How to support people who wish to change their gender? Responsible for ruling on this issue, as sensitive as it is politicized, the High Health Authority (HAS) saw part of its work leaked on Thursday, December 12. A document presenting the provisional recommendations of the institution was thus revealed by Le Figaro. The newspaper also made public the names of several of the experts commissioned on the subject.
This is not a first: in June 2023, the identity of several members of this working group responsible for reviewing the scientific literature had already been revealed. The case led to a complaint against X from the High Health Authority. A few months ago, the association Jurists for Children also tried to obtain this list. Without success: his appeal was rejected by the Council of State.
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Faced with these attacks, the HAS denounces the “instrumentalization for polemical purposes” of a document which has “no definitive character” and calls for the “responsibility” of everyone. In an interview with L'Express, Claire Compagnon, member of the HAS College and president of the institution's Recommendations, Relevance, Pathways and Indicators (CRPPI) commission, attempts to reframe the debates, which are far removed from the real missions of the HAS according to her.
L'Express: When and under what conditions was the High Authority of Health contacted?
Claire Compagnon: The HAS was contacted by the Ministry of Health, Olivier Véran, in April 2021. The Ministry of Health has this capacity, as do the associative stakeholders, learned societies and the National Health Insurance Fund. This is part of the usual framework of HAS working procedures. If the HAS accepts the referral, it then sets up a working group responsible for studying the scientific literature relating to the subject of the referral.
What question was asked by the ministry?
The question that was asked to us was that of the medical care of people in the gender transition process. We are not asked to take a position on transidentity, or on the merits of their journey itself.
Could HAS refuse to answer this question?
HAS is an independent institution. We could refuse. But it seems to me that it is in line with the missions of the HAS to develop recommendations on good clinical practices for the care and support of people. We did it to support people suffering from obesity, children more specifically too. We do it on kidney disease, on heart diseases… The journey of these people in gender transition is, in fact, marked by a certain number of meetings, of acts, which require to be looked at with the light of what the international literature says.
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Can trans identity be put on the same level as obesity or kidney disease?
This is not the question posed to us by the ministry. The care pathway for transgender people involves health and social psychological care that needs to be clarified, which is what we are doing.
How was the expert group formed?
Like any work process of the High Authority for Health, there is a first step, which consists of the development of a framework note specifying the working framework of the institution. This was validated on September 7, 2022, and published immediately. Then, the HAS services contact the stakeholders to form a working group: national professional councils, learned societies, associations, asking them to kindly propose people to this working group, on an individual basis.
Our concern is that all interested people and experts are part of the group to have a plurality of opinions and points of view. This is what happened to this working group. There are two presidents, they should work with the greatest possible peace of mind. This begins with an analysis of the most exhaustive literature possible on all the questions we ask, then through a certain number of consultations and rereadings.
Who is part of the working group?
HAS never reveals the names of its experts before the publication of the recommendations, to guarantee the smooth running of the discussions and their peace of mind. But the profile of these people has been known since the publication of the framework note on the HAS website, i.e. for two years. Co-presidency is shared between a health professional and a user of the health system.
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The rest is a group of experts. It includes two general practitioners, an endocrinologist, a pediatrician, a psychiatrist, a child psychiatrist, an obstetrician-gynecologist, a urologist, a plastic surgeon, a fertility and reproduction doctor, a pharmacologist, a school nurse, an occupational physician , a sports doctor, a psychologist, a sociologist, a social worker and five users of the health system.
What do you say to those who accuse this group of not being representative?
I remind you that it is not for us to position ourselves on the legitimacy of gender transitions or care, but on good practices within the framework of the care pathway. On this subject, the working group is made up of experts who do not share the same analyses.
How does the development of recommendations take place, once the working group is formed?
As I told you, the working group begins by reviewing the literature. As with all work, it also carries out stakeholder hearings. Then there is a critical rereading phase, this is the phase we are currently in. A group of external reviewers intervenes, made up of other experts and other stakeholders.
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Then, and contrary to what the article published in Le Figarothere is obviously new in-depth work that will be launched. This is where the institutions responsible by regulation for ensuring the quality of our productions will come into play: the Recommendations Commission, then the College of the High Authority. Each of these bodies has the possibility of reconsidering the recommendations. We must not fall into the trap that is set here: modifications are likely to be made until the last moment.
Obviously, the people who leaked a draft document relating to your work are members of the review group. Is HAS surprised by the controversy and tensions on the subject?
We deplore the fact that unfinished, non-final and confidential working documents are published. That this question would be the subject of controversy was expected, because the subject is particularly complex and is the subject of numerous social debates, like others in their time.
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