RUTHFULLY YOURS

It seems like just yesterday the sexual revolution was focused on legal protections for same-sex couples and individuals with same-sex orientations. But once that battle was won (or lost, depending on your perspective), radicals in the LGBT movement flooded the cultural zone with new demands.

“Gay rights” became yesterday’s cause, replaced by “transgender rights.” The goal was to increase the tiny population of people with gender dysphoria and elevate their problems and demands above those of any other group.

The most troubling agenda item for the transgender radicals became the demand that dysphoric children be provided medical intervention to help their bodies mimic those of the opposite sex. Such interventions can include puberty blockers (which disrupt the natural maturation of the body), cross-sex hormones (which flood the body with hormones natural to the opposite sex), and surgery to remove healthy but unwanted reproductive organs and perhaps to craft faux organs natural to the opposite sex.

These treatments are controversial even among the “LGBs” in the LGBT alliance, in part because plentiful research demonstrates that the vast majority of children with dysphoria will outgrow it without receiving dangerous and potentially irreversible treatment. Their concerns are shared by the self-described “left-leaning, open-minded, and pro-gay rights” group youthtranscriticalprofessionals.org. These professionals warn that “policies that encourage––either directly or indirectly––such medical treatment for young people who may not be able to evaluate the risks and benefits are highly suspect, in our opinion.”

Despite the recklessness of administering such “gender-affirming treatment,” many physicians have either jumped on the bandwagon (whether out of fear, ideology, or lust for financial reward) or have kept a discreet silence lest they be targeted for apostasy. And when they join or otherwise enable the mob, lives can literally be ruined.

Presumably all physicians understand the biological reality that there are only two sexes, and that an individual cannot change his or her chromosomes to shift from one to the other. Hormone levels can be raised or lowered and mutilating surgery can be performed, but the patient is still left with a cheap (or rather, highly expensive) imitation of the real thing.

Given this reality and the dearth of long-term studies on the effects of hormone manipulation, one would expect reputable physicians to urge caution, at the very least, in administering these treatments. One would be wrong.

Polarization Within the Profession

An early warning indicator of the politicization within the profession came from the American Medical Association, which in 2008 went on record supporting increased access to hormonal and surgical treatment for patients suffering from the recognized mental disorder then known as gender identity disorder. This was followed five years later by the new edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), changing gender identity disorder to gender dysphoria. According to one psychiatrist who helped write the new criteria, the goal was to move toward viewing transgender identification as a normal variation of sexual orientation.

These attitudinal changes in the medical environment fertilized the soil for the sudden blooming of “transgender clinics,” many connected with hospitals. Such clinics are designed to help the rapidly multiplying number of gender dysphoric patients get medical alterations and, by happy coincidence, create a lucrative new specialty for physicians willing to push the Hippocratic envelope.

Since the new normal involves treating the psychological condition of gender dysphoria with hormones and hormone-disrupting drugs, endocrinologists are at the center of the controversial new practices. The Endocrine Society, which purports to speak for medical professionals in hormone research and the clinical practice of endocrinology, has signaled that its members should ride the gender dysphoria wave regardless of concerns about safety and ethics. The Endocrine Society’s clinical practice guidelines on the treatment of dysphoria for both adults and children, first published in 2009 and then in revised form in 2017, suggest a dangerous elevation of political ideology over sound medical practice.

The guidelines are based on those issued by the World Professional Association for Transgender Health (WPATH), a political advocacy organization that masquerades as an association of health-care professionals (no medical credentials are required for membership). WPATH envisions “a world wherein people of all gender identities and gender expressions have access to evidence-based healthcare, social services, justice and equality.” The organization thus exists not to slow down the train of radical treatment for gender dysphoria but rather to rev up the engine.

Following WPATH’s lead, the Endocrine Society guidelines give a nod to the need for “safe and effective” hormone regimens for patients suffering from gender dysphoria. But the guidelines never acknowledge that no one really knows what’s “safe and effective” in this context, or even what those words mean.

Does “safe” indicate there are no irreversible side effects, or only that the hormone treatments don’t kill the patient? Does “effective” mean they fully convert the girl into a boy or the boy into a girl, or only that they make one sex look more like the other? Are safety and effectiveness achieved as long as the patient is no more suicidal after the treatment than he or she was before?

Involving Mental Health Professionals

Having glided over these problems, the guidelines also mention the advisability of involving a mental health professional in the diagnosis of dysphoria. But what if that doesn’t happen? Some physicians, such as the radical activist Dr. Johanna Olson-Kennedy in California, see no more need for a psychological evaluation in this case than in the case of a child who needs insulin. Or what if the evaluation is the cursory “check the box” assessment complained of by many parents trying to protect their confused children from this medical-political cabal? The guidelines are silent.

As for the actual hormone treatment, the guidelines recommend that a gender dysphoric child who begins showing signs of puberty should be placed on GnRH analogues such as Lupron (otherwise known as puberty blockers). There is no mention of the sometimes devastating side effects, and even the irreversibility, of such drugs.

When the adolescent goes on to request cross-hormone treatment (and patients who receive puberty blocking always go on to request cross-sex hormones, unlike up to 98 percent of patients who do not), the guidelines do mention the irreversible nature of the treatment, particularly permanent loss of fertility. So do they warn physicians not to do such a terrible thing to a teenager? No. They merely recommend administering a “gradually increasing dose” of the hormones to those teens who have “sufficient mental capacity to give informed consent.” What teens would those be? Those who are…16 years old.

So the Endocrine Society thinks a 16-year-old who is too immature to vote or join the army should be able to make the life-altering, and perhaps life-destroying, decision to give up the joys of children and family. (The guidelines do recommend counseling about “options for fertility preservation,” another subject beyond the capacity of a 16-year-old to even comprehend, much less make decisions about.)

As for the known side effects of using puberty blockers and cross-sex hormones to alter natural development rather than to treat illness or dysfunction––side effects such as decreased bone mineral density and increased cancer risk––the guidelines recommend that the professional team keep a lookout. Don’t stop it, and don’t take responsibility for having started it, just recognize it when you see it.

The truly disturbing aspect of the Endocrine Society’s conduct with respect to these guidelines is the admitted lack of good evidence for them. Consider the summary by Dr. Monique Robles, a pediatric critical care physician who explored the guidelines and their implementation at a transgender clinic she visited:

When I asked about the protocols used at the clinic, I learned they are not standardized, because not enough conclusive studies have been done. The Endocrine Society published their clinical practice guideline for gender dysphoria in 2017, which consists of twenty-eight recommendations. Each recommendation is graded by the strength (strong or weak) and the quality (very low, low, moderate, or high) of the evidence for it. Twenty-one percent of the recommendations are “ungraded good practice statements.” Of the graded recommendations, 45 percent have strong evidence and 55 percent have weak. In terms of the quality of evidence, 23 percent have very low quality evidence, 63 percent have low quality, and 14 percent have moderate. None of the recommendations is supported by high-quality evidence.

In other words, the Endocrine Society is sailing in uncharted seas. The people who will be swept overboard when the waves crash are innocent kids who have no idea what they’re doing and depend on supposed adults to protect them from their impulses. Those adults are in short supply.

Some Physicians Dissent

But not every physician has been cowed into submission by the LGBT bullies. Doctors in the American College of Pediatricians (ACPeds) can be described as profiles in courage, as can intrepid psychiatrists who bravely point out the naked emperor who seems to have seized control of the medical profession. Most recently, a group of endocrinologists have dared to challenge the politicized insanity in their own professional organization.

Their objections take the form of a letter to the editor of the Journal of Clinical Endocrinology and Metabolism (JCEM). In that letter Dr. Michael Laidlaw, Quentin Van Meter, Paul W. Hruz, Andre Van Mol, and William J. Malone lay out the case against the “gender affirmative treatment” (GAT) advocated by the Endocrine Society:

The consequences of this . . . GAT are not trivial and include potential sterility, sexual dysfunction, thromboembolic and cardiovascular disease, and malignancy.

Children with GD will outgrow this condition in 61-98% of cases by adulthood. There is currently no way to predict who will desist and who will remain dysphoric. The degree to which GAT has contributed to the rapidly increasing prevalence of GD in children is unknown. The recent phenomenon of teenage girls suddenly developing GD – Rapid Onset GD – without prior history through social contagion is particularly concerning.

When physicians have administered puberty blockers to help adolescent patients “buy time” to affirm their gender incongruence, “they simply ‘bought’ themselves lower bone density and the need for lifelong medical therapy.”

Patients treated with puberty blockers according to the guidelines (the vast majority of whom do not even attempt fertility preservation) “will have no prospect of biological offspring while on HDCS hormones and continuing on to gonadectomy.”

Cross-sex hormone treatments as recommended by the guidelines are associated with “increased ovarian cancer risk and metabolic abnormalities” in women and a five-fold increase in venous thromboembolism risk in males.

The health consequences of GAT are highly detrimental, the stated quality of evidence in the guidelines is low, and diagnostic certainty is poor. Furthermore, limited long-term outcome data fail to demonstrate long-term success in suicide prevention.

Given these undeniable medical and psychological risks of GAT, the physicians question how any child, adolescent, or parent can give truly informed consent. Moreover, “[h]ow can the physician ethically administer GAT knowing that a significant number of patients will be irreversibly harmed?”

The physicians call for randomized controlled clinical trials “to establish and validate the safety and efficacy of alternative treatment approaches for this vulnerable patient population.” In the meantime, they urge reliance on existing care models based on psychotherapy, which “have been shown to alleviate GD in children, thus avoiding the radical changes and health risks of GAT” – doing “the least harm with the most benefit.”

The doctors conclude by calling for a return to objective medicine in this highly charged political arena:

Physicians need to start examining GAT through the objective eye of the scientist-clinician rather than the ideological lens of the social activist. Far more children with gender dysphoria will ultimately be helped by this approach.

So these physicians have thrown down the gauntlet and are presumably bracing for the inevitable backlash from ideologues. But there’s safety in numbers, and their courage may catalyze more professional opposition to the politicization and corruption of medicine. Perhaps this resistance will expand to include all people, physicians and otherwise, of all ideological stripes, who will finally rise up to protect children from those who would sacrifice them as pawns in a political battle.