PATHSA endorsed an open letter written by PsySSA to the editor of the South African Jewish Report (SAJR), regarding an op-ed titled  "There’s no Pride to be found in gender ideology"  that was published in the SAJR on 30 June 2022. It is described in the letter as a hurtful and discriminatory diatribe that creates a climate for people to justify and rationalise anti-queer and transphobic discrimination or violence. 

The open letter can be read here:

https://www.psyssa.com/open-letter-to-the-editor-of-the-south-african-jewish-report-adam-sachs-theres-no-pride-to-be-found-in-gender-ideology-should-be-retracted-and-an-apology-for-publi/

“I hate the word homophobia. It’s not a phobia. You’re not scared. You’re an asshole.” – (attributed to Morgan Freeman)

When writing about homophobia, this well-known quote from actor Morgan Freeman always jumps to mind. Such a loaded word, complex concept, yet in the same category of people scared of spiders, heights and all other random things. So why a phobia? The Merriam-Webster Dictionary describes a phobia as “an exaggerated usually inexplicable and illogical fear of a particular object, class of objects, or situation.”

What about a homosexual, transgender, or bisexual human scares you so much that it is more pronounced than fears? I believe it is time that we as, well, humanity (!?) start facing our fears, especially if they are “usually inexplicable and illogical”.

In my work as clinical social worker I work with a variety of clients on and off the gender spectrum, and an expansive lot with different sexual orientations. As a clinician I also feel that I can never know or learn enough within this field! And with that, perhaps, THAT is where we need to start if we want to see change: ask questions, gain knowledge, expand your horizons! I am a firm believer that in order for people to do better, the need to know better. If they then consciously make an educated decision to discriminate, put down and hate a person based on their gender and sexuality, then I stick with mr. Freeman’s quote.

However, if someone starts asking the difficult questions and having the difficult conversations, exploring, expanding and purely and honestly want to do and be better, we have to step up and gently teach and educate. Whether it is the hundredth time you explain the differences in gender identity, gender expression and sex and sexuality, for that person it might be the first honest, difficult conversation they have on this topic. If we want the world to change, we have to be the change. If we want to create awareness, we have to be okay to have the difficult conversations. If this change is to happen, it needs to start with us: the trans, gay, lesbian, bisexual person, or ally. We don’t just need an ‘International Day Against Homophobia, Transphobia and Biphobia’, it’s an everyday thing, but man, when we get our day, let’s step up, be the better person and gently speak to these “fears”, whichever they may be, of those who are willing to listen.

Marchané Janeke, PATHSA member

A report focusing on key populations was published by the TAC and others in January 2022. Most transgender respondents said that they do not have access to hormone therapy.

Here is a link to an article that includes comments from PATHSA about the need for sensitisation training for all staff at health facilities:

https://www.spotlightnsp.co.za/2022/02/07/in-depth-landmark-survey-of-key-populations-confirms-scale-of-problems/

Here is a link to the Ritshidze report:

https://ritshidze.org.za/wp-content/uploads/2022/01/Ritshidze-State-of-Healthcare-for-Key-Populations-2022.pdf

PATHSA welcomes the UK’s Appeal Court’s ruling overturning the controversial judgement of 1 December 2020 that children under 16 are highly unlikely to be able to give consent to taking hormone blockers. The previous ruling said that a court would have to give authorization for puberty blockers or cross sex hormones for any gender diverse children under 16 years old. In a judgement on Friday the 17^th September 2021, the Appeal Court said it had been inappropriate for the Divisional Court to issue this guidance and acknowledged that “it was for clinicians rather than the court to decide on competence [to consent].”

The Divisional Court judgment caused the Tavistock clinic to stop accepting all new referrals of gender diverse youth to be considered for puberty blockers from December 2020. This further added to a waiting list that was already 22-24 months for a first appointment. This will have a permanent negative impact on the mental health and future prognosis of many of these youth, whose puberty will have progressed further before accessing puberty blockers. In addition, the Divisional Court ruling created confusion and anxiety in the minds of parents, health care professionals and people all over the world around the crucial evidenced based need for puberty blockers for transgender youth. The ruling was used by right wing organisations, usually with religious motivations, as evidence that the current best practice guidelines were not appropriate.

We are relieved to learn that UK Appeal Court has looked at the evidence in more detail and set aside the High Court ruling. According to the appeal judgment, “The evidence of Tavistock and the Trusts was that the treatment was safe, internationally endorsed, reversible and subject to a rigorous assessment process at each stage.” 

The appeal judgement recognises “the difficulties and complexities associated with the question of whether children are competent to consent to the prescription of puberty blockers and cross-sex hormones” and says: “Clinicians will inevitably take great care before recommending treatment to a child and be astute to ensure that the consent obtained from both child and parents is properly informed by the advantages and disadvantages of the proposed course of treatment and in the light of evolving research and understanding of the implications and long-term consequences of such treatment. Great care is needed to ensure that the necessary consents are properly obtained.” PATHSA supports this approach of informed consent which is in line with international guidelines and best practice in gender-affirming healthcare.

 

On the 9th of September 2021, a historical and critically important event was hosted during the World Association for Sexual Health's (WAS) 25th international congress, co-hosted with the Southern African Sexual Health Association (SASHA) and for the first time in its history, hosted in South Africa and on the African continent. A Transgender and Gender Diverse assembly was hosted, comprising 4 themed one-hour sessions, each with a chair and panellists totalling 15 participants. Everyone was Transgender, Gender Diverse or Intersex.

Assembly Session 1: Theme: WAS Statement Concerning Actions to Support Gender Diversity World Wide

Session Chair: Esben Esther Pirelli Benestad (WAS Advisory - Norway)

Panel: Nic Rider (The Institute for Sexual and Gender Health -USA); Savuka Matyila (Genderdynamix – RSA); Avery Everhart (Centre for Applied Transgender Studies USC - USA)  

Assembly Session 2: Theme: Depathologisation - Lived Experiences & Contemporary Challenges

Session Chair: Jabulani (Jabu) Pereira (Iranti – RSA)

Panel: Mauro Grinspan (GATE- Argentina);  Anastacia Tomson (MD/Activist – RSA)

Assembly Session 3: Theme: Pan African Best Practice in Transgender and Gender Diverse Sexual & Reproductive Health

Session Chair: Dzoe Ahmad (Genderdynamix - RSA)

Panel: Barbra Wangare (EATHAN - Kenya); Jholerina Timbo (Wings to Transcend Namibia Trust -Namibia); Anil Padavatan (Genderdynamix –RSA); Sean Reggee (Trans Bantu – Zambia)

Assembly Session 4: Theme: Human Rights – Priorities for Transgender and Gender Diverse Communities

Session Chair: Akani Shimange (Matimba - RSA)

Panel: Yvee Odour (GALCK - Kenya); Oumaima Dermoumi (LGBTQIA+ Advocate & co-initiator of Nassawiyat - Morocco); Taymy Caso (Randi and Fred Ettner Postdoctoral fellow in Transgender Health – USA)

Here the link to the recording of this historical assembly event:

TRANSGENDER AND GENDER DIVERSITY ASSEMBLY = https://vimeo.com/601348992/9827accaae

• 9 September 2021

  PATHSA would like to respond to views expressed in a seminar titled “What does science says about LGBTQA+”, that was held by the Vice-Chancellor of UCT on 5 September 2021 with Dr. Kgomotso Mathabe, who is a practising urologist and a member of the Steve Biko Academic Hospital’s Gender Clinic.

  PATHSA recognises and is concerned with the fact that great pain has been caused by the discussions during the seminar.

  We understand that the intention of the seminar was to discuss diversity, and in principle we welcome dialogue that contributes to better understanding of the challenges faced by intersex and transgender and gender diverse people. Access to gender-affirming healthcare and especially surgery is a critical concern.

  Gender-affirming healthcare is a field in medicine that is fast evolving, and globally approaches and insights are changing over time. We would like to focus our response here on depathologisation, models of care, and access to care in South Africa.

  The Professional Association for Transgender Health South Africa (PATHSA) is an interdisciplinary health professional organisation working to promote the health, wellbeing, and self-actualisation of trans and gender diverse people.

  One of the objectives in our constitution is:

  “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.”

We recognise that health professionals have often viewed diverse gender identities as pathology, and in the past classified it as a mental illness. Historically, medical research produced the “scientific” evidence that pathologised sexualities and gender identities that did not conform to societal expectations, as well as supported treatments such as so-called “conversion therapy” that is now regarded as unethical. The depathologisation movement led to the WHO declaring with the publication of the International Classification of Diseases and Related Health Problems (ICD) version 11, that gender diversity is not a mental health disorder. Gender-affirming care models utilise an approach of depathologisation of human gender diversity (transgender as “identity”), rather than a pathological perspective (transgender as “disorder”).

In the statement by the Gender Diversity Coalition on 7 September 2021, the coalition say that “If we state we are Trans, we don’t need medical scrutiny to affirm this.” This aligns with the informed consent model recognised by the World Professional Association for Transgender Health (WPATH) Standards of Care 7 and that is described in the South African guidelines that will be launched in at the Southern African HIV Clinicians Society (SAHCS) conference on 20 October 2021. As health professionals, we have an ethical duty to prevent harm (non-maleficence). In the context of gender-affirming healthcare, such harm can include a health professional taking advantage of power relationships and gatekeeping access to care. In contrast, the Informed Consent model empowers the individual, by upholding their autonomy and maintaining their integrity. The client and healthcare provider become collaborative partners in decision making.

We have a broken health system in South Africa that is not currently able to meet the needs of our people. Transgender and gender diverse people experience huge challenges to access gender-affirming healthcare, especially in the public sector, and this needs to change. In the seminar, Dr. Mathabe correctly pointed out that she is one of very few surgeons in South Africa performing gender-affirming genital surgery. PATHSA acknowledges that only a few surgeons are involved in gender-affirming surgery in South Africa and thus it is crucial for gender-affirming surgeons to advocate for their clients and affirm their self-actualised identities. GEMS (Government Employees Medical Scheme) lists “gender reassignment surgery” for all their plans apart from the entry level “Tanzanite one” plan from 2021, and Discovery Health includes it in some of their plans. Where will we find the surgeons who are skilled to perform these procedures?

In the light of the above, PATHSA recognises the voices of the Gender Diversity Coalition, and we share the goal of “a health care system that is depathologised and affirming of gender identities, gender expression and sex characteristics”.

PATHSA notes that the Gender Diversity Coalition strongly speaks out against 'genital mutilation' of intersex people. Although PATHSA's focus is trans and gender diversity we acknowledge that some members of the intersex community also identify under the trans and gender diverse umbrella. We uphold and respect self-determination of all people in regard to sex, sexuality and gender diversity. As a professional society we uphold the ethical principle of 'do no harm' and do not support any acts of genital mutilation. Furthermore, intersex people's bodies are not seen as pathological and that something is 'wrong' or 'disordered' with their bodies. Diversity in sex development is seen as being part of the spectrum of sex development that is inherently part of all societies. As multi-disciplinary teams of healthcare providers we can offer support, where needed by the intersex individual, or family of the intersex child. Often in the area of intersex children, psychosocial support for the parent(s) to navigate community reactions could be of great value if required by the parent(s). Furthermore, healthcare providers should provide information to counter community stigma and promote inclusion of all bodies. PATHSA upholds depathologisation, not only of trans and gender diversity, but also of all diverse body presentations. As PATHSA we acknowledge that healthcare workers have been and in certain spaces still is, the violator of 'genital mutilation'. We strongly speak out against any act of 'genital mutilation', we see it as a crime and violation against humanity and stand in solidarity with the intersex community who calls for the ending of surgeries performed on intersex infants.

We call on all our professional and academic colleagues to listen to transgender and gender diverse people and intersex people with humility, and to work together to create health services that will respectfully provide the care that is so needed. The need to use sensitive language is critical when engaging with topics around trans and gender diversity and intersex, to avoid causing further harm.

As academics and health professionals, we need to engage in meaningful conversations beyond the traditional dominance held by both the institution of Western medicine and academia; the marginalisation of trans and gender diverse people and intersex people is not ethical and their voices and lived experience must be centralised. We as healthcare providers may not mimic allyship but must be committed to real transformation where oppressive, violent, and marginalising systems are challenged and dismantled.

We believe public seminars are invariably more helpful should intersex or transgender and gender diverse people be consulted, included, and given the first voice to speak and help professionals when they fall short in understanding what is helpful for their communities, hence the activist motto: “Nothing about us without us”.

PATHSA is willing to participate in conversations that lead to a better understanding of the issues and assist in maximising the essential contribution health professionals make to the transgender and gender diverse and intersex community.

PATHSA celebrates diversity, upholds self-determination of sex, sexuality, and gender identity, upholds depathologisation, fights hetero-cis-normativity and supports ethical practices.

Aluta continua 

Chris McLachlan

Chairperson

For the board of PATHSA

Facts over phobia: A response to Alleyn Diesel By Kellyn Botha

published on 3 September 2021 at this link https://www.news24.com/witness/opinion/columnists/facts-over-phobia-a-response-to-diesel-20210903

I volunteer at a support group for trans and gender-diverse minors and their parents. In these spaces I often find myself hammering home to the kids every time we engage, that the medical stuff isn’t everything - that they are valid and beautiful no matter what path they choose. I do this because it is true, but also because I find myself having to constantly fight a false narrative that we are pushing surgeries or hormones onto children. And yet, for most of the young people I work with, it is still something they desperately want and need.

On 25 August, an op-ed published in The Witness by one Alleyn Diesel caught my attention. As someone who has worked long hours with young trans and gender-diverse people, I cannot stress enough the kind of damage that articles like Diesel’s can do to the lives of innocent young people. To be transgender is not, as Diesel claims, a choice, or a desire to escape from social norms, or a form of mutilation, or a form of expressing one’s sexuality. To be trans is simply to not identify with the gender assigned to you at birth, and can involve myriad sexual orientations or forms of self-expression. I am not sure whether to read Diesel’s misrepresentation of such basic facts as merely a case of ignorance, or as deliberate malice. Having never met her prior it may not be wise to make assumptions as to which is applicable.

Diesel starts her piece off by referring to a previous review of the novel, Detransition, Baby, by Torrey Peters, as something which drew her attention to the “fact” that “growing numbers who embraced transsexual [sic] lifestyles because of apparent gender dysphoria, are now embarking on detransitioning”. Diesel either does not realise - or counts on the viewers to not realise - that the novel to which she refers is just that. A novel. A work of fiction. Further, Torrey Peters is a trans woman who was nominated for an acclaimed women’s prize for literature, much to the chagrin of the very anti-trans voices with whom Diesel aligns.

In reality there is no evidence that a “growing number” of trans people are detransitioning. While some anti-trans commentators like to cry that the rise in people coming out as trans is some kind of pandemic, the reality is likely just that more people now have the tools and language to describe themselves openly, where before stigma and ignorance forced them to remain in the closet.

The number of people who later in life return to identifying with their assigned sex at birth remains vanishingly small. A 2015 survey by the Transgender Centre for National Equality found that in the United States, about eight percent of respondents chose to detransition - but of those who did detransition, around 62 percent said it was only a temporary measure due to social pressure or lack of access to medical treatments. The survey found that only 0.4 percent of respondents detransitioned after realising they were not transgender.

Another study in Sweden, which took place over 50 years, found that only 2 percent of respondents expressed any form of regret after medically transitioning, while a similar report from researchers in the Netherlands found that 98.1 percent of people showed no regret or propensity for detransition.

Clearly then, this is not the great and growing threat that the anti-trans lobby would have us believe. I have often heard people decry the advancement of trans recognition and equality by claiming that to amend our way of thinking and acting for such a small minority would be totally unreasonable. And yet if an even smaller minority presents itself as being supposed evidence for the anti-trans lobby to go on the attack, well then, suddenly statistics don’t matter all that much.

This is not to belittle or ignore the lived realities of those who do detransition. Everyone deserves the freedom to decide for themselves who they are and how best to live their lives, and it is important to have open and honest discussions about how to best help and serve that small minority who do come to realise they are not transgender. But the fact that such people get touted as evidence against the necessity of medical transition is exceedingly harmful. An analysis by Cornell University of more than 4000 separate studies attests to the efficacy of medical transition in alleviating depression, suicidality, anxiety and social isolation among the vast majority of trans people. And we have known for decades now that “conversion therapies” aimed at changing a person’s sexual orientation and gender identity are at best ineffective and at worst, traumatic and dangerous.

Diesel goes on to claim that in Britain and America there is “growing concern” about the rising rate of young trans people seeking gender-affirming medical care. In fact the consensus in favour of offering such support to trans people has never been higher, but much like with those who detransition, a vocal minority are held up by the likes of Diesel, with little regard for what the informed, educated and compassionate majority are saying.

The Professional Association for Transgender Health South Africa (PATHSA), an organisation with members across the medical and psychological fields, states unequivocally in its policy statement on children that to consider trans identities and affirming healthcare to be some kind of ideology “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.”

The policy goes on to state that “PATHSA’s firm and clear position on gender-affirming healthcare for children and adolescents is supported and substantiated by a number of outcome studies [...] that have produced good evidence for the improved mental health in children who were supported and allowed to socially transition.”

One of Diesel’s primary examples of the dangers of allowing young people to access gender-affirming medical care is the case of Keira Bell in the United Kingdom, who identified for several years as a trans man. She went onto puberty blockers at age 16. At 18 she started a regimen of testosterone. At 20 she received a double mastectomy. Later, Bell realised she wasn’t transgender and was swept up by a cohort of anti-trans activists who managed - only temporarily - to have puberty blockers banned for minors.

Let the details of the Keira Bell case sink in for a minute. Minors were prevented from accessing safe and reversible medical care which would give them time to grow up and decide their paths for themselves, because one person at the age of 18 and 20 - a full grown adult - made decisions she would come to regret. This case was clearly never about protecting children so much as trying to make life harder for trans people. 

In its public reply to Keira Bell’s court case, PATHSA stated its extreme concern that the judgement “ignores the fact that transgender youth have been put on hormone blockers for over 20 years now and the outcomes are overwhelmingly positive, among a group of teenagers with a very high risk of poor mental health outcomes without these interventions.”

“The judgement fails to appreciate the permanent poor outcomes of transgender youth having to go through the psychological trauma of going through a puberty that they do not want and which result in permanent physical changes (e.g. voices dropping and growing breasts) that cause them to face a life time of discrimination and gender dysphoria.”

And I should add here as a brief aside, for anyone concerned about this particular point: It is not practice or policy anywhere in the world to perform genital surgery on transgender minors! Not only that, but many trans people do not even want surgeries, and those who do are more often than not excluded by exorbitant medical bills. If you are truly outraged at the thought of such irreversible surgeries taking place on children, I encourage you to join the efforts of us LGBTI+ activists in banning genital surgeries on intersex newborns.

Diesel also uses the example of Katherine Burnham from the United States - similarly, a woman who thought for a time she was non-binary transmasculine, and who was above the age of consent when she briefly started taking testosterone. Burnham alludes the essay to which Diesel links that she was only able to access hormones after reaching the age of consent - so hardly a case of children being coerced into anything - and that she feels she could only have learned who she was by going on that personal journey, and not by being pushed away from her trans identity by others.

These two cases put forward by Diesel are very clearly cherry-picked to construct a narrative that, frankly, does not reflect reality. As PATHSA notes in its response to the Keira Bell case: “Youth are given hormone blockers only at [...] a stage where research had already shown over 90% of them will not change their gender identity. Deducing that hormone blockers cause more children to sustain a transgender gender identity is simply false.”

I could probably write a short novel if I had to go for a point-by-point takedown of every inaccurate or harmful thing contained in Diesel’s op-ed. Perhaps if I did I could be nominated for a literature award like Torrey Peters. But I am not sure what good that would do to anyone who has already made up their minds about trans and gender-diverse people. So instead I want to aim the closing of this piece at those who are on the fence. Those who do not hate trans people, but who are genuinely concerned about the children. To the parents, the teachers, the doctors, and the therapists out there who can still make a positive difference.

I am transgender. I do not want to be. It is difficult and painful and it has cost me so much. And yet, I will not and cannot change. I don’t hate being trans - I hate being trans in a world full of bigotry and disgust and violence aimed at people like me.

Transgender people are who we say we are. The research backs this up. We are not a fad or an ideology - we are your friends, your colleagues, your siblings and your children.

The teenagers I work with are not broken. Like anyone else their age they like drawing, gossiping, and watching hilarious TikTok videos. They speak in a slang that is often alien to me - a born-free millennial - making me feel older than I actually am. They get into fights, worry about their grades at school, and navigate the tumultuous world of love and relationships that all teenagers struggle with. They are, for lack of a better word, normal. And they are trans.

I dare Alleyn Diesel to spend an afternoon talking to the people most harmed by her words before writing another ill-informed article about them.

A concerning opinion was published in The Witness on News24 on 25 August 2021: 

https://www.news24.com/witness/opinion/columnists/guestwriters/breaking-boundaries-safely-20210824

PATHSA’s response was published on 3 September 2021 at this link https://www.news24.com/witness/opinion/columnists/path-to-quality-of-life-a-response-to-diesel-20210903

The full letter follows below.

In addition, a trans activist Kellyn Botha wrote a beautiful response which was also published on 3 September 2021 at this link https://www.news24.com/witness/opinion/columnists/facts-over-phobia-a-response-to-diesel-20210903 The full text be posted on this website.

The Witness published a response by Diesel to PATHSA’s letter by Diesel on the same day (3 September 2021), see https://www.news24.com/witness/opinion/columnists/sa-situation-has-not-demonstrated-openness-to-critical-discussion-20210902

PATHSA letter to The Witness regarding “Breaking boundaries safely” (25 August 2021) – published on 3 September 2021

As the Professional Association for Transgender Health, South Africa (PATHSA), we would like to respond to “Breaking boundaries safely” (25 August 2021) by Alleyn Diesel as we believe it is not an accurate reflection of gender-affirming healthcare. PATHSA is an interdisciplinary health professional organisation working to promote the health, wellbeing, and self-actualisation of trans and gender diverse people.

While we acknowledge that a minority of individuals who accessed gender-affirming healthcare will detransition and that their stories need to be taken seriously, we assert that this is not the whole picture. Regret is very rare and the majority of people who access gender-affirming healthcare have significant improved quality of life.

The approach to gender-affirming healthcare is different for prepubertal children, adolescents and adults. An affirming approach is followed for prepubertal children, which means that instead of attempting to direct a child toward a particular identity, parents and

caregivers accept a child’s own individual journey. (Temple Newhook et al., 2018) Following careful assessment by a qualified mental health professional, social transition may be recommended. (Durwood et al., 2017) Within this model of care, it is understood that the gender that is the “right fit” may differ at different ages and stages of life. Research has shown that transgender and gender diverse children who are affirmed in their gender have mental health outcomes equivalent with cisgender children (whose gender identity and sex assigned at birth are aligned). (Olson et al., 2016)This is in stark contrast to the high levels of psychological distress and behavioral problems documented among children who were discouraged from asserting their identities in childhood. (Turban, 2017)

It can be very distressing for a transgender adolescent to experience the puberty changes in their body, of a gender they do not experience themselves as. In this context, puberty blockers can be safely used to halt the progression of physical changes. Gonadotrophin-releasing hormone agonists (GnRHa) suppress the hormonal axis that results in secretion of endogenous oestrogen and testosterone responsible for induction of secondary sexual characteristics, such as breast growth and menstruation in trans boys and voice deepening and facial hair development in trans girls. This permits the adolescent to develop emotionally and cognitively, before making decisions on gender-affirming hormone therapy which is likely to have irreversible effects. Pubertal suppression has been shown to improve mental health and decrease suicidality. (Turban et al., 2020) The effects of puberty blockers are reversible and when the treatment is stopped, the development of secondary sexual characteristics will continue unless the adolescent is started on hormone treatment. Follow-up studies after puberty suppression from the Netherlands show that the rate of adolescents that stop the reversible blockers because they no longer wish to transition is very low; between 1.9% (Wiepjes et al., 2018) and 3.5% (Brik et al., 2020) in two respective studies.

For older adolescents, hormone treatment is an internationally accepted option. Given that this can have potentially irreversible effects, the International Endocrine Society Guidelines recommend initiating treatment after a multidisciplinary team has confirmed gender incongruence and sufficient mental capacity to provide informed consent. While we agree with Diesel that “hasty and ill-considered diagnoses and treatments” are not in the best interest of anyone, gender-affirming healthcare that follows a thorough informed consent process can be lifesaving and improves the lives of many transgender and gender diverse people, including in South Africa. The informed consent model of care ensures a process where the risks and benefits of various treatment options are discussed with the adolescent and their parents / legal guardians to enable an informed decision. The membership of PATHSA includes health professionals who have collectively cared for hundreds of transgender and gender diverse young people, who have better lives as a result.

Diesel uses very distasteful language to describe gender-affirming surgery such as “mutilations” and “a Frankenstein body”. This is an insult to both transgender individuals who access surgery and the surgeons who perform these procedures. Research has shown that satisfaction following gender-affirming surgery is usually high, with less gender dysphoria, reduced psychological turmoil, and resulting in better integration into society. In contrast to Diesel’s allegation of bodies being “frequently not sexual functioning”, research shows improved sexual functioning following vaginoplasty with high satisfaction reported for intercourse and orgasm. (Zavlin et al., 2018)Regret following surgery is very low, with a large Dutch cohort reporting regret in 0.6% of trans women and 0.3% of trans men. We would like to clarify that gender-affirming surgery is rarely performed in adolescents. There are cases where a multidisciplinary team will recommend mastectomy for a trans boy with severe chest dysphoria before the age of 18, but that will be following careful consideration that it is indeed in the best interest of the specific individual.

Diesel refers to the principle in medical ethics of “first do no harm”. We would like to point out that withholding gender-affirming treatment is not a neutral act and can indeed be harmful, as South African doctor Anastacia Tomson argues eloquently in an article on Gender-affirming care in the context of medical ethics. It would be unethical to withhold treatment with a strong evidence base for benefit, because of the small percentage of individuals who may later regret their decision and detransition. The autonomy of transgender and gender diverse individuals needs to be respected to make choices about their treatment, and our role as health professionals is to facilitate safe access to care. We certainly do not force any individual down a particular path.

Although Diesel calls for a more “tolerant world”, she appears not to be tolerant of either health professionals providing gender-affirming healthcare or transgender and gender diverse individuals who make autonomous decisions to access care. PATHSA yearns for a world where all transgender and gender diverse people will be respected and accepted as fellow human beings and be able to access responsible and quality gender-affirming healthcare.

References

Almazan, A. N., & Keuroghlian, A. S. (2021). Association between Gender-Affirming Surgeries and Mental Health Outcomes. JAMA Surgery, 156(7), 611–618. https://doi.org/10.1001/jamasurg.2021.0952

Brik, T., Vrouenraets, L. J. J. J., de Vries, M. C., & Hannema, S. E. (2020). Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. Archives of Sexual Behavior, 49(7), 2611–2618. https://doi.org/10.1007/s10508-020-01660-8

Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental Health and Self-Worth in Socially Transitioned Transgender Youth. J Am Acad Child Adolesc Psychiatry, 56(2), 116–123. https://doi.org/10.1016/j.jaac.2016.10.016.Mental

Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869–3903. https://doi.org/10.1210/jc.2017-01658

Olson, K. R., Durwood, L., Demeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3). https://doi.org/10.1542/peds.2015-3223

Telfer, M. M., Tollit, M. A., Pace, C. C., & Pang, K. C. (2018). Australian standards of care and treatment guidelines for transgender and gender diverse children and adolescents. The Medical Journal of Australia, 209(3), 1. https://doi.org/10.5694/mja17.01044

Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M. L., Jamieson, A., & Pickett, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism, 19(2), 212–224. https://doi.org/10.1080/15532739.2018.1456390

Tomson, A. (2018). Gender-affirming care in the context of medical ethics – gatekeeping v . informed consent. S Afr J Bioethics Law, 11(1), 24–28. https://doi.org/10.7196/SAJBL.2018.v11i1.616

Turban, J. L. (2017). Transgender Youth: The Building Evidence Base for Early Social Transition. In Journal of the American Academy of Child and Adolescent Psychiatry (Vol. 56, Issue 2, pp. 101–102). Elsevier. https://doi.org/10.1016/j.jaac.2016.11.008

Turban, J. L., King, D., Carswell, J. M., & Keuroghlian, A. S. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics, 145(2). https://doi.org/10.1542/peds.2019-1725

Wiepjes, C. M., Nota, N. M., Blok, C. J. M. de, Klaver, M., Vries, A. L. C. de, Wensing-Kruger, S. A., Jongh, R. T. de, Bouman, M.-B., Steensma, T. D., Cohen-Kettenis, P., Gooren, L. J. G., Kreukels, B. P. C., & Heijer, M. den. (2018). The Amsterdam Cohort of Gender Dysphoria Study (1972–2015): Trends in Prevalence, Treatment, and Regrets. The Journal of Sexual Medicine, 15(4), 582–590. https://doi.org/10.1016/J.JSXM.2018.01.016

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 Trans young people and school uniforms

https://select.timeslive.co.za/news/2021-07-19-all-for-a-piece-of-clothing-school-puts-trans-boy-through-the-wringer/

This article was published today and refers to the open letter to the Education Department regarding discrimination against LGBTQI learners, of which PATHSA is a signatory. It is great that different organisations are working together for a common aim, to improve the lives of TGD people. The letter can be viewed here:

https://triangle.org.za/wp-content/uploads/2021/07/TP-LRC-et-al-2021-July-Open-Letter-to-WCED-Discrimination-against-LGBTQI-learners-in-schools-based-on-SOGIESC.pdf

“Dit is beter om te dink oor gender as ’n spektrum eerder as twee pole. Omdat daar meer openheid is, is dit ook nou meer moontlik vir niebinêre persone om uitgesproke te wees oor hulle genderidentiteit.” ‘n Gesprek tussen die teoloog Pieter GR de Villiers en Elma de Vries.

Lees die hele artikel hier.

Difficult questions about gender diversity, and how church communities can be more understanding – for the Afrikaans journal LitNet.