Apology for the Priesthood Ban / "March of Dimes Syndrome" / "Mission Creep" / "Spencer's Law"

[Analytics]

19 hours ago, smac97 said:

An August 2023 article responding to the Times article cited earlier by @Analytics: A Slow Trek Back to Truth?

Some excerpts:

Ideological/sociopolitical influences/pressures on medical care. 

This is rich. According to your source:

"Ghorayshi and the Times deserve credit for a well-researched article. Ghorayshi does a good job allowing different sides in the controversy to be heard. Her discussion of the medical research, though not the focus of her article, is refreshingly honest and accurate."

Thank you for quoting that and acknowledging the accurate journalism I cited. However, what you quoted doesn’t support your "Ideological/sociopolitical influences/pressures on medical care” mantra you continuously copy and paste.

What you quoted isn’t talking about pressure on medical care; it is talking about pressure on news sources that my sources successfully disregarded. If you click the link in your source about the pressure it is under, it says:

"The New York Times is a righteously proud beast...[and the article on Washington University’s youth gender clinic in St. Louis that I quoted is] a lengthy, rigorous and balanced feature examining outcomes for patients and testimonies from staff at a US gender clinic."

And it says the New York Times was put under pressure because an organization called GLAAD parked a van in front of the Times’s home office for a day with a message on it. 

GLAAD parking a van in front of the New York Times doesn’t mean there is Massive ideological/sociopolitical influences/pressures on medical care. 

19 hours ago, smac97 said:

I have spoken on this topic many times over the years, and have cited various sources as the basis for my position, and I have provided a litany of issues that pertain directly to the complexities involved in so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

The problem with your approach is you seem to think these concerns are unique to this specific subspecialty of medicine and in general aren’t ubiquitous across just about everything involving medical care. And you seem to be implying that the psychologists, psychiatrists, and physicians who do this for a living are somehow unaware of these issues and aren’t making good-faith efforts to deal with them.

19 hours ago, smac97 said:

Third, two of the concerns I have raised are:

• Compromised assessments of the best interests of the child. 
• Massive ideological/sociopolitical influences/pressures on medical care. 

I think there are plenty of otherwise good and decent people who fit within these parameters.  For example, parents who support PSTM out of a reactionary fear to the commonly-cited alternative - their child committing suicide - may very well be said to be compromised in their assessments "about the wellbeing of children."  Perhaps some doctors as well.

Likewise, there are people who, because of their own ideological/religious/sociological convictions declined to give their children professional medical care for these issues and subsequently, their children did successfully committed suicide.

There is in fact academic research on this. In 2020, The journal Pediatrics published an article "Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation” which concluded that:

There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.

Despite this “significant” finding which “aligns with past literature,” you are against this treatment in general and  are against this specific scientific conclusion being taken into account by competent, diligent doctors and conscientious parents when evaluating whether or not pubertal suppression during adolescence might be right for any given patient. Why? Is it because of your own massive ideological/sociopolitical and religious convictions? That would explain why you cherry pick sources that support your ideological position.

I’m not saying that the issues you raise are fake issues. But I am saying that the way you cherry pick references (which are usually editorials and not investigative news stories or medical journal papers) that support ideological positions indicates that you aren’t addressing these serious issues in serious ways.

Massive ideological/sociopolitical influences/pressures on medical care?

Projecting?

[smac97]

4 hours ago, Analytics said:

The problem with your approach

Most of Europe and quite a few parts of the U.S. are substantially revisiting PSTM.  It's not my approach.

4 hours ago, Analytics said:

is you seem to think these concerns are unique to this specific subspecialty of medicine and in general aren’t ubiquitous across just about everything involving medical care.

PSTM involves electively removing healthy body parts of minors (i.e. penectomies and mastectomies) and electively sterilizing minors.  These procedures have occurred despite substantial issues arising from:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

I think these things need to be addressed.

4 hours ago, Analytics said:

And you seem to be implying that the psychologists, psychiatrists, and physicians who do this for a living are somehow unaware of these issues and aren’t making good-faith efforts to deal with them.

And yet, we have substantial issues with comorbidities not being addressed, informed consent, irreversibility, sterilization of minors, etc.

I think we have ample grounds to be concerned about compromised assessments of the best interests of the child and ideological/sociopolitical influences/pressures on medical care.

4 hours ago, Analytics said:

Likewise, there are people who, because of their own ideological/religious/sociological convictions declined to give their children professional medical care for these issues and subsequently, their children did successfully committed suicide.

What other medical procedures are authorized under threat of suicide?  

I think this speaks to comorbidities not being addressed, informed consent, irreversibility, sterilization of minors, etc.

4 hours ago, Analytics said:

There is in fact academic research on this. In 2020, The journal Pediatrics published an article "Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation” which concluded that:

There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.

I find it noteworthy that you omitted one sentence from the paragraph you are quoting:

Quote

This is the first study in which associations between access to pubertal suppression and suicidality are examined. There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment. These results align with past literature, suggesting that pubertal suppression for transgender adolescents who want this treatment is associated with favorable mental health outcomes.

"This is the first study..."  Longitudinal studies are essentially absent.  Yeah.  This issue deserves more attention.

Regarding the article you quote above (about the "Turban" studies), see this June 2022 articles which addresses it: Puberty Blockers, Cross-Sex Hormones, and Youth Suicide

Some excerpts, starting with the summary:

Quote

 Summary

Lowering legal barriers to make it easier for minors to undergo cross-sex medical interventions without parental consent does not reduce suicide rates—in fact, it likely leads to higher rates of suicide among young people in states that adopt these changes. States should instead adopt parental bills of rights that affirm the fact that parents have primary responsibility for their children’s education and health, and that require school officials and health professionals to receive permission from parents before administering health services, including medication and “gender-affirming” counseling, to children under 18. States should also tighten the criteria for receiving cross-sex treatments, including raising the minimum eligibility age.

Massive ideological/sociopolitical influences/pressures on medical care.

Quote

Adolescents who are confused about their gender suffer from an abnormally high suicide rate.1  Though research demonstrates that gender confusion generally resolves itself without medical intervention,2 some educators and medical professionals encourage teens, and even pre-teens, to take puberty blockers or cross-sex hormones so that their secondary sex characteristics, such as body and facial hair, breast tissue, muscular build, and fat composition, align more closely with the gender with which they identify.3

1.Michelle M. Johns et al., “Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students—19 States and Large Urban School Districts, 2017,” Morbidity and Mortality Weekly Report, Vol. 68, No. 3 (January 25, 2019), pp. 67–71, https://doi.org/10.15585/mmwr.mm6803a3 (accessed May 25, 2022). 

2. James M. Cantor, “Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy,” Journal of Sex & Marital Therapy, Vol. 46, No. 4, 2020), pp. 307–313, https://www.tandfonline.com/doi/abs/10.1080/0092623X.2019.1698481 (accessed May 25, 2022). Also see Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Arlington, VA: American Psychiatric Association, 2013), pp. 451–459, and Ryan T. Anderson, When Harry Became Sally: Responding to the Transgender Moment (New York, NY: Encounter Books, 2018), pp. 93–144.

3. Society for Evidence Based Gender Medicine, “Our Aim Is to Promote Safe, Compassionate, Ethical and Evidence-Informed Healthcare for Children, Adolescents, and Young Adults with Gender Dysphoria,” https://segm.org/home (accessed May 25, 2022), and Julia E. Richards and R. Scott Hawley, The Human Genome: A User’s Guide, Third Edition (Cambridge, MA: Academic Press, 2010), Chapter 8.

I think there are people who are so enthralled, so committed to certain ideological propositions, that they refuse to address these issues.

Quote

While the World Professional Association for Transgender Health (WPATH) acknowledges that these interventions can have significant complications, it warns that delaying intervention also has serious risks:

Quote

Refusing timely medical interventions for adolescents might prolong gender dysphoria and contribute to an appearance that could provoke abuse and stigmatization. As the level of gender-related abuse is strongly associated with the degree of psychiatric distress during adolescence (Nuttbrock et al., 2010), withholding puberty suppression and subsequent feminizing or masculinizing hormone therapy is not a neutral option for adolescents.4

Other advocates, members of the media, and even White House staff invoke scientific authority to assert that cross-sex medical interventions reduce the risk of suicide. Sarah Harte, director for the Washington, DC, branch of an organization that provides medical intervention and support for youth called The Dorm, stated with confidence that “[l]aws and systems barring gender-affirming healthcare will contribute to higher rates of significant mental health problems, including deaths by suicide.”5  The CEO of The Trevor Project, Amit Paley, said, “It’s clear that gender-affirming care has the potential to reduce rates of depression and suicide attempts.”6

In an opinion piece in The Washington Post, University of Virginia Law School professors Anne Coughlin and Naomi Cahn claimed that cross-sex medication “has been shown to reduce the risk of depression and suicide for transgender youth,” and that “banning it creates an excruciating conflict for parents, as the steps they take to preserve their children’s lives may lead the state to investigate and punish them.”7   Even former White House press secretary Jen Psaki referred to such medical interventions as “medically necessary, lifesaving healthcare for [kids].”8

The danger of adolescents committing suicide if they do not receive these medical interventions is thought to be so urgent that the Biden Administration recently issued a statement “confirming the positive impact of gender affirming care on youth mental health,” while referencing “the evidence behind the positive effects of gender affirming care.”9

 A number of states have also considered or enacted legislation making it easier for minors to access cross-sex interventions without their parents’ knowledge or consent. For example, California recently enacted a new law, AB 1184, to prevent insurance companies from notifying parents if children on their policies receive “sensitive services,” which were defined to include “gender affirming care.”10

4. Eli Coleman et al., “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People,” International Journal of Transgenderism, Vol. 13, No. 4 (2012), p. 21, https://www.tandfonline.com/doi/abs/10.1080/15532739.2011.700873 (accessed May 25, 2022).

5. “The ‘Life-Saving’ Science Behind Gender-Affirming Care for Youth,” Medical News Today, March 29, 2022, https://www.medicalnewstoday.com/articles/the-life-saving-science-behind-gender-affirming-care-for-youth (accessed May 25, 2022).

6. Jo Yurcaba, “Hormone Therapy Linked to Lower Suicide Risk for Trans Youths, Study Finds,” NBC News, December 14, 2021, https://www.nbcnews.com/nbc-out/out-health-and-wellness/hormone-therapy-linked-lower-suicide-risk-trans-youths-study-finds-rcna8617 (accessed May 25, 2022).

7. “Texas Is Trampling Parents’ Rights in Its Investigations of Trans Kids,” The Washington Post, April 8, 2022, https://www.washingtonpost.com/outlook/2022/04/08/texas-transgender-family-law/ (accessed May 25, 2022).

8. The White House, “Press Briefing by Press Secretary Jen Psaki, April 7, 2022,” https://www.whitehouse.gov/briefing-room/press-briefings/2022/04/07/press-briefing-by-press-secretary-jen-psaki-april-7-2022/ (accessed May 25, 2022).

9. The White House, “Fact Sheet: Biden–Harris Administration Advances Equality and Visibility for Transgender Americans,” March 31, 2022, https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/31/fact-sheet-biden-harris-administration-advances-equality-and-visibility-for-transgender-americans/ (accessed May 25, 2022).

PSTM or suicide.  That's the supposed dilemma that is contributing to compromised assessments of the best interests of the child. 

Here's where the article gets interesting:

Quote

However, young people may also experience significant and irreversible harms from such medical interventions.11  This Backgrounder reviews existing research on the relationship between cross-sex interventions and suicide, and then presents a new empirical analysis that examines whether easing access by adolescents to these interventions is likely to result in fewer adolescent suicides. The new analysis presented here finds that the existing literature on this topic suffers from a series of weaknesses that prevent researchers from being able to draw credible causal conclusions about a relationship between medical interventions and suicide. Using a superior research design, the new analysis finds that increasing minors’ access to cross-sex interventions is associated with a significant increase in the adolescent suicide rate. Rather than facilitating access by minors to these medical interventions without parental consent, states should be pursuing policies that strengthen parental involvement in these important decisions with life-long implications for their children.

11.Michael Biggs, “Revisiting the Effect of GnRH Analogue Treatment on Bone Mineral Density in Young Adolescents with Gender Dysphoria,” Journal of Pediatric Endocrinology and Metabolism, Vol. 34, No. 7 (July 1, 2021), pp. 937–939, https://doi.org/10.1515/jpem-2021-0180 (accessed May 25, 2022); Noreen Islam et al., “Is There a Link Between Hormone Use and Diabetes Incidence in Transgender People? Data From the STRONG Cohort,” The Journal of Clinical Endocrinology & Metabolism, Vol. 107, No. 4 (April 1, 2022), pp. e1549–e1557, https://doi.org/10.1210/clinem/dgab832 (accessed May 25, 2022); Shira Baram et al., “Fertility Preservation for Transgender Adolescents and Young Adults: A Systematic Review,” Human Reproduction Update, Vol. 25, No. 6 (November 5, 2019), pp. 694–716, https://doi.org/10.1093/humupd/dmz026 (accessed May 25, 2022); Elie Vandenbussche, “Detransition-Related Needs and Support: A Cross-Sectional Online Survey,” Journal of Homosexuality, April 30, 2021, pp. 1–19, https://doi.org/10.1080/00918369.2021.1919479 (accessed May 25, 2022); Alison Clayton, “The Gender Affirmative Treatment Model for Youth with Gender Dysphoria: A Medical Advance or Dangerous Medicine?” Archives of Sexual Behavior, Vol. 51, No. 2 (February 1, 2022), pp. 691–698, https://doi.org/10.1007/s10508-021-02232-0 (accessed May 25, 2022); and Society for Evidence Based Gender Medicine, “Studies,” https://segm.org/studies (accessed May 25, 2022). 

• "The new analysis presented here finds that the existing literature on this topic suffers from a series of weaknesses that prevent researchers from being able to draw credible causal conclusions about a relationship between medical interventions and suicide."
• "Using a superior research design, the new analysis finds that increasing minors’ access to cross-sex interventions is associated with a significant increase in the adolescent suicide rate."
• "Rather than facilitating access by minors to these medical interventions without parental consent, states should be pursuing policies that strengthen parental involvement in these important decisions with life-long implications for their children."

I think we need to be having discussions about these things.

Quote

The Context

Around 1990, some doctors in the Netherlands began to use drugs designed to delay the onset of puberty in teenagers who were confused about their gender.12  Puberty-blocking therapies, such as gonadotropin-releasing hormone analogues, were meant to prevent children entering puberty from developing the secondary sex characteristics, such as facial hair for men or breasts for women, if those features did not align with the gender with which they identified. Puberty blockers would be followed by the use of sex hormones, such as testosterone, for girls who identify as male, and estrogen for boys who identify as female, so that they could develop secondary sex characteristics that were associated with the sex that they identified with.13

This treatment protocol of puberty blockers followed by cross-sex hormones among adolescents did not exist in the United States prior to 2007 and was extremely rare before 2010. Cross-sex hormones were available as a medical intervention for adolescents before 2010, but their use was extremely limited. Starting in 2010, however, the use of both puberty blockers and cross-sex hormones for adolescents who identified as transgender rose dramatically and was widely available by 2015.

Precise data are not available on how often puberty blockers and cross-sex hormones have been given to teenagers over time in the United States, but it is possible to track a proxy for these interventions. Google Trends provides data on the relative frequency that terms have been used for searches since 2004. A score of 100 in Google Trends indicates the peak frequency for the term. Before August 2007, Google Trends reports a 0 for the term “puberty blockers,” meaning that it was searched so infrequently in the U.S. that “there was not enough data for this term.” The term “puberty blockers” did not average 5, or one-twentieth of its peak popularity, in any year before 2015.14  

The average of the Google Trends scores for the terms, “puberty blockers,” “transgender,” “gender identity disorder,” and “gender dysphoria,” yields a reasonable proxy for how common cross-sex interventions have been over time.15 As shown in Chart 1, these four terms were searched infrequently until about 2015, when there was a dramatic increase that continued through the end of 2020. This picture is consistent with anecdotal reports of how the use of puberty blockers and cross-sex hormones only became widely available in the past several years.

There is also a lack of precise information on where cross-sex medical interventions are more readily available to adolescents.

12. Ibid.

13. Klotz, “The Fractious Evolution of Pediatric Transgender Medicine.”

14. Google Trends, “Puberty Blockers,” https://trends.google.com/trends/explore?date=2004-01-01 2020-12-31&geo=US&q=puberty blockers (accessed April 20, 2022). Note: Numbers represent search interest relative to the highest point on the chart for the given region and time. A value of 100 is the peak popularity for a term. A value of 50 means that the term is half as popular. A score of 0 means there was not enough data for this term.

15. Ibid.; Google Trends, “Transgender,” Google Trends, https://trends.google.com/trends/explore?date=2004-01-01 2020-12-31&geo=US&q=puberty blockers (accessed April 20, 2022); Google Trends, “Gender Identity Disorder,” https://trends.google.com/trends/explore?date=2004-01-01 2020-12-31&geo=US&q=puberty blockers (accessed May 20, 2022); and Google Trends, “Gender Dysphoria,” https://trends.google.com/trends/explore?date=2004-01-01 2020-12-31&geo=US&q=puberty blockers (accessed April 20, 2022).

• "This treatment protocol of puberty blockers followed by cross-sex hormones among adolescents did not exist in the United States prior to 2007 and was extremely rare before 2010."
• "Starting in 2010, however, the use of both puberty blockers and cross-sex hormones for adolescents who identified as transgender rose dramatically and was widely available by 2015."
• "Precise data are not available on how often puberty blockers and cross-sex hormones have been given to teenagers over time in the United States."

Longitudinal studies essentially absent. 

The next part addresses the Turban studies:

Quote

Prior Research

The effects of puberty blockers and cross-sex hormones as a medical intervention for adolescents who identify as transgender have never been subjected to a large-scale randomized controlled trial (RCT), like the kind that is typically required for approval of new medications.23  Puberty blockers and sex hormones had been developed originally for other purposes. Puberty blockers were originally designed to delay precocious puberty among very young children who began puberty well before their peers. Sex hormones were developed primarily to treat people who were unable to produce enough of the hormones of their biological sex. These were the uses for which these drugs were originally tested and approved. These drugs have been prescribed for young people wishing to change their secondary sex characteristics without undergoing testing and formal approval for these new uses. The lack of any experimental evidence of the effects of these medical interventions prevents the gold-standard research one would normally expect in order to isolate the causal effects of these interventions.24

The use of puberty blockers and sex hormones to address gender issues is also relatively recent, with widespread adoption occurring only within the past few years.25   The fact that randomized experiments were not required for this use of puberty blockers and sex hormones, and that this novel use of these drugs is relatively recent, means that only a handful of studies examine their effects, and all these studies use inferior correlational research designs.

23. Claudia Haupt et al., “Antiandrogen or Estradiol Treatment or Both During Hormone Therapy in Transitioning Transgender Women,” Cochrane Database of Systematic Reviews, Vol. 11, No. 11 (November 2020), https://pubmed.ncbi.nlm.nih.gov/33251587/ (accessed May 26, 2022).

24. Randomization in a randomized controlled trial isolates the exposure variable of interest and eliminates concerns of confounding in a statistical analysis.

25. Michael Biggs, “Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria,” Archives of Sexual Behavior, Vol. 49, No. 7 (October 2020), pp. 2227–2229, https://doi.org/10.1007/s10508-020-01743-6 (accessed May 26, 2022), and Klotz, “The Fractious Evolution of Pediatric Transgender Medicine.”

• "The effects of puberty blockers and cross-sex hormones as a medical intervention for adolescents who identify as transgender have never been subjected to a large-scale randomized controlled trial (RCT), like the kind that is typically required for approval of new medications."
• "The use of puberty blockers and sex hormones to address gender issues is also relatively recent, with widespread adoption occurring only within the past few years."
• "The fact that randomized experiments were not required for this use of puberty blockers and sex hormones, and that this novel use of these drugs is relatively recent, means that only a handful of studies examine their effects, and all these studies use inferior correlational research designs."

Longitudinal studies essentially absent. 

Here's the bit addressing Turban directly:

Quote

The main defect of studies relying on correlational research designs is that they are unable to determine with confidence whether any relationships between receiving these drugs and later health outcomes are causal. That is, one can never know with confidence whether the drugs cause those outcomes, or whether other factors that make people more likely to receive the drugs were the causes. This inherent weakness in correlational research is precisely why regulators, such as the U.S. Food and Drug Administration, typically require randomized experiments before approving a drug.26   In an experiment, the only thing that determines whether people receive the medical intervention is chance, so any differences in outcomes between those who did and did not get the treatment would have to be caused by the intervention and not another factor.

This weakness of correlational research designs can be illustrated by examining one of the most prominent studies claiming to find that adolescents who receive cross-sex hormones have a lower risk of suicide.27  That study, led by Jack Turban of Stanford Medical School and published in PLOS ONE in 2022, examines the results of a 2015 survey of more than 27,000 American adults who identify as transgender. The survey was not meant to be representative of all such adults because its participants were recruited as a convenience sample, largely through transgender support groups. Subjects were asked whether they had ever sought cross-sex hormones, and then whether they had ever received them. Respondents who never sought cross-sex hormones were excluded from the analysis. The main comparison examined in the study was between those who had sought and received the hormones, and those who had sought but never received them when they were between 14 and 17.

The obvious defect in this comparison is that there are reasons why some people were able to get the hormones while others could not, even though all of them report wanting to get them. The reasons that allowed some to access them but not others are likely strongly related to later mental health. One of the most important reasons why some adolescents were able to access the hormone therapies while others could not is that parental consent is often, though not always, required to get these drugs.  As is well known from research on gender-confused youth, as well as more generally, closer and more positive relationships between children and parents promote mental well-being and is protective against suicide.

The problem, then, with the Turban study, is that it is impossible to know whether the reduced odds of contemplating suicide among adults who sought and received hormone therapy as children were a result of the relationship with their parents who gave consent for this intervention or a result of the intervention itself. If a close and positive relationship between parents and children struggling with gender identity is the key to successful outcomes for those adolescents, then the hormones themselves might make no difference, or even be harmful. But that effect would be masked by the kind of parent–child relationship that exists when parents are more likely to consent.

Turban’s own data show enormous differences in relationships between children and parents among those who obtained the hormones and those who did not, despite desiring them. Of those who were unable to get the hormones, 35 percent had not “come out” to their parents, compared to 3 percent among those who obtained hormones at ages 14 and 15, and 4 percent among those who obtained hormones at ages 16 and 17. Among those who got the hormones as teenagers, nearly 80 percent reported feeling supported by their parents, compared to 33 percent of those who were unable to get the drugs.

Turban attempts to control statistically for these reported differences, but that adjustment cannot fully fix the bias, especially when the differences between the groups being compared are so stark and when the measures of parent–child relationship are imprecise. This would be like trying to adjust for the effects of family income during childhood knowing only whether someone reports having felt poor. Memories are imperfect, and simply dividing people into poor and not-poor categories fails to capture the difference between the children of billionaires and those raised in public housing projects. Adolescents who can get their parents’ consent for hormone therapy have dramatically different relationships with their parents than those who cannot, and that difference in relationship can affect mental health later in life, even if the hormones themselves have no benefit, or are harmful.

Another important factor that determines whether young people get cross-sex hormones is their psychological condition when they are seeking that intervention. According to guidelines issued by WPATH, a key condition for prescribing cross-sex hormones is that “any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment.”28  The difference between those who desired hormone therapy and received it and those who sought it but were unable to receive it could be the state of their mental health at the time they tried to get the drugs.

The Turban study lacks information on, and therefore cannot make any statistical adjustments for, the mental health at the time the subjects sought hormone therapy. The respondents who were unable to get hormone therapy despite saying they wanted it may have worse mental health outcomes because they began with more severe psychological issues that prevented them from obtaining the hormones. The pre-existing mental health challenges could be the cause of later outcomes, not whether they received the hormones.

The inability to sort out this kind of uncertainty about what is causing differences in mental health outcomes is inherent in the correlational research design employed by Turban and his colleagues. These same concerns apply to an earlier study by Turban and his colleagues published in Pediatrics in 2020. This study examines the relationship between puberty blockers and later mental health outcomes and relies on the same correlational research design to analyze data from the same survey as the cross-sex hormone study.29  The use of a correlational research design also makes it impossible to draw causal conclusions from a study by Amy Green and colleagues that analyzes the mental health effects of adolescents receiving cross-sex hormones based on data from a different survey.30

The two studies led by Turban, and the one led by Green, are the only three studies that examine the relationship between cross-sex medical interventions by teenagers and suicide risks that make any use of a comparison group. As the 2020 Turban study describes itself, “This is the first study in which associations between access to pubertal suppression and suicidality are examined.”31  The 2022 Turban study observes that there have been six studies that track the mental health outcomes of teens who received hormone treatments, but emphasizes that “these studies did not include a comparison group of adolescents who did not access GAH [gender affirming hormones].”32  Studies that track adolescents who receive these medical interventions are even weaker than correlational studies in their ability to draw causal conclusions about the effects of those interventions, because they have no information on how those individuals would have fared had they not received the interventions.

The prior research on this subject is not only weak because it contains no credibly causal studies and only a handful of correlational studies, but also because those correlational studies are poorly executed. For example, the 2022 Turban study combines the use of testosterone for natal females and estrogen for natal males and only reports the combined effects of hormones. When Michael Biggs analyzes the same data and disaggregates the hormone by type, he finds that: “Males who took estrogen are more likely to plan suicide, to attempt suicide, and to require hospitalization for a suicide attempt.”33   This negative effect is masked in Turban’s study by the failure to report the separate effects by type of hormone.

Similarly, the 2022 Turban study finds that 16- and 17-year-olds who received hormones were more than twice as likely to report a “past-year suicide attempt requiring inpatient hospitalization,” but that finding fails to achieve statistical significance by setting the standard for significance higher than is conventional.34  Only by adopting a standard for statistical significance that is different from the one more commonly used in empirical research does the study avoid concluding that this significant harm from hormone therapy exists.

The two Turban studies do not consistently use the same set of control variables when generating their adjusted-odds ratio, even changing what is controlled when analyzing different outcomes within the same study. The two Turban studies also change the main outcome of interest from lifetime suicidal ideation in the study on puberty blockers to suicidal ideation in the last 12 months in the study on hormones. Researchers should determine which confounding variables to control and which outcome variable to examine in their statistical models based on sound theory and prior empirical research, and then consistently apply those decisions, especially within the same study. Changing which factors are controlled in the statistical analysis of each outcome variable, as well as which outcome on which to focus, opens the door to p-hacking, the process of changing empirical models in an ad hoc fashion to yield desired, though likely spurious, results.

The bottom line is that the most influential recent research on the relationship between adolescent cross-sex interventions and later mental health outcomes, including suicide risk, does not provide convincing evidence. Only a small number of studies make comparisons to a control group—and those studies employ correlational research designs that do not allow causal conclusions, nor have those correlational studies been conducted properly.  

26. U.S. Food and Drug Administration, “CFR– Code of Federal Regulations Title 21,” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=314.126 (accessed May 26, 2022).

27. Jack L. Turban et al., “Access to Gender-Affirming Hormones During Adolescence and Mental Health Outcomes Among Transgender Adults,” PLOS ONE, Vol. 17, No. 1 (January 12, 2022), p. e0261039, https://doi.org/10.1371/journal.pone.0261039 (accessed May 26, 2022).

28. Eli Coleman et al., “Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7,” International Journal of Transgenderism, Vol. 13, No. 4 (2012), p. 19, https://www.tandfonline.com/doi/abs/10.1080/15532739.2011.700873 (accessed May 26, 2022).

29. Jack L. Turban et al., “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation,” Pediatrics, Vol. 145, No. 2 (February 2020), p. e20191725, https://doi.org/10.1542/peds.2019-1725 (accessed May 26, 2022).

30. Amy E. Green et al., “Association of Gender-Affirming Hormone Therapy with Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth,” Journal of Adolescent Health, Vol. 70, No. 4 (April 2022), pp. 643–649, https://doi.org/10.1016/j.jadohealth.2021.10.036 (accessed May 26, 2022).

31. Turban et al., “Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation.”

32. Turban et al., “Access to Gender-Affirming Hormones During Adolescence and Mental Health Outcomes Among Transgender Adults.”

33. Michael Biggs, “Comment on Turban et al. 2022: Estrogen Is Associated with Greater Suicidality Among Transgender Males, and Puberty Suppression Is Not Associated with Better Mental Health Outcomes for Either Sex,” figshare, journal contribution, 2022, https://doi.org/10.6084/m9.figshare.19018868.v1 (accessed May 27, 2022).

34. Turban et al., “Access to Gender-Affirming Hormones During Adolescence and Mental Health Outcomes Among Transgender Adults.”

• "The main defect of studies relying on correlational research designs is that they are unable to determine with confidence whether any relationships between receiving these drugs and later health outcomes are causal. ... This inherent weakness in correlational research is precisely why regulators, such as the U.S. Food and Drug Administration, typically require randomized experiments before approving a drug."
• "The survey {relied upon by Turban} was not meant to be representative of all such adults because its participants were recruited as a convenience sample, largely through transgender support groups.  Subjects were asked whether they had ever sought cross-sex hormones, and then whether they had ever received them.  Respondents who never sought cross-sex hormones were excluded from the analysis."
• "The problem, then, with the Turban study, is that it is impossible to know whether the reduced odds of contemplating suicide among adults who sought and received hormone therapy as children were a result of the relationship with their parents who gave consent for this intervention or a result of the intervention itself."
• "Turban’s own data show enormous differences in relationships between children and parents among those who obtained the hormones and those who did not, despite desiring them."
• "The Turban study lacks information on, and therefore cannot make any statistical adjustments for, the mental health at the time the subjects sought hormone therapy. ... The pre-existing mental health challenges could be the cause of later outcomes, not whether they received the hormones."
• "The inability to sort out this kind of uncertainty about what is causing differences in mental health outcomes is inherent in the correlational research design employed by Turban and his colleagues."
• "The two Turban studies do not consistently use the same set of control variables when generating their adjusted-odds ratio, even changing what is controlled when analyzing different outcomes within the same study."
• "The two Turban studies also change the main outcome of interest from lifetime suicidal ideation in the study on puberty blockers to suicidal ideation in the last 12 months in the study on hormones."
• "The bottom line is that the most influential recent research on the relationship between adolescent cross-sex interventions and later mental health outcomes, including suicide risk, does not provide convincing evidence."

These things need to be addressed.

The article goes on to propose "A Better Research Approach."  I think it's worth a read.  He then not some interesting developments in suicide rates based on states with differing approaches to parental involvement:

Quote

The Results

In the past several years, the suicide rate among those ages 12 to 23 has become significantly higher in states that have a provision that allows minors to receive routine health care without parental consent than in states without such a provision. Before 2010, these two groups of states did not differ in their youth suicide rates. Starting in 2010, when puberty blockers and cross-sex hormones became widely available, elevated suicide rates in states where minors can more easily access those medical interventions became observable.

Rather than being protective against suicide, this pattern indicates that easier access by minors to cross-sex medical interventions without parental consent is associated with higher risk of suicide. The Heritage model plotted the difference in a three-year rolling average of suicide rates between states with minor access provisions and states with no such provision. Chart 2 plots the trend in this difference for those ages 12 to 23 who could have been affected by the policy when cross-sex medical interventions became available. For comparison, Chart 2 also shows the trend in this difference for a group ages 28 to 39, who could not have been affected by these policies, since the people in this group would have been at least 18 when puberty blockers and cross-sex hormones became available.

Without making any adjustments, suicide rates among those ages 12 to 23 (blue line) begin to spike in states that have provisions that allow minors to access health care without parental consent relative to states that have no such provision around 2016, after cross-sex medical interventions became more common. By 2020, there are about 3.5 more suicides per 100,000 people ages 12 to 23 in states with easier access than in states without an access provision. There is no similar spike in suicide rates among those ages 28 to 39 (grey line) at that time.

It is also clear that the states with a provision always had somewhat higher suicide rates than the states with no provision. To isolate the effect of this provision on youth suicide rates, it is better to control statistically for the youth suicide rate in each state at baseline as well as the suicide rate in each state in each year among the older and unaffected age group.

Making these adjustments and plotting three-year rolling averages yields the trend pictured in Chart 3. It is clear that the presence of a state-level provision for minors to access health care without parental consent makes no difference in suicide rates among those ages 12 to 23 until about 2010, when the suicide rate begins to drift up in states with easier access. In 2015, the estimated increase in suicide rates in states with easier access accelerates. By 2020, there are about 1.6 more suicides per 100,000 people ages 12 to 23 in states that have a policy allowing minors to access health care without parental consent than in states without such a policy. The average state suicide rate in this age group between 1999 and 2020 was 11.1, making an additional 1.6 suicides per 100,000 an increase of 14 percent in the suicide rate.

This increase in suicide rates in states where it is easier for minors to access puberty blockers and cross-sex hormones increased at almost the same time, and to the same degree, as those interventions became available. Using Google Trends results for the terms associated with those medical interventions as a proxy for their availability shows that increased suicide rates in states with easier access almost perfectly track the prevalence of those terms. (Compare Charts 1 and 3.)

This elevated rate of youth suicide is statistically significant at conventional levels, and robust to different approaches to modeling the trend over time. (See Appendix Tables 2–5 for regression results.)

It is useful to conduct a “placebo test” to examine whether the elevated rate of suicides among young people in states where it was easier for minors to access cross-sex interventions also existed among slightly older people who could not have been affected by minor access provisions. Using the same exact regression model while replacing the suicide rate among those ages 12 to 23 with the rate for those ages 28 to 39 in the same states as the dependent variable shows no relationship between the ease of accessing cross-sex medical care and suicide rates among those too old to have been affected by these state policies. (See Appendix Table 6.) This placebo test strongly indicates that making it easier for minors to access puberty blockers and cross-sex hormones when those interventions became available is causally related to increased suicide rates, because no similar increase was seen by those slightly older who would have been unaffected.

• "In the past several years, the suicide rate among those ages 12 to 23 has become significantly higher in states that have a provision that allows minors to receive routine health care without parental consent than in states without such a provision."
• "Rather than being protective against suicide, this pattern indicates that easier access by minors to cross-sex medical interventions without parental consent is associated with higher risk of suicide."

Thoughts?

Quote

Discussion

The results presented in this Backgrounder provide strong evidence for the claim that suicides among young people have increased significantly since 2010 in states that have a policy allowing minors to access routine health care without parental consent. That increase in suicide rates accelerated around 2015. Prior to 2010, whether a state had such a policy or not had no significant effect on the trend in suicide rates among those ages 12 to 23. The timing of the increase in suicide rates only among young people, only after puberty blockers and cross-sex hormones are introduced and used widely, and only in states where minors could access those medical interventions without parental consent raises serious concerns about their effects on suicide risks.

The research presented here does not directly examine whether the individuals who receive gender-related medical interventions are at a higher risk of suicide, but it does directly examine the state policies that facilitate minors accessing those interventions without parental consent and finds that those policies raise suicide risks among young people.

To believe that easier access to puberty blockers and cross-sex hormones are not the cause of elevated suicide risk in those states, one would have to be able to imagine other medical interventions that only became widely available after 2010 and would only affect young people. The lack of theoretically plausible alternatives strengthens the case for concluding that cross-sex medical interventions are the cause of the observed increase in suicide among young people.

State Policy Recommendations

At a minimum, the results presented in this Backgrounder demonstrate that efforts to lower legal barriers for minors to receive cross-sex medical interventions do not reduce suicide rates and likely lead to higher rates among young people in states that adopt those changes. States that currently facilitate minors’ access to routine health care without the consent of a parent or legal guardian should consider revising such policies. States should also adopt parental bills of rights that affirm that parents have primary responsibility for their children’s education and health, and that require schools to receive permission from parents before administering health services to students, including medication and gender-related counseling to students under age 18.

This research adds to the well-established wisdom that children are better off if they are not allowed to make major life decisions without their parents’ involvement and permission. In general, parents are better positioned than anyone else, including the children themselves, to understand the needs of their children when making important decisions. State policies that undermine this relationship between parents and children are dangerous and should be repealed. Similarly, those who work with children in professional capacities, including health, education, and counseling, should be careful about substituting their own judgment for that of the parents. The research presented here supports the view that children fare significantly better when their parents have the authority to know about, and help to make, major decisions for their own children.

Lastly, given the danger of cross-sex treatments demonstrated in this Backgrounder, states should tighten the criteria for receiving these interventions, including raising the minimum eligibility age.

• "{S}uicides among young people have increased significantly since 2010 in states that have a policy allowing minors to access routine health care without parental consent."
• "The research presented here does not directly examine whether the individuals who receive gender-related medical interventions are at a higher risk of suicide, but it does directly examine the state policies that facilitate minors accessing those interventions without parental consent and finds that those policies raise suicide risks among young people."
• "{E}fforts to lower legal barriers for minors to receive cross-sex medical interventions do not reduce suicide rates and likely lead to higher rates among young people in states that adopt those changes."
• "{C}hildren are better off if they are not allowed to make major life decisions without their parents’ involvement and permission. ... State policies that undermine this relationship between parents and children are dangerous and should be repealed."
• "{G}iven the danger of cross-sex treatments demonstrated in this Backgrounder, states should tighten the criteria for receiving these interventions, including raising the minimum eligibility age."

Some pretty cogent stuff, this.

4 hours ago, Analytics said:

Despite this “significant” finding which “aligns with past literature,” you are against this treatment in general and  are against this specific scientific conclusion being taken into account by competent, diligent doctors and conscientious parents when evaluating whether or not pubertal suppression during adolescence might be right for any given patient. Why?

Meh.  I reject your characterization here.

4 hours ago, Analytics said:

I’m not saying that the issues you raise are fake issues.

Glad to hear it.

Thanks,

-Smac

[bluebell]

On 10/11/2024 at 2:03 PM, smac97 said:

I took her comments as more of a "gotcha."  My comments have clearly been about so-called "gender affirming" medical treatments involving electively removing healthy body parts of children and electively sterilizing children (or, if you prefer, "PSTM").

I was not speaking about circumcision.  At all.

Thanks,

-Smac

That’s clear to everyone. I think Calm was trying to find out if you applied the same logic to all unnecessary surgeries (even ones the church condoned) as you do to transgender surgeries.

In other words, she was probably trying to find out if your objection to gender affirming surgeries was purely secular as you were claiming. Or if it was more theological in nature than your argument seemed. 

[smac97]

On 10/12/2024 at 6:35 PM, bluebell said:

That’s clear to everyone. I think Calm was trying to find out if you applied the same logic to all unnecessary surgeries (even ones the church condoned) as you do to transgender surgeries.

No.  I have not bee speaking about "all unnecessary surgeries."  I have, instead, been speaking about "Pediatric Sex Trait Modification" medical treatments.  That is to say, medical treatments involving electively removing healthy body parts of children and electively sterilizing children.  That is further to say, medical treatments which involve the following ongoing concerns:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

I have not been speaking of circumcision.  I have not been speaking of adults receiving these treatments.

On 10/12/2024 at 6:35 PM, bluebell said:

In other words, she was probably trying to find out if your objection to gender affirming surgeries was purely secular as you were claiming.

My concerns pertain to pediatric sex trait modification ("PSTM") treatments.

On 10/12/2024 at 6:35 PM, bluebell said:

Or if it was more theological in nature than your argument seemed. 

There is religious/moral dimension to my perspective on this issue.  However, my particularized concerns about PSTM pertains to the foregoing bulleted items, which I believe I would hold even if I were not a Latter-day Saint.  

Thanks,

-Smac

Edited October 14, 2024 by smac97

[Analytics]

On 10/12/2024 at 4:56 PM, smac97 said:

Most of Europe and quite a few parts of the U.S. are substantially revisiting PSTM.  It's not my approach.

Your approach is to mine the internet for politically oriented editorials that support your preconceived notions. I agree that, unfortunately, there are some lawmakers who follow this same approach to rationalize laws that constrain the ability of qualified, conscientious healthcare professionals to treat their patients. 

On 10/12/2024 at 4:56 PM, smac97 said:

Regarding the article you quote above (about the "Turban" studies), see this June 2022 articles which addresses it: Puberty Blockers, Cross-Sex Hormones, and Youth Suicide...

This illustrates my point. I cited a recent article from a prestigious medical journal that reports on a clinical study regarding this issue. In response, you did a Google search to find something that supports your preconceived notions, and found a propaganda piece written by a political scientist.

Edited October 14, 2024 by Analytics

[bluebell]

13 hours ago, smac97 said:

No.  I have not bee speaking about "all unnecessary surgeries."  I have, instead, been speaking about "Pediatric Sex Trait Modification" medical treatments.  That is to say, medical treatments involving electively removing healthy body parts of children and electively sterilizing children.  That is further to say, medical treatments which involve the following ongoing concerns:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

I have not been speaking of circumcision.  I have not been speaking of adults receiving these treatments.

My concerns pertain to pediatric sex trait modification ("PSTM") treatments.

There is religious/moral dimension to my perspective on this issue.  However, my particularized concerns about PSTM pertains to the foregoing bulleted items, which I believe I would hold even if I were not a Latter-day Saint.  

Thanks,

-Smac

I think there may be a disconnect somewhere in how I'm explaining myself, because we all understand that you were not talking about circumcision (and I didn't say pediatric because I thought it was implied, but I can see why you clarified that).

Even though you weren't talking about it, Calm was asking if your reasoning and logic about unnecessary surgeries was as applicable to circumcision as it was to gender affirming surgeries.

You've obviously clarified a lot since the conversation started, and I think you've answered the question by adding in the theological components of your argument that weren't specifically included at first.   But in the beginning of the discussion, you claimed, without all the clarification that we've since had, that you were against medically unnecessary surgeries that removed parts of the body. 

That blanket claim is what triggered Calm's question.  

[smac97]

11 hours ago, Analytics said:

Quote

Most of Europe and quite a few parts of the U.S. are substantially revisiting PSTM.  It's not my approach.

Your approach is to mine the internet for politically oriented editorials that support your preconceived notions.

Over a period of years, and through extensive (albeit neophyte) research and study and evaluation, I have developed a fairly well-informed opinion about the topic of PSTM.  For example, I was not initially aware of the prevalence of unaddressed/disregarded comorbidities, I had not really examined this issue through the lens of "informed consent," and so on.  Now I have.  I have examined and re-examined my assessment by reading relevant materials, and by listening to people whose opinions and perspectives differ from my own.  Some of these folks respond less by substantive analysis, and more through personal attacks and taunts.

For me, this topic is not primarily political.  Political parties and figures may well have their own opinions that align with, or disagree with, my assessment.  I don't pay much attention to political platforms when formulating my opinions, as politics are - for me - downstream from morality, ethics, evidence, reasoning, etc.  So I am more particularly interested in articles that address the topic in substantive ways.  The article in my previous post, by Jay Greene, did that.  The article was not just Jay Greene spouting off about his say-so (though his opinion is clearly there), as he included dozens of articles and other references which supported and corroborated his assessment.  Politics and legislative actions are obviously part of the picture, but these are - or ought to be - downstream from reasoned, evidence-based assessments of the issues.  

Notably absent from the article, however, was any particular religious/theological argument or critique of PSTM.  That is not to say that such arguments don't or can't our ought not play any role, but there are plenty of substantial grounds to oppose, or be gravely concerned about, PSTM which are over and above such considerations.

11 hours ago, Analytics said:

I agree that, unfortunately, there are some lawmakers who follow this same approach to rationalize laws that constrain the ability of qualified, conscientious healthcare professionals to treat their patients. 

I never said such a thing with which you can be said to "agree."  Instead, I have noted a number of areas of concern for me re: PSTM:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

Jay Greene makes a number of solid evidentiary and policy arguments in his article, some of which touch on some of the foregoing concerns.  Front and center, I think, is the absence of meaningful data and longitudinal studies addressing, as Greene put it, "the relationship between cross-sex medical interventions by teenagers and suicide risks" (this fits within a few of the above bullet points, such as "longitudinal studies essentially absent," "comorbidities," and "compromised assessments of the best interests of the child," and - perhaps implicitly - "ideological/sociopolitical influences/pressures on medical care").  He states that the study you cited, by Turban, along with two others - also by Turban - "are the only three studies that examine the relationship between cross-sex medical interventions by teenagers and suicide risks that make any use of a comparison group."  He then examines Turban's work, notes what he thinks are substantial flaws, and concludes: 

Quote

The bottom line is that the most influential recent research on the relationship between adolescent cross-sex interventions and later mental health outcomes, including suicide risk, does not provide convincing evidence. Only a small number of studies make comparisons to a control group—and those studies employ correlational research designs that do not allow causal conclusions, nor have those correlational studies been conducted properly.

He then goes on to present what he thinks is "a better research approach."

All of this is worth some discussion.  I have also cited and quoted a number of other articles and resources which I think also merit some discussion and consideration.  Yet instead of doing that, you first posit that you are "agnostic" on the issue, and then proceed to hector me about my ideological presuppositions.  That seems like an ideological argument, Mr. Agnostic, as does your vague appeal to sympathy for medical personnel who have applied PSTM to minors.  Some may well be "qualified, conscientious healthcare professionals" and yet may also be compromised in their assessments of the best interests of the child and subject to ideological/sociopolitical influences/pressures on medical care.  

11 hours ago, Analytics said:

Quote

Regarding the article you quote above (about the "Turban" studies), see this June 2022 articles which addresses it: Puberty Blockers, Cross-Sex Hormones, and Youth Suicide...

This illustrates my point.

It does not. 

11 hours ago, Analytics said:

I cited a recent article from a prestigious medical journal that reports on a clinical study regarding this issue.

Which I suspect you, Mr. Agnostic-on-the-Topic-of-PSTM, found online by searching for references which support your ideological perspective.  For shame!

11 hours ago, Analytics said:

In response, you did a Google search to find something that supports your preconceived notions, and found a propaganda piece written by a political scientist.

I have cited many references which illuminate and inform and substantiate my concerns.  The above was one of these many.

I think we ought to discuss and focus on the topic of pediatric sex trait modification procedures.  That is, so-called "gender affirming" medical treatments involving electively removing healthy body parts of minors (like penectomies and mastectomies) and electively sterilizing minors.  It is, for me, understandable that some may not want to commit themselves to openly/publicly supporting such procedures.  Like supporting elective abortion, I think supporting PSTM becomes quite difficult when we get down to brass tacks, hence the tendency in both circumstances for ideological supporters to A) retreat to the "I have no opinion about this, and society should not have a say about this, either"-style approach; and/or B) attempt to divert attention away from the brass tacks and toward personal jabs/attacks against perceived ideological opponents.

I think we ought to have open discussions about these things.  I think there are ample grounds to be gravely concerned about, and/or specifically opposed to, PSTM in its current condition.

Both sides claim to be concerned for the welfare of children.  Perhaps we can start by giving each other the benefit of the doubt on that point, and then proceed to examine whether that benefit can be justifiably upheld.

Thanks,

-Smac

Edited October 14, 2024 by smac97

[smac97]

1 hour ago, bluebell said:

But in the beginning of the discussion, you claimed, without all the clarification that we've since had, that you were against medically unnecessary surgeries that removed parts of the body. 

No, I don't think I did this.  I have been addressing pediatric sex trait modifications.  Not all "medically unnecessary surgeries that removed parts of the body."

Thanks,

-Smac

[Analytics]

8 hours ago, smac97 said:

Over a period of years, and through extensive (albeit neophyte) research and study and evaluation, I have developed a fairly well-informed opinion about the topic of PSTM. 

Earlier you (selectively) quoted from this article. So I can better understand where you’re coming from, let’s look at a case study from that article:

• On the two-hour drive back from the hospital, Danielle Boyer kept replaying the doctor’s questions in her mind. Was her then-12-year-old child, Ryace, hearing voices? Was she using illegal drugs? Had she ever been hospitalized for psychiatric treatment? Had she ever harmed herself?
  
  Danielle was still shaken when she and Ryace arrived home in this small town nestled in a bend of the Ohio River. Dinner would have to wait. She had to talk to her husband. “They were asking us these sad, terrible questions,” she told Steve Boyer as the two sat in their garage that August 2020 evening. “Do you know kids have tried to kill themselves?”
  
  “I had no idea,” he said.
  
  Ryace (pronounced RYE-us) was assigned male at birth, but by the time she was 4, it was clear to her parents that she identified as a girl. She referred to herself as a girl. She wanted to dress as a girl. But her parents feared for her safety if they let her live openly as a girl in their tightly knit rural community. So they struck an uneasy compromise. At home, Ryace could be a girl, wearing makeup and dresses. At school, around town and in family photos, Ryace would remain a boy.
  
  Ryace chafed at the restrictions. When she started middle school, she grew increasingly anxious about what puberty would bring: facial hair, an Adam’s apple, a deeper voice. That’s when Danielle sought help at Akron Children’s Hospital and its new gender clinic, where staff told her they could treat Ryace with puberty-blocking drugs and sex hormones to help her transition.
  
  “This is what I’ve always wanted,” Ryace told her mother as they left the hospital. Afterward, the pair went on a celebratory shopping trip for girl’s clothes. Danielle was relieved. After years of struggling in isolation to do what they thought was best for Ryace, the Boyers were now getting expert help from people who understood their situation.
  
  But the initial consultation brought troubling new questions. The doctor at the Akron clinic told Danielle and Ryace that puberty blockers could weaken Ryace’s bones. The effects on her brain development and fertility weren’t well-understood. The risk of inaction was even more alarming: Without treatment, the doctor said, Ryace would remain at increased risk of suicide.
  
  Mention of suicide raised the stakes. “She’s been asking for how many years now to be a girl?” Danielle said to her husband as they sat talking in their garage that evening. “We just keep telling her no, and we’re crushing her..." 

So here are my questions for you:

• Do you understand the details of Ryace’s specific situation better than her doctors and parents?
• Do you understand the possible risks and benefits of taking or not taking leuprolide better than Ryace’s doctors?
• Do you care about Ryace more than her parents and doctors care about her?

We’re talking about real world psychiatrists, psychologists, and physicians who have dedicated their lives to understanding these situations and providing real help. And we’re talking about real parents and real children who have invested infinitely more time, attention, and tears to figuring this out than you do. And they are the ones who have to live with the consequences. But you come riding in on your high horse and make sweeping generalizations that, quite frankly, come across as nothing other than demanding to be the victim on something that has absolutely nothing to do with you. When you ask questions like, "What other medical procedures are authorized under threat of suicide?” It sounds like you’re saying, “Better dead in a body that is free from puberty blockers than alive in a body with them (and I say that because unlike your parents, I really care)."

You really shouldn’t talk in such a glib manner about other people’s medical decisions. If you really think you have something worthwhile to say on these issues, why don’t you make your voice heard in a venue that actually matters rather than just virtue signaling here?

 

Edited October 15, 2024 by Analytics

[california boy]

3 hours ago, Analytics said:

Earlier you (selectively) quoted from this article. So I can better understand where you’re coming from, let’s look at a case study from that article:

• On the two-hour drive back from the hospital, Danielle Boyer kept replaying the doctor’s questions in her mind. Was her then-12-year-old child, Ryace, hearing voices? Was she using illegal drugs? Had she ever been hospitalized for psychiatric treatment? Had she ever harmed herself?
  
  Danielle was still shaken when she and Ryace arrived home in this small town nestled in a bend of the Ohio River. Dinner would have to wait. She had to talk to her husband. “They were asking us these sad, terrible questions,” she told Steve Boyer as the two sat in their garage that August 2020 evening. “Do you know kids have tried to kill themselves?”
  
  “I had no idea,” he said.
  
  Ryace (pronounced RYE-us) was assigned male at birth, but by the time she was 4, it was clear to her parents that she identified as a girl. She referred to herself as a girl. She wanted to dress as a girl. But her parents feared for her safety if they let her live openly as a girl in their tightly knit rural community. So they struck an uneasy compromise. At home, Ryace could be a girl, wearing makeup and dresses. At school, around town and in family photos, Ryace would remain a boy.
  
  Ryace chafed at the restrictions. When she started middle school, she grew increasingly anxious about what puberty would bring: facial hair, an Adam’s apple, a deeper voice. That’s when Danielle sought help at Akron Children’s Hospital and its new gender clinic, where staff told her they could treat Ryace with puberty-blocking drugs and sex hormones to help her transition.
  
  “This is what I’ve always wanted,” Ryace told her mother as they left the hospital. Afterward, the pair went on a celebratory shopping trip for girl’s clothes. Danielle was relieved. After years of struggling in isolation to do what they thought was best for Ryace, the Boyers were now getting expert help from people who understood their situation.
  
  But the initial consultation brought troubling new questions. The doctor at the Akron clinic told Danielle and Ryace that puberty blockers could weaken Ryace’s bones. The effects on her brain development and fertility weren’t well-understood. The risk of inaction was even more alarming: Without treatment, the doctor said, Ryace would remain at increased risk of suicide.
  
  Mention of suicide raised the stakes. “She’s been asking for how many years now to be a girl?” Danielle said to her husband as they sat talking in their garage that evening. “We just keep telling her no, and we’re crushing her..." 

So here are my questions for you:

• Do you understand the details of Ryace’s specific situation better than her doctors and parents?
• Do you understand the possible risks and benefits of taking or not taking leuprolide better than Ryace’s doctors?
• Do you care about Ryace more than her parents and doctors care about her?

We’re talking about real world psychiatrists, psychologists, and physicians who have dedicated their lives to understanding these situations and providing real help. And we’re talking about real parents and real children who have invested infinitely more time, attention, and tears to figuring this out than you do. And they are the ones who have to live with the consequences. But you come riding in on your high horse and make sweeping generalizations that, quite frankly, come across as nothing other than demanding to be the victim on something that has absolutely nothing to do with you. When you ask questions like, "What other medical procedures are authorized under threat of suicide?” It sounds like you’re saying, “Better dead in a body that is free from puberty blockers than alive in a body with them (and I say that because unlike your parents, I really care)."

You really shouldn’t talk in such a glib manner about other people’s medical decisions. If you really think you have something worthwhile to say on these issues, why don’t you make your voice heard in a venue that actually matters rather than just virtue signaling here?

 

I don't think any of us know what it is like to struggle with gender.  I certainly have no idea what this child is going through or any other child.  It seems insulting to just give a glib answer from a point of view that no one in this forum has even had the slightest inclination to feel like they are not the gender their body is masking.

What I do fully believe is that there can not be only one way to proceed and assume it will work for every single kid that is struggling with this issue.  

[smac97]

20 hours ago, Analytics said:

Quote

Over a period of years, and through extensive (albeit neophyte) research and study and evaluation, I have developed a fairly well-informed opinion about the topic of PSTM. 

Earlier you (selectively) quoted from this article.

Short of quoting an article in its entirety, we always "selectively" quote them.  I did, however, provide a link to the article.

20 hours ago, Analytics said:

So I can better understand where you’re coming from,

Your comments evince nothing like a desire to "understand where {I am} coming from."

This is a difficult topic.  I am attempting to address it in measured and moderate ways.  And yet here you are substantially mischaracterizing my statements and imputing thoughts and motives onto me which I do not hold.

20 hours ago, Analytics said:

let’s look at a case study from that article:

• SNIP

So here are my questions for you:

• Do you understand the details of Ryace’s specific situation better than her doctors and parents?

I have said nothing about this "specific situation."

I have, instead, been speaking about PSTM in a broader sociopolitical and moral context.  I have raised a number of substantial issues/concerns about pediatric sex trait modification treatments:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Cutting off healthy body parts. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Massive ideological/sociopolitical influences/pressures on medical care. 
• Massive social contagion risks. 
• Massive risk of financial devastation for the individual (and burden on society).

I do not have information about comorbidities, informed consent, etc. about a specific party.  Neither do you.  So there's not much point in discussing that specific party.

20 hours ago, Analytics said:

We’re talking about real world psychiatrists, psychologists, and physicians who have dedicated their lives to understanding these situations and providing real help.

Including people like Doctor Bell, correct?

I am curious as to your thoughts about this story:

Quote

BOSTON (TND) — Boston Children’s Hospital (BCH), a nationally renowned hospital ranked number one in the nation by U.S. News and World Report, was the first major pediatric hospital in the country dedicated to providing life-altering surgical procedures for gender-dysphoric youth.

The Center for Gender Surgery at Boston Children's Hospital offers gender affirmation surgery services to eligible adolescents and young adults who are ready to take this step in their journey,” BCH’s website reads.

Among the “gender-affirming” surgeries offered at BCH are “gender-affirming hysterectomies,” which involve the removal of the cervix, or the lower, narrow end of the uterus that forms a canal between the uterus and vagina, as well as the fallopian tubes.

Per this USA Today article, BCH is denying that it is performing hysterectomies on minors, despite their website advertising "gender affirmation surgery services to eligible adolescents and young adults who are ready to take this step in their journey."

Back to the first article:

Quote

Hysterectomies, which are irreversible, are commonly used for cancer patients and a litany of other gynecological health problems. Now, one of the nation’s leading hospitals wants to remove healthy cervixes and fallopian tubes, which would permanently prevent a patient from being able to bear children.

The hysterectomy procedures are done through BCH's gynecology department, which specializes“in gynecologic care for newborns to young adults.”

We pride ourselves in providing the answers you seek in simple language that children, teens, and parents can understand — from addressing common concerns such as missed periods, heavy bleeding, pelvic pain, and endometriosis to managing more complex conditions like congenital anomalies of the reproductive tract,” BCH's website on pediatric gynecology states.

On BCH’s same pediatric gynecology webpage, underneath a subheading that reads “Delivering Specialty Care” which lists the treatments offered by BCH's pediatric gynecologists, “transgender reproductive health” is included.

Our team are world leaders in the care of teens with endometriosis, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, complex anomalies of the reproductive tract, and transcare,” the webpage continues. “We also work closely with the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center’s Fertility Preservation Program to give young girls with cancer a chance to have their own families in the future.”

"Our team are world leaders in the care of teens ... {needing} transcare."

But "transcare" does not, per BCH, include hysterectomies.

Quote

Erika Sanzi,director of outreach at nonprofit Parents Defending Education, told The National Desk (TND) that she fears the infusion of gender ideology in schools around the country will ultimately lead to this sort of “mutilation” of healthy bodies.

A world renown pediatric facility proudly talking about removing the uteruses of healthy young girls in the name of gender affirming care is terrifying,” Sanzi told TND.

According to the eligibility requirements for BCH’s “Gender Surgery Program," minors as young as 15 can receive breast augmentation and double mastectomies with parental consent, but phalloplasty and metoidioplasty surgeries require patients to be 18, while 17-year-olds can access vaginoplasties.

The program’s webpage makes no indication about hysterectomies.

"{M}inors as young as 15 can receive {} double mastectomies with parental consent."  "17-year-olds can access vaginoplasties."  But not phalloplasty and metoidioplasty surgeries. 

See also this story: DC children's hospital offered 'gender affirming' hysterectomies for kids, audio and deleted webpage reveal

Quote

Children's National Hospital in Washington, D.C. offered "gender-affirming" hysterectomies for kids between the ages of 0-21, a recently deleted webpage shows.

An archived webpage from Aug. 18 on Children's National Hospital's website listed "gender-affirming medical care and gender-affirming hysterectomy" among the services offered for "patients between the ages of 0-21" through the hospital's gynecology program.

The webpage was recently modified and no longer states that the program offers gender-affirming hysterectomies for kids.

Libs of TikTok first reported that the hospital offered the procedure to youth.

An archived webpage from Aug. 18 on Children's National Hospital's website listed "gender-affirming medical care and gender-affirming hysterectomy" among the services offered for "patients between the ages of 0-21" through the hospital's gynecology program. (Screenshot/Internet Archive)

In a phone call with hospital staff, the Libs of TikTok founder asked how young someone can be in order for doctors to perform a gender-affirming hysterectomy. The worker said that hysterectomies have been performed on children who are younger than the age of 16, according to the audio.

Asked about the recording by Fox News Digital, a hospital spokesperson said the call "reflects a call with hospital operators not anyone who delivers care to our patients."

A Children's National Hospital spokesperson told Fox News Digital that the hospital does not provide gender-affirming surgery for kids.

"Children's National Hospital is committed to fostering a welcoming and inclusive environment for all and to serving our LGBTQ+ patients and families in the full spectrum of their care," the spokesperson said. "We do not provide gender-affirming surgery for anyone under the age of 18. We do not provide hormone therapy to children before puberty begins. Care is individualized for each patient and always involves families making decisions in coordination with a team of highly trained pediatric specialists."

When pressed on why a previous version of the webpage states that the hospital offers "gender-affirming" hysterectomies for individuals between the ages of 0-21, the spokesperson said "that was a flaw in the design of our website."

The webpage has stated since at least June 2021 that the hospital offers "gender-affirming" hysterectomies for individuals between the ages of 0-21, according to internet archives, prior to the recent change.

And this story: Putting numbers on the rise in children seeking gender care

Quote

Thousands of children in the United States now openly identify as a gender different from the one they were assigned at birth, their numbers surging amid growing recognition of transgender identity and rights even as they face persistent prejudice and discrimination.

As the number of transgender children has grown, so has their access to gender-affirming care, much of it provided at scores of clinics at major hospitals.

Reliable counts of adolescents receiving gender-affirming treatment have long been guesswork – until now. Reuters worked with health technology company Komodo Health Inc to identify how many youths have sought and received care. The data show that more and more families across the country are grappling with profound questions about what type of care to pursue for their children, placing them at the center of a vitriolic national political debate over what it means to protect youth who identify as transgender.

Diagnoses of youths with gender dysphoria surge

 

In 2021, about 42,000 children and teens across the United States received a diagnosis of gender dysphoria, nearly triple the number in 2017, according to data Komodo compiled for Reuters. Gender dysphoria is defined as the distress caused by a discrepancy between a person’s gender identity and the one assigned to them at birth.

Overall, the analysis found that at least 121,882 children ages 6 to 17 were diagnosed with gender dysphoria from 2017 through 2021. Reuters found similar trends when it requested state-level data on diagnoses among children covered by Medicaid, the public insurance program for lower-income families.

Gender-affirming care for youths takes several forms, from social recognition of a preferred name and pronouns to medical interventions such as hormone therapy and, sometimes, surgery. A small but increasing number of U.S. children diagnosed with gender dysphoria are choosing medical interventions to express their identity and help alleviate their distress.

These medical treatments don’t begin until the onset of puberty, typically around age 10 or 11.

For children at this age and stage of development, puberty-blocking medications are an option. These drugs, known as GnRH agonists, suppress the release of the sex hormones testosterone and estrogen. The U.S. Food and Drug Administration has approved the drugs to treat prostate cancer, endometriosis and central precocious puberty, but not gender dysphoria. Their off-label use in gender-affirming care, while legal, lacks the support of clinical trials to establish their safety for such treatment.

Over the last five years, there were at least 4,780 adolescents who started on puberty blockers and had a prior gender dysphoria diagnosis.

This tally and others in the Komodo analysis are likely an undercount because they didn’t include treatment that wasn’t covered by insurance and were limited to pediatric patients with a gender dysphoria diagnosis. Practitioners may not log this diagnosis when prescribing treatment.

By suppressing sex hormones, puberty-blocking medications stop the onset of secondary sex characteristics, such as breast development and menstruation in adolescents assigned female at birth. For those assigned male at birth, the drugs inhibit development of a deeper voice and an Adam’s apple and growth of facial and body hair. They also limit growth of genitalia.

Without puberty blockers, such physical changes can cause severe distress in many transgender children. If an adolescent stops the medication, puberty resumes.

The medications are administered as injections, typically every few months, or through an implant under the skin of the upper arm.

That seems like a substantial trend upwards.  I am curious what has happened since 2021.

Quote

After suppressing puberty, a child may pursue hormone treatments to initiate a puberty that aligns with their gender identity. Those for whom the opportunity to block puberty has already passed or who declined the option may also pursue hormone therapy.

At least 14,726 minors started hormone treatment with a prior gender dysphoria diagnosis from 2017 through 2021, according to the Komodo analysis.

Hormones – testosterone for adolescents assigned female at birth and estrogen for those assigned male – promote development of secondary sex characteristics. Adolescents assigned female at birth who take testosterone may notice that fat is redistributed from the hips and thighs to the abdomen. Arms and legs may appear more muscular. The brow and jawline may become more pronounced. Body hair may coarsen and thicken. Teens assigned male at birth who take estrogen may notice the hair on their body softens and thins. Fat may be redistributed from the abdomen to the buttocks and thighs. Their testicles may shrink and sex drive diminish. Some changes from hormone treatment are permanent.

Hormones are taken in a variety of ways: injections, pills, patches and gels. Some minors will continue to take hormones for many years well into adulthood, or they may stop if they achieve the physical traits they want.

Hormone treatment may leave an adolescent infertile, especially if the child also took puberty blockers at an early age. That and other potential side effects are not well-studied, experts say.

"Some changes from hormone treatment are permanent."

"Hormone treatment may leave an adolescent infertile, especially if the child also took puberty blockers at an early age. That and other potential side effects are not well-studied, experts say."

We ought to be discussing these things.

Quote

The ultimate step in gender-affirming medical treatment is surgery, which is uncommon in patients under age 18. Some children’s hospitals and gender clinics don’t offer surgery to minors, requiring that they be adults before deciding on procedures that are irreversible and carry a heightened risk of complications.

The Komodo analysis of insurance claims found 56 genital surgeries among patients ages 13 to 17 with a prior gender dysphoria diagnosis from 2019 to 2021. Among teens, “top surgery” to remove breasts is more common. In the three years ending in 2021, at least 776 mastectomies were performed in the United States on patients ages 13 to 17 with a gender dysphoria diagnosis, according to Komodo’s data analysis of insurance claims. This tally does not include procedures that were paid for out of pocket.

"In the three years ending in 2021, at least 776 mastectomies were performed in the United States on patients ages 13 to 17 with a gender dysphoria diagnosis, according to Komodo’s data analysis of insurance claims. This tally does not include procedures that were paid for out of pocket."

We ought to be discussing these things.

Again, I do not have information about the specific "psychiatrists, psychologists, and physicians" involved in a specific instance of PSTM treatment.  Neither do you.  So there's not much point in discussing that specific instance.

Meanwhile, however, the broader issues (comorbidities, informed consent, ideological/sociopolitical influences/pressures on medical care, etc.) all remain relevant and proper areas of scrutiny and discussion.

20 hours ago, Analytics said:

And we’re talking about real parents and real children who have invested infinitely more time, attention, and tears to figuring this out than you do. And they are the ones who have to live with the consequences.

I agree.  Hence the need to address the concerns listed above, as those "consequences" are pretty extreme.

I get that you do not want to publicly commit to an ideological position that specifically supports medical procedures that, for example, sterilize minors.  It is, on its face, a profoundly important and consequential medical procedure that a minor may come to regret later in life.  Hence the importance of addressing things like informed consent, comorbidities, longitudinal data, ideological/sociopolitical influences/pressures on medical care, etc., and so on.  But for that last one, I would be perplexed at why people who are otherwise obviously intelligent and rational can nevertheless be compromised in their assessments of the best interests of the child.  

The other day I came across this video on YouTube, which reminded me of you:

The transcript (modified for clarity) :

Quote

Interviewer: 0:00 Do you think a 12-year-old should be 0:01 able to get a tattoo

Respondent #1: I'm going to say no 0:03

Respondent #2: probably not

Respondent #3: no

Respondent #2: It's probably too young 0:05 to make decisions.

Respondent #2: It's a pretty 0:07 permanent decision

Respondent #3: They can't make the 0:09 decision for themselves they had 0:10 something permanent on their body.

Interviewer: Do you 0:11 think a 12-year-old should be able to 0:13 consent to puberty blockers?

Respondent #1: Yes

Respondent #3: Yes

Respondent #1: And 0:15 I understand how that sounds really 0:17 hypocritical

Respondent #3: Yes it's a permanent change 0:18 on their body but I think that at that 0:20 point in their life they probably know 0:22 who they are who they want to be.

Interviewer: And you 0:24 think so at 12 years old?

Respondent #3: Yes.

Interviewer: Do you 0:27 think a 12-year-old should be able to 0:29 consent to puberty blockers?

Respondent #2: Yes, because 0:31 that's not a permanent decision.

Respondent #4: That's a 0:32 life-changing decision I don't think 0:35 that any 12-year-old is in a position to 0:40 make a decision that's going to affect 0:42 them long term.

Respondent #2: When you get puberty 0:44 blockers for a lot of kids that's like 0:46 life- saving is keeping them from having 0:47 to go through a puberty I think puberty 0:50 blockers are a great sort of like middle 0:51 ground to allow a 0:54 child to better understand themselves 0:57 without having to make decisions like 0:59 surgery or doing nothing and having to 1:01 live through a puberty 1:04 that is not 1:07 within that they don't identify with.

Respondent #4: I 1:10 think there's plenty of time to make 1:11 those decisions later on once they've 1:13 had a chance to decide exactly what they 1:16 want their identity to be.

Respondent #1: I think that 1:18 maybe there should be more 1:19 waiting but I don't want to like put 1:22 down trans ideas, so...

Interviewer: Do you think a 1:25 12-year-old should be able to consent to 1:26 puberty blockers?

Respondent #5: If they can make an 1:28 informed decision, yeah yeah.

Interviewer: And you 1:30 think a 12-year-old can make an informed 1:32 decision?

Respondent #5: I don't know, I guess it depends 1:34 on the 12-year-old.

Interviewer: Be like a really 1:36 mature 12-year-old.

Respondent #5: Right.  Yea. 

Respondent #6: Because 1:38 some children you can just tell like 1:40 when they that that decision is legit 1:43 with them but like a 12-year-old child I 1:45 think that would be a little difficult.

Respondent #2: 1:47 At 12 years old you have a sense of your 1:49 gender identity of your sex identity um 1:53 so I don't see why I mean we we know 1:55 there's kids that young killing 1:57 themselves because they don't, because 2:00 they have so much gender dysphoria that 2:03 they're having to deal with the 2:04 struggles of being trans so why would we 2:08 if there's a simple answer like puberty 2:10 blockers I I think it's one of the best 2:15 resources.

Interviewer: So if a 12-year-old 2:17 thinks they're a different gender they 2:19 should be able to go in and be like I 2:20 want puberty 2:22 blockers?

Respondent #7: I mean I don't think it's that 2:24 simple as that I think there's a lot 2:25 more like like medical theory and social 2:30 wellness that needs to be 2:31 incorporated into that interaction 2:33 between a 12-year-old and I guess a 2:35 doctor if that's what you're saying 2:36 they're going to but I do think that a 2:38 12-year-old should have that choice.

Interviewer: What 2:40 do you have to say to those people that 2:42 let their children consent to puberty 2:44 blockers at like 10 11 12 years old?

Respondent #4: I 2:47 would say that I disagree with you and I 2:49 think you're an irresponsible 2:51 parent, bottom line.

Which of the respondents in the above video hew closer to your perspective?

20 hours ago, Analytics said:

But you come riding in on your high horse

Sigh.

20 hours ago, Analytics said:

and make sweeping generalizations that, quite frankly, come across as nothing other than demanding to be the victim on something that has absolutely nothing to do with you.

I am claiming no such thing.  I think we ought to be discussing pediatric sex trait modification procedures.  I think it is wrong for people to attempt to stifle such discussion.

20 hours ago, Analytics said:

When you ask questions like, "What other medical procedures are authorized under threat of suicide?” It sounds like you’re saying, “Better dead in a body that is free from puberty blockers than alive in a body with them (and I say that because unlike your parents, I really care)."

Your gloss.  You are fabricating and imputing motives and sentiments onto me which I do not hold.

I think you are doing this because you are trying to silence discussion of this topic.

I think we should be having these discussions.

As for "Better dead in a body that is free from puberty blockers than alive in a body with them," I think you are either succumbing to or perpetuating the fallacy of false dilemma:

Quote

The fallacy of false dilemma, also known as the "either-or" fallacy, is a logical fallacy that misrepresents an issue by presenting only two options as if they were the only options available. This can force people to choose between two extremes, even though there is a spectrum of possibilities in between.

See, you gave us:

Option 1: "dead in a body that is free from puberty blockers"

and

Option 2: "alive in a body with them."

There are, in fact, more options than just these two.  Indeed, I think this false dilemma is often central to the compromised thinking of some regarding the best interests of the child.

20 hours ago, Analytics said:

You really shouldn’t talk in such a glib manner about other people’s medical decisions.

"Glib" as in "(of words or the person speaking them) fluent and voluble but insincere and shallow."

Again, you are fabricating and imputing motives and sentiments onto me which I do not hold.

Again, I think you are doing this because you are trying to silence discussion of this topic."

Again, I think we should be having these discussions.

I think my question is a reasonable one.  "What other medical procedures are authorized under threat of suicide?”

20 hours ago, Analytics said:

If you really think you have something worthwhile to say on these issues, why don’t you make your voice heard in a venue that actually matters rather than just virtue signaling here?

Again, you are fabricating and imputing motives and sentiments onto me which I do not hold.

Again, I think you are doing this because you are trying to silence discussion of this topic."

Again, I think we should be having these discussions.

I harbor similar concerns about so-called "gender affirming" medical treatments for adults, but I ultimately reach a different conclusion about them.  I think issues like comorbidities and informed consent remain present as to adults receiving these treatments.  I think comorbidities need to be substantively addressed, and informed consent needs to be obtained.  If and when an otherwise mentally competent adult addresses these issues and still wants such elective treatments, then that is, or ought to be, their right.  While I would not personally support such a procedure, I would not support legislatively eliminating the right for adults to seek and receive such treatments, either.

Thanks,

-Smac

Edited October 15, 2024 by smac97

[Dario_M]

 But seriously...since when does a kid know about him/her self what he/her is? Bi? Gay? A men? A woman? Gender neutral etc? I mean...when i was a kid i didn't even know i was gay. Later when i was around 13 i found out i was probably gay. But even then i was not sure. A child doesn't know these thinks and only wants to play with his lego or whatever. I child learn all this stuff later on when he/she get's older. 

Edited October 15, 2024 by Dario_M

[smac97]

13 hours ago, california boy said:

I don't think any of us know what it is like to struggle with gender.  

I don't know what it is like to struggle with anorexia or bulimia, but that does not mean I cannot have an opinion on whether we as a society should be encouraging/facilitating such behaviors.

13 hours ago, california boy said:

I certainly have no idea what this child is going through or any other child.  

Yes, mental health issues can be difficult to fathom.  I think we all agree on that.

13 hours ago, california boy said:

It seems insulting to just give a glib answer from a point of view that no one in this forum has even had the slightest inclination to feel like they are not the gender their body is masking.

"Glib" as in "(of words or the person speaking them) fluent and voluble but insincere and shallow."

You, like Roger, are fabricating and imputing motives and sentiments onto me which I do not hold.

Again, I think you are doing this because you are trying to silence discussion of this topic.

Again, I think we should be having these discussions.

I think my question is a reasonable one.  "What other medical procedures are authorized under threat of suicide?”

13 hours ago, california boy said:

What I do fully believe is that there can not be only one way to proceed and assume it will work for every single kid that is struggling with this issue.  

I can go along with that.

But I think there can be some "way{s} to proceed" that are not appropriate for minors.  

A 15-year-old girl who is 5'6 and weights 98 pounds and suffers from Body Dysmorphic Disorder (BDD) or an eating disorder, such as anorexia nervosa, may really really want to receive some form of bariatric surgery.  Would there be any circumstance in which you feel such a procedure would be beneficial to the patient?  

Now suppose she even says that she will commit suicide if she doesn't get the procedure.  Would that alter the calculus?  Is a threat of suicide a legitimate factor when considering bariatric surgery for this patient?

Thanks,

-Smac

[Analytics]

30 minutes ago, smac97 said:

I do not have information about comorbidities, informed consent, etc. about a specific party.  Neither do you.  So there's not much point in discussing that specific party.

That's my point. All medical decisions are about specific parties. 

30 minutes ago, smac97 said:

We ought to be discussing these things.

Why? Other people’s medical decisions are none of our business.

30 minutes ago, smac97 said:

I get that you do not want to publicly commit to an ideological position that specifically supports medical procedures that, for example, sterilize minors.

I support medical decisions being made by doctors and patients, and if the patient is a minor, by his or her parents as well. They are the ones who are best positioned to evaluate the risks and make the best decisions that are right for them.

It seems that you are the one suffering from the “March of Dimes Syndrome.” You have a psychological need to be outraged about something, and the medical care that other people’s children are receiving is the next thing.

 

[Dario_M]

8 minutes ago, Analytics said:

 

I support medical decisions being made by doctors and patients, and if the patient is a minor, by his or her parents as well. They are the ones who are best positioned to evaluate the risks and make the best decisions that are right for them.

Parents don't always make the best decisions for their child. Why do you think child protection otherwise exist for? 

Edited October 15, 2024 by Dario_M

[smac97]

2 minutes ago, Analytics said:

That's my point. All medical decisions are about specific parties. 

Medical decisions are based principally on the standard of care, and on the law.

2 minutes ago, Analytics said:

Quote

We ought to be discussing these things.

Why? Other people’s medical decisions are none of our business.

Society generally, and the State, have legitimate interests in the welfare of minors.

2 minutes ago, Analytics said:

Quote

I get that you do not want to publicly commit to an ideological position that specifically supports medical procedures that, for example, sterilize minors.

I support medical decisions being made by doctors and patients, and if the patient is a minor, by his or her parents as well.

See?  You can't or won't actually say that you support elective medical procedures that sterilize minors.

2 minutes ago, Analytics said:

They are the ones who are best positioned to evaluate the risks and make the best decisions that are right for them.

Again, society generally, and the State, have legitimate interests in the welfare of minors. 

A minor often lacks the legal capacity to give informed consent.  And parents may be emotionally and/or ideologically compromised in their assessment of what is best for their child. 

Consider, for example, the legislative testimony of Chloe Cole:

Quote

My name is Chloe Cole. I’m 18 and my story is not hyperbole. Starting around the age of 12, I began to believe that I was transgender. This belief was not organic. All the media I consumed as a kid showed me how stupid and vulnerable being a girl was.  All the sexualized images of women gave me an unrealistic expectation of womanhood. I spent a lot of time online and quickly saw all the praise coming out as trans got on Instagram and other social media. I was a bit awkward in school and had some trouble making friends. Like many dysphoric children, I also suffer from a variety of mental health conditions, so I easily fell prey to the narrative that if I felt different and did not want to be a highly sexualized girl, that I must be a boy.

I obsessed over becoming a boy. I believed that all of my insecurities and anxiety would magically disappear once I transitioned. 

Chloe now believes that her perspective at age 12 "was not organic," and was instead unduly influenced by "{a}ll the media {she} consumed as a kid."

Do you think Chloe Cole was "best positioned to evaluate the risks and make the best decisions that are right for {her}"?

Quote

The mental health professionals did not try to dissuade me of this delusional belief. I was fast-tracked into medical transition after I was diagnosed with dysphoria. In California, a child can pick their gender identity and a care provider questioning that would be considered conversion therapy.

Which of Chloe's narratives do you think should have carried the day?  The one she had as a minor, steeped in "media" and "sexualized images of women {which} gave {her} an unrealistic expectation of womanhood," having "spent a lot of time online" and noticing "all the praise coming out as trans got on Instagram and other social media," and having comorbities ("a variety of mental health conditions"), and so on?

Or the one she had later?

Which version of Chloe, the minor or the adult, was "best positioned to evaluate the risks and make the best decisions that are right for {her}"?

Quote

This wasn’t a misdiagnosis, it was mistreatment.  

My parents were told that the options were transition or suicide. They complied because they were not offered any other treatment solution for my distress. My distraught parents wanted me alive, so they listened to my doctors. I was placed on puberty blockers, testosterone after expressing my gender dysphoria to my therapist and I was approved for a double mastectomy all by the age of 15. No one explored why I did not want to be girl.

Do you think these this father and mother, whose daughter was suffering from "a variety of mental health conditions," and who had been heavily influenced by social media content (including "all the praise coming out as trans got"), and who were told by "mental health professionals" that "the options {for their daughter, Chloe} were transition or suicide," were "best positioned to evaluate the risks and make the best decisions that are right for {her}"?

Or is it possible that these parents, given these "options," were compromised in their assessments of Chloe's best interests?

2 minutes ago, Analytics said:

It seems that you are the one suffering from the “March of Dimes Syndrome.” You have a psychological need to be outraged about something, and the medical care that other people’s children are receiving is the next thing.

This is a difficult topic.  I am attempting to address it in measured and moderate ways.  And yet here you are substantially mischaracterizing my statements and imputing thoughts and motives onto me which I do not hold.

Thanks,

-Smac

[Analytics]

16 minutes ago, smac97 said:

Again, society generally, and the State, have legitimate interests in the welfare of minors. 

That is why society should provide universal health insurance so that people can obtain the assistance of competent medical professionals when needed.

 

[LoudmouthMormon]

20 hours ago, Analytics said:

“Better dead in a body that is free from puberty blockers than alive in a body with them

It seems like every week, there's a new unhappy former trans person speaking out against the opposite of this notion.   All of them tell a variation of the same story:
- They were convinced they were trans youth
- They finally got their reluctant parents to go to the gender-affirming care doctor, who all told the parents a variation of this phrase.  "You can either have a living son or a dead daughter", etc. 
- That phrase convinced the reluctant parents, who agreed to the procedure/medicine.
- Later, sometimes immediately later, they realized they made a mistake.
- Now they bemoan the lasting impacts of medical or surgical transition, and wish the doctor had never uttered that horrible notion.  

I've lost count of the numbers of individuals telling a variation of this story.  Maybe half started this journey as an adult, the other half as minors.  They all express the same regrets.  Many of them complain about lifelong medical issues as a result.

So many of them, they've started organizing into groups.  The Detrans Alliance on TikTok.  The Detransawareness.org people. They buddy up with activists like Riley Gains, and she'll post their stories.  They often find their ways to the Gays Against Groomers org and tell their stories on that platform.  Google 'em up if you like.  A lot of them want to tell their stories anonymously.  Many give a video or write a bit and disappear.  Not enough anecdotes for a study.

But yeah, I figure "better a living trans kid than a dead one forced to live their birth sex" will go down in the history books in the same class as claims blacks were inferior because of biology, or the stuff aryan racists said in nazi germany about Jews, or the corpus of human thought on why women shouldn't do this or that.  Maybe in my lifetime I'll see that.

Edited October 15, 2024 by LoudmouthMormon

[SeekingUnderstanding]

27 minutes ago, LoudmouthMormon said:

I've lost count of the numbers of individuals telling a variation of this story.  Maybe half started this journey as an adult, the other half as minors.  They all express the same regrets.  Many of them complain about lifelong medical issues as a result.

So many of them, they've started organizing into groups. 

What percentage of people who undergo these procedures later regret it? How does that compare to other major surgeries or drug treatment regimes. What percentage of teens that were on psychiatric drugs regret it? How does that compare to puberty blockers? 

[Calm]

49 minutes ago, LoudmouthMormon said:

But yeah, I figure "better a living trans kid than a dead one forced to live their birth sex" will go down in the history books in the same class as claims blacks were inferior because of biology, or the stuff aryan racists said in nazi germany about Jews, or the corpus of human thought on why women shouldn't do this or that.  Maybe in my lifetime I'll see that.

Weird choice of analogies…feels more like one of these things is not like the others. 

[smac97]

2 hours ago, LoudmouthMormon said:

Quote

“Better dead in a body that is free from puberty blockers than alive in a body with them

It seems like every week, there's a new unhappy former trans person speaking out against the opposite of this notion.   

I recently came across this website: Parents with Inconvenient Truths about Trans (PITT)

It includes quite a few "Desistance Stories" that I think merit some attention.

2 hours ago, LoudmouthMormon said:

All of them tell a variation of the same story:
- They were convinced they were trans youth
- They finally got their reluctant parents to go to the gender-affirming care doctor, who all told the parents a variation of this phrase.  "You can either have a living son or a dead daughter", etc. 

Yep.  That's the same false dilemma that @Analytics is advancing:

Quote

“Better dead in a body that is free from puberty blockers than alive in a body with them."

Roger was attributing this to me as an inversion of his false dilemma.  And falsely, since I do not subscribe to this notion.

2 hours ago, LoudmouthMormon said:

- That phrase convinced the reluctant parents, who agreed to the procedure/medicine.

"Agreed" in only the loosest sense.  Parents who are given such a false dilemma are almost certainly emotionally/mentally compromised in their assessment of the best interests of their child.  

2 hours ago, LoudmouthMormon said:

- Later, sometimes immediately later, they realized they made a mistake.

And yet they still might fear admitting the mistake, for fear of being labeled "transphobe," "bigot," and so on.

Thanks,

-Smac

Edited October 15, 2024 by smac97

[longview]

Smac's link to the PITT article has this line:  ". . . to gender ideology and the dystopian nightmare we now face.  Our children are being injured and mutilated and are being turned against us." What an apt description of our times! So much derangement being dished out by radicals and swallowed by the gullible. "Dystopian" is a very appropriate description of the frightful array of schools, institutions, and the medical/industrial complex. Not only in America but in Europe and around the world. This brings to mind the scripture: "Satan will rage in the hearts of men."

[Analytics]

1 hour ago, LoudmouthMormon said:

It seems like every week, there's a new unhappy former trans person speaking out against the opposite of this notion.   All of them tell a variation of the same story:
- They were convinced they were trans youth
- They finally got their reluctant parents to go to the gender-affirming care doctor, who all told the parents a variation of this phrase.  "You can either have a living son or a dead daughter", etc. 
- That phrase convinced the reluctant parents, who agreed to the procedure/medicine.
- Later, sometimes immediately later, they realized they made a mistake.
- Now they bemoan the lasting impacts of medical or surgical transition, and wish the doctor had never uttered that horrible notion.  

I've lost count of the numbers of individuals telling a variation of this story.  Maybe half started this journey as an adult, the other half as minors.  They all express the same regrets.  Many of them complain about lifelong medical issues as a result.

So many of them, they've started organizing into groups.  The Detrans Alliance on TikTok.  The Detransawareness.org people. They buddy up with activists like Riley Gains, and she'll post their stories.  They often find their ways to the Gays Against Groomers org and tell their stories on that platform.  Google 'em up if you like.  A lot of them want to tell their stories anonymously.  Many give a video or write a bit and disappear.  Not enough anecdotes for a study.

But yeah, I figure "better a living trans kid than a dead one forced to live their birth sex" will go down in the history books in the same class as claims blacks were inferior because of biology, or the stuff aryan racists said in nazi germany about Jews, or the corpus of human thought on why women shouldn't do this or that.  Maybe in my lifetime I'll see that.

Please keep in mind the context of my comments. Smac is insinuating that doctors should ignore the scientific evidence about suicide risk because if they address this reality, they’ll somehow be authorizing bad medical care “under the threat of suicide.” 

Your belief that "every week, there's a new unhappy former trans person speaking out against the opposite of this notion" reflects cherry-picking from politicized echo chambers rather than engaging with the broader evidence-based reality. While detransitioner stories are real and important on an individual level, they don’t seem to be representative of the majority of experiences with gender-affirming care. 

If we genuinely care about the well-being of transgender youth, we should rely on mainstream academic research rather than selective anecdotes. The people who are best positioned to evaluate the totality of the evidence and how it should be utilized in a clinical setting are people like the members of the American Academy of Pediatrics.

They are the ones who should be having this debate--not conservative politicians and their tools who are continually outraged by the culture wars.

Edited October 15, 2024 by Analytics

[smac97]

9 minutes ago, Analytics said:

Please keep in mind the context of my comments. Smac is insinuating that doctors should ignore the scientific evidence about suicide risk because if they address this reality, they’ll somehow be authorizing bad medical care “under the threat of suicide.” 

You continue to mischaracterize my position, and substantially so.

I am not aware of the "standard of care" that allows, or requires, a doctor to perform elective medical procedures under threat of the patient committing suicide.  If you have evidence on this point, I would like to see it.

I asked ChatGPT: "In the United States, can a doctor perform an elective medical procedure as a means of avoiding a suicide threatened by the patient if the procedure is not performed?"

The response:

Quote

In the United States, a doctor cannot perform an elective medical procedure solely as a means to prevent a patient's threatened suicide unless specific legal and ethical guidelines are followed. Medical decisions, particularly around elective procedures, are governed by principles of patient autonomy, medical necessity, and beneficence. Here's how this issue is addressed:

1. Patient Autonomy: Patients generally have the right to make informed decisions about their healthcare, including the right to refuse or request medical procedures. However, when a patient threatens suicide, it raises concerns about their mental health and decision-making capacity. If the threat of suicide is a result of impaired mental health (such as depression), it may undermine the patient's ability to make an informed decision, and the physician might need to assess whether the patient is competent to consent to or refuse treatment.

2. Medical Necessity: Elective procedures are typically those that are not medically necessary for the patient's immediate physical health. Performing a procedure purely to prevent a suicide threat may not meet the standard of medical necessity unless the procedure itself is directly related to the patient's mental or emotional well-being. In such cases, a thorough evaluation by a mental health professional is critical.

3. Ethical Considerations: Physicians must adhere to ethical guidelines that prioritize the patient's overall health and well-being. In cases of threatened suicide, the primary obligation of the physician is to address the underlying mental health crisis. This might involve psychiatric evaluation, counseling, or even involuntary hospitalization under mental health laws like "5150" in California (involuntary psychiatric hold for individuals posing a danger to themselves).

4. Legal Considerations: If a patient threatens suicide, performing an elective procedure to appease the patient could expose the doctor to legal liabilities, particularly if the procedure is not medically justified. In some cases, physicians may be legally obligated to seek psychiatric intervention rather than proceed with a requested elective procedure.

Thus, a doctor in the U.S. must focus on addressing the suicidal ideation through appropriate mental health interventions and cannot ethically or legally perform an elective procedure solely as a response to a suicide threat without addressing the underlying mental health concerns.

I followed up: "Is there an exception to the above principles where the patient has been diagnosed with Gender Dysphoria and is threatening suicide unless he/she receives "gender affirmation surgery" or similar medical treatment?"

The response:

Quote

In the United States, there are legal and ethical complexities surrounding the treatment of patients with Gender Dysphoria who may threaten suicide unless they receive gender-affirming surgery or similar medical treatments. The situation involves balancing medical necessity, patient autonomy, mental health considerations, and ethical principles.

Key Considerations:

1. Medical Necessity and Guidelines: Gender-affirming surgeries and treatments can be considered medically necessary for individuals with Gender Dysphoria, particularly when less invasive treatments (such as hormone therapy or counseling) have been tried and shown to be insufficient. The World Professional Association for Transgender Health (WPATH) and the Endocrine Society provide guidelines recommending thorough assessments, including mental health evaluations, before proceeding with gender-affirming surgery. If a patient’s distress (including suicidal ideation) is directly related to their Gender Dysphoria, medical treatment—including surgery—may be justified as part of a comprehensive approach to care.

2. Ethical Principles: While patient autonomy is important, physicians must still ensure that any surgery is clinically indicated and in the patient's best interest. This includes considering the patient's long-term mental health and ensuring the patient has received adequate mental health support. If a patient is in crisis due to suicidal ideation, it is the physician’s ethical duty to prioritize stabilizing the patient's mental health before proceeding with any surgery.

3. Mental Health Considerations: Threats of suicide require urgent mental health intervention. Physicians must address the immediate suicidal threat through psychiatric care, including counseling or, in extreme cases, hospitalization. Informed consent is crucial before gender-affirming surgeries, and a person in an acute mental health crisis may not be able to provide valid consent until stabilized. This is particularly important because gender-affirming surgeries are permanent and significant.

4. Legal Considerations: In most jurisdictions, legal standards would prevent performing an elective surgery like gender affirmation without ensuring that the procedure is medically indicated and that the patient can provide informed consent. A suicidal threat, while concerning, does not override the need for careful medical and psychiatric evaluation. For patients with Gender Dysphoria, the threat of suicide can be a signal of the urgent need for mental health care and may justify timely medical treatment, but only within the framework of established medical guidelines and ethical standards.

Potential Exceptions:

For individuals with Gender Dysphoria, where a strong clinical link exists between their distress and the lack of gender-affirming treatment, clinicians might consider these procedures medically necessary to alleviate extreme psychological distress. However, each case requires a comprehensive, individualized assessment by both mental health and medical professionals before proceeding with surgery or treatments based solely on suicidal threats.

In short, while gender-affirming surgery may be considered in certain cases as a means of addressing severe psychological distress, including suicidal ideation, it cannot be done without addressing mental health, ensuring informed consent, and following appropriate guidelines like those from WPATH

Scholar Fact Check

YouTube

.

WPATH has been in the news: Why disturbing leaks from US gender group WPATH ring alarm bells in the NHS

Quote

The medical transitioning of children has become one of the most controversial and polarising issues of our time. For some, it is a medical scandal. For others, life-saving treatment.

So, when hundreds of messages were leaked from an internal forum of doctors and mental health workers from the World Professional Association for Transgender Health, it was bound to spark interest. WPATH describes itself as an “interdisciplinary professional and educational organisation devoted to transgender health”. Most significantly, it produces standards of care (SOC) which, it claims, articulate “professional consensus” about how best to help people with gender dysphoria.

Despite its grand title, WPATH is neither solely a professional body – a significant proportion of its membership are activists – nor does it represent the “world” view on how to care for this group of people. There is no global agreement on best practice. The leaked messages (and the odd recording) – dubbed the WPATH files – are disturbing. In one video, doctors acknowledge that patients are sometimes too young to fully understand the consequences of puberty blockers and hormones for their fertility. “It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall,” one Canadian endocrinologist says.

"WPATH is neither solely a professional body – a significant proportion of its membership are activists – nor does it represent the “world” view on how to care for this group of people."

"In one video, doctors acknowledge that patients are sometimes too young to fully understand the consequences of puberty blockers and hormones for their fertility. 'It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall,' one Canadian endocrinologist says."

These things should be discussed.

Quote

WPATH’s president, Dr Marci Bowers, comments on the impact of early blocking of puberty on sexual function in adulthood. “To date,” she writes, “I’m unaware of an individual claiming ability to orgasm when they were blocked at Tanner 2.” Tanner stage 2 is the beginning of puberty. It can be as young as nine in girls.

Elsewhere, there are extraordinary discussions on how to manage “trans clients” with dissociative identity disorder (what used to be called multiple personality disorder) when “not all the alters have the same gender identity”. Surgeons talk about procedures that result in bodies that don’t exist in nature: those with both sets of genitals – the “phallus-preserving vaginoplasty”; double mastectomies that don’t have nipples; “nullification” surgery, where there are no genitals at all, just smooth skin. And doctors discuss the possibility that 16-year-old patients have liver cancer as the result of taking hormones. The problem is not necessarily the discussions themselves, but that the organisation is not so open when speaking publicly.

"Surgeons talk about procedures that result in bodies that don’t exist in nature: those with both sets of genitals – the 'phallus-preserving vaginoplasty'; double mastectomies that don’t have nipples; 'nullification' surgery, where there are no genitals at all, just smooth skin."

"{D}octors discuss the possibility that 16-year-old patients have liver cancer as the result of taking hormones."

"The problem is not necessarily the discussions themselves, but that the organisation is not so open when speaking publicly."

Quote

The views of WPATH matter to the UK. For years, the organisation and its SOC have been cited as a source of “best practice” for trans healthcare by numerous medical bodies, including the British Medical Association and the General Medical Council – and still is. The Royal College of Psychiatrists refers to WPATH in its own recommendations for care.

Most relevant is that WPATH is cited as “good practice” in the current service specifications underpinning youth and adult gender clinics in England and Scotland, albeit in both cases it is WPATH’s previous SOC that is mentioned. The most recent version does away with all age limits from the beginning of puberty for hormones and surgical interventions, other than female to male genital surgery, and contains a chapter on eunuchs.

Several staff at England’s NHS adult gender clinics are not just members of WPATH (one is the former president), but authors of that current SOC. So too was Susie Green, the former boss of the young people’s charity Mermaids; a lack of medical expertise does not exclude either membership of WPATH or the power to influence policy.

England’s only NHS children’s gender clinic – the Gender Identity Development Service (Gids) at London’s Tavistock and Portman NHS Foundation Trust – will close its doors at the end of March, having been earmarked for closure since July 2022. But the 2016 service specification still underpinning Gids states that “the service will be delivered in line with” WPATH 7. While Gids was generally more cautious than other WPATH practitioners, clinicians I spoke to for my book, Time to Think, also relayed how young people claiming to have multiple personalities, or who identified with another race, could be referred for puberty blockers.

Gids staff have also presented at WPATH conferences for the past decade, including the most recent, held in 2022. This doesn’t imply agreement with WPATH’s principles, but association with the group becomes harder to justify as its views become more extreme.

It is difficult to see how the Department of Health’s assertion that NHS England “moved away from WPATH guidelines more than five years ago” holds.

What is true is that there is no mention of WPATH in updated guidance that will underpin the new youth gender services opening on 1 April. What’s more, NHS England has made it clear that WPATH’s views are irrelevant to its core recommendation that puberty blockers will no longer be available as part of routine clinical practice.

There is a battle raging over how best to care for children and young people struggling with their gender identity, with ever increasing numbers of European countries choosing to take a more cautious, less medical, approach after finding the evidence base underpinning those treatments to be wanting. NHS England insists that new services will operate in accordance with recommendations of the independent Cass review, and that it is well placed to develop policies “in line with clinical evidence and expertise”. But it won’t be easy. There is already discussion among professionals working in gender services planning a pushback against Cass’s as yet unpublished final recommendations.

"There is a battle raging over how best to care for children and young people struggling with their gender identity, with ever increasing numbers of European countries choosing to take a more cautious, less medical, approach after finding the evidence base underpinning those treatments to be wanting."

Thanks,

-Smac

[Analytics]

43 minutes ago, smac97 said:

You continue to mischaracterize my position, and substantially so.

As far as I can tell, you are arguing against a straw man.

Has anybody, ever, said that if a child goes into a doctors office and threatens, “if you don’t surgically chop off my body parts I’m going to commit suicide!”, the doctor should surgically chop off said body parts because of the threat?

43 minutes ago, smac97 said:

I am not aware of the "standard of care" that allows, or requires, a doctor to perform elective medical procedures under threat of the patient committing suicide. 

And I have no idea what you are talking about. This is a straw man. The (mis)leading questions you made to ChatPPT are irrelevant. 

I posed the following question to ChatGPT4o:

Q: If a pre-teen is experiencing gender dysphoria, what considerations should be taken into account? Please provide an answer in a direct but conversational tone, and base your answer on the AAP’s Policy Statement: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents

A: When a pre-teen is experiencing gender dysphoria, key considerations include providing a supportive and affirming environment, recognizing the child’s self-identified gender, and ensuring comprehensive care that includes mental health support. It is important to collaborate with healthcare providers to assess the child’s needs and options, such as counseling, family support, and possibly discussing medical interventions like puberty blockers. The goal is to prioritize the child’s mental and emotional well-being through personalized care.

For more detailed information, you can access the full article here.

I then asked the following neutral follow-up question:

Q: When the patient’s medical team is deciding on a course of action, could you tell me whether or not the risk of suicide should be discussed with the child’s parents?

A: Yes, the risk of suicide should be discussed with the child’s parents, especially since this can be a significant factor when considering treatment options for gender dysphoria. Parents need to be aware of the potential mental health risks, including depression and suicidal ideation, that gender-diverse youth might face without proper support and care. Open communication about these risks can help families make informed decisions that prioritize the child’s emotional well-being and safety.

I then asked this:

Q: What is your opinion? Is the AAP a good source for guidance on these issues? And should these decisions be made by doctors and parents with the input of the patients, or should State implement laws to protect children from their misguided parents and doctors?

A: The American Academy of Pediatrics (AAP) is widely regarded as a credible source on child health, including issues like gender dysphoria. Their guidelines are based on research and expert consensus, focusing on the child’s overall well-being and mental health.

In terms of decision-making, I believe it should be a collaborative process involving doctors, parents, and the child. Input from the child is crucial since they are directly impacted, but parental guidance and medical expertise are also essential. State involvement is a delicate issue; laws should protect children from harm, but blanket regulations can oversimplify complex medical and psychological situations. It’s better to approach these decisions on a case-by-case basis with the child’s best interest at the core.

Resetting this as a baseline, here is where I’m at: If my life circumstances forced me to have an opinion on these issues, I would start my research by carefully reading the AAP’s latest policy statement, and finding a team of healthcare providers that was conscientious and up to speed with the latest research. I would then carefully consider their recommendations based on the individual circumstances of who I was taking care of.

That is my opinion on the issue. Do you think I am a fool for taking this approach?

And to clarify, I am in favor of the effectiveness, appropriateness, and risks of different treatment options being debated; I just think those debates should be taking place among doctors and medical researchers, not AM radio hosts and culture warriors on discussion boards.

 

Edited October 15, 2024 by Analytics