American Academy of Pediatrics will review treatment guidelines for transgender minors

[LoudmouthMormon]

Back in 2018, the American Academy of Pediatrics issued it's first policy statement, it urged clinicians use a nonjudgmental approach where the clinician supported the child's professed gender identity.  Youth should, the policy recommended, have "access to comprehensive gender-affirming and developmentally appropriate health care".    

Now, according to the Wall Street Journal, they're going to conduct a systematic evidence review and might amend it's policy based on the results.

Quote

The exact scope of the review has yet to be determined, but is expected to include an evaluation of medical interventions such as puberty blockers and hormones, which are in some cases used to delay puberty or boost physical features associated with a gender different from the patient’s sex at birth. 
The process, known as a systematic evidence review, typically looks at all relevant evidence behind any given treatment, adjusting for bias and other potential flaws. It will be conducted by an external organization, the AAP said. 
Its goal will seek to confirm best practices for treatments of transgender youth, adolescents and young adults, the AAP said. The association’s board, voting in its headquarters in the Chicago area, approved the external review on Thursday afternoon.

 

When systematic evidence reviews were conducted in the U.K., Sweden, Finland, Norway, and France, the result in all those countries was to urge more caution with medical interventions, noting there simply wasn't enough evidence to support the notion that benefits outweigh the risks.  The US became an outlier with it's policy to "provide medical, even surgical, support to whatever the minor says about themselves".

I'm cautiously optimistic that a systematic review of available evidence will result in better, more soundly evidence-based, guidelines.  

And I'll bet anyone here ten bucks that they end up revising their policies in a "use more caution before supporting medically or surgically" direction.   Because helping a 16 yr old girl chop off her own breasts, without any preconditions like psychotherapy or an awful lot of diagnostic rigor, just because she feels like a boy, is one of the most idiotic things the human race has ever run with since they awarded the Nobel Peace prize to the guy who invented the frontal lobotomy. 

If anyone wishes to take me up on this bet, send me a PM.  I'll gladly pay via Paypal or Venmo if I lose, to anyone who agrees to pay me if I win.

Any takers?

Edited August 3, 2023 by LoudmouthMormon

[The Nehor]

The only problem with those claims about how Europe is going the other way is that it is largely bull*!%*. A big lie that is being repeated again and again.

There are no big comprehensive studies based on evidence backing this argument. The nations that are cherry-picked are not generally reversing a previously more liberal policy. They were always more restrictive about youth transgender care than the US. The UK in particular (colloquially referred to as TERF island by some transgender people) has never been a bastion of allowing youth access to transgender care.

When you trace the source of these misrepresentations and lies the sources are virtually all anti-transgender activists who want all these procedures banned for everyone including adults. So of course they pretend it is “for the children”. This is built up on the right-wing worldview that Europe is a bunch of leftist socialists since that is the line they have been feeding from their propaganda outlets for years.

I never thought I would see so many on the Right become Russophiles. Now they are going to take medical advice from nations with socialized medicine? Things are so very weird.

And yes, there is a real good faith discussion to be had about when and how youth transgender care can and should operate but it is never going to be had with the people who spew this propaganda and probably will never be had at all with this much poison in the discussion.

 

On a personal note please leave my transgender friends alone. Their lives are hard enough without being the target of the latest manufactured moral panic.

https://www.theonion.com/it-is-journalism-s-sacred-duty-to-endanger-the-lives-of-1850126997

Quote

Research shows that trans people are over four times more likely than cisgender people to be the victim of a violent crime. We salute our colleagues across the media who are working tirelessly to make that number even higher.

 

[Calm]

Nehor, are you aware of any decent study of the effect of puberty blockers on brain development. I am seeing this become a talking point now, but am pulling up pretty much only requests for grants and suggestions on how to do the research. 

[LoudmouthMormon]

Honestly, I don't care which side is more successful in spinning sanity and humane treatment being their idea all along, as long as the humans get into a new equilibrium of sanity and humane treatment.   I suppose folks can ignore the publicly growing ranks of detransitioners, pretend their lived experiences don't exist or don't matter, if folks want to.  I'd be happy if the more radical forms of gender activism go down as a short-term fever blip in the cultural upheaval of the early 2020's, similar to the various circles in the American intellectual establishment with their fascination with fascism in the '40's.   

I also hope the good faith discussion grows and eventually carries the day.  Because yeah, trans folks have harder lives than most of the rest of us.  Higher rates of suicidal ideation, attempts, and completions.  Higher rates of mental illness.  And yes, higher rates of receiving violence.  Dictionary definition of "the least of these thy brethren".  To the extent we are individually judged on the specific impact we had on our larger culture, we will be judged by how well we loved our neighbor and left the 99 to find the 1.

Honestly @The Nehor, if you could look past your defensive need to demonize folks on the other side of your fences, you might see we have more in common than you are letting yourself think.  

Edited August 4, 2023 by LoudmouthMormon

[The Nehor]

20 minutes ago, Calm said:

Nehor, are you aware of any decent study of the effect of puberty blockers on brain development. I am seeing this become a talking point now, but am pulling up pretty much only requests for grants and suggestions on how to do the research. 

No, you would probably have to look to see what the effects of puberty blockers used on children with precocious puberty are. There might be more studies there since that is the most long-running use case for puberty blockers.

[Calm]

9 minutes ago, The Nehor said:

No, you would probably have to look to see what the effects of puberty blockers used on children with precocious puberty are. There might be more studies there since that is the most long-running use case for puberty blockers.

That is a good idea, thanks. 

[The Nehor]

29 minutes ago, LoudmouthMormon said:

Honestly, I don't care which side is more successful in spinning sanity and humane treatment being their idea all along, as long as the humans get into a new equilibrium of sanity and humane treatment.   I suppose folks can ignore the publicly growing ranks of detransitioners, pretend their lived experiences don't exist or don't matter, if folks want to.

Detransitioners are a small minority. Yes, they matter. Their voices are amplified by people with an agenda. Suggesting their experience means we should shut everything down is less rational than shutting down the church because some people are hurt when they leave it.

33 minutes ago, LoudmouthMormon said:

I'd be happy if the more radical forms of gender activism go down as a short-term fever blip in the cultural upheaval of the early 2020's, similar to the various circles in the American intellectual establishment with their fascination with fascism in the '40's.   

I also hope the good faith discussion grows and eventually carries the day.  Because yeah, trans folks have harder lives than most of the rest of us.  Higher rates of suicidal ideation, attempts, and completions.  Higher rates of mental illness.  And yes, higher rates of receiving violence.  Dictionary definition of "the least of these thy brethren".  To the extent we are individually judged on the specific impact we had on our larger culture, we will be judged by how well we loved our neighbor and left the 99 to find the 1.

You hope the good faith discussion will continue while you compare the whole movement to fascism? So many cultural “fads” you could have chosen and you went with that one? You’re really not helping.

35 minutes ago, LoudmouthMormon said:

Honestly @The Nehor, if you could look past your defensive need to demonize folks on the other side of your fences, you might see we have more in common than you are letting yourself think.  

I am defensive because I see the ramifications of all of this. One of my best friends is leaving our state mostly due to rampant transphobic state legislation. I know others who are leaving or are looking to leave. Most of these laws are being struck down in the courts but the message is clear that they aren’t welcome to live here and those who are supposed to represent them want them gone or closeted. I have lived closeted. It is awful. To intentionally inflict that on someone is cruel.

[MrShorty]

This sounds like exactly the kind of thing a good healthcare organization ought to be doing -- studying the latest research and determining if current recommendations are still in line with the latest, good research. My main hope is that the review can be conducted with mostly scientific input and a minimum of political input. If there are questions and doubts about the current recommendations, let's find out what are better recommendations and implement them.

[LoudmouthMormon]

12 hours ago, MrShorty said:

This sounds like exactly the kind of thing a good healthcare organization ought to be doing -- studying the latest research and determining if current recommendations are still in line with the latest, good research. My main hope is that the review can be conducted with mostly scientific input and a minimum of political input. If there are questions and doubts about the current recommendations, let's find out what are better recommendations and implement them.

Agreed.  And I'm cautiously hopeful politics might be able to stay out of the review.  They've made it an independent external review, which may be a good thing or a bad thing, depending on who will actually be conducting the review.  Got my finger's crossed.

And I continue to offer my bet to any takers.

[OGHoosier]

13 hours ago, The Nehor said:

Detransitioners are a small minority. Yes, they matter. Their voices are amplified by people with an agenda.

This dismissal could be deployed against about any activist-adjacent group which has not yet mainstreamed, an irony which I imagine is not lost on you. 

The above quoted is not grounds for dismissal, it is a statement of agenda preference.

[The Nehor]

1 hour ago, OGHoosier said:

This dismissal could be deployed against about any activist-adjacent group which has not yet mainstreamed, an irony which I imagine is not lost on you. 

The above quoted is not grounds for dismissal, it is a statement of agenda preference.

It is not a dismissal. It is a call for a sense of proportion.

Listen to them and take them seriously but seeing them as a reason that we have to further roadblock people seeking gender-affirming care is insanity. Most of the people who seek out this care find it improves their lives. Most of those who detransition do so due to lack of access to medical care for various reasons or due to social pressure. The number who regret transitioning is reliably under 3%.

[pogi]

20 hours ago, LoudmouthMormon said:

Back in 2018, the American Academy of Pediatrics issued it's first policy statement, it urged clinicians use a nonjudgmental approach where the clinician supported the child's professed gender identity.  Youth should, the policy recommended, have "access to comprehensive gender-affirming and developmentally appropriate health care".    

Now, according to the Wall Street Journal, they're going to conduct a systematic evidence review and might amend it's policy based on the results.

 

When systematic evidence reviews were conducted in the U.K., Sweden, Finland, Norway, and France, the result in all those countries was to urge more caution with medical interventions, noting there simply wasn't enough evidence to support the notion that benefits outweigh the risks.  The US became an outlier with it's policy to "provide medical, even surgical, support to whatever the minor says about themselves".

I'm cautiously optimistic that a systematic review of available evidence will result in better, more soundly evidence-based, guidelines.  

And I'll bet anyone here ten bucks that they end up revising their policies in a "use more caution before supporting medically or surgically" direction.   Because helping a 16 yr old girl chop off her own breasts, without any preconditions like psychotherapy or an awful lot of diagnostic rigor, just because she feels like a boy, is one of the most idiotic things the human race has ever run with since they awarded the Nobel Peace prize to the guy who invented the frontal lobotomy. 

If anyone wishes to take me up on this bet, send me a PM.  I'll gladly pay via Paypal or Venmo if I lose, to anyone who agrees to pay me if I win.

Any takers?

I can't read the article about the "results in all those countries" (it is behind a paywall) which show that there is "not enough evidence to support the notion that the benefits outweigh the risks".  

I would be curious to see some of the actual reviews and the statistics for the known risks and benefits and how they compared them.  Do you know where one could find those?

I personally always favor extreme caution where extremely invasive medical procedures are concerned.  I think that is a medical ethic that all in the field should hold - hence the review.   But that is not to say that there is never a place for invasive medical procedures.  I think people's biases are preceding the evidence.  Let's let the review play out before we pick sides.   However, I have extreme doubts, based on much experience, that the best evidence and medical consensus will be good enough to sway public and political biases.   

[OGHoosier]

1 hour ago, The Nehor said:

It is not a dismissal. It is a call for a sense of proportion.

Listen to them and take them seriously but seeing them as a reason that we have to further roadblock people seeking gender-affirming care is insanity. Most of the people who seek out this care find it improves their lives. Most of those who detransition do so due to lack of access to medical care for various reasons or due to social pressure. The number who regret transitioning is reliably under 3%.

Listen to them, take them seriously...and then what? What does "take them seriously" mean if we do not take their stories as examples that we should be cautious about interventions of this scale?

[Benjamin McGuire]

35 minutes ago, pogi said:

I personally always favor extreme caution where extremely invasive medical procedures are concerned.  I think that is a medical ethic that all in the field should hold - hence the review.   But that is not to say that there is never a place for invasive medical procedures.  I think people's biases are preceding the evidence.  Let's let the review play out before we pick sides.   However, I have extreme doubts, based on much experience, that the best evidence and medical consensus will be good enough to sway public and political biases. 

Surgery as transgender care for minors, is relatively rare, and of those, the huge majority are mastectomies. The statistics that I have access to show less than 20 genital surgeries per year for minors in the U.S. Most transgender care for minors is not medically invasive. This figure is dwarfed by the number of medical interventions performed each year on new born infants.

[rodheadlee]

17 hours ago, The Nehor said:

Detransitioners are a small minority. Yes, they matter. Their voices are amplified by people with an agenda. Suggesting their experience means we should shut everything down is less rational than shutting down the church because some people are hurt when they leave it.

You hope the good faith discussion will continue while you compare the whole movement to fascism? So many cultural “fads” you could have chosen and you went with that one? You’re really not helping.

I am defensive because I see the ramifications of all of this. One of my best friends is leaving our state mostly due to rampant transphobic state legislation. I know others who are leaving or are looking to leave. Most of these laws are being struck down in the courts but the message is clear that they aren’t welcome to live here and those who are supposed to represent them want them gone or closeted. I have lived closeted. It is awful. To intentionally inflict that on someone is cruel.

Well the good news is we have 50 states to choose from.

[The Nehor]

1 hour ago, OGHoosier said:

Listen to them, take them seriously...and then what? What does "take them seriously" mean if we do not take their stories as examples that we should be cautious about interventions of this scale?

Find the reasons they wanted to transition that they later found to be false. Find commonalities. What is different in these cases?

Of course the actual response is usually to just call for a blanket ban on transitioning or to throw up onerous and pointless roadblocks up in everyone's way that have no relation to cases where people later regretted transitioning so I am not convinced it is a good faith argument.

[The Nehor]

1 hour ago, rodheadlee said:

Well the good news is we have 50 states to choose from.

I am sure that that was a great comfort to my ancestors fleeing the Missouri extermination order.

[BlueDreams]

24 minutes ago, The Nehor said:

Find the reasons they wanted to transition that they later found to be false. Find commonalities. What is different in these cases?

Of course the actual response is usually to just call for a blanket ban on transitioning or to throw up onerous and pointless roadblocks up in everyone's way that have no relation to cases where people later regretted transitioning so I am not convinced it is a good faith argument.

Honestly, I see this conversation being reduced by two polarized sides that doesn't allow a lot of space for nuanced positions to exist. One or the other will build a strawman of an argument or point to extreme cases to make their points. Kinda similar to just about any social issues topic we have nowadays in the US.

I have serious concerns about the holes I've read about from largely in-between sources who want these decisions to be done more carefully, but don't want to stigmatize or dismiss trans identities all together. I've had them for a long time and I'd like to believe I don't fit the stereotype of people who hold these. I don't want any form of treatment to be completely blocked off. But ones with more permanent or long-term health risks involved I would like to see more as a last resort rather than an assumed path for resolution for gender dysphoria and/or comorbid mental health concerns.

 

With luv,

BD 

[SeekingUnderstanding]

11 minutes ago, BlueDreams said:

I would like to see more as a last resort rather

Are state legislatures the place to ensure this takes place in your opinion? Honest question. 

[Calm]

4 hours ago, SeekingUnderstanding said:

Are state legislatures the place to ensure this takes place in your opinion? Honest question. 

My opinion is the same as Bluedreams….last resort.  I have seen too much careless and too rushed, not in-depth enough quality of care for youth mental health (been looking at it for a long time, personally involved for 20 years), I don’t trust that this happens to be an area where they have enough resources, practitioners, and time to get it right in a significant majority of cases…therefore caution should be very high when results are permanent.

My response to the above question is I wish politics was kept completely out of medicine, doctors should be making decisions based on science and the needs of their patients, not on any political or social agenda and politicians shouldn’t be involved at all idealistically speaking.  But given there is extensive federal and state funding in healthcare, my ideal isn’t going to happen anytime soon.

Edited August 5, 2023 by Calm

[BlueDreams]

4 hours ago, SeekingUnderstanding said:

Are state legislatures the place to ensure this takes place in your opinion? Honest question. 

A lot of mental health practices are both regulated by ethics boards and state laws. Usually these follow the regulations of larger national group like APA. I would hope whatever legislation would follow most recent research and practices, research that from I've seen has serious limitations and concerns when it comes to child/teen care when it comes to gender dysphoria and the medical practices around trans identity. I think that's why you're see more debate about this. There's inconsistency in care and the care given us expanding well past the parameters and demographics of the dutch model.

 

FTR I also have problems with other forms of over medicalization for teen and young child mental health concerns. I would honestly love to see more consistent regulations that matches current research (and lack thereof) more carefully. But I would rather have this done by scientific board more the Congressional reps. Especially in our current political climate 

 

With luv,

BD

Edited August 5, 2023 by BlueDreams

[Kenngo1969]

I don't know how rare or how prevalent drastic gender-affirming care, such as mastectomies for FTM, augmentations for MTF, other such alterations, and so on, are.  Where there is money to be made, in at least some cases [in perhaps too many cases], I think there is ample room to question how much those with such vested interests can be trusted to make decisions that are best for patients as opposed to being best for treatment providers' bottom lines.

[Thinking]

On 8/3/2023 at 6:50 PM, The Nehor said:

https://www.theonion.com/it-is-journalism-s-sacred-duty-to-endanger-the-lives-of-1850126997

You do realize that you just quoted the Onion?

[MrShorty]

22 hours ago, LoudmouthMormon said:

And I'm cautiously hopeful politics might be able to stay out of the review.

I would agree, but somewhat pessimistic as well. It seems that so many conversations around whether the APA did a good thing in removing porn/sex addiction from the DSM5 (especially when Fight the New Drug type of people get involved) turns into a debate over how much science and how much politics went into that decision. I think I fear that, no matter how well the review is done, whatever conclusion final decision they come do will be haunted by accusations of politics over science -- especially since I also expect that the best of the science is going to inevitably end up with some judgement calls in the final decisions and best practices.

[MrShorty]

Some thoughts on regrets.

Yes, I can see that a certain, small percentage of transitioners end up regretting their transition. One challenge I see is that regret is a part of many decisions in life. In circles where women discuss breast augmentation surgeries, there are frequently a small number who regret having their augmentation surgery for a variety of reasons. There are also a small percentage of women who regret not getting an augmentation or regret waiting as long as they did. Expanding further, you can also find people who regret going to college or not going to college, who regret a career choice, or regret marrying someone or regret not marrying someone. As difficult as regret can be, regret seems to be an inevitable part of life and making choices without the benefit of crystal balls or other methods of perfectly knowing the future.

In my own case of colon cancer, I find after completing the treatment regimen that the final surgery that removed a portion of my GI tract potentially leaves with some long term digestive consequences. On bad days, I kind of regret that surgery and wonder if it would have been better to live with cancer. If I wanted, I could blame the medical establishment who, the year I was diagnosed right as I turned 50, decided that it would be better for people to start screening for colon cancer at 45. Based on what I've learned about colon cancer, one nagging regret I have is that I did not get screened sooner, and the reason I didn't was because the medical establishment did not judge that the risk of cancer at 45 (when I was 45) was great enough to merit regular screening. But I also know that, in the world of cancer screening, there can be a long debate over when and how often to screen, as the system needs to balance costs against benefits, risks against rewards, false positives against true positives and false negatives against true negatives, and so on and so forth.

I think the point I am trying to make is that we need to be prepared to accept that this sort of thing often does not result in clear, bright lines for making decisions. Even when the process in untainted by politics and informed by the best science, the final best practice recommendations will often be a balance between risks and rewards and even balancing patients who regret receiving a treatment against patients who regret not receiving a treatment. Specifically here, balancing those who regret transitioning and seek to detransition against those who regret choosing not to transition or are denied transitioning treatment.