Transitioning? Not So Fast!

"For years and years, people have been homophobic, transphobic."

"We're now trying to correct that, but by doing that we're putting others at risk. And those others we're putting at risk are children."

Mary, Toronto,  (last name withheld)

"No one makes these decisions lightly. They are made very slowly, very cautiously, after long discussions with these youth and their parents."

"It would be incredibly worrisome [to create additional delays in treatment]. It would harm so many kids. I would hate to think what would happen to them."

Dr.Margaret Lawson, medical director, gender-diversity clinic, Children's Hospital of Eastern Ontario

"In trans health care, patients diagnose themselves and prescribe their own treatment."

"Medical professionals are encouraged to accept a person's belief without question under the assumption that it will never change."

Michalle Zacchigna (first to be treated under the new transition model, and living with regrets)

Maciek Jasik

 

"Alarms are being sounded all over the world [against the trend to proceed in undue haste to effect transgender changes in young people]. And Canada seems completely deaf to it", stated Aaron Kimberley a transgender man living in British Columbia. He is also a registered nurse and is experiencing qualms over the current approach in Canada among medical professionals and parents to proceed with alacrity and insufficient caution to usher children into the process of gender transition; gender dysphoria is declared, minors are treated with hormones, and surgery follows soon afterward.

A government move is underway in the House of Commons, supported by all political parties, to make it illegal to subject children or adults to any form of conversion therapy. A practise that has been said to be discredited, with its goal of focusing on changing someone's sexual orientation or gender identity. The bill has passed in the House and is prepared to move to the Senate for assent before it becomes law. The bill is a reflection of the current zeitgeist, the sacred belief that children expressing discomfort in their birth gender assignment must be encouraged to transition to a more 'comfortable-fitting' gender.

Mary's daughter insisted she had to alter her sexual identity, suddenly announcing at age 16 that she was a transgender boy. The young girl had long suffered depression and uncertainty along with a deep sense of anxiety. A doctor wrote a prescription for testosterone following a few 15-minute appointments and within months the teen had a double mastectomy, to become a trans male. Her mother recalls that as her daughter was  being wheeled into the operating room for the mastectomy she expressed self-doubts about her decision.

She is now 21 and in the process of "detransitioning", a reversion to her original female identity. Her mother, Mary, has become a partner in a movement asking that the health care system now geared to affirmation of a young person's transgender feelings with drugs and surgery slow down, and seriously consider assessments of other psychological issues before declaring the young to be fully capable of making such a life-altering decision.

Outside of Canada which has embraced full transitioning for young people with scarcely enough medical and psychological examinations of their expressed feelings and emotions over the issue -- which has seen a tidal wave of children demanding they be assisted in their determination to leave the gender they were assigned at birth based on their physical characteristics, when they claim their minds and emotions are lodged in the other gender -- a reversal of social attitude is taking place.

Countries as diverse as Finland and Australia have taken steps to back up from the affirmative approach. At the same time, some leading figures in the transgender medical world have themselves begun to urge caution. A provincial bill in Ontario's legislature is set to speed up access to medical transition and to reduce the need for medical practitioners to make referrals for treatment. At both the provincial and federal level, the way is being paved for children to confuse their identities and face an uncertain future.

While there may well be a good number of legitimate instances of a psychological need to transition, the entire process has taken on a popular social-activist stance, with young children wanting to be part of the new trend. Parents and detransitioners indicate their support for improving access to medical transitions for those who really require it to be done, and feel transphobic bigotry has no place in society. While not opposing gender neutral bathrooms or public funding for transition treatment, they argue the pendulum has swung uncontrollably, and not to society's or the most vulnerables' advantage.

In some instances, gender treatment  occurs outside hospitals. The questioning newly arisen of the status quo has arrived in parallel with a boom in demand driven by patient demographics; both looking suspiciously like red flags that something is badly amiss. People presenting with gender dysphoria were predominately young boys or middle-aged men, traditionally. Now, gender-identity clinics are coming face-to-face with mostly teenagers born girls. 

Pediatric patients numbers at ten hospital clinics across Canada leaped from close to none in 2004 to over 1,000 by 2016. Some 80 percent represented natal girls, most under age 16, when first arriving at the clinics. In the U.S., a major college health study found the percentage of students identifying as transgender or gender non-conforming rose from .05 percent between 2008 and 2014 to three to four percent more recently. 

 

An American study of parents skeptical about gender treatment in 2018 hypothesized that there was a new "rapid-onset gender dysphoria" phenomenon among young girls sometimes convinced by online influencers and through social contagion. According to gender-medical professionals the explosion is a reflection of a growing acceptance of transgenderism following years of stigma and isolation, and the true number of youth in need may in fact be much higher.

The complaint from critics is that health care practitioners are too ready to place children on "puberty-blockers"; drugs to "pause" the development of puberty, and then cross-sex hormones, followed frequently by reassignment surgery. The emphasis, they feel, should lie in an exploration of the complex mental health issues of young people presenting as trans. "We feel the health-care system has been completely taken over by a political agenda at the expense of the actual evidence", said a representative of the group Gender Dysphoria Alliance.

Dr.Marci Bowers, a trans woman, a widely respected gender-reassignment surgeon herself, preparing to become president of the World Professional Association for Transgender Health (WPATH), is among top figures in the field who have expressed concerns. Concerns which led to change in recent months in some countries. Where Finland last year encouraged psychotherapy before transition treatment, and the Australia-New Zealand psychiatry regulator claimed it to be essential. In Sweden, clinics stopped prescribing puberty blocking drugs and cross-sex hormones to patients under 18 this year.

Dr.Bowers, the gender reassignment surgeon, suggested that children are sometimes placed on puberty blockers too soon, with complications arising in reassignment surgery which can deprive them potentially of sexual satisfaction for their lifetimes. Transgender women Erica Anderson and Laura Edwards-Leeper, senior officers with WPATH as psychologists, spoke of sloppy and dangerous assessment of young people presenting as transgender, the results of overly hasty prescribing of medical interventions.