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 beschrijft sociale transitie van kinderen vóór de puberteit als een behandeling bedoeld om genderklachten te verminderen, niet als een neutrale of louter ondersteunende stap.
• Hij betoogt dat vroege sociale transitie waarschijnlijk tot levenslange medische behandeling leidt: cross-sex hormonen en operaties.
• Hij voorspelt dat sociale transitie hoe vaak genderklachten aanhouden 'dramatisch zal doen toenemen', vergeleken met oudere studies van kinderen die niet transitioneerden.
• Hij suggereert dat dit effect 'als iatrogeen kan worden gekarakteriseerd', wat betekent dat de aanhoudende klachten deels door de transitie zelf worden veroorzaakt.
• Hij pleit voor respect en begrip voor ouders met andere opvattingen over hoe hun kind het best kan worden geholpen.
• Het stuk maakt deel uit van een debatreeks uit 2020 in Child and Adolescent Mental Health die ook bijdragen van Wren, Minnis, Theodosiou, en Butler en Hutchinson omvatte.

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.