Management of minors with “gender dysphoria”: Questioning the medical protocol applied by gender clinics

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Beryl Koener (1), Luc Vandecasteele (2), Caroline Eliacheff (3), Jacques Robert (4), Magali Pignard (5), Claudio Rubiliani (6), Patrick K. Hunter (7), Sophie F. Dechêne (8), Jean-Paul Leclercq (9), Jean-Pierre Lebrun (10), Céline Masson (11) Published in the journal : December 2024 Category : Psychiatrie infanto-juvénile

Summary :

There has been an exponential increase in the number of minors diagnosed with “gender dysphoria” over the past two decades. Specialized clinics in Ghent, Liège, and Antwerp treat them using the Dutch protocol, an approach described as “affirmative” of the desired gender, based on the administration of GnRH agonists followed by gender-affirming hormones.

Many clinicians are unaware of this protocol’s lack of evidence-based foundation, the many biases fostered by the World Professional Association for Transgender Health (WPATH) that promotes it, and the scandal that has erupted in various countries following its misuse. These have been revealed by the National Health Service (NHS) in the United Kingdom (UK) thanks to the Cass Review and by a report on the transidentification of minors in the French Senate. The European Society of Child and Adolescent Psychiatry (ESCAP) recently called for a halt to the routine use of the Dutch protocol for gender-dysphoric minors.

The aim of the present article is to outline the origins and foundations of this protocol, to document the drifts and biases that have occurred worldwide, and to present the current recommendations.

What is already known about the topic?

Recently published literature reviews analyzing practices over the past few decades regarding gender dysphoric minors have revealed a lack of evidence-based support for the guidelines established by the WPATH. However, gender clinics continue to defend these guidelines, and in Belgium, the number of centers dedicated to the treatment of gender dysphoria is increasing.

Systematic reviews recently published as part of the Cass Review in the UK, commissioned by the NHS, show a lack of benefit for gender dysphoria and mental health following treatment of minors with GnRH agonists and gender-affirming hormones. As a result, the ESCAP has recently issued new recommendations on management practices in the light of the systematic evidence available.

What does this article bring up for us?

The aim of this article is to inform the Belgian medical community about the lack of evidence-based foundation of the current Dutch protocol for the treatment of gender dysphoric minors, promoted by the WPATH. Through an analysis of the social reasons behind the increase in the number of minors diagnosed with gender dysphoria, the article describes the abuses that have occurred worldwide and concludes with a discussion of the new treatment recommendations that have just been published.

The article is based on an analysis of all the systematic reviews used to develop the Cass Review, which led to the NHS suspending routine use of the Dutch protocol.

The article draws a parallel between the findings of the Cass Review, which are consistent with those of the French Senate report on the transidentification of minors, and those of the ESCAP.

Keywords

Gender dysphoria, Cass Review, Dutch protocol, European Society of Child and Adolescent Psychiatry (ESCAP)