The World Professional Association for Transgender Health (WPATH) recently published its eighth Standards of Care document (SoC8). It characterises surgery and hormonal interventions for those with a marked sense of gender incongruence as “medically necessary”. It includes a new category of ‘eunuch’ within its remit. Although SOC8 originally specified age limits for surgical and hormonal interventions, these were swiftly removed post-publication. A new chapter on ethics had been also been proposed during the guideline’s development, but does not feature in the final publication. SOC8 includes insufficient discussion of studies that show historically high rates of desistance in clinic-referred boys with gender dysphoria, the possibility of regret, or of endocrine and surgical interventions causing iatrogenic harms. Further, WPATH write in SOC8 that “a systematic review regarding outcomes of treatment in adolescents is not possible” – not mentioning existing evidence reviews, such as by the National Institute for Clinical Excellence (NICE), which found very low certainty results in the case of endocrine interventions for children and adolescents.
GETA’s clinical guide, co-written by one of CAN-SG’s members, is therefore both timely and welcome as a contrasting piece of literature. GETA is a group of clinicians who advocate for exploratory psychotherapy before patients embark on irreversible medical treatment. The guide outlines what its authors believe such therapy is – and what it is not. Readers may not agree with all of its recommendations or conclusions. But in a highly contentious area such as this, where young people’s safety is at risk, an open and honest conversation about different treatment approaches is vital.
We hope that these types of psychotherapeutic interventions will be considered by new NHS services and researched appropriately.
The GETA guide is available below.