High Court Weighs Up Treatment Consent in Children with Gender Dysphoria

[janterry]

Most of the articles I've seen online are one-sided.

This one makes a good effort at presenting both sides (so well worth reading).

This case could have wide ramifications for whether to 'watchfully wait' or to use medications with children who are gender non-conforming.

https://www.medscape.com/viewarticle/938899

The suit was brought by Kiera Bell, who used blockers and then went on to use testosterone. There are lasting effects and changes to her body that she deeply regrets. She wishes the clinicians had worked with her more to understand where her dysphoria originated and help her come to terms with her gender non-conformity.

There is research from the GIDS about the efficacy of using blockers, but that continues to be withheld (they did not release it to the court).

From the article:
A study conducted by GIDS, completed in 2019, that is currently undergoing the peer-review process before publication, was unavailable for this judicial review. However Mr Hyam noted that preliminary findings show that: "The suppression of hormones does not impact positively on the experience of gender dysphoria," and that "natal girls appeared to be more dissatisfied with their sex characteristics, and there was an increase in reporting of thoughts of self-harm or suicide by children in the study".

Also from the article:
Defence lawyer Ms Morris, pointed out: "If [the young people] are able to consent, and wish to continue blockers, they can have them for a few years, can stop and restart and over this time, work is done to expand their understanding and their life experience increases, and this is made relevant and salient to their understanding of longer-term treatment and whether they want to start cross-sex hormones at age 16."

For her part, Kiera Bell says it was a brash decision and
"I couldn't weigh the loss of experiences, but this should have been obvious to the treating physicians." Mr Hyam noted that Ms Bell experienced hot flushes, cognitive dysfunction, joint issues… at the time, and later problems linked to sexuality."

She worries additionally whether her chance to ever have children has been impacted.

[rusty fender]

1. Urging caution with aggressive medical treatment

in children with gender dysphoria is what has engendered the hateful attacks on JK Rowling, and all of us who urge this caution.

[janterry]

4. I think this will shift

we need researchers to be able to follow these children - and do their job.

But I too have watched the de-transitioners and it's so hard. As an older woman - it breaks ones heart.

[PTWB]

13. JK Rowling has a documented history of making inflammatory, insensitive trans exclusionary comments.

Urging caution with these medical procedures is reasonable. Her history of insensitive comments is not.

[MineralMan]

2. It's such a complex issue. I can't really form an opinion on it.

It takes all of childhood to learn how to make good decisions of all kinds. Some people never learn how to make good decisions, in fact. Normally, parents step in to help their children avoid making life-changing decisions that might cause them harm.

I'm skeptical of decisions that might be irreversible being made by children, either before or during puberty. I'm just not sure that children know their own future all that well, and might make a decision while young that they end up deeply regretting later.

I'm also uncomfortable with parents making such decisions for their children.

So, I'm unable to decide how I feel about this. Since I had no gender dysphoria, I can't begin to understand what is going on with those who do have it.

I don't know, really, what the courts should say about this. As the person at the center of the case says, she wasn't really fully prepared to make the decisions for herself. Now, as an adult, she is now not sure if her decision was correct and is regretting having made it, perhaps.

Difficult stuff.

[janterry]

3. The affirmation model

basically says you can't explore other things that have impacted the child and might contribute to how they are feeling (you need to affirm that they are a different gender).

Kiera went to the GIDS and was never helped to examine her GD and look at what might be causing it (for her, she was simply gender non-conforming).

Many adults, who have GD, they say they do not wish to be challenged, just supported. The detransitioners, of course, look back and wish someone had explored this more with them.

On a positive note, the NHS has taken down it's claim that cross-sex hormones have no lasting effects. They do.

[Proud Liberal Dem]

6. Nothing else is known to "cause" gender dysphoria

You pretty much either identify with your gender assigned at birth or you don't. If you're actually gender dysphoric, the recommended course of treatment is to transition. Anti-depressants or other psychotropic medications or counseling aren't going to change those feelings.

[janterry]

8. How would you care for Kiera

and the others who, like her, are left with disfigurement, infertility (in some cases), and permanent changes to their body.

How do you figure out who is whom?

I'm sure we all want to protect children like her.

[Proud Liberal Dem]

10. No system of care is perfect

but transition regret is very rare. It's unfortunate that she did not make the right choice for herself and regretted it and I'm not quite sure what the ultimate answer for her is but transition is not a quick and easy process (esp. where children are involved) and there is a whole standard of care that is observed (at least here in the US) in regards to transition-related care (google WPATH).

[janterry]

12. There are hundreds in the UK

[Proud Liberal Dem]

15. But out of how many other people who transition without regret?

Last edited Fri Oct 9, 2020, 05:00 PM - Edit history (1)

And let me emphasize that I support people whom choose to detransition as long as they're not in turn trying to make it harder for people seeking transition to get the care they need.

[janterry]

18. I don't think we know

The stats on that are outdated and from a tiny sample where a significant number dropped out.

That said, I'd guess that most do not have regret. But as someone who likes the scientific method - I know that is not good enough. We need real data points

What we do know, is that the statistics on de-transitioners is pretty horrible. They feel terrible shame - and tend not to be seen. And the non-de-transitioners (those happy)? Well, they also drop out of the stats because they go on with their lives. Why would they want to keep in touch if everything is going well.

(So, we suck at data collection in both ways).

Over the next few years, I think we'll find out.

[Proud Liberal Dem]

7. There are always going to be a few people who transition and then de-transition

No system of care is going to be perfect. De-transitioning is still very rare. Very few people de-transition or experience regret (and a lot of those people who do do so because of adverse social circumstances). I feel like some people would rather 10 Transgender people be denied or delayed gender affirming care instead of having 1 person make a mistake regarding transition and have to deal with the consequences thereof.

[MineralMan]

9. Well, I'm not in any position to make any sort of decision at all.

Nor would I be comfortable every being in that position. I have zero problems with transitioning as a decision. It's not my decision, nor would I suggest what anyone should do. I know only a couple of people who have considered or have made a transition. I'm supportive of any person who makes such a decision. It's their life, after all.

My concern, and my only concern, is for people who are not at a point in their life, due to age, where they can make a fully informed and reasoned decision.

Beyond that, it should only be up to the individual, not anyone else at all.

[Proud Liberal Dem]

11. If you're referring to children

Children transitioning are under multiple layers of care and supervision during the process and parents are engaged as well. Children are not typically receiving cross-sex hormones until they're 16 and nobody gets surgeries until they're 18.

[MineralMan]

14. I am. And it's a good thing that children are being closely supervised.

As for the teen years, things get a little more complicated.

[Proud Liberal Dem]

16. True

but prebubescent children get NOTHING in terms of medication, hormones, surgery, etc.
Pubescent children can get put on blockers in order to delay the onset of puberty. These have no known serious side effects for children and just put the brakes on natal puberty. Natal puberty produces some changes to ones body that can exacerbate gender dysphoria for Transgender people and be costly to address via surgery and other procedures. It is undeniably ideal for Transgender children to not have to go through their natal puberty. Cross-sex hormones, which DO cause changes in the body are not typically introduced until age 16 or so recommended by their doctors and nobody is getting surgery until adulthood. There will always be some people for whom transition may have been the wrong choice and desire to detransition. They should be supported and affirmed in that choice. However, what I am most concerned about is people freaking out about a handful of detransitioners or people regretting their choice and imposing new and unreasonably stricter rules on others whom literally are going to die if their dysphoria is not addressed. Bigotry against Transgender people, especially in the UK, is a serious problem and people like JKR are promoting ideas and theories and information that is harmful to the cause of Transgender equality and access to transition-related care.

So, if I seemed a little concerned about that in this thread, this is why. Thank you for being supportive and trying to understand.

[MineralMan]

17. Thanks for your additional information.

[Proud Liberal Dem]

5. I don't know a lot about the UK and Transgender Care

but they are generally even more restrictive with transition-related care than the US. From what I have heard from my Trans brethren across the pond there are usually long waiting periods and require trans people to live in their identified gender for up to two years before they are given cross-sex hormones, surgery, etc. Here in the US, transition care for children is generally pretty conservative and heavily monitored by doctors, endos, and psychologists throughout the process. Cross-sex hormones aren't usually approved until children are about 16 or so and are often prescribed blockers (which are used for non-Trans related reasons as well) around the onset of puberty. This case seems to be more like a case of transition regret (which does occasionally happen) but the problem that I have with it is that it could have adverse consequences on the majority of children whom are gender dysphoric if it becomes more restrictive as a result. There is a lot of misinformation put out there and information not supported by evidence by people like JKR and TERFs whom are simply bigoted towards Transgender people.