New Guidelines on Treating Gender Dysphoria
One interesting development has been how medical practitioners across the world are taking stock of the trans epidemic and are beginning to pause or reverse the affirmative care model in favor of a wait-and-see model. There is now a fear of premature transitioning of adolescents because of new evidence and because of possible lawsuits by de-transitioning teens.
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) has just released a position statement on the role of psychiatrists in working with Trans and Gender Diverse people which shows the current state of debate for what is the best practice for treating teens with gender dysphoria.
For me, this is very important because I attended a Victorian Equal Opportunity Human Rights Commission (re)education seminar where we were told that a medical practitioner cannot treat an adolescent with gender dysphoria in such a way that the adolescent would desist in their symptoms. In which case, any treatment to address underlying pathologies in a gender-confused teen was illegal, the only legally approved type of care was affirmation with a view to transitioning. No, I’m not making this up, I recorded the seminar convener on my iPhone.
Now, however, we have a disparity between the anti-gender suppression legislation in the state of Victoria and the national advice given by the leading professional body of psychiatrists in Australia and New Zealand.
If you read the position statement, a few things stand out.
First, the position paper proffers a patient-oriented approach, affirms a no-harm principle, advocates a case-by-case approach, and warrants transitioning in proper instances. It is not a broad blanket ban on transitioning.
Second, the position paper differentiates sex (reproductive anatomy) from gender (social expression of sexual identity). This means that sex is not fluid or malleable. Yes, it is complicated by things like several intersex conditions, but biological sex is not a Rorschach drawing. Note the definitions:
Sex refers to the biological characteristics that define humans as female or male. While these sets of biological characteristics are not mutually exclusive, as there are individuals who possess both, they differentiate humans as males and females in the vast majority of people.[1]
Gender refers to the state of being male, female, or other, and/or masculine, feminine and other, with regard to personal, social and cultural characteristics, rather than genetic, hormonal or anatomical characteristics.
Third, the position paper states that departing from gender stereotypes is normal. In which case, boys who play with dolls and girls who play with trucks are not neccessarily “trans,” they just don’t conform to gender stereotypes.
Gender expansive and non-conforming behaviour and preferences can be normal at any age and should not necessarily be a cause for concern or require attention. For some people, gender identity and/or gender expression can change over time.
Fourth, the position paper does not rule out transitioning adolescents, but it does urge caution:
While a number of major professional organisations support the use of puberty suppressants and cross-sex hormones for adolescents, health authorities in some European countries have recommended restrictions be placed on their use … In regard to children and adolescents who experience gender dysphoria or are gender questioning, psychiatrists should consider the young person’s developmental stage, presence of developmental comorbidities (e.g., ASD), and capacity to give informed consent to treatment, in addition to considering the views of their parents/carers.
Fifth, there is recognition too of the growing number of de-transitioners and the trauma that they have experienced.
Individuals who detransition have been reported to experience mental health concerns including depressive and anxiety disorders and may have difficulty accessing health care services. Some individuals report that they have been harmed by previous gender-affirming care and some have launched legal proceedings against health care providers. Sufficient information should be provided to allow for informed consent for gender-affirming medical and surgical treatments. This should always involve thorough, open discussion of the possibility of disappointment, continued gender dysphoria, regret about irreversible effects of treatment, regret about reduced fertility, and shifts in gender identity or treatment wishes.
Let me be clear, it is not a matter of being pro or anti-trans. What is at stake is pursuing the best care, based on the best evidence, for children and teens who experience gender dysphoria. That treatment should not be based on activist legislation any more than it should be based on reactivist legislation.
Any medical professionals out there, feel free to chime in!
Let me be clear, it is not a matter of being pro or anti-trans. What is at stake is pursuing the best care, based on the best evidence, for children and teens who experience gender dysphoria. That treatment should not be based on activist legislation any more than it should be based on reactivist legislation.
Primum non nocere.
As a father of a 20-year-old trans child with diagnosed gender dysphoria and a 14-year-old gender questioning child, these positions would have been welcomed. However, the care given to my oldest, from medical doctors and psychiatrists, has been on the affirning side. She (his preferred pronoun) was diagnosed with GD at fifteen. My youngest has not been diagnosed with GD but is being counseled affirmatively. I am a minister, committed to the traditional view of marriage and gender, so you can imagine that this has been difficult for all involved. As I stated in a comment last week, I would go to my children's weddings, just not officiate or participate in any way. Perhaps these positions will make their way across the Pacific and provide healthier responses in the future. All I want for them is the BEST care possible.