I have not attempted to verify the information in the post. In writing this comment, I am assuming it is well researched: this is excellent information. This post was well presented. While I think this post will not likely result in much comments, this is among the kinds of posts that I really like seeing as a reader, as part of what RLS puts out. Such information helps to educate me and to reinforce what amount of knowledge I have.
Question for you. It is my understanding that the default human body is feminine - androgen insensitive males develop as women. If you give androgen blockers to pre-pubescent boys, won't they develop along feminine lines - even without estrogen supplementation? In which case, long term use of androgen blockers are going to result in feminization anyway. Am I correct?
I appreciate SEGM's work and hope the following critique is taken constructively.
Briefly, the article falls short:
1. It is not "pediatric gender medicine," nor "sex reassignment surgery." Let us not whitewash it: let us say clearly that these are procedures to alter phenotypic sexual characteristics.
2. The evidence on the psychological benefits of puberty blockers is no longer "limited and of low certainty." There is sufficient certainty about their harms and about the fact that their scant benefits are transient.
3. Regarding puberty blockers, it is not true that "little is known." It is known, for example, that those who use them almost all go on to use cross-sex hormones.
4. Experiencing endogenous puberty does not cause harm. On the contrary, it has been demonstrated that children who wished for an (impossible) "sex change" desisted from that idea upon going through puberty (see R. Green, "The Sissy Boy Syndrome").
5. In the section on desistance and regret, no mention is made of those who committed suicide or died prematurely due to these procedures, nor of those who cannot abandon hormonal treatments or undo the mutilations they have suffered.
6. In the section on the persistence of gender dysphoria, the iatrogenic effect of overvalued trans beliefs—sustained by much of academia—has been omitted, as have the obstacles to genuine supportive psychological therapy, education, and acceptance.
I think they did cover some of your issues, but agree some of your other points are valuable ones to make!
In particular, one can focus on all the adverse outcomes you mention, rather than only regret (it is not shown that these interventions change suicide risk, but they surely haven't prevented completed suicides in many cases, tragically), and the cultural contributions to persistence appear significant.
Regarding puberty blockers-- "low certainty" evidence is a technical term, it is what the systematic reviews of the evidence on the effects of puberty blockers find.
I think they agree with you in 1.4, above, about harms of puberty blockers and that puberty isn't harm?
Studies such as the one by Ruusca et al., along with other meta-analyses, provide the evidence base needed to use more categorical language.
Furthermore, the labels we use carry significant weight. When a young person—a child, for instance—says they need hormones or, worse yet, surgery, it is not a good idea to explain the harms of gender "medicine." The use of the label "medicine" initially implies something that serves to "remedy" a condition. Therefore, speaking of the harms of the "remedy" of gender "medicine" stops short of the full picture, making the issue seem like a matter of probabilities or mere differences of opinion. In contrast, by speaking of "procedures to alter sex characteristics," we are being precise and avoiding the implication that these procedures can "remedy" anything.
Gender medicalization, the word used sometimes in Stella O'Malley substack, is probably a more descriptive name than gender medicine, since these are experimental procedures with risks including cardio-vascular, cognitive, bone development, hormonal imbalance and others.
First of all, gender is not a disease. Second, a medicine is a substance used to improve a condition or to cure a disease.
I believe that when people with gender-related dysphoria or distress hear about "gender medicine," they think of something that will help them, because medicine is supposed to be for that.
And when they hear those of us who criticize "gender medicine," they do not fully understand the depth of our critique.
The misnamed "gender medicine" not only does not cure or resolve a condition, but it provokes it, it produces it. Altering with cross-sex hormones or removing healthy parts of the body is not something we can call "medicine." The most neutral way to describe it is to say that these are procedures to alter phenotypic sexual characteristics; that is, the observable physical, anatomical, and physiological traits of an organism that define it as male or female.
Gender medicalization, the word used sometimes in Stella O'Malley substack, is probably a more descriptive name than gender medicine, since these are experimental procedures with serious risks including cardio-vascular, cognitive, bone development, hormonal imbalance and others that were well presented in the last year conference in Albuquerque organized by Stella and also in HHS report. Besides psychiatrists and philosophers, does SEGM have medical doctors speakers as well?
I have not attempted to verify the information in the post. In writing this comment, I am assuming it is well researched: this is excellent information. This post was well presented. While I think this post will not likely result in much comments, this is among the kinds of posts that I really like seeing as a reader, as part of what RLS puts out. Such information helps to educate me and to reinforce what amount of knowledge I have.
Question for you. It is my understanding that the default human body is feminine - androgen insensitive males develop as women. If you give androgen blockers to pre-pubescent boys, won't they develop along feminine lines - even without estrogen supplementation? In which case, long term use of androgen blockers are going to result in feminization anyway. Am I correct?
I appreciate SEGM's work and hope the following critique is taken constructively.
Briefly, the article falls short:
1. It is not "pediatric gender medicine," nor "sex reassignment surgery." Let us not whitewash it: let us say clearly that these are procedures to alter phenotypic sexual characteristics.
2. The evidence on the psychological benefits of puberty blockers is no longer "limited and of low certainty." There is sufficient certainty about their harms and about the fact that their scant benefits are transient.
3. Regarding puberty blockers, it is not true that "little is known." It is known, for example, that those who use them almost all go on to use cross-sex hormones.
4. Experiencing endogenous puberty does not cause harm. On the contrary, it has been demonstrated that children who wished for an (impossible) "sex change" desisted from that idea upon going through puberty (see R. Green, "The Sissy Boy Syndrome").
5. In the section on desistance and regret, no mention is made of those who committed suicide or died prematurely due to these procedures, nor of those who cannot abandon hormonal treatments or undo the mutilations they have suffered.
6. In the section on the persistence of gender dysphoria, the iatrogenic effect of overvalued trans beliefs—sustained by much of academia—has been omitted, as have the obstacles to genuine supportive psychological therapy, education, and acceptance.
I think they did cover some of your issues, but agree some of your other points are valuable ones to make!
In particular, one can focus on all the adverse outcomes you mention, rather than only regret (it is not shown that these interventions change suicide risk, but they surely haven't prevented completed suicides in many cases, tragically), and the cultural contributions to persistence appear significant.
Regarding puberty blockers-- "low certainty" evidence is a technical term, it is what the systematic reviews of the evidence on the effects of puberty blockers find.
I think they agree with you in 1.4, above, about harms of puberty blockers and that puberty isn't harm?
Studies such as the one by Ruusca et al., along with other meta-analyses, provide the evidence base needed to use more categorical language.
Furthermore, the labels we use carry significant weight. When a young person—a child, for instance—says they need hormones or, worse yet, surgery, it is not a good idea to explain the harms of gender "medicine." The use of the label "medicine" initially implies something that serves to "remedy" a condition. Therefore, speaking of the harms of the "remedy" of gender "medicine" stops short of the full picture, making the issue seem like a matter of probabilities or mere differences of opinion. In contrast, by speaking of "procedures to alter sex characteristics," we are being precise and avoiding the implication that these procedures can "remedy" anything.
Gender medicalization, the word used sometimes in Stella O'Malley substack, is probably a more descriptive name than gender medicine, since these are experimental procedures with risks including cardio-vascular, cognitive, bone development, hormonal imbalance and others.
But gender is not "medicalized."
First of all, gender is not a disease. Second, a medicine is a substance used to improve a condition or to cure a disease.
I believe that when people with gender-related dysphoria or distress hear about "gender medicine," they think of something that will help them, because medicine is supposed to be for that.
And when they hear those of us who criticize "gender medicine," they do not fully understand the depth of our critique.
The misnamed "gender medicine" not only does not cure or resolve a condition, but it provokes it, it produces it. Altering with cross-sex hormones or removing healthy parts of the body is not something we can call "medicine." The most neutral way to describe it is to say that these are procedures to alter phenotypic sexual characteristics; that is, the observable physical, anatomical, and physiological traits of an organism that define it as male or female.
Gender medicalization, the word used sometimes in Stella O'Malley substack, is probably a more descriptive name than gender medicine, since these are experimental procedures with serious risks including cardio-vascular, cognitive, bone development, hormonal imbalance and others that were well presented in the last year conference in Albuquerque organized by Stella and also in HHS report. Besides psychiatrists and philosophers, does SEGM have medical doctors speakers as well?