FIRST AFFIRM THE EVIDENCE
“Those who can make you believe absurdities, can make you commit atrocities.” Voltaire
Affirm - verb. To state as a fact; assert strongly; declare one’s support for; accept or confirm the validity of.
Gender - noun. Grammatical term from the 14th century referring to classes of noun designated as masculine, feminine, or neuter. Has been used synonymously with the term sex which refers to the binary of male vs female. More contemporary use refers to cultural and social differences and may encompass a more broad range of identities than the binary of male and female.
Recently, I became aware there has been a huge increase in the number of young children and adolescents presenting with confusion regarding their sex or gender and seeking affirmation that their chosen gender represents reality. Girls are saying they are boys and boys are saying they are girls. .
Like most people, I never gave much thought to the issue of transsexualism (now referred to as transgenderism) because the numbers of transsexuals (transgenders) were but a tiny sliver of the population representing less than 1%, although that percentage has been gradually trending upward. My libertarian inclinations lead me to believe that what consenting ADULTS are doing with their private time is their business and not mine.
But a reported sudden 5,000% increase in gender confused CHILDREN is an issue of epidemic proportions that requires responsible adult understanding and supervision. Then I read that many of these children were being subjected to irreversible medical ‘treatments’ and surgical mutilations of normal anatomy. These medical and surgical ‘treatments’ seemed extreme and I began to wonder if any of this could meet an evidence based standard of care? As a parent and grandparent and a physician, I needed to know more.
SUDDEN INCREASE IN NUMBERS OF GENDER CONFUSED CHILDREN
There was a time 15-20 years ago when children presenting with gender confusion were very rare. There were but three gender clinics in the world and they would see 9 - 18 patients annually. The vast majority of the patients were pre-schoolers and prepubescent and were reported to not have psychiatric comorbidities.
The first gender clinic for children in the U.S. was opened at Boston Children’s Hospital by Dr. Norman Spack in 2007. Megyn Kelley reported on this guy in 2008 and that Fox News video is contained within this article. Now there are at least 300 hospitals, clinics, and offices where gender confused youth may go to have their chosen gender affirmed with hormones and procedures. The majority of these clinics have developed since 2010.
The explosive growth in gender confused children is now mostly occurring in adolescents and, in a reversal of the male/female ratio, the majority are now females. Most also have other psychiatric diagnoses - anxiety, depression, autism spectrum, PTSD from dysfunctional families, ADHD. Onset is rapid in these children who did not previously manifest the desire to become the opposite sex.
Four developments come to mind that likely explains how this explosive growth has been created and promoted:
1) Obamacare requires Medicare, Medicaid, and private insurance to pay for medical and surgical procedures used for gender transitioning. Trump canceled the insurance requirement to pay for these expensive “treatments” but Biden reactivated the directive in his first 100 days in office. Also, a later addition to Obamacare stated that insurance companies could not deny coverage to people who change their gender identity (whether they self-identify as male or female, or whatever).
2) Social media has promoted the gay and transexual lifestyle as the cool thing to do and makes the false promise of social acceptance to those children and adolescents who feel alone and are struggling with being accepted by their peers. This has been referred to as a social contagion and young pre-teen and teenage girls are particularly susceptible to a social contagion as was observed a few years ago with anorexia.
A high prevalence of anxiety, depression, autism spectrum, and PTSD from broken and abusive family upbringing have led many of these kids to immerse themselves into a seductive social media promising them relief from their psychologic pain and discomfort and all they have to do is heroically transition to another gender.
3) Follow the money. A multi-billion dollar gender affirmation industry has arisen within the U.S. and is more than willing to profit while permanently altering the bodies and brains of these children and turning them into life-long patients. Large medical centers in the U.S. and pediatric hospitals advertise they offer these treatments for children. The “profit” link just cited contains a video from Vanderbilt Medical Center bragging about all the money to be made from surgeries and hormones inflicted upon children. Nationally, children presenting for gender affirmation was a nearly $5 billion dollar business in 2022. The LGBTQ agenda which includes gender affirmation activism is extremely well funded to promote their causes in the U.S. and around the globe by billionaire individuals, families, and foundations.
4) Public (i.e. government) education, gender clinics, Planned Parenthood, and perhaps your child’s pediatrician have all been primed to recognize (and recruit) these troubled kids and hustle them into the assembly line of social transitioning, puberty blockers leading to cross-sex hormones, and onto gender affirming surgeries.
THE SEXUALIZATION OF CHILDREN
The sexualization of our children seems to be everywhere now. Corporate and government celebration of “pride month”. Drag queen story hours in taxpayer funded grade schools and local libraries. LGBTQ parades chanting “we’re coming for your children” and featuring nudity and sexual acts with adults and children cheering them on. Middle age nude men standing on sidewalks while children walk by. Tik Tok and other social media outlets are actively promoting sexuality, alternative lifestyles, and gender transformation to the young and impressionable minds of children whose brains will not be anatomically and psychologically mature for another 10-20 years.
And I emphasize, we are discussing the “grooming” and sexual exploitation of children here; adults are considered capable of weighing evidence and risks and making adult decisions regarding their own bodies and their own lives. But children are dependent upon adults for protection and supervision. We recognize their brains are not yet fully formed and capable of mature decisions that take into account risk and benefit. That is the basis for age of consent. We don’t let them buy guns or alcohol, drive cars, vote, take medicine from a school nurse or get a tattoo or go to a tanning salon without parental consent.
The only inherent qualifications necessary to have protective concerns for children is to be a human being. All forms of animal life are endowed with the genetics to protect the young, for it is the young who guarantee the continuation of the species. Humans are no different; it is in our DNA to protect our children. Sure, there have been deviants throughout recorded history who have sexually preyed upon children or imprisoned them into forced labor, but the vast majority of humans have protected and nurtured children. However, unless you have moved off the grid and are living in a cave somewhere, it has become in-your-face obvious that things have changed.
So, what’s different in how we are protecting our children? Government, schools, and formerly trusted medical professional organizations have been promoting a gender ideology that moves physiologically immature, psychologically troubled and vulnerable children into an experiment of irreversible medical and surgical “treatments” called gender affirmation.
The gender affirmation process begins with what is called social transition which allows and/or encourages the change in hair style, clothes, and pronouns the child has decided are consistent with his or her self-perceived gender (male, female, or something else). The next step in the process is the administration of GnRH analogues (so called “puberty blockers”) in the early stages of puberty. After a few months or a year or two, the puberty blockers are replaced with cross-sex hormones (testosterone for the females and estrogens for the males). The last stage of the affirmation process are the irreversible and mutilating surgeries which I will describe later in this discussion.
Keep in mind these cross sex hormones or the “puberty blockers” do not have FDA approval for “gender affirmation”. They are all prescribed “off label” and should be looked upon as experimental and only to be given within the confines, indications, and parameters of a cautiously conducted research protocol with strict inclusion criteria.
THE ORIGINS OF GENDER IDEOLOGY
Alfred Kinsey was a PhD zoologist who began doing sex research in the 1940’s. He published a book in 1948 titled “Sexual Behavior In the Human Male” and a few years later published a book dealing with female sexual behavior. He became celebrated and famous and has been called the “father of the sexual revolution”. But upon more recent, objective review of his research data, it is evident his research techniques were immoral and unethical and involved sex with his researchers and with his students. In his 1947 book, there are data tables tabulating the number and duration of orgasms in infants and children between the ages of 5 months and 14 years of age. People familiar with his research and techniques state he sexually abused close to 300 children in developing data for his books. Much of the sex education taught in public schools is based upon Kinsey’s work. If you want to learn more about Kinsey, I refer you to this reference which includes a video.
John Money was a PhD at Johns Hopkins and became interested in the rare occurrence of children that were born with ambiguous sexual anatomy. He developed the concept that sex was different than gender - sex referred to the binary biology at birth - male vs female. But gender was a psychosocial construct and was malleable; it could change. He developed the terms gender identity, sexual orientation and gender role. Dr. Money had the opportunity to test his theory of sex vs. gender, nature vs. nurture when he was contacted by the desperate parents of the Reimer twins.
Bruce and Bryan Reimer were normal identical male twins born in 1965. When 8 months old, Bruce underwent a circumcision procedure and his penis was accidentally destroyed by the surgeon who was using an electrocautery device. This was a dream come true for Dr. Money who heard of the case and convinced the desperate parents their only option was to raise the child as a girl. The parents could not reveal the biologic truth to Bruce who became Brenda, or to his twin brother, Bryan, who would serve as the experimental control for the sex vs gender experiment.
The story of the Reimer twins is a sordid but instructive tale of human experimentation and exploitation, child sexual abuse, but is an important story due to its influence on the subsequent development of transexual and gender ideology. Dr. Money publicized the experiment as a stunning success that proved his theory that gender was a psychosocial construct and could be “assigned” opposite the biologic sex. His concepts became baked into the literature and teachings of gender ideology that continues today. But his unethical and immoral experiment on the Reimer children was an epic disaster for the twins, both of whom committed suicide in their 30’s. I encourage you watch the short BBC documentary of the story.
Before we leave John Money, I will include a quote of his that I fear is prescient as to where the transgender (TG) activists and their corporate, government, and education enablers are leading the sexualization of our children: the social acceptance and perhaps the legalization of pedophilia. I know that is hard to believe, but there are absurdities and atrocities happening now that we wouldn’t have believed just 5 years ago. Dr. Money’s quote:
“If I were to see the case of a boy aged ten or eleven who’s intensely erotically attracted toward a man in his twenties or thirties, if the relationship is totally mutual, and the bonding is genuinely totally mutual, then I would not call it pathological in any way.”
GENDER IDENTITY DISORDER BECOMES MEDICALIZED
Let’s start with a brief explanation of how terminology and diagnostic classification was changed to facilitate and encourage the use of medications and surgery to treat what was previously in the domain of psychiatric diagnosis and intervention.
The Diagnostic and Statistical Manual (DSM) originates with the American Psychiatric Association (APA) and contains a taxonomy of psychiatric diagnoses. The term “transsexualism” first appeared in the DSM-III in 1980. DSM-IV arrived in 1994 and replaced transsexualism with “gender identity disorder” with the stated reason of reducing the stigma of having a psychiatric diagnosis. But the TG advocates and some clinicians remained upset and thought this diagnostic category made the term and concept of identity seem derogatory and pathologic rather than being a true disorder.
In 2013, along came DSM-5 and gender identity disorder was eliminated and replaced with “gender dysphoria”. The term “dysphoria” is the opposite of euphoria and is a symptom. As stated on the APA website, “The presence of gender variance is not the pathology but dysphoria is from the distress caused by the body and mind not aligning and/or societal marginalization of gender-variant people.”
So, according to the APA, gender variance is when the body and mind are not aligned and then society “marginalizes” these gender-variant people and causes the symptoms and distress called dysphoria which then needs medical (hormones) and surgical treatments to relieve that dysphoria. Thus the evolutionary medicalization of transsexualism. To put further emphasis on all this, ICD-11 is the International Classification of Diseases 11th revision and replaced the diagnosis of gender identity disorder with gender incongruence and the diagnosis was moved out of the mental disorders section into a new chapter called “Conditions Related to Sexual Health”.
With the strategic and clever use of ever-changing words and classifications, the professional organizations and clinicians who write the governing diagnostic references have taken what was known as transsexualism and gender disorders of children and adolescents out of a psychiatric connotation in need of psychiatric intervention and counseling and have medicalized those diagnoses, which facilitates, promotes, and ‘normalizes’ acceptance of hormones and surgery as “treatments”.
But what is the scientific and research evidence for applying these medical and surgical treatments to children? Are there research trial results that justify giving powerful hormone drugs that do not have FDA approval for gender affirmation in children? What data are there in support of surgically and irreversibly altering what was the normal anatomy of children as part of the gender affirmation process? What is the quality of evidence that looks at the risks and benefits of these medical and surgical treatments?
For those answers, an evidence based standard should be applied to the data that have been cited by the proponents to justify these medical and surgical treatments in children. Since transsexualism or gender identity disorder or incongruence or dysphoria or whatever else it is to be called has now been medicalized, diagnosis and treatment of it should be required to meet rigorous evidence based standards as have been applied to the diagnosis and treatments of myocardial infarction, congestive heart failure, diabetes, cancer, or to receive a pacemaker, just to name a few. But first, a brief recap of what EBM is and what it isn’t.
EVIDENCE BASED MEDICINE - WHAT IT IS AND WHAT IT ISN’T
David L. Sackett was a British physician and professor at Oxford and is considered the father of evidence based medicine (EBM). He defined EBM as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. The practice of EBM requires “integrating individual clinical expertise with the best available external clinical evidence from systematic research”.
Sackett developed the concepts that became EBM in the 1990’s after observing there was an exponential increase in the amount of medical research trials and publications that were overwhelming physicians who were trying to stay abreast of all the new information.
Gordon Guyatt, M.D. is also one of the pioneers and promoters of EBM and is the co-chair of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group that rates quality of evidence as follows:
Re-read these GRADE definitions, particularly the Low and Very low designates, and remember there is not clinical certainty provided by or guaranteed by the available evidence, particularly if low or very low quality evidence.
It is also important to remember that research trial participants are usually narrowly defined in their demographics and clinical characteristics but the results are often generalized and inappropriately applied to demographic groups that were not studied in the referenced clinical trials.
EBM deserves criticism and condemnation when medical treatments or procedures are approved (or required) on the basis of biased, corrupted, or politicized research trials that have been falsely imbued with the legitimacy of “evidence based”. Such misuse of EBM puts medical care in the position of being authoritarian and tyrannical. Many are now awakening to these truths as they reflect upon our shared experiences of the past 3 years of the orchestrated Covid response.
LOOKING AT GENDER AFFIRMATION THROUGH THE EBM LENS
The contemporary, assembly-line “treatments” of gender dysphoria have their origin in what is called the Dutch protocol. In the 1990’s, sex researchers in Holland carefully selected 70 children who met their inclusion criteria of persistent gender incongruence (the girls felt as though they were boys and the boys felt they were girls) since early childhood. They could have no coexisting psychologic problems and were otherwise healthy.
The 70 children were then administered “puberty blockers” at a mean age of 13. 55 of the initial 70 children then received cross-sex hormones at a mean age of 16 and gender reassignment surgery at a mean age of 20. Follow-up psychologic testing was completed approximately one year later.
Outcomes in the 55 children who went on to receive cross-sex hormones and surgeries were determined by a psychological questionnaire and were reported in a research study published in 2014:
“A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults.”
That sounds great doesn’t it? “ …well functioning young adults.” But there were a number of problems with the Dutch study that should have limited its generalizability to other populations of children.
As mentioned, the children were highly selected with no evident co-existing psychologic problems such as depression, bipolar disorder, autism spectrum, or significant anxiety. Those are psychiatric issues that have been shown to be common in children currently thought to have gender dysphoria. There is a fairly large body of literature written on the association of Autism Spectrum Disorder (ASD) with gender dysphoria. If further interested in exploring that issue, this reference has a number of credible links.
There was no control group of similar profiled children to treat with psychologic counseling and psychotherapy although psychiatric intervention was offered to the 55 study subjects which further confounds the results. And the follow-up of only one year was too short to determine how many of the 55 experimental subjects went on to detransition (meaning, reversing their gender presentation so as to be aligned with their biologic sex). How many developed psychiatric issues as they became dissatisfied with what the hormones and the surgeries turned them into? And how many went on to commit suicide? And importantly, the Dutch study did not look at adverse physical side effects and outcomes, of which many are being reported in children subjected to these drugs and surgeries. The study’s only endpoint was improvement in dysphoria at one year.
The Dutch study which became the Dutch Protocol did not meet EBM standards. The “evidence” has been deemed to be very low quality due to a small number of selection bias research subjects entered into an observational study with confounding biases and variables.
But that did not stop Western European and U.S. pediatric and psychiatric physicians, clinics, public health agencies, schools, and transexual rights activists from generalizing the study results and treatment protocol to a population of children unlike the 55 children in the Dutch study. See how the misuse of EBM works? Unfortunately, the Dutch Protocol has been aggressively promoted to demographic and psychiatric diverse children considered to be gender confused.
But don’t just take my word for it. There have been two large, independent analyses of the gender ideology literature published in the past 2 years. Both published reviews concluded the available study literature used to support current gender affirming protocols were of very low quality and did not offer certainty regarding risk/benefit by treating these children and adolescents with experimental hormones and surgeries.
A study by Abbruzzese and Levine ( The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed) published in January, 2023, came to the following conclusions regarding the Dutch protocol: Selection bias assured that only the most successful cases were included in the results. Concomitant psychotherapy made it impossible to separate the effects of that intervention from those of hormones and surgery. And a flawed analytical tool that guaranteed a favorable outcome for gender resolution was used.
This analytic review paper by Abbruzzese is comprehensive and applies EBM standards to the research methodology, conclusions, and recommendations that came out of the Dutch protocol and found the supporting evidence to be of very low quality as per the GRADE definition in the above chart.
The National Health Service (NHS) of England, in 2020, commissioned Dr. Hillary Cass to undertake a review of the published evidence on the use of puberty blockers and cross sex hormones in children and young people with gender dysphoria. This exhaustive review of the available literature by the National Institute for Health and Care Excellence (NICE) published their findings in 2 parts in 2022. The first report dealt with the available evidence to justify the use of “puberty blockers” in children. The second report reviewed the evidence supporting the use of cross-sex hormones in adolescents.
Regarding the use of “puberty blockers” (GnRH analogues) in children, the NICE review of the available literature came to the following conclusions:
“The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning) in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up. Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance.” Bold emphasis mine.
Regarding the use of cross sex hormones (estrogens in males, testosterone in females) the NICE review came to the following conclusions:
“This evidence review found limited evidence for the effectiveness and safety of gender- affirming hormones in children and adolescents with gender dysphoria, with all studies being uncontrolled, observational studies, and all outcomes of very low certainty. Any potential benefits of treatment must be weighed against the largely unknown long-term safety profile of these treatments.” Bold emphasis mine.
The NICE evidence-based analysis and review resulted in the decision to close the Tavistock Clinic, the oldest and largest gender affirmation clinic in England. Poor outcomes, corruption of data, and fear of litigation were contributing factors in the closure of the clinic. Sweden, Finland, Norway, the UK, France, Australia, and New Zealand are all slowing down, turning away, or warning the Dutch Protocol may do more harm than good. Some have recommended the cross sex hormones or surgeries only be done within a research framework. But here in the United States, gender affirmation is a growth industry with large health care systems and others competing for the billions of dollars to be made in the exploitation of confused children.
The TG treating clinicians and activists contend that the GnRH analogue hormones (the “puberty blockers”) are just a “reversible pause” in the progression of puberty. Dr. Cass wrote a letter to the UK National Health Service, and in that letter expressed the following concerns these drugs are not harmlessly reversible and likely cause disrupted brain maturation resulting in long-term neuropsychological consequences.
“We do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation. We therefore have no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process. A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgement). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences. To date, there has been very limited research on the short-, medium- or longer-term impact of puberty blockers on neurocognitive development.”
Manipulating hormones in children during the prepubertal and pubertal maturation process is risky business and can also lead to multiple medical problems such as osteoporosis, lipid (cholesterol) abnormalities, heart disease, hypertension, obesity, sexual dysfunction, and sterility. Many of these children become life-long patients with these iatrogenic problems at an enormous expense to society.
Despite the Dutch studies’ methodological problems, they are widely cited by medical organizations to justify the “gender affirmation” approach to gender dysphoria, which instructs doctors to affirm a patient’s transgender identity through cross-sex medical procedures rather than encouraging them, through the application of psychiatric counseling, to come to terms with their biologic sex.
It has become evident that 80-95% of children who are gender confused or “dysphoric” will psychologically mature during puberty and come to accept the reality of their binary sex. A wait and watch approach involves psychiatric support and counseling for the psychologic comorbidities present in most of these children. Many go on to be gay but they are anatomically correct, have intact sexual function, and are not sterile - issues that transsexuals treated with hormones and surgeries come to regret 2 - 10 years later.
Medical organizations and TG activists have actually discouraged psychiatric intervention in these children by referring to it as “conversion therapy”. That is a term that is applied to the historical psychiatric effort to “convert” homosexuals away from a gay and lesbian life. It apparently was a largely failed effort that was discredited and now there are laws, in some places, against “conversion” efforts by therapists treating homosexuals. To do so puts their medical licenses at risk. Knowledgeable psychiatrists and psychologists and those in the gay and lesbian activist community, all agree homosexuality is not an issue of gender confusion - homosexuality refers to a person who is romantically attracted to a person of the same sex.
But these laws against “conversion therapy” have been generalized to include gender confused children based upon very sparse evidence. More importantly, the laws against conversion therapy are seen as threatening by psychotherapists attempting to help gender confused children with psychiatric counseling rather than hormones and surgeries. The potential criminal charge of performing conversion therapy suppresses the legitimate psychiatric support and counseling for the psychiatric comorbidities present in most of these gender confused children.
A few comments concerning suicide is in order. It has been repeatedly stated that parents are coerced and frightened into giving consent for gender affirmation treatments for their children. (“Would you rather have a live daughter or a dead son?”) A large Scandinavian study of incidence of suicide in transgenders, revealed the rates are 4-5 times higher in transgender people than in the general population. The UK NICE study found only very low GRADE evidence that either GnRH hormones (the “puberty blockers”) or cross-sex hormones made a statistical difference in depression, anger, or self-harm in the studied gender dysphoric children.
There is an excellent review by Biggs and published by the Archives of Sexual Behavior and the NIH that deals with suicide in transgender youth. From the article is the following:
“The proportion of individual patients [transgender youths] who died by suicide was 0.03%, which is order of magnitude smaller than the proportion of transgender adolescents who report attempting suicide when surveyed.”
The point of this is the exaggeration of the suicide risk in order to manipulate parents and public opinion to promote and facilitate the agenda driven assembly line affirmation of gender confused children. “40% risk of suicide” if these children are not treated with hormones and surgery is the number that has been popularized by the TG activists and is a fabrication devoid of data. And the warnings and discussion of suicide by adults has an effect upon these children. The former lead psychologist at the Tavistock Clinic in London warned, “when inaccurate data and alarmist opinion are conveyed very authoritatively to families we have to wonder what the impact would be on children’s understanding of the kind of person they are….and their likely fate”.
GENDER AFFIRMING SURGERIES FROM TOP TO BOTTOM
You may have heard that various surgeries are often the final step in the gender affirmation process applied to children and usually follow the administration of cross-sex hormones (testosterone for females and estrogen for males). But most people have not heard the grotesque details of these procedures.
Traditionally, and historically, surgery has been done in an effort to treat a disease process such as cancer, or to save lives following trauma. There are orthopedic, gynecologic, neurologic, urologic, and cardiovascular surgeries for a variety of maladies and diseases and surgical techniques can lead to prolongation of life or to an improved quality of life.
People who have body dysphoria do not like some aspect of their appearance. Cosmetic surgery has the purpose of improving a person’s appearance, to meet a person’s expectation or desire of how they will look. Cosmetic surgery is not done for life threatening indications, does not remove functional body parts and organs, and is elective, meaning non-emergent.
So, how does gender affirmation surgeries fit into all of this? It is for non life threatening indications and it can change their outward appearance. The activists may say to not have the surgery may lead to suicide but the data actually do not support that contention. These surgeries do not improve bodily functions - the reality is usually the opposite with development of chronic urinary problems, infections, sterility, and loss of sexual function. The faux vaginas need to be dilated regularly to keep them open (maintain patency in medical parlance). The males who have had bottom surgery lose sensation in their groin and have no ability for sexual activity. Hormones and the surgeries result in sterility in both males and females.
TG activists would prefer the use of the term “top surgery” to refer to the double mastectomies done on young girls with healthy breasts in order to achieve a male appearance. The term also applies to breast implant surgery on a male as he strives to appear female. Between 2016 and 2019 there has been a 389% increase in the number of young girls having double mastectomies.
The term “bottom surgery” is used to describe the surgical creation of a faux “phallus” created from the forearm skin of a young female recipient of that tissue surgically fashioned into a tube that neither looks or functions as a real penis. There is a high complication rate to this radical surgery and often months of recovery. Those young females may also choose or be encouraged to have a complete hysterectomy and surgical obliteration of their vaginas.
“Bottom surgery” is also the sanitized terminology used to describe the destruction of a normal penis on a young male by “hollowing” it out and creating a blind tissue pouch that is invaginated up into the perineal area to create a “vagina”. That procedure is accompanied by castration of normal testes. If the male was started on “puberty blockers” at a young age, he likely only developed a micro sized penis, not large enough to fashion into a “vagina”. Surgeons have then used a segment of colon to make a “vagina”, sometimes with drastic infection consequences.
It has been reported that up to 25% of the male “bottom surgeries” require extended hospitalizations for complications. In any other surgeries besides TG surgeries, these high surgical complication rates, done for non life-threatening reasons, would (and should) result in the surgeon losing hospital staff privileges and the state board of medicine canceling his or her license to practice medicine.
The only surgical procedures that I can think of where healthy organs are removed or amputated might occur in an adult female who has a high-risk genetic predisposition for breast cancer and chooses to have a preemptive double mastectomy. Or perhaps the adult female at risk for cervical, endometrial, or ovarian cancer who goes in for a complete hysterectomy.
It seems to me an ethical surgeon would not consent to remove healthy tissue, organs, or appendages as a cosmetic “treatment” of gender preference or incongruence arising from a psychiatric or psychosocial construct in a child. And these surgeries are being done on children. Although age 18 is the usual legal requirement for age of consent and participating in adult activities and assuming adult responsibilities, the study of neurophysiology and neuroanatomy informs us that brain maturity typically is not achieved until the mid 20’s.
Physicians and surgeons have an ethical and moral obligation to assess patients physiologically and psychiatrically and not just with an arbitrary chronological age that will legally permit irreversible treatments and procedures on immature human beings. If the person is a rational adult, and the surgical cost is not borne by the taxpayers of this country (either through Medicare or increased insurance costs), then the surgery could be up to the surgeon and the patient following informed consent.
THE CIRCULAR ECHO CHAMBER OF EVIDENCE ATTRIBUTION
There are 4 professional organizations that have been aggressively involved with the promotion of the Dutch Protocol for children (I will henceforth include “adolescents” when saying “children”; adolescents may not be prepubescent but they are children). The 4 prominent organizations are the American Academy of Pediatrics (AAP), the Endocrine Society (ES), the World Professional Association for Transgender Health (WPATH), and the American Psychiatric Association (APA). These organizations attribute the evidence and “consensus” for gender affirmation treatment to one another but it all goes back to the foundational Dutch Protocol and flows out through the guidelines coming from WPATH. Here are a few brief words about these organizations.
The WPATH is the organization that formulates and publishes the gender ideology and affirmation guidelines and is what clinicians and others in the sexology world look to for recommendations and guidance. These guys and gals appear to be a political transgender advocacy group impersonating and camouflaged as a medical science organization. Not much to say here other than they are all in on the one-size-fits-all Dutch Protocol being aggressively applied to children who express they might be transgender. Oh, they say they are evidence-based and promote scientific discussion, treatment options, and informed consent but the use of their “treatment” protocols and guidelines promote an assembly line of gender affirmation with hormones often leading to various surgeries.
To give you a bit more insight into the inclinations of this group, in the latest iteration of the WPATH Standards of Care guidelines version 8 (SOC 8), they removed the lower age limit recommendations for providing puberty blockers to children, they now require only one letter from a primary care referring provider to start “treatment”, requirements for hormonal treatments before surgical interventions were lowered, and the requirements for living in the desired gender role for a period of time prior to hormonal or irreversible surgical procedures were eliminated. Does that sound like first do no harm clinical caution prior to initiating experimental and irreversible medical and surgical “therapies” on children?
The WPATH gender affirmation approach to children, is also being promoted and applied to the more recent phenomenon that is being seen and termed Rapid Onset Gender Dysphoria (ROGD). ROGD is predominately occurring in adolescent girls who did not manifest incongruence or dysphoria as younger children and this is the cohort that appears to be caught up in a social contagion. There is no data that supports what is being done to those young females (or males).
The American Academy of Pediatrics is in lock-step with the WPATH when it comes to the treatment of these gender confused children. This professional organization of pediatricians has an affirm only/affirm early policy that is not validated by the “evidence” they use to support their recommendations. The AAP uses one of the often cited 11 outcome studies of gender dysphoric children that demonstrate most children with gender dysphoria will not remain gender dysphoric after puberty. Many will go on to be gay but many will also mature into heterosexual straight young adults. The AAP’s affirm only recommendations are not supported by the data they claim are in the one study they reference for that support. It’s as if they needed to cite an evidence source to validate their gender affirming WPATH recommendations and assumed no one would look at the reference and see the one study they cite does not provide that validation.
The AAP has suppressed concern coming from elements of their pediatrician membership about gender affirmation treatment; discussion of alternative treatments has not been allowed. They recently feigned objectivity by saying they would allow review of the recommendations and alternatives, but a change in policy is doubtful. Such authoritarian oppression of scientific disagreement is what we have seen during the COVID response. Intimidation of physicians into apathetic, group-think conformity seems to be an easy task to accomplish.
The American Psychiatric Association represents psychiatrists and is an influential organization within the gender ideology crowd. I could not find any significant difference in their affirmation recommendations that distinguishes them from the other 3 organizations mentioned here.
There is an editorial by Dr Jack Drescher who is a psychiatrist and apparently prominent within the APA. To channel and paraphrase Ron Burgundy (film character played by Will Farrell), Dr. Drescher is “kind of a big deal; people know who he is”. In his editorial, Dr. Drescher dismissed concerns about “puberty blocking” GnRH analogues being given to young children and adolescents by citing the anecdotal experience of giving the drugs to very young children who have the rare condition of premature puberty. That is not a valid control comparison to what is being done now. But it serves the editorial purpose of influencing opinion in the absence of valid evidence based data.
The Endocrine Society has acknowledged the available evidence is low quality to absent for treating gender confused/dysphoric children with GnRH and cross-sex hormones. Inexplicably, however, they recommend proceeding with the WPATH guidelines for gender affirmation. Presumably, their false conclusions are best explained as being in support of preconceived policy goals.
The ES also believes age 16 defines the age of consent for irreversible medical procedures. From their gender-dysphoric/gender-incongruent (GD/GI) practice guidelines statement is the following:
“Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age.” Bold emphasis mine.
Meanwhile, the WPATH removed the lower age limit for starting “puberty blockers”.
Planned Parenthood has now ventured into the gender ideology business by offering testosterone or estrogens to gender confused youth after a brief 30 minute conversation with a nurse practitioner. Informed consent discussions are minimal to absent and many of these young people have significant psychiatric comorbidities such as autism. Gender clinics which have been more structured and cautious in prescribing these powerful drugs, are now loosening their evaluation requirements in order to compete for gender “business” with Planned Parenthood.
Not to be outdone by these organizations when it comes to the age of consent, Governor Newsom of California put the age of consent for “gender counseling”, without parental involvement, at age 12 in Assembly Bill 665 which he signed.
Go to the websites of these professional organizations and read their statements, articles and recommendations. When it comes to the issue of gender ideology and gender affirmation, their beliefs and recommendations appear to be mostly identical and they all seem to be singing from the same secular faith hymnal. Some would say that represents “professional consensus” and the “science is settled”. They do not engage in debate or even acknowledge the very low GRADE quality of EBM they use in support of their diagnostic and treatment algorithms that are being used on children. An annual five billion dollar (and climbing) industry in the U.S. has been created based upon the published results of a hopelessly flawed Dutch study of 55 children thought to have gender dysphoria.
These organizations continue to claim a high rate of suicide in children who are not allowed to transition but the data reveal the highest suicide rate is in those who do and is consistent with the elevated suicide rate in non gender confused children with similar psychologic comorbidities. They proclaim the detransition rate is rare and approximately 1% and do not reveal that statistic comes from short term follow up studies, that more recent studies put the detransition rate at 20-30%, and higher, and it is often 4-10 years before the regret becomes severe enough to lead to detransitioning (or suicide). And, do not forget, detransitioning is the result of iatrogenic harm - physical, pharmacologic, psychiatric, and/or social.
FINAL THOUGHTS
Biology has been described as the last collective tether to reality. A physician who evaluates and treats human beings must remain based within biological reality. Empirical testing and the scientific method validates diagnosis, particularly when there is deviance from the bell shape curve that represents the statistical reality of known normal biology. Sure, there can be recognition and sensitivity to psychiatric overlays on the biological reality, but that biologic reality is always there. The 23rd pair of chromosomes (xx or xy) is in every cell of the human body, was determined at conception, can not be re-assigned or changed at birth or later in life, and most certainly should not be denied or ignored by physicians.
There can be recognition and sensitivity to the spectrum of the behavioral expression of the binary of our biologic sex. The spectrum of behavioral expression refers to how some female children are very feminine and “girly” whereas others display more masculine, “tomboy” traits. Conversely, male children express themselves on a spectrum of masculine to feminine. The majority of these children emerge from puberty, if not chemically assaulted with expensive and pharmacologic derived hormones, as either straight heterosexuals or as gay females and males. Or, to state this using contemporary sex phraseology, gender congruent with their biologic sex.
This paper was difficult to research and write because of all the changing concepts, terminology, and definitions, particularly over the course of the past 10-15 years. And none of the changes and concepts driving radical pharmacologic and surgical treatments in children have a basis in new biological findings or the development of a diagnostic empirical test. No, these changes appear to have activist and political motivations. And as was demonstrated earlier in this paper, an evidence-based review and inspection of the data used to justify these “treatments” are acknowledged to be very low quality and offer no certainty as to effectiveness and risk.
If we are to remain grounded in valid scientific evidence and biological reality, especially when it comes to how we treat vulnerable children who are dependent upon adults for their safety and welfare, then first do no harm must take precedence over experimental drug and surgical treatments. And do not mistake this as a statistically small problem. The gender ideology that is behind the Dutch Protocol has permeated and metastasized throughout our society and culture and has become part of the K-12 sex education curriculum that is being taught in our schools to young children in health, science, and social studies classes (see Gender Unicorn).
Increasing awareness of how pervasive radical gender ideology has become in our culture and our schools has awakened adults of all racial, political, cultural, and religious persuasions who are beginning to coalesce into a movement to confront this political indoctrination in public schools and to reject this assault on the health of our children, both physical and psychological. The protection of our children will require unsuppressed parental activism, the wide dissemination of valid evidence-based knowledge, and a change in state, federal, and education political leadership. The absurdities and the atrocities must be ended.
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