controversies about how institutions should treat individuals who identify as a gender that does not correspond to their biological sex have recently been debated in the halls of government, in courtrooms, and on TV talk shows. Should males who identify as women have access to women’s restrooms? Which school locker room should girls who identify as boys be permitted, or required, to use? Should teachers be compelled to use a student’s preferred pronoun, or even a gender-neutral pronoun such as “ze” instead of “he” or “she”?
● The Gender Identity Development Service in the United Kingdom, which treats only children under the age of 18, reports that it received 94 referrals of children in 2009/2010 and 1,986 referrals of children in 2016/2017 — a relative increase of 2,000%.The service also reports that it received six referrals for children under the age of 6 in 2009/2010, compared to thirty-two referrals for children under the age of 6 in 2016/2017 — a relative increase of 43
.● In a brief paper by psychologists from a gender clinic in Toronto, the authors reported a large increase in the number of referrals for children (ages 3 to 12) per year between 1988 and 1991, when the number of children referred went from around 40 per year to around 80, a rate that remained steady through 2011. The authors also reported that between 2004 and 2007, the rate of adolescents (ages 13 to 20) referred to their clinic rose from roughly 20 per year to 60, and then to nearly 100 per year by 2011.
● In a paper by clinicians at Children’s Hospital Boston, the authors reported on the number of individuals who presented at the hospital with gender identity issues. Between 1998 and 2006, such patients presented to the hospital’s Endocrine Division at an average rate of 4.5 patients per year, but in the period from 2007 to 2009, after the hospital opened a gender identity clinic, the annual average of patients presenting with gender identity issues rose to 19 patients per year.
● In a paper published in 2016, physicians from an Indianapolis pediatric endocrinology clinic reported a “dramatic increase” in referrals for gender dysphoria since 2002, finding that of 38 patients referred between 2002 and 2015, “74% were referred during the last 3 years.
”The authors emphasized that their clinic does not specialize in gender dysphoria, and that “the remarkable increase in the number of new patients seen in our clinic over the last 3 years has occurred even though our referral base is unchanged, and our clinic has not specifically advertised its care for transgender patients.”
1. The adolescent growth spurt; i.e., an acceleration followed by a deceleration of growth in most skeletal dimensions and in many internal organs.
2. The development of the gonads.
3. The development of the secondary reproductive organs and the secondary sex characters.
4. Changes in body composition, i.e., in the quantity and distribution of fat in association with growth of the skeleton and musculature.
5. Development of the circulatory and respiratory systems leading, particularly in boys, to an increase in strength and endurance.
1. The adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed);
2. Gender dysphoria emerged or worsened with the onset of puberty;
3. Any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment;4. The adolescent has given informed consent and, particularly when the adolescent has not reached the age of medical consent, the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process.
i) a presence of gender dysphoria from early childhood on; (ii) an increase of the gender dysphoria after the first pubertal changes; (iii) an absence of psychiatric comorbidity that interferes with the diagnostic work-up or treatment; (iv) adequate psychological and social support during treatment; and (v) a demonstration of knowledge and understanding of the effects of GnRH, cross-sex hormone treatment, surgery, and the social consequences of sex reassignment.
● The Dutch scientists who developed the protocol for puberty suppression describe it as “fully reversible.”
● Pediatric endocrinologist Daniel Metzger says that “the effect of the puberty-blocking drugs is reversible.”
● Norman Spack, a physician at Boston’s Children Hospital who treats gender dysphoria, describes puberty-suppressing drugs as “totally reversible.”
● In a review of the research on puberty-blocking drugs for an LGBT advocacy group, Laura E. Kuper, a researcher focused on transgender health, describes puberty blocking as “fully reversible.”
● Transgender journalist Mitch Kellaway, writing for the website Advocate.com about how “blocking puberty is beneficial for transgender youth,” describes puberty blocking as “fully reversible.”
● In another Advocate.com story about puberty blocking, transgender activist Andrea James writes that “the treatment is reversible.”
● Bioethicist Arthur Caplan has described puberty blocking as reversible, saying that “if it’s decided to stop the treatment, puberty will resume.”
● Pediatric endocrinologists Christopher P. Houk and Peter A. Lee write that puberty suppression in children with gender dysphoria is “reversible.”