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First strike against puberty blockers
The Italian Psychoanalytic Society has taken its concerns to Prime Minister Meloni
The Italian Psychoanalytic Society has written to the country’s Prime Minister Giorgia Meloni expressing “great concern” about the use of puberty blockers with children and calling for “rigorous scientific discussion” of youth gender problems.
The letter dated 12 January 2023 is believed to be the first time that a health professional body in Italy has put on the public record its concern about medicalised gender change for minors, according to the parents’ group Genitori de Gender.
“The debate in Italy is still very lacking, and even the most important information, such as Sweden's abandonment of the ‘gender affirmative’ [medical] protocol, finds little or no space in the [Italian] media,” said a representative of the group, which was formed in the European spring last year.
The letter to Ms Meloni — who in a 2022 speech declared “yes to sexual identity, no to gender ideology” — sets out several reasons why it might not be a good idea to prescribe drugs that interrupt the natural development of children.
“The diagnosis of gender dysphoria at prepubertal age is based on the statements of the individuals concerned and cannot be subject to careful evaluation while the development of sexual identity is still in progress,” the letter says.
“Only a minority of children who state that they do not identify with their [biological] sex confirm this position in adolescence, after puberty.
“To suspend or prevent a [child’s] psychosexual development pending the maturation of a stable identity definition is contradictory to the fact that this development is a central factor in the definition process.
“Even in cases where the declared gender dysphoria in prepuberty is confirmed in adolescence, the developmental arrest [by puberty blockade] cannot result in a body that is sexually different from the original one.
“The sexual development of one's own body, even when it contradicts an [opposite-sex] internal orientation, allows an erotic fulfilment that a 'blocked' or manipulated body does not offer.”
Hormone suppression drugs, known as Gonadotropin-Releasing Hormone agonists (GnRHa), were adopted for puberty blockade in the 1990s by gender clinicians in the Netherlands.
This use of puberty blockers is the first stage in what has become known internationally as the “Dutch protocol” for the medical transition of dysphoric juveniles who report a distressful disconnect between their biological sex and an inner, opposite-sex identity.
(These hormone suppression drugs have regulatory approval for other conditions including precocious puberty, prostate cancer, endometriosis and “chemical castration” of sex offenders.)
Picked up by affluent countries across the Western world, the puberty blocker promise of escape from unwanted sexual development has helped drive an exponential growth in adolescent patients at gender clinics.
Blockers have been variously promoted as a diagnostic tool, a reversible measure to give patients distress-free time to consider moving on to irreversible cross-sex hormones, and as an early intervention to make it easier for the patient to “pass” as the opposite sex when an adult.
However, on the limited data available, the vast majority of those who start on puberty blockers — given as young as 10 years of age — go on to cross-sex hormones. The safety and reversibility of puberty blockers is contested.
Recent systematic reviews of the medical literature have found that the evidence base for the use of puberty blocker drugs with gender-dysphoric adolescents is weak and uncertain. Since 2020 Finland, Sweden and England have issued new, more cautious policies to end the routine use of puberty blockers.
Low bone density is among the known risks of blockers, and uncertainties include the effect on development of the adolescent brain.
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Video: Paediatrician Julia Mason and gender clinician Erica Anderson talk puberty blockers
The psychoanalysts’ letter to Italy’s prime minister says: “The current experimentation [with puberty blockers and minors] eludes careful scientific evaluation accompanied by in-depth reflection on psychic development and gives rise to serious misgivings.
“It is important to initiate a rigorous scientific discussion on the issue of children with gender problems, to which the Italian Psychoanalytic Society will gladly contribute.”
A spokesman for the society told GCN it was unclear why no other health professional bodies in Italy had raised the issue of youth gender medicine with the government.
He said the gender dysphoria issue had received less attention to date “because, fortunately, this type of medical practice is not yet too widespread.”
The representative of the group Genitori di Gender said very few people in Italy “know about the risks of the use of puberal blockers and cross-sex hormones, and often the general public is not even aware that in our country they are administered to minors.
“The phenomenon of detransitioners is not mentioned, while there is a lot of confusion between transgender people and homosexuality, with the result that many [people] are led to believe that being on the side of rights for homosexuals automatically means supporting the medical transition of minors as well.”