Talk:Gender dysphoria in children

Dubious sources on long term effects of puberty blockers

Of the three sources listed for the claim "Research on the long-term effects on brain development, cognitive function, fertility, and sexual function is limited." one is a newspaper article, another disagrees with that claim, and the third one from "Annals of Pediatric Endocrinology & Metabolism" is misquoted. It explains that research is limited specifically for the use of puberty blockers on trans youth and that controlled studies aren't common because they are considered unpractical and unethical.

What the author is explaining here is that it's very difficult to see the effects of puberty blockers on trans youth by using the usual double blind placebo controlled studies, because they're already the standard of care. Giving a group of patients placebo instead of the actual standard of care would be unethical, so these studies aren't contucted in the usual manner, and not frequently. When they are, longitudinal studies are conducted instead. The limited data we have seems to indicate the somewhat obvious conclusion of puberty blockers being helpful at preventing trans children from having their gender dysphoria worsened.

Also it's important to know that puberty blockers have been used for a very long time to treat precocious puberty.

Overall, I don't like the sources cited for that claim, they don't support it. We should either find better sources or remove the claim entirely. Egefeyzi (talk) 23:30, 3 June 2023 (UTC)

I agree better sources should be found, but the claim is not completely unsupported. Specifically, I think reliable sources positively affirming the contrary should be provided if the research of long-term effects is not 'limited'. The Reuters article contains "Puberty blockers and sex hormones do not have U.S. Food and Drug Administration (FDA) approval for children’s gender care. No clinical trials have established their safety for such off-label use," which is clear enough in itself. --TadejM ^{my talk} 19:04, 27 June 2023 (UTC)-

If a source such as a newspaper article does not meet the criteria for WP:MEDRS, it probably is not reliable for establishing anything important for this subject. See in particular: WP:MEDPOP. Hist9600 (talk) 19:22, 27 June 2023 (UTC)

In my opinion, this goes along with "As the quality of press coverage of medicine ranges from excellent to irresponsible, use common sense, and see how well the source fits the verifiability policy and general reliable sources guidelines." Specifically, there are two crucial claims that are easy to verify. --TadejM ^{my talk} 19:34, 27 June 2023 (UTC)

I believe the interpretation of the Reuters article regarding the lack of FDA approval is a classic example of a statement that is (presumably) true but does provide any information about the question at hand, in this case, whether puberty blockers are safe for trans youth. Lack of FDA approval due to lack of clinical trials itself is clearly not the same as "it is unsafe" or "nothing is known about its safety".

I agree with Hist9600 and Egefeyzi that we clearly need sources that meet WP:MEDRS. For example, doi:10.1111/camh.12437 is a recent review already cited in the article and concludes that "[a]lthough large long-term studies with diverse and multicultural populations have not been done, the evidence to date supports the finding of few serious adverse outcomes and several potential positive outcomes."--TempusTacet (talk) 19:55, 27 June 2023 (UTC)

If it was a matter of citing well-known easily-verifiable facts, then it might not be an issue. But since this is a controversial topic, and people should be able to verify any and all details, I don't find one or two sentences in a news article to be sufficient. Better sources should be used that summarize the latest findings. From WP:MEDRS: Ideal sources for biomedical information include: review articles (especially systematic reviews) published in reputable medical journals; academic and professional books written by experts in the relevant fields and from respected publishers; and guidelines or position statements from national or international expert bodies. Hist9600 (talk) 19:57, 27 June 2023 (UTC)

Ok, but the question at hand is not whether they are safe but whether the research is limited as this is what the statement in the article claims. The provided source corroborates the opinion of Reuters in this regard: "long-term studies with diverse and multicultural populations have not been done". --TadejM ^{my talk} 20:01, 27 June 2023 (UTC)

Yes. There is not necessarily a contradiction but WP:MEDRS-compatible sources should take precedence & the phrasing in the article should not imply that a lack of studies means that there is a lack of safety or a significant level of uncertainty regarding safety.--TempusTacet (talk) 20:11, 27 June 2023 (UTC)

Exactly, pharma companies don't reapply for FDA approval for a new area their medications can be used in is discovered. It's an extremely expensive process that they have no reason to repeat when they're already allowed to sell the medication in the US.

We do already know GnRH agonists safely and effectively block puberty, since they've been used for precocious puberty for ages now (see article for details/sources.) Any studies in their use for GD would focus on effectiveness in psychiatric concerns, not safety. Egefeyzi (talk) 23:12, 28 June 2023 (UTC)

As long-term research is lacking, the question of the long-term safety of puberty blockers, particularly regarding bone health and psychosocial health, remains open.[1] There may also be unknown long-term adverse effects. As stated: "Lack of information about long-term effects of GnRHa use was not considered an important problem by interviewed adolescents with gender dysphoria in the study by Vrouenraets, Fredriks, Hannema, Cohen-Kettenis, and de Vries (2016), but is seen as a major problem by many professionals (Vrouenraets et al., 2015)." [2] --TadejM ^{my talk} 17:38, 30 June 2023 (UTC)

I would argue that psychosocial health is not a safety concern but rather a question of treatment effectiveness. I still think that the review by Rew et al. doi:10.1111/camh.12437 (published in 2021) is a good, recent source that comes to more concrete conclusions than doi:10.1111/apa.1679 who are mostly concerned with methodological problems. I didn't have the time yet to compare the two in detail but I'd assume a significant overlap in the studies considered in the two analyses. I also came across doi:10.1111/camh.12533, which is a commentary on the 2021 Rew et al. paper sponsored by the "Society for Evidence-Based Gender Medicine" that one could consider the anti-PB voice in the debate. Puberty_blocker#Medical_uses contains a relatively comprehensive review of the recent literature that one could draw from and/or link to.

In general I believe that the discussion around long-term safety is a bit of a red herring. Considering the poor mental health outcomes in children with GD concerns over effects on bone density are surely valid but small in comparison to eg Combined_oral_contraceptive_pill#Side_effects.--TempusTacet (talk) 21:11, 30 June 2023 (UTC)

I would disagree with you and recent research confirms my earlier stance.[3][4][5] --TadejM ^{my talk} 14:51, 6 March 2024 (UTC)

I agree with your point, but I think more importantly, discussions of the evidence base of puberty blockers belongs on the puberty blocker page. This page is already too long and I would support removing this section. HenrikHolen (talk) 19:46, 29 September 2024 (UTC)

References

Persistence

The introduction to this paragraph alleges a persistence rate of 12-27%. This seems to contradict other parts of the article which recognize that gender identity is generally fixed. Moreover, the reference used cites Bonifacio. Bonifacio in turn cites Holt, Skagerberg and Dunsford (2014), but this study makes no reference to this number, and does not discuss the issue of persistence.

In short, the paragraph seems poorly written and, barring any objections, I will make some revisions. HenrikHolen (talk) 21:24, 29 September 2024 (UTC)

@HenrikHolen I added most of that section (to contradict the 12-27% originally stated in wikivoice), so I'll take a crack at re-organizing and trimming it right now! Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 21:53, 29 September 2024 (UTC)

It seems to me that there are varying definitions of persistence depending on how you define the study cohort. Some will include only those that pursued medical treatments, others include anyone who displays gender variant behavior. I think the most objective approach is this; rather than writing about the persistence of gender dysphoria, which can be a bit vague and hard to define, we might write about the percentage of those receiving treatment in childhood who will continue to identify as transgender in adulthood. HenrikHolen (talk) 22:43, 29 September 2024 (UTC)

It seems that Bonifacio's numbers do not come from Holt, Skagerberg and Dunsford (2014) but from Steensma, Biemond, De Boer, & Cohen-Kettenis (2011), which is cited in Holt.

However, Steensma, Biemond, De Boer, & Cohen-Kettenis (2011) (Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study) simply claims that 2-27% (notice the absence of 1 before the first 2) is the range of persistence rates in the following studies:

Bakwin, 1968; Davenport, 1986; Drummond, Bradley, Peterson-Badali & Zucker, 2008; Green, 1987; Kosky, 1987; Lebovitz, 1972; Money & Ruso, 1979; Wallien & Cohen-Kettenis, 2008; Zucker & Bradley, 1995; Zuger, 1984

This would not be a usable source on it's own and the fact that someone writing a review included these numbers while also citing in a weird way and making a typo probably does not make this data worthy of inclusion. Flounder fillet (talk) 22:27, 29 September 2024 (UTC)

Removing instances of “transgender”

I believe instances of “transgender” should be removed from the article to avoid stigmatizing transgender people, and I will be working on this in the coming days. Banesmouth (talk) 02:47, 2 October 2024 (UTC)

I personally would oppose the removal of the word transgender. Transgender is the word most generally used in day-to-day conversation and not using it could impair the clarity of the article. HenrikHolen (talk) 13:42, 3 October 2024 (UTC)

I think mostly it is true that the in-text uses are fine, however I think this recent change to the lede should be reverted. Not everyone who is diagnosed in this way is a "transgender child", this wording sort of begs the whole question of desistance and resolution. The previous wording was clear and straightforward, and didn't make any presumptions, so I don't see why this was needed. Void if removed (talk) 13:55, 3 October 2024 (UTC)

The diagnosis was created for trans people to get healthcare, mentioning the population it pertains to is useful...

From the APA website: The term “transgender” refers to a person whose sex assigned at birth (i.e. the sex assigned at birth, usually based on external genitalia) does not align their gender identity (i.e., one’s psychological sense of their gender). Some people who are transgender will experience “gender dysphoria,” which refers to psychological distress that results from an incongruence between one’s sex assigned at birth and one’s gender identity.[6]

From the WHOs: ICD-11 has redefined gender identity-related health, replacing outdated diagnostic categories like ICD-10’s “transsexualism” and “gender identity disorder of children” with “gender incongruence of adolescence and adulthood” and “gender incongruence of childhood” respectively. Gender incongruence has been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.
Inclusion of gender incongruence in the ICD-11 should ensure transgender people’s access to gender-affirming health care, as well as adequate health insurance coverage for such services.[7]

So, both the APA (who made the DSM) and the WHO (who made the ICD) are in agreement that the diagnosis pertains to transgender people.

On an additional note, according to RS desistance is a nonsense term that's poorly defined. Some quacks keep screaming from the rooftops "most trans kids grow out of it" but this does not make it true or the data it's based on less laughably shoddy. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:15, 3 October 2024 (UTC)

This is longstanding consensus wording you've changed with no justifiable source, to the detriment if the article. None of this comment supports your change as worded, and the definitions in the sources you provide demonstrate the opposite.

Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children. Void if removed (talk) 20:18, 3 October 2024 (UTC)

Bolding pre-pubertal doesn't mean they're not referring to transgender people... I did add "pre-pubescent" to the lead as that is a key part of the diagnostic criteria though.

The WHO website explicitly states, twice, that the diagnosis exists to refer to transgender people and ensure their healthcare. Gender incongruence has been moved out of the “Mental and behavioural disorders” chapter and into the new “Conditions related to sexual health” chapter. This reflects current knowledge that trans-related and gender diverse identities are not conditions of mental ill-health, and that classifying them as such can cause enormous stigma.
Inclusion of gender incongruence in the ICD-11 should ensure transgender people’s access to gender-affirming health care.

Who do you think the diagnosis refers to? Cis kids who are slightly gender-nonconforming? That's only true in the imaginations of Telegraph writers and SEGM weirdos. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 02:34, 4 October 2024 (UTC)

Can you please stay on topic.

The question is : who does a diagnosis of "childhood gender dysphoria" apply to? According to the WP:RS you supplied, that is children. Not "transgender children", just "children".

That is the neutral wording that's been in the lede for ages, you made this change with no source to substantiate it, and are backing it up with your own opinion and quotes from sources that don't justify this change.

Now you continue to edit the lede to reinforce this unsubstantiated change, as well as the substantial changes to the body to remove reference to or downplay desistance, and remove links between childhood gender dysphoria and adult homosexuality. How are these improvements to the article? Void if removed (talk) 15:53, 4 October 2024 (UTC)

According to the sources GD/GI as diagnoses exist to refer to trans people, they replaced "gender identity disorder" and "transsexualism" because that was offensive. I am backing it up with two sources explicitly saying the diagnoses replaced offensive terminology but still refer to trans people for insurance reasons.

This is like arguing that when "homosexuality" was a medical diagnosis it was referring to "people", not "gay people", just "people".

The changes to the body highlight what RS do, that desistance is a nonsense concept and the whole "kids with GD grow up to be gay adults" is based on awful data (and lobbying from conversion therapists). If you seriously don't understand the history of the diagnosis (or that nonsense claim), ask me on my talk page and I'll explain it, but please WP:DROPTHESTICK here. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:43, 4 October 2024 (UTC)

Can you please stop presenting your own opinion as fact and dismissing all the sources that disagree with you.

that desistance is a nonsense concept

No, it is not. Just the other day you were citing the recent Japanese guidelines which specifically highlight the importance of not intervening too early, because of the possibility of resolution in adolescence. Gender dysphoria resolving in adolescence without medical transition in many cases is a perfectly ordinary concept, and your removal of material relating to it from this article is unsupportable. Void if removed (talk) 09:25, 6 October 2024 (UTC)

Gender dysphoria is the formal medical diagnosis for transgender individuals.

If someone doesn't experience gender dysphoria, then they are cisgender, else, they fall under the transgender umbrella. Raladic (talk) 02:37, 4 October 2024 (UTC)

"Transgender" is not a medical diagnosis, I really think you need to rethink how you've worded this. A person is not transgender because they've been formally diagnosed with gender dysphoria, and cisgender otherwise. Void if removed (talk) 16:03, 4 October 2024 (UTC)

Yes and no. "Transgender" has never been a medical diagnosis, but "transsexualism" was, and GD replaced it. A person is not trans because they got a GD diagnosis, but only trans people are going around getting GD diagnoses. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 18:49, 4 October 2024 (UTC)

only trans people are going around getting GD diagnoses.

Do you have a source that 100% of children who receive a GD diagnosis grow up to be transgender adults, and that desistance, detransition, or any other resolution are 0%? Void if removed (talk) 10:32, 6 October 2024 (UTC)

Who mentioned transgender adults? Being trans is not an 18+ activity. -- Maddy from Celeste (WAVEDASH) 11:07, 6 October 2024 (UTC)

Children whose transgender identity persists into adulthood inevitably become transgender adults.

For the statement only trans people are going around getting GD diagnoses to be true then - in the context of children - every single child diagnosed with gender dysphoria must grow up to be a transgender adult.

Is there a source for this claim? Void if removed (talk) 11:13, 6 October 2024 (UTC)

For what it's worth, I agree with the above two editors, per their arguments. Gender dysphoria / gender incongruence is the medical framework for giving trans people gender-affirming treatment. -- Maddy from Celeste (WAVEDASH) 14:30, 4 October 2024 (UTC)

This reads as POV to the point of being disruptive. Hard disagree. Snokalok (talk) 19:10, 3 October 2024 (UTC)

I refrained from contributing here as I was unsure what the "proposal" even meant. I now see that the OP has been blocked for vandalism and that the vague incoherence of the proposal was part of a pattern of intentional trolling across several articles. Their attempts to mess up the article were promptly reverted so maybe we are done here? DanielRigal (talk) 10:54, 6 October 2024 (UTC)

Sort of - the originating editor and request was unconstructive. However at the same time I have taken issue with the change to the lede a couple of days ago to transform "gender dysphoria/incongruence in children" from a diagnosis that applies to children (which was longstanding consensus wording), to one that applies to transgender children. This unsourced change is not supported by sources referenced in the page or in talk (quote the opposite), and contradicted by ones that are. Eg.

Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/ expressed gender and the assigned sex in pre-pubertal children.

This is a significant change to the lede, and fundamentally to the meaning of the diagnosis. That this change took place while also removing sourced references to rates of persistence is also significant.

I don't care about this editor's original demands for change to the rest of the article, but I've reinstated this particular wording in the lede, and added a specific citation. I think to change the lede in this way requires a direct citation to MEDRS saying this diagnosis only applies to "transgender children", not the sort of over-interpretation on display in justification here. Void if removed (talk) 11:09, 6 October 2024 (UTC)

Transgender in lead

@Void if removed, there is a clear consensus against you here. @HenrikHolen, @Snokalok, @DanielRigal, @Maddy from Celeste, and I supported noting the diagnosis is aimed to transgender children. We provided sources. You have refused to WP:DROPTHESTICK and are doing plain WP:IDHT. Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:13, 6 October 2024 (UTC)

As such I reverted your change to the lead.[8] Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 16:13, 6 October 2024 (UTC)

You have made a change to longstanding, neutral, consensus text with no source.

When challenged you supplied two sources which do not support the change. They say:

The DSM-5-TR defines gender dysphoria in children as a marked incongruence between one’s experienced/expressed gender and assigned gender, lasting at least 6 months, as manifested by at least six of the following

And

Gender incongruence of childhood : Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children.

Neither say "transgender children" as part of the definition. Only one mentions "transgender children" at all, and that is in the context of bullying.

I reverted, and supplied a high quality citation inline.

You are engaging in WP:SYNTH and misrepresenting sources and should self-revert. Void if removed (talk) 16:36, 6 October 2024 (UTC)

Unlike Cass, who has been criticized for leaving the word transgender completely out of a review of trans healthcare, the APA and WHO defined these terms and are a lot more authoritative.

The DSM-II listed "homosexuality" defined as a "sexual deviation" and did not once use the word "gay people" in it's definition. Unless the homosexuality diagnosis wasn't referring to gay people, this is a silly line of argument.

You keep purposefully omitting all the parts around the diagnosis where they specify they are no longer making trans the diagnosis but the distress associated with it. The APA said some trans people experience GD. It didn't say "GD is experienced by cis and trans people". The WHO said they moved the diagnosis to highlight being trans isn't a mental health disorder, stating they were retaining a diagnosis to provide coverage to trans people. The 2 organizations that defined these terms explicitly discuss their relation to the trans community.

Yes or no question: Do the WHO and APA refer to the diagnosis in relation to transgender people? I am not asking "do the diagnoses use the word trans" I am asking "did the orgs who defined these terms say they are related to transgender people" Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:00, 6 October 2024 (UTC)

Yes or no question: does the WHO source you yourself cited say:

Gender incongruence of childhood : Gender incongruence of childhood is characterised by a marked incongruence between an individual’s experienced/expressed gender and the assigned sex in pre-pubertal children.

Void if removed (talk) 17:41, 6 October 2024 (UTC)

I am not asking "do the diagnoses use the word trans" I am asking "did the orgs who defined these terms say they are related to transgender people" - you are evading the question Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:54, 6 October 2024 (UTC)

I'll add that the chapter on children in SOC8 also does not use the wording "transgender children". We are talking about a diagnosis, and to whom it applies, it is quite straightforward - presupposing that it only applies to transgender children (rather than applying to children) is not supported by WP:RS.

Your inline quotes you've added to the citations don't support your change, and you've - for the second time - removed well-sourced information on persistence rates with no justification. All POVs should be present and you cannot simply elide one you dislike. Void if removed (talk) 17:38, 6 October 2024 (UTC)

1) The APA and WHO, not WPATH, define GD/GI (though WPATH was involved)

2) The SOC 8 chapter on children says These Standards of Care pertain to prepubescent gender diverse children ... The term, "gender diverse", includes transgender binary and nonbinary children, as well as gender diverse children who will ultimately not identify as transgender later in life p 67 - this supports the current lead which says pre-pubescent transgender and gender diverse children

3) That wasn't well sourced, at all, and I did provide justification - the paper was outdated and based on the DSM-4, which set much looser criteria for diagnosis, in addition to being full of notes about how the kids who explicitly said they were trans (ie, matching the modern definition) were incredibly likely to "persist". Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:53, 6 October 2024 (UTC)

Also, please discuss persistence in the section above, not this one which is focused on the lead Your Friendly Neighborhood Sociologist ⚧ Ⓐ (talk) 17:54, 6 October 2024 (UTC)