In view of a Gozo court ruling to have a nine-year-old girl’s gender identity legally changed, aiming for a more serene life for the child, I feel compelled to share the following comments on the current state of play surrounding transgender children and adolescents.

Children and adolescents are a special case for issues of gender identity and expression. In the course of their development, many children express the idea of being of the opposite sex. However, robust research shows that nearly all children ultimately identify with their biological sex.

A consensus exists that for adolescents who exhibit a long history of gender non-conformity, self-affirmed gender identity is likely to be stable. Persistence, insistence and consistency are generally recognised as the distinguishing features of stability.

That said, it cannot be overstated that parents should always allow their children freedom to return to a gender identity that aligns with the sex assigned at birth or another gender identity at any point.

The aforementioned child’s feelings as a girl are reported to have been strong and persistent since she was around three years old.  She is now nine. Proper support seems have been provided to the child by her parents and professionals alike through the process of exploration and self-identification. The family hopes the government’s promised gender clinic and gender reassignment clinic will also take into consideration transgender children.

I acknowledge the fear and responsibility that the child’s parents may feel as they make their decisions about the welfare of their daughter. Regrettably, the road ahead is fraught with risks.

Various reputable studies confirm that there is no single, large, randomised and controlled study that documents the alleged potential benefits and harms to cross-gender children from pubertal suppression and decades of cross-sex hormone use, or that compares the outcomes of various psychotherapeutic and medical interventions for transgender childhood with those of pubertal suppression followed by decades of toxic synthetic steroids.

This alone should give parents, the legal and healthcare professionals, government agencies and the courts pause for thought.

Parents should always allow their children freedom to return to a gender identity that aligns with sex assigned at birth or another gender identity

As consultant psychiatrist and psychotherapist Peter Muscat rightly put it: “A transgender child needs to be followed up and monitored at regular intervals because of the psychological and physical issues that may arise.

“There is schooling to be considered, besides social interactions, sports and other non-curricular activities. There is hormonal suppression to be addressed pre-puberty and sex reassignment surgery in late adolescence. It is an ongoing process that may need to be continued even after sex reassignment surgery.”

There is an online community of gay-affirming physicians, mental health professionals and academics who on their home page, ‘First, do no harm: youth trans-critical professionals’, write: “We are concerned about the current trend to quickly diagnose and affirm young people as transgender, often setting them down a path toward medical transition… We feel that unnecessary surgeries and/or hormonal treatments which have not been proven safe in the long-term represent significant risks for young people.

“Policies that encourage – either directly or indirectly – such medical treatment for young people, who may not be able to evaluate the risks and benefits, are highly suspect, in our opinion.”

Children and adolescents are not guinea pigs. They deserve compassionate care rooted in sound scientific and medical evidence, which presently simply does not exist. Parents, the legal and healthcare professionals, government agencies and the courts need to carefully reflect on their personal values and beliefs about gender identity development in conjunction with available research and keep the best interests of the child and adolescent at the forefront of their deliberations and conclusions.

Children are not only legally but also cognitively incapable of informed consent on the nature and duration of their treatments, particularly on the risks associated with medical interventions. Informed consent is a fundamental ethical requirement.

Moreover, the Convention of the Rights of the Child says: “In all actions concerning children, whether undertaken by public or private social welfare institutions, court of law, administrative authorities or legislative bodies, the best interests of the child should be the primary consideration.”

Following a publication of rising child referral figures from the Tavistock Clinic, a day conference was held there last June which attracted leading professionals from across Europe to share their expertise and research in the area of transgender and gender diverse children and adolescents.

It is reported that the central theme of the day was perhaps the point at which social and political change meets clinical care of children, and the ethical considerations this generates.

The take-home message was the need for caution, as well as more research and evidence, in view of the climate of media-generated hyperbole, sensationalism and cheerleading on the one hand and political silencing of debate on the other.

Frank Muscat is a retired guardian ad litem and reporting officer (London)and retired member of the Law Society Child Care Panel Interviewer (London).