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The National Association of Practising Psychiatrists (NAPP) in Australia have issued new guidelines for managing gender dysphoria in young people.

The new guidelines come in the same month in which more than 100 Australian clinicians signed an open letter calling on national health bodies to cease the use of puberty blockers, cross-sex hormones, and surgical interventions on children and adolescents with gender-related distress.

Instead of automatically pursuing so-called affirmation practices that include medical interventions with harmful, irreversible drugs, the NAPP guidelines urge caution and psychiatric care first and foremost.

Individualised psycho-social interventions should be implemented to discover the root of a child’s gender anxiety and treated accordingly.

There is little evidence that the use of off-label, harmful drugs alleviates the underlying issues that could be addressed using less invasive techniques.

Updated this month, the NAPP released a media statement on 8 June describing the changes. Segments from the media release are quoted below.

Managing Gender Dysphoria in Young People – The National Association of Practising Psychiatrists Guide

Medical interventions to block puberty and cross-hormone treatment to achieve feminisation and masculinisation according to the young person’s perceived gender are not fully reversible and can cause significant adverse effects on physical, cognitive, reproductive and psychosexual development.

Currently, while some individuals report a successful transition, we are not aware of published long-term outcome studies that have followed up adults who have undergone childhood or adolescent transition that show substantial benefit. As a consequence, there is no consensus that medical treatments such as the use of puberty-blocking drugs, cross-sex hormones or sexual reassignment surgery led to better future psycho-social adjustment.

Increasing numbers of individuals who have undergone hormonal treatment and surgical interventions subsequently report experiencing regret and a wish to de-transition. They describe significant psychological and physical suffering, including loss of fertility and sexual function as a consequence of decisions made when younger.

Medico legal considerations must be fully appreciated in this area of clinical practice. Health professionals are exposed to significant legal risk:

• if a child or adolescent is found not to have been competent to give an informed consent;
• if in children under age 18 years both parents have not agreed to puberty suppression and cross-hormone treatment;
• if gender affirming treatment is not preceded by a comprehensive psycho-social assessment, that considers and excludes alternate diagnoses; or
• if the patient was not informed of all the risks of puberty-blockers and cross-hormone treatment including their experimental nature.
• Clinicians should therefore reflect carefully before recommending treatments for gender dysphoria/incongruence.

Need for Gender Identity Practice Comprehensive Review

The guidelines are responsible and protective of the child and the clinician.

They put the child’s health and welfare first and allow for holistic care that has great potential to enable gender incongruent children to grow and develop into healthy and whole adults.

It is time all medical associations undertook stringent and comprehensive reviews to ensure best practices when it comes to caring for vulnerable children so as to not put them in harm’s way.

Read the full NAPP media release here.