Il Gender and Identity Development Service della clinica di Tavistok, UK, è stato per anni un punto di riferimento per il trattamento della disforia di genere negli adolescenti, anche per gruppi di pressione all’estero, quali il World Professional Association of Transgender Health americano.

Ora però, riferisce un articolo di Commonsense.news,  l’NHS ha deciso di chiudere la clinica a causa della mancanza di prove sull’efficacia dei trattamenti nel migliorare la condizione psicologica dei pazienti, in particolare nel caso di ormoni “cross-sex”, di soppressori della pubertà e di interventi chirurgici.

La questione delle transizioni era già stata sollevata da  Keira Bell, una donna che aveva denunciato la clinica per la sua transizione troppo precoce e poco informata ma aveva perso l’appello alla Corte Suprema. Il tema sembra rimanere attuale, vista la crescita di richieste di transizioni precoci, rispetto alle quali i medici non sono sempre sicuri di quale sia la condotta etica e deontologica più appropriata.

Contemporaneamente, Finlandia e Svezia stanno radicalmente rivedendo le proprie linee guida. In Svezia si è notata una grande crescita e un cambiamento nelle caratteristiche di chiede la transizione precoce:

The 2015 guidelines were created with a certain cohort in mind. At the turn of the 21st century, the Dutch had designed a medical protocol for what was then called gender-identity disorder, based on a small group, mostly male, that had long-lasting, childhood-onset gender dysphoria and didn’t have other serious mental-health issues. They seemed to fare well after medical transition in adolescence, but the methodology asserting this wasn’t terribly reliable.

By contrast, the young people who sought care at Swedish clinics after 2015 were increasingly teenage girls with multiple psychiatric diagnoses—and there were a lot of them. “It rose from four to 77 per 100,000 inhabitants,” Linden said.“The guidelines were written for what we thought was a smaller group of patients and also more homogeneous.”

La Finlandia in particolare vuole abolire interventi irreversibili prima della fine della pubertà. Nell’articolo è pubblicata un’intervista alla responsabile di COHERE (il Council for Choices in Health Care finlandese) e riportato i risultato dell’analisi della letteratura scientifica sulla transizione in età adolescenziale:

COHERE began with a systematic review, conducted by a panel of neutral experts, of the literature on the safety and efficacy of treatments. The panel found that even studies of adult patients were of such low quality that it was impossible to claim medical and surgical reassignment improved psychiatric problems. And studies of children didn’t clearly assert a correlation between medical interventions and improved mental function. After the evidence review, Kaltiala-Heino’s team finished a paper that found that cross-sex hormones did not improve problems related to “functioning, progression of developmental tasks of adolescence, and psychiatric symptoms.”

“Scientific evidence for any interventions on minors with gender identity indication is actually zero,” Kaltiala-Heino told me. That is, there are some studies that show improvement from interventions, but they are of such a low quality that they can’t be relied on to tell us anything important about the wider population.

Gli Stati Uniti non sembrano al momento intenzionati, nota Common Sense News, a muoversi in una direzione simile. La ragione è indicata in questi termini:

What we have is a culture war. Specifically, we have lots of battles playing out in legislatures and courts, which could go on for years. All the while, we are not conducting long-term research or following up with young patients. We have no idea how many kids are transitioning, how well they are faring, and whether or not they will come to regret it.