How many ways are there to say: “We just don’t know?”
On June 30, 2015, PBS Frontline aired a story about “transgender kids.” The program presented a more balanced view than the usual pro-transition media coverage, with doctors actually admitting that there is much that remains unknown about dosing kids with hormones and performing surgery at younger and younger ages.
Frontline posted a companion article about pediatric transition on their website. In this post, I will excerpt from the PBS piece, along with several other sources, highlighting quotes from well-known gender specialists.
There’s a lot of redundancy in what I’m about to share, and that’s the point. It turns out that the top dogs of pediatric transition agree: we just don’t know whether puberty blockers, cross-sex hormones, “social” transition, and the other “treatments” being foisted on our “gender nonconforming” youth can be justified—because we don’t have the evidence.
Some phrases you’ll see:
- There is no objective test
- We still don’t know
- Someone will figure it out
- There are so many unanswered questions
- Hopefully there will be research to begin to answer these questions
- Unknown consequences
- What’s lacking are specific studies
- Risk is unknown
- We don’t know the long-term effects
- We’re in unknown territory
- There is no medical consensus
Oh, but the gender doctors do bemoan the unfortunate lack of evidence. They wring their hands, claim to be “worried” and “troubled.” They say they sincerely “hope” that “someone” will do the necessary research. Funny how none of them mention how or whether they themselves will spearhead these desperately needed studies, or apply for research grants.
There is no mention of slowing down or stopping the medical transition of children. No suggestion that maybe it would be prudent to halt what they’re doing until there is some actual evidence that they are not doing irreparable harm. To CHILDREN.
Nope, lack of evidence isn’t stopping any of these “gender specialists” from plowing full speed ahead, continuing to diagnose and treat “gender nonconforming” toddlers, elementary-school children, and adolescents as transgender-until-proven-otherwise.
It’s as if they think they can be absolved of responsibility for future negative consequences, just by confessing in the Church of Public Opinion that they are operating in the dark.
From the PBS Frontline article:
“What makes [puberty blocker] treatment tricky is that there is no test that can tell whether a child experiencing distress about their gender will grow up to be transgender. The handful of studies that do exist suggest that gender dysphoria persists in a minority of children, but they involved very few children and were done mostly abroad.
… the use of puberty blockers to treat transgender children is what’s considered an “off label” use of the medication — something that hasn’t been approved by the Food and Drug Administration. And doctors say their biggest concern is about how long children stay on the medication, because there isn’t enough research into the effects of stalling puberty at the age when children normally go through it.
… However, doctors caution that estrogen and testosterone, the hormones that are blocked by these medications, also play a role in a child’s neurological development and bone growth.
“We do know that there is some decrease in bone density during treatment with pubertal suppression,” Finlayson said, adding that initial studies have shown that starting estrogen and testosterone can help regain the bone density.
…Finlayson said there isn’t enough research on whether someone who was on puberty blockers will regain all their bone strength, or if they might be at risk for osteoporosis in the future.
Another area where doctors say there isn’t enough research is the impact that suppressing puberty has on brain development.
“The bottom line is we don’t really know how sex hormones impact any adolescent’s brain development,” Dr. Lisa Simons, a pediatrician at Lurie Children’s, told FRONTLINE. “We know that there’s a lot of brain development between childhood and adulthood, but it’s not clear what’s behind that.” What’s lacking, she said, are specific studies that look at the neurocognitive effects of puberty blockers.
…The physical changes that hormones bring about are irreversible, making the decision more weighty than taking puberty blockers. Some of the known side effects of hormones include things that might sound familiar: acne and changes in mood. Patients are also warned that they may be at higher risk for heart disease or diabetes later in life. The risk of blood clots increases for those who start estrogen. And the risk for cancer is an unknown, but it is included in the warnings doctors give their patients.
…Another potential dilemma facing transgender children, their families and their doctors is this: Taking cross hormones can reduce fertility. And there isn’t enough research to find out of it is reversible or not. So when children make the decision to start taking hormones, they have to consider whether they ever want to have biological children.
[Take a breath and ponder the above sentence: CHILDREN have to consider whether they ever want their own biological CHILDREN.]
“I think it’s really important to talk to these children and families about fertility,” Finlayson says. “I do worry that at that stage in life many of them may not be able to realize how important that would be to them someday.”
[But you’re not THAT worried, are you Dr. Finlayson? You’re not bothered by this enough to put the brakes on these “treatments” are you?]
…It’s an ethical question that each family has to deal with in their own way, because if a child goes from taking puberty blockers to taking hormones, they may no longer have viable eggs or sperm at the age when they decide they would like to have children. They do have the option to start their puberty and delay their treatment in order to store eggs or sperm, but some of them may not want to.
While transgender adults have taken hormones sometimes for years, the generation growing up now is among the first to start taking hormones so young. Since most people who start hormones take them for life, doctors say there also isn’t enough research into the long-term impact of taking estrogen or testosterone for what could end up being 50 to 70 years.
“There are so many unanswered questions around the long-term consequences, and whether your health risk profile really becomes that of a male or female,” Garofalo says. “If we start testosterone today, will you have the cardiac risk profile of a male or female as you grow older? Will you develop breast cancer because we’re administering estrogen?
“I think those are the unanswered questions that really trouble me, and can only be answered with long-term follow-up studies.”
[Excuse me, Dr. Garafalo, but if these unanswered questions “really troubled you” that much, you wouldn’t be experimenting on kids, now would you?]
…Ultimately, the doctors working in clinics like the one at Lurie Children’s hope to spare transgender children some of the anguish and societal isolation that earlier generations of transgender people went through. But they too would like the answers to the unknown consequences of these medications.
[Just who exactly do you think is going to give you these answers, doctors?]
“The stakes are super high, and we don’t have all the answers,” Garofalo says. “Hopefully, there’s going to be more research and some of those unanswered questions, hopefully, will begin to be answered.”
The Frontline piece is only one source of confessions by “troubled,” “worried” gender doctors. Here is a sampler of quotable quotes from some of the other big guns in the pediatric transgender world.
Dr. Ximena Lopez is founder and head of GENder Education and Care, Interdisciplinary Support (GENECIS), one of the newer gender clinics in the US, and the first in the Southwest.
“There is a strong need for research in this field to improve the outcomes of our patients,” explains Dr. Lopez. “For example, it is still unclear which very young patients with gender dysphoria will persist as transgender individuals through adulthood. There is no objective diagnostic test available that can predict this.”
In a 2013 New Yorker piece, we have this:
Eli Coleman, a psychologist who heads the human-sexuality program at the University of Minnesota Medical School, chaired the committee that, in November, 2011, drafted the latest guidelines of the World Professional Association for Transgender Health, the leading organization of doctors and other health-care workers who assist trans patients. The committee endorsed the use of puberty blockers for some children, but Coleman told me that caution was warranted: “We still don’t know the subtle or potential long-term effects on brain function or bone development. Many people recognize it’s not a benign treatment.”
Alice Dreger, the bioethicist, said, of cross-gender hormones and surgery, “These are not trivial medical interventions. You’re taking away fertility, in most cases. And how do you really know who you are before you’re sexual? No child, with gender dysphoria or not, should have to decide who they are that early in life.”
Dr. Johanna Olson, Medical Director of the Center for Transyouth Health and Development at Los Angeles Children’s Hospital is one of the better known pediatric transition proponents. She has even argued for skipping puberty blockers and going straight to cross-sex hormones for “transgender” pre-adolescents. Olson said this in a 2012 NBC Dateline broadcast I wrote about last month:
What’s missing in the data right now is: these exact characteristics mean for sure this person is going to be a trans adolescent and adult. We don’t have that data.
More mea-culpa redundancy from Houstonia magazine, in “What do Transgender Children Need” published in 2014:
There is no medical consensus on the best course of treatment for gender-dysphoric prepubescent children, mainly because it’s almost impossible to tell which kids will continue to experience the condition as adolescents and adults. Citing informal studies, Drescher and Meyer estimate that only about 20 percent of prepubescent children who exhibit cross-gender behavior continue that behavior into adolescence.
“You’re in unknown territory, where the experts disagree,” says Dr. Jack Drescher, a New York–based psychiatrist who, along with Dr. Kenneth J. Zucker of the University of Toronto’s Gender Identity Service, helped write the entry for gender dysphoria in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. “If most of these kids won’t grow up to be transgender,” says Drescher, “[socially transitioning] could be harmful,” never mind hormone therapy.
And finally, this treasury of quotes would not be complete without some words of wisdom from Dr. Norman Spack, head of the Disorders of Sexual Development (DSD) and Gender Management Service (GeMs) at Boston Children’s Hospital, whose pediatric gender clinic is the “first of its kind in the nation.”
Dr. Spack holds forth in an interview/blog post in April 2015. Notice his use of future tense. “Someone” else is eventually going to solve the problem.
Question: GeMS was the first transgender treatment clinic in the U.S., and there are now over 40 programs across the country. You’re reaching more and more kids and at a younger age. What’s next for this field of medicine?
Dr. Spack: I think that there is an absolutely tremendous need for tools with which to discern which of the kids are really among the 20 percent who are definitely going to be transgender. With these tools, people could far more freely encourage their kids to act and dress as the gender they identify with, and kids will have a much easier time in school.
…These tools are going to be based on analysis from the neck up, not blood levels of anything I can think of—unless it’s maybe a genetic test, but I doubt it. My theory is that we just don’t know enough about the brain… I’m convinced that sooner rather than later, someone’s going to figure something out related to the brains of the 20 percent transgender kids.
Sooner or later….we just don’t know enough….there is a tremendous need…
But meanwhile: Carry on! with administering off-label puberty blockers followed by cross-sex hormones. Keep sterilizing our guinea pi– um, kids.
“Someone” will figure it out—sooner or later.
Reblogged this on Stop Trans Chauvinism.
Reblogged this on A feminist roars.
These poor kids are basically the lab rats in an uncontrolled experiment. Where are the ethics in medical research people on this? People protest animals being used in experiments but these kids are getting no protection from adults with sexual agendas and other adults happy to line their pockets with money.
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But the side effects of gnrha antagonists ARE known. All they talk about is “puberty blockers” this, “puberty blockers” that. But they NEVER mention what these things are. There is no drug called “puberty blockers”. This seems to be intentional. Gnrha antagonists are chemotherapy for cancer patients. They are dangerous and if adults suffer after using them for six months (the recommended time period), children will have it much worse after using them for years.
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what planet are these people on? i can tell you that there are very disastrous consequences to long-term cross sex hormones and my sibling is an example. she is paralysed and requires 24/7 care….strokes, embolisms and multiple sclerosis….how can these people say they are responsible for children?
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What happened to your sibling?
My brother had sex change surgery in 1975, under the guidance of Harry Benjamin via Dr Stanley Biber. At that time there were no endocrinologists involved in his case, but he managed to take cross sex hormones for a few years before surgery. After 10 years, she (my now sister) had a massive physical breakdown. At first the docs thought it was AIDS as that was a new disease. However, she lay for months in a vegetative state. She managed to return to consciousness, but was severely paralysed. The doctors discovered she had suffered strokes from embolisms, and heart attacks and was now diagnosed with MS. She has not lived without her wheelchair and is now in 24/7 care; she can only move her arm to change the TV channel. We strongly believe that the whole medical crash she had was a result of the cross sex hormones, Premarin. She was 34 when she crashed. She is now 66 years old. The doctors do not know whether to maintain her Premarin treatment or not….there has been no studies over long period of time with these cases of cross-sex administration. We do not know what to do. Another issue has been repeated urinary tract infections, which has led to delirium states, long hospital stays and near-death experiences. The surgery from male to female is difficult and can lead to such incidents. She has had heart attacks and strokes since the original crash…one leading to her suffering third degree burns during a stroke incident, while she had a fire in her microwave (she dragged it out, but it landed in her lap, burning her body.) This is all a big mess, and nobody has ever taken responsibility for her case. I am presently trying to see an endocrinologist who says there are no long term studies or follow-ups on aging transsexual bodies. I am hoping that people will understand the long term problems with cross sex hormone treatments. thanks for asking. it has been a tough and arduous road to care for her without support. She was a pioneer in our country and yet, the translobby has totally rejected her because she is a failure!
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I really appreciate you sharing what I’m sure is an incredibly painful and ongoing experience. Thanks for being part of this online community. All the media hype and celebration around Bruce/Caitlyn Jenner and the many “trans kids” create an allure and a near magnetic pull to “transition” for young people. Stories like that of your brother/sister are obscured and never receive any media attention.
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Thank you for sharing this tragic story cyborgurl.
I think a lot of bad things will happen to the health of trans children.
They have to deal the the side effects of gnrh agonists AND hormones and no one knows exactly how bad it will be or what exact health problems they will get.
Here is a masterpost about puberty blockers:
The side effects are really scary.
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Great summary, 4thwave. It’s important for parents considering this to really see what a rickety construction it all is. All they have been getting is: “your child is trans, will permanently identify as trans, and this is the only treatment we have.”
That is not actually based on science. What I see are a lot of medical people dying to be “pioneers.” Not like there is any precedent for ego in medicine, huh?
I am sure there are some honking heavy consent forms these ppl must sign. “We don’t know what we are doing and you agree we don’t know, and you promise not to sue us if it all goes to heck later.”
Ai yai yai….
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The thing is, some of these kids who were sterilized by these providers (and by consent, their parents) will likely not be legally constrained by those papers in a couple of decades…
I wonder if those kids will be successful at overturning the legality of those informed consent contracts by also suing their own parents.
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Reblogged this on Gender Is War.
Saw an after-show talk the other night on utube with the makers of the documentary, one of the parents, a young trans person and a doctor involved in trans clinics in Chicago. Very supportive towards trans, which is fine, that is their agenda. But one listener asked a question about the ratio of boys claiming to be girls versus girls claiming to be boys. Simple question and answering it would have revealed no personal information. BUT, the doctor all of a sudden got VERY coy and dodgy and would not answer at all. He blathered a bit about oh, how different clinics see different ratios but whatever so he wasn’t going to answer. Wonder what is going on that he did not want to discuss that issues? Anybody know?
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Southwest, can you provide a link to that show? I do know that we are seeing a HUGE uptick in girls wanting to transition. It used to be way more boys. Those of us who have been investigating this shift have been pointing to social pressures, misogyny, and other reasons. Wonder if that “provider” might have been leery of opening the Pandora’s box?
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You can also search “Frontline google trans” and it should be easy to find. 2nd half of show contains the dodgy doctor moment.
According to this article from the NYT, boys are seven times more likely to be referred to gender clinics (shiver) than girls. To me it seems obvious that when girls were busting gender roles we did not have the medical technology we have today. (So patriarchy just twisted our liberation into “porn as empowment.”) Now we see boys busting gender roles and parents *can* medicalize it, so they are.
Oops – article link is http://www.nytimes.com/2012/08/12/magazine/whats-so-bad-about-a-boy-who-wants-to-wear-a-dress.html?_r=0
I don’t think the doctor was being coy or dodgy, the question is actually a bit complicated. In the past, clinics saw more boys with gender dysphoria than girls. The numbers evened up a bit with teenagers, although there were still more male patients.
The adult sex ratios vary from country to country, but most European gender clinics see more male than female patients. The exceptions are Poland and Japan where more females apply to transition at clinics.
Since about 2004, a number of clinics have reported a large surge in the number of teenage referrals. The surge has been much higher for female patients so that now clinics are seeing more female teenagers than male teens. Some clinics are also reporting that they are seeing more teenage patients with major psychopathology than they expected.
We don’t know why the numbers are increasing. This is an urgent question for researchers.
Finally, if they were talking to an American doctor, there isn’t a lot of data for the United States because the US doesn’t have free national clinics like some other countries do.
From what I understand these doctors don’t set the treatment protocols or the diagnosis criteria so they are kind of stuck. Unless they want to change specialties (and why would they? it pays crazy amounts of $$$ to do this right now) they don’t have a lot of room to recommend anything else but transition for children. I imagine that they are so great at repeating the phrases about how little we know because they have to say them to parents over and over for informed consent, parents who are eager to get their child transitioned. A lot of people just ignore things they don’t want to hear and sign the forms. I just really wish the parents had to undergo psychological evaluation in order to qualify their child for this treatment, so many seem to be utterly homophobic or so dysfunctional that they want to use their child’s transition for personal gain.
A lot of these gender doctors are heavily involved in setting standards through WPATH (World Professional Association for Transgender Health). They actively participate in agenda-setting. Also, they take an oath to “do no harm.” They absolutely have the power to question these protocols. Dr. Margaret Moon, who I wrote about in an earlier post, is an example of an MD who is far more cautious about this stuff.
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Isn’t it true there are more MtT than FtT? This is what I always understood in the literature that I’ve read. Medicine is a business, especially in the US.
4thwave: I’m going to check out Margaret Moon. Any suggestions?
Sorry for the slow response. I am working on a post about the increase in girls presenting to gender clinics and have been collecting research links. At one point, the ratio was far, far more boys to girls, but that has been changing in recent years. Here is one from Germany: http://www.ncbi.nlm.nih.gov/m/pubmed/25296510/
If other readers have links on this, I would appreciate hearing, as I’m actively collating now.
As to Dr. Moon, she has mostly been quiet (as far as I can find) since the 2012 special I blogged about here:
Although she did write an Op-Ed for the New York Times just a few days ago, along with Dr. Spack, Mark Cummings, and Skylar Kergil. Check it out:
You know who has good resources on women who transition? DirtyWhiteBoi aka Dirt. She hosts on blogspot.
Yep, very aware of her blog. Probably time for me to take a long tour through there again for research links.
the finnish study on comorbid conditions mentions the very high number of natal female ‘applicants’ vs male in recent patients presenting to adolescent gender identity services:
As some know, I blogged about this study here: https://4thwavenow.wordpress.com/2015/05/23/new-study-out-of-finland-girls-with-gender-dysphoria-have-many-other-mental-health-issues/
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I can sorta see where the parents of natal males are coming from because, let’s face it, society has a pretty bad response to ‘boy in a dress.’ I don’t think it’s a coincidence that 4thwave and most of the parents who post here are parents of natal females. If your kid is not suffering from extreme gender-related dysphoria, I can see where the sense of urgency might seem less, in terms of the kid being able to present as male long-term, vs a natal male presenting as female. (Yes, breasts, but still…. not analogous to a really tall muscular guy who hopes to present female, you know?)
But it enrages me that these ‘gender specialist’ folks are willing to do an end run around the Hippocratic Oath by saying, “well, we have to do something, because suicide.” Yes, of course, you have to do something, but there are other ways of treating depression if depression is the root of the problem. There are definitely other ways of treating body image disorders (anorexia, the perfect case in point). These disorders can be very tough to treat, admittedly, but no reputable provider tries to treat something like anorexia by assisting in surgical fixes to make the anorexic patient feel even thinner. But there is not a sociopolitical push for that kind of treatment, unlike the push for early transing. (Not to mention, the long-term $ involved in early transing.)
Definitely I think there is lack of agreement regarding the amount of risk involved. The transactivists act like there is zero risk, you know, and that the only reason for a parent to hesitate is ‘phobia.’ And some parents just appear to be way less risk-averse than me. Like, they really believe gnrh antagonists and long-term use of opposite-sex hormones and elective surgeries are all going to result in a happy, healthy adult down the line, and that the health risks are minimal and are an acceptable tradeoff. (Not to mention the sterility factor.) Me, I don’t see such great evidence of this, and particularly not evidence that would make me sign off on that kind of modification for a minor. Especially when I think so much of the push is coming from older natal males who wish they had had early treatment so they could be prettier. And especially when I see so many natal females cranking each other up on the internet, hoping they can opt out of the whole gender hierarchy by trying to become men. (I am sure that for some of these girls, it feels like seizing power — but natal males are not going to embrace that move and easily view these kids as their equals, you know? It just does not work that way.)
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And for girls they dismiss the fact that testosterone treatment is forever: they will NEVER lose that deepened voice, male-pattern baldness, increased facial and body hair if they change their minds later. It would be one thing if it were a temporary lark. I read a haunting post by a detransitioned FTM who said she was struck by the fact that at gatherings of MTFs and FTMs, all the voices were male. The literal eradication of the female voice.
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Right. But you see, if you maintain that regret and detransition are super super rare (as most transactivists do) then the permanency factor is going to be viewed as negligible. You know? They’d say you WANT that stuff to be permanent. But to me, of even more concern than the factors you mention, is the unknown long-term risk of chronic medical issues, including metabolic issues, cardiac issues, endometrial hyperplasia, vaginal issues, PCOS, cancer. All requiring long-term medical monitoring and sometimes treatment. Increasingly providers are pushing FTMs to seriously consider hysterectomies not too many years after transition since reproductive health can be a serious problem — and not just because it’s tough for them to find supportive providers. You put testosterone into a system that’s not meant to be supplemented with it, you get more than hair loss and a low voice. You know? These are not benign outcomes even if the transman has zero regret.
I’ve got an teen who took YEARS to simply establish basic oral hygiene. And there are some other health problems (not her fault, but they do require maintenance). I’m not super optimistic about adding MORE health requirements when she has not shown much interest in taking care of herself.
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In the mid 80’s, I had endometriosis of the uterine lining so bad that it prevented pregnancy. A fertility clinic in Augusta, GA put me on Lupron for 6 months initially, then an additional 3 months b/c the condition, although improved, was not totally resolved. They were VERY clear to me that they wanted to keep me on it for as short a time as possible, due to side effects. They checked my bone density and did blood work monthly.
I know for a fact that they were extremely cautious about the length of time I stayed on the Lupron. I cannot IMAGINE these pre-pubescent kids being on this stuff for YEARS… at a time when their natal hormones would be building/strengthening their bones! I was 25 years old, and they were concerned with the effect on my bones, which had reached maximum length & density by my age, and even knowing that upon cessation of Lupron, my natal hormones would resume. STILL they were cautious about the long-term effect on my bones. Where did this ‘do no harm’ concern go, in terms of these youngters?!
Side Note: Because of the treatment, I was able to have two beautiful, healthy children. Lupron, for me, was a God-send. But I repeat… I was only on it for 9 months!
Someone stop this madness. This medication is not for growing kids.
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Thank you so much for the hard work you put into compiling all these damning quotes. Delving so deeply into something so unconscionable can be soul sucking. It’s hard enough to read when it’s nicely organized. But invaluable as a resource. Thank you, thank you.