Friday, January 26, 2018

The craziest polemic of the week leads us to some sound research

Dr. Andre Van Mol
Dr. Andre Van Mol - Loony of the week
I find sexuality science absolutely fascinating, particularly when it involves how clinicians deal with children. To get there I first have to deal with some religious dogma and how it improperly shapes the way that some doctors treat kids. It is both sad and infuriating. So bear with me. I will get to the good stuff.

Andre Van Mol, MD is a nutty physician in the lovely city of Redding California. Van Mol is a 1986 graduate of the inconsequential Medical College of Wisconsin — one of a handful of medical schools refusing to fill out a US News statistical summary. Perhaps the most important thing about the unremarkable Van Mol is that he is co-chair of the American College of Pediatricians’ (ACPeds) Committee on Adolescent Sexuality.

Aside from the fact that the real professional peer association is the American Academy of Pediatrics, ACPeds is designated as a hate group by the Southern Poverty Law Center. What a parent needs to know is that this guy places Christianity above medical science. I am sure that there are better choices in Redding. By the way, in his voluntary physician profile, rather than leaving it blank, Van Mol indicates “White.”

I wrote about Van Mol five years ago when he was championing  the Regnerus nonsense and advocating for gay conversion therapy. In addition to ACPeds Van Mol is a member of the Christian Medical and Dental Association.

I am not going to spend much time with Van Mol's essay titled: “Transgenderism: A State-Sponsored Religion?” It is offered at the pseudo-intellectual outlet of Witherspoon Institute, an ultra-conservative Catholic organization run by an Opus Dei numerary. The subtitle to Van Mol's religious tantrum is:
Gender dysphoria is a serious mental health issue. By contrast, transgenderism is a belief system that increasingly looks like a cultish religion—a modern day Gnosticism denying physical reality for deceived perceptions—being forced on the public by the state.
Suffice it to say, being transgender is a patient-chosen form of gender affirmation. Through gender affirmation, people find relief from the suffering caused by gender dysphoria. No boy is going to volunteer for severe ridicule by going to go to school in his sister's dress unless doing so provides significant relief from crushing anxiety and depression. The fact that the kid does this drives conservative Christians insane.

Van Mol indulges in the usual promotion of desistence percentages that don't mean what he proposes they mean and are based on studies that do not really study trans youth. Van Mol employs plenty of self-serving language intended to inoculate him from criticism.

You have read this nonsense before. You have read my response to the religious crackpottery before. It exists because of a difference in methodology. Scientists start with an hypothesis, subject it to tests and draw conclusions from the evidence. Van Mol started with a religious belief which he seeks to somehow prove is true. Using selective observation I can probably prove that 10% of our citizenry (including me) is capable of teleportation time travel. It only works, by the way, going back in time and has a practical limit of 243 years. But I digress.

Rather than spend time with Van Mol's spew, I prefer that we should spend some time with one of the studies that Van Mol cites, supposedly to bolster his cause. It is a 2008 investigation culminating in The Treatment of Adolescent Transsexuals: Changing Insights. It was pursued out of the Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands. It is ten years old and still refers to “gender identity disorder” but it is a good read for anyone interested in the actual science.

The objective of the study is to share findings from their own clinic. The treatment methodology is straight-forward:
The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of gonadotropin-releasing hormone analogs in 12–16 year olds; the latter serves also as a diagnostic tool. Very recently, other clinics in Europe and North America have followed this policy.
I have seen puberty blockers referred to as reversible and a temporary measure. This is the first time that I have seen puberty suppression referred to as a diagnostic tool but it makes sense.

They refer to McHugh and dispense with him directly:
Research on post mortem brains of male-to-female transsexuals (MtFs) and one female-to-male transsexual (FtM) has demonstrated that one of the sex-dimorphic brain nuclei, the central part of the bed nucleus of the stria terminalis, shows all characteristics of opposite—sex differentiation.
In other words, this is more than just a delusion or, as conservative Catholics often state, gender confusion. McHugh's premise is that treating gender dysphoria with anything other than talk therapy is, as he states, the equivalent to performing liposuction on an anorexic. McHugh admits, by the way, that he is a defender of the faith.

The researchers acknowledge desistence rates which they perceive as a requirement for caution. They slowly tear apart those same rates.
First, there is a diagnostic phase in which the actual diagnosis of GID is made, and an estimation is made of potential risk factors for posttreatment regret. Then, during a phase called the “real life test” or “real life experience,” both clinician and patient check whether the applicant is able to live satisfactorily in the desired gender role.
Keep in mind that this is 2008 when the prevailing wisdom was to prevent kids from transitioning:
For a long time, health professionals have waited till their patients have reached young adulthood, or, in general, the age of legal consent to medical treatment, even though these adolescents make very clear that they find their pubertal physical changes unbearable.
Describing young people entering their clinic starting 20 years prior:
Despite many years of psychotherapy, gender dysphoria had not abated in these youngsters. Many of the problems they were struggling with seemed to be the consequence rather than the cause of their GID.
That about sums it up. They also found that these young people “had no psychopathology that would obtrude their self-assessment.” In other words, they do not have gender dysphoria because of psychological problems. Rather, they have psychological problems because of gender dysphoria. There is no underlying pathology to treat. People like McHugh are not relying on clinical observation. They do not care. Their goal is to promote the teachings of the Church.

Their own observations caused the folks in Amsterdam to change their approach and treat teens with hormones prior to the age of 18. The results speak for themselves:
In several studies this protocol has been evaluated. From these studies it appeared that the youth who were selected for early hormone treatment (starting between 16 and 18 years) no longer suffered from gender dysphoria, and that 1–5 years after surgery, they were socially and psychologically functioning not very different from their peers.
In other words, gender affirmation allows previously suffering people to function normally — and, again, this is ten years ago.

Explaining the increase in trans youth:
Over the last 5–6 years the age of adolescents applying for SR has dropped considerably. It is no longer unusual to have 12-year-olds presenting at gender identity clinics with the wish to undergo SR [non-surgical sex reassignment]. Most are accompanied and supported by their parents. These youngsters are no longer willing to wait for many years, knowing that the alienating experience of development of the secondary sex characteristics of their biological sex by then will have been completed and can only be incompletely reversed at a high price of medical interventions.
Explaining the use of puberty blockers in children under 16:
No cross-sex hormones are administered at this stage. In our view, these early hormonal interventions should not be considered as sex reassignment per se. Their effects are reversible. By blocking, delaying or “freezing” puberty by means of GnRH analogs time is “bought.” The peace of mind of the adolescent provides more opportunity to explore with the mental health professional the applicant's wish for SR thoroughly. The prospect of the alienating experience of developing sex characteristics, which they do not regard as their own, will not occur. It is also proof of solidarity of the health professional with the plight of the applicant.
They devote a considerable amount of space to expressing the pros and cons of puberty blockers. You can read it in full at the link. They form their perspective from observable results:
However, GID persisting into early puberty appears to be highly persistent: at the Amsterdam gender identity clinic for adolescents, none of the patients who were diagnosed with a GID and considered eligible for SR dropped out of the diagnostic or treatment procedures or regretted SR.
While seemingly accepting the desistence rates, what they are saying is that properly evaluated and carefully attended to, suffering can be relieved without concern for the youngster changing his or her mind. This closely parallels the more recent research by Kristina Olson at U/W

I wrote about Van Mol five years ago when he was championing  the Regnerus nonsense and advocating for gay conversion therapy. Van Mol is also a member of the Christian Medical and Dental Association.. Desistence rates are based on children who were never transgender to begin with.

There is a great deal more to this and I am trying to be economical. They conclude:
In the field of treatment of young adolescents, it may be that the adage “in dubio abstine” needs to be reconsidered. Particularly when there are research opportunities to lessen this “dubium” to the benefit of those who suffer from gender dysphoria.
The idea of “when in doubt, do nothing” needs to be challenged by lessening the doubt which they seem to do quite capably.

This brings me back to Dr. Andre Van Mol. Did he bother to read this study or was he content simply to cite it because, on the surface, it confirmed high desistence rates? He needs to decide whether he wants to treat patients as a cleric or as a physician. He probably has LGBT kids in his care and that frightens the hell out of me. I'd bet my pearls that Van Mol has an American College of Pediatricians plaque on the wall, passing it off as if it were the real professional peer group.

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