Summary

In a short debate piece, Kenneth Zucker, a psychologist who led the Toronto CAMH child gender clinic until 2015, argues that socially transitioning a young child (new name, pronouns, presentation) is not a neutral act but a form of treatment. Older follow-up studies found that most children with gender distress who did not transition no longer had it after puberty. So he predicts that early social transition will make it much more likely the distress lasts, often leading to lifelong hormones and surgery. He suggests this could be called iatrogenic, meaning caused by the treatment itself. He asks doctors to respect families' differing views. It is an informed expert opinion and a key statement of the view that social transition is a treatment, but it offers no new data.

Key findings

• Zucker beskriver social transition af børn før puberteten som en behandling beregnet til at reducere kønslidelse, ikke et neutralt eller udelukkende støttende skridt.
• Han argumenterer for, at tidlig social transition sandsynligvis fører til livslang medicinsk behandling: krydskønshormoner og kirurgi.
• Han forudsiger, at social transition ‘dramatisk vil øge’, hvor ofte kønslidelse varer ved, sammenlignet med ældre studier af børn, der ikke transitionerede.
• Han antyder, at denne effekt ‘kunne karakteriseres som iatrogen’, hvilket betyder, at den vedvarende lidelse delvis er forårsaget af selve transitionen.
• Han opfordrer til respekt og forståelse over for forældre, der har forskellige synspunkter om, hvordan man bedst hjælper sit barn.
• Indlægget er en del af en debatserie fra 2020 i Child and Adolescent Mental Health, som også omfattede indlæg af Wren, Minnis, Theodosiou samt Butler og Hutchinson.

Abstract

A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender-affirming hormonal treatment and surgery). Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterized as iatrogenic. Parents who bring their children for clinical care hold different philosophical views on what is the best way to help reduce the gender dysphoria, which require both respect and understanding.

Conclusion

Social transition of prepubertal children should be understood as a psychosocial treatment with likely downstream biomedical consequences; it will probably increase persistence of gender dysphoria relative to earlier follow-up studies and might be characterised as iatrogenic. Parents hold differing philosophical views about how best to reduce their child's gender dysphoria, and these require both respect and understanding.