The care of transgender children and adolescents in France: Recent controversies and ethical issues

In recent years the medical community has been crossed by societal debates around gender, sex, procreation, and human rights. Also, questions around the medical care of transgender children and adolescents very regularly come to the fore in the media leading colleagues to seek prohibiting hormonal treatment until the age of 25 years. In the current report, we propose to explore all controversial proposals in the field of contemporary transgender care, i.e.: social transition, puberty suppression with GnRH, hormonal transition, and surgical transition. In addition, we expose the way such a practice is ongoing in France. If most of the clinical studies carried out internationally for more than 25 years have shown considerable positive impacts of the medical care of adolescents on their psychological future and emphasizing the relative safety of the treatments, the psychodynamic support remains essential considering the uniqueness of each patient over the course of the meetings. A long period of time is sometimes required, while sometimes it is contraindicated depending on each clinical situation. Drug prescriptions before puberty are not permitted, and for adolescents the average time between the first consultation (for which they often waited a year) and a possible prescription is one year. As transgender children and adolescents are a particularly vulnerable population, doing no harm does not always mean refraining from prescribing, and each clinical situation has to be assessed in its uniqueness with care and discernment. Since 2015 in France these decisions are taken after assessment during multidisciplinary concertation meetings. Beyond societal opinions and debates, real ethical issues must be considered, especially around the notion of free and informed consent in children and adolescents, and research must continue.