Last summer, France urged “great medical caution” in pursuing gender treatments for minors because of the psychological vulnerability of these children and the potentially irreversible side effects of medicines and surgery.
“If France allows the use of puberty blockers or cross-sex hormones with parental authorization and no age limitations, the greatest caution is needed in their use, taking into account the side effects such as the impact on growth, bone weakening, risk of sterility, emotional and intellectual consequences and, for girls, menopause-like symptoms,” the French National Academy said, according to a translation published by National Review.
Further, France noted that there is currently no way to determine which patients have persistent gender dysphoria and which have transient adolescent dysphoria, which typically dissipates post-puberty. This means there is a real “risk of over-diagnosis,” the French National Academy asserts.
And while Norway’s government agency has not made any changes to its policy on gender transitions for minors, the Norwegian Healthcare Investigation Board, an independent body, recommended earlier this year to label puberty blockers, hormone therapy, and surgical sex changes “experimental” or “exploratory” treatments.
The shifting standard of care across Europe is significant because this was the first wave of countries to subscribe to what’s known as the “Dutch Model” or “Dutch Protocol”. The Dutch Model was spurred by a small study of seventy patients in the Netherlands released in 2011 that found “behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly” when adolescents who had persistent gender dysphoria underwent puberty suppression.
Despite being lauded as the gold standard of transgender research, the study has several notable drawbacks. First, youth patients who used puberty blockers in the Netherlands also received intense psychotherapy, meaning it’s impossible to distinguish which treatment actually caused the improved mental health outcomes. Second, the participants in the study were chosen retrospectively and non-randomly; the study only evaluated youth who were approved to continue on to cross-sex hormones. Individuals who discontinued treatment for a variety of reasons — including harm from the puberty blockers or a resolution of their gender dysphoria — were excluded from the analysis, which skewed the results. The study also relied on a flawed questionnaire to make the claim that gender dysphoria improved among participants.
Also important is that the Dutch study did not weigh whether the perceived benefits to a dysphoric youth’s mental health outweighed the negative physical side effects. One subject was excluded from the study because they died from a failed vaginoplasty.
Aside from all of these issues with the research, Dutch gender experts have warned that their model cannot be applied properly without a strict assessment of patients. In the Netherlands, minors who receive medical intervention for gender distress must have had persistent dysphoria since before puberty, must be free of other psychiatric issues, and must have the support of their families. The author of the infamous Dutch study has even said her research likely does not apply to the large number of teens seeking sex changes today.