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

• زاکر گذار اجتماعی کودکان پیش از بلوغ را درمانی با هدف کاهش ناراحتی جنسیتی توصیف می‌کند، نه گامی خنثی یا صرفاً حمایتی.
• او استدلال می‌کند گذار اجتماعی زودهنگام احتمالاً به درمان پزشکی مادام‌العمر می‌انجامد: هورمون‌های جنس مخالف و جراحی.
• او پیش‌بینی می‌کند گذار اجتماعی بسامد ادامهٔ ناراحتی جنسیتی را در مقایسه با مطالعات قدیمی‌تر کودکانی که گذار نکردند «به‌طور چشمگیری افزایش» دهد.
• او پیشنهاد می‌کند این اثر را «می‌توان ایاتروژنیک خواند»، یعنی ناراحتی پایدار تا حدی از خود گذار ناشی می‌شود.
• او خواستار احترام و درک نسبت به والدینی است که دربارهٔ بهترین راه کمک به فرزندشان دیدگاه‌های متفاوتی دارند.
• این مقاله بخشی از مجموعهٔ بحث 2020 در Child and Adolescent Mental Health است که مقاله‌هایی از رن، مینیس، تئودوسیو، و باتلر و هاچینسون را نیز شامل بود.

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.