Opponents of this model see overconfident practitioners experimenting on the same vulnerable patients, many with life-long effects such as puberty-blocking drugs, cross-sex hormones, and surgeries. They may not be able to give truly informed consent to potential treatments.
Both views will be vindicated in a new report by the think tank Environmental Progress. The report contains a cache of leaked internal discussions from within WPATH, the World Professional Association for Transgender Health, an association that brings together clinicians from a variety of specialties involved in gender treatment. Patients with discomfort. These discussions reveal both caring people trying hard to make things right and a medical culture that appears to be operating without adequate guardrails for things to go wrong.
One exchange is both the most reassuring and the most worrying for those trying to sort out competing narratives. At a workshop discussing transition and the challenges of obtaining informed consent from minors for gender affirmation procedures, participants came across as deeply thoughtful people who do their best to deal with complexities. I am. However, some admit that patients are actually unable to give fully informed consent. Many people do not complete adolescence, or high school biology. And even at the age of 16, she, the brightest, still cannot fully understand the implications of treatments that in some cases can mean lifelong infertility and medical maintenance.
This is not a new problem in medicine. As therapist Diane Berg points out in that discussion, if a child has diabetes, they are given insulin even if they haven’t learned how the pancreas works. If you have depression, you may be given drugs that can increase your risk of suicide or permanently change your developing brain for a happier future. And when a child has childhood cancer, doctors don’t wait until she’s old enough to give informed consent about amputation or infertility. Because without treatment, the child may never reach that age.
Adolescent gender medicine has a strong tendency to treat puberty as if it were a life-threatening disease like cancer or diabetes, and to treat birth genitalia as if it were a potentially dangerous growth. It has become. This is, of course, completely appropriate. teeth If you threaten them or let nature take its course, you will either commit suicide or suffer a lifetime of mental suffering. Of course, certainty in such a diagnosis is desired. And unlike doctors who treat cancer or diabetes, who can rely on blood tests and diagnostic imaging, gender specialists ultimately have to consider only their patients’ emotions.
In popular discourse, and certainly in some gender clinics, it is often taken for granted that that is enough. Transgender people are at high risk for suicide, and we know that transgender medical interventions save lives. And that’s true even for adults, who have the right to decide what to do with their bodies. However, for children, this risk, while real, is less severe than that of cancer or diabetes, and it is more complicated because it can persist even after treatment. A large Dutch study found that the risk of suicide among trans people was almost four times that of the general population. Researchers observed 49 suicides among more than 8,000 patients, many of which occurred during or after transition. A national survey of suicide rates among transgender people in Denmark similarly found that 12 out of a population of 3,759 committed suicide.
Perhaps doctors can identify future trans adults, block their puberty, and eventually use hormone treatments and even surgery to bring their adult appearance closer to their gender identity, reducing that percentage. It would be ideal if it could be reduced to zero. Unfortunately, we still don’t know how much these treatments actually improve mental health or prevent suicide. Data on long-term efficacy are unnecessarily limited, even in adults. The evidence regarding interventions for adolescents is even less clear.
Several European health authorities have reviewed the available research and have labeled the evidence for the use of puberty blockers and cross-sex hormones in dysphoric youth as “very low certainty,” “insufficient,” and “methodological.” “It is limited by its own weaknesses.” A recent systematic evidence review by German researchers concluded that the current body of evidence is “based on a very small number of studies with small samples and methodological and quality issues.” Appropriate and meaningful long-term studies are similarly lacking. ”
In other words, although WPATH says these interventions are “not experimental,” youth gender medicine is still experimental in nature. Now, this also applies to many pediatric oncology treatments. When a child’s life is at risk, doctors do everything in their power to help. According to CureSearch, which funds childhood cancer research, about 60% of young cancer patients participate in clinical trials. However, gender medicine has not yet reached the same level of rigor as FDA-supervised clinical trials.
This puts clinicians in a difficult position, and this is what we see in WPATH files. Well-meaning doctors and therapists are groping their way through major gaps in current medical knowledge. However, this effort can also be seen as becoming more difficult, as an editorial in the journal Acta Paediatrica recently stated: medical problem. ”
In a discussion of detransitioning, one writer calls the whole idea “problematic.” That’s because “being cisgender is constructed as the default and reinforcing being transgender as a pathology” (as if, when possible, we prefer options that don’t require drugs or surgery. (As if people are inherently bigots.) Some have rather blithely suggested that desexualization should be reframed as “learning” or part of a “gender journey” rather than a gender change. Masu. “error.”
Of course, many other conversations in the WPATH files depict sensitive, intelligent caregivers doing their best. Despite the many uncertainties, they ultimately have little doubt that they are doing the right thing for most patients. I am glad that such people are trying to help alleviate the terrible suffering of our vulnerable people. But I also came away wishing they were a little more receptive to questioning.
