No hormones on Chile's public purse
The health ministry's plan to finance puberty blockers and cross-sex hormones for minors, in defiance of the weak evidence base, has been blocked
No money
Chile’s Ministry of Health is prohibited from funding poorly evidenced hormonal or surgical treatments for gender-distressed minors following a historic vote by legislators in the National Congress.
On November 20, senators of the upper house of Chile’s bicameral congress voted 22-19 to block any allocation of funds for puberty blockers or cross-sex hormones in the 2025 health ministry budget, rejecting a government attempt to override a similar veto by deputies of the lower house.
Debate about the safety and extent of medicalised gender change has opened up rapidly in the South American republic following mobilisation by concerned parents’ group Kairós; game-changing coverage on May 29 by journalist Sabine Drysdale in the national media outlet BíoBío; the final report from England’s Cass review; and scrutiny of activist policy making by a committee of investigation in Chile’s Chamber of Deputies.
“Until May 29, when my article in Bíobío was released, most Chileans were in the dark about gender-affirming therapies being given to minors,” Ms Drysdale told GCN. “The terms gender dysphoria, puberty blockers, or cross-sex hormones were not in the public domain.”
“Chilean people had no idea doctors were freely prescribing these drugs at the first appointment to vulnerable and mentally distressed children who went to see them with their terrified parents who had been told, ‘Trans your kid or they will commit suicide’.”
“Very few people knew these drugs were going to convert healthy children into infertile, menopausal, anorgasmic young people—into adults suffering osteoporosis, metabolic diseases and other severe health conditions that lower the quality and span of their lives. It was not talked about.”
The votes of prohibition on public funding for youth gender medicine in the Chamber of Deputies and the Senate came predominantly from members to the right of the political spectrum.
It is open to the government of Chile’s left-wing President Gabriel Boric to launch a constitutional appeal against the ban on the grounds that the legislative branch has interfered in an executive matter.
The private health sector is not affected by the prohibition.
“Less than a year ago, very few knew about the PAIG [a Chilean government program] which promotes social transition in children as young as three years old or refers children as young as nine for hormonal treatment. Everyone denied the existence of sex-reassignment surgery for minors. Nobody knew that parents were harassed, pressured and prosecuted for ‘resisting’ or ‘doubting’ these interventions.”—Spokesperson, Agrupación Kairós
“[The Senate] rejected funding for puberty blockers and hormone treatments, leaving hundreds of minors and their families unable to choose their treatment. It’s a new barrier to health access and will mainly affect families who depend on the public health system.”—Equality Foundation, Chilean lobby for “sexual and gender diversity,” tweet, 21 November 2024
“With 22 votes in favour and 19 against, public funding for hormone treatments for minors is ended. These treatments have serious side effects and no quality scientific backing.”—Nicolás Raveau of Detrans Chile, tweet, 21 November 2024
What the ministry knew
In June, just after publication of Ms Drysdale’s 13,500-word article in BíoBío linking the Cass report to emerging concerns in Chile, the prestigious private US Christus health network announced a suspension of puberty blockers and cross-sex hormones for new under-18 patients, and the Ministry of Health “suggested” a deferral of any new treatment in the public system pending new national guidelines to be drawn up by an expert committee.
However, the ministry’s response has been criticised by the special investigative committee set up in July by the Chamber of Deputies to scrutinise two government programs, the Program for Support of Gender Identity (Programa de Acompañamiento a la Identidad de Género, PAIG, also known as Grow with Pride or Crece con Orgullo) and the Trans Health Program (Programa de Salud Trans, PST).
In a report approved on November 18, the investigative committee highlighted the revelation that the health ministry had in its possession a March 2023 review of the scientific literature confirming the weak quality and uncertain nature of the evidence for gender medicalisation of minors.
“It is not possible to establish the effect of the use of [the cross-sex hormones] estradiol [and] testosterone and [puberty blockers] in adolescents with gender dysphoria on mental health (depression), suicide attempt events, quality of life, body-mass index and adverse events, as no comparative studies are available,” said the review conducted by the ministry’s Department of Health Technology Assessment (ETESA-SBE).
The ministry’s internal review warned that any research results showing a change in measures before and after hormonal treatment had “to be treated with caution, as the effectiveness and safety of the intervention cannot be established, and the certainty of the existing evidence is very low, so there is considerable uncertainty about the clinical benefit of the estimates presented.”
And yet, after the concerns documented in BíoBío and the Cass report, the ministry had appointed experts to create guidelines for the use of this hormonal treatment with minors.
“[D]espite having in their hands reports that showed that there was a lack of good quality information, the question [for the ministry] was not whether or not to give minors hormonal treatment, but how to do it. The difference is crucial and the responsibility is ministerial,” said the report of the special investigative committee.
“The suffering of children who identify as trans is genuine and we are witnesses to that, but we do not believe that irreversible interventions that have not been proven to be safe are the answer. The underlying problem is the delivery, through the affirmative model, of a quick and hasty response to suffering that is not explored.
“As long as the debate remains caught up in political causes, it is difficult to validate the questioning of social and medical interventions for children, and the state continues to fail to provide safeguards for children’s rights.”—Spokesperson, Agrupación Kairós
Not neutral
The government’s position has been that the PAIG program is confined to neutral support for “trans” and gender non-conforming children from psychologists and social workers.
However, the investigative committee report concluded that the PAIG was “configured as the ‘gateway’ to hormone therapies and encourages social transition [from the age of three] without necessarily having the consent of parents or caregivers.”
“The PAIG is implemented in 37 hospitals in the country and the psychosocial teams are empowered to carry out family interventions, within educational spaces, referrals to hormone therapies, as well as the power to take legal action against ‘resistant parents’ who oppose their children’s gender transition or seek greater caution in advancing through the different stages of gender transition.”
The report said the health ministry had failed to provide data on the age, sex and type of intervention given the 600 minors said to be receiving treatment among the 2,000-odd children enrolled in the PAIG.
The report cited evidence to the investigative committee from paediatric endocrinologist Dr María Francisca Ugarte that social transition was a serious intervention and that it was a “fallacy” to claim puberty blockers were reversible.
“[S]ocial transition is an intervention that modifies the child’s life experiences, the spontaneous course of the psychosexual development process and brain maturation,” Dr Ugarte said.
“[D]uring childhood and adolescence, the great plasticity of brain development makes these periods of high vulnerability and that is why social transition during childhood is an intervention that modifies brain development with changes in the process.”
The report also concluded that the PST program did in fact cover minors and provided for children from the age of 9-10 to be given puberty blockers, notwithstanding the fact that, as yet, public funding for hormonal treatment had only been approved for adult patients.
The report called for a suspension of the PAIG; no new hormonal treatment of gender-distressed minors in public health; collection of better data on minors currently being medicated; and provision of “necessary care” for those who desist or detransition.
“Previously, public funds were spent on hormonal interventions for minors without a specific allocation in the budget. Now, there is a specific prohibition against any such funding in the future. These therapies are no longer in the dark, and Chileans are demanding better information and measures to be taken in such delicate matters.”—Chilean journalist Sabine Drysdale, message to GCN, 21 November 2024
Indirect funding
Chilean detransitioner Nicolás Raveau, a former trans activist, told GCN that the congressional prohibition on public funding of hormonal and surgical treatment for minors had set a precedent and had called into question the “deficient Chilean model of affirmative action.”
He said that, beyond the PAIG and PST, there was still government money for training and workshops run by trans activist organisations—“nothing very constructive or lasting for the people they claim to help.”
Although the PAIG and PST did not themselves allocate public money specifically for medical treatment, there was “diffuse” funding for hormones, Mr Raveau said.
“For example, the PST distributes hormones that come from the purchase of the Central Supply Centre of the National Health Services System (CENABAST),” he said.
“But CENABAST does not adequately monitor the destination of such medicines—this was acknowledged at the investigative committee—and they may end up in public hospitals, in the hands of trans organisations, gender-identity polyclinics, and who knows where else.
“And it is clear from reading the PST [documents] and knowing the system, that the PST can procure treatments on its own, without going through CENABAST.”
As for the PAIG, while the program itself did not provide puberty blockers or cross-sex hormones, “it does make referrals to endocrinologists in the public system,” the spokesperson for the parents’ group Kairós said.
After a search of records, “42 cases of surgeries associated with gender reassignment on minors were detected between 2004 and 2024,” said the report of the investigative committee.
“Of these, 6 were reportedly performed on 17-year-olds between 2009 and 2019… The remaining 36 cases are in the private sector.”
No cases were found in the last five years. It was not clear how many of the surgeries found in the records were for mastectomy, as opposed to genital operations.
And the results of this search were inconsistent with responses to an information request put to the health ministry by Mr Raveau and evidence heard by the investigative committee, according to the report.
WORD SALAD
A random collection of spurious lifesaving claims and a few facts
• “We cannot carry on in this field that involves permanently changing young people’s bodies if we don’t fully understand what we’re doing and learn from those we fail.” (Dr Laura Edwards-Leeper, co-author of WPATH Treatment guidelines and founder of the first paediatric gender clinic in the US)
• Dr Telfer is credited with helping to save many children's lives without pulling out a single scalpel or tending to any life-threatening diseases. (ABC)
• There is no robust empirical evidence that puberty blockers reduce suicidality or suicide rates. (NIH)
• Clinical gender dysphoria does not appear to be predictive of all cause nor suicide mortality when psychiatric treatment history is accounted for (BMJ Health)
• “I had the honour of meeting Dr Michelle Telfer who is one of Australia’s leading health researchers who is saving lives” (Ricki Spencer)
• “Transgender unit at Melbourne's Royal Children's hospital gets $6m boost. A major funding boost to Australia's only multidisciplinary clinic for children with gender dysphoria will save countless lives”, the chief executive of Transgender Victoria, Sally Goldner, has said. (the Guardian)
• Dr Edwards-Leeper has advocated for better training of gender therapists and increased diligence in assessing mental health issues before assigning medical interventions such as puberty blockers and cross-sex hormones to patients.
• Suicidality in young people attending the GIDS is similar to that of young people referred to child and adolescent mental health services. (Aust Institute of Health & Welfare)
• The age-specific death rate for Aboriginal and Torres Strait Islander child suicide was 8.3 deaths per 100,000 Aboriginal and Torres Strait Islander children, compared to 2.1 per 100,000 for non-Indigenous children (Aust Institute of Health & Welfare)
• Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for (BMJ)
• A Study titled 'All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019'
analysed overall mortality and suicide among gender-referred young people in Finland over a 25-year time span. The study found no convincing evidence that gender-referred youth have statistically significantly higher suicide rates as compared to the general population, after controlling for psychiatric needs (BMJ Mental Health)
• Australia’s guidelines on gender affirmative medicine lack rigour and independence and fail to recommend formal assessment processes that screen for body image problems, autism spectrum disorder, sexual orientation according to international researchers commissioned. (UK Cass review)
As someone who is both American and Venezuelan and a student of Latin American societies and politics, I am interested in whether trans activism in Chile has created or is supported by what we in the US call cancel culture. Here, it is almost impossible for sex realists to have a say in the gender affirming politics, policies and programs embraced the Democratic Party mainstream. Trans activists have been successful in persuading most Dems that anyone who questions any aspect of gender identity ideology is a "transphobe," that is, a terrible and hateful person. With a few exceptions, America higher education also responds to outspoken faculty or student sex realists by shunning, shaming and censoring them. That is why sex realists have had to look the courts and Republican controlled state legislatures to curb the excesses of trans activism.
Do critics of gender identity ideology in Chile face a similar repressive atmosphere?
Also, assuming there are trans activists in Chile, how much direct influence have foreign trans activists had on their ideology, tactics and programs?