GENDER DYSPHORIA - FACTS AND INFORMATION
No one is born in the wrong body - There is no biological explanation
It is often claimed that transsexuality has a biological basis, due to an atypical hormonal exposure in the womb, which would cause transgender brain structures to have characteristics more similar to the ‘perceived’ sex than the ‘assigned’ sex. There is no evidence to support this, and it is contradicted by all clinical science and experience. Worth mentioning is the insight gained from studying DSDs (Disorders of Differences of Sex Development). For example, female babies born with congenital adrenal hyperplasia (CAH), a condition that exposes the developing baby to high levels of male hormones, often exhibit typically masculine preferences and behaviours. Several possible explanations for this phenomenon have been proposed that are independent of prenatal exposure to the male hormone. Importantly, the vast majority of affected children with CAH have not experienced transgender identity or gender dysphoria in the past.
The lack of a sustainable biological basis for transgender identity is best demonstrated by studies with identical twins, which show that when one twin develops gender dysphoria, it only occurs in 28% of both, despite the fact that they have identical genes.
Claims about structural similarity of the brain are myths and are refuted by technically advanced methods in morphological studies with transgender and control groups.
There are static differences between the brains of men and women. For example, male brains are on average 10% larger than female brains. Women have a higher density of “grey matter” (abundance of neural cell nuclei) and correspondingly the volume of “white matter” (abundance of non-neuronal glial cells, in particular “myelination” of neurons) is greater in men. The cerebral cortex of men is thinner than that of women.
Extensive research has been done on human brains with so-called Functional Magnetic Resonance Imaging (fMRI) . The conclusions were that the variability in each region, ‘nucleus’, was so great that it is impossible to say that this region shows that this brain belongs to a man or a woman. Nevertheless, deep learning computer programmes can see with 93% accuracy that there are two brain classes, male and female.
In trans women (born male), differences in brain morphology were found with the control group, but the differences observed were identical to those for gay men and were not comparable to the morphology of female brains. A similar relationship was seen between trans men (biological women), lesbians and a control group of women. Thus, scanning imaging can determine gender from brain morphology but not gender identity.
Similar studies have been done on changes in brain structures for different professional occupations. For example, a long-term study of comparison between stewardesses (airplane) and taxi drivers showed that occupation over time can have a major impact on the size of brain structures, such as the hippocampus, a brain structure known to be crucial for memory processing and spatial orientation. Studies of various mental disorders (e.g. schizophrenia, depression, sleep deprivation) also show significant differences from control groups.
Differences in brain morphology of individuals suffering from gender dysphoria compared to control groups is also likely to be influenced by differences observed for different psychiatric disorders and psychological stress. In summary, there is no evidence that the transwomen’s brain is more similar to the control group’s female brain, nor are there corresponding differences in the transmen’s brain.
In children, the brain is not fully developed and is programmed to change with age, genetically and with exposure to sex-specific hormones. During puberty, testosterone in males causes the cerebral cortex to become thinner than in females and then ‘male’ in its characteristics. This means that before puberty, there are no details about how the brain will develop during and after puberty (up to 25 years). It is therefore impossible, even theoretically, to use fMRI in children to conclude whether the child is suffering from gender dysphoria or from other psychological/psychosocial problems.
Perhaps even more important than the above is the following article, which describes the striking similarity between Anorexia and gender dysphoria:
Gender Dysphoria and Changes in the Resting State Networks
It is becoming increasingly evident that Gender Dysphoria is not a case of having an opposite sex gendered brain in your body—a belief with no basis in science or logic. Instead, evidence points to connectivity within the Resting State Networks of the brain to explain why some feel that they are the opposite of their actual sex. Namely, research indicates that, with gender dysphoria, as with anorexia nervosa and other body dysmorphia disorders, there are visible connectivity changes within the Default Mode (DMN) and Salient (SN) Networks, which are believed to be the neurological basis for the sense of self.
In their study of brain morphology and on the possible neurobiological underpinnings of Gender Dysphoria, Savic et al conducted a study of brain differences in individuals that expressed gender dysphoria. What they found is that the brain morphology of gender dysphoric individuals was indistinguishable from their natal sex, once adjusted for homosexuality (interestingly, there were differences noted between homosexual and heterosexual individuals). There were changes, however, in gender dysphoric individuals, not in the brains themselves, but in the neuroplastic connectivity networks responsible for “mediating self–body perception”— showing decreased communication in individuals with dysphoria. Because of these connectivity changes, they noted that they were unable to determine that gender dysphoria is innate, or if instead, it is the result of long-term rumination.
Similar findings have been made in studies of anorexia patients. Similar to the gender dysphoria studies, researchers found that there was weakened functional activity in the DMN, and microstructural abnormalities in fronto-occipital brain structure in patients with anorexia, a disorder that has, at its root, a similar disconnect between the image of self and the body, in this case, body weight and size, rather than gender. These disorders appear to be more similar than activists would have us believe, and both involve a disconnect between biological reality and self that is observable within the brain.
In the case of both gender dysphoria and anorexia, the cause and effect is unclear— did a mental disconnect in the subjects, between “their own body image and perception of self”, potentially due to rumination and social influences (known causal factors for both ailments), subsequently lead “to a weakening of the structural and functional connections in these networks”, or did weakened connections and decreased connectivity create the chasm or dysphoria in the person’s sense of self? More study is needed to address the root causes. However, it is clear that disrupted neural pathways can disrupt the sense of self and lead to a variety of distressing conditions.
However much activists would like to believe that these afflictions are different, the brain says otherwise. The commonalities between Anorexia and Gender Dysphoria patients are so evident, that it is striking that this is continually overlooked by researchers. Equally striking, however, are the very different ways that these two disorders are treated, because the common root cause or symptom is being overlooked. Anorexia is treated through psychological care, whereas gender dysphoria is currently treated through affirmation and medicalization to support the disordered thinking. These divergent treatment protocols are baffling. Physicians and psychologists treating eating disorders never affirm the observably false idea, caused by the disruption in accurate body perception, that the patient is overweight, and it is known that eating disorders can be resolved by following this approach, in combination with supportive medical care. With gender dysphoria, however, the school of thought is to agree with the patient’s observably false perception of self and to undertake medical and psychological treatments that further enhance the dysphoria.
Now, when wrong sex hormones are introduced into these individuals with mental dissociation, neural networks are further disrupted by this chemical intervention. As the study by Clemens shows, males treated with hormones showed decreased connectivity between the left frontoparietal cortex and the left dorsolateral prefrontal cortex. In other words, the hormone interventions decreased communication pathways in unintended ways in the brain. One might say that this has the effect of further deepening the body perception disorder, rather than working to resolve it. Not a desirable effect!
See also: No such thing as the wrong puberty
Causes - Self-image as a cornerstone
If we are to be able to say anything meaningful about gender dysphoria, we must look for what lies at the root of it. The difficulty with the aetiology is that no single factor has been found to determine gender dysphoria. Instead, gender dysphoria is generally regarded as a multifactorial disorder involving both psychological and biological aspects.
To get a handle on it, one can divide it into three different types of gender dysphoria, distinguishing between the differences in the age of onset (childhood, adolescence or adulthood), the speed of onset (gradual or sudden) and the corresponding sexual orientation.
Type 1 – Childhood gender dysphoria
This type, which starts in childhood, affects both boys and girls. Most of them will be attracted to homosexual relationships in adolescence and adulthood. Risk factors that persist with this type of gender dysphoria are socioeconomic status and autistic traits (obsessional thinking).
Type 2 – Autogynephilic gender dysphoria
Occurs almost exclusively in men. It is associated with the tendency to become sexually aroused by the thought or image of oneself as a woman. This type of gender dysphoria begins in adolescence or adulthood, and the onset is usually gradual.
Type 3 – Rapid-onset gender dysphoria (ROGD)
This is a recent phenomenon responsible for the current epidemic of gender dysphoric young people. It is striking that they had no sign of gender dysphoria as young children. The vast majority of them are adolescent and young adult women. Before the onset of their ROGD, they do not see themselves as heterosexual. Social contamination is very real, leading them to believe that they are transgender and that this was the hidden cause of their problems. In addition, a large comorbidity of certain psychiatric problems, especially aspects related to borderline personality disorder (e.g. non-suicidal self-harm) and mild forms of autism, were found to be present. Extensive information can be found in the published studies of Lisa Littman.
Of course, this is only a division to make it more understandable, which means that types are never rigidly defined. For example, where a person of type 1, ‘childhood gender dysphoria’, overcame this previously in adolescence, they do not remain immune to the current social contagion and social acceptance, so they persist. If the challenge fades, why should it change its mind?
The list below represents the most common causes:
- Autogynephilia (a heterosexual man who becomes sexually aroused at the thought of himself as a woman)
- Rejection of one’s homosexuality (for example, preference to live as a trans woman, attracted to men)
- The consequences of concrete thought processes characteristic of autism spectrum disorder (e.g., I don’t like dresses, therefore I must be a boy)
- Protective mechanism to prevent repeated sexual trauma
- Due to stress from simply not fitting into society’s stereotypical expectations of gender roles
- Vitim of bullying
The above division and enumeration of possible causes does not necessarily make it more insightful. One soon gets lost in the multitude of listings and lacks a well-founded explanation. Also, the temptation arises to assign people to one or the other category, which does them an injustice, and creates an illusion of real and false trans people.
Therefore, it is interesting to point out a common ground, that gender dysphoria is rather a signal, indicating that an underlying problem needs to be addressed and that resilience and self-acceptance need to be built up. The lack of self-acceptance is the basis of gender dysphoria, and this is correlated with our self-image. The thoughts we form about ourselves make up how we experience life. However, self-image has nothing to do with gender identity. Gender identity is propagated by the trans lobby as an immutable characteristic that matters more than biological sex. This is fiction, and cannot be scientifically justified in any way. Spreading this idea is reprehensible, because it pushes people towards transition and causes irreparable damage.
Mainly, the development of our self-image takes place unconsciously, and is determined by fitting in with our sensitivities, predispositions and limitations in the environment in which we end up. Our self-image is never a representation of reality, or how others see us. We look, as it were, through a coloured lens. Perhaps we can best understand this as the field of tension between our inner experience and the outside world. When we become too aware of our self-image, or in other words, identify with this self-image, it becomes a source of conflict and self-criticism. It isolates us, and makes us inaccessible to impulses from the unconscious and the environment. This hyper-reflection, or fixed identity, is a universal fact that forms the basis of much human suffering. Hyper-reflection opens the way to delusions, i.e. the projection of the imaginary world onto the real world, and this is the very essence of gender dysphoria! People tend to believe what they think is right, regardless. The useful is good, the desired is right, the desired is real. That mantra is at the root of every delusion, which makes it so difficult to recognize.
Interesting is the definition of delusion described by Huub Mous:
The delusion is a transformation of reality into a form of indulgence whose function is to remove obstacles that structurally stand in the way of a goal that is considered necessary. It is therefore an erroneous, but not infrequently efficient ‘out-of-the-box solution’ for a problem deemed insoluble, which has created a structural sense of unease.
Back to Reality – Letting Go as Salvation
We can get stuck in our thinking and feeling, so that reality is no longer perceived objectively. Recovery should focus on the way back, in relation to ourselves and reality. Liberation lies in self-acceptance. This is coming home to ourselves and knowing ourselves connected.
The philosopher Ype de Boer has illustrated this beautifully from the stories of the Japanese writer Murakami. With a video of less than three minutes long, ‘What the writer Murakami teaches you about life’, the essence is presented in a nutshell.
What does Murakami tell us about life? If you would summarise it in one sentence, it would be that we have to form our own identity, or find an authentic self, that we have to become who we are, that we have to let that go.
If we look at the main characters at the beginning of his stories, we get the idea that these people do know who they are. That they have built a stable image of themselves, and have created a life in which they have an overview.
But as constant as that starting position is the problematisation of it. It is precisely these people who have arranged their lives in this way, in comfort, routine, self-protection, that something happens to them which creates a gap between the old life, who they thought they were, and the person they are now, or what life offers them now.
How do they deal with this? How do they deal with the experience of being split?
There are 3 options, all of which occur.
- Denial: Either they cling even more to the old self. Or they try to deny the crisis, go back to the way it was.
- Rebirth: Or they experience that moment as a crisis, a phase they have to go through, in order to become a new person, just as stable as before, but just a little bit different.
- Acceptance: Or, and this is the final option, which emerges with Murakami – they learn to embrace that split. They learn to let go of the whole idea that you have to be someone, that stability is so important. Because only when we don’t try to match the image that we have made of ourselves, or that someone else may have made of us, only then is there room for difference, for desires that go beyond your status quo, is there room for love, for someone else to influence your life, instead of that other person who only has a function in reinforcing that image and that life you already had. If we learn to keep the right distance from that idea, and of course those images continue to play a role in our lives, only then will there be enough space to actually allow new things to happen.
It is clear that only in the third option do we become free, become human in the full sense of the word. If gender care really is care, then it must be clear that these people need to be guided towards self-acceptance, and not into denying reality and confirming a problematic self-image.
Gender clinics ignore key studies - Medical treatment offers no benefit in terms of mental well-being and suicidality
Gender clinics prefer medical treatment, arguing that waiting longer is more dangerous and damaging, and mentioning suicide and mental wellbeing. In doing so, they are guilty of ignoring important studies.
- On January 2, 2023, there was the publication, “The Myth of Reliable Research in Pediatric Gender Medicine“, focuses on the two Dutch studies that gave rise to “gender-affirmative” care for youth worldwide. The authors convincingly demonstrate that rather than “solid prospective research” the Dutch research suffers from profound, previously unrecognized problems. These problems range from erroneously concluding that gender dysphoria disappeared as a result of “gender-affirmative treatment,” to reporting only the best-case scenario outcomes and failing to properly examine the risks, despite the fact that a significant proportion of the treated sample experienced adverse effects.
- The American Journal of Psychiatry (August 2020) published an extraordinary correction to a Karolinska Institute publication (Bränström & Pachankis 2019), which claimed to be the first to provide evidence of the long-term mental health benefits of biomedical treatment for adults. After correction, it was concluded that neither hormones nor surgery provide any benefit in terms of long-term mental health and suicidality. This is the largest objective study of its kind to date with fully recorded patient health data.
- In a recent study (Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom – January 18, 2022) from one of the world’s largest pediatric gender clinics, the suicide rate among trans-identified youth was estimated at 0.03% over a 10-year period, which is comparable to young people who register for care with psychological problems.
- There is even a Swedish study (Dhejne 2011) that looked at the general population, which found that those who had transitioned committed suicide 19 times more than controls corresponding to the general population. This tells us that a transition does not prevent suicide.
There are serious medical risks and side effects of puberty blockers and hormone treatment
The myths that pubertal blocking agents are harmless are old hypotheses before studies and follow-ups were published. Risk of irreversible infertility, as well as irreversible effects on bone density (e.g. chronic spine problems, effects on ribs) and reduced IQ (up to about 8 points, due to cessation of brain development) were noted.
In addition to these studies, the British NHS recently conducted follow-up research into the effects of puberty blockers on children, and analysis of this data shows that psychiatric problems (suicidal thoughts, self-harm, anxiety, gender incongruity – i.e. dissatisfaction with some gendered aspects of their body characteristics) increased in girls after treatment with puberty blockers.
Regardless of the medical findings in recent research, treatment with puberty blockers is unethical, as puberty blockers 100% consolidate gender dysphoria in treated children, who would otherwise grow into ‘normal’ adults.
I knew about testosterone under the old-fashioned label of steroids which medical professionals are quick to condemn when it comes to athletes. However, now it seemed to be ok to give it to teenage girls off-label with no medical studies as to its safety or effectiveness. After an average of three months, a girl’s voice will be permanently coarsened and body hair will have started growing. There will be cosmetic changes like fat redistribution and muscle gain, but the real damage is taking place internally. After around four years the changes to the uterus make cancer likely and a hysterectomy is recommended. If this is accompanied by an oophorectomy (removal of the ovaries) then no more oestrogen will be produced. The girl will be dependent for life on external hormones and will be immediately menopausal. There are many more side effects including changes to the heart and taken together, these changes considerably shorten expected lifespan.
The long-term effects of testosterone are largely unknown, but it is certain that they involve serious risks. The following can certainly be said:
- Risk of heart failure increases by 300% (This is four times the risk in women, or twice the risk in men).
- Painful vaginal atrophy.
- Clitoral growth can cause pain and numbness.
- Irreversible fertility (if testosterone is started after puberty; if administered immediately after puberty blockers, irreversible sterility is the norm)
- Acne that is severe enough to require treatment.
- Male pattern baldness with genetic predisposition.
- Some reports suggest that increased muscle mass on a female frame may lead to thoracic outlet syndrome.
- Studies also suggest that in women, higher endogenous testosterone levels correlate with insulin resistance and the development of diabetes, and studies suggest that administering testosterone as a medication may increase the risk of diabetes.
- Changes in the ovaries and uterus that may lead to an increased risk of cancer, which is why many experts recommend hysterectomy and bilateral salpingo-ovarioctomy.
- Possible liver and kidney damage.
- Testosterone can cause mood swings.
- Changes in voice, bone structure, hair distribution and genitalia are permanent, even if the use of the hormone is stopped.
- A significantly higher prevalence of venous thrombosis, myocardial infarction, cardiovascular disease.
- Increases risk of ischaemic stroke by 250%.
- A 46 times higher incidence of breast cancer.
- Hepatic steatosis (fatty liver).
- Insulin resistance leading to type 2 diabetes.
- An increased risk of Alzheimer’s disease and psychopathology.
- Lifetime monitoring.
Using progesterone with oestrogen does not make it safe!
See also: Estrogen is really bad for men
- Testosterone & young females: What is known about lifelong effects?
- Key issues in decision-making for gender transition treatment: Questions and answers
- Pelvic pain and persistent menses in transgender men
- The Homone Health Crisis with Endocrinologist William Malone, MD
- Transgender Medical Interventions: Impacts on the Brain
WPATH Standards of Care - Not recommended as clinical practice
The WPATH (World Professional Association for Transgender Health) has rejected psychological counselling as a treatment for incongruence between perceived and biological sex, claiming that this approach has proved unsuccessful and harmful. But the evidence cited to support this claim tends to use case reports from over forty years ago.
This has led to psychotherapy being largely abandoned as a treatment for gender dysphoria. But the finding that gender dysphoric people continue to struggle with a significant burden of mental illness, both before and after transition, brings the demand for quality mental health services back to the fore. Similarly, the recently corrected study by Bränström & Pachankis 2019, which concluded that neither hormones nor surgery provide any benefit in terms of long-term mental health and suicidality, calls into question the one-sided approach of positive affirmation therapy.
Despite these findings, gender clinics, also in Flanders (UZ Ghent) continue to promote the ‘Standards of Care’ (WPATH SOCv8) as the ultimate treatment. However, there is little evidence to support these recommendations in clinical practice.
WPATH Standards of Care 8
The eighth version of the Standards of Care (SOC8) was published at the end of September. These new standards of care were soon met with bewilderment and dismay. Vulnerable children are not protected, the drafters adhere to an ideological view, without supporting evidence. We briefly mention the main objections:
- The standards specifically promote the affirmative model of care and continue to widely endorse medical treatments (medications and surgery) for trans-identifying youth, despite rising scientific skepticism.
- WPATH recommends early medicalization as fundamental. Age limits were removed, distancing them from their responsibility for basic standards of child protection.
- The conclusion of independent systematic reviews, which rate the evidence for gender-affirming treatments in young people as very low quality, is ignored.
- A chapter on ethics was deleted.
- Eunuch was included as a new gender identity, with no convincing evidence of its existence.
- Detransition is misunderstood as a traumatic experience.
It should also be noted that American medical organisations are very vulnerable to commercial pressure, as the American health system is based on profit.
The gender transition epidemic - Time for reflection or more gender clinics?
In all countries of the Western world, there has been an extreme increase in people attending gender clinics. For example, in the United Kingdom, from 77 in 2009 to 2,590 in 2018. This trend is also present in Belgium. The centre for Sexology & Gender at the UZ Gent received 694 registrations in the first nine months of this year, which is already more than in 2020, which was also a record year (source: De Zondag 10 October 2021).
This is explained by the increasing concern and attention for trans people. Certainly, there is no denying that the media, which only talks about success stories, plays an important role in the general acceptance of the transgender story, and people looking for a solution. The only answer to the now increasing waiting lists is the establishment of new gender clinics.
However, one would expect that with a change of this magnitude, as with any other health phenomenon (e.g. increase in cancer or diabetes), there would be a need to investigate and understand the cause. The exponential increase in adolescent and young adult women alone should raise critical questions. Questions such as, why do we not see a proportional coming out among middle-aged women, and why is it now mostly women where it used to be middle-aged men?
We also now know that it is often accompanied by other psychological problems (OCD, anxiety and depression, etc.), so why is this not taken seriously? Moreover, a study has shown that the risk of suicide for those undergoing a transition is 19 times higher than for the general population. There is also no evidence that transitioning promotes long-term mental health.
In a health system supported by society, how can we continue to justify this? Is it not time for reflection? Setting up new gender clinics will irreparably harm and medicalise even more people, depriving them of the real care they deserve.
Detransition - People with regrets, a growing phenomenon
The visibility of detransition, or people with regrets, is quite recent and growing rapidly. Especially from 2016 onwards, we see how detransitioners started posting videos in which they shared their experience. Meanwhile, numerous projects have been established where detransitioners can go, such as ‘Pique Resilience Project‘, ‘Post Trans‘, ‘Detrans Voices‘ among others. The subplatform reddit/detrans already has 50,000 members.
Despite the fact that this reality can no longer be denied, gender clinics and trans activists continue to minimise their existence, citing how they were misused as an argument against transgender care.
No one knows exactly how many people have regret, as there has been little reliable research to date. What is certain is that the number of people with regret is much higher than the 1-3% figure usually quoted. Studies on regret routinely lose 30-40% (least satisfied – or … dead) of people for follow-up, while databases that do not lose people show high suicide rates after surgery. This is now confirmed in a new study by Lisa Littman, which reports that less than a quarter (24%) of people who discontinued their medical treatment informed their treating clinicians. It should also be noted that the landscape of gender care has changed dramatically since 2015. A new population of people emerged, from middle-aged men to young girls. No one can predict what the regret rate will be here.
The main reason given for detransition, and this applies to both genders, is that transition did not alleviate their gender dysphoria, and that they felt more comfortable identifying with their birth gender, due to a change in their personal definition of feminine and masculine. A majority also realised that their gender dysphoria was related to other problems. There is a difference between men and women for yet other reasons. Women often report concerns about possible medical complications, and about too much physical change. In contrast, men reported dissatisfaction with too little physical change, deteriorating physical health, mental health problems and a feeling of discrimination.
For many people, detransition is a very isolating experience. Having to admit to having been wrong, having to continue living with a battered body, is often more difficult than the initial transition. Elie Vandenbussche, a Belgian detransitioner, published the following conclusion
in a recent study ‘Detransition-Related Needs and Support‘:
Unfortunately, the support that detransitioners receive to meet these needs is currently very poor. Participants described serious problems with medical and mental health systems, as well as experiences of outright rejection by the LGBT+ community. Many respondents expressed a desire to find alternative treatments to deal with their gender dysphoria, but reported that it was impossible to talk about it within LGBT+ spaces and in the medical sphere.
These reports are worrying and they demonstrate the urgency to raise awareness on the issue of detransition among healthcare providers and members of the LGBT+ community and to reduce hostility in order to meet the specific needs of the detransitioners.
How could it come to this? - A turning point presents itself
This all came to be from a societal sense of social injustice that is characteristic of our time and is a result of civil rights movements, such as gay rights and women’s rights. Thanks to these movements, we can now talk about equal rights between men and women, and equality for gays. But people went on to look for other sources of structural injustice that may not have been there at all. Thus, transgenderism became allied to LGB movements, and transactivism emerged. No longer was someone’s self-declared identity, as male or female, independent of their biological sex, allowed to be questioned. Critical questions were quickly dismissed as transphobia. Schools, care centres and the mainstream media began to support this activism out of social concern.
We now see an influx of young people, especially girls, to gender clinics. Their gender dysphoria seems to be the new anorexia, looking for a way out to acceptance. Social media plays an important role in this, influencers open up a trans world in which they come home to. But also the current climate, in which transgenderism is imposed as normal, and the low threshold of gender centres, which further confirm these people on the path they have taken, have a non-negligible influence.
The consequences are there for all to see. The blind spot of this identity thinking is gradually becoming clear. Detransitioners, the victims of gender ideology, can no longer be denied and are beginning to group together. Apart from the medical consequences, they are stigmatised and have to rebuild their lives. The broken families, the parents who know their child’s life story better than anyone, are not heard. They know their child is not trans, but their opinion does not matter.
But there is hope; all over the Western world we see people rising up who will no longer remain silent. New organisations are being founded and are supporting each other. Ethical therapists are sounding the alarm. New studies refute the effectiveness of invasive affirmative care and advocate psychotherapy. The countries that advocated the most liberal stance on transgender care are now urging caution and reluctantly adjusting their policies.
Finland was the first country to distance itself from the WPATH (World Professional Association for Transgender Health) guidelines (Standards of Care) and reported that psychotherapy should come first. This change took place after a systematic review.
Psychiatrist Dr Riittakerttu Kaltiala-Heino conducted groundbreaking research in 2015 which showed that more than 75% of adolescents who sought gender reassignment surgery needed help for psychiatric problems other than gender dysphoria. These findings were strongly confirmed in recently published research papers (89% of the interested parties needed such help). As a result of these findings, Finland adopted strict guidelines in 2020 that prioritise therapy over hormones and surgery.
At Karolinska Hospital in Sweden, a new policy banning hormone treatment for minors came into force in May 2021. This was because the risk-benefit ratio was found to be highly uncertain by, among others, the UK NICE evidence review (National Institute for Health and Care Excellence) and Sweden’s own Health and Technology Assessment (SBU) evidence review conducted in 2019, which found a lack of evidence for medical treatments, and a lack of explanation for the sharp increase in the number of adolescents with gender dysphoria in recent years.
The interim publication of the Cass Report – an independent review of gender identity services for children and young people commissioned by the NHS (National Health Service) – led to the decision to close the world’s largest pediatric gender clinic, the Gender Identity Development Service (GIDS) in London , also known as the Tavistock. The report said the clinic is not a safe option for young people because the interventions are based on poor evidence and pose a significant risk to mental health. Tavistock is accused of adopting an unquestioning gender affirmative approach, misdiagnosing vulnerable minors and encouraging harmful medical and surgical treatments.
Following extensive stakeholder engagement and a systematic review of evidence, England’s National Health Service (NHS) has released new draft guidance. The “gender affirming” approach endorsed by WPATH and characterized by the conceptualization of gender dysphoric minors as “transgender children” has been replaced by a holistic view of identity development in children and adolescents. In addition, there is a new recognition that many gender dysphoric adolescents suffer from mental illness and neurocognitive problems, making it difficult to predict the course of their gender identity development.
The new NHS guideline also mentions social transition as a form of psychosocial intervention and not as a neutral action, as this can have significant effects on psychological functioning.
On February 22, 2022, the French National Academy of Medicine stated: “Extreme medical caution is advised in children and adolescents, because of the high vulnerability, more specifically the psychological vulnerability, of this population and because of the many undesirable effects, and even serious complications, that some of the available therapies may cause”.
In March 2023, Norway joined these countries that are moving away from the WPATH guidelines. The Norwegian Healthcare Investigation Board (NHIB/UKOM) has classified puberty blockers, cross-sex hormones and surgery for children and adolescents as experimental and found that current ‘gender-affirming guidelines’ are not based on evidence and need to be revised.
In August 2023, Denmark also decided to severely restrict gender transitions for young people. The medical journal Ugeskrift for Læger confirmed this. Most young people referred to the centralized gender clinic will no longer receive a prescription for puberty blockers, hormones or surgery, but will receive therapeutic guidance and support.
Belgium’s Director of Cochrane Belgium has expressed public concerns that puberty blockers are experimental and that the treatment guidelines promulgated by WPATH are not evidence-based. However it is not clear whether the Belgium health authority plans to act on these concerns.