In France, Senator LR from Val-d’Oise, Jacqueline Eustache-Brinio announced the creation of a working group on the trans-identification of minors and the HAS (Haute Autorité de Santé) is organizing a working group on recommendations concerning trans people (from 16 years old).
In England, the NHS (British health service) has just announced that it is limiting the use of puberty blockers to children enrolled in clinical trials, stating that “there is not enough evidence to support their safety or clinical effectiveness as a commonly available treatment”.
In addition, a major congress in Finland brought together international experts who advocate a revision of the protocols concerning 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, given current scientific and/or legal data.
The effects of puberty blockers are reversible: true and false
Doctors who prescribe puberty blockers for transidentified minors, outside of the MA (Marketing Authorization) affirm their harmlessness and total reversibility. Recent and still ongoing studies, however, point to side effects that are not always reversible, not only bone (osteoporosis) but also neurocognitive, sexual as well as risks to future fertility.
This prescription is made when the young person presents significant psychological suffering attributed to the bodily transformations in the process of appearing. However, puberty is not just about bodily changes. These products are administered when puberty begins (Tanner stage 2), on average between 11 and 13 years old, sometimes earlier, and for several years.
As their name suggests, they block the occurrence of secondary sexual characteristics. In girls, breasts, body hair, menstruation; in boys, penis growth, body hair, voice change, and in both sexes, growth spurt. But they also block all psychological maturation.
It is true that the blocking of secondary sexual characteristics is reversible upon discontinuation of treatment. But it is wrong to stop there. Apart from the side effects already described, and in the absence of serious studies, we do not know the consequences on the brain and the psyche of this artificial blocking of the psychic transformations of puberty on an otherwise healthy subject. These blockers are presented as a “standby solution” to be determined later ; we now know that in the vast majority of cases, they drive young people to the prescription of cross-hormones, generally from the age of 16.
Conversely, serious studies show that with psychological care without prescription medication, the vast majority of these young people (80 to 90%) are reconciled with their birth sex.
The Tavistock clinic has closed its dedicated service, the GIDS: true and false
In July 2022, the National Health Service (NHS), the public health system of the United Kingdom, post a report written by pediatrician Hilary Cass, followed by the announcement of the closure in spring 2023, of the world’s largest pediatric service specializing in gender dysphoria, the GIDS (Gender Identity Development Service) within the Tavistock Gender Clinic (a specialized Tavistock Clinic services for children, adolescents and families).
The GIDS will ultimately remain open until March 2024. In the meantime, more than 8,000 young people are currently awaiting care or being cared for in interim solutions. The Cass Review team said there was general consensus that the current model, within a single specialist gender service, cannot provide holistic care to children and teenagers in pain. New care arrangements are 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 drug treatment: false
“If your child doesn’t transition, they will kill themselves” is a false argument. It often serves to precipitate the young person into a transition by putting pressure on the parents when they express reservations. The slogan often heard by parents of girls is: “Do you want a dead girl or a living boy?”.
Some studies attribute the reduction in suicide risk to the medicalization of these young people, which represents an essential legitimization of treatments; as a result, they are often cited by gender doctors. However, the methodology of these studies is criticized because they are far from fulfilling the criteria of theevidence-based medicine which constitute the imperatives for evaluating the quality of work in the medical field. In reality, there is little evidence making it possible to affirm that the medical transition decreases suicide rates and that puberty blockers are necessary to prevent suicide.
After sex reassignment surgery, a study showed 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. Likewise, a australian item noted that many patients had poor transition outcomes, which put them at risk of suicide.
Social transition is reversible: true and false
We call “social transition” the fact of declaring oneself of the felt gender and adopting its social attributes. It designates 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 but militant definition). This involves announcing it to those around you (“coming out”) and can lead to a request for a change of first name and pronoun as well as a change in physical appearance (hairstyle, clothes).
It is wrong to think that the social transition can be completely reversible since it generates a discrepancy between the appearance and the reality of the body, which can have the consequence of aggravating “gender dysphoria” and precipitating the young person into a medical transition, especially if encouraged by influencers on social networks. It has now been shown that if the young person is 100% approved and encouraged by those around him without leaving any room for possible ambivalence, it will be extremely difficult for him to dare to go back if he wishes. The social transition totally approved by the entourage then appears as the first step leading to the transition to medication. This is what the Swedes called the “trans train”.
At school, parental authorization must be required for a change of first name: true
Referring to the Blanquer circular which came into force on September 21, 2021, minors can, with the agreement of their legal representatives, request a change of first name at the school. It is then a question of ensuring that the first name chosen is used by all the members of the educational community, respect for the gender identity of a pupil should not be left to the free appreciation of adults and of other students.
Parental authorization must be required for any treatment before the age of 18: true
Obtaining the consent of the holder(s) of parental authority is mandatory for any medical or surgical intervention on the minor. To consent to treatment, you must be able to give informed consent. This necessarily requires fair, clear and appropriate information.
Mastectomy (known as torsoplasty) is prohibited for minors: false
It is not forbidden to remove the breasts of underage girls without physical pathology, although this meets the definition of mutilation from a medical point of view. These operations are rare without being exceptional. The youngest operated in France was 14 years old. They are performed by plastic surgeons in public or private hospitals and can be reimbursed by Social Security after prior agreement without even the opinion of a psychiatrist today, but after parental authorization. Is it necessary to specify that this mutilation is irreversible.
Sex reassignment surgery is prohibited for minors: false
This so-called “lower surgery” is not prohibited for minors but it is not performed at these ages (to our knowledge). From the age of 18, young people can now be operated on for vaginoplasty; girls may undergo removal of the uterus and ovaries, and for some, phalloplasty. All these acts are carried out on demand 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. Withdrawals if they have only made a social transition.
Requests for transition and those for de-transition are much more numerous among girls than among boys. A number of studies show that these returns to the original sexual identity are on the increase: 7 to 10% of detransitions are observed in the GIC study. According to the authors, they are underestimated and should increase further in the coming years: according to them, it takes at least eight years post-treatment to assess the number of detransitions, when they are only sixteen months old. back. Numbers 20% To 30 % discontinuation of treatment are also observed. If these behaviors are not strictly speaking detransitions, they are often the beginnings. Everything converges to think that a significant increase in detransitions will be observed in the coming years. The start of the increase in requests dates from 2013, while the average age of detransitioners is just under 25 years old.
The figure of 1% brandished by gender doctors and activists is based on unreliable studies but it is useful for them to suggest that it is a marginal phenomenon that cannot call into question the current hormonal-surgical protocol..
Transphobia is a crime: true
Transphobia is a crime punishable by criminal penalties. Discrimination based on sexual orientation or gender identity is an offense punishable by criminal penalties: 3 years’ imprisonment and a fine of €45,000, 5 years’ imprisonment and €75,000 when the discriminatory refusal is committed in a place open to the public or committed by a person holding public authority
However, questioning or criticizing the notion of gender identity is not transphobic. Protecting transidentified minors from too rapid medicalization is not transphobic. Exploring the gender of a young person who questions their gender identity is not transphobic.
What is transphobic is the fact of discriminating against trans people simply because they are trans people.
*The Little Mermaid Observatory, a multidisciplinary collective of professional practitioners and researchers, is committed to the issue of transidentity. It was founded by Céline Masson, Caroline Eliacheff and Anna Cognet.