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

[Malc]

1 minute ago, Doctor Steuss said:

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).  There are probably maybe 20 people in the entire world who have seen me with my shirt off, including medical professionals.  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.

As a teen I had terrible acne. I suffered it, though, because topical treatments did not help much, and my doc warned me about the feminizing effects of the other treatments that were available.

Off topic a little: When I returned to my old high school as a teacher, one of the first staff members I met was a favourite teacher.

He said: "Good to see you, Malc. Did you know that as a student you had the worst acne in the entire school?" I replied: "Yes, Mr M - how could I possibly not have known that."

So, cruelty about such personal matters is not the exclusive province of kids.

[Doctor Steuss]

Just now, Malc said:

As a teen I had terrible acne. I suffered it, though, because topical treatments did not help much, and my doc warned me about the feminizing effects of the other treatments that were available.

Off topic a little: When I returned to my old high school as a teacher, one of the first staff members I met was a favourite teacher.

He said: "Good to see you, Malc. Did you know that as a student you had the worst acne in the entire school?" I replied: "Yes, Mr M - how could I possibly not have known that."

So, cruelty about such personal matters is not the exclusive province of kids.

Ugh, I am so sorry.

It seems even when we are able to heal from the trauma of our younger selves, there will always be the landmine field of people willing to remind us of who we once were, and that which burdened us, and lurks in the shadows tempting to burden us again.

[Calm]

16 minutes ago, Doctor Steuss said:

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."

Being overly generously endowed (having my father call me voluptuous was creepy for me due to my over sensitivity, but as far as he was concerned it was a simple description), I would have done almost anything, possibly even surgery if I had thought it an option as a teen, to be free of all that weight. Killed my posture and contributed to constant headaches my whole life. 

But just the appearance of it looked so wrong to me from the start. I have hated my body ever since puberty because of it.  My roommates saying they were jealous only made it worse. 

I put off surgery because I thought it important to breastfeed and then because of money. Thankfully we were in Canada at that time and since it was considered necessary because of back and head pain, it ended up costing nothing. 
I just wish he had cut off more. But the (male) doctor had a different opinion about what was attractive and therefore necessary apparently and I didn’t get a choice.

But it did help me feel more normal even if it still looks so wrong to me. No one else in my family is very large, except one great aunt. Must be a throwback to an earlier generation.  I don’t know if it is that or just because I was very petite and slender before puberty and that is my mindset of who I am. I don’t see it as unattractive as I know it is attractive when my weight is decent and was from the beginning, it is just not my body, but someone else’s.

I have a lot of sympathy for transgender kids. I wasn’t teased thankfully, but it isn’t really possible to be very happy when feeling so disconnected from one’s body imo. 

Edited October 17, 2024 by Calm

[SeekingUnderstanding]

1 hour ago, LoudmouthMormon said:

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.  

Ok. So helping kids feel “more at home with their bodies” makes it mutilation. And wanting  “my boy to look like his father” is not. Sure. 

[Calm]

12 minutes ago, Doctor Steuss said:

seems even when we are able to heal from the trauma of our younger selves

Do you ever actually heal though?  Maybe stop bleeding figuratively speaking, but the scars are there and pull from time to time (literally for me, lol).

[ZealouslyStriving]

3 hours 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.

Apples and oranges, but

Who leaked my photo?!?!

😝

[Calm]

16 minutes ago, ZealouslyStriving said:

Apples and oranges, but

Who leaked my photo?!?!

😝

Why?  Same identical surgery. Both cases are gender affirming with the purpose of helping the minor feel more comfortable in their body. 
 

Would you be okay with a 16 year old girl getting a breast reduction to make herself feel more feminine, graceful because her breasts were overly large for the rest of her body?

Edited October 18, 2024 by Calm

[bluebell]

3 hours ago, Malc said:

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.

Sounds good.  

[Tacenda]

48 minutes ago, Calm said:

Why?  Same identical surgery. Both cases are gender affirming with the purpose of helping the minor feel more comfortable in their body. 
 

Would you be okay with a 16 year old girl getting a breast reduction to make herself feel more feminine, graceful because her breasts were overly large for the rest of her body?

I'm not who you asked but I know a girl that had breast reduction in her teens. 

[ZealouslyStriving]

1 hour ago, Calm said:

Why?  Same identical surgery. Both cases are gender affirming with the purpose of helping the minor feel more comfortable in their body. 
 

Would you be okay with a 16 year old girl getting a breast reduction to make herself feel more feminine, graceful because her breasts were overly large for the rest of her body?

Overly large breasts can cause skeletal muscular issues esp. in developing bodies, so it would be prudent to reduce them.

 

[Malc]

39 minutes ago, Tacenda said:

I'm not who you asked but I know a girl that had breast reduction in her teens. 

Likewise. She had difficulty finding clothes that fitted, and was constantly in pain.

[Calm]

18 hours ago, ZealouslyStriving said:

Overly large breasts can cause skeletal muscular issues esp. in developing bodies, so it would be prudent to reduce them.

 

But boys’ breasts are rarely that large (as far as I know, I haven’t delved into it deeply, the studies I have read did not discuss size)..  Certainly the boy in the picture shown has no back problems due to the weight.  Might if he hunched over trying to hide it, but that is due to emotional issues and should be endured if one is telling transgender kids to endure instead of getting a reduction based on emotional issues in their bodies, correct?  Aren’t you assuming emotional issues are not enough to justify surgery?  Please correct me if I misunderstand you.

My guess is if on a female, that would be a B cup and with his larger shoulders and body frame, there should be no skeletal issues.  So are you okay with just telling the boy he has to live with it?

 

Edited October 18, 2024 by Calm

[Calm]

12 hours ago, Malc said:

Likewise. She had difficulty finding clothes that fitted, and was constantly in pain.

But what about if she was not overly large to the point of pain, but wanted to appear more feminine just as the boy in the picture probably desires to appear more masculine?

It seems everyone agrees if there is a physical consequence of skeletal distortion or back pain of not performing the surgery, reduction is okay in a teen.

But zealously and perhaps others appear to see a significant difference between a biological male getting a breast reduction for purely cosmetic reasons to appear more manly and a biological female getting a breast reduction for purely cosmetic reasons to appear more manly.

I am wondering if he is okay with a biological female getting a reduction to appear more feminine.  While being voluptuous/buxom is one form of femininity, so is being petite and delicate, ‘cute’.  From what I have seen that is generally the more popular way of being feminine when a teen and in many cultures at all ages if one goes by the actresses that are put up as attractive.  So many larger girls (not in weight but structure overall) might not see themselves as feminine.

Edited October 18, 2024 by Calm

[Calm]

55 minutes ago, Malc said:

Likewise. She had difficulty finding clothes that fitted, and was constantly in pain.

Yes, I had a friend in my mid 20s who had it done when a teen. She encouraged me to get it done immediately rather than wait till I was finished having babies.  I wanted to breastfeed to give my kids a good start because of allergies in my family.  If I knew what I know now, I would have signed up as soon as insurance made it affordable. 

[Doctor Steuss]

15 hours ago, Calm said:

Do you ever actually heal though?  Maybe stop bleeding figuratively speaking, but the scars are there and pull from time to time (literally for me, lol).

A therapist I had in my early 20s said something that has really stuck, and helped me make sense of how I could be the person I am in that moment, but have difficulty seeing myself as anyone other than my 11-year-old self.  Even now, as a 6 foot, 285 lb man that's economically comfortable, I feel like a 150 pound kid, with acne, massive clearance glasses, braces, and clothes that were handmade by my mother, and worn by my two older brothers before they reached me.

The younger parts of us will always be the oldest.  When we are 25, the parts of us that formed when we were 24 are only a year old.  They are still fragile, and malleable.  The parts of us that formed when we were 11 though are 14 years old.  They are solid, and foundational.  Sometimes it's possible to tear them down, and rebuild them, but more often than not, the best we can do is shore them up with newer parts of us.

Edited October 18, 2024 by Doctor Steuss

[Calm]

6 hours ago, Doctor Steuss said:

Sometimes it's possible to tear them down, and rebuild them, but more often than not, the best we can do is shore them up with newer parts of us.

That is really what it feels like to me. The insecurities of youth are like a thick cement foundation; a jackhammer of self examination, therapy, whatever barely chips off those characteristics.  The insecurities of adulthood can be processed, and then worked on and eventually resolved if the resources are there though it may take time and effort…at least up to the point they hook into the narrative of youth.

Edited October 18, 2024 by Calm

[Malc]

11 hours ago, Calm said:

But what about if she was not overly large to the point of pain, but wanted to appear more feminine just as the boy in the picture probably desires to appear more masculine?

It seems everyone agrees if there is a physical consequence of skeletal distortion or back pain of not performing the surgery, reduction is okay in a teen.

But zealously and perhaps others appear to see a significant difference between a biological male getting a breast reduction for purely cosmetic reasons to appear more manly and a biological female getting a breast reduction for purely cosmetic reasons to appear more manly.

I am wondering if he is okay with a biological female getting a reduction to appear more feminine.  While being voluptuous/buxom is one form of femininity, so is being petite and delicate, ‘cute’.  From what I have seen that is generally the more popular way of being feminine when a teen and in many cultures at all ages if one goes by the actresses that are put up as attractive.

Someone I know had breast augmentation surgery to conform better to her husband's preferences.

I definitely have mixed feelings about this, ranging from "how dare he" to "her body, her choice". I've seen no indication that he pressured her to have the surgery, but "pressure" can be quite subtle, so I really don't know.

[Calm]

4 hours ago, Malc said:

Someone I know had breast augmentation surgery to conform better to her husband's preferences.

I definitely have mixed feelings about this, ranging from "how dare he" to "her body, her choice". I've seen no indication that he pressured her to have the surgery, but "pressure" can be quite subtle, so I really don't know.

Breast augmentation is more painful and more likely to have complications apparently, so depending on how much her husband’s preference mattered to her and why, I might have a big argument with it (if she did it out of fear of losing him, for example).

[bluebell]

28 minutes ago, Calm said:

Breast augmentation is more painful and more likely to have complications apparently, so depending on how much her husband’s preference mattered to her and why, I might have a big argument with it (if she did it out of fear of losing him, for example).

I’ve heard that breast reductions are a lot more painful and harder on the body. Now I’m curious and will have to look it up. 😂

[Doctor Steuss]

5 minutes ago, bluebell said:

I’ve heard that breast reductions are a lot more painful and harder on the body. Now I’m curious and will have to look it up. 😂

With the obvious disclaimers that this is second-hand (obviously), and everyone handles pain and recovery differently:   From memory, it was about 2 months before my ex-wife was feeling "normal" again, and could do regular activities without excessive pain after her reduction.  I think it was another month after that before she was fully pain-free.

It was an outpatient procedure.  Dropped her off, went and grabbed some lunch, and the surgeon called about 45 minutes later telling me they had her in recovery and she was coming out of anesthesia.  The first couple of days it was pretty difficult for the pain meds to stay ahead of the pain.  She only had a reduction, without any type of "lift" or other cosmetic procedures performed.  I imagine if she had any type of reconstructive aspects, it would've been even more gnarly.

 

[Calm]

42 minutes ago, bluebell said:

I’ve heard that breast reductions are a lot more painful and harder on the body. Now I’m curious and will have to look it up. 😂

I always thought they would be more as I assumed there would be more slicing and dicing, but apparently trying to push mass into a body area where it doesn’t belong hurts. Plus there is a lot of slicing to slip the implant behind the breast matter.  As far as I can tell the skin being stretched feels like a sunburn.

30 minutes ago, Doctor Steuss said:

With the obvious disclaimers that this is second-hand (obviously), and everyone handles pain and recovery differently:   From memory, it was about 2 months before my ex-wife was feeling "normal" again, and could do regular activities without excessive pain after her reduction.  I think it was another month after that before she was fully pain-free.

It was an outpatient procedure.  Dropped her off, went and grabbed some lunch, and the surgeon called about 45 minutes later telling me they had her in recovery and she was coming out of anesthesia.  The first couple of days it was pretty difficult for the pain meds to stay ahead of the pain.  She only had a reduction, without any type of "lift" or other cosmetic procedures performed.  I imagine if she had any type of reconstructive aspects, it would've been even more gnarly.

 

I felt great for the most part initially.  I don’t remember long term recovery like I did for abdominal surgery….that was horrible.  I only remember feeling like Wonder Woman the first day on morphine because they had me strapped up in almost an identical ‘corset’ as she wore…obviously not red though, lol.  I do remember raising my arms was a problem later for a short time….maybe bending over, not sure.  It probably helped that they gave me codeine, which would have unknowingly improved my sleep because it did great with rls back then (prior to diagnosis).

My problem was with long term healing as I got keloid scars that still get irritated.  They had warned me, but said corticosteroid iirc shots would soften them up later on, which they did.  Unfortunately they are pretty ugly.

My guess with breast reduction for men/boys there is probably less pain due to less mass trying to be saved on the outer side of the cut, so less pulling on internal stitches and scars from gravity.

Edited October 18, 2024 by Calm

[smac97]

On 10/17/2024 at 11:06 AM, Analytics said:

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

First, I have provided a number of links to articles addressing this (see, e.g., here, here).

Second, you are at least as capable as I am to investigate these issues.

Third, you keep asserting that discussion of these issues is, or ought to be, outside the purview of people like you and me, and yet you are asking me to inform you about my assessment of these issues.  Please make up your mind.

Fourth, I have recently come across an excellent amicus curiae brief filed with the U.S. Supreme Court in 2019 on behalf of Dr. Paul McHugh.  From the summary:

Quote

Dr. McHugh appears as amicus not to discuss statutory construction but to critically evaluate, on the basis of his clinical and scientific expertise, Respondents’ and the Court of Appeals’ conflation of sex and gender identity. He also seeks to discuss the frequently heard claims about gender identity, which sometimes masquerade as science but are really ideological pronouncements not supported by scientific evidence. In addition to showing that sex, from a medical standpoint, does not include gender identity, Dr. McHugh’s expertise is helpful in challenging the supposed scientific imperative for gender affirmation.

The entire brief is worth a read.  For example, he goes on to suggest - rather forcefully, - that several otherwise vaunted medical organizations, which in your view are the be-all-end-all sources of information about these issues, are ideologically compromised:

Quote

At issue in this case is the meaning of sex under Title VII, and by extension, the meaning of sex under federal law generally. For the duration of amicus’s long professional career (having graduated from Harvard Medical School in 1956), “sex” has consistently referred to being objectively and biologically male or female. “Gender identity” refers to something quite different from sex – namely, a person’s subjective sense of being male or female or something else. Sex is innate, fixed, and binary; gender identity is a fluid belief system based on cultural constructs.

The American Medical Association (AMA) and the American Psychiatric Association (APA) thoroughly confuse sex and gender identity or transpose them, as if gender identity is innate and fixed at birth, while sex is malleable and the body configurable to one’s sense of gender identity. They attempt to obfuscate their ideological pronouncements as science. However, “[t]he hypothesis that gender identity is an innate, fixed property of human beings that is independent of biological sex — that a person might be ‘a man trapped in a woman’s body’ or ‘a woman trapped in a man’s body’ — is not supported by scientific evidence.” Lawrence S. Mayer and Paul R. McHugh, Sexuality and Gender: Findings from the Biological Psychological, and Social Sciences, New Atlantis, Fall 2016, at 8. In addition, “[s]tudies comparing the brain structures of transgender and non-transgender individuals . . . do not provide any evidence for a neurobiological basis for cross-gender identification.” Id.
...
The AMA and APA briefs demonstrate that when medical associations are committed to an ideology, it erodes the objectivity of their scientific claims. Dr. McHugh notes that unfortunately in his profession, “there is a deep prejudice in favor of the idea that nature is totally malleable.”3  However, 

Quote

[w]ithout any fixed position on what is given in human nature, any manipulation can be defended as legitimate. A practice that appears to give people what they want — and what some of them are prepared to clamor for — turns out to be difficult to combat with ordinary professional experience and wisdom. Even controlled trials or careful follow-up studies to ensure that the practice itself is not damaging are often resisted and the results rejected. 

Id.  

The AMA’s and APA’s prioritization of ideology over science is not good for anyone. “Sex change” is biologically impossible, and those associations are “doing no favors” to either the public or those who identify as transgender “by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention.”4

The treatment of gender identity is much like the famous Hans Christian Anderson tale, The Emperor’s New Clothes, in which the spectators all pretend not to notice that the emperor walks through the streets wearing nothing.5 Those watching “the contemporary transgender parade” know that “a disfavored opinion is worse than bad taste,” so they shrink from stating clear facts. Id. McHugh recognized that he is “ever trying to be the boy among the bystanders who points to what’s real. [He does] so not only because truth matters, but also because overlooked amid the hoopla . . . stand many victims.” Id.

From a medical and scientific standpoint, the more something appears to be true based on what is observable, greater care is necessary before reaching an opposite conclusion. Here the biological reality of sex is undeniable, and the benefits of affirming persons’ disbelief in this reality are unclear and the risks are significant. As such, interpreting the law in such a way to create gender affirming policies (policies that require persons to affirm others’ beliefs that they are the opposite sex) may be causing rather than relieving suffering. 
...
Sex is not and cannot be “assigned at birth,” despite the assertions of the AMA, APA, and Respondents. See Stephen’s Br. at 5 (“[S]ex assigned at birth refers to sex an infant is presumed to be at birth.”). The language of “assigned at birth” is purposefully misleading and would be identical to an assertion that blood type is assigned at birth. Yes, a doctor can check your blood type and list it. But blood type, like sex, is objectively recognizable, not assigned. In fact, the sex of a child can be ascertained well before birth. See Keith L. Moore & T.V.N. Persaud, The Developing Human: Clinically Oriented Embryology 307 (Saunders 7th ed. 2003) (“[T]he type of sex chromosome complex established at fertilization determines the type of gonad that differentiates from the indifferent gonad. The type of gonads present then determines the type of sexual differentiation that occurs in the genital ducts and external genitalia.”).7
...
Stephens, as well as the APA and AMA, asserts that “everyone has a gender identity, which is ‘one’s internal, deeply held sense of gender.’” Stephen’s Br. at 5. The APA’s and the AMA’s proffered descriptions of gender identity operate, in all essentials, analogous to a religious belief system. But neither the sincerity of a religious belief nor the sincerity of a person’s beliefs about gender identity determine reality.9 Even the Sixth Circuit noted that gender identity has an “internal genesis that lacks a fixed external referent,” and much like religion, should be “authenticat[ed]” through professions of identity rather than “medical diagnoses.” Pet. App. at 24a-25a n.4. But because it is more like a belief system, it does a great disservice to everyone, those suffering with gender dysphoria and others who are affected, to treat gender identity like sex. A person is either a man or a woman, regardless of what anyone — including that person — happens to believe. 
...
Hayes Inc., a company which focuses on “unbiased” “evidence-based assessments of health technologies and clinical programs to determine their impact on patient safety,” gave the quality of evidence for hormone treatment its lowest possible rating. See Hayes, Inc., “Hormone Therapy for the Treatment of Gender Dysphoria,” Hayes Medical Technology Directory (May 19, 2014) at 4.19 The Hayes Directory explains that some groups advocate for hormonal treatments as “medically necessary treatments.” See Id. at 2. However, these treatments do “not readily fit traditional concepts of medical necessity since research to date has not established anatomical or physiological anomalies associated with [gender dysphoria].” See Id. 

After reviewing twenty-one studies, the Hayes Directory concluded that the studies “were inconsistent with respect to a relationship between hormone therapy and general psychological health, substance abuse, suicide attempts, and sexual function and satisfaction.” See Id. at 3. For quality of life, “[d]ifferences between treated and untreated study participants were very small or of unknown magnitude,” see id. suggesting little evidence of effectiveness.  

Alarmingly, and contrary to the AMA’s and the APA’s narrative, the Hayes Directory reports that the studies show the prevalence of suicide attempts was not affected by hormone therapy. See id.  Additionally, hormone therapy increased risk of cardiovascular disease, cerebrovascular and thromboembolic events, osteoporosis, and cancer. See Id. No proof of improved mortality, suicide rates, or death from illicit drug use was observed. See id. 

Similarly, in 2010, Mohammad Hassan Murad of the Mayo Clinic studied the body of research involving the outcomes of hormonal therapies used in advance of sex reassignment procedures. New Atlantis, supra at 112. He found there to be “very low quality evidence” that hormonal interventions “likely improve[] gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.” Mohammad Hassan Murad et al., Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes, 72 Clinical Endocrinology (2010) 214-231.

Without well-designed studies that provide conclusive results that treatments designed to block natural maturation of the body are helpful, public policy should not be used to mandate the kind of gender affirmation that result in such treatments.  
...
In contrast to the belief that we and our children are best served by observing and cooperating with our observable biological reality, the AMA and the APA say that children who suffer from gender dysphoria can relieve that dysphoria through social transition, puberty blockers, cross-sex hormones, and eventually surgically altering sex-based anatomy to look like that of the opposite sex. This progression, however, is unhelpful since children who identify with the opposite sex but who are allowed to go through puberty without puberty blockers and cross-sex hormones cease identifying with the opposite sex 70% to 98% of the time for males and 50% to 88% of the time for females. See DSM-5, at 455. 

Conversely, when children are encouraged to progress through social transition to puberty blockers, they tend to persist with their dysphoria. Yet no longitudinal, controlled studies support gender-affirming treatments for gender dysphoria. See Cretella, supra, at 52. The problem is that while some persons who go through all these stages may report satisfaction with an eventual surgery,21 they may still suffer the same morbidities and experience startlingly high rates of suicide and attempted suicide. See Public Discourse, supra. 

Not only does the progression from affirmation to surgery result in increased psychological problems, but the evidence is insufficient to suggest that each step along the way is safe and efficacious. While affirming a child’s gender identity may appear a compassionate way to help a child during a painful and confusing experience, it is not. 

Quote

There is an obvious self-fulfilling nature to encouraging young [gender dysphoric] children to impersonate the opposite sex and then institute pubertal suppression. . . . All of his same-sex peers develop into young men, his opposite sex friends develop into young women, but he remains a pre-pubertal boy. He will be left psycho-socially isolated and alone. 

American College of Pediatricians, Gender Ideology Harms Children, Sept. 2017. 
...
We should treat everyone with dignity and respect, but there is significant disagreement in the particulars of what is helpful to those identifying as transgender and what should be asked of others in the process. Though some research has been conducted regarding treatment of those who identify as transgender, when “research touches on controversial themes, it is particularly important to be clear about precisely what science has and has not shown.” See New Atlantis, supra, at 114. 

As discussed above, the existing studies on treatment of and outcomes for transgender persons are poor support for gender affirmation or the progression to medication or surgery,24 yet the large medical associations like the AMA and APA ardently endorse these practices. Unfortunately, ideology rather than science is driving the support. And since dissent is systematically eliminated and those who disagree are loudly condemned, the kind of research necessary to inform the public debate is not occurring. 

“Consensus” in the scientific community is more contrived than scientific. “Mainstream clinicians and scientists who consider gender discordance to be a mental disorder have been deliberately excluded in the makeup of the steering committees of academic and medical professional societies which are promulgating guidelines that were previously unheard of.” Id. For instance, when the Endocrine Society created its guidelines, “the panel selected included only those who supported the emerging practices and attempts by many of the endocrinologists present to raise concerns were muted.” Ryan T. Anderson, When Harry Became Sally: Responding to the Transgender Moment 11213 (Encounter Books 2018). 

The American Psychiatric Association, in the most recent edition of DSM, removed gender identity disorder and replaced it with gender dysphoria.  “Changes in diagnostic nomenclature in this area were not initiated through the result of scientific information but rather the result of cultural changes fueling political interest groups within professional organizations.” Decl. Josephson, supra, at 6. Naturally, considering identity with the opposite sex to be a mental disorder is incompatible with social affirmation. Therefore, the nomenclature was changed so that only the anxiety caused by the incongruity between sex and identification is considered to be a disorder. 

Yet, since we would neither affirm a person who believed themselves disabled when they have a fully functional body nor suggest surgeries to disable such persons to conform their bodies to their beliefs, we should carefully consider the approach we take concerning persons’ subjective beliefs about their sex. Indeed, if something conflicts with our understanding of biological facts, is inconsistently applied, and defies common sense, we should demand more evidence to suggest that these factors are all pointing the wrong direction. The support for gender affirmation, medications, and surgery come from testimonials, but that is not evidence. It would be akin to asking consumers if they are satisfied with their vehicles, and publishing those testimonies, claiming it to be evidence of quality or reliability. It is not as if we do not know how to get good data, such as with control studies, but we refuse to conduct good science or follow the science — and that has everything to do with activism and ideology — not good medicine. 

As confirmation of the power of activism over science, those who follow the science are often shut down. Consider Lisa Littman, Assistant Professor of the Practice of Behavioral and Social Sciences at Brown University, who coined the phrase “rapid onset gender dysphoria.” She made the observation based on various parental reports that those who identify as transgender during or after puberty appear to have underlying and preexisting psychiatric conditions, and she called for more research. After members of the transgender community criticized the research, Brown quickly distanced itself. And ultimately, she lost a consulting job due to the research.25 Jeffrey S. Flier, M.D., former dean of Harvard Medical School, wrote, “I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published. One can only assume that the response was in large measure due to the intense lobbying the journal received. . . .”26

Similarly, Dr. Kenneth Zucker, a leading expert on gender dysphoria in children, who headed the Child Youth and Family Gender Identity Clinic in Toronto, was removed from his clinic on baseless charges and the clinic shut down.27 Zucker helped to write the “standards of care” guidelines for the WPATH and led the group that developed criteria for gender dysphoria used in DSM-5. See id. But as others increasingly pushed gender affirmation and social transition, Zucker’s clinic continued to be cautious, suggesting that it was better to “help children feel comfortable in their own bodies,” since it recognized the malleable nature of gender identity in children and the likelihood that it will resolve. See id. Activists saw this as a rejection of children’s gender identities. As a result, the parent organization running the gender identity clinic interviewed activists and clinicians critical of the clinic and fired Zucker and shut down the clinic based on false claims. See id. Yet for the many families who benefited from Zucker’s work and others who would benefit, “a sustained campaign of political pressure” took away their options to find help feeling comfortable with their own bodies. Id. 

---

26 As a Former Dean of Harvard Medical School, I Question Brown’s Failure to Defend Lisa Littman, Quillette, August 31, 2018. https://quillette.com/2018/08/31/as-a-former-dean-ofharvard-medical-school-i-question-browns-failure-to-defendlisa-littman/ . This type of intolerance to following the science within academic communities is not unique. Fifty-four academics in the UK wrote: 

Quote

We are also concerned about the suppression of proper academic analysis and discussion of the social phenomenon of transgenderism, and its multiple causes and effects. Members of our group have experienced campus protests, calls for dismissal in the press, harassment, foiled plots to bring about dismissal, no-platforming, and attempts to censor academic research and publications. Such attacks are out of line with the ordinary reception of critical ideas in the academy, where it is normally accepted that disagreement is reasonable productive. 

Professor Kathleen Stock, et al., Academics are being harassed over their research into transgender issues, The Guardian, October 16, 2018. https://www.theguardian.com/society/2018/ oct/16/academics-are-being-harassed-over-their-research-intotransgender-issues .

• "The American Medical Association (AMA) and the American Psychiatric Association (APA) thoroughly confuse sex and gender identity or transpose them, as if gender identity is innate and fixed at birth, while sex is malleable and the body configurable to one’s sense of gender identity. They attempt to obfuscate their ideological pronouncements as science. However, '[t]he hypothesis that gender identity is an innate, fixed property of human beings that is independent of biological sex — that a person might be ‘a man trapped in a woman’s body’ or "a woman trapped in a man’s body" — is not supported by scientific evidence.'"

Question: You previously said that, you "want to turn to organizations of doctors who have a vested interest in the wellbeing of their patients."  Well, so do I.  But I assume we would also want to know if these organizations are ideologically or otherwise compromised.  Do you see any possibility that this is happening?

• "The AMA and APA briefs demonstrate that when medical associations are committed to an ideology, it erodes the objectivity of their scientific claims."

Question: Does Dr. McHugh's assessment here, that the APA and APA "are committed to an ideology," affect your assessment of their objectivity and competence when evaluating these issues?

• "'{W}ithout any fixed position on what is given in human nature, any manipulation can be defended as legitimate. A practice that appears to give people what they want — and what some of them are prepared to clamor for — turns out to be difficult to combat with ordinary professional experience and wisdom.'"

Question: Do you think there is any risk of this happening?  That recent trends regarding pediatric sex train modification may amount to "giv{ing} people what they want — and what some of them are prepared to clamor for"?

• "The AMA’s and APA’s prioritization of ideology over science is not good for anyone. 'Sex change' is biologically impossible, and those associations are 'doing no favors' to either the public or those who identify as transgender 'by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention.'"

Question: Are the positions taken by the AMA and APA susceptible to criticisms of those organizations having "{prioritized} ideology over science"?

• "Here the biological reality of sex is undeniable, and the benefits of affirming persons’ disbelief in this reality are unclear and the risks are significant. As such, interpreting the law in such a way to create gender affirming policies (policies that require persons to affirm others’ beliefs that they are the opposite sex) may be causing rather than relieving suffering."
• "Sex is not and cannot be “assigned at birth,” despite the assertions of the AMA, APA, and Respondents."
• "Stephens, as well as the APA and AMA, asserts that 'everyone has a gender identity, which is "one’s internal, deeply held sense of gender."' {} The APA’s and the AMA’s proffered descriptions of gender identity operate, in all essentials, analogous to a religious belief system."

Question: Are the positions taken by the AMA and APA susceptible to criticisms of those organizations having adopted an approach to medical care which "operate, in all essentials, analogous to a religious belief system"?

• "Alarmingly, and contrary to the AMA’s and the APA’s narrative, the Hayes Directory reports that the studies show the prevalence of suicide attempts was not affected by hormone therapy."
• "Additionally, hormone therapy increased risk of cardiovascular disease, cerebrovascular and thromboembolic events, osteoporosis, and cancer. See Id. No proof of improved mortality, suicide rates, or death from illicit drug use was observed."
• "{Mohammad Hassan Murad of the Mayo Clinic} found there to be 'very low quality evidence' that hormonal interventions 'likely improve[] gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.'"

Question: If there is a substantial contradiction between the position taken by the AMA and APA and the findings of the Hayes Directory and Dr. Murad, would that affect your assessment of their objectivity and competence when evaluating these issues?

• "In contrast to the belief that we and our children are best served by observing and cooperating with our observable biological reality, the AMA and the APA say that children who suffer from gender dysphoria can relieve that dysphoria through social transition, puberty blockers, cross-sex hormones, and eventually surgically altering sex-based anatomy to look like that of the opposite sex. This progression, however, is unhelpful since children who identify with the opposite sex but who are allowed to go through puberty without puberty blockers and cross-sex hormones cease identifying with the opposite sex 70% to 98% of the time for males and 50% to 88% of the time for females."

Question: Do you think Dr. McHugh might have a point here?  That "social transition, puberty blockers, cross-sex hormones, and eventually surgically altering sex-based anatomy to look like that of the opposite sex" might be "unhelpful since children who identify with the opposite sex but who are allowed to go through puberty without puberty blockers and cross-sex hormones cease identifying with the opposite sex 70% to 98% of the time for males and 50% to 88% of the time for females"?

• "Conversely, when children are encouraged to progress through social transition to puberty blockers, they tend to persist with their dysphoria. Yet no longitudinal, controlled studies support gender-affirming treatments for gender dysphoria."

Question: Do you have evidence to contradict Dr. McHugh's statement here?  That "no longitudinal, controlled studies support gender-affirming treatments for gender dysphoria"?

• "{T}he existing studies on treatment of and outcomes for transgender persons are poor support for gender affirmation or the progression to medication or surgery,24 yet the large medical associations like the AMA and APA ardently endorse these practices. Unfortunately, ideology rather than science is driving the support. And since dissent is systematically eliminated and those who disagree are loudly condemned, the kind of research necessary to inform the public debate is not occurring."

Question: Does Dr. McHugh's assessment here - that "ideology rather than science is driving the {AMA's and APA's} support" for these treatments - carry any weight with you?  If not, why not?

• "'Mainstream clinicians and scientists who consider gender discordance to be a mental disorder have been deliberately excluded in the makeup of the steering committees of academic and medical professional societies which are promulgating guidelines that were previously unheard of.'  For instance, when the Endocrine Society created its guidelines, 'the panel selected included only those who supported the emerging practices and attempts by many of the endocrinologists present to raise concerns were muted.'"

Question: The Endocrine Society was one of the other medical organizations you cite as endorsing "gender-affirming interventions."  If that organization really did, in creating its guidelines, "included only those who supported the emerging practices," and if that organization "{muted} attempts by many of the endocrinologists present to raise concerns," does that affect your assessment of this organization's endorsement of these interventions?  If not, why not?

• "The American Psychiatric Association, in the most recent edition of DSM, removed gender identity disorder and replaced it with gender dysphoria.  'Changes in diagnostic nomenclature in this area were not initiated through the result of scientific information but rather the result of cultural changes fueling political interest groups within professional organizations.'"

Question: If the APA really did change the DSM because of "the result of cultural changes fueling political interest groups within professional organizations" rather than "through the result of scientific information," does that affect your assessment of the APA's actions re: modifying the DSM?  If not, why not?

• "As confirmation of the power of activism over science, those who follow the science are often shut down. Consider Lisa Littman ... sed on various parental reports that those who identify as transgender during or after puberty appear to have underlying and preexisting psychiatric conditions, and she called for more research. After members of the transgender community criticized the research, Brown quickly distanced itself. And ultimately, she lost a consulting job due to the research."

Question: Do you agree or disagree that Lisa Littman was "shut down" after "members of the transgender community criticized {her} research"?

• "Jeffrey S. Flier, M.D., former dean of Harvard Medical School, wrote, 'I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published. One can only assume that the response was in large measure due to the intense lobbying the journal received. . . .'"

Question: Do you agree with Dr. Lier's assessment here, that Dr. Littman's published research was stifled "in large measure due to the intense lobbying the journal received"?

Question: Does the possibility of medical organizations being subjected to "intense lobbying" affect your assessment of their objectivity and competence when evaluating these issues?

• "Similarly, Dr. Kenneth Zucker ... was removed from his clinic on baseless charges and the clinic shut down.  ... Zucker’s clinic continued to be cautious, suggesting that it was better to 'help children feel comfortable in their own bodies,' ... Activists saw this as a rejection of children’s gender identities. As a result, the parent organization running the gender identity clinic interviewed activists and clinicians critical of the clinic and fired Zucker and shut down the clinic."

Question: Do you think Dr. Zucker was fired and the clinic shut down due to ideological, rather than professional/clinical, considerations?

• "This type of intolerance to following the science within academic communities is not unique. Fifty-four academics in the UK wrote: 'We are also concerned about the suppression of proper academic analysis and discussion of the social phenomenon of transgenderism, and its multiple causes and effects. Members of our group have experienced campus protests, calls for dismissal in the press, harassment, foiled plots to bring about dismissal, no-platforming, and attempts to censor academic research and publications. Such attacks are out of line with the ordinary reception of critical ideas in the academy, where it is normally accepted that disagreement is reasonable productive.'"

Question: Do you think these "fifty-four academics in the UK" have a legitimate concern?  

Question: When they speak of "the suppression of proper academic analysis and discussion of the social phenomenon of transgenderism, and its multiple causes and effects," do you think their concerns merit some attention and consideration?

Question: When professional organizations and their members face "campus protests, calls for dismissal in the press, harassment, foiled plots to bring about dismissal, no-platforming, and attempts to censor academic research and publications," is it possible that these organizations might let these influences and pressures affect their professional/scientific/objective/clinical evaluation of transgender issues? 

On 10/17/2024 at 11:06 AM, Analytics said:

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?

I have said nothing about comorbidities associated with Juvenile Rheumatoid Arthritis.

On 10/17/2024 at 11:06 AM, Analytics said:

You always lead your responses by saying “comorbidities”, but I have no clue what your point actually is with that.

Well, feel free to do the same research and reading that you keep complaining about when I do it.

I have provided many links addressing the impact of comorbidities (see, e.g., here).

I would be rather surprised if you have not yet read the Cass Report.  We've talked about it many times.  It addresses the impact of comorbidities on transgender treatment:

Quote

2.9 The Dutch protocol was further elaborated in an article in 2006 (Delemarre-van de Waal & Cohen-Kettenis, 2006) by which time 54 patients were being treated, and in 2011 the Dutch team published a prospective study (de Vries et al., 2011b) of 70 patients who had received early treatment with puberty blockers between 2000 and 2008. Inclusion criteria were that the patients had to be minimum age 12, have suffered from life-long gender dysphoria that had increased around puberty, be psychologically stable without serious comorbid psychiatric disorders that might interfere with the diagnostic process, and have family support. The authors discussed the challenge in adolescents with an autistic spectrum disorder (ASD) of disentangling “whether gender dysphoria evolves from a general feeling of being just “different” or whether a true “core” cross-gender identity exists”. 

Question: Thoughts?

Quote

3.12 Most studies included in this review did not report comorbidities and no study reported concurrent treatments in detail. Because of this it is not clear whether any of the changes seen were due to gender-affirming hormones or other treatments the participants may have received.

Question: Thoughts?

Quote

5.65 The Review met with The Tavistock and Portman NHS Foundation Trust to discuss deaths of patients (where known) who had been referred to or were currently or previously under the care of GIDS. The patients who died by suicide between 2018 and 2023 were described as presenting with multiple comorbidities and/ or complex backgrounds. 

Question: Thoughts?

Quote

14.9 The lack of consensus across the clinical community was highlighted by a 2015 study (Vrouenraets et al., 2015), which approached 17 multi-professional treatment teams worldwide to determine their views on use of puberty blockers. They identified seven themes on which there were widely disparate views:  

• the (non-) availability of an explanatory model for gender dysphoria
• the nature of gender dysphoria (normal variation, social construct or [mental] illness)
• the role of physiological puberty in developing gender identity
• the role of comorbidity
• possible physical or psychological effects of refraining from) early medical interventions
• child competence and decision-making authority
• the role of social context in how gender dysphoria is perceived. 

Question: Thoughts?

Quote

15.38 A systematic review of suicide-related outcomes following gender-affirming treatment (Jackson, 2023) reported that in a majority of studies there was a reduction in suicidality following gender-affirming treatment. However, there were major methodological problems in most of the studies, with the biggest problem being a failure to adequately control for the presence of psychiatric comorbidity and treatment, such that no firm conclusions could be drawn. 

Question: Thoughts?

The Cass Review came out six months ago.  I addressed in April here, and in May here, a thread in which you participated, and more recently in this thread, in which you are also participating.

Question: Have you read the Cass Review?  If not, why not?

On 10/17/2024 at 11:06 AM, Analytics said:

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?

I have said exactly zero about you and your medical issues (for which you have my sympathy).

I have also said, many times now, that I substantially differentiate between informed consent by adults versus informed consent by minors, particularly minors suffering from serious mental health comorbidities.

On 10/17/2024 at 11:06 AM, Analytics said:

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.

Once again, you materially distort and mischaracterize my position.

I am certainly willing to listen to "the experts," but I'm not going to turn my brain off and reflexively defer to their every pronouncement, particularly when there is substantial evidence that professional organizations - including many of those you keep presenting as ultimate authorities - are ideologically compromised in varying ways and extents.

Thanks,

-Smac

Edited October 18, 2024 by smac97

[Calm]

15 minutes ago, smac97 said:

Sex is innate, fixed, and binary

That is suspect right there in terms of biased interpretation of the science. How anyone can state it’s binary given the various intersex combinations is beyond me. 

[Calm]

28 minutes ago, smac97 said:

Hayes Inc., a company which focuses on “unbiased” “evidence-based assessments of health technologies and clinical programs to determine their impact on patient safety,”

If they say so themselves…

Can you find any reviews that evaluate how well Hayes Inc does “unbiased” research?

All I can find is self advertising 

Edited October 18, 2024 by Calm

[CV75]

18 minutes ago, Calm said:

That is suspect right there in terms of biased interpretation of the science. How anyone can state it’s binary given the various intersex combinations is beyond me. 

If sex wasn't binary, we would have not arrived at the observation and concept of "various intersex combinations." Homo sapiens would have given each variation a unique term without reference to male or female, the first time any appeared.