They knew
The pressure is on Chile's Ministry of Health over the country's under-the-radar provision of paediatric medical transition
Stop it now
A report revealing that Chile’s health authorities knew there was no good evidence for gender medicalisation of minors has been approved by a historic vote of the country’s Chamber of Deputies.
The report from a special investigative commission of the chamber—the lower house of the Chilean Congress—calls for the immediate suspension of the government’s “Gender Identity Support Program (PAIG),” which refers children for hormonal treatment.
The chamber endorsed the report on Thursday by 56 votes to 31.1
Other recommendations, listed by the newspaper El Mercurio, include a review of guidelines for hormonal treatment, restricting this intervention to adults; care for young people who detransition; an end to the “gender-affirming” treatment approach with minors; the scrapping of an official policy enabling social transition in schools; reinforcement of parental rights; and the referral of material to the Public Prosecutor’s Office for investigation of possible crimes.
The commission’s report showed that the Ministry of Health decided to set up an expert committee last year to develop guidelines for hormonal treatment of minors despite being in possession of an internal March 2023 review of the weak evidence base—a review that warned it was “not possible” to know the effects on minors of puberty blockers or cross-sex hormones.
Gender-affirming medical treatment of minors, exposing them to sterilisation, is happening in Chile in defiance of law and bioethical principle, according to a recent analysis by Professor Alejandra Zúñiga-Fajuri of the Autonomous University of Madrid and the University of Valparaíso.
A chance at reform
The report of the special investigative commission is not binding on Chile’s government, but the health ministry said it would review the recommendations as “an opportunity to strengthen the quality of our programmes and transparency in public management.”
The government led by left-wing President Gabriel Boric, a former student leader, rates poorly in opinion polls and faces elections in November.
“Although the report is not binding, the Ministry of Health will undoubtedly be unable to ignore it,” said detransitioner and researcher Nicolás Raveau. “This report is a first step; more alternatives still need to be developed.”
The concerned parents’ association Agrupación Kairós urged the government to heed the report, as well as England’s Cass review, “and promote the necessary reforms to implement a comprehensive, psychological, and non-medicalised care model for children and adolescents who identify as trans.”
A spokesperson for Kairós told GCN that the “psychosocial support” offered by the program PAIG “is not neutral, but consists of an active and exclusive application of the affirmative approach.”
The program referred children for hormonal treatment, and it should at least be “thoroughly reviewed.”
The spokesperson said the revelations of the commission’s report included—
“The situation experienced by families receiving care in the public health system: coercion and pressure from the psychosocial team
“Pressure from schools and colleges as a result of Circular 812 of the Ministry of Education, which supports [social transition] without our consent for adolescents aged 14 and over
“Legal complaints, persecution and loss of custody of our children for disagreeing with the affirmative approach and the social and medical interventions it entails
“The absence of statistical data as a basis for this public policy”
The health ministry continues to insist that the PAIG program, open to children aged 3-17, does not itself provide hormonal treatment to minors, and that any prescribing is done by doctors in the exercise of their professional autonomy.
However, it was reported last year that about 600 of the 1,900 children in PAIG were on puberty blockers. At age 10, children become eligible for hormonal treatment under the government’s Trans Health Program (PST), another focus of the chamber’s special investigative commission.
Journalist Sabine Drysdale—whose breakthrough media coverage in BíoBíoChile last May on the sometimes coercive practice of paediatric gender transition shocked readers—told GCN she believed hormonal treatments were still being given to minors in public and private health.2
She said that although a pause to such treatment in the public sector was “recommended” last year, there was a lack of transparent information about what was happening, and certainly no ban on puberty blockers or cross-sex hormones. “They are sold over the counter.”
She said the report approved by the chamber was important because it “opens the way” for reform of the country’s Gender Identity Law and its regulations in order to stop gender medicalisation of minors.
Republican Party deputy Stephan Schubert said it was time to suspend the PAIG and “firmly regulate” these hormonal treatments.
“If we do not do so now, we will continue to be complicit in a silent crisis that is destroying families and deeply harming our children,” he told El Mercurio.
Opposition parties—Unión Demócrata Independiente and Renovación Nacional—delivered sizeable numbers of chamber votes in favour of the report, although it was also supported by left-wing deputy Pamela Jiles, a former investigative journalist who reportedly has a trans-identified adult child.
On Twitter/X, Ms Jiles said: “Those who abuse, harm, mutilate or sterilise children should be imprisoned for life.”
“We approved, by a cross-party majority, a report to prevent hormone treatment and irreparable harm to minors, requested by the children themselves and their mothers.
“The absence of the ruling party from the vote is striking.”
Renovación Nacional deputy Camila Flores said the government had “an obsession with sexualising children, and children do not belong to the government, they do not belong to the state; they belong to their parents, and their parents know what is best for each of their children.”
“That is why this investigative commission was important, and its approval was categorical, so that Gabriel Boric’s government stops experimenting with children and adolescents in our country with therapies that do not even have sufficient scientific evidence.”
Deputy Ana María Gazmuri of the left-wing party Acción Humanista, who was a member of the commission, told La Tercera that “PAIG was created by law to provide support, not to medicalise.”
“But during the work of the investigative commission, we received testimonies from families who, from or together with the PAIG, were referred to hormone treatments without technical guidelines, without specific protocols for each age group and without sufficient guarantees.”
Another commission member, the chamber’s openly transgender deputy Emilia Schneider, took to social media to claim the report promoted “hate against trans people … The far right wants to take away our rights.”
The Medical College of Chile, a professional association of doctors, described the chamber’s embrace of the report as “serious … because it affects fundamental human rights, such as the right to integrity, and can seriously affect the right to health of children and adolescents.”
The college president, Dr Anamaría Arriagada, whose members are involved in delivery of the PAIG program, confirmed its linkage to hormonal treatment.
She said the PAIG was “basically psychological support for the children and their parents, but obviously these children are also treated by technical teams that include paediatricians and endocrinologists.”
The college has in the past complained of what it called “the persecution of doctors who treat transgender people.” This appeared to be a reference to an investigation of “sex change” surgeries on minors in public health.
Six of the 155 deputies abstained and 62 were absent.
HOW INFORMED IS INFORMED CONCENT?
I reference an article titled ‘Current Concerns About Gender-Affirming Therapy in Adolescents’ from Current Sexual Health Reports 14 April 2023.
I have attempted to summarised the key points in this 13 page article
• Public health authorities in Finland, Sweden & the UK conclude that the risk/benefit ratio of youth gender transition ranges from unknown to unfavourable.
• The longest-term studies with the strongest methodologies reported markedly increased morbidity and mortality and a persistently high risk of post-transition suicide among transitioned adults.
• Children and adolescents are too young to assume their gender identity is permanent.
• Despite the promise that gender transition is key to ameliorating the suffering of gender-dysphoric youth, systematic reviews of evidence failed to find trustworthy evidence of such improvements.
• Regarding cross-sex hormones the review found that improvements in mental health were highly uncertain and had to be carefully weighed against the risks of hormonal interventions.
• A recent long-term Swedish study also failed to find that either hormones or surgery improved long-term mental health outcomes of gender dysphoric adults. Those who refrained from surgery fare no worse, but they also had half as many serious suicidal attempts
• Proponents of gender-transitioning youth insist the benefits of the practice are self-evident even if systematic reviews of evidence cannot detect them.
• Benefit does not preclude regrets, which typically appear later. The “honeymoon period” can last from several months to several years with adverse effects emerging 8–10 years following.
There exists multiple scientific studies confirming the fact that grave negative outcomes occur following gender transition, particularly in the medium and long-term..
Medical ethics demand that patients (and in the case of minors the parents or guardians) are fully aware of all the possible positive and negative outcomes that could occur following an intervention.
In the case of gender transition the list of negative outcomes would include:
Elevated suicide rates, regret, early death, elevated mental health comorbidities, elevated cardiovascular risk, sterility, social stigma, exclusion from preferred gender toilets/change-rooms, challenged long-term relationships, discrimination etc.