Boston Children’s Hospital establishes a framework for gender-affirming surgeries on minors

Posted on June 1, 2019 by Zinnia Jones

Zinnia JonesThroughout the past decade, there’s been no shortage of popular alarmism surrounding the spectre of “children being given sex changes” – a misconception borne of either incidental or deliberately cultivated ignorance about what transition entails at various ages, suggesting the image of five-year-olds being given irreversible surgeries. In response to this, trans people and allies point out for the thousandth time that young transgender children undergo social transitions consisting of nothing more than changes of names, attire, and presentation, only those adolescents whose gender dysphoria persists past the onset of puberty are given puberty blockers that pause development without producing any permanent changes, and only legal adults aged 18 or older are able to access any irreversible gender-affirming surgeries such as vaginoplasty or chest surgery.

And this reply is largely accurate – just not entirely. Continue reading →

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Michael Laidlaw and friends still misunderstand the basics of affirming care for trans youth

Posted on May 31, 2019 by Zinnia Jones

Zinnia JonesI’ve previously covered Dr. Michael K. Laidlaw et al.’s (2019) remarkable feat of fitting so many inaccuracies and distortions about trans youth treatments into an eight-paragraph letter to the editor in the Journal of Clinical Endocrinology & Metabolism, it took several thousand words to dissect these errors thoroughly. These included:

  • Claims that gender-affirming medical care causes “sexual dysfunction”, without acknowledgment that untreated gender dysphoria can itself be a significant source of sexual dysfunction and gender-affirming care is associated with improvements in sexual function.
  • Asserting that youth with untreated gender dysphoria are “healthy”, omitting any recognition of the many severe comorbidities that can accompany these.
  • Asserting the existence of new “rapid onset” form of gender dysphoria developing “suddenly” in teenagers through “social contagion”, supported by a single study that examined only parental reports and perceptions without including a single transgender, gender-nonconforming, or gender dysphoric youth.
  • Incorrectly claiming that all transgender adolescents who take puberty blockers will continue on to take cross-sex hormones as well.
  • And the utterly groundless assertion that use of puberty blockers induces persistence of adolescent gender dysphoria that would supposedly otherwise remit spontaneously.

As it turns out, that last item appears to be a persistent point of confusion for Laidlaw and his coauthors. In their letter to the editor, Laidlaw et al. stated that most “children” would “outgrow” their gender dysphoria “by adulthood”, inaccurately suggesting that adulthood rather than the onset of adolescence is the point at which gender dysphoria is observed to persist or desist. This is not the case: statistics about “desistance”, which are themselves often questionable and highly variable, are about whether or not childhood gender dysphoria persists beyond the onset of adolescence. Past that point, these dysphoric youth are unlikely to experience spontaneous remission of their dysphoria upon reaching adulthood – but Laidlaw et al.’s misrepresentation makes it seem as though this is the case. This is an attempt to provide a pretext for the continued denial of medically necessary care to gender-dysphoric adolescents, based on the false belief that it will simply go away within a few years and any affirming care would be unnecessary and inappropriate. Continue reading →

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Gender-affirming chest reconstruction surgery is highly effective for nonbinary patients

Posted on May 31, 2019 by Zinnia Jones

Zinnia JonesEven in the context of transgender identities and gender-affirming care and medical treatments, gender norms and stereotypes received from a cissexist society can still be uncomfortably prevalent, and this is particularly visible in the hostility with which nonbinary people trans people are often met. From within trans communities, “transmedicalist” factions often argue that the authenticity of one’s transness is defined by one’s desire and willingness to undergo certain gender-affirming medical interventions; from outside, “gender-critical” trolls characterize being nonbinary as merely adopting a superficial identity for the sake of distinguishing oneself as “special” or “different”, while wider society often has little awareness of the possibility and reality of genders outside the female/male binary at all.

None of these notions reflect the reality of nonbinary trans people’s lives – and one instance in which this becomes particularly clear is in nonbinary trans people’s pursuit of gender-affirming surgeries. Continue reading →

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A measured look at lactation and breastfeeding by trans women

Posted on May 31, 2019 by Zinnia Jones

Zinnia JonesWhile public awareness of transness and visibility of trans people have grown substantially in recent years, many people are still unaware of some of the particular details of the medical process of transitioning. For instance, trans women have described occasionally encountering individuals who are wholly unaware of what our breasts are made of; these people often assume that trans women’s breasts are always created by breast augmentation surgery. In reality, hormone therapy with antiandrogens and estrogen (and sometimes progesterone or other progestins) is sufficient to produce the development of breasts – not merely the appearance of breasts, but actual breast tissue histologically identical to that seen in cis women, along with the accompanying anatomical structures (Phillips et al., 2014).

And one of the least-understood aspects of trans women’s breasts is their capacity for lactation and nursing infants. Continue reading →

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Dr. Michael Laidlaw et al. publish anti-trans letter with more errors than paragraphs (part 4)

Posted on April 1, 2019 by Zinnia Jones

Previously in Part 1: Endocrine aspects, cardiovascular risk, and sexual functioning.

Previously in Part 2: Desistance, persistence, and “objective tests” for gender dysphoria.

Previously in Part 3: Medical ethics, fertility preservation, and ovarian pathology.

 

Dhejne et al. (2011) and the “health consequences” of transitioning

The health consequences of GAT are highly detrimental, the stated quality of evidence in the guidelines is low, and diagnostic certainty is poor. Furthermore, limited long-term outcome data fail to demonstrate long-term success in suicide prevention (7). How can a child, adolescent, or even parent provide genuine consent to such a treatment? How can the physician ethically administer GAT knowing that a significant number of patients will be irreversibly harmed?

Are the health “consequences” of medical transition really “highly detrimental”? Laidlaw et al. seem content to depict transition treatment as something being provided for no actual reason, which does nothing of any benefit and then kills you in six different ways. Contrary to the authors’ opposite-day take on the existing body of medical evidence, transitioning has repeatedly been shown to result in reduction of gender-dysphoric symptoms, improvements in body image and sexual functioning, better quality of life, reductions in depression and anxiety, reduction of dissociative symptoms, and lower rates of substance abuse and suicidality. Continue reading →

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