I don’t think many people working outside pediatric healthcare really have an understanding about how comfortable healthcare providers are prescribing interventional care.
When diagnosing and treating a patient we come up with a plan of care that is weighted on total outcomes. Now this isn’t a perfect system, for example we may not completely understand the potential harm of new medications. However, we are creating the plan of care with the best information we have at the time. Taking potential side effects and weighing it against the potential harm that could occur without any treatment.
I specialize in pediatric orthopedics and rehabilitation…so take anything I say about gender affirming care with a grain of salt. However, the potential outcome for not treating gender dysphoria as I understand it is pretty bad…self harm and suicide are about as bad as an outcome as one could imagine. Now weigh that against the medications that are usually prescribed for gender affirming care which are well known, and most often prescribed without negative effect for a plethora of treatments ranging from precocious puberty, to monitoring rate of which growth plates close.
Hormone replacement therapy has been going on for decades and is very common place at any hospital that atends to pediatric patients. To claim that intervention isn’t appropriate for something with a potential total outcome as bad as suicide, based off “kids can’t consent” is a ridiculous notion considering that the same drugs are often prescribed to make sure a child doesn’t develop a limb length discrepancy after an orthopedic surgery.
Given the prevalence of forced mutilation of intersex babies as well as medically unnecessary circumcisions, I humbly disagree that these procedures are “weighted on total outcomes”. Unnecessarily cutting off (part of) a baby’s penis is not comparable to being unaware of a new drug’s side effects. Every doctor who has performed that procedure was fully aware that it was medically unnecessary and did not have reason to believe the baby would not come to regret not being given a choice years down the road. I’d argue these procedures are institutionalized medical malpractice.
No shade on you personally because you seem to be approaching the topic rstionally, but I think it’s critical to acknowledge that the field of medicine still has very strong biases in these matters and is not nearly as Cartesian as it is sometimes made out to be. Especially on sensitive topics such as gender identity or reproductive rights doctors have a lot of latitude to be bigoted and to unilaterally deny necessary care.
Given the prevalence of forced mutilation of intersex babies as well as medically unnecessary circumcisions, I humbly disagree that these procedures are “weighted on total outcomes”.
As I said, it’s not a perfect system. However, a lot of the times the flawed treatments of their times were influenced by how physicians perceived cultural norms.
As cultural mores are adjusted and education within the medical community improves, treatment options are usually re-aligned to fit the science. For example circumcisions are becoming a thing of the past and intersex operations nare usually conducted after secondary sex organs develop.
Every doctor who has performed that procedure was fully aware that it was medically unnecessary and did not have reason to believe the baby would not come to regret not being given a choice years down the road. I’d argue these procedures are institutionalized medical malpractice.
Eh… Doctors are a slave to social mores as much as anyone is. They are unfortunately just as susceptible to belief as lawyers or politicians. There were beliefs that spouted about hygiene etc, but in reality those were just to validate belief systems held by the vast majority of the population. In the end they believed that the harm was not very significant to the pts overall health.
but I think it’s critical to acknowledge that the field of medicine still has very strong biases in these matters and is not nearly as Cartesian as it is sometimes made out to be.
I think it’s fairly obvious that the medical system has failed several minority groups, most recently trans people. I am proclaiming how medical providers should behave and how we were trained to treat all patients. Unfortunately, as you have stated, beliefs systems unjustly often interjects itself in medical care. Whether that be in prescribing birth control or administrating gender affirming care.
Yeah, when you live in a society that treats you like shit for an immutable characteristic that tends to happen. It’s called minority stress, and it happens to cis queer people as well.
I totally agree and it sucks that people are like that. I was just responding to the argument that any treatment is worth it when the alternative is suicide, because studies range from showing HRT helps a little to not at all at preventing suicide.
Trans people just need to be loved and accepted like everyone else but unfortunately a lot of people really suck.
because studies range from showing HRT helps a little to not at all at preventing suicide.
No they don’t. There are a couple of studies that are deliberately misrepresented by transphobes to imply this, and they often get passed around as fact, by people who aren’t familiar with the studies in question.
Then there is this one https://pmc.ncbi.nlm.nih.gov/articles/PMC3043071/. It’s older, and it is misrepresented to claim that the suicide rate of trans folk doesn’t change after transition. The thing about that study is that doesn’t even assess the impact of transition. The entire cohort of trans people in the study were post transition, and questions were asked about their lifetime suicide attempts, without comparing before/after transition data. So because 41% of trans people in that study had made at least one suicide attempt at some point in their lives, the claim was made that transition doesn’t help, because “41% of post op trans people have attempted suicide”. The lead author of this particular study has spoken out several times on the misuse of the study by transphobes with an agenda, but to this day, it keeps happening…
This is a consolidation of the findings of research on trans health care, and the impact of transition on the well being of trans folk. To summarise, they looked at 55 studies on the impact of transition. 51 of those found transition to be beneficial, and 4 of them contained mixed findings.
You’ve stumbled on one of the tools that transphobes use. Deliberate misrepresentation of the facts, so that they can push for trans folk to be cut off from transition related healthcare, all whilst sounding reasonable, and sometimes even supportive. That, and trans people in sports, were the two main wedge tactics that they used to open the door to the wave of transphobia now sweeping the world.
because studies range from showing HRT helps a little to not at all at preventing suicide
You’re misinformed, the evidence supporting HRT for those that want it is sufficient that withholding it is unethical. HRT alone not being able to overcome extreme minority stress for everyone doesn’t mean it’s not helpful or necessary.
While family and community support is extremely important, it can’t replace medical transition for those that want it. You can’t hug the dysphoria away.
I’m primarily going off this meta study. They found many studies failed to reach statistical significance and many failed to account for confounding issues like psychological conditions, trauma, abuse, and substance use.
Instead of using a single meta study (which itself has limitations) as a reason to declare that HRT has no effect on suicidality—which isn’t even something the meta study claimed—you could take a peek at the political climate for trans people right now and just not?
was just responding to the argument that any treatment is worth it when the alternative is suicide
That’s not the argument…
The argument is that treatment plans are developed by evaluating risk and reward.
The risk for not treating is very high, even if the treatment doesn’t have a high rate of efficacy as long as it doesn’t introduce further risk, it’s still a valid treatment.
I made the conscious decision when I was around 14 to not transition, because I knew that it would lead to a more difficult life.
I could not make it. I would be dead if not for transition in my early 20’s.
My life is still more difficult, and I struggle with suicidal ideation, but that is entirely related to the way society treats me. I have been chased out of my career field, I have been told I am disgusting, I have been threatened, I have been sexually assault. Those things have happened because I am trans, and they have made me suicidal. But denying me treatment would take away the one aspect - the comfort in my own body - that helps protect me from the decision to commit suicide.
and transitioning at 14 might on average result in a person integrating into cis-normative society more easily than transitioning after puberty in their 20s, this means less dysphoria, less job discrimination, less chance of being a hate crime statistic, etc. - we need to make it much easier for trans kids to get the help they need so they live healthier and happier lives.
We just don’t have any evidence or reason to think trans kids are very likely to be wrong about transitioning, and we meanwhile have a mountain of evidence telling us treatment is very effective and has unusually low regret rates … this is just so obvious from a medical and scientific viewpoint, the only hangup seems to be cultural lag.
Even if we are accepting that as true, that doesn’t really have anything to do with an individual patients treatment plan. You aren’t evaluating risk based on the general population, you are evaluating risk based on patient populations with the same diagnosis.
If any risk is mitigated with gender affirming care compared to patient populations who aren’t receiving care , and the risk of harmful side effects are minimal then the treatment plan is valid.
I don’t really see how you think that comparing them to the general population makes any sense?
That would be like someone saying that people receiving treatment for HIV are still more immuno compromised than the general population…well yeah, but treatment vastly improves their total outcomes.
That would be like someone saying that people receiving treatment for HIV are still more immuno compromised than the general population…well yeah, but treatment vastly improves their total outcomes.
I don’t think many people working outside pediatric healthcare really have an understanding about how comfortable healthcare providers are prescribing interventional care.
When diagnosing and treating a patient we come up with a plan of care that is weighted on total outcomes. Now this isn’t a perfect system, for example we may not completely understand the potential harm of new medications. However, we are creating the plan of care with the best information we have at the time. Taking potential side effects and weighing it against the potential harm that could occur without any treatment.
I specialize in pediatric orthopedics and rehabilitation…so take anything I say about gender affirming care with a grain of salt. However, the potential outcome for not treating gender dysphoria as I understand it is pretty bad…self harm and suicide are about as bad as an outcome as one could imagine. Now weigh that against the medications that are usually prescribed for gender affirming care which are well known, and most often prescribed without negative effect for a plethora of treatments ranging from precocious puberty, to monitoring rate of which growth plates close.
Hormone replacement therapy has been going on for decades and is very common place at any hospital that atends to pediatric patients. To claim that intervention isn’t appropriate for something with a potential total outcome as bad as suicide, based off “kids can’t consent” is a ridiculous notion considering that the same drugs are often prescribed to make sure a child doesn’t develop a limb length discrepancy after an orthopedic surgery.
Given the prevalence of forced mutilation of intersex babies as well as medically unnecessary circumcisions, I humbly disagree that these procedures are “weighted on total outcomes”. Unnecessarily cutting off (part of) a baby’s penis is not comparable to being unaware of a new drug’s side effects. Every doctor who has performed that procedure was fully aware that it was medically unnecessary and did not have reason to believe the baby would not come to regret not being given a choice years down the road. I’d argue these procedures are institutionalized medical malpractice.
No shade on you personally because you seem to be approaching the topic rstionally, but I think it’s critical to acknowledge that the field of medicine still has very strong biases in these matters and is not nearly as Cartesian as it is sometimes made out to be. Especially on sensitive topics such as gender identity or reproductive rights doctors have a lot of latitude to be bigoted and to unilaterally deny necessary care.
As I said, it’s not a perfect system. However, a lot of the times the flawed treatments of their times were influenced by how physicians perceived cultural norms.
As cultural mores are adjusted and education within the medical community improves, treatment options are usually re-aligned to fit the science. For example circumcisions are becoming a thing of the past and intersex operations nare usually conducted after secondary sex organs develop.
Eh… Doctors are a slave to social mores as much as anyone is. They are unfortunately just as susceptible to belief as lawyers or politicians. There were beliefs that spouted about hygiene etc, but in reality those were just to validate belief systems held by the vast majority of the population. In the end they believed that the harm was not very significant to the pts overall health.
I think it’s fairly obvious that the medical system has failed several minority groups, most recently trans people. I am proclaiming how medical providers should behave and how we were trained to treat all patients. Unfortunately, as you have stated, beliefs systems unjustly often interjects itself in medical care. Whether that be in prescribing birth control or administrating gender affirming care.
Suicide attempts and ideation among transgender people receiving gender affirming treatment is still very high compared to the general population.
That’s because of transphobia, not the treatment.
I’m old enough to remember the same argument being used to “prove” gays were unstable, and it’s still utter horseshit
Yeah, when you live in a society that treats you like shit for an immutable characteristic that tends to happen. It’s called minority stress, and it happens to cis queer people as well.
I totally agree and it sucks that people are like that. I was just responding to the argument that any treatment is worth it when the alternative is suicide, because studies range from showing HRT helps a little to not at all at preventing suicide.
Trans people just need to be loved and accepted like everyone else but unfortunately a lot of people really suck.
No they don’t. There are a couple of studies that are deliberately misrepresented by transphobes to imply this, and they often get passed around as fact, by people who aren’t familiar with the studies in question.
Firstly, there was this Finnish one https://mentalhealth.bmj.com/content/27/1/e300940
You can see more about the hatchet job that the New York Post did on that one here https://skeptics.stackexchange.com/questions/56772/does-gender-transitioning-do-nothing-to-help-suicidal-ideation
Then there is this one https://pmc.ncbi.nlm.nih.gov/articles/PMC3043071/. It’s older, and it is misrepresented to claim that the suicide rate of trans folk doesn’t change after transition. The thing about that study is that doesn’t even assess the impact of transition. The entire cohort of trans people in the study were post transition, and questions were asked about their lifetime suicide attempts, without comparing before/after transition data. So because 41% of trans people in that study had made at least one suicide attempt at some point in their lives, the claim was made that transition doesn’t help, because “41% of post op trans people have attempted suicide”. The lead author of this particular study has spoken out several times on the misuse of the study by transphobes with an agenda, but to this day, it keeps happening…
So, let me give you the actual data…
https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/
This is a consolidation of the findings of research on trans health care, and the impact of transition on the well being of trans folk. To summarise, they looked at 55 studies on the impact of transition. 51 of those found transition to be beneficial, and 4 of them contained mixed findings.
You’ve stumbled on one of the tools that transphobes use. Deliberate misrepresentation of the facts, so that they can push for trans folk to be cut off from transition related healthcare, all whilst sounding reasonable, and sometimes even supportive. That, and trans people in sports, were the two main wedge tactics that they used to open the door to the wave of transphobia now sweeping the world.
You’re misinformed, the evidence supporting HRT for those that want it is sufficient that withholding it is unethical. HRT alone not being able to overcome extreme minority stress for everyone doesn’t mean it’s not helpful or necessary.
While family and community support is extremely important, it can’t replace medical transition for those that want it. You can’t hug the dysphoria away.
I’m primarily going off this meta study. They found many studies failed to reach statistical significance and many failed to account for confounding issues like psychological conditions, trauma, abuse, and substance use.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10027312/
Instead of using a single meta study (which itself has limitations) as a reason to declare that HRT has no effect on suicidality—which isn’t even something the meta study claimed—you could take a peek at the political climate for trans people right now and just not?
That’s not the argument…
The argument is that treatment plans are developed by evaluating risk and reward.
The risk for not treating is very high, even if the treatment doesn’t have a high rate of efficacy as long as it doesn’t introduce further risk, it’s still a valid treatment.
I made the conscious decision when I was around 14 to not transition, because I knew that it would lead to a more difficult life.
I could not make it. I would be dead if not for transition in my early 20’s.
My life is still more difficult, and I struggle with suicidal ideation, but that is entirely related to the way society treats me. I have been chased out of my career field, I have been told I am disgusting, I have been threatened, I have been sexually assault. Those things have happened because I am trans, and they have made me suicidal. But denying me treatment would take away the one aspect - the comfort in my own body - that helps protect me from the decision to commit suicide.
and transitioning at 14 might on average result in a person integrating into cis-normative society more easily than transitioning after puberty in their 20s, this means less dysphoria, less job discrimination, less chance of being a hate crime statistic, etc. - we need to make it much easier for trans kids to get the help they need so they live healthier and happier lives.
We just don’t have any evidence or reason to think trans kids are very likely to be wrong about transitioning, and we meanwhile have a mountain of evidence telling us treatment is very effective and has unusually low regret rates … this is just so obvious from a medical and scientific viewpoint, the only hangup seems to be cultural lag.
Even if we are accepting that as true, that doesn’t really have anything to do with an individual patients treatment plan. You aren’t evaluating risk based on the general population, you are evaluating risk based on patient populations with the same diagnosis.
If any risk is mitigated with gender affirming care compared to patient populations who aren’t receiving care , and the risk of harmful side effects are minimal then the treatment plan is valid.
I don’t really see how you think that comparing them to the general population makes any sense?
That would be like someone saying that people receiving treatment for HIV are still more immuno compromised than the general population…well yeah, but treatment vastly improves their total outcomes.
this illustrates it so well, well done