Medical Ethics and Pediatric Medical Transition for Gender Dysphoric Youth
NEWS LINKS
Recently there have been many more health professionals, and others, who have been critiquing the pros and cons of pediatric medical transition, and the benefits of medical transition overall, to gender dysphoric people. We are updating these links to be tagged to our section on medical ethics for those who are interested in researching and understanding health and psychological consequences of transitioning minors.
QUESTIONING MEDICAL ETHICS
1) Dr. James Cantor has written a critique of The American Academy of Pediatric’s guidelines on treating gender dysphoric youth. These guidelines ignore desistance statistics and support full social and medical transition for minors. Link to both the paper and a podcast interview below.
Dr James Cantor, clinical psychologist and sexologist, talks to Jonathan Kay about his recent peer-reviewed critique of the American Academy of Pediatrics’ guidelines on treating trans children.
2) Sky News has covered the ethics topic and the fact that therapists can not provide therapy to youth beyond fully affirming them as trans.
“NHS 'over-diagnosing' children having transgender treatment, former staff warn:”
Thirty five psychologists have resigned from the children's gender-identity service in London in the last three years, Sky News research suggests.
Sky News- clip of Dr. Evans:
Dr Marcus Evans resigned from the Tavistock & Portman NHS Trust over concerns about its gender identity service. He questions how a child of 11 can consent to treatment that will 'profoundly effect' their physical and psychological well-being.
3) Below is an article written by Marcus Evans about his deep misgivings about transitioning minors and the affirmative model.
A similar article exists on Medscape.
“UK Gender Identity Service at Crunch Point as Pressure Mounts”
4) Another article on the Tavistock gender clinic in the UK was published in The Telegraph.
5) This is an article about another British psychologist.
“Transgender Children: 'The concept of being born in the wrong body is troubling'“
6) A former Tavistock employee is bringing a legal case:
Children cannot consent to transgender treatment, a nurse bringing a landmark legal case has said, claiming that many are autistic, homosexual or just confused.
Susan Evans, 62, a former psychiatric nurse at the Tavistock and Portman NHS foundation trust, said that “experimental” and “invasive medical treatment” should be prevented in order to protect children.
7) The Economist has printed an article on the possible dangers of pediatric medical transition and the use of hormone blockers. GHQ covers some of those risks here.
“What to do about puberty blockers”
8) The increase in and complexity of gender dysphoria cases are making ethical decisions more difficult and some Australian health professions believe there are problems with the quality of a new study in Australia designed to track outcomes in trans people.
Our specific ethical concerns centre on whether the ‘informed consent’ offered to parents and their children reflect the rapid advances in complexity and uncertainty that have been reported in recent studiesiv,v,vi
9) Below are three links on The BMJ.
“Family doctors lack training and feel under pressure to prescribe, finds Sally Howard”
“The struggle for GPs to get the right care for patients with gender dysphoria:”
I am concerned to see yet another article in the BMJ trying to persuade GPs to get involved in prescribing for patients who express a desire to be the opposite sex. I am concerned at the journal’s editorial bias on this issue at a time when, as the article says, the number of young people wanting referrals to gender identity clinics because of gender issues has risen hugely and we are reading and seeing more cases of detransitioners who start going down the gender changing pathway and then regret it.
And a response from a parent is linked.
10) Sasha Ayad is a therapist who supports mental health exploration for gender dysphoric teens.
“What does the word transgender mean?”
11) A psychiatrist, David Bell, is having to deal with legal fees for having raised alarms about what has been happening with the NHS in Britain, indicating there is a price to be paid by whislteblowers.
12) Some individuals have filed complaints against a plastic surgeon who posts pictures of young people who have had mastectomies along with pictures of biohazard buckets full of breast tissue for marketing purposes.
“News Release: Complaint Filed Against Gender-Affirming Surgeons:”
A coalition including Canadian Gender Report, Parents of ROGD Kids, Canadian Women’s Sex-based Rightsand GNC Centric have submitted a complaint to the College of Physicians and Surgeons of Ontario about the McLean Clinic and two of its physicians: Dr Hugh McLean and Dr Giancarlo McEvenue.
13) This paper (Steensma 2017) reviews the difficulties in these types of cases.
Abstract
Our analysis focuses on the importance of balanced decision making when counseling and treating adolescents with nonconforming gender identities. We argue that clinicians’ communicating appropriate expectations about the effectiveness and limitations of hormone therapy and the risks of psychological and physical iatrogenic effects is critical.
14) This is a translated version of a German presentation about the ethics of transitioning minors.
THE AFFIRMATIVE MODEL
1) This is a pro affirmative model paper that doesn’t express concern that social transition could lead to inappropriate medical transition and argues transition should be allowed.
“Importance of being persistent. Should transgender children be allowed to transition socially?”
2) The below paper promotes the informed consent model, stating any gatekeeping is unethical:
“Gatekeeping hormone replacement therapy for transgender patients is dehumanising”
3) It appears therapists in the Seattle area actively encourage trans identification, even when a lesbian is attempting to detransition (see 56:00):