No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
"Gender Ideology" and the Catholic Morality of Transgender- Enhancing Treatment and Sex Change
Abstract
This chapter aims to sociologically unpack and clarify the Catholic Church's concept of "gender ideology" and analyze the morality of gender-enhancing treatment and surgical procedures to align transgenders' gender or experience of masculinity and femininity in society with their biological sex assigned during birth to address gender dysphoria and other psychological problems in light of Pope Francis's synodal inductive approach. It argues that the traditional philosophical moral approach grounded in natural law theory is inadequate to morally analyze these contemporary sexual issues. It recommends the sociological approach of inquiring motives and not just the meaning of these "unnatural" external acts before moral judgment as well as the application of the principle of double effect to understand the morality of transgenderism, gender-enhancing treatment, and transgender sexuality to resolve the moral panic of gender ideology" in the Catholic Church.
ResearchGate has not been able to resolve any citations for this publication.
Gender-affirming hormones have been shown to improve psychological functioning and quality of life among transgender and nonbinary (trans) people, yet, scant research exists regarding whether and why individuals take more or less hormones than prescribed. Drawing on survey data from 379 trans people who were prescribed hormones, we utilized multivariable logistic regression models to identify factors associated with hormone-dosing behaviors and content analysis to examine the reasons for dose modifications. Overall, 24% of trans individuals took more hormones than prescribed and 57% took less. Taking more hormones than prescribed was significantly associated with having the same provider for primary and gender-affirming care and gender-based discrimination. Income and insurance coverage barriers were significantly associated with taking less hormones than prescribed. Differences by gender identity were also observed. Addressing barriers to hormone access and cost could help to ensure safe hormone-dosing behaviors and the achievement trans people’s gender-affirmation goals.
This study examines the formation of the ideal of the “good parish priest” as a means for the Catholic Church to recover its social influence in the Spain that emerged from the liberal revolutions of the early nineteenth century. It makes use of the concept of masculinity as a resource for illuminating the forms of authority and social relationships that were held to define the ideal priest. In doing so it draws on two levels of analysis. On the one hand, it considers the manuals of clerical behaviour and regulations of the seminaries, which pursued a model of priestly masculinity that was difficult to achieve in practice. On the other, it considers individual experiences and life stories, as an indispensable viewpoint from which to comprehend the identity of the Catholic clergy. By these means this article enters into a field that has been little explored by Spanish or international historiography, the contribution of religion to the formation of historic masculinities.
The Vatican and United States Conference of Catholic Bishops (USCCB) have issued official responses to the phenomenon of gender diversity, as well as instructions for the education and care of transgender and gender diverse (TGD) people in America. However, have these authorities effectively utilized current sociological research to develop and implement contextually appropriate pastoral practices that are lifegiving and to the greatest benefit of this at-risk population? This article argues that they have not and that their recommendations have been linked to increased harm and marginalization. Utilizing Richard Osmer’s framework for practical theological interpretation, this article begins with an overview of the Magisterium’s guidance, followed by a summary of quantitative data gleaned from national surveys, population studies, and demographic analyses that reveals unique experiences of suffering and oppression. The middle sections bring in leading theories and findings from social, health, and medical fields, which illustrate TGD needs and vulnerabilities and expose the Magisterial offices’ dangerous failure to meet or even acknowledge them. The final sections call for a revised pastoral approach grounded in the concrete situations of TGD people and congruent with the Church’s commitment to love, service, and social justice. Good practice models and ethical norms are suggested for immediate incorporation into care and praxis.
Background
Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender‐affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin‐releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition.
Methods
We conducted a critical review of the literature to answer a series of questions about criteria for using puberty‐blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria.
Results
Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged ‘excellent’, five studies met the majority of quality criteria resulting in ‘good’ ratings, whereas three studies were judged fair and had serious risks of bias.
Conclusion
Given the potentially life‐saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.
In July of 2016 during a closed session with Polish bishops, Pope Francis stated, “In Europe, America, Latin America, Africa, and in some countries of Asia, there are genuine forms of ideological colonization taking place. And one of these – I will call it clearly by its name – is the ideology of ‘gender.’” Several months later, in the Republic of Georgia, the Pope publicly condemned gender discourse as the “great enemy” in a “global war” of ideas. Around the globe, religious and other conservative actors are intensifying their attacks on feminist and LGBTQ+ scholarship and activism, casting advocates as “gender feminists” promoting a radical “gender ideology.” Language deployed by the Vatican, such as gender ideology, gender theory, and genderism, has been captured by right-wing enthusiasts to thwart emancipatory gender agendas worldwide. This article examines antigender campaigns as palpable transnational countermovements, and considers their use of gender ideology as salient counterstrategies to feminist and LGBTQ+ social movements. By situating antigenderism within countermovement theory, I show that recentantigender activity transcends generalized resistance and instead operates within distinct and coordinated countermovements to defeat feminist and LGBTQ+ policy. By conceptualizing antigenderism as a countermovement, I provide a useful framework for studying national and supranational antigenderism and for understanding the stakes in the tug-of-war among progressive social movements and countermovements for ontological and political control over the term “gender.”
Introduction: Gender dysphoria (GD) (DMS-5) is a condition marked by increasing psychological suffering that accompanies the incongruence between one's experienced or expressed gender and one's assigned gender. Manifestation of GD can be seen early on during childhood and adolescence. During this period, the development of undesirable sexual characteristics marks an acute suffering of being opposite to the sex of birth. Pubertal suppression with gonadotropin releasing hormone analogs (GnRHa) has been proposed for these individuals as a reversible treatment for postponing the pubertal development and attenuating psychological suffering. Recently, increased interest has been observed on the impact of this treatment on brain maturation, cognition and psychological performance.
Objectives: The aim of this clinical report is to review the effects of puberty suppression on the brain white matter (WM) during adolescence. WM Fractional anisotropy, voice and cognitive functions were assessed before and during the treatment. MRI scans were acquired before, and after 22 and 28 months of hormonal suppression.
Methods: We performed a longitudinal evaluation of a pubertal transgender girl undergoing hormonal treatment with GnRH analog. Three longitudinal magnetic resonance imaging (MRI) scans were performed for diffusion tensor imaging (DTI), regarding Fractional Anisotropy (FA) for regions of interest analysis. In parallel, voice samples for acoustic analysis as well as executive functioning with the Wechsler Intelligence Scale (WISC-IV) were performed.
Results: During the follow-up, white matter fractional anisotropy did not increase, compared to normal male puberty effects on the brain. After 22 months of pubertal suppression, operational memory dropped 9 points and remained stable after 28 months of follow-up. The fundamental frequency of voice varied during the first year; however, it remained in the female range.
Conclusion: Brain white matter fractional anisotropy remained unchanged in the GD girl during pubertal suppression with GnRHa for 28 months, which may be related to the reduced serum testosterone levels and/or to the patient's baseline low average cognitive performance.Global performance on the Weschler scale was slightly lower during pubertal suppression compared to baseline, predominantly due to a reduction in operational memory. Either a baseline of low average cognition or the hormonal status could play a role in cognitive performance during pubertal suppression. The voice pattern during the follow-up seemed to reflect testosterone levels under suppression by GnRHa treatment.
Purpose:
Transgender youth are at high risk for mental health morbidities. Based on treatment guidelines, puberty blockers and gender-affirming hormone therapy should be considered to alleviate distress due to discordance between an individual's assigned sex and gender identity. The goals of this study were to examine the: (1) prevalence of mental health diagnoses, self-injurious behaviors, and school victimization and (2) rates of insurance coverage for hormone therapy, among a cohort of transgender adolescents at a large pediatric gender program, to understand access to recommended therapy.
Methods:
An IRB-approved retrospective medical record review (2014-2016) was conducted of patients with ICD 9/10 codes for gender dysphoria referred to pediatric endocrinology within a large multidisciplinary gender program. Researchers extracted the following details: demographics, age, assigned sex, identified gender, insurance provider/coverage, mental health diagnoses, self-injurious behavior, and school victimization.
Results:
Seventy-nine records (51 transgender males, 28 transgender females) met inclusion criteria (median age: 15 years, range: 9-18). Seventy-three subjects (92.4%) were diagnosed with one or more of the following conditions: depression, anxiety, post-traumatic stress disorder, eating disorders, autism spectrum disorder, and bipolar disorder. Fifty-nine (74.7%) reported suicidal ideation, 44 (55.7%) exhibited self-harm, and 24 (30.4%) had one or more suicide attempts. Forty-six (58.2%) subjects reported school victimization. Of the 27 patients prescribed gonadotropin-releasing hormone analogues, only 8 (29.6%) received insurance coverage.
Conclusion:
Transgender youth face significant barriers in accessing appropriate hormone therapy. Given the high rates of mental health concerns, self-injurious behavior, and school victimization among this vulnerable population, healthcare professionals must work alongside policy makers toward insurance coverage reform.
Inspired by the feminist thoughts of Rosi Braidotti and Donna Haraway, the author of this article endeavours to depict the emerging concept of gender neutrality that has developed in Sweden in recent years. The author uses an interpretative paradigm with a variety of qualitative field research tools, to gain a deeper understanding of how gender neutrality works in practice at school and nursery level in Sweden. The study took place in Stockholm in Sep-tember 2014 with the author living in situ. The case study involved the use of: field notes and observations, interviews with university scholars, heads of schools and nurseries and open-ended questionnaires with teachers, carers and students. The analysis of written resources included the school and nursery national curriculum, press discourse and scientific publications on the subject matter. The author of the article argues that gender neutrality may be perceived as a concept originating from post-humanism, therefore it should be examined within the post-human socio-pedagogical reflection and embedded in norm critical discourse.
Sociology has seen a renewed interest in the study of morality. However, a theory of the self that explains individual variation in moral behavior and emotions is noticeably absent. In this study, we use identity theory to explain this variability. According to identity theory, actors are self-regulating entities whose goal is to verify their identities. An individual’s moral identity—wherever it falls on the moral–immoral continuum—guides behavior, and people experience negative emotions when identity verification does not ensue. Furthermore, the identity verification process occurs within situations that have cultural expectations—that is, framing rules and feeling rules—regarding how individuals should act and feel. These cultural expectations also influence the degree to which people behave morally. We test these assumptions on a sample of more than 350 university students. We investigate whether the moral identity and framing situations in moral terms influences behavior and feelings. Findings reveal that the identity process and framing of situations as moral are significantly associated with moral action and moral emotions of guilt and shame.
Sociology was once integral to the scientific study of morality, but its explicit focus has waned over the past half-century. This article calls for greater sociological engagement in order to speak to the resurgence of the study of morality in cognate fields. We identify important treatments of morality, some of which are not explicitly so, and identify those treatments that build a distinctly sociological focus on morality: room for culturally divergent understandings of its content, a focus on antecedent social factors that shape it, and a concern with ecologically valid explorations of its social importance.
In this chapter I ask what’s new and what’s old about the new sociology of morality. What might it learn from earlier sociologies of morality? What wheels needn’t be reinvented? In the second section I discuss three old issues: (a) whether morality can and should be scientifically investigated; (b) the fact of moral variation; and (c) the explanation of moral variation. I spell out these three points using the writings of Martineau, Lévy-Bruhl, and Durkheim. In the third section I discuss two new challenges: (a) the implications of moral realism; and (b) the implications of moral neuroscience. I argue that neither challenge can be easily dismissed. Finally, in the fourth section, I very briefly consider the future of the new sociology of morality: what’s next and what unique contributions it can make.
Puberty suppression by means of gonadotropin releasing hormone (GnRH) analogs is considered a diagnostic aid in gender dysphoric adolescents. However, there are also concerns about potential risks, such as poor outcome or post-surgical regret, adverse effects on metabolic and endocrine status, impaired increment of bone mass, and interference with brain development. This case report is on a 22-year follow-up of a female-to-male transsexual, treated with GnRH analogs at 13 years of age and considered eligible for androgen treatment at age 17, and who had gender reassignment surgery at 20 and 22 years of age. At follow-up, he indicated no regrets about his treatment. He was functioning well psychologically, intellectually, and socially; however, he experienced some feelings of sadness about choices he had made in a long-lasting intimate relationship. There were no clinical signs of a negative impact on brain development. He was physically in good health, and metabolic and endocrine parameters were within reference ranges. Bone mineral density was within the normal range for both sexes. His final height was short as compared to Dutch males; however, his body proportions were within normal range. This first report on long-term effects of puberty suppression suggests that negative side effects are limited and that it can be a useful additional tool in the diagnosis and treatment of gender dysphoric adolescents.
This introductory article presents some subtle and, perhaps, controversial aspects of providing care to adolescents who identify as transgender. I will describe (1) how praise from careproviders can benefit parents who have difficulty accepting the gender identity of their child that was not assigned at birth; (2) how adolescents who identify as transgender may follow the internet advice of peers on how to "con" careproviders; (3) how it may be difficult for careproviders to decide whether to further patients' felt needs and to protect them, paternalistically, from making an irreversible decision they may later regret; and (4) how careproviders can benefit adolescents by taking the initiative to discuss sex and how to say "no." I emphasize how careproviders who see these patients, even when they have no special expertise in this area, may be able to enhance patients' equality in every respect, even when they otherwise might not choose to do so.
The term ‘gender ideology’ has become a conceptual and political tool used by various religious and secular actors who defend a legal system embedded in a sexual universal morality. Although the use of the term began within the Catholic sphere, it currently characterizes the politics of different countries that are facing a wave of neoconservative activism. The article analyzes the expansion and uses of this term by considering two main aspects: first, an analysis of its emergence as a strategy by the Vatican to combat the impact of Sexual and Reproductive Rights (SRR) on Universal Human Rights; second, a presentation of the appropriations and uses of the fight against gender ideology as part of a neoconservative movement in Latin America.
Background and objectives:
Gonadotropin-releasing hormone analogues are commonly prescribed to suppress endogenous puberty for transgender adolescents. There are limited data regarding the mental health benefits of this treatment. Our objective for this study was to examine associations between access to pubertal suppression during adolescence and adult mental health outcomes.
Methods:
Using a cross-sectional survey of 20 619 transgender adults aged 18 to 36 years, we examined self-reported history of pubertal suppression during adolescence. Using multivariable logistic regression, we examined associations between access to pubertal suppression and adult mental health outcomes, including multiple measures of suicidality.
Results:
Of the sample, 16.9% reported that they ever wanted pubertal suppression as part of their gender-related care. Their mean age was 23.4 years, and 45.2% were assigned male sex at birth. Of them, 2.5% received pubertal suppression. After adjustment for demographic variables and level of family support for gender identity, those who received treatment with pubertal suppression, when compared with those who wanted pubertal suppression but did not receive it, had lower odds of lifetime suicidal ideation (adjusted odds ratio = 0.3; 95% confidence interval = 0.2-0.6).
Conclusions:
This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.
This essay traces the Vatican’s decades-long, worldwide, multifront war on what it has come to call “gender ideology” from its very recent incarnation in Donald Trump’s United States back through its origins in the past century, highlighting the central role that concerns about transgender rights have always played for the two popes who have most directly shaped the contours of this war, Benedict XVI and Francis. Among the claims of the essay is that the conceptual apparatus behind the Vatican’s anathematization of the complex of feminist, reproductive, and LGBT rights issues it has for a quarter century lumped together as “gender ideology” was already fully developed a decade before the 1995 Beijing Conference, in the report that Joseph Cardinal Ratzinger, the future Benedict XVI, issued about the state of his Church in 1984. Another is that the papacy of Francis, far from calling a truce, has given new energy to this war. The essay explores ways in which events in their respective homelands of Germany and Argentina shaped each of the two popes’ strategies for this war and how events in the United States delayed the opening of a US home front in the war on “gender ideology” until the very recent past.
Several significant aspects are addressed in this article to gain clarity and to pursue awareness regarding transgender teenagers. It begins by offering a brief introduction and then moves towards a common understanding of the language and landscape surrounding transgender teenagers. Next the paper centers on maligned, marginalized, and misunderstood transgender teenagers and the experiences they encounter. Hopefully, the information gleaned in this article will empower pastoral care givers to minister directly to this particular underserved sexual minority group.
Background:
Transgender adolescents aspiring to have the body characteristics of the affirmed sex can receive hormonal treatment. However, it is unknown how body shape and composition develop during treatment and whether transgender persons obtain the desired body phenotype.
Aim:
To examine the change in body shape and composition from the start of treatment with gonadotropin-releasing hormone agonists (GnRHa) until 22 years of age and to compare these measurements at 22 years with those of age-matched peers.
Methods:
71 transwomen (birth-assigned boys) and 121 transmen (birth-assigned girls) who started treatment from 1998 through 2014 were included in this retrospective study. GnRHa treatment was started and cross-sex hormonal treatment was added at 16 years of age. Anthropometric and whole-body dual-energy x-ray absorptiometry data were retrieved from medical records. Linear mixed model regression was performed to examine changes over time. SD scores (SDS) were calculated to compare body shape and composition with those of age-matched peers.
Outcomes:
Change in waist-hip ratio (WHR), total body fat (TBF), and total lean body mass (LBM) during hormonal treatment. SDS of measures of body shape and composition compared with age-matched peers at 22 years of age.
Results:
In transwomen, TBF increased (+10%, 95% CI = 7-11) while total LBM (-10%, 95% CI = -11 to -7) and WHR (-0.04, 95% CI = -0.05 to -0.02) decreased. Compared with ciswomen, SDS at 22 years of age were +0.3 (95% CI = 0.0-0.5) for WHR, and 0.0 (95% CI = -0.2 to 0.3) for TBF. Compared with cismen, SDS were -1.0 (95% CI = -1.3 to -0.7) for WHR, and +2.2 (95% CI = 2.2-2.4) for TBF. In transmen, TBF decreased (-3%, 95% CI = -4 to -1), while LBM (+3%, 95% CI = 1-4) and WHR (+0.03, 95% CI = 0.01-0.04) increased. Compared with ciswomen, SDS at 22 years of age were +0.6 (95% CI = 0.4-0.8) for WHR, and -1.1 (95% CI = -1.4 to -0.9) for TBF. Compared with cismen, SDS were -0.5 (95% CI = -0.8 to -0.3) for WHR, and +1.8 (95% CI = 1.6-1.9) for TBF.
Clinical implications:
Knowing body shape and composition outcomes at 22 years of age will help care providers in counseling transgender youth on expectations of attaining the desired body phenotype.
Strengths and limitations:
This study presents the largest group of transgender adults to date who started treatment in their teens. Despite missing data, selection bias was not found.
Conclusions:
During treatment, WHR and body composition changed toward the affirmed sex. At 22 years of age, transwomen compared better to age-matched ciswomen than to cismen, whereas transmen were between reference values for ciswomen and cismen. Klaver M, de Mutsert R, Wiepjes CM, et al. Early Hormonal Treatment Affects Body Composition and Body Shape in Young Transgender Adolescents. J Sex Med 2018;15:251-260.
This essay investigates a divergence between medical and autobiographical accounts of transexuality. By analyzing a letter to the editor in the journal Aesthetic Plastic Surgery that defends trans patients as a “special case” (Selvaggi and Giordano, 2014), I examine how medicine produces trans patients as a separate category of patients. The differential treatment paths of trans and nontrans people who pursue “gender-enhancing” medical interventions demonstrate a double standard that undermines claims to act in the best interest of the patient. Using the evidence of trans men’s accounts of themselves as well as research into the experiences of trans people from across the United Kingdom, Australia, and North America, I critique the medical management of transexuality and call on clinicians to rethink the treatment practices of trans medicine.
Puberty is highly important for the accumulation of bone mass. Bone turnover and bone mineral density (BMD) can be affected in transgender adolescents when puberty is suppressed by gonadotropin-releasing hormone analogues (GnRHa), followed by treatment with cross-sex hormone therapy (CSHT). We aimed to investigate the effect of GnRHa and CSHT on bone turnover markers (BTMs) and bone mineral apparent density (BMAD) in transgender adolescents. Gender dysphoria was diagnosed based on diagnostic criteria according to the DSM-IV (TR). Thirty four female-to-male persons (transmen) and 22 male-to-female persons (transwomen)were included. Patients were allocated to a young (bone age of < 15 years in transwomen or < 14 in transmen) or old group (bone age of ≥ 15 years in transwomen or ≥ 14 years in transmen). All were treated with GnRHa triptorelin and CSHT was added in incremental doses from the age of 16 years. Transmen received testosterone esters (Sustanon, MSD) and transwomen received 17-β estradiol. P1NP, osteocalcin, ICTP and BMD of lumbar spine (LS) and femoral neck (FN) were measured at three time points. In addition, BMAD and Z-scores were calculated. We found a decrease of P1NP and 1CTP during GnRHa treatment, indicating decreased bone turnover (young transmen 95% CI − 74 to − 50%, p = 0.02, young transwomen 95% CI − 73 to − 43, p = 0.008). The decrease in bone turnover upon GnRHa treatment was accompanied by an unchanged BMAD of FN and LS, whereas BMAD Z-scores of predominantly the LS decreased especially in the young transwomen. Twenty-four months after CSHT the BTMs P1NP and ICTP were even more decreased in all groups except for the old transmen. During CSHT BMAD increased and Z-scores returned towards normal, especially of the LS (young transwomen CI 95% 0.1 to 0.6, p = 0.01, old transwomen 95% CI 0.3 to 0.8, p = 0.04). To conclude, suppressing puberty by GnRHa leads to a decrease of BTMs in both transwomen and transmen transgender adolescents. The increase of BMAD and BMAD Z-scores predominantly in the LS as a result of treatment with CSHT is accompanied by decreasing BTM concentrations after 24 months of CSHT. Therefore, the added value of evaluating BTMs seems to be limited and DXA-scans remain important in follow-up of bone health of transgender adolescents.
In 2012, the governmental and parliamentary discussions around the ratification of the Council’s of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence stirred wave of negative reactions from the Roman Catholic Church representatives in Poland. In our view, these interventions offer an interesting case for studying the presence of religious actors in the public sphere and democratic society. The chapter analyses the arguments used by the representatives of the Roman Catholic Church in their official accounts of “gender” and “gender ideology” with a twofold aim. We reconstruct the Church’s official discourse and use the findings to engage in the discussion on intersections between (public) religion, gender (equality), and politics in the Polish context. The analytical section follows an introduction to the theoretical considerations on the intersections between religion, politics and gender, and presentation of the Polish context with the overview of the analysed materials.
Puberty suppression using gonadotropin-releasing hormone agonists (GnRHas) is recommended by current guidelines as the treatment of choice for gender dysphoric adolescents. Although GnRHas have long been used to treat precocious puberty, there are few data on the efficacy and safety in gender dysphoric adolescents. Therefore, the Endocrine Society guideline recommends frequent monitoring of gonadotropins, sex steroids, and renal and liver function.
To evaluate the efficacy and safety of GnRHa treatment to suppress puberty in gender dysphoric adolescents.
Forty-nine male-to-female and 67 female-to-male gender dysphoric adolescents treated with triptorelin were included in the analysis.
Physical examination, including assessment of Tanner stage, took place every 3 months and blood samples were drawn at 0, 3, and 6 months and then every 6 months. Body composition was evaluated using dual energy x-ray absorptiometry.
GnRHa treatment caused a decrease in testicular volume in 43 of 49 male-to-female subjects. In one of four female-to-male subjects who presented at Tanner breast stage 2, breast development completely regressed. Gonadotropins and sex steroid levels were suppressed within 3 months. Treatment did not have to be adjusted because of insufficient suppression in any subject. No sustained abnormalities of liver enzymes or creatinine were encountered. Alkaline phosphatase decreased, probably related to a slower growth velocity, because height SD score decreased in boys and girls. Lean body mass percentage significantly decreased during the first year of treatment in girls and boys, whereas fat percentage significantly increased.
Triptorelin effectively suppresses puberty in gender dysphoric adolescents. These data suggest routine monitoring of gonadotropins, sex steroids, creatinine, and liver function is not necessary during treatment with triptorelin. Further studies should evaluate the extent to which changes in height SD score and body composition that occur during GnRHa treatment can be reversed during subsequent cross-sex hormone treatment.
Objective
Recent literature has raised an important ethical concern relating to the way in which surgeons approach people with gender dysphoria (GD): it has been suggested that referring transsexual patients to mental assessment can constitute a form of unjust discrimination. The aim of this paper is to examine some of the ethical issues concerning the role of the mental health professional in gender reassignment surgeries (GRS).
Method
The role of the mental health professional in GRS is analyzed by presenting the Standards of Care by the World Professional Association of Transgender Health, and discussing the principles of autonomy and non-discrimination.
Results
Purposes of psychotherapy are exploring gender identity; addressing the negative impact of GD on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; promoting resilience; and assisting the surgeons with the preparation prior to the surgery and the patient’s follow-up. Offering or requesting psychological assistance is in no way a form of negative discrimination or an attack to the patient’s autonomy. Contrarily, it might improve transsexual patients’ care, and thus at the most may represent a form of positive discrimination. To treat people as equal does not mean that they should be treated in the same way, but with the same concern and respect, so that their unique needs and goals can be achieved.
Conclusions
Offering or requesting psychological assistance to individuals with GD is a form of responsible care, and not unjust discrimination.
Level of Evidence V
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www. springer. com/ 00266.
To describe patient characteristics at presentation, treatment, and response to treatment in youth with gender dysphoria.
A retrospective chart review of 84 youth with a diagnosis of gender dysphoria seen at BC Children's Hospital from 1998-2011.
Of the 84 patients, 45 (54%) identified as female-to-male (FtM), 37 (44%) as male-to-female (MtF), and 2 (2%) as natal males who were undecided. Median age of presentation was 16.9 years (range 11.4-19.8 years) and 16.6 years (range 12.3-22.5 years) for FtM and MtF youth, respectively. Gonadotropin-releasing hormone analog treatment was prescribed in 27 (32%) patients. One FtM patient developed sterile abscesses with leuprolide acetate; he was switched to triptorelin and tolerated this well. Cross-sex hormones were prescribed in 63 of 84 patients (39 FtM vs 24 MtF, P < .02). Median age at initiation of testosterone injections in FtM patients was 17.3 years (range 13.7-19.8 years); median age at initiation of estrogen therapy in MtF patients was 17.9 years (range 13.3-22.3 years). Three patients stopped cross-sex hormones temporarily due to psychiatric comorbidities (2 FtM) and distress over androgenic alopecia (1 FtM). No severe complications were noted in patients treated with testosterone or estrogen.
Treatment with gonadotropin-releasing hormone analog and/or cross-sex hormones, in collaboration with transgender-competent mental health professionals, is an intervention that appears to be appropriate in carefully selected youth with gender dysphoria. Long-term follow-up studies are needed to determine the safety of these treatments in this age group.
In 2007, an interdisciplinary clinic for children and adolescents with disorders of sex development (DSD) or gender identity disorder (GID) opened in a major pediatric center. Psychometric evaluation and endocrine treatment via pubertal suppressive therapy and administration of cross-sex steroid hormones was offered to carefully selected patients according to effective protocols used in Holland. Hembree et al.'s (2009) Guidelines for Endocrine Treatment of Transsexual Persons published by the Endocrine Society endorsed these methods. A description of the clinic's protocol and general patient demographics are provided, along with treatment philosophy and goals.
Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment.
To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents.
Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment.
Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinician's rated Children's Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed.
Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.
Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents.
This article examines the struggle of two social movements to free subjects from gender subordination. It is commonly held that while biological sex is fixed, gender is social, environmental and flexible. However, this article shows that what is known as "biological sex" also involves a social-legal dimension. This article analyzes a process of translation of medical theories into legal rights narratives in current intersex and transsex advocacy. Two distinct advocacy goals are presently at stake: (1) a struggle to end normalizing genital surgeries on intersex infants and young children, and; (2) a struggle for Medicaid coverage of sex reassignment surgeries for transsex identified individuals. In these two struggles, the concepts "medical necessity," "cosmetic surgery," and "experimentation" produce distinctly different social-legal meanings. The article shows that paradoxically, a current state of crisis in scientific expertise regarding the distinction between sex and gender corresponds perfectly with the legal structure of the two social movements (intersex and transsex) whose determination turns on the sex-gender distinction. The article argues that the current legal struggles of the two movements are based on two sides of ongoing medical-scientific debates regarding the meaning of 'gender identity,' often referred to as the nature/nurture debates. Transsex advocacy for state financing of sex reassignment surgeries is mostly backed by medical theories and experts who focus on "nurture" narratives regarding 'gender identity' and psychological sex, while intersex efforts seeking the termination of unwanted normalizing genital surgeries are ordinarily supported by "nature" narratives that focus on a biological hormonal sexual brain. The article shows how these medical alliances locate the two movements in a state of disharmony. Finally, the article examines the legal claim against early intersex surgery as a traditional claim for 'negative liberty,' and the legal claim for transsex surgery, based on the Medicaid Statute, as a form of 'positive liberty.' In conclusion, the article calls for more reliance on liberal notions of choice and pluralism, and less reliance on medical expertise.
The no-nonsense guide to sexual diversity (No-Nonsense Guides)
- V Baird
Baird, Vanessa. 2007. The No-Nonsense Guide to Sexual Diversity (No-Nonsense Guides).
Transgender persons and catholic healthcare
- C Bayley
Bayley, Carol. 2016. "Transgender Persons and Catholic Healthcare." Healthcare Ethics USA
24(1): 1-17.
Transgender bodies, catholic schools, and a queer natural law theology of exploration
- C J Ford
Ford, Craig Jr. 2018. "Transgender Bodies, Catholic Schools, and a Queer Natural Law Theology
of Exploration." The Journal of Moral Theology 7(1): 70-98.
Clinical Management of Youth with Gender Dysphoria in Vancouver
- K Khatchadourian
- S Amed
- D L Metzer
Khatchadourian, K., Amed, S., and Metzer, D.L. 2014. "Clinical Management of Youth with
Gender Dysphoria in Vancouver." The Journal of Pediatrics 164, 906-911.
Understanding Transgender People: The Basics
National Center for Transgender Equality. 2023. "Understanding Transgender People: The
Basics." National Center for Transgender Equality Website (January 27, 2023).
Encyclical Letter of Pope Francis on the Care on Care of Our Common Home.” Vatican: Dicastero per la Comunicazione-Libreria Editrice Vaticana
- Pope Francis
Pope Francis. 2015. Laudato si [Praise Be To You]: Encyclical Letter of Pope Francis on the Care
on Care of Our Common Home." Vatican: Dicastero per la Comunicazione -Libreria Editrice
Vaticana.https://www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20150524_enciclica-laudato-si.html
Vatican: Dicastero per la Comunicazione -Libreria Editrice Vaticana
- Pope Francis
Pope Francis. 2016. "Post-Synodal Exhortation Amoris Laetitia." Vatican: Dicastero per la
Comunicazione -Libreria Editrice Vaticana.
https://www.vatican.va/content/francesco/en/apost_exhortations/documents/papa-francesco_esortazione-ap_20160319_amoris-laetitia.html
Unofficial full English translation
- Pope Francis
Pope Francis. 2023. "Apostolic Letter Issued "Motu Proprio" Ad Theologiam Promovendam [To
Promote Theology]." Unofficial full English translation available at:
https://returntotradition.org/unofficial-full-english-translation-of-francis-revolutionary-motuproprio-ad-theologiam-promovendam-plus-breaking-news-report-on-text/
Recommendations for promoting the health and well-being of lesbian, gay, bisexual, and transgender adolescents: A Position paper of the Society for Adolescent Health and Medicine
SAHM (Society for Adolescent Health and Medicine). 2013. "Recommendations for promoting
the health and well-being of lesbian, gay, bisexual, and transgender adolescents: A Position paper
of the Society for Adolescent Health and Medicine." Journal of Adoles Health 52:506e10.
- Max Weber
Weber, Max. 1978. Economy and Society. Berkeley: University of California Press.
Puberty suppression in a gender-dysphoric adolescent: A 22-year follow-up
- P T Cohen-Kettenis
- See Schagen
- T D Steensma
- Alc Devries
- H A Delemarre-Van De Waal
Apostolic Letter Issued “Motu Proprio” Ad Theologiam Promovendam
- Pope Francis
Post-Synodal exhortation Amoris Laetitia. Vatican: Dicastero per la Comunicazione-Libreria Editrice Vaticana
- Pope Francis
Brain maturation, cognition, and voice pattern in a gender dysphoria case under pubertal suppression
- M A Schneider
- P M Spritzer
- Bmb Soll
- Amv Fontanari
- M Carneiro
- F Tovar-Moll
- Mir Lobato