Bishop: Transgender Children - The Odd Realm Where the Religious Resort to Science
Thursday, April 26, 2018
There was a demonstration last week outside that hub of controversy, St. Pius Church, protesting a speech by Michelle Cretella, of the small but staunchly independent American College of Pediatricians. Cretella questioned affirmative clinical protocols for gender variant children embracing their expressed genders over their biological genders. She especially decried pharmaceutical interventions delaying puberty and administration of cross-sex hormones for those who have not reached the age of majority.
This outlook bucks the will of those who view failure of medical professionals to affirm a child’s expressed gender as engaged in “conversion therapy”. That would be the selfsame lobby and gullible legislators who last year purported to adopt this formulation as the law in Rhode Island. This is a fairly ironic point of view as the true conversions envisioned are radical medical interventions in the growth and development of youngsters.
This path of medically effected gender transition is hardly undertaken as child abuse, but with the intent of alleviating the stress of confusion when a child’s born and expressed gender conflict. But unlike various forms of social transition involving hairstyle, clothes and peer relations, these pharmaceutical interventions can have neurological and musculoskeletal consequences for youth and adolescents who are still developing. And these treatments ultimately result in the sterilization of the young people to whom they are administered. We used to call that eugenics which we used to call out. As such the conformance of this ‘treatment’ with the Hippocratic Oath to : “do good or to do no harm” is highly questionable.
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTIt would have to be demonstrated through evidence that these drug routines for children “do good”; and, given the potential for harm, it would have to be a pretty significant good. There is evidence that social transitioning short of medical intervention alleviates stress, but the same 2013 study that pointed this out also recognized that social transitioning is associated with persistence of gender dysphoria into adulthood. In other words, social transitioning is a potentially self-reinforcing and perpetuating treatment for a distress that resolves itself in the vast majority of children. The desistance rate noted in that 2013 study was 62%, and that is actually amongst the lowest reported desistance rates in the literature, with much higher rates reported elsewhere, especially for boys.
As many as 80 or 90% of children presenting with either “gender identity disorder” or the later diagnosis that replaced it, “gender dysphoria”, as defined by the American Psychiatric Association, desist in those beliefs by later adolescence or adulthood. The point is that self-perception of gender is a malleable trait amongst youngsters so adults embracing a child’s expression of gender nonconformity can be having an effect on the outcome of the child’s confusion rather than simply ameliorating their distress.
With desistance rates that high it can hardly be suggested that modest efforts at behavioral modification should be outside clinical protocols, yet that is what Rhode Island has attempted to legislate. Michelle Cretella had the unmitigated gall to explain this. And, as some alternative newspaper called the Providence Journal reported, she made the outrageous claim that boys are born with a Y chromosome and girls are not, as if science has anything to do with this! In an evening full of ironies it was the devout Catholics who relied on science and their progressive critics who advanced a fealty to any transgender expression with religious zealotry.
Dr. Cretella didn’t suggest that transgender identification or associated distress in young people was not sincere. But she emphasized it was not necessarily lasting and adult embrace of that identification, or failure to call it out as at odds with biological reality, could introduce a confirmation bias. Against this, activists in the audience who largely did listen to if not appreciate the presentation, advanced the concern of suicide amongst gender non-conforming youths during questions. After all, what’s a little pharmaceutical self-mutilation compared to being dead?
That bears some consideration, although one of the latest comprehensive evalutions of suicide risk amongst LGBT populations found that “no significant association was observed between childhood gender non-conformity and suicide attempt history.” Of course, this was a particularly unsatisfactory point to transgendered activists who attended the talk because their experiences are rife with anecdotes from their community and their own lives of depression and suicide attempts. As the 2013 study does note, previous efforts have come out both ways on correlation of transgendered expression and suicide, but at best for their arguments, the question remains unresolved.
What is quite clear then is, at present, there is no good scientific support for the assumption that affirmation of childhood gender non-conforming behaviors leading somewhat inexorably to pharmaceutical and surgical interventions is an evidence-based course of treatment. Without such evidence, medical interventions in young people represent a violation of the principle that the physician ought to: first, do no harm. Yet, the profession as a whole seems willing to subject virtually the entire cohort of gender dysphoric youth to a vast experiment with no controls.
Along several dimensions of this debate there may be space for study and experiment to develop evidence about the relative benefits of treatment approaches. But in order to conduct such trials, one would have to compare nonself-selecting samples subjected to either affirmative or ‘normalizing’ therapies – the well documented alternatives, e.g., that have given promise and relief to some distressed individuals despite not affirming their expressed identity or inviting transition. Yet these are the therapies that activists would outlaw, preventing any scientific trials. Even the ACLU understood the state was wrong to insert itself into the practice of medicine in this regard.
It isn’t clear to me that medical interventions should be withheld until the age of 21 as the American College of Pediatricians recommends, but it is frighteningly clear that for a mature expression of the severity of transgendered identity that can support hormonal and surgical intervention, adult reasoning must have evolved. The introduction of puberty blockers through the off label, i.e. unapproved, use of Lupron, is, by definition, a medical intervention that precedes the maturity necessary to make such a treatment decision.
I would be the first to afford adults access to medicines and treatments without the blessing of the FDA, but where children are concerned and the very integrity of their adulthood and personhood is at stake, this is no decision from which their adult selves can be removed. It can hardly be left to parents bamboozled by a professional community more attendant to political correctness than to evidence-based medical practice.
Brian Bishop is on the board of OSTPA and has spent 20 years of activism protecting property rights, fighting over regulation and perverse incentives in tax policy.
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