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Affirmative Abandonment

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Affirmative Abandonment

The medical establishment is betraying science in dealing with gender-dysphoric children. June 23, 2020
Health Care
The Social Order

Nine states are considering bills to ban hormone treatments for minors who suffer “gender dysphoria,” the phenomenon of feeling severe discomfort in one’s biological sex. The disorder is real, if rare: historically, it afflicts roughly 0.01 percent of the population—overwhelmingly males—and first presents in early childhood. But medicine for transgendered people has become so politicized that doctors now rush to meet patient demands, even for untested treatments on minor children. Republican lawmakers are now scrambling to apply the brakes.

Once used in chemical castration of sex offenders, “puberty blockers” like Lupron are approved by the Food and Drug Administration as a treatment for precocious puberty. If a four-year-old girl starts developing breasts, her doctor might prescribe the drug to shut down the overactive part of her pituitary gland. But the FDA has never approved use of puberty blockers to halt normal puberty. Nonetheless, Lupron has become a common first-step medical treatment for children in the early stages of puberty who claim to suffer gender dysphoria.

Proponents of puberty blockers often make claims resembling those recited by Jack Turban, a Harvard psychiatrist and specialist in adolescent sexuality, in a New York Times op-ed. Turban says that blockers are perfectly “safe”; that they reduce suicidal behavior and are thus life-saving; and that “broad consensus” exists among doctors about the salutary nature of these interventions. None of this is true—and the appearance of consensus is manufactured only by suppressing dissent.

In fact, a dizzying array of dangers plagues these treatments: interference with brain development; inhibition of normal bone-density development, leading to greater risk of osteoporosis; permanent loss of sexual function. Since no good long-term studies exist on children who took puberty blockers to arrest healthy puberty, no one knows the full extent of these risks. All that is known for certain is that adolescents who proceed from blockers to cross-sex hormones—the next step in medical “transition”—will become permanently infertile and may never develop the capacity for orgasm.

Activists, and even some physicians, commonly depict blockers as a mere “pause button” on puberty. In truth, when puberty blockers are administered to arrest normal, healthy puberty, no one has any idea what the long-term effects will be. What is known is that taking a course of blockers seems to guarantee “graduation” to opposite-sex hormones. In a clinical trial of 70 transgender-identified children on puberty blockers, all proceeded to cross-sex hormones.

Contrary to proponents’ claims, identifying as the opposite sex and arresting healthy puberty are psychologically radical interventions. It’s no small thing to send a girl off to high school with the sexual development of an 11-year-old, as many psychologists have told me in interviews. Unlike her peers, such a girl will have no breasts, no hips; she will have never had a period and may never have had a teenager’s sexual curiosity or desire, either. At that point, it may be easier for her to plow ahead with cross-sex hormones than to admit the mistake and scramble to rejoin her peers.

“What we are doing now is a massive uncontrolled medical experiment on children without adequate informed consent and without the backing of any kind of institutional review board,” said pediatrician Julia Mason of the Society for Evidence-Based Gender Medicine, a recently-formed international consortium of clinicians who oppose the prevailing approach to transgender medicine.

Proponents of puberty blockers for gender-dysphoric minors typically claim, as Turban did, that puberty blockers lower the risk of suicide among the transgender-identified. But his own data show that claim to be exaggerated. Of the 89 adult subjects who had taken puberty blockers as adolescents, 50 percent had experienced suicidality within the previous year.

“That’s not very good,” points out child and adolescent psychologist Kenneth Zucker. “It’s a little lower than the 64 percent who said they wanted [blockers] but didn’t get it. But gee, that’s still a lot of suicidal ideation.”

Worse, according to Turban’s data set, the patients who had been on puberty blockers reported more “suicidal ideation with plan and attempt” than those who had not been on blockers—a seemingly more acute suffering than ideation alone.

Because the long-term outcomes of these blockers for gender-dysphoric kids are so uncertain, because the blockers do not appear to lessen the risk of suicide, and because they practically guarantee that a child will push ahead to the more permanent cross-sex hormones, there is, in fact, no genuine medical consensus on when and whether to use them. As clinician critics of this treatment often tell me, gender-dysphoric kids who are not given hormones or “socially transitioned” to an opposite-sex identity will typically outgrow gender dysphoria on their own.

Why, then, aren’t we hearing about the risks of transgender medicine? According to endocrinologist Will Malone and several other doctors I’ve spoken with, the medical professional organizations aren’t interested in exploring them. Mason attended the recent annual conference of the American Academy of Pediatrics, where the benefits of transgender hormone treatments were touted—the risks, she says, neither explored nor acknowledged. As for the medical journals, “all I can say is that we’re submitting [letters to the editor] and they’re not being published,” Dr. Malone said.

In this area of medicine, debate has been neatly supplanted by self-congratulation: Nearly every relevant medical professional organization has adopted “affirmative care,” according to which doctors must accept patients’ self-diagnosis when it comes to gender dysphoria. (The American Medical Association, the American Academy of Pediatrics, the Pediatric Endocrine Society, and the American Psychological Association have all adopted this standard.) So much for expert opinion or differential diagnosis.

After failing to engage in scientific debate to ensure that these medicines are safe, doctors who prescribe these treatments duck all responsibility for them. Parents are asked to give “informed consent” to the sacrifice of their kids’ fertility and future sexual function—and children, rather gallingly, are asked for their “assent.” As if a girl of nine or ten could possibly gauge this loss.

Though the medical establishment panders to these patients like university administrators appeasing a victim-identity group, gender dysphoria is a real psychological ailment—by all accounts, excruciating—with a diagnostic history stretching back a century or more. While most kids outgrow it, some never do. The current medical protocol, which jumps straight to affirmation and medication, never makes any real attempt to sort out the majority who might be likely to outgrow it from the small number who never will. Before any medical determination can be made, it wraps them all in the now popular social identity—“transgender.”

Perhaps a medical establishment that refuses to submit the risks and benefits of these protocols to rigorous inquiry deserves to have its hands tied by new laws. If you’re not going to act like a scientist, it’s just as well that you shouldn’t be treated as one. But gender-dysphoric patients, rich in “affirmation,” deserve much more.

Photo: KatarzynaBialasiewicz/iStock

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