Another Scandinavian country has weighed in on gender-affirming care in children and teens. This time it's Norway:
Ukom recommends that puberty delaying treatment (puberty blockers) and hormonal and surgical gender confirmation treatment for children and young people are defined as experimental treatment. This is particularly important for teenagers with gender dysphoria.
(Ukom is the Norwegian Healthcare Investigation Board, an independent government agency.)
Interestingly, Ukom takes the time to recommend that we all cool it:
We see that in the field of gender incongruence a demanding climate of expression has developed....We hear about fear and dread of making mistakes from all sides. Different opinions about what is the right treatment can create a difficult cross-pressure. Different emphasis and mention of what is necessary at group level can confuse and destroy the patient-therapist relationship and a personalized approach for the person concerned. There is a need to establish a constructive community for everyone who is engaged in good health care for people with gender incongruence.
Those Norwegians. They think the only thing that matters is what's best for kids, rather than making trans care into a war zone for scoring political points. That's adorable. We could teach them a thing or two about that.
Wise words from the north. I have to agree with them. Those early years are not the time to be making life decisions. Time to slow down for certain.
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I heard part of an NPR program yesterday that discussed a UK "office" that counseled children with gender dysphoria. The goal was to help them to deal with their feelings about their bodies, until they grew old enough to contemplate making "the change". Many by then had had second thoughts; others went on and got treatment.
As a person who thinks there actually are such things as "women" (not to mention "men"; I'm a traditionalist) this approach makes a lot of sense. It addresses the trauma of children/adolescents, and gives them more information and time to make this life-altering decision.
Yeah, I've got a lot of Norwegian ancestry.
Yes, "On Point" from WBUR interviewed the British author of a new book about the GIDS service at the Tavistock, which was the world's biggest gender clinic (it served all of England and Wales).
The British did a systematic review of the evidence and concluded that what they were doing at the Tavistock was not in the best interest of the children and the plan is to shut it down and replace it with multiple regional centers, who will be multidisciplinary and try to address the whole child, not just the gender issues.
There's good evidence that a majority of gender distressed kids will desist with puberty if they are given open minded psychological support and their parents refrain from renaming them and changing their pronouns. A majority discover they are homosexual, when the hormones kick in.
We need better data about which kids do well with transition and which will desist with time.
It's almost like these things work themselves out and there's no conspiracy of JK Rowling hating, Netflix-destroying, Jesse Singal-effigy burning enbees trying to keep real science down.
I'm still waiting for these things to "work themselves out" here in the United States. Right now, it's a mess. The major American medical associations have circled the wagons and are maintaining denial in the face of growing evidence that you can't just ask a child if they are trans and initiate medicalization based on that.
(That's a synopsis of "gender affirming care.")
They've circled their wagons due to the main US medical organizations looking at GAC for adolescents are almost exclusively sourcing their studies from a single researcher at Stanford, Jack Turban. Digging through the sources for these orgs, The Endocrine Society and WPATH, they both ultimately put most of the weight of their stances on the same works by this fella.
I don't think this guy is necessarily trying to be misleading, but I do think that the strength of his conclusions in the few of his papers on this topic that I've read are presented with much stronger confidence than I think is warranted from the data he analyzes. For example, he often bins the subjects according to various subjective classifications. In some instances, a subset may be set aside for it's own analysis with an "n" as low as 4. It's quite easy to significantly change some of his topline "%'s of x do y" into saying the opposite of what he concludes by just manipulating a few of the boundaries for those subjective classifications. I have no idea how I would do it better, so I defer to his judgement, but my confidence still isn't very high.
He frankly has no choice, since this is all experimental. The history of trans-youth to the point of having statistically valid numbers to work with is not yet here. This generation will have to be the guinea pigs in order to better determine what happens with future generations.
Some of the European medical establishment is overall more skeptical of his work leading to the non-unified stances within and between European nations. They cite some of the same issues with Turban's work that I mentioned here (as well as a few others).
I am very suspicious of a process or pronouncement that lumps blockers together with surgery.
Surgery can wait, it will do the same thing regardless of age.
In some respects, hormones can wait. Hormones give, they don't take away. They will do what they do regardless of age.
However, blockers will prevent a bunch of things that if allowed, will make later transition much harder. AND, they are generally reversable. If you go off them, the hormones do their thing and you get hair on your face, and growth on facial bones.
So the policy as stated seems to be stated from ignorance. I do endorse talking to children and taking some time to sort out what's going on with them. But blockers will buy exactly that time.
Totally wrong.
We got the same lies from the pediatric endocrinologist. Which is the answer to your next post about getting between doctors and patients. I can return later to give chapter and verse on why puberty blockers are not benign.
I see. Call me a liar (it seems I'm in good company) but then march off in a huff offering no evidence and not so much as an anecdote. Nice move there.
I'm sorry, but my storehouse of good faith doesn't contain enough to cover this.
Its called a life and it means I'm not always here to engage in conversation/education.
First, puberty blockers don't "buy time" to consider. That's the line .. but ask "how many kids proceed with medicalization following a course of puberty blockers?" And the answer is "99% because they know" Kids aren't right about 99% of anything. So Puberty Blockers are the first step on a VERY slippery stair case.
Second, they aren't benign. Time doesn't pause because you are delaying puberty... things happen regardless. Kids are supposed to experience an increase in bone density during puberty ... and that doesn't happen magically later. There is evidence of decreases in IQ of as much as 10 pts. And since the stuff is still off label use that hasn't gone through proper trials, no one really knows what's happening with sexual development in these kids. Finally, its simply not possible for kids to actually consent to something that a) they cannot comprehend and b) we can't fully express the known risks of.
If you're an MD you should have access to things like MedScape and the NIH. Look there for things like:
https://pubmed.ncbi.nlm.nih.gov/34418372/
https://www.medscape.com/viewarticle/958742
https://www.tandfonline.com/doi/full/10.1080/20502877.2022.2088048
So, the new book by Hannah Barnes is called "Time to Think," because that is what puberty blockers are promised to accomplish.
However, that is not what puberty blockers do. I am a pediatrician, and I became concerned about GAC (gender affirming care) when every single person, from the transwoman leading a "trans youth group" to the attending level endocrinologist told me that 99+% of kids put on puberty blockers go on to hormones and surgery.
They would tell me this like "see? the kids, they know who they are inside."
I thought about my 25+ year experience with kids as a pediatrician and thought "kids aren't 99% consistent on what they want to dress up as for Halloween this year, they change their minds all the time".
The fact that 99% persist when treated with PBs tells me that they are not a harmless reversible pause that gives them time and space in which to decide what to do next. They are an active intervention that concretizes what might have been a temporary cross-sex identification.
I am not an MD, but as a research psychologist I dealt with confounds throughout my career, so I would point out that minors receiving puberty blockers are not a randomly assigned treatment group. It may not be the medications themselves, but the personal, family and social factors that led to seeking them, that lead on to hormones and surgery.
I also have a much higher-level question: Why do we think we need to get in between doctors and their patients? Why do we think we know better, when we know the least of these three parties?
Seriously? Yes, politics doesn't have a place here but the process of building a consensus about what is and is not effective treatment is essential. And please, are you going to argue that "conversion therapy" should be allowed because clearly the therapist knows best?
The issue is that there's a gap between the enthusiasts and the rank and file pediatricians. I've had a friend say to me "Look, this is all very complicated and confusing, so I just want to refer to the specialists."
The problem is that the specialists are all believers in the idea that gender is internal, immutable and eternal. The existence of detranstitioners puts the lie to that belief, which is why they are attacked so fiercely.
First in Covid, first in Human rights, my ancestors would be proud! Maybe not, Vikings weren’t known for their tolerance. We must have gotten the barbarism out of our system a long time ago!
I think recent interpretations and archaeological finds have shown that the "barbarism" has been vastly overplayed. As one example, the supposed "Saxon invasion" of England now appears to have been just regular migration and settlement activity on the east side of the British Isles, which was apparently accepted and even welcomed by the indigenes.
The whole "King Arthur" legend seems to have been made up to give an unwarranted "heroic" history of battling savage invaders and uniting the scattered tribes into one glorious, conquering kingdom. Too bad; it was a great tale and has been revered for millennia ... but truths coming out are pretty cool, too.
Wasn’t it Alfred who defeated the barbarians and unified England? The victors right the history…
Ezra Klein has a podcast this week where his guest highlights the suicide / depression factor among transgender people. So again the answer is… let them do what they want or else they will kill themselves. I’m not personally interested in enabling them, but neither do I care if they take drugs and cut off parts of their bodies if it makes them feel better. I’ll keep my distance from them because, well, who knows?
Though I do wonder if it just delays the inevitable… that like so many with mental illness some will still be unhappy regardless. Again, not my problem.
“So gender dysphoria carries with it a number of other symptoms and especially when untreated. And that can range from depression and anxiety to low self-esteem, down to poor academic performance, struggling to build healthy relationships with friends or their family, all the way up to suicidality. And according to a vast array of research, transgender youth have a significantly higher rate of suicidality than their peers.”
Gay men and lesbians are proud and productive. Normal even! Transgender are fragile, suicidal, and suffering mental illness. Not exactly something I want to associate with. No wonder they have trouble making friends.
Good luck to them. They need it.
https://www.nytimes.com/2023/03/07/opinion/ezra-klein-podcast-gillian-branstetter.html?showTranscript=1
There are actually a lot of trans people who are happy and well-adjusted, but they are far less visible than the unhappy ones, because once fully transitioned they can usually pass for cis. The unhappy ones are visible because they complain a lot. Gay men and lesbians are visible even when they are not complaining because of their partners.
'I'll keep my distance' 'Not my problem', 'not something I want to associate with'. These are tells, as is the 'Asians thrive in America, why don't the blacks?' parallel you make between gay and trans people. You're a real enlightened piece of work, there, Justin. You have a lot of company in this thread--that may be something you'd want to contemplate, Kevin.
The article you link to doesn't say that they're going to 'slow' treatment. It acknowledges that there are gaps in knowledge, and that the emerging population of youth who identify as non-binary is especially under-documented. It also states that it's just as possible that some trans youth are under-served, as over served. It's a very balanced, responsible article, and it doesn't adopt a position other than to say that due to the limited agency of young people, 'special vigilance' is needed, and they emphasize this in particular for non-binary patients who were born female. This is such a different position and critical nuance, utterly elided in the glib, cursory way you frame it, and missing altogether in the fake paternalism of writers like Singal. No one seriously argues there shouldn't be probity and some humility about something of this enormity, but one side definitely likes to act as if Trans Care is this Wild West Gender Free For All.
Um, sure the translation never uses the word "slow" but the three recommendations are clearly intended to stop the current system and proceed with something more deliberate. Note that this is also a veiled but pointed repudiation of WPATH standards. And sorry, but I'd argue that WPATH SOC 8 is entirely absent of probity and humility and thus does constitute a Wild West Gender Free for All - I mean, no minimum age? And yeah, Planned Parenthood handing out hormones on "informed consent" is pretty Wild West too.
I read these three recommendations as "slowing" the current system.
1) "revise the national professional guideline" to "be based on a systematic summary of knowledge"
2) puberty blockers be "defined as experimental treatment". Because yeah, once you slap the big EXPERIMENTAL label on something more parents, providers and even kids will be more cautious and less willing to proceed.
3) the stuff about a National Registry and "unjustified variation in patient treatment" ... this one is a bit Rorschach but I read that as "we don't know what we're doing and maybe we should figure it out first".
Ah, the good ole comment thread 'Um', rivalled only by 'Actually' as a tell of the respondent's openness to fruitful exchange. Followed by expressions of certitude that the referenced text doesn't warrant or support: 'Clearly intended', 'IS also a veiled but pointed repudiation', 'ENTIRELY absent of' etc. Not a word acknowledging the parents and their children's agonizing dilemma, or the urgency that impels them to seek out treatment (which paternalistic dismissiveness notwithstanding, they ALL know is experimental on some level). From your first salvo, your tone has been of someone who wants to flatten out any dissent from your foregone conclusion, and caricature to the point of unrecognizability the dynamics of the treatment in question. In any matter this charged, this incendiary, that's an unproductive, boresome stance.
LOL .. and thus begins the tiresome Queer Shuffle. You make baseless claims, I provide counterpoints and even concede that one of my conclusions could be taken differently. You take offense that I dare suggest the Emperor is wearing no clothes and neither respond to my points nor offer any evidence of "probity and humility", and for good measure toss in chaff about pain, suffering and insist that I'm the problem.
Deal with the issues at hand and then we can have an actual conversation.
My position is not that people suffering gender dysphoria do not deserve care and consideration, but that medicalization is fraught with problems and if we simply looked at honest evidence then we - like Finland, Sweden, UK,
Norway, etc - would cease putting kids into this system without proper controls. You know, controls like maybe making sure we have some actual studies with control groups and random treatments. Controls like ongoing panels to track the effects of hormones. Controls like actual FDA approval of drugs for this use. Controls like making it more difficult to obtain powerful medications than getting a tattoo.
Did you know that Sunday was Detransition Awareness Day? Please be sure your concerns for the agonizing dilemma faced by these patients and families includes the lifelong pain and loss these detransitioners will endure.