I’m no expert on this but just as in the transition surgery there are ways of approximating. As you’ve noted before there are frequent decisions that we make in life that are difficult or impossible to reverse later. That doesn’t mean we ban the ability to make those decisions. Frequently Conservatives are the ones who argue that people should have the freedom to make even bad decisions yet we see that in this in many cases they would rather enforce a paternalistic big government attitude.
How many underage cases of penises lobbed off? Do you understand the chemical castration is reversible?
Spoiler Sorry loud minority liberal D&D…you are the minority. You use emotional blackmail to (try to) get your way. “We must affirm them or they’ll kill themselves!” “We must allow them to cut off their dicks/breasts or they’ll kill themselves!” “We must give them the same drug(s)(Lupron) they use to castrate sex offenders or else they’ll kill themselves!” “Would you rather have a trans daughter or dead son?!” No different than an abuser telling their s/o “Stay with me or I’ll kill myself.” How did “trans kids” (or even “trans people” in general) survive in the 60s/70s/80s/90s without this “life saving” “gender affirming care”? I mean, you say trans people have been around since the beginning of time. How did they survive without this care? On one hand, you say the mass increase (really mainly Gen Z) of trans coming out is “acceptance”. On the other hand, you cry about “genocide”. There’s a genocide going on! 4000% increase in trans…yeah, totally natural (LOL) Why aren’t baby boomers and Gen X (and anyone who is not Gen Z) “coming out” if it’s more acceptable? ____________________ https://www.nytimes.com/2022/06/10/science/transgender-teenagers-national-survey.html Teenagers and adults under 25 make up an estimated 43 percent of the transgender population. Ages of teens and adults who are transgender Age 13-17: 18.3% 18-24: 24.4% 25-64: 46.8% 65+: 10.5% Ages of all teens and adults in the United States 13-17: 7.6% 18-24: 11% 25-64: 61.8% 65+: 19.6% The study found people 13 to 25 accounted for a disproportionately largely share of the transgender population. While younger teenagers were just 7.6 percent of the total U.S. population, they made up roughly 18 percent of transgender people. Likewise, 18- to 24-year-olds made up 11 percent of the total population but 24 percent of the transgender population. Older adults had a disproportionately small share: Though 62 percent of the total population, only 47 percent of transgender people were 25 to 64. And while 20 percent of Americans are over 65, that age group makes up only 10 percent of the total number of transgender people nationwide. ____________________ https://williamsinstitute.law.ucla.edu/visualization/lgbt-stats/?topic=LGBT 58% female, 58% white, 71% not raising children ____________________ https://www.advocate.com/news/transgender-poll-american-anti-trans In the Post-KFF poll, conducted November 10 through December 1, 57 percent of respondents said a person’s gender can’t differ from what was assigned at birth, while 43 percent said it can. Other polls have seen an increase in respondents saying gender is fixed at birth. In one conducted last year by the Pew Research Center, 60 percent gave that response, up from 54 percent in 2017. “Even among young adults, who are the most accepting of trans identity, about half said in the Post-KFF poll that a person’s gender is determined by their sex at birth,” the Post reports. A majority of participants in the Post-KFF poll opposed some gender-affirming treatments for young people. Sixty-eight percent opposed the use of puberty blockers for trans youth aged 10-14, and 58 percent opposed hormonal treatments for those aged 15-17. Majorities did approve of gender-affirming counseling or therapy for both age groups. There was also majority opposition to letting trans girls and women compete on female sports teams. More than 60 percent opposed trans inclusion, whether in youth, high school, college, or professional sports. Majorities said it was inappropriate for teachers to trans identity in the classroom before students reach high school. Seventy-seven percent said it was not appropriate in kindergarten through third grade, 70 percent in fourth and fifth grade, and 52 percent in sixth through eighth grade. Only 36 percent said it was inappropriate in ninth through 12th grades. The poll included 1,338 U.S. adults, including 515 who are trans and 823 who are cisgender. Unsurprisingly, trans people were more supportive than cis ones of access to gender-affirming care and inclusion in sports, and a majority said gender can differ from what was assigned at birth. ____________________ https://www.washingtonpost.com/dc-m...ns-oppose-transgender-athletes-female-sports/ Even as an increasing share of Americans report familiarity with and tolerance for transgender people, most oppose allowing transgender female athletes to compete against other women at the professional, college and high school level, according to a Washington Post-University of Maryland poll. The poll, conducted May 4 through 17 among 1,503 people across the United States, finds 55 percent of Americans opposed to allowing transgender women and girls to compete with other women and girls in high school sports and 58 percent opposed to it for college and professional sports. About 3 in 10 Americans said transgender women and girls should be allowed to compete at each of those levels, while an additional 15 percent have no opinion. At the youth level, 49 percent are opposed to transgender girls competing with other girls, while 33 percent say they should be allowed to compete and 17 percent have no opinion. The Post-UMD poll finds over two-thirds of Americans, 68 percent, say that transgender girls would have a competitive advantage over other girls if they were allowed to compete with them in youth sports; 30 percent say neither would have an advantage, while 2 percent say other girls would have an advantage. ____________________ https://www.washingtonpost.com/education/2023/05/05/trans-poll-gop-politics-laws/ Clear majorities of Americans support restrictions affecting transgender children, a Washington Post-KFF poll finds, offering political jet fuel for Republicans in state legislatures and Congress who are pushing measures restricting curriculum, sports participation and medical care. Most Americans don’t believe it’s even possible to be a gender that differs from that assigned at birth. A 57 percent majority of adults said a person’s gender is determined from the start, with 43 percent saying it can differ. And some Americans have become more conservative on these questions as Republicans have seized the issue and worked to promote new restrictions. The Pew Research Center found 60 percent last year saying one’s gender is determined by the sex assigned at birth, up from 54 percent in 2017. Even among young adults, who are the most accepting of trans identity, about half said in the Post-KFF poll that a person’s gender is determined by their sex at birth. More than 6 in 10 adults in the Post-KFF poll said trans girls and women should not be allowed to compete in girls’ and women’s sports, including professional, college, high school and youth levels. The Post-KFF poll found significant opposition to gender-affirming medical care for children and teens. Nearly 7 in 10 adults said they oppose allowing children ages 10 to 14 access to medication that stops the body from going through puberty, and nearly 6 in 10 oppose giving 15- to 17-year-olds access to hormone treatments. (There was, however, majority support for gender-affirming counseling or therapy, with more than 6 in 10 supporting this for both age groups.) There is also wide support for limits on classroom conversation about gender identity with younger children. More than 3 in 4 adults said it was inappropriate to discuss trans identity with students in kindergarten through third grade, and nearly as many said the same for fourth and fifth grades. It was a different story, though, for older students. People were roughly divided when asked about middle-schoolers, and nearly 2 in 3 supported discussion of trans identity in high school.
Spoiler https://www.prri.org/research/chall...indings-from-the-2022-american-values-survey/ A majority of Americans (62%) believe that there are only two genders (male and female), including 44% who feel strongly that this is the case and an additional 18% who do not feel strongly about it. More than one-third of Americans (35%) say there is a range of genders, including 22% who think this but do not feel strongly about it and 13% who feel strongly. These beliefs are generally unchanged since 2021. Nearly nine in ten Republicans (88%) believe that there are two genders, including 73% who feel strongly about it. Just 10% of Republicans believe there is a range of gender identities. By contrast, only 36% of Democrats believe there are just two genders, including 21% who feel strongly that gender is binary. A majority of Democrats (62%) believe there is a range of gender identities, and 27% feel strongly about it. Independents closely mirror all Americans, with 62% believing that there are two genders, including a 40% plurality who feel strongly about it. More than one-third of independents (36%) feel that there is a range of gender identities, including 10% who strongly feel about it. Majorities of Black Americans (68%), white Americans (65%), and Hispanic Americans (55%), believe that there are only two genders, compared with 50% of multiracial and other-race Americans. White Americans are particularly divided along education lines: 69% of white Americans without a four-year college degree say there are only two genders, compared with 57% of white Americans with at least a four-year college degree. Belief in a gender binary generally increases with age. Americans ages 18–29 are the least likely to believe that there are only two genders (53%), compared with 60% of those ages 30–49, 68% of Americans ages 50–64, and 65% of Americans over age 65. Men (68%) are more likely than women (57%) to believe that there are only two genders. Americans who know someone who is gay, lesbian, or bisexual (60%), and particularly those who know someone who is transgender (47%), are significantly less likely than those who don’t know any gay, lesbian or bisexual people (71%) or transgender people (70%) to say that there are two genders. Americans continue to be divided over policies that would require transgender individuals to use bathrooms that correspond to their sex at birth rather than their current gender identity (52% favor, 44% oppose). Strikingly, despite increasing support for LGBTQ rights generally, Americans are moving in the opposite direction on this specific question. Americans are 17 percentage points more likely to favor such policies today than they were in 2016, when the question was first asked (35% favor, 53% oppose). Compared with responses from 2016, support for restrictive bathroom policies is notably higher among Republicans and independents. The biggest shift is among Republicans, who are 30 percentage points more likely to favor requiring transgender individuals to use bathrooms that correspond to their sex at birth (from 44% in 2016 to 74% in 2022). Independents are also more likely to support these policies today (55%) than they were in 2016 (37%). Democrats (31% in 2022) have not shifted significantly since 2016 (27%). Similarly, slim majorities of Americans who are multiracial or another race (53%), Hispanic Americans (52%), and white Americans (51%), along with half of Black Americans (50%), support restrictive bathroom policies. However, white Americans with a college degree are notably less likely than those without a college degree to support restrictive bathroom policies (46% vs. 55%). Support for restrictive bathroom policies increases with age. Americans ages 18–29 (39%) are least supportive, while half of Americans ages 30–49 (50%) support these restrictions, as do majorities of Americans ages 50–64 (58%) and Americans over age 65 (59%). Men (58%) are more likely than women (46%) to support restrictive bathroom policies. Nearly seven in ten Americans who believe that there are only two genders (69%) also support restrictive bathroom policies, compared with only about one in four among those who believe that there is a range of gender identities (23%). Americans who know someone who is gay, lesbian, or bisexual (49%), and particularly those who know someone who is transgender (39%), are notably less likely to support restrictive bathroom policies than those who don’t know any gay, lesbian, or bisexual people (66%) or transgender people (60%). More than four in ten Americans (44%) support laws that would prevent parents from allowing their child to receive medical care for a gender transition, compared with a slim majority who oppose these laws (53%). Republicans (61%) are about three times as likely as Democrats (22%) to support these laws, while independents closely resemble all Americans (46%). Interestingly, both young Americans ages 18–29 (41%) and seniors age 65 and older (38%) are less likely to support these laws than Americans ages 30–49 (46%) and 50–64 (48%). Women (40%) are also less likely than men (47%) to support these laws. Not surprisingly, a majority of Americans who believe that there are only two genders (57%) also support laws that prevent medical care for gender transition for children, compared with only 21% of Americans who believe that there is a range of gender identities. Americans who say they know someone who is transgender (36%) are significantly less likely to support these laws than those who don’t know anyone who is transgender (47%). ____________________ And let’s go to our most important poll…the CF D&D poll. https://bbs.clutchfans.net/threads/where-do-you-draw-the-line-transgender.318624/ A whopping 69% says we should not play along with any of the delusions of these mentally ill sex fetish freaks. ____________________ We are not a cult. We are not a cult. We are not a cult. We are not forcing anything on anyone. We just want to tuck our penises and be left alone. We are not forcing anything on anyone. We are not a cult. We are not forcing anything on anyone. We just want to be left alone. IDAHO STUDENT BANNED FROM GRADUATION FOR SAYING “GUYS ARE GUYS AND GIRLS ARE GIRLS” Only if he said Buy Large Mansions or Tranny Lives Matter, he would’ve been allowed to walk. University of Cincinnati student says professor failed her for using the term ‘biological women’ “Olivia, this is a solid proposal. However, the terms "biological women" are exclusionary and are not allowed in this course as they further reinforce heteronormativity.” Dallas city council’s warning to workers: Use preferred pronouns or risk being fired Dallas City employees are “expected to respectfully use the transitioning employee’s preferred name and pronouns, regardless of whether or not they ‘believe in,’ approve of, or accept an individual’s right to be transgender or undergo a gender transition.” “Refusing to respect an employee’s gender identity by intentionally referring to an employee by a name or by pronouns that do not correspond to the employee’s gender identity” is a form of discrimination and harassment the documents warned, adding that employees who fail to comply “may be disciplined up to and including termination.” In a statement, the city of Dallas defended the guidance and noted they were developed by the City’s Office of Equity. ____________________ When they talk about “banning books”, this is some of the **** being removed. But I’m not surprised that libs want to talk to toddlers and little kids about sex and gender and telling them they’re born in the wrong body and “GAC” will magically cure them. Of course under the guise of “education, tolerance and acceptance.”
I'm not a doctor, but I don't consider circumcision to be medicinal in nature (holds no therapeutic benefit if not outright harmful) so I'd be perfectly content if it were against the law. I find it odd that you did not feel the same given your crusade about consent and such, given that circumcision is overwhelmingly done at an age where consent isn't even remotely possible.
Spoiler The loving and affirming care. D&D friends, would you hit? You would definitely hit (or else you’re a transphobe). (How many of you D&D guy “allies” would date a “trans woman”?) (If they don’t show, click the tweets, they are available) Oh, you had your male dog neutered? I guess it’s a she now! ____________________ “Republicans hate women!” “Republicans war on women!” blah blah blah because abortion was returned to the states. Meanwhile, you are erasing women. Move over, shut up, accept it. You must allow men (and they are men) into your spaces. You have relegated women to a feeling. You can’t even define what a woman is. You don’t even call them a woman anymore. You have relegated them to a feeling. You have relegated them to terms like •“Womxn” •“Birthing person” •“Chestfeeder” •“Person who bleeds” •“Menstruating person” •“Uterus owner” •“Vulva owner” •“Cervix haver” •“Bodies with vaginas” •“Fronthole” I obviously am not a woman but I can’t imagine any self-respecting woman wants to be called a “person who bleeds” or a “birthing person” or a “uterus owner”. Notice how we aren’t calling men “penis owners”, “testicle havers”, “prostate havers”, or “ejaculators”. This is what a majority of you really think. A feeling. If I say I’m a woman, I’m automatically a woman! And I deserve, I demand every right to women’s spaces! If someone says they’re black, they’re black. Not a tough concept! #TransRightsAreMensRights #TransWomenAreMen #MensRightsMovement When did “trans rights” supersede women’s rights? Where are all the trans men (bio women) demanding access to men’s locker rooms, bathrooms and men’s spaces? Why aren’t they demanding to be included in men’s sports?
Umm I said I am against the practice (in boys, even much more so in girls). What more did you want me to do, bomb doctors offices where they do these surgeries?
There's a big difference between being "against" something and wanting people who do that thing to be put into prison.
So wait, you would be content if chopping off the foreskin were against the law, but chopping off the whole willy is ok?
Spoiler I’m not saying they don’t exist but where are all the black trannies? Asian trannies? (Not the ladyboys in Thailand) Hispanic/Latino trannies? Oh right, take a look around — any trans protests, trans rallies — it’s middle class white people. And the so-called “trans kids”? White liberal moms. “Well because the typical demographic is upper middle class white kids of progressive parents. for two reasons. They have time and money to worry about such things, and have been conditioned to believe through Critical Theory that they are an oppressor and there is no way they can ever escape that status, so they see this as a way to join an oppressed class for which they are celebrated for instead of condemned. It’s the relationship between CRT and Queer theory.” ____________________ Should we start affirming anorexic girls? Give them liposuction, maybe a gastric band? Why not? They legitimately think and feel like they’re fat. We need to affirm them! Affirmation is love! Oh, you’re against that? What about that schizophrenic that says the toaster is talking to them? Affirm them too!
If you were sincerely trying to understand what I’m saying then you’d learn how to read lol.. reading comprehension is the first step to understanding dialogue in written form. Start with that then ask a literate question. Thanks!
Spoiler Now I do want to get serious. Why is Sweden, Finland, England, Norway and some of these countries moving away from “gender affirming care” while the US is full steam ahead? (Besides they are “fascist governments/countries”) Why is the US right and these countries are wrong? These countries, these doctors must so obviously want to see kids die. December 2020: The UK High Court rules that #PubertyBlockers for normally-timed puberty are experimental and that young gender-dysphoric people (under 16) are unlikely to be able to provide meaningful informed consent. It is not yet known whether there is long-term psychological harm or benefit, whether suicide rates are increased, decreased or unchanged, and whether blockers contribute to longer-term persistence of gender dysphoria and adverse impacts on future morbidity and mortality. Ethical practitioners must humbly recognize the significant uncertainties in the field of gender medicine. We hope that the Court's landmark judgement will mark the beginning of international commitment to generating quality evidence base for young people with #GenderDysphoria. April 2021: Earlier this week, two new systematic reviews of puberty blockers and cross-sex hormones were published. They were commissioned by NHS England, as part of a review of gender dysphoria healthcare led by Dr Hilary Cass. These reviews make sober reading. The major finding of the puberty blocker review was that GnRH agonists lead to little or no change in gender dysphoria, mental health, body image and psychosocial functioning. The review of cross-sex hormones identified significant shortcomings in the quality of the evidence. In SEGM's view, the low confidence in the balance of risks and benefits of hormonal interventions calls for extreme caution when working with gender-dysphoric youth, who are in the midst of a developmentally-appropriate phase of identity exploration and consolidation. Noninvasive approaches including exploratory psychotherapy should be the first line of treatment for gender-dysphoric youth. Medical interventions should be conducted only in research settings with study designs able to determine whether these interventions are beneficial. Patients must be informed of the limited prognostic ability of the gender dysphoria diagnosis for youth, and the many uncertainties regarding the long-term mental and physical health outcomes of the poorly studied and largely experimental medical "affirmative" interventions. May 2021: Suppressing puberty in gender-dysphoric children by administering puberty blockers entails several known risks including decreased bone density. A new study found that after 2 years on GnRHas, up to 1/3 of the children have abnormally low bone density. The study found that Z-scores for a significant minority of the children declined to a level that should trigger clinical concern. The clinical consequences of the failure to accrue normal bone mass are unknown, but decreased bone density is associated with future osteoporosis. Clinicians using GnRHas off-label for gender dysphoria should be aware of the risk to bone health. Bone density & fractures should be monitored during puberty and into adulthood to assess if the expected higher risk of osteoporosis eventuates. May 2021: The Karolinska Hospital in Sweden has issued a policy statement regarding treatment of gender dysphoric minors at its pediatric gender services division. This policy ends the practice of prescribing puberty blockers and cross-sex hormones to minors <16. Sweden becomes the first country to stop the use of the "Dutch protocol" for treating gender dysphoric minors over concerns of medical harm and low certainty of benefit. Other countries (UK, Finland) are also moving away from medicalizing minors. As international awareness of the low quality of evidence behind "gender-affirming" hormonal interventions grows, the focus is expected to shift to non-invasive options for ameliorating the distress of gender-dysphoric minors, including psychological treatment and support. UPDATE: Following their March policy statement, the Karolinska Hospital issued a new policy (effective May 1, 2021). The new policy specifies that hormonal interventions for gender dysphoria will no longer be initiated for any minors <18, outside of clinical trials. The new policy does not specify if gender-dysphoric minors <16 will be eligible for clinical trials. June 2021: A recent large-sample study (n=237) of detransitioners highlights their experiences and unmet mental and physical healthcare needs. On average, detransition occurred at age 23 (30 for males), about 5 years after the transition was initiated. The study subjects' decision to detransition was most often tied to the realization that their gender dysphoria was related to other issues (70%), health concerns (62%), and a failure to alleviate dysphoria despite transition (50%). Study participants reported significant difficulties finding help during their detransition process from medical, mental health and LGBT communities. It is vital that healthcare providers develop protocols to both track and support this vulnerable patient population. July 2021: In June 2020, Finland broke from WPATH's guidelines by stating that therapy, rather than puberty blockers, hormones and surgery should be the first line treatment for minors with gender dysphoria. SEGM has now translated the full text of the guidelines. While pediatric medical transition is still allowed in Finland, it is now largely reserved for those with early childhood onset of gender dysphoria and no co-occurring mental health conditions. Surgery is not offered to those <18. The Finnish guidelines issue a sobering warning about the uncertainty of providing any irreversible "gender-affirming" interventions for young people < 25, due to the lack of neurological maturity. The guidelines also raise the concern that puberty blockers may negatively impact brain maturity and impair the young person's ability to provide informed consent to the subsequent and more irreversible parts of the Dutch protocol: cross-sex hormones and surgeries. These changes reflect the growing international concern about the unexplained sharp rise in adolescents presenting with gender dysphoria, which is occurring in increasingly complex developmental and mental health contexts. The Dutch protocol was not designed for such cases. The Finnish gender identity services program is a worldwide leader in pediatric gender medicine. The 2020 guidelines send a strong signal that the pioneers of pediatric medical transition are concerned about unintended harm to the growing number of gender dysphoric youth.
There's over 8 billion people on Earth. I can imagine that in some very rare cases genital surgery may be medically defensible if not preferable. One in particular that jumps out to me are intersex folks. I don't think circumcision and genital reconstruction/reassignment surgery are really analogous as a procedure and certainly not as therapy.
Spoiler October 2021: A new study of individuals who medically/surgically transitioned and subsequently detransitioned has been published. It suggests that detransitioners have complex problems not solved by transition & that the prevalence of detransition is underestimated. The key take-aways are that complex mental health needs of gender dysphoric patients were frequently overlooked prior to medical transition; social influence played a key role in developing a trans identity/seeking transition; and inappropriate transition often led to regret. The female study participants were on average 20 years old when they sought care to transition and 24 when they decided to detransition. Males were considerably older: the average ages to seek medical transition and to subsequently detransition were 26 and 33, respectively. The leading reason for detransition for both sexes was becoming more comfortable with identifying with their natal sex due to a change in personal definition of female and male. This notion was cited by 65% of females and 48% of males. However, other reasons differed by sex. For females, the second and third most frequently cited reasons for detransition were concerns about potential medical complications from transitioning (58%) and dissatisfaction with the physical results/too much change (51%). In contrast, males endorsed dissatisfaction with the physical results/too little change, deteriorating physical health, continued mental health problems, and feeling that they were discriminated against (36% each) as the reasons for detransition. 50% of the study participants reported strong or very strong regret associated with transition. The majority of respondents were dissatisfied with their decision to transition (70%) and were satisfied with their decision to detransition (85%). Nearly a third of detransitioners endorsed the response “someone else told me that the feelings I was having meant that I was transgender and I believed them” to describe how they felt about identifying as transgender in the past. /8 Many participants selected social media, online communities, and in-person friend groups as sources that encouraged them to believe that transitioning would help them. Some participants reported that mental health and medical clinicians pressured them to medically transition. The study raises concerns about the the quality of health care provided to many of the participants. Although psychiatric conditions/trauma prior to the onset of gender dysphoria were common, 65% of the participants said these factors were not evaluated by gender clinicians. Less than a quarter of the participants (24%) told their treating clinicians that they discontinued medical treatment. This, in turn, suggests that clinicians may be unaware of their own patients who detransition and that clinic rates of detransition are likely underestimated. Most of the study subjects transitioned before 2015, the year when the landscape of gender care drastically changed. Many more young people are now expressing gender-related distress, while the "gender-affirmative," rather than exploratory, approach has become widespread. November 2021: The Royal Australian and New Zealand College of Psychiatrists (RANZCP) released a position statement in which it no longer presents "gender-affirming" hormonal and surgical interventions as the preferred treatment for gender dysphoria in youth. The position cites “polarised views and mixed evidence regarding treatment options for people presenting with gender identity concerns, especially children and young people,” stating that “professional opinion is divided" whether affirmation vs other treatments are appropriate. The statement recognizes that gender dysphoria can arise from multiple causes, and highlights the important role psychiatrists have in performing a comprehensive assessment. Psychotherapy is presented as a valid alternative to gender-affirmation with hormones and surgery. January 2022: The topic of suicide in trans-identifying youth is frequently in the headlines. Yet, until recently, the focus has been on their self-harming thoughts & behaviors, rather than completed suicides. A new study fills this key knowledge gap. Using data from the world’s largest gender clinic (UK GIDS), the rate of completed suicides in the UK was found to be 0.03%, or an annualized rate of 13 per 100,000. No difference between those waitlisted vs treated was detected, likely due to low numbers of suicides (n=4). Gender-dysphoric youth who self-harm must be supported, including - if indicated - with evidence-based suicide prevention protocols. To date, however, no studies have shown that transition reduces the risk of suicide long-term. While higher than the rate found in the general population, the 0.03% statistic suggests the absolute risk of suicide is low. This, combined with the lack of evidence that hormones & surgery reduce the risk of suicide, calls into question the “transition or suicide” narrative. Suicide is rarely attributable to a single cause: mental illness, autism, eating disorders - prevalent in trans-identifying youth - all increase its risk. However, the fact that death by suicide is rare should provide some reassurance to families of gender-dysphoric youth. February 2022: Yesterday, Sweden released its long-awaited guidelines for the care of gender-dysphoric youth. These guidelines represent a major departure from the WPATH "Standards of Care," and are a vital step towards safeguarding vulnerable youth from medical harm. Below is a summary of our initial take-aways and observations. Sweden’s new guidelines emphasize that gender-dysphoric youth will continue to receive care. However, health care for gender dysphoria is no longer reduced to “hormones and surgeries.” The recommendations now call out a key role for psychiatric and psychosocial services. The guidelines assert that based on current evidence, the risks of hormonal interventions outweigh the possible benefits. Thus, these interventions (often referred to as "gender-affirming care") will not be available outside of research settings, except as "last-resort." Sweden is realigning with the classic “Dutch Protocol” model, where only early childhood-onset gender dysphoria cases will be considered for hormones and surgeries. Those with post-puberty onset of trans identity will not be candidates for hormones/surgeries as minors. The guidelines highlight the unexplained rapid rise in trans identification in youth, especially teenage girls. They also note the worrying rise of detransitioners & regretters, which contradicts prior estimates of "low regret." They cite Littman 2021. The guidelines also note the lack of knowledge about how to treat "non-binary" youth (the predominant presentation today). They assert that access to medical interventions should be based on the presence of gender dysphoria, rather than the presense of a transgender identity. Sweden is centralizing its gender care for minors to a few centers for highly specialized care. Individual clinics and private providers will not be allowed to provide "gender-affirming" services. The guidelines express concern that little advance in quality knowledge has occurred since "gender-affirming" interventions were first recommended in Sweden in 2015, and that generally, little is known about how to best care for gender-dysphoric youth. In summary, Sweden has changed direction because of a lack of evidence to support medical interventions for gender-dysphoric minors. A new emphasis has been placed on psychiatric care and psychosocial support. Hormonal interventions for minors will be highly restricted.
Spoiler March 2022: As promised, SEGM has completed our preliminary analysis of the newly updated Swedish care guidelines for gender-dysphoric youth. The most salient points from the 104-page document are outlined in our recent blog below. We have also compared Sweden's new recommendations to those outlined in WPATH's draft SOC8. Sweden's guidelines are much more cautious, prioritizing psychological exploration and reserving puberty blockers and hormones to exceptional cases in clinical trial settings. March 2022: The National Academy of Health in France has just issued a press release regarding the care of gender-dysphoric youth. The Academy is advising psychological exploration, and cautions about the risks of pursuing hormones & surgery in youth. The statement notes that the rise in trans identity in youth may be in part due to excessive reliance on social media and "the questioning of an overly dichotomous view of gender identity by some young people." The press release states,"great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological," and points to risks for bone health, sterility, emotional and intellectual consequences and, for females, menopause-like symptoms. Due to growing numbers of gender-dysphoric youth, the National Academy of Medicine in France recommends extensive psychological evaluations, a multi-disciplinary approach to the decision to treat medically, and calls for studies of both medical as well as ethical implications. The National Academy of Medicine of France cautions parents of gender-dysphoric youth to "remain vigilant" regarding the addictive role of social media and its negative influence on psychological development in general, and on the onset of gender-related distress in particular. March 2022: The Cass Review, tasked with evaluating England's pediatric gender identity services, has issued its interim report. The Review expresses the concern that puberty blockers and hormones may not be the best approach for all desiring these interventions. The Cass Review defines the "affirmative model" as an American model of care. The Review notes that clinicians often "feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis..." The Review calls out the rapidly changing demographics of gender-dysphoric youth, increasingly complex presentations including neurocognitive &mental health comorbidities, and a lack of clinical consensus that hormonal "gender-affirming" interventions are appropriate for most. The Review is concerned not only with young patients <18 who have complex and poorly-understood presentations of gender dysphoria, but also with the vulnerable 18-25 age group. The recommendations recognize that the sharply increased demand for gender transitions has created pressures on the system, and as a result, assessments have often become less comprehensive. Further, many clinicians are afraid to conduct proper differential diagnosis. The Cass Review calls out the poor quality of evidence for the practice of pediatric gender transition and states that "decisions need to be informed by long-term data on the range of outcomes" from satisfaction with transition, to regret and detransition. Dr. Cass has a reassuring message for gender-dysphoric youth: "I have heard that young service users are particularly worried that I will suggest that services should be reduced or stopped. I want to assure you that this is absolutely not the case – the reverse is true." However, the Cass Review does not reduce care for gender-dysphoric youth to puberty blockers and cross-sex hormones. Gender dysphoria is recognized as having multiple possible causes, with multiple paths to resolution. The interim recommendations are to restructure gender services to provide more care locally; ensure extensive multidisciplinary assessments, differential diagnosis, and comprehensive informed consent prior to initiating hormonal treatments; and to conduct additional research. March 2022: Youth considering gender transition are denied true informed consent when they make decisions based on incomplete, inaccurate & biased information delivered in a cursory fashion, argues a key new publication on informed consent in gender medicine. Busy physicians and concerned parents put faith in “gender specialists,” hoping for a thorough evaluation of gender dysphoria causes and tailored solutions to lower a young person's distress. Instead, they typically get a rubber-stamped recommendation to transition. The authors argue that the belief that transition is the best treatment for distressed & struggling gender-dysphoric youth must be separated from the reality: Every aspect of transition from diagnosis to post-transition outcomes is fraught with profound uncertainty and risk. Few clinicians realize that the practice of pediatric transition rests on a single-site uncontrolled Dutch experiment. The authors argue that the results of this experiment have been misunderstood and the protocol has been misapplied to patients for whom it was not intended. The Dutch protocol (puberty blockers, cross sex hormones & surgery) excluded youth w/mental health problems or late onset of dysphoria. Paradoxically, today, the protocol is presented as the solution to mental health problems for this very group. Even for the subjects for whom the protocol was intended—adolescents with early childhood-onset of gender dysphoria that worsened in puberty—the results are not reassuring. The pre-post changes in psychological function were small, and serious adverse outcomes were observed. Of the 70 youth treated, one died due to surgical complications, 3 developed severe obesity/diabetes, and 1 terminated treatment—a possible 7% rate of short-term adverse effects, and no evaluation of long-term health outcomes. Can such an intervention claim to be “safe”? Post-transition, roughly half of the psychological measures showed no statistically significant improvements. Depression, anxiety, anger were unchanged. Other changes are modest, with marginal clinical significance at best. Can such an intervention be considered “effective”?
