In an age when trans care is increasingly coming under attack, it should come as no surprise that trans youth care in particular is an area particularly fraught with what one might call “debate”. The focus of this “debate”, however, is not always thoughtful and well-informed discussions over the particulars of care, but rather can feature inaccurate or even false information regarding the realities of trans youth care, particularly under the gender affirming model.
Enter Dr. Jack Turban, a pediatric psychiatrist specializing in the care of trans youth in the United States and director of the Gender Psychiatry Program at the University of California San Francisco, who has written numerous research papers on the subject as well as penned articles for the lay audience to explain just what does go on. His book Free to Be is an effort to try and not only explain what gender care for youth looks like, but to also explain the medical science behind the current gender affirming model of care.
Before we move forward, I will try to explain to the best of my ability what this model of care entails as Dr. Turban presents it. Unlike the notions thrown around about doctors “rushing children into irreversible procedures”, the affirming model of care places less emphasis on doctors and their ideas about “what is best for the patient”, and more on what the patients themselves indicate they want or need. The role of the doctor is presented as being that of a good listener, first and foremost, and being someone who can provide both patients and their legal guardians with information on what options exist and what lies ahead down the many paths they might take. It is, in other words, a patient-centered approach. The doctor does, however, make determinations as to what options are most appropriate, and has the final say as to what will be prescribed and what letters of recommendation are given.
How is this form of care actually carried out? Dr. Turban illustrates this through the stories of three different patients, Meredith, a trans girl, Kyle, a trans boy, and Sam, a nonbinary youth, following them from their childhoods through to young adulthood. These three are composites based on different patients Dr. Turban has seen through the years. Throughout the book, they are presented in the context of their family, school, and social life in addition to their struggles and feelings about their genders. The situations and trajectories of the lives of these three differ greatly, and are presented vividly and with nuance. Discussions include not only the social and psychological aspects of care, but also the use of GnRH agonists (aka puberty blockers), hormone replacement therapy, and surgeries at different stages of care. The impression is not of anyone rushing patients through anything, but of careful consideration at each step, and each step taken only when the need presents itself and there is a firm understanding of what comes next. Not all of these steps are taken by the three composite patients presented. This is likely what could be expected in actual patient care, especially in a body of patients as diverse as transgender youth.
Interspersed among their stories are discussions of the history of the scientific thinking behind the formation of gender identity, the history of trans youth care, as well as looks at the political and social landscape surrounding the greater visibility of trans people in society. This includes how these things affect trans youth.
While Jack Turban himself practices medicine in the United States and thus the stories he presents won’t necessarily reflect what is happening globally, this book provides an important window into the realities of care for trans youth in an affirming setting. Hopefully, it will provide a much needed counter-balance to the waves of disinformation out there.
