Science Vs - Trans Kids’ Healthcare: Are We Getting It Wrong?

Episode Date: June 6, 2024

Health care for trans kids has been in the spotlight, with battles over what the science says and tons of U.S. states restricting the care that children can get. And then there’s a new report out of the UK, called the Cass Review, saying that a bunch of the evidence that doctors have been relying on to treat trans kids is “remarkably weak.” So what’s going on here? What is the best health care for trans kids? We sort through the science with Professor Stephen Russell, Dr. Cal Horton, and Dr. Ada Cheung. UPDATE 6/6/24: In a previous version of this episode, we said a study was published this year, when it was actually published last year. The episode has been updated. Mental health resources, including suicide lifelines, for around the world: spotify.com/resources Trans Lifeline: A Trans peer support hotline: [phone] Trevor Project: crisis support services to LGBTQ young people: Call 1-866-488-7386 or Text ‘START’ to 678-678 Find our transcript here: bit.ly/ScienceVsTransKidsCassReviewTranscript  Here are links to our previous episodes about the science of being transgender and misinformation about care for trans kids. In this episode, we cover: (00:00) The battle over care for trans kids (02:45) What to do when a kid wants to change their name and pronouns (13:44) Do puberty blockers help trans kids’ mental health? (20:44) Does hormone therapy help trans people’s mental health? (25:25) How often are people "retransitioning"? This episode was produced by Meryl Horn and Wendy Zukerman, with help from Michelle Dang and Rose Rimler. We’re edited by Blythe Terrell. Fact checking by Eva Dasher. Consulting by Rebecca Kling. Mix and sound design by Bobby Lord. Music written by Bobby Lord, Bumi Hidaka and Peter Leonard. Thanks so much to all the researchers we spoke with for this episode, including Blake Cavve, Dr. Doug VanderLaan, and Dr. Quinnehtukqut McLamore. And a very special thanks to the trans folks and their families we talked to, Christopher Suter, the Zukerman Family and Joseph Lavelle Wilson. Science Vs is a Spotify Studios Original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hi, I'm Wendy Zuckerman and you're listening to Science Versus. Before we get started, this episode discusses suicide and self-harm a little bit. So please take care while you're listening and we'll put some resources in the show notes. Today on the show, kids who are transgender. It's a topic we've covered before, but there's new research, a new battle amongst researchers, and a new election, which is all putting transgender health care into the spotlight like never before. Texas, now the largest state to block gender-affirming care for transgender children. This morning, Idaho and Indiana are officially banning gender-affirming care for transgender youth. So-called gender-affirming care. Ridiculous.

If you are forcing a trans child to go through puberty when they are trans, that is tantamount to torture. Some politicians even want to make it harder for kids to do things like changing their pronouns or names to fit their gender. And they say that all of this talk of being trans, it's just a phase that they'll grow out of. And so all of this politics has been bubbling away. But then just a few months ago,

a nearly 400-page scientific report for the UK government called the Cass Review came out. And it kind of sounds like it agrees with many of those politicians. It said that supporting a kid who's trans could actually be harmful for them and that the evidence behind medicines like puberty blockers or hormones, which are sometimes given to trans teens,

is basically garbage. Well, they called the evidence remarkably weak. The report has found no good evidence for giving puberty blockers to adolescents. These clinicians gave puberty blockers to adolescents. These clinicians gave puberty blockers to these children. But what is that if not experimenting? It is a medical scandal. In the UK, the government just announced an emergency ban on puberty blockers. So today on the show, we are diving back into this topic to find out what is going on.

What is the new science telling us about, one, if your kid says that they want to use different pronouns or change their name, what should you do? Two, is the evidence behind puberty blockers and hormones actually crappy? And three, what's the chance that this is just a phase that your kid will grow out of? With more and more kids coming out as trans and gender diverse, the stakes of getting this right are higher than ever. And it's all coming up just after the break. Bumble knows it's hard to start conversations.

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Then sit back and let your matches start the chat. Download Bumble and try it for yourself. Metrolinks and Crosslinks are reminding everyone to be careful as Eglinton Crosstown LRT train testing is in progress. Please be alert as trains can pass at any time on the tracks. Remember to follow all traffic signals, be careful along our tracks and only make left turns where it's safe to do so. Be alert, be aware and stay safe. Welcome back. Today on the show, we are asking,

when a kid is trans, what is the best thing that we can do for them? Should we let them change their name and pronouns? Give them medicines? To help us wade through the research here, we have senior producer Meryl Horde. Hey, Meryl. Hey, Wendy. Oh my gosh. When

this cast report first came out, you know, this scientific report, I pretty much called you right away, right? And I guess I'm just like, did we get the science wrong here? Because last time when we reported on this several years ago, I mean, we were basically saying the exact opposite thing of what this report has found, right? I know. It was like, what? We got this all wrong? What did they, like, in a nutshell, you read that 400-page report? I didn't read, like, all of Appendix 6, but I read a lot of it.

Did you read Appendix 5, though? I think I might have. Yeah, I think that was a good one. Okay, good, good, good, good. All right. So as you were reading it, what did strike you? Well, overall, they just kept saying that, you know, the evidence is really weak for all of this stuff, for puberty blockers, for hormones, that we just like don't have good

research on a lot of this stuff. Okay. So let's start not with medicines like puberty blockers and hormones. We're going to get into all of that. But first, let's start with actually kind of the first thing that your kid might need to do. It's called social transitioning. So this is a situation where you've got a kid saying, you know, don't call me by a girl's name because I'm a boy. Don't put me in a dress. Don't use the pronouns she, I'm a boy, use he.

And when we talked about this last on the show, it seemed like the science was pretty clear. Like if your kid wants to do this, you should support them in doing that. Yeah. Okay. But it's been a couple of years. So what is the research telling us that. Yeah. Okay. But it's been a couple of years. So what is the research telling us now? Yeah. So this was something that really surprised me when I read the cast review, because they were basically like, the science here is mixed. And they even pointed to some

research that really seemed to show that if you let your kid do this, that it can actually make things worse for them. Like it could be harmful to their mental health. Oh, wow. And that was just really different, like you said, from like what we thought when we last looked at this. Yeah. So what, I mean, is it true? So what is, what's the truth here? What do you think the science is?

Yeah. So they really kind of pointed out one study in particular, which seemed to show that this could be bad for kids. So I wanted to start there. So what these researchers did is they surveyed thousands of trans and gender diverse adults. And then they asked them about when they socially transitioned and also about their mental health. And what they found was that for the people who said like, I socially transitioned when I was an adolescent, they were more likely to have attempted suicide at some point in their lives compared to people who socially transitioned as adults. And the cast review says that this

basically means that, you know, social transitioning could be bad for adolescents. And that's what the study concluded or the cast review? Well, what was weird was that when I looked at the actual study, they said it wasn't actually the social transitioning itself that was making these kids feel crappy. It was the bullying that can come along with that. Oh, so they could tell from the data that it was the kids who got bullied more,

they were the ones who were more likely to be attempting suicide years later. That's what was driving this increased risk in suicide attempts. The paper, so they said, quote, social transition itself is not harmful, unquote. But if you're getting harassed because of it, then that is the thing that can make you feel horrible. And I actually talked about this with Professor Steven Russell. He's at the University of Texas in Austin. Yeah. What that study suggests is that the critical factor there is discrimination and stigma. We know a lot of trans kids do face a lot of bullying, and this can be really brutal, especially if you're trying to figure out all this stuff when you're pretty young, like around like middle school.

That's scary. Being the target of homophobia and transphobia, not when you're 24, but when you're 14. And you've got to deal with that, which is a totally different story than when we used to come out when we were in our 20s and 30s and figure it out then. We're all our nastiest little turds when we're in middle school, right?

Yeah, exactly. And so I talked to Stephen about what we make of all of this. How does it make you feel when you see that kind of study being used to say, you shouldn't let your kid socially transition when they're young because then they'll get bullied more and that will increase their suicide risk. Well, there are so many layers of that. And I understand the anxiety. I understand where it comes from. I totally get it.

I raised a gay kid. I was not interested in someday safety for him. I was interested in safety that afternoon, you know, like sending him to school that morning and him being safe then. So all of my great ideas about like averages and statistical properties and like, who cares? What about my kid today? I bet there are a lot of parents who have this anxiety. And now we have this study sort of suggesting like if a kid does want to socially transition,

they should wait until, you know, at least after middle school, maybe after high school when it's less likely that they'll get bullied. What do you think? I mean, that's the question, right? Like, would it be better to kind of discourage this? Or should we just like support kids anyway? And Stephen actually did this study that really helps answer this. It focuses on this one specific part of social transitioning, which is changing your name. So this is like, you know, if your parents named you Michael,

but you're realizing that like, no, actually, I am a girl, you might, you probably want to change your name, right? Into something that fits you better. And so this can be a big step. And Stephen wanted to look at like, what might happen after someone decides to do this. So he did this study a few years ago.

And so this was before we were talking about pronouns even. And so I just thought, well, we should just ask about whether kids can use the name they want. Oh, so how did he study this? All right. So he surveyed almost 130 trans and gender nonconforming teens and younger adults. And he asked them, do you have a preferred name that's like different from the name that you were given at birth? And if they said yes, then the survey asked them, and this is the important part, how many people in your life actually use that name? It's like, well, are you able to use

it at home, at school, at work, and with your friends? And he also asked them about their mental health. And he wanted to know, like, if there are people in the person's life that are using that name, is their mental health better? And he wasn't, like, really expecting

that he'd see much in the data. But then his colleague knocked on his door. She came in with the results and was like, Stephen, you're not gonna believe this. Oh my gosh, oh my gosh, it worked. It's like, it's real. The people who said, yes, I get called my chosen name in at least just one place,

that lowered their risk of suicidal behavior by 56%. Oh my gosh, 56%. I talked to Stephen about that. Yeah, it's dramatic. So it could mean the difference between life and death for someone. Well, yes, absolutely. Absolutely. The more people in their lives used the person's chosen name, the more their risk for suicidal behavior dropped.

That's such a dramatic finding. I don't know, it's a bit surprising. I don't think it is, actually. Like, Steven was like, no, this makes sense. I feel like it's that amazing possibility to be seen or heard. Like, and maybe for the first time, you know, it's so deep when you think about it that you can imagine that if you're a queer trans kid that, you know, feels like Susan is not who you are, but Stephen is, and you get to, there's at least one place

where people will call you Stephen, it's got to be amazing. When kids can use their name, it transforms them. Another study has actually since backed that up. They found something really similar. And then we also have a study that looks at younger kids who socially transitioned when they're around seven years old. And that one also found that the kids had better mental health after they socially transitioned. And the researchers thought that this would just generally be true of kids that are in supportive families. So like zooming out, it really feels like for a kid who's decided to socially transition and that's what they want to do, the studies say that you should support them. So then, I mean, it feels like other than the messiness with the bullying study, it feels like the research isn't that mixed. That it's really pointing to, like, if your kid is transitioning, you should support them.

Why was the cast review so down on this? I mean, they did seem to put a lot of stock in that bullying study. Like, that was kind of their big conclusion. They said that, like, look, when kids get called by their chosen name, it helps them, but then there's the study that finds that suicide attempts go up. It was almost like those all canceled each other out, and so we just don't know what to do. I mean, it feels like the actual answer is try to stop bullying and then support your kids to socially transition. Yeah, exactly.

And also this idea of waiting until you're out of high school to come out as trans, for some kids, it's just not really an option. Here's Steven. And I think that what so many trans and gender diverse people will tell us, just like so many, you know, LGB people will tell us, just like many straight people would tell us if we told them not to be straight and just wait, they would tell us, I can't just wait. It's inauthentic and it's undermining my well-being to just put an entire part of myself on hold for 5, 10, 15 years.

After the break, puberty blockers and hormones. We're giving them to some trans kids, but is it the right move? Coming up. Welcome back. Today, we're looking at the new science on transgender health care. And now we're going to go to the most controversial part of this debate. We brought Ada Chung into the studio to discuss it. She's an endocrinologist and head of the Trans Health Research Group at the University of Melbourne.

All right, we're going to jump right into the controversy. We've been looking at your Twitter and it seems like you're a Swifty. Oh yes, of course. So what do you think of the new album? I love it. Yeah, I unashamedly love Taylor Swift. I can't get into it. I love that people love it, but I cannot get through a whole album.

Oh. Wendy, how do you not like Taylor Swift? whole album. Oh, Wendy. How do you not like Taylor Swift? Come on. She's fine. I just don't. I feel nothing in my soul when I listen to it. Anyway, anyway.

Okay, so we, Meryl and I, chatted with Ada together, and we're here to talk about some of the medicines that we're using for trans kids. Now, Ada treats trans adults. She gives them hormone therapy, but she knows a lot about this space in general. And so let's start by talking about the first medication that a trans kid might go on. And I talked with Ada about the basics here.

Okay, so these are called puberty blockers. So they might start these when some of the first signs of puberty kick in. So think when the kid is like around 11. What they do is they block the pituitary gland hormones so that it pauses puberty. So it's temporary, it's a pause. So the idea is that you temporarily stop your body from going through puberty

because if you're, let's say, a trans girl assigned male at birth, you may really not want to go through male puberty. That would mean growing hair on your face, having your voice drop. On the other hand, in a trans boy, we can prevent the development of breasts that otherwise might require invasive surgery down the track to correct. Okay, so in our past episodes on puberty blockers, we've mainly talked about the side effects and these drugs are pretty safe. They've actually been used for decades

for something called precocious puberty, which is when kids go through puberty early. And we've never really dug into this question of do they improve mental health or not. So, Meryl, what did that big science report from the UK say about this? Yeah, they did not think the evidence was great. They came down pretty hard on puberty blockers. They said that like when it came to whether or not being on puberty blockers helps kids' mental health, the results were insufficient and inconsistent. So what is the evidence? Why did they think that?

So, okay, one of the things that they point out is that we don't have the highest quality of evidence for puberty blockers. So we all know what you'd really like is a randomized controlled trial. So that's where you get a group of people, you know, split them into two groups. One gets the drug, one group doesn't at random. And then you compare the two. Love a randomized controlled trial. Yeah, right. Love them. But a lot of researchers have said that that would basically be impossible for this area because there's no kids that would want to sign up for a trial where they might get a you know puberty blocker or they might get a placebo and then their bodies will go through all these

um you know irreversible changes right but like we do have these other studies um so like observational studies that look at kids who get puberty blockers and then um checks like what happens to their mental health after they go on them. But what the cast review noticed is that the results are kind of mixed. And that's true. Like, so some of the studies will find that when they look at like trans adolescents' mental health after they go on puberty blockers, it'll get better. But then other studies don't find an improvement. I can see then why people are then questioning these meds. Yeah, I mean, that's what I thought too when I first looked at this.

But then I spoke to researchers about it, like Cal Horton. So they're a research fellow at Oxford Brookes University in the UK, and they've done a bunch of studies on trans kids and their families. So I asked them about puberty blockers. One of the things that surprised me when I read it was this idea that there's not good evidence that they improve mental health. So the purpose of puberty blockers is to block puberty. They are very successful and effective at blocking puberty. What they're meant to do is stop well-being decreasing. So they're preventing something from happening.

And what we would hope to see is just a kind of keeping on the same, even, you know, just mental health being as it was before puberty. Yeah. So, okay. It feels like what the CAS report is saying is that they're kind of expecting kids to get this big, like, boost to their mental health after they're on puberty blockers. And like, sometimes we do see that. But the thing is, like, what you really want to know is like, what happens when people don't get puberty blockers at all? Right. Yes. Because that's ultimately what would lead to potentially depression, right? Like if you don't get the blockers and you start growing boobs or getting a period and you are a boy. Yeah. You know, yes. Okay. So do we have a study then that looks at

the kids who did not get them? Like, and what happened to their mental health? We have a study like that. Oh, okay, great. So, okay, they looked at mental health of over 200 trans kids who were around 14 years old, and they were not on puberty blockers. So probably had started to go through, you know, some puberty that they didn't want. Okay. And they had pretty terrible mental health

compared to, like, just cisgender kids who are around the same age from the same population. They had more stuff like self-harm, suicidality, depression, anxiety. It looked like they were really struggling. That's awful. So from that, like we could see that kids, trans kids who are not on puberty blockers, their mental health is not great. And then if you look at the kids who were on the puberty blockers, they were doing better. Like they were doing better than the kids that didn't get them. And in fact, they were actually doing basically as good as the kids who weren't trans.

Okay, so all of this seems to be saying that if you don't let kids access puberty blockers, like the exact situation that is happening in more and more states around the US and now in the UK as well. Yeah. Those kids have the worst mental health compared to everyone. Yeah. That's where we're at. Yes, this stuff really matters. So now on to perhaps the most controversial side of all this, which is giving hormones. So for lots of trans folks, after they go on puberty blockers, if they want to then physically

transition, they might take hormones. Right. Yeah. A lot of trans people might go on to take testosterone or estrogen to help their bodies match their gender better. Yes, yes, exactly. And so hormones, that's actually a big part of Ada Chung, our Swifty and endocrinologist's research. So she just did this randomized clinical trial. So she got more than 60 trans and gender diverse folks who were mostly in their early 20s and she gave half of them testosterone therapy immediately while the others were on a wait list. And then after three months, she looked to see what was going on with their mental health. So did the group that got hormone therapy do better? And here's what she found. We found a marked reduction in depression and most significantly, this marked reduction in suicidal ideation.

So half the people had complete resolution of their suicidal ideation. Whoa, from a result of testosterone therapy? Yep, from that first three months of testosterone therapy. That's huge. Huge. How did you feel? It was really affirming because this is mirroring what we're seeing clinically. Testosterone therapy for someone who has via gender dysphoria can, you know, save lives.

And I can just sort of see the, I don't know, like the emotion in your eyes, which I don't get from when I talk to most academics about most things. Can you tell me a little more about how you're feeling as you're thinking about your patients? You know, I see patients who have quite severe mental health conditions. I see people who are struggling, you know, in hospital with various conditions and then they affirm their gender. And then I see people thrive. People are happy. And it is a pure joy when I see people so well. on people who were mainly in their 20s, there is another study which involved more than 150 trans teens

getting testosterone therapy, and it also found that their depression and anxiety scores dropped after the treatment, which Ada says is exactly what she'd expect. I personally, I actually think the effects of testosterone on a 22-year-old compared to an 18-year-old are pretty similar, or even a 16-year-old. Like, it causes the same physiological effects. So I would expect similar effects of testosterone therapy on gender dysphoria, on psychological functioning, on suicidality.

It's also important to point out that some of the benefits that Ada saw in her study might have been due to the placebo effect because there wasn't a placebo control. And also, Ada's study was specifically on people taking testosterone, right? So, Meryl, what do we know about trans women taking estrogen? We do know that with estrogen, the effects on the body might be a little bit more slow or subtle, at least in the beginning. Because like with testosterone, you can start getting facial hair pretty much like, you know, within months pretty quickly. But with estrogen, it could take years to grow breasts. Yes, I remember my own. Those titties don't grow out

of nowhere. No, exactly. It takes like years. You got that awkward budding thing going on. Okay, so do we have research on estrogen and trans teens? Yeah, there is some. So there's this study that looked at young trans feminine people. So basically teens taking estrogen and they tracked them for two years and still didn't see like clear improvements to their mental health.

Oh, right, right. And the researchers said it could be because they just didn't follow them long enough. Like maybe they were actually still in that like awkward budding phase. And we're not really sure like why it didn't help them because we do have a handful of studies in adults that has shown that estrogen therapy can help.

Even in the CAS reports review on hormone therapy, most of those studies showed mental health benefits to younger kids, like adolescents taking hormones. Okay, so the last thing that we want to look at, which is this big question that's kind of like sitting like an elephant in all of this talk around trans kids and how to best help them, which is this idea that they're going to regret any medicine that they've been on, that this is just a phase. Yeah. And I remember from previous episodes that we've done on this, we would talk about how there are like these strands of evidence pointing to an answer here, but we really wanted more data in this space.

Yes. Now it feels like we finally have studies on this question of like how many people identify as trans and then stop identifying that way later on, including one that just came out a couple weeks ago by this guy. Hi there. Steven Russell. So he just did this study where they followed hundreds of people.

They were 15 to 21 years old for over three years. And they asked them again and again and again, like, how do you identify to see whether their gender identities shifted over time? And what he found was that it was actually super common to see all sorts of things, people going from like cis to trans to cis, like just all sorts of different things. And I was like, oh my gosh, that's amazing. And who knew? Like, I'm constantly amazed by the data that tells me how old I am or how, you know. Out of touch. Out of touch. Out of touch. That like there's that much change happening in gender.

And so were you surprised when you saw that there were a big chunk of kids who identified as trans at one point, but then ultimately identified as cis by the end of the study? Yeah, I was. I wasn't expecting as much change. So if you took everyone who identified as trans at the start of the study and then looked at what happened, half of them still identified as trans by the end of it, but half of them identified as cis. Oh, interesting. So then I guess, then what does this mean for this big fear that kids are going to be on medicines that they don't need to be on? Like, is that happening? Right, yeah. So that's the question, right? But Stephen looked at that.

He asked everybody whether they were on hormones or puberty blockers. Great. He saw that while most of the people who identified as trans the whole time were taking hormones, it was actually really rare for the people who started identifying as trans and then later switched to identifying as cis. It was really rare for them to be taking hormones. It was actually only one person out of 32. Oh, interesting. And none of them were on puberty blockers. And the results from Stephen's study were actually like remarkably similar to another study looking at this, which came out earlier this year. So that one was from a pediatric gender clinic in Western Australia. So in that study, there were 29 people who switched from identifying from trans to cis, and only two of them were on any kind of medication.

I mean, it is fascinating because it does show that when people say things like, you know, oh, they're just kids, this is just a phase. I mean, for some kids, there is some truth in that. I mean, saying it's just a phase might feel derogatory, but they're just exploring who they are. But then what the data is telling us is to take that argument further and to say, like, therefore we should not allow any trans kids to be on medication, that is wrong, right? Like, according to these two studies, at least, that we have,

the trans kids that are going on medications far and away, they're not in that, like, exploratory phase. Like, they are sticking with that identity. Yeah, exactly. And then, like, if we do look at that group of people who are changing things, like identifying as trans first and then cis, the vast majority of them are not taking any of these meds, over 90% of them. Right, right. And while that study was on teens, there's actually data from younger kids

that seems to show that if you socially transitioned when you're like around eight years old, you're much less likely to be switching up your identity. So yeah, the data does not seem to be backing up this idea that there's all these people who are, you know, taking these meds and then later not identifying as trans anymore. Right. Yeah. Yeah. Okay. So then, you know, I feel like the cast review might have highlighted some places where we want more research. More research is always good. But it still feels like if you look at the data that we have,

it is supporting social transitioning, puberty blockers, and the use of hormones. That's what it looked like to me. By the way, I reached out to the cast review people to ask them about why it seemed like they overlooked a bunch of the stuff that we talked about today. Yeah. that like we need to show that affirmative care works and like it's good to like demand good quality evidence but then they they kind of ignore like the fact that if you don't do any of this stuff a kid could really suffer i mean like that's what we see in the data like when kids don't get

puberty blockers their mental health is worse that's right right. That's right. I mean, that's what these, when people make these arguments of like, the evidence base isn't perfect, so let's do nothing. Like, they're not able to acknowledge that doing nothing is doing something. Like, you're actively saying no to a child. You're actively saying like, no, we will not support you. We will not give you the medicines that you need. And we have evidence that that is harmful. Yeah. And now as a result of this report, there are these huge implications for all these kids. So like here is Cal Horton. They're the UK researcher that we heard from earlier.

It's really disheartening. Disheartening is the wrong word. I was kind of you know pretty much unable to function for like a week afterwards and and i speak to trans people and i speak to parents of trans kids around the country and you know we've all been absolutely devastated by the impact of the of the cast report because it was a car crash we could see coming but were unable to in any way influence. And we know the impacts that the impacts it's already having are devastating and the impacts it's going to have are just just heartbreaking.

And, you know, knowing and caring about trans kids, it's just it's devastating that that we've got to where we are. And it's devastating that this harm is being veiled in a banner of evidence-based policy. That really, like, cuts to my core because it's not evidence-based. Yeah, and it's not just Cal. Other big, like, science-y groups in the space have, like, looked at all this and said, if you follow the evidence, it still leads to gender-affirming care being the best thing for kids, like the American Academy of Pediatrics and the Endocrine Society. And so, yeah, when it comes to this argument that the evidence here is weak, here's what Stephen thinks.

I mean, we really, we have just started. And, you know, for what it is, we have really good data. Rich community samples that follow kids over time. Using multiple methods from different areas of the world and the country, asking similar questions to come up with the same kind of results. It's insulting to say that it's weak. It's not weak. So, you know, we know a lot.

Thanks, Meryl. Thanks, Wendy. That's Science Versus. And how many citations are in this week's episode? We have 81 citations. And if people want to see them, where should they go? To our show notes and then follow the links to the transcripts. And we'll also put a link there to our last episode that we did on trans kids' healthcare.

In that one, we go in some more detail about stuff like the side effects of puberty blockers and hormones. Yes. And on Instagram this week, which is science underscore VS, we're going to have a video of me chatting to Dr. Ada Chung. I'll also pop it on my TikTok, which is at Wendy Zuckerman. See you, Meryl. Bye, Wendy.

This episode was produced by me, Meryl Hornne, and Wendy Zuckerman, with help from Michelle Dang and Rose Rimler. We're edited by Blythe Terrell. Fact-checking by Eva Dasher. Consulting by Rebecca Kling. Mix and sound design by Bobby Lord. Music written by Bobby Lord, Bumi Hidaka, and Peter Leonard. Thanks so much to all the researchers we spoke to for this episode, including Blake Cave, Dr. Doug Vanderlaan, and Dr. Quinnitucket McLemore. And a very special thanks to all of the trans folks and their families that we spoke to, Christopher Suter, the Zuckerman family, and Joseph Lavelle Wilson. Science Versus is a Spotify Studios original. Listen for free on Spotify or wherever you get your podcasts. Follow us and tap the bell for episode notifications.

See you next week.