Two very recent studies -one published on 17 April in the scientific journal Acta Paediatrica and entitled A systematic review of hormone treatment for children with gender dysphoria and recommendations for researchthe other made public on 14 April by Current Sexual Health Reports, title Current Concerns About Gender-Affirming Therapy in Adolescents- focus on pharmacological and surgical 'therapies' for girls and boys with gender non-conforming behaviour -recourse to puberty blockers, sex-cross hormones and scalpels-.
Here is conclusions of the two studies:
Acta PaediatricaSystematic review of almost 10000 abstracts suggests that the long-term effects of hormone therapy on the physical and psycho-social health of children are currently unknown except that treatment with GnRha (Gonadotropin-releasing hormone analogues) appears to delay bone maturation and increased bone mineral density'.
In essence, in the absence of scientifically validated studies the treatment of minors with puberty blockers and sex-cross hormones is entirely experimental because their effects, other than their proven effects on bone mineralisation, are unknown. These therapies are therefore prescribed in the absence of scientific support and trials proving their effectiveness: which from a medical point of view is absolutely unethical. One should therefore discontinue the administration of said drugs until there are studies that rigorously verify the benefits.
Current Sexual Health Reports"Meeting the diagnostic criteria for gender dysphoria (DSM) or gender incongruence (ICD) in children or adolescents today does not predict its persistence in the future. Doctors may be wrong in their assumptions about the causes, persistence and future trajectory of gender dysphoria in adolescents. The rapid increase in the number of young people with gender dysphoria treated with hormones and surgery and the delayed onset of 'repentance' (the reference is to detransitioners, ed.) mean that the extent of possible iatrogenic damage will not be known for several years.
Evidence of the effectiveness of such confirmatory interventions is scarce and of very low quality. While the evidence of benefits is highly uncertain, the damage to sexual and reproductive functions are certain, while there are many uncertainties about long-term health effects. Consequently, it is It is difficult to ethically justify continuing to use hormones and surgery as the first-line 'treatment' for young gender dysphorics.
Political arguments based on social justice, civil rights and freedom of expression are convincing and powerful in the public arena. Few mental health professionals would argue against these vital human rights. However, they tend to complicate clinicians' considerations of how to respond to gender dysphoric adolescents and their families.
Parents want to know: "Where does this identity come from?". "What about my child's previous difficulties?" and again, "Will the transition give my child the best chance of a happy and fulfilling life?" Clinicians are ethically bound to honestly represent the uncertainty of the current state of knowledge instead of claiming that body modification is the best, safest and most effective treatment. When a concerned family comes to us they are looking for our science, not our political ideas and beliefs'.
In the UK, Sweden, Finland, Norway, Australia and several US states, even in the Netherlands where the 'affirmative protocol' was invented, the pharmacological approach has long been the focus of serious concern and the debate is well advanced. In Italy, where these 'therapies' are regularly in use, one cannot even know the number of minors in treatment while the social pressure on the adolescents is very strong, in particular the drive to read 'fabulously' as gender dysphoria every psychological disorder, as evidenced by the over-mobilisation of schools to introduce the so-called "career alias". And with few exceptions, the medical profession gives in to the fear of being accused of transphobia.
These important new studies demonstrate the urgent need to open a discussion in the medical profession involving the entire public. It is no longer possible to wait.
Marina Terragni
