PATHSA is greatly concerned about the recent incident and resultant controversy where a health care practitioner in an open forum challenged the validity and credibility of gender-affirming healthcare for children and adolescents.
As a result, PATHSA and its founding members deem it not only critical, but also our professional and ethical responsibility and in the interest of public good to speak out and offer our position statement with regards to gender-affirming care for transgender children and adolescents.
PATHSA’s constitution states:
- “Develop, advocate for and promote best practices and clinical resources for gender-affirming health care.”
- “To disseminate awareness around power dynamics that are typically inherent to all health care seeker/provider interactions involving people who are part of the trans and gender-diverse communities, to acknowledge the damage that has been done by such dynamics, and to insist that gender-affirming clinicians must take steps to dismantle these typical power hierarchies.”
PATHSA in concert with many international professional healthcare bodies and associations take a gender-affirming position when it comes to transgender and gender diverse children and youth (American Counselling Association 2010; British Psychological Society, 2012; WPATH SOC 7, 2011; Psychological Society of South Africa, 2013; Oliphant et al 2018; Telfer et al, 2018). PATHSA regards gender affirmation of transgender children and adolescents as evidence based, internationally recognised and in the best interest of the child and adolescent (Bonifacio et al 2019; Deutsch, 2016; Devries, Kathard & Muller, 2020; Van Breda and Addinall, 2020; McLachlan et al, 2019; Spencer, Meer & Muller, 2017). This includes being supportive of social transition of prepubertal transgender and gender diverse children and puberty suppression for the transgender adolescent (Bonifacio, 2019; Deutsch et al, 2016; de Vries ALC et al 2011 & 2014; Durwood et al, 2017).
PATHSA strongly opposes any form of so called “conversion therapy” or “reparative therapy” imposed on transgender children and adolescents where the aim is to convince the child that their gender identity experience, which does not match their gender assigned at birth, to be a pathology and the child being counselled to accept their gender assigned at birth. Outcome research on this type of intervention has already been found to do harm, to worsen the mental health status of children and adolescents exposed to it; and it significantly increases the risk for self-harm and suicide (Durwood et al, 2017; Giovanardi, 2017; Oliphant et al, 2018). PATHSA stands in solidarity with the many international professional bodies who have declared such practices to be unethical and illegal and grounds for professional sanction of health care professionals who practice this.
PATHSA takes professional, academic and scientific exception to any religious or culturally positioned individuals and entities who from their subjective, fundamental, unscientific, non-evidence based biased positions attempt to discredit and characterise gender-affirming care of children and adolescents as an ideology. This is objectively false, inaccurate and could lead to significant harm should it result in parents being dissuaded to act in the best interests of their transgender and gender diverse children in accessing gender-affirming care (Spencer et al, 2017; Olson et al, 2018; Newhook et al, 2018)
PATHSA’s firm and clear position on gender-affirming healthcare for children and adolescents is supported and substantiated by a number of outcome studies already completed since the WPATH standards of Care version 7 was released in 2011. These are the studies that have produced good evidence for the improved mental health in children who were supported and allowed to socially transition; as well as the studies that produced good evidence that puberty suppression also results in significant improvement in the mental health of transgender and gender diverse adolescents further reducing the risk of self-harm and suicide. (Bonifacio et al, 2019; Devries et al, 2014; Durwood et al 2017; Giovanardi, 2017; Newhook et al, 2018; Olson et al, 2018)
Signed by the board and founding members of PATHSA
Ron Addinall-van Straaten
Elma de Vries
American Counselling Association (2010). American Counselling Association competencies
for counselling with transgender clients. Journal of LGBT Issues in Counselling, 4, 135‐159.
Bonifacio, J.H.; Maser, C; Stadelman, K and Palmert, M. 2019. Management of Gender Dysphoria in Adolescents in Primary Care. The Canadian Medical Association Journal: CMAJ 2019 January 21;191: E69-75. doi: 10.1503/cmaj.180672
British Psychological Society (2012). Guidelines and literature review for psychologists
working therapeutically with sexual and gender minority clients.Retrieved from
Deutsch, M.B. Editor. 2016. Gender-Affirming Care of Transgender and Gender Nonbinary People. 2nd Edition. Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California.
De Vries ALC, Steensma TD, Doreleijers TAH, and Cohen-Kettenis PT. 2011
Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine; 8:2276–2283.
De Vries, A.L.C; McGuire, J.K.; Steensma, T.D.; Wagenaar, E.C.F.; Doreleijers, T.A.H. and Cohen-Kettenis, P.T. 2014. Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics; originally published online September 8, 2014; DOI: 10.1542/peds.2013-2958
De Vries, E., Kathard, H. & Müller, A. (2020). Debate: Why should gender-affirming
health care be included in health science curricula? BMC Medical Education, 20(51), 1-10, https://doi.org/10.1186/s12909-020-1963-6
Durwood, L; McLaughlin, K.A and Olson, K.R. 2017. Mental Health and Self-Worth in Socially Transitioned Transgender Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56(2): 116–123.e2. doi:10.1016/j.jaac.
Giovanardi G. Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents. Porto Biomed. J. 2017. http://dx.doi.org/10.1016/j.pbj.2017.06.001
McLachlan, C., Nel, J.A., Pillay, S. & Victor, C.J. (2019). The Psychological Society of South Africa’s guidelines for psychology professionals working with sexually and gender-diverse people: towards inclusive and affirmative practice. South African Journal of Psychology 1 –11, DOI: 10.1177/0081246319853423 journals.sagepub.com/home/sap
Newhook, J.T.; Pyne, J.; Winters, K.; Feder, S.; Holmes, C.; Tosh, J.; Sinnott, M.; Jamieson, A. and Pickett, S. 2018. A Critical Commentary on Follow-up Studies and “Desistance” Theories About Transgender and Gender Nonconforming Children. International Journal of Transgenderism, Vol 19 (2): 212-224. https://doi.org/10.1080/15532739.2018.1456390
Psychological Society of South Africa. (2013). Sexual and gender diversity position statement. Retrieved from http://www.psyssa.com/documents/PsySSA_sexuality_ gender_position_statement_2013.pdf
Oliphant J, Veale J, Macdonald J, Carroll R, Johnson R, Harte M, Stephenson C, Bullock J. 2018. Guidelines for gender-affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato. ISBN: 978-0-473-45837-9
Olson, K.R.; Durwood, L.; DeMeules, M. and McLaughlin, K.A. 2018. Mental Health of Transgender Children Who Are Supported in Their Identities. Paediatrics 137 (3). http://pediatrics.aappublications.org
Spencer, S., Meer, T. & Müller, A. (2017). “The care is the best you can give at the time”: Healthcare professionals’ experiences in providing gender-affirming care in South Africa. PLoS ONE 12(7): e0181132. https://doi.org/10.1371/journal.pone.0181132
Telfer, M.M.; Tollit, M.A.; Pace, C.C. and Pang, K.C. 2018. Australian Standards of Care and Treatment Guidelines for Transgender and Gender Diverse Children and Adolescents. Medical Journal of Australia, 209 (3)
Van Breda, A. D., & Addinall, R. M. (2020). State of Clinical Social Work in South Africa. Clinical Social Work Journal. doi:10.1007/s10615-020-00761-0
Wilson, D; Marais, A; de Villiers, A; Addinall, R; and Campbell, M.M. 2014. Transgender Issues in South Africa, with Particular Reference to the Groote Schuur Hospital transgender Unit. South African Medical Journal, Vol 104, No. 6.
World Professional Association for Transgender Health. 2011. Standards of Care for the Health of Transexual, Transgender, and Nonconforming People. Version 7. www.wpath.org.za.