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将青春期前儿童的社会性过渡描述为一种旨在减少性别痛苦的治疗，而不是中立或纯粹支持性的步骤。
• 他认为，早期的社会性过渡很可能导致终生的医学治疗：跨性别激素和手术。
• 他预测，与较早的、儿童没有过渡的研究相比，社会性过渡将“大幅增加”性别痛苦持续的频率。
• 他认为这种效应“可能被描述为医源性的”，意思是持续的痛苦部分是由过渡本身造成的。
• 他呼吁尊重和理解对如何最好地帮助孩子持有不同看法的家长。
• 这篇文章是《Child and Adolescent Mental Health》2020年辩论系列的一部分，该系列还包括Wren、Minnis、Theodosiou以及Butler和Hutchinson的文章。

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.