Do a very small minority of children need medical and surgical intervention for gender dysphoria?

[ATeamAmy]

Whilst watching an otherwise excellent interview on GB news, where Andrew Doyle interviews barristers Sarah Phillimore and Dennis Kavanagh about the Conversion Therapy Bill, SP said something that concerned me. At 15.40, she says:

"A very small minority of children may need medical and surgical intervention."

Says who, which medical experts have decided any child needs medical and surgical intervention for gender dysphoria and can they be trusted not to be shills for the trans lobby and pharmaceutical companies seeking to capitalise on this trend? On what criteria will this happen? Who are the gatekeepers of this? What about Gillick competence with respect to these cases, will the loophole achieved by the Good Law Project allow parents to impose this on their children? What is to prevent these exceptional rules being exploited once again by the trans lobby?

My view is that nobody as a child (i.e. under 18) should be given any hormone/surgical intervention, and that the only medical intervention they should receive is talking therapy and treatment for any co -morbidities that may be at the heart of the dysphoria. I'm quite concerned about throw away remarks like this being made by the GC side, because the slope is a slippery one, and it does tend to suggest that some children may indeed be affirmed as having been born "in the wrong body"; for why else then, would surgery (no matter how exceptional) be advocated for any child?

link

It wouldn't surprise me if that was the best option for a tiny proportion of children

Unfortunately the whole "trend" has probably made those children hard to identify, meaning outcomes for such children likely to become worse

By tiny I mean a teacher might come across one such child in their whole career

I don’t know. I don’t know whether there is a group of children who have presented “as the opposite sex” since they were so young that detransition would be more harmful to them psychologically than hormones and surgery.

I don’t believe in innate gender incongruence (so I think there’s always something else going on for these children), but the question is whether it can be corrected without serious, avoidable distress.

I would want to see a root and branch review of the whole ‘gender medicine’ space and a deep dive into the causes of dysphoria before I had an opinion.

It wouldn't surprise me if that was the best option for a tiny proportion of children

Why though?

And since when?

When in the entire history of humankind has any child ever, been better off injecting themselves with untested off label drugs, and surgically mutilating a perfectly healthy body?

Since when has this ever been on the table for children?

I’m not sure that there is evidence that medical transitioning is of long term benefit to under 18s.
Let alone risks outweighed by benefit when they are living their lives for all the subsequent decades of being adults (into their elderly years). Unbelievably it does seem this kind of research hasn’t been started or done. Has anybody been asking them as adults how they feel about their childhood transition and transitioned adult life, about their medical conditions caused by the medications and surgeries, the loss of natural fertility, whether their mental health has improved and if so whether they feel that has outweighed the physical side effects caused by transition? the list goes on.

I think there is no evidence of that.

But it may be she did not feel she could categorically say none did, given that some doctors seem to think it's the case.

There have always been people who can't cope and for some of them the treatments might help abs be better than alternative

Most medical treatment have side effects - we give children chemo if it's deemed appropriate

I don’t know whether there is a group of children who have presented “as the opposite sex” since they were so young that detransition would be more harmful to them psychologically than hormones and surgery.

Most gender non conforming children grow to accept their bodies in puberty.

Before the year 2015 "watching and waiting" used to be the acceptable approach because experts weren't captured by the American pharmaceutical drugganaught.

The key word is 'may'. It doesn't mean there ARE a small number, it could be there are none. But 'may' simply acknowledges that the possibility exists.

we give children chemo if it's deemed appropriate

You can't change your mind about having cancer or just grow out of it

Linguini

I think it’s still the only acceptable approach, unless someone comes up with proof that gender identity can be innate, and is able to test for that.

If such children exist at all they are like unicorns. Safest thing is no drugs or surgery under 18.

However, if a young person gets to 16 and their distress is so acute that hormones are the only thing proper psychiatrists (not gender woo doctors) think will work, I think I would support them being able to take the risk.

My issue is that these decisions are being made on nearly no evidence, and for much younger children.

This wasn't about the majority of kids

It was about the possibility that for some it might be the right thing

Closed minds won't help

I think it's that real rare person that has created the space for the whole mess - something weaponised by the pharmaceutical industry

I think in the context of her remarks earlier in the interview she's saying that a small number of children may have gender dysphoria which persists and it may be appropriate to it with medical or surgical intervention as adults, although she doesn't finish the sentence to say that explicitly. I thought she was clear that puberty blockers and cross sex hormones were a bad idea for children so I doubt she'd support surgery in childhood.

We don't allow children to vote. Even though their opinion on which of three choices is thrown in a mixing pot with everyone else in their local area.

How anyone in their right mind can think that children can make suitable life altering choices about their bodies absoloutley baffles me. And makes me mad.

Treat it

Doesn’t she mean may need in future when they are adults though?

I don't think it should be the child's choice

I just won't say it could never be the best thing

My view is that nobody as a child (i.e. under 18) should be given any hormone/surgical intervention, and that the only medical intervention they should receive is talking therapy and treatment for any co -morbidities that may be at the heart of the dysphoria.

I don't think SP disagrees with you. To me, she was using 'children' because she was considering the age at which the talking therapy etc. might commence and looking ahead to the numbers who might exit that (at 18 or older) with a resolution to embrace medical/surgical intervention.

Even if there were a small number, unless we have a physical test that can separate lifelong dysphoria patients from will grow out of it in time dysphoria patients, I don't think it could be ethical to treat. Particularly when we know children are being coached to lie about their history in order to get treatments they think they want.

"First do no harm."

Agreed there

I don’t think any medical professional would treat anorexia by allowing a patient to starve themselves. The treatment is to prevent the physical harm done to the body by the patient’s dysmorphia. Surely, the only appropriate treatment for a child with gender dysphoria is to treat the dysphoria.

With an adult, it might not be so straightforward. I still believe it’s not an appropriate treatment.

There are many anorexic people who die

If you had a less than ideal treatment would it be appropriate

Her comment jarred with me too, OP!

I'm not a doctor. But I'm happy to stick my neck out, and say that NO mental distress requires surgical intervention. None. At any age. Even if a patient asks a doctor to perform a surgery which is medically unnecessary, and is prepared to pay - the answer should be no.

Perhaps she felt that she had to stop slightly short of dismissing the whole trans thing completely? She's a barrister so may have her reasons?

But it's hard to see why she said that. Perhaps she will tell us, if she's on MN?