Pamala Paul: Ideology impedes gender treatement in U.S.

July 13, 2024 • 10:45 am

If you’ve followed this website regularly, you’ll know that the UK’s Cass Review, which evaluated and criticized the NHS’s treatment of gender dysphoria, has been widely accepted in the UK, causing the country to slow down on “affirmative care”, following the lead of other European countries.  No longer will the NHS run a conveyer belt from childhood gender dysphoria to universal acceptance by therapists that a dysphoric child needs to transition, and from there on to puberty blockers, other hormones, and then, perhaps, surgery.  (See here, and here, for example.)

Despite the realization of European doctors and therapists that unbridled “affirmative care” is not only dangerous, but isn’t very effective, the United States has resolutely ignored Cass’s review, persisting in offering affirmative care despite the paucity of evidence that it works. Even the Biden Administration, with its increasing wokeness, has been lax about dealing with gender issues.

This is all discussed in a new article by NYT op-ed writer Pamela Paul—a thorough and sensible piece of reporting that will nevertheless infuriate gender ideologues and all the “progressive” NYT writers who beef on the paper’s Slack channel.

Gender issues are one thing that the Biden administration has fouled up, and here’s one example from Paul.  (WPATH is The World Professional Association for Transgender Health, which isn’t very attuned to what the rest of the world is doing, but obstinately fights for affirmative care, no matter what):

The Biden administration has essentially ceded the issue to the progressive wing of the Democratic Party, incorporating gender-affirming protocols into Department of Health and Human Services policy. Moreover, recently revealed emails indicate that President Biden’s assistant secretary of health, Dr. Rachel Levine, a pediatrician and transgender woman, successfully pushed WPATH to remove age requirements from its guidelines for gender medicine before their publication, because — mixing political and public health concerns — she thought supporters of gender treatment bans might cite them to show that the procedures are harmful. (WPATH’s draft guidelines had originally recommended age minimums of 14 for cross-sex hormones, 15 for mastectomies, 16 for breast augmentation or facial surgery and 17 for genital surgeries or hysterectomies.)

Now there are no guidelines! Surgery and hormones at any age!

Paul is heterodox and brave, but her piece is now the third I’ve seen where the NYT reports objectively and sometimes critically on affirmative care. The progressive staffers, of course, got in a tizzy about the previous pieces, and Paul’s will increase their ire even more. But the fact that a Left-leaning paper is willing to publish stuff like this—it’s well referenced, too—may signal a sea change in the attitudes of “progressivists” towards affirmative care in the US. Click to read; you can also find the piece archived here archived here:

I’ve written about nearly all of what Paul says, but if you haven’t followed the controversy, her piece is the place to start.  As I’ve said, I think that in a decade or two Americans will look back at the dosing and mutilating of American adolescents and ask, “What were we thinking?”  Of course many people are happy with their medical transitioning, but remember that many cases of gender dysphoria in children and adolescents who aren’t treated with affirmative therapy tend to “resolve,” often with the young people becoming gay.  If you can cure dysphoria that way rather than by permanently changing bodies with hormones and surgery, then that’s surely a route worth investigating.

Here’s a long quotation from Paul’s piece, which is itself long:

Imagine a comprehensive review of research on a treatment for children found “remarkably weak evidence” that it was effective. Now imagine the medical establishment shrugged off the conclusions and continued providing the same unproven and life-altering treatment to its young patients.

This is where we are with gender medicine in the United States.

It’s been three months since the release of the Cass Review, an independent assessment of gender treatment for youths commissioned by England’s National Health Service. The four-year review of research, led by Dr. Hilary Cass, one of Britain’s top pediatricians, found no definitive proof that gender dysphoria in children or teenagers was resolved or alleviated by what advocates call gender-affirming care, in which a young person’s declared “gender identity” is affirmed and supported with social transition, puberty blockers and/or cross-sex hormones. Nor, she said, is there clear evidence that transitioning kids decreases the likelihood that gender dysphoric youths will turn to suicide, as adherents of gender-affirming care claim. These findings backed up what critics of this approach have been saying for years.

“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass concluded. Instead, she wrote, mental health providers and pediatricians should provide holistic psychological care and psychosocial support for young people without defaulting to gender reassignment treatments until further research is conducted.

After the release of Cass’s findings, the British government issued an emergency ban on puberty blockers for people under 18. Medical societies, government officials and legislative panels in Germany, France, Switzerland, Scotland, the Netherlands and Belgium have proposed moving away from a medical approach to gender issues, in some cases directly acknowledging the Cass Review. Scandinavian countries have been moving away from the gender-affirming model for the past few years. Reem Alsalem, the United Nations special rapporteur on violence against women and girls, called the review’s recommendations “seminal” and said that policies on gender treatments have “breached fundamental principles” of children’s human rights, with “devastating consequences.”

But in the United States, federal agencies and professional associations that have staunchly supported the gender-affirming care model greeted the Cass Review with silence or utter disregard.

There’s been no response from the Department of Health and Human Services, whose website says that “gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents” and which previously pushed to eliminate recommended age minimums for gender surgery. Nor has there been a response from the American Medical Association, which also backs gender-affirming care for pediatric patients.

When I reached out to H.H.S. officials, they declined to speak on the record. The A.M.A. referred me to the American Academy of Pediatrics and the Endocrine Society. The Endocrine Society, the primary professional organization of endocrinologists, told me, “the Cass Review does not contain any new research that would contradict the recommendations made in” the society’s own guidelines. (Cass’s mandate was to assess the quality and importance of existing research.)

Who is to blame for the situation in America? Ideologues—and those include WPATH, the many doctors and therapists who push affirmative therapy onto young people, and, of course, the Biden administration, especially Rachel Levine. It is worth considering that it may have been unwise to put the issue of age limits (i.e., none) on affirmative care and surgery into the hands of a transgender woman.

Why is this happening in the U.S. while Europe has taken a more cautious and sensible attitude towards this type of therapy? Paul gives several reasons, which includes more pervasive “progressive” ideology in the U.S., the fact that centralized medical care like that in Europe makes it harder to “give patients what they ask for” (and no, not all kids who ask for gender transitioning should automatically get it), and the litigious climate of the U.S., which make doctors hesitant to change course because they could get sued for admitting they were wrong.

I’m a big fan of Paul, not because she’s “antiwoke,” but because she’s sensible and has the courage to speak truths that will get her demonized in the fraternity of NYT “progressives”.  And, of course, because we tend to have confluent opinions.  We also agree on how gender dysphoric young people should be treated, and I’ll finish with Paul’s take, which agrees with the conclusions of The Cass Review:

The Cass Review recommends a more holistic approach to treating gender dysphoria in kids. This involves untangling gender discomfort from common pre-existing conditions like autism spectrum disorder and A.D.H.D. and treating it alongside frequent comorbidities, which include anxiety, self-harm and eating disorders. A mental health counselor can help children with any difficulties during puberty and in coming to terms with their sexual orientation — without pathologizing either.

The goal throughout is to help. This includes working with kids to understand the causes of their gender dysphoria, relieve its symptoms, help resolve it or, in a case that proves persistent, consistent and insistent, help kids understand the pros and cons of pursuing gender reassignment for when they enter adulthood.

Once again we see ideology not only impeding science, but screwing up people’s lives.

33 thoughts on “Pamala Paul: Ideology impedes gender treatement in U.S.”

  1. IMHO the worst act by WPATH (which Paul only touched on) was the multiple systematic reviews of gender-affirming medicine that WPATH commissioned from researchers at Johns Hopkins and then suppressed when the reviews found no good evidence for the efficacy or safety of blockers, hormones, or surgery.

    https://x.com/jessesingal/status/1806351204609364318

    1. Same thing in Canada as in the US. WPATH files and Cass review seem virtually unknown in Canada. It’s shameful.

  2. Sending kids to a psychiatrist for gender dysphoria (or just waiting for them to grow out of it) is “conversion therapy”.

    Surgically altering kids’ bodies to convert them into facsimiles of the opposite sex is *not* “conversion therapy”.

    Makes sense.

  3. I have to wonder about how much the money question affects this subject in the US.
    The medical costs imo do not get much publicity.
    I know from personal experience when prescribed Lupron for testosterone suppression during prostate treatment that each injection (3) cost in the region of £700.00 and this was quite some years ago now and I would assume that this cost is similar in North America. Who is paying for all this treatment? I suspect that this must be making some people in the medical / pharmaceutical business quite wealthy at the cost of injury to children? Just wondering.

      1. Thanks for the link, as I suspected there is money to be made out of this, nothing like a dose of greed at someone else’s distress. The health care “industry” must take its share of blame for this dreadful business but no doubt it will not.

        1. Check out what Jennifer Bilek has to say about the “Follow the money” issue, quite terrifying.

  4. How do you treat transgender children. Just talking for years as puberty causes havoc on their bodies and minds till only multiple intervention and surgeries that can never truly undo the damage of being forced through the wrong puberty. The suicide rate has shot up since blockers were stopped for trans children.

    1. Do you care to link us to the evidence for your claim that”The suicide rate has shot up since blockers were stopped for trans children.” Are you talking about the U.S., where blockers have NOT been stopped for trans children? No, you must be talking about Europe where blockers have been stopped as regular treatment and are now regarded as part of clinical trials. So let’s see your evidence from a reputable source.

    2. How do you treat transgender children.

      You don’t. The evidence is that, if you just leave them alone, then 80% will desist and grow to be happy with their bodies. (The remainder can transition when adults if that’s their settled adult desire.)

      The suicide rate has shot up since blockers were stopped for trans children.

      If this is in the UK context then it seems to be a claim made (and made up?) by activists and attributed to unnamed “whistleblowers”. No evidence has been supplied.

    3. Laura, if a bedrock principle of medical care is: “first, do no harm”, how does the medical establishment explain as non-harmful, physical medical interventions that may foreclose for young teenagers the ability to bear or genetically father children when the teens become adults?

    4. There are no “transgender children”. There are children in distress with their sexed bodies. This distress comes from a variety of reasons, and the solution should never be to immediately put them on the path for sterilisation and a lifetime of medical interventions. The first line of treatment should be therapy, to figure out the origin of the distress and try to alleviate it without destroying the only body they’re ever going to have. Oh, and puberty is a natural process; it’s ridiculous to refer to it as ‘wrong’.

    5. It is hard to draw oneself out of a state of moral panic, as that is a powerful thing that can capture anyone. But do try to at least consider the points made above.

    6. Puberty usually causes them to grow out of gender dysphoria. But regardless, just accept them for who they are, including if they are masculine girls or feminine men.

      There’s little evidence that being “gender non-conforming” should be treated with social transition, puberty blockers, surgery, etc.

      If you produce eggs, you are female; if you produce sperm, you are a male. Accept that reality, and just dress and act how you want. If, as an adult, you want to have body modification surgery, that’s your own business. Go for it.

      P.S., it sounds ridiculous to say that puberty “causes havoc” for children. It’s a normal part of growing up that everyone goes through. If someone can’t accept that, it’s a psychological issue, not a physical one. It’s like a pathological fear of death that prevents you from living your life. The treatment is psychological; the treatment is not impossibly trying to live forever.

    7. The claim that there can be any such thing as “wrong-sex puberty” as a motivator for medical treatment is an extraordinary claim. As such it requires extraordinary evidence, which there is none. It is not even in principle a falsifiable claim, which puts it in the realm of metaphysics or religion.

      (Your specific claims about suicide have already been called out. I won’t pile on.)

  5. An Evidence-Based Critique of the Cass Review

    Above can be found at law.yale.edu

      1. It is a science based site (not “sight”) and that’s why I asked you to support your claim about suicide with some evidence. You didn’t, because there IS no such evidence.

        BYE!

    3. As dd points out, the word “evidence” in Eli Siegel’s comment is highly elastic. Siegel refers to the critique of the Cass Review at the Yale Law site. This is put out by “The Integrity Project”, an advocacy group for gender affirmative medicine.

  7. I just finished Pamela Paul’s piece. It’s solid, sane, and sensible. Let’s see how it’s received.

    1. It’s always interesting to check the most recommended reader comments.

      They’re all in agreement with one commenter pointing that you have to be over 18 to get a tattoo. Why won earth would major life-altering surgery be permitted for under-18s?

  8. The tragedy of puberty blockers and cross sex hormones is that they are used mostly for the purpose of “passing” as the new chosen gender/sex. Trans advocates want to intervene early to increase the ability to “pass” beyond natural puberty, and suppressing natural puberty is the best means to achieve this goal. Would you rather have a “trans child or a dead child” is a horrific fact less lie, apparent to anyone who has reviewed the ample literature for a few hours. The only splinter of truth sits with the ability to better “pass” as the other sex.

    Non-binary my ass. The whole affirmation via drugs and medical intervention is hyper binary.

    1. Right you are. Especially for boys, the body as art project requires a blank canvas to give full expression unsullied by male bone structure, muscle development, facial hair, and voice changes. The activists even talk this way. The surgeons have recognized a conundrum, though. They can’t easily create an open wound lined with penile tissue to mimic a vagina when male puberty has been arrested early enough to pass otherwise. They have figured out creative ways to get around this, since come to find out few “transgirls” actually use their eye-wateringly expensive neovaginas for sex anyway. (It does require a willing partner, don’t forget, and with rampant transphobia just simply everywhere….)

  9. Back in the day it was ADHD, a legit thing as much as being Trans is. But there is a push against it from wherever, there is a push back and so on, this goes on and all get totally toxic.

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