A parents’ initiative of so-called trans teens is calling on medical societies to stop the planned treatment guidelines for teenagers with gender dysphoria. In an open letter to the board of directors and presidiums, they demand a move away from medical treatments with hormones and operations for healthy children and young people who are of the opinion that their innate gender does not match their feelings. The letter is available to WELT.
The co-founders of the interest group “TransTeens Concern is justified”, Anna Weber and David Allison, criticize the “early and systematic gender-affirmative treatment” of minors in the paper. This is neither practical nor ethically acceptable, turns healthy young people into “lifelong patients” and limits their future. The initiative consists of parents with “gender uncertain or gender dysphoric adolescents and young adults in Germany”.
The parent group warns of “increased overdiagnosis and false-positive cases.” The expansion of new gender-affirming advice centers, internet offerings and clinics for transgender health is “in full swing”. The legal options for “changing” gender have also recently been simplified by the Self-Determination Act. “Drastic medical and life-changing interventions should always be the last option and not the first choice treatment, as is currently routinely the case in Germany,” write the initiators.
Instead of inappropriately and unnecessarily medicalizing girls in particular, it would make sense to postpone invasive procedures until “mature adulthood” in order to give them an open future, the association argues. The desire for a different gender is often strong during puberty, but ultimately mostly temporary.
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The German treatment guidelines for minors are closely based on the recommendations of the international transgender organization “WPATH” (World Professional Association for Transgender Health) and the global “Endrocrine Society,” warn the initiators in the letter. WPATH, which advocates the administration of hormones and puberty blockers to minors, recently came under criticism when excerpts from members’ discussions became public.
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Doctors from the activist and professional organization had revealed that they were treating teenagers with hormones who were unable to think through the implications of their decisions. Some countries have already moved away from the WPATH line due to a lack of evidence, including the UK, Sweden and Finland. They are increasingly relying on psychosocial support and psychotherapy; in Great Britain the administration of puberty blockers was recently stopped. The main argument is that the lifelong consequences of these treatments cannot be estimated and the benefits are doubtful.
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“Self-determination” decided
Germany’s medical associations, on the other hand, continue to follow the so-called trans-affirmative direction, i.e. adapting to the patients’ ideas. On March 22nd, the specialist societies of pediatric and adolescent medicine published the draft of the new treatment guidelines for dealing with children and adolescents who are affected by “gender incongruence” or “gender dysphoria”. The German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) is in charge.
The paper is not yet official, but is currently in circulation with colleagues who can comment on it. The guideline is based on the paradigm shift in dealing with what was previously called “transsexuality” and classified as a mental disorder. “Gender dysphoria” is now no longer considered an illness, but rather a condition. Doctors claim that this cannot be treated primarily through psychotherapy, but that those affected should primarily be helped through medical interventions.
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The children’s self-assessment is effectively placed above the medical diagnosis. The preamble to the guideline states that doctors must respect the wishes of children and adolescents who identify as belonging to a gender other than that of their birth. Therapy approaches that aim to direct this feeling of belonging in a certain direction would be viewed as “unethical”.
The guideline is based on the consent of the commission members, not on medical evidence. That’s why she had to be downgraded in status. The fact that there is a lack of evidence for medications and interventions is pointed out in many places throughout the work. Nevertheless, the administration of puberty blockers, cross-sex hormones and the amputation of the female breast in minors are mentioned as options.
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The parents’ initiative also addresses the lack of evidence in its letter: “It is unethical to acknowledge the poor quality of the evidence, but then – without adequately knowing the benefits and harms – to make strong recommendations for the medical transition of minors.” Puberty blockers and for life Required cross-sex hormone treatments are “not trivial, but rather life-changing interventions”.
WPATH’s claims that puberty blocking provides a pause for “thinking” and is reversible have often been debunked. The fact that almost all teenagers switch to hormones suggests that they are becoming fixated on the transition path. The “irresponsible exaggeration of the risk of suicide and self-harm” in gender-confused children and young people does not correspond to the current state of research.
From the perspective of the parents’ initiative, it is inconsistent to no longer classify gender dysphoria as an illness, but still treat young people with hormones: “Our children have a right to an open future and to physical integrity. Adolescents and young adults need at least freedom of choice in the form of non-invasive treatment alternatives.”
Criticism also from doctors
The parents are not alone in their rejection. In advance, the guidelines had already caused outrage among critics from the medical community. One of them is Professor Florian Zepf, head of the clinic for child and adolescent psychiatry, psychosomatics and psychotherapy at the Jena University Hospital. He was a member of the guidelines commission himself, but left it at his own request at the end of 2022 due to professional ethical concerns.
The guidelines ignore the fact that there is currently no clear medical evidence for the treatment of biologically healthy minors with gender dysphoria with puberty blockers or hormones, Zepf told WELT when the paper was published. Tobias Banaschewski, medical director of the Clinic for Psychiatry and Psychotherapy for Children and Adolescents, warned of a “medical scandal” caused by the treatment of healthy minors.
This assessment is confirmed by an independent study published at the beginning of April, which advises “extreme caution” when using hormone therapy for gender reassignment in minors. In the almost 400-page final report, pediatrician Hilary Cass makes 32 recommendations for dealing with children whose physical sexual characteristics do not correspond to their perceived gender identity. She concludes that “for most young people, a medical route is not the best way to resolve their gender-related issues.”
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The report was commissioned by the NHS in 2020 after more and more children and young people sought medical advice about their gender identity. The authors examined 23 treatment guidelines and recommendations for minors with gender dysphoria worldwide. The WPATH recommendations and those of the Endocrine Society performed particularly poorly. Among other things, the authors were classified as not independent. Only the Swedish and Finnish lines, which primarily recommend psychotherapy and psychosocial care, seemed credible to the authors.
Not only the medical guidelines for children and young people, but also the political framework have changed in Germany. With the new Self-Determination Act, minors will also be able to have their gender entry changed in the future. Young people aged 14 and over need the consent of their parents. Parents can make a declaration to change their gender up to the age of 14 – but not against the child’s will. From the age of five, the child must consent to this. In the event of a dispute, state representatives should decide.