Globally, there are significant difficulties in discussing, let alone challenging, the practice of gender clinics, due to the belief systems of those who adhere to gender identity theory – a non-clinical ideological perspective for which there is little to no empirical support. This position requires clinicians to believe that everyone has an innate, subjective gender identity and that individuals whose bodies do not match this should be provided with ‘gender-affirming’ medical interventions regardless of the harms and lack of evidence of benefit (6,7,8). However, a child or adolescent’s sense of gender is part of a complex inner sense of self that can change during the process of development. Medicalising young people on the basis of unsubstantiated theory is unethical: there are many reasons why they might feel dysphoria, disgust, dissociated or ‘cut off’ from their physical bodies, including internalised homophobia, histories of trauma, cognitive difficulties and mental health problems. Each person suffering from such distress requires space and time to understand their feelings.
Offering puberty blockers, cross-sex hormones and radical surgery with the implicit promise of almost magical transformation may cause, and has caused, serious harms. With inadequate follow up by GIDS, no comprehensive long-term observational studies, and no reliable clinical trial data, there is simply no evidence on which to base these interventions (2,6,7,8). It is unsurprising that ‘detransitioners’ (disillusioned people who wish to reverse the effects of ‘treatments’) are coming forward; some may want legal redress and plaintiffs’ firms are seeking them out (9). Without outcome information – let alone understanding how any pre-pubertal child could make a decision to alienate adult functions they cannot understand (like sexual pleasure) – patients and their parents were never in a position to give properly informed consent to uncontrolled experimental interventions (6) clinicians failed to properly describe. These initial cases may herald more as increasing numbers of patients, parents and clinicians question the so-called ‘affirmative model’.
Source: Clinical standards and negligence in gender identity services | The BMJ