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?

@Linguini

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?

This.

It absolutely is not acceptable nor appropriate nor ethical.

How do you know ?

Further by denying that sometimes it's the best option you leave yourself open to one case "proving " that it's the best for everyone

I don't get the comparison with the treatment for anorexia (upthread)? We don't treat anorexia by lopping off parts of people's bodies.

Unnecessary surgeries/drugs are not 'treatment' (not in my book, anyhow).

Perhaps I've missed the point, but I don't get the comparison. We usually cite anorexia when pointing out that 'affirmation' is a really bad idea.

The answer is no. Because no child can consent to the “treatments”. And no adult can consent on the child’s behalf because they cannot be clearly told what the future holds.

Puberty is an essential part of human development, essential for normal adult health. Despite the huge strain on adolescent mental health services, we manage to keep children safe with supervision plans regardless of their diagnosis. Children with body dysmorphia about puberty are no different to any of the other children.

The “tiny number need it” trope has come from a small number of precocious, articulate, “persistent and insistent” children who woo adults with their apparent clarity of thinking on their futures.

But that was Jazz Jennings, and look how that’s turned out .

@oldwomanwhoruns

I don't get the comparison with the treatment for anorexia (upthread)? We don't treat anorexia by lopping off parts of people's bodies.

Unnecessary surgeries/drugs are not 'treatment' (not in my book, anyhow).

Perhaps I've missed the point, but I don't get the comparison. We usually cite anorexia when pointing out that 'affirmation' is a really bad idea.

Precisely.

The treatment for anorexia is intensive therapy to guide the patient towards accepting their body as it is and to move away from the delusion that their body is in anyway wrong. It also involves delving into underlying causes of their body dysphoria and treating these.

It doesn't involve dishing out slimming pills

Doing the same for gender dysphoria is labelled "conversion therapy". Which is completely backwards.

As we've seen, and as discussed by Marci Bowers, PBs are potentially very problematic even for those who go on to fully 'transition'. I can't see evidence of any benefit to children at all.

If we accept that 80 or 90% of children desist from gender incongruence in puberty, then we are also accepting that a small minority do not. Unfortunately medicine has yet to produce an alternative to hormones and surgery for that minority. This has long been the case and those treatments were traditionally introduced in adulthood. That those remedies are being given earlier is a new issue.

From my understanding of her views I think she is referring to that small group but on the assumption that medical intervention is not given in childhood.

Agree, unwashed. The main issue is scale - whereas gender questioning used to be a rare issue it's become suddenly commonplace, and whereas most children were treated with watchful waiting we're seeing more and more going through medical treatment. If 80-90% would desist but all are treated that means an awful lot of children may end up with lifelong issues caused by unnecessary treatment.

Personally I think if we were able to support children and address homophobia and sex stereotyping the number who would remain still persisting may be even smaller yet.

I can't see evidence of any benefit to children at all.

As far as I can tell PBs serve two purposes

1. A pretence at "reversibility" and not committing to anything
2. Coupled to that, it's not permitted (or even legal?) in many places to give children cross-sex hormones, so they're a substitute.

If, as supposed, one could somehow identify which children would transition as adults, and you think it would be beneficial to perform a "better" transition earlier, it seems quite likely (to this layman) that starting on cross-sex hormones early to have a less disrupted puberty would ultimately be less harmful than using puberty blockers at all.

Although it's still not going to help with the (somehow unexpected!?!?) Jazz Jennings "not enough tissue" problem.

I remain unconvinced that puberty disruption wins any sort of cost-benefit analysis, even for those who would transition as adults.

Even if 10% persist, they still can’t consent at the age of 10-12 to treatments that will lead them infertile, sexually dysfunctional, osteoporotic etc etc. The figure of how many doesn’t matter, it’s consent that matters.

Because even those that persist to adulthood need to be adequately consented that there is evidence that medical treatments won’t help them as adults either (the issued correction to the American Journal of Psychiatry). I think it takes a particular type of medical professional to undertake these treatments knowing what we know.

I remain unconvinced that puberty disruption wins any sort of cost-benefit analysis, even for those who would transition as adults.

Exactly. Children need to go through puberty even if they later choose as adults to 'transition'.

No. Absolutely not. Children should be given proper treatment for their gender dysphoria by psychiatrists and specialists in their main co-morbidities. If we have girls in mainstream schools with an autism diagnosis, then we need as a first try to be meeting their social and sensory needs in a specialist school before steralizing them.

I take the view that if women are are very rarely permitted to be sterilised as contraception because it’s too permeant prior to their late twenties early thirties then we should take the same approach to trans surgeries.

It should be the option of last resort for those who cannot be helped by other options.

@unwashedanddazed

If we accept that 80 or 90% of children desist from gender incongruence in puberty, then we are also accepting that a small minority do not. Unfortunately medicine has yet to produce an alternative to hormones and surgery for that minority. This has long been the case and those treatments were traditionally introduced in adulthood. That those remedies are being given earlier is a new issue.

From my understanding of her views I think she is referring to that small group but on the assumption that medical intervention is not given in childhood.

Agree with the thought that so many desist, then obviously there will be some who persist. It's just that they will have to wait til adulthood for any drugs or surgery. I still see no problem with waiting even for those very few. It used to be that they would "pass" better if given puberty blockers and hormones, however we can easily see that even if started at a very young age, by the time they hit 20/21 they do not pass any more.

Maybe phillimore meant to add as an adult ? Maybe its edited out (I haven't watched the link, no time now)

Probably if one child finds the right way to express the urgency of drugs/blockers that information will be dissembled and more children will find out the right way too.

I feel terrible for those few, but safeguarding and the very real loss of fertility means we cant take chances.

I think that we are pretty well in agreement here that all interventions on young people are wrong. And I would define 'young' as under 25, as the brain is not fully developed until then.

So we are talking adults. And then, I think that more consideration needs to be given to the population of us females, not just those few troubled individuals. Some may be gay, with internalised homophobia. But giving AGPs cross-sex treatments, and access into women's spaces is not fair or just to the rest of us.
If they are unhappy and disturbed with their sexed bodies, then, tough. It's time that they started thinking of us women. Listening to Ray Blanchard on The Mess a while back made this so clear. He had zero interest in the women who were being impacted by these men he was advising to live 'as women' ie to use their facilities. Zero interest.

Listening to Ray Blanchard on The Mess a while back made this so clear. He had zero interest in the women who were being impacted by these men he was advising to live 'as women' ie to use their facilities. Zero interest.

I recall a gay family friend who was advised by his psychiatrist to sleep with women to be absolutely sure that he had no sexual interest in them. (He wasn't consulting the psychiatrist about his sexual orientation to be explicit about this but the psychiatrist decided that this was something that needed to be explored.) The psychiatrist had absolutely no thought to any woman involved and obviously regarded women as service humans in this context.

That was back in the 80s. Ray Blanchard has the same vibe despite it being almost 40 years on.

This is a tricky question.

I don't think any child ever needs to be set on a path of medical interventions to alter themselves in this way. I don't think "trans children" exist. Children are children and can express themselves however they please and sensible adults should be carefully guiding them and protecting them through it all.

Adults? Well, if you're mucking about making yourself look like a cat or whatever, I think that you've got issues but, whatever, it's your money and your life. You're an adult now so crack on as you please.

However, trans identified men do not want only to surgically alter their appearance, they want a slew of "rights" that impact upon half of the population. Most without surgery anyway. It's not as simple as getting surgery to make yourself feel better about your outward appearance.

Man who thinks he's a cat and gets whiskers implanted in his cheeks doesn't encroach upon the lives and rights of catkind.

Man who thinks he's a cat and gets whiskers implanted in his cheeks doesn't encroach upon the lives and rights of catkind

Excellent point Grombles

1. I'm pretty sure that SP only meant older children, with parental consent for severe GD cases- in line with UK medical practice after the high court ruling. So we aren't talking about cross sex hormones before 18.

1. It's not a decision any of us are qualified to make. It's absolutely OK for us to campaign against Mermaids pressuring the medical establishment, against amateurs pushing transition, for better access to talking therapy and for evidenced based care rather than guesswork; but the final decision belongs to medical professionals.

At the moment the broad consensus is that PBs followed (in adulthood) by medical transition is sometimes the best treatment. I hope one day that won't be needed but we can't claim to know better than the medical profession (as opposed to pointing out individuals who go beyond the evidence).

In my uneducated opinion it’s a mental illness and should be treated as such.

With therapy not surgery.

It’s odd. I had horrendous body [partly gender] dysphoria as a teenager, but I kind of muddled my way through - and looking back, I think that’s part of puberty. I have no doubt that if I was growing up now, I would be trans, identifying as male. I was horrified that my hips widened, hair appeared in places there’d been none before, a couple of melons grew from my chest area - I didn’t want any of it, to the point suicide crossed my mind more than once. I thought everyone felt that way during puberty.

But for most, I don’t think medical options are the way to go. In psychiatry it’s never considered a good idea to indulge or confirm delusional thinking. This is no different. I think it’s important that teenagers experiencing these issues have talking therapies, to help them accept that they are the sex they are, and that it’s not scientifically possible to change sex. In my opinion, most could come out the other side far happier, and self-accepting.

For a small percentage who have continued, persistent gender dysphoria, then maybe medical transition should be considered. To me, that’s the conversion therapy, and it should be the last resort.

Joan Collins wrote a great piece about the effect puberty had on her.

Not even a small minority of children need their health wrecked and their life shortened by blockers and hormones, or their tits or balls cut off.

Did I even have to say that?

I still disagree

If you did have a child who was so anorexic that you expected them to die within hours, for which no cure would be possible , and that they would live if they were sterilised - would you then say no?

There almost certainly is a tiny fraction of trans identity children for whom that is necessary

I would agree that until we have proper ways of proving and testing for this condition we should steer well clear

I would agree that none medical solutions are far better

I would agree that the current presentation of children as trans is so high that a blanket ban is an absolute must to protect as many as possible

I would also agree that the current social media knowledge makes is more likely that children will be pushed over an edge from which return becomes impossible- that people suggesting it as a solution may be harming children minds

But I can't agree that it is never ever the best thing to do