French President Emmanuel Macron tweeted “Being oneself is not a crime”
in January when welcoming a new law against “conversion therapy”.
Critics say these laws may entrench medicalised gender change.
A French medical organisation has sounded the alarm about an epidemic-like surge in young people seeking hormone drugs and surgery
The French National Academy of Medicine has joined the international shift to caution on medicalised gender change for young people.
The academy, which advises France’s government on health, warns physicians of the epidemic-like rise in minors seeking hormonal drug treatments, the risk of over-diagnosis and the possible role of social media immersion.
“Great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population”, the academy says in a statement supported by a majority vote of its members last month.
The academy says the hormonal and surgical treatments known as “gender affirming care” — with results supposed to mimic the opposite-sex body desired by young people who identify as transgender — can cause “many undesirable effects and even serious complications [including] risk of sterility”.
It stresses the role of psychological support for young people and families, and advises parents to stay “vigilant” for excessive social media use by their children.
The academy cites the May 2021 decision by the Astrid Lindgren Children’s Hospital, part of the famous Karolinska medical complex in Stockholm, to cease routine use of puberty blockers and cross-sex hormones with minors.
The academy’s authority is moral, rather than legal, but its intervention is seen as significant amid growing public debate about youth gender clinics in France.
And its call for caution may influence an updated medico-legal treatment guideline being developed by the French National Authority for Health.
Note: For longer news reports, I’ll try to break them into a summary, The gist, for readers who want a quick rundown of the basics, and The detail, for when people have time to take in the fine print.
The distinguished French psychiatrist and researcher Professor Bernard Golse has welcomed the academy of medicine’s position as “wise”.
“At last, [we have] a position of prudence and listening at a time of haste and media exploitation”, Professor Golse, former chief of child and adolescent psychiatry at the Necker Hospital for Sick Children in Paris, told GCN.
The first gender clinic consultations for minors began in 2013 at the Paris hospitals of Pitié-Salpétrière, the Fondation Vallée and Robert Debré, according to lawyer Dr Aude Mirkovic, a specialist in family law and bioethics.
Several other major French cities have since opened clinics, but there is no good patient data available, and sceptics of medicalisation are attacked as “transphobes”.
In 2013, the Paris region of Île de France had about 10 referrals a year of young people but now it is more like 10 a month, a 2021 conference was told.
Dr Mirkovic, legal director with the organisation Lawyers for Childhood, says recent media reports put the number of minors whose cases are followed by specialist hospital clinics at 600-700.
“If we add the consultations opened in nine other hospitals outside Paris, we can estimate that well over a thousand children are currently being followed in France”, she said.
“However, this figure only concerns children followed in hospitals.”
Dr Mirkovic says there has been “real propaganda in favour of trans identity in children” promoted by major newspapers and TV channels, plus the trans influence of social media and activist visits to schools.
“The slightest reservation about this so-called self-determined trans identity is quickly labeled as ‘transphobic’”, she said.
She says the academy of medicine’s intervention in favour of caution is “very valuable” for groups such as hers seeking to protect children and adolescents from a medicalised idea of “gender utopia”.
She hopes the new position statement will help to break down resistance to free and open debate about an issue affecting vulnerable children.
“Everyone can make up their own mind, but it is necessary that people have access to reality, and not to the idealised images conveyed by activist reports.”
Guideline in play
The academy of medicine’s stance is seen as a significant corrective to an emotive and unbalanced campaign in France promoting underage gender medicine.
Its timing is noteworthy, too, because the French National Authority for Health, which gives independent scientific advice to public agencies, is revising its 2009 medico-legal guideline entitled “The medical care of transsexualism”.
It will be difficult for experts updating the guideline to ignore the concerns expressed by the academy of medicine, according to psychiatrist Claire Squires, a senior lecturer at the University of Paris.
“They must be more cautious, in what they are saying [in the guideline]“, Dr Squires told GCN.
Dr Squires was one of 50 medical, legal and education professionals, feminists and intellectuals who put their names to a September 2021 opinion article in the French news magazine L’Express protesting against gender ideology and “the kidnapping of childhood”.
The signatories, associated with a watchdog group called The Little Mermaid, argued that the false idea of “self-declared gender” would put children on a path to lifelong medicalisation, closing off normal adolescent development and at odds with biological reality.
Dr Squires said the Little Mermaid group had asked the national authority of health to take part in the guideline project but received no reply.
However, the group has a meeting scheduled next month with some committee members from the authority on the more limited issue of “social problems” associated with youth gender dysphoria.
Dr Squires says the position statement of the academy of medicine is an important challenge to the perception of puberty blockers as a mainstream treatment.
But she says the academy’s position is weak when compared to the new policy of Sweden’s National Board of Health and Welfare that puberty blockers and cross-sex hormones should only be given in “exceptional” cases outside research studies.
It’s not clear what the academy means by “great caution”, Dr Squires says.
The Little Mermaid group took shape last year as a reaction to the screening of the 2020 documentary Little Girl, which launched the first serious debate about “trans children” in France.
The film profiles 8-year-old Sasha, a biological male who identifies as a girl, and is diagnosed with gender dysphoria, distress arising from a feeling of conflict between biological sex and an inner sense of “gender identity”.
That diagnosis, with the next step being puberty blockers, appeared to be made with very little psychological inquiry into the child and his family, according to The Little Mermaid group.
“One can believe that Sasha dreams of being a girl; one doubts he understood what puberty blockers were”, says a commentary posted by The Little Mermaid.
The watchdog group calls for clinicians “to be attentive to the developmental process specific to childhood and adolescence and to take time before any indication of medical treatment”.
Dr Squires says the Little Mermaid group will collaborate with the Contemporary Institute of Childhood, which was founded last year by the psychiatrist Professor Golse as a vehicle for education, research and advocacy.
“We are beginning to organise ourselves”, Dr Squires says. The Little Mermaid group has also linked up with the international Society for Evidence Based Gender Medicine.
A study by paediatric endocrinologists at the Robert Debré hospital in Paris, covering 2013-21, involved 216 adolescents, two-thirds of them biological girls identifying as boys.
A third of the girls (48) had breasts removed by surgery (“la torsoplastie”), the youngest being age 14, according to conference slides of the study’s results.
From 2017, fertility preservation — such as freezing eggs, ovarian tissue, sperm or testicular tissue — was offered systematically at the hospital.
The combination of puberty blockers and cross-sex hormones is believed likely to sterilise patients. Depending on age and sex, some fertility preservation procedures are experimental, with no proven success in humans.
Six males and 8 females at the hospital — 6.5 per cent of the group — attempted fertility preservation.
A 2018 paper in the European Journal of Endocrinology, with French clinician Laetitia Martinerie as lead author, claims that the effects of puberty blockers (GnRH agonists) are “completely reversible”.
“If the adolescent no longer wishes hormonal transitioning, treatment can be discontinued and physiological puberty will resume“, says.
It acknowledges that the long-term medical outcomes for adolescents on puberty blockers followed by cross-sex hormones are unknown.
This review paper is cited by the French academy of medicine.
A small bomb
Dr Mirkovic, of Lawyers for Childhood, says the article in L’Express went off like a small bomb because it showed that many well known people with a variety of political backgrounds and opinions had put aside their differences to defend children.
The Little Mermaid group issued a more detailed statement of concern on its website, and this has attracted more than 400 signatories from a wide range of disciplines.
Professor Céline Masson and Dr Caroline Eliacheff, the psychoanalyst authors of a new book, The Factory of the Transgender Child, have argued that hormonal and surgical gender change for minors may be “the first great health scandal of the 21st century”.
Both Prof Masson and Dr Eliacheff put their names to the article in L’Express, and so did the eminent child psychiatrist and psychoanalyst Dr Christian Flavigny.
He says the academy’s statement is ambiguous, fails to come to grips with the problem of gender-confused children, and its unintended effect is to ratify hormonal and surgical transition.
“The reason is that psychology is approached [by the academy] as the necessary accompaniment to the suffering of young people [who are given medical treatment], and not as support for understanding, and thereby resolving, this suffering”, said Dr Flavigny, former director of child and adolescent psychiatry at Salpêtrière Hospital in Paris.
Dr Flavigny — author of the the book Helping Transgender Children: Against the Americanisation of Care — says the academy of medicine has endorsed the United States activist idea of “gender assignment”.
He says the translation of “gender” into the French word “le genre” is misleading; the correct word would be “le sexe” — and this cannot be “assigned” as if mere words dictate biological reality.
“Sex is indeed a bodily fact, and what is at stake in development of the personality is that the child is able to appropriate the body as his or her own body”, he told GCN.
“This involves impregnation of the masculine for the boy, and the feminine for the girl, based on complex relationships with the parents, especially the child’s same-sex parent.”
He says French psychological culture is capable of understanding the complexity of this process, and the confusion of children, whereas simplistic activists falsely claim these children were “born in the wrong body”.
But Dr Flavigny says French law and ministerial policy, especially on schooling, support the “false path” of medical transition, and make it difficult for psychologists to help confused young people to take possession of the sexed body given them by nature.
In January, France became the latest jurisdiction to enact a law against “conversion therapy” which criminalises attempts “to change or suppress a person’s actual or perceived sexual orientation or gender identity”.
Critics of these laws say they are deceptive, and risk entrenching medicalised gender change by suppressing ethical, exploratory psychotherapy for young people who are questioning their gender.
The strict new control of underage gender medicine in Sweden is not the only international reference used by the French academy of medicine to support its call for caution.
To illustrate the epidemic-like spread of teenage gender dysphoria, the academy points to the Royal Children’s Hospital in Melbourne, stating its patient numbers had risen from one in 2003 “whereas today it treats nearly 200”.
In fact, the academy understates the increase, which went from one new referral in 2003 to more than 800 in 2021. In the decade to last year, new referrals increased a hundredfold. [Note: An earlier version of this post stated there was “one new referral in 2013”, rather than 2003.]
The French academy also makes reference to the troubled Tavistock youth gender clinic in the United Kingdom.
The litigation against the Tavistock clinic by detransitioner Keira Bell has also been followed by the French professionals of the watchdog group The Little Mermaid.
And the academy, which claims that social media addiction is the driver of “a very significant part” of the spike in caseloads at youth gender clinics, cites the 2018 “rapid-onset gender dysphoria” paper of US public health researcher Dr Lisa Littman, who pointed to the possible role of social influence online and via school friendship groups.
Since the academy issued its call for caution, the Karolinska youth gender clinic in Stockholm has made a formal notification of the serious injury done to patient “Leo”, a biological female who identifies as male, and developed osteoporosis after four years on puberty blocker drugs. The Swedish TV program, Mission: Investigate, the team behind the Trans Train series, has reported several claims of injuries inflicted at the Karolinska clinic.
Dr Mirkovic, of the group Lawyers for Childhood, says that under French law, parental consent is necessary for medical transition of a minor, whose consent would also be recorded if he or she is capable of being involved in the decision.
But she says the consent of a competent child alone is not enough and “in no way absolves adults of their own responsibility”.
“If the child one day reproaches parents for the medical acts carried out and the treatments administered, they will not be able to hide behind the child’s consent”, she said.
“This concerns both parents and physicians, who could be held responsible if one day the child regrets the acts performed.”
Dr Mirkovic said her group is apolitical, non-religious and seeks to defend the rights of children by, for example, working on legislation or taking court action.
She says the group has lost track of the number of media items and programs featuring gender transition for minors as the “path to happiness”.
“These programs provoke emotion because these children and adolescents are very touching”, she said.
“The problem is not what these children ask for, the problem is the response of adults to these requests.“
“The media clearly promote the instruction: good parents support their children’s trans journey, including medical treatment.“
“We think it is a lie to let a child believe that a boy can be a girl, or a girl can be a boy.“
“A boy does not become a girl thanks to hormones, and a girl cannot be changed into a boy by removing her breasts.“
“The responsibility of adults is to help children to accept and, if possible, to love themselves as they are, not as they imagine themselves to be.”
Note: GCN sought comment from the European Professional Association for Transgender Health, the Paris-based lobby group Inter-LGBT, Dr Martinerie, and the Royal Children’s Hospital Melbourne.