The Pennsylvania Department of Human Services gave more than $176,000 over three years to the Gender and Sexuality Development Program at the Children’s Hospital of Philadelphia (CHOP) to create a series of transgender therapy training workshops.
The webinars and in-person training have been taken by more than 1,800 mental health providers and educators between 2018–2022.
Pennsylvania’s Office of Mental Health and Substance Abuse Services within the Department of Human Services gave CHOP $45,283 through the Community Mental Health Services Block Grant in fiscal year 2018–2019, then $51,966 in 2019–2020 and $79,446 in 2020–2021 to develop and provide training.
Puberty Blockers
The trainings teach mental health providers to treat children under age 8 with “acceptance and affirmation,” and “help guide the family through social gender transition” by choosing a name, haircut, clothing style, and public bathroom of the gender the child wants to be. Puberty blocker medicines may start between ages 8–14. Ages 14 and up can be treated with testosterone, estrogen, and “gender affirming surgeries,” the training advises.The decision to give a child puberty blockers can have permanent effects.
Puberty blockers can “put the pause button” on puberty, giving children more time to explore their gender identity, the training says, before the development of “irreversible secondary sex characteristics,” such as the natural development of breasts or deepening of the voice. If these characteristics never develop, the child may not need surgery later, the training indicates.
“If a trans male does not develop breasts, then they are less likely to need chest surgery, or top surgery later on,” said Dr. Zachary McClain, assistant professor of pediatrics at the Perelman School of Medicine and program director of adolescent medicine, in one of the trainings.
Puberty blockers will lower depression and anxiety, the training said.
Puberty blockers are not approved by the Food and Drug Administration for use in gender transition, the training said.
Hormones are needed to build bone, so children taking puberty blockers will have weaker bones during development and throughout adulthood, putting them at higher risk of bone fractures. Blockers may also stall cognitive brain development.
Hefty Costs
Puberty blockers are not cheap. The histrelin implant that goes into a child’s arm in this off label use costs $49,000, according to the training. Histerline is ordinarily used to treat the symptoms associated with advanced prostate cancer or precocious puberty. It can affect the growth of children and teens.The Lupron injection, a brand name of leuprolide, taken every three months, costs $9,000 per shot, and is another prostate cancer medicine used as a puberty blocker.
“The really good news is, we usually get it covered. We have amazing social workers here at CHOP and in these clinics across the country, who work really hard to put in prior authorizations and write letters of medical necessity,” said McClain, adding that insurance covers the cost 72 percent of the time.
While puberty blockers stop puberty, hormone therapy moves a child’s body toward characteristics of the gender they want to be. Hormone therapy can start when the child’s peer group starts to show external signs of puberty, usually around age 14, the training says.
“When I start testosterone on a trans youth, they will have a voice drop and a little moustache in three months,” said McClain.