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Michelle Cretalla, an M.D served for seventeen years in clinical practice as a paediatrician in the United States before retiring in 2012, has expressed her concern that medical professionals who are wary of the process of gender transition among children are being unfairly maligned given the risks associated with the invasive treatment.
Currently, the medical industry holds a transition affirming view. This means that children which ‘consistently and persistently’ insist that they are not the gender associated with their biological sex are transgender. Parents of transgender children are encouraged to allow their children to live their lives as the gender that they believe that they are before placing them on puberty blockers at the age of 11 or 12.
At the age of 16, children may be placed on cross-sex hormones and transgender male teenagers may obtain a double vasectomy. Full gender confirmation surgeries which involve genital reassignment are not recommended prior to the age of eighteen.
However, Dr Cretalla along with various other colleagues has questioned the logic of introducing medical treatment into the gender reassignment process so early. She points to the American Psychological Association’s Handbook of Sexuality and Psychology which claims that 75-95% of children who are identified as transgender do not recognise themselves as having body dysmorphia when they enter late adolescence.
In addition to this, the treatment administrated to children who are identified as being transgender may not be entirely appropriate. Puberty blockers have been found to be safe and effective in the treatment of a medical disorder called precocious puberty which is when children begin to secrete pubertal hormones at an early and unhealthy rate. However, this does not mean that these drugs are necessarily safe for the treatment of children with gender dysphoria who are not exhibiting symptoms of precocious puberty.
In fact, there is some evidence that puberty blockers are associated with a decrease in bone mineralisation which can lead to an increased risk of bone fractures in young adults. There are further risks associated with puberty blockers including an increased risk of obesity, testicular cancer and potential impacts on psychological and cognitive development. While the research is still uncertain at this point in time, puberty blockers may come to have a significant impact on the patient’s fertility in later life.
In addition to this, the cross-sex hormones that are administered to children over the age of sixteen are also associated with a range of side effects including cardiac disease, high blood pressure, blood clots, strokes, diabetes and even certain forms of cancer.
Transgender advocates and the vast majority of professionals working in this field believe that the children and the parents of children undergoing this kind of treatment are fully informed about the risks of the medical treatment and that every major medicine has some kind of side-effects. It is the prevailing view that the risks associated with the treatment are outweighed by the potential mental health effects associated with bodily dysmorphia.
Research has consistently shown that transgender individuals are significantly more at risk of dying from suicide than their cisgender peers. However, Dr Cretella denies that there is any significant research which suggests that suicide rates among transgender children are lowered when treatment is administered.
Dr Cretella’s views are bound to be met with criticism from transgender advocates, particularly as she espouses the view that transgenderism is a ‘delusion’ and a ‘confusion’ and still believes that it ought to be classified as a mental illness. Notwithstanding these highly controversial views which are not accepted by the general medical community and many consider to be deeply offensive, it still remains to be seen whether these early gender transitioning treatments for children and young people will have a lasting effect on their physical and mental health as they grow older. At this time, the research simply does not exist for doctors and the parents of these children to make a truly informed choice about children’s health.