Tuesday, June 20, 2017

Ryan T. Anderson & McHugh, Mayer and Hruz Promote the Transgender Catechism

Ryan T. Anderson
At Heritage Foundation's blog, Ryan T. Anderson writes: “New Paper Says Puberty Blockers Aren’t the Answer to Gender Confusion.” The “paper” that Anderson is referring to is a piece at the New Atlantis which is nothing more than a pretentious Christian blog. Titled Growing Pains, the post was written by Paul W. Hruz, Lawrence S. Mayer and Paul R. McHugh. It is a literature review that is not peer reviewed and is subject to selective observation. The subtitle reads: “Problems with Puberty Suppression in Treating Gender Dysphoria.”

If nothing else Anderson is predictable. Anderson is a rather robotic defender of the faith who accepts, as ultimate truth, the teachings of the Catholic Church. The Pope says that transgender people do not exist and that is good enough for Anderson. He will torture science, reality and logic to divine arguments that support his religious views. It's fascinating really because gender dysphoria is a medical issue and the shapers of Church doctrine are theologians who obviously lack applicable skills and training.

While Anderson sets out to write what appears to be a factual piece it is an editorial starting with the title. Calling gender dysphoria “gender confusion” doesn't make it so. People with gender dysphoria are not confused (that is just Church BS). Their gender is not congruent with their natal sex. Most of us are also right-handed. Left-handed people are not dexterity-confused.
Increasingly, gender therapists and physicians argue that children as young as nine should be given puberty-blocking drugs if they experience gender dysphoria.

But a new article by three medical experts reveals that there is little scientific evidence to support such a radical procedure.
None of the three are experienced or even trained in the field of adolescent gender dysphoria. As for the science, Anderson is only partially correct. As Dr. Jack Turban (who is an expert in this area) wrote in the New York Times:
At this point, data on the benefits of early social transition is scarce. But this year researchers at the University of Washington published a study based on 63 transgender youth who were allowed to socially transition. They found that their levels of anxiety and depression were just about indistinguishable from their non-transgender peers.
Moreover, there is nothing “radical” about puberty blockers. The scientific consensus (which McHugh et al disagree with) is that puberty blockers are reversible. None of these folks have ever done independent research on transgender kids, let alone any that has been published to a scholarly peer-reviewed journal.

It is important to understand that puberty blockers treat the symptoms rather than the underlying condition. There is no known medical intervention to effectively treat gender dysphoria. Treating the effects demonstrably reduces the potential for self-harm; something that should concern Mr. Anderson not to mention McHugh, Mayer and Hruz. Relieving the anxiety and depression saves lives irrespective of the disapproval of the Catholic Church. It also relieves suffering.

Last January McHugh, Mayer and Hruz wrote an anti-trans amicus brief for the Supreme Court in Gloucester County School Board v. G.G.. It is loaded with misleading statements. They seem to care more about ideology than the welfare of children in distress because of gender dysphoria.

Getting back to Anderson:
As I explain in my forthcoming book, “When Harry Became Sally: Responding to the Transgender Moment,” the best biology, psychology, and philosophy all support an understanding of sex as a bodily reality, and of gender as a social manifestation of bodily sex.
That's just bullshit (including the self-promotion of yet another anti-LGBT book). Gender is a social reality (manifestation suggests an abstraction). Gender is our state of being male or female and it is not binary.
Biology isn’t bigotry, and we need a sober and honest assessment of the human costs of getting human nature wrong. This is especially true with children.
In other words Anderson does not want to be judged a bigot simply for asserting that trans people do not exist. It takes a colossal amount of chutzpah to write about human costs considering the effect of not treating gender dysphoric children properly.
Never mind that according to the best studies—the ones that even transgender activists themselves cite—80 to 95 percent of children with gender dysphoria will come to identify with and embrace their bodily sex.
Anderson does not cite a study but an article in New York Magazine written by someone who is an editor for the outlet (and not a scientist). He, in turn does cite a 2013 study that seems to be well constructed. It concludes “Intensity of early GD appears to be an important predictor of persistence of GD. ” That does not support Anderson's argument which is probably why he cites the New York Magazine piece.

Call me a cynic but Anderson knows that his readers probably won't read the piece. Furthermore it is highly unlikely that they will read the then cited research.

According to Dr. Turban who is unarguably the only expert among us (including me, Anderson, and the Three Amigos):
Once transgender youth hit puberty, their gender identity is unlikely to change.
In a Dutch study of 55 transgender people who were given puberty blockers during adolescence, however, none changed their minds and none regretted treatment. All went onto cross-sex hormones around age 16 and later gender-affirming surgery. Psychological functioning improved steadily over the treatment period, and by the end, metrics of happiness and quality of life were on a par with those of the general population.
He also notes:
Critics point to flawed studies that suggest that roughly 80 percent of prepubescent children ultimately change their minds about being transgender. Even if this were true, would it have been worth forcing Hannah [a trans girl and the subject of his New York Times piece] to live as a boy, putting her at risk for depression and perhaps suicide? Though going back to a boy’s name and boys’ clothes would probably be hard, even a small risk of suicide is scarier.
Do you get it? The experts balance the risks. Anderson doesn't get it.
Never mind that 41 percent of people who identify as transgender will attempt suicide at some point in their lives, compared to 4.6 percent of the general population.
That link is to a 2014 study by the Williams Institute. The argument is idiotic in context. The highest rate of suicide according to the cite was among young people, 18 to 24. There is little doubt that gender affirmation reduces stress and depression which means that it reduces self-harm. What does Anderson propose as an alternative other than “don't be transgender” which means “don't be gender dysphoric.” As I said, it is an idiotic argument.
Never mind that people who have had transition surgery are 19 times more likely than average to die by suicide.
The cite is to a Swedish study which analyzed data of people who had gender affirming surgery between 1973 and 2003. During that period of time there is a considerable difference in the level of minority stress that those people experienced. Most of those people would have been treated later in life while more recent research suggests that younger transition provides a long term benefit. More importantly, the conclusion of that study undercuts Anderson's argument:
Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
Anderson implies that gender-affirming surgery increases mortality. That is simply untrue.

Did I mention that Anderson tortures logic?
These statistics should stop us in our tracks. Clearly, we must work to find ways to effectively prevent these suicides and address the underlying causes. We certainly shouldn’t be encouraging children to “transition.”
That is precisely the opposite of what the statistics and the research demonstrate!
Meanwhile, despite claims by advocates, there is no evidence that puberty blocking is “reversible,” nor that it is harmless. Most concerning of all is that these treatments run the risk that children may persist in their gender dysphoria.
Really? In 2008, Hruz's own professional organization, the Endocrine Society declared that puberty blockers were safe and effective. They reiterated their finding in 2011. That was updated in 2015 based upon peer-reviewed research published to the Society's journal.
In their new article, Hruz, Mayer, and McHugh explain that transgender-affirming treatments of children “may drive some children to persist in identifying as transgender when they might otherwise have, as they grow older, found their gender to be aligned with their sex.”
Again, none of these people treat children with gender dysphoria. Dr. Turban's prior quote seems to make the most sense. It might be difficult for a child to re-transition back to their natal gender but not treating gender dysphoria in the first place puts the child at considerable risk for self-harm and caused needless suffering. The New Atlantis post uses the selective observation of a literature review to draw conclusions that conform to religious doctrine. They, and Anderson, seem more interested in catechism than the best care of children.
Whereas 80 to 95 percent of children with gender dysphoria will come to identify with and embrace their biological sex, none of the children placed on puberty blockers in the Dutch clinic that pioneered this treatment came to identify with their biological sex. All of them persisted in their transgender identity.
Anderson doesn't cite a source because it is untrue that 80 to 95 percent revert. Anderson undercuts his own argument by citing gender persistence. It means that they are not reverting. The intended inference is that they are persistent — not because of their gender — but because they were treated causing what is in effect reverse gender dysphoria. That makes no sense because the intense discomfort would cause the kids to correct the absence of congruence between gender and sex just as they did when they began treatment. Nor does that comport with the findings of the study.

As Turban noted, regarding the same study: “Psychological functioning improved steadily over the treatment period, and by the end, metrics of happiness and quality of life were on a par with those of the general population. ” That doesn't sound like kids with reverse gender dysphoria. Anderson leaves that part out and this discloses the very nature of the selective observation of literature reviews. The intent is to “prove” a point.
Indeed, as Hruz, Mayer, and McHugh explain, for children placed on puberty blockers, “[r]ather than resuming biologically normal puberty, these adolescents generally go from suppressed puberty to medically conditioned cross-sex puberty, when they are administered cross-sex hormones at approximately age 16.”
That is probably true. Let's give some credit to the clinicians who actually work with these kids. They are highly trained specialists dedicated to the best interests of the patients in their care.
The Dutch doctors who pioneered puberty blocking as a treatment for gender dysphoria argue that it would give a child “more time to explore their gender identity, without the distress of the developing secondary sex characteristics.”
The full text of the 2008 Dutch article is available. One paragraph reads:
Some individuals who have shown a pattern of extreme cross-sex identification from toddlerhood onwards develop psychological problems, such as depression, suicidality, anorexia, or social phobias, which are consequences of the agony about the pubertal physical development rather than comorbidity unrelated to the GID. This burden can adversely affect social and intellectual development. Patients and their parents often report that halting the physical features of puberty is an immediate relief of the patients’ suffering.
The reference to GID rather than gender dysphoria is a consequence of the vintage of the study. Anderson gets himself into more trouble:
This is an odd argument. As Drs. Hruz, Mayer, and McHugh explain, “It presumes that natural sex characteristics interfere with the ‘exploration’ of gender identity, when one would expect that the development of natural sex characteristics might contribute to the natural consolidation of one’s gender identity.”
It makes no such presumption. Anderson should read the study and judge for himself rather than read the New Atlantis post.
The rush of one’s natural sex hormone and the bodily development that takes place during puberty may be the very thing that helps a developing boy or girl come to appreciate and identify with their bodily sex. And yet puberty blockers would prevent this from taking place.
It is an interesting argument. However, it departs from the conclusions of the Endocrine Society. Moreover, rather than seeking certainty this is about balancing risk. What is likely to do the least harm? Allowing a group of children to suffer and possibly harm themselves because some might naturally cease to be distressed seems to be out of balance particularly when the available evidence suggests persistence. And, again, we need to rely on the expertise of clinicians to assess the degree of discomfort that the child experiences.
The sad reality is that prolonged puberty suppression as a treatment for gender dysphoria has “been accepted so rapidly by much of the medical community, apparently without scientific scrutiny, that there is reason to be concerned about the welfare of children who are receiving it, as well as reason to question the veracity of some of the claims made to support its use—such as the assertion that it is physiologically and psychologically ‘reversible.’”
The Endocrine Society reached its preliminary conclusions nearly ten years ago based on research that goes back much further. Just because the Church disapproves does not mean that puberty blockers are irreversible. Moreover, as the Dutch study argues:
… the child who will live permanently in the desired gender role as an adult may be spared the torment of (full) pubescent development of the “wrong” secondary sex characteristics (e.g., a low voice and male facial features for the ones who will live as women, and breasts and a short stature [males are on average 12 cm taller than women] for the ones who will live as men). This is obviously an enormous and life-long disadvantage. Ross and Need [21] found that postoperative psychopathology was primarily associated with factors that made it difficult for transsexuals to pass postoperatively successfully as members of their new sex. If the adolescents would make a social gender change without receiving hormone treatment, they may fail to be perceived by others as a member of the desired sex and be easy targets for harassment or violence.
And, to Anderson's prior argument about post-operative suicidality:
… follow-up studies among adult transsexuals show that unfavorable postoperative outcome seems to be related to a late rather than an early start of the sex reassignment procedure … Age at time of assessment also emerged as a factor differentiating two groups of MtFs with and without postoperative regrets.
Anderson is persistent:
But doctors have no way of knowing whether these treatments truly are reversible, because very few people have ever sought to have them reversed: “There are virtually no published reports, even case studies, of adolescents withdrawing from puberty-suppressing drugs, and then resuming the normal pubertal development typical for their sex.
Maybe that is because reversion is rare? That would seem to be the most likely explanation. No?
There are also long-term health risks associated with the use of puberty blockers for gender dysphoria, though no one really knows all of the potential consequences, since this use has not been rigorously studied.
The clinicians — the real experts — would argue that the consequences of taking puberty blockers are outweighed by the consequences of children in distress not taking them. I take a pile of meds for PTSD. They come in interesting and sometimes unique shapes, colors and sizes. They all come with side effects. Experienced clinicians and I have determined that the benefits outweigh the concerns.
This new article in “The New Atlantis” should make all of us pause before embracing radical medical treatments for children.

As I explain in “When Harry Became Sally,” the most helpful therapies focus not on achieving the impossible—changing bodies to conform to thoughts and feelings—but on helping people accept and even embrace the truth about their bodies and reality.
Promoting that idiotic book again. The funny thing is that Anderson's verbose polemic fails to cite a single study regarding the treatment of the underlying condition, gender dysphoria. It's also noticeably absent in the New Atlantis post. I wonder why that is so.

While absence of evidence is not evidence of absence the care of children should reflect the best available medical information. Unless and until there is an intervention to directly treat gender dysphoria, the available evidence dictates gender affirmation. The views of the Catholic Church are irrelevant. They are also risky and harmful. The Church harms LGBT people, particularly vulnerable children, every day. This is just a perpetuation of pernicious ignorance and we should not stand for it. Anderson is just a repeater of the malevolence. He has marginalized himself.

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