Photo by Aiden Craver on Unsplash
Published on December 16, 2024
by Joren Vermeersch
Original: De Standaard – Wanneer voeren we in BelgiĂ« eindelijk het debat over transgenderzorg bij kinderen?
In many European countries, the debate on transgender care for children with gender dysphoria has led to a ban. Here, the medical world quietly continues, and no one seems to care, writes Joren Vermeersch.
Elsewhere in Europe, transgender care for children dominates the ethical debate. This issue is particularly relevant for Belgium. Yet it does not receive the attention it deserves here.
Member of Parliament Kathleen Depoorter (N-VA), who requested the figures from Health Minister Frank Vandenbroucke (Vooruit), expressed concern: “These substances stop a crucial moment of bodily development. I wonder if we should not handle this more cautiously, especially since there has long been a debate in Europe about the safety of these blockers.”
Girls with gender dysphoria in Belgium can have their breasts removed from the age of 16. We do not realize how exceptional this is in the European context. Outside of Belgium, only the Netherlands allows this. In Belgium, there is also no legal age limit for administering testosterone or estrogen to children with gender dysphoria. This happens from the age of 16, and sometimes even earlier. At much younger ages, such children in Belgium can also obtain “puberty blockers.”
These are GnRH analogues: chemical substances that halt the natural production of male and female hormones in children’s bodies. They are administered to children with gender dysphoria to prevent their bodies from naturally developing sex characteristics, pending a surgical transition (which is only possible from the age of 18).
These are not exceptional cases. In 2022, 684 children aged 9 to 17 were prescribed this treatment, a 60 percent increase compared to 2019. Member of Parliament Kathleen Depoorter (N-VA), who requested the figures from Health Minister Frank Vandenbroucke (Vooruit), expressed concern: “These substances stop a crucial moment of bodily development. I wonder if we should not handle this more cautiously, especially since there has long been a debate in Europe about the safety of these blockers.”
GnRH analogues were not developed for this purpose. They were approved as medication for temporarily delaying puberty in children who begin puberty at an unhealthily early age, and for treating endometriosis and hormone-sensitive cancers like prostate cancer and certain breast cancers. In other words, they were designed to remedy real and dangerous physical conditions. Today, they are prescribed long-term in Belgian gender clinics to physically healthy children. This is done off-label, contrary to the official instructions.
This also happens in a few other European countries, but that group is small and shrinking each year. The Southern and Eastern European EU member states never followed Belgium’s pioneering role. Nor did France. Initially, the Scandinavian countries did. However, they have now effectively banned the administration of puberty blockers to physically healthy minors with gender dysphoria. Last week, British Health Minister Wes Streeting made the same decision.
And what if some of the 684 children currently undergoing such treatment in Belgium regret their decision later? Then our society will have failed in its most sacred duty: protecting the physical integrity of children, the most vulnerable in our society.
The British, Finnish, Danish, Swedish, and Norwegian governments justified this decision with new reports from medical experts, who warn of serious health risks. Long-term use of GnRH analogues can lead to weakened bone structure, infertility, impotence, the lifelong inability to achieve orgasm, and impaired cognitive development in children.
There are also serious philosophical and legal concerns. Children’s brains are not yet fully developed, and thus neither is their judgment. That is why children are legally considered incapable of acting independently. To protect them, the law forbids them from making significant decisions with lasting impacts on their lives, even if they have parental consent.
There are many examples of this. Children are not allowed to marry. They cannot take out loans. Their physical integrity is also protected against their own decisions. For instance, they cannot undergo cosmetic surgery without medical necessity. They cannot even get a tattoo. But in this one area, the medical world abandons this logic of protection. And without societal or political debate.
Children, who in some cases are still in primary school, are now expected to make a reasoned decision about a treatment plan that (if continued) is unhealthy, permanently changes their bodies, and makes them infertile. And all of this without medical necessity.
If Belgian hospitals would refuse to provide this treatment to minors, as is the case in France, those children would simply grow up to be healthy and fertile adults.
And what if some of the 684 children currently undergoing such treatment in Belgium regret their decision later? Then our society will have failed in its most sacred duty: protecting the physical integrity of children, the most vulnerable in our society. The fact that this issue causes so little stir in Belgium, while newspapers elsewhere in Europe are filled with it, is almost incomprehensible. When will we also have a serious debate about transgender care for children here? Finally?
Joren Vermeersch is a lawyer, historian and author. He is an advisor to the N-VA faction in the House of Representatives and writes in his own name. His column appears every two weeks on Mondays.