The evidence behind this surge in treatment
The BMJ reports gender dysphoria in young people is rising—and so is professional disagreement.
In a new report from The BMJ Investigations Unit, Jennifer Block, investigations reporter, looks into the evidence base behind this surge in treatment.
More adolescents with no history of gender dysphoria are presenting at gender clinics. For example, a recent analysis of insurance claims found that nearly 18,000 US minors began taking puberty blockers or hormones from 2017 to 2021, the number rising each year.
Meanwhile, the number of US private clinics focused on providing hormones and surgeries have grown from just a few a decade ago to more than 100 today.
It could be that there was a huge underserved population of adolescents suffering from gender dysphoria and getting no help, or it could be that a huge population of unhappy adolescents has latched on to “gender dysphoria” as the source and meaning of their unhappiness. It could also be a mix of both. But I think one thing we can say is: it seems very unlikely that the explosion in attention to “gender dysphoria” has done nothing at all to nudge unhappy adolescents into latching on to it.
In short the BMJ is wondering if the spike in adolescents taking blockers or hormones and the spike in the number of clinics might have something to do with social contagion.
Ya think?
American medical professional groups are aligned in support of “gender affirming care” for gender dysphoria, which may include hormone treatment to suppress puberty and promote secondary sex characteristics, and surgical removal or augmentation of breasts, genitals, and other physical features.
And that fact is sad and alarming and baffling. “Hello Jane/John, nice to meet you, you’re unhappy in your body? Well let’s get you started on puberty blockers. Next month we’ll talk about lopping off those tits/that dick. See you then!”
Three organisations in particular have had a major role in shaping the US approach to gender dysphoria care: The World Professional Association for Transgender Health (WPATH), the American Academy of Pediatrics, and the Endocrine Society, all of which have guidelines or policies that support early medical treatment for gender dysphoria in young people.
All because…what? I don’t know. What the reason for this stampede is I don’t know. These aren’t kids on Twitter, these are adult medial professionals, yet here we are. One answer could be “Because they’re right and you’re wrong,” but sadly another could be that the profession is subject to lurches into recklessness sometimes. Lobotomy is the go-to example.
These endorsements are often cited to suggest that medical treatment is both uncontroversial and backed by rigorous science, but governing bodies around the world have come to different conclusions regarding the safety and efficacy of certain treatments, notes Block.
For example, Sweden’s National Board of Health and Welfare, which sets guidelines for care, determined earlier this year that the risks of puberty blockers and treatment with hormones “currently outweigh the possible benefits” for minors.
And NHS England, which is in the midst of an independent review of gender identity services, recently stated that there is “scarce and inconclusive evidence to support clinical decision-making” for minors with gender dysphoria, and that for most who present before puberty it will be a “transient phase,” requiring clinicians to focus on psychological support and to be “mindful” of the risks of even social transition.
Pause pause pause.
The cynic in me sees this as “We can’t let them make it through this “transient phase” without turning them into life-long medical dependents. If we wait too long, it’s too late and the money train has left the station.”
Why be a boring, ordinary homosexual when you could become a lifelong project in experimental drugs, hormones, and surgery? Don’t delay! Start your Gender Journey today! IF YOU DON”T, YOU’LL PROBABLY KILL YOURSELF!
I find it frustrating how the entire medical profession has to tip-toe around the subject of gender distress, holding back from saying things that are obvious. It’s patently obvious that this is the first generation of adolescents experiencing anything like this, in terms of the number of adolescents affected, and the degree to which they seem to be experiencing distress over sex and gender.
This is the only area of medicine I can think of that believes “an overabundance of caution” means caution about offending activists instead of caution about the health of vulnerable patients. It was out of an overabundance of caution over fears of being perceived as transphobic that they rushed to greenlight experimental treatments on vulnerable adolescents before they had any good data to back them up, and in the face of overwhelming data that shows none of this treatment is entirely necessary, plus a growing body of data that shows most of it may in fact be harmful.
“Gender dysphoria” is being defined ever more broadly, and treated more aggressively at the same time. Fifteen years ago it was “gender identity disorder” —a full-blown debilitating mental disorder. Now it’s just a feeling of distress. And plans are already underway to redefine it again, this time as “gender incongruence” — nothing more than a preference to be one sex over the other. But these softer thresholds aren’t being matched with softer treatments. It’s full-on sex changes for everyone; the more the better. So there it is, the underlying ideal, a bizarre new “human right”: sex is a choice.
A lot of people have drifted into the position that sex is a choice without properly examining it. It’s bad on multiple levels. At the lowest level, it’s not true: sex is not a choice; it’s something we’re all born with. Next level up: so-called “sex change” treatment doesn’t literally change anyone’s sex, because that’s impossible. This is all just cosmetics with sterility and other major medical problems as inconvenient side effects. And up on the social level, simply giving in to everyone’s desire to change their sex ignores the social factors that are influencing people to feel this way in the first place: namely, sexism and homophobia.
Because if men and women, gays and straights, were truly equal, and were truly free to live our lives the way we see fit, then why would anyone feel such an urgent need to switch their body from one sex to the other? Especially when they aren’t even really switching sexes; they’re just paying a massive medical price to undertake a lifelong pretence of switching?
This is so not a leap forward for humanity; it’s such an obvious lurch in the wrong direction.
This was at yesterday’s Let Women Speak event in Sydney. Looking forward to hearing KJK in Adelaide on Thursday.
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Oh man, Arty. NAILED it.
All I can say is– I’m glad this is not my problem. I’m glad I don’t have a kid who has jumped onto the trans bandwagon. I’m glad I’m quietly gay and married, and safely OLD and OUT OF IT.
At the beginning of this semester, for the first time, I had a student come to me and tell me that SHE is “non-binary” and “goes by they/them pronouns.” My response was a silent WTF?
Now, this week, I got a notice from a counselor that the student is having “difficulties” and needs special care “to have a successful semester,” meaning, she needs “extra time for assignments” and “days off” beyond my attendance requirements. This is not coming from a disabilities office, mind you, but from an adviser of sorts. I did not inquire why. I simply repeated the requirements listed on my syllabus.
Well said Artmorty.
It does seem odd the way the USA has so wholly dived into this. Or maybe not? From the outside the US health ‘system’ is very different from much of the west and non-west for that matter. It’s primarily a business with successful practitioners becoming very rich. While not devoid of regulation, there certainly seems to be much greater scope for variation in style of practice, treatments recommended, stance taken. Its really limited only by the governing body that a practitioner chooses to sign up with and the practitioners insurer. Add to that the way the whole trans issue has become subsumed into the culture war and been politicised. All largely on the coattails of the LGB movement. It’s a potent mix with medical practitioners seeing a large, lucrative, developing market where their hitherto niche skills can be applied, and many well meaning people vehemently and indiscriminately supporting the idea of transition without really having much idea of what it means, why, or what alternatives might exist. The cultural layers are very complex. The business layer is really more straightforward, although saying that the concept of free markets and personal choice are heavily embedded in US culture.
As a consultant I used to say that my clients were allowed to make mistakes as long as they were informed mistakes. I’m not at all sure that these kids and their families are properly informed.
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No they’re not being properly informed; but some seem to be happy to be misinformed, both parents and children. Children I can understand; they don’t know any better. But Parents? Trans away the gay? Sure! Put puberty on hold (it’s safe and revesible!) Okay! Change your sex? Yahoo! And this is coming from those treating them, as well as putative trans “support” and “advocacy” groups. Yes, this is a huge betrayal of trust that is going to take millions of dollars in lawsuits to slow down and stop. With friends like this…. But there is more information to be had. It’s not like contrary views aren’t out there and aren’t accessible. Hard to find? Perhaps. Impossible to find? No.
The life-long “instant fix” of transitioning might just feel like a lot less effort than a struggle to deal with underlying issues and comorbidities that are more likely to be the root cause of their distress. Sometimes reality sucks, and some things you can’t change. How seductive to think that instead of facing your demons, you can make them (supposedly) vanish by changing your sex and becoming a Stunning and Brave Special, Sacred Person.
And once again, If the recent surge in trans-identification were entirely due to previously closeted trans people coming out, and if living as the “wrong gender” has always been so intolerable that the only alternative to social and/or medical transition was usually suicide, we should until quite recently have seen an epidemic of inexplicable suicides followed by an equally inexplicable drop in suicide rates as all these closeted trans people began coming out en masse. I’m still not convinced the empirical data bears this out.
I think that the first question that should be asked when confronted with an extraordinary phenomenon, before seeking rash solutions with lifelong effects, should be “Is this true?” And if that turns out to be the case, the second question should be “What is at the root of it?” I think those two questions are the basics in the Skeptics Toolbox.
In the case of suicide for not being transitioned, I don’t see that anyone has asked that question, except for those evil transphobic TERFS, those damned “fascists for facts.”
Me? I think that the reason that gender-nonconforming kids end up killing themselves is that they are bullied for being different, and weaker. Human adolescents have that tendency seen in chickens – to peck at the weakest ones, and boys identified as being more effeminate than the norm are picked on. Been there. I never wanted to kill myself, but I sure wanted to get the hell out and start in a new school where I could feign macho and get away with it just to not get picked on. And I ended up having a fun senior year. It got better, in a sense, but there’s always more to the story and I’m not going to tell it here.
Would I have wanted to be transed as an adolescent going through that? I can look back and say no in hindsight, but if I had been exposed to a social media such as Tumblr or Discord, where interested parties were telling me that I was a girl born in the wrong body? I can’t say for sure. I was certainly impressionable enough to believe that I had been blessed by the Holy Spirit to speak in tongues, so it’s quite possible.
Rather than face the fact that we are not making much headway on dismantling the patriarchy, especially since the backlash has been effective at labeling such attempts as feminists foolishly denying that there is a difference between men and women, people are grasping at the answer that’s easy for society even if it harms a few thousand kids (we don’t want to hear about the dangers, do we Governor Walz?)
And, it’s profitable besides.
All the data I’ve seen points to suicide having increased in the past decade, especially among young people.