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 menggambarkan transisi sosial anak sebelum pubertas sebagai perawatan yang dimaksudkan untuk mengurangi tekanan gender, bukan langkah netral atau semata-mata suportif.
• Ia berargumen bahwa transisi sosial dini kemungkinan mengarah pada perawatan medis seumur hidup: hormon lintas-seks dan operasi.
• Ia memperkirakan transisi sosial akan 'meningkatkan secara dramatis' seberapa sering tekanan gender bertahan, dibandingkan dengan studi lama tentang anak yang tidak bertransisi.
• Ia menyarankan efek ini 'mungkin dapat disebut iatrogenik', artinya tekanan batin yang bertahan sebagian disebabkan oleh transisi itu sendiri.
• Ia menyerukan penghormatan dan pengertian terhadap orang tua yang memiliki pandangan berbeda tentang cara terbaik membantu anak mereka.
• Tulisan ini adalah bagian dari seri debat 2020 di Child and Adolescent Mental Health yang juga mencakup tulisan oleh Wren, Minnis, Theodosiou, serta Butler dan 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.