Two medical societies reject the planned treatment guidelines for minors with “gender dysphoria” for German-speaking countries. Among the critics is the largest medical society in Germany that deals with mental health, the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). It has around 11,000 members. What is explosive about this is that both societies were involved in the development of the guidelines and sent a representative to the commission.

But the development did not go smoothly. Criticism of the draft treatment guidelines of the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP), published at the end of March, was voiced months ago. 26 other medical societies and trans lobby groups from Germany, Switzerland and Austria were involved in the development – including the two societies that are now doubting the draft. The paper advocates the trans-affirmative approach, i.e. adaptation to the patient’s ideas. The children’s self-assessment is thus effectively placed above the medical diagnosis.

The preamble to the guideline states that doctors must respect the wishes of children and adolescents who feel they belong to a different gender than the one they were born with. This includes puberty blockers, cross-sex hormones and the removal of the developing female breast. Therapy approaches that aim to direct this feeling of belonging in a certain direction are considered “unethical”.

Now DGPPN President Andreas Meyer-Lindenberg has expressed his concerns in a letter to child psychiatrist Georg Romer, who was responsible for developing the guideline. Essentially, it is a treatment recommendation for dealing with children and young people who believe they were born in the “wrong” body and belong to a different gender than their biological one. The guideline is intended to apply to Germany, Austria and Switzerland. The specialists and lobbyists support the so-called gender-affirmative approach, which allows puberty blockers, cross-sex hormones and operations for children and young people.

In the letter, which WELT has received, DGPPN President Meyer-Lindenberg is now calling for changes to the draft. He writes that “hormonal and surgical interventions” should be “reserved for a few cases”. And even for these, comprehensive and multi-professional diagnostics are required. The bottom line is that there is “a disagreement with a large number of recommendations in the guideline”. Finally, he urges the commission to take into account the current research results in the literature since 2020 on the subject of “gender dysphoria” in a revised version, including the results of the “Cass Report”.

The Swiss Society for Child and Adolescent Psychiatry and Psychotherapy (SGKJPP) has also expressed criticism and called for a revision. The association supports the statement of the European Society for Child and Adolescent Psychiatry (ESCAP). The ESCAP criticizes the non-compliance with medical ethical and professional principles in the treatment of minors with gender dysphoria in some countries. These standards must be adhered to without fail. This includes, above all, the principle of “non-harm.”

Parent groups continue to demand that the guideline be stopped. The group “Transteens with custody rights” turned to the DGKJP ombudsman’s office and asked the representative Andreas Warnke to meet with them. There are no treatment alternatives like in other countries, including psychotherapy. There has been no response to the letter, which WELT has seen.

When WELT asked how the responsible professional association DGKJP would deal with the objections, the office replied that the text of the guidelines was currently being revised “taking into account all comments received”. “Differentiated technical replies to individual feedback” would follow.

The draft is currently being voted on by the boards of the 27 professional societies and, if adopted, will be published as a final guideline in the course of June 2024. This will serve as a guideline for doctors in the treatment of children and adolescents in the still little-researched area of ​​the phenomenon of “gender dysphoria”.

Some countries have turned against the use of hormones in minors due to a lack of evidence, including Great Britain, Sweden and Finland. These are increasingly relying on psychosocial support and psychotherapy, and in Great Britain the administration of puberty blockers was recently stopped. The lifelong consequences of these treatments cannot be estimated and the benefits are doubtful, is the main argument.

After the German draft of the treatment guidelines was published, various child psychiatrists, the German Medical Association and a group of 15 university professors voiced sharp criticism, arguing that there was insufficient medical evidence for the administration of puberty blockers and other hormones and that irreversible damage was possible. The draft also ignored current research results and stuck to the gender-affirmative approach.