If you feel like you were born in the wrong body, you can be given puberty blockers from the age of 11. Hormones from the age of fifteen. A new British report is critical of that approach. Is it safe? A conversation in This is the Day (EO).
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Do you know someone who is transgender?
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This is the situation
‘Dutch approach’: transgender care in the Netherlands
In 1959, an operation to change a person’s gender was performed for the first time in the Netherlands. Since then, the number of people reporting as transgender has increased sharply: the number of reports increased twentyfold in the past ten years. It is therefore important to provide appropriate care to those young transgender people.
A lot of scientific research has been done into the correct methods. Fifteen years ago, Dutch scientists experimented with puberty blockers. By using it from a young age, puberty is slowed down. This buys time for the child to decide whether or not he or she wants to have gender reassignment surgery.
Many other countries adopted this method. Abroad they therefore call this approach ‘the Dutch approach’. Yet in recent years, Finland, Sweden and England have chosen to make their care for young transgender people stricter. A report criticizes the Dutch approach and warns that medical treatment is not a solution for (mental) problems. Welke kritiek is er op transgenderzorg in Nederland?
- The Dutch research is 15 years old. Moreover, it was carried out without a control group. The participants also received psychological help, which may have influenced outcomes.
- The research was conducted on a different target group. At that time, most reports came from psychologically stable young people who had suffered from gender dysphoria from an early age. Now most reports come from girls with depressive complaints, an anxiety disorder and autism, with gender dysphoria occurring at the end of puberty.
- The puberty blockers do not improve the mental problems. However, there may be (negative) effects on bone density, heart, brain development and critical thinking skills.
This is the discussion
Does care for young transgender people need to change?
After strong criticism of ‘the Dutch approach’, several countries decided to adjust their care for young transgender people. Should that also happen in the Netherlands? According to Jilles Smids, visiting researcher in medical ethics at Erasmus University, the criticism in the report is clear. He says this in This is the Day (EO):
“De conclusie van het rapport is helder. Ze is echt teleurgesteld dat er na al die jaren geen beter wetenschappelijk bewijs verzameld is. (…) Alle landen die systematische reviews hebben uitgevoerd, komen tot dezelfde conclusie: er is te weinig bewijs. Die landen hebben dus ook hun richtlijnen aangepast en zijn veel voorzichtiger en terughoudender geworden.”
Lisa van Ginneken is a former MP for D66. She was the first transgender Member of Parliament in the Netherlands. She adds a nuance to the criticism: not treating can sometimes be a worse option.
“Stel je voor dat je met een zorgvraag in het ziekenhuis komt. Dan wil je toch gewoon de allerbeste behandeling naar de kennis van dat moment? (…) Jongeren die met deze vragen worstelen hebben last van depressie. De suïcidecijfers zijn heel hoog. Er is veel trauma, veel schooluitval. Niet behandelen is een nog veel slechtere optie dan wel behandelen.”
Yet Jilles Smids believes that research should be conducted into the consequences for transgender people if they do not receive treatment at a very young age.
“Daar is eigenlijk heel weinig over bekend. Wat zou er gebeuren bij afwachten? Als je de behandeling afwacht en intussen de jongeren ondersteunt in hun psychische problemen. Blijft die identificatie als transgender dan in stand? Blijft de genderproblematiek? Wordt de ervaren noodzaak van die jongeren tot medisch behandelen anders?”
According to Lisa van Ginneken, there is already an emphasis on waiting in transgender care. All conversations with psychologists actually rule out the possibility that it is a phase, or that someone is better off without treatment, says Van Ginneken.
“De kern van de aanpak voor jongeren is juist dat wachten. Dan heb ik het niet over dat je sowieso al drie jaar moet wachten voordat je überhaupt met een psycholoog kunt praten. Bevliegingen kunnen we sowieso uit de discussie halen. Zo’n jongere, en het hele gezin, wordt jarenlang gevolgd en begeleid voordat er een behandeling komt.”
What do you think?
Can we improve care for young transgender people?
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Rel in dartswereld: hoe gaan we om met transgender vrouwen in de topsport?
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