Révolution Permanente – France – 2024
In a groundbreaking development for the care of transgender youth in France, the French Society of Pediatric Endocrinology and Diabetology has released what is being called the first French national medical consensus on trans youth care. The document’s release comes as a variety of other countries consider the politically-influenced guidelines from the Cass Review in the United Kingdom, which has since been heavily criticized and its recommendations rejected by multiple medical societies in other countries. Importantly, the new guidelines recommend transgender youth care, denounce a “wait-and-see” approach for transgender adolescents, and promote individualized care for every transgender patient.
The guidelines, described as both robust and extensive, were meticulously prepared. According to the document, one to three authors were assigned to each section, conducting comprehensive literature reviews. Their findings were then refined through multiple iterations, with input from the broader group until a consensus was achieved. Finally, the recommendations underwent review by external experts. The result is a thorough and authoritative set of guidelines aimed at providing clear direction for doctors caring for transgender youth in France.
The guidelines encompass a wide range of care recommendations for transgender youth, offering official support for puberty blockers and gender-affirming hormone therapy. Regarding puberty blockers, the guidelines emphasize their role in allowing transgender youth to explore their gender identity without the added distress of undergoing puberty, while also reducing the need for future surgeries. For hormone therapy, the recommendations advocate its use for transgender youth who meet the criteria outlined in the ICD-11, ensuring an individualized and evidence-based approach to care.
The recommendations strongly oppose the “wait-and-see” approach for transgender adolescents, often referred to as “gender exploratory therapy.” This practice, considered a form of conversion therapy, seeks to attribute a transgender person’s identity to external factors rather than recognizing it as authentic, delaying access to care—often until adulthood. The guidelines reject this method, stating it “does not reduce psychological distress” and instead “increases the risk of committing suicide and can affect psycho-affective and cognitive development.” These findings align with a report from the U.S. Centers for Disease Control showing that 25% of transgender youth in the United States have attempted suicide, alongside another study in Nature Human Behavior indicating that anti-trans laws, including healthcare bans, have caused up to a 72% increase in suicide attempts.
The authors also refute suggestions in the Cass Review around negative impacts of transgender healthcare. For instance, the Cass Review in several occasions speaks of potential “loss of bone density” among trans youth taking puberty blockers. Instead, the French review notes that trans people have low bone densities regardless of treatment due to other factors: “Trans youth have an average BMD before the onset of puberty that is lower than that of the general population, regardless of treatment. This is probably related to the consequences of dysphoria: less physical activity, eating disorders, and/or poor dietary balance,” and they also note that after moving to gender affirming hormones, “BMD comparable to that of the experienced gender.” They also recommend vitamin D and exercise to mitigate potential concerns.
The group also explored suggestions found in the Cass Review that puberty blockers could harm brain development. On this subject, they found that “GnRHa treatments in transgender adolescents have no negative effect on the association between intellectual quotient and academic success nor on executive function performances.”
These guidelines are poised to resonate both in France and globally. As countries and major medical associations increasingly distance themselves from the U.K.’s Cass Review—criticized for its connections to SPLC-designated hate groups—the scientific consensus continues to affirm the importance of gender-affirming care for transgender youth. Their release comes just one day before the U.S. Supreme Court hears oral arguments on healthcare bans targeting transgender youth across the United States. In a climate where medical care for trans youth is under relentless political attack, guidelines like these offer a beacon of evidence-based practice and will be instrumental in shaping a future where access to essential care is protected and secured for all.
