This article originally appeared in the National Post.
By David Zitner, August 28, 2023
Parenting has always been rife with challenges, but in the modern era, a new dilemma has emerged that demands our attention: the issue of hormone treatment for prepubertal children who question their gender identity.
The profound, complex decisions facing parents in these situations were unheard of in previous generations. On one side are physicians advocating for aggressive medical and surgical interventions, promising immediate results but also exposing children to potentially lifelong side-effects. On the other side are equally qualified medical experts who emphasize caution, urging parents to “wait and see.”
In the world of medicine, decisions about care are typically guided by well-organized studies that assess the benefits and risks of various treatments. Such studies are essential for understanding which individuals are likely to benefit from a particular intervention, and which are likely to be harmed.
European countries are leaders in demanding rigorous research before clinicians can embark on aggressive treatments aimed at influencing a person’s gender identity. Unfortunately, Canada’s regulatory landscape has not been as diligent. Even the most optimistic advocates of gender-affirming treatments acknowledge that the evidence supporting their approach is low grade.
History shows how medical superstitions can persist until scientific research reveals the harmful consequences of certain interventions. To see the danger of embracing medical practices without sufficient evidence, consider cases such as thalidomide’s impact on fetuses, misguided radiation treatments or long-term hormone treatments for menopausal symptoms. It’s crucial to learn from these mistakes and ensure that the well-being of vulnerable individuals isn’t compromised by interventions that may end up doing more harm than good.
A personal anecdote highlights how some within the medical community have allowed this issue to cloud their objectivity. A patient of mine once requested low-dose steroids to enhance his appearance as he pursued an acting career. He was fully aware of the potential side-effects and was willing to undergo regular monitoring.
I was prepared to accede to his well-informed choice but believed that the regulatory colleges would criticize this off-label use of steroids. Regulatory bodies routinely censure prescribers and users of anabolic performance-enhancing drugs, however those same drugs are being used in some gender-modification procedures.
Hormone treatment is not a trivial matter. British experts openly acknowledge the gaps in our understanding of the mental health effects of aggressive gender-affirming treatments. It is noteworthy that a substantial percentage of patients who receive hormone treatments discontinue them within a few years, suggesting either dissatisfaction or unforeseen consequences.
The differences of professional opinions over this issue was examined in the respected British Medical Journal, which aptly titled one section of its article “Same Evidence, Divergent Recommendations,” encapsulating the complex environment that medical professionals navigate when making decisions about gender-affirming treatments.
Globally, governing bodies have varying approaches about medically treating gender dysphoria. Sweden and Finland have guidelines that err on the side of caution, emphasizing psycho-social support as the initial course of action and limiting surgical interventions to adults. Medical societies in France, Australia and New Zealand have also advocated against early medicalization. The United Kingdom’s National Health Service, in a comprehensive review of gender identity services, acknowledged the inconclusive evidence and often transient nature of prepubertal gender dysphoria.
The controversies surrounding both the mental health benefits and harms of aggressive treatments underscore why Canadian regulatory bodies must adopt a more stringent approach, requiring rigorous studies before allowing such interventions and monitoring patients to understand the characteristics that predict positive or negative outcomes. Canadian professionals must prioritize the well-being of these young individuals.
The issue surrounding hormone treatment for prepubertal children grappling with gender identity demands thoughtful consideration and rigorous research. The documented evidence of medical interventions gone awry highlights the importance of basing decisions on studies rather than superstitions. As experts debate the merits of aggressive treatments, Canadian regulatory bodies must ensure that vulnerable youth are protected, and demand evidence that supports potential benefits and identifies potential harms.
In this complicated landscape, one thing remains clear: hormone treatment is no trivial matter, but a significant, life-altering decision requiring the utmost care and consideration.
David Zitner is a senior fellow at the Macdonald-Laurier Institute, a physician and a former professor in Dalhousie University’s faculty of medicine.
