Dear School Counsellors,
We represent a group of women, including parents, grandparents, educators, social workers, and other professionals, who are very concerned about the effects of social and medical gender transition on young people. A powerful and fashionable narrative is increasingly convincing our youth, particularly young girls, that it is possible to be born in the wrong body and that changing sex is both desirable and easy.
We are writing to ensure New Zealand school counsellors have access to the latest research on this issue as it has largely not been published in the New Zealand media. In particular, we want to provide information and evidence that illustrates problems with puberty blockers, gender transition, and unquestioning affirmation for young people with gender dysphoria. We would also like to share some suggestions for effective counselling approaches which are alternative to ‘affirmation only.’
Puberty blockers are not simply a ‘pause time’
We are told that puberty blockers simply provide a ‘pause’ for young people who are questioning their gender identity. But these medications have serious side effects that are often glossed over and, rather than truly allowing them time to think and question, those children who are prescribed puberty blockers nearly always continue on to take cross sex hormones and consequently a lifetime of medicalisation and surgery.1
The use of puberty blockers and cross sex hormones – now the recommended treatment for gender-distressed youth – is an experimental treatment that has had no long-term studies to ensure either its safety or efficacy. In fact, there is a growing body of evidence that the use of these drugs can lead to loss of bone density, impaired cognitive development and loss of sexual pleasure and fertility.2
The outcome of the current affirmation-only policy to gender dysphoria is that children and teenagers are being given powerful and experimental drugs, when counselling or psychotherapy to address their distress and unhappiness, or simply a ‘watch and wait approach’, may be more appropriate.
A landmark case in point is that of Keira Bell, a 23-year-old female from the United Kingdom, who has now de-transitioned and resumed life as a woman. In 2020, she took the Tavistock Clinic (a world-renowned London clinic specialising in gender identity treatment) to court for medical malpractice. Bell is quoted as wishing “she had been challenged more” before being prescribed puberty blockers, cross sex hormones and later undergoing a double mastectomy. The United Kingdom High Court ruling received very little publicity in New Zealand, although it stated unanimously that the prescribing of puberty blockers to those under 16 should be subject to court approval. The court referred to “the long-term consequences of the clinical interventions” and the “as yet innovative and experimental treatment.” 3
Gender transition does not provide long term relief
A recent study of a large cohort of people in Sweden diagnosed with gender incongruence shows that gender transition, both hormonal and surgical, does not give long term relief from gender dysphoria. In fact, in one measure, those patients who had received gender-affirming surgery were more likely to be treated for anxiety disorders than those who had not received surgery.4 Long term studies from the UK Tavistock Clinic also do not provide evidence of benefits for most patients.5
Affirmation is not the best treatment
In the past, young people with gender dysphoria were treated with a policy of ‘watchful waiting’. This was because the majority of people (73-96%) are known to overcome their dysphoria and accept their sex as adults.6 Recent practice, however, is to unquestioningly affirm the child’s assertion of being transgender. This means that other possible causes of the dysphoria may be overlooked and that underlying problems such as past trauma, internalised homophobia, autism, eating disorders, and other psychological conditions may not be investigated.
An Australian study, published in April 2021, shows that these other problems are over-represented in young people identified as having gender dysphoria. Children attending a gender service in New South Wales had high rates of comorbid mental health disorders (for example, 62% depression, 35% behavioural disorders, 14% autism) and also high rates of adverse childhood experiences (66% family conflict, 63% parental illness, 59% separation).7
There is a crucial role for counsellors in challenging the currently accepted pathway of lifelong medical treatment and permanent bodily harm for young people who believe changing their gender will ‘fix’ their problems. There is no question that medical transition causes harm and, while an adult may choose a medical transition, we agree with the High Court in the UK that young people are not capable of making this choice and should not be started down this path before reaching maturity. A very small number of people do experience gender dysphoria to the extent that medical intervention is warranted but the evidence shows clearly that wise counselling and guidance will allow the vast majority of young people to explore what is happening in their lives and adjust to it without the need for life-long and health impairing medication or surgery.8
Effective alternative counselling approaches
Many counsellors, therapists, and medical practitioners recognise that deeper exploration of the causes of a young person’s dysphoria is an essential part of high-quality treatment. The following link offers some guiding questions and themes from Sasha Ayad, a practising counsellor in the US, for use with adolescents who present with gender dysphoria.9
Counsellors are key support people for students and have their best interests at heart. We ask that in your practice you give consideration to the results of ongoing research, some of which we have listed in this letter, and to the resulting recent changes in best practice in other countries such as Finland10 and Sweden.11
If you would like to respond to our letter or would like further information, we will be very pleased to hear from you. The media have not allowed a public debate on the issues we have raised and we are very happy to address any of your queries, challenges or concerns.
Yours sincerely Margaret Curnow, Jan Thorburn and Fern Hickson