Gender-Affirming Treatments to Children with Gender Dysphoria
Balancing the Children's Constitutional Rights
Abstract
Gender dysphoria occurs not only in adults but also in underage children. Their inner conviction that their gender identity does not align with their physical body leads to a desire to alter their physical appearance through gender-affirming treatment(s) that affirm their gender identity. Examples include genitoplasty, puberty blockers, and cross-sex hormone therapies. Proponents argue that these desires should be accommodated because everyone, including children, has the right to determine what can be done to their own bodies. Moreover, some findings suggest that such treatments can have positive psychological benefits for these children. On the other hand, opponents question whether the consent given by children who desire such treatments is legitimate. Additionally, providing irreversible medical treatments solely to affirm gender identity can have physiological and psychological impacts. Thus, instead of affirming the desires of these children, medical physicians should focus on saving them from irreversible medical actions. This discourse is conducted by considering proportionally the constitutional rights of children, which need to be balanced with ensuring their knowledge and maturity in making decisions.
Keywords: Children, Gender Dysphoria, Gender-affirming Treatments.
References
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American Psychological Association, “Guidelines for psychological practice with transgender and gender nonconforming people,” (2015) 70:9 American Psychologist 832-864.
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.
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Blok, Christel Josefa Maria de, et. al., “Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study,” (2018) 103:2 The Journal of Clinical Endocrinology & Metabolism 532–538.
C, Polly, Gary B., Una M., et. al, “Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK,” (2021) 16:2 PLoS ONE 1-26.
C., Lopez M., et. al., “Trends in the use of Puberty Blockers among Transgender Children in the United States,” (2017) 2:2 Journal of Pediatric Endocrinology 1-5.
Claahsen, Hedi, et al., “Gender Incongruence and Gender Dysphoria in Childhood and Adolescence—Current Insights in Diagnostics, Management, and Follow Up,” (2021) 180:5 European Journal of Pediatrics 1349-1357.
Cole, Pamela M., et.al., “From children’s expressive control to emotion regulation: Looking back, looking ahead,” (2018) 15:6 Eur J Dev Psychil 658-677.
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D’hoore, Laurens and Guy T’Sjoen, “Gender-affirming hormone therapy: An Updated literature review with eye on the future,” (2022) 291:5 Journal of Internal Medicine 574-592.
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Jorgensen, Sarah C. J., et. al., “Puberty blockers for gender dysphoric youth: A lack of sound science,” (2022) 5:9 Journal of the American College of Clinical Pharmacy 1005-1007.
Kartini, Ade and Asep Maulana, “Redefenisi Gender dan Seks,” (2019) 12:2 Jurnal Kajian Perempuan dan Keislaman 217-239.
Katchadourian, Karine, Amed S, Metzger DL, “Clinical management of youth with gender dysphoria in Vancouver,” (2014) 164:4 J Pediatr 906-911.
Kettenis, Peggy T. Cohen, et.al., “Puberty Suppresion in a Gender Dysphoric Adolescent: A 22-Year Follow-Up,” (2011) 40:4 Arch Sex Behav 843-847.
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Kozlowska, Kasia et. al., “Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service,” (2021) 1:1 Human Systems: Therapy, Culture and Attachments 70-95.
Lavorato, Elisabetta, et.al., “Gender Dysphoria: Overview and Psychological Interventions.” In: Bettocchi, C., Busetto, G.M., Carrieri, G., Cormio, L. (eds) Practical Clinical Andrology (Cham: Springer, 2023): 263-272.
Levine, Stephen B. and E Abbruzzese, “Current Concerns About Gender-Affirming Therapy in Adolescents,” (2023) 15 Current Sexual Health Reports 113–123.
Lips, Hilary M., Sex and Gender (Waveland Press Inc, 2020).
Maharani, Suci and Ashif Az Zafi, “Respons Masyarakat terhadap Pelaku Transgender,” (2020) 9:1 Jurnal Intelektualita: Keislaman, Sosial, dan Sains 197-199.
Majelis Kehormatan Etik Kedokteran Indonesia, “Kode etik kedokteran Indonesia dan pedoman pelaksanaan kode etik kedokteran Indonesia” online at http://mkekidi.id/wp-content/uploads/2016/01/KODEKI-Tahun-2012.pdf.
Marbun, Stefanus and Kalis Stevanus, “Pendidikan Seks Pada Remaja,” (2019) 2:2 Jurnal Teologi Sistematika dan Praktika 325-343.
Maruli, Sahat, Pengantar Sistem Hukum Indonesia: Suatu Tinjauan Teoritis (Bandung: Logoz Publishing, 2020), 17.
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Moretti, Patrizia, et. al., “Dysphoria as a Psychiatric Syndrome: A Preliminary Study for a New Transnosographic Dimensional Approach,” (2018) 30:Suppl7 Psychiatria Danubina, 582-587.
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Newhook, Julia Temple, et al., “Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children,” (2018) 64:5 Canadian Family Physician 332-335.
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Olsavsky, Anna L., Connor Grannis, Josh Bricker, et.al. “Associations Among Gender-Affirming Hormonal Interventions, Social Support, and Transgender Adolescents’Mental Health,” (2013) 72:6 Journal of Adolescent Health 860-868.
Pan, Elizabeth and Rana R. McKay, “GNRH agonists vs antagonists in prostate cancer: How to choose,” UCC, (June 2021), online:.
Parsapoor, Alireza, et. al., “Autonomy of Children and Adolescents in Consent to Treatment: Ethical, Jurisprudential and Legal Considerations,” (2014) 24:3 Iran J Pediatr 24, no. 3 (Mar 2014): 241-248.
Pearse, Lindsey Elizabeth, “Cognitive Development and The Understanding of Informed Consent,” (2008) Thesis, The University of Tennessee at Chattanooga 4-11.
Phillips, Katharine A., “Body dysmorphic disorder: recognizing and treating imagined ugliness,” (2004) 3:1 World Psychiatry 12-17.
Prediger, Christina, et. al., “LGBTQIA+ Adolescents’ Perceptions of Gender Tailoring and Portrayal in a Virtual-Reality-Based Alcohol-Prevention Tool: A Qualitative Interview Study and Thematic Analysis,” (2023) 20:2784 International Journal of Environmental Research and Public Health 1-20.
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Republic of Indonesia, Undang-Undang Perubahan atas Undang-Undang Nomor 23 Tahun 2006 tentang Administrasi Kependudukan, UU No.24 Tahun 2013, LN. 2013/ No.232, TLN No. 5475.
Rocker, Steven, et al. “The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery,” (2019) 16:5 Jurnal Sexual Medicine 661-672.
Roden, Rosemary Claire, “Reversible interventions for menstrual management in adolescents and young adults with gender incongruence,” (2023) 17:6 Ther Adv Reprod Health 1-14.
Ruzaipah, Abdul Manan, dan Qurrota A’yun, “Penetapan Usia Kedewasaan Dalam Sistem Hukum Di Indonesia,” (2021) 1:1 Jurnal Misaqan Ghalizan 1-20.
Seal, Leighton J, “A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria,” (2016) 53:1 Annals of Clinical Biochemistry 10-20.
Shah, Parth, et al., “Informed Consent,” (5 June 2023)online: National Library of Medicine,
Stevenson, Mary O., et.al., “Osteoporosis and Bone Health in Transgender Persons,” (2019) 48:2 Endocrinol Metab Clin North Am 421-427.
Tomson, A, “Gender-affirming care in the context of medical ethics –gatekeeping v. informed consent,” (2018) 11:1 South African Journal of Bioethics and Law 24-28.
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Usmani, Mohammad Amir, et. al., “Treatment of Transvestic Fetishism With Fluoxetine: A Case Report, “ (2012) 6:2 Iran J Psychiatry Behav Sci 100-101.
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Vlot, Markisa C, Daniel T Klink, Martin den Heijer, et. al., “Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents,” (2017) 95 Bone 11-19.
Vries, Annelou L C de, Thomas D Steensma, Theo A H Doreleijers, and Peggy T Cohen-Kettenis, “Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study,” (2011) 8:8 J Sex Med 2276-2283.
Young, Jacpues, et.al., “Clinical Management of Congenital Hypogonadotropic Hypogonadisme,” (2019) 40:2 Endocrine Reviews 669 - 710.
Zamzami, Fitriyan, “Mengejutkan, Terjadi Ledakan Transgender Anak di Barat,” (27 November 2022), online: Republika,.
Zulhasmar and Eric, "Implikasi Hukum Penolakan Tindakan Medik." (2008) 5:2 Lex Jurnalica 83-111.
American Psychological Association, “Guidelines for psychological practice with transgender and gender nonconforming people,” (2015) 70:9 American Psychologist 832-864.
American Psychological Association, “Understanding sexual orientation and homosexuality,” online:
Balien, Natasha H., et.al., “Understanding Emotion in Adolescents: A Review of Emotional Frequency, Intensity, and Clarity,” (2019) 11:1 Emotion Review 63-73.
Barbosa, Mariana, et.al., “Pituitary apoplexy induced by gonadtropin-releasing hormone agonist administration: a rare complication of prostate cancer treatment,” (2020) Endocrinol Diabetes Metab Case Rep 1-6.
BBC Indonesia, “Operasi kelamin gagal, transeksual minta disuntik mati,” (3 October 2013), online:
Biggs, Michael, “Puberty lockers and suicidality in adolescents suffering from gender dysphoria,” (2021) 50:4 Archive Sex Behaviour 2227-2229.
Bizic, Marta R., Milos J, Slavica P, et. al., “Gender Dysphoria: Bioethical Aspects of Medical Treatment,” (2018) BioMed Research International 1-6.
Blok, Christel Josefa Maria de, et. al., “Breast Development in Transwomen After 1 Year of Cross-Sex Hormone Therapy: Results of a Prospective Multicenter Study,” (2018) 103:2 The Journal of Clinical Endocrinology & Metabolism 532–538.
C, Polly, Gary B., Una M., et. al, “Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK,” (2021) 16:2 PLoS ONE 1-26.
C., Lopez M., et. al., “Trends in the use of Puberty Blockers among Transgender Children in the United States,” (2017) 2:2 Journal of Pediatric Endocrinology 1-5.
Claahsen, Hedi, et al., “Gender Incongruence and Gender Dysphoria in Childhood and Adolescence—Current Insights in Diagnostics, Management, and Follow Up,” (2021) 180:5 European Journal of Pediatrics 1349-1357.
Cole, Pamela M., et.al., “From children’s expressive control to emotion regulation: Looking back, looking ahead,” (2018) 15:6 Eur J Dev Psychil 658-677.
Coleman, Eli, et. al., “Standards of care for the health of transgender and gender diverse people,” (2022) 23:Suppl 1 Int J Transgend Health S1-S259.
Cooper, Kate, et al., “The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis,” (2020) 80:101875 Clinical Psychology Review.
Council of Europe, “Free and informed consent as a core principle of the protection of human rights in the field of biomedicine,” (18 December 2017), online:
D, Mittan, Lee S, Miller E, et. al, “Standards of care for the health of transsexual, transgender, and gender-nonconforming people,” (2011) 13 Int J Transgenderism 165-232.
D’hoore, Laurens and Guy T’Sjoen, “Gender-affirming hormone therapy: An Updated literature review with eye on the future,” (2022) 291:5 Journal of Internal Medicine 574-592.
Fisher, Rachel, et. al., “Decisional Regret About Surgical and Non-Surgical Issues After Genitoplasty Among Caregivers of Female Infants with CAH,” (2022) 18:1 Journal of Pediatric Urology 27-33.
Gradinarova, Neli, “Children’s rights and access to health care,” (2023) 2:1 Medical Science and Research 43-48.
Guss, Carly and Catherine M. Gordon, “Pubertal Blockade and Subsequent Gender Affirming Therapy: True, True, and Unrelated?” (2022) 5:11 Jama Network Open 1-3.
H, Asscheman, et. al., “Venous thrombo-embolism as a complication of crosssex hormone treatment of male-to-female transsexual subjects: a review,” (2014) 46 Andrologia 791–795.
Hakeem, Az, “Psychotherapy for gender identity disorders,” (2012) 18 Advances in psychiatric treatment 17–24.
Hari, Christiana, Seri Psikologi Perkembangan: Perkembangan Anak Sejak Pembuahan Sampai dengan Kanak-kanak Akhir (Kencana, 2018).
Heijer, Martin den, Alex Bakker, and Louis Gooren, “Long Term Hormonal Treatment for Transgender People,” (2017) 359:j5027 British Medical Journal.
Hembree, et. al., “Guidelines on Gender Dysphoric/Gender-Incrongruent Persons,” (2017) 102:11 J Clin Endocrinol Metab (3869-3903).
Horton, Cal, “Experiences of Puberty and Puberty Blockers: insights From Trans Children, Trans Adolescents, and Their Parents,” (2022) Journal of Adolescent Research 1-27.
Humas FKU UGM, “Otonomi vs Paternalisme: Mana yang Lebih Baik?” (19 May 2023), online: Fakultas Kedokteran, Kesehatan Masyarakat, dan Keperawatan Universitas Gadjah Mada
Ikatan Dokter Anak Indonesia, “Panduan Etika dan Perilaku Profesi Dokter Spesialis Anak Indonesia” online at https://www.idai.or.id/professional-resources/ethic/pep-dsai.
Ikatan Dokter Anak Indonesia, Panduan Etika dan Perilaku Profesi Dokter Spesialis Anak Indonesia, (2014).
Indonesia, Keputusan Presiden tentang Pengesahan Convention on the Rights of the Child, Keppres No. 36 Tahun 1990.
Irwig, Michael, “Detransition Among Transgender and Gender-Diverse People—An Increasing and Increasingly Complex Phenomenon,” (2022) 107:10 The Journal of Clinical Endocrinology and Metabolism e4261-e4262.
Jorgensen, Sarah C. J., et. al., “Puberty blockers for gender dysphoric youth: A lack of sound science,” (2022) 5:9 Journal of the American College of Clinical Pharmacy 1005-1007.
Kartini, Ade and Asep Maulana, “Redefenisi Gender dan Seks,” (2019) 12:2 Jurnal Kajian Perempuan dan Keislaman 217-239.
Katchadourian, Karine, Amed S, Metzger DL, “Clinical management of youth with gender dysphoria in Vancouver,” (2014) 164:4 J Pediatr 906-911.
Kettenis, Peggy T. Cohen, et.al., “Puberty Suppresion in a Gender Dysphoric Adolescent: A 22-Year Follow-Up,” (2011) 40:4 Arch Sex Behav 843-847.
Kimberly, Laura L, Folkers KM, Friesen P, et.al, “Ethical issues in gender-affirming care for youth,” (2018) 142:6 Pediatrics.
Komodo Health, “Komodo Findings Point To Rising Healthcare Needs for Transgender Youth,” (6 October 2022), online: Komodo Health
Kozlowska, Kasia et. al., “Australian children and adolescents with gender dysphoria: Clinical presentations and challenges experienced by a multidisciplinary team and gender service,” (2021) 1:1 Human Systems: Therapy, Culture and Attachments 70-95.
Lavorato, Elisabetta, et.al., “Gender Dysphoria: Overview and Psychological Interventions.” In: Bettocchi, C., Busetto, G.M., Carrieri, G., Cormio, L. (eds) Practical Clinical Andrology (Cham: Springer, 2023): 263-272.
Levine, Stephen B. and E Abbruzzese, “Current Concerns About Gender-Affirming Therapy in Adolescents,” (2023) 15 Current Sexual Health Reports 113–123.
Lips, Hilary M., Sex and Gender (Waveland Press Inc, 2020).
Maharani, Suci and Ashif Az Zafi, “Respons Masyarakat terhadap Pelaku Transgender,” (2020) 9:1 Jurnal Intelektualita: Keislaman, Sosial, dan Sains 197-199.
Majelis Kehormatan Etik Kedokteran Indonesia, “Kode etik kedokteran Indonesia dan pedoman pelaksanaan kode etik kedokteran Indonesia” online at http://mkekidi.id/wp-content/uploads/2016/01/KODEKI-Tahun-2012.pdf.
Marbun, Stefanus and Kalis Stevanus, “Pendidikan Seks Pada Remaja,” (2019) 2:2 Jurnal Teologi Sistematika dan Praktika 325-343.
Maruli, Sahat, Pengantar Sistem Hukum Indonesia: Suatu Tinjauan Teoritis (Bandung: Logoz Publishing, 2020), 17.
Messinger, Adam M, et. al., “Transgender Polyvictimization in the U.S. Transgender survey,” (2022) 37:19-20 J Interpers Violence.
Moretti, Patrizia, et. al., “Dysphoria as a Psychiatric Syndrome: A Preliminary Study for a New Transnosographic Dimensional Approach,” (2018) 30:Suppl7 Psychiatria Danubina, 582-587.
National Health Service England, “NHS commissioning: Implementing advice from the Cass Review,” (Juni 2023), online:
Newhook, Julia Temple, et al., “Teach your parents and providers well: Call for refocus on the health of trans and gender-diverse children,” (2018) 64:5 Canadian Family Physician 332-335.
Nurhayati, Bernadeta Resti and Hartyo Purwanto, “Kajian Terhadap Pemenuhan Hak Asasi Manusia Anak dalam Pelaksanaan Informed Consent Pasien Anak,” (2022) 3:2 Jurnal Pacta Sunt Servanda 155-162.
Olsavsky, Anna L., Connor Grannis, Josh Bricker, et.al. “Associations Among Gender-Affirming Hormonal Interventions, Social Support, and Transgender Adolescents’Mental Health,” (2013) 72:6 Journal of Adolescent Health 860-868.
Pan, Elizabeth and Rana R. McKay, “GNRH agonists vs antagonists in prostate cancer: How to choose,” UCC, (June 2021), online:
Parsapoor, Alireza, et. al., “Autonomy of Children and Adolescents in Consent to Treatment: Ethical, Jurisprudential and Legal Considerations,” (2014) 24:3 Iran J Pediatr 24, no. 3 (Mar 2014): 241-248.
Pearse, Lindsey Elizabeth, “Cognitive Development and The Understanding of Informed Consent,” (2008) Thesis, The University of Tennessee at Chattanooga 4-11.
Phillips, Katharine A., “Body dysmorphic disorder: recognizing and treating imagined ugliness,” (2004) 3:1 World Psychiatry 12-17.
Prediger, Christina, et. al., “LGBTQIA+ Adolescents’ Perceptions of Gender Tailoring and Portrayal in a Virtual-Reality-Based Alcohol-Prevention Tool: A Qualitative Interview Study and Thematic Analysis,” (2023) 20:2784 International Journal of Environmental Research and Public Health 1-20.
Republic of Indonesia, Kitab Undang-Undang Hukum Perdata.
Republic of Indonesia, Undang-Undang Kesehatan, UU No. 17 Tahun 2023, LN. 2023/No.105, TLN No. 6887.
Republic of Indonesia, Undang-Undang Perkawinan, UU No.1 Tahun 1974, LN. 1974/ No.1, TLN No. 3019.
Republic of Indonesia, Undang-Undang Perlindungan Anak, UU No. 35 Tahun 2014, LN No. 297 Tahun 2014, TLN No. 5606.
Republic of Indonesia, Undang-Undang Perubahan atas Undang-Undang Nomor 23 Tahun 2006 tentang Administrasi Kependudukan, UU No.24 Tahun 2013, LN. 2013/ No.232, TLN No. 5475.
Rocker, Steven, et al. “The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery,” (2019) 16:5 Jurnal Sexual Medicine 661-672.
Roden, Rosemary Claire, “Reversible interventions for menstrual management in adolescents and young adults with gender incongruence,” (2023) 17:6 Ther Adv Reprod Health 1-14.
Ruzaipah, Abdul Manan, dan Qurrota A’yun, “Penetapan Usia Kedewasaan Dalam Sistem Hukum Di Indonesia,” (2021) 1:1 Jurnal Misaqan Ghalizan 1-20.
Seal, Leighton J, “A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria,” (2016) 53:1 Annals of Clinical Biochemistry 10-20.
Shah, Parth, et al., “Informed Consent,” (5 June 2023)online: National Library of Medicine,
Stevenson, Mary O., et.al., “Osteoporosis and Bone Health in Transgender Persons,” (2019) 48:2 Endocrinol Metab Clin North Am 421-427.
Tomson, A, “Gender-affirming care in the context of medical ethics –gatekeeping v. informed consent,” (2018) 11:1 South African Journal of Bioethics and Law 24-28.
Transgender Trend, “Are puberty blockers reversible? The NHS no longer says so,” (30 June 2020), online:
Treaty Office, “Details of Treaty No.164,” online: Council of Europe,
United Brain Association, “Transvestic Disorder,” online:
Usmani, Mohammad Amir, et. al., “Treatment of Transvestic Fetishism With Fluoxetine: A Case Report, “ (2012) 6:2 Iran J Psychiatry Behav Sci 100-101.
Varkey, Basil, "Principles of Clinical Ethics and Their Application to Practice," (2021) 30:1 Medical Principles and Practice 17-28.
Vlot, Markisa C, Daniel T Klink, Martin den Heijer, et. al., “Effect of pubertal suppression and cross-sex hormone therapy on bone turnover markers and bone mineral apparent density (BMAD) in transgender adolescents,” (2017) 95 Bone 11-19.
Vries, Annelou L C de, Thomas D Steensma, Theo A H Doreleijers, and Peggy T Cohen-Kettenis, “Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study,” (2011) 8:8 J Sex Med 2276-2283.
Young, Jacpues, et.al., “Clinical Management of Congenital Hypogonadotropic Hypogonadisme,” (2019) 40:2 Endocrine Reviews 669 - 710.
Zamzami, Fitriyan, “Mengejutkan, Terjadi Ledakan Transgender Anak di Barat,” (27 November 2022), online: Republika,
Zulhasmar and Eric, "Implikasi Hukum Penolakan Tindakan Medik." (2008) 5:2 Lex Jurnalica 83-111.
Published
2024-06-29
How to Cite
TAQWA, Muhamad Dzadit; YUUBINA, Venitta; MANURUNG, Stephen Joy Herald.
Gender-Affirming Treatments to Children with Gender Dysphoria.
Journal of Southeast Asian Human Rights, [S.l.], v. 8, n. 1, june 2024.
ISSN 2599-2147.
Available at: <https://jurnal.unej.ac.id/index.php/JSEAHR/article/view/43469>. Date accessed: 03 july 2024.
doi: https://doi.org/10.19184/jseahr.v8i1.43469.
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
