Gender Dysphoria in Children: Two Views

So, I'm going to present two articles here with differing views on how doctors should handle gender dysphoria in children. Then, I think we could discuss the two views (preferably after reading both articles, or at least enough to get the general idea; the second article is quite long, but worth reading if you want to understand the current "best arguments" for each view).

The first one is a recent opinion piece I came across in the New York Times. I found it to be persuasively written.

Hannah Is a Girl. Doctors Finally Treat Her Like One.

The author of the piece is:

Quote:

Jack Turban is a research fellow at Yale School of Medicine, where he lectures on the treatment of transgender and gender-nonconforming youth.

Please read the whole thing, but I'll try to quote enough to give you the gist:

Quote:

NEW HAVEN — Hannah is a 14-year-old girl, clad in leggings and an oversize T-shirt, with long brown hair that she curls around a finger. She was also born a boy. . . . Hannah is using a puberty-blocking implant and getting ready to embark on the path of developing a female body by starting estrogen. Ten years ago most doctors would have called this malpractice. New data has now made it the protocol for thousands of American children. . . . The implant has been in place for two years, preventing the process that would have deepened her voice and given her an Adam’s apple. She has been happy with the blocker, but is ready to move on. “I’m tired of being the only girl in my grade who looks like a little kid,” she says. She has a point. A review of recent studies suggests we could start cross-sex hormones as early as 14, so that transgender kids don’t suffer the stigma of starting puberty years after their classmates. . . . Once transgender youth hit puberty, their gender identity is unlikely to change. At that point, doctors often consider medical interventions. The puberty blocker is the first step. In the unlikely event that a child were to change her mind about being transgender, we could remove the implant, and she would then go through male puberty. The implant has some mild side effects, most notably a decrease in bone density, but that quickly improves after the removal of the implant or the initiation of cross-sex hormones like estrogen or testosterone. The effects of cross-sex hormones like estrogen are not easily reversible. The hormones can impair fertility, but transgender teens are offered fertility preservation options before that stage, like freezing sperm or eggs. Surgery, which often follows in young adulthood, is also, of course, essentially permanent. . . . Adult transgender people often tell me what it would have meant for them to have escaped the wrong puberty. They mourn for their bodies that were permanently changed, while celebrating the future for children who can live the way they feel.

There's more of course, but I can't quote all of it.

Basically, kids diagnosed as transgender could be given a so-called "puberty blocker" before the onset of puberty so that their bodies don't take on the sex characteristics of their biological sex. After that, the proposal seems to be to start giving them "cross-gender hormones" at around age 14 so that they go through the puberty of their chosen gender. Apparently, this is already being practiced in many places.

So here is another view that a member of another forum pointed me to, from the American College of Pediatrics. It was published in August 2016, less than a year ago, and as far as I know, their view hasn't changed.

Gender Dysphoria in Children

This one is very long, with footnotes, etc. I'll quote the Abstract but I suggest reading more to understand the reasoning.

Quote:

ABSTRACT: Gender dysphoria (GD) of childhood describes a psychological condition in which children experience a marked incongruence between their experienced gender and the gender associated with their biological sex. When this occurs in the pre-pubertal child, GD resolves in the vast majority of patients by late adolescence. Currently there is a vigorous, albeit suppressed, debate among physicians, therapists, and academics regarding what is fast becoming the new treatment standard for GD in children. This new paradigm is rooted in the assumption that GD is innate, and involves pubertal suppression with gonadotropin releasing hormone (GnRH) agonists followed by the use of cross-sex hormones—a combination that results in the sterility of minors. A review of the current literature suggests that this protocol is founded upon an unscientific gender ideology, lacks an evidence base, and violates the long-standing ethical principle of “First do no harm.”

So my own reaction after reading the two articles is that, although I was initially persuaded by the first one, the second one gave me plenty of reasons to doubt it. One of the main issues is the fact that this process will render the children infertile (the "fertility preserving options" notwithstanding). Is it ethical to allow such a young person to make that choice? What are your thoughts?

via International Skeptics Forum http://ift.tt/2psIyp8