How many ways are there to say: “We just don’t know?”
On June 30, 2015, PBS Frontline aired a story about “transgender kids.” The program presented a more balanced view than the usual pro-transition media coverage, with doctors actually admitting that there is much that remains unknown about dosing kids with hormones and performing surgery at younger and younger ages.
Frontline posted a companion article about pediatric transition on their website. In this post, I will excerpt from the PBS piece, along with several other sources, highlighting quotes from well-known gender specialists.
There’s a lot of redundancy in what I’m about to share, and that’s the point. It turns out that the top dogs of pediatric transition agree: we just don’t know whether puberty blockers, cross-sex hormones, social transition, and the other “treatments” being practiced on our gender nonconforming youth can be justified and what the ultimate outcomes are going to be—because we don’t have the evidence.
Some phrases you’ll see:
- There is no objective test
- We still don’t know
- Someone will figure it out
- There are so many unanswered questions
- Hopefully there will be research to begin to answer these questions
- Unknown consequences
- What’s lacking are specific studies
- Risk is unknown
- We don’t know the long-term effects
- We’re in unknown territory
- There is no medical consensus
Oh, the gender doctors do bemoan the unfortunate lack of evidence. They wring their hands, claim to be “worried” and “troubled.” They say they sincerely “hope” that “someone” will do the necessary longterm research. Funny how none of them mention how or whether they themselves will spearhead these desperately needed studies, or apply for research grants.
There is no mention of slowing down or stopping the medical transition of children. No suggestion that maybe it would be prudent to halt what they’re doing until there is some actual evidence that they are not doing irreparable harm. To children.
Nope, lack of evidence isn’t stopping any of these “gender specialists” from plowing full speed ahead, continuing to diagnose and treat “gender nonconforming” toddlers, elementary-school children, and adolescents as transgender-until-proven-otherwise.
It’s as if they think they can be absolved of responsibility for future negative consequences, just by confessing in the Church of Public Opinion that they are operating in the dark.
From the PBS Frontline article:
“What makes [puberty blocker] treatment tricky is that there is no test that can tell whether a child experiencing distress about their gender will grow up to be transgender. The handful of studies that do exist suggest that gender dysphoria persists in a minority of children, but they involved very few children and were done mostly abroad.
… the use of puberty blockers to treat transgender children is what’s considered an “off label” use of the medication — something that hasn’t been approved by the Food and Drug Administration. And doctors say their biggest concern is about how long children stay on the medication, because there isn’t enough research into the effects of stalling puberty at the age when children normally go through it.
… However, doctors caution that estrogen and testosterone, the hormones that are blocked by these medications, also play a role in a child’s neurological development and bone growth.
“We do know that there is some decrease in bone density during treatment with pubertal suppression,” Finlayson said, adding that initial studies have shown that starting estrogen and testosterone can help regain the bone density.
…Finlayson said there isn’t enough research on whether someone who was on puberty blockers will regain all their bone strength, or if they might be at risk for osteoporosis in the future.
Another area where doctors say there isn’t enough research is the impact that suppressing puberty has on brain development.
“The bottom line is we don’t really know how sex hormones impact any adolescent’s brain development,” Dr. Lisa Simons, a pediatrician at Lurie Children’s, told FRONTLINE. “We know that there’s a lot of brain development between childhood and adulthood, but it’s not clear what’s behind that.” What’s lacking, she said, are specific studies that look at the neurocognitive effects of puberty blockers.
…The physical changes that hormones bring about are irreversible, making the decision more weighty than taking puberty blockers. Some of the known side effects of hormones include things that might sound familiar: acne and changes in mood. Patients are also warned that they may be at higher risk for heart disease or diabetes later in life. The risk of blood clots increases for those who start estrogen. And the risk for cancer is an unknown, but it is included in the warnings doctors give their patients.
…Another potential dilemma facing transgender children, their families and their doctors is this: Taking cross hormones can reduce fertility. And there isn’t enough research to find out of it is reversible or not. So when children make the decision to start taking hormones, they have to consider whether they ever want to have biological children.
[Ponder the above sentence: CHILDREN have to consider whether they ever want their own biological CHILDREN.]
“I think it’s really important to talk to these children and families about fertility,” Finlayson says. “I do worry that at that stage in life many of them may not be able to realize how important that would be to them someday.”
[But you’re not THAT worried, are you Dr. Finlayson? You’re not bothered by this enough to put the brakes on this, are you?]
…It’s an ethical question that each family has to deal with in their own way, because if a child goes from taking puberty blockers to taking hormones, they may no longer have viable eggs or sperm at the age when they decide they would like to have children. They do have the option to start their puberty and delay their treatment in order to store eggs or sperm, but some of them may not want to.
While transgender adults have taken hormones sometimes for years, the generation growing up now is among the first to start taking hormones so young. Since most people who start hormones take them for life, doctors say there also isn’t enough research into the long-term impact of taking estrogen or testosterone for what could end up being 50 to 70 years.
“There are so many unanswered questions around the long-term consequences, and whether your health risk profile really becomes that of a male or female,” Garofalo says. “If we start testosterone today, will you have the cardiac risk profile of a male or female as you grow older? Will you develop breast cancer because we’re administering estrogen?
“I think those are the unanswered questions that really trouble me, and can only be answered with long-term follow-up studies.”
[Excuse me, Dr. Garofalo, but if these unanswered questions “really troubled you” that much, you wouldn’t be experimenting, would you?]
…Ultimately, the doctors working in clinics like the one at Lurie Children’s hope to spare transgender children some of the anguish and societal isolation that earlier generations of transgender people went through. But they too would like the answers to the unknown consequences of these medications.
[Just who exactly do you think is going to give you these answers, doctors?]
“The stakes are super high, and we don’t have all the answers,” Garofalo says. “Hopefully, there’s going to be more research and some of those unanswered questions, hopefully, will begin to be answered.”
The Frontline piece is only one source of confessions by “troubled,” “worried” gender doctors. Here is a sampler of quotable quotes from some of the other big guns in the pediatric transgender world.
Dr. Ximena Lopez is founder and head of GENder Education and Care, Interdisciplinary Support (GENECIS), one of the newer gender clinics in the US, and the first in the Southwest.
Dr. Lopez tells us:
“There is a strong need for research in this field to improve the outcomes of our patients,” explains Dr. Lopez. “For example, it is still unclear which very young patients with gender dysphoria will persist as transgender individuals through adulthood. There is no objective diagnostic test available that can predict this.”
In a 2013 New Yorker piece, we have this:
Eli Coleman, a psychologist who heads the human-sexuality program at the University of Minnesota Medical School, chaired the committee that, in November, 2011, drafted the latest guidelines of the World Professional Association for Transgender Health, the leading organization of doctors and other health-care workers who assist trans patients. The committee endorsed the use of puberty blockers for some children, but Coleman told me that caution was warranted: “We still don’t know the subtle or potential long-term effects on brain function or bone development. Many people recognize it’s not a benign treatment.”
And this:
Alice Dreger, the bioethicist, said, of cross-gender hormones and surgery, “These are not trivial medical interventions. You’re taking away fertility, in most cases. And how do you really know who you are before you’re sexual? No child, with gender dysphoria or not, should have to decide who they are that early in life.”
Dr. Johanna Olson, Medical Director of the Center for Transyouth Health and Development at Los Angeles Children’s Hospital is one of the better known pediatric transition proponents. She has even argued for skipping puberty blockers and going straight to cross-sex hormones for “transgender” pre-adolescents. Olson said this in a 2012 NBC Dateline broadcast I wrote about last month:
What’s missing in the data right now is: these exact characteristics mean for sure this person is going to be a trans adolescent and adult. We don’t have that data.
More mea-culpa redundancy from Houstonia magazine, in “What do Transgender Children Need” published in 2014:
There is no medical consensus on the best course of treatment for gender-dysphoric prepubescent children, mainly because it’s almost impossible to tell which kids will continue to experience the condition as adolescents and adults. Citing informal studies, Drescher and Meyer estimate that only about 20 percent of prepubescent children who exhibit cross-gender behavior continue that behavior into adolescence.
“You’re in unknown territory, where the experts disagree,” says Dr. Jack Drescher, a New York–based psychiatrist who, along with Dr. Kenneth J. Zucker of the University of Toronto’s Gender Identity Service, helped write the entry for gender dysphoria in the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. “If most of these kids won’t grow up to be transgender,” says Drescher, “[socially transitioning] could be harmful,” never mind hormone therapy.
And finally, this treasury of quotes would not be complete without some words of wisdom from Dr. Norman Spack, head of the Disorders of Sexual Development (DSD) and Gender Management Service (GeMs) at Boston Children’s Hospital, whose pediatric gender clinic is the “first of its kind in the nation.”
Dr. Spack holds forth in an interview/blog post in April 2015. Notice his use of future tense. “Someone” else is eventually going to solve the problem.
Question: GeMS was the first transgender treatment clinic in the U.S., and there are now over 40 programs across the country. You’re reaching more and more kids and at a younger age. What’s next for this field of medicine?
Dr. Spack: I think that there is an absolutely tremendous need for tools with which to discern which of the kids are really among the 20 percent who are definitely going to be transgender. With these tools, people could far more freely encourage their kids to act and dress as the gender they identify with, and kids will have a much easier time in school.
…These tools are going to be based on analysis from the neck up, not blood levels of anything I can think of—unless it’s maybe a genetic test, but I doubt it. My theory is that we just don’t know enough about the brain… I’m convinced that sooner rather than later, someone’s going to figure something out related to the brains of the 20 percent transgender kids.
Sooner or later….we just don’t know enough….there is a tremendous need…
But meanwhile: Carry on! with administering puberty blockers followed by cross-sex hormones. Keep sterilizing our guinea pi– um, kids.
“Someone” will figure it out—sooner or later.
