Keeping away from social media and other media, here is a website run by apparently well qualified people presenting the science. There is quite a lot of reading there if you go to all the papers.
https://segm.org/studies
Does it say that blokes with bolt on tits and makeup are not real sheilas?
Peak Warming Man said:
Does it say that blokes with bolt on tits and makeup are not real sheilas?
Bolt on ones could allow the freedom to change size and shape when the mood takes
Peak Warming Man said:
Does it say that blokes with bolt on tits and makeup are not real sheilas?
It does define sex and gender quite clearly.
buffy said:
Peak Warming Man said:
Does it say that blokes with bolt on tits and makeup are not real sheilas?
It does define sex and gender quite clearly.
It’s a quagmire now, offence taken when none is implied and in fact the person has no issue with it at all.
Like a lot of isms the right to be a tool and rude is OK if you belong to the group even though its about you as a person not whom you identify as.
Have a look at the qualifications of the people involved in the website. International, varied, all with knowledge in the field.
wait no not last time we checked
How the technology in The Rocky Horror Shows works
Actually, the news link of that page is very interesting if you want very recent information.
https://segm.org/news
buffy said:
Actually, the news link of that page is very interesting if you want very recent information.https://segm.org/news
Having a read now, the below could be a worry, what if down the track they realise they made a mistake, whose going to help.
In the past, medical interventions were preceded by a prolonged engagement with the patient, including ongoing psychological assessment. Now there has been a shift to a more automatic “affirmation” of the individual’s view of themselves as transgender. As such, the provision of medical intervention now happens with a much-reduced psychological assessment.
Cymek said:
buffy said:
Actually, the news link of that page is very interesting if you want very recent information.https://segm.org/news
Having a read now, the below could be a worry, what if down the track they realise they made a mistake, whose going to help.
In the past, medical interventions were preceded by a prolonged engagement with the patient, including ongoing psychological assessment. Now there has been a shift to a more automatic “affirmation” of the individual’s view of themselves as transgender. As such, the provision of medical intervention now happens with a much-reduced psychological assessment.
The Swedes have very recently stopped the use of puberty blockers and cross sex hormones. Here is the information, including the evidence.
https://segm.org/segm-summary-sweden-prioritizes-therapy-curbs-hormones-for-gender-dysphoric-youth
Cymek said:
buffy said:
Actually, the news link of that page is very interesting if you want very recent information.https://segm.org/news
Having a read now, the below could be a worry, what if down the track they realise they made a mistake, whose going to help.
In the past, medical interventions were preceded by a prolonged engagement with the patient, including ongoing psychological assessment. Now there has been a shift to a more automatic “affirmation” of the individual’s view of themselves as transgender. As such, the provision of medical intervention now happens with a much-reduced psychological assessment.
well there’s always a balance between accepting the universe the way it is, and changing it to the way one wants, and depending on possibilities and benefits and risks and costs and all that, the decisions must change over time
SCIENCE said:
Cymek said:
buffy said:
Actually, the news link of that page is very interesting if you want very recent information.https://segm.org/news
Having a read now, the below could be a worry, what if down the track they realise they made a mistake, whose going to help.
In the past, medical interventions were preceded by a prolonged engagement with the patient, including ongoing psychological assessment. Now there has been a shift to a more automatic “affirmation” of the individual’s view of themselves as transgender. As such, the provision of medical intervention now happens with a much-reduced psychological assessment.
well there’s always a balance between accepting the universe the way it is, and changing it to the way one wants, and depending on possibilities and benefits and risks and costs and all that, the decisions must change over time
Yes thought though with such a drastic change to ones life it would require some more thinking time
buffy said:
Peak Warming Man said:
Does it say that blokes with bolt on tits and makeup are not real sheilas?
It does define sex and gender quite clearly.
> various treatment approaches for gender dysphoria
OK. So we’re talking about the mental illness. Pages 493 to 538 of the Diagnostic and Statistical Manual of metal disorders IV.
> adolescent-onset gender dysphoria with mental health comorbidities
I don’t see any genetic or hormonal causes among the 15 papers there.
Do you see any papers there about how name calling by bullies and teachers in school affects the development of gender dysphoria? It did for Missy. But a more pronounced influence was peer group pressure in early adulthood. And a gross misunderstanding of what gender actually is.
Fair enough but I don’t comment on this topic any more, it’s none of my business. Boris is your man.
I’m sure if they’re are any real or perceived problems regarding this issue, Boris will be able to sort it all out. with a hearty LOL :)
Bubblecar said:
Fair enough but I don’t comment on this topic any more, it’s none of my business. Boris is your man.I’m sure if they’re are any real or perceived problems regarding this issue, Boris will be able to sort it all out. with a hearty LOL :)
they’re = there :)
In the UK, the Cass Review Interim Report has been released.
>The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) was commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence.
Here’s the response of one of Britain’s leading gender-critical lobby groups:
(Transgender Trend – Who Are We?
We are an organisation of parents, professionals and academics based in the UK who are concerned about the current trend to diagnose children as transgender, including the unprecedented number of teenage girls suddenly self-identifying as ‘trans’ (Rapid Onset Gender Dysphoria or ROGD). We are also concerned about legislation which places transgender rights above the right to safety for girls and young women in public toilets and changing rooms along with fairness for girls in sport.)
The Cass Review, led by Hilary Cass OBE, has published its Interim Report today. The report vindicates many of the points we have been making over the past six years regarding the right of children with gender-related distress to receive the same level of clinical care as any other child, especially in light of the poor evidence base and the changed cohort of young people accessing these services….
…The report says:
- the current service model is not sustainable.
- the unquestioning affirmative approach is flagged in several places in reports from clinicians and therapists who feel that this is at odds with their professional training and standards:
“Some secondary care providers told us that their training and professional standards dictate that when working with a child or young person they should be taking a mental health approach to formulating a differential diagnosis of the child or young person’s problems. However, they are afraid of the consequences of doing so in relation to gender distress because of the pressure to take a purely affirmative approach. Some clinicians feel that they are not supported by their professional body on this matter. Hence the practice of passing referrals straight through to GIDS is not just a reflection of local service capacity problems, but also of professionals’ practical concerns about the appropriate clinical management of this group of children and young people.”
- the current cohort of children is different to historic cases in terms of age and sex; existing data therefore does not apply to this group and outcomes are not known.
- there are significant differences between the NHS approach and the Dutch approach to the use of puberty blockers:
“Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.”
Bubblecar said:
In the UK, the Cass Review Interim Report has been released.>The Independent Review of Gender Identity Services for Children and Young People (The Cass Review) was commissioned by NHS England and NHS Improvement in Autumn 2020 to make recommendations about the services provided by the NHS to children and young people who are questioning their gender identity or experiencing gender incongruence.
Here’s the response of one of Britain’s leading gender-critical lobby groups:
(Transgender Trend – Who Are We?
We are an organisation of parents, professionals and academics based in the UK who are concerned about the current trend to diagnose children as transgender, including the unprecedented number of teenage girls suddenly self-identifying as ‘trans’ (Rapid Onset Gender Dysphoria or ROGD). We are also concerned about legislation which places transgender rights above the right to safety for girls and young women in public toilets and changing rooms along with fairness for girls in sport.)
The Cass Review, led by Hilary Cass OBE, has published its Interim Report today. The report vindicates many of the points we have been making over the past six years regarding the right of children with gender-related distress to receive the same level of clinical care as any other child, especially in light of the poor evidence base and the changed cohort of young people accessing these services….
…The report says:
- the current service model is not sustainable.
- the unquestioning affirmative approach is flagged in several places in reports from clinicians and therapists who feel that this is at odds with their professional training and standards:
“Some secondary care providers told us that their training and professional standards dictate that when working with a child or young person they should be taking a mental health approach to formulating a differential diagnosis of the child or young person’s problems. However, they are afraid of the consequences of doing so in relation to gender distress because of the pressure to take a purely affirmative approach. Some clinicians feel that they are not supported by their professional body on this matter. Hence the practice of passing referrals straight through to GIDS is not just a reflection of local service capacity problems, but also of professionals’ practical concerns about the appropriate clinical management of this group of children and young people.”- the current cohort of children is different to historic cases in terms of age and sex; existing data therefore does not apply to this group and outcomes are not known.
- there are significant differences between the NHS approach and the Dutch approach to the use of puberty blockers:
“Within the Dutch Approach, children and young people with neurodiversity and/or complex mental health problems are routinely given therapeutic support in advance of, or when considered appropriate, instead of early hormone intervention. Whereas criteria to have accessed therapeutic support prior to starting hormone blocking treatment do not appear to be integral to the current NHS process.”
After some consideration I sent the link to segm to my psychologist sister in law who has the transitioning twenty-something natal girlchild (started at age 16, had puberty blockers etc, now using testosterone). I was cautious because I didn’t know how she would take it. However, I felt she should probably know about the bone and cardiovascular problems which may be in the future and the site is run by qualified people. She responded that she would have a read but that she is worried that it may be “people who care, but are basically conservative”. I don’t see that is necessarily a problem. The site is based on “do no harm”. I’ll wait to see if she is still talking to me…
Probably not science, but to keep stuff in one place:
https://www.abc.net.au/news/2022-03-22/world-athletics-president-womens-sport-trans-integrity-threat/100929656
“World Athletics president Sebastian Coe says the “integrity of women’s sport” is under threat after Lia Thomas became the first transgender woman to win a US National Collegiate Athletic Association (NCAA) swimming event. “
buffy said:
Probably not science, but to keep stuff in one place:https://www.abc.net.au/news/2022-03-22/world-athletics-president-womens-sport-trans-integrity-threat/100929656
“World Athletics president Sebastian Coe says the “integrity of women’s sport” is under threat after Lia Thomas became the first transgender woman to win a US National Collegiate Athletic Association (NCAA) swimming event. “
The competitors’ verdict:
captain_spalding said:
buffy said:
Probably not science, but to keep stuff in one place:https://www.abc.net.au/news/2022-03-22/world-athletics-president-womens-sport-trans-integrity-threat/100929656
“World Athletics president Sebastian Coe says the “integrity of women’s sport” is under threat after Lia Thomas became the first transgender woman to win a US National Collegiate Athletic Association (NCAA) swimming event. “
The competitors’ verdict:
Tamb said:
captain_spalding said:
buffy said:
Probably not science, but to keep stuff in one place:https://www.abc.net.au/news/2022-03-22/world-athletics-president-womens-sport-trans-integrity-threat/100929656
“World Athletics president Sebastian Coe says the “integrity of women’s sport” is under threat after Lia Thomas became the first transgender woman to win a US National Collegiate Athletic Association (NCAA) swimming event. “
The competitors’ verdict:
Seems to demonstrate some physical disparity.
Also what you see there is a group of girls on the right who have been training with and competing against each other for years and have a social network organized. Lia did that stuff in the mens’ team before. I suspect behaviour patterns are different.
Britain changes tack in its treatment of trans-identifying children
It may not be in time to prevent lawsuits
Nov 17th 2022
Is Britain tiptoeing away from a medical scandal? Until recently, many gender specialists in the National Health Service (nhs) treated trans-identifying children by broadly following an “affirmative” approach which accepts patients’ self-diagnosis as the starting-point for treatment. That can mean the prescription of puberty blockers from early adolescence, followed by cross-sex hormones.
But Britain now appears to be changing tack. Next spring the nhs will close its specialist youth gender-identity clinic in England, the Gender and Identity Development Service (gids) at the Tavistock foundation trust in London. It will be replaced by eight regional centres in which gender services will be integrated with other mental-health services. That is partly because gids had long waiting lists. But it also reflects concerns that in the hurry to affirm gender identity, other conditions were ignored. Children with gender dysphoria often experience comorbidities, including autism, depression and eating disorders.
The impetus for the closure of gids was a review by Hilary Cass, a former head of the Royal College of Paediatrics and Child Health. Her interim report, published in February, said there was too little known about the effects of blockers, which prevent the development of secondary sexual characteristics. Dr Cass also warned that “social transition”—when a person changes their name and clothing to fit with their gender identity—is no “neutral act” but can effect “psychological functioning”.
Dr Cass’s report seems to have prompted the nhs to rethink its wider approach to gender ideology— which holds that gender identity is as important as biological sex. The affirmation model is predicated on the idea that being trans, like being gay, is innate. Yet in draft guidelines published in October the nhs cautioned that in children “gender incongruence…may be a transient phase”. This suggests that prescribing blockers to some children may have harmed them. The vast majority who take blockers proceed to cross-sex hormones; this combination can lead to sterility and an inability to reach orgasm. It is unclear when the guidelines, which could be altered, will come into effect.
Beyond the nhs, too, things are changing. This month a group of education organisations published guidance on “provision for transgender pupils”. Apparently aimed in part at protecting schools from lawsuits, it warns that making all toilets open to both biological sexes can raise safeguarding concerns and that requiring a pupil to sleep or undress “in the presence of members of the other sex” could break equality law. Its straightforward, scientific language stands in contrast to literature and training produced for schools by Mermaids, an activist charity which is also coming under increasing fire.
The Charity Commission has launched a “regulatory compliance case” over Mermaids following reports it has promoted the use of chest binders to girls (who identify as boys) without their parents’ knowledge. Separately, a trustee of Mermaids resigned after he was found to have attended a conference for a group that supports paedophiles; a “digital engagement officer” employed by the charity was later discovered to have posted explicit photographs of himself dressed as a schoolgirl. Such revelations can be particularly distressing for trans people. Some say they fear a backlash against extreme trans activism will provoke discrimination against them.
The way politicians speak about gender ideology is also beginning to change. Sir Keir Starmer, the leader of the Labour Party, has long tried to sidestep a furious row between trans activists and “gender-critical” feminists within his party. But in October he said that “children should not be making these very important decisions without the consent of their parents”. Trans-rights activists were livid.
Three big concerns remain. The first is that more young people may try to buy blockers online. The nhs may be on to this: its new draft guidelines say that obtaining such drugs outside “the established protocols” may spark child-safeguarding investigations. Second, some doctors are concerned that gender specialists at the new regional clinics may continue to operate as they did at gids. It can be difficult to say “no” to giving medication that people have been told is life-saving.
The third is that, although the nhs is already curtailing the use of hormone drugs for the under-18s, they are sometimes prescribed to adults with insufficient care. Bob Withers, a psychotherapist who has worked with young people who have regretted medical transitions, says he is particularly concerned about those in their late teens and early 20s, who may be more impulsive than older adults. A significant number of those who identify as trans are unhappily gay, he adds.
Ritchie, a 35-year-old civil servant from Newcastle, shares that concern. Having grown up in a former mining town in the north of England where “hyper masculinity” was valued, he reckons he would have come to terms with his homosexuality had he not, when deeply unhappy and suffering from severe obsessive-compulsive disorder, stumbled across a trans forum where members told him he was “uber trans”. He went to a gender-dysphoria clinic, one of seven in Britain that serve adults. At the age of 26 he was prescribed hormones; aged 30, he had surgery to remove his penis and testicles.
It did not take him long to realise this was a terrible mistake: “I was like, what the fuck have I done?” This feeling intensified as the surgery’s long-term side-effects became obvious. Emptying his bladder takes ten minutes. He is often in pain. At first, he assumed the responsibility was his alone. But later, reading his medical notes, he saw they were peppered with indications of mental illness. He is suing three parties involved in his transition. Further legal action seems likely. At least one law firm says it is hoping to bring a group negligence claim against the Tavistock.
Though the NHS has signalled a change of course, Mr Withers says it has more to do. It is, for example, still listed as a signatory to a memorandum of understanding on conversion therapy, published by the British Association for Counselling and Psychotherapy, which appears to conflate trans conversion therapy (which could simply mean talking therapy for gender dysphoria) with gay conversion therapy, the cruel practice of trying to turn a gay person straight. An ideological reversal is under way, but is far from complete.
https://www.economist.com/britain/2022/11/17/britain-changes-tack-in-its-treatment-of-trans-identifying-children?
They always want to “help” people – don’t they .
Witty Rejoinder said:
Britain changes tack in its treatment of trans-identifying children
It may not be in time to prevent lawsuitsNov 17th 2022
Is Britain tiptoeing away from a medical scandal? Until recently, many gender specialists in the National Health Service (nhs) treated trans-identifying children by broadly following an “affirmative” approach which accepts patients’ self-diagnosis as the starting-point for treatment. That can mean the prescription of puberty blockers from early adolescence, followed by cross-sex hormones.
But Britain now appears to be changing tack. Next spring the nhs will close its specialist youth gender-identity clinic in England, the Gender and Identity Development Service (gids) at the Tavistock foundation trust in London. It will be replaced by eight regional centres in which gender services will be integrated with other mental-health services. That is partly because gids had long waiting lists. But it also reflects concerns that in the hurry to affirm gender identity, other conditions were ignored. Children with gender dysphoria often experience comorbidities, including autism, depression and eating disorders.
The impetus for the closure of gids was a review by Hilary Cass, a former head of the Royal College of Paediatrics and Child Health. Her interim report, published in February, said there was too little known about the effects of blockers, which prevent the development of secondary sexual characteristics. Dr Cass also warned that “social transition”—when a person changes their name and clothing to fit with their gender identity—is no “neutral act” but can effect “psychological functioning”.
Dr Cass’s report seems to have prompted the nhs to rethink its wider approach to gender ideology— which holds that gender identity is as important as biological sex. The affirmation model is predicated on the idea that being trans, like being gay, is innate. Yet in draft guidelines published in October the nhs cautioned that in children “gender incongruence…may be a transient phase”. This suggests that prescribing blockers to some children may have harmed them. The vast majority who take blockers proceed to cross-sex hormones; this combination can lead to sterility and an inability to reach orgasm. It is unclear when the guidelines, which could be altered, will come into effect.
Beyond the nhs, too, things are changing. This month a group of education organisations published guidance on “provision for transgender pupils”. Apparently aimed in part at protecting schools from lawsuits, it warns that making all toilets open to both biological sexes can raise safeguarding concerns and that requiring a pupil to sleep or undress “in the presence of members of the other sex” could break equality law. Its straightforward, scientific language stands in contrast to literature and training produced for schools by Mermaids, an activist charity which is also coming under increasing fire.
The Charity Commission has launched a “regulatory compliance case” over Mermaids following reports it has promoted the use of chest binders to girls (who identify as boys) without their parents’ knowledge. Separately, a trustee of Mermaids resigned after he was found to have attended a conference for a group that supports paedophiles; a “digital engagement officer” employed by the charity was later discovered to have posted explicit photographs of himself dressed as a schoolgirl. Such revelations can be particularly distressing for trans people. Some say they fear a backlash against extreme trans activism will provoke discrimination against them.
The way politicians speak about gender ideology is also beginning to change. Sir Keir Starmer, the leader of the Labour Party, has long tried to sidestep a furious row between trans activists and “gender-critical” feminists within his party. But in October he said that “children should not be making these very important decisions without the consent of their parents”. Trans-rights activists were livid.
Three big concerns remain. The first is that more young people may try to buy blockers online. The nhs may be on to this: its new draft guidelines say that obtaining such drugs outside “the established protocols” may spark child-safeguarding investigations. Second, some doctors are concerned that gender specialists at the new regional clinics may continue to operate as they did at gids. It can be difficult to say “no” to giving medication that people have been told is life-saving.
The third is that, although the nhs is already curtailing the use of hormone drugs for the under-18s, they are sometimes prescribed to adults with insufficient care. Bob Withers, a psychotherapist who has worked with young people who have regretted medical transitions, says he is particularly concerned about those in their late teens and early 20s, who may be more impulsive than older adults. A significant number of those who identify as trans are unhappily gay, he adds.
Ritchie, a 35-year-old civil servant from Newcastle, shares that concern. Having grown up in a former mining town in the north of England where “hyper masculinity” was valued, he reckons he would have come to terms with his homosexuality had he not, when deeply unhappy and suffering from severe obsessive-compulsive disorder, stumbled across a trans forum where members told him he was “uber trans”. He went to a gender-dysphoria clinic, one of seven in Britain that serve adults. At the age of 26 he was prescribed hormones; aged 30, he had surgery to remove his penis and testicles.
It did not take him long to realise this was a terrible mistake: “I was like, what the fuck have I done?” This feeling intensified as the surgery’s long-term side-effects became obvious. Emptying his bladder takes ten minutes. He is often in pain. At first, he assumed the responsibility was his alone. But later, reading his medical notes, he saw they were peppered with indications of mental illness. He is suing three parties involved in his transition. Further legal action seems likely. At least one law firm says it is hoping to bring a group negligence claim against the Tavistock.
Though the NHS has signalled a change of course, Mr Withers says it has more to do. It is, for example, still listed as a signatory to a memorandum of understanding on conversion therapy, published by the British Association for Counselling and Psychotherapy, which appears to conflate trans conversion therapy (which could simply mean talking therapy for gender dysphoria) with gay conversion therapy, the cruel practice of trying to turn a gay person straight. An ideological reversal is under way, but is far from complete.
https://www.economist.com/britain/2022/11/17/britain-changes-tack-in-its-treatment-of-trans-identifying-children?
Some months ago when I understood what they were doing with the testosterone for the XXs I commented to Mr buffy that we already know the science of doing this, because it was done to athletes years ago, in some countries and in some sports. And it’s not good for the body and we know how it is not good. I seem to remember telling Mr buffy there would be lawsuits in time. I understand that here in Australia such work is done through the childrens’ hospitals and involves at least some psychological workup. I hope this is true.
Not science per se but better here than chat methinks:
…
LGBTQ+ Americans have stronger support than ever — and fiercer backlash
‘We’re sort of in a constant pendulum struggle,’ says historian Hugh Ryan
By Casey Parks
June 14, 2023 at 8:00 a.m. EDT
Montana state Rep. Zooey Zephyr (D), center, and her fiancée, activist Erin Reed, left, talk with Ruth Belay of Los Angeles during a Pride celebration at the White House on Saturday. (Elizabeth Frantz for The Washington Post)
Republican-led state legislators and their allies have mounted a far-reaching and coordinated effort to pass a record wave of new measures restricting gay and transgender rights. Almost no aspect of life is untouched.
Among the roughly 60 laws enacted in nearly half of U.S. states this year are limits on what children can read about LGBTQ people, whether trans youths can participate in school athletics, what trans or nonbinary adults can wear in public, which bathrooms and pronouns they can use, and whom doctors can treat.
Trans Americans make up less than 1 percent of the population. But this year, they are facing heightened scrutiny. The backers of the restrictions say they want to protect children. Conflicts over LGBTQ rights have spilled into the streets, school board meetings and store aisles. Drag story hours and Pride Month displays are now occasions for protests, vandalism and even violence. Conservative pundits and elected officials regularly cast LGBTQ people as a threat to children and refer to them as “groomers,” echoing anti-LGBTQ campaigns of the 1970s.
All of this led the Human Rights Campaign this month to issue a state of emergency for LGBTQ Americans — the first in the nonprofit’s more than 40-year history. It also has prompted the architects of anti-trans laws, who say they have “maxed out” at the state level, to set their sights on passing federal restrictions. Both sides agree that the battle over LGBTQ rights is likely to intensify as another presidential election approaches.
Still, Erin Reed, an activist and content creator who publishes a daily newsletter on anti-LGBTQ legislation, said queer and trans people remain hopeful. They’ve endured discrimination in the past, and this time, they have a bigger community and a raft of new knowledge, including some gleaned from abortion rights activists who have navigated similar fights since the Supreme Court overturned Roe v. Wade last year.
“The story of LGBTQ history is a story of resilience through community,” Reed said. “No matter how much they keep turning the dial on the cruelty and the extremeness of these laws, trans people still exist. We’re not going anywhere. We remain undaunted.”
A cultural shift on the right and the left
Across the country, LGBTQ activists say they have told themselves one thing over and over this year: We’ve been here before.
Though some might think social progress is a straight line up, historian Hugh Ryan said policymakers have often moved to curtail rights after periods of social liberation. Ryan, the author of LGBTQ history books including “When Brooklyn Was Queer,” noted that New York passed its first specifically anti-gay law, a cruising ban, 100 years ago, “immediately after moment that is so progressive, it is still referred to as the Progressive Era.”
In the ’70s, Ryan said, a few years after the Stonewall riots, Florida’s Dade County passed housing and employment protections for gay people, a move that prompted Florida citrus pitchwoman and Christian crusader Anita Bryant to launch “Save Our Children,” a campaign that both overturned the ordinance and cast gay people as predators who would “recruit” children.
“There’s no straight progress forever forward,” Ryan said. “Things get better, and they get worse, and they get better, and they get worse, and they change. We’re sort of in a constant pendulum struggle.”
Singer Anita Bryant, who launched an anti-gay “Save Our Children” campaign, in her home in Miami Beach in 1978. (Kathy A. Willens/AP)
This newest swing right began, in part, after the Supreme Court legalized same-sex marriage in 2015. Lawmakers filed more than 250 discriminatory bills the following year, up from 85 the year before the Obergefell v. Hodges decision. Though some of those — including a Mississippi measure to allow state employees, service providers and others to deny service to LGBTQ people — eventually became law, policymakers backed off an anti-trans bill in North Carolina. After Donald Trump became president, the number of bills dwindled.
Before 2020, no state banned trans girls from participating in school sports or trans youths from accessing transition-related health care. Then, a few weeks after the coronavirus shuttered most of the country, Idaho became the first to pass a sports ban. Arkansas passed the nation’s first ban on gender-affirming care the following year, and in that year’s legislative sessions, the number of anti-LGBTQ bills across the country ramped up again, to 268. By the spring of 2023, that number had surged past 400, according to a Washington Post analysis of data from the American Civil Liberties Union and the Movement Advancement Project (MAP).
Whereas previous anti-LGBTQ efforts focused on one issue — marriage, say, or military service — this year’s onslaught stunned Logan Casey, MAP’s senior researcher, in its scope and “cruel creativity.”
“This moment is unlike any before, given the truly wild breadth and scale of the attacks,” Casey said.
Conservative groups including the American Principles Project and America First Legal also collectively spent at least $50 million airing anti-trans ads in 25 states in the 2022 election, according to the Human Rights Campaign, and politicians from Georgia to Arizona ran on anti-LGBTQ platforms.
Terry Schilling, president of the American Principles Project, said his group began focusing on transgender issues after North Carolina rescinded a 2016 measure that required trans people to use a bathroom that matched the gender on their birth certificate. The group had invested in 2022 campaign ads not because of a cultural shift on the right, but on the left, he said.
“They went toward kids, teaching them weird things in school, taking away parental rights, putting kids on puberty blockers and cross-sex hormones, teaching kids that boys can become girls and girls boys,” Schilling said. “Put aside the merits of their arguments and whether or not they’re right. This is new. This is different.”
Florida Gov. Ron DeSantis ®, flanked by elementary school students, displays the signed Parental Rights in Education bill on March 28, 2022, at Classical Preparatory School in Shady Hills, Fla. (Douglas R. Clifford/Tampa Bay Times/AP)
Schilling and others have pressed on with an anti-LGBTQ agenda despite mixed political results. Florida Gov. Ron DeSantis ® handily won reelection last year after signing and promoting the country’s first Parental Rights in Education bill — a piece of legislation critics dubbed the “don’t say gay” law. But campaigning on anti-trans policies hasn’t helped every candidate. Drag critic Kari Lake lost in Arizona. Herschel Walker lost in Georgia after running on a platform to ban trans women from women’s sports. And Janet Protasiewicz defeated a conservative challenger for a spot on the Wisconsin Supreme Court, even after the American Principles Project PAC spent nearly $800,000 to defeat her with anti-trans ads.
The issue may lack resonance for swing voters. Although conservatives have expressed waning support for transgender inclusion in the military and in women’s sports, just 8 percent of people nationwide closely followed anti-trans bills last year, according to the Pew Research Center.
After Michigan Republicans lost all three branches of government to Democrats in November, the party’s chief of staff ascribed the defeat in part to the campaigns’ reliance on similar ads.
“There were more ads on transgender sports than inflation, gas prices and bread and butter issues that could have swayed independent voters,” Paul Cordes wrote in a memo to the state GOP. “We did not have a turn out problem — middle of the road voters simply didn’t like what was selling.”
Schilling allowed that his group’s efforts weren’t enough to overcome some electability issues, but he said they made significant inroads. American Principles’ polling showed that the nonprofit’s ads swayed tens of thousands of voters in Arizona, Virginia and Wisconsin, Schilling said.
“I can assure you that if the ads weren’t effective in persuading voters, I wouldn’t be running them,” Schilling said. “I’ll just let my record speak for itself and where the American people are.”
Targeting hospitals and adults
About 22 states now ban trans people from competing in women’s sports, and teachers in nearly a dozen states can no longer affirm students’ gender, according to MAP. And at least 19 have passed bans on transition health care for minors, despite the fact that all major medical associations oppose such restrictions.
Conservatives have succeeded in passing these bills, in part, by showcasing a small group of detransitioners who have flown to multiple states to testify that they felt abused and fast-tracked by gender-affirming doctors. Lawmakers and activists alike have accused those doctors of “mutilating” minors.
Only a handful of hospitals have released their numbers, but those that have been show that transition-related surgeries on minors are rare. An internal review at the Transgender Center at Washington University in St. Louis found that just six of the hospital’s 1,165 transgender patients younger than 18 had undergone gender-affirming procedures since 2018, and all of them were chest surgeries. A Reuters analysis of insurance claims found that while 42,167 young people nationwide were diagnosed with gender dysphoria in 2021, just 282 had top surgery that year.
Lawmakers and conservative activists have successfully pressured hospitals in Mississippi, Oklahoma, Tennessee and Texas to stop treating transgender children.
Republicans have begun to target gender-affirming care for adults, too. Florida’s DeSantis essentially cut off access for trans adults in the spring by imposing rules so strict that activists estimated 80 percent of trans adults in the state could no longer get hormones. And in April, Missouri Attorney General Andrew Bailey ® issued an emergency ruling for regulations so stringent that most trans adults would have lost access to hormones. Bailey later abandoned the ruling, but trans Missourians like Casey, the researcher at MAP, say the proposal hurt in ways they can still feel.
“Even when we win, even when these bills don’t become law, the bills are still causing harm that can be very long-lasting and difficult to shake for many people,” Casey said.
Conservatives have spoken openly about their plans to escalate, according to Ari Drennen, a trans woman who monitors anti-trans rhetoric in conservative media as LGBTQ program director for Media Matters for America, a liberal watchdog group.
In April, conservative pundit Matt Walsh urged his Twitter followers to pick a “woke” company to “target … with a ruthless boycott campaign. Claim one scalp then move onto the next.” The next month, shoppers began harassing Target employees over the store’s Pride collection, even though the big-box company has sold similar merchandise for more than a decade.
And Daily Wire commentator Michael Knowles, who earlier this year said that “transgenderism must be eradicated from public life entirely,” said in May that conservatives have to make Pride symbols “culturally toxic” as part of a grander plan to “come back in with more political force to ban some of this stuff.”
These campaigns have led to boycotts, canceled Pride festivals and hundreds of protests, Drennen said, in part because more than half of Americans don’t know a trans person. Polls show that voters who know transgender people are less likely to support restrictions on them. But many anti-LGBTQ bills ensure that trans people won’t become more visible, Drennen said.
Sports, for instance, are one of the main ways young people build community, Drennen said. Lawmakers have said they pushed bans on trans competitors because they want to ensure competition is fair for women and girls, but those laws exclude trans kids from participating in one of their school’s most public spheres.
“Not knowing a trans person is what enables that propaganda to take hold,” Drennen said. “Once trans people become fully integrated as members of their community, as their visible neighbors, co-workers, family members, it’s that much harder to paint a picture of us as terrifying monsters.”
The role of Roe and the courts
For Drennen and others, this era is directly connected to the fight that abortion rights activists have waged for decades over bodily autonomy. The map of states that have banned abortion since Roe fell is nearly identical to the map that shows which states have banned gender-affirming care for minors this year.
Doctors in states that have banned both say the bans feel similar. Colleen McNicholas, chief medical officer for Planned Parenthood in the St. Louis region, said that in both instances, conservative groups and lawmakers homed in on a vulnerable and stigmatized population, then bullied the providers who care for them by making those doctors seem “unqualified, self-serving and, in some capacity, immoral.”
“It is painfully obvious to us that they are using the same playbook, but in an expedited time frame,” McNicholas said.
When the Missouri attorney general began targeting transition care in the spring, McNicholas’s clinics were able to mobilize without hesitation in large part because they’d learned how to adapt after Missouri banned abortion last year. The clinics added additional appointments, and staffers worked overtime. They prepared themselves for potential litigation, and they sent the highest-risk clients over the river to Illinois. After Roe fell, southern Illinois became a hub for people forced to travel for abortion care, and McNicholas said she expects the region will see an influx of trans patients soon.
“The same phenomenon that happened with abortion care happened with trans care,” McNicholas said. “We had to be ready to quickly use all of the resources we have to make sure folks knew what care they could get, where they could get it and for potentially how long they could get it.”
In another parallel with the post-Roe landscape, 13 states, including Maryland, Illinois and New Mexico, have recently passed explicit protections for transgender people, according to Reed.
As most states wrap up their legislative sessions, Schilling, the executive at the American Principles Project, said his group has probably “maxed out” on state legislative wins. The group plans to turn its focus toward federal policies as the presidential election nears.
Meanwhile, LGBTQ activists say they are eager to see what will happen in the courts. This month a judge declared Tennessee’s drag ban unconstitutional, and courts in Arkansas, Alabama and Florida have temporarily blocked medical bans from taking effect. Activists believe that at least one of the health-care cases will eventually make it to the Supreme Court, and they’re not sure how the justices will rule.
Some say they’re hopeful that Bostock v. Clayton County, a 2020 decision that protects gay and trans employees from discrimination, will serve as precedent for future LGBTQ cases, but activists say the high court’s decision to overturn a decades-old precedent like Roe has left them feeling less optimistic.
In the spring, near the end of a painful and record-breaking legislative season, Reed and her fiancée, Montana state Rep. Zooey Zephyr (D), went for a walk in western Montana. The year had marked an era of unprecedented success and oppression for the women, both of whom are trans. Reed had become a go-to pundit for PBS and other news outlets, but she’d endured “swatting” attempts and daily online harassment. Zephyr had started the session as Montana’s first trans state lawmaker. She had ended it working from a bench outside the House of Representatives after her colleagues barred her from the chamber for criticizing a proposed ban on transition care for minors.
Still, as the women walked, Zephyr said that “it was hard to feel anything other than hope.” Even in Montana’s most conservative reaches, every few minutes, people stopped to tell Zephyr they disagreed with her colleagues’ anti-trans policies and actions. They included security guards and National Guard members, lifelong libertarians and people who told Zephyr they’d voted for Trump twice. Each one told Zephyr they supported her.
“Given the growing awareness that I’m seeing about what’s at stake in our country, I feel hope that change is possible,” Zephyr said.
After Reed flew home to Maryland, she said she continued to find promise in an unlikely place — Louisiana. Last month, a Republican lawmaker there bucked the Southern trend and refused to advance out of committee a ban on gender-affirming care. State Sen. Fred Mills said he’d voted to kill the ban because a Louisiana Health Department report showed that each year very few minors went on puberty blockers, just a few dozen started cross-sex hormones and none on Medicaid underwent surgery.
“My decision was really, really based on the numbers,” Mills told the Louisiana Illuminator. “All the testimony I heard by the proponents that children are getting mutilated, I didn’t see it in the statistics.”
A different committee eventually pushed the bill through, but as Reed followed Mills’s decision, she couldn’t help but think of her childhood. Reed grew up in south Louisiana, and when she was a child in the 1990s, her classmates bullied her. She wasn’t able to come out until she was 30. But the environment was changing, she believed.
Late last year, a trans teenager from a parish close to Reed’s hometown wrote to say her classmates had nominated her to the homecoming court. She sent along a celebratory picture as proof.
“I cried because I remember how hard it was for me,” Reed said. “To see a trans girl in small-town Louisiana not only being accepted but celebrated and loved, seeing her driven on the back of a car with her dad around the football stadium, waving at everybody, that’s how change happens.”
https://www.washingtonpost.com/dc-md-va/2023/06/14/lgbtq-rights-state-legislative-attacks/?
The ‘Four Corners’ program was very good IMO.
https://iview.abc.net.au/show/four-corners
Witty Rejoinder said:
The ‘Four Corners’ program was very good IMO.https://iview.abc.net.au/show/four-corners
Found it on YouTube.
Leaked discussions reveal uncertainty about transgender care
The files shed light on a controversial area of medicine that has largely retreated into the shadows
Mar 5th 2024 | Washington, DC
Few areas of medicine arouse as strong emotions in America as transgender care. The publication this week of hundreds of posts from an internal messaging forum will add fuel to this fire. The files show members of the World Professional Association for Transgender Health (WPATH), an interdisciplinary professional and educational association devoted to the field, discussing how to treat patients.
The non-profit group that published the files, Environmental Progress, which pushes strong views on more than just the environment, claims that the documents reveal “widespread medical malpractice on children and vulnerable adults”. That claim is questionable. But WPATH’s standards of care have been cited by other medical organisations, particularly in America. WPATH’s president, Marci Bowers, said in response that “WPATH is and has always been a science- and evidence-based organisation.” Yet the discussions show that the provision of so-called gender-affirming care is riddled with far more doubt than WPATH’s message that such treatments are “not considered experimental”.
Shedding light on this field is helpful, even if the leaking of private information—including names of practitioners—is ethically dubious. Because gender-affirming care has become politicised, its practice has retreated into the shadows. It is rare to get a sense of what it entails.
Based on the files, WPATH has members who are worryingly dogmatic. But mostly the exchanges reveal a group of surgeons, social workers and therapists struggling with how best to serve patients. They debate the challenges of gaining informed consent for medical treatments from children and people with mental-health disorders. They exchange tips on how to deal with requests for “non-standard” surgery, such as patients who would like to preserve their penis but also have a “neovagina” (through a procedure known as “phallus-preserving vaginoplasty”).
“I’m definitely a little stumped,” says one therapist about trying to get patients as young as nine to understand the impact that interventions would have on their fertility. (Hormone medications can permanently reduce fertility, and even cause sterility in some cases.) Colleagues agree that talking to a 14-year-old about fertility preservation brings reactions such as: “Ew, kids, babies, gross”, or “I’m going to adopt.” One clinician admits that “We try to talk about it, but most of the kids are nowhere in any kind of brain space to really talk about it in a serious way.” He adds: “That has always bothered me.”
Concerns about making irreversible changes to children’s bodies, and the impossibility of gaining their informed consent for this, have been at the heart of controversy over transgender medicine. In America 23 states have now restricted or banned such care for minors, even though almost all medical associations in America support it—an issue the Supreme Court has been asked to rule on. Much less focus has been on whether adult patients with psychiatric disorders can give informed consent for such procedures. On that matter the files are especially revealing.
In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (did), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view did primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling.
Are you sure?
The conversation ventures into the absurd—and sounds more ideological than clinical—when talking about unusual requests for body modifications. “I’ve found more and more patients recently requesting ‘non-standard’ procedures such as top surgery without nipples, nullification , and phallus-preserving vaginoplasty,” writes a surgeon from California. Several members recognise this and exchange tips. One asks whether “non-standard” is the best term as “they may become standard in the future”.
The surgeon from California shares his website, which includes a menu of surgical options, and adds that he’s “quite comfortable tailoring my operations to serve the needs of each patient”. This attitude to surgical shopping is uniquely American. Pandering to it will not help gender medicine with its argument that it is medically necessary and non-experimental.
In response to the leaks, the surgeon says he is comfortable performing these operations because WPATH “acknowledges these procedures and has established evidence-based guidelines on how to help a patient who is requesting them.” But a doctor in Canada says that after joining the forum her “expectations of scientific discourse were soon dashed”. Her posts were met with “emotional, political or social reactions rather than clinical ones”.
WPATH, and those arguing for gender-affirming care more broadly, have felt the need to present a level of certainty in an area of medicine full of uncertainty. Bringing frank discussion into the open will surely be healthy.
https://www.economist.com/united-states/2024/03/05/leaked-discussions-reveal-uncertainty-about-transgender-care?
Witty Rejoinder said:
Leaked discussions reveal uncertainty about transgender care
The files shed light on a controversial area of medicine that has largely retreated into the shadowsMar 5th 2024 | Washington, DC
Few areas of medicine arouse as strong emotions in America as transgender care. The publication this week of hundreds of posts from an internal messaging forum will add fuel to this fire. The files show members of the World Professional Association for Transgender Health (WPATH), an interdisciplinary professional and educational association devoted to the field, discussing how to treat patients.
The non-profit group that published the files, Environmental Progress, which pushes strong views on more than just the environment, claims that the documents reveal “widespread medical malpractice on children and vulnerable adults”. That claim is questionable. But WPATH’s standards of care have been cited by other medical organisations, particularly in America. WPATH’s president, Marci Bowers, said in response that “WPATH is and has always been a science- and evidence-based organisation.” Yet the discussions show that the provision of so-called gender-affirming care is riddled with far more doubt than WPATH’s message that such treatments are “not considered experimental”.
Shedding light on this field is helpful, even if the leaking of private information—including names of practitioners—is ethically dubious. Because gender-affirming care has become politicised, its practice has retreated into the shadows. It is rare to get a sense of what it entails.
Based on the files, WPATH has members who are worryingly dogmatic. But mostly the exchanges reveal a group of surgeons, social workers and therapists struggling with how best to serve patients. They debate the challenges of gaining informed consent for medical treatments from children and people with mental-health disorders. They exchange tips on how to deal with requests for “non-standard” surgery, such as patients who would like to preserve their penis but also have a “neovagina” (through a procedure known as “phallus-preserving vaginoplasty”).
“I’m definitely a little stumped,” says one therapist about trying to get patients as young as nine to understand the impact that interventions would have on their fertility. (Hormone medications can permanently reduce fertility, and even cause sterility in some cases.) Colleagues agree that talking to a 14-year-old about fertility preservation brings reactions such as: “Ew, kids, babies, gross”, or “I’m going to adopt.” One clinician admits that “We try to talk about it, but most of the kids are nowhere in any kind of brain space to really talk about it in a serious way.” He adds: “That has always bothered me.”
Concerns about making irreversible changes to children’s bodies, and the impossibility of gaining their informed consent for this, have been at the heart of controversy over transgender medicine. In America 23 states have now restricted or banned such care for minors, even though almost all medical associations in America support it—an issue the Supreme Court has been asked to rule on. Much less focus has been on whether adult patients with psychiatric disorders can give informed consent for such procedures. On that matter the files are especially revealing.
In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (did), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view did primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling.
Are you sure?
The conversation ventures into the absurd—and sounds more ideological than clinical—when talking about unusual requests for body modifications. “I’ve found more and more patients recently requesting ‘non-standard’ procedures such as top surgery without nipples, nullification , and phallus-preserving vaginoplasty,” writes a surgeon from California. Several members recognise this and exchange tips. One asks whether “non-standard” is the best term as “they may become standard in the future”.The surgeon from California shares his website, which includes a menu of surgical options, and adds that he’s “quite comfortable tailoring my operations to serve the needs of each patient”. This attitude to surgical shopping is uniquely American. Pandering to it will not help gender medicine with its argument that it is medically necessary and non-experimental.
In response to the leaks, the surgeon says he is comfortable performing these operations because WPATH “acknowledges these procedures and has established evidence-based guidelines on how to help a patient who is requesting them.” But a doctor in Canada says that after joining the forum her “expectations of scientific discourse were soon dashed”. Her posts were met with “emotional, political or social reactions rather than clinical ones”.
WPATH, and those arguing for gender-affirming care more broadly, have felt the need to present a level of certainty in an area of medicine full of uncertainty. Bringing frank discussion into the open will surely be healthy.
https://www.economist.com/united-states/2024/03/05/leaked-discussions-reveal-uncertainty-about-transgender-care?
Seems like an awful ethical minefield. Lime all minefields, it might be just best not to go there at all.
party_pants said:
Witty Rejoinder said:
Leaked discussions reveal uncertainty about transgender care
The files shed light on a controversial area of medicine that has largely retreated into the shadowsMar 5th 2024 | Washington, DC
Few areas of medicine arouse as strong emotions in America as transgender care. The publication this week of hundreds of posts from an internal messaging forum will add fuel to this fire. The files show members of the World Professional Association for Transgender Health (WPATH), an interdisciplinary professional and educational association devoted to the field, discussing how to treat patients.
The non-profit group that published the files, Environmental Progress, which pushes strong views on more than just the environment, claims that the documents reveal “widespread medical malpractice on children and vulnerable adults”. That claim is questionable. But WPATH’s standards of care have been cited by other medical organisations, particularly in America. WPATH’s president, Marci Bowers, said in response that “WPATH is and has always been a science- and evidence-based organisation.” Yet the discussions show that the provision of so-called gender-affirming care is riddled with far more doubt than WPATH’s message that such treatments are “not considered experimental”.
Shedding light on this field is helpful, even if the leaking of private information—including names of practitioners—is ethically dubious. Because gender-affirming care has become politicised, its practice has retreated into the shadows. It is rare to get a sense of what it entails.
Based on the files, WPATH has members who are worryingly dogmatic. But mostly the exchanges reveal a group of surgeons, social workers and therapists struggling with how best to serve patients. They debate the challenges of gaining informed consent for medical treatments from children and people with mental-health disorders. They exchange tips on how to deal with requests for “non-standard” surgery, such as patients who would like to preserve their penis but also have a “neovagina” (through a procedure known as “phallus-preserving vaginoplasty”).
“I’m definitely a little stumped,” says one therapist about trying to get patients as young as nine to understand the impact that interventions would have on their fertility. (Hormone medications can permanently reduce fertility, and even cause sterility in some cases.) Colleagues agree that talking to a 14-year-old about fertility preservation brings reactions such as: “Ew, kids, babies, gross”, or “I’m going to adopt.” One clinician admits that “We try to talk about it, but most of the kids are nowhere in any kind of brain space to really talk about it in a serious way.” He adds: “That has always bothered me.”
Concerns about making irreversible changes to children’s bodies, and the impossibility of gaining their informed consent for this, have been at the heart of controversy over transgender medicine. In America 23 states have now restricted or banned such care for minors, even though almost all medical associations in America support it—an issue the Supreme Court has been asked to rule on. Much less focus has been on whether adult patients with psychiatric disorders can give informed consent for such procedures. On that matter the files are especially revealing.
In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (did), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view did primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling.
Are you sure?
The conversation ventures into the absurd—and sounds more ideological than clinical—when talking about unusual requests for body modifications. “I’ve found more and more patients recently requesting ‘non-standard’ procedures such as top surgery without nipples, nullification , and phallus-preserving vaginoplasty,” writes a surgeon from California. Several members recognise this and exchange tips. One asks whether “non-standard” is the best term as “they may become standard in the future”.The surgeon from California shares his website, which includes a menu of surgical options, and adds that he’s “quite comfortable tailoring my operations to serve the needs of each patient”. This attitude to surgical shopping is uniquely American. Pandering to it will not help gender medicine with its argument that it is medically necessary and non-experimental.
In response to the leaks, the surgeon says he is comfortable performing these operations because WPATH “acknowledges these procedures and has established evidence-based guidelines on how to help a patient who is requesting them.” But a doctor in Canada says that after joining the forum her “expectations of scientific discourse were soon dashed”. Her posts were met with “emotional, political or social reactions rather than clinical ones”.
WPATH, and those arguing for gender-affirming care more broadly, have felt the need to present a level of certainty in an area of medicine full of uncertainty. Bringing frank discussion into the open will surely be healthy.
https://www.economist.com/united-states/2024/03/05/leaked-discussions-reveal-uncertainty-about-transgender-care?
Seems like an awful ethical minefield.
Limeall minefields, it might be just best not to go there at all.
like all minefields
Witty Rejoinder said:
Leaked discussions reveal uncertainty about transgender care
The files shed light on a controversial area of medicine that has largely retreated into the shadowsMar 5th 2024 | Washington, DC
Few areas of medicine arouse as strong emotions in America as transgender care. The publication this week of hundreds of posts from an internal messaging forum will add fuel to this fire. The files show members of the World Professional Association for Transgender Health (WPATH), an interdisciplinary professional and educational association devoted to the field, discussing how to treat patients.
The non-profit group that published the files, Environmental Progress, which pushes strong views on more than just the environment, claims that the documents reveal “widespread medical malpractice on children and vulnerable adults”. That claim is questionable. But WPATH’s standards of care have been cited by other medical organisations, particularly in America. WPATH’s president, Marci Bowers, said in response that “WPATH is and has always been a science- and evidence-based organisation.” Yet the discussions show that the provision of so-called gender-affirming care is riddled with far more doubt than WPATH’s message that such treatments are “not considered experimental”.
Shedding light on this field is helpful, even if the leaking of private information—including names of practitioners—is ethically dubious. Because gender-affirming care has become politicised, its practice has retreated into the shadows. It is rare to get a sense of what it entails.
Based on the files, WPATH has members who are worryingly dogmatic. But mostly the exchanges reveal a group of surgeons, social workers and therapists struggling with how best to serve patients. They debate the challenges of gaining informed consent for medical treatments from children and people with mental-health disorders. They exchange tips on how to deal with requests for “non-standard” surgery, such as patients who would like to preserve their penis but also have a “neovagina” (through a procedure known as “phallus-preserving vaginoplasty”).
“I’m definitely a little stumped,” says one therapist about trying to get patients as young as nine to understand the impact that interventions would have on their fertility. (Hormone medications can permanently reduce fertility, and even cause sterility in some cases.) Colleagues agree that talking to a 14-year-old about fertility preservation brings reactions such as: “Ew, kids, babies, gross”, or “I’m going to adopt.” One clinician admits that “We try to talk about it, but most of the kids are nowhere in any kind of brain space to really talk about it in a serious way.” He adds: “That has always bothered me.”
Concerns about making irreversible changes to children’s bodies, and the impossibility of gaining their informed consent for this, have been at the heart of controversy over transgender medicine. In America 23 states have now restricted or banned such care for minors, even though almost all medical associations in America support it—an issue the Supreme Court has been asked to rule on. Much less focus has been on whether adult patients with psychiatric disorders can give informed consent for such procedures. On that matter the files are especially revealing.
In the autumn of 2021 several practitioners mentioned that they had a high number of patients with dissociative identity disorder (did), formerly known as multiple-personality disorder. The group discussed the challenges of gaining consent from each “alter” (alternative personality) before starting hormone therapy, particularly when the alters had different gender identities. Some members appeared to view did primarily through the lens of identity. As one therapist put it: “I too would love to hear from others how we as clinicians…can work with these clients to honour their gender identity and fractured ego identities.” For a field sometimes accused of over-medicalisation, such “under-medicalisation” is just as troubling.
Are you sure?
The conversation ventures into the absurd—and sounds more ideological than clinical—when talking about unusual requests for body modifications. “I’ve found more and more patients recently requesting ‘non-standard’ procedures such as top surgery without nipples, nullification , and phallus-preserving vaginoplasty,” writes a surgeon from California. Several members recognise this and exchange tips. One asks whether “non-standard” is the best term as “they may become standard in the future”.The surgeon from California shares his website, which includes a menu of surgical options, and adds that he’s “quite comfortable tailoring my operations to serve the needs of each patient”. This attitude to surgical shopping is uniquely American. Pandering to it will not help gender medicine with its argument that it is medically necessary and non-experimental.
In response to the leaks, the surgeon says he is comfortable performing these operations because WPATH “acknowledges these procedures and has established evidence-based guidelines on how to help a patient who is requesting them.” But a doctor in Canada says that after joining the forum her “expectations of scientific discourse were soon dashed”. Her posts were met with “emotional, political or social reactions rather than clinical ones”.
WPATH, and those arguing for gender-affirming care more broadly, have felt the need to present a level of certainty in an area of medicine full of uncertainty. Bringing frank discussion into the open will surely be healthy.
https://www.economist.com/united-states/2024/03/05/leaked-discussions-reveal-uncertainty-about-transgender-care?
Thank you for that Witty. Seems to be an American problem in large part. Europe is moving away from radical treatment of minors.
Britain’s Supreme Court considers what a woman is
At last. Britons had been wondering what those 34m people who are not men might be
Nov 28th 2024
“Court rise.” A hush falls in the Supreme Court. Five judges—three lords, two ladies, roughly two centuries of accumulated professional experience—walk in. The question that the country’s highest court and finest legal minds have come to consider, in a two-day hearing that took place on November 26th and 27th, is: what is a woman? Finally, an answer looms for those who wonder what those 34m people in Britain who are not men might be.
Inside the Supreme Court, with its supremely institutional grandeur (portraits, panelled walls, truly tasteless carpets), there is talk of cervixes and men who are women and women who are men. There is talk of “women” who have penises and of pregnant “men”. The word “prostate” is used. It is strong stuff for a Tuesday. Britain’s finest legal minds sound a little confused. This, says one, is “quite difficult”.
Sex in Britain was once quite simple. The Oxford English Dictionary stated, with Hemingwayesque brevity, that a woman is an “adult human female”—and more or less all Britons agreed. Then came the rise of trans rights and the mantra that “trans women are women”. This case came about because the Scottish authorities have stated that when the Equality Act 2010 says “woman” this means not just “woman” but also any man with a full gender recognition certificate (GRC). A group called For Women Scotland (FWS) cried “bunkum” and went to court. That it has reached the Supreme Court makes this, says Michael Foran, a lecturer in law at Glasgow University, a “monumental case”.
Britain’s legal system has tackled the question of what a woman might be before. Not always to its credit: in a 1914 case it concluded that a woman is not a “person”. It has also considered how someone might become a woman. In a 1970 case a British judge ruled that four factors (chromosomes, gonads, genitals and “psychological factors”) make someone a woman—but that a “sex-change” operation did not. Many who underwent one signed a document stating that they understood that it would “not alter my male sex”.
In 2004 the GRC was introduced in Britain. This government document can be acquired by obtaining a diagnosis of gender dysphoria, jumping through some legal hoops and paying £5 ($6.30). It changes a person’s legal sex for such things as birth, death and marriage certificates. It made it possible for a man, with full male genitalia, legally to become a woman, and vice versa.
Such transubstantiation sounds odd but is not unprecedented. The law allows for “legal fictions”. It calls a company a “person” (when clearly it is not) and states that “the King never dies” (when kingly corpses in Westminster Abbey amply prove otherwise). But these should be understood as a judicial sleight of hand (which the law is good at) and not as metaphysical mastery (which it is not).
Supporters of the GRC say that it helps alleviate the undoubted pain of gender dysphoria. Critics say that it spreads confusion, and sometimes worse; in one case a trans woman (a biological male) was made the head of a rape-crisis centre. No one, tellingly, is that interested in the question of “what is a man?”. Since women are underrepresented among murderers (7%), assaulters (a fifth) and sexual assaulters (2%), women who transition are rarely considered a threat.
To have a certificate that transforms a man into a woman is, says Naomi Cunningham, the chair of Sex Matters, a human-rights charity, “as stupid as… a certificate to say that they are dead when they are alive or that they are alive when they are dead”. Unshackle the meaning of words such as “man” and “woman” from biology, said Aidan O’Neill KC, acting for FWS, and it results in “absurd” and “nonsensical outcomes”.
There was a bit of this absurdity in the Supreme Court. Is there, asked one judge, a “third gender”? The court tittered. The barrister speaking demurred: there is not a third gender. And, as FWS argues, there are also just two sexes: male and female. The lords and ladies of the Supreme Court will give their ruling in a few months’ time. And it will matter.
https://www.economist.com/britain/2024/11/28/britains-supreme-court-considers-what-a-woman-is?
As to science, the word biology was used once.
A big transgender-rights case heads to America’s Supreme Court
The justices take on paediatric gender medicine
Dec 2nd 2024
A case to be heard by the Supreme Court on December 4th is set to reignite debate about one of the election’s most controversial issues: the rights of transgender people, and specifically the medical transitioning of minors. In 2023, Tennessee enacted Senate Bill 1 (SB1), which bans puberty blockers, cross-sex hormones and surgery for minors who identify as trans. It is one of 26 states that have done so. Now, in United States v Skrmetti, the federal government, supported by the American Civil Liberties Union (ACLU), is suing Tennessee on behalf of the parents of three teenagers, claiming the ban violates the equal-protection clause of the constitution’s 14th Amendment.
The question before the Supreme Court is not whether the treatment of minors is effective or experimental, but whether the appeals court that upheld the ban should have set a higher bar, known as “heightened scrutiny”, when assessing if it treats people differently on the basis of protected characteristics, such as race or sex. In short, is this just a medical matter, which states can regulate as they normally do, or does it constitute discrimination against a protected class of people?
Unlike sex, gender identity is not recognised under the constitution as a protected characteristic (known legally as a “suspect classification”) that would trigger heightened scrutiny from judges. So the plaintiffs have chosen to fight the battle primarily on the basis of sex discrimination, saying that children who identify as transgender and want puberty blockers or hormones (the suit does not include surgery) are being discriminated against on the basis of their sex.
The ACLU states that the Tennessee ban means a doctor “could prescribe oestrogen to a cisgender teenage girl for any clinical diagnosis but could not do the same for a transgender girl diagnosed with gender dysphoria”. Yet at the same time as arguing that a girl and a trans girl are metaphysically the same, the federal government and the aclu are arguing, in order to prove there has been sex-based discrimination, that a girl and a trans girl are, in fact, physically not the same. And that to not give oestrogen to a trans girl constitutes discrimination based on sex.
Opponents dismiss such claims as ridiculous. Saying doctors should give oestrogen to a boy who identifies as a girl is “like saying you should give a boy a hysterectomy”, says Elspeth Cypher, a former justice on the Supreme Judicial Court of Massachusetts. She says this puts it in a similar category to the race-based discrimination that would occur if hormones were refused to a black child.
An array of NGOs back the government’s case, arguing that this is the next step in the civil-rights movement. “Access to scientifically proven medical care is essential for transgender youth to thrive,” says Sasha Buchert of Lambda Legal, a law firm supporting the ACLU. The supporters point to a Supreme Court ruling in 2020, Bostock v Clayton County, in which, in his majority ruling, Justice Neil Gorsuch wrote “it is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex”. Though he wrote that the ruling relates only to employment, some have tried to apply it to other arenas, notably education. Chase Strangio, the ACLU lawyer who will argue before the justices on December 4th (along with the solicitor-general, Elizabeth Prelogar) says that “the well-being of countless transgender youth…rests on the court adhering to the facts, the constitution and its own precedent”.
Opposing this view is a scrappy selection of advocacy groups, including a growing number on the political left, who say the concept of gender identity is nebulous and unfalsifiable and should not ground any legal ruling. They recognise that many teenagers are struggling and say they want them to receive compassion and help. But, says Glenna Goldis, a lawyer who is also a team member of Democrats for an Informed Approach to Gender (DIAG), “this is a belief system that doctors and lawyers are falsely marketing to Americans as science.” Those pushing adolescent transitioning are “trying to appropriate the protections of sex, while stripping away the meaning of sex, and substituting it with gender identity,” says Zhenya Abbruzzese of the Society for Evidence-Based Gender Medicine.
Polling suggests that public opinion is not simply pro- or anti-trans. A majority of Americans support trans people being protected from discrimination but do not support natal males participating in women’s sports or being housed in women’s prisons, or adolescent transitioning. Many European countries have announced tight restrictions on the treatment of minors, leaving America as an outlier. The new Labour government in Britain has said it will fully implement the Cass Review, a four-year study that shows that the evidence for benefits from adolescent transitioning is “remarkably weak”. Yet medical bodies such as the American Academy of Paediatrics continue to insist it is beneficial.
A ruling is not expected for months. In the meantime a newly inaugurated President Trump may decide to weigh in on the broader issues. But if the Supreme Court rules in favour of Tennessee, the other bans are likely to stand, and the national blue-red division on the issue will continue (as will plenty more litigation).
If it goes against Tennessee, the bans may be sent back to lower state courts to be reconsidered under the “heightened scrutiny” standard. But the much bigger implication, says Ms Cypher, is that, as with the Bostock ruling, even if not stated explicitly, it could cause further movement towards treating gender identity as a protected characteristic. Beyond the possibility of more children being given irreversible treatments which they come to regret, this would have the biggest impact on women’s rights, she says, and lead to yet more legal wrangles. “It would become a tie. My biology trumps your internal feelings, and vice versa, and the courts would have to decide.”
https://www.economist.com/united-states/2024/12/02/a-big-transgender-rights-case-heads-to-americas-supreme-court?
Thanks for those Witty. You reminded me to check where SEGM (Society for Evidence Based Gender Medicine) is up to. There are some more papers there for perusal. But not tonight.