Gender transition concerns are gaining traction
Support is growing worldwide for a more wholistic approach to children and teenagers who experience gender dysphoria rather than steering them to puberty blockers or sex change hormones.
Last week saw Sweden’s leading gender clinic become the first to end routine treatment of minors with hormonal drugs.
“Possibly the tide has begun to turn in the direction of common sense” – Professor John Whitehall
The decision by Sweden’s Karolinska hospital cites the English High Court’s Tavistock clinic finding in 2020 that the use of puberty blockers to delay the onset of adolescence must be regarded as experimental, and that children aged under 16 are unlikely to be able to give informed consent to be treated with puberty-blocking drugs.
A series of independent international reviews have likewise found that the evidence for the efficacy of affirmative treatment is weak and there is no data on long-term safety.
In Australia, clinicians at Westmead Children’s Hospital gender clinic released a paper expressing their concerns that a focus on the gender affirmation model including the medical and surgical reassignment pathway “is likely to promote a healthcare delivery model that dehumanises the child by not examining the child’s and family’s lived experience, and that promotes medical solutions…for a problem that is much more complex”.
The paper described “socio-political” pressures as contributing to a “tick the box” mentality that puts young people on a medical gender-affirming pathway. It also said that young people who present with gender dysphoria are often not open to exploring other possible factors contributing to their distress, such as family trauma, sexual abuse, depression and autism.
A more wholistic approach to treatment emphasises “that children’s conceptions of themselves are still developing through the teenage years and that they can be harmed when clinicians unquestioningly accept the individual child’s assertion of gender identity or when clinicians fail to challenge the child’s beliefs pertaining to that identity or fail to understand the developmental trajectory that had brought the child to what is often a place of distress and suffering” it said.
The authors spoke to the UK’s Keira Bell, 24, who took legal action against Britain’s Tavistock gender clinic for rushing her through a sex reassignment when she was a teenager.
“[individuals with gender dysphoria] need . . . access to psychological support from impartial practitioners who do not subscribe to gender identity ideology” – Keira Bell
Individuals with gender dysphoria “need . . . access to psychological support from impartial practitioners who do not subscribe to gender identity ideology and are able to help people explore their thoughts and feelings about their sex, sexuality and the underlying causes of their gender dysphoria,” Ms Bell said.
Sydney psychotherapist Professor Dianna Kenny said she was “very relieved” at the groundswell of support for extreme caution “as opposed to the cavalier process we have seen occurring over the last five to 10 years in which the majority of children presenting with gender dysphoria are automatically affirmed and medically transitioned”.
“These are concerns we have been expressing for a long time, because we’re now finding children have been medically transitioned and young people surgically transitioned retain their mental health issues,” she said.
“Clouding the issue is in the immediate short term after transition, a young person feels euphoric and it’s not until later that they realise it did not solve all of their problems.”
She is one of those in private practice who form part of the increasing wave of concern internationally about the experimental nature of puberty blockers and cross sex hormones for children and adolescents along with the potential for long-term harm.
Professor of paediatrics and child health Professor John Whitehall also felt encouraged to see the Sydney-based gender clinicians looking deeper into the causes for children’s distress when they present with gender dysphoria.
“It is in line with the Travistock position that children under the age of 16 are very unlikely to be able to evaluate and make sensible decisions about these matters of such life-long magnitude and it’s also corroborated by the recent decision in Sweden and before that in Finland,” he said. “Possibly the tide has begun to turn in the direction of common sense.”
But he was concerned about “the more superficial gender affirmative approach” taken in Melbourne and that there was still an assumption that puberty blockers are safe and irreversible when clinical studies on animals showed they produced significant sustained damage to the limbic system.