Protecting children with intersex traits: legal, ethical, and human rights considerations

Dalke, Katharine B.; Baratz, Arlene B.; Greenberg, Julie A.

doi:10.1016/b978-0-12-815968-2.00010-4

“…International human rights organizations have increasingly expressed their concerns that surgeries performed before a child can participate meaningfully in decision-making may endanger the child’s human rights to autonomy, self-determination, and an open future (e.g., Human Rights Watch, 2017 ). Numerous medical and intersex advocacy organizations as well as several countries have joined these international human rights groups in recommending the delay of surgery when medically feasible (Dalke et al., 2020 ; National Academies of Sciences, Engineering, and Medicine, 2020 ). However, it is important to note some anatomic variations, such as obstruction of urinary flow or exposure of pelvic organs, pose an imminent risk to physical health (Mouriquand et al., 2016 ).…”

Section: Chapter 10 Intersexmentioning

confidence: 99%

“…Nonetheless, long-term outcome studies are limited and most studies reporting positive outcomes lack a non-surgical comparison group (Dalke, et al., 2020 ; National Academies of Sciences, Engineering, and Medicine, 2020 ). There is also no evidence surgery protects children with intersex conditions from stigma (Roen, 2019 ).…”

Section: Chapter 10 Intersexmentioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

¹

,

Radix

²

,

Bouman

³

et al. 2022

International Journal of Transgender Health

View full text Add to dashboard Cite

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for t...

show abstract

“…International human rights organizations have increasingly expressed their concerns that surgeries performed before a child can participate meaningfully in decision-making may endanger the child's human rights to autonomy, self-determination, and an open future (e.g., Human Rights Watch, 2017). Numerous medical and intersex advocacy organizations as well as several countries have joined these international human rights groups in recommending the delay of surgery when medically feasible (Dalke et al, 2020; National Academies of Sciences, Engineering, and Medicine, 2020). However, it is important to note some anatomic variations, such as obstruction of urinary flow or exposure of pelvic organs, pose an imminent risk to physical health (Mouriquand et al, 2016).…”

Section: Statement 108mentioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman¹,

AE²,

WP³

et al. 2023

ESPE

0

View full text Add to dashboard Cite

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirmi...

show abstract

“…Debates about the psychological sequelae of certain interventions in the care of children with V/DSD have been presented as ethical or rights-based questions [2, [27][28][29]. Garland et al [27] characterize genital surgery as non-therapeutic and assert that the need to protect bodily integrity outweighs the preservation of family integrity.…”

Section: The Ethics Of Medicalization Rights and Individual Goalsmentioning

confidence: 99%

Psychological Care of Children and Families with Variations or Differences in Sex Development

Alderson

¹

,

Hamblin

²

,

Crowne³

2022

View full text Add to dashboard Cite

Paediatric clinical psychology literature provides applicable evidence for use in specialist health care settings and services. The general approach of psychological care of children and families with paediatric conditions is recognisable as preventative and de-stigmatising, aimed to maximise personal agency with shared responsibility for achieving best outcomes via multi-professional teamwork. Recent commentaries regarding healthcare for children with different sex development (DSD), have noted service-level pitfalls including poor teamwork and underuse of early and integrated psychological intervention. Psychological research regarding the variously termed DSD, Variations in Sex Development (VSD, Variation in Sex Characteristics (VSC), or intersex, has historically centred around the assessment of sex differences, gender identity and the impact of including hormone influences on brain and behaviour. Psychological research in this specialist area has not focussed on the evaluation of specific clinical interventions or psychotherapeutic models but has investigated psychological aspects of multi-professional healthcare provision. There are new goals for psychological care of children with variation or difference in sex development. These require a framework of good communication to enable those receiving care to come to know and articulate their own hopes for treatment and support. Paediatric psychological intervention studies involving larger clinical groups such as diabetes, provide evidence applicable to DSD populations. A risk of stigma is recognised as inherent to some physical interventions within routine paediatric care of people with variations or differences in sex development. Psychological care and intervention should be aimed at minimising these risks via questioning and examining their assumed need. Psychological approaches can provide a foundation for ethical and rights-based multi-professional care of children with variation or difference in sex development.

show abstract

Protecting children with intersex traits: legal, ethical, and human rights considerations

Cited by 11 publications

References 35 publications

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Psychological Care of Children and Families with Variations or Differences in Sex Development

Contact Info

Product

Resources

About