Policy shift in Finland for gender dysphoria treatment

The international activist group SEGM, the Society for Evidence-Based Gender Medicine, has published a review of a radical shift in the standards of care for gender dysphoric children in Finland. A year ago, the Finnish Health Authority issued new guidelines which back psychotherapy, rather than puberty blockers and cross-sex hormones, as the first-line of treatment. It took this step after a systematic review of the evidence which found the evidence for paediatric evidence “inconclusive”. Here are a few excerpts from SEGM’s summary. Although pediatric medical transition is still allowed in Finland, the guidelines urge caution given the unclear nature of the benefits of these interventions, largely reserving puberty blocker and cross-sex hormones for minors with early-childhood onset of gender dysphoria and no co-occurring mental health conditions. Surgery is not offered to those <18. Eligibility for pediatric gender reassignment is being determined on a "case-by-case basis" in two centralized gender dysphoria research clinics. The Finnish guidelines warn of the uncertainty of providing any irreversible "gender-affirming" interventions for those 25 and under, due to the lack of neurological maturity. The guidelines also raise the concern that puberty blockers may negatively impact brain maturity and impair the young person's ability to provide informed consent to the subsequent and more irreversible parts of the Dutch protocol: cross-sex hormones and surgeries. The Finnish guidelines reflect the growing international concern about the unexplained sharp rise in adolescents presenting with gender dysphoria, which is occurring in increasingly complex developmentaland mental health contexts, and often without a childhood history of gender-related distress. There are significant questions as to whether the Dutch protocol (hormonal and surgical interventions for youth), designed for a distinctly different population of high-functioning teens with childhood-onset cross-sex identification and with no significant mental health comorbidities, is appropriate for this novel population. The Finnish Health Authority states that the guidelines will not be further revised until research is able to: explain the recent sharp rise in adolescents presenting with gender dysphoria; determine whether transgender identities in this population are stable or will evolve; assess whether gender-affirming treatments are able to improve health outcomes of those who present with co-occurring mental health problems, including improvements in depression and suicide; and quantify the rate of regret. h/t to Bioedge

London newspaper reveals ‘shocking evidence’ about transgender treatments

After a legal battle The Mail on Sunday has published what it called “shocking evidence” about transgender medicine which led a High Court judge to ban a government gender clinic from prescribing puberty-blockers. The Gender Identity Development Service (GIDS) clinic in London, also known as the Tavistock Centre, began prescribing these for children under 16 in 2011. In December the clinic was forced to stop after the Court ruled that it was “very doubtful” that youngsters could give informed consent. Swedish psychiatrist Christopher Gillberg testified that the use of puberty blockers is basically “a live experiment” on vulnerable children. “In my years as a physician,” he wrote, “I cannot remember an issue of greater significance for the practice of medicine. We have left established evidence-based clinical practice and are using powerful life-altering medication for a vulnerable group of adolescents and children based upon a belief.” According to the newspaper, the evidence of Gillberg and other experts was that: Puberty-halting drugs can harm a patient's brain and bone development; Clinics are urging gender-changing teen girls to choose sperm donors to fertilise eggs before freezing them; Medics are failing to warn about the infertility risks posed by puberty blockers; Children who regret treatment find themselves “locked” into new bodies; Internet sites persuade autistic children that they are transgender when they simply have “identity issues”. The Tavistock centre has had a 60-fold increase in requests for its services over the past 15 years. Judges were told that there had been a steep rise in the number of girls aged 12 to 17 requesting help and that they outnumbered biological males wanting to transition by two to one. Doctors also testified that there was a “disproportionate number” of children across the world claiming trans identities who were in care, adopted, autistic, anorexic or had psychiatric or mental illnesses. The evidence included testimony from dozens of young women who claimed that their lives had been ruined by sex change treatments. Lucy, a woman who underwent sex change surgery, described herself as “mutilated”. “I'm horrified that when I went for the hysterectomy they didn't emphasise to me how important these organs are. Now it's too late. I'm 23 and I am basically in menopause and all the health implications that come with that. I can't comprehend how doctors could let this happen.” Professor Stephen Levine, an American expert in the field of gender treatment, testified that “there was no other field of medicine where such radical interventions are offered to children with such a poor evidence base”. He also claimed that treatment was taking place in such a “toxic and febrile context that critical and cautious voices are shouted down as transphobic, hateful and engaging in conversion therapy. “Such a climate has created an intimidating and hostile environment where silence and acquiescence are the inevitable consequence. It is left to those of us at the end of our careers, who have nothing to lose, to voice our concerns.' “Scientific requirements for establishing an intervention's utility are well known in medicine,” he said. “Advances are undertaken through carefully controlled clinical trials. Why should gender problems be considered an exception?” The director of GIDS, Dr Polly Carmichael, insisted in her submission to the High Court that all the potential side effects and impacts were explained to young people by clinicians before referring them for puberty blockers. She submitted that the primary purpose of puberty blockers was to give a young person time “to think about their gender identity”. Conservative peer Baroness Nicholson, a former director of Save The Children, told Mail on Sunday: “Puberty blockers are... a harrowing, physical destructive experiment on immature boys and girls. It closes normal development in favour of a painful life and a curtailed barren future – the NHS should never have allowed such unresearched use of public money on irremediable surgery on healthy bodies.”

Gender dysphoria soars in Sweden

by Michael Cook | 23 Feb 2020 |

The number of teenagers born as girls who have been diagnosed with gender dysphoria has increased by almost 1,500 percent in ten years in Sweden, according to a report from the Board of Health and Welfare (Socialstyrelsen).

The report examines mental health and the rise of gender between 2008 and 2018. In that time the number of natal men aged 18-24 diagnosed with gender dysphoria grew by 400 percent. The biggest increase was amongst natal girls between 13 and 17, which grew by 1,500 percent. Nearly 6,000 people were diagnosed with some kind of gender dysphoria in Sweden in 2018.

"There is no doubt that there is a clear increase, but we do not know what causes the increase," Peter Salmi, an analyst at the Board of Health and Welfare, said in a statement.

The government figures show that people with gender dysphoria are more at risk of death by suicide than the general population. But they also show that people with other psychiatric diagnoses are at even higher risk of suicide than people with gender dysphoria.

"People with gender dysphoria who committed suicide also had very high incidence of concurrent difficult psychiatric diagnoses, making it difficult to distinguish one from the other in terms of suicide risk," said Salmi.

Michael Cook is editor of BioEdge

Biologists question transgender claims

by Michael Cook | 23 Feb 2020 | Two biologists have denounced “sex denialism” in a Wall Street Journal op-ed. Colin Wright, of Penn State University, and Emma Hilton, of the University of Manchester, argue that the existence of only two sexes, male and female, is a scientific fact and that transgender ideology is “an eccentric academic theory”. As they point out, even science journals are promoting a non-binary view of sex. “The idea of two sexes is simplistic,” Nature declared in 2015. “Biologists now think there is a wider spectrum than that.” A 2018 Scientific American article asserted that “biologists now think there is a larger spectrum than just binary female and male”. And in 2018 the New York Time explained “Why Sex Is Not Binary”. Wright and Hilton describe such views as “a dangerous and anti-scientific trend towards the outright denial of biological sex”. They continue, “To characterise this line of reasoning as having no basis in reality would be an egregious understatement. It is false at every conceivable scale of resolution.” This is no longer a laughing matter, they argue: The time for politeness on this issue has passed. Biologists and medical professionals need to stand up for the empirical reality of biological sex. When authoritative scientific institutions ignore or deny empirical fact in the name of social accommodation, it is an egregious betrayal to the scientific community they represent. It undermines public trust in science, and it is dangerously harmful to those most vulnerable.

New Vatican document says gender theory is 'cultural and ideological revolution'

Vatican City, Jun 10, 2019 / 08:35am h/t CNA

A Vatican department has issued a sweeping denunciation of so-called gender theory, and affirmed the principles of human dignity, difference, and complementarity.  

“In all such [gender] theories, from the most moderate to the most radical, there is agreement that one’s gender ends up being viewed as more important than being of male or female sex,” the Congregation for Catholic Education wrote June 10, in a new document entitled “Male and Female He Created Them.”

“The effect of this move is chiefly to create a cultural and ideological revolution driven by relativism, and secondarily a juridical revolution, since such beliefs claim specific rights for the individual and across society.”

The document says it aims to set out an intellectual framework “towards a path of dialogue on the question of gender theory in education.”

Published at the beginning of “Pride Month,” during which many cities and corporations mark the campaign of LGBT advocacy, the document says that the Church teaches an essential difference between men and woman, ordered in the natural law and essential to the family and human flourishing.

“There is a need to reaffirm the metaphysical roots of sexual difference, as an anthropological refutation of attempts to negate the male-female duality of human nature, from which the family is generated,” the document explains.

“The denial of this duality not only erases the vision of human beings as the fruit of an act of creation but creates the idea of the human person as a sort of abstraction who ‘chooses for himself what his nature is to be.’”

The text, signed by Cardinal Giuseppe Versaldi, prefect of the Congregation for Catholic Education, outlines the philosophical origins of the gender theory movement, and notes the broad movement to enshrine its distinct anthropology in policy and law.

The Congregation explains that, beginning in the middle of the twentieth century, a series of studies were published which proposed that external conditioning had the primary determinative influence on personality. When such studies were applied to human sexuality, the document says, they did so with a view to demonstrating that sexuality identity was more a social construct than a given natural or biological fact.

“These schools of thought were united in denying the existence of any original given element in the individual, which would precede and at the same time constitute our personal identity, forming the necessary basis of everything we do.”

“Over the course of time, gender theory has expanded its field of application. At the beginning of the 1990s, its focus was upon the possibility of the individual determining his or her own sexual tendencies without having to take account of the reciprocity and complementarity of male-female relationships, nor of the procreative end of sexuality,” the document says.

The result was a “radical separation between gender and sex, with the former having priority over the later.”

The problem with this theory, according to the Congregation, is not the distinction between the two terms, which can be properly understood, but in the separation of the two from each other.

“The propositions of gender theory converge in the concept of ‘queer’, which refers to dimensions of sexuality that are extremely fluid, flexible, and as it were, nomadic.”

The result of this ideological trend, according to the Congregation’s assessment, is an undermining of the family.

“[In gender theory] the only thing that matters in personal relationships is the affection between the individuals involved, irrespective of sexual difference or procreation which would be seen as irrelevant in the formation of families.”

“Thus, the institutional model of the family (where a structure and finality exist independent of the subjective preferences of the spouses) is bypassed, in favor of a vision of family that is purely contractual and voluntary.”

The document said that despite the challenges, dialogue remains possible. It also called for protection of human and family rights, decried unjust discrimination, and noted points of unity among people of divergent perspectives on gender ideology.

“For instance, educational programs on this area often share a laudable desire to combat all expressions of unjust discrimination, a requirement that can be shared by all sides,” the document said.

“Indeed, it cannot be denied that through the centuries forms of unjust discrimination have been a sad fact of history and have also had an influence within the Church. This has brought a certain rigid status quo, delaying the necessary and progressive inculturation of the truth of Jesus’ proclamation of the equal dignity of men and women, and has provoked accusations of a sort of masculinist mentality, veiled to a greater or lesser degree by religious motives.”

The aim of the Church at the institutional and individual level must be the education of children in line with authentic principles which defend and instil authentic human dignity, the Congregation explains.

“In practice, the advocacy for the different identities often presents them as being of completely equal value compared to each other.”

“The generic concept of ‘non-discrimination’ often hides an ideology that denies the difference as well as natural reciprocity that exists between men and women.”

Referencing classical philosophy, historic Church teaching, Vatican Council II and the writings of several popes, the document explains the Church’s understanding of a Christian anthropology, insisting that it be at the heart of human formation.

For Christians working in schools, both religious and secular, the radical individualism of gender theory should be avoided in favor of teaching children “to overcome their individualism and discover, in the light of faith, their specific vocation to live responsibly in a community.”

Above all, the document says, the family remains “the primary community” to which the students belong and the fundamental vehicle for preserving, understanding, and transmitting human dignity.

“The school must respect the family’s culture. It must listen carefully to the needs that it finds and the expectations that are directed towards it.”

In the modern context, however, the essential alliance between school and family “has entered into crisis,” the Congregation notes.

“There is an urgent need to promote a new alliance that is genuine and not simply at the level of bureaucracy, a shared project that can offer a ‘positive and prudent sexual education’ that can harmonise the primary responsibility of parents with the work of teachers.”

“Although ideologically-driven approaches to the delicate questions around gender proclaim their respect for diversity, they actually run the risk of viewing such difference as static realities and end up leaving them isolated and disconnected from each other,” the document concludes.

Promoting a culture of dialogue between the Church and those advancing gender theory principles must take place, the document says, in a manner that respects “the legitimate aspirations of Catholic schools to maintain their own vision of human sexuality,” based on “an integral anthropology capable of harmonizing the human person’s physical, psychic and spiritual identity.”

The congregation ends by insisting on the rights of the Church, the family, and of Catholic educators to defend authentic teaching and understanding in the face of an increasingly exclusivist approach to education in line with secular progressive principles.

“A democratic state cannot reduce the range of education on offer to a single school of thought, all the more so in relation to this extremely delicate subject, which is concerned on the one hand with the fundamentals of human nature, and on the other with natural rights of parents to freely choose any educational model that accords with the dignity of the human person.”

Is denying transgender rights a kind of torture?

h/t Bioedge

Street mural in Brussels    

A completely different way of viewing transgender issues comes from the Oxford Human Rights Hub. Geoffrey Yeung, a Hong Kong activist studying at Oxford, argued last year that restrictions on transgender people are banned by the United Nations Convention Against Torture (CAT). He pointed out that

Many countries ... impose heavy burdens (such as sterilisation, surgery, hormonal treatment and psychiatric diagnosis) on transgender people before they can legally be recognised in their preferred gender ... [The Committee Against Torture has] explicitly recommended the repeal of “abusive” preconditions to legal gender recognition and called for respect for transgender people’s “autonomy and physical and psychological integrity”. 

The UN’s Special Rapporteur on torture, Juan E. Méndez, has given this interpretation of the Convention his blessing. “We have a tendency to regard violations against these groups as ill-treatment even where they would more appropriately be defined as torture,” Mr. Méndez said in a report to the Human Rights Council about gender-based violence.

Even if transgenders are not getting the bastinado, Yeung points out that what they experience in many countries is a kind of psychological torture:

It is important to make clear that what constitutes systematic ill-treatment (and thus torture under the CAT) is the legal requirement that all transgender people must undergo certain forms of medical or surgical treatment — regardless of their personal desires or medical necessity — to be recognised in their preferred gender.

If sex reassignment surgery is the answer, what is the question?

Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?

The answer to this theoretical question has practical consequences. If it is a therapy, then transgenderism is a disease. If it is an enhancement, then it hardly deserves to be funded by the government.

In a very interesting article in the Journal of Medicine and Philosophy, Tomislav Bracanović, of the University of Zagreb, in Croatia, analyses the competing conceptions.

Transgender scholars contend that sex reassignment surgery is not a therapy for gender identity disorder, because the feeling of being a man in a woman’s body or a woman in a man’s body is not a disorder. It is a “normal, albeit rare, human condition that is medicalized as a consequence of general discrimination of transsexual population. It should be removed, therefore, from all classifications of mental disorders, and sex reassignment surgery should be made available without medical “gatekeepers” deciding who qualifies for it and who does not.”

Their conclusion is that a sex change is no more a therapy than a “nose job”. They would prefer to describe sex reassignment surgery as an enhancement, like cosmetic surgery.

But is it plausible to describe it as non-therapeutic enhancement? Bracanović believes that it is not. “It does not improve, augment, or increase—above average—any trait or function typically mentioned in philosophical debates about enhancement. Intelligence, vision, hearing, physical strength, and immunity, for example, after sex reassignment surgery remain more or less the same as they were before.”

There is another way of framing enhancement, though: the welfarist model – does it enhance quality of life? At first blush this seems plausible because people who have had the operation report more satisfaction and a decrease in dissatisfaction. However, Bracanović  points out that the evidence for this is weak. There have been very few long-term studies of postoperative transsexuals’s quality of life.

... imagine the “sex change drug” that has the same risk–benefit ratio as sex reassignment surgery. Even if it improved the condition of many clinical trial subjects, it would probably not be approved by any regulatory agency (as either “therapy” or “enhancement”), if a large number of subjects mysteriously disappeared from the trial after taking the drug.

So Bracanović concludes that it would be wise to keep the gatekeepers for this type of surgery and to restrict access to it. Given the current state of knowledge, there is too great a risk of harm to the patients. Furthermore, if it is an enhancement which increases a person’s well-being, as transgender scholars contend, it is obviously more like enhancement for artistic ability rather than curing paraplegia. With limited resources, society would normally focus on paraplegia rather than gender dysphoria. The only way to prioritise it above paraplegia would be to medicalise it and describe it as a serious disorder – which theorists vehemently reject.

h/t Bioedge