Monday, July 6, 2020

J.K. Rowling Keeps Digging Her Hole Deeper

J.K. Rowling
via Lefteris Pitarakis, Associated Press
On Sunday, J.K. Rowling embarked on a tweetstorm worthy of Donald Trump. She set out to prove something. Ms. Rowling, in the process, confirms that she is an ignoramus. Rowling would be ignored were it not for the amplification of her microphone and the potential to influence others.

After all, Ms. Rowling is a fantasy fiction writer. She has no training in medicine or behavioral health. Rowling has created a fuss because of her celebrity status in contrast to anything passing for erudition. She should save the fantasy fiction for Harry Potter.
Selected tweets
“Many health professionals” is misleading. In the United States every mainstream medical professional organization is a proponent of gender-affirming care when it is warranted. If adolescents with gender dysphoria are needlessly struggling it is because of people like Rowling.

No one is being “shunted” into anything (shunt means shoved). Gender-affirming care requires the consent of the patient, their parents and multiple doctors. It is common among anti-trans agitators to suggest that people are being evilly influenced.
In the above, Rowling is claiming that transgender people are actually gay which is the rhetoric of trans denialists. Gender identity and sexual orientation are distinctly separate constructs. Then Rowling hits the common talking points: Lifelong medication, loss of fertility and sexual dysfunction.

Rowling refers to “young” people which is ambiguous. If she is writing about children, they are a long way from cross-sex hormones. Prepubescent kids receive no medications. Just upon entering puberty (Tanner stage 2), children might receive puberty blockers which are fully reversible. In later teens, they might receive hormones.

Yes, cross-sex hormones might cause adverse side effects; something that no one denies. Again, the patient, parents and doctors must reach a consensus that the benefits outweigh the risks. The bottom line is that adolescents do remarkably well with their gender affirmed. Absent affirmation, the potential for self-harm skyrockets.

“Dr.” Rowling doesn't seem to offer any alternatives. Does she propose to talk people out of their gender dysphoria?
Rowling is in no position to opine on who should, and who should not, transition. There are a comparatively minuscule number of detransitioners. Some of these people make a living as ex-transgender individuals. I do not know who Rowling is quoting. Nor do I know what comprises “the system.”

What I do know is that it is difficult to qualify for surgery (in the U.S.). It requires approvals from two behavioral health specialists, the surgeon and the hospital. Candidates must be adults who demonstrate a complete understanding of reasonable expectations and must have lived as their gender for at least one year (“real life experience”).
As I previously wrote, there are potential adverse consequences to taking hormones. Rowling makes a vague claim about the statements of those ubiquitous wicked “trans activists.” I closely follow this issue. While it not dispositive, I have never seen anyone minimizing the effects of cross-sex hormones.

Hormones are administered by endocrinologists and require fully informed consent. If Rowling is referring to minors then informed consent includes parental consent.
I believe that Rowling means Carl Heneghan. Heneghan is a general practitioner and not an endocrinologist. What he has written (in part) is this:
There are significant problems with how the evidence for Gender-affirming cross-sex hormone has been collected and analysed that prevents definitive conclusions to be drawn. Similar to puberty blockers, the evidence is limited by small sample sizes; retrospective methods, and loss of considerable numbers of patients in the follow-up period.
The above appeared in a blog in contrast to a peer-reviewed academic journal but he makes a point that more research is necessary. In the United States, the Endocrine Society (the oldest medical peer organization in the country) recommends these interventions.

As does the Pediatric Endocrine Society. As does Dr. Jack Turban, one of the nation's leading experts on juvenile gender dysphoria. Dr. Turban is associated with Harvard Medical School and Mass General. Let's not forget the American Academy of Pediatrics, a proponent of the gender-affirming care model.

There does not exist some vast sinister conspiracy to mislead people.
This issue has nothing to do with righteousness. The claim that people who follow the best available medical advice have made poor choices does a disservice to them and the dedicated clinicians who care for them. It also contributes to the oppression of a small minority group whose members are especially vulnerable and fragile.

There are qualified outliers with divergent views of gender-affirming care. There is nothing wrong with considering their opinions.

Mis. Rowling, however, is not qualified and she is indulging in selective observation. It is not often but, from time to time, I have had the privilege of speaking with parents. I listen far more than I speak. My advice is always the same: Adhere to the best available medical science. Doing so offers the best odds of success.

People who investigate transgender care should start with the Standards of Care published by WPATH. That can be augmented with published studies. “Published” means articles that appear in reputable academic journals that engage in the rigorous peer review of submissions.

In conclusion, J.K. Rowling doesn't seem to appreciate the absence of an alternative. The aforementioned Jack Turban and a team of highly qualified researchers have determined that any exposure to gender identity conversion therapy has the potential to cause lifelong adverse mental health consequences. That paper was published to the Journal of the American Medical Association as opposed to tweets or blog posts.

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