Tuesday, April 9, 2019

An anonymous post to Witherspoon's pseudo-intellectual blog

I know bullshit when I see it!
Anonymous mommy writes as Katherine Cave. Cave is supposedly a contributor to an anonymous transgender denial site called the Kelsey Coalition. There are several similar sites and I am reasonably certain that the U.S. Conference of Catholic Bishops is behind one or more of them. Ms. Cave might even be “Father Diddle” for all we know. Consider that Witherspoon Institute is a far-right Catholic organization headed by an Opus Dei numerary. Nevertheless, I will refer to the author as Ms. Cave.

The title of Cave's piece published to Witherspoon's outlet (edited by Ryan T. Anderson) is: The Medical Scandal that the Mainstream Media Ignores. The lengthy subtitle reads:
Over the past few years, media stories about “transgender” kids have become increasingly common, but critical questions are seldom asked. These children’s identities are portrayed as immutable, while the ideologically-driven medical practices solidifying them are not investigated. Why won’t they report the truth: that these children and their families are victims of ruthless medical practices with no basis in science?
Why, I wonder, is the word transgender in defensive quotes? These people are obsessed with calling anything they disapprove of an ideology. Medical science is based on evidence. It is neither a philosophy nor a doctrine. Religion is an ideology based on faith. We do not investigate doctors for adhering to best practices.
The pro forma narrative:
Five years ago, when my 13-year old daughter told me she was transgender, I was shocked by her out-of-the-blue announcement. My reaction was not fueled by prejudice—indeed, I am liberally-minded in my political beliefs—but based on a lifetime of caring for her as an observant and sensitive mother. It simply made no sense.

I sought professional guidance, as I was unsure how to respond to her. Yet therapists were not interested in exploring the possible reasons for her sudden identity. Instead, they told me that I must treat her as my son. I was advised to call her by a male name, refer to her by masculine pronouns, and purchase a binder (a restrictive garment that would flatten her breasts, but also cause tissue damage, and possibly other physical harms) to help her “pass” as a boy. The many therapists that I consulted did not consider any underlying issues, such as peer and media influences, or the fact that over 5% of the students at her school also considered themselves transgender.
It's always the same protocol:
  1. Claim that a child has late-onset gender dysphoria
  2. Claim to be a liberal
  3. Claim that this mysterious condition has underlying factors including contagion
  4. Discredit medical specialists
  5. Claim that a large number (usually 5%) of fellow students are transgender
  6. Claim wide-spread malfeasance on the part of the medical profession
  7. Attack conversion therapy bans
  8. Attack the treatment plan as harmful
  9. Imply that kids are candidates for gender confirmation surgery
I know bullshit when I see it. Let's back up a bit:
Transgender is neither a condition nor a diagnosis. That would be gender dysphoria or gender incongruence. In this case the required diagnosis would be late-onset adolescent gender dysphoria. This diagnosis in a child requires meeting six of eight criteria and the child must be experiencing significant distress or impairment in function, which has lasted for at least six months. The criteria are:
  1. A strong desire to be of the other gender or an insistence that one is the other gender
  2. A strong preference for wearing clothes typical of the opposite gender
  3. A strong preference for cross-gender roles in make-believe play or fantasy play
  4. A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
  5. A strong preference for playmates of the other gender
  6. A strong rejection of toys, games and activities typical of one’s assigned gender
  7. A strong dislike of one’s sexual anatomy
  8. A strong desire for the physical sex characteristics that match one’s experienced gender
Numerous questions are asked of both the child and the parent(s) to determine the applicability of each criterion. The clinician must determine if there is “significant distress or impairment.” Moreover, he or she will pay careful attention to the timeline. The general assumption that we all operate under is that doctors provide their best medical advice and use their best medical judgment unless proven otherwise.

My general assumption — my hope really — is that parents will investigate the background, reputation and board certifications of anyone treating their child. We solicit care from people we trust. I also assume (perhaps I should not) that parents obtain second opinions which are covered by most insurance policies.
Discredit the professionals.
The objective of the religious right is to convince people that if they take their child to a gender specialist he or she will automatically become transgender. Re-read Ms. Cave's narrative. That is precisely what she is trying to do.

Of greater importance is the fact that a 13-year-old suddenly claiming to be transgender is unlikely to be diagnosed with gender dysphoria (given the six months of distress that are required). This challenges the claim that clinicians are not interested in the underlying cause when the patient is in their teens. A child claiming to be gender dysphoric who is not requires therapy.
Squeeze in dishonesty about conversion therapy bans.
As I examined the practice of pediatric transgender medical care, I was disturbed by what I learned. Therapists and clinicians are trained not to question children’s new identities; in many states and municipalities across the US, this is against the law. Even more shocking is the unchallenged medical protocol that alters children’s bodies in serious and irreversible ways.
Framed as “what I learned” to convey the notion that there is an authoritative source for her BS. In order to arrive at a diagnosis of gender dysphoria it is absolutely necessary to question a child's gender identity. Doing so is not against the law in any state or locality. And before we get to that “medical protocol” we need to, again, stress that a diagnosis is required. Read the criteria again. It is not easy for a child to be diagnosed with gender dysphoria.

There exists no diagnostic process that is banned anywhere. The only thing that is banned in some locales are thoroughly discredited attempts to change a child's gender identity. In fact consider the case of the teen who claims late onset of the condition but does not meet the criteria to be diagnosed with gender dysphoria. It would be perfectly acceptable in any locale to treat what amounts to a fantasy.
And here we go with the drugs:
Drugs are used to block puberty in pre-teens, impacting their future fertility. Teen boys are treated with feminizing hormones, while girls as young as 13 are offered mastectomies, and at the tender age of 12, they are injected with testosterone. (It was recently revealed that in 2017, the age of testosterone treatment for girls in this $5.7 million taxpayer-funded NIH study was lowered to eight years old.)
All of the above requires parental consent and the last sentence is a lie. Eight-year-old girls are not receiving testosterone. Let's take this one at a time. All drugs have potential side effects including puberty blockers. In most cases these are completely safe and parents and the child are fully informed. The child needs to understand so that they can immediately report any adverse effects.

As for the mastectomies she cites a JAMA abstract. I have a press pass to JAMA which allowed me to obtain the full text. Cave is confused. 13-year-olds were able to participate in the study (which included surgical and nonsurgical teens) by completing a survey. It is possible that a teen has chest surgery but prompt treatment with puberty blockers would be preventative. The conclusion of the study, by the way:
Given the numerous complications associated with chest binding, the negative emotional and mental effects of chest dysphoria, and the positive outcome of chest surgery demonstrated in this study, changes in clinical practice and in insurance plans’ requirements for youth with gender dysphoria who are seeking surgery seem essential. Youth should be referred for chest surgery based on their individual needs, rather than their age or time spent taking medication. Individualized, patient-centered care plans should be considered the standard of care for all transgender adolescents, and referrals should be made accordingly.
There is ample evidence cited in the study that trans boys experience substantial distress from the development of breast tissue.

Cave's post is loaded with cites, scores of them. Must of them are to suspect sources, other anonymous trans denial sites, religious sites or the site does not confirm what it is supposed to confirm.

It continues:
There is no objective test upon which to base such invasive medical interventions, nor a single long-term study that supports their medical necessity. These hormonal treatments and irreversible surgeries are based on unprovable identities, resulting from myriad complex issues, that are likely to change over time. This is not evidence-based medicine.
First of all the criteria for diagnosing gender dysphoria is objective and the very study that she cited support the medical necessity of chest surgery on an individual by individual basis. The American Academy of Pediatrics reviewed the available evidence and concluded that the gender-affirmative care model was best for children suffering from gender dysphoria. Tell me this woman or man or priest or pastor does not have an agenda. Who to believe? The AAP or some anonymous person?
Denigrate clinicians:
Clinicians successfully obtain parents’ consent to these risky, and likely regrettable, hormonal and surgical treatments. They use false, coercive assurances that they are lifesaving and necessary to prevent their children’s likely suicide. In fact, serious complications, sterility, and loss of sexual function are the likely immediate outcomes of this medical experiment on children. And the long-term consequences are simply unknown. This is a medical scandal.
What was that about evidence? Perhaps Ms. Cave can point to one medical malpractice suit alleging that a parent received false information or was coerced. And no clinician would use hyperbole suggesting a kid's “likely suicide.”

The balance of this lengthy opera is about the media conspiracy to silence the voices of, … someone. The simple fact is that the overwhelming consensus of medical science is to treat gender dysphoria with gender affirmation. There are a handful of noisy cranks who advocate for what amounts to a form of conversion therapy. Those are at the fringe of medical science.

This nonsense concludes with:
Last month, I met with other parents in Washington, DC to begin a national grassroots movement, the Kelsey Coalition. Our transgender-identifying children (boys, girls, minors, and young adults) have been harmed by physicians, therapists, and clinics throughout the US. We have decided that since the mainstream media has yet not investigated this medical scandal, we will have to do this job ourselves. We encourage others to join us.
Where are all the malpractice suits and how did they organize a meeting among anonymous parents? Under the guise of telling the real truth these folks are out to misinform people about gender dysphoria and transgender children. They have no evidence to substantiate what they are saying. Where is the peer-reviewed research to support the notion that gender dysphoria should not be treated with gender affirmation?

They had one study that supposedly confirmed the existence of gender dysphoria by contagion. After six months of careful review it was subjected to a major edit. It is still up but has been eviscerated.

Why are they working so hard to convince parents to defy medical science? Why would any parent believe anonymous bloggers over a highly qualified doctor with many years of training and experience?

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