Renowned San Francisco phalloplasty surgeon hit with multiple lawsuits

Note: The administrators and contributors at 4thWaveNow do not take a position on the veracity of the allegations set forth in these lawsuits. We are reporting on public documents available on the Internet about these legal actions. Commenters’ opinions are their own.


In a previous 4thWaveNow post, we documented the proliferation of gender surgeons who perform mastectomies and “bottom surgeries.” Some of them, including San Francisco surgeon Curtis Crane,  have publicly indicated their willingness to operate on patients under the age of 18.

One of Crane’s former patients, a detransitioned woman who underwent a double mastectomy at age 17, wrote a guest post for 4thWaveNow.

It has come to our attention that Dr. Crane has been the defendant in no less than six lawsuits during the last year. The suits variously allege medical malpractice, medical negligence, and/or failure to obtain informed consent.

Some of the lawsuits are still active, and all court documents are available via a public search on the San Francisco County Superior Court website.

Obviously, the exact details of the lawsuits vary, but all are centered around serious complications from phalloplasty and other “bottom surgery” procedures.

The six cases are as follows. To see the Register of Action (list of documents with dates) for each case, and all associated documents, simply enter the case number in the search box at the above link. When clicking on a document, be sure your browser allows pop-up windows.

  • 554254
  • 550630
  • 556743
  • 556713
  • 557327
  • 557363

Screen captures are taken from the complaint documents in the referenced cases.

 

Lupron: What’s the harm?

Worried Mom and her son, Worried Brother, co-wrote this post.  Worried Mom is an attorney who currently works in the non-profit area, and Worried Brother is employed in the pharmaceutical industry, with a background in chemistry.  This piece is sourced in the scientific literature; click superscripted footnotes to follow links.

For recent mainstream coverage about the potential harms of pubertal suppression, see here and here.


by Worried Mom & Worried Brother

Before we can have a sensible discussion about Lupron and its hormone-suppressing effects, it is important to understand what normal hormonal balance means in a healthy teenager or adult.

Normal body functioning requires a certain latent amount of testosterone and estradiol (estradiol is the major estrogen in humans).  Men and women both have some of these hormones naturally present in their bodies, produced by testes in men and ovaries in women.  Testosterone is involved in the development of muscle bulk and strength, the maintenance of proper bone density, the creation of red blood cells, the sleep cycle, mood regulation, sex drive, hair growth, and cholesterol metabolism.1,2,3  Low testosterone levels can lead to deficiencies in any of these areas.  For example, lack of testosterone can cause fatigue, insomnia, and interference with mood and sleep, together with a host of other impacts on, for instance, a person’s sex drive.

Like testosterone, estradiol is involved in the maintenance of proper bone density, mood regulation, skin health, and reproductive health.4,5,6  Lack of estradiol can lead to adverse impacts in those areas.  Because estradiol is a crucial component in maintaining bone density, individuals who lack sufficient amounts of estradiol will fail to undergo proper bone development, because the growth plates on the ends of the bones will never close.7  This profoundly alters the physical structure of the body.

Lower levels of estrogen are also associated with significantly lower mood.  The primary regulators of mood in the brain, according to our current understanding of neurochemistry, are the systems relating to the neurotransmitter serotonin.  Estrogen receptors are prevalent along the mid-brain’s serotonin systems, and they are believed to play an important role in serotonin-mediated behaviors such as mood, eating, sleeping, temperature control, libido and cognition.  Mice that are bred missing this particular sub-type of estrogen receptor show enhanced anxiety and decreased levels of serotonin and dopamine.8

As noted, both men and women naturally produce testosterone and estradiol in their bodies.  The levels of these hormones fluctuate greatly depending on the person’s stage of life.  At the start of puberty, a child’s body will begin to produce either testosterone or estradiol in much greater quantities than it had previously.  This increased production leads to the development of secondary sexual characteristics.  As men and women age, their levels of testosterone and estradiol also decrease, leading to well-known age-related effects, such as thinning bones and hair in both men and women.

A current focus in the treatment of transgender children and teenagers is to arrest, or delay, the impact of testosterone and/or estradiol in adolescence.  Arresting the impact of these hormones will prevent the development of secondary sexual characteristics.  Moreover, many clinicians recommend–if a child or teen is unsure as to whether he or she wishes to become a transgender adult–that the administration of so-called “blockers” will “delay” puberty and “buy time” for the teen to make a more informed or mature decision.  Theoretically, a teen could always desist from taking blockers and then normal puberty would ensue, although there is very little data in this area.  It is also currently unknown whether, if a teen takes a puberty blocker during what would otherwise have been his or her normal puberty and then stops, whether puberty will proceed entirely as normal or whether there will be some other effects from having delayed it for a period of years.  The “puberty blocker” discussed in this article is leuprolide acetate, better known by its trade name Lupron.

What is Lupron?  Lupron is a gonadotropin-releasing hormone analog.  The primary pharmacological effect of Lupron administration is a decrease in the concentrations of testosterone and estradiol throughout the body.9,10  How does it achieve this decrease?  It does so by tinkering with a hormonal feedback loop between the hypothalamus and the pituitary gland, and interferes in the release of gonadotropins (“Gn”), which is a catchall term for 2 separate hormones, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).  Gn acts as the primary means by which the body controls the release of testosterone and estradiol.  Gn interacts with the tissues that are involved with the release of these two hormones.  It stimulates specialized tissues in the ovaries and the testes to produce testosterone and estradiol.  LH stimulates the Leydig cells in the testes and the theca cells in the ovaries to produce testosterone11.  FSH stimulates the spermatogenic cells in the testes and the granulosa cells in the ovarian follicles (the granulosa develop to produce a layered structure around the egg), as well as stimulating the production of estrogen by the ovaries12,13,14. There are Gn receptors embedded in the cell membranes of these tissues and binding with Gn results in those tissues producing the hormones.  The hormones are released into the bloodstream, and travel to specialized receptors that are located systemically, in most major tissue groups.  The systemic distribution of these receptors is responsible for Lupron’s effect on the entire body.

The hypothalamus releases GnRH (Gn-releasing hormone) which binds with GnRH receptors on the pituitary gland15.  The hypothalamus responds to the concentrations in the blood of testosterone and estrogen, as well as the presence of Gn16,17.  Since Lupron is chemically similar to GnRH, it is essentially repeatedly stimulating the GnRH receptors on the pituitary gland.  This artificially high activation of these receptors desensitizes the pituitary gland to the presence of GnRH18.  There is an initial flare-up of Gn release in response to the presence of the Lupron, but it eventually results in down-regulation or deactivation of these receptors19.  In physical terms, this means that the pituitary, in an effort to restore normal functioning, will cull the number of GnRH receptors.  This results in a significantly lowered response to a given concentration of GnRH in the blood. Why is this?

This is the key point, because the strength of an organ or tissue’s response to any drug is directly proportional to how many receptors are activated by the presence of the drug.  So, using this idea, lower the number of receptors, lower the response, and if there is an absolutely lower number of receptors present, there is an absolutely lower potential response20.  Once the drug is removed from the body, the pituitary is left in a desensitized state, rendering it unable to respond to ‘normal’ activation by GnRH.  This results in decreased production of Gn, which in turn means decreased production of both testosterone and estradiol in the tissues with which Gn would normally interact.

Lupron use in otherwise normal teenagers to delay puberty is both relatively new and off-label.  Lupron does have a history in treating a condition called ‘precocious puberty,’ which is what happens when a child’s body enters puberty too quickly for his or her age.  However, this is a clinical condition typified by concentrations of sex hormones deemed wildly abnormal in the course of normal development.  As such, the usage of this drug may be more appropriate in  these particular individuals, because the marginal benefit of leaving this condition untreated is higher than it would otherwise be. Any competent medical professional would not generalize from outcomes observed in a population of individuals affected by abnormal hormone levels, to individuals with normal hormone levels.

Industry standards21 judge the usage of Lupron in treating gender dysphoria as providing at best no proven benefit and hold that there is an insufficient quantity of published evidence to prove its safety for this purpose.  UnitedHealthcare, the nation’s largest insurer, makes its stance clear on Lupron for usage in treating gender dysphoria on their Drug Policy page:22

‘Hayes compiled a Medical Technology Directory on hormone therapy for the treatment of gender dysphoria dated May 19, 2014.  Hayes assigned a rating of D2, no proven benefit and/or not safe, for pubertal suppression therapy in adolescents. This rating was based upon insufficient published evidence to assess safety and/or impact on health outcomes or patient management.’

A D2 rating is the lowest rating possible on that particular institution’s scale of safety and efficacy.  The Hayes Technology Review is considered to be the industry standard in linking treatments with patient outcomes.

In Lupron’s case, the vast majority of clinical data is found in samples of middle-aged or older men with late-stage prostate cancer.  This means the aggregate of the medical community’s understanding of Lupron’s safety profile relates to its use in this context, in terms of both the condition it is meant to treat and the individuals for whom it is approved.  When using Lupron as a “blocker,” medical professionals are, in both senses, treading untested waters, for the dual reason that it is not approved or recommended to “treat” this particular condition, and clinical studies relating to its long-term or even short-term safety in treatment of gender dysphoria are vanishingly rare.  To further illustrate this second point, the population to whom Lupron is most commonly prescribed on-label, middle-aged and elderly men, has a much shorter life expectancy from the date of administration than do teenagers.  In other words, based on the current state of research, one would not expect to see data collected from groups who are 40, 50 or 60 years “out” from administration.

Putting together what we know about how the body normally reacts and develops during puberty with what we know about how Lupron works, we can conclude the following: administration of Lupron to young people for the purposes of blocking puberty is a disruption of a delicate hormonal balance that has the potential to cause adverse health effects.  The risk is further compounded by the off-label usage of the drug for this purpose, as well as the lack of long-term data related to safety.

 

Open letter to the American Psychological Association (APA) on the rise in trans youth diagnoses

Note: The APA Committee on Sexual Orientation and Gender Diversity meets in late March.  Anyone with concerns similar to those expressed by Justine Kreher in this post may want to address them to the committee. Lisa Marchiano, LCSW, a Jungian therapist who blogs at www.theJungSoul.com (Twitter: @LisaMarchiano), has also written a letter to the APA which was posted today at Youth Gender Professionals.

Justine Kreher blogs at thehomoarchy.com and can be found on Twitter @thehomoarchy.


by Justine Kreher

I am a 48-year-old, married, average US citizen, who has been in a same-sex relationship with the same person for 18 years. I consider myself a centrist skeptic. I believe that all sides of every issue need to be heard in order to truly make informed and fair decisions.  I am very concerned about how valid criticism/discussion is now called “hate speech” in many arenas of identity politics and how this is being used to try to muzzle free speech. Curtailing discussion around something as serious as permanently altering minors (children and teens) is a very bad idea.

I became aware of youth transitions because I wanted to blog about lesbian relationship issues (thehomoarchy.com). This led me to read more LGBT websites and message boards. That is when I first became aware that some gay men and lesbians are concerned about how gender dysphoric children are treated, and that most dysphoric children grow up to be LGB and not trans. I am a latecomer to this issue compared to some lesbians who have been talking and writing about the impacts of transitions on the lesbian community for years now.

I delved into most of the studies available to the public and gathered other information. A detailed list of the risks involved in youth transitions can be found in my blog post “Do Youth Transgender Diagnoses Put Would Be Gay, Lesbian, and Bisexual Adults at Risk for Unnecessary Medical Intervention?” [A summary of a few of the key points can be found at the bottom of the current post.∗]

I can only speak for myself and don’t necessarily endorse anyone else’s opinions. I am not opposed to treatment for transgender children if evidence shows it is safe for all gender nonconforming youth and I want the best care for everybody.

I wrote a letter outlining my concerns and emailed it to over 150 people in LGBT rights orgs and media, as well as to mental health organizations. The American Psychological Association (APA) was one of only two which even responded. Their response, written by Clinton W. Anderson, at that time the Director of the Office on Sexual Orientation and Gender Diversity at APA, was pretty generic and did not address my concerns.  It consisted mostly of a reiteration of the APA’s current policies, although Anderson did say he (?) would share my concerns at an upcoming meeting of the APA Committee on Sexual Orientation and Gender Diversity in late March.

I have just written the below reply, which I sent today. (Letter has been altered slightly for publication on 4thWaveNow).


To the Office on Sexual Orientation and Gender Diversity at the APA,

Thank you very much for your response to my letter.  I would like a chance to address some unresolved issues. I will be posting this letter publicly.

I began researching the sharp rise in children being diagnosed as transgender to diffuse what I then saw as increasing transphobia among some gays and lesbians who were extremely angry about the prospect of false positives in youth transitions, because of how it disproportionately affects their communities. I was certain that gender therapists, researchers, medical practitioners, and LGBT organizations would be taking great care to ensure the safety of all gender nonconforming children. Instead, what I found, were…

  • dishonest statements about the known safety of hormone blockers and early social transitions
  • numerous stories about negligent gender therapists
  • lesbian/bi minor females identifying as trans for long enough to have an official diagnosis and be endangered
  • a tone-deaf attitude among supporters of the 100% gender affirmation model towards gay men and lesbian adults who promise this could have been them as children
  • trans kid camp materials where no other coping skills or role models are provided other than transition
  • sex reassignment surgery on minors discussed as if it were no more harmless than a mani-pedi
  • public statements that the only option parents have with every single child who claims they are transgender is to transition them or they will commit suicide
  • parents of children who had desisted being ignored
  • detransitioners being treated badly
  • professionals insinuating/stating outright that transitioning a few kids inappropriately is worth it
  • a general failure to take seriously the damage false positives can do, and the horrible human rights abuse against the diversity of expression of the non-trans gay/bisexual community.

I acknowledge transgender people’s right to advocate for their own community and to advocate for what is best for trans young people. I also understand that they view any hindrance to transition as an affront to their humanity and their rights. And I truly want to believe the vast majority of the young people in these programs have intractable gender identity disorder/gender dysphoria. I respect that they have rights and society is morally obligated to provide them the best evidence-based mental health and medical care.

I’m also familiar with the positive research on transitions to treat gender dysphoria. Almost all of the studies on transgender adults show low regret rates. Many studies also show that transition relieves the dysphoria. I’m also aware of the research studies on trans youth that show positive psychological benefits associated with earlier transitions. The two most cited are the Dutch 2014 study where the youth were intensively screened (a type of gatekeeping rapidly going away in many cases), where five stopped communications and one died from complications of genital surgery, but the remaining 50 eligible for followup were doing very well. The other is the Trans Youth Project study that showed socially transitioned children at followup had almost normal levels of mental health. However, as this Yale medical student stated, “The authors compared their cohort of children to cohorts in studies that were conducted more than 10 years ago, during a time when society was even less accepting of transgender youth.” This study doesn’t compare them with kids in loving, supportive homes, who are not transitioned as children, but who will be accepted in their own decision-making process when they are adults.

Neither of these studies had control groups to compare desistance rates for early social transitions or for the effects of hormone blockers, because (according to the current narrative), using such control groups would be unethical.

You mentioned you want to provide “evidence based care.”  So when you have your meeting at the end of March 2017, these are the issues I hope you will be discussing:

 1)    As I asked in my previous email, why do almost no children desist once put on Lupron, and where is evidence it doesn’t interfere with the youth’s identity formation? There has also been a recent negative story about the safety of Lupron.

2)    Why are there twice as many female young people coming to some gender clinics than males in Canada, England, and the Netherlands? Why is this not a cause for concern, when in Oregon, a 15-year old can obtain a mastectomy without parental consent, and activists are pushing for this everywhere else? Any other time the epidemiology of a condition changes this much, researchers have taken notice. Why, on this issue, is it treated as nothing but social liberation that deserves nothing less than total affirmation by a large number of mental health professionals, especially when it is well known that female teens are prone to body hatred issues and social contagion? I’m not aware of any APA studies seeking answers.

3)    Why is a hypothetical study involving for example, 200 gender dysphoric youth who are…

  • loved/supported
  • not gender policed in anyway as far as clothing and behavior
  • placed in safe schools
  • provided adult role models who have coped with being gender nonconforming without surgery
  • lovingly told there is nothing wrong with them and they will be loved and supported in their transition when they are mature as possible
  • afforded exceptions if the child was self harming and transition viewed as the best option

…not morally acceptable, but what is morally acceptable is…. 

  • the APA and medical field instituting ill-defined protocols, which are loosening daily, with no control groups, in circumstances where most dysphoric kids are pre-gay/lesbian, /bi and not trans, when effects on desistance are unknown
  • uncertainty if these practices risk disfiguring healthy bodies
  • risking perpetrating violations of the Hippocratic oath to not over treat
  • potentially violating the future 60-70 years of a child’s life in the case of false positives, that violates his/her journey to come to accept him or herself as a gay man or lesbian, even one with a difficult childhood; which amounts to an abuse of his/her human right to fertility, and an abuse of his/her now drastically altered sexuality
  • unknowingly participating in a civil and human rights abuse of gender nonconforming people who turn out not to be trans but are more likely homosexual; something that could affect thousands of people in the future?

Is this happening to socially transitioned children and tweens on hormone blockers? I am not saying I know it is, but unfortunately, you can’t prove it is not.

The psych field (including APA members) has skipped an entire, more moderate approach to treatment as outlined in the first example and gone straight to a 100% affirmation model (no attempt is made to help the child find alternative ways to cope) with no control studies and no meaningful publicly expressed concern over effects on persistence.

Does the APA understand that even though there is no clear-cut data that the very high stakes are parents having their children ripped from them by trans activists and gender therapists working with the government? Parents who may be loving and supportive but don’t want to permanently, physically alter their minor child for the rest of their lives based on data that is not solid. Does the APA understand that these governmental policies activists are working to implement could result in children being removed from the care of parents who protected their gender confused teens from permanent disfigurement by keeping them away from the gender clinic and the 100% affirmation model?

 This is morally acceptable to the psychological and medical field?

4)    Since the APA is encouraging supporting nonbinary identities, what research does the APA have to justify these recommendations, since it is increasing numbers of 18/19-year-old females (younger now in some cases) adopting these identities, many of which are recent proliferations spread on social media; and many of these “nonbinary” females are seeking breast amputation? Since there are now up to 50 of these gender identities, does the APA support reinforcing all of them, and if so, based on what data? Does the APA have proof that the use of dozens of different pronouns associated with these identities is actually adaptive and healthy for these young people?  Has the APA considered what will happen to these young people, the vast majority of whom would have found a way to fit into the binary 15 years ago? When these young people leave the open minded, nurturing environments of the therapist’s office and academia, they may be faced with employers who have every motivation to not hire individuals who require them to force employees/customers to use self created language or risk lawsuits/fines.

The story below highlights the fact that the “infinite genders” (actual quote) approach of gender-affirming therapists is in fact contributing to gender and sexual confusion in teenage girls. There are many more examples and I hope APA members are watching genderqueer young people on social media, because it is not reflecting a culture of mental health.

https://4thwavenow.com/2016/01/18/teen-decides-shes-not-trans-after-all-but-struggles-with-peer-pressure/

Will the APA study the effects on 5th grade girls (known to have inferiority complexes in relation to their male peers) who are not encouraged to view their traits as an expression of personality or as an indication they may be lesbian or bisexual when they get older (because at 10 this isn’t appropriate), but to instead view themselves as trans by gender-activist trainings in schools? This is in fact happening (for just one example see this video at 3:07:00). And can the APA demonstrate why any of this is actually healthier for these individuals and society than normalizing female “masculinity” and male “femininity” and stressing the shared, diverse traits and humanity of the two sexes?

What culture are you helping to foster? Several parents of transgender children who have been featured in the media have made statements which appear homophobic (i.e. “trans isn’t like homosexuality, it’s ok to talk to kids about it” “I hope my little ‘girl’ stays exactly the same”). From observations by some who have attended support groups for gender nonconforming children (often not run by mental health professionals), they are very politicized environments, where even questioning any of these practices is met with extremely negative reactions. What will be the effect on borderline dysphoric children, when their social life revolves around support groups such as this one; whose members and leaders screamed “transphobia” when a judge removed a child from a home due to possible Munchausen-by-proxy child abuse? Since you and your colleagues are medicalizing gender nonconforming children; and since the APA considers helping a young person adjust to their natal sex as “conversion therapy,” shouldn’t it be a priority to ensure the “conversion therapy” is not ever happening the other way around?

5) In your meeting, please acknowledge that the collateral damage of youth transitions is going to be an untold number of irreversibly altered young people who are not happy. To take only a few recent examples, the detransitioners who have created the vlogs below (mastectomies at 17 and 18, social transitions years earlier) fit all of the criteria for medical transition. The APA should be honest with the public about the risk of regret and detransition. You should include this information on your website material concerning trans youth, even if these regretters are a small minority. Ask yourselves how the APA can support lesbian youth, because such females who don’t identify as trans under the age of 21 are becoming a lot rarer. The detransitioners in these videos cite lack of support for a lesbian identity and positive role models as factors in their decisions to transition.

https://www.youtube.com/watch?v=D2KpkSSrV4o

https://www.youtube.com/watch?v=Q3-r7ttcw6c&t=4s

No one knows the ultimate effects of early transitions on younger children and tweens. We have in fact seen that youth transitions are dangerous to some teenagers and young adults, particularly ones that are lesbian, autistic, or have mental health problems. Child/teen transitions may be wonderful for the trans community and supportive of trans rights and mental health. I am not denying that. But every false positive that happens to a minor, affecting the next 60 years of that person’s life, is a human rights abuse. A top priority of the APA should be to analyze whether or not your recommendations are increasing persistence rates for dysphoric children. Because if they are, you may be doing amazing things for trans health and trans rights but you are also participating in the most serious human rights violation of LGB people since they where given electroshock therapy in the 1950’s. This is not even treated as a passing afterthought by many in the medical and mental health field, including APA members, from my numerous observations. I find this highly unethical and I hope it changes soon.

Thank you for your time.

-Justine Kreher

 


∗ Some risks and uncertainties involved in youth transition:

·         Most children–even some who have serious gender dysphoria–desist (grow out of it) and are likely to be gay/lesbian adults, so it makes sense to be concerned about children who are socially transitioned at a young age.  Gender-affirming mental health professionals almost always tout the safety of social transitions in the public statements they make to the press and in seminars they give, even though they have no proof it is. One example is Kristina Olson, involved in the Trans Youth Project; her attitude is the norm.

·         Gender clinics report that either no or very few children desist when they are put on puberty blockers (GnRh agonists such as Lupron). These chemicals prevent the secretion of pubertal hormones, despite the fact that exposure to sex hormones may help the child become comfortable with their natal sex. This has been done with no control group of children not put on blockers. Gender-affirming mental and health care professionals all claim that these hormone blockers are fully reversible in their public statements, despite a lack of data.

·         There has been a huge increase in female teens seeking services in gender clinics. The numbers are almost 2 to 1 in some clinics. The overall numbers have gone up but why are more females relative to males coming to these clinics when the adult transgender population doesn’t reflect this? I have read many articles and watched hours of trans seminar footage from gender affirming professionals where this isn’t even discussed. The clinicians at Tavistock & Portman in Britain are the few who even bother to mention it or express any concern.

·         4thWaveNow and its followers/commenters have documented several cases where teens who desisted were initially affirmed as trans by professionals or identified as trans for over 6 months, yet grew out of it even though this would have given them an official transgender diagnosis.

·         I cite examples in this post over the seeming apathy about the safety of gender nonconforming youth who may be borderline by gender affirming professionals. This is another example.

·         Censorship around this topic is a major problem. I have encountered this apathy many times, from health care professionals, media, and even politicians. For example, Canadian politician Cheri DiNovo immediately blocked me on Twitter for trying to send her my post and for sending her links about young people who have been seriously harmed by transition in the real world. I’m shocked that any person with influence would refuse to consider information about something so important. Followers of 4thWaveNow are well aware that there is a refusal to gather all sides of this story by many people in health care, the media, and from LGBT organizations themselves. The threat of trans suicides is used to squelch anyone who asks even the most basic questions about these practices.

·         Homophobia from parents or even other societies may play a part. For example in Iran, homosexual adults are forced to transition because it is more acceptable to be transgender. A mother in a recent HBO special on trans youth admitted that, prior to identifying her young son as transgender, she would punish him for being “feminine, dramatic, and flamboyant.” A recent longitudinal study of nearly 5000 adolescents found a high correlation between “gender nonconforming” behavior at age 3 and later homosexuality.

“Reportable trauma”? US gender docs “train” judges & call CPS on balking parents

The meteoric rise in kids diagnosed as transgender in the last five years has caught many parents by surprise. Gender specialists, trans activists, and their media handmaidens explain this accelerating trend as simply the welcome result of society becoming more accepting of trans people; a continuation of the tolerance that ushered in same-sex marriage. Indeed, activist-clinicians are quick to claim equivalence between trans and being gay or lesbian, despite their fundamental differences.

For one thing, lesbians and gay men ask only to be accepted for who they love, while we are asked to believe that being “authentic” as trans may require us to approve drastic medical interventions–for our own kids. And no mental gymnastics are necessary for parents to see with their own eyes when a daughter or son is homosexual. But a sudden pronouncement by one’s kid that they are really the opposite sex requires a suspension of disbelief; a demand to ignore one’s own insight, perception, and knowledge in order to “validate” the “identity” of our kids.

Despite the insistence that hormones and surgeries are “life-saving” medical necessities, the push is on to “depathologize” trans identity as a “normal human variation.” Yet nearly to a one, the parents who have gathered on- and offline as part of the 4thWaveNow community report a history of mental illness, social difficulties, frequently multiple diagnoses that predate the sudden announcement “I’m trans!” Indeed, a cursory hunt through decades of medical and psychological literature reveals that gender dysphoria occurs with troubling frequency in concert with a range of other mental disturbances, including personality disorders, depression, anxiety, and autism. To take but one example, this 2003 survey of nearly 200 Dutch psychiatrists found that a large majority of people with gender dysphoria had comorbid psychiatric problems.

2003-dutch-psychiatrist-survey-mental-illness

What has actually changed since 2003, apart from trans activism overruling sensible debate and clinical experience?

Given the experience of so many parents, corroborated by research evidence and clinical experience around the world, is it any wonder parents might balk at the idea that their (often troubled) tween or teen needs immediate “affirmation” and “validation” of their trans ID—complete with puberty blockers and/or cross-sex hormones?

But in 2017, at least in the US, pediatric gender specialists see co-occurring mental illness as no barrier to prescribing puberty blockers or cross sex hormones–even in the case of obviously troubled young people who have undergone multiple psychiatric hospitalizations. To these gender clinicians, puberty blockers are absolutely vital—even when the psychiatric team isn’t on board. (And even, apparently, when new information has come to light about the serious adverse effects of Lupron on children and adults.)

The inaugural conference of USPATH, the newly formed offshoot of WPATH, was held the first weekend of February in Los Angeles. At a session entitled “PUBERTY SUPPRESSION IN THE UNITED STATES; PRACTICE MODELS, LESSONS LEARNED, AND UNANSWERED QUESTIONS,” gender doctor Michelle Forcier presented a case study of a young teen “K.” who had been seen in Forcier’s gender clinic. K., born female, had been hospitalized multiple times for suicidality, cutting, an eating disorder, and other self harm. K’s mother was reluctant to use a male name and pronouns, and was not initially willing to consent to Lupron.

During one of K’s months-long hospitalizations, Forcier pushed for the child to start blockers, despite the fact that the psychiatric team caring for K. was not in agreement, but was intent on medically stabilizing the child before contemplating other interventions.

After the child was released from hospital, the mother eventually consented to puberty blockers; the child was hospitalized again a few weeks after the Lupron injection. In her presentation, Forcier said that the time spent without blockers was one of many “missed opportunities;” she used the case as an example of how psychiatrists need to be better “educated.”

This notion that “gender care” (Forcier’s term) is the curative elixir, the pharmacological key to solving a whole host of other psychiatric issues, is a common refrain with US gender specialists. Parental reluctance to go along with this recommendation is viewed with, at best, condescension, and at worst, bald contempt. Do these providers stop for an instant to think maybe, just maybe, these parents have some wisdom regarding their own kids, whom they have raised and loved from birth? Nope.

Even young people who identify as “nonbinary” are encouraged if they choose hormones—or even surgeries. The USPATH conference devoted plenty of time to medical interventions for youth who want to dabble in irreversible chemical or surgical interventions:

Balking parents must be “educated”, cajoled into going against their deepest protective instincts. If this indoctrination process doesn’t work, there’s the frequent threat your kid will kill themselves because of your hesitations. This weaponization of adult self-harm statistics is wielded by activists, clinicians, and the media alike, to terrorize parents into handing their offspring off to be drugged, sterilized, and (increasingly) surgically “corrected” by therapists and doctors who are confident they know best when it comes to other people’s children.

Never mind that there is scant evidence that medical transition cures self harm in the long run; never mind that the constantly quoted 41% trans suicide attempt rate didn’t control for mental illness (a flaw readily admitted by the survey authors). Never mind that the 41% survey was of adults over 18, not kids. Never mind that there is no prior historical evidence of “trans kids” so desperate to escape their “wrong” bodies that they become suicidal; never mind that the highly publicized clusters of transgender teen suicides have mostly been young people who were supported in their desire to transition. Never mind that no one is studying the mental health of formerly trans-identified youth who were fully supported in gender nonconformity but not endorsed as being in the “wrong body.”  And never mind that only mentally ill people see suicide as a solution to life’s frustrations.  (As an analogy, the suicide rate for white Americans is much higher than for other ethnic groups, who by any measure face more discrimination and difficulties, yet manage to maintain more psychological resilience.)

But none of this stops irresponsible journalists and activists from spreading suicide contagion to vulnerable gender-confused youth.

dead-daughter

When it comes to coercing parents, the suicide trump card usually works. The daily onslaught of celebratory “trans kid” stories often includes a statement by a parent that they’d “rather have a live son than a dead daughter” (or vice versa).  Not surprisingly, scaring parents with their worst possible nightmare has been quite effective in many cases (including that of Ryland, one of the better known celebrity trans kids).

Hillary Googled the word “transgender” and came across a horrifying statistic: 41% of transgender Americans attempt suicide.

“This made things very clear to me,” says Hillary. “Did I want a living son or a dead daughter? I wasn’t going to take the risk by waiting around and doing nothing.”

So Hillary and Jeff spoke to psychologists, psychiatrists and gender therapists, who all reached the same conclusion: Ryland is transgender. As Hillary describes it, “Although Ryland was born with the anatomy of a girl, her brain identifies with that of a boy.”

That day, Hillary and Jeff – both churchgoing Christians who were raised in conservative families – made a vow: to bring up Ryland as a boy, without any strings attached.

Not only do the people most invested in medically transitioning children push suicide or transition as the only two alternatives; they are not shy about blaming the parents themselves for the child’s self harming behaviors.

judge-order-hormones-remove-child-from-house

Towards the end of a USPATH session, ADDRESSING SUICIDALITY IN TRANSGENDER YOUTH: A MULTI-DIMENSIONAL APPROACH, presenters Elizabeth Burke, Matthew Oransky,  and Sarah McGrew touched on what to do about parents who weren’t on board with “gender care.”­­

And the final piece on suicidality is family non-acceptance. This is where you have a family who is saying, no, no, no…and then you realize that actually the family is contributing to some of that negativity at home. So the family is creating a toxic environment. And that’s where we have let the young person know the potential ramifications of calling DHS and saying that this is an unsafe environment.  And that we’ve given the family every chance. To learn, to grow. And they’re continuing to be part of the problem. So thankfully this was an important time when I realized it was worthwhile in starting the clinic at children’s hospital to have lots of meetings with the lawyers in  risk management. To be able to say, “alright. I have the ethicist, I have the lawyer, I have the guru from risk management, I’m gonna sit down and say, I need to describe a case to you and make sure this is actually parents being negligent in the healthcare needs of their child.

Thankfully we’ve had a lot of support in that realm.  Because of the trainings we’ve done with DHS workers in Delaware, Pennsylvania, and New Jersey. DHS workers will go and say you’re creating an unsafe environment for your child.  And we need to have that stop.…unfortunately staying in that home environment is going to result in a child’s suicide.

So we see that gender specialists and activists are being proactive about going after parents who are saying “no no no” to the dictate that they must “affirm” their child as the opposite sex. They are “training” child protective services workers to pressure parents into “gender care”—or risk losing custody of their sons and daughters.

This isn’t a brand-new strategy. For example, at least as far back as June 2015, Jenn Burleton, an MTF and director of TransActive Gender Center, put out a call for attorneys to intervene in custody disputes involving “trans kids”, to enthusiastic responses on Burleton’s Facebook page.

Asaf Orr, for those who don’t know, is the lead staff attorney for the inaccurately named “National Center for Lesbian Rights” (NCLR). Given the fact that an increasingly large number of same-sex attracted adolescent girls are being transitioned, it’s hard to imagine any organization straying further from its mission than NCLR.

Regular readers of 4thWaveNow know that Burleton has been in the business of sneaking behind the backs of “unsupportive” parents with TransActive’s “In a Bind” free binder distribution program. Previously offered to young women 22 and under, the program now only sends binders to 18 and unders—secretly, if need be, subverting the will of parents who might have concerns about the unhealthy effects on their daughters: crushing pubescent breast tissue, bruising ribs, breathing and musculoskeletal problems, and more.

The topic of bending reluctant parents to the will of gender experts is a popular one for WPATH. In mid-February, we find some familiar people scheming away about what to do about parents who won’t give in, again including Jenn Burleton, who has had “some success” in convincing authorities that a parent’s unwillingness to approve hormones for their minor children is a form of “reportable trauma.”

At the February USPATH conference, Drs. Johanna Olson-Kennedy and Michelle Forcier, during the Q&A portion of their aforementioned talk on puberty suppression, tell their audience that they’re not afraid to involve the courts when they must to “bring along” the “recalcitrant” parents.  One questioner, a psychologist who runs a gender clinic, wants to know whether there is a way to legally “force parents” to go along with the recommendations of a gender therapist to administer puberty blockers.

OLSON-KENNEDY: I can say that the stickiest situations I’ve had is where one parent is supportive and one isn’t and they share medical custody. And so we work really hard to bring both parents in and bring them both on board. Because even if you get a court order, the most protective factor for a good outcome is parental support.  So it’s not my first line to go to court to get somebody what they need.  But it is my second line and I will do it.  We’ve been pretty successful in 5 or 6 situations where…we really had a recalcitrant parent that we just could not bring along.

For her part, Forcier says her team has been busy training family court judges in her region:

FORCIER: Yeah, there’s no precedent but you can again work with the child protection team for medical neglect. Work with one parent…at least to get things started. And again, you can do some education. We did education with judges in Rhode Island. We spent a half day with family court judges, telling them this is what gender and transgender is

So there we have it. Activists/clinicians aren’t content to simply “educate,” cajole, or negotiate with parents. If parents aren’t terrorized into medically transitioning their kids by the relentless scolding that the only alternative is suicide, these people are perfectly willing to call the authorities on you; even to try to take your children away from you. And woe betide you if you’re a divorced or divorcing parent trying to put the brakes on hormones or surgeries for your minor child. The likes of Asaf Orr and other assorted attorneys assembled by adult trans activists will intervene in your custody dispute. (How ironic is it that an organization purporting to protect lesbian rights can be instrumental in forcing parents of lesbian teens to “transition” them to the opposite sex?).

Lest we simply dismiss all this as a form of mind-numbing hubris from people who should mind their own business, this excerpt from a letter written by four activist MtoFs in 2004 as part of a campaign to discredit sexologist Michael Bailey, might shed some light on the motivations of key activists who have been at the forefront of the pediatric transition explosion.

We are socially assimilated trans women who are mentors to many young transsexuals in transition. Unable to bear children of our own, the girls we mentor become like children to us. These young women depend on us for guidance during the difficult period of transition and then on during their adventures afterwards – dating, careers, marriages and sometimes adoption of their own children. As a result, we have large extended families and are blessed by these relationships. …

You may have wondered why hundreds of successful, assimilated trans women like us, women from all across the country, are being so persistent in investigating Mr. Bailey and in uncovering and reporting his misdeeds. Now you have your answer: We are hundreds of loving moms whose children he is tormenting!

So some trans activists fancy themselves the “loving moms” of (our) trans-identified kids, young people they consider their “extended family.” Not content to fight for their own rights to non-discrimination in housing and employment, activists like these were and still are the driving force behind the proliferation of pediatric gender clinics and activist organizations that have sprung up like mushrooms across the Western world in the last decade.

As should be clear from the examples in this post (representing only the tip of the iceberg), certain trans activists and gender clinicians will stop at nothing to force their will on parents who resist the affirm-only, puberty-blocking, sterilizing doctrine of pediatric medical transition. Rather than demonstrating a willingness to learn; rather than having the humility to consider that parents just might have a better handle on who their children are and what they need than a group of professionals beholden to an activist juggernaut, gender doctors and trans activists like Jenn Burleton may well try to take your children away from you.

What can be done? If you believe a gender specialist, psychologist, or doctor has rushed to “affirm” your troubled child as “trans”; if you believe someone entrusted with your child’s care has not adequately explored your child’s mental health and other underlying issues which may be contributing to their gender confusion, report them to their professional organizations and regulating boards.

Lobotomy: The rise and fall of a miracle cure

Overwhelmed is the mother of a daughter who previously identified as transgender. Her daughter is now comfortable being female.  Overwhelmed can be found on Twitter: @LavenderVerse


by Overwhelmed

If you look back at history, some appalling medical treatments were once uncritically accepted.  Of course, hindsight is 20/20. It’s easy to critique from the future, now that we know better. But in the thick of it, members of the public don’t know better. They rely on medical professionals to guide them. And things can get out of hand when doctors promote bad science, the press sensationally markets it as a miracle cure, and the medical establishment stays silent.

Prefrontal lobotomies were performed in the 1930s to 70s, but were especially prevalent in the late 1940s to early 50s. The procedure was popular in many countries, racking up a significant number of patients:

 In the United States, approximately 40,000 people were lobotomized. In Great Britain, 17,000 lobotomies were performed, and the three Nordic countries of Finland, Norway, and Sweden had a combined figure of approximately 9,300 lobotomies.  …In Denmark, there were 4,500 known lobotomies, mainly young women, as well as children with learning difficulties. In Japan, the majority of lobotomies were performed on children with behavior problems. The Soviet Union banned the practice in 1950 on moral grounds, and Japan and Germany soon followed suit.

In the United States, the lobotomy pioneer and leading practitioner was Dr. Walter Freeman, a neurologist based in Washington, D.C. His story is featured in the hour-long 2008 PBS documentary, “The Lobotomist,” which I will quote from throughout this blog post. Here is the full transcript of the program.

freeman

Freeman believed that mental illnesses were caused by physical defects in the brain. In the spring of 1936 he came across a study conducted by Egas Moniz, a Portuguese neurologist, who took small corings from the brains of 20 patients with anxiety, depression and schizophrenia. Moniz claimed that the procedure eliminated symptoms in a third of them

Freeman built on the work of Moniz. He thought that disrupting the connections in the brain’s frontal lobes would bring patients relief from intense emotions and reset their personalities. Freeman didn’t have a license to perform surgery so he hired neurosurgeon James Watts. Later in 1936, Watts, under the direction of Freeman, performed their first lobotomy. He made incisions on the patient’s head, drilled holes through the skull, inserted a small spatula-like instrument into the brain and sliced through neural fibers connecting the frontal lobes to the thalamus.

Narrator: Four hours later, Alice Hammatt, the first patient to receive a lobotomy in the United States, opened her eyes. “Her face presented a placid expression,” Freeman noted, “By evening she was quite alert, manifested no anxiety or apprehension.” Excited by their results, Freeman and Watts began to do more lobotomies, acquiring patients from Freeman’s private practice.

After just a dozen operations, Freeman was ready to declare the lobotomy a success. He was confident in the procedure even if some patients relapsed (which prompted second, and sometimes third, operations). And even if there were some troubling side effects.

Edward Shorter, Medical Historian: Freeman’s definition of success is that the patients are no longer agitated. That doesn’t mean that you’re cured, that means they could be discharged from the asylum, but they were incapable of carrying on normal social life. They were usually demobilized and lacking in energy. And they were that on a permanent basis.

 Eventually Freeman sought an easier, quicker way to lobotomize patients. By 1946 he devised a new method to access the brain using simple tools—an ice pick and hammer. (The first ice pick was actually taken from Freeman’s kitchen drawer. But modifications were made over time. The tip on earlier versions occasionally broke during the procedure.)

lobotomy-instrumentAndrew Scull, Professor of Sociology: Freeman would peel back each eyelid, insert his ice pick and with a hammer tap through the brain, wiggle it about, sever the frontal lobes, withdraw it. And when the patient came to, he or she would be given dark glasses to hide the black eyes they’d been given.

 Freeman did the procedures himself, sometimes in his office. It took only a matter of minutes. He did not require an operating room and the equipment was portable, which made it convenient for travelling to mental asylums. (It was at this point that Freeman and Watts—who had grave concerns about the “ice pick” lobotomy being performed by those without formal surgical training—parted ways.)

lobotomy-eyeball

Initially Freeman’s procedure was heralded in the press as a miracle cure and correspondingly there was a rise in patients receiving lobotomies. But after the advent of antipsychotic medications and the poor outcomes noted in the first clinical trials, the procedure was recognized as barbaric and Freeman himself downgraded in the public eye to a charlatan. The history of medical fads (lobotomy being only one of them) tells us that pioneering doctors, and the medical establishment that embraces them, can fail in their duty to “Do No Harm.” That people, even those possessing medical degrees, are imperfect and can champion poor science.

Back in 1987, Dr. Valenstein (at the time a professor of psychology and neuroscience at the University of Michigan), reminded attendees at a science meeting that it was important to remember the history of the lobotomy. He warned that ”all the major factors that shaped its development are still with us today.”


valenstein

A few years ago, I believed that drastic treatments like the lobotomy could never again gain widespread acceptance. But I was wrong. It was quite a shock to realize how enthusiastic professionals were to medically transition young people like my daughter.

At initial glance, it may appear that lobotomies (which target assumed defects of the brain) and the medical transition of gender dysphoric children (which target assumed defects of the body) have little in common. But if you look past which body parts are “corrected,” you see that both are psychological conditions which were/are being treated by drastic, irreversible medical interventions. There are a number of parallels I’ll discuss in this post.

Desperate times call for desperate measures.

Both lobotomies and now the medical transitioning of young people were/are more easily accepted because of the environment in which they originated. A sense of hopelessness paired with yearning for a cure leads people to take chances they wouldn’t normally.

In the 1930s, anti-psychotic drugs weren’t yet invented. People suffering from severe mental illness were warehoused in overcrowded, underfunded mental asylums. The conditions were horrible. No one knew how to help these patients. Some were tied-up on benches. Others lay naked on the floor. Feces were sometimes smeared on the walls. And conditions became further strained with the return of shell-shocked World War II veterans. There was a huge impetus to find treatments to alleviate their symptoms and allow them to go home to their families. When lobotomies were introduced and touted as a cure, many chose to have loved ones undergo the procedure, rather than admit them to one of these terrible mental asylums– like the one exposed in this newspaper story:

pottstown

According to his son, Freeman felt justified in performing lobotomies because eliminating a patient’s intense suffering (and the associated high suicide rate) outweighed the loss of intellect and personality:

Walter Freeman III, son: …suffering the demons of mental illness. And he was trying to cure them of that, and the fact that they might turn into, let’s say, fat slobs afterwards was a small price to pay for the relief from this intense mental anguish. He pointed out repeatedly a very high rate of suicide of these individuals that they can’t stand this mental pain and he was helping them.

Currently, whenever a transgender-identifying child is discussed in the media, without fail a high suicide attempt rate is mentioned. It is implied by gender specialists that children will die unless fully “supported” in their chosen gender identities. We are told that proper pronouns, new clothes, a binder, puberty blockers, cross-sex hormones, mastectomies and genital surgeries may be necessary just to keep them alive.

This is just one of many examples found in today’s media coverage of trans-identifying children:

Neal found a therapist who told her and her husband to fully embrace Trinity’s female identity. She said that the therapist also gave strikingly blunt advice.

“She said, ‘Your daughter already knows who she is. Now you have to decide. Do you want a happy little girl or a dead little boy?'”

Gender specialists and trans activists continually scare parents with high suicide attempt statistics from a flawed survey study which did not ask whether suicide attempts occurred before or after transition; nor were co-occurring mental health problems controlled for in the study. Many highly publicized suicides of trans-identifying teens were young people who had been fully supported in their transitions by family, friends, and professionals (this phenomenon was discussed in this post, along with the risk of suicide contagion in vulnerable youth). One long-term study has shown that suicide rates, compared to those of the general population, are significantly higher in those who have medically transitioned.

If parents exclusively rely on distorted statistics or frank misinformation, it’s not surprising they would choose to medically transition their child. Nothing is worse than the prospect of losing a child to suicide.

 Someone other than the patient authorized/s treatment.

 During the lobotomy craze, many patients were not able to consent to the procedure themselves. Parents, spouses, and siblings were then called upon to make the decision. Many opted to have their loved ones lobotomized based upon a mental health professional’s recommendation. Some felt they were misled.

“I got the impression that it was no more serious than having a tooth extracted.”

There were family members who profoundly regretted their decision.

…her father opened up about the regret he felt about allowing the VA to lobotomize his brother. “The guilt came from the realization that it wasn’t as great as it was supposed to be and that he wasn’t able to be independent,” says Ms. Malzahn. “They thought it would make things all better, and it didn’t. In some ways, it made it worse.”

Currently, parents are responsible for approval of medical interventions for their under 18 year-old gender dysphoric children (although in Oregon it’s possible for 15 year-olds to get double mastectomies or other surgeries without parental consent). Based on media coverage, it appears quite a few children are undergoing gender-affirming treatment with parent approval.

A parent’s choice of what direction to take is highly influenced by the information sources they rely upon. Many gender specialists (and the media) paint a pretty rosy picture of what life can be like for gender dysphoric children if they are affirmed in their gender identity and given body-altering treatments so they can pass as the opposite sex. But this is an optimistic belief, based on opinion and anecdote, not solid evidence. Particularly since there is no media coverage of what life is like for those gender dysphoric children who are fully supported in being “gender nonconforming” but not endorsed in the idea that they are “really” the opposite sex.

Highly variable results.

Lobotomy outcomes were all over the map, which isn’t surprising if you consider the procedure itself was not exactly replicable. It was literally a “stab in the dark.” And Dr. Freeman’s patients—ranging from severely mentally ill adults to misbehaving children—had a wide variety of symptoms pre-treatment. Some suffered from a transient problem, which may have resolved by itself.

According to a Wall Street Journal article, lobotomy outcomes generally could be divided into three categories:

Drs. Freeman and Watts considered about one-third of their operations successes in which the patient was able to lead a “productive life,” Dr. Freeman’s son says. Another third were able to return home but not support themselves. The final third were “failures,” according to Dr. Watts.

Before and after lobotomy pictures (Case 121, 1942). Before: “Forever fighting…the meanest woman.” After: “She giggles a lot.”

lobotomy-before-and-after

 But the patients with successful outcomes still had concerning side effects. They often lost their ambition and weren’t able to make judgments or function well socially. Most were significantly changed, never to be the same person again.

A fellow 4thWaveNow parent, SunMum, shared this memory with me for this post:

It struck me a long time ago that my horror of surgical intervention for mental problems probably dates from my memory of seeing my mother’s best friend who had had a lobotomy. It was one of the tragedies of my mother’s life. She told me that her friend had been ‘brilliant and beautiful’. They were both unusual as female students at the London School of Economics in the 1930s. The friend had a breakdown after her husband left her for another woman. As her next of kin, it was the husband who gave permission for the lobotomy. The friend would come to London at Christmas and stay in a hotel. We would meet her for tea. She was capable of flat small talk but nothing else. She did not show any feeling.

 A few patients were fortunate enough to have no noticeable side effects. For them, having a lobotomy appeared to bring great relief. But these patients were relatively rare.

A significant number of post-op patients were reduced to a persistent vegetative state. And for others, the operation was fatal.

Narrator: At Cherokee state hospital in Iowa, three of Freeman’s patients died on the operating table, one after Freeman’s ice pick slipped while he was taking a photograph. Without pausing, he packed up and left for his next demonstration.

Statistics from the Veterans Administration (which performed approximately 2,000 lobotomies), kept track of how many died as a result of the procedure:

The VA did try to determine whether the benefits outweighed the risks. And the risks were severe. Overall, 8% of lobotomized veterans died soon after the operation, according to a 1947 document. One hospital reported a 15% fatality rate.

There are a variety of outcomes to medical gender transition as well. Some people say that transitioning is life saving. Some react poorly to cross-sex hormones or have surgical complications. Some decide to de-transition and/or re-identify as their natal sex. And some even die due to medical transition itself (here is an analysis of a 2014 Dutch survey study in which one patient died from complications of surgery).

Treatment based on theories, not solid evidence.

 As the patient caseload of Freeman and Watts grew, they gained confidence in their technique and wanted to share it with colleagues. They presented their findings at a Baltimore medical conference.

Andrew Scull, Professor of Sociology: Freeman got up to announce that they had a new cure for mental illness. This was a very dramatic and highly charged occasion. There were angry interjections from the audience. There were questions. There were attempts to even shout him down.

 Jack El-Hai, Writer: Some of them were simply astonished that he would even try such a thing, and a few were outraged that he would try an untested procedure like this.

 Narrator: Freeman begged his audience for time. It would take months, even years, he argued, to properly evaluate the progress of lobotomy patients. Meanwhile, he promised, lobotomy would remain ‘an operation of last resort.’ But Freeman knew that ultimately it didn’t matter how much other doctors might oppose him; their disapproval would never reach the outside world. 

Elliot S. Valenstein, Professor of Neuroscience: At that time, it was considered unethical to publicly criticize another physician. So people didn’t write critical articles, they may have talked among themselves, they may even have raised critical questions at a meeting. But they did not write anything that would stop him from continuing his work.

Freeman was undeterred by their criticism and plowed ahead, convinced that lobotomies were the best option for treating mental illness. Fellow doctors remained silent. The lobotomy craze was largely unchecked until the mid-1950s.

But even after the medical establishment turned against him and his procedure, Freeman moved to the west coast where he continued performing lobotomies until 1967. And maybe he would have kept operating if his hospital privileges had not been revoked. The hospital took this action only after one of Freeman’s patients died from a brain hemorrhage. (It was her third lobotomy.)

As has been discussed many times on 4thWaveNow, there is a dearth of research that backs up the medical transition of children. The current protocol being used in the United States is based on best guesses, not solid evidence. However, this has not been a barrier for children being treated with puberty blockers and cross-sex hormones, nor has it stopped them from receiving mastectomies, hysterectomies and genital surgeries.

In the United States, the first pediatric gender clinic opened its doors in 2007, and since then many similar clinics have popped up across the country. But it wasn’t until May of 2016, almost a decade later, that an NIH-funded study was launched to record the effects of puberty blockers and cross-sex hormones on gender dysphoric youth. The results won’t be published for years; and since the study follows patients for only 5 years, longterm outcomes won’t be know for decades . In the meantime, concerned professionals, for the most part, remain silent and it appears that medical transition of youth is proceeding at an accelerated pace.

The power of the press.

Dr. Freeman used the media as a promotional tool. He often had newspaper journalists and photographers waiting for him at mental asylums.

Narrator: Aware of the power of public relations, Freeman aggressively courted the press. Soon he was receiving glowing reviews in major publications. The Washington Star called lobotomy “One of the greatest surgical innovations of this generation.” The New York Times called it “surgery of the soul,” and declared it “history making.”

 In 1941, the Saturday Evening Post, described how patients felt before and after lobotomies: “A world that once seemed the abode of misery, cruelty and hate is now radiant with sunshine and kindness to them.”

saturday evening post.jpg

Robert Whitaker, Writer: We think of science as having this sober sort of process, something is introduced, it goes to a medical journal, it’s peer-reviewed there. Freeman sort of bypassed that process because he in fact knew he was going to get a lot of resistance and he brings the press into it right from the beginning. And the press — they’re always eager for miracle surgery, it sells papers and so, next thing you know, you start having this story out there, not of damaging the brain, but of plucking madness from the brain, and it’s such a story of progress.

 A 1999 study analyzed popular press coverage of the lobotomy and its potential influence on how quickly acceptance of the procedure spread. The Abstract:

 This study analyzed the content of popular press articles on lobotomy between the years 1935 and 1960. Both a qualitative and quantitative analysis provided evidence that the press initially used uncritical and sensational reporting styles, with the content of articles on lobotomy becoming increasingly negative through time. The initial positive bias occurred despite opposing views in the medical community, which provided a basis for more balanced coverage. These findings support the theory that biased reporting in popular press articles may have been a factor influencing the quick and widespread adoption of lobotomy as a psychiatric treatment.

I don’t know if you caught that, but there were “opposing views in the medical community” that journalists often omitted. In 1941, the American Medical Association issued “a warning about several negative effects on personality including apathy, inappropriate social behavior, and lack of initiative (i.e., the frontal lobe syndrome).”

Also of interest in the study were these statements: “In addition to sensationalizing the positive effects of lobotomy, articles during this time period rarely discussed risks involved in the operation.” and “…in most cases mention of negative side effects was either absent or cursory.”

Currently there are nearly daily examples of trans kid media stories. They tend to be pretty formulaic. From an early age, the child realizes they feel different from their peers. A girl that throws a fit when mom puts her in a dress; a boy that wants to wear a dress. In general, preferences in clothes, toys and haircuts are used to validate that they are transgender. The child (or parent) finds out about transgender through the internet, on the radio or television and latches tightly onto that explanation. They either want to avoid the “wrong puberty” (which brings puberty blockers into the discussion) or have struggled through puberty and want to correct their bodies with cross-sex hormones and surgeries. Parents sometimes admit that they didn’t immediately believe their child was transgender. But when they learn of the suicide statistics, then they get on board. To drive the point home, the article quotes a gender doctor or therapist, a purported expert in the field, who states unproven theories as if they were settled science.

There are in fact opposing views in the medical community; views based on years of experience and research in gender identity clinics. But reporters who churn out the celebratory articles about “trans kids” rarely mention contrary views, nor do they ask any inconvenient questions of the parents who unquestioningly “affirm” their offspring. Recently, troubling new questions have been raised about Lupron, a GnRh agonist, but the reporter covering that controversy omitted the fact that Lupron is the drug used most commonly (off label) to block puberty in “trans” kids. With few exceptions, journalists focus on the feel-good aspect of the child being accepted as the opposite sex, a triumph over adversity. Not much time (if any) is spent discussing the significant risks associated with medical transition. Biased media coverage like this is likely contributing to the rapid increase in children presenting to gender clinics.

Embraced by the medical community.

 Initially many of Dr. Freeman’s fellow doctors were reluctant to embrace the lobotomy as an acceptable treatment, but that soon changed. Thanks to favorable newspaper articles, Freeman became somewhat of a celebrity. The public believed that he had found a miracle cure. His services were sought after.

Additionally, state-funded mental asylums were overcrowded and seriously underfunded, some so financially strapped that they were on the verge of closing. Freeman began travelling to these institutions, promoting lobotomies as a cost-cutting measure. The more patients that were discharged, the greater the savings. The procedure was seen as a godsend by many overworked asylum doctors and administrators.

Freeman aggressively championed his cause, even convincing the federal government via the Veterans Administration to perform lobotomies on veterans.

In 1948 Freeman was elected president of the American Board of Psychiatry and Neurology. In 1949 Egas Moniz, whose work inspired Freeman’s procedure, was awarded a Nobel Prize for psychosurgery. (He was nominated by Freeman.) The lobotomy gained further credibility.

Narrator: By decade’s end lobotomy had won the acceptance of mainstream medicine. Lobotomies were being performed at Johns Hopkins, Mass General Hospital, the Mayo Clinic, and other elite medical institutions.

Currently, there appears to be widespread acceptance of medical interventions for gender dysphoric youth. Clinics all across the country, many of which are part of elite Children’s Hospitals, are providing gender care for kids. It is becoming more common to obtain insurance coverage for puberty blockers, cross-sex hormones and surgeries. And laws  have been passed in some states that forbid therapists from trying to change children’s gender identities. Many mental health professionals seem to believe their duty is to simply affirm children’s gender identities, not to explore why there is a mind-body disconnect.

Lambda Legal has a handy list of organizations (last revised in 2012) that declare support for transgender people in health care. Here are AMA and APA statements:

 

Expanding the patient base.

Dr. Freeman barnstormed mental asylums, operating on many patients in each location. He was frequently gloveless, mask-less and sometimes sleeveless. Once he performed 25 transorbital lobotomies in a single day.

gloveless-freeman

(He appeared to enjoy surprising his audience. On some occasions, Freeman would start out operating using his right hand, and half way through switch to using his left hand. Other times he would an insert ice pick under each eyelid and simultaneously lobotomize through both eye sockets. Sometimes doctors in the audience would faint, or even vomit.)

While at the institutions, he would train others in his craft.

Andrew Scull, Professor of Sociology: He was convinced this was an operation which could be replicated very easily. As he put it, “Any damned fool, even a hospital psychiatrist could learn it within an afternoon.”

Freeman trained one psychiatrist in Rusk, Texas who performed 75 lobotomies in one day.

Narrator: Spurred on by Freeman, the number of lobotomies performed annually soared from 150 in 1945 to over 5,000 in 1949. Despite the known side effects, there seemed to be an endless supply of willing patients.

The momentum of lobotomy enthusiasm was greatly slowed in the mid-1950s by the advent of a pharmaceutical and results published in medical journals. An antipsychotic drug called Thorazine, promoted as a “chemical lobotomy,” became increasingly used. Also, the first long-term clinical studies of lobotomies were assessed by the medical community. Now that doctors had published proof of lobotomy’s negative side effects, and there was a suitable alternative, the medical establishment quickly turned against Dr. Freeman and his procedure. He no longer felt welcome in Washington, D.C. and moved across the country to California.

Freeman did not give up on performing lobotomies. On the contrary, he cultivated new categories of patients to treat. Disaffected housewives, people with chronic headaches, and misbehaved children were all fair game.

Andrew Scull, Professor of Sociology: If housewives found their early 1950s existence too depressing for words, why Freeman had a solution that would get them through their day happy as little clams. If children were misbehaving, conditions we might now see being called hyperactivity disorder, why they might need a lobotomy.

Nineteen of Freeman’s patients were children under the age of 18. One was only 4 years old.

 For pediatric gender care, the actual patient numbers in the United States are difficult to determine. But based on the fast-paced expansion of gender clinics across the nation, the patient load has likely escalated similarly to what has been seen in the UK:

gender-clinic-stats

The first gender clinic in the US opened in 2007 in Boston. An October 2016 article states there are now more than 60. The demand is growing quickly, but there are still waiting lists for new patients. Based on this information, in conjunction with the growing number of 4thWaveNow parents (many who note the number of trans-identifying students in their local schools are multiplying), it appears that the cases of young people with gender dysphoria are skyrocketing.

Attempts to “cure” sexual orientation and gender non-conformity.

During the lobotomy’s reign, homosexuality was considered a mental disorder. Cruel “treatments” of this time period included chemical castration with cross-sex hormones, aversion therapy (using electrical shocks or vomit-inducing drugs) and masturbatory reconditioning. Lobotomies were also performed on patients like this gay man who was a patient at Pilgrim State Psychiatric Center in Long Island, New York.

CASE NO. 236 Man, 29, “had a psychotic attack [at age 19] and responded satisfactorily to 44 insulin comas.” Admitted to Pilgrim at age 20. “In the years which followed, this patient was consistently one of the most severe behavior problems, aggressively homosexual, out of contact, noisy, disturbed, overactive; he wet and soiled.” Lobotomy on Feb. 15, 1949. “Slow improvement. He was clean, pleasant, but mentally defective— a moron. He speech was clear but brief. On the insistence of his parents, he was released on June 15, 1949 but returned after a few weeks because of restlessness and poor judgment. There is no severe behavior problem, but he is hebephrenic— silly. He is now clean, quiet, passive, well-behaved, probably hallucinated, speech brief but rather scattered, but he is well-informed on current baseball scores, etc.”

At 4thWaveNow, we have repeatedly stressed that the majority of gender dysphoric children, if left alone, will grow out of their distress. Most mature into lesbian and gay adults. Sexology researcher Dr. James Cantor  posted a compilation of childhood gender dysphoria research going back many decades on his site Sexology Today:

In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.

When seen from this perspective, it is difficult to ignore the impacts on children who would likely grow up to be homosexual. “Trans kid” media stories are full of “gender nonconforming” behavior, which is often a sign a child or teen is or may eventually be gay or lesbian. Frequently, a preteen or teen even admits that he/she is attracted to the same sex. But parents in these celebratory articles conclude that their child is transgender and needs irreversible medical interventions. (Strangely,  journalists never question it.)

Since puberty is often the time that gender dysphoria resolves (and sexual orientation begins to be self-recognized), the use of puberty blockers (along with the reinforcement from gender therapists that the child is in the “wrong body”) likely prevents many young people from ever becoming comfortable in their unaltered bodies. Further, the vast majority (some clinics report 100%–see here and here) of children on puberty blockers proceed to cross-sex hormones, irreversible sterilization, and possibly later surgeries.

Earlier interventions to prevent potential problems.

 Initially Freeman claimed that the lobotomy would be an operation of last resort. He once said, “I won’t touch them unless they are faced with disability or suicide.” But as time went on he altered his views. He started advocating for lobotomy earlier, as a way to prevent progression of mental deterioration. In a 1952 Time article (“Mass Lobotomies”), he is quoted as saying, “it is safer to operate than to wait.”

The push for early intervention is also seen in medical transition of “trans” kids. Initially it was reserved for gender dysphoric adults, but now children are increasingly being treated. The justification: if gender dysphoria is caught while they are young, they can avoid the years of misery that many older trans people report. It is assumed that treating children with puberty blockers, cross-sex hormones and surgeries will help them appear more convincingly as the opposite sex. This, along with consistent affirmation of their gender identity, is assumed to help these children avoid suicidality, depression, unemployment, sexually transmitted diseases, drug abuse and homelessness commonly found in the current adult transgender population. Gender doctors state they are saving these children from potential future problems (without acknowledging the significant risks introduced by treatment).

“These kids have a very high risk of depression, substance abuse, suicidal thoughts, and suicide attempts,” said Stephen Rosenthal, MD, a pediatric endocrinologist and medical director of the Child and Adolescent Gender Center at UCSF Benioff Children’s Hospital San Francisco …. “Not treating is not a neutral option.”

Ambitious doctors.

Freeman came from a prominent medical family. His grandfather William Keen was a famous surgeon, the first to extract a brain tumor from a living patient. He enjoyed being a showman, performing operations which were viewed by large audiences. Freeman looked up to his grandfather and wanted to be as successful.

Early in his career Freeman became determined to alleviate the mental anguish of patients in the overcrowded, horrible conditions of mental institutions. Early on he spent a great deal of time examining the brains of dead mental patients, trying to find a defect which could be corrected. But he was never able to find any.

He was thrilled to come across Portuguese neurologist Egas Moniz’s work, which became the basis for Freeman’s lobotomy procedure.

Jack El-Hai, Writer: Freeman almost went wild with excitement. He thought, ‘This may be it.’ He saw a vision of the future unfold, not only a future in the treatment of the mentally ill, but his own personal future.

He latched tightly onto lobotomies as a way to bring patients a sense of peace, and never let it go. Freeman appeared to genuinely believe he was helping people by lobotomizing them, but seemed blind to the negative impacts of his procedures. It was as if he was looking through rose-colored glasses.

Andrew Scull, Professor of Sociology: One of the characteristics of an enthusiast, and Walter Freeman was certainly that, is that they are able to overlook everything that contradicts their enthusiasm. And they concentrate on all the things they see that show they’re on the right path. So over and over again, we can see Freeman managing to dismiss the casualties of his surgical interventions.

On the medical transition front, Dr. Norman Spack, a pediatric endocrinologist, in 2007 co-founded the first US gender clinic for youth in Boston.

In media articles, Dr. Spack appears to be a compassionate person who is concerned about gender dysphoric children. Over and over again, he talks about suicide rates  He implies that kids desperately need medical treatment because otherwise many of them will kill themselves, especially if they are unable to avoid their natal puberty.

World trans authority Dr. Norman Spack, a pediatric endocrinologist (or hormone doctor for children), warned the dangers of failure to treat trans teenagers. He said almost one in three trans individuals will attempt suicide if they do not receive treatment until after puberty….

…‘If your neighbor is bleeding, you should not stand idly by,’ Spack said, quoting Jewish philosopher Maimonides, and adding: ‘For trans people, the inevitable conclusion is that puberty is noxious.’

 He is a big proponent of using GnRH-agonists (commonly known as puberty blockers) to pause the puberty of gender distressed children. “Safe,” “reversible” and “life saving” are often words that gender specialists use to describe these pharmaceuticals. But there have been severe side effects reported, especially when administered to children.

This June 2015 article discusses what inspired Spack to incorporate puberty blockers into his treatment protocol:

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

“I was salivating,” he recalled. “I said we had to do this.”

The puberty-blocking protocol gained legitimacy in 2009, when it was endorsed by the Endocrine Society, the leading association of hormone experts, on the recommendation of a task force including Dr. Spack.

 In August 2012, it was reported that Spack has trained many other gender professionals across the United States and in Canada.

Today, clinics for transgender kids in British Columbia, San Francisco, Los Angeles, Chicago, Denver, Minneapolis, New York, Hartford, Providence, and Washington, DC, have either been created or expanded. And in almost all of these places is a doctor that Spack has trained, mentored, or guided.

 And this October 2016 article states that Spack’s program has spread to over 60 pediatric gender clinics in the United States.

His program, copied in over 60 centers across the US, provides treatment including hormone blockers – ideally at the onset of puberty – and hormones for trans teens according to need and capacity to understand the implications of what was being done.

Spack says that treating gender dysphoric children is less complicated than it would seem:

spack.jpg

Many parents at 4thWaveNow are concerned that we may be in the midst of another disastrous medical fad. Our kids’ sudden change in gender identities has been easily accepted by their peers, schools, therapists and doctors. Puberty blockers, cross-sex hormones and surgeries are routinely encouraged as necessary next steps. The level of enthusiasm is stunning. There is an absence of caution. We don’t know how many young people will grow up to regret their permanently altered bodies. Which of them will wonder what their lives could have been like had they not taken this path? Some families in our community have witnessed their daughters or sons desisting from trans identity, and finding peace in their own skins—but in just the nick of time, and against the recommendations of enthusiastic gender therapists. These young people matter just as much as those who are being encouraged to believe they are the opposite sex and have begun medical transition. Who speaks for these desisters?

The no-holds-barred, uncritical championing of child transition now will eventually fizzle. Lessons will be learned. Science will evolve. And eventually books and documentaries may try to explain how things got so out of hand. How long that will take is anyone’s guess.

Mission creep: Respected LGB family support org goes full-on trans

Worriedmom is a mother of four (allegedly) adult children, who lives in the Northeastern part of the United States.  She practiced law for many years and now works in the non-profit area. She is available to interact in the comments section of this post.


by Worriedmom

A piece of advice that parents of the newly-trans often hear, right after the admonition to “educate yourself,” is to attend meetings of PFLAG (which previously stood for Parents, Friends and Families of Lesbians and Gays and now does not stand for anything, the acronyms apparently having become unmanageable).  According to its website, PFLAG currently has over 400 chapters, representing over 200,000 people in all 50 states, Washington D.C., and Puerto Rico.  PFLAG has a national administrative and lobbying presence but operates primarily through local chapters.

PFLAG’s original mission called for parents to support one another in what was then the frightening, emotionally draining, and fraught experience of having a gay son or a lesbian daughter.  When PFLAG was founded back in 1972, by a courageous New York City mom, having a gay son or a lesbian daughter meant being in a terribly lonely place, where parents were fearful of confiding even in other loved ones, and social ostracism was the rule, not the exception.  Then, too, ignorance about gay and lesbian people reigned supreme.  Even highly-educated people believed that being gay or lesbian was, at the very least, the symptom of serious mental illness, and that at any rate, the closet was by far the best place for “queers” and their unfortunate parents to live.

pflag-1972

As the 70’s turned into the 80’s, parents needed PFLAG desperately, as AIDS swept through the gay population and families frequently dealt with two simultaneous revelations: their son was gay, and he had come home to die.  Parents became even more isolated and traumatized, often the target of violence and community exclusion (read up on Ryan White for a tragic example, although there were many more).  It’s hard to believe, looking back today, how crazy AIDS made people in the time before effective drugs.  PFLAG served the vital function of connecting parents who were dealing, in many cases, with incurable illness and horribly premature death, and who, as an extra-cruel burden, had to do it in secret.  The support and comfort offered by PFLAG chapter meetings was truly a lifeline for many.

Time and medical science marched on, giving birth to the culture wars.  At the time that my story begins, the U.S. was smack in the middle of the anti-gay-marriage law-making binge that many people thought helped re-elect George W. Bush in 2004.  What originally brought me to PFLAG was my then-14 year old son, who was experiencing the feelings that eventually led him in the direction of bisexuality.  He had dealt with a lot of bullying and other negative behavior in school, and I felt that I needed support to cope with this strange and upsetting situation.  In 2006, primarily due to my congenital inability to say “no” in any given volunteer setting, I became the head of my local PFLAG chapter.  My PFLAG experience became further pertinent in 2012 when my older daughter came out as lesbian during her first semester of college.

To preface, I can’t say whether my experience is typical for PFLAG, although I have no reason to believe it isn’t.  When I decided to help start a chapter, I received no vetting of any kind.  I was not asked to undergo a criminal background check, provide references, or establish my bona fides in any way.  Neither when I established the chapter, nor at any time afterward, was I asked to become knowledgeable in any formal sense about the GLB community.  My good faith was assumed.  Much to my initial chagrin, I was not offered training in group facilitation or dynamics to help me work with an often-emotional and always unpredictable group of people.  I have never had any training or experience in the fields of psychology, human sexuality, addiction or mental health, even though all of these issues came up repeatedly at our chapter meetings.  (I should add that much, much later, PFLAG did begin to offer voluntary training in group facilitation.)  I was actually a bit shocked that I was expected to, and did, “wing it,” in situations that often became intense and even confrontational.

This brings me to my first point on PFLAG and its place in the “trans puzzle” — that neither PFLAG leaders, nor other group members, should be assumed to have any expertise about anything or anyone involved on the “trans spectrum.”  One might argue that when PFLAG’s mission was limited to parents of lesbians and gays extending kindness and empathy to other parents, this lack of professionalism and education was not a major liability (although, as I note above, on occasion I found it daunting).  As the “T” part of the equation has come to predominate, however, it would be natural for parents to expect some level of informed if not authoritative opinion from PFLAG leaders and group members as to the many medical, psychological and social issues involved with an individual’s becoming transgender.  If I am any example, however, it is more a case of “the blind leading the blind.”

Moving on, and energized by the rampant opposition prevalent in the “W years,” our chapter attracted upwards of a dozen people to each meeting, even 20 or more when we featured an author, academic or other person of note.   As a PFLAG representative, I spoke at symposiums, conferences, youth meetings, schools, churches and more.  Every year we fielded a large contingent at the local gay pride march.  The chapter hot-line was connected to my home phone, and I spent hours every month, counseling parents.  And people always called at dinner-time!

And then… the bottom fell out.  By the early 2010’s, the enthusiasm and interest were just – gone.  Newbies became “one and done,” then “none and done.”  We were victims of our own success.  Parents no longer grieved, no longer felt condemned to live in secrecy and fear.  Gay became normal, fine even.  We went on hiatus for a while, then re-booted, in a different location and time.  We tinkered with the format.  We tried publicity, Facebook, networking with other groups.  But the writing was on the wall: parents just didn’t need PFLAG like they used to, and it was pretty obvious they never would again.

We were not alone.  At our monthly regional conference calls, everybody had the same sad story: attendance was down, commitment was non-existent.  The yearly national conference went to bi-annual, staff was cut at National, the end was near.

And then, about four years ago, things changed again.  The chapter hot-line, formerly covered with cobwebs, began ringing off the hook.  This time, it was parents of “gender-non-conforming” children, desperate for help and advice.  Again, I had no expertise, no real understanding of transgender issues, but simply assumed that the “strong affirmation” model that worked fine for lesbian and gay people, would go double for trans.  Today I am ashamed to say that I unthinkingly referred over 50 individuals and families to our local “gender-affirmative” therapist, and at least as many more to trans-activist and other trans-supportive groups (such as “free binder” sites).  I also steered people away from organizations such as Straight Spouse Network, on the basis that those groups were not sufficiently “trans-affirming.”

I don’t feel good about my blind acceptance of trans dogma, but in my defense, I was never encouraged to develop any sort of critical perspective.  The word, from National on down, was that “it’s 95% the same” (in other words, if we were experienced in providing support to parents of gay and lesbian children, we were perfectly well equipped to do the same for parents of transgender children).  I was also told that I shouldn’t worry that I was ignorant about the remaining “5%” (relating to the medical particulars of transition).  As leaders, we were to affirm “innate gender identity” and transition, full stop. “Trans theory” was accepted scientific fact.  No other opinions or viewpoints were entertained, much less explored, and there was no contemplation of the wisdom or safety of the medical procedures that transition entailed.  Parents who questioned were crazy.  End of discussion.

A quick review of PFLAG’s website shows that it is, today, all-in on trans.  We have an online course on “our transgender loved ones,” training in Trans Ally 101, a publication available for sale on becoming a Trans Ally, a transgender reading list for adults, a transgender reading list for young adults, a transgender reading list for children, films on gender and many, many more.  It’s all just so wonderful!

pflag-present-day

Notwithstanding all this joy, meeting attendance was up but the mood was down.  Parents were gutted.  We had “learned” that “trans is the new gay,” but something was off.  So many of the parents had children who already had mental health problems, or were on the autism spectrum, and as they cried and expressed their fear of what life would hold for their vulnerable children, it became increasingly difficult to remain sanguine.  It began to occur to me that it wasn’t terribly likely that transition was going to “cure” anything for these kids, but instead would leave the child, and the family, with two serious problems instead of one.  Parents worried that their children would never find employment, or even someone to love.  Again, it grew difficult to assume those concerns away.  While I had always felt quite comfortable assuring a parent that a gay or lesbian child could go on to lead a normal, even boring, life, I felt like a faker saying the same thing to the parent of a trans child.  But there was never any space to explore alternative ways to mitigate the effects of gender dysphoria, how or whether to slow down a child’s rush to transition, or even whether the proper goal for every potentially trans person might not be transition, ASAP.

Meetings grew increasingly baroque.  A parent would walk in the door:

“My 12 year old daughter just came out as pangender.”

“My older daughter is transitioning to be my son, and my younger daughter is now aromantic.  Is it possible these things are related?”

“I think my three year old son is possibly transgender.  What should we do?”

“My 19 year old son just came back from his first broney convention!”

“Our lesbian daughter is the only non-trans person in her entire GLBT youth group.  Now who is she going to date?”

Gay and lesbian were boring old vanilla, and I was seriously out of my league. Conferences and gay pride panels became an exercise in “can you top this?”  The mantra was “the children are leading the way, and isn’t it exciting!”  Having several children of my own, I was pretty skeptical, given that these children leading the way could not reliably load a dishwasher or return a library book.

I began to look for more balanced discussion of the facts regarding transgender issues, and was horrified to learn (for instance) that transitioned children, whom I had blithely assumed would go on to lead happy and fulfilled lives, would actually wind up permanently sterilized.  To put it mildly, PFLAG does not advertise this detail; nor are most leaders, in my experience, even aware of it.  I also could no longer deny that some of the folks I had encountered via PFLAG were, in the vernacular, “creepy.”  There had been discussion of fetishes and other “alternative” behavior that would, in any other context, have sent me right out the door.  In retrospect, in the name of tolerance, I permitted my own boundaries to become fuzzier than I should have.

The final straw, for me, was the parent-assisted mastectomy of a troubled young woman in my community.  I was just done. I actually continued to run our chapter for another excruciating summer, loathe to simply shut it down after so many years involved with PFLAG, but finally did.  I do not expect that my concerns (which I circulated in a lengthy letter) will have any impact on PFLAG at all.

Absent the trans issue, I believe that PFLAG probably would have died a natural death, and that wouldn’t have been a bad thing!  (As an example, Love Makes a Family, the marriage equality group in Connecticut, showed great integrity in shutting down after it achieved its objective.)  The transgender cause has been a life-saver for PFLAG, organizationally speaking, even though there is a strong suspicion that homophobic parents may embrace transgenderism as a “cure” for their gay and lesbian children – hardly the vision of family acceptance originally put forward for PFLAG.  (Go here for another sad story of an unacceptable lesbian daughter who became a cherished straight son.)  “Trans” has provided new purpose and energy, a new “mission field,” and from what I’ve seen, trans people and their supportive parents have become the majority of PFLAG’s leaders and members.  Some chapters are, today, almost entirely trans and trans-related.  It’s where the action is.

A parent attending a PFLAG meeting needs to know that the people he or she will encounter are most likely strongly and personally invested in the promotion of transgenderism.  If a parent has already endorsed and facilitated transition for his or her own child, obviously that parent has to believe that this was a necessary, benign and positive step.  PFLAG is the last place to hear a dispassionate discussion of the actual facts of transition, much less any mention of the feminist perspective.  Remember: PFLAG leaders and group members don’t necessarily know any more than anybody else about transgenderism, and most often are motivated to affirm and confirm their own decisions.

In my view, PFLAG has entered the trans arena with an approach and philosophy that will not serve it well for the long-term.  Transgenderism is not just “super-gay,” and the “empathetic parent” model that worked so well back in 1984 is increasingly irrelevant in a context involving permanent, serious and potentially disfiguring medical decisions.  Especially where PFLAG is seen as endorsing childhood or teen transition, eventually there will be consequences.  It will be sad to see an organization that did so much good for so many in the last century, come to grief in this one.

 

pflag-then-and-now

Then….                                                                                            …and now

 

 

 

Shriveled raisins: The bitter harvest of “affirmative” care

by the parents of 4thWaveNow

Note to readers: This is another in an ongoing series of posts which shine a light on the public statements made by gender specialists in various forums. The aim here, as always, is to inform the public, particularly parents, about the actions and self-reported thoughts and plans of individuals who are currently involved in providing hormones and surgeries to minors. All screen captures are from publicly accessible (i.e. not password-protected or otherwise private) websites. We intend to continue to exercise our free-speech right to report on these public statements, as well as publishing our personal opinions on pediatric transition and those who enable and promote it.

To anyone who may object to our work in this area, hear this: The backlash represented by 4thWaveNow, Transgender Trend, Youth Gender Professionals, and the increasing number of individuals and organizations who question the burgeoning increase in child and youth transition is precisely that: a backlash against the decision taken by trans activists and their media handmaidens to relentlessly promote pediatric transition—especially MEDICAL transition.

The final straw, for many of us, has been the shameless and daily attempts by activists, journalists, and some clinicians to misuse self-harm statistics as a weapon to bludgeon parents into submission. A recent article in Spiked Online exposed this immoral and deeply destructive tactic, and we will continue to expose it on 4thWaveNow.


Scattered through the posts on this site, we have discussed the fact that puberty blockers followed by (or used concurrently with) cross-sex hormones to prevent the “wrong puberty” in prepubertal kids results in irreversible sterilization. This is well-recognized fact, openly acknowledged by researchers and top pediatric gender specialists alike [see the bottom of this post for a collection of links on this matter].

rainbow-health

The reason is that gametes (sperm and ova) require natural, biological puberty to mature to the point that they are viable for reproduction. It is not currently possible to freeze immature gametes, as it is for those of adult trans people who have been allowed to go through natal puberty.

Our point is not that anyone and everyone should have biological children or that women are only fit to be baby machines (a red herring “argument” that has been used against us by trans activists). It also has nothing to do with the demographics of who will ultimately decide to bear or father children. (I notice none of these activists cavalierly argue for sterilization of disabled or gay people, both of whom have a lower statistical rate of becoming biological parents). The point is that it is a human rights violation to sterilize minors, who by definition cannot consent nor understand what it means to give up that future right.  And given that the majority of “persisting” trans kids are same-sex attracted, it is not a stretch to see that prepubescent sterilization of “trans kids” amounts in many cases to a form of proactive anti-gay eugenics—even if that is not the conscious intention. What’s more, as many parents know, the decision to reproduce may come later in life, even if we thought in our youth that we wouldn’t have wanted children. Most young people naturally don’t spend their time thinking about having kids of their own; they have other priorities at that stage of life, as well they should.

But does any of this matter if adult trans people aren’t particularly interested in reproduction?

trans-men-want-children

Well, it turns out that several studies have shown that a majority of trans men and trans women desire to have biological children of their own. 

 

But even setting aside research evidence, all you have to do is look at the increasing number of (sometimes sensationalized) media stories about “pregnant men” to know this is “a thing”.

There are a sufficient number of trans men becoming pregnant and giving birth that the premier midwifery organization in the United States has changed all its literature to be “gender neutral” in an ostensible effort to avoid “triggering” its clients with words like “woman” and “breasts.” Planned Parenthood now campaigns on behalf of “menstruators” and the venerable La Leche League has even scrubbed its language of inconvenient mentions of biological reality, to ensure that trans men who want to “chest feed” won’t feel excluded.

la-leche-chestfeeding

But when it comes to the fertility of trans people,  trans activists want to have their cake and eat it too: Celebrate and support adult trans who decide (often unexpectedly) to reproduce, while fiercely lobbying for medical intervention which permanently sterilizes prepubescent children. There is really no way to square this contradiction. They constantly claim that stopping the “wrong puberty” is the only antidote to suicide, yet that “wrong” puberty is the one and only pathway to possible reproduction in the future.

Not to put too fine a point on it, but the very people arguing that the only alternative to these sterilizing pediatric treatments is suicide are very much alive, and quite a fair few of them (notably, several top MTF trans activists) have biological children of their own. “Do as I say, not as I do” is rightly ridiculed as hypocrisy when it comes to any other subject. How on earth did these people survive to adulthood, father children, yet now harangue us that the “wrong” puberty of these children must be stopped?

As to the weaponization of suicidality: There is no record in the history of medicine of children and teenagers killing themselves because they could not medically transition in childhood, or because they were “born in the wrong body.” (Since August when this piece was posted, we’ve been waiting for any evidence to the contrary.) Even the most frequently cited “41%” study of trans adults who have reported suicidal ideation doesn’t assert that medical transition cures suicidality.


So, given that

  • large numbers of adult trans men and women express a desire to have biological children;
  • no child or pre-adolescent can know for certain whether or not they will eventually want to reproduce;
  • it is a universally acknowledged human rights violation to sterilize minors;
  • and there is no evidence that early medical transition will ultimately reduce self harming behaviors,

we must ask: Why do gender specialists continue the reckless practice of promoting sterilizing hormones and surgical interventions on prepubescent children, who, by virtue of their undeveloped powers of reason and judgment, cannot meaningfully consent to such treatments? On what authority does any adult—including these children’s parents—have the right to make a decision for a minor that should solely belong to adults of reproductive age themselves?

Even if it turns out to be true that most of these kids won’t opt for biological reproduction in the future, what of the (already limited) pool of potential life partners they might fall in love with? It’s not at all uncommon for couples to part company over disagreements about whether to have children. And then there’s the issue of what genital surgeries do to sexual response and function. None of this is ever discussed in the glowing portraits of “trans kids” that we see daily in the mainstream media (though it is by the clinicians themselves—as you’ll see shortly).

The gender specialists are fully aware of the irreversible effects of their interventions. Gender clinics detail the risks of infertility and other permanent changes on their consent forms. Research articles, public statements, and news articles capture the admissions by prominent gender specialists (again, see the bottom of this piece for links). Some express reservations (but no accompanying intention to cease and desist or even slow down their caseloads); some mention it in passing. And some, as you’ll see in a moment, appear to lose no sleep at night over what they’re doing, but only express interest in the future market for even more high tech interventions for the young people entrusted to their care.

Last March, Johanna Olson-Kennedy, MD (herself a parent), one of the world’s most successful and best known pediatric gender specialists, posted a call on the publicly accessible WPATH Facebook page for earlier genital surgeries on minors. We wrote about it at the time in this post.

Olson orig post.jpg

The irony is inescapable: By puberty blocking young people, endocrinologists create a situation where these youth naturally yearn for puberty, as they watch their unblocked peers mature and move on. Olson-Kennedy’s solution? More high-tech, expensive medical intervention; earlier cross-sex hormones, earlier sex reassignment surgery. An iatrogenic problem created in the first place by suppressing the perfectly healthy bodies of young people.

Just a few days ago, Olson’s original post was revived via several new comments supporting her radical idea. This one, by Susan Maasch, founder of the Trans Youth Equality Foundation (TYEF) is particularly striking. ( We wrote about TYEF—a purveyor of free breast binders (secretly to girls with “unsupportive” parents) and youth transition propaganda, last year.)

shriveled-raisins

“Shriveled raisins”: The outcome of years of hormone treatment unnatural to the female body.

Other activists and pediatric gender specialists, including Rixt Luikenaar (ironically, an OB-GYN), Kathie Moelig (founder of TransFamily Support Services), and others acknowledge that sterilization (which their clients may someday regret) will result from early surgeries and hormones, but place their faith in high-tech medicine to find a way around it—eventually.

rixt-et-al-on-sterlization

This unquestioning belief that medical technology will solve the problems created by zealous “affirmative” gender specialists is widely shared.  Just a couple of days ago, NPR ran an article acknowledging that immature gametes can’t currently be preserved for future reproduction. But by drawing on fertility preservation research  in cancer survivors treated with sterilizing chemotherapy, the pediatric-transition pushers hope that  puberty-blocked children’s ova and sperm can eventually be coaxed to reproductive viability in a petri dish.

Both groups — young cancer patients and trans kids hoping to transition early — have a demand for fertility preservation at an age where it has not usually been possible. But researchers say they are drawing closer to a solution with new techniques to freeze, or cryopreserve, immature reproductive cells…

… they started to look for ways to grow that tissue in a petri dish, so it can develop into a mature egg. “We’ve had to borrow knowledge from other disciplines and sort of figure out how that applies to trans people … What can be frustrating sometimes is having to adapt and extrapolate all of this information from work that is not done for trans people.” — Zil Goldstein, Mount Sinai

Brave New World. Puts a whole new spin on “test tube babies.” Not to mention a future boost for the surrogacy industry.

No one in the mainstream media—in this case, NPR– seems willing to point out the obvious: If you let these kids simply mature naturally–as their healthy bodies are desperately fighting to be allowed to do–they can preserve their fertility and decide whether they want to choose hormonal or surgical interventions when they reach adulthood,  with mature judgment and reasoning powers. There would be the added benefit of giving kids a chance to desist before it’s too late—as so many were allowed to do before “gender affirmative” treatment was advertised 24 hours a day, 7 days a week.  Only a few years ago, this would have been seen as just common sense caution. Adults-only transition was the norm.

There are other ramifications besides infertility resulting from this reckless rush for earlier and earlier surgeries and hormonal treatments.  Here, Olson-Kennedy and other commenters analyze the impact of surgeries on sexual function—but disagree on how much should be discussed with the kids themselves about their future orgasm potential after their genitalia have been surgically rejiggered.

olson-orgasm

At least one “practitioner” seems not to want concerns about orgasm potential to be a “hindrance” to  a child achieving their “authentic self”:

low-orgasm

Bringing us into 2017, Jenn Burleton, head of Transactive Gender Center, assured the Facebook group on January 18 that orgasm is a discussion topic amongst “caregivers” in Transactive support groups. Good to know parents and other adults feel empowered to make decisions for these kids about their adult sexual function and fertility in their “support groups.”

Burleton orgasm.jpg

(Just a thought: how many of these people publicly pontificating about the sexual function of children consider how they’d have felt as teens if adults had been scheming about their orgasm potential, and the impact thereon from a surgeon’s scalpel?)

In January 2017, nearly a year after Olson-Kennedy’s original post calling for the WPATH Standards of Care 8 to support earlier genital surgeries, many clinicians, activists, and parent leaders of trans youth groups remain keenly interested in lowering age of surgeries for youth. From the sounds of it, “many many” surgeons are eager to oblige.

maasch-et-al-earlier-surgeries

Dan Karasic, MD, director of a gender clinic at UC San Francisco, moderator of the WPATH Facebook page,  and a key player in WPATH and the co-chair of the recently formed USPATH, helpfully informs us  that a discussion on under-18 surgeries will take place at the inaugural USPATH conference February 5 2017. “Advocacy” to pressure insurance companies to get onboard and pay for genital surgeries on minors is also an important part of the discussion.

This isn’t the first time we’ve seen Dr. Karasic advocating for lowering the age for surgeries. In this post, we discussed his public support for a mother obtaining double mastectomy for her 15-year-old and her attempts to get her insurance company to foot the bill for it.

Again: The people advocating for drastic and irreversible medical interventions on minors have enormous power over the future lives of children. The decisions they have taken with their careers and activism will impact a generation of youth for a lifetime. These adults, trans or not, were allowed to mature without medical interference in the era preceding this Age of the Trans Child.

Some of the people weighing in are trans adults, among them MTFs who have fathered children and had successful careers, who were not subjected to tampering and scheming about their most private and personal bodily functions as children. And as much as the trans activists may claim they’d have welcomed such interventions as children, the fact remains: Somehow they made it to adulthood, fertility and sexual function intact, without killing themselves.

Exactly what authority gives these people the right to advocate for and perform medical experiments on children, “trans” or not? This is a question a lot more people need to be asking.

Meanwhile, the USPATH conference  session on surgery in minors is on Sunday, February 5 at 10:15 AM  in Los Angeles.

Readers will undoubtedly recognize some of the names on this panel.

uspath-minor-surgery-1


For more information about the irreversible sterilizing effects of puberty blockers followed by cross-sex hormones on prepubescent children, see below. Readers contributions are welcome and will be added to this list.

Sahar Sadjadi, The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?

It must be remembered that puberty suppression as the first step to medical transition, if followed by cross-sex hormones, which has been the case for almost all reported cases, leads to infertility due to the permanent immaturity of the gonads and the reproductive tract. The absence of the discussion of sterilization of children as a major ethical challenge in this bioethics article, and many other clinical debates on puberty suppression, is striking. For any other group of children, such an intervention would be discussed extensively with ethics review boards. (What grounds might justify the permanent elimination of the child’s reproductive ability? Should parents be able to make such a decision for the child? Which futures are opened by the treatment and which ones are foreclosed? How might benefits be weighed in relation to the loss of reproductive capacity?) The media would likely react with investigations and questions about the long-term consequences of treatment. These “queer” children’s bodily integrity and reproductive rights should not be any less pressing than other children’s. Needless to say, children are not legally capable of consent, and 9–10 year olds are not capable of understanding all the health consequences of the treatment. Parents are asked to make life decisions on issues as critical as fertility for young children. Can they make an informed decision and evaluate benefits vis a vis risks when confronted with such horrendous forecasts for their children?

 Unique ethical and legal implications of fertility preservation research in the pediatric population

 Norman Spack, MD, founder of first US pediatric gender clinic:

The biggest challenge is the issue of fertility. When young people halt their puberty before their bodies have developed, and then take cross-hormones for a few years, they’ll probably be infertile. You have to explain to the patients that if they go ahead, they may not be able to have children. When you’re talking to a 12-year-old, that’s a heavy-duty conversation. Does a kid that age really think about fertility? But if you don’t start treatment, they will always have trouble fitting in. And my patients always remind me that what’s most important to them is their identity.

Brill & Pepper, The Transgender Child, 2008, p. 216

“The choice to progress from GnRH inhibitors to estrogen without fully experiencing male puberty should be viewed as giving up one’s fertility, and the family and child should be counseled accordingly”. For girls, sterilization is the outcome too, because “eggs do not mature until the body goes through puberty”

Diane Ehrensaft, video clip from conference. Time stamp: 5:06

“Another thing that’s a show-stopper around [parents] giving consent is the fertility issue. That if the child goes directly from puberty blockers to cross- sex hormones they are pretty much forfeiting their fertility and won’t be able to have a genetically related child.”

Robert Garofolo, PBS.org:

“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.