By Gabriel Arruda de Castro*
The logic of gender transition advocates is that the only way to avoid a high risk of suicide among young people with gender dysphoria (a sense of inadequacy with one’s biological sex) is to inject hormones that block puberty and, later, to perform sex reassignment surgeries – measures that are termed “gender affirmation.”
Until recently, challenging such dogma was considered the equivalent of putting one’s life at risk.
But the cracks in these pillars are increasingly evident.
While new research questions the effectiveness of the “affirmative” approach, European countries that pioneered the implementation of such measures as policies aimed at gender transition are now adopting a more cautious stance.
ASSUMPTIONS CALLED INTO QUESTION
Scientific studies on how best to deal with gender dysphoria are far from building a consensus, which takes decades.
Since the literature on the subject is relatively recent, the debate is open.
Gazeta do Povo analyzed articles published in scientific journals dealing with gender transition from 2021 to now and found questioning the two studies on which the defense of “affirmative” therapies is based – both were done in the Netherlands and published in 2011 and 2014 by Annelou de Vries.
According to her, puberty blockers, accompanied by sex reassignment surgery, are effective in improving the mental health of young people with gender dysphoria, which would imply a reduction in the number of suicides.
This is the foundation of the thesis that if a young person has a mismatch between their biological sex and their subjective identity, the best thing to do is gender transition rather than treat the psychological or psychiatric condition.
But the studies (the second of which involved 55 people) are problematic – starting with the fact that the only attempt to replicate the experiments, by British researchers, was unsuccessful.
An article published in the Journal of Sex & Marital Therapy in January of this year points out serious flaws in the methodology of De Vries’ gender transition surveys.
“These Dutch studies suffer from such profound limitations that they should never have been used as a justification for promoting these interventions in general medical practice,” the article says.
According to the three scientists who signed the article, the Dutch researcher and her colleagues selected only successful cases to include in the study.
Furthermore, the study would have been done so that it is impossible to know whether the improvements in mental health are due to sexual reassignment or psychotherapy.
A few months before this new article, in a letter published in the Journal of the American College of Clinical Pharmacy, a group of five researchers called attention to the lack of evidence in favor of the effectiveness of puberty blockers in adolescents.
They warn of the possibility of damage to neurological development and emphasize that this approach chains the child or adolescent to a gender identity that could be temporary.
“Over 95% of young people treated with GnRH analogs [a hormone that releases gonadotropin and has the ability to stop puberty] go on to receive hormones of the opposite sex.”
“On the other hand, 61 to 98 percent of those treated with psychological support alone reconcile their gender identity with their biological sex during puberty,” the researchers state.
“Several European countries that pioneered medical transition for young people are now taking a more cautious approach to using GnRH analogs and opposite-sex hormones after their own evidence reviews showed no mental health benefits and demonstrated a profound lack of knowledge about harms,” the study says.
In a paper published in 2021, psychiatrist Alison Clayton of the University of Melbourne goes in the same direction.
She argues that supporters of “affirmative” therapies overestimate the evidence in favor of the method they advocate.
She states that there is a worrying trend in the literature on gender dysphoria: the overvaluation of the evidence in favor of sex reassignment therapies.
Moreover, she points out findings contrary to the practice that receive far less prominence than those in the other direction.
Another field in which the scientific literature has advanced is the correlation between gender dysphoria and autism.
The data are already known: in 2010, an article showed that 7.8% of children and adolescents with gender dysphoria have autism, compared to 0.6% of the rest of the population.
Another 2016 study showed that 23% of patients with gender dysphoria had Asperger’s Syndrome.
Moving on from studies that pointed to a correlation between autism and gender dysphoria, a new paper published in the scientific journal Autism found that a diagnosis of gender dysphoria was more common among autistics with lower family support.
In other words: social factors may explain at least part of the cases of this dysphoria.
Countries rethink their position on gender transition
In recent months, some European countries have backed off their policies supporting the combination of puberty blockers and sex reassignment surgeries.
Sweden, the first country to legalize sexual reassignment, decided last year to increase the strictness with such interventions on minors. Hormone therapies have been stopped except in extreme cases.
The Swedish Medical and Social Assessment Committee (SBU), which acts as a regulatory agency, found no evidence that hormone treatment benefits mental health.
In May 2021, Karolinska University Hospital in Stockholm had already banned the use of puberty blockers.
Also, a year ago, the French National Academy of Medicine passed a resolution (by 59 votes to 20) that shows concern about the sudden increase in demand for such interventions, especially among adolescents.
The document further states that “there is no test to distinguish between persistent gender dysphoria and transient adolescent dysphoria” and that “the risk of over-diagnosis is real, as evidenced by the increasing number of young adults who wish to undo their transition.”
The UK has adopted a similar stance. Last year, the British government decided to close the doors of its only gender clinic, Tavistock.
The clinic opened its doors in 1983.
In recent years, the number of attendances had jumped rapidly: from 138 in 2010 to 2,383 between 2020 and 2021.
In 2020, the clinic gained the spotlight when Keira Bell, a woman who underwent sexual reassignment when she was a minor, sued Tavistock in court.
Pediatrician Hilary Cass, who once chaired the prestigious Royal College of Paediatrics and Child Health, investigated the clinic’s problems and wrote a report suggesting that the site be closed – which was welcomed by the National Health System (NHS), the UK’s healthcare system.
The idea is to create a network of local support centers offering “fundamentally different” treatment.
In her report, Hilary Cass mentions problems such as the “lack of clear written justification for decisions made in individual cases” and the fact that staff “felt pressured to adopt an ‘affirmative’ approach without asking questions.”
She also mentions that “there is a lack of consensus and open discussion about the nature of gender dysphoria and, therefore, the appropriate clinical response.”
“These countries are doing a literature review and seeing that the number of regrets has increased a lot,” says physician Raphael Câmara, Secretary of Primary Health Care in the Bolsonaro administration.
“We have no way of knowing a priori who will repent or not. The earlier the diagnosis is given, the more cases of repentance there are,” he adds.
When the Federal Council of Medicine (CFM) discussed the issue, Câmara defended that the cross hormonal treatment (with hormones from the opposite sex) should only be authorized after age 18 and the surgery at 21.
He ended up defeated. The limits approved by the CFM are 16 and 18 years old, respectively.
BREAKING THE SILENCE
European countries that have been rethinking their approach to gender dysphoria among young people cannot be defined as conservative.
Nor does the label apply to The New York Times, a symbol of the so-called “progressive” mindset in the United States.
Nevertheless, earlier this year, the newspaper was the target of a public letter from LGBT activists and employees of the newspaper itself.
The reason: the newspaper would be giving space to transphobic voices that raise questions about the effectiveness of puberty blockers – even if in a timid way.
One of the criticized articles showed stories of students who adopted a new gender identity without their parents knowing.
Another article coyly showed that irreversible therapies applied to teenagers could bring sequelae.
A third had the innocuous title of “Doctors debate whether trans teens need therapy before hormones.”
That was enough for activists from GLAAD, a powerful NGO that claims to defend LGBT rights, to demand that the newspaper stop “publishing biased anti-trans reporting.”
But in an internal statement, the newspaper has given no sign that it will change its coverage of the issue.
*special for Gazeta do Povo
With information from Gazeta do Povo