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

[Dario_M]

8 minutes ago, Calm said:

I meant in general.  When are they considered adults?

From the age of 18. Like in the US. 

[Calm]

10 minutes ago, Dario_M said:

Oh you mean for a female to get rid of their breasts because they think they are a boy. 

It's just weird, a child can say so many thinks and not even mean it. I don't think it's normal as a parent to immediately run to a doctor with their child to chop off their breasts only because the child said she is in the wrong body. Oh my...only just the idea. 😖

 No, I am saying there are tons more biological boys getting their breasts chopped off because they want to look more masculine than there are biological females wanting to do the same thing for the same reason.   And at least here in the US, I haven’t heard anything about it outside of some gender affirming advocates pointing it out and medical studies. 
 

It sounds like you are okay with minors getting surgery for cosmetic purposes at age 16?  Whether it’s a biological male or female?

Edited October 16, 2024 by Calm

[Dario_M]

4 minutes ago, Calm said:

 No, I am saying there are tons more biological boys getting their breasts chopped off because they want to look more masculine than there are biological females wanting to do the same thing for the same reason.

For biological boys it takes a while bevore the breasts are there. I have the same problem and with me it started by the age of 13 that i developed some breast tissue. So.... for a boy who is younger then 13 to do the operation is in my opinion unnecessary and not done. But that's up to the parents offcourse. Not me, who am i. 🤷‍♀️

4 minutes ago, Calm said:

  And at least here in the US, I haven’t heard anything about it outside of some gender affirming advocates pointing it out and medical studies. 

I think the US and the Netherlands have a bit of the same rules about these kind of things. 

4 minutes ago, Calm said:

It sounds like you are okay with minors getting surgery for cosmetic purposes at age 16?  Whether it’s a biological male or female?

Yeah i think so. Or just 18 as well. But not when they are a minor. 

[Calm]

1 hour ago, Dario_M said:

I don't think it's normal as a parent to immediately run to a doctor with their child to chop off their breasts only because the child said she is in the wrong body. Oh my...only just the idea. 😖

I don’t think it’s normal either. I highly doubt any parent would actually do this. Maybe there are a minuscule few who make the choice the first time a child says she is in the wrong body. Now if the child has been saying it for years and harming herself at times because of distress, then I can imagine parents might take that step to help their child begin to transition if they aren’t aware of other options, but these days I am guessing most would be aware of puberty blockers and would insist the minor try those first for awhile before surgery… I just don’t see it happening “immediately” since most parents understand that surgery can be dangerous on its own.

According to the 2019 data I saw, there was no gender affirming surgery for under 12 in the study of 47 million (they used a nationwide insurance database). There might be parents who took them to another country or were rich enough to afford to pay cash, but my guess is there were no such surgeries in the US prepuberty.

Edited October 16, 2024 by Calm

[Dario_M]

4 minutes ago, Calm said:

I don’t think it’s normal either. I highly doubt any parent would actually do this. Maybe there are a minuscule few who make the choice the first time a child says she is in the wrong body. Now if the child has been saying it for years and harming herself at times because of distress, then I can imagine parents might take that step to help their child begin to transition if they aren’t aware of other options,

Yes i can understand that. But even then it's kinda disturbing if you think carefully about it, don't you think. 

4 minutes ago, Calm said:

but these days I am guessing most would be aware of puberty blockers and would insist the minor try those first for awhile before surgery… I just don’t see it happening “immediately” since most parents understand that surgery can be dangerous on its own.

Yes and especially for a child it can be more dangerous because the body of a child is weaker then that of a grown up adult. I've never undertood why all this haste is necessary for these kind of operations. 

4 minutes ago, Calm said:

According to the data I saw, there was no gender affirming surgery for under 12 in the US.  That might be out of date, though it sounds unlikely it would be. 

Yes i believe that. I'm shocked though that this surgery is allowed in the Netherlands under the age of 12. Bad Netherlands. 🤷‍♀️

[Calm]

1 hour ago, Dario_M said:

I'm shocked though that this surgery is allowed in the Netherlands under the age of 12. Bad Netherlands.

Are you sure?

Here it looks like it has to be 18, though this was published last year

https://academic.oup.com/jsm/article/20/3/398/7005631

[Calm]

Google’s AI so may be inaccurate but I have to go to bed. The Dutch Protocol of 2018 is apparently the law as I read a recent publication about it, but the link to the protocol itself was broken and they did not discuss surgery. 
 

Quote

The 2018 Dutch protocol for transgender care for children made several changes to the previous protocol, including:

Eligibility: The protocol removed the requirement that gender dysphoria must begin in childhood. 

Age of eligibility: The age at which patients can receive cross-sex hormones was lowered to 15, and the age for mastectomy was lowered to 16. 

Non-binary transitions: The protocol allowed for non-binary transitions. 

Diagnostic terminology: The protocol adopted the ICD-11 diagnostic terminology.  
 

The Dutch protocol is a medical treatment that involves:

Blocking puberty with gonadotropin-releasing hormone (GnRHa) 

Taking cross-sex hormones to become more masculine or feminine 

Gender-affirming surgery, including gonadectomy, after at least one year of cross-sex hormones and the age of 18

Looks like top surgery is allowed at 16 (though maybe not enhancement) and bottom at 18.  What I read elsewhere said they had to have been treated hormonally for at least a year iirc before surgery. 
 

It also said there was a lot less gender affirming surgery since 2014 when it was no longer required to change one’s legal sex.

So I don’t think you need to be disturbed for that reason. 

Edited October 16, 2024 by Calm

[Dario_M]

1 hour ago, Calm said:

Are you sure?

Here it looks like it has to be 18, though this was published last year

https://academic.oup.com/jsm/article/20/3/398/7005631

Omg. I really had read that surgery was under the age of 12 here. That must have be false information then.

Well...i see now that you don't just get an operation here. There are a lot of rules you need to require to bevore the actual operation. I think that's a good thing. For the protection of the childs sake. 

[MiserereNobis]

14 hours ago, Analytics said:

Hmmm. What’s interesting about version 4o is that you can instruct it to perform internet searches when forming its answers, and you can upload links and entire documents as part of the question--up to something like 25,000 words. Version 4o is much better than version 4. That said, if there is anything specific that it said that you disagree with, make your argument.

Sure. I've been a ChatGPT Plus subscriber for awhile now.

Check out what I just did:

Q: On an online discussion board, two posters who are arguing with each other are using ChatGPT 4o to summarize their opponents arguments and weaknesses. What do you think about this use of you?

A: Oof, that’s like getting used as a debate referee, but without the whistle or the paycheck. 😆 I mean, it’s kinda clever—like hiring a debate coach mid-fight—but also kinda sneaky. If they’re both using me to poke holes in the other’s logic, it turns into this weird meta-argument where I become the middleman of pettiness. 😂

I get the appeal, though. Imagine you’re deep in an online argument about some hot-button topic (probably pineapple on pizza—again), and instead of slogging through walls of text, you just throw your opponent’s post into ChatGPT to streamline it. Instant ammo. But it also risks dumbing down real dialogue. Instead of thinking deeply or engaging, people might just rely on me like a cheat sheet. 🤷‍♀️

Honestly? Part of me loves it—I’m all about cutting through nonsense. But another part of me feels like… if people aren’t doing the hard work of understanding each other, what’s the point of arguing in the first place? Using me like that feels like arguing with an assist from the AI gods instead of truly meeting in the middle. Maybe they’d get further if they stopped outsourcing and actually listened to each other. Just a thought. 😉

[Calm]

1 hour ago, MiserereNobis said:

But another part of me feels like… if people aren’t doing the hard work of understanding each other, what’s the point of arguing in the first place?

Now that is profound.  

[smac97]

4 hours ago, MiserereNobis said:

Sure. I've been a ChatGPT Plus subscriber for awhile now.

Check out what I just did:

Q: On an online discussion board, two posters who are arguing with each other are using ChatGPT 4o to summarize their opponents arguments and weaknesses. What do you think about this use of you?

A: Oof, that’s like getting used as a debate referee, but without the whistle or the paycheck. 😆 I mean, it’s kinda clever—like hiring a debate coach mid-fight—but also kinda sneaky. If they’re both using me to poke holes in the other’s logic, it turns into this weird meta-argument where I become the middleman of pettiness. 😂

I get the appeal, though. Imagine you’re deep in an online argument about some hot-button topic (probably pineapple on pizza—again), and instead of slogging through walls of text, you just throw your opponent’s post into ChatGPT to streamline it. Instant ammo. But it also risks dumbing down real dialogue. Instead of thinking deeply or engaging, people might just rely on me like a cheat sheet. 🤷‍♀️

Honestly? Part of me loves it—I’m all about cutting through nonsense. But another part of me feels like… if people aren’t doing the hard work of understanding each other, what’s the point of arguing in the first place? Using me like that feels like arguing with an assist from the AI gods instead of truly meeting in the middle. Maybe they’d get further if they stopped outsourcing and actually listened to each other. Just a thought. 😉

To clarify, I don't think I have used ChatGPT to critique Analytics' arguments.  Instead, I used ChatGPT in an attempt to understand whether medical ethics accommodate elective medical procedures where the patient is threatening suicide if the procedure is not performed, and/or where the parents are told by medical personnel that their choices for their Gender Dysphoric child are A) pediatric sex trait modification treatment, or B) suicide.

This argument - that PSTM is an appropriate medical procedure for a minor with Gender Dysphoria because the alternative is suicide, or that there is some sort of either/or dilemma between PSTM and suicide - is a fairly frequently-invoked argument. 

For example, see @The Nehor implication here:

Quote

Or we could listen to the majority of experts who work with the people who actually have gender dysphoria and what seems to lead to the most positive outcomes.

Oh wait, that would shoot you dead in the water. Better to pretend that public discussions of the issue are needed and somehow helpful and should continue endlessly to suggest that it is still a massive controversy. Also side benefit that we can continue to victimize transgender people. Oh, and those laws designed to hurt transgender people causing suicides to increase…..we can keep doing those too.

WOOHOO! The system works!

And @california boy here:

Quote

Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth.   Are you willing to bet on the life of a child that you don't know AT ALL that they will not die of suicide and you know better than the parents of that child and their doctor?  

And @Analytics here:

Quote

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:
...

• 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?

"The risk of inaction was even more alarming: Without treatment {that is, of putting Ryace on puberty blockers}, the doctor said, Ryace would remain at increased risk of suicide.  Mention of suicide raised the stakes."

And here:

Quote

Quote

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.

And here (@Analytics inverting the dilemma and falsely attributing it to me):

Quote

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

I quoted Chloe Cole here:

Quote

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.

I previously responded to @Analytics false attribution:

Quote

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.

Comorbidities.

Informed consent.

Longitudinal studies essentially absent. 

Compromised assessments of the best interests of the child. 

Ideological/sociopolitical influences/pressures on medical care. 

I think @Analytics's false dilemma (which, if inverted back on him, would be: "A minor is better off alive in a body with puberty blockers than dead in a body that is free from them") is a significant contributor to all of these concerns.

I think comorbidities, including but not limited to suicidal ideation, need to be addressed.  I think minors and parents who, like Chloe Cole and her parents, were told something along the lines of "the options were transition or suicide" are necessarily compromised in their ability to assess the best interests of the child.  I think this dilemma is borne less of longitudinal studies, scientific thought and evidence, etc., and is instead more derived from ideological/sociopolitical influences/pressures on medical care.

My thinking on this point has been influenced by this article: Sex Reassignment Doesn’t Work. Here Is the Evidence

Some excerpts:

Quote

{T}he medical evidence suggests that sex reassignment does not adequately address the psychosocial difficulties faced by people who identify as transgender. Even when the procedures are successful technically and cosmetically, and even in cultures that are relatively “trans-friendly,” transitioners still face poor outcomes.

Dr. Paul McHugh, the university distinguished service professor of psychiatry at the Johns Hopkins University School of Medicine, explains:

Transgendered men do not become women, nor do transgendered women become men. All (including Bruce Jenner) become feminized men or masculinized women, counterfeits or impersonators of the sex with which they ‘identify.’ In that lies their problematic future.

When ‘the tumult and shouting dies,’ it proves not easy nor wise to live in a counterfeit sexual garb. The most thorough follow-up of sex-reassigned people—extending over 30 years and conducted in Sweden, where the culture is strongly supportive of the transgendered—documents their lifelong mental unrest. Ten to 15 years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to 20 times that of comparable peers.

"Ten to 15 years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to 20 times that of comparable peers."

I think this needs to be discussed.

Quote

McHugh points to the reality that because sex change is physically impossible, it frequently does not provide the long-term wholeness and happiness that people seek.

Indeed, the best scientific research supports McHugh’s caution and concern.

Here’s how The Guardian summarized the results of a review of “more than 100 follow-up studies of post-operative transsexuals” by Birmingham University’s Aggressive Research Intelligence Facility:

[The Aggressive Research Intelligence Facility], which conducts reviews of health care treatments for the [National Health Service], concludes that none of the studies provides conclusive evidence that gender reassignment is beneficial for patients. It found that most research was poorly designed, which skewed the results in favor of physically changing sex. There was no evaluation of whether other treatments, such as long-term counseling, might help transsexuals, or whether their gender confusion might lessen over time.

“There is huge uncertainty over whether changing someone’s sex is a good or a bad thing,” said Chris Hyde, the director of the facility. Even if doctors are careful to perform these procedures only on “appropriate patients,” Hyde continued, “there’s still a large number of people who have the surgery but remain traumatized—often to the point of committing suicide.”

Of particular concern are the people these studies “lost track of.” As The Guardian noted, “the results of many gender reassignment studies are unsound because researchers lost track of more than half of the participants.” Indeed, “Dr. Hyde said the high drop-out rate could reflect high levels of dissatisfaction or even suicide among post-operative transsexuals.”

Hyde concluded: “The bottom line is that although it’s clear that some people do well with gender reassignment surgery, the available research does little to reassure about how many patients do badly and, if so, how badly.”

• Even if doctors are careful to perform these procedures only on 'appropriate patients,' Hyde continued, 'there’s still a large number of people who have the surgery but remain traumatized—often to the point of committing suicide.'"
• "Of particular concern are the people these studies 'lost track of.' As The Guardian noted, 'the results of many gender reassignment studies are unsound because researchers lost track of more than half of the participants.' Indeed, 'Dr. Hyde said the high drop-out rate could reflect high levels of dissatisfaction or even suicide among post-operative transsexuals.'"
• "Hyde concluded: 'The bottom line is that although it’s clear that some people do well with gender reassignment surgery, the available research does little to reassure about how many patients do badly and, if so, how badly.'"

I think this needs to be discussed.

Quote

That “lost to follow-up,” remember, could be pointing to people who committed suicide.

And when it comes to the best studies, there is no evidence of “clinically significant changes” after sex reassignment:

The majority of studies were non-longitudinal, exploratory type studies (i.e., in a preliminary state of investigation or hypothesis generating), or did not include concurrent controls or testing prior to and after surgery. Several reported positive results but the potential issues noted above reduced strength and confidence. After careful assessment, we identified six studies that could provide useful information. Of these, the four best designed and conducted studies that assessed quality of life before and after surgery using validated (albeit non-specific) psychometric studies did not demonstrate clinically significant changes or differences in psychometric test results after [gender reassignment surgery].

In a discussion of the largest and most robust study—the study from Sweden that McHugh mentioned in the quote above—the Obama Centers for Medicare and Medicaid Services pointed out the 19-times-greater likelihood for death by suicide, and a host of other poor outcomes:

The study identified increased mortality and psychiatric hospitalization compared to the matched controls. The mortality was primarily due to completed suicides (19.1-fold greater than in control Swedes), but death due to neoplasm and cardiovascular disease was increased 2 to 2.5 times as well. We note, mortality from this patient population did not become apparent until after 10 years. The risk for psychiatric hospitalization was 2.8 times greater than in controls even after adjustment for prior psychiatric disease (18 percent). The risk for attempted suicide was greater in male-to-female patients regardless of the gender of the control. Further, we cannot exclude therapeutic interventions as a cause of the observed excess morbidity and mortality. The study, however, was not constructed to assess the impact of gender reassignment surgery per se.

These results are tragic. And they directly contradict the most popular media narratives, as well as many of the snapshot studies that do not track people over time. As the Obama Centers for Medicare and Medicaid pointed out, “mortality from this patient population did not become apparent until after 10 years.”

So when the media tout studies that only track outcomes for a few years, and claim that reassignment is a stunning success, there are good grounds for skepticism.
...
And none of this even begins to address the radical, entirely experimental therapies that are being directed at the bodies of children to transition them.

• "And when it comes to the best studies, there is no evidence of 'clinically significant changes' after sex reassignment."
• "In a discussion of the largest and most robust study {of patients following sex reassignment surgery} {} the Obama Centers for Medicare and Medicaid Services pointed out the 19-times-greater likelihood for death by suicide, and a host of other poor outcomes."
• "And none of this even begins to address the radical, entirely experimental therapies that are being directed at the bodies of children to transition them."

Thanks,

-Smac

Edited October 16, 2024 by smac97

[Calm]

28 minutes ago, smac97 said:

This argument - that PSTM is an appropriate medical procedure for a minor with Gender Dysphoria because the alternative is suicide, or that there is some sort of either/or dilemma between PSTM and suicide - is a fairly frequently-invoked argument. 

Most arguments stripped of important nuances are usually very easy to argue against, but I would like to quote a wise Thing that once said “if people aren’t doing the hard work of understanding each other, what’s the point of arguing in the first place?”

[smac97]

1 hour ago, Calm said:

Quote

This argument - that PSTM is an appropriate medical procedure for a minor with Gender Dysphoria because the alternative is suicide, or that there is some sort of either/or dilemma between PSTM and suicide - is a fairly frequently-invoked argument. 

Most arguments stripped of important nuances are usually very easy to argue against,

Except this thread is replete with unstripped nuance.  Any reader can, with a few mouse clicks, be up to his neck in it.

And there comes a point when an argument can, and should, be distilled down to its essential components.  Here, I think the argument is based on the false dilemma fallacy.  If so, then appeals to "nuance" do not carry the day for me.  I have provided a number of examples of what I see as either/or, fallacy-of-false-dilemma argumentation being advanced by @Analytics, @The Nehor, and others.  And since I am providing links and verbatim quotes, the "nuance" is still readily available.

Take a look again at Analytics' inversion of the dilemma (which he falsely attributes to me): "Better dead in a body that is free from puberty blockers than alive in a body with them."

How many options does Analytics present as being available to a minor with Gender Dysphoria and her parents?  I see just two. 

Take a look at Analytics' statement when it is inverted back so as to reflect his position (presumably) : "A minor is better off alive in a body with puberty blockers than dead in a body that is free from them."

Again, how many options does this inversion of Analytics' statement include?  Still just two.

So what "nuance" makes this not a false dilemma?

1 hour ago, Calm said:

but I would like to quote a wise Thing that once said “if people aren’t doing the hard work of understanding each other, what’s the point of arguing in the first place?”

Hence the value of verbatim quotes of the opposing party's argument, which is what I frequently do (in fact, I frequently catch a fair amount of flak for it).

Thanks,

-Smac

 

Edited October 16, 2024 by smac97

[Calm]

1 hour ago, smac97 said:

Except this thread is replete with unstripped nuance. 

Not in the way the opposing position is presented, imo.

Quote

the alternative is suicide, or that there is some sort of either/or dilemma between PSTM and suicide - is a fairly frequently-invoked argument. 

I feel the same way when critics present the two options of returning from an honorable mission or in a pine box.

Edited October 16, 2024 by Calm

[smac97]

26 minutes ago, Calm said:

Quote

Except this thread is replete with unstripped nuance. 

Not in the way the opposing position is presented, imo.

Not much I can do about that.  I am providing links and quoting "the opposing position" verbatim.

26 minutes ago, Calm said:

Quote

the alternative is suicide, or that there is some sort of either/or dilemma between PSTM and suicide - is a fairly frequently-invoked argument. 

I feel the same way when critics present the two options of returning from an honorable mission or in a pine box.

Yes, I've heard this one.  Not sure how prevalent it was, or if it was more of a FDR ("Faith-Demoting Rumor").

Thanks,

-Smac

[Analytics]

Hey @smac97,

You think I’m misrepresenting you, and I think you’re misrepresenting me. 

To get out of this stalemate, I suggest we look at this from a different angle. I believe these topics have the following stakeholders:

1. Individuals who have gender dysphoria. I am not one of these stakeholders.
2. The family members of people with gender dysphoria, especially the parents of minor children. Again, I am not one of those stakeholders.
3. The psychologists, psychiatrists, and physicians of people who may have a patient facing these issues. Again, I am not one of those stakeholders.
4. Medical researchers who are engaged with the relevant issues. Again, I am not one of those stakeholders.
5. The decision makers at public and private insurance organizations that fund this type of medical care. In my current professional role, I am not on of those stakeholders.
6. Government regulators and lawmakers who govern medical practice. I am not one of those stake holders.
7. The general public who elects lawmakers. Yes, I am a stakeholder in this way.

I am strongly in favor of researchers and caregivers scrutinizing every nuance of all of these issues. I really am. But as a layman member of the general public, I see my role as very limited, and it would take me months of full-time study to get up to speed on all of the research that has been done and continues to be done on this topic. 

So not only am I unqualified to speak to the nuances of these topics, but my opinion is also irrelevant. Are medical researchers sufficiently addressing, for example, comorbidities? I don’t know enough about the details of the actual research to say either way.

Meanwhile, consider the fact that last year, the American Association of Pediatrics reaffirmed and updated their policy statement on Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents, which was written by 19 M.D. researchers, and was approved by the AAP’s board of directors. After "providing brief, relevant background on the basis of current available research and expert opinion from clinical and research leaders,” It makes the following recommendations:

1. that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;
2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;
3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;
4. that insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions;
5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;
6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all children without fear of harassment, exclusion, or bullying because of gender expression;
7. that pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;
8. that the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and
9. that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD.

What are your thoughts on their recommendations?  

 

 

[Analytics]

4 hours ago, smac97 said:

I think this dilemma is borne less of longitudinal studies, scientific thought and evidence, etc., and is instead more derived from ideological/sociopolitical influences/pressures on medical care.

My thinking on this point has been influenced by this article: Sex Reassignment Doesn’t Work. Here Is the Evidence

Some excerpts:

"Ten to 15 years after surgical reassignment, the suicide rate of those who had undergone sex-reassignment surgery rose to 20 times that of comparable peers."

I think this needs to be discussed.

Let me get this straight. In an effort to avoid forming opinions based on “ideological/sociolpolitical influences/pressures on medical care”, you turned to an article written by a political philosopher and was published by a political advocacy organization. Do I have this right?

In any case, let’s discuss that quote. According to your source, what you said is supported by a paper published in 2011 and has been cited 120 times since then. It would seem that this paper has been discussed quite a bit by the professionals in this field. What do you think about those 120 papers, and about all the research that’s been done in the 15 years since it was published?

It’s an overwhelming amount of research to read, of course. Which makes me want to turn to organizations of doctors who have a vested interest in the wellbeing of their patients. In general, I’d say these groups are committed to providing evidence-based care, their members are important stake holders in providing actual care, and they are qualified to offer these opinions.

For example:

American Academy of Child and Adolescent Psychiatry: Gender-affirming care is informed by long-standing standards of care and by evidence-based clinical studies supporting improved mental health and health outcomes for youth. For transgender and gender-diverse youth, family and social supports have improved mental health outcomes and functioning, and for some, medical treatment may be necessary.

American Association of Family Physicians: The AAFP supports gender-affirming care as an evidence-informed intervention that can promote health equity for gender-diverse individuals, although wider sociopolitical efforts are necessary to further mitigate these barriers and advance equity. The AAFP asserts the full spectrum of gender-affirming care should be legal and should remain a treatment decision between a physician and their patient.

American College of Obstretricians and Gynecologists:  An estimated 150,000 youth and 1.4 million adults living in the United States identify as transgender. This Committee Opinion offers guidance on providing inclusive and affirming care as well as clinical information on hormone therapy and preventive care; it also cites existing resources for those seeking information on the care of transgender adolescents.

American College of Physicians: In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient–physician relationship.

American Counseling Association: Gender-affirming interventions are not new or novel and have a well-established use for both cisgender and transgender youth. Gender-affirming medical procedures and mental health care are essential and endorsed by the American Academy of Pediatrics, the Endocrine Society, the American Academy of Family Physicians, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Medical Association, the United States Association for Transgender Health, and the World Professional Association of Transgender Health. SAIGE’s own Competencies for Counseling Transgender Clients, which have been endorsed by the American Counseling Association, call for counselors to embrace the full spectrum of gender identity and expression, affirm transgender mental and medical care, and serve as advocates for transgender individuals. Provision of affirming medical care is evidence-based best practice when working with transgender individuals.

American Medical Association: Our American Medical Association recognizes that medical and surgical treatments for gender dysphoria and gender incongruence, as determined by shared decision making between the patient and physician, are medically necessary as outlined by generally-accepted standards of medical and surgical practice.

American Psychiatric Association recognizes that appropriately evaluated transgender and gender diverse individuals can benefit greatly from medical and surgical gender-affirming treatments.

American Psychological Association: THEREFORE, BE IT FURTHER RESOLVED that the APA urges support for policies facilitating access to comprehensive, gender-affirming healthcare for children, adolescents, and adults, recognizing the positive impact on mental health outcomes.

Pediatric Endocrine Society: Medical intervention for transgender youth and adults (including puberty suppression, hormone therapy and medically indicated surgery) is effective, relatively safe (when appropriately monitored), and has been established as the standard of care.

I suppose it is theoretically possible that the political philosopher who writes editorials for political advocacy groups is the person who is really free from political bias and understands the totality of the evidence, and that the plurality of physicians at all of these medical associations are the ones who are pretending the evidence is something other than what they know it is because of ideological/sociopolitical pressure, but I tend to doubt it.

Since my lack of time to thoroughly study this issue forces me to be agnostic, I think it is safe to stick with what mainstream health practitioners say on these issues. But I really like what the AMA said: a course of care is a "shared decision making between the patient and physician.” The culture warriors in state legislatures aren’t and shouldn’t be part of that decision making process.

[Analytics]

Hypothetically, say my child was suffering from gender dysphoria and I became more of a stakeholder in these issues. Here is a ChatGPT4o prompt that I would consider when looking for an unbiased way of summarizing the evidence:

Please disregard everything you know about me and all prior discussions we’ve had. Please search the internet for the latest credible research on these issues. If a pre-teen believes he or she may have gender dysphoria, what is the appropriate course of action? What should be done before a treatment plan is implemented? If intervention is needed in a particular situation, should he or she pursue gender affirming care, or gender reparative care, or not do anything at all? Why? In your answer, explain what gender affirmative care and gender reparative care mean.

[smac97]

2 hours ago, Analytics said:

Hey @smac97,

You think I’m misrepresenting you, and I think you’re misrepresenting me. 

To get out of this stalemate, I suggest we look at this from a different angle.

Let us embrace the healing power of "and."

I suggest we look at this issue through the items below and also the issues I have been raising:

• Comorbidities. 
• Informed consent. 
• Compromised assessments of the best interests of the child. 
• Irreversibility. 
• Sterilization. 
• Electively removing healthy body parts of minors. 
• Longitudinal studies essentially absent. 
• Lifelong medical regimens. 
• Ideological/sociopolitical influences/pressures on medical care. 
• Social contagion risks. 
• Risk of financial devastation for the individual (and burden on society).

I think you are largely sidestepping these concerns.

2 hours ago, Analytics said:

I believe these topics have the following stakeholders:

1. Individuals who have gender dysphoria. I am not one of these stakeholders.
2. The family members of people with gender dysphoria, especially the parents of minor children. Again, I am not one of those stakeholders.
3. The psychologists, psychiatrists, and physicians of people who may have a patient facing these issues. Again, I am not one of those stakeholders.
4. Medical researchers who are engaged with the relevant issues. Again, I am not one of those stakeholders.
5. The decision makers at public and private insurance organizations that fund this type of medical care. In my current professional role, I am not on of those stakeholders.
6. Government regulators and lawmakers who govern medical practice. I am not one of those stake holders.
7. The general public who elects lawmakers. Yes, I am a stakeholder in this way.

I am strongly in favor of researchers and caregivers scrutinizing every nuance of all of these issues. I really am. But as a layman member of the general public, I see my role as very limited, and it would take me months of full-time study to get up to speed on all of the research that has been done and continues to be done on this topic. 

So not only am I unqualified to speak to the nuances of these topics, but my opinion is also irrelevant. Are medical researchers sufficiently addressing, for example, comorbidities? I don’t know enough about the details of the actual research to say either way.

You are not a Latter-day Saint, but you have spent years, and thousand and thousands of posts, commentating and critiquing the Church, its leaders, doctrines, policies, history, etc.

You have also spent dozens (hundreds?) of posts commentating about pediatric sex trait modifications.  And yet, at the same time, you occasionally pepper your ongoing commentary with disclaimers and weird evasions and qualifiers hinting/declaring that you should not be talking about these issues, comments like "I am not a stakeholder," "I am agnostic on what medical treatments other people receive," "I see my role as very limited," "I {am} unqualified to speak," {M}y opinion is {} irrelevant," "I don't know enough about the details," "{C}ulture warriors {} shouldn’t be part of that decision making process," and so on.

If you don't want to talk about this stuff, fine.  Nobody is holding a gun to your head.  Some of us, however, think these issues can and should be discussed.

2 hours ago, Analytics said:

Meanwhile, consider the fact that last year, the American Association of Pediatrics reaffirmed and updated their policy statement on Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents, which was written by 19 M.D. researchers, and was approved by the AAP’s board of directors. After "providing brief, relevant background on the basis of current available research and expert opinion from clinical and research leaders,” It makes the following recommendations:

1. that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;
2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;
3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;
4. that insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions;
5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;
6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all children without fear of harassment, exclusion, or bullying because of gender expression;
7. that pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;
8. that the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and
9. that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD.

What are your thoughts on their recommendations?  

As to the topic?  Broad and vague, to the point of pablum.

The closest these guidelines get to the topic at hand - pediatric sex trait modification - is #4: "{C}overage for medical, psychological, and, when indicated, surgical gender-affirming interventions {for youth who identify as TGD}."  And even then, nothing here examines or addresses comorbidities, informed consent, and so on.

Thanks,

-Smac

Edited October 17, 2024 by smac97

[smac97]

1 hour ago, Analytics said:

Let me get this straight.

You have a poor track record of characterizing my position, even when (perhaps particularly when) you preface your mischaracterizations with ironies like "Let me get this straight..."

1 hour ago, Analytics said:

In an effort to avoid forming opinions based on “ideological/sociolpolitical influences/pressures on medical care”, you turned to an article written by a political philosopher and was published by a political advocacy organization. Do I have this right?

No.  Not even close.  Not remotely.

First, I have cited quite a few - dozens? - of articles, studies, etc., in this thread and others, which address the concerns I have been addressing in this thread.

Second, the specific article in my previous post cites commentary from Dr. Paul McHugh, "a review of 'more than 100 follow-up studies of post-operative transsexuals' by Birmingham University’s Aggressive Research Intelligence Facility," Centers for Medicare & Medicaid Services, Dr. Deanna Adkins, Dr. Lawrence Mayer, Dr. Michelle Cretella, Dr. Leon Kass, and so on.

Third, I reject the notion - which you seem to be advancing - that pediatric sex trait modification treatment is, or ought to be, the exclusive province of medical doctors and professional organizations.  This issue requires input from various medical, sociological, legal and other disciplines.

Thanks,

-Smac

Edited October 17, 2024 by smac97

[Analytics]

3 hours ago, smac97 said:

Let us embrace the healing power of "and."

I suggest we look at this issue through the items below and also the issues I have been raising:

• Comorbidities. 

Okay. Let’s talk about these things. I believe doctors should treat the whole person and be aware of comorbidities when developing plans of care. I don’t think this is controversial, is it? What do you think saying “Comorbidities” implies?

3 hours ago, smac97 said:

• Informed consent. 

I believe doctors should make sure patients fully understand their treatment options, risks, and benefits before agreeing to anything, and that they’re making the decision without pressure. It’s about clear communication and respect for their autonomy. Is this controversial?

3 hours ago, smac97 said:

• Compromised assessments of the best interests of the child. 

I believe doctors should make accurate assessments of what is in the best interests of the child. Is this controversial?

3 hours ago, smac97 said:

• Irreversibility. 

Yes, irreversible medical decisions need to be considered very carefully. Isn’t that why doctors generally start with treatment options that are generally considered reversible, such as puberty blockers.

3 hours ago, smac97 said:

• Sterilization. 

Yes, this is something that should be considered in medical treatment. 

3 hours ago, smac97 said:

• Electively removing healthy body parts of minors. 

That characterization is quite misleading. Gender-affirming surgery is rarely, if ever, performed on minors. For minors, gender-affirming care typically involves reversible treatments like puberty blockers and hormone therapy, if appropriate. Surgical interventions are usually reserved for adults or older teens under very specific medical and psychological circumstances, and always involve thorough evaluation by healthcare professionals. Referring to it as "electively removing healthy body parts" oversimplifies and misrepresents the complex medical and psychological process behind these decisions.

3 hours ago, smac97 said:

• Longitudinal studies essentially absent. 

In your view, what counts as a longitudinal study? And are you only talking about surgery, or are you talking about gender affirming care in general?

3 hours ago, smac97 said:

• Lifelong medical regimens. 

Yes, the benefits, risks, costs, and side-effects of entering medical regimes ought to be carefully considered. 

3 hours ago, smac97 said:

• Ideological/sociopolitical influences/pressures on medical care. 

Yes, medical decisions should be made by competent doctors who are following the best practices of evidence-based medicine, and not be influenced by politicians who use the medical conditions of others for their own political purposes.

3 hours ago, smac97 said:

• Social contagion risks. 

BOSTON, August 3, 2022—A study published today in Pediatrics, using a large national dataset of adolescents in the U.S., provided evidence against the notion that adolescents in the U.S. come to identify as transgender due to “social contagion.”

https://fenwayhealth.org/new-study-examines-the-social-contagion-hypothesis-of-transgender-and-gender-diverse-identities/

3 hours ago, smac97 said:

• Risk of financial devastation for the individual (and burden on society).

I suppose that is an issue, but by the same token, the cost of untreated gender dysphoria may also be high due to mental health issues that can arise if care is not accessible, potentially leading to long-term financial devastation in other aspects of life. 

3 hours ago, smac97 said:

I think you are largely sidestepping these concerns.

In general, I think medical decisions are a private thing that ought to be made by patients and medical providers.

3 hours ago, smac97 said:

You have also spent dozens (hundreds?) of posts commentating about pediatric sex trait modifications. 

Actually, my posts have generally been an attempt to 

3 hours ago, smac97 said:

And yet, at the same time, you occasionally pepper your ongoing commentary with disclaimers and weird evasions and qualifiers hinting/declaring that you should not be talking about these issues, comments like "I am not a stakeholder," "I am agnostic on what medical treatments other people receive," "I see my role as very limited," "I {am} unqualified to speak," {M}y opinion is {} irrelevant," "I don't know enough about the details," "{C}ulture warriors {} shouldn’t be part of that decision making process," and so on.

If you don't want to talk about this stuff, fine.  Nobody is holding a gun to your head.  Some of us, however, think these issues can and should be discussed.

I think pointing out the enormous gap between what you are saying and what mainstream science says is a worthwhile thing to comment on.

And I also think it’s worthwhile to point out how fundamentally wrongheaded it is to make unqualified comments about whether you are in favor or against this or that medical treatment. These are clinical decisions that need to be made on a case by case basis. I do feel strongly about that, and think it is worthwhile to explain why it is so.

 

3 hours ago, smac97 said:

As to the topic?  Broad and vague, to the point of pablum.

The closest these guidelines get to the topic at hand - pediatric sex trait modification - is #4: "{C}overage for medical, psychological, and, when indicated, surgical gender-affirming interventions {for youth who identify as TGD}."  And even then, nothing here examines or addresses comorbidities, informed consent, and so on.

Item #1 on the list is the recommendation "that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space."

Have you read the entire policy statement? The point of this is that if a kid walks into a pediatricians office and indicates he or she might have gender dysphoria, pediatricians should turn to this single article for an accurate overview and summary of best practices on the topics. The research it summarizes considers everything, including comorbidities:

Quote

Adolescents and adults who identify as transgender have high rates of depression, anxiety, eating disorders, self-harm, and suicide.^13,–20 Evidence suggests that an identity of TGD has an increased prevalence among individuals with autism spectrum disorder, but this association is not yet well understood.^21,22 In 1 retrospective cohort study of 180 trans youth and matched cisgender peers, 56 youth who identified as transgender reported previous suicidal ideation, and 31 reported a previous suicide attempt, compared with 20 and 11 among matched youth who identified as cisgender, respectively.¹³ Some youth who identify as TGD also experience gender dysphoria, which is a specific diagnosis given to those who experience impairment in peer and/or family relationships, school performance, or other aspects of their life as a consequence of the incongruence between their assigned sex and their gender identity.²³ 

There is no evidence that risk for mental illness is inherently attributable to one’s identity of TGD. Rather, it is believed to be multifactorial, stemming from an internal conflict between one’s appearance and identity, limited availability of mental health services, low access to health care providers with expertise in caring for youth who identify as TGD, discrimination, stigma, and social rejection.²⁴ This was affirmed by the American Psychological Association in 2008²⁵(with practice guidelines released in 2015⁸) and the American Psychiatric Association, which made the following statement in 2012:

Being transgender or gender variant implies no impairment in judgment, stability, reliability, or general social or vocational capabilities; however, these individuals often experience discrimination due to a lack of civil rights protections for their gender identity or expression.… [Such] discrimination and lack of equal civil rights is damaging to the mental health of transgender and gender variant individuals.²⁶ 

That is an accurate summary of the mainstream beliefs among pediatricians about common comorbidities. They do address it, and unlike you and me, they are both qualified to assess the sum total of the evidence, and are in the clinic with patients.

Regarding what they mean by access to gender-affirming care, it says:

Quote

Gender-Affirmative Care

In a gender-affirmative care model (GACM), pediatric providers offer developmentally appropriate care that is oriented toward understanding and appreciating the youth’s gender experience. A strong, nonjudgmental partnership with youth and their families can facilitate exploration of complicated emotions and gender-diverse expressions while allowing questions and concerns to be raised in a supportive environment.⁵ In a GACM, the following messages are conveyed:

• transgender identities and diverse gender expressions do not constitute a mental disorder;

• variations in gender identity and expression are normal aspects of human diversity, and binary definitions of gender do not always reflect emerging gender identities;

• gender identity evolves as an interplay of biology, development, socialization, and culture; and

• if a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child.^27,33 

The GACM is best facilitated through the integration of medical, mental health, and social services, including specific resources and supports for parents and families.²⁴ Providers work together to destigmatize gender variance, promote the child’s self-worth, facilitate access to care, educate families, and advocate for safer community spaces where children are free to develop and explore their gender.⁵ A specialized gender-affirmative therapist, when available, may be an asset in helping children and their families build skills for dealing with gender-based stigma, address symptoms of anxiety or depression, and reinforce the child’s overall resiliency.^34,35 There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.^24,36,37 

 

In contrast, “conversion” or “reparative” treatment models are used to prevent children and adolescents from identifying as transgender or to dissuade them from exhibiting gender-diverse expressions. The Substance Abuse and Mental Health Services Administration has concluded that any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate.³³ Reparative approaches have been proven to be not only unsuccessful³⁸ but also deleterious and are considered outside the mainstream of traditional medical practice.^29,39,–42The AAP described reparative approaches as “unfair and deceptive.”⁴³ At the time of this writing,^* conversion therapy was banned by executive regulation in New York and by legislative statutes in 9 other states as well as the District of Columbia.⁴⁴ 

 

Pediatric providers have an essential role in assessing gender concerns and providing evidence-based information to assist youth and families in medical decision-making. Not doing so can prolong or exacerbate gender dysphoria and contribute to abuse and stigmatization.³⁵ If a pediatric provider does not feel prepared to address gender concerns when they occur, then referral to a pediatric or mental health provider with more expertise is appropriate. There is little research on communication and efficacy with transfers in care for youth who identify as TGD, particularly from pediatric to adult providers.

This is representative of mainstream, scientific thought. If you’d like to cite an article from the Heritage Foundation that says they are wrong about all this then knock yourself out.

I just think it is important to acknowledge what mainstream science says on these issues. Don’t you?

 

Edited October 17, 2024 by Analytics

[Calm]

2 hours ago, Analytics said:

Gender-affirming surgery is rarely, if ever, performed on minors.

Unless it’s to help cis gendered males look more masculine, though even with that, it was only around 14,000 a decade ago.  If AI is accurate, it’s also much less now, with only around 3000 in 2022.

I wonder if the campaign against gender affirming care for female minors transitioning has also impacted males trying to appear more masculine as predicted in some of the older studies I read.

Edited October 17, 2024 by Calm

[Calm]

1 hour ago, Analytics said:

Actually, my posts have generally been an attempt to 

??

[MustardSeed]

I’m interested in knowing how people who are opposed to trans gender surgery feel about cis gendered folks receiving gender magnification surgeries such as breast enhancement or penile enlargement surgery. Maybe that’s a different topic and maybe nobody needs to answer it, but I’m still interested in it. 

[Rain]

30 minutes ago, MustardSeed said:

I’m interested in knowing how people who are opposed to trans gender surgery feel about cis gendered folks receiving gender magnification surgeries such as breast enhancement or penile enlargement surgery. Maybe that’s a different topic and maybe nobody needs to answer it, but I’m still interested in it. 

Having had 4 major surgeries and 2 minor surgeries I am not against surgery, but I am one that thinks you shouldn't lightly jump into them, especially if they are not medically necessary and if done on children or people who struggle with mental issues. 

So I'm definitely not happy about the idea of breast enlargement for children and not for adults either, but figure it is an adult's choice. The same goes for penal enlargement for "gender magnification", though I do wonder if there medical or use reasons for it. 

Honestly, I would feel better about letting people make their own choice if 1. I didn't already know some parents of trans people that concern me. In fact more concern me than not. 2. I didn't have a lot of experience with doctors with some of them concerning me. 3. If there was some kind of system set up - CA boy talked about training which I think is good, but this is such a big deal I think it really should take a team of trained and unbiased medial staff, time spent doing other methods of transitioning etc. 4. How I changed mentally and emotionally till into my mid 20s.

I say unbiased for a reason.  I can't tell you how many times I have seen a doctor catch onto an idea and then run with it seemingly after every patient.  I recall one time with something was recommended to me and then in a rare moment of verbal clarity I confidentally shared all the reasons why that would not be a good idea for me, but at other times doctors have pretty confidentally pushed things on me that I wasn't sure about and it wasn't till later when I was using the protocal that I could share why it was wrong. Doctors are human too so I am not confident that some would not do that with these surgeries as well.

We have talked about making laws here and I definitely have concerns about that.  I know that many lawmakers have no clue about refugees coming into this country so I know that many will have no clue about transgender surgery or for that matter, surgeries of any kind. I'm not confident they can set up good laws about transgender surgery.  I just want a way to make it safer for children whose parents and doctors are ready to jump into surgery for children - yes, I know most won't do that, but experience shows me some will.