Very interesting indeed. This sign of desperation in the guise of human rights is worrying as it puts transgender treatment in the same category as a new suit or dress from Kmart.
With medical criteria no longer a factor, doctors aren't necessary. A Certificate IV in Appearance & Bodily Stitching should do the job.
It seems the shift from Gender Medicine to Transhumanism has begun.
"What the article says, in very simple terms, is that the measures of the effectiveness of gender affirming medical treatment (GAMT) which researchers have used to date, such as improvement of psychological function and absence of regret, are irrelevant. Treatments should be provided simply because young people desire them."
My hot take is that the entire field of so-called gender medicine should immediately formalize this position as their exclusive standard of care. There should be a massive campaign to publicize this far and wide.
Why? Because there are names for the type of medical treatments that are provided simply because the patient desires them. If the therapies alter the person's apperance, as "top" and "bottom" surgeries do, then they're called "cosmetic." Nonessential treatments are also called "elective."
Not only would gender medicine not be "life-saving," it would no longer be covered by insurance. And so gender medicine bites the dust!
A person can dream, can't he?
It is hard to believe that the gender-medicine industrial complex could be brought down that easily. Still, it's sometimes worth pushing on doors that appear to be locked. They may just swing wide open.
As they did in the original Dutch Protocol, the paper's authors ignore the question of the harmful effects of puberty blockers and wrong-sex hormones and how that should be balanced against claimed benefits. That is unconscionable.
Sterility, lack of sexual function, pelvic floor dysfunction, weak bones, lack of cognitive/emotional development, lowered IQ, premature menopause symptoms and prospects for future premature cardiac issues and shorted lifespan all await kids beginning transition. No self-assessed claim to improved mental health is worth that.
Please don't get sucked into judging the issue on terms set by trans activists. If we are merely reactive to what they say, we will be led by the nose into bad analysis.
I got my daughter’s middle school into compliance by reading the state laws.
They allowed my daughter to attend GSA club without my approval. Because I said no, my child lied “I don’t feel safe telling my mom” and was allowed to come.
Then, I also found out, anecdotally, that the outgoing principal who approved the GSA Club thought it was Girl Scouts of America.
Finally my child told me “most kids’ parents signed permission slips.”
What did compliance look like the next year? Me proactively telling the GSA Club sponsor not to let my child attend, and the school actually spelling out what the club is in communications—Genders and Sexualities Alliance. Informed Consent!
If you smell something fishy, look for it.
This year, the GSA sponsor is my kid’s teacher. I take the high road and discuss academics with her.
Parents need legal protection to get ahead of this stuff. It’s an abomination. I don’t see it getting better.
My daughter’s friend group — and many families in our community— are affirming parents of ROGD FTM girls.
Nice piece. There may be more than one of course, but a quick search reveals an Ezra Oosthoek (“they/them” of course!) who is but one year into a PhD programme, having graduated with a degree in Anthropology and Sociology and an MA in… “Gender Studies”.
Thank you for bringing attention to this article, and for your important and insightful critique. This is why, in the authors' own words, what they offer ('GAMT') should be located outside of the profession of medicine, outside of established clinical medical methodology, outside of science, evidence and reason, outside of rational and respectful discourse, and outside of medical ethics. That the article was published in a peer-reviewed journal of medical ethics, shows how far there is still go for 'GAMT' to be located in its proper place, far, far away from a world view and medical profession that is grounded in science and reason, and sound and honest ethics.
Thorough article, but was this necessary: “the ideological debate is split into two opposing camps. One, which includes some radical feminists and most religious conservatives opposes all forms of gender affirming treatments”? There are a lot of professionals who oppose gender treatment, so it seems biased and inflammatory to call out only these two groups.
Good article, but it's just the end of the beginning. The point of moving from a healthcare to a rights framework is to exempt these elective gender treatments from medical regulation. Planned Parenthood is already a significant supplier of testosterone to girls and young women, for example.
It also means eliminating the 'gatekeeping' of psychiatry and psychotherapy professionals who might challenge whether the patient has significant enough gender dysphoria to justify the risks of deliberate endocrinological disruption.
Edit: This is Leslie, retired physician. Substack gets us mixed up even with separate e-mail addresses.
Modest demurral:
As long as the treatment has to be prescribed by a physician or performed by a surgeon, it will always fall under medical regulation. Think purely cosmetic surgery. A doctor can still lose his licence or get sued for malpractice even with purely appearance-based treatment for body embodiment. A doctor could do tattoos if he wanted to. If he did, the tattoo would have to meet the standard expected of a physician, not a tattoo artist. So doctors don't do tattoos, for that reason. (And normal medicine pays better.) What changes in a rights-based appearance rubric is the doctrine of medical necessity. This is what insurance companies use to decide whether to reimburse for something. If a treatment is deemed "cosmetic" or "enhancing embodiment goals", it is no longer medically necessary and insurance doesn't have to pay.
Medical necessity is also what the medical regulators use to decide if treatment met a standard of, well, being necessary. If a doctor removes an gall-bladder or does a hysterectomy, there is an expectation that the patient needed it, based on the doctor's opinion and advice that she needed it. Patients don't come in to the doctor's office and say I need my gall-bladder out. If one did, our first question would be, "Why do you think you need your gall-bladder out?" But they do come to a plastic surgeon and say, "I want a smaller nose and bigger breasts." The surgeon generally takes her at her word and schedules the surgery. His first question would just be, How small and how big?
You're right that in cosmetic or "rights-based" care, there is no gatekeeping from the mental health disciplines. You want your boobs bigger, we'll do that. You want 'em removed, we'll do that too. Do you want the chest sculpting option at extra cost? Or the basic surgery? Order off the menu and pay cash on the barrel head.
Thanks for the comment, Leslie. One would hope that medical regulation would still apply in the case of regulated drugs, but for an example of how this can fail, see the GenderGP online clinic.
I've also been provided with a report of falsified documentation in which a testosterone prescription for gender dysphoria was classified by Planned Parenthood under the billing code 'endocrine disorder: unspecified' even though no blood work was carried out on the patient.
In the case of UK abortion providers, which have long worked within the rights-based framework, 97% to 98% of abortions were carried out under the insanity clause of the 1967 Act even though there were no psychiatric evaluations. We could call that 'pregnancy dysphoria'.
The only reprimand I've ever heard of for a UK abortion provider was when an NHS hospital was caught pre-signing blank forms confirming that the patient had met the requirements of the 1967 Act. The Act's requirement for two doctors' signatures for an abortion was done away with in emergency Covid-19 legislation.
So, we have evidence that in practice, once a rights-based framework is applied to a medical or surgical procedure, regulation is bypassed within the system and eventually withers away. And then we have gender clinic tourism in which patients travel outside of the regulated zone to obtain treatment that would be regulated or illegal in their own jurisdiction.
The only way out of this I can see is to turn the tables on the rights argument, saying that people who have gender dysphoria or simply want to alter their gender presentation have the right to legal protection from unethical doctors offering treatments which lack an evidence base, and medical or surgical experimentation. The bizarre procedures carried out on transgender people would never be allowed in a cohort that wasn't mentally ill.
"Treatments should be provided simply because young people desire them." And those treatments should continue even if it shatters the kid's parents and families. Seems heartless to not consider the ripple effects of senseless, elective body modifications and the accompanying falsehoods that are forced on grieving parents and society. But that is where we are at currently.
"...the (implicit) normative expectation that GAMT should result in improvements across multiple physical, psychological, and psychosocial outcomes risks undermining the provision of this care practice"
IOW, providing this treatment is paramount, and anything as commonplace as expecting that the patient will feel better afterwards is contemptuous.
If queer theory informed the normative, implicit-bias practice of bridge engineering, no one could cross a river.
As the parent of a child who has been taking cross sex hormones for three years starting between rounds of inpatient anorexia treatment, this article makes me absolutely crazy. I once asked my other non binary daughter if someone wanted their arm chopped off should a doctor do it and she said yes! This is not medicine.
The term “gender medicine” seems peculiar, as gender is a social construct and a personal feeling. Can it be addressed with physical ‘medicine’, or should it solely involve psychological or psychiatric intervention? Perhaps the term “gender medical intervention” is more fitting, as it could encompass surgical procedures for a psychiatric condition, similar to how lobotomies were once used.
You won't get a clear answer on gender being a social construct from the gender industry, because postmodernism is only one of the influences on it. The other is heretical Christianity, influenced by Eastern religion including Buddhism.
Because gnosis is secret wisdom or insight, it cannot be shared with unbelievers, let alone debated. Much like how Scientologists cannot reveal the 'truth' unless the devotee has progressed through all levels of the cult.
The compromise position between the two influences is that gender is a mystical essence, but how that gender is performed is socially constructed. For example: my soul is male, society requires males to be tough.
Very interesting indeed. This sign of desperation in the guise of human rights is worrying as it puts transgender treatment in the same category as a new suit or dress from Kmart.
With medical criteria no longer a factor, doctors aren't necessary. A Certificate IV in Appearance & Bodily Stitching should do the job.
It seems the shift from Gender Medicine to Transhumanism has begun.
"What the article says, in very simple terms, is that the measures of the effectiveness of gender affirming medical treatment (GAMT) which researchers have used to date, such as improvement of psychological function and absence of regret, are irrelevant. Treatments should be provided simply because young people desire them."
My hot take is that the entire field of so-called gender medicine should immediately formalize this position as their exclusive standard of care. There should be a massive campaign to publicize this far and wide.
Why? Because there are names for the type of medical treatments that are provided simply because the patient desires them. If the therapies alter the person's apperance, as "top" and "bottom" surgeries do, then they're called "cosmetic." Nonessential treatments are also called "elective."
Not only would gender medicine not be "life-saving," it would no longer be covered by insurance. And so gender medicine bites the dust!
A person can dream, can't he?
It is hard to believe that the gender-medicine industrial complex could be brought down that easily. Still, it's sometimes worth pushing on doors that appear to be locked. They may just swing wide open.
As they did in the original Dutch Protocol, the paper's authors ignore the question of the harmful effects of puberty blockers and wrong-sex hormones and how that should be balanced against claimed benefits. That is unconscionable.
Sterility, lack of sexual function, pelvic floor dysfunction, weak bones, lack of cognitive/emotional development, lowered IQ, premature menopause symptoms and prospects for future premature cardiac issues and shorted lifespan all await kids beginning transition. No self-assessed claim to improved mental health is worth that.
Please don't get sucked into judging the issue on terms set by trans activists. If we are merely reactive to what they say, we will be led by the nose into bad analysis.
IT’S NOT JUST MEDICAL.
I got my daughter’s middle school into compliance by reading the state laws.
They allowed my daughter to attend GSA club without my approval. Because I said no, my child lied “I don’t feel safe telling my mom” and was allowed to come.
Then, I also found out, anecdotally, that the outgoing principal who approved the GSA Club thought it was Girl Scouts of America.
Finally my child told me “most kids’ parents signed permission slips.”
What did compliance look like the next year? Me proactively telling the GSA Club sponsor not to let my child attend, and the school actually spelling out what the club is in communications—Genders and Sexualities Alliance. Informed Consent!
If you smell something fishy, look for it.
This year, the GSA sponsor is my kid’s teacher. I take the high road and discuss academics with her.
Parents need legal protection to get ahead of this stuff. It’s an abomination. I don’t see it getting better.
My daughter’s friend group — and many families in our community— are affirming parents of ROGD FTM girls.
Nice piece. There may be more than one of course, but a quick search reveals an Ezra Oosthoek (“they/them” of course!) who is but one year into a PhD programme, having graduated with a degree in Anthropology and Sociology and an MA in… “Gender Studies”.
Thank you for bringing attention to this article, and for your important and insightful critique. This is why, in the authors' own words, what they offer ('GAMT') should be located outside of the profession of medicine, outside of established clinical medical methodology, outside of science, evidence and reason, outside of rational and respectful discourse, and outside of medical ethics. That the article was published in a peer-reviewed journal of medical ethics, shows how far there is still go for 'GAMT' to be located in its proper place, far, far away from a world view and medical profession that is grounded in science and reason, and sound and honest ethics.
Pathetic attempt to use verbiage to cover up failure of this ideologically based harmful non treatment
Thorough article, but was this necessary: “the ideological debate is split into two opposing camps. One, which includes some radical feminists and most religious conservatives opposes all forms of gender affirming treatments”? There are a lot of professionals who oppose gender treatment, so it seems biased and inflammatory to call out only these two groups.
Good article, but it's just the end of the beginning. The point of moving from a healthcare to a rights framework is to exempt these elective gender treatments from medical regulation. Planned Parenthood is already a significant supplier of testosterone to girls and young women, for example.
It also means eliminating the 'gatekeeping' of psychiatry and psychotherapy professionals who might challenge whether the patient has significant enough gender dysphoria to justify the risks of deliberate endocrinological disruption.
terrifying
Edit: This is Leslie, retired physician. Substack gets us mixed up even with separate e-mail addresses.
Modest demurral:
As long as the treatment has to be prescribed by a physician or performed by a surgeon, it will always fall under medical regulation. Think purely cosmetic surgery. A doctor can still lose his licence or get sued for malpractice even with purely appearance-based treatment for body embodiment. A doctor could do tattoos if he wanted to. If he did, the tattoo would have to meet the standard expected of a physician, not a tattoo artist. So doctors don't do tattoos, for that reason. (And normal medicine pays better.) What changes in a rights-based appearance rubric is the doctrine of medical necessity. This is what insurance companies use to decide whether to reimburse for something. If a treatment is deemed "cosmetic" or "enhancing embodiment goals", it is no longer medically necessary and insurance doesn't have to pay.
Medical necessity is also what the medical regulators use to decide if treatment met a standard of, well, being necessary. If a doctor removes an gall-bladder or does a hysterectomy, there is an expectation that the patient needed it, based on the doctor's opinion and advice that she needed it. Patients don't come in to the doctor's office and say I need my gall-bladder out. If one did, our first question would be, "Why do you think you need your gall-bladder out?" But they do come to a plastic surgeon and say, "I want a smaller nose and bigger breasts." The surgeon generally takes her at her word and schedules the surgery. His first question would just be, How small and how big?
You're right that in cosmetic or "rights-based" care, there is no gatekeeping from the mental health disciplines. You want your boobs bigger, we'll do that. You want 'em removed, we'll do that too. Do you want the chest sculpting option at extra cost? Or the basic surgery? Order off the menu and pay cash on the barrel head.
Thanks for the comment, Leslie. One would hope that medical regulation would still apply in the case of regulated drugs, but for an example of how this can fail, see the GenderGP online clinic.
I've also been provided with a report of falsified documentation in which a testosterone prescription for gender dysphoria was classified by Planned Parenthood under the billing code 'endocrine disorder: unspecified' even though no blood work was carried out on the patient.
In the case of UK abortion providers, which have long worked within the rights-based framework, 97% to 98% of abortions were carried out under the insanity clause of the 1967 Act even though there were no psychiatric evaluations. We could call that 'pregnancy dysphoria'.
The only reprimand I've ever heard of for a UK abortion provider was when an NHS hospital was caught pre-signing blank forms confirming that the patient had met the requirements of the 1967 Act. The Act's requirement for two doctors' signatures for an abortion was done away with in emergency Covid-19 legislation.
So, we have evidence that in practice, once a rights-based framework is applied to a medical or surgical procedure, regulation is bypassed within the system and eventually withers away. And then we have gender clinic tourism in which patients travel outside of the regulated zone to obtain treatment that would be regulated or illegal in their own jurisdiction.
The only way out of this I can see is to turn the tables on the rights argument, saying that people who have gender dysphoria or simply want to alter their gender presentation have the right to legal protection from unethical doctors offering treatments which lack an evidence base, and medical or surgical experimentation. The bizarre procedures carried out on transgender people would never be allowed in a cohort that wasn't mentally ill.
"Treatments should be provided simply because young people desire them." And those treatments should continue even if it shatters the kid's parents and families. Seems heartless to not consider the ripple effects of senseless, elective body modifications and the accompanying falsehoods that are forced on grieving parents and society. But that is where we are at currently.
"...the (implicit) normative expectation that GAMT should result in improvements across multiple physical, psychological, and psychosocial outcomes risks undermining the provision of this care practice"
IOW, providing this treatment is paramount, and anything as commonplace as expecting that the patient will feel better afterwards is contemptuous.
If queer theory informed the normative, implicit-bias practice of bridge engineering, no one could cross a river.
As the parent of a child who has been taking cross sex hormones for three years starting between rounds of inpatient anorexia treatment, this article makes me absolutely crazy. I once asked my other non binary daughter if someone wanted their arm chopped off should a doctor do it and she said yes! This is not medicine.
Excellent analysis.
I hope this piece gets wide exposure!
The term “gender medicine” seems peculiar, as gender is a social construct and a personal feeling. Can it be addressed with physical ‘medicine’, or should it solely involve psychological or psychiatric intervention? Perhaps the term “gender medical intervention” is more fitting, as it could encompass surgical procedures for a psychiatric condition, similar to how lobotomies were once used.
You won't get a clear answer on gender being a social construct from the gender industry, because postmodernism is only one of the influences on it. The other is heretical Christianity, influenced by Eastern religion including Buddhism.
Because gnosis is secret wisdom or insight, it cannot be shared with unbelievers, let alone debated. Much like how Scientologists cannot reveal the 'truth' unless the devotee has progressed through all levels of the cult.
The compromise position between the two influences is that gender is a mystical essence, but how that gender is performed is socially constructed. For example: my soul is male, society requires males to be tough.