197 Children’s Legal Rights Journal [Vol.36:3 2016]
A. Further Research: Gender Dysphoria, Medication, etc.
Research indicates that much is yet unknown about gender dysphoria; outcomes vary
wildly and the effects of clinical interventions are not clear.
201 Treatment can be difficult to
determine absent a test that can predict whether a child experiencing distress regarding their gender
will grow up to be transgender.
There is very limited research on supporting transgender youth and a child’s gender identity
—making it impossible to know how many children step outside gender bounds203—and most
providers have little to no training on how to support these youth.
204 Studies in the future should
avoid requiring the subject to identify as male or female and offer additional options.
likelihood of serious adverse effects is dependent on numerous factors such as the medication
itself, dose, route of administration, and a patient’s clinical characteristics, thus making it
impossible to predict whether a given adverse effect will happen in an individual patient. Lupron
and other medications typically used to prevent puberty need to undergo further research to
determine the long-term effects of using these drugs in the treatment of gender dysphoria.
long-term effects on bone density and brain development of stalling puberty with medication need
further research as well.
B. Recommendation for an Accepted Practice of Approaching
Gender Dysphoria Treatment in Domestic Relations Courts
States should have a legitimate interest in guiding youth to make informed life decisions
concerning their medical treatment.
208 Accordingly, once this interest is recognized, it is in the
State’s best interests to adhere to a protocol when dealing with the custody of a transgender child
to better ensure fairness in the decision-making process.
209 While currently transition related care
is not currently considered medically necessary (accordingly, there is no guarantee that it will be
covered by insurance), this recommendation will operate under the assumption that, as gender
dysphoria is recognized under DSM-V, appropriate treatment will be covered under insurance.
When parents disagree on the treatment of their transgender or gender-nonconforming
child, the first step should be for the courts to suggest mediation by a social worker. Best practices
indicate that social workers, in this case acting as mental health professionals, should help families
201 Dreger, supra note 83.
202 Boghani, supra note 75.
203 Padawer, supra note 55.
204 RYAN, supra note 27, at 2.
205 AM. PSYCHOLOGICAL ASS’N, supra note 49, at 835 (“the majority of research has required a forced choice between
a man and a woman, thus failing to represent or depict those with different gender identities”).
206 Dreger, supra note 83; see also Scutti, supra note 19 (While the use of drugs as treatment for conditions other than
those the drug has FDA approval for is not uncommon, the long-term consequences of their use is unknown.).
207 Boghani, supra note 75.
210 Howe, supra note 16, at 10 (“Because of the significant benefits hormone therapy and sex-reassignment surgery
offer transgender youth with [gender dysphoria] transition-related care is, or ought to be, considered medically
necessary . . . .”); see also FAQ on Access to Transition-Related Care, LAMBDA LEGAL,
http://www.lambdalegal.org/know-your-rights/transgender/transition-related-care-faq (last visited Apr. 27, 2016)
(“The myth that transition-related care is ‘cosmetic’ or ‘experimental’ is discriminatory and out of touch with current
medical thinking. The [American Medical Association] and [World Professional Association for Transgender Health]
have specifically rejected these arguments, and courts have affirmed their conclusion.”).