The German Medical Association passed two resolutions this month, the first to protect children and adolescents with gender dysphoria from puberty blockers, cross-sex hormones, and surgeries, and the second to allow only young people over the age of 18 to “self-identify” as a gender that is inconsistent with their biological sex without a prior psychiatric diagnosis and consultation.
The resolutions are consistent with the final report of a systematic review of studies and guidelines advancing “gender-affirmation” released in April by British pediatrician Dr. Hilary Cass. The review found that such medical interventions for children are based on “remarkably weak” evidence.
At least eight foreign governments have recognized the harm that comes to young people who are prescribed puberty blockers, cross-sex hormones, and life-altering surgeries, including the governments of the UK, Finland, France, Netherlands, Norway, Sweden, and Russia.
Self-described as “the joint association of the 17 State Chambers of Physicians” that “represents the interests of the medical profession in Germany in matters relating to professional policy,” the association says it “plays an active role in opinion-forming processes with regard to health and social policy and in legislative procedures.”
The German Medical Association’s resolutions, however, conflict with recommendations in the 2024 draft guidelines developed under Germany’s Association of Scientific Medical Societies (AWMF). The proposed guidelines, titled “Gender Incongruence and Gender Dysphoria in Childhood and Adolescence: Diagnosis and Treatment,” follow the so-called “gender-affirming” model.
The Society for Evidence-Based Gender Medicine (SEGM) detailed the stark difference between the positions of the German Medical Association and the guidelines developed under AWMF, an organization led by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, along with 26 other medical groups from Germany, Switzerland, and Austria:
According to the draft guidelines, the only requirement for medical gender transition of youth is the provision of the adolescent diagnosis of “Gender Incongruence.” The previously required “distress” criterion has been re-interpreted merely as “anticipatory anxiety” over developing secondary sexual characteristics and a desire to avoid future pubertal changes. Further, the current draft states that requiring psychotherapy as a prerequisite for gender-transitioning of minors is not ethical, and allows for the prescription of puberty blockers “provisionally” before a comprehensive evaluation takes place.
In its first resolution, the German Medical Association urges the German government to allow puberty blockers, cross-sex hormones, and gender surgeries in minors only “in the context of controlled scientific studies and with the involvement of a multidisciplinary team and a clinical ethics committee and after medical and, in particular, psychiatric diagnosis and treatment of any mental disorders.”
The association advises:
The therapy results of any interventions of this kind must be followed up sociologically, medically, child and adolescent psychiatrically, socially and psychologically over a period of at least ten years and the evaluation results incorporated into the revision of the “Guideline on gender incongruence and gender dysphoria in childhood and adolescence: diagnosis and treatment.”
The organization justifies its resolution with the assertion that the “current medical evidence clearly and unambiguously states” that drugs and surgeries associated with the “gender-affirming” model “do not improve” gender dysphoria “symptoms or mental health in minors.”
The association observes the dire long-term consequences of such medical interventions:
These are irreversible interventions in the human body in physiologically primarily healthy minors, who cannot give informed consent in the absence of evidence for such measures. Such interventions also influence the human psyche, especially in minors during their development. Most minors who receive PB [puberty blockers] and CSH [cross-sex hormones] later wish to have sex surgery. The use of interventions such as PB or CSH administration is a form of experimental medicine on children, which is very likely to be followed by interventions in the child’s body, such as the amputation of the breast or penis, and which result in the loss of reproductive capacity and a reduction in the ability to experience sex, including anorgasmia.
The German Medical Association also noted that young children and adolescents are incapable at their stage of cognitive development of comprehending the long-term ramifications of “gender-affirming” treatments. Gender medicine doctors associated with the World Professional Association of Transgender Health (WPATH) admitted to that fact in a recent exposé of WPATH by journalists Michael Shellenberger and Mia Hughes.
“Gender or sex dissatisfaction is most common at around the age of eleven, and the frequency of this symptomatology then decreases with age,” the German group stated. “The clear majority of minors show no persistent gender or sex dissatisfaction over the course of their lives.”
Analysis by SEGM indicates the AWMF draft is scheduled to be voted on by the boards of the 27 societies and, “if accepted, will be published in June 2024 as the final guideline.”
SEGM, however, describes the divergence between AWMF’s draft and the Cass report as “remarkable,” and adds that the conflict “can be largely explained by the difference in the assumptions about the role of evidence in the process of making the recommendations.”
While the Cass Report began its systematic reviews of evidence with the assumption that “the best treatment approach for gender dysphoric youth is unknown,” SEGM notes the German AWMF update underscored that the ICD diagnosis of “gender incongruence” was reclassified from a mental to a physical health condition – reflecting a “societal paradigm shift.” Consequently, AWMF decided such a “shift” required that procedures to alter one’s body are accessible to everyone—including children and adolescents.
“The intention to align treatment recommendations with the “societal paradigm shift” is stated in the guideline registration with AWMF in 2020, and is apparent in the approach that the guideline development team took toward the evidence,” SEGM adds.
Following its analysis of AWMF’s draft guidelines, SEGM concluded the guidelines “do not meet the basic requirement of credible, trustworthy, evidence-based guidelines.”
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