Article

The Endocrinologist's Office-Puberty Suppression: Saving Children from a Natural Disaster?

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Abstract

In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children brought under clinical purview.

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... There are now forty gender clinics across the United States that promote the use of pubertal suppression and cross-sex hormones in children and adolescent populations [1]. The rationale for use of puberty suppression is to allow the gender-dysphoric child time to explore gender identity free from the emotional distress triggered by the onset of secondary sex characteristics that typically present in the stages of puberty [8] [6]. ...
... There is an adequate case in favor of utilizing puberty suppression, and cross gender hormones in order to address the psychological, social, and emotional concerns for children and adolescents faced with gender dysphoria. By suppressing the individual's production of sex hormones, administering cross hormone therapy for transition to desired gender would be be more effective [6]. Puberty suppressive drugs usage would effectively inhibit the endogenous pubertal changes that may worsen the individual's gender dysphoria, creating further emotional, social and psychological distress [6]. ...
... By suppressing the individual's production of sex hormones, administering cross hormone therapy for transition to desired gender would be be more effective [6]. Puberty suppressive drugs usage would effectively inhibit the endogenous pubertal changes that may worsen the individual's gender dysphoria, creating further emotional, social and psychological distress [6]. In fact, those who support the use of such medication indicate that withholding this treatment would be more harmful. ...
... Many raise concerns about the potential sterilizing effects of treatment (Waehre & KA Tønseth, 2018;Sadjadi, 2013;Nataha et al., 2017;Jeffreys, 2012;Cretella, 2016). Gametes may not fully mature when pubertal suppression is followed by cross-hormone treatment. ...
... Those who choose to work within their own communities have little reason to exoticize their participants, but these studies are all too often devalued in academia, for being too close to home in the literal sense (Gupta & Ferguson, 1997). The belief is that a researcher may fail to be objective while studying their own community (ibid; Abu-Lughod, 1991 In Western society, the media, clinicians, academics and activists alike often term medical interventions for gender variant people as "life-saving" (Sadjadi, 2013;Giordano, 2008;Turban, 2017). Norway is no exception (livreddende and livsviktig are the words used in Norwegian plain and simple. ...
... Some parents described that prior to pubertal onset, all one could do is sit back and wait as, apart from a social transition, nothing more can be done. But, once puberty begins, so too begins a sense of emergency and a race against the clock (Sadjadi, 2013). ...
... Many raise concerns about the potential sterilizing effects of treatment (Waehre & Tønseth, 2018;Sadjadi, 2013;Nataha et al., 2017;Jeffreys, 2012;Cretella, 2016). Gametes may not fully mature when pubertal suppression is followed by cross-hormone treatment. ...
... Those who choose to work within their own communities have little reason to exoticize their participants, but these studies are all too often devalued in academia, for being too close to home in the literal sense (Gupta & Ferguson, 1997). The belief is that a researcher may fail to be objective while studying their own community (ibid; Abu-Lughod, 1991 In Western society, the media, clinicians, academics and activists alike often term medical interventions for gender variant people as "life-saving" (Sadjadi, 2013;Giordano, 2008;Turban, 2017). Norway is no exception (livreddende and livsviktig are the words used in Norwegian plain and simple. ...
... Some parents described that prior to pubertal onset, all one could do is sit back and wait as, apart from a social transition, nothing more can be done. But, once puberty begins, so too begins a sense of emergency and a race against the clock (Sadjadi, 2013). ...
Thesis
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At the time of writing, the system of gender affirming care (GAC) in Norway is in a state of flux. Recent controversies have arisen around the monopoly on care held by the publicly funded gender clinic (Nasjonal behandlingstjeneste for transseksualisme, NBTS) and the emergence of private providers outside of NBTS. The current situation presents an interesting context for the research behind this thesis, which had the aim of gaining a deeper understanding of the experiences gender variant youth and their parents have while seeking GAC in Norway. The study behind this thesis used several qualitative methods. Semi-structured interviews were conducted with gender variant youth ages 12-22 and parents with experiences seeking GAC. Interviews were also conducted with key informant healthcare providers and activists to provide deeper context. Related grey materials and media were analyzed, and community engagement provided further depth to contextual understandings. Findings are divided into two chapters. The first examines the experiences that lead families to seek interventions like puberty blockers and hormone replacement therapy (HRT) and the meanings they place on these treatments. This thesis explores how study participants experience puberty as a 'crisis' warranting swift preventative action and how these experiences inform conceptualizations of GAC as 'lifesaving' treatment. A new threefold framework of social, embodied and psychological suffering is introduced to understand some of the experiences that motivate study participants to seek care. The second chapter of findings looks at the families' care seeking experiences, in particular, experiences that led to the erosion of trust in the system of GAC. Drawing on several established theories of trust in healthcare, a variety of scenarios that may contribute to the development of distrust in clinicians throughout the care seeking process are explored in the context of recent controversies in GAC. This study contributes to a deeper understanding of the experiences, values and beliefs that motivate families to seek GAC. It also provides important insights into processes of trust development and its erosion in healthcare. The findings suggest a desire for more transparency and information in the care seeking process, a system that caters more to individual needs, and greater partnership in treatment decision-making.
... Consistent with this, use of GnRHa in trans adolescents is associated with reduced bone mineral density (BMD) (19,20), and the potential functional impact of this on bone quality and fracture risk in adulthood remains unknown (21). Long-term GnRHa therapy from early puberty would also be expected to inhibit typical pubertal development of reproductive potential (15,22); this effect is considered likely reversible but has not been directly studied (22). Finally, significant brain and cognitive development occurs during adolescence. ...
... Consistent with this, use of GnRHa in trans adolescents is associated with reduced bone mineral density (BMD) (19,20), and the potential functional impact of this on bone quality and fracture risk in adulthood remains unknown (21). Long-term GnRHa therapy from early puberty would also be expected to inhibit typical pubertal development of reproductive potential (15,22); this effect is considered likely reversible but has not been directly studied (22). Finally, significant brain and cognitive development occurs during adolescence. ...
Article
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Gender dysphoria describes the distress associated with having a gender identity that differs from one’s birth-assigned sex. To relieve this distress, transgender, and gender diverse (henceforth, trans) individuals commonly undergo medical transition involving hormonal treatments. Current hormonal treatment guidelines cater almost exclusively for those who wish to transition from male to female or vice versa. In contrast, there is a dearth of hormonal options for those trans individuals who identify as non-binary and seek an androgynous appearance that is neither overtly male nor female. Though prolonged puberty suppression with gonadotrophin releasing hormone agonists (GnRHa) could in theory be gender-affirming by preventing the development of unwanted secondary sex characteristics, this treatment option would be limited to pre- or peri-pubertal adolescents and likely have harmful effects. Here, we discuss the theoretical use of Selective Estrogen Receptor Modulators (SERMs) for non-binary people assigned male at birth (AMAB) who are seeking an androgynous appearance through partial feminization without breast growth. Given their unique range of pharmacodynamic effects, SERMs may represent a potential gender-affirming treatment for this population, but there is a lack of knowledge regarding their use and potentially adverse effects in this context.
... The construction of normative sexed embodiments has played a significant part in the history of medicalizing diverse sexed embodiments, to the point that we question whether the majority, rather than a minority, of medical providers can even imagine healthy gender identities for their gender variant intersex and trans patients. Moreover, pushing for and policing interventions that modify bodies to fit within gender expectations itself disparages intersex and trans embodiments (Sadjadi 2013), in essence culturally disciplining them through medical technologies. In these cases, there is no clear division between cultural expertise and medical expertise (Rose 2007): Providers treat intersex and trans people because society awards them authority to "fix" bodies that deviate from normative expectations (Foucault [1973(Foucault [ ] 1994. ...
... Defining success for giving sex by shaping patient-sexed embodiments to fit into binary categories further pathologizes intersex and trans embodiments, while leaving the medical system, its agents, and the cultural investment in those binaries unchallenged (Sadjadi 2013). Medical decisions reflect the bureaucratic and ideological work of a medical gaze that makes gender recognizable while perpetuating essentialist ideologies about sex differences, allowing some, but not all, intersex and trans bodies to exist by giving sex in order to give gender. ...
Article
Although medical providers rely on similar tools to “treat” intersex and trans individuals, their enactment of medicalization practices varies. To deconstruct these complexities, we employ a comparative analysis of providers who specialize in intersex and trans medicine. While both sets of providers tend to hold essentialist ideologies about sex, gender, and sexuality, we argue they medicalize intersex and trans embodiments in different ways. Providers for intersex people are inclined to approach intersex as an emergency that necessitates medical attention, whereas providers for trans people attempt to slow down their patients’ urgent requests for transitioning services. Building on conceptualizations of “giving gender,” we contend both sets of providers “give gender” by “giving sex.” In both cases too, providers shift their own responsibility for their medicalization practices onto others: parents in the case of intersex, or adult recipients of care in the case of trans. According to the accounts of most providers, successful medical interventions are achieved when a person adheres to heteronormative gender practices.
... Indeed, for some, waiting is not just a miserable experience; it feels unbearable, even lethal. Horak (2014) calls transition vlogs "lifesaving" because they take place against a backdrop of high reported rates of attempted suicide among trans people-40 percent or more in some studies (Bauer et al., 2015;James et al., 2016)-and trans subjectivity is now discursively linked to self-harm and suicide (McDermott, 2015;Roen, 2018;Sadjadi, 2013). 8 There are many references to the deadliness of waiting in the vlogs I followed, such as, Waiting to transition medically is absolutely deadly for trans people. ...
... Scholars have also noted a broader media discourse equating trans and queer youth with risk, self-harm, and suicidality (McDermott and Roen, 2016;Roen, 2018). The etiology of trans suicidality is often reduced to either psychological or social causes (see Baril, 2017 for critical discussion), with little discussion of the role of medicine other than as heroic savior from gender dysphoria (Sadjadi, 2013). The public focus on queer suicidality elides the question of "what kinds of 'slow deaths' have been ongoing that a suicide might represent an escape from" (Puar, 2011: 152). ...
Article
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Waiting is a common experience in medicalized gender transition. In this article, I address subjective experiences of medicalized gender transition through a temporal lens, focusing on personal narratives of wait lists, setbacks, and other delays experienced by trans patients. I consider administered waiting as a biopolitical practice of governance, one that has subjectifying and somatic effects on individuals and that speaks to the role of time in the administration of bodies, sex/gender, and biomedical citizenship. I ground my discussion in narratives created by trans people that chronicle their gender transitions; I analyze a set of gender transition vlogs appearing on YouTube, focusing on temporal aspects of medicalized transition and experiences of waiting. My discussion recognizes that the temporal modes of gender transition are multivalent, but these social media narratives also suggest being made to wait is an experience of power relations, one that is capable of producing submission, weariness, and precarity.
... a. Infertilität) verbunden ist. Schon deshalb sollte die Chance einer möglichen Nachreifung der Persönlichkeit und Aussöhnung mit dem Geburtsgeschlecht nicht frühzeitig vergeben werden (Sadjadi, 2013). ...
Article
Full-text available
Gender identity disorder (GID), gender dysphoria (GD) respectively, is considered a multifactorial disease whose etiology is subject to complex bio-psycho-social conditions, each with different weighting. As a result, therapists, who treat children and adolescents with GID/GD, have to deal with a very heterogeneous group with individually varying causes, differing psychopathology and varying disease progression. In addition to general psychiatric aspects of development, particularly psychiatric comorbidity, but also the different individual psychodynamics – i. e. the specific constellation of conflicts and possible ego deficits and structural deficits in the learning history of the person are of differential importance. In regard to the indication for gender reassignment measures this sometimes is relevant for the decision. The difficulties arising for decision making and the usefulness of a systematic evaluation of case reports as a basis for further optimization of the treatment recommendations are illustrated by two case reports. In the course of this, also the disadvantages and potential dangers of too early diagnostic definition and introduction of gender somato-medical and legal measures are shown exemplarily.
... As suggested in the SOC guidelines cited above, the term " transgender " does not assume either a need or desire for medical diagnosis or treatment of any kind. However, in medical discourse the term " transgender " is consistently associated with medical treatment (Ehrensaft, 2012; Sadjadi, 2013 ), which includes hormone treatment and relevant surgical procedures (primarily chest or breast construction, and vaginal or penile construction, but also facial and other kinds of plastic surgery) to feminize or masculinize appearance. My analysis traces how transgender becomes a medically treatable category in the case of young people. ...
... In such condition, if a female assignment at birth is performed and no GD is experienced thereafter (because of a female gender identity), a puberty suppression could be considered, avoiding the (male) puberty progression. The latter, in fact, could be perceived by the adolescent as a natural disaster, devastating his/her body and (gendered) integrity [92]. We have also to consider that in that case, differently from GD without DSD, puberty is characterized by physical modifications, possibly inducing a switch in the phenotypic sex. ...
Article
Introduction Disorders of Sex Development (DSD) are a wide range of congenital conditions characterized by an incongruence of components involved in sexual differentiation, including gender psychosexual development. The management of such disorders is complex, and one of the most crucial decision is represented by gender assignment. In fact, the primary goal in DSD is to have a gender assignment consistent with the underlying gender identity in order to prevent the distress related to a forthcoming Gender Dysphoria. Historically, gender assignment was based essentially on surgical outcomes, assuming the neutrality of gender identity at birth. This policy has been challenged in the past decade refocusing on the importance of prenatal and postnatal hormonal and genetic influences on psychosexual development. Aims (1) to update the main psychological and medical issues that surround DSD, in particular regarding gender identity and gender assignment; (2) to report specific clinical recommendations according to the different diagnosis. Methods A systematic search of published evidence was performed using Medline (from 1972 to March 2016). Review of the relevant literature and recommendations was based on authors’ expertise. Results A review of gender identity and assignment in DSD is provided as well as clinical recommendations for the management of individuals with DSD. Conclusions Given the complexity of this management, DSD individuals and their families need to be supported by a specialized multidisciplinary team, which has been universally recognized as the best practice for intersexual conditions. In case of juvenile GD in DSD, the prescription of gonadotropin-releasing hormone analogues, following the World Professional Association for Transgender Health and the Endocrine Society guidelines, should be considered. It should always be taken into account that every DSD person is unique and has to be treated with individualized care. In this perspective, international registries are crucial to improve the understanding of these challenging conditions and clinical practice, in providing a better prediction of gender identity.
... Es gibt durchaus Eltern, die sich dessen bewusst sind und deshalb davor zurückschrecken. Entscheidungen von derartiger Tragweite würden bei anderen Patientengruppen vermutlich ausführliche Diskussionen einer eigens dazu einberufenen Ethikkommission voraussetzen (Sadjadi, 2013). ...
Article
Full-text available
Child and adolescent psychiatrists experience more and more patients who are uncertain or dissatisfied in regard to their birth sex; some wish to join the opposite sex. Within the framework of the recently revised DSM, DSM-5 (2013), this article discusses the diagnostic classification Gender Dysphoria (GD), in particular the question of the persistence of GD and the therapeutic implications. It reviews at length the different approaches for treatment, especially the pros and cons of early hormonal therapy. The study is based on a selective Medline literature search, national and international guidelines, and the results of a debate among experts in multiple relevant disciplines. Strong evidence indicates that only a minority of children with GD manifest an irreversible transsexualism in adulthood. This indicates the use of age-differentiated therapy with an open outcome, a treatment approach which in the case of younger children primarily aims at strengthening the sense of concordance with their birth sex and which in principle uses developmental tasks beyond the gender identity issue for all age groups, and takes possible comorbid psychiatric disorders into account. For adolescents with transsexualism in statu nascendi a real-life test under psychotherapeutical supervision is indicated. The treatment with developmental-and body-altering hormones should be initiated only after the juvenile's somato-and psychosexual development has been completed. The article also debates the medical ethics involved here.
... Es gibt durchaus Eltern, die sich dessen bewusst sind und deshalb davor zurückschrecken. Entscheidungen von derartiger Tragweite würden bei anderen Patientengruppen vermutlich ausführliche Diskussionen einer eigens dazu einberufenen Ethikkommission voraussetzen (Sadjadi, 2013). ...
Article
Full-text available
Child and adolescent psychiatrists experience more and more patients who are uncertain or dissatisfied in regard to their birth sex; some wish to join the opposite sex. Within the framework of the recently revised DSM, DSM-5 (2013), this article discusses the diagnostic clas-sification Gender Dysphoria (GD), in particular the question of the persistence of GD and the therapeutic implications. It reviews at length the different approaches for treatment, especially the pros and cons of early hormonal therapy. The study is based on a selective Medline literature search, national and international guidelines, and the results of a debate among experts in multiple relevant disciplines. Strong evidence indicates that only a minority of children with GD manifest an irreversible transsexualism in adulthood. This indicates the use of age-differentiated therapy with an open outcome, a treatment approach which in the case of younger children primarily aims at strengthening the sense of concordance with their birth sex and which in principle uses developmental tasks beyond the gender identity issue for all age groups, and takes possible comorbid psychiatric disorders into account. For adolescents with transsexualism in statu nascendi a real-life test under psychotherapeutical supervision is indicated. The treatment with developmental- and body-altering hormones should be initiated only after the juvenile’s somato- and psychosexual development has been completed. The article also debates the medical ethics involved here.
... She believed, "the child as a proto-adult is constituted as a mutable body available for adult re-configuration as it traverses a developmental trajectory from immaturity to maturity." This results in a discourse according to which the sufferings of transgender young people are natural (i.e., developmental), and medical intervention is therefore necessary (Sadjadi, 2013). ...
Article
Our aim in this qualitative study was to explore the meaning and experiences of transgender youth in their everyday interactions. Participants included 24 transgender youth from Yazd and Isfahan Cities (Iran). We selected participants through purposeful sampling method. Research data were collected through semi-structured interviews. The interview transcripts were analyzed using theoretical coding techniques. The results showed that transgender people like to present their favorite identity in behaviors, wearing and social appearances, their social and domestic acceptance is deferred as the society defines transgender as a taboo and ostracizes persons. They felt themselves in a converse body and under pressure for coexistence by peers and neighbors. They attempt to save their desired identity through daydreaming and performing identity role in solitude.
... a. Infertilität) verbunden ist. Schon deshalb sollte die Chance einer möglichen Nachreifung der Persönlichkeit und Aussöhnung mit dem Geburtsgeschlecht nicht frühzeitig vergeben werden (Sadjadi, 2013). ...
Article
Full-text available
Gender identity disorder (GID), gender dysphoria (GD) respectively, is considered a multifactorial disease whose etiology is subject to complex bio-psycho-social conditions, each with different weighting. As a result, therapists, who treat children and adolescents with GID/GD, have to deal with a very heterogeneous group with individually varying causes, differing psychopathology and varying disease progression. In addition to general psychiatric aspects of development, particularly psychiatric comorbidity, but also the different individual psychodynamics--i. e. the specific constellation of conflicts and possible ego deficits and structural deficits in the learning history of the person are of differential importance. In regard to the indication for gender reassignment measures this sometimes is relevant for the decision. The difficulties arising for decision making and the usefulness of a systematic evaluation of case reports as a basis for further optimization of the treatment recommendations are illustrated by two case reports. In the course of this, also the disadvantages and potential dangers of too early diagnostic definition and introduction of gender somato-medical and legal measures are shown exemplarily.
... Indeed, fear and panic could make a parent either completely reject their child's non-typical gender identification or alternatively be drawn into a possibly premature resolution. As Sadjadi (2013) argues, people can be led astray 'in recognising what is vexing the child and make promises that the magic bullet of puberty suppression might fail to keep'. ...
The care of children and adolescents whose experience of the body is at odds with their gender feelings raises a number of questions that are as much ethical as medical or psychological. In this article I highlight some areas of ethical concern from the point of view of a senior clinician at the nationally commissioned UK Gender Identity Development Service (GIDS). I make the assumption that ethical deliberation is relational and grounded in the natural, social, political and institutional worlds in which the ethical questions arise. I try to show how matters of empirical fact, alongside an appreciation of broad social contexts, and historic and current power relations, provide an essential framework for the ways that ethical choices are framed by key groups of people as they take up different, sometimes opposing, ethical positions. I argue that practising ethically in such a service is not helpfully reduced to a single event, a treatment decision aimed at achieving the morally ‘right’ outcome, but an extended process in time. In the charged debate surrounding the recognition of these young people’s needs, we must do more to promote responsible debate about the scope of sound ethical practice.
... When puberty begins, the GnRH is secreted by the hypothalamus neurons and released in the hypophyseal portal system, where it stimulates the secretion of a folliclestimulating hormone (FSH) and a luteinizing hormone (LH), which in turn induce the gonads to secrete sex steroids (testosterone in males, estrogen and progesterone in females) prompting the development and function of secondary sex characteristics [42]. Understandably, this physical pathway for trans-children and adolescents has given rise to wide media and scientific debates [43][44][45][46]. ...
Article
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Purpose In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments. Methods Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. Results: the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality. Conclusions The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.
... It is important to note that there has been only one longitudinal report of adult outcomes, 8 and questions remain regarding the potential for both positive and disruptive effects of pubertal suppression on neurodevelopment. [12][13][14] The pubertal and adolescent period is associated with profound neurodevelopment, including trajectories of increasing capacities for abstraction and logical thinking, 15 integrative thinking (e.g., consideration of multiple perspectives), 16,17 and social thinking and competence. 18,19 During this period, there is a developmental shift toward greater exploration and novelty seeking, 20,21 salience of peer perspectives and interactions, 22 and accelerated development of passions/ interests and identities. ...
Article
Full-text available
Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that occur during puberty, a critical question is whether this treatment impacts neurodevelopment. Methods: A Delphi consensus procedure engaged 24 international experts in neurodevelopment, gender development, puberty/adolescence, neuroendocrinology, and statistics/psychometrics to identify priority research methodologies to address the empirical question: is pubertal suppression treatment associated with real-world neurocognitive sequelae? Recommended study approaches reaching 80% consensus were included in the consensus parameter. Results: The Delphi procedure identified 160 initial expert recommendations, 44 of which ultimately achieved consensus. Consensus study design elements include the following: a minimum of three measurement time points, pubertal staging at baseline, statistical modeling of sex in analyses, use of analytic approaches that account for heterogeneity, and use of multiple comparison groups to minimize the limitations of any one group. Consensus study comparison groups include untreated transgender youth matched on pubertal stage, cisgender (i.e., gender congruent) youth matched on pubertal stage, and an independent sample from a large-scale youth development database. The consensus domains for assessment includes: mental health, executive function/cognitive control, and social awareness/functioning. Conclusion: An international interdisciplinary team of experts achieved consensus around primary methods and domains for assessing neurodevelopmental effects (i.e., benefits and/or difficulties) of pubertal suppression treatment in transgender youth.
... Ello ha llevado a algunos profesionales de la salud e investigadores a sostener que el tratamiento médico de las personas con DG constituye, en realidad, una suerte de "experimento en vivo" (Bannerman, 2019). Por otro lado, un cuerpo creciente de literatura ha comenzado a advertir sobre las posibles consecuencias derivadas de estos tratamientos: (1) infertilidad (Cohen-Kettenis y Klink, 2015; Dubin et al., 2019;Laidlaw et al., 2019), especialmente si el uso de bloqueadores de la pubertad es seguido inmediatamente de la administración de hormonas del sexo opuesto (Sadjadi, 2013); (2) alteraciones de la función sexual, incluyendo atrofias, pérdida de sensibilidad y dificultades tanto para la erección como para el orgasmo (Laidlaw et al., 2019); (3) alteraciones en el funcionamiento cognitivo, el desarrollo óseo y la función cardiovascular normal (Heneghan y Jefferson, 2019); y (4) problemas uroginecológicos a largo plazo, como incontinencia urinaria o infecciones del tracto urinario (Combaz y Kuhn, 2017). 20 ...
Thesis
La disforia de género ha sido definida en los ámbitos psicológico y psiquiátrico como el malestar clínicamente significativo que puede acompañar a la incongruencia entre el género sentido o expresado por una persona y su sexo biológico. Muchas de las personas que experimentan este malestar se identifican como transgénero—o simplemente trans—y buscan atención médica especializada para alinear su cuerpo con su género sentido, un proceso habitualmente conocido como transición de género. En los últimos años, no obstante, han comenzado a surgir diversos testimonios de personas que, después de un período más o menos extenso de tiempo, detienen sus procesos de transición de género y deciden volver a vivir conforme a su sexo natal. Las experiencias de estas personas, conocidas como “destrans,” apenas han sido objeto de atención en la literatura académica hasta tiempos muy recientes. En consecuencia, nuestro conocimiento acerca de los motivos o vivencias que conducen a estas personas a destransicionar es aún muy limitado, y está basado fundamentalmente en evidencia de carácter anecdótico. Por consiguiente, el objetivo principal de este trabajo consiste en explorar, analizar y visibilizar una realidad aún muy desconocida en el contexto español, haciendo hincapié sobre cómo una mejor comprensión de este fenómeno puede contribuir a mejorar los servicios sanitarios de atención para las personas con disforia de género. Para ello, después de un recorrido por la literatura más relevante sobre identidad y disforia de género, presentaré el relato de vida de M., una mujer destrans española, el cual irá acompañado por su respectiva línea de vida. Ambas herramientas permiten comprender el proceso de destransición desde una perspectiva subjetiva e íntima, así como las redes de significados culturales, sociales y políticos que se encuentran encarnados en los cuerpos destrans.
Chapter
Purpose: Historically, it has been common practice for doctors and parents to withhold the diagnosis from their minor intersex patients. This study seeks to integrate intersex youth experiences into the growing body of literature on diagnosis disclosure for intersex patients. Methodology/approach: Using gender structure theory as a model, 16 intersex youth were given in-depth surveys regarding their experiences with their intersex identity in individual, interactional, and institutional contexts. Findings: Participants more positively experience intersex than the earlier generations of intersex people. They were not deeply troubled by their diagnosis as doctors have historically feared, and they are open about their diagnosis with their non-intersex peers and teachers. They also find peer support valuable. Research limitations/implications: Data was collected from a single event and cannot represent all intersex youth. Future research must continue to engage with intersex youth experiences both inside of and beyond activist and support group networks. Practical implications: These findings are strong exploratory evidence for the importance of diagnosis disclosure for intersex youth. Policies of withholding intersex diagnoses in clinical and familial contexts should be reevaluated in light of the experiences of intersex youth. Social implications: Diagnosis disclosure for intersex youth creates the potential for increased medical decision-making participation and increased capacity for activism and community building around intersex issues. Originality/value: Our results encourage future studies that center the experiences of intersex youth, for we conclude that theorizing the lived experiences of intersex people is incomplete without their perspectives.
Article
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The World Professional Association for Transgender Health's standards of care recommend suspending puberty, preferably with the use of gonadotropin-releasing hormone agonists, in certain gender non-conforming minors (aged under 18 years) who have undergone a psychiatric assessment and have reached at least Tanner stage II of puberty. This approach seeks to lessen the discordance between assigned natal sex and gender identity by temporarily halting the development of secondary sexual characteristics, essentially widening the temporal window for gender clarification. Despite promising preliminary evidence on the clinical utility of this approach, there is a dearth of research to inform evidence-based practice. In view of these challenges, we review the available empirical evidence on the cognitive, physical, and surgical implications of puberty suppression in gender-incongruent children and adolescents. We also explore the historical underpinnings and clinical impetus for suspending puberty in this population, and propose key research priorities.
Article
Around 5–10 years ago parents began to use the term ‘pink boy’ for children assigned male at birth, who in one way or another are linked to the colour pink and the stigma of gender nonconformity. Since then pink boys have become the objects and subjects of a new discourse that grapples with cultural, medical and psychological concepts of feminine boyhood and the more recent phenomenon of the transgender child. I am interested in the ways in which pink has come to be visually, symbolically and affectively connected to seemingly fixed markers of gender nonconformity in children assigned male at birth. I will historically situate the recent formation of the pink boy by delving into the cultural and medical history of feminine boyhood. Reading the pink boy discourse as part of a longer history of feminine boyhood in America will give me an opportunity to reflect on the ways in which colour both reaffirms and upsets the binary of masculine contained emotions and feminine excessive emotionality which has marginalized, indeed pathologized, femininity in boys and men.
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Oxytocin, serotonin, codeine, cortisone, the estrogens, omeprazole, testosterone, and so on, correspond to the group of molecules currently available for the manufacturing of subjectivity and its affects. We are technobiopolitically equipped to screw, reproduce the National Body, and consume. We live under the control of molecular technologies, hormonal straitjackets intended to maintain biopower: hyperestrogened bodies-rape-testosterone-love-pregnancy-sex drives-abjection-ejaculation. And the state draws its pleasure from the production and control of our pornogore subjectivity. (Preciado 2013: 118) Biomedicine is at the forefront of the contemporary biopolitics of sex, gender, sexuality, and race … and the transgender child is emerging as one of its newest anchors. (Gill-Peterson 2014: 412)
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Los análogos de la hormona liberadora de gonadotropinas existen desde 1970. Sus indicaciones no han dejado de desarrollarse desde entonces. Es necesario controlar sus indicaciones y efectos secundarios para conseguir que se cumpla el tratamiento. En este artículo, se presentan las diferentes indicaciones y tratamientos que deben asociarse para disminuir los efectos secundarios.
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To distinguish the phenotypic sex of a newborn, observers typically inspect the primary external genitalia and pronounce the child female, male, or intersex. Throughout maturation, and most notably during exposure to increased gonadal hormones during puberty, secondary sex characteristics develop (Table 10.1). These include the development of patterned body hair, the presence or absence of breasts, change in muscle mass, and differentiation of the skeleton, including the face and skull. Among all the secondary sex characteristics, facial features are the most visible in social life and have a significant impact on a person’s vision of themselves in the mirror. They are also the most difficult to alter. This chapter outlines the importance and implications of facial gender markers from a social, historical, and patient perspective.
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The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate. Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide. Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits. As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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In the face of the world's disorders, moral concerns have provided a powerful ground for developing international as well as local policies. Didier Fassin draws on case materials from France, South Africa, Venezuela, and Palestine to explore the meaning of humanitarianism in the contexts of immigration and asylum, disease and poverty, disaster and war. He traces and analyzes recent shifts in moral and political discourse and practices-what he terms "humanitarian reason"- and shows in vivid examples how humanitarianism is confronted by inequality and violence. Deftly illuminating the tensions and contradictions in humanitarian government, he reveals the ambiguities confronting states and organizations as they struggle to deal with the intolerable. His critique of humanitarian reason, respectful of the participants involved but lucid about the stakes they disregard, offers theoretical and empirical foundations for a political and moral anthropology.
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This book explores the unintended consequences of compassion in the world of immigration politics. Miriam Ticktin focuses on France and its humanitarian immigration practices to argue that a politics based on care and protection can lead the state to view issues of immigration and asylum through a medical lens. Examining two "regimes of care"-humanitarianism and the movement to stop violence against women-Ticktin asks what it means to permit the sick and sexually violated to cross borders while the impoverished cannot? She demonstrates how in an inhospitable immigration climate, unusual pathologies can become the means to residency papers, making conditions like HIV, cancer, and select experiences of sexual violence into distinct advantages for would-be migrants. Ticktin's analysis also indicts the inequalities forged by global capitalism that drive people to migrate, and the state practices that criminalize the majority of undocumented migrants at the expense of care for the exceptional few.
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Against her better judgment, Kathryn Mathers turns her attention to America's most popular reporter on Africa, and comes down with a serious case of colonial déjà vu.
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:Drawing on the work of Gayle Rubin and Emma Goldman, this article argues that campaigns past and present against trafficking (popularly understood as the trafficking of women into prostitution) constitute displaced conversations about and interventions into heterosexuality, the major site of struggle over sexuality in the past 150 years. These campaigns situate their critiques of heterosexuality outside conventional heterosexual intimacy and marriage by carving off an allegedly unique and dangerous zone (in public, for money, at the hands of strangers) in which sex is exchanged for money and livelihood. These efforts to "draw the line" between disapproved and expected forms of exploitation and inequality (sexual and nonsexual) are filled with contradiction and incoherence, particularly in regard to the sexual culpability of men or women. Recent international law (2000) recasts trafficking by defining it as a crime of labor exploitation (not prostitution) that can harm any person (not just women and girls). Despite this reframing, the melodramatic narrative used to tell the story of trafficking subverts the new laws by highlighting sexual danger, innocent women, and male lust as the causal factors in trafficking. Critiques of heterosexual intimacy, institutions, and economies are redirected to the exceptional and the sexual in contemporary campaigns against trafficking, despite the progressive elements of recent law.
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Keywords: humanitarian intervention, international society, justification, legitimacy, military intervention, norm, pluralism, solidarism, UN Security Council Argues that there has been a change of norm in relation to the legitimacy of humanitarian intervention in the 1990s. It shows how humanitarian justifications for the use of force lacked legitimacy in Cold War international society, focusing on the cases of India, Vietnam, and Tanzania's interventions in the 1970s. This reflected the dominance of pluralist international society thinking in shaping the legal rules and institutions of international society. By focusing on cases of intervention in Iraq, Somalia, Rwanda, Bosnia, and Kosovo, the second part of the book shows how a new solidarist conception of international society shaped Western interventions in the 1990s. In arguing that a new norm has developed that has facilitated new state actions; the book identifies two key limits to this norm: first, military intervention justified on humanitarian grounds requires UN Security Council authorization; second, whilst new norms enable new actions, they do not determine that intervention will take place when it is urgently needed as in Rwanda.
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Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.
Mr. Kristof, I Presume?” Transition
  • K Mathers