By Paul Sugy, Stéphane Kovacs, and Agnès Leclair
About a dozen specialized hospital units receive young people who are uncomfortable with their puberty and gender identity, 16% of whom are under 12 years old. Praewphan - stock.adobe.com
ANALYSIS - The elected officials present an alarming report on the medical care of young people questioning their gender.
The transidentity of minors is at the heart of a "tense scientific and medical debate": this is the euphemism with which the LR senators approach, in the preamble to their report, the thorny issue of sex change in children. Their conclusions are unlikely to ease the controversy. The result of nearly a year’s work, this substantial document, published by Val-d'Oise senator Jacqueline Eustache-Brinio, aims to highlight the prevalence of a "trans-affirmative" ideology among healthcare professionals who support adolescents uncomfortable with their puberty and gender identity. The authors then accuse transactivist associations, amplified by influential publications on social media, of accelerating the pathway of these children towards gender transition.
Following the report, the right-wing senators announced the submission of a bill before the summer to ban any medical transition in France before the age of 18. Without waiting for the recommendations currently being drafted by the French National Authority for Health (HAS), the bill seeks to prevent the prescription or administration of puberty blockers, cross-sex hormones, and sex reassignment surgery for minors receiving care for gender dysphoria. The current framework gives more autonomy to doctors.
The LR senators believe that the number of children identifying as trans has exploded in the last ten years. Due to the lack of official statistics in France, the authors infer this trend from British, Swedish, or American studies: in the United States, the number of diagnoses has tripled in five years, now affecting more than 40,000 children under 17. David Cohen, head of the child psychiatry department at La Pitié-Salpêtrière Hospital, indicated during his hearing that he receives around 40 new consultation requests each year. There are at least a dozen similar specialized units in hospitals. Sixteen percent of his minor patients are under 12 years old.
Assisted by psychologist Céline Masson and child psychiatrist Caroline Eliacheff, who advocate for an alternative approach to gender issues in children, the senators point out that the majority of minors consulting in specialized units are eventually diagnosed with gender dysphoria, even though their distress is more general and calls for broader support. In medical terms, healthcare professionals refer to "comorbidities." For example, a quarter of the children seen at La Pitié-Salpêtrière for these reasons are school dropouts, 42% have been bullied, 61% have experienced depression, and one in five has attempted suicide. Their care also suffers from the impoverished state of French child psychiatry, the senators say.
Overrepresentation of Girls
During his hearing, English psychiatrist and psychoanalyst David Bell, who authored a critical 2018 report on the treatment of trans children in the British healthcare system, added that a third of the children who passed through his Tavistock clinic even suffered from autistic disorders. According to him, "the clinic’s main objective" was not "to treat these young people's psychological distress, but to get them out of their bodies." This haste, he says, neglected several other factors of distress that should have been of greater interest to the medical community: intrafamily violence or, often, difficulty accepting or expressing one's homosexuality.
"Do these blockers allow for the situation to be paused for a few years, or do they promote entry into a reassignment process? This is the central question today," said Jean Chambry.
In more than 80% of cases, children seeking to transition are young girls. In France, in varying proportions, this overrepresentation of girls is also found among the patients of the healthcare professionals interviewed. Persistent difficulties in being seen as "tomboys" turn into a need for hurried reassignment, observes Dr. Catherine Zittoun, a child psychiatrist in Paris.
"In reality, we find that most children who have taken puberty blockers have moved towards gender reassignment. Do these blockers allow for the situation to be paused for a few years, or do they promote entry into a reassignment process? This is the central question today," summarizes Parisian child psychiatrist Jean Chambry, head of the intersectoral center for adolescent care (Ciapa). "The difficulty is that we lack perspective," he admits.
"A Step Back"
Chambry opened one of the first consultations in France on transidentity issues for minors, where he has followed nearly 200 young people over the past ten years. The total ban proposed by the senatorial report seems "disproportionate compared to the reality of practices, which have not been normalized in France as in some of our neighboring countries." He suggests instead strictly regulating their use. "Blockers should only be prescribed to children who are beginning puberty and are experiencing severe distress, with suicidal thoughts," he says. This is a solution closer to the one recently adopted in the UK, with exceptional authorizations in a research framework.
"A Return to Reason"
Within the parents' collective Ypomoni, there is praise for "this return to reason." "We should be even stricter: a child is not old enough to ask to modify their body!" says Maud Vasselle, whose daughter waited until she was an adult to have surgery two years ago. "This topic should not even be on the table, not at school or in middle school. Banning interventions by associations that do not respect the principle of neutrality? That’s obvious, but it’s not enough: the phenomenon has grown so much that there can’t be a TV show without a trans character, even if it’s set in the Middle Ages!"
Doctors do not explain the consequences of puberty blockers. My daughter didn’t realize that life wouldn’t be so easy with all these treatments… Maud Vasselle
Finally, to prove that the current legal framework is not protective enough, the authors of the report highlight the difficult path of "detransitioners," those children who want to reverse their medical transition. One of them testified at length before the senators: now 20 years old, she found answers to her troubles on the internet, which pushed her to request hormone prescriptions and breast removal. She later regretted her decision two years later. But it was too late: she will never regain her breasts or her female voice, despite her psychiatrist suggesting a "reconstruction" operation. The young woman says she now wants to move away from the constant pressure to change her body. Lawyer Olivia Sarton warns of the risk of these regrets leading to a surge in legal cases: in the United States, more than a dozen lawsuits are already underway.
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