Gender-Affirmative Treatment

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Benefits, Harms and Uncertainties of the Gender-Affirmative Treatment


"Historically, medical interventions to achieve the appearance of the desired sex were reserved primarily for adults with long histories of dysphoria. Medical interventions were preceded by a prolonged engagement with the patient, including thorough psychological assessments. While the population-level data on the benefits of adult gender transitions undertaken in prior decades remain mixed, with evidence of persistent mental health struggles and sharply elevated mortality and morbidity, a number of individuals who underwent gender transition following rigorous assessments have reported being very satisfied with their decision to transition, do not regret it, and live happy and productive lives.

However, around 2010's, there was a marked change in the approach to the management of gender dysphoria. A number of countries in Western Europe, North America, and Australia, began to promote the "gender-affirmative" model of care for youth. Under this model of care, young people presenting with gender dysphoria or asserting a transgender identity are affirmed in their desire to undergo gender transition, and are provided with hormonal and surgical interventions. While mental health professionals are often involved, their role is typically limited to preparing the young person for gender transition, regardless of the co-occurring mental health challenges or the relatively recent history of transgender identification. As such, the provision of medical intervention now happens with a much-reduced psychological assessment.

In the last 24 months, a growing number of Western European countries have recognized the significant concerns with the "gender-affirmative" model of care, which became visible, in part, due to the growing voices of detransitioners and regretters coming from the novel population of gender-dysphoric youth. As of the current writing, Sweden has made the decision to no longer offers gender transition to minors outside of clinical trials. Finland has sharply restricted eligibility for gender transition to minors with a classic, early childhood-onset of gender dysphoria and no mental health comorbidities, and stated that psychotherapy should be the first line of treatment. The UK appears to be moving in a similar direction, according to the recent Interim report. The National Academy of Medicine in France has signaled a move in the same direction in their recent announcement. The Royal Australian and New Zealand College of Psychiatrists (RANZCP) issued a set of guideline calling for psychotherapy to be the first line of treatment for gender dysphoria in youth.

In North America, a number of individual states have begun to pass laws to ban gender reassignment of minors, which have proven contentious. At the Federal level, however, the US continues to assert that "gender-affirming" care is safe and effective, despite the findings of multiple systematic reviews of evidence that found the benefits of gender transition for minors are highly uncertain, while the risks may be significant. Specifically, if the Endocrine Society's treatment guidelines for gender-dysphoric youth are followed, a minor's future sterility is likely. Other health risks include compromised bone health, altered brain development, cardiovascular complications, and a number of other, as yet unknown, risks."