Psychiatrists in AU and NZ Shift Stance on Gender Dysphoria, Recommend Therapy

[janterry]

A new position statement from the Royal Australian and New Zealand College of Psychiatrists (RANZCP) stresses the importance of a mental health evaluation for people with gender dysphoria — in particular for children and adolescents — before any firm decisions are made on whether to prescribe hormonal treatments to transition, or perform surgeries, often referred to as "gender-affirming care."

"There is a paucity of quality evidence on the outcomes of those presenting with gender dysphoria. In particular, there is a need for better evidence in relation to outcomes for children and young people," the guidance states.

and

Asked to explain the new RANZCP position, Philip Morris, MBBS, FRANZCP, said: "The College acknowledged the complexity of the issues and the legitimacy of different approaches." Exploration of a patient's reasons for identifying as transgender is essential, he told Medscape Medical News, especially when it comes to young people. "There may be other reasons for doing it and we need to look for those, identify them and treat them. This needs to be done before initiating hormones and changing the whole physical nature of the child," he said.

and

Concerns have arisen that some transgender identification is due to social contagion, and there is a growing number of "detransitioners" — people who identified as transgender, transitioned to the opposite gender, but then regretted their decision, changed their minds, and "detransitioned" back to their birth sex. If they have had hormone therapy, and in some cases surgery, they are left with irreversible changes to their bodies.

As a result, Scandinavian countries, most notably Finland, once eager advocates of the gender-affirmative approach, have pulled back and issued new treatment guidelines in 2020 stating that psychotherapy, rather than gender reassignment, should be the first line of treatment for gender-dysphoric youth.

https://www.medscape.com/viewarticle/960390

[hlthe2b]

1. I don't know what the "right" answer is, but I've found those NOT RARE instances of

so-called "detransitioners" — people who identified as transgender, transitioned to the opposite gender, but then regretted their decision, changed their minds, and "detransitioned" back to their birth sex very concerning myself. I've seen some detailed interviews with some of these individuals who seem mentally broken and many barely coping.

Such a difficult issue that even an individualized approach-- sans any meaningful data-- seems to have failed far too many. I do find the experience of those in Scandinavian countries worth acknowledging.

Complex and difficult does not begin to cover it--even for those truly wanting to do the "right" thing.

[janterry]

2. two members of WPATH

gave statements this week to a journalist in which they talked about issues they view as problems with care for this population. One worried about puberty blockade (as MD's prefer to call it) and said that the consequences might be that they would never have sexual satisfaction. The other worried that we were not carefully assessing the children/teens that are currently being treated.

Here is what Dr. Bowers (transgender, herself - and an MD who worked with Jazz Jennings) said:

When you block puberty, the problem is that a lot of the kids are orgasmically naive. So in other words, if you've never had an orgasm pre-surgery and then your puberty's blocked, it's very difficult to achieve that afterwards. And I think that I consider that a big problem, actually. It's kind of an overlooked problem that in our informed consent of children undergoing puberty blockers, we've in some respects overlooked that a little bit.


Personally (and this is just me), the first time I watched those detransitioners being interviewed and talking about their experience - I just cried.

[snpsmom]

3. Seems to me that age of consent

for all the things: sex, conversion therapy, hormone therapy, etc..., should be about the same.

[Whatthe_Firetruck]

5. But there are kids who are rock solid sure

...as preadolescents. When they go through puberty, every day their bodies become more and more alien to them. This is what dysphoria is all about. The more they move to the 'wrong' (birth) gender, the harder it is for the transitioning treatments to work. But they must be very sure and serious about it.

[janterry]

6. did you read what Dr. Bowers said about giving puberty

blockers at tanner stage 2? Can a child meaningfully make a decision about their future sexual life prior to puberty? (Most kids at that age are pretty ambivalent about the dynamics of sex itself). So, if we say to the parents -- and the kids -- the outcome for many (many- that's what Dr. Bowers is saying)will be an inability to experience orgasm.

Is that a good outcome?

ETA: here's another link. https://www.medscape.com/viewarticle/950964
Sweden has stopped routinely prescribing pb's to kids because the quality of research is poor and the kids who are presenting for treatment do not seem to meet the criteria set up in DSM (persistent, consistent). This is on the heels of Finland also prioritizing talk tx. and not medical intervention.

[snpsmom]

7. Preadolescent brains

are not fully developed, so it's hard to say that kids can be fully sure of themselves.

If we can be sure that they are unable to consent to other medical treatment and sure that they cannot consent to sex, we should be very careful about allowing them to consent to this specific type of life altering medical treatment.

[bucolic_frolic]

4. Adolescent uncertainty is bombarded by modern society with messaging

that is overt, subliminal, relentless, unorganized, and highly sexual. It's creating confusion. Then there is the mix of cues from peers, parents, and institutions. And they want psychologists to sort it out. I think these kids need detox and time. Their true nature and path will come to them when they strengthen themselves and stop focusing on external stimuli and its rewards.

That's my quick take on it.