During the twentieth century, and into the twenty-first, small numbers of mostly adult men with lifelong gender distress have been treated with estrogen and surgery to help them live as women. Then in recent years came new research on whether medical transition—primarily hormonal—could be done successfully on minors.
One motivation of the medical professionals overseeing these treatments was to prevent young people from facing the difficulties adult men had experienced in trying to convincingly appear as women. The most prominent advocates of youth transition were a group of Dutch clinicians. They published a breakthrough paper in 2011 establishing that if young people with gender dysphoria were able to avoid their natural puberty by blocking it with pharmaceuticals, followed by receiving opposite-sex hormones, they could start living their transgender lives earlier and more credibly.
It became known as the “Dutch protocol.” The patient population the Dutch doctors described was a small number of young people—almost all male—who, from their earliest years, insisted they were girls. The carefully selected patients, apart from their gender distress, were mentally healthy and high-functioning. The Dutch clinicians reported that following early intervention, these young people thrived as members of the opposite sex. The protocol was quickly adopted internationally as the gold standard treatment in this new field of pediatric gender medicine.
Concurrently, there arose an activist movement that declared gender transition was not just a medical procedure, but a human right. This movement became increasingly high profile, and the activists’ agenda dominated the media coverage of this field. Advocates for transition also understood the power of the emerging technology of social media. In response to all this, in Finland the Ministry of Social Affairs and Health wanted to create a national pediatric gender program. The task was given to the two hospitals that already housed gender identity services for adults. In 2011, my department was tasked with opening this new service, and I as the chief psychiatrist became the head of it.
As the service got underway starting in 2011, there were many surprises. Not only did the patients come, they came in droves. Around the Western world the numbers of gender-dysphoric children were skyrocketing.
But the ones who came were nothing like what was described by the Dutch. We expected a small number of boys who had persistently declared they were girls. Instead, 90 percent of our patients were girls, mainly 15 to 17 years old, and instead of being high-functioning, the vast majority presented with severe psychiatric conditions.
So I started talking about our observations with a network of professionals in Europe. I found out that everybody was dealing with a similar caseload of girls with multiple psychiatric problems.
Soon after our hospital began offering hormonal interventions for these patients, we began to see that the miracle we had been promised was not happening. What we were seeing was just the opposite.
Our study was published in 2015, and I believe it was the first journal publication from a gender clinician raising serious questions about this new treatment.
We realized they were networking and exchanging information about how to talk to us. And so, we got our first experience of social contagion–linked gender dysphoria. This, too, was happening in pediatric gender clinics around the world, and again health providers were failing to speak up.
I understood this silence. Anyone, including physicians, researchers, academics, and writers, who raised concerns about the growing power of gender activists, and about the effects of medically transitioning young people, were subjected to organized campaigns of vilification and threats to their careers.
[T]he foundation on which the Dutch protocol was based is crumbling. Researchers have shown that their data had some serious problems, and that in their follow-up, they failed to include many of the very people who may have regretted transition or changed their minds. One of the patients had died due to complications from genital transition surgery.
[O]ne new study shows that nearly 30 percent of patients in the sample ceased filling their hormone prescription within four years.
In June of 2020 a major event happened in my field. Finland’s national medical body, COHERE, released its findings and recommendations regarding youth gender transition. It concluded that the studies touting the success of the “gender-affirming” model were biased and unreliable—systematically so in some cases.
It had taken quite a while, but I felt vindicated.
Fortunately, Finland is not alone. After similar reviews, the UK and Sweden have come to similar conclusions. And many other countries with national healthcare systems are re-evaluating their “gender-affirming” stance.
Source: ‘Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It.’ | The Free Press