Zucker: tranziția socială a copiilor mici este un tratament care probabil crește persistența și ar putea fi iatrogen

Dezbatere: fiecare după nevoile lui

Comentarii și analize Desistența în copilărie

Authors: Kenneth J. Zucker
Journal: Child and Adolescent Mental Health
Year: 2020
Source: https://doi.org/10.1111/camh.12330

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 descrie tranziția socială a copiilor înainte de pubertate ca pe un tratament menit să reducă suferința legată de gen, nu ca pe un pas neutru sau pur de sprijin.
El susține că tranziția socială timpurie va duce probabil la tratament medical pe viață: hormoni de sex opus și chirurgie.
El prezice că tranziția socială va „crește dramatic” cât de des persistă suferința legată de gen, comparativ cu studiile mai vechi pe copii care nu au făcut tranziția.
El sugerează că acest efect „ar putea fi caracterizat ca iatrogen”, adică suferința persistentă este cauzată în parte de tranziția în sine.
El cere respect și înțelegere față de părinții care au păreri diferite despre cum să-și ajute cel mai bine copilul.
Articolul face parte dintr-o serie de dezbateri din 2020 din Child and Adolescent Mental Health care a inclus și articole de Wren, Minnis, Theodosiou și Butler și 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.

Methodological limitations

Opinion, not research: This is a two-page debate piece, not a study, and it presents no new data.
A prediction, not proof: The claim that social transition will 'increase dramatically' how often distress lasts is a forecast, based on comparing older groups of children who did not transition with newer data. It is not a fair side-by-side comparison.
Disputed older studies: The older studies it relies on, which found most children grew out of gender distress, used older diagnostic rules, included children who might not be diagnosed today, and lost track of many children. Critics such as Olson et al. (2022) have raised these points.
Author's place in the debate: Zucker led the Toronto child gender clinic, which CAMH closed in 2015 after an outside review. In 2018 CAMH apologised and paid a settlement after errors in that review were found. He has long argued for a 'watch and support development' approach for young children rather than transition first.
Not a full review of the evidence: The piece does not carefully survey the research on social transition. The later Cass Review evidence review (Hall et al., 2024) found the evidence on both benefits and harms was limited and weak.
Full text not read: This record is based on the published summary; the full two-page argument could not be accessed.

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