How Young Is Too Young for Sterilization? An influential transgender advocacy group releases new recommendations based on politics—not science. Lisa Selin Davis
https://www.commonsense.news/p/how-young-is-too-young-for-sterilization?utm_source=email
“To calm this strife, WPATH could have produced an evidence-based, apolitical document for physicians and others desperately seeking guidance. That’s not what happened. The new guidelines are “a weird amalgam of pseudo-medical speech, and political statements, and fetishistic practices,” said Julia Mason, a pediatrician in Oregon and a clinical advisor to the Society for Evidence-Based Gender Medicine. Dr. Mason added that she was dismayed that WPATH rejected the chapter on ethics that had been in an earlier draft, but retained the chapter on eunuchs. (These guidelines see eunuchs not as a deeply tragic part of history but as a “gender identity” which health care professionals should support.)”
What do you do if you are the parent of a child who believes they were born in the wrong body? What if your kid doesn’t fit the stereotypical behavior of their sex—your daughter is a tomboy, your son is effeminate—and a teacher or school counselor suggests they might be transgender? What if your teenager, uncomfortable with their changing body at puberty, says they will harm themselves—or worse—if they are not allowed to medically transition?
A growing number of parents are facing such questions in 2022. Desperate for answers, they are turning to the experts: the doctors, psychologists, and professional organizations devoted to diagnosing and treating gender dysphoria.
Among the most important of these associations is the World Professional Association for Transgender Health (WPATH). Founded in 1979, it is regarded by many as a premier advocacy group for medical care, education, and research regarding transgender and “gender diverse” people. Though it’s not a medical association—in addition to doctors and psychologists, its ranks include lawyers, educators, students, and electrologists—WPATH’s Standards of Care are considered by practitioners around the world to be the gold standard of recommendations for treating gender-related distress.
WPATH has just released a long-awaited update to those Standards of Care for people seeking “lasting personal comfort with their gendered selves.” This 260-page update— the eighth version of WPATH’s standards—includes several new chapters. One is on the increasing number of nonbinary individuals. A second is on supportive care for “those who identify as eunuchs” and “may also seek castration to better align their bodies with their gender identity” (yes, you read that right). A third, and perhaps the most anticipated, is on the treatment of transgender of gender diverse adolescents—added, writes WPATH, due to “the exponential growth in adolescent referral rates.”
This skyrocketing population of young people with gender dysphoria is fueling our culture wars. Some states, including Alabama and Arizona, have outlawed gender medical treatments of minors—including irreversible hormonal and surgical interventions—while other states are seeking to make it a felony to provide such care. In response, California aims to pass a law to become a sanctuary state for minors seeking gender medical interventions—even without parental consent.
Controversies have surrounded some of the country’s leading children’s hospitals, due to the young ages at which they offer life-altering surgeries—such as double mastectomies for girls, and surgeries for older teens that will permanently sterilize them. (These surgeries include vaginoplasties—the removal of penis and testicles and the creation of a neo-vagina from that tissue—for males, and hysterectomies for females.) Boston Children’s Hospital received a bomb threat after videos it made promoting its surgeries for young people were shared on Twitter. In another incident, the Transgender Health Clinic at Vanderbilt University Medical Center took down its entire website after a leaked video went viral. The video featured one of the clinic’s physicians describing how these surgeries have become “huge money makers” and that in some cases, an “entire clinic is supported just by the phalloplasty.”
To calm this strife, WPATH could have produced an evidence-based, apolitical document for physicians and others desperately seeking guidance. That’s not what happened.
The new guidelines are “a weird amalgam of pseudo-medical speech, and political statements, and fetishistic practices,” said Julia Mason, a pediatrician in Oregon and a clinical advisor to the Society for Evidence-Based Gender Medicine. Dr. Mason added that she was dismayed that WPATH rejected the chapter on ethics that had been in an earlier draft, but retained the chapter on eunuchs. (These guidelines see eunuchs not as a deeply tragic part of history but as a “gender identity” which health care professionals should support.)
The rollout of these new Standards of Care has been marred with confusion. Last December, WPATH released draft guidelines, which included minimum age recommendations for life-changing treatment, including age 14 for receiving estrogen or testosterone (the previous WPATH standards had been age 16), and allowing minors to have mastectomies (which the guidance often calls “chest-masculinization surgery”) beginning at age 15, and vaginoplasty and hysterectomy at 17.
The official guidelines were then released online to the public September 15. Within hours, a major correction was appended that said that the recommended age minimums were being removed from the final document. It turns out that between the draft release and the final version, WPATH had backtracked on providing age minimums, preferring to leave decisions to practitioners.
Why the reversal on such an important issue? WPATH is notoriously resistant to the press (the organization has not responded to my request for comment), and has offered no official explanation. But on Monday, The New York Times quoted WPATH President Marci Bowers—a surgeon who is herself transgender—as saying that reinstituting the young age recommendations will require “a better political climate.”
Then came a video from the WPATH annual conference last week that was posted on Twitter.
In the video, Amy Tishelman—a psychologist at Boston Children’s Hospital and the lead author of the WPATH chapter on children—discusses why the chapter on children was vaguely worded. “We were thinking, and it was scary for me, about the potential uses of the chapter for legal and insurance contexts,” Dr. Tishelman said. “What we didn’t want to do was create a chapter that would make it more likely that practitioners would be sued because they weren’t following exactly what we said.”
After an uproar, WPATH put out a statement claiming that the video “was taken out of context, twisted and used to spread hate and lies on social media.” It added that Dr. Tishelman was talking about “therapeutic support” and “not medical care.”
Comments are closed.
