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

[smac97]

1 hour 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. 

I think there is a substantial difference between an adult undergoing such elective procedures as compared to minors.  I think some of the concerns remain (comorbidities, informed consent, etc.), but generally an adult can do what he or she likes to their own body.

I seriously question whether minors can give informed consent where comorbidities are present, where longitudinal data as to long-term effects are mostly absent, where decisions about having children are far in the future, where there are substantial risks of compromised assessments of the best interests of the child and ideological/sociopolitical influences/pressures on medical care and risks of social contagion, where the vast majority of minors with Gender Dysphoria outgrow it, and so on.

Thanks,

-Smac

[Analytics]

7 hours ago, Calm said:

??

Actually, my posts have generally been an attempt to...

1. Explain that Smac’s repeated questions about being in favor or against gender affirming care in some general sense is the wrong question. As my quotes from the AMA, AAP, etc. above illustrate, choosing a medical intervention should be based on “shared decision making between the patient and physician” (AMA) after being “appropriately evaluated” (APA) and finding that the intervention is “clinically indicated” (ACP). It’s a personal decision that is dependent upon the specific situation, not a generic situation we can pontificate about here.
    
2. In the words of the American Counseling Association, "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...Provision of affirming medical care is evidence-based best practice when working with transgender individuals.” This fact should be acknowledged.
   
   The fact that @smac97 found an article from the Heritage Foundation that quotes a doctor with a different opinion doesn’t even begin to counterbalance the weight of the opinions held by all of these prestigious medical organizations.
    
3. Medical studies need to be read in the context of understanding the totality of what existing research already indicates. Very few of us have the training, experience, and time to do this properly. Really understanding what this stuff all means and how it should be applied in a clinical situation is hard. In contrast, it is easy to form an opinion based upon your religion or politics, and then read (or write) editorials that cherry pick sentences from the research to support your political position.  
    
4. Quoting from individuals who regret their medical decisions our outcomes to prove something about a medical procedure in general is a fallacy. Everybody matters, but you can’t extrapolate from one individual to prove a point about a medical intervention in general.
    
5. Does more research need to be done? Of course. Is it possible that mainstream medicine is wrong about different things? Of course. Are mistakes made in clinical settings? All too often. But none of these things change the fact that according to the vast majority of experts who provide mental and medical healthcare for a living, "appropriately evaluated transgender and gender diverse individuals can benefit greatly from medical and surgical gender-affirming treatments."
    
6. Again, they can be wrong, and discussions about that should be taking place. However, those discussions should be among qualified people with the appropriate expertise, and those conversations should be happening in medical journals and medical conferences, not here.

I have complicated and intense feelings and thoughts about the U.S. medical system. This is a big, personal issue for me. From the age of 10 to 30, I suffered from a severe auto-immune disease. By accepting a mission call with this disease and earnestly trying to fulfill that call, I did immense, permanent damage to my joints. Around the year 2000 when I turned 30, I was put into a clinical trial for Enbrel, and my life changed. By injecting Enbrel under my skin, carefully engineered proteins directly neutralized excess TNF cells in my immune system, which caused it to stop attacking my own body. For the first time in 20 years, I didn’t feel like I had the flu. The intense inflammation went away. The aches went away. The tiredness went away. And it was done with something that targeted the underlying trigger of the whole autoimmune process with the precision of a sniper rifle; thus it had no side effects.  It was a miracle.

My disease was genetic (the HLA-B27 gene, if you’re curious), and I inherited it from my mother. She took the same miracle drug that I did, and the fine print on the label says what you would expect something that messes with your immune system to say: "Patients treated with Enbrel are at increased risk for developing serious infections involving various organ systems and sites that may lead to hospitalization or death.” And that is exactly what happened to my mom--the drug that saved my life intubated my mother at IHC, where she died 2 weeks later.

Meanwhile, over the course of 20 years, my health insurance company paid something close to $1,000,000 in medical care to manage my autoimmune disease.  

In 2020, after 20 years of being on Enbrel and related drugs, my disease went into remission, and I’ve been perfectly healthy and drug free for over 4 years now. I did this with the help of a functional medicine doctor who said the underlying cause of my disease had to do with gut health (Read The Plant Paradox by Steven Gundry for more information). In my own N-of-1 trial, I found out that I, personally, didn’t need to inject myself with the drug that killed my mother--all I needed to do was heal my gut by going on a pretty intense diet for 10 months.

Having said all that, I am neither for nor against Enbrel. Nor am I for or against functional medicine. However, I am in favor of medical research, of people taking responsibility for their own healthcare, of finding the best doctors you can, and of being extremely cautious before agreeing to take drugs or subject yourself to medical procedures.

I do consider myself to be a stakeholder in research about biological and non-biological disease-modifying antirheumatic drugs, and I have a lot I could say on these issues. But I’d want to have to conversations with clinicians, medical researchers, and organizations that fund medical research. Talking about it here to posture about my moral superiority would be a waste of time.

[Analytics]

1 hour ago, smac97 said:

I seriously question whether minors can give informed consent where comorbidities are present, where longitudinal data as to long-term effects are mostly absent...

Can you clarify what you are saying here? Why would comorbidities being present have any effect on these things?

For example, when I was ten, I was diagnosed with Juvenile Rheumatoid Arthritis, and I had some comorbidities including allergies, and probably some other undiagnosed psychological issue. Likewise, the treatment plan I was given (taking 18 aspirin a day to the point where my ears would ring) could (and did) have long-term effects. How does the existence of comorbidities affect my ability to give consent to the treatment plan my doctors recommended? You always lead your responses by saying “comorbidities”, but I have no clue what your point actually is with that.

Since in my case there were comorbidities and uncertainties about the long-term effects of the treatment plan, was I incapable of making an informed decision about my arthritis? Does that somehow mean that I shouldn’t have been treated at all?

1 hour ago, smac97 said:

...where there are substantial risks of compromised assessments of the best interests of the child and ideological/sociopolitical influences/pressures on medical care and risks of social contagion...

This cuts both ways. the idea that you should reject the opinions of medical organizations and embrace the opinion of the Heritage Foundation because of "risks of compromised assessments of the best interests of the child and ideological/sociopolitical influences/pressures on medical care” is ludicrous. 

1 hour ago, smac97 said:

where the vast majority of minors with Gender Dysphoria outgrow it...

The sources that you somehow believe are free of ideological/sociopolitical influences/pressures claim this, of course, and everyone would agree that whether any given patient is likely to outgrow their feelings should be carefully considered on a case by case basis. However, there are valid reasons that the consensus of the mainstream medical community disagrees with you on this point.

Edited October 17, 2024 by Analytics

[Malc]

2 hours ago, smac97 said:

I think there is a substantial difference between an adult undergoing such elective procedures as compared to minors.  I think some of the concerns remain (comorbidities, informed consent, etc.), but generally an adult can do what he or she likes to their own body.

I seriously question whether minors can give informed consent where comorbidities are present, where longitudinal data as to long-term effects are mostly absent, where decisions about having children are far in the future, where there are substantial risks of compromised assessments of the best interests of the child and ideological/sociopolitical influences/pressures on medical care and risks of social contagion, where the vast majority of minors with Gender Dysphoria outgrow it, and so on.

Thanks,

-Smac

[my emphasis]

Would it be overly political to point out that this may be generally true in many places except for a number of jurisdictions in the US, the country in which I believe most of the members of this board live.

[bluebell]

4 minutes ago, Malc said:

[my emphasis]

Would it be overly political to point out that this may be generally true in many places except for a number of jurisdictions in the US, the country in which I believe most of the members of this board live.

Is this in reference to abortion or do you mean something else (trying to make sure I understand you correctly)?  If it's about abortion, I think it's the addition of the second body that causes the exception. 

[smac97]

13 minutes ago, Malc said:

Quote

I think there is a substantial difference between an adult undergoing such elective procedures as compared to minors.  I think some of the concerns remain (comorbidities, informed consent, etc.), but generally an adult can do what he or she likes to their own body.

I seriously question whether minors can give informed consent where comorbidities are present, where longitudinal data as to long-term effects are mostly absent, where decisions about having children are far in the future, where there are substantial risks of compromised assessments of the best interests of the child and ideological/sociopolitical influences/pressures on medical care and risks of social contagion, where the vast majority of minors with Gender Dysphoria outgrow it, and so on.

[my emphasis]

"I think there is a substantial difference between an adult undergoing such elective procedures as compared to minors.  I think some of the concerns remain (comorbidities, informed consent, etc.), but generally an adult can do what he or she likes to their own body."

[my emphasis]

13 minutes ago, Malc said:

Would it be overly political to point out that this may be generally true in many places except for a number of jurisdictions in the US, the country in which I believe most of the members of this board live.

Which jurisdictions are you referencing here?  And what medical procedures are you referencing that you believe are preclude "a number of jurisdictions in the US" from the broad observation that "generally an adult can do what he or she likes to their own body"?  Are you, as Bluebell suspects, referencing abortion?

Thanks,

-Smac

[Calm]

4 hours 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. 

Breast enhancement is supposedly much more painful and problematic than breast reduction as well as the issue that breasts implants have not be approved for younger than 18 and I can’t think of any condition that could allow them to be used off label, lol.  So I don’t see that as good for younger than 18.

Breast reduction is less problematic, but given minors are still growing, including breast tissue, delaying surgery until older is wise, imo, in order to do it right.  Still there are some medical reasons such could be done besides appearance or even valid for appearance (Alexa tells me a 17 year old was the youngest in the US who was required to get a mastectomy, I assume she wanted reconstruction at the usual time and not having to prolong her recovery time by a number of months)), so I wouldn’t want to have a complete ban on either case or even one that states the exceptions, unless the exception allowed was “on advice of the doctor” because of unforeseen problems.

Edited October 17, 2024 by Calm

[Calm]

2 hours ago, Analytics said:

taking 18 aspirin a day to the point where my ears would ring) could (and did) have long-term effects

This is so awful. I can’t take Tylenol or I can’t sleep my ears are so loud.  I don’t know what I would have done if it hit me as a teen (I would hear music or whispering at time, hearing music was kind of fun; ringing never is, soooo annoying, intrusive, it truly lowers the quality of life).

Thanks for sharing. I think it helps to see what contributes to personal rationales.  It must have been so heartrending when your mother passed.

Your relationship to Enbrel must have been complicated. 

Edited October 17, 2024 by Calm

[LoudmouthMormon]

5 hours 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. 

For minors, I'd consider it tantamount to mutilation if it was urged as part of some cultural push to help kids feel more at home with their own bodies, or some progressive push to right the wrongs of historically marginalized groups of people.  By those measures, I might even be open to notions of criminalizing certain procedures and penalizing those who perform them.   If it's done for a clear medical reason, that's a different answer.  I'm aware, for example, of breast reduction being done for massively enowed small-framed girls who are at risk of having their spines not grow right because of the weight. 

For adults, I care far less. Do whatever you want to yourself, just don't make me pay for it in the form of taxes or insurance rates.   I might express opinions and be part of the public conversation, if I felt that folks were pushing too hard, notions of surgically altering yourself as a way of gaining self esteem or mental health.  But I won't be begrudging any adult human a differing opinion.  I might support or oppose various bits of legislation on the matter.  But in general I won't care.  And if I hear someone had it done, I'd be the same sort of "love thy neighbor" as I am when I hear someone has tattoos or used to be a sex worker or whatever.

As far as I can tell, there is pretty much zero light between my answers here, and my answers on trans gender surgery.

Edited October 17, 2024 by LoudmouthMormon

[SeekingUnderstanding]

19 minutes ago, LoudmouthMormon said:

For minors, I'd consider it tantamount to mutilation if it was urged as part of some cultural push to help kids feel more at home with their own bodies,

So are you against circumcision then?

[LoudmouthMormon]

11 minutes ago, SeekingUnderstanding said:

So are you against circumcision then?

It's a fair question.  I'm neither for nor against it.  Is my opinion hypocritical?  Let's look: Circumcision isn't about "helping kids feel more at home with their own bodies".  It's about tradition and dads who want "my boy to look like his father".  Kind of not about the kid at all.  

Why am I not as worked up about circumcision?  The question I answered asked about "gender magnification surgeries such as ... penile enlargement surgery."  Circumcision doesn't really fall into that category.  Does it?  I don't know anyone who circumcises their kid so they'll be more or less of a man.  But I don't know everybody...

 

Edited October 17, 2024 by LoudmouthMormon

[Calm]

5 minutes ago, LoudmouthMormon said:

It's about tradition and dads who want "my boy to look like his father".  Kind of not about the kid at all.  

Apparently there are likely health benefits as well. Must be new research because last I heard that was disproven, but now the APA is for it….sort of  

https://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Where-We-Stand-Circumcision.aspx#:~:text=The American Academy of Pediatrics,advantages%2C as well as risks.

Quote

Current evidence suggests that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. However, existing scientific evidence is not sufficient to recommend routine circumcision.

 

[Analytics]

45 minutes ago, LoudmouthMormon said:

For minors, I'd consider it tantamount to mutilation if it was urged as part of some cultural push to help kids feel more at home with their own bodies, or some progressive push to right the wrongs of historically marginalized groups of people.  By those measures, I might even be open to notions of criminalizing certain procedures and penalizing those who perform them.   If it's done for a clear medical reason, that's a different answer.  I'm aware, for example, of breast reduction being done for massively enowed small-framed girls who are at risk of having their spines not grow right because of the weight. 

Let's look at a specific case that might be different than the one you are imagining. Say there is a 12-year old male, by both sex at birth and affirmed gender. But, he is suffering from gynecomastia--he has significant breast tissue.

From the website of a doctor who specializes in treating this:

 

"For some boys going through puberty, their bodies produce elevated levels of estrogen. The result is male breast growth during a time when feeling normal and fitting in are paramount. The boy may end up feeling embarrassed. In gym class when they call “Shirts and Skins”, the boy may feel like hiding. The same goes for changing or showering in the locker room. Knowing they look different from their peers can make teen boys feel diminished, depressed, and wishing they were like every other boy."

If a specific child was psychologically suffering from this, should gender affirming care that would “help him feel more at home in his own body” be legal? Or is this the type of elective surgery that is tantamount to mutilation and should be outlawed?

I think medical decisions like this should be left in the hands of the child, the parents, and their competent medical providers.

But that’s just me.

[MustardSeed]

Interesting topic, surgery for kids.  
 

when my brother was 9 he had his ears pinned back.  We have this genetic trend in our family for massive sticky outie ears.  
He was mercilessly teased until the change. 

 

[Tacenda]

31 minutes ago, Analytics said:

Let's look at a specific case that might be different than the one you are imagining. Say there is a 12-year old male, by both sex at birth and affirmed gender. But, he is suffering from gynecomastia--he has significant breast tissue.

From the website of a doctor who specializes in treating this:

 

"For some boys going through puberty, their bodies produce elevated levels of estrogen. The result is male breast growth during a time when feeling normal and fitting in are paramount. The boy may end up feeling embarrassed. In gym class when they call “Shirts and Skins”, the boy may feel like hiding. The same goes for changing or showering in the locker room. Knowing they look different from their peers can make teen boys feel diminished, depressed, and wishing they were like every other boy."

If a specific child was psychologically suffering from this, should gender affirming care that would “help him feel more at home in his own body” be legal? Or is this the type of elective surgery that is tantamount to mutilation and should be outlawed?

I think medical decisions like this should be left in the hands of the child, the parents, and their competent medical providers.

But that’s just me.

This is a circumstance I hadn't thought about. I think it's very appropriate for this young man to have breast reduction and I'll bet that happens often.

[Malc]

2 hours ago, bluebell said:

Is this in reference to abortion or do you mean something else (trying to make sure I understand you correctly)?  If it's about abortion, I think it's the addition of the second body that causes the exception. 

It is about abortion - and I believe that it is debatable, for many of the procedures, whether there is another body involved, rather than a clump of cells.

I believe that, to avoid the "no politics" rule, I should likely leave this as my stating an opinion, and not something that I feel obliged to debate further.

[Malc]

2 hours ago, smac97 said:

"I think there is a substantial difference between an adult undergoing such elective procedures as compared to minors.  I think some of the concerns remain (comorbidities, informed consent, etc.), but generally an adult can do what he or she likes to their own body."

[my emphasis]

Which jurisdictions are you referencing here?  And what medical procedures are you referencing that you believe are preclude "a number of jurisdictions in the US" from the broad observation that "generally an adult can do what he or she likes to their own body"?  Are you, as Bluebell suspects, referencing abortion?

Thanks,

-Smac

Here is my reply to Bluebell:

Quote

It is about abortion - and I believe that it is debatable, for many of the procedures, whether there is another body involved, rather than a clump of cells.

I believe that, to avoid the "no politics" rule, I should likely leave this as my stating an opinion, and not something that I feel obliged to debate further.

I guess I could make a list of jurisdictions here, but I am not sure that it is necessary. I'm pretty sure everyone who follows US news knows which I mean.

[Malc]

8 minutes ago, Tacenda said:

This is a circumstance I hadn't thought about. I think it's very appropriate for this young man to have breast reduction and I'll bet that happens often.

I remember several of the boys in my high school gym class who were teased unmercifully because they suffered from this condition. I honestly don't remember if I joined in, but I'm horrified at the thought that I may have done so - even more so that I probably did.

Kids can be remarkably cruel and thoughtless.

[smac97]

3 minutes ago, Malc said:

Here is my reply to Bluebell:

Quote

It is about abortion - and I believe that it is debatable, for many of the procedures, whether there is another body involved, rather than a clump of cells.

I believe that, to avoid the "no politics" rule, I should likely leave this as my stating an opinion, and not something that I feel obliged to debate further.

I guess I could make a list of jurisdictions here, but I am not sure that it is necessary. I'm pretty sure everyone who follows US news knows which I mean.

Discussing abortion on this board is fine (though implicating political parties, platforms, etc. is likely not).

I have never understood the "clump of cells" designation.  When, in your view, does a "clump of cells" become a "body"?

Thanks,

-Smac

[Malc]

2 minutes ago, smac97 said:

Discussing abortion on this board is fine (though implicating political parties, platforms, etc. is likely not).

I have never understood the "clump of cells" designation.  When, in your view, does a "clump of cells" become a "body"?

Thanks,

-Smac

I don't have a firm opinion on the matter of "when", and a definition may not be needed if we leave the decision about performing the procedure to the doctor, and the pregnant person with or without spiritual counseling as they see fit.

[smac97]

1 minute ago, Malc said:

Quote

Discussing abortion on this board is fine (though implicating political parties, platforms, etc. is likely not).

I have never understood the "clump of cells" designation.  When, in your view, does a "clump of cells" become a "body"?

I don't have a firm opinion on the matter of "when", and a definition may not be needed if we leave the decision about performing the procedure to the doctor, and the pregnant person with or without spiritual counseling as they see fit.

The law sometimes requires that "we" (legislatures, society, etc.) arrive at a consensus on these sorts of things.  

"Clump of cells" is a popular and/or ideological phrase, not a scientific or legal one.  Technically, we all are "clumps of cells," so differentiating it from "a body" doesn't work.

IMO, the real question (for legal/legislative purposes, anyway) is when do/should we attach "personhood" to an in utero child.

Thanks,

-Smac

[Calm]

4 minutes ago, smac97 said:

Clump of cells" is a popular and/or ideological phrase, not a scientific or legal one.  Technically, we all are "clumps of cells," so differentiating it from "a body" doesn't work.

 

I believe he is talking about a blastula or a blastocyst stages, which really are a clump of cells imo. At most a ball of cells. 

Edited October 17, 2024 by Calm

[Doctor Steuss]

21 minutes ago, Malc said:

I remember several of the boys in my high school gym class who were teased unmercifully because they suffered from this condition. I honestly don't remember if I joined in, but I'm horrified at the thought that I may have done so - even more so that I probably did.

Kids can be remarkably cruel and thoughtless.

Fortunately, there are some promising pharmaceutical interventions using breast cancer drugs (one of which has some studies showing a 60%+ success rate).  Unfortunately, very few doctors have experience with using them for this particular reason.  Of course, pharmaceutical intervention does carry its own risks (it is, after all, tinkering with the endocrine system, and estrogen receptors), but is also much less expensive (and invasive).

I had pubertal gyno that never went away.  One of the reasons I took up weightlifting was to try to hide it (basically, get really big muscles, and the breast tissue wouldn't be as noticeable -- and it worked for the most part, at least while wearing a shirt).  There are maybe 20 people in the entire world who have seen me with my shirt off, including medical professionals and family.  This year, I started one of the pharmaceutical treatments, and it helped reduce it significantly (by at least 2/3rds), and has really helped my confidence and start to feel "normal."

Thank God for gender affirming care.

Edited October 17, 2024 by Doctor Steuss

[Malc]

6 minutes ago, smac97 said:

The law sometimes requires that "we" (legislatures, society, etc.) arrive at a consensus on these sorts of things.  

"Clump of cells" is a popular and/or ideological phrase, not a scientific or legal one.  Technically, we all are "clumps of cells," so differentiating it from "a body" doesn't work.

IMO, the real question (for legal/legislative purposes, anyway) is when do/should we attach "personhood" to an in utero child.

Thanks,

-Smac

Fair points. I wasn't attempting to make a scientific argument.

[smac97]

5 minutes ago, Malc said:

Fair points. I wasn't attempting to make a scientific argument.

Understood.  Perhaps this is a discussion for another time and thread.

Thanks,

-Smac