Over the past ten years, we have seen, first in Anglo-Saxon countries and more recently in France, a very strong increase in the number of people declaring themselves transgender: often young girls, suddenly in adolescence without apparent sign during childhood, a phenomenon described as "epidemic-like" by the Academy of Medicine.
We are delighted that the increased visibility of "trans" people allows them better recognition and a reduction in discrimination against them. However, we are concerned about the over-representation of young people with autism and ADHD (Attention Deficit Hyperactivity Disorder) self-identifying as transgender and wishing to transition.
For what ? Because young NDD (neurodevelopmental disorders) are more vulnerable! Sensory issues, social anxiety, feeling out of step with the social dimension of sexuality, tendency to imitate others in a formal way, frequent indifference to sexual social stereotypes, all typical phenomena of autism, can be interpreted as signs of trans identity (see Autism and gender identity report by J. Galloway, autistic person).
Young people with autism are frequently socially isolated when, like everyone else, they feel a need to belong to a group: this isolation, often coupled with gender non-conformity – common among so-called “autistic” people – makes them very sensitive to the trans community, in which they can feel accepted and valued in their difference, without having all the keys to decode that the process leads them to irreversible physical transformations.
We are alerted by the fact that professionals are following a trans affirmative approach in first intention: allowing all those who request it (including minors) to access hormonal and surgical treatments as soon as possible, without psychotherapeutic follow-up, without necessarily taking into account frequently associated disorders, such as autism or ADHD. We question this trans affirmative approach in minors, given:
- that complex presentations lead to many possible pathways, as Dr Cass points out in his independent review of gender identity services commissioned by England's National Health Service. It is risky to subject minors to medical transition due to psychological distress which may be rooted in several other types of underlying issues;
- that the formation of identity in young people is an evolutionary process. Childhood gender incongruence often resolves naturally in adulthood;
- that the disorders and conditions frequently associated with gender incongruence such as autism, ADHD or anorexia, are not sufficiently taken into account: as Professor Gillberg points out in a collective letter addressed to the Swedish Ministry of Health Health in November 2018, "it cannot be excluded that proper investigation, treatment and stabilization of these would reduce or completely eliminate the need for medical transition for a significant number of people";
- that reviews of the evidence commissioned by Sweden, England, Finland, on puberty blockers and gender-affirming hormones, all conclude that the evidence base is of very low quality, calling for the need to carefully weigh the low-certainty benefits against the significant risks of these interventions. This has led these countries and some American states to review the care pathway to move in the direction of caution;
- that, as the Academy of Medicine points out, more and more people regret their transition, or are detransitioning: studies conclude that for some of them, their problems do not come from transidentity, these people believing also not being sufficiently informed about the implications of treatments and surgery on their health.
For all these reasons, we ask that psychosocial support that helps the young person to live with the pubertal development of their body without drugs be the first option in their care pathway, just as Sweden, England or Finland advocate . As Professor Gillberg, who warned in 2019 about experimental gender-affirming treatments, mentions, it is common for these autistic young people to "have even more identity problems at puberty - who am I? How should I behave? What will I become ? Am I straight? – than the average youngster.
Often, the diagnosis of autism and/or ADHD comes months after the young person has started to question their gender: all their thoughts usually revolve around how to transition as quickly as possible, encouraged by the community, not living more than that. While an early diagnosis would have given him keys to better understand his functioning, and perhaps to accept his body as it is. Anyway, we think it is important to accept the child as he is, and to see what will happen when he grows up, accompanying him, with a global and developmental approach. .
We consider that gender affirmation care should be reserved for adults with resistant gender dysphoria, which prevents them from living. And that they should be offered exceptionally in children, whose clear identification of the opposite sex appears in childhood and causes obvious suffering in adolescence.
While the High Authority for Health is in the process of developing recommendations on the care pathway for transgender people, we are surprised that it did not consider it useful to consult specialists in autism and other neurodevelopmental disorders, knowing, however, the overrepresentation of people with autism and ADHD among young people declaring themselves transgender.
We call on the government to be extremely vigilant that these recommendations take into account the reviews of the evidence of the precursor countries, based on the available scientific data, absent of any ideology, based on the evidence, and respecting ethics. of medicine.
*The signatories: André Masin (president of the AFG Autisme association); Danielle Artuso (director of EDI training); Christine Getin (president of Tdah France); the collegiate council and founding members of Autistic People for Responsible and Innovative Self-Determination; Jean-Marc Monguillet (president of Autisme en Ile de France); Isabelle Rolland (co-president of Autistes Sans Frontières); Hélène Hardiman Taveau (president of Asperger Aide France); Florent Chapel (president of the Association Autisme Info Service); Catherine Pivolos (Asperger's Star); Autism Café, the association of parents and people with ASD; Yenny Gorce (President of Living and Working Differently); Cécile Coudert (Psychologist Neuropsychologist specialized in Autism Spectrum Disorder (ASD)
