Spain : The experts revolt

An unprecedented alliance of Spain’s medical societies warns of danger in self-declared gender change

Oct 19 2022 Bernard Lane

Expert medical societies in Spain are in open revolt against the national government’s draft Trans Law that allows legal sex change for minors, predicting it will cause harm to vulnerable young people.

On Tuesday, the country’s mass market newspaper El Mundo splashed the story on its front page with the headline: “Psychiatrists and Endocrinologists warn: the Trans Law will bring pain and many will regret it”.

Sub-headings include: “There is an avalanche of adolescents who believe they are trans and the majority are not”; and “What do we do with someone whose penis has been cut off and wants it back?”

Psychiatrists explode against the Trans Law: “It can bring a lot of pain and regret to many people”
For the first time, the main mental health societies in Spain, in addition to the Endocrinology Society and even the Madrid College of Physicians, publicly criticize Irene Montero’s law: “There is an avalanche of young people with disorders who seek in trans a magic solution”

In interviews with El Mundo, the directors of Spain’s Society of Psychiatry, Association of Child and Adolescent Psychiatry, and Society of Endocrinology have gone public with their fears and objections to the Trans Law. 

They join the renowned psychiatrist Dr Celso Arango and the College of Physicians of Madrid in an unprecedented call for prudence and science to take over from the haste and ideology of the draft law.

The medical society directors all see a link between the bill for self-declared sex change and mistaken trans identity claims, neglect of underlying disorders, needless medicalisation and treatment regret.

In an editorialEl Mundo said the bill’s proposal to enable legal sex change for minors without any mental health oversight was at odds with the right of young people to comprehensive health care.

“It is incomprehensible that the Trans Law should go ahead without the government deigning to listen to doctors and psychiatrists,” the newspaper said. “The hijacking of a key public discussion, with the excuse of transphobia, is unacceptable.” 

Meanwhile, division within the Socialist Party of Prime Minister Pedro Sánchez has forced a partial pause in the fast-tracking of the draft law, allowing at least another week for amendments. 

The Socialists are caught between feminist opposition to self-declared gender identity — at odds with sex-based protections for girls and women — and the trans rights imperative of their populist-woke coalition partners Unidas Podemos, who oppose any delay.

El Mundo predicted a rough passage for the trans bill in Spain’s parliament, with a likely suggestion during debate that the age threshold for self-declared sex change in official records should be raised to 18 years.

The draft Trans Law allows a change of sex in the registry from the age of 12 with judicial approval; from the age of 14 with parental support (but a judge can override parental refusal); and from the age of 16 independently. 

In the name of depathologisation, the law allowing self-identified gender to erase birth sex would do away with the current requirement for psychological assessment before any legal change.

El Mundo’s editorial said: “The underlying issue is that [minors] are offered hormone treatment or surgery —often irreversible — as if it were a magic solution, and health professionals are even singled out as promoters of ‘conversion therapies’ if they offer other alternatives.

“What sense does it make that if a citizen wants to undergo surgery for obesity or receive euthanasia, he or she must have a favourable psychological assessment, but not if he or she intends to change sex?

“The government must modify the most controversial issues of the Trans Law, especially those related to minors, due to the serious effects it can have on them. 

“There are two major problems with this [bill]: the self-determination of gender through mere registration, with the implications this will have for women’s rights in areas such as sport and gender violence; and the treatments offered to minors, without the concurrence of a judge or a health professional. The Council of State and the General Council of the Judiciary have criticised this.

“As five leading specialists in the field tell us in our pages, there is no scientific consensus on the supposed benefits of hormone treatment or surgery on a child or adolescent without a professional evaluating each case. 

“On the contrary: experts warn of the possibility of an accumulation of suffering, disappointments and disorders to which neither the government nor the parliament can open the door.”

The editorial noted that Sweden, Finland and the United Kingdom had shifted away from hormonal interventions as routine treatment for adolescents. 

Systematic reviews of the medical literature in SwedenFinland, the U.K. and the U.S. state of Florida show the very weak evidence base for medicalised gender change with today’s adolescent patients, who are disproportionately female.

Advocates for these “gender-affirming” hormonal and surgical interventions often side-step the lack of quality evidence by invoking the endorsements of medical societies which preach access to “trans healthcare”.

The policy positions of these societies — whether promoting trans medical interventions or warning of their risks — have taken on more importance in the debate, partly because they attract mainstream media coverage.

Dr Víctor Pérez, president of the Spanish Society of Psychiatry, told El Mundo that his organisation supported the depathologising of trans identity.

But he said this should not prevent mental health professionals responding to “the avalanche of adolescents who are receiving significant pressure, especially through social networks, to believe that transsexuality is the instant solution to their problems, when in reality they suffer from disorders that, of course, need a diagnosis and support that this law denies them, and that we are forbidden to provide.

“Many of these adolescents actually suffer from disorders, sometimes adaptive, sometimes eating disorders, sometimes personality disorders. Many young people have intense discomfort about things that have nothing to do with gender.

“Adolescence is pure personality development and we must be very cautious.”

Dr Luisa González, vice-president of the College of Physicians of Madrid, said minors had a “human right to receive comprehensive medical care, physical and mental, something that is persecuted and even prohibited in this law.

“And I must say that as a mother, the parents of these minors are robbed of their right to effective guardianship, to the development of parental authority. 

“The state wants to usurp this power, carrying out treatments that are not even scientifically tested, and which are in many cases irreversible. It is a very serious matter.”

Dr González said she had met the heads of the gender unit at the Ramón y Cajal University Hospital in Madrid, as well as parents from the group AMANDA, who had “knocked on our door in desperation”. Most of the children of families in this group are said to have manifested Rapid-Onset Gender Dysphoria as described by American researcher Dr Lisa Littman.

On October 8, with Dr Arango as sponsor, AMANDA staged its public debut in the packed auditorium of the college of physicians in Madrid. 

Dr Luisa Lázaro, president of the Spanish Association of Child and Adolescent Psychiatry, told El Mundo that there was a “very significant” increase in the number of adolescents who suddenly declared themselves trans without having shown any previous concern about their gender.

“As professionals, we must evaluate whether this [gender] non-conformity is in addition to a disorder” — that is, whether there is a pre-existing disorder, she said.

“In several [of Spain’s autonomous regions] clinics have been established that quickly introduce medical treatment, but you can’t go so fast, because later many of these adolescents come to mental health [services with] their fears and doubts.”

Dr Marcelino Gómez, from the Spanish Society of Endocrinology and head of the gender unit of the Doctor Peset University Hospital in Valencia, said the draft trans law “only shows the option of medicalisation, when transsexuality is a complex phenomenon that requires different solutions, and patience, when what this law brings is the opposite”.

The medical society directors told El Mundo that today’s atypical presentation of gender issues, chiefly among teenage females, was a global phenomenon influenced by social networks and the institutional gains of queer theory.

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