine if they can start HRT. This is an appropriate time because most youth will have a solid idea of their gender identity at this age, and they can proceed with their correct puberty at an age that is similar to their peers. HRT can have permanent changes, but it is safe to stop. If the teenager isn’t sure, they can remain on puberty blockers up to the age of 18, generally. The World Professional Association for Transgender Health (WPATH) updated in their recent revision that HRT can be started as early as 14 or 15, but it’s okay to stay on puberty blockers for longer!

References:
WPATH Standards of Care v. 8: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644
More info on puberty blockers in children: https://www.gendergp.com/puberty-blockers-bone-health-for-transgender-youth/
Additional info from the Mayo Clinic on blockers: Puberty blockers for transgender and gender-diverse youth - Mayo Clinic
Study on bone health of youth on puberty blockers: Bone health in transgender people: a narrative review - PMC
Great study from the American Academy of Pediatrics about comprehensive care for trans and gender-diverse youth https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for?autologincheck=redirected
Children’s Hospital Boston page on precocious puberty Precocious Early Puberty | Boston Children's Hospital
Cleveland Clinic page on precocious puberty Precocious Puberty - Early Puberty: Symptoms & Causes
Yoo, 2016 Effects of early menarche on physical and psychosocial health problems in adolescent girls and adult women https://www.e-cep.org/journal/view.php?doi=10.3345/kjp.2016.59.9.355
Cohen-Kettenis et. al, 2011, “Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up” Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up - PMC
McGregor et. al, 2023, Association of Pubertal Blockade at Tanner 2/3 With Psychosocial Benefits in Transgender and Gender Diverse Youth at Hormone Readiness Assessment https://www.sciencedirect.com/science/article/abs/pii/S1054139X23005608

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Top (chest) Surgery on Teenagers

The best and most comprehensive document on all aspects of transgender and non-binary physical and mental health is the World Professional Association for Transgender Health (WPATH)'s Standards of Care. They collect data from peer-reviewed studies, white papers (individual organizations that put out recommendations), and medical case studies. The current version is #8 and can be found online here: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

The section that applies to adolescents and teenagers is section 6, starting on page 45 of the document.

To summarize the WPATH guidelines, teenagers can be candidates for top surgery depending on their age, health history, mental health, and their ability to understand informed consent about the procedure. They recommend that top surgery can be done at age 16+, although individual surgeons have done top surgeries on teens at age 14 and not followed the standards of care.

WPATH guidelines state that a multidisciplinary team be working with the teen, including gender-affirming therapy, well-informed primary care doctors and surgeons, and parental/guardian support.

The teenager usually has to be diagnosed with gender incongruence or gender dysphoria for a period of 12+ months or more, depending on the country (ICD-11 diagnostic code). The teenager also has to demonstrably show that they understand the risks, potential outcomes, and the effects on breast/chest feeding in the future. They have to show that they are cognitively developed enough to understand that gender expression can change over time, that they have had timne to self-reflect on if this decision is right for them, and that they can think carefully about future implications of having the top surgery.

For transmasculine youth, they found that having chest dysphoria is associated with higher rates of anxiety, depression, and mental distress, even when the teenager can bind their chest (but especially if their chest is too big to bind effectively). HRT is NOT required (or should not be required) to have top surgery, as testosterone does not alleviate chest dysphoria.

So far, studies have shown that transmasculine teenagers who have top surgery have good surgical outcomes, satisfaction with the results, and a very very very low incidence rate of regret.

Here are some of the studies referenced:
https://www.tandfonline.com/doi/full/10.1080/15532739.2017.1349706

WPATH Standards of Care v.8 https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

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Teenager HRT

The WPATH (World Professional Association for Transgender Health) is the worldwide authority on all things regarding transgender/non-binary/metagender people, with hundreds of citations of well-researched studies. Specifically applicable to you would be Chapter 6 on adolescents, and Chapter 12 on hormone replacement therapy.

The WPATH doesn’t recommend puberty blockers for youth older than 15 (although you can be on them for longer), but does recommend starting HRT at age 14 (at the earliest) if the teenager is medically eligible and mentally prepared. In general, teenagers who express that they are trans, especially if they have known that truth about themselves for a few years, have the cognitive ability and reasoning skills necessary for making long-term decisions regarding their bodies. Teenagers may know from birth that they are not their assigned gender, or it may be a developmental process that has grown with them.

Many studies have shown that MOST youth do not regret having puberty blockers or starting HRT. While there are permanent changes with both testosterone HRT and estrogen HRT, if a teen decides to stop they will no longer progress in body changes corresponding to their HRT. Several Dutch studies have found that the rate of a person starting HRT in their teens and deciding not to continue is about 2-3.5%, which is a lower regret rate than the rate of breast augmentation performed on cisgender teenage girls (~25%) and also low compared to the regret rate of cisgender men who have penile implants (25-30%), as a few examples.

Overwhelmingly, youth who start HRT in their teens have massively reduced suicide rates and less depression and anxiety. A massive Trevor Project study found that gender-diverse teens on HRT with at least one supportive guardian in their lives had 40% lower odds of experiencing a suicidal crisis or attempt. Another study published in PLOS One found that among almost 13,000 teen participants who started HRT at age 14-15, the odds of severe psychological distress were decreased 222% and the odds of past-year suicidal ideation were decreased 135%. Among those who started HRT during later, at age 16-17, the odds of severe psychological distress and past-year suicide ideation were decreased by 153% and 62%, respectively, indicating that an earlier start produces greater benefits in terms of mental health.

I understand the fear and uncertainty of allowing a teenager to make a big step! But it’s super important for families and caregivers to know that there are great, reputable, long-term studies about HRT and the body of evidence is growing every year. Supportive guardians are key for the long-term health and safety of a trans teen by showing understanding, awareness, and the knowledge of bodily autonomy. And letting trans teens start HRT absolutely saves lives.

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Thank you so much for sharing all this. I so appreciate your advocacy, all the work to share so many great resources and debunking misinformation. As an older queer, I have seen so much change and yet some things remain or even roll back. Some 20years ago I realized everyone I’d ever dated had been either or both harassed or bashed for being visibly outside the gender binary.

And now, I see so much push back and I want to scream about all the work I did as a young queer for inclusion. I’m one of those older queer dykes who cared for people dying at home alone with AIDS when they were being abandoned because of homophobia. I have done so much in over the years in my communities for health inequities, studies, conferences, and education. Now, I volunteer with children and families and this work to make the world better for them so they can be fully themselves and in BIPOC community work specifically welcoming for QT BIPOC folks.

I am very much in favor of this resolution and was deeply touched by the pro sharing in the mini assembly.

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Thank you so much for all of these juicy resources, @SashaBriarGast. I really appreciate your work.

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Thank you for your presence here on the chat boards and for the work you do irl. I really admire your voice and how you are consistently firm, positive, and kind in your interactions here. I aspire to compose prose that has as much poise as yours!

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Thank you Leilani :purple_heart: I am so appreciative of our older queers in the family and everything you have fought for!

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Thank you Regina! Feel free to use them in whatever capacity, I write these for the knowledge to share!

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I have a few more pieces that I’ve written, just for some more additional education!

Puberty Blockers and Brain Development

Puberty blockers have been safely used with cis children to treat precocious puberty (the medical term for early puberty) or to treat puberty that is happening too fast for decades. Puberty blockers have been prescribed since the early 1980’s off label to treat precocious puberty in children, and was approved by the FDA for that specific use in 1993 (as well as to treat other conditions such as idiopathic short stature in children). Adults can take the same drugs labeled as puberty blockers and are used to treat some forms of breast and prostrate cancer, polycystic ovary syndrome, and endometriosis (with varying results and very different risk profiles for adults than for children).

In the US, which is where my experience comes from, puberty blockers are still regulated and approved by the FDA, and are extremely well studied.

There are very few studies on the long-term affects of puberty blockers and brain development. A metanalysis of published studies did not find agreement amongst studies that there even is any statistically significant relationship between the blocker and developmental milestones.

HOWEVER, it is very very important to note that long term robust studies were only rarely conducted for children with precocious puberty, mostly because of the drug safety and doctors seeing the results that children weren’t developmentally altered once they stopped taking the puberty blocker. It only became an issue of major concern when puberty blockers started to be used for trans and non-binary youth, and they are mostly concerns pushed by those who are vehemently against any measures that affirm trans lives. Studies on this have exploded with the criticism and scare tactics of trans antagonists demanding a “reason” to deny puberty blockers from gender diverse youth.

A study published in 2016 looked at the effects of precocious puberty on Korean women and found that there were significant barriers for those who did NOT receive puberty blockers, and they were mostly psychosocial in nature. Things like risky sex, cigarette and alcohol use, internalizing body image and eating disorders, and easy influence by peers, as well as biochemical alterations. This study concluded that untreated precocious puberty was damaging to these adults.

There is one long-term study of ONE individual that I could find that began in 1988 and progressed until 2010. That study found no statistically-significant declines in brain development in that person compared to adults who did not receive puberty blockers as children at the end of the study.

Another study published in 2023 with a focus on gender diverse youth found that of the 40 people who took puberty blockers (compared against 398 who did not receive puberty blockers as youth), there were statistically significant decreases in anxiety, depression, stress, and internalizing negative beliefs.

So all in all, so far there are no significant indications of decreased brain development on any child who receives puberty blockers, whether it is for precocious puberty or gender diverse youth. That isn’t to say that some youth might have different experiences or difficulties when not given appropriate support and care, but so far these numbers appear to be very very low.

References:
WPATH Guidelines: https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644
Summary of that PLOS One study if this is easier to read: New Study Shows Transgender People Who Access Gender-Affirming Hormones During Adolescence Are Significantly Less Likely To Experience Psychological Distress Or Suicidal Ideation - Fenway Health
The Trevor Project about LGBTQIA+ su1 rates https://www.thetrevorproject.org/resources/article/facts-about-lgbtq-youth-suicide/
Article about the WPATH lowering recommendations for HRT to start at age 14 in the most recent edition Guidelines lower minimum age for gender transition treatment and surgery | AP News
Great study from the American Academy of Pediatrics about comprehensive care for trans and gender-diverse youth Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents | Pediatrics | American Academy of Pediatrics
Children’s Hospital Boston page on precocious puberty Precocious Early Puberty | Boston Children's Hospital
Cleveland Clinic page on precocious puberty Precocious Puberty - Early Puberty: Symptoms & Causes
Yoo, 2016 Effects of early menarche on physical and psychosocial health problems in adolescent girls and adult women https://www.e-cep.org/journal/view.php?doi=10.3345/kjp.2016.59.9.355
Cohen-Kettenis et. al, 2011, “Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up” Puberty Suppression in a Gender-Dysphoric Adolescent: A 22-Year Follow-Up - PMC
McGregor et. al, 2023, Association of Pubertal Blockade at Tanner 2/3 With Psychosocial Benefits in Transgender and Gender Diverse Youth at Hormone Readiness Assessment https://www.sciencedirect.com/science/article/abs/pii/S1054139X23005608

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Thank you for all of your sharing, writing and links! I have so many thoughts about all of the info and my experience working with children, families and even adults - for several years I was the chair of a sexual minority health clinic. I volunteered at the first trans conferences in the late 90s that I knew of and how I have seen this work help children, families and adults thrive. I’ll save all my stories for now and summarize with yes! And I’m in favor of this business resolution!

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I have one more relevant article I’ve written to share, about the actual danger that can be involved with youth denied HRT or anywhere where this a barrier to access. This topic is still related to the matter at hand.

Dangers of Non-Medically Prescribed (DIY) Hormones and Why Prescribed HRT Is Critical

WPATH guidelines state that HRT can be prescribed at ages 14+ in youth who are able to make informed consent. In the US, a parent or guardian is always required to consent to a doctor prescribing HRT in minors under the age of 18.

There are not very many options available to trans teens without parental or guardian support, however there are services online that connect you with a doctor who handles prescribing hormones, sending in orders for blood work, and careful monitoring of patients, like Plume, Folx, and Gender GP, however they cannot help minors.

When a teenager is unable to obtain live-saving gender affirming care, many turn to non-prescribed hormones as a way to prevent their own suicide or mental health crises. In nearly every instance, a lack of access to appropriate gender affirming care is the reason why youth turn to DIY hormones.

There are very many risk factors and dangerous outcomes from DIY hormones, and that we cannot support, and it is on legislative bodies and medical professionals to prevent the use of DIY hormones in the first place.

First, DIY hormones carry the risk of coming from unregulated labs and factories, can contain synthetic compounds and not bioavailable hormones, may not contain the actual hormone on the bottle, can contain toxicants, and can have additives that can adversely affect your long-term health. For example, there are synthetic versions of estradiol that carry an extreme risk of blood clots, strokes, and pulmonary embolisms. People have died due to synthetic hormones. You truly cannot guarantee the safety and efficacy of non-prescribed hormones coming from non regulated sources.

Second, using DIY hormones comes without a proper medical assessment of underlying conditions, no blood work monitoring (which is truly essential for safety), and no supervision. Many underlying conditions can affect your HRT process and need to be addressed for safety. For example, testosterone can raise your cholesterol, and so before I could start testosterone I had to go on a statin to reduce my cholesterol and have regular blood work done. Blood work is also important to know the hormone levels in your body and if they are too high or too low. DIY hormones are linked to increases in suicidality due to improper hormone levels in the body.

Finally, if one cannot find the correct materials for injectable forms of HRT, needle sharing is a significant risk. Even if you put a needle through a flame, that does not kill all bacteria or viruses present in blood. Needle sharing for DIY hormones has been shown to increase the risk of HIV/AIDS, hepatitis B, hepatitis C, and other blood borne pathogens. Teenagers are at increased risk for needle sharing due to not being able to buy supplies themselves. One teenager in a case study I read before writing this piece was in stage 3 renal failure directly as the result of hepatitis.

Hormones are gatekept, deprived of so many people who are put on long wait lists for care, and aren’t available to youth. Dysphoria and feeling unable to be in your body without severe distress is horrible, and we CAN make changes and a difference in people’s lives with advocacy and support. However, the risks of DIY HRT are so high compared to waiting until the age of 18 to be able to have HRT without parental consent - which again, could be prevented.

Resources:

https://www.tandfonline.com/doi/pdf/10.1080/26895269.2022.2100644

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The Cass Review and all studies that assert the existence of so-called “rapid onset gender dysphoria” (ROGD) have been thoroughly debunked; they are ideologically motivated anti-trans documents that are neither rooted in solid data/research, nor motivated by true support for trans or gender-nonconforming youth. This anti-trans pseudoscience and misinformation has no place in good faith discussion on the support needs of trans youth or adults.

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I agree with your re-wording of the title using the word “is” in place of “as.” The embracing is the expression of our values.

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I don’t translate “congregations” as “boards”; I agree that there can be problems within, but in such a case, I would read this as asking us to support those who are being harmed—the congregational members—not those inflicting the damage.

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I also don’t think supporting “congregations” should translate as “boards”, but it currently does according to the UUA and CUC, since boards are the official representatives of a congregation. Neither organization directly supports individuals.

The CUC is making some changes now to help address this problem in the future, because of more than a few issues of boards acting against our principles. At the moment though, because of how these words are used right now, if we want to support individuals we need to explicitly spell that out, though I don’t think the frameworks are there for that right now. My experience of the UUA is it’s even worse for the whole issue of only talking to boards and taking board narratives at face value than the CUC is, but the UUA is also larger and so more internally conflicted/less consistent in how they respond to certain situations.