As the LGBTQIA+ community has gained broader acceptance in most of the Western world, a backlash against the community too has grown, fuelled by conservatives and a section of feminists in the US and the UK. A great deal of this backlash has come to be focused on trans persons and, in recent years, on health services provided to children who identify as transgender. In the US, close to half of the states now limit or ban access of adolescents to gender-affirming care. Gender affirming care includes mental health services, access to puberty blockers (that delay the onset of puberty), access to hormone replacement therapy and, in rare cases for minors, surgical procedures.
The issue has taken on political dimensions that have often centred parents’ rights—and political rhetoric—in the discourse rather than the needs or rights of the child. Misinformation is rifemany in India too have heard of the overblown stories of children now identifying as cats and schools providing them litter boxes. The discourse is toxic.
It is in this environment that a four-year review of gender identity services provided by the National Health Services in the UK has been released. The report, authored by highly respected paediatrician Dr Hilary Cass, has said that there is no good quality evidence on the long-term outcomes of interventions used to treat gender-related distress.
Specifically, the report says evidence in favour of the current medical approach in addressing the needs of children with gender dysphoria is weak. England and Scotland have now effectively banned the use of puberty blockers, as have a few other European countries. The report calls for a holistic approach to treating children with gender dysphoria and better quality research.
However, critics have raised concerns that the report does not consider the context in which care is provided in the UK—most care is available only after several years waiting, for one. Similarly, concerns have been raised about the weaponisation of the report against the trans community, which only creates more barriers to access care that was barely accessible to begin with.
While these are nascent discussions in India, where trans persons still struggle to access healthcare services, education and jobs, they still provide an insight into how to address sensitive issues, how care could be provided, including for children, and how lives of trans persons must be centred in issues pertaining to their lives and well being.