James C. Sherlock
Reuters launched a progressive but unusually balanced and deep trend report on transgender children with the words:
Across the United States, thousands of young people are lining up for gender-affirming care. But when families decide to go the medical route, they must make decisions about life-changing treatments for which there is little scientific evidence of their long-term safety and effectiveness.
“Gender Affirmation”. Progressives who read this entire article will find many statements from people who agree, but do not insist, on on-demand hormones for these children. They just won’t find anyone offering evidence that these treatments are appropriate or safe. Not one.
This is not a new topic for readers of Bacon’s Rebellion. We have reported a major international trend to be entirely more cautious in this process than the norm in the United States. We gave another example in a article on Swedish protocols.
Today, England’s National Health Service (NHS) is considerably contraction the guidelines for the treatment of incongruous minors.
The NHS report does two things:
- It clearly outlines scientific evidence for changes to existing policies and protocols; and
- It brings major changes towards more careful, structured and broader clinical decision-making, data collection and patient safety.
The new changes, currently posted for public comment through December 4, prioritize emotional health over medical treatment.
They don’t completely ban medical treatment, but will only allow GnRHa (puberty blockers) under a formal research protocol. The research protocol, once completed, will establish strict eligibility criteria for participation.
As in America, the new British system will focus on children’s hospitals.
But, unlike in the UK, the fact that current medical treatments for gender dysphoric minors are not supported by scientific evidence of long-term safety and other health effects is not even taken into account. account in some Commonwealth Children’s Hospitals.
This is both irresponsible and unethical. And must be stopped.
UK Change case. The case indicated for the change includes:
- “A significant and clear increase in referrals” from 250 in 2011/12 to over 5,000 in 2021/22;
- “Marked changes in the types of patients referred that are not well understood”. Previously, it was mostly boys who wanted to be girls. Now two-thirds are girls who want to be boys;
- “Scarce and inconclusive evidence to support clinical decision-making. This has led to a lack of clinical consensus on what the best model of care for children and young people should be; and a lack of evidence to help families make informed decisions about interventions that can have lifelong consequences.
New rules. The new rules, all described as substantial changes, focus on emotional health rather than medical treatment.
- They require expanded multidisciplinary teams that, in addition to gender dysphoria specialists, will include experts in pediatric medicine, autism, neuro-disability and mental health. The reason for this proposal is to respond to evidence that there is a higher prevalence of other complex presentations in children and young people who have gender dysphoria;
- The clinical lead will be a physician;
- They describe a more structured approach that requires referrals to transgender clinics by general practitioners. A meeting with the general practitioner is necessary to determine if the patient meets the criteria for access to the gender clinic;
- The specifications also propose that all children and young people who meet the access criteria do not need to be seen directly by a gender clinic. Those who can should be supported by local clinicians, including support in articulating needs and risks in individualized care planning;
- The clinical approach to prepubertal children will reflect the evidence that in most cases, gender incongruity does not persist into adolescence; and that for adolescents, the provision of approaches for social transition should only be considered when the approach is necessary to alleviate or prevent clinically significant distress or significant impairment in social functioning, and the young person is able to understand fully the implications of affirming a social transition.
The NHS is so convinced of the use of puberty blockers and transgender hormones from unregulated sources or online suppliers that it will ban users from NHS endocrine care.
These are called by the NHS first steps to implement the findings of the Cass review. The final version is expected in 2023/24.
Reuters on suicide risk
Gender care experts say more specific research is needed to determine whether medical transitioning as a minor reduces suicidal thoughts and suicides compared to those who transition socially or wait before starting treatment.
Some gender equality professionals complain that the risk of suicide is too often used to pressure and even scare parents into consenting to treatment. “I think it’s irresponsible for clinicians to do this,” said Anderson, the former president of WPATH’s US chapter. “As a clinical psychologist, I don’t assess suicide by class membership. The level of risk varies enormously from one individual to another.
De Vries, the Dutch researcher, told Reuters there was no evidence that “providing care would immediately lead to a decrease in self-harm or prevent suicide”.
Virginia law and regulations. I oppose maintaining the legality of endocrine treatment of minors for gender dysphoria.
But if they are to be allowed to continue, they must be subject to the same well-reasoned structure and limitations that the UK adopts.
It’s a regulatory issue. In Virginia, the regulator in this case is the Board of Health. I can find no law restricting the ability of the Board to impose patient safety regulations similar to those of the NHS.
Virginia Code § 32.1-127. B. 21 states that regulations promulgated by the Board of Health “shall require each hospital…to develop a policy governing the determination of the medical and ethical appropriateness of proposed medical care.” The regulations must, in particular, require a process for obtaining a second opinion and the active participation of an interdisciplinary medical review committee.
It would be reasonable to ask whether interdisciplinary medical review boards acted in this file.
I searched and did not find that the Board of Health has issued a regulation that meets this requirement of the law. I may have missed it.
But it is reasonable to wonder how parents can give informed consent when no practitioner can know the efficacy or safety of puberty blockers or transgender hormones in treating minors with a diagnosis of dysphoria of gender.
Bottom line. Of Reuters:
Puberty blockers and sex hormones do not have US Food and Drug Administration (FDA) approval for the gender care of children. No clinical trial has established their safety for such off-label use. The long-term effects of drugs on fertility and sexual function remain unclear. And in 2016, the FDA ordered makers of puberty blockers to add a warning about psychiatric issues to the drug’s label after the agency received several reports of suicidal thoughts in children taking them.
The National Institutes of Health told Reuters that “evidence is limited on whether these treatments pose short- or long-term health risks for transgender and other gender-differentiated adolescents.”
Even the Endocrine Society, which somehow supports hormone treatments, itself acknowledges the “low” or “very low” certainty of the evidence supporting its recommendations.
On the other hand, puberty blockers can cost tens of thousands of dollars a year and transgender hormone treatments create lifelong patients for endocrinologists.
So there is this.
The term “gender affirmation”. as used in the dark corners of the American medical community engaged in underage gender transition, represents ideological construction, reckless predisposition, and headlong rush to specific treatment, not medical conclusion.
Some have become hormone pushers.
Reuters interviewed the parents of 39 minors who had sought gender-affirming care. The parents of 28 of these children said they felt compelled or pressured to continue treatment.
It’s almost impossible to understand how this somehow became a political issue, but everything did.
Some progressives, and only a few, decided that these medical experiments on children were “gender affirming” without any proof of their effectiveness or safety, and called the opposition “hate.”
To hell with them.
Enough of that.