Not so fast

The Republicans of France hope to stop the surge in youth gender medicine

Photo by Martti Salmi on Unsplash

A great scandal

France’s centre-right Republican Party is proposing a law to stop the momentum towards easier and faster medicalised gender transition of minors, which it fears may prove to be an “ethical scandal.”

The Republicans (LR) plan to introduce a draft law before the northern summer to impose a national ban on puberty blockers, cross-sex hormones and surgery for under-18s following a historic report to the Senate.

The leader of a working group involving 18 LR senators, Jacqueline Eustache-Brinio, warns in the report that “the sexual transition of young people will be considered one of the greatest ethical scandals in the history of medicine” if it turns out that advocates for early medicalisation have underestimated the role of social influence and associated risks.

The report to the Senate highlights the lack of evidence for youth gender medicine and its side effects; the worrying surge in demand; the suspected role of “fashion”; the poor mental health of would-be teenage patients; and the pressure for their accelerated medicalisation coming from “trans-affirmative” health professionals and activists, according to the newspaper Le Point, which published leaks from the document on March 18.

Le Point said the report “proposes a complete reversal of the current trend by making sex changes not easier but impossible before reaching legal age.”

“After years on the defensive against enthusiastic and determined trans activists, right-wing politicians are convinced that they are moving in the direction of history,” the newspaper said, citing the shift to more cautious treatment policy in Finland, Sweden, Norway, Denmark and England.

The expert authors of the report to the French Senate on the “trans identification of minors” are clinical psychologist Céline Masson and child psychiatrist Caroline Eliacheff, who are co-directors of The Little Mermaid, a watchdog group on youth gender medicine bringing together researchers and professionals.

“[The report] is a very important event in France, as it will open up the debate,” Dr Masson told GCN.

“It will enable politicians to take up these issues, since gender clinic doctors have not done so.”

Le Point suggested most mainstream physicians would agree that medicalised gender change for minors should be restricted and noted a survey of 1,034 healthcare professionals run by the French language International Journal of Medicine, which found 84 per cent support for a ban on all hormonal treatment of trans-identified minors.

“The National Academy of Medicine in France has issued a press release in which it cautions medical practitioners that the growing cases of transgender identity in young people are often socially mediated and that great caution in treatment is needed. The Academy draws attention to the fact that hormonal and surgical treatments carry health risks and have permanent effects, and that it is not possible to distinguish a durable trans identity from a passing phase of an adolescent’s development.”—Society for Evidence-based Gender Medicine, post, 3 March 2022

They cannot consent

In a March 19 interview with Le Figaro, the LR working group leader Senator Eustache-Brinio declared that, “The law must prohibit the prescription of puberty blockers to minors diagnosed with gender dysphoria, as [England’s National Health Service] has just decided.”

As well as banning hormones and surgery, the LR report to the Senate calls for repeal of a policy known as the “Blanquer circular”, which enables social transition of children at school, replacing it with advice that staff “remain neutral towards children who are questioning their gender.”

“Before the age of 18, consent is not the same as it is at adulthood, and children run the risk of making decisions that are sometimes irreversible, which some later regret, too late,” Senator Eustache-Brinio, who was a teacher before politics, told the newspaper Le Figaro.

“Before the summer, I will be submitting a Bill to the Senate to regulate [gender] medical practices in the care of minors,” she said.

“Minors must be treated first and foremost by child psychiatrists. Only children who do not present other major psychopathological disorders may, if their gender-related distress persists, be redirected to services specialising in gender incongruence.

“The suffering of children who are uncomfortable with their gender is a psychological malaise that takes time to understand. Adolescence is often the age when acceptance of one’s pubescent body and sexual identity is most difficult.

“But when children suffering from this malaise receive appropriate support, they don’t necessarily ask for a sex change.

“We recommend better psychiatric care for these children, but we want France to take a uniform stance on the responses offered to adolescents. Child protection is at stake, and so it’s the role of the legislator.

“We’ve found that ‘detransitioning’ children are often afraid to tell healthcare professionals that they regret their choice: the medical world therefore underestimates the number of children who have backed out.”

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Screenshot: Writer JK Rowling retweets the news from France and likens youth gender medicine to a quietly sinking ship (the news photo shows Senator Eustache-Brinio)

Identity medicine

However, the senators of the working group also heard arguments against restrictions on gender medicine, with Claire Vandendriessche, co-ordinator of the advocacy group Trans Youth Trajectories (TJT) declaring that, “Discovering one’s own transgender identity is an intimate and personal experience. No one has the right to decide for us whether we are trans or not.”

TJT “believes that the willpower, even that of a minor, is enough to set in motion an entire chain of care leading up to surgery, including these famous puberty blockers,” Le Point said.

The report from the Senate working group follows almost a year’s work and evidence from 67 people including gender clinicians, doctors, psychologists, health and education officials, legal experts, parents’ and feminist groups and transgender advocates. Last September in Paris, the senators heard from the British psychiatrist Dr David Bell, who was a pivotal figure in unmasking the scandal at the London-based Tavistock gender clinic.

Dr Masson told GCN she was unsure whether or not the Senate report would influence the forthcoming treatment guideline for over-16s under secretive development by the National Authority for Health (HAS).

She said the report’s expert recommendations would shape the draft law proposed by LR.

“I think [LR] will have strong support [for its Bill] in the Senate, and I hope they’ll have support in the National Assembly from all sides of the political spectrum,” she said.

LR is dominant in the Senate. In the Assembly, LR has 61 of the 577 members. The largest group (245) form President Macron’s coalition Together!

Last November Drs Eliacheff and Masson—two of France’s most prominent critics of youth gender medicine and co-authors of the book 2022 book The Factory of the Transgender Child—were awarded the 2023 Marcelle Blum bursary for the study of female psychology by the Academy of Moral and Political Sciences in recognition of their work carried out in the face of activist push-back.

“We were attacked when our book came out, then little by little, professionals—including doctors and psychologists, but also researchers—realised that we were facing a dictatorship of minorities,” Dr Masson said.

“A Lille-based trans rights group called J’en Suis J’y Reste (I’m here and I’m staying) called for supporters to protest [Dr Eliacheff’s appearance] at the Lille event, which was organised by a secular philosophy group called CitePhilo. About 200 people swarmed outside the room stomping their feet and banging tambourines, while others stationed inside shouted ‘transphobe’ and ‘facho’ (fascist). Dr Eliacheff gave up trying to speak after one hour.”—Rose Kelleher, Genspect, 28 November 2022

Weak evidence

In this week’s coverage by Le Point, Senator Eustache-Brinio said the working group had discovered the “very fragile” claim to safety of the puberty blocker-driven 2011-14 “Dutch protocol” for “juvenile transsexuals”, the evidentiary basis for the surge in youth gender clinics internationally.

The protocol “assumes complete reversibility” of puberty blockers and involves data from only 54 patients, Le Point reported, adding the fact “that it was partly funded by Ferring Pharmaceuticals, a laboratory that produces puberty blockers.”

In her Figaro interview, Senator Eustache-Brinio said she “became interested in this subject because it seemed to me that the care of minors who identify themselves as trans in France was still very much ignored by public opinion, despite the fact that things are evolving very rapidly and many crucial questions are being asked.”

She noted there were no official statistics to measure the extent of trans identification among minors.

“But all the doctors and psychologists we interviewed agree that the phenomenon is on the rise… Psychologist Angélique Gozlan, who specialises in social networking among teenagers, described the role played by transgender influencers with young people in distress, whom algorithms end up trapping in information bubbles where only the same discourse resonates, replicated ad infinitum.”