'Stop the harm'

Feminist groups call for an end to risky hormonal treatment of children

Protestors turn out in the streets of Madrid earlier this year to campaign for women’s sex-based rights

On September 19, groups under the banner of the Feminist Front wrote to health ministers in seven countries to put a stop to puberty blockers and cross-sex hormones for minors. This is an edited text of the Spanish letter, interspersed with material from supporting documents—Bernard Lane

Madrid, 19 September 2023

To the Spanish Health Minister, José Manuel Miñones Conde,

In Spain, puberty-suppressing treatments maintained for four or more years are being prescribed to girls and boys in [early puberty], which will result in sterility in the vast majority of cases, despite the fact that Article 149.1 of the criminal code expressly prohibits this—“Whoever causes another, by any means or procedure, the loss or uselessness of a principal organ or member, or of a sense, impotence, sterility, serious deformity, or a serious somatic or psychic illness, will be punished with imprisonment of six to 12 years.”

In Spain, too, cross-sex hormonal treatment is being prescribed to minors, which, apart from serious general health problems, can lead to anorgasmia or painful orgasms in girls and impotence problems in boys. And healthy organs are being removed, also from minors, which contravenes Article 149.2 [of the criminal code]—“Whoever causes genital mutilation in any of its manifestations to another shall be punished with imprisonment of six to 12 years...”]. 

While it is true that, according to Article 156 of the criminal code, consent creates an exemption from criminal liability in cases of sterilisation and transsexual surgery, this article also makes clear that the consent exemption does not apply when—“...the person giving consent is a minor or is totally incapable of giving it, in which case the consent given by them or their legal representatives shall not be valid.”

[This exemption from criminal liability obviously does not apply in] cases where healthy organs are removed from children under 18 years of age or where they are subjected to puberty blocker or cross-sex hormone treatments (sometimes at the first consultation and without even prior tests), and which internationally have already been labelled as experimental (none of them have marketing authorisation for the use they are being given) and the extent of their side effects is not really known, although the high risk of cardiovascular diseases and early cancers, anorgasmia, sterilisation and early osteoporosis, among others, is already recognised.

“In Spain, from 2017-21, a minimum of 20,755 people between the ages of nine and 40—more women than men, concentrated in the 14-25 age group—would have been seen in gender identity clinics. A minimum of 1,000 healthy minors, from 2019-21, would have started treatments to artificially stop their pubertal development with drugs lacking technical data, in an experimental way, with harmful and irreversible effects for their health.”—estimates by the Confluence of the Feminist Movement, from documents supporting the letter to the minister, September 2023

Chart: Percentage of minors in gender clinic caseloads in Spain’s autonomous community of Andalucía

The y-axis shows the percentage of minors, while the x-axis shows calendar year

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The letter continues

Framed as a phenomenon known as “Rapid-Onset Gender Dysphoria”, as explained by [American researcher Dr Lisa] Littman in 2018, it is mostly teenagers and very young women whose breasts, uterus and ovaries are being removed by surgeons. Phalloplasties [the creation of an artificial penis] are also being performed, a procedure that is often practically or completely dysfunctional. 

In the case of males, amputations of the penis and testicles are being performed, as well as the creation of artificial orifices [a neo-vagina], sometimes requiring the use of part of the colon for this procedure. 

With regard to pubertal blocking and cross-hormonal treatments, which have come to be prescribed by tele-consultation, these are treatments outside the technical specifications and even expressly contraindicated [and] prescribed without a report from the [Spanish Agency for Medicines and Health Products] and without having been validated by any scientific, health or medical authority. These treatments lead to irreversible consequences and, if the gonads are also removed, to lifelong dependence [on synthetic hormones].

“The latest research shows that GnRH agonists (puberty blockers) affect or can negatively affect the skeleton, cardiovascular system, thyroid, brain, genitals, reproductive system, digestive system, urinary tract, muscles, eyes and immune system. GnRH agonists can be detrimental to mental health and may increase the risk of suicide.”—from supporting documents, Alliance Against the Erasure of Women, September 2023

Chart: The rise of females under age 18 in the gender clinics of Andalucía

The y-axis shows the percentage of males and females in clinics, while the x-axis shows the female trend as a purple line and males as the green line

The letter

In our country, the Law 4/2023 of February 28—called the “Law for the real and effective equality of trans people and for the guarantee of the rights of LGTBI people”—and the different regional trans laws allow all these surgical and pharmacological interventions to be carried out without these individuals, who do not accept their biological sex, having to consult a mental health specialist beforehand (what is more, these laws tend to call [mental health intervention] of this kind “conversion therapy” and penalise them). Furthermore, the health protocols of [Spain’s autonomous communities or regions] reinforce the immediate prescription of the aforementioned treatments, based on a “self-diagnosis” (something that does not happen with any other type of patient).

And yet, according to international data, in addition to lesbians and gays (who make up a high percentage of these young people), the proportion of neurodivergent adolescents, especially autistic adolescents (more than a third of the latter alone, according to the lowest estimates) is much higher than in the general population. These young people are therefore particularly vulnerable and suffer from social anxiety or depression. In the case of girls, it is often a rejection of the inferiority of the female gender in our society. They confuse their “non-femininity” with trans identity. There is also a not insignificant number of girls who claim to be the opposite sex shortly after being sexually assaulted. 

“My daughter has borderline personality disorder and is a lesbian. During her confinement, her mental health deteriorated a lot and soon after she met a trans boy and told us that she was not a lesbian but a trans boy. As she is of legal age, she asked to be seen at [the Catalonian gender clinic] Transit. She was seen by video conference by a gynaecologist who did not ask about her background, and at the end of the video conference, she received the prescription for testosterone by email, without any prior tests. Her mental health continues to deteriorate.”—testimony from supporting documents, Association of Mothers of Adolescents and Children with ROGD, September 2023

The letter

But instead of providing proper care for those who are suffering and in need of help, irreparable physical harm is done to them, while their mental health is neglected.

In several European countries (the United Kingdom, Sweden, Finland and Norway), political leaders are beginning to be aware of the danger posed by these trans activist proposals and have adopted precautionary measures, such as the [restriction] of blockers, hormones or surgeries for minors under 18 years of age. 

In Spain, by contrast, these [medical interventions] have been encouraged and facilitated with practically no restrictions for years now, and with greater impunity since the recent approval of the so-called Trans Law (4/2023), which has generated a great deal of controversy and does not have anywhere near the support of the social majority it has been touted as having.

In recent years, we have seen an exponential increase in the number of cases of individuals requesting sex reassignment and their profile has changed radically (before most of them were adult men, now they are mainly teenage girls). Faced with this alarming situation, we ask that the Ministry of Health and the Regional Ministries of the Autonomous Communities take into account the arguments of all medical and scientific societies.

“The [Spanish Association of Primary Care Paediatrics (AEPap)] considers that the draft Trans Law does not value the participation of parents and health professionals in the process of sexual self-definition of children to the extent that would be desirable. Adolescence is a period in which individuals may have a certain lack of definition and insecurity about sexual roles and other aspects of personal development. The support of health professionals, especially mental health professionals, can play an important role in the development of sexual identity and orientation.”—statement from supporting documents, AEPap, 26 October 2022

The letter

Healthcare professionals must fulfil their obligations of prudence and respect for health and bodily integrity. The code of ethics demands, above all, that any medical act be based on a rigorous diagnosis, and that the treatments offered be individualised and based on scientific evidence, in accordance with the Lex Artis [or professional standards]. 

A prescription with such far-reaching consequences as a hormone treatment or an operation that is not necessary for life should only be given to people of legal age, in full use of their mental faculties, by a multidisciplinary team made up of health professionals from all the fields involved, including, of course, mental health, in a hospital environment and preceded by a mandatory period of reflection. 

We also ask that in the field of care for young people and minors suffering from this type of problem, they should be attended by properly trained medical professionals and psychotherapists. And we recall that the first fundamental right of a minor is to reach the age of majority in good health.

We are already seeing the complications of these abusive medical interventions; lawsuits have already begun to be filed in the face of treatments prescribed outside the Lex Artis, in which consent for hormone treatments and operations was neither free nor informed; the main scientific societies and medical professional associations [in Spain] have already taken a stance against these activities.

Minister, in the face of this health scandal, which is increasing daily, we ask you to take action.

Yours faithfully,

Alliance Against the Erasure of Women (Alianza Contra el Borrado de las Mujeres); Association of Mothers of Adolescents and Children with ROGD (Agrupación AMANDA); Confluence of the Feminist Movement (Confluencia Movimiento Feminista); Feminists in Congress (Feministas al Congreso); Feminists of Catalonia (Feministes de Catalunya); Political Feminist Forum (Fórum de Política Feminista).

Para obtener información en español sobre la campaña del Frente Feminista, pulse aquí.