The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine? | SpringerLink

Many of the other somatic psychiatric treatments of the twentieth century were given predominantly to females. Pressman (1998) wrote that “an enduring mystery of the psychosurgery story, is why women were lobotomized nationally at a rate twice that of males” (p. 303). Braslow (1997) argued that the doctors entwined madness and unladylike behavior, and psychosurgery was seen as a potential intervention to restore femininity. In addition, women were “shackled, straightjacketed, bound and secluded” much more often than men (p. 157). Women who masturbated could be ordered to undergo clitoridectomy; men who masturbated and acted out “never lost their penises or testicles as a cure for these activities” (p. 168). In a feminist account, Showalter (1985) also portrayed psychiatry as a history of the colonization and subjugation of women.

Homosexuals’ bodies have also been a favored site for experimental twentieth century medical and surgical interventions in which treatment, social control, and punishment goals blur.

My final historical example is the hormonal treatment of “tall girls” and “short boys.” From the 1960s through until the 1980s, large numbers of adolescents, who had no underlying medical pathology or hormonal abnormality, were prescribed hormonal treatment for their height (Cohen & Cosgrove, 2010). The reasons stated for such treatments, for what nowadays might be called “height dysphoria,” included that adolescents were distressed, and their height had negative social impact. For example, “careers in classical ballet or being an airline hostess were closed” to “tall girls” and their prospects of finding a husband were jeopardized (Wettenhall et al., 1975). Some adolescents and their parents eagerly sought this treatment, led to it by the encouragement of physicians and school nurses, enthusiastic media promotion, and pharmaceutical companies’ advertising. At the time, the hormones were declared safe, but years later concerns emerged about long-term adverse effects, including impaired fertility and increased risk of cancers (Benyi et al., 2014; Venn et al., 2004). Some boys treated with growth hormone developed Creutzfeld–Jacob disease, an aggressive early onset and fatal dementia. In Australia, this led to a federal government inquiry and an apology. In France, criminal charges were laid against some of the physicians involved (Cohen & Cosgrove, 2009, pp. 262, 350). Importantly, there had been a lack of controlled trials to confirm the efficacy, either on improving psychosocial outcome or the impact on height, of these treatments. A retrospective cohort study of “tall girls” revealed that 42% of the study group regretted the hormonal treatment they received (ibid., p. 232). Tall girls and short boys may be a visual affront to some societal “ideals” of male strength female fragility. This seems another part of the story of medicine acting to reinforce society’s sex stereotypes, and for some patients it came at disastrous personal cost.

Masculinizing chest surgery is part of the controversial gender affirmative treatment approach to GD youth. This approach is underpinned by the view that a child or adolescent’s stated gender identity should be endorsed not questioned, and that they should be supported to undertake social transition, medical transition, masculinizing chest surgery, and, some also argue, genital surgery. Those advocating this approach consider these gender affirming treatments medically and ethically essential (Baams, 2021; de Vries et al., 2021; Transgender Health, 2020; Walch et al., 2021).

Some influential LGBTIQ and parent groups are vocal in their support of affirmative treatments for GD youths, but other such groups express concern. Some consider that placing the label “trans” on gender non-conforming youth is an expression of the homophobia of our society. They are concerned that the hormonal and surgical interventions maybe a repetition, albeit unwittingly, of historical treatments that aimed at converting homosexual people to fit with heterosexual norms (Stock, 2021, pp. 83–84). There is emerging research data that support these concerns.

How, then, do we best read the affirmative treatment approach for GD youth? Should it be read triumphantly as cutting-edge, ethical, and evidence-based medicine continuing on its progressive march of improving human life? Or is it a manifestation of dangerous medicine, that despite best intentions will cause more harm than benefit to vulnerable youths, and over which future historians and physicians will shake their heads?

Between the ages of 16 and 20, Kiera Bell identified as a man and took testosterone and underwent a double mastectomy. She then detransitioned. In a court testimony, she described her regret: “I felt like a fraud…more lost, isolated and confused than I did when I was pre-transitioned…only recently…I have started to think about having children and if that is ever a possibility, I have to live with the fact that I will not be able to breastfeed my children…I made a brash decision as a teenager…trying to find confidence and happiness…now the rest of my life will be negatively affected” (Bell, 2020, pp. 21–22). In these words, Bell holds herself responsible for making a “brash decision” in her youth. This may be an indication of maturity and taking responsibility, but it also has a more concerning element–a victim blaming herself for mistreatment. In my view, the medical profession needs to consider whether, in its championing of the gender affirmative approach for GD youth, it is also acting brashly and making mistakes that will negatively impact some young people for the rest of their lives.

Source: The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine? | SpringerLink

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