So Today I Want To Talk About Puberty Blockers For Transgender Kids, Because Despite Being Cisgender,

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community.

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it.

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

12 museums that you can visit online

www.hermitagemuseum.org

britishmuseum.org

www.louvre.fr

www.museodelprado.es

collections.vam.ac.uk

www.moma.org

www.khm.at

www.digitalsculpture.org

www.tnm.jp

artsandculture.google.com

collections.lacma.org

collections.rom.on.ca

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go check them out promoting the artist support the artist the land before time a year older than me

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aikokima

1 year ago

This is so accurate!!¡!!

looking for fics about your favorite character on ao3 be like:

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what the actual fuck

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unfinished

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the best fic ive ever read in my life. this absolutely ruined me and ill never be the same ever again

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aikokima

1 year ago

I'm okay with not having an AO3 app, since it works fine as a mobile site. My sister's eldest only knows how to use any browser due to us taking the time to teach them how. Their 18...

So this was originally a response to this post:

****

Which is about people wanting an AO3 app, but then it became large and way off topic, so here you go.

Nobody under the age of 20 knows how to use a computer or the internet. At all. They only know how to use apps. Their whole lives are in their phones or *maybe* a tablet/iPad if they're an artist. This is becoming a huge concern.

I'm a private tutor for middle- and high-school students, and since 2020 my business has been 100% virtual. Either the student's on a tablet, which comes with its own series of problems for screen-sharing and file access, or they're on mom's or dad's computer, and they have zero understanding of it.

They also don't know what the internet is, or even the absolute basics of how it works. You might not think that's an important thing to know, but stick with me.

Last week I accepted a new student. The first session is always about the tech -- I tell them this in advance, that they'll have to set up a few things, but once we're set up, we'll be good to go. They all say the same thing -- it won't be a problem because they're so "online" that they get technology easily.

I never laugh in their faces, but it's always a close thing. Because they are expecting an app. They are not expecting to be shown how little they actually know about tech.

I must say up front: this story is not an outlier. This is *every* student during their first session with me. Every single one. I go through this with each of them because most of them learn more, and more solidly, via discussion and discovery rather than direct instruction.

Once she logged in, I asked her to click on the icon for screen-sharing. I described the icon, then started with "Okay, move your mouse to the bottom right corner of the screen." She did the thing that those of us who are old enough to remember the beginnings of widespread home computers remember - picked up the mouse and moved it and then put it down. I explained she had to pull the mouse along the surface, and then click on the icon. She found this cumbersome. I asked if she was on a laptop or desktop computer. She didn't know what I meant. I asked if the computer screen was connected to the keyboard as one piece of machinery that you can open and close, or if there was a monitor - like a TV - and the keyboard was connected to another machine either by cord or by Bluetooth. Once we figured it out was a laptop, I asked her if she could use the touchpad, because it's similar (though not equivalent) to a phone screen in terms of touching clicking and dragging.

Once we got her using the touchpad, we tried screen-sharing again. We got it working, to an extent, but she was having trouble with... lots of things. I asked if she could email me a download or a photo of her homework instead, and we could both have a copy, and talk through it rather than put it on the screen, and we'd worry about learning more tech another day. She said she tried, but her email blocked her from sending anything to me.

This is because the only email address she has is for school, and she never uses email for any other purpose. I asked if her mom or dad could email it to me. They weren't home.

(Re: school email that blocks any emails not whitelisted by the school: that's great for kids as are all parental controls for young ones, but 16-year-olds really should be getting used to using an email that belongs to them, not an institution.)

I asked if the homework was on a paper handout, or in a book, or on the computer. She said it was on the computer. Great! I asked her where it was saved. She didn't know. I asked her to search for the name of the file. She said she already did that and now it was on her screen. Then, she said to me: "You can just search for it yourself - it's Chapter 5, page 11."

This is because homework is on the school's website, in her math class's homework section, which is where she searched. For her, that was "searching the internet."

Her concepts of "on my computer" "on the internet" or "on my school's website" are all the same thing. If something is displayed on the monitor, it's "on the internet" and "on my phone/tablet/computer" and "on the school's website."

She doesn't understand "upload" or "download," because she does her homework on the school's website and hits a "submit" button when she's done. I asked her how she shares photos and stuff with friends; she said she posts to Snapchat or TikTok, or she AirDrops. (She said she sometimes uses Insta, though she said Insta is more "for old people"). So in her world, there's a button for "post" or "share," and that's how you put things on "the internet".

She doesn't know how it works. None of it. And she doesn't know how to use it, either.

Also, none of them can type. Not a one. They don't want to learn how, because "everything is on my phone."

And you know, maybe that's where we're headed. Maybe one day, everything will be on "my phone" and computers as we know them will be a thing of the past. But for the time being, they're not. Students need to learn how to use computers. They need to learn how to type. No one is telling them this, because people think teenagers are "digital natives." And to an extent, they are, but the definition of that has changed radically in the last 20-30 years. Today it means "everything is on my phone."

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aikokima

6 months ago

!!!!!¡¡!¡!! That takes massive talent and training!!¡!!