Should minors be allowed to transition?

[Raze]

Gender dysphoria is a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity. This sense of unease or dissatisfaction may be so intense it can lead to depression and anxiety and have a harmful impact on daily life.
Originally gender dysphoria in minor boys was rare, and in minor girls extremely rare, and the popular protocol for treatment was called “watchful waiting” where the doctor would basically have the child continue to live as their birth sex and wait to start transitioning until they were older if they still had gender dysphoria.

However this treatment has been updated  

https://publications.aap.org/pediatrics/article/142/4/e20182162/37381/Ensuring-Comprehensive-Care-and-Support-for

Now it is recommended for minors with gender dysphoria to be put on puberty blockers, and then if their gender dysphoria persists to begin cross hormone therapy to begin transitioning earlier. The idea being that this way when the transgender person is an adult since they didn’t go through their birth sex puberty they will look more like the opposite sex, in addition going through puberty for someone with gender dysphoria can be very emotionally painful and dysphroic.

However this approach is controversial, see this criticism by a Physician from the bottom of the above link where he speaks in defense of the original watchful waiting approach

Quote

What is best practice, when a 7-year-old boy announces that he is really a girl? We do have longitudinal cohort studies which provide useful evidence. Wallien and Cohen-Kettenis (2008) reported on 45 boys and 14 girls who presented with gender dysphoria with a mean age of 8.4 years. Ten years later, 28 of those boys, and 5 of the girls, were no longer gender dysphoric. In other words, of 45 boys followed over ten years, 28 boys, or 62%, did not persist in gender dysphoria. In another study (Singh 2012), 139 boys with gender dysphoria were enrolled at an average age of 7.5 years; at follow-up, averaging 13 years later, only 17 boys out of 139 (12.7%) were still gender-dysphoric. These studies, and others like them (see Zucker 2008 for review), suggest that the majority of boys who identify as gender-dysphoric prior to the onset of puberty will not persist in gender dysphoria after the onset of puberty.

Suppose parents consult a physician regarding their 7-year-old son who has said that he is really a girl. Suppose the physician, mindful of Wallien & Cohen-Kettenis (2008), Singh (2012), and Zucker et al. (2012), advises a cautious wait-and-see approach. The 7-year-old wants to study ballet? Excellent. But he will study ballet as a boy, not a girl, at least for the next year.

Rafferty & Committee (2018) savagely denounce such an approach as “outdated.” Even worse: that physician is trying “to prevent children and adolescents from identifying as transgender”. Such an approach they label “reparative therapy.” They then assert that reparative therapies have been shown to be unsuccessful. In support of that assertion they provide one citation, citation #38, a 1994 report of the lack of success of strategies intended to change the sexual orientation of homosexual men and women. Outdated, indeed. A report documenting the failure of efforts to change the sexual orientation of adults is of doubtful relevance to the question of whether a 5-year-old boy who says that he is a girl should be encouraged to transition.

Rafferty & Committee assert that “more robust and current research” has proven that the old strategy of “watchful waiting” is harmful, and that gender-affirmative strategies should be deployed in prepubertal children. They set no lower age limit for the age at which a child can decide that the child should be reassigned to a different gender. They provide no longitudinal cohort study documenting any outcomes significantly different from those cited above. However, if a clinician were to conclude from studies such as Wallien & Cohen-Kettenis (2008) that watchful waiting is a reasonable approach, Rafferty & Committee harshly reject such an approach, without providing any more recent longitudinal cohort study documenting different outcomes.

Common sense suggests that a 3-year-old boy who says that he is a girl should be subject to some degree of watchful waiting before the boy is put in a dress and has his name legally changed. But such common sense is notably lacking from Rafferty & Committee.

Currently rates of gender dysphoria in minors is skyrocketing 

See this graph of referrals to a gender clinic in the UK

https://www.reuters.com/investigates/special-report/usa-transyouth-data/

 

For more data, here is some data on referrals of children with gender dysphoria in the USA

Quote

New diagnoses in the United States of patients ages 6-17

2017 - 15,172

2018 - 18,321

2019 - 21,375

2020 - 24,847

2021 - 42,167

No one knows for sure why the rate is increasing. Some argue that this is just the natural rate of gender dysphoric youth, but they didn’t come out in the past due to a hostile environment. Others say this is peer contagion and most of these children do not have true gender dysphoria.

In addition, there is growing controversy about the treatments.

Puberty blockers were initially thought to be completely reversible with minimal side effects. However recently a Swedish investigative journalist documentary was released about some patients reporting serious side effects. See here: https://www.svtplay.se/video/33358590/uppdrag-granskning/mission-investigate-trans-children-avsnitt-1

There are also class action lawsuits for hormonal replacement therapies

https://www.nationalconsumerlawyers.com/hrt/lawsuit/

Quote

Hormone replacement therapy (HRT) lawsuits seek monetary compensation for women who have sustained serious health complications from taking HRT drugs, such as Prempro. Prempro is produced by Wyeth Pharmaceuticals (a division of Pfizer). Currently, Wyeth is facing more than 10,000 HRT lawsuits, and has paid out more than $165 million in HRT litigation settlements.

Prescribed for years in the treatment of menopausal symptoms, hormone replacement therapy uses estrogen, progesterone, and/or progestin to minimize hot flashes, night sweats, anxiety, and other menopausal symptoms. It comes in pill form, and it has been taken by more than 6 million women in the U.S.

Serious risks and side effects associated with the use of Prempro became public when, in 2002, the Women’s Health Initiative announced that it was ceasing a large clinical study on HRT medication due to findings that the drugs were increasing the risk of breast cancer by 26 percent, of blood clots by 100 percent risk, and of stroke by 41 percent.

Basis for Hormone Replacement Therapy Lawsuits

Along with breast cancer, blood clots, and stroke, other serious health complications that form the basis of HRT litigation include:

endometrial cancer (a type of uterine cancer)

gallbladder disease

heart attack

increased breast density (which some researchers believe may also increase the risk of developing breast cancer)

ovarian cancer

pulmonary embolism (blood clots lodged in the lungs that impede breathing and can be fatal without prompt treatment).

 

In the past, reports of patients having regret for undergoing transgender surgeries and treatments was rare. However, there are a growing number of people who call themselves “detransitioners” coming out and claiming to regret the treatments. Some are even sueing.

https://www.youtube.com/watch?v=WZVpTFUAsBA

https://www.youtube.com/watch?v=V8P8RJwVrZQ

Here are some reports of transition regret from the Reddit form /r/detrans (note these are anonymous posts and cannot be confirmed)

https://imgur.com/a/t9kSpNs

 

So what do you think? Should minors be allowed to begin transition or should the old watchful waiting approach be brought back? Or is there a better way?

 

 

[Matt23]

I don't think minors should be allowed to transition... chemically/hormonally.  If a boy wants to wear dresses and lipstick and go by the label "girl" or a female name, etc and pretend to be a girl, that's fine.  But I don't think it's very responsible and is a bit drastic to be messing with young peoples' hormones etc.  Let them fully develop and become independent adults. 

Also, there's interesting research indicating that gender dysphoria is very prominent in autism.  They have been "finding" more people that are autistic in modern times... some think because of more knowledge and testing about it.  I wonder if there is actually an increase in autistic traits, and thus gender dysphoria.  One idea is that since autism is both a difficulty in "mentalizing" (i.e. understanding) others' internal experiences and one's own, it makes sense that a person with autism would have more difficulty in figuring out their own sexuality, gender, and orientation etc.. 

[Ulax]

@Raze Based on the first quote I'd say I'd recommend the watchful waiting strategy.

On a side note, I don't take that argument about common sense seriously. Imo, a major part of academia is about exposing fallacies inherent to 'common sense'.

[Leo Gura]

There needs to be a rigorous psych evaluation and controls to weed out kids who are just culturally confused before they are allowed to get hormones or surgery. The filtering process needs to be perfected.

Edited January 20, 2023 by Leo Gura

[Tyler Robinson]

No

[Devin]

What is the point of transitioning?(Rhetorical question)

It's mutilating someone to fit into traditional social roles, that's egregious to do to a child. 

[Ulax]

@Devin I think the idea is that the process helps overcome dysphoria.

 

[Devin]

34 minutes ago, Ulax said:

@Devin I think the idea is that the process helps overcome dysphoria.

 

Yeah. Have you looked into this much? I don't see this as even remotely intelligent, it seems obvious it's coming from social pressure given gender identity is social(traditional gender roles).

[Danioover9000]

@Raze  I am strongly against it as its too soon for them to undergo hormonal therapy and surgery to alter their sex.

[Ulax]

@Devin I've looked into it a bit, yes. Tho, I do find it difficult to resolve the seeming paradox between the idea that gender is purely performative and the idea of dysphoria. I'd need to look into some more queer theory to get a better understanding of the various viewpoints.

[Danioover9000]

@Ulax

57 minutes ago, Ulax said:

@Devin I think the idea is that the process helps overcome dysphoria.

 

   Well, that was the idea, but they didn't seem to stop and think of the consequences of hormonal therapy ti children.

[Leo Gura]

Studies show that regret rate among those who go through transition is under 5%. Let's assume it's 10% to be conservative. That's still quite low. Every major medical procedure has some regret rate.

How does your worldview accommodate that fact?

Edited January 20, 2023 by Leo Gura

[Tyler Robinson]

Just now, Leo Gura said:

Studies show that regret rate among those who go through transition is under 5%.

How do you explain that?

And how you would know that the rest are processing it fine despite zero regret?

The bottom line is that you can't run evaluation tests on a psyche that is not yet fully developed. 

 

[Leo Gura]

5 minutes ago, Tyler Robinson said:

And how you would know that the rest are processing it fine despite zero regret?

If they have zero regret then what is the problem? Who are you to tell a person what's bad for them?

As a doctor you have to listen to how your patient is feeling, not what you think is theoretically good for them.

Edited January 20, 2023 by Leo Gura

[Tyler Robinson]

Just now, Leo Gura said:

If they have zero regret then what is the problem?

It doesn't necessarily state/mean that they are perfectly fine. It could mean a bunch of things. Maybe they cannot specifically identify what they should be regretting. They're undeveloped and hence not fully capable of rationalizing either their decisions or the outcomes of their decisions. They might be enticed to do such things in the moment but come to regret it as an adult. Children's minds are moldable like clay, you can make them believe almost anything. You can be sexual to a child and make them accept that and they won't regret being inappropriately touched, but would that make such a thing okay. The problem with transition is not of consent but the lack of a broader statistical study on the future impact of such actions on the minors. Do we have a rigorous study on what happened to the adults who underwent any kind of gender related procedure as a minor? Did they suffer guilt, depression or trauma? In the absence of such studies, what you say becomes mere speculation without any solid backing to support it.

The lack of negative feedback does not always = this is fine.

It should be tested across age and time to know its overall impact. 

[Tyler Robinson]

8 minutes ago, Leo Gura said:

As a doctor you have to listen to how your patient is feeling, and also  what you think is practically good for them not just in the moment but also long term. 

Corrected your statement and brought more clarity. 

 

[Tyler Robinson]

@Leo Gura if you are a doctor/shaman/healer/guru you have a moral obligation to not withhold what could be deleterious to your patient/client/student in a broader social context long term. 

Gender decisions can adversely impact mental health as its closely related to our social image and dating and relationships. 

Gender conflicts can lead to low self esteem and feelings of worry and guilt. 

A lot of adults regret going through transitions and desperately want reversals. 

Minors are a whole different story. 

 

[Leo Gura]

Still doesn't align with the clinical data.

They are not just measuring them for regret the day after the surgery. Obviously there is a period of acclimation.

Edited January 20, 2023 by Leo Gura

[Matt23]

8 minutes ago, Leo Gura said:

If they have zero regret then what is the problem? Who are you to tell a person what's bad for them?

As a doctor you have to listen to how your patient is feeling, not what you think is theoretically good for them.

Obviously this makes sense... though maybe a fine line.

I suppose you could doubt the source of that 5%... I dunno how they came to it etc..  

But anyways... Rebel Wisdom did a video piece on these issues and cited evidence that many people who transitioned experienced regret and were trying to go back.  I want to say they were more adults... but I dunno.  I'll try to find the video and post it.  

Again, I super don't know, but what I heard from the rebel wisdom piece made me think that what they were talking about was legit.  

But, if the 5% regret is accurate, and accurate throughout their life, then ya... sure.  Even comparing it against people who never got the surgery yet feel transgender would be a better analysis to see what, in general, the effects are of getting surgery or not.  Then we'd have a way better idea of what we're dealing with in terms of psychological effects.

Then obviously there's the issue of governments paying for it etc. (Like here in canada) with taxpayers money, but not paying for things like prescription glasses, dental, and other stuff like that.  Seems we gotta do the fairzees game... and I'm not saying I know what's fair etc.  Just that that needs to be considered in the big picture of prioritizing where taxpayer money goes.   Like, if they find that feeling transgender and not getting surgery is worse for a person's psychological and physical well-being than not having prescription glasses or dental work, then ok, I might be more on board with that.    Not saying proving that is at all easy, just saying that'd probably be the move to make if you're trying to decide whether to subsidize procedures via taxpayer money and make sure fairness and equality is at play. 

Use "Fix the most detrimental issues that affect the most people" as your axiom and go from there.  

Though, I'm sure lots of other stuff is around this debate and it's sensitive.

 

[Tyler Robinson]

12 minutes ago, Leo Gura said:

Still doesn't align with the clinical data.

They are not just measuring them for regret the day after the surgery. Obviously there is a period of acclimation.

I do not completely disagree with you. You have a valid point. Yet, I do not have full data on transgender studies in the present moment. 

What you say definitely makes sense from a purely referential and logical point of view. 

Yet I would like to be more nuanced before I can give a green light. 

What would you do if your 14 year old younger brother wanted gender change? Of course you wouldn't right away tell him to just do it. 

You'd want to know if they're really wanting it. Despite psych evaluations, you would have inhibitions and skepticism as to how the decision would impact his life and future. 

More studies and research is needed in this area, what we have now is inadequate in my opinion.