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The politicization of gender dysphoria

People protest U.S. President Donald Trump's announcement that he plans to reinstate a ban on transgender individuals from serving in any capacity in the U.S. military, in Times Square, in New York City, New York, U.S., July 26, 2017.
People protest U.S. President Donald Trump's announcement that he plans to reinstate a ban on transgender individuals from serving in any capacity in the U.S. military, in Times Square, in New York City, New York, U.S., July 26, 2017. | (Photo: REUTERS/Carlo Allegri)

Politicization of the medical profession proceeds apace, at least in the treatment of individuals suffering from gender dysphoria (GD) (“transgender” patients). Just how far some medical practitioners have slid into the depths of Anti-Science is apparent from a recent interview with endocrinologist Dr. William Malone, who excoriated the dangerous but burgeoning practice of so-called gender-affirming treatment (GAT) – administering puberty-blocking drugs and cross-sex hormones to these vulnerable patients.

The complete interview merits close attention. But one of Malone’s more striking points concerned the uniqueness of the current mindset toward treating GD. In their embrace of politically correct, not to mention highly lucrative, GAT, medical professional associations and many physicians now single out GD for treatment protocols that are not and would never be acceptable in any other area of medicine.

Malone explained to interviewer Benjamin Boyce the incontrovertible scientific case against GAT. Laying out evidence from unrefuted studies (such as in Circulation and Annals of Internal Medicine), Malone cited concerns about the role of testosterone in “massive” and “profound” increases in the odds of developing heart attacks for females who identify themselves as men, (13:00), and a highly significant 2-3 fold increased rate of blood clot and stroke development for males taking estrogen (16:15). 

Where else in medicine are such risks downplayed or ignored? No examples leap to mind.

But perhaps more frightening than the known risks are the unknown long-term consequences.  Malone agreed with the editor-in-chief of the British Medical JournalEvidence Based Medicine in observing that the absence of long-term studies means GAT is being implemented in the context of “profound scientific ignorance” about its effects (5:00).  Federally financed GAT enthusiasts claim to be examining such consequences by following patients for . . . five years. So if an 11-year-old is still happy with her “transition” and hasn’t suffered a heart attack by age 16, the researchers will declare GAT safe and effective. What happens to her at age 20 or 30 or 40 isn’t their concern.

Hacsi Horvath, a male epidemiologist who suffered through GAT and lived as a woman for 13 years before “detransitioning,” offers the darker suggestion that politicized practitioners don’t want to know the long-term consequences. “The existence of ‘regret’ and detransition is a huge thorn in their side,” he writes, “a threat to their ‘validity.’ This may be the reason that few studies bother to assess regret, or even keep good track of their patients, as is done in other areas of medicine that commonly maintain patients in long-term chronic disease care.”

But GAT activists apparently consider their area of practice exempt from the usual rules.

Malone explained that professional medical associations also single out GD for special treatment by clamping a cone of silence over the issue. He described the typical point/counterpoint format used at Endocrine Society conferences to educate members on, say, a new treatment for diabetes (30:15). Presenters use detailed PowerPoints to argue the pros and cons ad infinitum. Not so with GAT presentations. In that case, one speaker will present GAT as simply “the way [GD] is treated now” – no meaningful discussion about this highly controversial topic is facilitated. When physicians trust these associations to provide accurate scientific information, Malone says, “it’s a real shame” that they refuse to do so with respect to treating GD (35:00).

Malone makes a final, fundamental point about the special status awarded GD treatment by the medical profession:

                                [In all other medical/mental health practice], [i]f the mind and

                                the body are misaligned – so if the mind is at odds with material

                                reality (biological reality or some other reality) – we do everything

                                we can to get that individual back to foundational reality. But in

                                this situation, we’re essentially changing the body to match the

                                brain [mind] . . . . It doesn’t make any sense. It’s at odds with how

                                we practice medicine in any other aspect (17:00).

As analogized by Dr. Paul McHugh, former chief of psychiatry at Johns Hopkins Hospital, a physician would never recommend liposuction for an anorexic patient, no matter how insistent she is that her body is wrong and needs to be fixed. Treatment is dictated by reality, not feelings. But for GAT practitioners, feelings rule.

Could the difference between the two situations be the absence of a politically powerful lobby threatening doctors on behalf of anorexics – and using vulnerable patients as pawns to restructure the broader culture? Could it be that unlike in the world of GAT (see here and here), there are no anorexic physicians or mental-health providers anxious to validate and normalize their own experiences and choices?

Epidemiologist Horvath points out that GD is nothing special in the realm of identity disorders: “GD is not sui generis, unique, super-special! It is well within the spectrum of conditions efficaciously treated with transdiagnostic approaches. It is as though the ‘transition’ promoters of mainstream transgenderism had some kind of a racket going on.”

So far, the racket hums along. But with honest discussion from physicians like Dr. Malone, the scam is being exposed.

Jane Robbins is an attorney and writer in Atlanta, Georgia.

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