The problem with any debate about Gender Affirming treatment is the ferocity with which the majority of the media, many politicians, medical associations, educational associations and particularly the activists have pushed against it.

There is also a devotion in many circles, including education, and apparently even the medical profession to Gender/Queer Theory, which if delved into makes no logical sense whatsoever.

My biggest concern is thewhole concept of "Gender Affirmation". If we are serious about all the confusion, mental health issues and bodily changes that occur in young adolescents (particularly females) any thought of rapid progression through the gender/sexual changing system is antithetical to appropriate medical evaluation and treatment. There are no other medical, bodily or psychological conditions that I am aware of that we allow patients to diagnose themselves, and we treat them with potentially life-altering medications and/or surgeries without a full spectrum of diagnostic investigations. There is also the question of the huge increase in gender confused children, especially young females, who by nature have many body affirming issues to begin with. With the rise of social media and the inculcation of Gender theory in education is it any wonder there is such an increase, and questions should arise about what is true Gender Dysphoria and what is a confused child?

We also have to be very honest about what transitioning means. Males and females are not interchangeable, men cannot get pregnant or have periods, and the future for those who do transition and regret it later can be very bleak.

If those serious conversations are not explored because medical professionals, politicians and educators are too timid about being called "transphobes" then we will potentially have another Opioid Crisis in the making.

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Speaking here as a mental health professional, I completely agree with all you have said.

There currently are two problems with respect to treating gender dysphoric children. The first is identifying who are the "real" cases of gender dysphoria. I suspect that there aren't many more of them than there were 30 or more years ago, even though the condition is less stigmatized now than it was then. We need to rigorously investigate this condition, about which we know little.

The second problem is that a mental health epidemic has been confirmed to exist among adolescent girls and young adult women in the U.S. The psychologist Jonathan Haidt and his colleagues have published results of their research into this problem, and their conclusion is that this epidemic is more prevalent among young women who identify as politically liberal. The investigators found, however, that this demographic spends more time on social media than any other group of young people, and this variable was the one most related to reported depression, anxiety, suicidal ideation and self-harm.

Trans women are obviously among the most popular celebrities on social media, and are "followed" by staggering numbers of adolescent girls and young women. If the followers suddenly decide they themselves are "trans" or "nonbinary, etc., and these same followers also report a host of other serious psychiatric symptoms, healthcare professionals should be seeing flashing neon red flags. They should also expect that the young women are completely familiar with personal accounts of gender transitions, and that they are completely capable of pulling off a performative "trans" presentation.

Even if we can get all these "extra" cases channelled to psychotherapeutic and body preserving treatments, many questions still remain about the treatment of children who would have developed gender dysphoria in the more distant past, before social media took over the lives of so many girls.

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The word apologetics comes to mind when I read this article, but I’m not sure why.

This sounds like someone trying to save themselves, when they realize that what they have been doing is wrong, misguided, and maybe even evil.

The author appears to want to have it both ways, and to save herself.

Suing states re school systems that hide and (abet) some critical aspect about a child/student’s life from parents is a good thing, but it doesn’t make up for what she has been doing otherwise.

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It sounds from your comment as if, long before you read her piece, you’d already made up your mind that what she’s doing is “wrong, misguided, and maybe even evil.” Reasonable, well-meaning people (including medical professionals) can differ on the best approach to providing care and support to transgender youth - while still firmly believing they need care and support.

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“Reasonable, well meaning people . . . care and support” - The same could be said about lobotomies.

I concur with most of Lisa Selin Davis’s ideas on the subject. See also Michelle Zacchigona’s recent post on Public.

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That could also be said about what type of breast cancer treatment is best for an individual patient, or whether to perform prostate surgery on an elderly man, or at what point to prescribe medication or lifestyle changes to treat high blood pressure….the list goes on. Also, it’s interesting that you brought up lobotomies. If you’re using that as an example of an irreversible, potentially harmful surgery (which it is), one might conclude that you’re thereby arguing for extreme caution in performing similarly irreversible, potentially harmful gender reassignment surgery on minors. Which is precisely the position being taken by the author of this piece.

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Mar 29, 2023·edited Mar 29, 2023

Differences of opinion regarding breast cancer treatments or those other problems are fundamentally different from the issue of medical transition of children. They are not fronts in the culture wars, and the debates are among professionals who know what they're talking about. Nor are the deliberations married by efforts to shut down debate. "The science is Settled!" "You're just saying that because you're a [insert one or more of [Bigot|Homophobe|Transphobe|Communist|Wokeista]."

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A bit off-topic and likely politically antithetical to my opinions, but I believe lobotomies were introduced as treatment for chronic severe psychosis at a time when no other effective therapy was available, and probably provided very substantial relief. Unfortunately, its use expanded too broadly over time, and the practice continued long after it should have ceased.

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Mia Ashton’s piece, today, on Public takes a much more balanced, rational, and human approach to “transitioning” children.

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Thanks for the tip about the piece on Public. I have -- foolishly, given the posture of the mainstream media on this issue -- searched for articles in my hometown paper, the Washington Post, that take a balanced, nuanced view of teenage gender uncertainty and gender affirming treatment. It's all feel good stories about trans kids and "haters" in the red states passing laws to prohibit under-age gender affirming treatment -- a cartoonish approach that any halfway rational reader is likely to find inadequate. But I am glad to see the NY Times apparently taking a different tack, and will seek out the piece referred to by Dr. Anderson if I can figure out a way around the paywall.

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It is very worthwhile to dig into this madness. You will learn a lot. The most important thing is that this is not some innocuous grass roots effort. It has been a well funded top down campaign to normalize and encourage transgenderism. My eyes opened wide especially when I realized it's the same playbook for other mass marketing campaigns...

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Mia Ashton's piece - a very good analogy. thanks.

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While I appreciate and agree with the author’s attempt to encourage a broader view, this article missed a few key points that must be addressed before any meaningful dialog can occur on treatment.

We need a serious debate about gender ideology. Like much of the narrative on this subject, this article presumes everyone agrees with the basic tenets. We do not. Many of us believe that sex is immutable, that we should bust male and female stereotypes instead of our biologic reality, that a tiny proportion of our society has emotional difficulty accepting their sex and these folks should have the best treatments available. Until 2013 individuals who experienced marked and persistent identification with the opposite sex were said to have “gender identity disorder”. The name was changed to “gender dysphoria” in 2013 and the medical institutions took the position that gender dysphoria was no longer a mental condition requiring treatment. It was not long before children were told they had a “gender assigned at birth” and sometimes the doctors got it right and sometimes they got it wrong.

We need a serious debate on why gender ideology and “gender affirming care” has been mass marketed to western society. Why is it that the government, schools, teachers’ unions, medical institutions, TQ+ lobbies and activists insist that kids be taught that sex is fluid and they can be a boy, a girl, both or neither and promote health destroying drugs when they listen. Do not insult our intelligence by saying that it was necessary to teach all kids they could change their sex so kids would not bully a very small percentage of primarily young boys who identified as girls.

We need a serious debate on the consequences of mass marketing gender ideology and “gender affirming care”. It did not take a PhD to see that social contagion would become a factor once the gender snowball got rolling. Nor did it take any imagination to predict that Big Pharma and sex change surgeons would jump into the game to vacuum up the profits. Anyone could also predict that influencers and/or groomers would target vulnerable kids on social media. These factors allowed the transgender campaign to self-perpetuate.

Considering how many schools and psychologists immediately “affirm” without the benefit of comprehensive psychological evaluation and in fact seek to eliminate the parents from the conversation, I am glad some states have banned sex change surgery and drugs for minors. Something must be done to protect these kids. In some cases, however, medicalization may be the correct answer and this alternative should be available, although it is hard to imagine anyone prescribing puberty blockers and/or cross sex hormones to kids before their brains are fully formed. The States that have banned medicalization should also address the core tenets of gender ideology. Otherwise, they just feed into the culture wars of the uninformed.

Ultimately it should be informed parents who decide if gender ideology is taught to their kids, not the government or teachers’ union and informed parents who decide upon the best treatment.

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Interesting, and well said.

Jordan Peterson, among others, has said that many health care professionals are compelled to affirm gender dysphoria. If this is so, it is very wrong.

I feel sorry for parents with kids with real gender problems, who must traverse an ideological minefield trying to get help.

The institutional capture of medical organizations is scary.

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From conversations I have had with a psychiatrist friend, treating a kid with GD is a minefield. This person says there is much pressure to affirm. Plus I believe certain states like California have passed "anticonversion" therapy laws which effectively tie the therapists hands. Dr Miriam Grossman has written good articles on this subject one of which is in the Federalist 11/11/21, "Therapists Have Betrayed the Parents of Gender Confused Kids and There'll Be Hell to Pay".

When I started researching the transgender campaign, ran across PITT on substack. Highly recommend and there are many examples of parents dealing with therapists who simply affirm even when other psychological conditions are present.

Totally agree about the medical organizations. How can one trust them when they are so easily manipulated?

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The trans author fails to disclose her own journey. At what age was she? Did she have top surgery? Bottom surgery? Can she have an orgasm or did surgery preclude that? Are her bones dust? There's a big difference between dressing the part and mutilating children. Does she live as a lesbian, homosexual, or bisexual? This article convinces me of nothing. I'm as skeptical of so-called gender affirming care as I was before I read it.

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I appreciate the reasonable and nuanced tone of Dr. Anderson's article, and couldn't agree more that what we need is a whole lot more debate, discussion and research about the nature of gender dysphoria. I am talking here about discussion within the scientific and healthcare communities.

One problem I have with the article is that the author repeats a belief that, "The truth is that nothing is binary about gender." I have no idea what Dr. Anderson means by this, because the term "gender" does not have a clear, consistently endorsed definition within the scientific community or elsewhere.

I am not going to engage in debate about that here, however, because the focus of controversy is primarily about medical interventions designed to create hormonal and cosmetic changes in patients' bodies. Prescribing cross sex hormones and performing gender surgeries is motivated entirely by the accurate perception that biological sex is binary, and the surgeries are in almost all cases undertaken to make the patient's body look more like the other of two sexes. How often does one find a male patient asking for a surgery that will result in him looking like "some other gender." On the contrary, he wants to live as a woman and pass as a woman, and he generally wants to be an attractive one. Conversely, females who request medical help with gender transitions are doing so because they want to look more like men.

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Gender means what they want it to mean. If you think about it, if gender is really fluid, why should someone need to change their sex, after all, you may feel differently the next day or the next year?

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Precisely. And if gender is entirely "socially constructed" why are concrete changes in the physical body necessary at all? Why not just isolate oneself in a cooperative social group that constantly constructs whatever one wants as an identity? This point can be argued all the more strongly if "gender is a way we feel about ourselves on the inside, and no one knows what our gender is until we tell them." It shouldn't matter at all then if the body/prison doesn't match the "feeling."

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Exactly. This is why Gender Theory is nonsensical in itself. Pushing this nonsense onto already anxious, body dysmorphic kids is lunacy.

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Yes, and it is also abusive. Especially for little kids who are in the process of figuring out how to relate to reality, parents who refuse to affirm their child's real sex may be damaging them for life. Nowadays, when new parents are asked about the baby's sex some of them say, "We aren't going to assign a gender." No one knows what this kind of negligence will do to children. (And obviously there are additional problems in the family, when parents use their own children in their social experiments).

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The road to Hell…

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I welcome your humane, reasonable, and exceedingly well-informed essay. I think your commentary is exemplary, but (speaking as an elderly, straight cis-male) I'm surprised by how central the issue has become for the national (and international) culture war. It's a topic of real personal concern, but only to a very small segment of the population, whereas a Martian trying to decipher contemporary human thought might conclude that it was the single most urgent and crucial matter facing Homo sapiens.

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This is a central issue in the culture war because kids are being sacrificed. I know that sounds harsh but a deep dive into the transgender campaign, gender dysphoria trends, sales figures, etc will reveal the truth of this statement.

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If you want to learn more about these issues, I highly recommend the work of Jesse Singal on the topic. Predictably, the TRAs nut cases have gone after him for daring to suggest that a degree of caution with respect to transitioning minors.

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Mar 27, 2023·edited Mar 27, 2023

Thank you Dr. Anderson for speaking up about this!

I do want to add some information:

1. "the research evidence for certain forms of care has come under question in several Western European countries" --the care under question is puberty blockers, hormones and surgeries (i.e., all the medical interventions that I am aware of). Some countries did not consider surgeries at the moment as they are focused on minors and don't provide surgeries to minors. The health agency for the State of Florida also did an umbrella review of the evidence and found it to be low or very low quality, and the Endocrine Society evaluations of the evidence behind their recommendations is low or very low (aside from confirming diagnosis of gender dysphoria, a set of symptoms, giving fertility preservation advice and taking into account physical health issues). The article referenced by Dr. Anderson gives a lot of useful detail, more can be found at segm.org which is tracking this information.

2. The assessment protocols people often follow are similar to those of the Dutch model, whose initiators found that those who did not meet their protocols later on did not want surgery (aside from one who just wanted breast enhancement but no longer genital surgery, and two more with unrealistic expectations), e.g. https://www.sciencedirect.com/science/article/abs/pii/S089085670960397X .

However, the long term outcomes of the young people who pass these assessments and who are medically treated is unknown. The Dutch Protocol study (de Vries 2014) only checked them about a year after surgery, close to the known honeymoon period. The long term outcomes of some have now been reported by the Dutch, described by Abbruzzese et al. (2023, https://www.tandfonline.com/eprint/XR7KI2WV7XC5GSUGGJUP/full), they are not promising for a large portion of the young people, e.g. ""the rate of cross-sex identification was not as stable as originally expected, with a sizable percentage reporting one or more instances of identity changes after treatment completion, especially among the individuals on the autistic spectrum (Steensma et al., 2022)." It is clear that some are very happy, witness Dr. Anderson herself. But it is not clear what the outcomes of those who pass these assessments is.

The Dutch protocol assessments required lifelong cross-sex identification (they didn't have the non-binary category), psychological stability, support of the family and a clear understanding of what the interventions would and would not do (e.g. see https://eje.bioscientifica.com/view/journals/eje/155/suppl_1/1550131.xml and also de Vries/Cohen-Kettenis 2012-- "If they speak about their natal son as being a girl [...]we stress that they have a male child who very much wants to be a girl, but will need an invasive treatment to align his body with his identity if this desire does not remit.").

I hope that Dr. Anderson will call for follow-up of those who have had these assessments, as the US version of these assessments was started in 2007, and so at this point one can actually look at or past the 8-10 year mark when adults who regretted or who had been mistaken about pursuing surgery came to this realization. It is possible that with young people it might take longer to reach long term outcomes as they are still changing and maturing. Hormones are taken for one's entire life, so these people can be tracked down. There should also be decent statistics: Reuters reports that over 17,000 minors were started on puberty blockers or hormones from 2017 to 2021 (https://www.reuters.com/investigates/special-report/usa-transyouth-care/ ).

Last but not least, I believe there is a suspicion that social transition makes gender dysphoria "stick". It's one thing to celebrate a feminine boy or a masculine girl exploring their ways of self expression, another to tell the person they are the other sex, a correlation seen in studies which needs understanding. As a result, the NHS proposed guidelines called for informed consent if adolescents were to undergo social transition, as do Levine et al. (2022). https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2046221

Psychotherapy (rather than assessment) has helped many people identify how their gender dysphoria arose and for for many, unlike Dr. Anderson, they realize medical intervention would likely not be beneficial. Many in the US are not aware of this fact, although the Gender Exploratory Therapy Association has a guide, webinars and more for clinicians, as well as names of clinicians one can consult for help. Many detransitioners regret not even knowing about this option before they undertook medical intervention.

This is a serious process and I am grateful to Dr. Anderson for speaking out about it!

Thank you again.

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