New French Guidelines Support Gender-Affirming Care for Trans Youth

The French Society of Paediatric Endocrinology and Diabetology has issued its first national practice guidelines in support of gender-affirming care for transgender youth, including the use of puberty blockers.

The provision of gender-affirming healthcare for minors has become an emotive and contentious global issue. Critics argue that children lack the capacity to make informed decisions about their gender identity, particularly concerning medical interventions they claim are irreversible and dangerous.

These perspectives were bolstered by the controversial April 2024 Cass Review on gender identity services for children and young people in the UK. The review concluded that trans-affirming treatments, such as puberty blockers, were untested and lacked sufficient evidence to evaluate their physical risks and benefits.

Despite criticism of the Cass Review from organisations such as the World Professional Association for Transgender Health (WPATH), the US Professional Association for Transgender Health (USPATH), and the British Medical Association (BMA), the UK government cited its findings in a December 2024 decision to end gender-affirming healthcare for those under 18.

French Guidelines Challenge the Cass Review

The French Society of Paediatric Endocrinology and Diabetology has now refuted many of the Cass Review’s conclusions through its guidelines for professionals supporting the hormonal transition of trans youth.

The authors conducted an extensive review of available evidence, verified by a group of external experts, to reach a consensus on the importance of a multi-professional approach to care for transgender adolescents.

Addressing the long-term effects of hormonal treatments, the guidelines emphasise that “no severe adverse effects have been reported to date,” while noting that “the long-term medical and psychological effects must continue to be evaluated.”

The experts argue that the benefits of gender-affirming care outweigh the potential risks, stating:

“A wait-and-see attitude in adolescence does not reduce psychological distress, increases the risk of committing suicide, and can affect psycho-affective and cognitive development.”

They advocate for a personalised approach to medical support that considers the unique needs of each young person without rigid protocols.

Puberty Blockers and Trans Youth

The guidelines strongly recommend offering puberty suppression through a multidisciplinary team or network trained in supporting transgender adolescents.

They highlight that suspending the onset of puberty provides young trans people the opportunity to continue exploring gender identity without the distress that the progression of puberty would cause.

The guidelines also point out that delaying puberty may reduce the need for or invasiveness of certain future surgeries, such as mastectomies or facial procedures.

On the often-debated impact of puberty blockers on brain development, the authors conclude that no negative effects have been observed on IQ, academic performance, or executive function.

Addressing Bone Density Concerns

The guidelines acknowledge concerns about the effect of puberty blockers on bone mineral density (BMD) but explain that trans youth tend to have lower BMD irrespective of treatment.

This lower density is attributed to factors associated with gender dysphoria (the distress experienced when a person’s gender identity differs from their sex assigned at birth), such as reduced physical activity, eating disorders, or poor nutrition.

The experts note that trans individuals who benefit from puberty suppression at the onset of puberty appear to ultimately achieve BMD levels comparable to their experienced gender by the end of their transition.

Centring Evidence and Well-Being

The French guidelines offer a vital counterpoint to narratives that restrict gender-affirming healthcare. They provide a robust, evidence-based perspective on tailored gender-affirming care for trans youth, particularly those under 16.

They focus on safeguarding the physical and mental well-being of trans adolescents, advocating for their rights while stressing the importance of ongoing data collection to enhance care.

 

This article was made possible with the support of the Other Foundation. The views expressed herein do not necessarily represent those of the Other Foundation. www.theotherfoundation.org