Thank you for your thoughtful comments. As a scientist I must ask two questions before evaluating each individual case. 1. Is there any physiological indication that the child is not developing normally? and 2. What is the scientific basis for any proposed intervention? The answers to these questions should not depend on differences of opinion between pediatricians. After almost three decades of disabusing orthopaedic residents of the notion that correlation equals causation, my eyes roll when a physician claims his degree makes him a scientist. I like your idea of a committee evaluating each surgical intervention. It should be based in a hospital licensed to house the committee, and include a relevant scientist (from the local medical school). You will note that I did not include a psychologist/psychiatrist on the committee. In the best of all worlds it should. But I am so frustrated by the politicalization of their professional organizations that I can't think straight about how to pick one. I'd be thankful for any constructive suggestions.
O.K. I've read the article. I agree with its sense, although I am not comfortable with leaving the transgender problem up to the parents. I have met leftist parents who are more interested in making their children political statements than in allowing the child time and resources to develop until they understand what gender is about, with guidance from their pediatrician. Pediatricians need to be trained in understanding the science behind gender determination in mammals. Given the current political activism in pediatric professional societies I'm not confident this need will be fulfilled soon.
I agree Howard. As a physician I would hesitate to give life altering treatments like blocking puberty, and certainly not surgery, regardless of what the parents or doctor thinks. And I don't think this is generally happening against the parents will. In the one case in my family I am familiar with and suspect is typical, the child wanted it, the parents didn't, and the medical and psych people pushed heavy on the parents to consent who eventually gave in.
And I don't know that I would leave it up to a pediatrician because it is simple enough to find one that is very pro treatment and those specifically specializing in transition medicine are obviously very much in favor of doing it. Perhaps an independent board. The typical age for puberty in females is 8-13 and that should not be the age to make life altering decisions.
Right now there is a sharp divide between the understanding in the UK and Sweden and American medicine and I favor our overseas friends who have put the brakes on life altering treatments for children. Neither children, parents, or doctors consistently make the right choices.
Thank you for your thoughtful comments. As a scientist I must ask two questions before evaluating each individual case. 1. Is there any physiological indication that the child is not developing normally? and 2. What is the scientific basis for any proposed intervention? The answers to these questions should not depend on differences of opinion between pediatricians. After almost three decades of disabusing orthopaedic residents of the notion that correlation equals causation, my eyes roll when a physician claims his degree makes him a scientist. I like your idea of a committee evaluating each surgical intervention. It should be based in a hospital licensed to house the committee, and include a relevant scientist (from the local medical school). You will note that I did not include a psychologist/psychiatrist on the committee. In the best of all worlds it should. But I am so frustrated by the politicalization of their professional organizations that I can't think straight about how to pick one. I'd be thankful for any constructive suggestions.
Those things are difficult, but I tend to fall back on an inclination I always had in medicine that to avoid interfering with natural processes unless you have to which disinclines me towards treatment for gender dysphoria. The history of treatment for say body image dysphoria, anorexia etc. has always been to get people to accept who they are. So, I have a philosophical objection to transitioning, but that's
just me. I dont think you can find an unbiased person, because it is largely a political issue and MDs and psychs would fall on either side. The import of the Cass study in UK is that we don't have enough longterm data to argue in favor or against which is why they put the breaks on it, since as MDs we are sworn to 'first, do no harm' so if you can't rule out negative effect you would avoid life altering treatments. I used to get 20 year olds in wishing sterilization and I would argue against making those decisions so young, and would never do it myself, and with puberty blockers we are talking of children as young as 10.
None the less, and I dont know if you are referring to a personal choice, but what I would do is at least find somebody without strong opinions who will not OK everybody or disallow everybody. I don't think you will find a clear objective standard and most of the people in this line of work are very pro transgender or they wouldn't be doing it.
What a dream is "objective standard"! Does "objective" limit one to "logically consistent with natural causes"? I like to think so. But to me that entails science. Specifically, sociobiology. I won't burden with my take on that subject. "Standard" is a tough nut in psychology when taken to mean normal. I've raised and taught kids enough to be convinced that they need a mental anchor of "normality" to transform from a frightened animal dominated by paleolithic genes to a civilized human. As they navigate the chaos of adolescence, their parents need to let them explore their own paths to individuality, gradually lifting the anchor to facilitate the quest. What we need to do as members of the Welcome Party is grill candidates for office on their approach to this problem. If they can avoid the identity politics traps they will further qualify for the "trust" list.
Wolfy Jack,
Thank you for your thoughtful comments. As a scientist I must ask two questions before evaluating each individual case. 1. Is there any physiological indication that the child is not developing normally? and 2. What is the scientific basis for any proposed intervention? The answers to these questions should not depend on differences of opinion between pediatricians. After almost three decades of disabusing orthopaedic residents of the notion that correlation equals causation, my eyes roll when a physician claims his degree makes him a scientist. I like your idea of a committee evaluating each surgical intervention. It should be based in a hospital licensed to house the committee, and include a relevant scientist (from the local medical school). You will note that I did not include a psychologist/psychiatrist on the committee. In the best of all worlds it should. But I am so frustrated by the politicalization of their professional organizations that I can't think straight about how to pick one. I'd be thankful for any constructive suggestions.
O.K. I've read the article. I agree with its sense, although I am not comfortable with leaving the transgender problem up to the parents. I have met leftist parents who are more interested in making their children political statements than in allowing the child time and resources to develop until they understand what gender is about, with guidance from their pediatrician. Pediatricians need to be trained in understanding the science behind gender determination in mammals. Given the current political activism in pediatric professional societies I'm not confident this need will be fulfilled soon.
I agree Howard. As a physician I would hesitate to give life altering treatments like blocking puberty, and certainly not surgery, regardless of what the parents or doctor thinks. And I don't think this is generally happening against the parents will. In the one case in my family I am familiar with and suspect is typical, the child wanted it, the parents didn't, and the medical and psych people pushed heavy on the parents to consent who eventually gave in.
And I don't know that I would leave it up to a pediatrician because it is simple enough to find one that is very pro treatment and those specifically specializing in transition medicine are obviously very much in favor of doing it. Perhaps an independent board. The typical age for puberty in females is 8-13 and that should not be the age to make life altering decisions.
Right now there is a sharp divide between the understanding in the UK and Sweden and American medicine and I favor our overseas friends who have put the brakes on life altering treatments for children. Neither children, parents, or doctors consistently make the right choices.
Wolfy Jack,
Thank you for your thoughtful comments. As a scientist I must ask two questions before evaluating each individual case. 1. Is there any physiological indication that the child is not developing normally? and 2. What is the scientific basis for any proposed intervention? The answers to these questions should not depend on differences of opinion between pediatricians. After almost three decades of disabusing orthopaedic residents of the notion that correlation equals causation, my eyes roll when a physician claims his degree makes him a scientist. I like your idea of a committee evaluating each surgical intervention. It should be based in a hospital licensed to house the committee, and include a relevant scientist (from the local medical school). You will note that I did not include a psychologist/psychiatrist on the committee. In the best of all worlds it should. But I am so frustrated by the politicalization of their professional organizations that I can't think straight about how to pick one. I'd be thankful for any constructive suggestions.
Those things are difficult, but I tend to fall back on an inclination I always had in medicine that to avoid interfering with natural processes unless you have to which disinclines me towards treatment for gender dysphoria. The history of treatment for say body image dysphoria, anorexia etc. has always been to get people to accept who they are. So, I have a philosophical objection to transitioning, but that's
just me. I dont think you can find an unbiased person, because it is largely a political issue and MDs and psychs would fall on either side. The import of the Cass study in UK is that we don't have enough longterm data to argue in favor or against which is why they put the breaks on it, since as MDs we are sworn to 'first, do no harm' so if you can't rule out negative effect you would avoid life altering treatments. I used to get 20 year olds in wishing sterilization and I would argue against making those decisions so young, and would never do it myself, and with puberty blockers we are talking of children as young as 10.
None the less, and I dont know if you are referring to a personal choice, but what I would do is at least find somebody without strong opinions who will not OK everybody or disallow everybody. I don't think you will find a clear objective standard and most of the people in this line of work are very pro transgender or they wouldn't be doing it.
What a dream is "objective standard"! Does "objective" limit one to "logically consistent with natural causes"? I like to think so. But to me that entails science. Specifically, sociobiology. I won't burden with my take on that subject. "Standard" is a tough nut in psychology when taken to mean normal. I've raised and taught kids enough to be convinced that they need a mental anchor of "normality" to transform from a frightened animal dominated by paleolithic genes to a civilized human. As they navigate the chaos of adolescence, their parents need to let them explore their own paths to individuality, gradually lifting the anchor to facilitate the quest. What we need to do as members of the Welcome Party is grill candidates for office on their approach to this problem. If they can avoid the identity politics traps they will further qualify for the "trust" list.