As pre-conversion therapy is increasingly administered to children worldwide, concerns are mounting over the manner in which these interventions are conducted in various countries. Previous studies regarding the effectiveness of the so-called Dutch protocol have also indicated that administrators tend to downplay the effects and consequences of significant interventions, sidestepping fundamental criteria for scientific rigour.

Juvenile gender reassignment is currently performed in numerous countries worldwide, following outdated protocols. Recent studies have revealed that even seemingly harmless medications, such as puberty blockers, pose significant health risks. The Economist has also noted in its article devoted to the topic that in recent years, numerous international health researchers have published studies emphasizing the effectiveness of radical interventions while remaining silent about the associated problems and dangers, the Hungarian daily Magyar Nemzet points out.

• In England and Wales, the number of teenagers seeking gender reassignment has increased 17-fold.
• In the US, more than 42,000 children and teenagers were diagnosed with gender dysphoria in 2021, a three-fold increase since 2017.
• A Finnish study in 2020 found that gender reassignment surgery on children constitutes experimentation.
• On the American continent, gender reassignment surgery, such as mastectomies, is not uncommon for people under 18. Many people later feel that they have been mutilated.
• Although adolescents who demand gender reassignment are treated according to the so-called Dutch protocol across almost the entire Western world, a number of recent studies have found that even seemingly harmless first steps carry extreme risks to young people’s well-being.
• The use of puberty blockers in children has typically not been approved by the various national regulatory authorities.
• In some countries, the same drugs that are used as puberty blockers are employed to chemically castrate sexual offenders.
• 98 per cent of US adolescents treated with puberty blockers choose to move on to the next phase, in which they are given opposite sex hormones.
• The administration of opposite sex hormones also causes permanent changes. For example, testosterone permanently changes the facial structure of women.
• The Economist cites as a typical example the case of a female patient, who was given testosterone treatment after just 15 minutes of discussion.
• There is a real risk that homophobic parents will encourage their children who are attracted to their own sex to change their gender rather than embrace their homosexuality.

As an increasing number of children worldwide undergo pre-conversion therapy, concerns are growing about the methods employed in many countries, The Economist points out, adding that earlier studies on the effectiveness of the so-called Dutch protocol have demonstrated a tendency to downplay the effects and consequences of significant interventions, sidestepping essential criteria for scientific rigour.

Gender reassignment fever

This trend is particularly concerning given the exponential increase in the number of young people identifying as transgender. In England and Wales, for example, the number of teenagers seeking to change their biological sex and seeking assistance from institutions addressing gender dysphoria (dissatisfaction with their biological sex) has risen 17-fold in recent years.

By 2021, over 42,000 children and teenagers in the US were diagnosed with gender dysphoria, representing a three-fold increase since 2017, a Reuters analysis cited by The Economist reveals.

Other rich countries, from Australia to Sweden, have also seen significant growth in this area.

As the number of cases has risen, an internationally recognised treatment approach has emerged in the Netherlands. This approach involves gender-affirming care, which supports the patient’s perceived identity rather than their biological sex. After undergoing a psychological evaluation, candidates receive a series of treatments, beginning with puberty-blocking drugs, followed by the administration of opposite-sex hormones, and ultimately, surgery.

Puberty blockers or chemical castration

Although this three-tier system, the so-called Dutch protocol, is used almost all over the Western world, a number of recent studies have found that even the seemingly harmless first steps carry extreme risks to young people’s well-being. While the use of puberty blockers is seen by many as desirable because it can buy adolescents time before irreversible transformations begin, a recent book looking at the concerns of British health professionals, for example, shows that these blockers are also extremely dangerous chemicals. It is noteworthy that in some countries, the same drugs that are used as puberty blockers are employed to chemically castrate sexual offenders.

It is also telling that the use of puberty blockers in children has typically not been approved by the various national regulatory authorities. Several Dutch researchers quoted by the Economist have recently concluded that the very act of administering these drugs increases the chances of subsequent irreversible interventions. Last October, their research found that 98 per cent of US adolescents treated with puberty blockers choose to move on to the next phase, in which they are given opposite sex hormones. As for the latter, it should be noted that the administration of these agents also causes permanent changes. For example, testosterone permanently changes the facial structure of women.

Unknown side effects

While one of the pioneers of the Dutch protocol, Annelou de Vries, wrote in her studies of the first patients treated at the beginning of the last decade that puberty blockerrs reduced depression and that the use of opposite-sex sex hormones and surgery eliminated gender dysphoria and had positive psychological effects, this is now widely disputed. For example, in 2020, the UK’s National Institute for Health and Care Excellence (NICE) has issued strong recommendations against the use of puberty blockers and opposite-sex hormones. Their latest study found that the blocker had little effect on patients’ wellbeing, and they also found little evidence that administering sex hormones of the opposite-sex improved mental health. They also warned about the risks of long-term side effects that are not yet fully known.

In comparison, according to data from health tech company Komodo, 5,000 teenagers in the US were prescribed puberty blockers or opposite-sex hormones in 2021, double the number in 2017. Surgical procedures on under-18s, such as mastectomies, are not uncommon in the US either.

Psychological assessment in fifteen minutes

Although the Dutch protocol requires a thorough assessment and psychological examination of teenage patients, in practice, this is rarely done. The Economist cites as a typical example the case of a female patient, who was given testosterone treatment after a 15-minute conversation.

In relation to the earlier studies, the British weekly also pointed out that although people who have undergone gender reassignment surgery must take opposite-sex hormones for the rest of their lives, these patients were not studied long-term, but only for 1-6 years. Most of the studies did not even use a control group, only looked at patients who were taking opposite-sex hormones.

So it is not known which elements of the therapy or other external circumstances caused the changes in their mood and self-image.

Two US professional bodies, the Endocrine Society (ES) and the World Professional Association for Transgender Health (WPATH), have not even examined whether the three-step protocol has helped to eliminate gender dysphoria or alleviate some of the mental health problems of teenagers, but have focused on the side effects. This oversight has also been noted in academic circles, with Gordon Guyatt of the University of Manchester calling the study fundamentally flawed.

Gender reassignment as a human experiment

Due to sloppy or biased research such as that mentioned above, the protocol, which is considered the canon of teenage gender reassignment, has recently come under scrutiny in several countries and has been condemned by many professional bodies. A Finnish study in 2020 found that gender reassignment surgery on children constitutes experimentation and therefore only warranted in exceptional cases. The Swedish authorities have found that the risks of physical interventions outweigh the potential benefits, and should only be allowed in very exceptional cases. A report by a British paediatrician assessed that gender-affirming care has spread without the appropriate quality assurance guarantees, which would be essential for the introduction of new treatments such as this.

Moreover, it is not clear from previous research how many people regret having attempted to alter their biological sex, or at least embarked on this path. Knowing their approximate number would be important, as this group experiences extremely high stress after having had permanent and visible changes to their bodies, and in the absence of proper treatment, may even commit suicide. One of the reasons for the lack of data is methodological, since those who stop the transition process will no longer consult their doctor and practically disappear from the statistics.

Up to a third of teens opt out mid-transition

The studies failed to devote any serious attention to assessing how many people might have changed their minds before undergoing more radical interventions, so estimates show wide deviations. According to some studies, this rate is only one per cent, while a recent survey of UK and US patients by the Journal of Sex and Marital Therapy found that the proportion of those who have opted out of treatment within a few years of starting ranged between 7 and 30 per cent. The Dutch studies conducted between 2011 and 2014 initially involved 70 patients, but the treatment of only 32 and 55 teenagers was followed through to completion. In addition, the final evaluation was performed only 18 months after the surgery, which is a rather short period of time to assess the effects of a treatment that lasts for a lifetime.

Critics of previous research also highlighted that patients could have been asked distorting questions to arrive at results that support the alleviation of gender dysphoria. For instance, before the treatment, female patients wanting to transition were asked how they felt being treated as women whereas post-interventions, they were asked what sensations were induced in them if they were viewed as men. This formulation may have generated positive results confirming the protocol.

Unsatisfied patients omitted from statistics

It is also problematic that the studies between 2011 and 2014 arbitrarily focused on patients for whom the therapy worked with the highest efficacy. From the outset, patients for whom puberty-blocking therapy did not progress well were left out from among the initial 111 adolescents, and those who did not return the questionnaire or simply quit the treatment were omitted from among the remaining 70. In light of all this, it should come as no surprise that the patient who died due to complications from the gender-reassignment surgery was not included in the research either. All in all, patients who were unsatisfied with the therapy or suffered some harm as the outcome of the treatment were excluded from the study.

In January this year, Northwestern University in the US published the results of their study that enrolled 315 adolescents – two of whom committed suicide – treated with cross-sex hormones. Findings show extremely low improvements: a few points on a scale of one hundred. This research included no control group either.

Outdated theories

As The Economist pointed out, the range of patients has changed significantly in recent years, and because of this, results from past research should be treated with even more caution in today’s context. While twenty years ago, pre-pubescent boys made up the majority, nowadays teenage girls are predominant among those enrolling for gender reassignment. These cohorts have significantly different characteristics and their condition must be assessed with other research methods. The gap between theory and practice is also shown by the fact that, while the original Dutch protocol advises against applying the treatment in mentally ill patients, three recent studies considered mental health issues as a priority reason for initiating gender-reassignment treatment, disregarding the contraindication – particularly in the US. Incidentally, more than 70 per cent of those seeking such therapy fall into this category.

Homosexuality wrapped in transgenderism

Homophobia in some parents is something that carries a potential risk that should not be neglected before gender-reassignment treatment. In an effort to avoid acknowledging their children’s homosexuality, these parents may be seeking an alternative identity for their children who are attracted to their own sex . In some cases, gender-reassignment treatment is used as a new type of „conversion therapy” for gay children, according to The Economist. This is bolstered by the fact that many teenagers in the US – where the lion’s share of gender reassignments in minors are performed – have regretted the irreversible harm to their bodies. The paper quotes, for example, a young woman who had a double mastectomy, saying that she has been „butchered by institutions we all thought we could trust”.