The watchful waiting model
The “watchful waiting” model was designed by the members of the interdisciplinary team at the Amsterdam Center of Expertise on Gender Dysphoria, VU University Medical Center, under the leadership of Dr Peggy Cohen-Kettenis. Borrowing from the medical use of GnRH agonists for children exhibiting precocious puberty, the Netherlands team is responsible for introducing the use of puberty blockers for gender purposes, to put a pause on pubertal growth and allow more time for a youth to explore their gender and consolidate their adolescent gender identity, with the future possibility of cross-sex hormone therapy to align their bodies with their affirmed gender identity. In contrast to the live in your own skin approach, a young child’s demonstration of gender nonconformity, be it in identity, expressions, or both, is not to be manipulated in any way, but observed over time. If a child’s cross-gender identifications and affirmations are persistent over time, interventions are made available for a child to consolidate a transgender identity, once it is assessed, through therapeutic intervention and psychometric assessment, as in the best interests of the child. These interventions include social transitions (the shift from one gender to another, including possible name change, gender marker change, and gender pronoun changes), puberty blockers, and later hormones and possible gender-affirming surgeries. No attempts are made to alter a child’s gender identity or expressions; yet it is postulated in this model that it would be better to hold off until puberty on any social transitions of a child from one gender to another, and instead give them safe spaces to fully express their gender as they prefer before facilitating any full gender transitions.18,19 The rationale for holding off on any social transitions until adolescence is not to ward off a transgender identity but rather that 1) it would be advantageous that a child experiences the first stages of physical puberty for that child to best make a determination of the gender that feels most authentic to him/her; 2) given developmental stages of childhood, facilitating a social transition from one gender to another at a young age may create a form of cognitive constriction – the child may be prematurely blocked from considering any other possibilities once moved into a cross-gender status and socially constricted from further childhood gender exploration because now they know the cross-gender identity is what everyone has come to expect from them; 3) socially transitioning a child at a very young age may preclude the child from maintaining a realistic understanding of their body and historical status – as a penis-bodied (once a boy) or a vagina-bodied (once a girl) person. In informing their practices, this model, like the live in your own skin model, relies on the data gathered about “persisters” and “desisters”, both at their own clinic in the Netherlands and in other international studies, particularly those conducted at the Centre for Addiction and Mental Health (CAMH) gender program in Toronto. In the most recent review of these studies, it was found that 63% of the children seeking services at a gender clinic at a young age, and diagnosed with gender dysphoria, no longer had that diagnosis at puberty, while 37% did have the diagnosis consistently from early childhood to adolescence.20 Since a large majority of gender nonconforming young children seeking services at gender clinics desist in their gender dysphoria by adolescence, best practices would be to wait and see if the child persists into adolescence before making any significant changes in a child’s gender identity.
During the preadolescent waiting period, the children are followed carefully by the clinical team in the watchful waiting model, with the support of outside therapists in the community (which is required before a child can receive medical services), to assure that the children are growing well and getting their emotional needs met, and in preparation for later transitioning and medical interventions if the child proves to be a good candidate. Like in the live in your own skin model, the children going through the program also receive a full battery of psychological tests, documenting not only their gender status but also their cognitive–social–emotional functioning. Some of these instruments are delivered to the children directly, some to their parents or teachers.
If the mother asking for help with her 4-year-old were to attend the Amsterdam clinic with her child, the team might do an assessment and advise that the 4-year-old be followed over time, with the understanding that if her son’s declarations of wanting to be a girl persisted over time and if he continued to be drawn only to “girl” toys and activities, consideration of puberty blockers to buy more time to explore gender could certainly happen later, but for now it would be best to let her son continue to be a son free to explore whatever activities he enjoyed, with no corrections on his expressed desire to be a girl.
Gender nonconforming youth: current perspectives - PMC
Beginning with a case vignette, a discussion follows of the reformulation of theories of gender development taking into consideration the recent upsurge of gender nonconforming and transgender youth presenting for gender services and also in the ...
www.ncbi.nlm.nih.gov
Watchful waiting doesn’t mean no puberty blockers: Anti-trans researchers misrepresent academic…
In the latest issue of the American Journal of Bioethics, a peer commentary by Michael Laidlaw, Michelle Cretella, and G. Kevin Donovan…
As I apprehend "watchful waiting" and the "Dutch model" from the 2 above articles, hormone therapy and gender choice reinforcement are simply delayed to 12 years old. Correct me if I am wrong.
