CCBI News: Gender Dysphoria (Gender Identity Disorder)

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November 10, 2023

Dear Friends of CCBI,

Gender Dysphoria (Gender Identity Disorder)

CCBI has been monitoring the appearance of varying approaches to gender dysphoria over the years, acutely aware of the growing differences of opinion in the field as to its definition and to changes in standards of treatment. Gender dysphoria, or gender identity disorder, is often defined as the psychological condition in which the individual feels an incongruence between his or her experienced gender and his or her biological sex. The last time we wrote on the topic for our ‘Bioethics Matters’ series (references below) we wrote:

Social constructs and theories are always in the process of being reshaped, remodelled or, as we try to improve our individual lives, those of others, and our common home. A “gender construct” approach to sexuality and sexual identity is as open to critique and change as any other social theory. While it has gained considerable traction, it is also being challenged at an evidence-based level and is arguably showing signs of fraying at the seams.

This ‘fraying’ is borne out in the changes now being made by many countries in light of lack of evidence-based results in somewhat hastily adopted and accepted treatment. A prime example is the closing of the world-famous Tavistock Clinic in London, England, a respected, pioneering centre for the treatment of transgender young people. The number of transferrals had increased from 138 in 2010-11 to 2. 383 in 2020-21. Other countries and centres have been experiencing similar increases in the numbers of young people looking for help, and research into the possible causes for this overwhelming increase is now ongoing done and will contribute to explaining the phenomenon. The Tavistock Clinic was also overwhelmed by numbers, but that was not the main reason for its winding down. Hilary Cass, a pediatrician, was commissioned to review the Clinic’s gender identity programs and confirmed that the Clinic and its services were under ‘unsustainable pressure.’ The dramatic increase in demand left staff unable to meet the needs, and young people were on waiting lists of up to two years, which is totally unacceptable for those who needed urgent help for the distress they were experiencing, sometimes also from other mental health issues.

An obvious answer to that would be to increase services, but that was not the only issue facing the National Health Services in its mandate to provide treatment. The Tavistock was thought to be the single most effective treatment centre for gender identity issues, hence the long waiting lists. It had faced criticism over the years, not least from those opposed to hormone treatment, pre-puberty, for young children. Minors’ capacity for estimating long-term effects and consequences of such treatments is a moral and legal question of the first order, yet often relegated or dismissed in decisions to relieve more immediately experienced distress occurring in many youngsters.

Not only the public but staff themselves had spoken out about what they considered overdiagnosis of gender dysphoria, and they question the reasons for such diagnosis. They had begun to look at the serious consequences of pre-pubertal and early medical interventions, as well as the dramatic increase in referrals of girls questioning their gender identity. The first two points – overdiagnosis and medical interventions – have been systematically analysed over the years and are beginning to yield statistically verifiable results with some changes in treatment standards in some countries. The last point, the disproportionate increase in the number of girls presenting, continues to be studied and, while some of the results, e.g., the possibility of ‘social contagion,’ are rejected by some and accepted by others, the trend is confirmed globally.

De-transitioning and a Plea for Evidence-Based Treatment

Added to the complexity of this issue is the reality check of ‘de-transitioning,’ where some young people find that gender-changing treatment was a mistake, that they had been too hasty in making body-altering changes through hormone treatment, only now realizing they were too young to make such decisions in the first place and had relied on parental and medical advice which they now find misguided. Lawsuits for malpractice have begun and are a cautionary note for anyone involved in this field. The prudent approach to treatment, long advocated not just in Catholic teaching but by many psychiatrists, psychologists, endocrinologists and other medical specialists, is that children and young people with gender dysphoria should be treated by ongoing counselling and support to help them and their families through these difficult experiences.

One Catholic health organization recently claimed that gender dysphoria is promoted “… by left-wing politicians and a politicized medical community as a condition with limited solutions: destructive surgical intervention and/or gender affirmation.” Backing up these claims, it refers to a new report by the Catholic Medical Association in the United States which states physicians should practise medicine “… according to its healing purpose, instead of affirming the child’s confusion, chemically blocking puberty, or administering life-altering cross-sex hormones to their young patients.” This demand is not new, having been the response for some time of those who are against such medical interventions, but new evidence has surfaced which points to lack of knowledge and research in the field and calls for caution or complete cessation apart from medical interventions apart from psychological support.

Illustrating the wisdom of this approach, a gender clinic based in a children’s hospital affiliated with Washington University in St. Louis charted a similar path to the Tavistock Clinic in England. A dramatic increase in the numbers of children seeking help left the staff overwhelmed. Again, the answer was not an increase of staff, since a former case manager publicly claimed that, “… doctors at the clinic had hastily prescribed hormones with lasting effects to adolescents with pressing psychiatric problems.” Young patients were arriving with mixed mental health issues. Clinic documents show staff raised questions and expressed disagreement over the causes of these issues and asking whether gender dysphoria is not the root cause of the distress but might be a consequence of something deeper. In other words, the treatment should be aligned with the cause, and not primarily with the consequence. For example, some youngsters, sadly, exhibit suicidal tendencies, and the question is: is this caused by gender dysphoria or is there a deeper cause? The answer to this is clearly necessary to establish ethical and effective treatment paths.

The critique claimed that the clinic relied on external therapists, some with little experience in gender issues, and that, “Doctors prescribed hormones to patients who had obtained such approvals, even adolescents whose medical histories raised red flags. Some of these patients later stopped identifying as transgender and received little to no support from the clinic after doing so.”

Lack of Long-Term Studies / Hasty Diagnoses

Concerns such as these are being expressed around the world, chief among them being lack of long-term studies, making it difficult for doctors to make effective treatment choices. Several European countries have limited treatments for young patients and have expanded mental health care while more data is collected, which seems the more scientific, evidence-based approach.

For example, Great Britain, Sweden, Finland, France, and Denmark have recently restricted the use of puberty blocking drugs in children with gender dysphoria, concerned, among other reasons, that such treatment protocol could be ideologically motivated rather than evidence based (Cf. Ludvigsson 2023). Concerns include factors such as children being given the diagnosis of gender dysphoria with insufficient clinical oversight and sometimes placed too rapidly on the sex reassignment protocol. A consequence of a hasty initial diagnosis is the progression to administration of puberty suppression and cross-sex hormonal treatment, followed by the possibility of sex reassignment surgery and its body- changing and life-altering effects. 

To be Continued

Over the next few week we will review some of the recent literature regarding medical interventions in children with gender dysphoria, ethical analyses in light of Catholic teaching, information from young people who now want to de-transition, the question of consent and the more socio-political issue of parental rights, all from a Catholic perspective.

Moira McQueen. “Born This Way: Not Borne Out.” Bioethics Matters, May, 2019. Outline (ccbi-utoronto.ca)
Transgender Ideology Is Harming Vulnerable Patients | RealClearHealth
The Ideology of Gender Harms Children – Catholic Medical Association : Catholic Medical Association (cathmed.org)
How a Small Gender Clinic Landed in a Political Storm – The New York Times (nytimes.com)
Ludvigsson JF, Adolfsson J, Höistad M, Rydelius PA, Kriström B, Landén M. A systematic review of hormone treatment for children with gender dysphoria and recommendations for research. Acta Paediatr. 2023 Nov;112(11):2279-2292. doi: 10.1111/apa.16791. Epub 2023 May 1. PMID: 37069492.

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For Pope Francis
We pray for the Holy Father; as he fulfills his mission, may he continue to accompany the flock entrusted to him, with the help of the Holy Spirit.

Moira and Bambi