we explain to you what is contained in the Republican bill, which worries trans associations

The Senate examines on Tuesday a text submitted by the LR group which plans to strongly restrict treatments and medical procedures accessible to young transgender people.

This is the new hobby horse of Republican senators. On Tuesday, May 28, the Senate examined a bill from the LR group which restricts the possibility for transgender minors (whose birth sex and perceived gender do not coincide) to make a medical transition. The text notably plans to prohibit the prescription of hormonal treatments before the age of 18 and to limit access to puberty blockers. It also introduces an obligation to review within five years of its promulgation, “to take into account possible advances in scientific knowledge”.

In 2020, just under 300 minors declared a long-term condition for transidentity (a status giving the right to reimbursement for certain care), recalls a report from the General Inspectorate of Social Affairs (Igas) published in March 2022. But the increase in the number of consultations of young people on gender questions questions LR senators. “We must be able to give time to minors who have questions” on their identity, explains Senator Jacqueline Eustache-Brinio, head of the working group that drafted the bill. A similar text was tabled by elected representatives of the National Rally in the Assembly, but has not yet been included on the agenda.

The bill, largely reworked in the Social Affairs Committee, partly takes up the recommendations of a recent report published by LR senators, already denounced by associations of transgender people and most of the medical community. If adopted, the text studied Tuesday “would be one of the most restrictive in the world in terms of care for trans minors”, worries Anaïs Perrin-Prevelle, director of the Outrans association. A petition asking parliamentarians to reject it was signed by more than 50,000 people. Franceinfo details the content of this text and the criticisms expressed by those who oppose it.

Limiting puberty blockers

Article 1 of the proposed law restricts trans minors’ access to puberty blockers, which delay their development. They allow children questioning gender to “take time” to explore their identity, and to avoid puberty which can be “violent” if it is not experienced in the gender with which they identify, explains Morgann Gicquel, president of the Espace santé trans association. But these treatments “are used, in the case of gender transitions, without specific marketing authorization”, denounces for her part senator LR Jacqueline Eustache-Brinio. A common situation for prescriptions of all kinds in pediatrics, recalled the National Council of the Order of Physicians in 2020.

The initial bill planned to completely ban these blockers. The Senate Social Affairs Committee reconsidered this choice, but decided to strongly regulate their authorization. The text now provides that a decree will list reference centers specializing in medical support for trans minors. Only doctors practicing there will be able to prescribe these treatments, after consulting a multidisciplinary commission. Patients will only be able to access it after having been followed for at least two years, if it is established that they have their “capacity of discernment”.

Associations of trans people denounce this framework which they consider too restrictive. “When you discover that you are trans, it is very complicated to talk about it to your family. Very often, children only speak when puberty begins because they have difficulty coping with the changes they are going through. They have to wait two years, it will already be too late”underlines Anaïs Perrin-Prevelle.

“It’s unimaginable to have puberty blockers prescribed at 17, because puberty has already passed that point.”

Morgann Gicquel, president of Espace santé trans

at franceinfo

The two women also fear that this minimum duration of follow-up “rushes children’s choices into gender questioning.” “We will immediately push them to embark on a medical course if they want to have access to blockers, without first giving them the possibility of exploring their claimed gender without constraint”, by adopting a new first name or changing the way you dress, for example, notes Anaïs Perrin-Prevelle. The associations also denounce the limitation of these prescriptions to specialized centers, fearing a “territorial disparity”. Conversely, they want patients to be able to be accompanied by their usual doctor.

The ban on hormonal treatments and reassignment surgeries

The first article of the text also plans to prohibit health professionals from prescribing to a minor hormonal treatments which allow them to develop the physical characteristics of the gender with which they identify, such as worsening of the voice or the growth of the breasts. Adolescents who have already started treatment will nevertheless be able to continue it. The text also prohibits gender reassignment surgical operations among young people, which are already very limited. The Senate Social Affairs Committee “considered it essential to give minors time to think about the advisability of long, heavy and difficult to reverse treatments”she justifies in her report.

Article 2 also provides that doctors who do not respect these bans, or the limited conditions for prescribing puberty blockers, may be punished with two years’ imprisonment and a fine of 30,000 euros.

Depriving young trans people of the possibility of hormonal treatment is “dangerous” for their health, alert the associations for their part. Anaïs Perrin-Prevelle, director of Outrans, fears in particular that in the absence of access to these treatments, trans children will remain on puberty blockers longer than today. In the long term, these treatments can nevertheless cause problems with bone density. Without hormonal treatment possible, young people stopping blockers or not having taken them will experience puberty of the kind in which they do not recognize themselves. A devastating psychological process which will require, for some, to then resort to “surgical operations that could have been avoided thanks to hormonal treatments”she says.

Some adolescents also risk engaging in a clandestine medical transition, by purchasing products on the internet, which could lead to “significant damage to health”. The LR bill “introduces discrimination between cis and trans children” by prohibiting only the latter from accessing surgery, also denounces Anaïs Perrin-Prevelle. Currently, surgical procedures related to transition that affect the genitals are prohibited in minors.

But adolescents, whether transgender or cisgender (whose birth sex and gender identity coincide), can resort to cosmetic surgery for the rest of the body. Rare trans boys therefore decide, during adolescence, to undergo torsoplasty (removal of the chest and masculinization of the thorax) so that their physical appearance is more in line with their gender.

The establishment of a national strategy for child psychiatry

Article 3 of the Republican bill calls for the establishment of a “national strategy for child psychiatry” so that any child or adolescent “benefits (…) from the means enabling him to regain a state of psychological well-being”. The report of the LR working group, prior to the text examined in Parliament, recalled that a number of minors declaring themselves transgender suffer from disorders such as anxiety, depression, autism or ADHD (attention deficit disorder). The LR senators therefore believed that medical support should primarily fall under psychiatry, even if transidentity has no longer been considered a mental illness in France since 2010.

This proposal aroused opposition from the left and LGBT+ associations, who recalled that the psychological difficulties encountered by trans people were often the consequence of the transphobia of which they were victims in society. They also see in this measure a return of conversion therapies, banned since 2022 in France.

The Social Affairs Committee therefore wanted to differentiate the proposals relating to transidentity and those linked to child psychiatry, which appear in a second chapter of the law. The senators nevertheless continue to demand the presence of a psychiatrist in future specialized centers caring for trans minors.