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 將青春期前兒童的社會性過渡描述為一種旨在減輕性別困擾的治療，而不是中立或純粹支持性的步驟。
• 他主張，早期的社會性過渡很可能導致終身的醫療處置：跨性別荷爾蒙和手術。
• 他預測，與較早期對未過渡兒童的研究相比，社會性過渡將「大幅增加」性別困擾持續的頻率。
• 他提出這種效果「可能被描述為醫源性的」，意思是持續的困擾有一部分是由過渡本身所造成的。
• 他呼籲對於在如何最好地幫助孩子上持有不同看法的家長，給予尊重與理解。
• 這篇文章是《Child and Adolescent Mental Health》2020 年辯論系列的一部分，該系列還包括 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.