Wednesday, August 7, 2019

Remarkable confusion over gender

Cathy Ruse writes: URGENT: Tell Virginia’s governor not to ban healing therapy for gender-confused kids.

The background to this is that Virginia is considering a ban on conversion therapy through an interpretation of regulations by the commonwealth's Department of Professional Regulations. Unfortunately, the link to the document text does not work. I am going to assume that a ban on conversion therapy is under consideration affecting licensed health providers.

At the outset, the “healing therapy” that Mrs. Ruse is promoting does not exist. An intervention would have to change child's gender identity to one congruent with their natal sex. It just doesn't exist. It is apparent that Ruse does not understand juvenile gender dysphoria. She writes:
Say a girl suffers from gender dysphoria. Say at some point she "socially transitions" to living as a boy. Maybe she got the idea in her Fairfax County Sex Ed class. Now she wants help living as a girl.
It just doesn't work that way and late-onset gender dysphoria (which see seems to describe) is suspect. Let's step through this.

About 2% of prepubescent children will experience some form of gender dysphoria. About three-fourths of those kids will grow out of the condition, with or without therapy. Those kids do not transition. The remaining fourth (0.5% of all children) are in severe distress and feel compelled to to affirm their gender in some way. Without gender affirmation, which includes parental support, these children are at significant risk of self-harm.

According to Dr. Deanna Adkins, a professor at the Duke University School of Medicine, gender dysphoria is, in part, related to brain structure:
Both post-mortem and functional brain studies that have been done on the brains of individuals with gender dysphoria show that these individuals have brain structure, connectivity, and function that do not match their birth-assigned sex. Variations in these studies include overall brain size, intra- and inter-hemispheric connectivity (number of connections within each half of the brain and between halves of the brain). Differences have been shown in visuospatial and verbal fluency tasks and their activation patterns in the brain. Variations in cortical thickness in the sensory motor areas, the white matter microstructure, and regional cerebral blood flow are also present in those with gender incongruence compared to those without.
Dr. Adkins also explains the severity of the condition and its inherent danger (emphasis added):
With the exception of some serious childhood cancers, gender dysphoria is the most fatal condition that I treat because of the harms that flow from not properly recognizing gender identity. Attempted suicide rates in the transgender community are over 40%, which is a risk of death that far exceeds most other medical conditions. The only treatment to avoid this serious harm is to recognize the gender identity of patients with gender dysphoria and differences of sex development.
Kids with acute gender dysphoria don't get the idea to transition from social media or “sex-ed class,” as Ruse states. Those children are desperate for relief and find some mitigation of their suffering through gender affirmation.

Parents do not transition kids. Clinicians do not transition kids. Kids transition themselves. The very notion that a social transition is whimsical or gratuitous is nonsensical. Ask a boy with gender dysphoria and he will not say “I think that I am a girl.” He will say “I am a girl!”

Consider the plight of a ten-year-old transgender girl who, one day, goes to school wearing a dress. She knows that she will be savaged by classmates, possibly bullied. She is willing to endure all of the negative attention because the transition provides her with relief from her rare medical condition.

Cathy Ruse would do well to review the DSM-5 requirements for diagnosing gender dysphoria. A 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.

No parent wants to have a transgender child. The question is this: Will they take their child to a board certified psychiatrist with experience in this area or are they going to subject their child to some form of conversion therapy? I can understand the appeal of the latter choice but it is irresponsible. It will cause added suffering and might endanger the child.

Ruse uses another common artifice:
The regulations specify that the ban does not prohibit counseling "that provides assistance to a person undergoing gender transition" or that provides "acceptance" and "support" for a person's "identity exploration."

You got that? It's a one-way street. Under Northam's ban, counselors are only allowed to use words that promote transgenderism — they cannot use words to help someone avoid it.
I previously quoted Ruse's text about a trans boy:
Now she wants help living as a girl.
Aside from the fact that Ruse was referring to late-onset gender dysphoria (which may not even exist)1, the desistance rates of transitioned children are minuscule. If someone wanted to de-transition and if it was their desire (in contrast to parental pressure) then a therapist is required (irrespective of regulations) to ascertain whether or not that person's gender has changed or, in the alternative, they want therapy to change their gender.

While presumably very rare, it might be possible for someone to experience a gender change. In that case a therapist could offer de-transition therapy without breaking the law. On the other hand, if someone is asking a therapist to help them change gender then (again, regardless of regulations) they have a professional obligation to inform the individual that doing so is not possible. There is no intervention known to medical science that can change incongruent gender to conform to one's natal sex.

Ruse is suggesting that the regulation would be unfair because it is one-sided. It is one-sided but not every situation has two reasonable sides. Absent from Ruse's appeal is any reference to peer-reviewed research confirming that gender change is possible.

Cathy Ruse is soliciting comments to the Department of Professional Regulation. I would hope that the Commonwealth of Virginia would make a decision based on evidentiary medical science over uninformed comments from the general public. Nevertheless, after I hit the “Publish” button, I intend to weigh in.
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1 Late onset gender dysphoria influenced by others was postulated in a paper by Dr. Lisa Littman at Brown University. The publishing journal subsequently apologized and issued a correction notice.

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