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 descreve a transição social de crianças antes da puberdade como um tratamento destinado a reduzir o sofrimento de gênero, não um passo neutro ou puramente de apoio.
• Ele argumenta que a transição social precoce provavelmente levará a tratamento médico para a vida toda: hormônios cruzados e cirurgia.
• Ele prevê que a transição social 'aumentará dramaticamente' a frequência com que o sofrimento de gênero persiste, em comparação com estudos mais antigos de crianças que não fizeram a transição.
• Ele sugere que esse efeito 'poderia ser caracterizado como iatrogênico', ou seja, que o sofrimento duradouro é em parte causado pela própria transição.
• Ele pede respeito e compreensão para com os pais que têm opiniões diferentes sobre a melhor forma de ajudar o filho.
• O texto faz parte de uma série de debates de 2020 na Child and Adolescent Mental Health que também incluiu textos de Wren, Minnis, Theodosiou e Butler e 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.