Editorial
Heading: “Your Dangerous, Inaccurate, and Ideological Guidelines for Trans-Identified Youth”
Sending this to 100s of mental health and medical professionals as this is a wide-spread problem- apathy about risk to LGB and other youth. This is profoundly destructive to these individuals and to our communities. The younger children are transitioned, the more of them there will be.
To the Endocrine Society and Pediatric Endocrine Society,
We are board members for an LGBT medical watchdog organization regarding pediatric medical transition for minors with gender dysphoria. In 6 years of intensely researching this issue, your recent statements and guidelines on this topic are some of the most unethical and sloppy of anything we have seen, in our free-speech opinion. And we have seen a lot of substandard discourse, confirmation bias, censorship, and blatant disregard for the safety of mostly LGB youth who may resolve GD as all prior research shows many do. There are so many ideological spins and factual errors in these documents it would take far too long to go over them all. And that should not be the public’s job. That is your job as the leadership and board members of The Pediatric Endocrine Society and the Endocrine Society, tasked with the most important goal of all, being trustworthy. Your organizations are experiencing ideological capture by extremist gender identity activists (even PhDs and MDs), and our guess is that you are entrusting small, agenda-driven committees to write balanced information. This is a huge mistake regarding this contentious and complicated issue that requires responsible nuance.
No, the “affirmative model” is not universally recognized as “safe” by all gender dysphoria experts, and it is clearly proving to be unsafe for some young people. That is the truth.
FB comment from WPATH member
Science bodies have a moral obligation to present facts and accurate information to the doctors and scientists they represent and the public. If you don’t, you will justifiably be accused of negligence and malpractice for the harm we are seeing befall young people due to the dishonesties represented in your documents regarding gender dysphoric youth. These dishonesties are being exposed by a groundswell of well-informed parents, doctors, mental health professionals, trans-rationalists, detransitioners, podcasters, and concerned LGB people who have been going public for years, negating the possibility of plausible deniability by organizations such as yours.
The documents in question:
https://www.endocrine.org/-/media/a65106b6ae7f4d2394a1ebeba458591d.ashx
https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa816/6031005
And here is this statement demonstrating the Endocrine Society and Pediatric Endocrine Society have a complete lack of concern or compassion for the young woman in the Bell v Tavistock case (she won) who transitioned at too young an age who is now permanently scarred by doctors such as yourselves. She is here merely as a prop to be kicked to the side and aggressively opposed so you can continue to prescribe extreme and experimental medical treatments on minors who don’t reach full executive function until age 25:
https://www.eurekalert.org/pub_releases/2020-12/tes-dpt121120.php
While there are too many errors and hard ideological slants to go over in the material in these links, we will review a few of the most egregious. This is unacceptable for doctors’ organizations.
Your attempt to debunk this quote falls flat to those of us who know what is really going on:
“Texas should ban chemical castration, puberty blockers, cross-sex hormones and genital mutilation surgery on all minor children for transition purposes, given that Texas children as young as three (3) are being transitioned from their biological sex to the opposite sex.” Even though “chemical castration” and “genital mutilation” are not part of gender-affirming care for minors, such wording serves to alarm the general public, and 94.57% of the electors supported the measure [15].
Not part of gender-affirming care for minors? While you may dislike the phrase “chemical castration” because it doesn’t have the marketable ring of “gender affirming” it is the proper term for the use of hormone blockers. These are the very drugs and terminology used to “chemically castrate” sex offenders. When you give puberty blockers to an 11-year-old, you stunt their genital growth. The problem of “micropenis” is well documented and the state becomes permanent when the youth goes on estrogen. This can permanently destroy the youth’s sexual response making a fully realized adult romantic relationship impossible. Due to lack of tissue, the youth now requires a rectosigmoid or peritoneal graph vaginoplasty to create a neovaginal canal as surgeons can’t do the “gold standard” one. These protocols sterilize both sexes. The wording in the quote above is hardly hyperbolic.
And now to the second part of the inaccuracy of the sentence. Genital surgeries are done on minors. Jazz Jennings, who likely has permanently destroyed sexual function for life, had this procedure done at 17 on national television. Jazz had to have 3 corrective surgeries after the experimental vaginoplasty “popped” and collapsed, an incident described by Jazz as extremely messy and painful. This path was decided by Jazz at age 11 when doctors such as yourselves prescribed hormone blockers. One of the patients in the Steensma/de Vries cohort died from the vaginoplasty, despite this being the #1 “success” study cited to promote pediatric transition. These young people are guinea pigs. We contest a child who hasn’t had a first boyfriend or crush even, can consent to permanent sexuality destruction despite your confidence in the face of conflicting data and views. There are trans people who adamantly oppose this.
Should the public feel “alarm” over this?
Here is evidence of vaginoplasty surgeries underage. The same is true for double mastectomies performed on tweens.
https://www.prweb.com/releases/2014/09/prweb12141694.htm:
“The patient, a California high school student who began administering estrogen and anti-androgens to transition from male to female at the age of 11, is the youngest transgender patient in U.S. history to completely avoid male puberty and subsequently undergo gender reassignment surgery at the age of 16.”
Another problem:
"Gender identity was considered malleable and subject to external influences. Today, however, this attitude is no longer considered valid."
A detransition subreddit with thousands of people holds views that say otherwise. We also document many social factors that influence gender dysphoria linked below. Of particular concern to us, but not you, is that homophobic bullying pushes youth towards trans identification. This is according to a peer-reviewed study and many anecdotal examples of LGB youth who claimed this was the case or their therapists saying so. Lack of stability in the home appears to be another environmental factor. There are many examples of social contagions throughout history, and most involve young females. We believe there is robust evidence to support this is currently the case with spiking levels of trans identification in females. Responsible doctors analyze situations when epidemiology has drastically changed.
We are an intellectually honest, evidence-based organization. We cover the valid "nature" data on brain research, lending credence to the above claim's possibility. But why does a layperson org have more comprehensive, evidence-based information than the Endocrine Society or Pediatric Endocrine Society? You pretend people who flatly state their social environment helped fuel their dysphoria and desire to transition don't exist. You pretend the multiple sex and gender researchers who worry that early social transitions may groom pre gay and lesbian children for medicalization don’t exist (Dr. Wren, Dr. Carmichael, Dr. Cantor, Dr. Zucker, Dr. Soh, Dr. Bailey, Dr. Blanchard, Dr. Korte, Dr. Drescher, Dr, Bradley, even Dr. Steensma have made these statements). The very design of your materials is to hide harm and risk. This is intentional, isn’t it? To see yourselves as protecting the important children even if it means recklessly endangering others by pretending they don’t exist, and ensuring your doctors and the public don’t know they exist.
https://www.genderhq.org/trans-nature-vs-nurture-innate-gender-identity-culture
https://www.genderhq.org/increase-trans-females-nonbinary-dysphoria
https://www.genderhq.org/trans-children-gender-dysphoria-desistance-gay/#anchor-page1-section-b
You cite Jack Turban and pretend serious critiques by GD experts of his work don't exist. A good list of these professionals can be found in the comments on his JAMA article (under paywall), which should have been published if people were acting with integrity around this issue.
https://www.genderhq.org/blog/conversion-therapy-trans-study-turban?rq=Turban
Another criticism:
https://pubmed.ncbi.nlm.nih.gov/30392631/
“We work and live with the co-occurrence of autism and gender diversity on a daily basis, and we are concerned that perpetuating misunderstanding about the co-occurrence places individuals at risk.”
More on Jack Turban:
http://link.springer.com/10.1007/s10508-020-01844-2
Moving on:
“Pre-pubertal youth who are supported and affirmed in their social transition long before medical interventions are indicated, experience no elevation in depression compared to their cis-gender peers.” (12)
Your reference is Achilles (2020). Should this not be Olson (2016)? Achilles is a drug study on adolescents. And the social transition Olson study is far from perfect.
Here is another example of the malpractice of your documents that violate all standards of informed consent:
"Over the last decade, there has been considerable research on and development of evidence-based standards of care that have proven to be both safe and efficacious for the treatment of gender dysphoria/gender incongruence in youth and adults.”
Where is this hard evidence this is “proven” “safe?” Jazz Jennings had 4 sexuality-destroying vaginoplasty corrective surgeries and will never have any sexual feeling, and you call this “safe.” Multiple gender dysphoria experts are concerned about this harming potential desisters, and you call this “safe.” There is information that this impacts bone health, and you call this “safe.” It looks like the blockers you are prescribing cognitively immature children can negatively impact pubertal brain development by lowering IQ. IQ is something very pertinent to career choice and earned income. But this is “safe.” There is no mention of the study that indicates a significant increased risk of heart attack in FtMs or mitochondrial damage or vaginal atrophy. You don’t mention you have no idea what the long-term consequences are of transitioning tweens on their bodies over the decades to come. How is this ethical, this hiding by you of negative, valid data? How? Having a good, honest desire to help this population is not a valid excuse for violating basic tenants of informed consent and “do no harm.” Citations for serious medical side-effects below:
https://www.genderhq.org/trans-youth-side-effects-hormone-blockers-surgery
We highly recommend you look at historical accounts of how medical and mental health professionals have harmed the public due to mirthful excitement about new protocols that wound up harming people because sterilizing children, destroying their sexual response forever, harming LGB youth, impacting bone health, IQ, and circulatory health are grave matters. We aren’t lawyers, but it sounds like “safe” is lawsuit-worthy (and was in the Bell v Tavistock case).
Bottom line- The sheer extremity of what you are doing to children is because you are being led to believe you are preventing suicides (referenced in your documents). There is a lack of robust proof that this is true, and several media-covered suicides used to promote underage transition involved fully affirmed youth with access to medical protocols. Inflating suicide risk, something often employed by affirmative model doctors and therapists to the public, violates all anti-suicide reporting guidelines, even those for LGBT youth laid out specifically by the American Foundation for the Prevention of Suicide. Suicide is highly socially contagious. Sending the message youth will kill themselves if not given strong drugs immediately is harmful. GHQ does not spin suicide. It is too serious a matter. No one should. Some studies indicate transition is helpful in this way. The studies in the Cornell review and others that have this information is on our evidence-based website.
But we will list studies/articles that should alarm you given the soaring numbers of children endocrinologists are “chemically castrating,” leading to underage surgeries:
Branstrom (2020) recently had to be corrected (authors really wanted positive results). The reality is this study from Sweden’s healthcare system, with a large population, failed to prove mental health benefits to either hormonal therapy or sex reassignment surgery. This is in a country that is very pro LGBT, where people have access to public healthcare. It’s not perfect data but better than much in the Cornell review.
Lipson (2019) should concern you. This is a large population of college students surveyed. Why is the mental health so poor in trans people at universities where trans identity is celebrated, minority status is elevated in general, and they have access to student health care that often pays for transition?
Graph circulated by a researcher on SM regarding Lipson (2019)
The use of puberty blockers has not been shown to improve mental health in the UK, one of the reasons Tavistock lost the Bell v Tavistock case. There are likely thousands of kids on these blockers now in the US.
At this time there are 20,000 adverse effects reported to the FDA from Lupron. An older article-
https://khn.org/news/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems/
See Adams (2017)- This study, a meta-synthesis analysis, indicates transition may be ineffective in reducing suicide risk. When combining averages across 42 of the more recent studies (relevant because being trans was likely more difficult and unaccepted in the past), they found very high suicide ideation rates, even within the last year. Past year's stats also are not much better than lifetime stats in this review. And these are individuals accessing "gender-affirming" medical care.
Stop engaging in desistance denial. This data is not presented in your documents. Having researched this for years, we understand why. Desistance data clearly shows pediatric transition is a risk to pre-gay and lesbian kids and ROGD (Littman 2018) shows this is a risk to teens struggling with puberty. This isn't included because you do not care about these youths. No one does in “affirmative” discourse. If you cared, you would address the risks to them and their needs. You can see it every time any data or evidence shows they are being harmed (they are) or may be harmed. You can see a long list of censorship incidences enforced not only by activists (who always threaten people) but by major universities, LGBT media, and magazines like Psychology Today. Everyone does it who wants to appear "progressive." Because LGB youth don’t matter. Girls struggling with puberty don’t matter. Girls who may have a sexual assault in their background don’t matter. If they mattered, you would talk about their needs and suffering, how they are scarred when their body parts are removed at too young an age, and how you are destroying their human right to just grow up and work out their identity issues.
You can't bring yourselves to write one sentence in care of them. Not one.
There is so much that is sloppy about your material and ignoring of legitimate studies and critiques of the happy/safe narrative. Please fix this. It delegitimizes you and violates your moral and professional obligations. There are too many people who are very well informed who will hold those accountable for ignoring risk and, worse, lying about it and covering it up. We will leave by summarizing the problems:
1) No acknowledgment of high rates of desistance in all prior research and the likelihood of them being gay or lesbian, thus obscuring risk to pre-gay kids by putting them in social transition at age 5 and interfering with their natural puberty with blockers.
2) No acknowledgment of bizarre trends of clusters of teenage females coming out as trans in a gender dysphoria spike unheard of 20 years ago. Any responsible health professional takes a close look at a condition when its epidemiology changes drastically, especially when treatment results in permanently altering a minor and social contagion is a well-established phenomenon with many historical examples.
3) No acknowledgment of several disturbing studies indicating the hormone blockers, hormones and sex reassignment surgery overall may not reduce the likelihood of mental health problems and suicide risk. And no honest review of information showing very significant negative health impacts.
4) References to Jack Turban and no references to the critiques of this barely out of med school doctor’s work.
5) No care from the Endocrine Society and Pediatric Endocrine Society for mounting numbers of mostly young women, many ASD and/or lesbian and bisexual, encouraged to hate their bodies as struggling same-sex attracted tomboys, who are now permanently scarred by the mental health and medical profession. See their stories on this subreddit with thousands (assume a high 90% are lurkers and just 10% detrans/desisters, this is a lot of people with regret on this site with 17K subscribers).
https://www.reddit.com/r/detrans/
Tout data that shows benefits to pediatric transition. It’s there. We don’t deny that. But this is an unfolding nightmare and major human rights violation for those of us who care about pre-gay and lesbian kids and LGB teenagers, known to experience intense but ultimately transient GD. We are also very small minority groups. More and more detransitioned young people are significantly impacted. Our communities and our humanity are significantly impacted. We do not blame the mounting numbers of scarred and permanently altered young people. We are working to ensure mental health and medical professionals involved in these inappropriate transitions are held accountable and are not allowed to kick these “bad optics” youth under the rug as morally acceptable collateral damage. Your endocrine guidelines/statements do just that and it’s intentional.
We are a trans-inclusive organization that cares about the obsession with passing being worshipped over brain development, bone health, genital development, avoiding severe and experimental bottom surgeries, and fertility.
This will be on our website. We will provide documentation of this to anyone who later feels they were harmed by the doctors in your organizations following substandard informational guidelines and want them held accountable. This has been successfully done in the UK. Don’t assume there isn’t an intense motivation to hold those accountable in the US. Don’t assume you are immune.
We aren’t the only people/organization/group concerned about this international issue. And some of them are trans.
https://lgballiance.org.uk (with chapters in the US, Canada, Poland, and Australia)
https://www.transgendertrend.com
Supporting parents of children with gender dysphoria
https://genderreport.ca
_____________________________________
Our board
https://www.genderhq.org/about
A list of supporters
https://www.genderhq.org/letter-signatures
References:
Adams, N., Hitomi, M., & Moody, C. (2017). Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature. Transgender Health, 2(1), 60-75. doi:10.1089/trgh.2016.0036
Holt, A. (2020, December 1). Puberty blockers: Under-16s 'unlikely to be able to give informed consent.' BBC. Retrieved from https://www.bbc.com/news/uk-england-cambridgeshire-55144148
Correction to Bränström and Pachankis. (2020, August). The American Journal of Psychiatry. Retrieved from https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction
Biggs, M. (2019, July 29). The Tavistock’s Experiment with Puberty Blockers. Retrieved from http://users.ox.ac.uk/~sfos0060/Biggs_ExperimentPubertyBlockers.pdf?fbclid=IwAR2X8HdzFfeUnaY0995EiTh9-gYCBKz5FmHG98PTdMjbXgZd5IhhGvl6uhY
Brunskill-Evans, M. (2018, June 21). A Woman’s Place is Standing Her Ground. Retrieved from http://www.heather-brunskell-evans.co.uk/body-politics/1114/
D’Angelo, R., Syrulnik, E., Ayad, S, Marchiano, L., Kenny, D.T., Clarke, P. One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria. Archives of Sex Behavior (2020). Retrieved from https://doi.org/10.1007/s10508-020-01844-2
Endocrine Society (2020, December 16). Discriminatory policies threaten care for transgender, gender diverse individuals. EurekAlert. Retrieved from https://www.eurekalert.org/pub_releases/2020-12/tes-dpt121120.php
Endocrine Society, Pediatric Endocrine Society. Transgender Health: Suporting Gender Diverse Youth to Improve their Health, Well-being, And Safety. Retrieved from https://www.endocrine.org/-/media/endocrine/files/advocacy/position-statement/transgender_health_minors_fact_sheet.pdf
Endocrine Society, Pediatric Endocrine Society. Endocrine Society and Pediatric Endocrine Society Transgender Health Position & Statement (2020). Retrieved from https://www.endocrine.org/-/media/a65106b6ae7f4d2394a1ebeba458591d.ashx
Endocrine Society (2020, December 16). Discriminatory policies threaten care for transgender, gender diverse individuals. EurekAlert. Retrieved from https://www.eurekalert.org/pub_releases/2020-12/tes-dpt121120.php
Jewett, C., & Kaiser Health News. (2017, November 30). Women Fear Drug They Used To Halt Puberty Led To Health Problems. Retrieved from https://khn.org/news/women-fear-drug-they-used-to-halt-puberty-led-to-health-problems/
Lipson, S.K, Raifman, J., Abelson, S., Reisner, S.L. Gender Minority Mental Health in the U.S.: Results of a National Survey on College Campuses. American Journal of Preventative Medicine 53(3), 293–301. doi.org/10.1016/j.amepre.2019.04.025
Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137(3), e20153223. doi:10.1542/peds.2015-3223
PRWeb. (2014, September 5). Beverly Hills Plastic Surgeon, Gary Alter, MD, Performs Gender Reassignment Surgery on Youngest Transsexual Patient in the United States. Retrieved from http://www.prweb.com/releases/2014/09/prweb12141694.htm
Strang, J.F., Janssen, A., Tishelman, A., Leibowitz, S.F., Kenworthy L, McGuire, J.K., Edwards-Leeper, L., Mazefsky, C.A., Rofey D., et al. (2018) Revisiting the Link: Evidence of the Rates of Autism in Studies of Gender Diverse Individuals. Journal of the American Academy of Child & Adolescent Psychiatry 57(11), 885-887. doi: 10.1016/j.jaac.2018.04.023
TLDEF's Trans Health Project (2020, December 17). Endocrine Society. Retrieved from https://transhealthproject.org/resources/medical-organization-statements/endocrine-society-statements/
van der Miesen, A., Cohen-Kettenis, P., de Vries, A. (2018) Is There a Link Between Gender Dysphoria and Autism Spectrum Disorder? Journal of the American Academy of Child & Adolescent Psychiatry 57(11), 884-885. doi:https://doi.org/10.1016/j.jaac.2018.04.022
Walch, A., Davidge-Pitts, C., Safer, J.D., Lopez, X., Tangpricha, V. Iwamoto, S.J. (2020, December 16). Proper Care of Transgender and Gender Diverse Persons in the Setting of Proposed Discrimination: A Policy Perspective. The Journal of Clinical Endocrinology & Metabolism. doi.org/10.1210/clinem/dgaa816