South African Medical Professionals Advocate for Evidence-Based Approaches to Gender Distress in Youth

Amidst a globally recognized rise in diagnoses of gender dysphoria and gender distress among children and adolescents, a group of concerned South African medical professionals has put forth an urgent call for their colleagues to evaluate critically the nature and administration of treatment provided to this vulnerable demographic. Their appeal comes at a time when differing approaches to care have led to intense debates both across South Africa and on the international stage.

Previously, a "gender affirming" approach had garnered international attention following Dutch studies published in 2011 and 2014, subsequently serving as a foundation for management guidelines by the World Professional Association for Transgender Health. This method involves social support for a child or adolescent's choice of gender identity, accompanied, as deemed suitable, by medical interventions, including puberty blockers, cross-sex hormones, and, eventually, surgical procedures.

Nevertheless, emerging scientific consensus indicates that the Dutch studies are hampered by significant methodological limitations such as biased small sample sizes and poor design. Attempts to replicate their findings in UK's Tavistock clinic – the largest of its kind – have not yielded reported psychological improvements. These facts have led to concerns among medical professionals about the robustness of such studies and the unsound, potential harm of the gender-affirming approach.

Systematic reviews in Finland, Sweden, and the UK have discredited the affirmed efficacy of gender-affirming care, holding socio-medical transitions and puberty blockers under scrutiny. Their conclusions unanimously tilt towards inadequate evidence of mental health benefits in minors, contrasting the significant risks of sterility, medication dependency, and the possibility of regret. Further, they dispel the popularized assertion that such interventions reduce suicide risk among non-affirmed youths. Instead, the consensus among a growing number of health authorities in traditionally liberal nations now leans toward psychotherapy as the first-line of treatment.

The local South African narratives, however, continue to be disputed. Some South African guidelines still advocate for a gender-affirming approach. This stands in stark contrast to international trends and the argument supported by First Do No Harm SA (FDNHSA), a voluntary association whose members – a range of South African health professionals – are vouching for an evidence-based care approach.

The FDNHSA members argue that given the present knowledge, a gender-affirming approach does not align with the best medical evidence and falls out of step with the cautious stances adopted by increasing numbers of national authorities. They emphasize the potential irreversible effects of medical interventions, highlighting the risk of medications and the premature closure of surgical options. Their advocacy for psychotherapy and a holistic management approach targets the complexities, ensuring other common coexisting disorders are not overlooked.

By advocating for evidence-based methods, they stress the importance of informed consent, particularly given children's limited ability to grasp the long-term implications of medical treatments. The advocates challenge their peers to critically assess the current practices and ensure that patient care prioritizes the constitutional and United Nations-mandated rights of the child – to "first do no harm."

This call for a change of course, respectfully submitted by the FDNHSA, marks a crucial moment for medical professionals in South Africa. It beseeches them to recognize the global shift toward less invasive, more exploratory, and potentially safer approaches in addressing the gender distress of children and adolescents.