American pediatricians against puberty blockers. And meanwhile at Careggi…
The American College of Pediatricians calls for an immediate stop to "affirmative therapy" for minors with gender dysphoria and invites colleagues to base themselves on growing scientific evidence and not on ideology. While waiting for a turning point in Italy too, an analysis of the informed consent form that the Florentine hospital submits to very young patients

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L'American College of Pediatricians just released a statement in which recall all the major medical associations For pushing the gender transition craze onto children.

These companies are asked to “IMMEDIATELY stop social affirmation promotion, puberty blockers, cross-sex hormones, and surgeries for children and adolescents experiencing distress about their biological sex.” 

“In light of recent research and revelations of the harmful approach advocated by WPATH and its followers in the United States, we the undersigned call upon professional medical organizations in the United States, including the American Academy of Pediatrics, the Endocrine Society, the Pediatric Endocrine Society, the American Medical Association, the American Psychological Association, and the American Academy of Child and Adolescent Psychiatry of follow the science and their European professional colleagues and to immediately stop the promotion of social affirmation, puberty blockers and cross-sex hormones, and surgery for children and adolescents who experience distress about their biological sex. These organizations rather, they should recommend comprehensive assessments and therapies aimed at identifying and addressing psychological comorbidities and neurodiversity underlying conditions that often predispose and accompany gender dysphoria, members of these professional organizations should contact their leadership and urge them to embrace the evidence-based research now available.”

The complete declaration can be read and signed here

Meanwhile in Italy the new opinion of the National Bioethics Committee is awaited on the use of puberty blockers and a inter-ministerial table - Health and Family - on the use of hormone puberty blocking drugs in the treatment of gender dysphoria in minors. The table was set up after the news about the hospital's center for minors with dysphoria Careggi of Florence, where the very young patients were started for treatment, as we learned, without an adequate preliminary neuropsychiatric evaluation.

What we publish next is the information form that Careggi offers to minors with gender dysphoria.

****************************************************************************************************************************************************************************

Car*, Dear parents,

You have been treated at this center for Gender Incongruence/Dysphoria.

Recently, the World Health Organization defined Gender Incongruence as a marked and persistent incongruence between experienced gender and the gender assigned at birth. Gender incongruence can present with intense and persistent suffering (called Gender Dysphoria).

The cause of Gender Incongruence/Dysphoria is not known, but is believed to be partially due to prenatal (before birth) hormones interfering with early brain development.

We shared that although you feel like a male, you are genetically, biologically, and physically female. The incongruity between your gender identity (male) and the female body is a condition that created you and is still a source of profound suffering. This is compromising your quality of life and your psychological functioning at school, but also in your friendships and emotional relationships.

For this reason, as professionals who deal with the management of Gender Dysphoria in developmental age, we have come to the conclusion, together with you and your family, that you can benefit from a medical treatment that helps you stop the changes in puberty in the female sense (as supported by international and national recommendations). In this way, it will be possible to make your body less incongruent with your gender identity, or how you feel. Above all, it will allow you to feel better because you will not have to continually deal with all those unwanted and irreversible physical changes in the body that are a source of intense suffering.

With the informed consent of your parents/guardians, you can then

start therapy with Triptorelin, a drug also called gonadotropin-releasing hormone analogue (GnRH analogue), which will prevent your body from experiencing further puberty changes in the female sense. Gonadotropins are hormones that have a stimulating effect on the gonads; Triptorelin initially stimulates the release of gonadotropins from the gland that produces them, but subsequently, like a key that remains in the door lock, blocks the activity of the gland. These drugs produce the effect of temporarily suspending the body changes that occur with pubertal development.

At the same time as Triptorelin therapy, you will have to carry out psychotherapeutic interviews that will help you further explore your gender identity, gender role and emotional experiences. The psychotherapeutic discussions will also be aimed at reflecting on the positive and negative consequences of any choice you may make in the future, including with respect to a possible transition from female to male. This is in order to have a clearer vision of the future.

You have been informed that although Triptorelin will reduce female hormone levels and prevent further feminine body changes, it will not make your body more masculine. Additionally, this treatment will not change your genetic sex (chromosomes), nor your external genitalia (vagina).

We explained to you that although Triptorelin is commonly used for children with precocious puberty, it has only recently been prescribed in young adolescents with Gender Dysphoria and that the long-term effects are not fully known at this time. As professionals who deal with Gender Dysphoria in adolescence, we believe that treatment with Triptorelin can be useful for gaining time to reflect on your sexual identity, to explore your gender and other developmental characteristics, but above all to alleviate secondary suffering upon contact with a body that is developing in an unwanted direction. This can make it easier for you if you decide on a subsequent physical transition, preventing the development of further female sexual characteristics. You have been made aware that if you decide you want to undertake a transition, it will be possible to interrupt Triptorelin therapy at any time.

Finally, we shared the following aspects related to Triptorelin therapy, when used in biological females:

  1. Treatment with Triptorelin is started in young people with Gender Dysphoria not before they have experienced the first signs of puberty (called Tanner stage 2-3). In biological females this means the development of breasts, pubic, axillary and facial hair, menarche and menstrual cycles. Such changes must have resulted in an increase in Gender Dysphoria.
  2. Triptorelin acts rapidly, reducing estrogen levels, inducing a partial regression of female sexual characteristics (for example the breasts may reduce in size and menstrual cycles disappear).
  3. Any co-existing psychological, medical or social issues that may interfere with treatment must be managed before starting.
  4. Triptorelin is prescribed in the form of deep intramuscular injections to be administered every 28 days for the first six months; subsequently a slow-release formulation may be prescribed to be administered every 3 months. These can be administered by the GP or by a member of the family of origin. Injections may cause some pain or redness at the injection site. Furthermore, in some cases they could cause allergies. You have been informed that you may notice this if red, painful abscesses appear where you inject. If this happens, you know that you will have to talk to your parents and/or your doctor and that the GnRH analogue drugs may have to be stopped. There may be no alternative medications available;
  5. When the person takes Triptorelin, he or she should have regular blood tests (usually every 3 months) to ensure that the dose of the drug is correct.
  6. In general, Triptorelin therapy is carried out for a period of no more than 4 years, after which it is either stopped or associated with testosterone-based therapy.
  7. If Triptorelin is not taken on a regular basis, pubertal development can quickly revert in the direction of biological sex (in this case in the female direction).
  8. When Triptorelin therapy is stopped, puberty is known to restart within approximately 3-6 months. As far as is known to date, there are no permanent effects on fertility, or on the possibility of becoming parents when you grow up, if Triptorelin is taken for a period and then stopped.
  1. The effects of puberty suppression on brain development are not yet fully known;
  2. Triptorelin may limit the increase in bone density that normally occurs with puberty. This could cause your bones to become more brittle as an adult. For this reason, it is important that people taking Triptorelin protect their bones by doing physical activity and taking in a correct amount of calcium in their diet. It is not known whether using Triptorelin increases the risk of osteoporosis in adulthood.
  3. There may be other long-term side effects of Triptorelin that are not yet known.

We shared the importance of letting us know if you are unhappy with your Triptorelin treatment or if you are experiencing any problems or difficulties.

We have explained to you that: (i) visits and blood tests according to certain deadlines are necessary to verify the effects of the therapy; (ii) Triptorelin may interfere with other medications, dietary supplements, herbs, alcohol and drugs; (iii) being honest with the doctor treating you will allow you to avoid medical complications that can even be serious, and (iv) although numerous professionals dealing with Gender Dysphoria have described the benefits linked to Triptorelin therapy in Gender Dysphoria To date, there is a lack of controlled studies that allow us to clearly establish greater effectiveness of Triptorelin therapy compared to psychological support alone.

We have informed you that you can decide to interrupt Triptorelin therapy at any time and that if you do so with the help of the doctor who follows me you will not have negative reactions when interrupting it. We may also suggest that you stop taking Triptorelin if you experience any significant side effects or if the health risks are not controlled.

You have been informed that you must continue to have meetings with the psychologist or psychiatrist at an agreed frequency.

For any doubts, information and communications you can contact the professionals who follow you:

  •  Dr. Jiska Ristori (psychotherapist psychologist)  
  •  Dr. Alessandra D. Fisher (endocrinologist) 
  •  Prof. Linda Vignozzi 

COMMENTS ON THIS FORM

  1. we address the patient and the parents, but then the only recipient of the information remains the minor
  2. From the first line the asterisk - the neuter - is used instead of the feminine or masculine declension. It only appears in a public document it is possible to use asterisks. Furthermore, the use of the asterisk appears as a self-fulfilling prophecy: the neutral recognized in a public document appears as aauthorization/approval addressed to the minor, authorization which similarly to the "alias" school career can produce the effect of hypostatize-approve a condition, that of gender inconsistency, which in the vast majority of cases is absolutely transitory and resolves spontaneously over time.  But further in the form, it is not clear why, the asterisk alternates with the feminine declension (?)
  3. already in the fifth line we talk about “gender assigned at birth”. But You are not “assigned” any gender at birth. At birth the medical staff, the midwife or the birth mother herself limit themselves to ascertain the sex of the unborn child, which is perfectly recognizable as masculine or feminine  except in the case of very rare genetic/chromosomal anomalies (intersex) which make the definition difficult: only in the - very rare - cases of intersexuality may it happen that it is necessary to attribute or assign one or the other of the two sexes. or having to suspend said assignment. But there is no relationship between intersexuality, which is a physical condition, and gender incongruence/dysphoria, which are eminently psychological conditions: the two situations should not be ideologically confused and overlapped, even more so in a medical document. Furthermore gender - that is, that set of social expectations which, partly according to historically changing stereotypes, is associated with each sex - is something very different from sex. The interchangeability of the two terms - sex and gender - produces confusion and, as has often been seen, it produces it intentionally. The expression "sex assigned at birth" in all its inappropriateness has now become common use among many of the medical profession who are adopting it uncritically.
  4. Further on it is argued that treatment with triptorelin “will allow you to feel better”: but as amply demonstrated by the Cass Review, by the testimonies of many detransitioners and by the statements of experts such as the "repentant" veteran of affirmative therapy, the Finnish Riittakerttu Kaltiala, there is no scientific evidence to support the fact that pharmacological therapy produces an actual increase in well-being in the minor.  “Every systematic review of the evidence to date,” says Kaltiala, “including a study published in the Journal of the Endocrine Society, has offered evidence with a low or very low certainty of the mental health benefits of hormone interventions for minors. The gender transition has gotten out of hand. Something went very wrong. The promised miracle did not materialize. The young women we were treating were not thriving. On the contrary, their lives deteriorated. They withdrew from all social activities. They didn't make friends. They no longer went to school."  It is therefore not correct to assure the minor that with triptorelin he will "feel better" as there is no scientific evidence to support this statement.
  5. The form claims that “These drugs produce the effect of temporarily suspending the changes in the body that occur with pubertal development.” The “temporarily” gives the minor the idea that the interrupted pubertal development can resume at the moment of any interruption of therapy, off-on mode. But a) in biology off-on does not exist  b) later some possible permanent effects of triptorelin are recognised: “the long-term effects are not completely known to date” c) again, it is said: “as far as is known to date, there are no permanent effects on fertility, or on the possibility of becoming parents when I grow up, if Triptorelin is taken for a period and then stopped": it is therefore admitted that to date there is no certainty that there will be no effects on fertility, therefore the suspension of development, also from this point of view, cannot be defined as "temporary" d) “The effects of puberty suppression on brain development are not yet fully known”: another admission of the fact that the effects of triptorelin cannot with certainty be defined as temporary  e) it is admitted that “Triptorelin can limit the increase in bone density that normally occurs with puberty. This could cause your bones to become more fragile as an adult.": another possible effect that is anything but temporary  f) it is admitted that “there may be other long-term side effects of Triptorelin that are not yet known”: further proof of the fact that the effects of the drug cannot be defined as temporary. 
  6. The minor is not informed of the fact that in the vast majority of cases (from 90 to 98 percent) those who start therapy with triptorelin go directly to cross-sex hormones, that is, they undertake the transition.
  7. Granted and not granted that a child at Tanner stage 2 - between the ages of 9 and 12 - is truly able to understand and appropriately evaluate information on fertility and bone density (even WPATH, the world's largest association for transgender health, declares the impossibility of consent in its internal chat: “In theory it's okay to talk to a 14-year-old about preserving his fertility, but I know it's like talking to a wall... Most kids don't have any brain space to talk about it seriously.” “Many people say: yuk: children, newborns, that's disgusting. Average response: Ok, in case I will adopt”. Even families don't understand well, "people who maybe didn't even study biology at school... some parents" says a therapist "can't even formulate questions regarding a medical intervention for which they have already signed consent"), it would also be appropriate to talk about the experience of the desisters, those who, giving time, see gender incongruence/dysphoria resolve spontaneously, and of the detransitioners, who after having undertaken the path of blockers-cross sex hormones-surgery with irreversible effects on their body regret it and decide to stop the drugs even though they know they can no longer go back.
  8. The form ends with the statement “You have been informed that you must continue to have meetings with the psychologist or psychiatrist with an agreed cadence". But the psychologist Jiska Ristori, among the service managers at Careggi, has publicly stated that before administering the drug no psychotherapy was carried out in the ward: “How a person identifies with their gender identity is known to the person, we are not the ones who can tell a person how they identify. Exactly as happens in cisgender people who do not require psychotherapy to define their gender identity, this also applies to trans people". So it is not clear what is meant by "continuing" a path which, as is claimed, has never even been started. 

MARINA TERRAGNI


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