Transgenderism, with an Emphasis on Children

[carpedm9587]

There is a significant uproar from many people who lean right about transgenderism and especially about “transing kids.” You hear a lot of extreme language: calling it “child abuse,” references to “cutting off breasts,” objections to “kids making these decisions,” and fears of the long term effects of puberty blockers. So let’s take a moment and tackle a few of these statements.

In the U.S., between 2016 and 2020, a total of just over 48,000 patients underwent Gender Affirming Surgery (GAS). The rate of these surgeries climbed from 4,552 in 2016 to a peak of 13,011 in 2019 before dropping slightly in 2020. Approximately 52.3% of these were performed on people 19-30 years old, 21.8% were 31-40 years old, 19.2% were over 40 years old, ande 7.7% (about 3,700 cases) were children aged 12-18. The most common procedures were breast and chest procedures, which occurred in 56.6% of the cases, followed by genital reconstruction in 35.1% of the cases, and other facial and cosmetic procedures in 13.9% of the cases. Breast and chest procedures made up a greater percentage of the surgeries in younger patients; genital surgeries were greater in older patients. (https://jamanetwork.com/journals/jam...rticle/2808707).

I have to admit that I was surprised by the number of cases, over four years, in children below 18 years of age. I tried to get a breakdown by year but was not able to find one. I have to believe that the vast majority of these surgeries are in the 16-18 year range. Classifying these as child abuse is pretty extreme language. Studies have shown that children who do not relate to the gender assigned at birth and who do not receive gender affirming care are more prone to self-mutilation, depression, and suicide. I can only imagine the pain of parents confronting this reality in their children, and having to make decisions about how best to help their child. The protocols for gender affirming care are rigorous and designed to weed out flights of fancy and casual whims. Only when a child (or adult) is diagnosed with gender dysphoria is there an avenue to explore care. And the general rule is to defer GAS until after 18 years of age, so it is typically only in the most urgent of cases that it is done earlier than that.

Of the treatment options, the most commonly taken path is puberty blockers. These medications do exactly what the name implies; they suppress the release of hormones that trigger puberty. The effect is temporary and puberty will restart if their use is discontinued. The only significant risk I have been able to find is a potential for loss of bone density, but there are protocols to manage this outcome as well. Every medication has side-effects, even aspirin.

I doubt anyone with an ounce of empathy would describe the mastectomy that women routinely undergo when they are diagnosed with sufficiently advanced breast cancer as “cutting off their breasts.” We’re not talking about the dungeons of the Marquis de Sade here. We’re talking about sterile, anesthetized, surgical procedures conducted when the need is determined to be great. No ethical doctor will amputate parts of the human body without cause. Such language is merely designed to inflame, and it does a lot of harm in the process.

I cannot say that I completely understand the phenomenon of transgenderism. As far as I can tell, no one does. Probably the ones who understand it most are the doctors and clinicians who have studied it, the parents and family who have a transperson in their midst, and the transperson themselves, not necessarily in that order. We don’t know if this is genetic, psychological, psycho-social, or a consequence of unusual formations within the brain. It may be all of these in some cases, or something we don’t even understand yet. Given that the rest of us have very little clue, it seems to me preposterous that we are in the process of inserting the federal and state governments into these medical, and highly personal, decisions. I trust the parents and medical professionals to evaluate each and every case and make the best choices they can with the available evidence and available resources. As we understand more and more what transgenderism is all about, perhaps then there will be a clear road to certain kinds of legislation or regulatory oversight. Until then, I don’t believe we should be placing any more (or less) regulatory oversight on GAS than is placed on any other medical procedure.

I’ll end with this observation: it is a matter of continued amazement to me that the party of “small government” and the “keep government out of the private sector” keeps pushing for greater and greater government intrusion into some of the most personal decisions a person could make for themselves: their own medical care. I personally would like to make those decisions with the assistance of my wife, my family, and my doctors. I’d rather not clear it with my local, state, or national politicians.

Rather than taking such a harsh, hidebound, negative stance on gender-affirming care, perhaps those who claim to be acting “to protect the children” might take a few moments to actually listen to these parents and children. For the vast majority of them, the care is life-changing. Are there some who regret the change? I’m sure you will find a few. Medicine and psychology are not exact sciences. Cherry picking these few cases and ignoring the vast field of successful treatments does not help anyone, and can do great harm.

By the way, there are no children making these decisions. That is just a flat out misrepresentation. No doctor is legally permitted to perform this kind of surgery (or most others) on a minor without the permission of their parents or guardian. The decision involves three players: the child, the parents/guardian, and the physician. All of them must agree for anything to happen. Personally, I trust the parents and the medical professionals to make the best decision they can for their patient.

[seer]

The decision involves three players: the child, the parents/guardian, and the physician. All of them must agree for anything to happen. Personally, I trust the parents and the medical professionals to make the best decision they can for their patient.ents/guardian, and the physician.

That is not exactly true is it, because at bottom it all goes back to the subjective reporting of the child. So 13 year Suzie wants to be a boy, to have her breasts cut off. But she really has no idea what it is like to be a boy, to feel like a boy, to be a boy. And the glaring FACT that no matter what Suzie does she will never be a boy just a mutilated girl. And do we know Suzie will feel or think the same way at 23, 33, 43? Perhaps some day she would like children and to breast feed - do you know she won't? Does she?

[Sam]

That is not exactly true is it, because at bottom it all goes back to the subjective reporting of the child. So 13 year Suzie wants to be a boy, to have her breasts cut off. But she really has no idea what it is like to be a boy, to feel like a boy, to be a boy. And the glaring FACT that no matter what Suzie does she will never be a boy just a mutilated girl. And do we know Suzie will feel or think the same way at 23, 33, 43? Perhaps some day she would like children and to breast feed - do you know she won't? Does she?

~3% of people who begin gender reassignment therapies end up detransitioning back to cisgender. Transgender reassignment surgeries have a (significantly) higher satisfaction rate than knee replacement surgeries.

More work can be done to study pediatric transgender care and guidelines will continue to better represent the patients' needs. In some cases, that will likely mean restricting some treatments for some patients that are currently offered. As it stands, very few irreversible treatments are allowed for patients under 18.

But that work will be done without catering to prejudice or the prejudiced.

What's interesting is that transgender reassignment surgeries have much higher satisfaction rates than circumcisions but I've yet to hear a single prominent anti-trans voice call for banning infant circumcision, despite the fact that the "children can't really understand or consent to life-altering medical procedures" definitely applies to eight-day old babies.

-Sam

[carpedm9587]

That is not exactly true is it, because at bottom it all goes back to the subjective reporting of the child. So 13 year Suzie wants to be a boy, to have her breasts cut off. But she really has no idea what it is like to be a boy, to feel like a boy, to be a boy. And the glaring FACT that no matter what Suzie does she will never be a boy just a mutilated girl. And do we know Suzie will feel or think the same way at 23, 33, 43? Perhaps some day she would like children and to breast feed - do you know she won't? Does she?

It is exactly true, Seer. The child can report anything they wish, but until their parents consent and the child passes all of the rigorous transgender protocols implemented by the medical centers that deal with these issues, nothing will happen. There are three decision points involved, with any one of them being able to veto things at any point. Your insistence that "children make this decision" ignores that reality, and makes the entire thing sound ridiculous. I have to say, I suspect that is your intent.

Your continued use of hyperbolic language certainly reflects your emotional response to this, Seer, but your arguments appear to be based on emotion and revulsion, not reason and an appeal to the facts of the situation.

As for "Suzie never being a boy," it is true that our existing medicine does not allow someone to change their genetic identity. So a person can take on the form of being physically female or physically being male, but cannot change anything that is bound to that genetic code. But they can most certainly be a woman, albeit a transwoman, or a man, albeit a transman. You seem to be rigorously insisting that male/female must forever be bound to man/woman. What the trans people are telling us is that there is a difference between the physical reality of male/female, and the internal reality of man/woman. They are asking us to separate gender from sex in our language. I see no reason not to grant them that request. Languages evolve to reflect new realities. Once we break the "gender = sex" assignment, then there is nothing to prevent us from having male men, female men, male women, and female women. With or without gender re-assignment.

Such a shift in language does not harm me. It does not harm others. I see no reason not to adjust my language accordingly. It is their experience, not mine. Who am I to tell someone what is going on within them?

And when our medicine reaches a point (if it does) that the entire genetic code can be revised, what happens to your argument then? That is not a zero possibility. There is nothing about revising the genetic code that violates the laws of physics or our understanding of biology. We may simply lack the technology for doing it today.

[carpedm9587]

~3% of people who begin gender reassignment therapies end up detransitioning back to cisgender. Transgender reassignment surgeries have a (significantly) higher satisfaction rate than knee replacement surgeries.

More work can be done to study pediatric transgender care and guidelines will continue to better represent the patients' needs. In some cases, that will likely mean restricting some treatments for some patients that are currently offered. As it stands, very few irreversible treatments are allowed for patients under 18.

But that work will be done without catering to prejudice or the prejudiced.

What's interesting is that transgender reassignment surgeries have much higher satisfaction rates than circumcisions but I've yet to hear a single prominent anti-trans voice call for banning infant circumcision, despite the fact that the "children can't really understand or consent to life-altering medical procedures" definitely applies to eight-day old babies.

-Sam

Agreed. The argument, "what if they change their mind" simply goes nowhere. People have cosmetic surgeries they cannot reverse. People have knee and hip replacement surgeries they cannot reverse. Are we going to deny everyone these surgeries because some of them may have second thoughts after the fact? Where else should we apply this bizarre argument for irreversible choices? Should we prevent parents from having children because they might regret it? Should we prevent people from getting organ transplants because some of them don't go well and people regret the choice? How about tattoos? Elective amputations? I have a leg that I might, someday, come to a point of wanting it removed as it degenerates, giving me the option to use some of the spiffy new prosthetics. Should the government take that choice from me too because I might regret it?

We make irreversible choices (or hard to reverse choices) all the time. Do we tell the vast, vast majority of people who find comfort and healing in the surgery "sorry, you might regret it later, so we're not going to let you make this choice? What on earth has happened to the conservative mantra, "keep the government out of my private life?" It seems that mantra only applies for things that are important to conservatives, and not for things important to others.

[seer]

It is exactly true, Seer. The child can report anything they wish, but until their parents consent and the child passes all of the rigorous transgender protocols implemented by the medical centers that deal with these issues, nothing will happen. There are three decision points involved, with any one of them being able to veto things at any point. Your insistence that "children make this decision" ignores that reality, and makes the entire thing sound ridiculous. I have to say, I suspect that is your intent.

Of course the child, first has to consent, which they can't -period - no matter what the adults say. Second, it all does depend on the child's subjective self-reporting. That is the basis for the whole process. The fact remains little Suzie has no idea what it feels like to be a boy. She is taking her cues from shifting cultural norms. So Suzie thinks she is a boy inside (which she can not know) and the adults come along and agree with this unknowable claim. And let's not forget what a cash cow this is for big medical.

[seer]

~3% of people who begin gender reassignment therapies end up detransitioning back to cisgender. Transgender reassignment surgeries have a (significantly) higher satisfaction rate than knee replacement surgeries.

Sam

Sure, I bet this guy is very satisfied. BTW how far do your studies go out? 15-20 years?

Quebec man has two healthy fingers amputated to relieve 'body integrity dysphoria'

It’s not the first time amputation has been used as a treatment for the rare condition

https://nationalpost.com/news/quebec...rity-dysphoria

[oxmixmudd]

There is a significant uproar from many people who lean right about transgenderism and especially about “transing kids.” You hear a lot of extreme language: calling it “child abuse,” references to “cutting off breasts,” objections to “kids making these decisions,” and fears of the long term effects of puberty blockers. So let’s take a moment and tackle a few of these statements.

In the U.S., between 2016 and 2020, a total of just over 48,000 patients underwent Gender Affirming Surgery (GAS). The rate of these surgeries climbed from 4,552 in 2016 to a peak of 13,011 in 2019 before dropping slightly in 2020. Approximately 52.3% of these were performed on people 19-30 years old, 21.8% were 31-40 years old, 19.2% were over 40 years old, ande 7.7% (about 3,700 cases) were children aged 12-18. The most common procedures were breast and chest procedures, which occurred in 56.6% of the cases, followed by genital reconstruction in 35.1% of the cases, and other facial and cosmetic procedures in 13.9% of the cases. Breast and chest procedures made up a greater percentage of the surgeries in younger patients; genital surgeries were greater in older patients. (https://jamanetwork.com/journals/jam...rticle/2808707).

I have to admit that I was surprised by the number of cases, over four years, in children below 18 years of age. I tried to get a breakdown by year but was not able to find one. I have to believe that the vast majority of these surgeries are in the 16-18 year range. Classifying these as child abuse is pretty extreme language. Studies have shown that children who do not relate to the gender assigned at birth and who do not receive gender affirming care are more prone to self-mutilation, depression, and suicide. I can only imagine the pain of parents confronting this reality in their children, and having to make decisions about how best to help their child. The protocols for gender affirming care are rigorous and designed to weed out flights of fancy and casual whims. Only when a child (or adult) is diagnosed with gender dysphoria is there an avenue to explore care. And the general rule is to defer GAS until after 18 years of age, so it is typically only in the most urgent of cases that it is done earlier than that.

Of the treatment options, the most commonly taken path is puberty blockers. These medications do exactly what the name implies; they suppress the release of hormones that trigger puberty. The effect is temporary and puberty will restart if their use is discontinued. The only significant risk I have been able to find is a potential for loss of bone density, but there are protocols to manage this outcome as well. Every medication has side-effects, even aspirin.

I doubt anyone with an ounce of empathy would describe the mastectomy that women routinely undergo when they are diagnosed with sufficiently advanced breast cancer as “cutting off their breasts.” We’re not talking about the dungeons of the Marquis de Sade here. We’re talking about sterile, anesthetized, surgical procedures conducted when the need is determined to be great. No ethical doctor will amputate parts of the human body without cause. Such language is merely designed to inflame, and it does a lot of harm in the process.

I cannot say that I completely understand the phenomenon of transgenderism. As far as I can tell, no one does. Probably the ones who understand it most are the doctors and clinicians who have studied it, the parents and family who have a transperson in their midst, and the transperson themselves, not necessarily in that order. We don’t know if this is genetic, psychological, psycho-social, or a consequence of unusual formations within the brain. It may be all of these in some cases, or something we don’t even understand yet. Given that the rest of us have very little clue, it seems to me preposterous that we are in the process of inserting the federal and state governments into these medical, and highly personal, decisions. I trust the parents and medical professionals to evaluate each and every case and make the best choices they can with the available evidence and available resources. As we understand more and more what transgenderism is all about, perhaps then there will be a clear road to certain kinds of legislation or regulatory oversight. Until then, I don’t believe we should be placing any more (or less) regulatory oversight on GAS than is placed on any other medical procedure.

I’ll end with this observation: it is a matter of continued amazement to me that the party of “small government” and the “keep government out of the private sector” keeps pushing for greater and greater government intrusion into some of the most personal decisions a person could make for themselves: their own medical care. I personally would like to make those decisions with the assistance of my wife, my family, and my doctors. I’d rather not clear it with my local, state, or national politicians.

Rather than taking such a harsh, hidebound, negative stance on gender-affirming care, perhaps those who claim to be acting “to protect the children” might take a few moments to actually listen to these parents and children. For the vast majority of them, the care is life-changing. Are there some who regret the change? I’m sure you will find a few. Medicine and psychology are not exact sciences. Cherry picking these few cases and ignoring the vast field of successful treatments does not help anyone, and can do great harm.

By the way, there are no children making these decisions. That is just a flat out misrepresentation. No doctor is legally permitted to perform this kind of surgery (or most others) on a minor without the permission of their parents or guardian. The decision involves three players: the child, the parents/guardian, and the physician. All of them must agree for anything to happen. Personally, I trust the parents and the medical professionals to make the best decision they can for their patient.

Again, well written. As a parent of a trans daughter, I have had to face some of my worst fears and misunderstandings on this issue. As a Christian from a fairly conservative background, I have also had to navigate the overt hatred that is shown to transpersons - and even those who do not overtly condemn them - by the Christian community and try to make sense of how to respond in love and compassion to a circumstance I'd give almost anything to have made go away.

thanks for presenting the situation in a clear and objective way.

This is a very difficult issue, even without calls to jail your son or daughter for using a bathroom consistent with their gender, or wondering of they go to a more conservatively biased part of the country if they will face verbal or physical abuse at the hand of someone incensed and spyrred on by the political rhetoric coming from the MAGA wing of the GOP.

[oxmixmudd]

Again, well written. As a parent of a trans daughter, I have had to face some of my worst fears and misunderstandings on this issue. As a Christian from a fairly conservative background, I have also had to navigate the overt hatred that is shown to transpersons - and even those who do not overtly condemn them - by the Christian community and try to make sense of how to respond in love and compassion to a circumstance I'd give almost anything to have made go away.

thanks for presenting the situation in a clear and objective way.

This is a very difficult issue, even without calls to jail your son or daughter for using a bathroom consistent with their gender, or wondering of they go to a more conservatively biased part of the country if they will face verbal or physical abuse at the hand of someone incensed and spyrred on by the political rhetoric coming from the MAGA wing of the GOP.

I need to amend one thing here - I have also been overwhelmed by the love and compassion of so many others in this same relatively conservative Christian community.

[seer]

This is a very difficult issue, even without calls to jail your son or daughter for using a bathroom consistent with their gender, or wondering of they go to a more conservatively biased part of the country if they will face verbal or physical abuse at the hand of someone incensed and spyrred on by the political rhetoric coming from the MAGA wing of the GOP.

It's simple, have your child use the bathroom consistent with their biological sex.

[Sparko]

~3% of people who begin gender reassignment therapies end up detransitioning back to cisgender. Transgender reassignment surgeries have a (significantly) higher satisfaction rate than knee replacement surgeries.

More work can be done to study pediatric transgender care and guidelines will continue to better represent the patients' needs. In some cases, that will likely mean restricting some treatments for some patients that are currently offered. As it stands, very few irreversible treatments are allowed for patients under 18.

But that work will be done without catering to prejudice or the prejudiced.

What's interesting is that transgender reassignment surgeries have much higher satisfaction rates than circumcisions but I've yet to hear a single prominent anti-trans voice call for banning infant circumcision, despite the fact that the "children can't really understand or consent to life-altering medical procedures" definitely applies to eight-day old babies.

-Sam

De transitioning doesn't restore them to their former self, It just mutilates them more. So it isn't a real solution.

[seer]

De transitioning doesn't restore them to their former self, It just mutilates them more. So it isn't a real solution.

And doubt that most would admit that they made a mistake, so they say they are satisfied, all is well.

[Cerebrum123]

There is an extreme increase in detransitioners which is already hard to measure due to the self-selecting bias the issue causes. Who is going to go back to people that ruined their lives? Then there is huge chance of losing the support you have with the LGBTQ community if you detransition. There is a conflation of autogynephilia with GD. There is the fact that a person's brain does not finish developing until well after their teens. There is the fact that people are being pushed to surgery and hormones after a mere two hours of interviewing and often with no questioning involved among other terrible practices. There is the fact that autistic people* are being targeted for transition. There is the fact that GD can often be treated psychologically, such as when it is caused by sexual trauma. So-called "gender-affirming care" is not going to help these people. Oh, and let's not forget how dangerous the Gender Identity movement is. It is leading to rapists identifying as trans so they can shield themselves from the consequences of their actions. This has become a big problem in prisons and has even started affecting schools.

*And other groups with other disorders like ADHD.

[Mountain Man]

Transgenderism is a mental disorder. The idea of treating it by catering to the person's delusion, including medically altering their body, seems insane to me. Suppose someone is hearing voices. Would we treat by having everybody else play along and pretend they can hear the voices, too? Of course not. So why are we expected to do basically the same thing for people suffering from gender dysphoria?

[carpedm9587]

Of course the child, first has to consent, which they can't -period - no matter what the adults say. Second, it all does depend on the child's subjective self-reporting. That is the basis for the whole process. The fact remains little Suzie has no idea what it feels like to be a boy. She is taking her cues from shifting cultural norms. So Suzie thinks she is a boy inside (which she can not know) and the adults come along and agree with this unknowable claim. And let's not forget what a cash cow this is for big medical.

And it all depends on a parent and a competent medical professional saying "yes." You are selectively ignoring two of the three legs of the "decision stool." I have to conclude it is because that paints the picture you want to paint: kids making decisions in isolation which they are not qualified to make.

And the issue of Suzie and cultural cues is exactly what the Amsterdam protocols are designed to filter out. There is a long, arduous process between Suzie saying, "I feel like a boy" and the administration of gender affirming care. It begins with counseling and (sometimes) psychotherapy. The counseling is for both parent and child. There is a screening process. You are painting an amazingly over-simplified, and distorted view of what the process is about.