Wednesday, September 25, 2019

"Hormones on Demand" and other BS

Religious fundamentalists find inventive ways to attack treatments for gender dysphoria because they cannot approve of transgender people.
The very existence of transgender people creates, in the fundamentalist mind, a conflict with Genesis 1:27. Therefore, transgender people cannot possibly exist. If they cannot exist then treatments for gender dysphoria gratuitously create “people who identify as transgender.” Attack the treatment and transgender people will cease to exist. No one ever said that this has to make sense.

I am negligent for not addressing this issue when I reviewed Mark Regnerus' polemic at Witherspoon Institute's pseudo-intellectual blog. According to Regnerus, referencing a piece of research done by Stephen B. Levine:
He notes that while the World Professional Association for Transgender Health endorses informed consent, this principle remains at odds with its recommendation of providing hormones on demand.

But the authors of the JAMA Psychiatry study, following the USTS’s survey measurement, aren’t interested in subtleties. The authors paint an entire class of cautious therapeutic approaches as intrinsically harmful …
I am seeing this on demand narrative in the emails that my “alters” receive. Once something enters the religious-right echo chamber it bounces around forever with increasing intensity. The misinformation can be thoroughly discredited but it will never be withdrawn.

Many of the fundamentalist cranks have suggested that minors can receive hormones on demand. This is done by conflating the age requirement for medical consent in some states with treatment criteria. In Oregon, for example, minors who are 15 years or older are able to consent to medical treatments without parental approval.

Informed consent does not mean “hormones on demand”
Here are the requirements for adult hormone therapy according to WPATH:
Initiation of hormone therapy may be undertaken after a psychosocial assessment has been conducted and informed consent has been obtained by a qualified health professional, as outlined in section VII of the SOC [Standards of Care]. A referral is required from the mental health professional who performed the assessment, unless the assessment was done by a hormone provider who is also qualified in this area.

The criteria for hormone therapy are as follows:
  1. Persistent, well-documented gender dysphoria;
  2. Capacity to make a fully informed decision and to consent for treatment;
  3. Age of majority in a given country (if younger, follow the SOC outlined in section VI);
  4. If significant medical or mental health concerns are present, they must be reasonably well controlled.
Now, let us return to Dr. Mark Regnerus and his reference to Dr. Levine. Dr. Levine's primary concern is the quality of information patients receive to achieve informed consent. According to Regnerus, WPATH “endorses” informed consent. No sir. WPATH requires informed consent. Some of the risks to be discussed with a patient prior to hormone therapy are represented in the chart below which is included in the WPATH Standards of Care:
It is important to realize that the chart, above, is just a partial summary. WPATH discusses risks at considerable length in the SOC. Providers even more so because of potential liability. In addition to the written consent form, clinicians will discuss risks in substantial detail. Beyond legal liability, the clinicians who provide this care are committed to the medical ethic of informed consent.

As for that 15-year-old in Oregon, he or she can legally consent. However, for medical purposes they are still a minor and will be treated as such. It begins with a complete medical history. If they have not previously been treated for gender dysphoria they are going to be referred to a behavioral health specialist for an evaluation long before receiving hormones.

The bottom line is that informed consent is an addition to the qualifications for hormone therapy. It is not a substitute for clinical requirements and it never has been.

The religious-right would like people to infer that someone can walk into a clinic and receive feminizing or masculinizing hormones on demand (spontaneously, at that). That is part of the continuing narrative to marginalize transgender people by marginalizing their medical treatment.

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