by Manlio Converti
29 MAR – Dear director,
we find ourselves in the curious situation, in Italy, in which a government that establishes giving birth to children as a universal crime also creates an inter-ministerial commission with the Ministry of the Family to establish the use of a drug, a unique case in the world.
I’m talking about the case of Triptorelin in Gender Variant minors.
There is no similar practice in any other circumstances.
On the other hand, there have been requests from LGBTI associations that are equally ideological and not supported by scientific literature, as the Ministry of Health claims to be.
We will then respond to the Ministry’s reasons, because they are scientifically wrong and are notoriously based on events that occurred in the UK, where the NHS, on the basis of a NICE evaluation (they are the equivalent of our NHS and ISS), has deconstructed decades of scientific evaluations in favor of the use of Triptorelin in Gender Variant minors.
Particularly incomprehensible is the exclusion of the study on the use of Triptorelin on over 20 thousand minors carried out by Turban (2021) and which demonstrates how effective they are from a psychiatric point of view in reducing risk factors such as suicide, in Gender Variant minors. Also by Turban (2021), a second work on the risk of detransitioning of Gender Variant minors, on a sample of over 17 thousand minors, estimated detransitioning minors at around 13% (but it would be more correct to say detransitioning, given that GnRH analogues do not produce no sexual modification). The prevailing causes of detransition were social and family pressures against it. In short, systemic transphobic violence. While in some cases it was the possibility of evaluating a fluid or non-binary subjectivity, but in any case transgender.
We will consider whether to publish a scientific article on the merits against NHS/NICE advice. In the meantime, we attach a complete literature on the subject and trace the objective lines of defense of the rights of Gender Variant minors from this aggression in the form of a commission comparable only to the Inquisition or worse to the Iranian Ministry of Morality.
Meanwhile, drugs such as Triptorelin are regularly used in minors, even pre-pubertal ones, affected by precocious puberty and dwarfism (Popovic, 2022). It is not clear why any limit should be placed only on Gender Variant minors. Above all, it is well known from scientific research on minors, even pre-pubescent ones, that Triptorelin and other analogues have no particular side effects and are to be considered safe (Olson, 2014).
On the other hand, failure to use these drugs can lead Gender Variant minors towards the abuse of Cross-sex hormones, easily available in the form of contraceptive pills (Estrogen) and doping in gyms (illegally, Testosterone). The use of these drugs, which instead have serious side effects, in minor patients, without medical supervision, represents one of the serious health risks that the Triptorelin protocol avoided.
Another risk is that of applying to the letter the request in the AIFA 2019 note to adopt every effort of psychologists, psychiatrists and psychotherapists before accepting the request for the use of Triptorelin. This text, from 2019, precedes the approval of the ICD-11, which de-psychiatrised Transgenderism, recognizing that Transgender people have the right to be recognized as such. This Copernican revolution, instead of pathologizing the fact of being Transgender (or Gender Variant, for minors), allows us to evaluate the real mental health condition and the real causes of suffering.
According to studies, only 50% of Transgender people have mental health problems and these are almost always caused by childhood abuse or current discrimination, including early family expulsion or other abuse, including sexual abuse.
The AIFA text therefore uses Mental Health by calling for Reparative Therapy, something that should today receive strong denial from the companies that deal with it.
SOC-8, the international guidelines for health professionals who deal with Transgender people, also follows the AIFA note, because it was only published in 2022. SOC-8 requires the mental health condition of Transgender people to be assessed and their ability to give Informed Consent, not to make a diagnosis of mental illness, as Gender Variant people. Being Gender Variant is a disease only under Italian law which dates back to a 1982 law.
Finally we must explain that reparative therapies cause serious harm to LGBTI people, especially minors. One for all is the study by Forsythe (2022) which demonstrates how, by comparing 3 relational styles of the Mental Health therapist, LGBTI people suffer very serious damage in the case of Reparative Therapies and Serious damage in the case of Indifference towards their specific needs. We are talking about an increase in self-harm, the risk of suicide, the abuse of Nicotine, Alcohol or Drugs as well as Anxiety and Depression. The risks related to Eating Disorders, which were also interrupted by the use of Triptorelin (Chaphekar, 2022), were also not mentioned in that study.
The AIFA text, providing for Reparative Therapies, as also requested by the President of the Italian Psychoanalysis Society, prescribes serious harm to Gender Variant minors and the request of this inter-ministerial commission to apply rules that date back to the 1982 law is completely devoid of scientific support .
We should revolutionize the AIFA note and apply the SOC-8 criteria instead of building ideological courts.
I also include in the bibliography small studies following the analysis of the Turban study, which always obtain the same positive results thanks to the use of hormones in Gender Variant minors (Achille, 2020; Carmichael, 2021; Tordoff, 2022).
Unfortunately we do not have the possibility of being called to this commission, where “we would like to be invited just to make it end” (as one of Sorrentino’s characters would say), and then establish a scientific commission that instead applies ICD-11 and SOC-8 in Italy.
Manlio Converti
Psychiatrist
President AMIGAY aps
Bibliography
Achille C, Taggart T, Eaton NR, Osipoff J, Tafuri K, Lane A, Wilson TA. Longitudinal impact of gender-affirming endocrine intervention on the mental health and well-being of transgender youth: preliminary results. Int J Pediatr Endocrinol. 2020;2020:8. doi: 10.1186/s13633-020-00078-2. Epub 2020 Apr 30. PMID: 32368216; PMCID: PMC7191719.
Carmichael P, Butler G, Masic U, Cole TJ, De Stavola BL, Davidson S, Skageberg EM, Khadr S, Viner RM. Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK. PLoS One. 2021 Feb 2;16(2):e0243894. doi: 10.1371/journal.pone.0243894. PMID: 33529227; PMCID: PMC7853497.
Chaphekar, Anita V et al. “Transgender and other gender diverse adolescents with eating disorders requiring medical stabilization.” Journal of eating disorders vol. 10.1 199. 23 Dec. 2022, doi:10.1186/s40337-022-00722-7
Forsythe A, Pick C, Tremblay G, Malaviya S, Green A, Sandman K. Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States. JAMA Pediatrician 2022 May 1;176(5):493-501. doi: 10.1001/jamapediatrics.2022.0042. PMID: 35254391; PMCID: PMC8902682.
Olson J, Garofalo R. The peripubertal gender-dysphoric child: puberty suppression and treatment paradigms. Pediatr Ann. 2014 Jun;43(6):e132-7. doi: 10.3928/00904481-20140522-08. PMID: 24972421.
Popovic, J., Geffner, M. E., Rogol, A. D., Silverman, L. A., Kaplowitz, P. B., Mauras, N., Zeitler, P., Eugster, E. A., & Klein, K. O. (2022). Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States. Frontiers in pediatrics, 10, 968485. https://doi.org/10.3389/fped.2022.968485
Tordoff DM, Wanta JW, Collin A, Stepney C, Inwards-Breland DJ, Ahrens K. Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Netw Open. 2022 Feb 1;5(2):e220978. doi: 10.1001/jamanetworkopen.2022.0978. Erratum in: JAMA Network Open. 2022 Jul 1;5(7):e2229031. PMID: 35212746; PMCID: PMC8881768.
Turban, J.L., (2021). Factors Leading to “Detransition” Among Transgender and Gender Diverse People in the United States: A Mixed-Methods Analysis. LGBT health, 8(4), 273–280. https://doi.org/10.1089/lgbt.2020.0437
Turban JL, et al. (2020) Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation. Pediatrics. 2020 Feb;145(2):e20191725. doi: 10.1542/peds.2019-1725. Erratum in: Pediatrics. 2021 Apr;147(4): PMID: 31974216; PMCID: PMC7073269.
March 29, 2024
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