dugdeep said:I'm not sure I'm understanding your post here, Oxajil, but it sounds like you're suggesting it's better for gender reassignment to be done in children because of procedural reasons. I would have to disagree with you there.
As we said in the show, a child is really and truly incapable of making such a momentous decision that will affect them for the rest of their lives. A child really has no concept of the future, of possible consequences or of the extraneous factors that may be affecting their decision. To leave this kind of decision to a prepubescent child is completely irresponsible, IMO. Considering how many changes all children go through between childhood, adolescence and adulthood, how could one be sure that a child's feelings wouldn't change entirely during that time? I believe elective surgeries and hormonal manipulation should be illegal in children. It is reckless and irresponsible.
If you're referring to cases of hermaphrodism, where the transition is used as a corrective measure, than I think that's different.
Odyssey said:For the life of me I cannot imagine that a child, or even teen for the matter, would have the mental capacity to make that decision for themselves. They cannot consent for even the most minor of surgeries or medical procedures let alone a lifetime or hormonal treatments and radical surgery -- the long term effects of which have not even been determined. As this article put it, it is medical malpractice. What adults choose to do with their own bodies, even if the feelings behind the decision are just as changeable, is their own business. Radically changing your entire life based on a decision made in your childhood is unconscionable to me.
That was a shocking article to read, I didn't know that many had committed suicide after such treatment.
I know that the brain isn't fully developed until at least mid 20s, and especially the frontal parts that are necessary for decision making processes. The reason I said the above is that this is what I was taught by specialists who have treated transgenders for many years; young and old. I mistakenly thought that it must be true when they said that based on their results the younger they start with the hormonal treatment etc. the better their quality of life will be. They said that if they go through a hormonal treatment and/or surgical operation at a young age, they can save a lot of years of depression and suffering that they can experience once they develop 'secondary sex characteristics'. On the other hand, what if they go through that operation (or the hormonal treatment) and find out at a later point they actually had confusing feelings and were happy the way they were before. That would be awful, and not worth taking the chance, especially considering the article you mentioned.
I looked into some studies on this. Some bits from a study entitled 'Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment' published in October 2014:
A protocol designed by Cohen-Kettenis and Delemarre-van de Waal14 (sometimes referred to as “the Dutch model”)4,7 considers adolescents, after a comprehensive psychological evaluation with many sessions over a longer period of time, eligible for puberty suppression, cross-sex hormones (CSH), and gender reassignment surgery (GRS) at the respective ages of 12, 16, and 18 years when there is a history of gender dysphoria (GD); no psychosocial problems interfering with assessment or treatment, for example, treatment might be postponed because of continuous moving from 1 institution to another or repeated psychiatric crises; adequate family or other support; and good comprehension of the impact of medical interventions.12 Puberty suppression is only started after the adolescent actually enters the first stages of puberty (Tanner stages 2–3), because although in most prepubertal children GD will desist, onset of puberty serves as a critical diagnostic stage, because the likelihood that GD will persist into adulthood is much higher in adolescence than in the case of childhood GD.15,16
This suggests that the later they start, the better it would be.
Despite the apparent usefulness of puberty suppression, there is only limited evidence available about the effectiveness of this approach. In the first cohort of adolescents who received GnRHa, we demonstrated an improvement in several domains of psychological functioning after, on average, 2 years of puberty suppression while GD remained unchanged.16 The current study is a longer-term evaluation of the same cohort, on average, 6 years after their initial presentation at the gender identity clinic. This time, we were not only interested in psychological functioning and GD, but added as important outcome measures objective and subjective well-being (often referred to as “quality of life”), that is, the individuals’ social life circumstances and their perceptions of satisfaction with life and happiness.17–19 After all, treatment cannot be considered a success if GD resolves without young adults reporting they are healthy, content with their lives, and in a position to make a good start with their adult professional and personal lives.20 Because various studies show that transgender youth may present with psychosocial problems,21,22 a clinical approach that includes both medical (puberty suppression) and mental health support (regular sessions, treatment when necessary, see Cohen-Kettenis et al12) aims to improve long-term well-being in all respects.
In the present longitudinal study, 3 primary research questions are addressed. Do gender dysphoric youth improve over time with medical intervention consisting of GnRHa, CSH, and GRS? After gender reassignment, how satisfied are young adults with their treatment and how do they evaluate their objective and subjective well-being? Finally, do young people who report relatively greater gains in psychological functioning also report a higher subjective well-being after gender reassignment?
Their results (though mostly applicable for transwomen):
Results of this first long-term evaluation of puberty suppression among transgender adolescents after CSH treatment and GRS indicate that not only was GD resolved, but well-being was in many respects comparable to peers.
The effectiveness of CSH and GRS for the treatment of GD in adolescents is in line with findings in adult transsexuals.35,36 Whereas some studies show that poor surgical results are a determinant of postoperative psychopathology and of dissatisfaction and regret,37,38 all young adults in this study were generally satisfied with their physical appearance and none regretted treatment. Puberty suppression had caused their bodies to not (further) develop contrary to their experienced gender.
Psychological functioning improved steadily over time, resulting in rates of clinical problems that are indistinguishable from general population samples (eg, percent in the clinical range dropped from 30% to 7% on the YSR/ASR30) and quality of life, satisfaction with life, and subjective happiness comparable to same-age peers.17,19,34 Apparently the clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons gave these formerly gender dysphoric youth the opportunity to develop into well-functioning young adults. These individuals, of whom an even higher percentage than the general population were pursuing higher education, seem different from the transgender youth in community samples with high rates of mental health disorders, suicidality and self-harming behavior, and poor access to health services.21,22,39,40
In this study, young adults who experienced relatively greater improvements in psychological functioning were more likely to also report higher levels of subjective postsurgical well-being. This finding suggests value to the protocol that involves monitoring the adolescents’ functioning, physically and psychologically, over many years, and providing more support whenever necessary.
This clinic-referred sample perceived the Environmental subdomain (with items like “access to health and social care” and “physical safety and security”) of the WHOQOL-BREF as even better than the Dutch standardization sample.17 Whereas in some other contexts transgender youth may experience gender-related abuse and victimization,22,41,42 the positive results may also be attributable to supportive parents, open-minded peers, and the social and financial support (treatment is covered by health insurance) that gender dysphoric individuals can receive in the Netherlands.
Both genders benefitted from the clinical approach, although transwomen showed more improvement in body image satisfaction (secondary sex characteristics) and in psychological functioning (anger and anxiety). None of the transmen in this study had yet had a phalloplasty because of waiting lists or a desire for improved surgery techniques. This finding warrants further study of the specific concerns of young transmen.
Despite promising findings, there were various limitations. First, the study sample was small and came from only 1 clinic. Second, this study did not focus on physical side effects of treatment. Publications on physical parameters of the same cohort of adolescents are submitted or in preparation. A concurring finding exists in the 22-year follow-up of the well-functioning first case now at age 35 years who has no clinical signs of a negative impact of earlier puberty suppression on brain development, metabolic and endocrine parameters, or bone mineral density.43 Third, despite the absence of pretreatment differences on measured indicators, a selection bias could exist between adolescents of the original cohort that participated in this study compared with nonparticipants.
Age criteria for puberty suppression and CSH are under debate, although they worked well for adolescents in the current study. Especially in natal females, puberty will often start before the age of 12 years. Despite the fact that developing evidence suggests that cognitive and affective cross-gender identification, social role transition, and age at assessment are related to persistence of childhood GD into adolescence, predicting individual persistence at a young age will always remain difficult.44 The age criterion of 16 years for the start of CSH may be problematic especially for transwomen, as growth in height continues as long as cross-sex steroids are not provided (causing the growth plates to close). Therefore, psychological maturity and the capacity to give full informed consent may surface as the required criteria for puberty suppression and CSH45 in cases that meet other eligibility criteria.
So while these particular patients did benefit from the treatment, it is of course not entirely clear how the situation will be at a later point in time, as in this study they checked with the patients just one year after the surgery.
In another study ('Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study') it was noted:
Although an increasing number of gender clinics have adopted this Dutch strategy and international guidelines exist in which puberty suppression is mentioned as a treatment option [8] and [9], many professionals working with gender dysphoric youth remain critical [10] and [11]. Concerns have been raised about the risk of making the wrong treatment decisions and the potential adverse effects on health and on psychological and psychosexual functioning. Proponents of puberty suppression, on the other hand, emphasize the beneficial effects of puberty suppression on the adolescents' mental health, quality of life, and of having a physical appearance that makes it possible to live unobtrusively in the desired gender role [12].
The [12] reference is to this study: https://www.ncbi.nlm.nih.gov/pubmed/21587245
I'm starting to see that it is primarily the Dutch who seem to be the main proponents of this treatment for children.
Considering all the above as well as your comments, I should've been more careful with what I said, it is a really big decision that shouldn't be made lightly, especially not at a young age. I'll have a look at the articles and references you provided Odyssey, I think the questions you asked are worth looking into.