A socio-historical investigation, conducted by Nicolas Sallée and Leda Raia, has just been published in the journal Sociologie. Drawing in particular on analyses of published texts and interviews with some of TJT’s founding members (Agnès Condat and Jean Chambry, child and adolescent psychiatrists), the authors revisit the historical intellectual contexts that have successively shaped clinical approaches to gender-nonconforming children and adolescents in France. The article notably traces the co-creation of Trans Youth Trajectories by healthcare professionals, researchers and associations of people directly concerned.
According to the authors, the clinical treatment of gender-nonconforming youth has long been marked by enduring controversies, structured around two rival clinical positions. On the one hand, a stance of “framing/supporting gender transition pathways for minors”; on the other, a “corrective” stance, aiming to realign as early as possible their gender identity with the sex category assigned at birth. These divergent approaches clash in particular over the question of age thresholds beyond which medical or surgical intervention becomes conceivable, making time and child development a major site of power struggles.
The history reconstructed by the authors begins in the United States in the 1960s, with clinicians’ efforts to correct effeminacy in young boys. Figures such as John Money and Richard Green developed a theoretical and practical framework for psychological intervention based on the idea of children’s “developmental plasticity”, inherited from the Johns Hopkins clinic in Baltimore and its corrective treatment of intersex children. Within this theoretical framework, the child is conceived as a “living laboratory” (Gill-Peterson, 2018), capable of being “reinstalled within the biological binary of sex” provided that intervention occurs early. This therapeutic paradigm was later extended to the treatment of children now considered transgender.
Colette Chiland, a French child psychiatrist and psychoanalyst, is one of the central figures in the importation of this corrective stance into France. In 1980, she met “Antoine”, a four-year-old boy who wished “to become a girl when he grows up”. She described him as a “Stoller-type boy”, referring to the psychiatrist Robert Stoller, who viewed some gender-nonconforming children as future “transsexuals” whose identity would be shaped by a dominant mother and an absent father. Chiland aligned herself with this lineage and hoped, as she later stated, that “with psychoanalytic treatment, we would manage to make them change their mind” (Chiland, 2013).
Inspired by North American work, she developed a form of psychotherapy aimed at preventing any “becoming trans” (Maud-Yeuse Thomas, 2010), while promoting an interactional explanation of “sexed identity”. She argued that this identity is constructed from as early as 18 months of age, at the intersection of a “biological bedrock” and a “psychological bedrock”, and that this latter dimension can be reoriented through treatment: “Treatments of children allow us to observe these interactions in vivo and to intervene directly in these interactions” (Braconnier, 2005).
This therapeutic stance, although paternalistic, was presented as being motivated by goodwill, insofar as it sought to protect children from the “suffering of the transsexual trajectory” (Chiland, 2013). Colette Chiland cites the example of Antoine, who reportedly stated at the end of treatment: “I don’t need to come anymore, now I know that I have to say that I am a boy.” This resignation, however, was interpreted as a therapeutic success, rather than as a constrained renunciation.
The introduction in 1980 of the diagnosis Gender Identity Disorder in Children (GIDC) in the DSM-III contributed to legitimising these corrective approaches. Yet this psychiatric classification evolved in 2013, when the DSM-5 replaced GIDC with “gender dysphoria in children”, defined no longer as a disorder but as distress linked to the incongruence between experienced gender and sex assigned at birth. This did not prevent “dysphoria [from continuing to be] understood as an individual reaction (stress, depression, etc.) to a hostile environment”, thus maintaining a pathologising framework (Hérault, 2015).
Despite these shifts, the corrective stance persisted, notably with Kenneth Zucker, who directed the specialised Toronto clinic until 2015. Although he claimed an approach described as “watchful waiting”, he considered that “for young children, things were still flexible” (Agnès Condat, quoted in the article). Zucker and Chiland thus shared the belief that trans identification could be prevented if intervention occurred early enough. Zucker, for example, emphasised that “in a large number of cases, this rejection [of biological sex] disappears during psychological work with the child and both parents.”
Paradoxically, Chiland also paved the way for a shift in practices. She contributed to the training of a generation of psychiatrists – notably Agnès Condat and Jean Chambry – who, in the early 2010s, initiated the first hospital-based consultations in France aimed at supporting gender transitions. At Pitié-Salpêtrière and Fondation Vallée, these practitioners, although trained within a traditional psychoanalytic framework, experimented with a more supervisory and flexible stance, more respectful of young people’s lived experience.
This evolution notably involved a revision of age thresholds. In France, legal medical adulthood is set at 18, but these new practices made it possible to initiate care pathways from the onset of puberty. In 2013, Chiland co-signed with Condat the first psychiatric certificate authorising puberty suppression and a social transition at school for a ten-year-old child. Condat nevertheless recalls the clinical thinking of the time: “If we could manage so that people would ultimately not be trans […], it would avoid going through treatments […], and above all through social rejection. So there was this idea that the benefit for the child, if it were possible, was still that they would become cis.”
The momentum initiated by these pioneering consultations led to the creation of Multidisciplinary Case Meetings (RCPs), aimed at shifting therapeutic decision-making by embedding it within a collegial framework. These RCPs are inspired by the oncology model and make it possible to discuss cases collectively, while providing practitioners with an ethical, scientific and legal framework (Thomazo, 2021).
However, from the late 2010s, a new wave of backlash began to emerge. It particularly targeted adolescents assigned female at birth, whose requests for transition toward masculinity or non-binary identities then became predominant (see on this topic the TYT articles published here and here). This resurgence of a corrective stance has been fuelled by a shift of the debate into the public and political sphere. In 2024, a bill adopted at first reading in the Senate – but never examined by the National Assembly – proposed strict regulation of access to puberty blockers and a ban on gender-affirming hormones and surgeries before the age of 18. This hardening reflects a reactivation of paternalism under the guise of “child protection.”
The authors finally stress the sociopolitical dimension of these debates. Behind medical discourses lie struggles over the definition of gender, norms of parenthood, the place of the child in society, and the relationship between expert knowledge and subjectivity. Current controversies place in tension “different conceptions of gender and of the links between sex and gender,” revealing the fault lines of a society being reshaped around questions of identity.
Drawing on an approach inspired by Michel Foucault, the article sheds light on the power dynamics at work in clinical practices: those of a medical and familial paternalism that positions itself as the guardian of sexual and gender norms. But it also highlights the forms of resistance that are emerging, carried by young people, their families, community organisations, and professionals committed to respecting the right to self-determination. This is the central challenge: to move beyond a pathologising framework and to build a space of care where identities can be expressed without being corrected.
To access the article, click here.