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Dr Rick Thomas

The Prime Minister’s transgender proposals dangerously oversimplify a complex mental health issue

Dr Rick Thomas is a Public Policy Researcher at CMF.
The views expressed do not necessarily reflect those of CMF.

The Government’s public consultation on possible means to make it simpler and easier for people in England and Wales to change their legal gender concludes on 19 October. Prime Minister Theresa May has said that she wants ‘to see a process that is more streamlined and de-medicalised – because being trans should never be treated as an illness.’ It’s true that the present system is overly bureaucratic and expensive – reform is overdue. But would the current proposals lead to better outcomes?

The main change proposed is to a system of self-declaration that would make gender identity simply a matter of a person’s subjective feelings about themselves, and changing legal gender simply a matter of personal choice. It encourages the view that gender identity defines reality and that biological sex is but a social construct, something ‘assigned’ at birth. This new ideological dogma has no evidence-base in science but self-declaration would appear to reinforce it as if proven fact.

There is evidence (see here and here) that amongst those who present with gender incongruence there is an elevated prevalence of co-morbid psychopathology, especially mood disorders, anxiety disorders and suicidality. A Dutch study also reported the co-occurrence of autistic spectrum disorders (ASD) and gender dysphoria. The incidence of ASD in a sample of 204 children and adolescents with dysphoria (mean age 10.8) was 7.8%.

Self-declaration would deprive these individuals of contact with mental health professionals at the time when their assessment and advice could be crucial. There is a real risk that people who require psychological support and specialised psychiatric treatment would not receive it.

This is of particular concern for teenagers, struggling with the turbulent effects of puberty, social transition and identity issues in general. Pursuing legal gender transition may harmfully distract a young person from addressing psychological issues such as anxiety and depression that may complicate gender dysphoria or even be at the root of it, with the help and support of mental health professionals and others.

According to trans activists, such psychological issues are due simply to ‘minority stress’, resulting from society’s negative attitudes towards trans people, but such claims are without supportive evidence. The results of another recent study suggest otherwise. It offers no proof that radical therapies such as puberty-blocking drugs and cross-sex hormone treatment will prevent adolescents from attempting suicide. If anything, the findings of the survey underline the need for serious scientific research into the potential environmental causes of gender dysphoria and the risks—both physical and psychological—of medical transition.

Paediatrician Michelle Cretella comments:  ‘It shows that the much higher rate of attempted suicide among female-to-male, non-binary, and questioning transgender youth has more to do with factors relating to their biological sex than it does with anything related to gender identity. If confirmed, this may help explain the causes, since it is possible that common underlying psychological and environmental factors may be at play triggering both gender dysphoria and suicidal tendencies in a subset of these adolescents.’

Clearly, much more research is needed. The prevailing rush to treat adolescents with puberty blockers and cross-sex hormones is not based on robust evidence that this approach results in lasting, improved mental health outcomes. The treatment is experimental, in response not to good quality trial outcomes so much as to well-organised lobbying by activists. Changing the law to make gender recognition dependent only upon self-declaration will catapult yet more young adults with complex mental health issues into the hands of a few, overly willing medical personnel without careful assessment of underlying causes and treatment of co-existent mental health disorders.

A new phenomenon, known as rapid-onset gender dysphoria (ROGD), has been observed to begin suddenly in an adolescent or young adult (usually a girl) who would not have met criteria for gender dysphoria in childhood. A peer-reviewed study published in August 2018 noted: ‘the worsening of mental well-being and parent-child relationships and behaviours that isolate adolescents and young adults from their parents, families, non-transgender friends and mainstream sources of information are particularly concerning’.  The role of social media in spreading a form of ‘dysphoria contagion’ among contacts needs further research. Mindful of this, Penny Mordaunt, the equalities minister has requested a study to look into why there has been so sharp a rise in referrals for gender reassignment among adolescents, particularly girls.

The same caution is needed in treating adults with gender dysphoria. The largest study following adults who have undergone medical gender transition was conducted in Sweden. Thirty years after their transition, the suicide rate was 19 times higher among transgender adults than among the non-transgender population. It is clear that these results do not support the alleged curative effects of transition.

We should also take note of the accounts of people seeking to ‘de-transition’ and re-identify with their birth gender. Self-declaration would make it both easier and quicker to change legal gender and thus encourage earlier medical transition. This would both expose the process to frivolous abuse and increase the possibility that people make choices they later come to regret.

Some in the LGBT community have moved away from a simple ‘binary’ view of gender, preferring to see gender identity as fluid – liable to change or fluctuate over time. It is difficult to imagine a legal process for gender change in such an environment that could be both fit for purpose and resistant to frivolous abuse. What is certain is that to remove all medical or social prerequisites for legal transition will trivialise what is a complex human developmental process.

The Government is to be commended for seeking to reduce the burden of the process, and it might indeed be possible to improve aspects of the existing law, but removing sensible ‘barriers’ to overly-easy transition will result in more people embarking on early medical transition with insufficient thought, more people living to regret irreversible changes to their bodies and an overall increase in co-morbid mental health issues including suicidality.

You can read the full text of CMF’s response to the government consultation here

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