Gender Incongruence Nonsense

The highly esteemed King’s College London recently announced the ‘Largest study to understand the support needs of young people experiencing gender incongruence.’ Why do I say this is nonsense? To answer the question, allow me a short digression. When I was a medical student an anecdote was doing the rounds to illustrate why doctors should always examine patients and not just take what they say at face value. A general practitioner had referred a patient to a gynaecologist, and in due course a reply, devastating in its brevity, was sent out. It said:

Dear Doctor, Thank you for referring this male transvestite to my gynaecology clinic. Yours, etc.  

Absurd, hyperbolic, and illiterate
I couldn’t help reading the name of the deputy chief investigator of this study as Dr Absurd. Actually, his name is Dr Michael Absoud, but the mis-reading might well be more appropriate. Why? Because, to start with, we’re informed that ‘This study will follow the stories of young people as they access the NHS Children and Young People’s Gender Service.’

The fact that there’s a gender service at all implies that problems related to gender are entities found in nature, and for people attending such a service there’s the further implication of a decision to treat accordingly. Do we have a depression service for people who feel depressed, or an anxiety service for people who feel anxious? No. These problems are properly dealt with by general practitioners or psychiatrists.

Furthermore, the investigators can study this problem till Kingdom Come, but we won’t get anywhere because the premise on which the whole edifice is based is merely an unproven assumption. Oh, excuse me. Another misreading. The independent chair of the NHS Children and Young People’s Gender Service National Provider Network for England, and that’s a mouthful in itself, who unfortunately is not involved in the study, is reported as saying: ‘This study will be the first of its kind in the world and couldn’t be more timely.’  Actually, her name is Dr Camilla Kingdon and she could simply have said, ‘This study is the first of its kind.’

Now let’s go, not just to the Protocol for this study, but to the Protocol Content (!) which consists of eleven sections. These are set out either in capital letters, many of them in bold as well, or in italics, so they must be important!

Littered with abbreviations
Another thing that catches the eye in the following thirty-seven pages setting out the protocol in detail, is that they’re littered with Oh-so-clever non-standard abbreviations.

Take the name of the study itself. The acronym, I kid you not, is contrived thus: Puberty suppression And Transitional Healthcare With Adaptive Youth Services. Voilà PATHWAYS (!). What happened to the suppression bit then? Talking of which, suppressing puberty in physically normal people cannot be anything but harmful. And if you think I’m exaggerating, you can find several heart-breaking ‘detransitioning’ stories in my blog on the delusion of ‘transgenderism.’

A little later on we find SCOFF, which is derived from the initial letters of words in a questionnaire for eating disorders: Sick, Control, One stone (14lb), Fat, and Food. As well as being pointless, this could be taken as showing disrespect for such people, because although one of the meanings of the British slang word, scoff, is to eat quickly and greedily, another meaning is to speak derisively of someone.

They don’t seem to know that a common abbreviation used in medicine, RCT, stands for ‘randomised controlled trial,’ and not, according to the protocol – I’m sorry, I mean according to the Protocol Content – a randomised clinical trial. How can this clinical trial, which by definition involves patients, be randomised, meaning the investigators are ‘blinded’ as to who receives the intervention with a puberty blocker and who doesn’t, in a possible future trial of these drugs? Speaking of which, we come to illiteracy on page 20: ‘Who are are you attracted to?’ It’s whom, whom, whom!

Furthermore, ‘Many healthcare professionals and parents have requested more objective clinical evidence to guide decision-making in the interests of longer-term positive outcomes.’ No reference is given for this statement. Who are these many healthcare professionals and parents and what do they mean by more objective clinical evidence? Do they mean the evidence should be more objective, or that there should be more of such evidence?

Up the garden path
Getting down to the nitty-gritty of the PATHWAYS trial, it’s so complicated that it seems we’re being led up the garden path. We start with an exposition of ‘The overarching aims of the full PATHWAYS research programme [sic]’ within which we find PATHWAYS HORIZON, HORIZON Intensive, PATHWAYS TRIAL, PATHWAYS CONNECT, PATHWAYS VOICES, and PATHWAYS ENGAGEMENT. (Capitalisation and emphasis in original.)

As if this isn’t complicated enough, we’re informed that ‘Recent changes in the UK service provision [have] established regional children and young people’s gender service hubs, referred to as the CYPGS.’ Furthermore, ‘These new services include paediatricians, psychiatrists, psychologists, psychotherapists, speech and language therapists, specialist nurses, and occupational therapists working in multidisciplinary teams.’ Wow, where do they get all these people from?

Furthermore, one of the two Primary Objectives [sic] of the study is ‘To improve understanding of the care needs and holistic developmental journeys of all CYP attending NHS Gender Services.’ If they want to improve understanding of the care needs of those attending NHS so-called Gender Services, they could spare us the meaningless ‘holistic developmental journeys.’

What is gender identity?
It would be tedious to critique the whole of this document, but I’ll mention just one more item which deals with gender identity. This, we are informed, uses a ‘two-item self-report measure…In this measure, gender identity is defined as the gender that someone feels and knows themselves to be.’

This appears to have been written, again, by Dr Absurd. Feeling and knowing are self-contradictory. If someone knows he or she has a certain gender identity, whatever that is, they don’t need to be asked what they feel this identity is as well. In any case, this is a loaded question because the answers are suggested, as follows: ‘definitely a boy’, ‘mainly a boy’, ‘in the middle’, ‘definitely a girl’, ‘mainly a girl’, ‘neither a boy or girl’, ‘not sure’, and ‘none of the above’. How can someone know, for example, that they’re mainly a boy? And by the way, Dr Absurd, if you were to ask me what my gender identity is, the question wouldn’t make sense. I’m a man; I don’t have a gender identity.

Finally, we’re informed that: ‘Longer-term follow-up is scientifically important due to the often life-long nature of gender incongruence.’ This is where it all falls down. If it’s not just important, mind you, but scientifically (!) important, to do longer-term follow-up, when are they going to stop? They’ll have to follow-up the study subjects for the rest of their lives.

Text © Gabriel Symonds

Picture credit: Davide Ragusa on Unsplash