Transgender, a Challenge for the Conservative Mindset

[Andropov]

Considering the proportion of people who appear to revert their gender identity back to their biological sex, you would hope we could better assess patients to help them. And when you consider other data around transpeople and the astronomical rise in cases, particularly FTM, there are numerous indications many of these cases may be a social phenomenon rather than a biological/psychological one. Additionally, some cases of GID may be caused by other underlying factors or psychological conditions that may be temporary or treatable without having to resort to hormones and surgery.

My concern is that we have a large number of people seeking potentially risky treatments with longterm permanent consequences, the majority of whom may come to regret their decision down the road. Children and adolescents are particularly volatile in their beliefs. Being able to best delineate where and when treatment is foundational to modern healthcare. Yet it seems trans healthcare has been entirely hijacked by activists and fear.

How many people do revert their gender identity when transitioning after puberty, though? It is my understanding that detransitioning has been fairly rare in the past. The most significant study I've read on the matter is The Amsterdam Cohort of Gender Dysphoria Study (1972-2015), with 6,793 people treated over 43 years. Of the ~5074 people who underwent a gonadectomy, only 14 (0.6% of the transgender women and 0.3% of the transgender men) reported that they were going to detransition, of which 2 reported due being to feeling non-binary, 5 due to social acceptance issues, and 7 due to what the authors call 'true regret' (0.07% of the sample!).
Admittedly, even this study has significant limitations: there's no record of the percentage of regrets in people who were on HRT but didn't underwent gonadectomy, which is a significant portion of the sample (~25%), and 36% of the people were lost to follow up. A study in Spain found 8 detransitions among 696 people (1.1%) in HRT, regardless of whether they had received a gonadectomy or not. It's a greater percentage than the one reported by the other study, but not dramatically so, and it takes another variable out of the equation by not sampling only people who underwent gonadectomy. Accounting for people lost to follow-up is obviously more difficult, and this is also a limitation of the spanish study. However, even accounting for a huge margin of error, I think it's safe to say that most people have not regretted their transition.

That's not to say that we should behave as if no people ever detransitioned, but I feel like the public debate on medical transition is often unfairly skewed in favor to those who will eventually realise that they're not transgender. It's not like delaying HRT is without risks for those who choose to transition either: some of the masculinizing/feminizing effects of sexual hormones will be greatly reduced if treatment is started later in life, and —while this is obviously anecdotal evidence and hardly proof of anything— I know some people say that having to undergo the changes of puberty for the gender they didn't identify with was the most traumatic part.

What I want to convey is that waiting around is often portrayed as an innocuous and cautious approach, and this is ultimately not true.

Agreed on all points. What adolescent doesn't say "this is me now" when joining a new scene/clique/fandom? People don't seem to realize that children and adolescents go through phases. No, that is not me saying "trans is just a phase", it is me saying that some children who are not trans might be mistaken for trans because they are going through a phase and are being encouraged to pursue this path by well-meaning people who are not appreciating the consequences of what they are doing. Gender non-conformity is not uncommon in children. Some studies indicate that gender non-conformity is more likely to correspond with homosexuality or bisexuality later in life. As a young boy, I went through a phase of wanting to be a girl (giving myself a girl's name, wearing my sister's clothes, playing with girl's toys)...but it turned out to be a phase. It may or may not have presaged my bisexuality, I don't know, but it was not a permanent thing and I did not end up being trans. Nowadays I feel like it would've been taken as a sign that I was trans and I should begin "socially transitioning" (which is often the first step towards hormones and puberty blockers). Trans activists are far too gung ho about supposed trans children. A child becoming disillusioned with gender norms and roles does not mean they are trans. I am firmly pro-LGBT but I never approach anything without questioning it and I think we need to be a lot more careful about what we're doing to children.

As far as I know, it has been established that the majority of gender dysphoric prepubertal children will not meet the criteria for gender dysphoria as adults and will not be transgender as adults. Working on identifying those who will become transgender adults is still a work in progress, but your specific choice of words reminded me of a (not very sciency, admittedly) quote from the section of Greenspan's Basic & Clinical Endocrinology on transgender endocrinology: [...] persisters believed they "were" the other sex, while desisters "wished they were" the other sex [...]. That same paragraph also mentions how most of those children will, as you say, correspond with homosexuality/bisexuality later in life. Anyway, I think anyone trying to indisputably identify a child as transgender (before puberty) is threading on very thin ice.

Once puberty starts though, if the child still identifies as transgender, I think it's unlikely to be a phase. And even for the few that is, this 'phase' burns out before any kind of irreversible medical intervention is carried out. It carries an amount of pressure and social stigma too great for anyone not absolutely sure to go through, unlike scenes/cliques/fandoms, which are essentially 'free to enter' and have a similar feeling of belonging to a group. A more apt comparison, IMHO, would be with sexual orientation. How many people express a non-heterosexual sexual orientation after puberty and then go back?

 

[AG_PhamD]

How many people do revert their gender identity when transitioning after puberty, though? It is my understanding that detransitioning has been fairly rare in the past. The most significant study I've read on the matter is The Amsterdam Cohort of Gender Dysphoria Study (1972-2015), with 6,793 people treated over 43 years. Of the ~5074 people who underwent a gonadectomy, only 14 (0.6% of the transgender women and 0.3% of the transgender men) reported that they were going to detransition, of which 2 reported due being to feeling non-binary, 5 due to social acceptance issues, and 7 due to what the authors call 'true regret' (0.07% of the sample!).
Admittedly, even this study has significant limitations: there's no record of the percentage of regrets in people who were on HRT but didn't underwent gonadectomy, which is a significant portion of the sample (~25%), and 36% of the people were lost to follow up. A study in Spain found 8 detransitions among 696 people (1.1%) in HRT, regardless of whether they had received a gonadectomy or not. It's a greater percentage than the one reported by the other study, but not dramatically so, and it takes another variable out of the equation by not sampling only people who underwent gonadectomy. Accounting for people lost to follow-up is obviously more difficult, and this is also a limitation of the spanish study. However, even accounting for a huge margin of error, I think it's safe to say that most people have not regretted their transition.

That's not to say that we should behave as if no people ever detransitioned, but I feel like the public debate on medical transition is often unfairly skewed in favor to those who will eventually realise that they're not transgender. It's not like delaying HRT is without risks for those who choose to transition either: some of the masculinizing/feminizing effects of sexual hormones will be greatly reduced if treatment is started later in life, and —while this is obviously anecdotal evidence and hardly proof of anything— I know some people say that having to undergo the changes of puberty for the gender they didn't identify with was the most traumatic part.

What I want to convey is that waiting around is often portrayed as an innocuous and cautious approach, and this is ultimately not true

The numbers are really all over the place. Some report it being extremely rare. There was a recent study that put the rate at 54% in FTM and 20 or 30% in MTF, this was in people affiliated with the military thought which has age bias and I would speculate transitioning is less socially acceptable in the military community.

The Swedish claim
“Growing visibility of detransition/regret: New knowledge about detransition in young adults challenges prior assumption of low regret, and the fact that most do not tell practitioners about their detransition could indicate that detransition rates have been underestimated.”

It’s also worth noting in the UK something like 1000/19000 patients are suing their largest youth gender clinic (Tavistock Clinic) for malpractice. We’ll have to see what claims are made and if others are suing privately.

If we go with the theory there is a large social influence component in young people, it would make sense rates now are higher than they used to be.

Another intriguing statistic is the the factor of race and gender. MTF between races is pretty similar between racial groups. But the rate of white FTM is 3x+ higher than Black and Hispanic FTM.

Waiting can certainly be damaging in legitimate cases. But hormone blockers have a multitude of risk from mental illness to affecting growth, to the underdevelopment of sex organs (which can affect the success of vaginoplasty), to permanent infertility, amongst others. The risks aren’t often talked about in public. In fact, I’ve seen child-targeted medical literature that fails to adequately inform risk. Hormone replacement therapy brings about a whole slew of additional risks. Surgery, especially bottom surgery, carries substantial risk of complications and often require multiple surgeries to correct.
The problem is currently we have little way of predicting what is transient and what is not. There definitely needs to be more research into this. For the past numbers of years however the very suggestion that transgenderism could be transient, despite evidence, was taken as being transphobic. To be clear, I’m not remotely supporting “conversion therapy, which is pseudoscientific, often religious abuse. Exploring why people feel the way they do and what might factors might be impacting them is not.

I will stress that the UK and Swedish guidelines make a point to say Trans-identifying people deserve to be treated with compassion, respect, and dignity. And I agree with that entirely.

It’s also worth noting Sweden does have some exceptions to their 18+ policy. But more time and research is necessary to see if their policy is appropriate.

My perception is the medical community got ahead of itself with gender affirming care. They had the best intentions of providing care to the trans community, there’s no nefarious conspiracy. But in my opinion there are too many red flags that warrant reassessing how this is approached.

 

[Clix Pix]

I know two women, (both MTF) who at a very young age -- barely out of toddlerhood -- identified as female although they had "boy parts". They didn't understand why they felt different but they knew that they WERE different. In each case they were made to dress and act as boys although it just did not feel right to them. Both of them early on tried to express how they felt and how they really wanted to play with dolls, not with toy trucks, but this was brushed aside and ignored, especially in the case of one of them. The other girl's family did allow the child to dress and play with whatever toys that she wanted at home but she still for various reasons was required to appear, dress and try to act as a boy when out in public.

One of them is an early pioneer in this whole thing, who after leaving her family as soon as she was able to do so, to her joy and relief found a new and much more welcoming family in the LGBTQ community long before it was even called that. After some time she understood and realized what she needed to do to truly be herself. She began the transitioning process, eventually undergoing surgical procedures at John Hopkins in Baltimore back in the days when that medical center had the very first clinic of its kind, one which provided gender affirming support, treatment and surgeries to those who were at that time often referred to as "transsexual." Once she had undergone the full medical and surgical transition this woman was able to move on through her life and career through the years as the woman she knew she truly was. Unfortunately that clinic at Johns Hopkins closed its doors in 1979 due to controversy and misunderstandings. Thankfully, in more enlightened times, Johns Hopkins has now once again established a program, the Center for Transgender Health, which offers current, comprehensive, evidence-based and affirming care for transgender youth and adults.

The other woman, born many years later than the first person, was fortunate in that her family was supportive right from the beginning, when she was very small and toddling around, even though they didn't quite understand what was going on with her and her insistence upon playing with "girl toys" and wanting to play dressup in angel and fairy costumes rather than going outside to play baseball with the neighborhood boys. Eventually just as she was on the brink of adolescence she and her family became aware of the term "transgender" and what it entailed, and as time went on it was clear that this clearly seemed to fit her like a glove. She began therapy and then at the age of seventeen moved into the more visible phase of transitioning by at home and in public dressing and living as the girl she had always known she was. When she was eighteen years old she underwent the physical transition with surgery. Today, she is a lovely and happy young woman enjoying her life.

While I am sure that there are people who regret having made a transition and who no longer regard themselves as transgender, there are also many, like the two women I mention here, who are very, very happy in being able to live their lives as the female individuals they have always felt they truly are.

That said, it does seem as though these days we are hearing more and more about young people transitioning or wanting to transition and young people who are declaring themselves as transgender or non-binary or some such to the point where this seems almost trendy or contagious, which definitely is rather unusual. This is where the medical professionals really have to be careful right from the get-go in their working with the families and clients who come to them for support and guidance. Definitely tricky territory!

 

[Clix Pix]

I know two women, (both MTF) who at a very young age -- barely out of toddlerhood -- identified as female although they had "boy parts". They didn't understand why they felt different but they knew that they WERE different. In each case they were made to dress and act as boys although it just did not feel right to them. Both of them early on tried to express how they felt and how they really wanted to play with dolls, not with toy trucks, but this was brushed aside and ignored, especially in the case of one of them. The other girl's family did allow the child to dress and play with whatever toys that she wanted at home but she still for various reasons was required to appear, dress and try to act as a boy when out in public.

One of them is an early pioneer in this whole thing, who after leaving her family as soon as she was able to do so, to her joy and relief found a new and much more welcoming family in the LGBTQ community long before it was even called that. After some time she understood and realized what she needed to do to truly be herself. She began the transitioning process, eventually undergoing surgical procedures at John Hopkins in Baltimore back in the days when that medical center had the very first clinic of its kind, one which provided gender affirming support, treatment and surgeries to those who were at that time often referred to as "transsexual." Once she had undergone the full medical and surgical transition this woman was able to move on through her life and career through the years as the woman she knew she truly was. Unfortunately that clinic at Johns Hopkins closed its doors in 1979 due to controversy and misunderstandings. Thankfully, in more enlightened times, Johns Hopkins has now once again established a program, the Center for Transgender Health, which offers current, comprehensive, evidence-based and affirming care for transgender youth and adults.

The other woman, born many years later than the first person, was fortunate in that her family was supportive right from the beginning, when she was very small and toddling around, even though they didn't quite understand what was going on with her and her insistence upon playing with "girl toys" and wanting to play dressup in angel and fairy costumes rather than going outside to play baseball with the neighborhood boys. Eventually just as she was on the brink of adolescence she and her family became aware of the term "transgender" and what it entailed, and as time went on it was clear that this clearly seemed to fit her like a glove. She began therapy and then at the age of seventeen moved into the more visible phase of transitioning by at home and in public dressing and living as the girl she had always known she was. When she was eighteen years old she underwent the physical transition with surgery. Today, she is a lovely and happy young woman enjoying her life.

While I am sure that there are people who regret having made a transition and who no longer regard themselves as transgender, there are also many, like the two women I mention here, who are very, very happy in being able to live their lives as the women they have always felt they truly are.

That said, it does seem as though these days we are hearing more and more about young people transitioning or wanting to transition and young people who are declaring themselves as transgender or non-binary or some such to the point where this seems almost trendy or contagious, which definitely is rather unusual. This is where the medical professionals really have to be careful right from the get-go in their working with the families and clients who come to them for support and guidance. Definitely tricky territory!

 

[lizkat]

The Rs' approach to transgender issues seems a lot like what the Rs are trying to do with abortion rights: overlay their own nonmedical opinions on decisions and choices that should remain a matter between people and their physicians.

 

[Clix Pix]

Sorry about the repetition above.....I tried to delete the second post since I'd included all I wanted to say in the first one but that didn't work out too well.

 

[AG_PhamD]

The Rs' approach to transgender issues seems a lot like what the Rs are trying to do with abortion rights: overlay their own nonmedical opinions on decisions and choices that should remain a matter between people and their physicians.

I have to agree for the most part. The fervent opposition from the R’s treats every case the same, particularly when it comes to children. I think they routinely over exaggerate how easy it is to get gender affirming care. While I think it’s true there are *some* more liberal places with incredibly lax standards and policies pertaining to children and some rather outrageous proposed laws, this is generally not the case in most places.

I think there needs to be a reasonable balance between allowing accessibility to treatment while also ensuring that these treatments decisions are made wisely.

What’s truly disgusting are those who feel it is their mission to attack trans people or their providers. Boston Children’s Hospital had a deluge of targeted attack and threats due to complete misinformation. The fact is the youngest bottom surgery they will consider is age 17… and it’s never happened. And fun fact, like most pediatric hospitals they also treat young adults (generally up to age 21 but apparently up to 35 with gender surgery- granted it’s part of a giant convoluted healthcare network with doctors often working between hospitals).

And what these idiots don’t realize when you call in threats, including bomb threats, hospitals implement a ton of extra security. It puts everyone on edge, especially the patients. And then every other hospital has to take precautions too.

 

[thekev]

While I am sure that there are people who regret having made a transition and who no longer regard themselves as transgender, there are also many, like the two women I mention here, who are very, very happy in being able to live their lives as the female individuals they have always felt they truly are.

That said, it does seem as though these days we are hearing more and more about young people transitioning or wanting to transition and young people who are declaring themselves as transgender or non-binary or some such to the point where this seems almost trendy or contagious, which definitely is rather unusual. This is where the medical professionals really have to be careful right from the get-go in their working with the families and clients who come to them for support and guidance. Definitely tricky territory!

The downside to this is that no surgical treatment is 100% reversible if it turns out to have been the wrong treatment in retrospect. I'm not sure that point really gets completely absorbed by kids in or just out of their teenage years. Non-binary seems more predictable. The term isn't highly associated with any kind of medical procedure, although I'm wondering whether it'll just become a thing of the 2020s.

 

[AG_PhamD]

The downside to this is that no surgical treatment is 100% reversible if it turns out to have been the wrong treatment in retrospect. I'm not sure that point really gets completely absorbed by kids in or just out of their teenage years. Non-binary seems more predictable. The term isn't highly associated with any kind of medical procedure, although I'm wondering whether it'll just become a thing of the 2020s.

I would argue no surgical treatment is reversible, period. Some are more “correctable” than others but in most typical cases of gender surgery it will never be the same.
It is possible to get a phalloplasty while retaining a functional vagina. But as I understand this is an exceedingly rare procedure. That’s probably the most reversible surgery.

I think part of the problem is (which seems to be recognized by countries like the UK and Sweden) is that there is a conflation of gender dysphoria and transgenderism resulting from curiosity, experimentation, making a social statement, status/attention seeking, perceived benefit of being the opposite gender, etc. Legitimate gender dysphoria means your gender incongruence is overwhelmingly distressing to the point it’s significantly affecting your ability to function- often resulting in suicidality.

If people want to explore the realms of gender I have no issue with that. But let’s not pretend it should be medically treated as cases of true gender dysphoria may warrant.

I believe the meteoric rise in gender affirming care is overwhelmingly related to it being “trendy” and in some cases a manifestation of other mental illness (that’s a whole discussion in itself). I think many data points very strongly suggests that. When I was growing up in the 90’s and early 2000’s there were various subculture trends like punk, goth, emo, and scene that all had their time with a small cohort of kids. I don’t think it’s unreasonable to question if a lot what we’re seeing with gender is just a modern example of these relatively short lived fads.

I’ve worked with a lot of transgender patients. Some of them, an increasing number, I really do worry about their long term satisfaction and motivations for transitioning.

I’ve literally had a 18yr FTM patient on 2yrs of HRT explain to me he “never really thought about [gender] until his friend transitioned FTM”. That suggests to me more social influence than organic origin.

And I’ve seen the flip side, what can happen to people when they come to realize they made a mistake transitioning. It’s truly heartbreaking.

I don’t care how people live their lives, I just want the best for everyone and for them to make good, informed decisions for themselves, to live contently.

 

[Herdfan]

That said, it does seem as though these days we are hearing more and more about young people transitioning or wanting to transition and young people who are declaring themselves as transgender or non-binary or some such to the point where this seems almost trendy or contagious, which definitely is rather unusual. This is where the medical professionals really have to be careful right from the get-go in their working with the families and clients who come to them for support and guidance. Definitely tricky territory!

Now add in parents who help feed this. Chardonnay mom wants to be able to brag to all her elitist friends how she has a transgender or non-binary child. So instead of slowing down and making sure the child really is transgendered, they are scheduling puberty blockers and surgery.

My biggest issue is keeping this from the parents. What is it they don't want them to know? Also, why is it that a 12 year old can't vote, buy alcohol, cigarettes, drive, get a tattoo or any number of things because they aren't mature enough, but can make life altering decisions behind their parent's backs.

 

[rdrr]

Now add in parents who help feed this. Chardonnay mom wants to be able to brag to all her elitist friends how she has a transgender or non-binary child. So instead of slowing down and making sure the child really is transgendered, they are scheduling puberty blockers and surgery.

My biggest issue is keeping this from the parents. What is it they don't want them to know? Also, why is it that a 12 year old can't vote, buy alcohol, cigarettes, drive, get a tattoo or any number of things because they aren't mature enough, but can make life altering decisions behind their parent's backs.

Got to ask... What percentage of parents want to "brag" to their friends as a motivation for pushing their underaged child to getting gender surgery? Or is this an extreme case of fear mongering, like when the Right were up in arms about gay marriage and citing some baseless example of people marrying their <insert kitchen appliance here>.

Even if there was one sick individual out there that did actually have that as a motivation. IMO no one would admit to that. I think you are just bringing up a pointless example that probably has a 0.0% chance of actually happening.

 

[Hrafn]

Got to ask... What percentage of parents want to "brag" to their friends as a motivation for pushing their underaged child to getting gender surgery? Or is this an extreme case of fear mongering, like when the Right were up in arms about gay marriage and citing some baseless example of people marrying their <insert kitchen appliance here>.

Even if there was one sick individual out there that did actually have that as a motivation. IMO no one would admit to that. I think you are just bringing up a pointless example that probably has a 0.0% chance of actually happening.

What if it’s solar flares making them do it? I’m on the fence when it’s flares.

 

[Russell Jackson]

I was recommended this.

That's Gender Dysphoria, FYI

A resource for those questioning their gender, already on a gender journey, or simply wanting to learn more about what it is to be transgender.

genderdysphoria.fyi

Also, when searching for this thread, I came across a Reddit post bearing the same name.


Ever heard of informed consent?

What is the informed consent model of transgender care?

Sex and gender can be considered in biological and cultural ways. Biological sex refers to a person’s anatomy. Typically, a biological male has a...

www.issm.info

You might want to take a look at this!

Erin's Informed Consent HRT map of the US - Google My Maps

Support the creator of this map with a donation: https://ko-fi.com/erininthemorn Lets make informed consent easier to access. Follow me on twitter @erininthemorn. Let me know there if anything has changed or if any of these are wrong, or if I'm missing any!

www.google.com

I also see this term thrown around a lot on social media.

Gender-critical feminism - Wikipedia

en.wikipedia.org

 

[AG_PhamD]

Got to ask... What percentage of parents want to "brag" to their friends as a motivation for pushing their underaged child to getting gender surgery? Or is this an extreme case of fear mongering, like when the Right were up in arms about gay marriage and citing some baseless example of people marrying their <insert kitchen appliance here>.

Even if there was one sick individual out there that did actually have that as a motivation. IMO no one would admit to that. I think you are just bringing up a pointless example that probably has a 0.0% chance of actually happening.

I think situations where parents “pressure” their children into being transgender are likely quite rare, but I wouldn’t say it’s impossible. A Munchausen by proxy-like situation is entirely possible. MBP isn’t that common but it is also usually very hard to detect. For example, one problem is it can be hard to tell if a parent is just a hypochondriac. One statistic states 0.4/100,000 documented cases in children under 16, but another study suggests up to 1000/100,000 or 1% of parents display MBP. I could see a situation where a parent want to evoke a certain image and seek attention from others.

Younger children are easily manipulated and look their parents for everything in life, so I don’t think it would be hard for a parent to essentially gaslight their child into believing they would be more comfortable as the opposite gender. But I want to be clear, this is not likely a common occurrence among trans children.

If we want to talk about the more likely factor/scenario of parental influence, based on my perception of how the topic of transgenderism is presented to young children, some parents are likely committed to raising their children outside of typical gender norms, which I don’t really think there’s a problem with that generally speaking. I do think it’s possible however for this to ironically get mixed up with the gender stereotypes the child will inevitably be exposed to. A parents well intentions to raise their child outside of the perceived restrictions restrictive social norms around gender so the child can be their genuine self and efforts to educate their children on identity and tolerance may cause a child to have convoluted ideas about what it means to be a man or woman. If a female child enjoys stereotypically “boyish” things, she may come think she would be better suited to live as boy, rather than simply a girl who like sports and trucks or whatever. I would think this would be especially true children who learn very early that gender is self-identified, fluid, and can be changed- before really understanding what gender identity, sex, etc really mean- these are complex concepts.

I believe we need more research into how to best approach this topic with children and at what age. I believe it’s important not to inadvertently promote confused conceptions of gender identity in children as this more often than not causes mental distress. Until we have a better idea how to present these concepts, its in children’s best interest to proceed with caution. Treating the child population effectively as an experiment is not a thoughtful or frankly ethical way of doing things.

From a psychological/medical standpoint, we have a lot to learn about transgenderism. There’s little quality data as it is. Anyone who says we know everything we need to know is either being disingenuous or has fallen victim of the Dunning-Kruger effect.

 

[AG_PhamD]

I was recommended this.

That's Gender Dysphoria, FYI

A resource for those questioning their gender, already on a gender journey, or simply wanting to learn more about what it is to be transgender.

genderdysphoria.fyi

Also, when searching for this thread, I came across a Reddit post bearing the same name.


Ever heard of informed consent?

What is the informed consent model of transgender care?

Sex and gender can be considered in biological and cultural ways. Biological sex refers to a person’s anatomy. Typically, a biological male has a...

www.issm.info

You might want to take a look at this!

Erin's Informed Consent HRT map of the US - Google My Maps

Support the creator of this map with a donation: https://ko-fi.com/erininthemorn Lets make informed consent easier to access. Follow me on twitter @erininthemorn. Let me know there if anything has changed or if any of these are wrong, or if I'm missing any!

www.google.com

I also see this term thrown around a lot on social media.

Gender-critical feminism - Wikipedia

en.wikipedia.org

Let me preface by saying I believe people should be able to live their lives as whatever gender they see fit. That said, proper precautions need to be in place to ensure the patient is making the best choice for themselves, whatever that may be.

Informed consent is essentially the foundation of healthcare ethics. But there are some issues with this in the gender clinic arena…
1) The number of children identifying as transgender has exploded in recent years. Most of the debates around transgender healthcare involve children. In medical ethics and almost universally in law, children CANNOT make informed consent. Many states have enacted laws or are trying to pass laws that allow children, some as young as 13, to start gender affirming care without parental consent. We all know children’s thoughts and opinions can change quickly and dramatically, as well as being easily influenced by others. While it’s important to ensure people have access to the care they need, it’s also important not to enable irreversible decisions with profound implications if the condition is temporary, as it often appears to be historically.

2. There is much evidence of doctors providing totally insufficient information for people to make informed consent. Things like medication side effects, how invasive and problematic surgeries can be, the effects of failed surgeries, what the experience of de-transition is like (either prior to transition or before deciding to de-transition), etc. As it is, most people who advocate for trans-rights are totally unaware of the many serious risks involved.

Just because on paper there is a suggestion of how things like informed consent should work doesn’t mean they’re being used appropriately in practice.

4. While there are talented surgeons with the experience to perform transition surgery (particularly bottom surgery), they are by far the minority. There’s a lot of doctors not well experienced in this type of care that do it anyways. They also can’t provide the best info. 20-30% of vaginoplasty patients suffer complications and 20-54% require second surgeries for cosmetic reasons alone. Those are very bad numbers. Genitourinary Reconstructive Surgeons are the most qualified for these procedures and yet only account for 1.8% of urologists.

Similarly, you have a lot of mental health clinicians (psychiatrists psychologists, social workers, etc) who are qualified to assess patients who do not actually have significant experience in this area.

5. It used to be most states required two mental health screenings. Some states have whittled down to one. Some states abolished the requirement altogether. There are activists groups advocating to abolish all MH screenings. These screenings are not only designed to assess the patients mental state and motivations, but also ensure the patient fully, deeply comprehend the risks and how they would cope if the worst happened. MH screenings are common in many areas of medicine. It’s absurd in my opinion to circumvent this step.

There is also no formalized screening system either. Two different clinicians may have widely varying qualities of assessment.

4. Doctors/Clinicians have been known to essentially recklessly push the patient into transitioning or not challenge the prospective patient’s motivations. There can be a financial motive to do so. If you look at the Tavastock clinic in the UK, their largest pediatric gender clinic (now shut down), they’re up against class action lawsuit with well over 1,000 patients of their 19,000 total suing for this very reason.

5. The public health authorities of UK and Sweden, startled by an explosive number of pediatric cases and after extensive review of the medical literature, have paused hormonal and surgical interventions in children (except in rare cases) for a number of reasons including evidence many pediatric cases are transient and questions over the clinical benefits. The standard of care is now counseling. I have discussed this in an earlier post.

——

There are obviously children (and adults) who have a legitimate and persistent disparity between sex and gender. I believe for some of these people things like hormones and surgery can be effective in allowing them to live a more fulfilling life. It is clear access to such care is important. At the same time, it’s just as important not to cause undo harm, including determining who is a good candidate for such consequential interventions and who is not. At the end of the day, the healthcare community must act responsibly and in the best longterm interest of the patient, which isn’t always known to the patient at the time. This means in some including in some cases providing other types of care.

This is an extremely complex topic and frankly there is just not good research into how to best help these people yet. Sadly, this area of healthcare has been so hijacked by politics and activism (from both the advocates and the antagonists). Consequently, this partisan commentary does nothing to actually help the gender dysphoric and trans communities.

 

[SuperMatt]

From a psychological/medical standpoint, we have a lot to learn about transgenderism. There’s little quality data as it is. Anyone who says we know everything we need to know is either being disingenuous or has fallen victim of the Dunning-Kruger effect.

So, people who aren’t even doctors or psychologists might write lengthy treatises on this topic if they fall victim to this effect? Interesting…

 

[Huntn]

We just had another 15 year old child of a friend declare his desire to be a woman. Apparantly he has had that desire for a long time. I know if I had a young child who was ambivalent about their sex, I would encourage them to lean towards their physical sex and if they pushed back, eventually I would help them achieve their goal. But since I’ve never been in that situation, I’d hope I would not make them miserable in the mean time.

 

[Eric]

We just had another 15 year old child of a friend declare his desire to be a woman. Apparantly he has had that desire for a long time. I know if I had a young child who was ambivalent about their sex, I would encourage them to lean towards their physical sex and if they pushed back, eventually I would help them achieve their goal. But since I’ve never been in that situation, I’d hope I would not make them miserable in the mean time.

A 15 year old is not a young child, at that age they're typically familiar with masturbation, understand what sex is and knows what moves them in that way. Who is anyone to "encourage" them one way or the other? We are who we are and that seems to really be hard for people to understand, if one believes you can "make them gay" then they'll never understand it IMO.

Let's say one is a man attracted to a woman, or vice versa, and then told that it's unnatural, how would that make that person feel? Take gender roles out of and apply some empathy.

 

[shadow puppet]

I believe in being open minded. After all, it's their life, not yours.

 

[Huntn]

I believe in being open minded. After all, it's their life, not yours.

Religion seems to play a huge role in this, when humans start dictating what their diety expects. Another issue for the Right is the concept of choice and what constitutes choice. I’ve said for a long time, we have little choice, as choices are never based in a vacuum on pure intellect.

An obvious counter is why did the perfect deity produce “children” who appear to be less than perfect? The less than perfect answer is that this is a test to see if by the power of intellect, we can overcome the imperfections built into us. If any credence is given to this argument, then it comes across as some sort of twisted God game and God becomes a sadist.

I’ve referenced the Earth Simulator before, option #126 is that this life could simply be an opportunity to experience a different reality, to gain a different perspective about the Jungle, or be a vacation spot to liven up an otherwise dull existence.