The debate on puberty blockers also opens in Italy - finally!

Breaking the silence is the Italian Psychoanalytic Society, which is calling for an open scientific debate on these treatments, which it defines as 'experimental', not supported by adequate studies and at great ethical risk because they predetermine the fate of girls and boys
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Significantly later than in the Great North of Europe, Great Britain, Australia, and some US states - which have abruptly put the brakes on the use of puberty blockers as a 'therapy' for girls and boys with gender non-conforming behaviour - Italy too is finally breaking its silence with a letter addressed to the government by the Italian Psychoanalytic Society, which calls for caution and the opening of a public scientific discussion.

Below we reproduce interviews conducted by Marina Terragni for The Sheet and by Mara Accettura for The Republic to the president of the Italian psychoanalysts Sarantis Thanopulos (pictured).

Anche in Italia si apre -finalmente!- il dibattito sui bloccanti della pubertà

The discussion is also opening in Italy. At last. And with a bang: an open letter addressed to Giorgia Meloni, the Minister of Health and the Aifa in which the president of the Italian Psychoanalytic Society, Sarantis Thanopulos, expresses concern over 'the use of drugs aimed at producing an arrest of pubertal development in boys of both sexes who have been diagnosed with 'gender dysphoria''. And it calls for serious consideration of 'the contraindications to this treatment', which radical feminism has unabashedly called 'new lobotomy'.

Contraindications already considered in countries pioneering the so-called 'affirmative approach': in Great Britain, where the Tavistock Clinic, the main centre for the administration of these drugs, closed down and the health service issued new guidelines: given the unknown effects and potential harm, the blocker will only be administered in research protocol settings. In Sweden, where the Karolinska Institute has admitted that minors have been exposed to the risk of 'serious injuries' and 'incorrect treatment' and that studies are insufficient. In Norway and Finland, where new guidelines note risks such as bone demineralisation and possible effects on the central nervous system and fertility. There are even setbacks in the Netherlands, where the protocol was born, and in Australia, while in the US thousands of paediatricians have sued the Biden administration for forcing them to prescribe these drugs, denouncing 'experimental medicine that puts patients at risk'.

In Italy, the Italian Society of Paediatrics speaks instead of 'proven complete reversibility of pubertal suspensions' (La Repubblica yesterday headlined 'quarrel about boys changing sex', although this is an ongoing debate and not a quarrel, ed.), a fact belied by various studies such as the one published by the British Medical Journal according to which treated children experience 'reduced growth in height and bone strength'. In Italy the use off-label of tryptorelin as a puberty blocker got the OK from the government's Bioethics Committee in 2018 (only one vote against, that of Assuntina Morresi). The number of minors in 'affirmative' treatment is not known, but some data from abroad may give the idea: in Catalonia the number of girls diagnosed as dysphoric grew by 5,700 per cent between 2015 and 2021, in line with the UK where in 2018 Equality Minister Penny Mordaunt reported a 4,000 per cent growth in a decade.

In his letter, Thanopulos also calls these treatments 'experimentation'.

"Diagnoses," he explains to the Foglio, "are often not made by psychotherapists and rely on what the children or their parents tell them. The available data do not allow for a careful evaluation of the results, nor is the objective clear. This is why treatment with blocker is experimental, not validated as a treatment method and poorly calculated in its consequences. And it hopes to solve the problem of gender incongruence by taking it from a position of uncertain 'dysphoria' to a stable one. In fact it prevents a real choice, it is a 'let's try and see what happens'".

One argument of the supporters is the high risk of suicide for these children.

"There are no rigorous, carefully collected and independently controlled data. Nor are there any studies on the difference in terms of suicide between supposed transgender boys who take the drug and those who do not. Furthermore, there is no adequate interpretation of the cause of the possible suicide: is it related to 'dysphoria', depression or the discomfort of seeing one's 'other-than-self' body fully manifest? Nor is it clear how arresting puberty for a period will be better experienced afterwards. Nor how one can achieve a 'transgender' identity or abandon it if one inhibits a fundamental factor of one's sexual definition: the sexual explosion of puberty. Pharmacological treatment does not eliminate incongruity, the outcome is not a body other than the one one was born with. And with one's body it is better to learn to live with it'.

Often there is coexistence of dysphoria and mental disorders such as depression, eating disorders or autism spectrum disorders.

"For this there is a need for a differential diagnosis, but few take care of it. Moreover, not being in tune with one's body is no big deal. The body is important, you cannot get rid of it without paying a price, depression is always lurking'.

You are against the use of blocker in all cases?

"A dialogue on a scientific level is necessary. We are talking about the fate of children before they are able to define it for themselves. There is an ethical problem. I hope that Aifa and the government will promote a serious debate'.

You write that 'only a minority of boys who state that they do not identify with their sex confirm this position after puberty'.

"Before puberty most boys do not have a defined identity. How do you determine whether a child is transgender if you inhibit puberty? For the Spi to remain silent would be a betrayal of its ethical and scientific principles and of the public. Many paediatricians are also sensitive to the problem, but they do not have the tools to deal with it, and their associations suffer from a problem in medicine as a whole: the estrangement from medical philosophy and psychology'.

Has there been much discussion in the Psychoanalytic Society about this letter?

"There was a discussion on how to communicate, adopting terms that did not make our communiqué seem repressive. We call for a debate in which everyone can have the opportunity to express his or her position on an equal footing'.

Which has not been possible so far?

"Unfortunately, on the part of some doctors and psychologists who are not trained in psychotherapy and who are flattened by interventionist models, there is a strong push for hormonal and often surgical treatment. I do not exclude that some psychotherapists also take ideological sides. It is a pity, because if you do not chemically or surgically modify the body, this body has much more chance of satisfaction than a manipulated body that will always remain artificial'.

Perhaps these psychologists fear being ostracised if they do not go along with the transgender mainstream.

"There is a part of the Lgbtq world that addresses the issue of sexual and gender differences in a political manner, keeping the problem of discrimination at the centre. The problem arises if the sacrosanct defence of the right not to be discriminated against becomes a push for homologation, for the construction of nominal definitions that one claims to propose as legally equivalent. In terms of rights and possibilities we are equal, but not equivalent. A woman in a man's body and a woman in a woman's body are different things. In the field of love and eroticism there must be freedom, it is not legal territory'.

The feeling is that transgender ideology is being pushed hard: by whom and why?

"Not by transgender people, I think, who would just like to be recognised and not despised. Rather, in a world where young people feel very precarious, there is a contagious tendency to represent themselves as trans even as a sign of rebellion. The problem is that the trans tendency markets itself economically, politically, culturally. And the risk is that this will also happen with the anti-trans reaction'.

For young people, sexual fluidity is a given, as evidenced by the struggle for 'career aliases' in schools.

"In each of us there is the woman and the man, the heterosexual and the homosexual. The definition in one sense or the other makes it possible to avoid the dispersion of erotic investments. There is no pair of lovers without a potential third party who could put it in crisis. Freedom does not lie in formulas - binary, non-binary - but in the complexity of our relationships. Fluidity has two aspects: bisexuality, which has always existed, and indecision between feeling like a woman or a man, which largely stems from the difficulty of defining oneself in deep erotic involvement. In surface encounter experiences we feel safer. Fluidity is the reserve towards a commitment to the relationship with the other, felt as a harbinger of disappointment and pain. It is a disengagement, a form of stillness'.

Advice for parents of children who do not recognise their birth sex.

"Don't fight or pander. Listen to discomfort, but also to fantasies and thoughts. Do not treat children as monsters nor as heroes. Do not take an ideological path and give children time to mature in their choices. Dialogue with a psychotherapist that does not aim at a 'cure' but at the elaboration of a way of being in life that can take one path rather than another can be helpful.

Marina Terragni

(This article was published in the Sheet 20 January 2023)


Alarm from psychoanalysts: 'Very concerned about the use of drugs that block puberty'

Interview with Sarantis Thanopulos by Mara Accettura

The Italian Psychoanalytic Society has broken its silence. And in a letter addressed to Giorgia Meloni, its president Sarantis Thanopulos expresses 'great concern about the use of drugs aimed at producing an arrest of pubertal development in boys of both sexes who have been diagnosed with 'gender dysphoria', i.e. not recognising themselves in their biological sex'. Puberty blockers also used in Italy off labelare experimental drugs that put the body on pause. Today they are under indictment in parts of Europe and the United States because, according to the British Medical Journalnot only would not reduce the suffering of dysphoric children, but would have a negative effect on bone structure and sexual development.

This is the first time a medical scientific society has taken a position on this issue controversial in Italy.

"At first we thought it was an American phenomenon and knew little about Italy. I felt the need to investigate after reading an article in the New York Times and became very concerned. I told the society's executive that as SPI we couldn't keep quiet, of course we risked creating a fuss'.

You write in one of the points that 'the diagnosis cannot be subject to careful evaluation as long as the development of sexual identity is still in progress'. What does that mean?

"It seems to me that we are totally in the irrational. How can a little boy or girl who has not experienced the fundamental moment of life that is sexual development define himself or herself? According to statistics, only a small part of the minors who have this dysphoria, that is, who feel different - and all the diagnosis is based on what they say without delving into it - confirm the choice later on. But how will they make a choice without experiencing puberty?".

The Italian Society of Paediatrics, however, is pro-blockers. They say that blockers are a break. You can still go back. But they fail to add that most of those who take them - the 98% - then proceed with hormones. And eventually with surgery.

"They are not a break and then no one really knows what the effects are, even if they seem significant. We completely understand people who suffer from dysphoria. But one must not create confusion. It's not that if I 'pause' one body I will pass into another body. I will have a body that is not sexually developed. You cannot build an artificial woman's body, so suspending it while waiting for it to have its own identity means inhibiting a man's body.

We are psychically bisexual beings. We express a choice in the course of our lives, but each of us has a feminine and a masculine part. All these things are not taken into consideration at all. But in what world do we live?

The less one touches puberty the better. The ways to accompany children and listen to their vicissitudes are there, there is psychotherapy. We do not want to impose anything, but we have to talk about it. In Italy there is no data on transitions. If they ever summon us we have to start from there'.

Do you follow cases of minors in transition?

"We have some. The situation is very complex, you have to understand what it is, accompany them not so much to understand what they are but what they live and give them the tools that will then allow them to decide. Before or during puberty we are in the pre-homosexual and pre-heterosexual phase, defining an identity is a gamble.

Certainly there is a lot of pressure from the medical dimension to take them down that road, to force them down it, and that is not a good thing.

Why?

"Because on the one hand, there is an ideology that thinks it defends people by imposing categories, whereas tolerance and discrimination must be spread.

And on the other there is obvious pressure from the biomedical model and pharmaceutical companies. In this confused and contaminated situation, keeping silent, on our part, risks becoming opportunism'.

Aren't you afraid of being attacked by the LGBT community?

"I already am. They even tell me I am a Melonian because I wrote to the current government. But who was I supposed to write to? The president of the Football League?

Mara Accettura 

(This article was published in The Republic 19 January 2023)


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