The rest of the Western world is rapidly backing off the “gender-affirming care” model for dealing with gender dysphoria in young children.
Gender clinics have been shut down, medical recommendations changed, and skepticism of current practices has skyrocketed. Norway followed Sweden and Great Britain in vastly scaling back the availability of hormones and surgery as medically advisable treatments for children.
Why? The evidence is weak to non-existent that it helps children, while the evidence that it creates permanent health problems is growing. Shocking, I know, that pumping children as young as 8 with puberty blockers and then hormones, followed by surgery might not be good for them.
Human beings practice medicine, and irrational enthusiasms, groupthink, and delusions can drive human beings. Eugenics was once well-established science, and frontal lobotomies were considered such a miracle treatment for mental illnesses or even mild behavioral problems in children that the inventor got a Nobel Prize.
Dr. Walter Freeman, an enthusiastic practicioner of the lobotomy actually converted a camper van into a mobile lobotomy surgical unit, where he performed over 2500 lobotomies until 1967. Some wag nicknamed his mobile unit the “lobotomobile.” His youngest patient was 12, and Freeman performed a lobotomy in his converted van on him.
Howard Dully was brought in for the procedure because his stepmother described him as “unbelievably defiant,” saying among other things: “He objects to going to bed but then sleeps well. He does a good deal of daydreaming and when asked about it he says ‘I don’t know.’ He turns the room’s lights on when there is broad sunlight outside.” After Howard’s stepmother visited with Dr. Freeman, he suggested that “the family should consider the possibility of changing Howard’s personality by means of transorbital lobotomy.”
So he suggested, and so he did. Howard has lived his life angry about what was stolen from him.
So horrible fads in medicine are nothing new, and no matter how devastating the possible side effect,s some doctors will enthusiastically embrace new miracle treatments as cure-alls, leaving in their wake thousands of victims.
They may consider themselves saviors, but they are practicing evil. Their victims will never recover what they lost.
Very few medical professionals are willing to stand up and fight the madness, because the consequences can be dire. As with the madness of the false “recovered memories” where preschoolers were coached by psychologists to make the most outlandish accuastions against caregivers that led to prosecutions and incarcerations for obviously innocent people, the madness can destroy anybody who gets in its way.
As Europe’s reverse in course shows, the madness usually passes, but the victims live with the consequences and the malefactors rarely pay a price, setting the stage for the next tragedy. Lots and lots of money is being made along the way, and professional careers are being made.
The Editor in Chief of the British Medical Journal has dipped his toe into the gender wars, very gently and carefully, pushing back against the gender affirming care model and especially America’s mad rush to trans the kids. While Kamran Abbasi doesn’t scream from the rooftops, as we culture warriors are trying to do, he does pop the epistemological bubble.
His basic point: big claims are being made, and there is little to no evidence for any of them. And lots of evidence that at least some of them are wrong, especially the claim that the treatments are harmless and reversible.
The debate on gender dysphoria perfectly captures all that is unsavoury about the intersection of science, medicine, and social media. Entrenched, even aggressively argued views are nothing new in science and medicine. But when it comes to gender dysphoria, just as with covid-19, there is little room for constructive dialogue. Unfortunately, what suffers is people’s welfare.
The priority for health professionals must be to offer the best possible care to their patients. Difficulties arise when the evidence base is preliminary or inconclusive. In that situation, when faced with a person seeking care, what is the best care to offer?
The dilemma is more acute if the person seeking care is a child or adolescent. This is the complex and difficult challenge that specialists in gender dysphoria must master to provide the best possible care to young people. John Launer describes the hostility and criticism that colleagues experienced at London’s Tavistock Clinic in striving “to make the best decisions they could in a situation where evidence was thin and the politics noisy” (doi:10.1136/bmj.p477).1
For those of you who don’t know, Tavistock is the clinic that was closed for practicing gender bending medicine a bit too enthusiastically. They basically transed everybody who walked through the door, with little to no evidence that they were actually helping anybody. It became a huge scandal because it became clear that they were doing the equivalent to what Dr. Freeman did with lobotomies: promote puberty blockers, hormones, and surgical treatments as cure alls, while threatening parents with the suggestion that failing to do so would be a death sentence for their children.
In other words, Tavistock was doing in Great Britain what doctors routinely do in America.
For a medical journal the focus is rightly on the quality of evidence behind a treatment recommendation. The BMJ has a longstanding and leading position in acknowledging the limits of evidence and advocating against overdiagnosis and overtreatment—even when the state of the science disagrees with individual preferences.
A review of the Gender Development Identity Service at the Tavistock Clinic by Hilary Cass reported interim findings last year acknowledging the difficulties that clinicians face when providing care to young people with gender related stress (doi:10.1136/bmj.p589 doi:10.1136/bmj.o629).23 The service had seen a rapid rise in referrals, and “there were different views held within the staff group about the appropriate clinical approach,” Cass wrote (https://cass.independent-review.uk/publications/interim-report).4 Cass’s final report will be delivered this year, but her interim report’s effect has been to question the evidence behind interventions, other than psychological support, being offered to young people seeking gender transition. Similar shifts are evident in other countries, such as Sweden.
The US, however, has moved in the opposite direction. An investigation by The BMJ finds that more and more young people are being offered medical and surgical intervention for gender transition, sometimes bypassing any psychological support (doi:10.1136/bmj.p382).5 Much of this clinical practice is supported by guidance from medical societies and associations, but closer inspection of that guidance finds that the strength of clinical recommendations is not in line with the strength of the evidence. The risk of overtreatment of gender dysphoria is real.
If we have the best interests of young people at heart, then surely our duty is to offer evidence informed care? And, if the evidence base is weak, we must provide the necessary support to young people as well as prioritising research to answer questions on issues that are causing a great deal of distress, much of which is amplified by social media.
As I said, his take is very gentle, but the message is clear enough: there is lots of support by the profession for a care model that has almost no evidence behind it.
This article was published only yesterday, but it coincides almost perfectly with Norway’s stepping back from its enthusiasm for gender affirming care.
It’s not like we pathologized the normal vicissitudes of being a teenager and used it to induct confused young people into a cult of medicalized self-harm or anything https://t.co/HOVyKkqtxx
— Wesley Yang (@wesyang) March 10, 2023
My own governor, Tim Walz, just issued an Executive Order protecting non-custodial parents who kidnap children to transport them to our state for gender bending treatments. His order is based upon the contention that science tells us that failure to sterilize and mutilate unhappy children may kill them, justifying a parent defying even court orders.
There is no science. These procedures are experimental. The consequences are permanent and in many cases dire.
This is madness, in exactly the same way that the enthusiasm for burning witches or scrambling the brains of bratty children is madness.
It must be stopped. As soon as humanly possible. And the perpetrators, this time, should suffer the consequences of their actions.
