CARPAY: Can a 14-year old girl decide on permanent infertility, facial hair and a male voice?

A new court case in British Columbia raises the question of whether a 14-year-old girl truly understands the nature, consequences and risks of taking puberty blockers and testosterone to address her gender dysphoria.

The girl wants to make her body less feminine and more masculine, and she wants this now, not later. Her father is concerned about the drugs’ negative and irreversible effects, and refuses to consent to drug and hormone therapy.

He does not believe his daughter is emotionally and psychologically mature enough to adequately comprehend the long-term and permanent consequences of this treatment.

B.C. Children’s Hospital intends to inject testosterone into the 14-year-old girl, claiming she understands the nature and risks of the proposed treatment, regardless of what her father thinks.

The BC Children’s Hospital has a consent form that warns girls who take testosterone of permanent physical changes, including a lower voice and facial hair.

Girls taking testosterone also risk heart disease, high blood pressure, diabetes, decreased good cholesterol (HDL), increased bad cholesterol (LDL), emotional change (anger and irritability), and vaginal abrasions and tears.

The form warns that the body sometimes converts testosterone to estrogen, which may increase the risks of ovarian, breast, cervical and uterine cancer. The BC Children’s Hospital states that the long-term effects of testosterone and puberty blockers on younger adolescents are unknown, and that the safety of testosterone is not fully understood.

Yet this Hospital still enables children to decide whether to receive these treatments.

The most serious risk of all is that of irreversible destruction of sexual function and fertility. Girls who take puberty blockers and testosterone will develop into adults who look and sound like men, but lack male genitalia. As adults, even after gender re-assignment surgery, they will not be able to father children, or get pregnant and bear children.

A 2011 Swedish study of 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) clearly proved that the long-term outcome of such treatments resulted in life-long psychological trauma and increased suicide.

The suicide rate in these patients was 19 times higher than the general population as these individuals passed through a post-treatment period of relative happiness but then began to experience significant morbidity and regret.

A growing number of transgender adults are warning that gender re-assignment surgery has brought them inexorable misery.

It would be different if this 14-year-old girl was risking permanent infertility (not to mention a permanent male voice and facial hair) as part of a treatment to fight a malignant cancer that threatened her life.

But unlike cancer, gender dysphoria usually goes away by itself. The vast majority of boys and girls revert to identify with their natal sex by the time they are 18, if they are allowed to go through puberty naturally.

With psychological counseling instead of hormones and drugs, the success rate ranges from 70% to 90%, depending on which of the many studies that one relies on.

For example, Dr. Kenneth Zucker ran the Child Youth and Family Gender Identity Clinic (GIC) in Toronto from 1981 to 2015, successfully treating hundreds of children struggling with gender dysphoria.

The American Psychiatric Association named Dr. Zucker to be the head of the Sexual and Gender Identity Disorders group in 2008, for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, also known as the?DSM-5.

He is a professionally trained psychologist with a profound expertise in gender dysphoria and the intricacies involved with childhood Gender Identity Disorder, which was reclassified as Gender Dysphoria under the DSM-5. His practice was closed due to political pressure, under then Premier Kathleen Wynne.

Dr. Miriam Grossman argues that the proper care of children who suffer from gender dysphoria “involves addressing the mental disorder, not administering puberty blockers and hormone treatment and surgery to attempt to harmonize their physical bodies with their troubled minds.

Such a course fails the patient. It does not treat the underlying issue, which will manifest later in life in serious mental illness, depression and an increased risk of suicide. The proper treatment of gender dysphoria involves addressing the root cause of the psychological distress and confusion.”

Debate about the best treatment of gender identity disorders rages on, amongst psychiatrists and other doctors, and other scientists. In addition to this medical debate, the legal debate in this case will center on whether a 14-year-old is sufficiently mature to make this life-altering decision.

Lawyer John Carpay is president of the Justice Centre for Constitutional Freedoms (JCCF.ca), which wrote a letter to the BC Children’s Hospital on behalf of the father in this case. The father is now represented by local counsel in BC.