{"id":3501,"date":"2025-09-26T19:00:57","date_gmt":"2025-09-26T17:00:57","guid":{"rendered":"https:\/\/trajectoiresjeunestrans.fr\/non-categorise\/trans-children-what-do-child-psychiatrists-think\/"},"modified":"2026-01-25T16:57:17","modified_gmt":"2026-01-25T15:57:17","slug":"trans-children-what-do-child-psychiatrists-think","status":"publish","type":"post","link":"https:\/\/trajectoiresjeunestrans.fr\/en\/news\/trans-children-what-do-child-psychiatrists-think\/","title":{"rendered":"Trans children: what do child psychiatrists think?"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text css=””]As preparatory work by the Haute Autorit\u00e9 de Sant\u00e9 is due to begin at the end of this year, with a view to developing good practice recommendations on the support of trans minors, a research article<\/a><\/span> published in the journal Neuropsychiatrie de l\u2019enfance et de l\u2019adolescence reports on a study based on interviews with French and Belgian child and adolescent psychiatrists on the care of prepubescent children experiencing gender incongruence.<\/p>\n

Between April 2022 and July 2023, the research team conducted interviews with 12 child and adolescent psychiatrists who had recently been involved in the care of such situations. The psychiatrists interviewed, 6 men and 6 women, were all cisgender, and 8 were specialised in this field. The interview period followed the publication of the so-called \u201cBlanquer\u201d circular (September 2021<\/a><\/span>), which allows social transition for students of any age within the French national education system – without the need for psychiatric certification and subject to parental consent – and also followed the ban on conversion therapies (January 2022<\/a><\/span>). It also coincided with the publication of the 8th version of the WPATH Standards of Care<\/a><\/span> (August 2022), which recommends, among other things, \u201cthat parents\/caregivers and health professionals support children who wish to be recognised in the gender that corresponds to their internal sense of gender identity\u201d (p. 88). <\/p>\n

Contrary to what the authors of the article claim in their introduction, recent scientific evidence no longer supports the idea that there is a \u201csignificant risk of desistance at the onset of puberty.\u201d The literature on social transition in children, reviewed by Hall and colleagues (2024<\/a><\/span>) and taken up by Hilary Cass (2024<\/a><\/span>, pp. 161-165), or by the AWMF (2025<\/a>, pp. 61-64) for example, highlights the low risk of desistance when the psychosocial and clinical environment is supportive, which was not the case in older studies (see in this regard the critical review of the literature by Temple Newhook and colleagues, 2018<\/a><\/span><\/span>). This is notably the case in the Trans Youth Project study by Olson and colleagues (2022<\/a><\/span>), which \u201cfound that 93 % of individuals who had socially transitioned between ages three and twelve continued to identify as transgender at the end of the study (approximately 5.4 years later). Among the others, 2.5 % were living as cisgender, 3.5 % as non-binary, and 1.3 % had undergone two re-transitions\u201d (Cass, statement 12.25, p. 162). <\/p>\n

It should be noted that this same Trans Youth Project led, in 2025, to a scientific monograph by deMayo and colleagues<\/a><\/span>, discussed here by Trans Youth Trajectories<\/a><\/span>, which confirms the high stability of gender identity among children who have socially transitioned, including when compared with cisgender children, whether siblings or children from other families. This therefore raises the question of the scientific justification for child and adolescent psychiatric consultations for prepubescent children who are socially integrated in their affirmed gender, in the absence of any psychiatric comorbidity. <\/p>\n

The article discussed here, written by Lucia Montecchio and her colleagues, immediately reveals a shift in the therapeutic framework under the influence of an all-pervasive social debate: \u201cIt\u2019s how much people in society ask us questions about this [\u2026] me, as a child psychiatrist, I should be a reference point on the issue of gender incongruence [\u2026] Around me, all the time people ask me questions [\u2026]\u201d (C1, E5, Table 5). This interpenetration of the social and the clinical feeds defensive stances and, at times, a recentring of decision-making power on healthcare professionals rather than on the children concerned. <\/p>\n

Some clinicians interpret the increase in consultations as a fashion phenomenon, even as an \u201cepidemic\u201d: \u201cYou know, 10 years ago, there were no requests [\u2026] there really are fashion effects. The problem is when are we going to question the meaning of the epidemic?\u201d (C2, E3, Table 5). This lexical framing (\u201cfashion,\u201d \u201cepidemic\u201d) risks pathologising life trajectories and obscuring attentive listening to the child\u2019s lived experience, even though France introduced, in January 2022, following the World Health Organization, the removal of trans identities from the category of mental illnesses. <\/p>\n

The child and adolescent psychiatrists also describe a blurring of their professional role under pressure from the public sphere: \u201c[\u2026] everyone has an opinion about it [\u2026] society comes in and takes hold [of the issue] [\u2026] I see extremely severe cases of anorexia, nobody cares. But gender incongruence [\u2026] everyone goes completely crazy about it\u201d (C3, E5, Table 5). This perception of \u201cinterference\u201d can lead to a stance of over-control, crowding out the work of open-ended support for the child and their family. <\/p>\n

Politics surfaces clearly in clinicians\u2019 accounts: \u201cThe hospital decided to launch a gender clinic under political impetus [\u2026] but without a physician [\u2026] it\u2019s essentially a political problem\u201d (C5, E3, Table 5). Yet reading these situations solely through the lens of politico-institutional conflict risks losing sight of a child-centred ethics of care. <\/p>\n

In the study by Montecchio and colleagues, certain positions hostile to associations stand out clearly: for instance, one child psychiatrist describes the creation of a \u201cgender clinic\u201d \u201cunder the impetus of associations,\u201d framing it as \u201ca political problem\u201d (C5); another considers that \u201cLGBTQIA+ associations remain somewhat sceptical about the role of psychiatrists\u201d and refers to risks of \u201cblacklisting\u201d (C7, E12, Table 5); a third speaks of a \u201cconflict of interest\u201d insofar as some clinicians might be \u201cactivists in LGBTQIA+ associations\u201d (C8, E3, Table 5). These assertions, which construct associations as forces of interference rather than as partners in care, depart from the spirit of health democracy enshrined in the so-called \u201cKouchner\u201d law (2002<\/a><\/span>), as well as from the most recent clinical recommendations (AWMF, 2025<\/a><\/span>). The latter explicitly require that the social environment receive \u201ceducational and information services, which also refer to information and counselling services offered by self-advocacy organisations of trans people and their relatives\u201d (Statement IX.K5, p. 263), thereby affirming the structuring role of associations in the psychosocial support of minors. <\/p>\n

In addition, the AWMF recalls in its introduction that its guideline was developed with \u201cTwenty-six medical and psychotherapeutic societies as well as two self-advocacy organisations were involved in drawing up and agreeing on the guideline,\u201d as a guarantee of co-construction with service users (p. 2). In other words, where some clinicians describe associations as vectors of pressure (C5, C7, C8), the AWMF framework recognises them as legitimate and necessary interlocutors in care pathways and risk prevention, and encourages health professionals to actively refer to them. It is worth noting, moreover, that some child and adolescent psychiatrists align with this view: \u201c[these associations] stay informed, (\u2026) are vigilant\u201d and act \u201cin a very loyal and very, very healthy way\u201d (C6, E2, Table 5), an assessment that precisely echoes the partnership-based approach promoted by health democracy. <\/p>\n

Some excerpts document explicit gatekeeping (control): \u201c[\u2026] we need a psychiatrist who will tell us who the real and the fake trans people are [\u2026] they wanted someone to be responsible\u201d (C18, E7, Table 5). Yet this delegation to child and adolescent psychiatrists of an arbitral function over \u201creal\/fake\u201d identities stands in tension with the AWMF recommendations: \u201cIn children before the onset of puberty who show signs of childhood gender incongruence, health professionals should assume that it is not possible to predict persistent gender incongruence in adolescence until the onset of puberty.\u201d (Recommendation II.K3, p. 57). In other words, developmental uncertainty calls for non-presumptive support, not identity certification. <\/p>\n

Clinicians also report a sense of being instrumentalised around puberty blockers: \u201c[\u2026] with children, I have more the impression that they really come seeking this puberty blocker treatment [\u2026] we feel instrumentalised [\u2026] and that they are in an expectation that will be only that [\u2026]\u201d (C19, E11, Table 5). And the pressure felt can become \u201cunbearable\u201d: \u201cI want this [\u2026] give me what I want [\u2026] right now\u201d (C20, E3, Table 5). Some stances then assert a firm temporisation: \u201cWe are just going to support you to limit the risk that he develops a reactive mental illness [\u2026] I never accept being put under pressure [\u2026] if I don\u2019t feel it [\u2026] well, manage without me [\u2026] we take our time\u201d (C46, E1, Table 5). <\/p>\n

The concern not to give in to haste is legitimate. But it must be articulated with clinical recommendations grounded in scientific evidence: the AWMF thus recommends opening safe spaces for gender exploration in a reversible way and without presuming the outcome, in order to support exploration and, where appropriate, improve later decision-making regarding medical interventions (VI.K3: \u201csafe social space,\u201d p. 137). Caution is not inaction: it is the establishment of a secure framework guided by the child\u2019s needs and voice. <\/p>\n

The empirical material moreover shows that psychosocial support improves children\u2019s wellbeing: \u201canxiety symptoms improve [\u2026] [Name] starts playing the guitar, has a few more friends [\u2026] we see the effect it has, if it\u2019s positive, we maintain it [\u2026] Precisely, we try to support\u201d (C47, E10, Table 5). This converges with scientific evidence: in Chapter III, \u00a7 4.2 (AWMF, pp. 56-58), psychosocial support, information about varied trajectories, and the reversibility of social steps are presented as useful interventions regardless of any future decisions about possible medicalisation. <\/p>\n

Under conditions of anonymity, several clinicians describe their exhaustion in the face of \u201cpressure\u201d and the lack of shared reference points. The risk, then, is a return to a logic of epistemic paternalism (the physician decides, the child aligns) rather than informed shared decision-making. The AWMF, cautious about levels of evidence, precisely proposes a procedural roadmap: transparent information, explicit acknowledgement of uncertainty, co-decision, family and school safety nets, and the possibility of going back without stigmatisation (II.K1-K3, pp. 56-58; VI.K5-K6, pp. 137-138). This is the infrastructure that allows the child to be heard without trapping them, either through acceleration or through obstruction. <\/p>\n

Overall, the study reveals a contrast: the more social pressure is felt, the more some child and adolescent psychiatrists harden into positions of control, at the risk of undermining children\u2019s self-determination. Yet the AWMF insists that the progressive autonomy of minors in matters of gender identity must be recognised and supported; and that \u201cdelaying or preventing\u201d without proportionate justification can increase suffering (ethical reminder in the preamble; and, in practice, \u00a7 4.2 of Chapter III on recommendation III.K2 supporting self-determination in children\u2019s social transition). The balanced path is clear: precaution (acknowledging uncertainty, avoiding premature over-medicalisation), openness (social exploration within a secure, reversible framework, VI.K3), family support (VI.K5-K6), and centring the child\u2019s voice (II.K1-K3). It is this architecture – and not suspicion (\u201cfashion effects\u201d) – that truly offers protection. <\/p>\n

In other words, to the question \u201chow do we avoid making a mistake?\u201d, the article responds indirectly: by relinquishing the power to decide who is \u201creal\u201d or \u201cfake,\u201d by defusing pressure through reversible frameworks (VI.K3), and by making the child a co-author of their trajectory through clear information about the range of possibilities, including detransition (II.K2). This is precisely the spirit of the AWMF recommendations (Chapter III, \u00a7 4.2, pp. 56-58): care grounded in self-determination, co-decision, and non-predetermination of outcomes. Under these conditions, teams move from a role of \u201cgatekeepers\u201d to the more demanding role of guarantors of a safe space in which children can genuinely determine themselves. [\/vc_column_text][\/vc_column][\/vc_row][vc_section][vc_row section_type=”container-width”][vc_column]

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\r\n\t\t\t\t\t\tThe Netherlands strengthens its gender-affirming care model for trans minors<\/span><\/a>\r\n\t\t\t
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The Netherlands strengthens its gender-affirming care model for trans minors<\/span><\/h3><\/a>\t\t\t
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The evidence supports gender-affirming care\n<\/p>Read more<\/span>\t\t\t\t\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t<\/svg>\r\n\t\t\t<\/a>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t

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\r\n\t\t\t\t\t\tPuberty Blockers and Suicidality: New Study of 230,000 Youths<\/span><\/a>\r\n\t\t\t
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Puberty Blockers and Suicidality: New Study of 230,000 Youths<\/span><\/h3><\/a>\t\t\t
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Lower Suicidality Among Transgender Youths\n<\/p>Read more<\/span>\t\t\t\t\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t<\/svg>\r\n\t\t\t<\/a>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t

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\r\n\t\t\t\t\t\tWithout consent: the scientific misconduct scandal at Norway\u2019s national centre for trans youth<\/span><\/a>\r\n\t\t\t
\"Oslo<\/div><\/div>\t\t<\/div>\r\n\t\t\t\t\t\t
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Without consent: the scientific misconduct scandal at Norway\u2019s national centre for trans youth<\/span><\/h3><\/a>\t\t\t
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Illegitimate research on trans minors\n<\/p>Read more<\/span>\t\t\t\t\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t<\/svg>\r\n\t\t\t<\/a>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t

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\r\n\t\t\t\t\t\tIt Is False to Say That Medical Transitions Worsen Young People\u2019s Mental Health<\/span><\/a>\r\n\t\t\t
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It Is False to Say That Medical Transitions Worsen Young People\u2019s Mental Health<\/span><\/h3><\/a>\t\t\t
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On the pseudoscientific exploitation of a study\n<\/p>Read more<\/span>\t\t\t\t\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t<\/svg>\r\n\t\t\t<\/a>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t

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\r\n\t\t\t\t\t\tWebinar \u201cA Trans-Skeptical Parenthood\u201d on July 2 at 6:30 p.m.<\/span><\/a>\r\n\t\t\t
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Webinar \u201cA Trans-Skeptical Parenthood\u201d on July 2 at 6:30 p.m.<\/span><\/h3><\/a>\t\t\t
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Trans Youth Trajectories webinar\n<\/p>Read more<\/span>\t\t\t\t\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t<\/svg>\r\n\t\t\t<\/a>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t

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\r\n\t\t\t\t\t\t2.2% of young people in France are trans or non-binary<\/span><\/a>\r\n\t\t\t
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2.2% of young people in France are trans or non-binary<\/span><\/h3><\/a>\t\t\t
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Findings from a nationally representative survey\n<\/p>Read more<\/span>\t\t\t\t\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t\t<\/polygon>\r\n\t\t\t\t<\/svg>\r\n\t\t\t<\/a>\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t

Study on French and Belgian child psychiatrists<\/p>\n","protected":false},"author":1,"featured_media":3500,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[52],"tags":[],"class_list":["post-3501","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","grve-entry-item","grve-blog-item"],"yoast_head":"\nTrans children: what do child psychiatrists think? - Trans Youth Trajectories<\/title>\n<meta name=\"description\" content=\"Study on French and Belgian child psychiatrists\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/trajectoiresjeunestrans.fr\/en\/news\/trans-children-what-do-child-psychiatrists-think\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trans children: what do child psychiatrists think? 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