Russian President Vladimir Putin signed new legislation on Monday that effectively outlaws gender affirming care procedures, dealing a severe blow to Russia’s LGBTQ+ community.
The bill, which was overwhelmingly approved by both chambers of parliament, prohibits any “medical interventions aimed at changing the sex of a person,” as well as changing one’s gender in official documents and public records. Medical intervention to cure congenital abnormalities will be the lone exception.
It also nullifies marriages when one of the partners has “changed gender” and prohibits transgender people from becoming foster or adoptive parents.
The prohibition is supposed to be the result of the Kremlin’s crusade to safeguard the country’s “traditional values.” Lawmakers claim the act is necessary to protect Russia from “Western anti-family ideology,” with some calling gender transitioning “pure satanism.”
Russia’s persecution on LGBTQ+ individuals began a decade ago, when Putin initially declared an emphasis on “traditional family values,” which the Russian Orthodox Church embraced.
The Kremlin passed regulations in 2013 prohibiting any public encouragement of “nontraditional sexual relations” among adolescents. Putin pushed through constitutional revision that prohibited same-sex marriage in 2020, and last year approved legislation prohibiting “propaganda of nontraditional sexual relations” among adults as well.
European countries are becoming more cautious when it comes to gender-affirming care for kids. The Norwegian Healthcare Investigation Board, for example, declared in March that it will change its present clinical recommendations for “gender-affirming care” for kids.
The new rules would limit the use of puberty blockers, transgender hormones, and transition-related surgeries to clinical research settings. Norway joins other European countries, including Finland, Sweden, and the United Kingdom, in imposing restrictions on the provision of gender-affirming care to minors.
In the United States, a partisan divide is forming between states that allow and guarantee access to gender-affirming care for kids and states that prohibit or severely restrict gender-affirming care for minors. There doesn’t appear to be much room for compromise.
This year, 12 states have either prohibited or severely restricted gender-affirming care for adolescents. More Republican-led states are likely to follow suit soon.
Simultaneously, five Democratic-led states have enacted laws to preserve transgender healthcare coverage and access for youngsters.
According to proponents and advocates, the goal of gender-affirming care is to provide medical therapy that allows a person to “live as the gender they are.”
There appears to be some evidence that gender-affirming care improves health outcomes in the near term, with fewer despair, anxiety, and suicidality.
Access to healthcare for trans children, according to Angela Goepferd, programme director for gender health at Children’s Minnesota, is “lifesaving.” According to Goepferd, children who have access to gender-affirming care “have less anxiety, less depression, they think about suicide less frequently, and they act on those suicidal thoughts less frequently.”
In the United States, proposing guardrails can result in being labelled “transphobic” or a “science denier.”
However, as European experience suggests, prudence with regard to gender affirming care for minors may be necessary. A series of systematic reviews of evidence for the benefits and dangers of puberty blockers and cross-sex hormones conducted in Europe found a low certainty of benefits.
Longitudinal data gathered and analysed by public health agencies in Finland, Sweden, the Netherlands, and England, in particular, have revealed that the risk-benefit ratio of youth gender change ranges from unknown to unfavourable.
As a result, there has been a gradual transition in care across Europe from one that prioritises access to pharmaceutical and surgical therapies to one that is less medicalized and more conservative, addressing potential psychiatric comorbidities and exploring the developmental aetiology of trans identity.
As a result, Europe has imposed restrictions on the availability of hormones.
Minors in most European nations can currently obtain puberty blockers and cross-sex hormones if they meet strict qualifying criteria. And this is becoming more common in the context of a closely regulated research setting.
Many European countries prohibit the use of transgender hormones until the age of 16, and then only after a series of psychotherapy sessions. Furthermore, the vast majority of European countries prohibit surgery until the age of 16.
From puberty blockers to cross-sex medications to surgery, European restrictions are either stricter than many states in the United States or tightening. For example, Sweden’s National Board of Health and Welfare recommends that children under the age of 12 should not utilise puberty blockers outside of clinical studies.
In England, one of the grounds for closing Tavistock’s Gender and Identity Development Service in 2022 was physician concerns that some patients were referred to a gender transitioning pathway too soon.
Hilary Cass, who headed an independent evaluation of gender identity services for children and young people, stated that there is “insufficient evidence” to give clear recommendations on the widespread use of puberty blockers. She has instructed the National Health Service to “enrol young people who are being considered for hormone treatment into a formal research protocol.”
Gender experts in Finland have expressed worry that some patients administered pharmacological therapies did not match the stringent eligibility conditions outlined in the so-called Dutch Protocol.
In the 1990s, gender specialists in the Netherlands laid the groundwork for gender-affirming healthcare for minors. From the late 1990s through 2012, clinicians designed and thoroughly documented this “careful and cautious approach.”
The Dutch Protocol, originally envisioned, established a set of criteria for treatment eligibility. A proven early childhood development of gender dysphoria, a rise in gender dysphoria after pubertal changes, the absence of major psychiatric comorbidity, and demonstrable knowledge and understanding of the repercussions of medical transition are all required.
Treatment with puberty blockers can only begin after the age of 12. Cross-sex hormones and surgery, which have apparent permanent consequences, are not available until the ages of 16 and 18, respectively. If patients go through the transitioning process, they will receive psychotherapy throughout.
Finland was one of the first to adopt the Dutch Protocol for paediatric gender medicine. However, by 2015, Finnish gender experts had noticed that the majority of their patients did not fulfil the Dutch Protocol’s relatively tight qualifying conditions for pharmacological treatments.
Clinicians in other European nations also remarked that guidelines were not carefully followed, effectively allowing for what could be considered unauthorised treatment of many more youngsters, particularly females, than the Dutch experts who devised the initial protocol.
Finally, health authorities in Finland, Sweden, and the United Kingdom conducted comprehensive assessments of evidence regarding the benefits and hazards of hormone therapies.
As a result of these reviews, the findings suggested that research referenced in support of hormonal therapies for teenagers are of “very low” certainty. As a result, access to hormones was severely limited. It also promoted the idea that such treatments are still in the “experimental” stage.
De facto, there is no medical consensus regarding the use of pharmacological and surgical therapies in gender dysphoric minors, according to European health authorities and medical specialists.
In a February essay published in the Netherlands, the author concludes that “more research on sex changes in young people under the age of 18 is urgently needed,” emphasising the significance of studying the long-term implications of medicalized transgender care.
The article is notable for its comprehensive quotations from one of the founding members of the Dutch team of researcher-clinicians that pioneered the use of puberty blockers in children with gender dysphoria over two decades ago.
To be sure, the Dutch have been more cautious—even more so than their European counterparts—in the use of therapies such as puberty blockers. Many Dutch doctors use “watchful waiting” before proceeding with therapies.
Furthermore, recent evidence analysed by Dutch physicians has given them pause concerning the Dutch Protocol’s watertightness. They discovered that some individuals who transitioned under a closely adhered to version of the Dutch Protocol appear to have significant reproductive regret, body shame, and sexual dysfunction when monitored.
Dutch academics presented these first findings at the World Professional Association for Transgender HealthWPATH Symposium in December 2022.
Americans who oppose state restrictions on gender-affirming care for minors frequently argue that Sweden, Finland, the Netherlands, and the United Kingdom have not eliminated hormonal interventions, and thus lawmakers who seek limits are presumably going against what European health authorities recommend.
Furthermore, proponents of America’s “affirmative-medicine” movement point to Europe, which does not prohibit gender-affirming care for youngsters. Because Europeans do not prohibit such care, legislators in the United States that pursue restrictions are contradicting European advice. However, this is simply a portion of a much larger and more complex story.
At the risk of generalising, the American approach gives kids more agency, with the medical establishment’s function primarily being to confirm a child’s claim that he or she is trans.
This affirmative model immediately removes several of the safeguards established by, instance, the Dutch Protocol, perhaps resulting in an inadequate lack of medical “safeguarding.”
A growing number of European countries are not providing “gender-affirming care” to kids in the same way that America does.
Indeed, Europe has been trending in a different path from the United States for several years, with Europeans exercising greater prudence when treating youngsters with gender dysphoria. Essentially, the message from European gender specialists is that until there is credible long-term proof that the benefits of youth gender transformation outweigh the hazards, it is best to limit most medical procedures to rigorous clinical research settings.