Opinion: Transgender minors: “Today, the threat of banning medical and surgical transitions is intensifying”

Opinion piece published in the journal Le Monde, translated from French.

On the occasion of the International Transgender Visibility Day, Sunday 31 March, a collective of more than one hundred health professionals express concern, in a tribune in Le Monde, about the consequences of a Senate report requesting the ban of hormone treatments and puberty blockers for minors.

Every 31 March, transgender communities celebrate their existence wherever they can. In several dozen countries, being a visible trans person means living under the constant threat of abuse, even imprisonment. Trans women, like gay men, face the death penalty in nearly a dozen countries.

China now suppresses any transgender or gender-nonconforming representation on television, and conversion therapy centres are proliferating there. In Russia, after banning all forms of transition, the LGBT+ movement is labelled as “terrorist”, leading to widespread police repression. In the United States, supporters of Donald Trump are leading an active campaign against LGBT+ minorities, with nearly 479 bills aimed at stripping away their rights. In the same vein, more than twenty conservative states have banned gender transitions for minors and criminalised their caregivers, despite strong opposition from medical and psychological associations.

In France, a group of senators from Les Républicains (LR) is following the example of conservative America by proposing to ban all transitions for minors. If this proposal were adopted, France would become the most severe European country on this issue. This measure is supported not by rigorous scientific analysis nor by a representative consultation of minors who have undertaken transition in the last twenty years in France, but by the interventions of a minority of anti-trans activists.

Today, the threat of banning medical and surgical transitions for minors is intensifying: the report by Senator Jacqueline Eustache-Brinio (LR) calls into question the right to transition before the age of 25 and elevates the voices of conservative organisations that are not involved in supporting those concerned.

Reactionary climate

This attack is closely linked to the current reactionary political climate. For several years now, collectives and associations have seized on every possible pretext to attack the rights of transgender people: calls to ban them from continuing to use bathrooms associated with their gender, from participating in competitive sports, calls to stop reimbursing their health care, to withdraw the protections they benefit from against discrimination and violence, and calls to repeal the 2017 law allowing them to obtain legal gender recognition (without sterilization). Trans lived experience is thus systematically denied, with the current focal point being transgender minors, who have now become the subject of incessant debates, with the complicity of certain media outlets, as documented by the Association of LGBT Journalists. It is also worth recalling that in 2023 the Conseil d’État had to reject the petitions of two child-focused associations seeking the annulment of the so-called Blanquer circular (concerning gender questioning in schools).

Today, transitions are threatened in the name of child protection, even though the physicians involved and trained (in mental and physical health) align their expertise with international good practice recommendations and the international classification of diseases, which specifies that trans identity is not a mental disorder. Among the 239 minors followed at the Gender Diversity clinic at the Pitié-Salpêtrière Hospital, only 11 % received puberty blockers – average age 13.9 years, average delay between first appointment and treatment ten months. And less than half (44 %) received hormonal treatment – average age 16.9 years, average delay before initiation fourteen months.

In this population study, rates of social ostracism far exceed those of non-transgender populations. Suicidal ideation, even attempts with lethal risk, must be seen in the context of misgendering of young people or use of their birth name instead of their chosen name. It is not trans identity that drives depression or school dropout, but the social and political living conditions that contribute to and heighten the distress of some young people.

Recommendation work

It is difficult to reproach trans people for taking an interest in their own health. Yet this is precisely what is being done today both in the Senate’s report and through the attacks on the working group for new recommendations of the Haute Autorité de Santé (HAS) or within multidisciplinary consultation meetings. These are spaces where experiential knowledge of those concerned is expected to be included via representative bodies (the associative structures in their plurality). And it is only in these configurations that advances in health have been the most significant and fruitful, adjusting care and wellbeing offers as accurately as possible on a case-by-case basis. Remember the 1989 AIDS years, and the slogan at an AIDS conference: “Nothing about us, without us.”

Since then, slowly but constantly, recognition of community knowledge and work with communities have enabled researchers and health professionals to improve scientific production and care, tailoring offers of support and wellbeing for people. It is crucial that a public scientific and independent body such as the HAS be able to make its care recommendations independently and without external pressure.

A transition is not just a matter of choice; it is above all a necessity that must be supported, meaning followed without preemption, in consultation with parents. Banning everything does not allow respectful medicine of the person. Suspending this support ethically contravenes the protection of the person.

Full list of signatories :

Fiot Elodie, pédiatre, Hôpital Robert Debré
Gayet claire, pédiatre, CHU Rouen
Anne-Sophie Lambert, pédiatre, Hôpital Bicêtre Paris Saclay
Hoarau Marie, médecin pediatre endocrinologue, Saint-Pierre, CHU de la Reunion
Linet Thelma, médecin, Paris
Faucher Philippe, gynécologue obstétricien, Hôpital Trousseau Paris
Mouton Charlotte, médecin généraliste
Delcour Clémence, gynécologue médicale, Hôpital universitaire Robert Debré
Brezin Francois, endocrino pédiatre (PH), CHU Strasbourg
Le Guiner Alexandra, médecin généraliste
Raven Bureau, docteur en psychologie, psychologue clinicien et ATER Université de Strasbourg
Charlotte Lebrun, psychologue, Hôpital Robert Debré
Rausky jonathan, chirurgien, Hôpital Tenon – AP-HP
Lechwar Jonathan, sage-femme MSU, Saint-Etienne
Mamou Grégor, pédopsychiatre, Établissement MGEN Chanay
Armangau Yael, doctorant en sociologie, Université Toulouse Jean-Jaurès
Sylvie Morel, maîtresse de conférences en sociologie, Nantes Université
Alessandrin Arnaud, sociologue, Bordeaux
Pailloux Aude, médecin généraliste
Warnery Vincent, conseiller conjugal et familial – formateur à l’accueil & l’accompagnement des personnes transgenres, Strasbourg
Florence Sophie, médecin, Paris
Cordon-Lesieux Cécile, kinésithérapeute-sexologue
Kenigsberg Margot, médecin généraliste ( MSP et CSS), Gennevilliers
Leroy Baptiste, médecin généraliste, Rennes
Bouchet Nolwenn, médecin généraliste, Langeac – Haute-Loire
Florence Bigey-Eckert, psychologue clinicienne
Dre Laura De Salas Prado, médecin généraliste et MSU de la Faculté de Médecine Jacques Lisfranc
Brunet laurence, juriste, APHP, Hop. Bicetre Paris
Burban Mélanie, sage-femme, masterante en études de genre, Paris 8
Michelle Veilleux, sexologue, doctorante en santé publique, Réseau de Santé Sexuelle Publique
Franke Sabrina, éducatrice spécialisée en maison des ados et étudiante en sexologie
Céline Bouënnec, infirmière DE, service de psychiatrie l’enfant et de l’adolescent de la Pitié Salpêtrière
Celine Puill, sage femme, master sociologie
Payet Marie, médecin généraliste, Gironde
Naïditch Nora, psychologue, Kremlin Bicêtre
Suomi Bombelli, sexologue, conseillère conjugale et familiale, anthropologue, Paris/Rome
Reignier Arnaud, MCU-PH – Médecin biologiste, CHU de Nantes – Médecine et Biologie de la Reproduction
Robert Marie-Françoise, psycho-sexologue clinicienne, Saint-Paul 974
Yelnik Vanessa, médecin généraliste, Marseille
Coutant Regis, pédiatre, Chu Angers
Dr Sander de Souza, interne de santé publique, Lyon
Freour Thomas, Chef de service médecine et biologie de la reproduction – biologiste, CHU Nantes
Aubart Orèn, interne en médecine interne, sexologue, Réseau de Santé Sexuelle Publique, AP-HP
Raymond Van Huizen, doctorant en santé publique
Delebarre Coraline, psychologue sexologue, libéral/cesame de l’Enipse
Pauline Duret, médecin généraliste, Nantes
Patrick Papazian, médecin sexologue, Hôpital Pitié Salpêtrière, Paris
Bensignor Candace, praticien hospitalier, CHU Dijon
Gaiani Giulia, médecin généraliste
Karine Martin, médecin/sexologue, Cannes
Corine Rodrigue, sexothérapeute et thérapeute de couples
Brière Étienne, médecin généraliste, Checkpoint Paris
Orriere Thibault, médecin, Paris 12
Robert Angélique, psychologue clinicienne
Roullaux Loïc, psychopraticien, analyste psycho-organique, Paris
Margaux Berthier, interne de gynécologie médicale, Rouen
David Friboulet, psychothérapeute ARS – Sexologue, CeGGID Institut Alfred Fournier Paris et Dispositif CeSaMe de l’ENIPSE
Rodrigues-Ribeiro Bonnefoy Niena, sexothérapeute, Le Raincy (Seine-Saint-Denis)
Tronel Cécile, médecin généraliste, Marseille
Diane Deswarte, sexothérapeute
Leaute Flora, médecin généraliste, Rouziers de Touraine
Gamelon Danaé, médecin généraliste urgentiste, Paris
Peyramaure Julien, médecin généraliste, Maison de Santé Pluriprofessionnelle Simone Veil de Mirebeau (86)
Therbault Melanie, psychologue
Oriol Séverine, médecin, Brest
Clémence Le Joubioux, médecin généraliste
Barbiere Lysistrata, psychanalyste / Doctorante en études de genre (Paris 8)
Guiollot Hadrien, interne en médecine générale, Université Paris Sorbonne, Centre de Planification
Bockstal-Fieulaine Klev Benoît, psychologue, UFITAA Hôpital Jean-Verdier Établissement de Santé Publique Ville-Evrard
Rogez Céline, assistante de Service Social, Hôpital Robert Debré, Paris
Honegger Frédérique, médecin généraliste, Saint Médard en Jalles
Domenech-Dorca Gwenaël, sexologue, AP-HP
Armelle Grangé-Cabane, médecin généraliste, Paris
Munoz Thibault Alexe, infirmier•e et thérapeute pair-aidant•e
Laetitia Martinerie, médecin endocrinologue pédiatre, Hôpital Robert Debré
David Cohen, médecin psychiatre, Hôpital Pitié Salpêtrière
François Medjkane, médecin pédopsychiatre, CHU Lille. Trans Santé France
Agnès Condat, médecin psychiatre, Hôpital Pitié Salpêtrière
Marie Agathe Trouvin, médecin endocrinologue pédiatre, Hôpital Bicêtre
Mathilde Lafaysse, médecin spécialiste en Médecine Générale
Jean Chambry, médecin pédopsychiatre, CSAPA Maison Blanche
Thierry Goguel d’Allondans, éducateur spécialisé, anthropologue et formateur en sciences humaines et sociales, Strasbourg
Fanny Poirier, docteur en psychologie, psychologue, Hôpital Pitié Salpêtrière
Nicolas Mendes, docteur en psychologie, psychologue, Hôpital Pitié Salpêtrière
Garance Gribé, sexologue, Réseau de Santé Sexuelle Publique
Aurélie Bourmaud, MCU-PH, médecin sexologue, Réseau de Santé Sexuelle Publique
Juliette Pellissier, docteure en psychologie, chercheuse, psychothérapeute
Serge Hefez, psychiatre, ESPAS
Chrystelle Lagrange, docteure en psychologie
Laurence Hérault, Pr anthropologie, Aix-Marseille Université
Karine Espineira, sociologue, LIRCES
Louise Redkine, psychologue, Réseau de santé sexuelle Publique
Emilie Moreau, psychologue, sexologue, Réseau de santé sexuelle Publique
Matthieu Clabaut, kinésithérapeute, conseiller en santé sexuelle, Réseau de santé sexuelle Publique
Axelle Romby, médecin sexologue, psychothérapeute, centre de santé sexuelle Mairie de Paris – Université Paris Cité
Sarah Iribarnegaray, psychiatre
Lisa Minier, docteur en psychologie, thérapeute familiale
Juliette Hugueny, interne en gynécologie médicale
François Baert, psychologue clinicien
Juliette Cuq, médecin gynécologue, Lyon
Alexandre Michel, pédopsychiatre, hôpital Robert Debré
Florian Guillemet, psychiatre sexologue, CHU Angers
Marion Philippe, médecin endocrinologue pédiatre, hôpital Robert Debré
Stéphanie Rouleau, médecin endocrinologue pédiatre
Stéphanie Barbu, docteure en biologie, enseignante-chercheuse
Ronald Geroudet, psychologue clinicien-psychothérapeute, président co-fondateur de l’association Queer&Care, Lyon
Sarah Castets, pédiatre endocrinologie, Marseille
Marion Lapoirie, endocrinologue, Lyon
Clara Cuzin, médecin généraliste, Centre de Santé Communautaire et Planétaire Le Jardin, Bron
Nicolas Morel Journel, médecin, Co-président de Trans Santé France
Emilie Plaintive Pochon, psychologue
Bérengère Ducrocq, médecin de la reproduction
Cécile Cousyn, médecin généraliste
Olivier Ouvry, médecin psychiatre
Pierre Grillon, médecin généraliste, Nantes
Julie Brunelle, médecin pédopsychiatre, Hôpital Pitié Salpetrière
Emmanuel Monneron, Psychiatre, Lyon
Natacha Bouhours-Nouet, endocrinologue pédiatre
Tom Reucher, psychologue clinicien
Nollet Charlotte, médecin Généraliste, Saint-Herblain
Hutteau Margaux, médecin généraliste, Saint Brieuc
Fezzoli Briard Stéphanie, médecin sexologue, CHU Caen
Massart Perrine, gynecologue, Clinique Jules Verne Nantes
Laurence François, psychiatre, psychothérapeute et sexologue, Paris
Forno Niloufar, Psychologue en thèse de doctorat à l’Université Paris-Cité
Balem Chiara, Psychologue clinicienne, Cabinet libéral et association Espace Santé Trans
Juliette Bouzy, Pédopsychiatre, Paris
Jeanne Delanous, Ingénieure d’études en sociologie, Centre Nantais de Sociologie
Vidal Camille, Psychiatre, Paris
Duez Emmanuelle, Psychologue
Allory Emmanuel, Médecine generaliste, Rennes
JULIER Ingrid, Médecin endocrinologue, CHU NIMES
Chelghaf Ismaël, Médecin, CHU Nantes
Gendrot Mathilde, Médecin généraliste
ETIEN Samuel, Médecine généraliste, Paris
GHERMANI Yasmina, psychologue clinicienne
Nathalie CHABBERT-BUFFET, Endocrinologue, Hôpital Tenon
DUMEZY Jean-Luc, Psychiatre, Nantes
GRAS-VINCENDON Agnès, médecin pédopsychiatre hospitalier, Strasbourg
Nicolas Hélène, MCF en Anthropologie, Université Paris 8 LEGS
LUTZ Manuel, Psychiatre, ILLKIRCH GRAFFENSTADEN
Marie Atea de Pourtales, Psychologue, Grenoble
Spizzo Anne-Hélène, Médecin endocrinologue, Strasbourg
BERTIN Chloé, infectiologue dermatologue, Bordeaux
MALINOWSKI David, psychologue clinicien, Paris 11
Granier Emmanuelle, Pedopsychiatre praticien hospitalier, Strasbourg
MOULIN Kévin, Psychologue, Cabinet libéral, L’Horme (42)
Lambert Tony, Médecin généraliste, Méricourt
Versini Claire, Psychomotricienne Sexologue, Dinan
Talbot Alice, Médecin généraliste, Marseille
Benoît MAILLET, Psychiatre d’adolescents, CHU de Nantes
Aragones Roxane, medecin généraliste, Grenoble
Morel-chevillet Myria, Infirmière DE, Para Médical
Saby Josephine, Orthophoniste, Bègles