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After seven years of discussion: Numerous German-speaking professional societies have agreed on common guidelines for dealing with young trans people. Big point of discussion: puberty blocks.
After seven years, the time has come in just a few weeks: 27 specialist societies from Germany, Austria and Switzerland are publishing a common guideline for dealing with trans children and young people. The size of the document shows that there was a great need for action, that the process was complex and the topic was demanding: the actual guidelines with practical recommendations are laid out on 200 pages; including the appendix, the document comprises 320 pages. The aim of the guideline: to provide support for specialists and to create therapeutic clarity.
Dagmar Pauli played a leading role in this for Switzerland. She is chief physician at the Clinic for Child and Adolescent Psychiatry and Psychotherapy at the Zurich University Psychiatric Hospital. Together with those responsible from Germany and Austria, she presented the guidelines in advance to a selected group on March 20th.
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A 200-page guide is intended to clarify how to deal with trans children and young people.
IMAGO/Michael Gstettenbauer
She says: “Most of the recommendations were made with over 95 percent consensus. This means that, based on very intensive debates about the individual formulations, we have tried to crystallize what the appropriate formulation is – always oriented towards the well-being of these young people.”
Use puberty blockers with caution
How do you make sure a young person really has gender dysphoria? When do you rely on medical measures and which ones? These are answers with far-reaching consequences that experts from different disciplines had to find.
We have consciously stayed away from any rigid age limits.
There was one particularly controversial topic in the discussions: the use of puberty blockers.
In a media interview, Achim Wüsthof, specialist in pediatric and adolescent medicine as well as in pediatric endocrinology and diabetology at the Endokrinologikum Hamburg, said: “We consciously stayed away from any rigid age limits.” The indication must be very individualized.
However, it is clear that puberty must have already begun, so puberty blockers should not be used preventatively. And: “It is very important that this treatment only takes place on young people for whom it makes sense.”
Specialists usually point out that puberty blockers are reversible and have no side effects. This is not without controversy: According to Wüsthof, there is evidence of the risk of osteoporosis. Long-term treatment can cause bone density to suffer.
The panel of experts also comments on the media discussion. Last week we read that Great Britain was banning puberty blockers. Dagmar Pauli corrects: “There is no country in Europe – with the exception of Russia – where puberty blocking is banned.”
The guidelines advocate “careful clarification and the use of puberty blockage with caution.” But there are also differences. “For example, we didn’t say it was only possible in the context of clinical studies.”
The document entitled “AWMF Guidelines on Gender Incongruence and Dysphoria in Children and Adolescents” will only be published in the coming months. It is now in the comment phase.