More Transgender Medical Muddle

The right path?
Let’s start by looking at an organisation pompously calling itself World Professional Association for Transgender Health (WPATH). In 2022 they produced their ‘Standards of Care for the Health of Transgender and Gender Diverse People, version 8.’ This is an impressive document running to 260 pages that lists 118 contributors and has sixty-eight pages of references. It’s very much ‘affirmative’ in its approach, which means – here we go again – drugs and surgery.

But these standards have been comprehensively demolished by an organisation called Sex Matters. They are rightly critical of WPATH’s approach with its ideologically driven language, removal of minimum ages for irreversible medicalisation, alienation of parents, focus on irreversible surgery, disregard of mental ill-health, ignoring the paucity of outcome studies, and other related matters.

Nonetheless, the path is now branching out. We also have European Professional Association for Transgender Health (EPATH). This, we learn, is a proud creation of Professor Guy T’Sjoen, the head of the Center for Sexology and Gender at Ghent University Hospital in Belgium. EPATH has likewise produced a document, ‘Transgender health care in Belgium’, mercifully consisting of only nineteen pages but on one of which we find the absurdities that ‘Some men have vaginas’ and ‘Some women have penises’ with the admonition to those who might hesitate to swallow this nonsense, to ‘Get over it!’

Gender discomfort or distress
In my previous blog I noted that the British Medical Association defines gender dysphoria as ‘psychological and physiological discomfort or distress that is caused by a discrepancy between a person’s gender identity, their sex assigned [sic] at birth, and their primary/secondary sex characteristics.’ We could simplify this to: gender dysphoria is discomfort or distress caused by a discrepancy between one’s sense of being male or female and one’s biological sex.

But even this simplified definition presents us with a difficulty. Apart from the fact that it’s entirely subjective, the proponents of the idea of gender dysphoria are at pains to point out that it’s not a mental illness, but in that case it can’t be a diagnosis, and if it’s not a diagnosis then it can’t be in need of treatment. It might help to leave out the Greek derivation of dysphoria (dusphoros = hard to bear) and just call it gender discomfort or gender distress.

What is conversion therapy?
Now The British Medical Journal (BMJ), which is published by the British Medical Association, is getting exercised over this matter. Professor T’Sjoen – yes, it’s him again – with two colleagues wrote what is called an editorial in the BMJ (4 March 2023) titled, ‘Banning conversion therapy for trans people’. Neither the good professor nor his colleagues are on the editorial board of the BMJ and there’s no indication that they wrote it as guest editors, but they do, however, make one interesting point:

A poorly defined broad ban leaves open the possibility that affirmation of a trans person’s gender identity could be seen as conversion from their sex assigned [sic] at birth.  

What do they mean, ‘could be seen as conversion’? Affirmative therapy, that is, hormones and surgery, not only could be seen, but by intention and result, does indeed convert the body so that to a certain extent it resembles that of the opposite sex.

A ban on conversion, that is, affirmative, therapy, is certainly needed. Experimental treatment, for such it is, to convert someone’s physical appearance to resemble that of the opposite sex is highly dubious on medical, biological, and ethical grounds and should be proscribed.

Weak evidence
In the following edition of the BMJ (11 March 2023) there is an actual editorial, ‘Caring for young people with gender dysphoria’. It admits that ‘the evidence base isn’t sufficiently robust to best advise young people seeking gender transition,’ and, ‘if the evidence base is weak, we must prioritise research.’

There is also a long article with the wordy title, ‘Gender dysphoria in young people is rising – and so is professional disagreement’ in which we find the advice to ‘link the strength of the recommendations to the quality of the evidence.’

However, the treatment that may be offered to people suffering from gender discomfort or distress is only directed in a roundabout way to relieve their symptoms: try and change the body, in so far as this might be possible, to correspond with the person’s sense, feeling, or belief about their gender. As I have pointed out before this is different from treating an identifiable physical blemish or disfigurement to relieve mental distress.

Common sense, anyone?
But in the case of gender dysphoria, if an adolescent girl declares she is in discomfort or distress because she feels, senses, or believes that she is really a boy, then the treatment that might be offered is drugs and surgery. This means a puberty blocker to prevent her going through normal female puberty, likely followed by male hormone (testosterone) injections and surgery to remove her breasts!

The fixation on evidence-based recommendations to deal with the entirely subjective concept of gender dysphoria – we can’t even call it a diagnosis because it’s not a mental illness, remember – is ivory tower thinking.

If a young person comes to a doctor, declares he or she has gender dysphoria and is seeking treatment to transition, what is the doctor supposed to say? ‘The evidence base for drugs and surgery in transitioning is of low quality, so my recommendations must be weak. What would you like to do?’

Treating a delusion
As for research, this would be unethical as well as impractical. It would mean taking a group of young people wishing to transition and treating them with drugs and perhaps surgery; taking a comparable group and not treating them – placebo treatment would be impossible; following up both groups for some years or even decades; and then comparing the results.

It cannot be overemphasised that using hormones and surgery in so-called transgender people will produce irreversible life changing bodily alterations. And all this to treat a delusion!

How about recommendations based on common sense?

Text © Gabriel Symonds

Picture credit: Wikimedia Commons