Trauma and gender dysphoria

1

Case Study: 13 year old gender dysphoric girl

- Sexually abused by father.

- disordered eating prevented pubertal development.

- After weight restored, claims male identity, wants   puberty blockers.

Innate male identity, or maladaptive strategy to   escape female vulnerability?

3x as many "adverse childhood events" compared to same age controls, e.g:

• Maternal mental illness
• Domestic violence
• Sexual abuse
• Physical abuse
• Bullying

• Lesbian, Gay, Bisexual:  50-100%
• Autism:                             5-15%
• Eating disorder:               ~15%

"When she went on to those pills and stuff I could see her going downhill, but no one believed me,"

-Grandfather

Three media reports of formerly trans-ID females in NZ:

All three lesbian, one on the autistic spectrum.

Clinics are unregulated and don't report data. Tip of the iceberg?

NZ Herald

New Zealand Counting Ourselves survey:

Third of surveyed trans-id females report being raped.

Half report attempted rapes.

Female respondent: 

Sexual assault 

Testosterone (pass as man)

Reduced risk of sexual  assault from heterosexual men

Regulatory landscape and fractured professional opinion

2

Fractured Professional Opinion

'Medical intervention has weak evidence (some: psychotherapy reccomended)'

'Medical intervention has good

evidence and is reccomended'

PATHA is the de facto regulator 

• Associated with WPATH
• Established in 2019 with 15 members.
• Hybrid organisation of both medical professionals and unqualified advocates
• No medical qualifications required to join.

Ministry of Health 'hands off'

"Blockers are safe and fully reversible"

"There is good evidence that puberty blocking...significantly improves mental health and wellbeing outcomes" (p. 17)

 "Refer promptly to appropriate services to access early interventions pre/during puberty..." (p. 28) 

 "Withholding...treatment is not considered a neutral option" (p. 26)

"Although some [autistic] people may have difficulty in articulating their gender identity, this should not create an unnecessary barrier to access any [treatment]. Some people may express their gender identity non-verbally." (p. 23)

Severe (non-verbal) autism no barrier to treatment:

"...suggest little change [in mental health] with [puberty blockers] from baseline to follow-up...Studies that found differences in outcomes...are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance."

"The current evidence base does not support informed decision making and safe practice in children."

"[puberty blockers are] likely to threaten the maturation of the adolescent mind."

"...unregulated live experiment on children."

Contrasting views from UK Health Authorities

"Individualised psychosocial interventions...should be first-line treatments for young people with [gender dysphoria]

...should be undertaken before experimental puberty-blocking drugs and other medical interventions...are considered."

"...there is a paucity of quality evidence on the outcomes of those presenting with Gender Dysphoria. In particular, there is a need for better evidence in relation to outcomes for children and young people."

Dr Erica Anderson - WPATH Board

"When I asked Anderson if she believes that psychological effects of puberty blockers are reversible, she said: “I’m not sure.”"

[On gender identity as a result of social influence]: “I think there probably are people who are influenced. There is a little bit of ‘Yeah, that’s so cool. Yeah, I kind of want to do that too."

It is my considered opinion...we’re going to have more young adults who will regret having gone through this process...I’m worried that decisions will be made that will later be regretted by those making them.

[When treated with blockers in early puberty]: "They’re not as functional. I worry about their reproductive rights later. I worry about their sexual health later and ability to find intimacy."

Dr Marci Bowers - WPATH President-elect

"To say that it is impossible for adolescents to experience peer pressure in this area when we know that they experience it in every other area is kind of crazy."

Dr Jamie Veale - PATHA president, WPATH Board Member

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Dr Laura Edwards-Leeper

WPATH Chair of the Child/Adolescent Committee

Recommendations

3

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1. Exclude "treatments and practices that explore and understand the underlying social, psychological and trauma-related influences on gender identity and any psychiatric comorbidity"

2. Remove description of blockers as "safe and fully reversible" from MoH website

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3. Comprehensive independent review of the treatement of child and adolescent gender dysphoria

Independent review panel

Restricted to a single medical university

Halted

GP does a course

Review active/completed

Puberty blocker prescriptions

Cooper's grandfather refused to use male pronouns or Cooper's male name. 

He was right and the doctors who treated her were wrong.

4. Parent and caregiver exclusion