Update: Worried Doc is a dad.
A few days ago, a commenter calling himself “worried doc” wrote to me. He is a physician who is skeptical of the current transition trend. Not only is his own teenage son embarking on this medical journey. The young man is also enrolled in the new multicenter NIH study of pediatric medical transition. Here is the doctor’s story.
“First, Do No Harm”: The Gender Dysphoria Hustle
by Worried Doc
I am surprised and dismayed to find myself having to write this letter. I am a physician, having practiced for forty years as a specialist in primary care medicine. As such, I would occasionally have patients who would complain of “being in the wrong body”, not being comfortable with who they are, or similar concerns. Having no way in my practice to evaluate or deal at all with this constellation of symptoms, I would refer them to what I presumed was appropriate psychiatric care.
I have a very difficult teenage son. He has been treated for mental health issues for a number of years without improvement, and has also attended multiple residential psychiatric facilities where he was tagged with diagnoses including anxiety and depression with intermittent suicidal tendencies. What has emerged more recently and prominently is his expressed desire to become a woman, with the threat of suicide if he is thwarted in doing so. I would bring this up to his therapists, who simply washed their hands of it, stating that they don’t treat this problem and suggesting he move on to someone else who does.
My first experience with a therapist who deals with “gender dysphoria”– the state of one’s self-perceived gender being incongruent with one’s natal biology– was alarming. Her suggestion was to immediately start my son on a lifelong regimen of cross-sex hormones and prepare him for multiple surgeries, including chondrolaryngoplasty (scalpular scraping of the thyroid cartilage to reduce the size of the Adam’s Apple) and a procedure described to me simply as “down below”, in order to feminize him as quickly as possible. I later learned that “down below”, or “bottom surgery”, is a polite, casual euphemism for a bilateral orchiectomy (surgical castration) and penile inversion vaginoplasty: the skinning and removal of the penis, with the empty flap of penile and scrotal skin inverted into a newly-made body cavity to create a “neovagina”. These recommendations were all made during the first visit, with no further insight given as to the nature or cause of the situation at hand. I was, however, referred along to a doctor “who knows that stuff” at a major medical facility. Upon arriving at that office, I was met with a friendly physician’s assistant who performed a physical exam on my son, after which we were promptly instructed on how to proceed. Very little of the discussion was regarding diagnosis or etiology; the risks, benefits, and side effects of the proposed treatment went largely unaddressed. He was to be started on estrogen at this stage, despite there being only the most superficial of clinical work-ups required for the diagnosis of gender dysphoria. The diagnosis was based almost entirely on the self-reported say-so of my troubled 15-year-old son.
My son was not advised, nor was I, regarding the frequency and treatment of complications arising from male-to-female transgender hormone therapy. This off-label administration of hormones to children was foreign to me, though as a doctor I knew the names of the drugs involved, and I also knew their possible side effects: deep vein thrombophlebitis, permanent infertility, polycythemia, pulmonary embolism, and death. The issue of infertility was raised by myself, concerned about the risk of my son becoming sterile and therefore having no chance to have a family of his own one day. All care at the facility prescribing his cross-sex hormone treatment was provided by a PA; I never saw a physician. I have scoured the medical literature and found little legitimate science regarding the medical treatment of pediatric gender dysphoria, the long-term outcomes of such treatment, or the sudden, recent groundswell of young people diagnosed with this previously-uncommon condition: so much speculation, so many unanswered questions, so few studies.
I took an oath with my medical degree. It states, “first, do no harm”. I wrestle with that oath daily: advised of my son’s suicidal ideation– which, I was told, will only increase in severity if his feminization treatments are denied– his gender therapist told me he was “better a live girl than a dead boy”, and what parent could possibly disagree? And yet, as a doctor, I know what these drugs can do. When the time comes for my son’s sex reassignment surgeries, I– and he– will have to contend with another set of potentially life-threatening complications, including the possibility of a rectovaginal fistula, a hole between the neovagina and rectum that can require the use of a colostomy bag, and can also result in infection and death. I can only hope that the day will come when my child, and other children faced with gender dysphoria, will have safe, legal guidelines and regulations for the treatment of their dysphoria, and that those laws will be based on quality, unbiased scientific studies. This brave new world of radical, life-changing gender reassignment for children too young to drive or vote seems all too much like the Wild West.
As I write this letter, there is a study underway regarding the hormonal treatment of pediatric gender dysphoria, yet with tremendous conflicts of interest throughout: at least a few of the doctors running the study are, or have been, employed as consultants by the pharmaceutical companies that manufacture the hormones being used. Is this why my son was seemingly sped through the process of diagnosis and prescription, hustled into hormones? There remain far more questions than answers. Yes, there is now a study, but the terrible irony is that one of the study’s subjects is my own son.
OMG that is terrifying! Poor kids shows up with anxiety and depression (which lots of people have) and the first thing they want to do is turn him into Frankenstein, no questions asked. WTF is going on??
Doctor, you’re brave to share your observations. Our family had a close shave with psychiatry for a barely 21 year old who had severe depression and hypoglycemia. That was dx by orthomolecular psychiatrist in SF who tapered her off three atypical neuroleptic psych meds they had put her on for their “pediatric bipolar” BS diagnosis. Gave her an initial course Zyprexa for that pediatric bipolar mullarky.
I know this is not cross sex hormones, but, the evidence and science behind these faux diseases was absent. I had worked in cancer clinical trial grant funded work so was familiar with objective medical diagnostic process which is absent in modern psychiatry.
In short, the psych field not only authorized and assisted with torture at Abu graib,they are very busy with off label drugs of VULNERABLE YOUTH w/o evidential and peer reviewed science.
You are your sons best advocate. I went on natural health boards on yahoo to find alternatives, hope you find resources. Your son sounds lost. Like he fell in a crevasse on a glacier and needs loving adult facilitation of hid rescue from trans clutches. Stop at nothing. Leave no stone unturned. Some day he will be grateful.
Oh, btw, the “good” shrink that tapered her off meds said that a certain %of severe depression, like 1-5%, present with symptoms that look psychotic but are just psychotty thinking what their brain does in severe emotional depression. She’s well and safe. I wish the same for your so.
Also, consult people in the Sedona Arizona “alternatives to Meds” foe help getthelp through orthomolecular psyciatry. Founded by Dr. Michael Lesser. MD Phd. Bless you and may we protect all our kids.
You are right Cheryl. Those drugs WILL cause suicide ideation.
SUICIDE AND VIOLENCE IDEATION FROM ANTI-DEPRESSANTS, PLUS DELUSIONS, HALLUCINATIONS PROVEN IN CLINICAL TRIALS.
http://davidhealy.org/articles/#Suicide_Articles
David Healy is the author of Let Them Eat Prozac, and Pharmageddon. He is a clinical psychopharmacologist at London Hospital
From Healy’s website:
http://davidhealy.org/psychiatry-gone-astray/
Anxiety and depression are natural for a teenager. So is bullying and now apparently, physician opportunism from those who practice a profession that has no scientific basis. Since this is your child’s LIFE, I would pull out all the stops: take out of school, spend 24/7 with him, fly to London to see Dr. Healy, and begin a program of intense exercise and hard outdoor activity. Remove your child from the peer group which is killing him.
What they are doing to your kid is made up bumpf from a pharma marketing department.
This blog will go down as one of the most chilling documentations of this entire trans mass delusion. You are doing really important work here. THANK YOU.
Wow! I’m not a medical professional, but as a lawyer I’ve spent many years representing psychiatric patients. I’m flabbergasted at the presumption by these people that hormones and surgery somehow would have no effect on any psych meds this young man might be taking. “Bottom” surgery is not only significantly invasive and risky but it has a lengthy recuperative period with a lot of physical restrictions, not an easy requirement for someone with depression and/or anxiety. So often, patients with significant mental health conditions are rushed into this process which is very taxing, yet there is very little evidence of any long-term mental health benefit.
Isn’t it time for a class action lawsuit for those being injured? What can be done to encourage this?
Unfortunately, because suicidality is used as an emotional cudgel, it would be hard to pursue anything. In the public opinion, trans are fully part of the LGBT and thus in the same boat as gays and lesbians, so you’re not going to get any popular resistance to transition in children even with a lot of medical evidence to the contrary. Really, it would take a massive adverse reaction on the scale of Thalidomide to make people take this seriously or some high-profile trans (ie, Jazz) to flame out.
The suicide declaration is a conversation/thought stopping cliche, and a form of conversation manipulation.
Pedophiles also claim a 50% suicide rate and use this to justify talking to 11 yearolds online and use it to talk their way out of trouble. They use this to intimidate children into posting nude photos, meeting them secretively, etc…It is being used as a conversation stopper by repeat sexoffenders as well.
The suicide threat is being used here as an intimidation tactic to get victims, and all those concerned- to back out of the argument, and be silenced..
Actual Suicidal people are mentally ill with depression and are a danger to themselves, and other people that catch their eye. They no longer care about their lives, or anyone elses. Some want to punish other people. They may be in the talking stages of taking a human life. What is more disturbing, is that suicidal people are dangerous- and may take others along when they kill themselves. In many murder-suicides, the suicidal person was thought to be harmless, but many are afraid to die alone, sometimes, they are too afraid to kill themselves first-, and need to kill someone else first, or take as many people with them before they are motivated to take their own life.
This makes suicidal people dangerous. If someone is threatening to kill themselves, you need to call mental health services to have them picked up before they hurt themselves or other people.Mental health services use to have a 72 hour facility that you were taken to if you mentioned suicide.
Another thought stopping manipulative claim is, the ‘I was raped by women cuz I trans , and need access to female rape victims that were raped by men’
When rape victims at shelters don’t want these men joining their groups to listen to rape-stories, These fetishists claim that they were raped by women. Whats’ worse, is even if they manipulate the center to force rape victims to tolerate him being there, they begin getting in , ‘not all men’ arguments with rape victims recounting their stories-trying to heal. These men will play sadistic games with female rapevictims, like forcing them to question the gender of their rapist,- and try to force them to say ‘women rape men all the time’ until they leave the group, or they are intimidated into shame and silence over men’s perceived right to access them..
There is NO evidence that gender reassignment reduces suicidality. Surely that is the crucial fact (trying to hold off crazed capitalization!). See Swedish study 2011 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/. The original gender reassignment service at Johns Hopkins was closed because there was NO evidence that hormones and surgery provided any better outcomes than simply talking therapy. My own guess is that gender dysphoria is simply one form that distress takes in our society which is obsessed with gender. In the past – in a religious society – madness often took the form of thinking you were Christ or the devil. Now, when the poor brain can no longer cope or make sense of a world that is distressing, it turns instead to gender delusions, since gender myths are constantly fed to us all through media and culture.
A lot of people said to me something like”what is the problem if someone change sex?” . If a person thinks this, I can certainly know that they have not son or daughter with gender disphorya.
When is your daughter/son/sibling the target of GID, you forget all the mainstream you heard in television and begin to reason with your head because you dont want this treatment for him/her.
Would thosee physicians act in the same manner with their sons? I dont think so…
Reblogged this on Stop Trans Chauvinism.
Not every day you meet a practitioner with forty years experience and a 15 year old son! Nonetheless, that is a very scary tale. I’m wondering what psychiatric medications he has been prescribed (as it seems a number of them cause suicidal ideation and worsen depression… Such as my namesake) if that therapy has been abandoned for hormone treatment and if his obvious co-morbidities have been diagnosed. It seems gender therapists are strictly in the business of processing gender change rather than finding out why. I hope he is aware that he cannot run away from himself, too.
Where I live there is a very obviously mentally ill transgender woman who is infamous for directing traffic on rollerblades, although others have anecdotes about considerably less harmless behaviour from this individual. It blows my mind that someone so obviously mentally ill was able to get SRS. If you are unmedicated and your behaviour is erratic, how can you really give informed consent for that? How can any of this be ethical?
Worried Doc responded to my email query confirming that he is a father. While many women are having kids later in life (or adopting), it is perhaps less surprising to see this great an age difference between a dad and his offspring. As to his story, it seems to be more and more common. Therapists are discouraged from questioning a young person’s self professed gender identity for fear of being labeled “transphobic.” In addition, many young people get information online about how to be convincing to gender specialists. My own daughter, when she first talked about “transition,” presented me with a whole list of symptoms, as well as treatment protocols, that she had never mentioned before. After doing my research, it was very clear that she had been frequenting websites that coached young people how to get therapists and doctors to agree to “informed consent.” Not only that, but as soon as someone presents with “gender dysphoria,” other mental health issues fade into the background, with the clinician often assuming those issues are CAUSED by the dysphoria, and will be cured by “transition.”
Ahh, I just typed out a reply and lost it, I think so I’ll just say thanks for the clarification, and thank you for providing a forum where people can discuss these things.
The thing that I find very troubling is that what little research that has been done on children who have been ‘transitioned’ which is being used to justify this ‘therapy’ was based on children who were carefully selected (and received psychiatric counseling over a lengthy period of time for their dysphoria) to avoid the complications caused by transitioning children with the kinds of psychiatric difficulties your son appears to be having. In other words, the studies are based on the children with the least problems to begin with. Additionally, the “long-term follow-up” which assessed the success of these experiments was not only done by the same people that conducted the experiments, they were done between one and two years after SRS. Long-term, not so much.
No fifteen year old is developmentally capable of considering the long-term consequences that this kind of decision requires, let alone one who has had these kinds of psychiatric issues long predating his self-diagnosed “gender” issues. Further, “transition” provides no guarantee of psychiatric relief- it is not ‘either or’- and the added complexities of living as a transperson may very well contribute to even greater distress, especially after this socially induced trend has run its course.
My heart goes out to you and your son. I hope that there is some way for you to find better care.
Reblogged this on anywomans humanity.
Doctor, would you consider alerting the IRB in the med center running the study about the conflict of interest and lack of informed consent you describe here?
I am so sorry that you are going through this. I am reminded to be grateful that I have only seen non-doctor therapists and I have no problem telling them I think they’re wrong.
Don’t forget — you can say no. For a few more years, you can refuse to allow your son to go on this path and can maybe buy his brain some time.
Good luck.
I wonder if these therapists, like two who have written about their concerns here, washed their hands of it because they disagree with the current evidence-free consensus and knew that however much damage they were willing to incur for standing by their ethics, they were unlikely to be able to protect patients who would go willingly to the Fantasy Glamour Bod and Happiness Abattoir.
I am so sorry — for him and for all the other kids.
Hey anywoman2, that’s fascinating stuff. Do you have a link for the pedophiles and suicide threats? Never heard that before.
Learning a lot of weird stuff about John Money though. Money asked a teenage patient in the 1970s if he’d ever experienced “golden showers”. 😝 He was not remotely a normal guy. And he is the one who brought sex changes to America. He was keen on sexually “exotic” stuff, aka perversions, including pedophilia. I wonder if he brought in sex changes to please autogynephiles. He certainly would’ve thought that was an OK thing to do. Reading
about him in the book As Nature Made Him about David Reimer.
Fantasy Glamour Bod and Happiness Abattoir is right!
10 years from now an exposé of all this will come out called The Gender Abattoir. 😖
Worried Doc, unless there’s something I don’t know — and there may be — it seems to me that you still have the right to withhold/withdraw consent to hormone treatment and surgery for your son until he’s 18. You can point out to him and to his therapists that until very recently, these procedures were only undertaken by adults who’d undergone a long, careful screening process, and you want the same standard of care for him.
This isn’t the same thing as refusing a kidney transplant for a child who would die without one, or an abortion for a pregnant 14-year-old who doesn’t want to carry the pregnancy to term. This is more like not consenting to ECT for a child with treatment-resistant depression. There was a time when ECT was considered acceptable for young people, even for teenagers; nowadays, no reputable psychiatrist will suggest it for anyone under 55 because it does so much damage to the memory.
What if his doctors were pushing ECT as your son’s last hope for recovering from depression, saying “nothing else has helped, the risks outweigh the benefits, you don’t want him to commit suicide, do you?” You’d still have the legal right to say no on the grounds that it would be courting serious, life-long cognitive impairment. I doubt any judge in North America would argue with that.
Say you pulled him out of this study and stopped the hormone treatment, and some activist tried to mount a legal challenge. You could respond this way: “If he’s adamant about transitioning, he can do so when he reaches his majority and has his own health insurance. Meanwhile, I will not be compelled to take on the moral responsibility for his undergoing an experimental procedure that will permanently change his body, leave him sterile, and may cause him serious health problems for the rest of his life long after I’m dead, gone, and unable to help him. If he wants to assume that risk for himself, fine, but I cannot assume it for him, because the consequences for him will extend beyond my lifetime.” Again, I think that would be pretty hard to argue with.
As for your son’s objections, well, you could be brutally honest — if he’s fifteen, the puberty ship has sailed. Waiting three more years won’t hurt his chances of passing if he still wants to go through with it.
About his suicidal thoughts — have you seen the site metanoia.org? The author believes that people commit suicide when the pain they’re in exceeds their resources for coping with it. There has got to be a decent therapist out there who will be more interested in building up your son’s coping resources than in slapping a particular diagnosis on him, whether it’s trans or anything else.
wow. That was really good. And it sure makes sense to me. Including that this would be a respectable and possibly legally valid argument in court. If it were to come to that.
I would also say to worried doc apropos the terrible side effects, look at some of the comments on this blog by sisgendered. Her brother had a sex change in the 70s. And 10 years later had one or more strokes. And became paralyzed. That stuff happens. And as always the very best of luck for you and your son.
Oh good grief! Doc, you need to categorically refuse any treatment at this point, and seek help from serious people who aren’t going to jump the gun on such a serious matter. Your points are completely valid–this process will have long-term consequences, and will cause harm if your child is not properly evaluated. I couldn’t believe my lying eyes when reading your letter.
One place I know of where you could look for advice/consult is the Boston Children’s GeMS service (http://www.childrenshospital.org/centers-and-services/disorders-of-sexual-development-dsd-and-gender-management-service-program). As far as I know from cases they have publicized (with patient and parental consent), they take a decisively cautious, thorough, and long-term approach to evaluating and treating children who present in this manner.
I wish you and your son all the best.
“Since this is your child’s LIFE, I would pull out all the stops: take out of school, spend 24/7 with him, fly to London to see Dr. Healy, and begin a program of intense exercise and hard outdoor activity.”
Indeed. Hit the Appalachian Trail together or do a similar, difficult months-long journey. Physical fatigue and physical accomplishment in nature will heal your son’s heart and rebuild your bond with him. I am sorry you are going through this. The Internet subcultures on this are doubtless toxic and full of emotionally troubled people.
“Transitioning” will make suicide more likely not less, since your son will now be sterile and will have far fewer options for intimacy and love in the future. Probably half of everyone feels suicidal at least once while growing up. Today’s culture steers troubled youth in directions that they never were before.
“The Internet subcultures on this are doubtless toxic and full of emotionally troubled people.”
I couldn’t agree more. This is a very serious medical matter with serious consequences. From what I’ve seen, certain “internet subcultures” are so appallingly far out of the ball park that you can’t take two steps (two clicks) without stumbling across clearly mentally ill adult individuals encouraging confused children with body dysmorphia down a harmful path not out of true compassion, but seemingly out of some perverse idealistic alternate view of reality.
I posted my previous reply to this thread, admittedly, without looking over this blog’s history. My reaction to this thread–the first I’ve read here–was that visceral. I’ve noticed that the blog author has previously referenced the clinicians in the service I recommended in a negative way, but I still believe that in this whirlwind of hysteria, theirs is the most measured response I’ve read about.
It’s OK to feel “different,” and I don’t deny that some children do feel strongly enough to consider drastic, irreversible medical intervention. However, as with any procedure, clinicians have the duty to do no harm. The notorious “boob job factories,” at least, produce somewhat reversible “products.” I hope that the medical community is diligent enough to not create a generation of damaged/torn adults who regret decisions they’ve made before they could legally buy an alcoholic drink at a restaurant.
What the doctor describes mirrors my “very good friend of the family” knowledge of the experience of a young relative of mine.
In the backwater we lived in (6th largest city in the US), xe’s various therapists and various MDs, none of whom saw transgender people on a frequent basis (for frequent as defined relative to SF, LA, NY, Seattle) were all eager to okay treatment with chemicals, hormones and surgeries without ever deeply examining the case, without even requiring any of the steps “we” are told must first be accomplished (living for a year as the opposite sex.)
Apparently there are quite a few doctors who do none of the standard of care stuff. I keep seeing articles about patients being given hormones at the first meeting with the doctor.
This is a story from the Guardian in Britain about a young gay man who was pressured into a sex change by his bisexual boyfriend. Later he de-transitioned, and only found out there were these criteria you were supposed to meet before you could get the sex change years afterwards from the movie Silence of the Lambs! His doctor didn’t do any of that stuff.
http://www.theguardian.com/lifeandstyle/2007/may/23/healthandwellbeing.health