Puberty blockers, Tavistock clinic, transphobia... Committed to the issue of transidentity among minors, the collective of practitioners clarifies its positions.
In France, the LR senator for Val-d'Oise, Jacqueline Eustache-Brinio, has announced the creation of a working group on the transidentification of minors, and the HAS (Haute Autorité de Santé) is organizing a working group on recommendations for trans people (aged 16 and over).
In England, the NHS has just announced that it is limiting the use of puberty blockers to children enrolled in clinical trials, stating that "there is insufficient evidence to support their safety or clinical efficacy as a commonly available treatment".
In addition, a major congress in Finland brought together international experts who advocated a revision of protocols for the care of trans-identified minors.
This is an opportunity for the Little Mermaid Observatory to take stock of the most frequently asked questions we receive, in the light of current scientific and/or legal data.
The effects of puberty blockers are reversible: true and false
Doctors who prescribe puberty blockers for trans-identified minors, outside the AMM (Autorisation de Mise sur le Marché), claim that they are completely safe and reversible. However, recent and ongoing studies point to side-effects that are not always reversible, not only bone-related (osteoporosis) but also neurocognitive and sexual, as well as risks to future fertility.
These drugs are prescribed when the young person is experiencing significant psychological distress as a result of the bodily transformations taking place. But puberty is not just about bodily changes. These products are administered when puberty is beginning (Tanner stage 2), on average between the ages of 11 and 13, sometimes earlier, and for several years.
As their name suggests, they block the onset of secondary sexual characteristics. In girls, they block breasts, body hair and menstruation; in boys, they block penis growth, body hair, voice moult and, in both sexes, peak growth. But they also block all psychological maturation.
It's true that the blockage of secondary sexual characteristics is reversible when treatment is stopped. But it's wrong to stop there. Apart from the side effects already described, and in the absence of serious studies, we know nothing about the consequences on the brain and psyche of this artificial blockade of the psychic transformations of puberty in an otherwise healthy subject. These blocking agents are presented as a "wait-and-see solution" for later determination; we now know that, in the vast majority of cases, they lead to young people being prescribed crossed hormones, generally from the age of 16 onwards.
On the other hand, serious studies show that, with psychological care that does not involve prescription medication, the vast majority of these young people (80-90%) come to terms with their birth gender.
Tavistock Clinic has closed its dedicated GIDS service: true and false
In July 2022, the UK's National Health Service (NHS) published a report by pediatrician Hilary Cass, followed by the announcement that the world's largest pediatric gender dysphoria service, GIDS (Gender Identity Development Service) at the Tavistock Gender Clinic (one of the Tavistock Clinic's specialist services for children, young people and families) would close in spring 2023.
The GIDS will remain open until March 2024. In the meantime, over 8,000 young people are currently waiting for care or are being cared for in interim solutions. The Cass Review team said there was a general consensus that the current model, within a single specialist gender service, cannot provide holistic care for children and young people in distress. The new care modalities are currently being developed. For the moment, the hospitals that will form the new regional centers have not yet been chosen.
Suicides are more frequent among young people who are refused medication: false
"If your child doesn't transition, he'll kill himself" is a false argument. It's often used to rush a young person into transition by putting pressure on parents when they express reservations. The slogan often heard by parents of girls is: "Do you want a dead girl or a live boy?".
Some studies attribute the drop in suicidal risk to the medicalization of these young people, which represents an essential legitimization of treatment; as a result, they are often cited by gender doctors. However, the methodology of these studies is criticized for falling far short of the evidence-based medicine criteria that are imperative for assessing the quality of work in the medical field. In fact, there is little evidence to suggest that medical transition decreases suicide rates and that puberty blockerś are necessary to prevent suicide.
After sex reassignment surgery, one study found that transgender adults were 4.9 times more likely to have attempted suicide and 19.1 times more likely to have died by suicide, after adjusting for prior psychiatric comorbidity. Similarly, an Australian article noted that many patients had poor transition outcomes, putting them at risk of suicide.
The social transition is reversible: true and false
Social transition" refers to the act of declaring one's gender and adopting its social attributes. It refers to all acts aimed at affirming socially or for oneself one's gender identity, which differs from one's biological sex (the expression used is "sex assigned at birth", which does not correspond to a scientific definition but to a militant one). This implies announcing it to those around you ("coming out") and may entail a request for a change of first name and pronoun, as well as a change of physical appearance (hairstyle, clothes).
It is wrong to think that social transition can be totally reversible, since it creates a discrepancy between appearance and the reality of the body, which can have the effect of aggravating "gender dysphoria" and precipitating the young person into a medical transition, especially if he or she is encouraged to do so by influencers on social networks. It has now been shown that if young people are 100% approved and encouraged by those around them, leaving no room for any ambivalence, it will be extremely difficult for them to dare go back if they so wish. The social transition, which is totally approved by those around him, therefore appears to be the first step towards the transition to medication. This is what the Swedes call the "trans train".
At school, parental authorization is required for first name changes: true
Referring to the Blanquer circular that came into force on September 21, 2021, minors can, with the agreement of their legal representatives, request a change of first name at school. In this case, care must be taken to ensure that the chosen first name is used by all members of the educational community, as respect for a student's gender identity should not be left to the free judgment of adults and other students
Parental consent is required for any treatment before the age of 18: true
For any medical or surgical intervention on a minor, consent must be obtained from the parent or guardians. To consent to medical care, a minor must be able to give informed consent. This requires fair, clear and appropriate information.
Mastectomy (also known as torsoplasty) is forbidden for minors: false
It is not forbidden to remove the breasts of under-age girls with no somatic pathology, although this does meet the medical definition of mutilation. Such operations are rare, but not exceptional. The youngest girl operated on in France was 14. They are performed by plastic surgeons in public or private hospitals, and may be reimbursed by the French Social Security system after prior agreement, without even the advice of a psychiatrist today, but with parental authorization. This mutilation is irreversible.
Sex reassignment surgery is prohibited for minors: false
This so-called "bottom surgery" is not prohibited for minors, but it is not performed at these ages (as far as we know). From the age of 18, young people today can undergo vaginoplasty; girls can have their uterus and ovaries removed, and some even undergo phalloplasty. All these procedures are carried out on request, without psychiatric consultation.
People who regret their transition are rare: false
People who regret are called detransitioners when they have made a social and medical transition. Desistors if they have only made a social transition.
Requests for transition and detransition are much more common among girls than boys. Numerous studies show that these returns to the original gendered identity are on the increase: 7 to 10% of detransitions were observed in the GIC study. According to the authors, they are underestimated and are likely to increase further in the coming years: in their view, it takes at least eight years post-treatment to assess the number of detransitions, whereas they only have sixteen months' hindsight. Figures of 20% to 30% of treatment discontinuation have also been observed. While these behaviors are not, strictly speaking, detransitions, they are often the beginnings of them. Everything points to a significant increase in detransitions over the next few years. The start of the increase in requests dates back to 2013, while the average age of detransitioners is just under 25.
The 1% figure bandied about by gender doctors and activists is based on unreliable studies, but it is useful in suggesting that this is a marginal phenomenon that cannot call into question the current hormonal-surgical protocol.
Transphobia is a crime: true
Transphobia is an offence punishable by criminal penalties. Discrimination based on sexual orientation or gender identity is a criminal offence punishable by 3 years' imprisonment and a €45,000 fine, and by 5 years' imprisonment and a €75,000 fine when the discriminatory refusal is committed in a place open to the public or by a person in a position of public authority.
However, questioning or criticizing the notion of gender identity is not transphobic. Protecting trans-identified minors from too rapid medicalization is not transphobic. Exploring the gender of a young person questioning his or her sexual identity is not transphobic.
What is transphobic is discriminating against trans people simply because they are trans.