De la transidentité à la transidentification. Déclenchement rapide de la « dysphorie de genre » chez des adolescents confrontés au malaise pubertaire

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

“…Although critics have claimed that earlier studies documenting high rates of desistance inappropriately included children who were merely gender-nonconforming (Olson, 2016;Temple Newhook et al, 2018), a reanalysis of these data that divided children into two groups: those who met the diagnostic threshold for gender identity disorder and those who did not but where nevertheless dysphoric enough to require referral to the gender clinic, showed that those who truly met the diagnostic threshold still had a desistance rate of 67%, while those who were subthreshold desisted at a rate of 93% (Zucker, 2018). Moreover, although it is often claimed that gender dysphoria persisting into early adolescence is highly likely to persist into adulthood (Cohen-Kettenis et al, 2008;de Vries et al, 2011;Gooren & Delemarre-van de Waal, 1996;Vrouenraets et al, 2015), this claim is based on small numbers of cases treated decades ago (Bradley & Zucker, 1997;Smith et al, 2001) and may not generalize to the current cohort of predominantly adolescent females (Butler et al, 2018;Hutchinson et al, 2020;Kaltiala-Heino et al, 2015Zucker, 2019), many of whom have complex psychiatric and neurodevelopmental problems (Becerra-Culqui et al, 2018;de Graaf et al, 2018;Kaltiala-Heino et al, 2015;Masson et al, 2023;Thrower et al, 2020).…”

“…Treatments that have non-negligible risks of serious harm are typically reserved for life-threatening indications. The situation becomes substantially more complex for children with gender dysphoria contemplating puberty blockers however; in addition to an absence of high-quality evidence to guide treatment decisions, the natural trajectory of gender dysphoria in the current cohort of predominantly adolescent females with complex psychiatric and neurodevelopmental conditions (Becerra-Culqui et al, 2018;de Graaf et al, 2018;Kaltiala-Heino et al, 2015;Masson et al, 2023;Thrower et al, 2020) is uncertain. Moreover, while pediatric clinicians frequently rely on observational evidence in the absence of RCTs, observational studies of puberty blockers for gender dysphoria are characterized by multiple methodological weaknesses, making many of them unsuitable to inform clinical practice.…”