This is an outstanding article, and I wish that every doctor would read it and give it serious consideration.
I am a clinical psychologist and my professional association has been taken over by the same pathological mass movement that supports gender ideology. Psychologists, psychiatrists and other mental health professionals have played a major role in convincing surgeons that a psychiatric condition, gender dysphoria, can be cured with surgery. There is of course a history of this practice in psychiatry, e.g., lobotomies, so the concept of "sexual reassignment surgery" was not as shocking to us as it should have been.
The healthcare professions are all morally responsible for perpetrating, facilitating or intentionally ignoring the destruction of so many childrens' lives in the name of helping them to be "their true selves."
I did not mean to imply that all psychiatrists were involved in the medicalization of transitions. Very few were or are, which is also true for psychologists. The mental health professionals who have been involved in gender care, however, played a major role in facilitating medicalized transitions of adults who requested hormones and surgeries. The Benjamin standard of care that was used prior to the current WPATH guidelines required that patients obtain letters of approval from mental health professionals before physicians and surgeons would provide hormones or surgeries.
In the current "affirmative care" process, physicians play the primary role in deciding who can get hormones and surgeries, and the role of mental health professionals has been reduced. Very recently, plastic surgeons have begun to say that they do not think the decision to proceed with gender should be made by them, and that mental health professionals should be responsible for those decisions. I have not read any opinion on this subject from Marci Bowers or any of the other well known gender surgeons.
The American Psychiatric Association and the American Psychological Association both support medicalized transitioning:
Perfectly written article, and a model for modesty in claiming medical miracles (sorry for alliteration).
Many writers claim that trans is the result of ideas as diverse as gay rights, feminism, postmodernism, critical theory, pedophilia, wokeness and Marxism and liberalism.
I claim that the current state of trans lies entirely at the feet of the medical profession. It is the only delusion which is treated by medieval surgery on body parts unrelated to the source of delusion, and the only delusion with follow-up treatment consisting of the rest of the world being forced legally to confirm the delusion.
It only requires the appropriate medical bodies to recognize the delusion and offer treatment consistent with all other delusions to not confirm them, but to learn to live with them while being happy and functioning as an adult.
Do publish and share this meditation on duty of care.
The major medical institutions that support this do not listen to the voices of most practitioners. Endocrinologists and surgeons who make loads of money off this are the main culprits. Most Pediatricians and Psychiatrists are actually against it. Follow the money.
The money is quite mild actually; total revenue in the US I estimate is at most perhaps $10- $20m annually - there simply aren’t that many people transing themselves. The reports of $3B are nonsensical. NIH reports 71 clinics in the entire US, vs 10,000 clinics for plastic surgery.
The liability has skyrocketed, I doubt it will be insurance against malpractice much longer.
My primary criticism is at psychiatrists. Gender is not an objective medical fact. Any reference to it is nonsensical, and pseudoscience. I’m beginning to understand how medieval psychiatry actually is.
If you follow other recent postings of insurance claims for trans - a big one repeated often of $120M over 5 years, my estimates were high. Only about 30-40% of claims are paid due to “adjustments”, or pre-approved prices with insurors. That puts the payments at $7 - $10M a year for the last 5 years or so - that’s quite a bit less than $2-$5B, like 200x less.
That is in line with procedures which cost $5-$10K not the $150K - $3M
Agree--but if a cucumber over the age of 25 (when the brain has finished developing) wants to become a pickle, okay. I'd prefer over the age of 30. With all the safeguards that used to be routine--living for a year in the chosen sex, therapy to explore the reasons the person wants to change their appearance, what it means to that person to "live as a woman" or "as a man."
No. An Adult, any Adult, who presents to a doctor saying: "I feel like I am the opposite sex. I want you to help me to achieve my dream" is deluded and if he/she persists he/she is psychotic, cut off from reality.
No one can change sex. No doctor should tell a patient a lie.
Any "treatment" which promotes this patient's delusion is unethical and a breach of the Hypocratic Oath "Do No Harm" because any intervention, even just "social transition" is absurd and dangerous.
So NO. No "pickles" for anyone. Just REALITY.
"I believe in facing reality even if it hurts very much". This is what I wrote in 2007 just after my Trans then-H had left us after 10 years of gas-lighting, and I still believe it.
I am coming to visit my son in San Francisco starting Sept 14th, for one month. Maybe we could meet up? Are you on Twitter? If you are and you tell me your handle we could DM each other?
Take a look at Buck Angel, who calls himself a transsexual. He is well aware that he's a woman and that he has merely changed his outward appearance. Even as a child, people asked him "Are you a boy?" and when (then she) got bottles thrown at her for being a masculine lesbian, she decided to transition. Read Jennifer Finney Boylan's She's Not There. These are adults who made decisions that made their lives easier. Yes, in reality they have not changed their sex, only their appearance. But they live more easily as a result and that's their business--they are adults. But no child should be medically altered in any way.
I have watched Buck Angel many times. SHE is a very extrovert, very butch lesbian. The most butch lesbian I have ever seen. SHE is still a woman. She keeps telling everyone about how her life is curtailed by the drugs she took and the completely unnecessary surgery which she had. She keeps telling others passionately NOT to do what she did. All she should have done was cut her hair really short and wear men's clothes. If others want to see her as a man, that is their choice. But her health should have been the primary consideration of the medical professionals. But it was not.
Sorry. It is another trans-identifying woman. It's "Scott Newgent" . She has been chucked off Twitter on both her accounts @ScottNewGent and @Notscottnewgent because she has attacked the "transing industry" for kids. Read the story of her "phalloplasty" and its life-threatening consequences. https://www.genderdysphoriaalliance.com/post/meet-scott-newgent
I used to agree with the position that adults can do what they want in terms of body modification as long as they can find cosmetic surgeons who agree to do it. I currently am struggling with conflict about this position. When a culture endorses the belief that people can "change sex," and adults are lauded by presidents for pretending to be the other sex, children certainly will want to have the same option. I know of a number of cases where children had gender surgeries arranged to occur as soon as possible after their eighteenth birthdays.
The entire idea that people can change sex, or that they can have some inner identity that doesn't match their body, is not a sane belief. Maybe if children are consistently educated about the inaccuracy of this belief, rather than being intensely indoctrinated to absorb it, they would have a chance of resisting the temptation to choose fantasy over reality. Unfortunately, as we all know, this is not what is currently happening in Western culture.
You're on the right track, "with all the safeguards that used to be routine." Importantly, one of those safeguards used to be the knowledge that, in the end, a man would still be a man or a woman would still be a woman. And children were raised to believe that sex inhered in biology, not in gender stereotypes. Ultimately, however, self-hatred should never have started to be "treated" by changing the core self to try to appease the hatred.
What about body integrity dysphoria? Do you believe doctors should willingly cut off the limbs of healthy adults because those adults identify as amputees? Just wondering where the line is for what the medical establishment should be expected to accommodate.
I do think the gender stuff is in a different category from voluntary amputees. It's worth reading Jennifer Finney Boylan's memoir "She's Not There"--she remembers playing "Girl Planet" in the woods behind her home as a child--she was five or seven and pretended she'd landed on a planet where the atmosphere turned you into a girl. I feel strongly that medical treatment at that age would have been a crime--because (1) All possibility of reproduction or orgasm would have been destroyed--not to mention several neurological disturbances and other problems and (2) because at that age it's impossible to know how the child will feel at adolescence--and so many boys who want to be girls or vice versa just turn out to be gay, and comfortable with their bodies, by adolescence.
Dr. Haim, you write, "It is this fear of harm that serves to build and maintain all the best attributes of a doctor." Don't many or most of the gender-affirming doctors/surgeons claim they do what they do out of a fear that the "transgender child" will kill themself if they don't get the medications and surgery, they say they must have to fix being in "the wrong body"?
Thank you for mentioning moral principles. I don't believe some doctors have them anymore when they remove healthy body parts and healthy reproductive organs without first conducting a differential diagnosis and offering non-invasive treatment options. My daughter had her breasts removed without her parents agreement and without treating her underlying comorbidies of mental distress, trauma, pain, autist traits, maladaptive copying and much more. What happened to first do no harm? Thank you for advocating for better care that is comprehensive.
Given the writer's many premises, the conclusions are inevitable. The problem is the multiplicity of undemonstrated premises, some of them arbitrary and highly implausible, whether for reasons ideological, socially habituated, or other. The result is a polemic rather than a logical or scientific article.
Thus the invocation of what many people instinctively feel about the "inherent absurdity" of transition, as if that were dispositive. A major unstated premise is that there are no real trans people, it is in all cases a delusion. That's a highly implausible premise, one usually based on religion, sometimes on the universal young children's level of knowledge of sexual biology, or on the many polemically misleading accounts of sexual biological science that are made nowadays to try to uphold the simple assumptions we all learned by the time we got to first grade and that are enshrined in religious texts written up thousands of years ago.
A further premise: tjat surgery is solely about the normal health of the non-mental part of the body, as if the brain were not a part of the body. Ignoring the evidence from studies that have shown that the trans brains they were able to study do vary from the cis brain and are closer to the brains of the opposite rest-of-body sex; something that in those cases makes the trans person a newly understood form of intersex, based on gene expression rather than gene name.
Another unstated premise that all people's bodies were originally free of contradictions, and thus the sole purpose of medicine is to bring them back to that original simply-consistent normal condition. In reality many bodies have medical contradictions within them from the start. Probably all do, on small scales. Some do on large scale.
Transgender surgeries are in each case a complex question, simplified in this article in dangerously misleading forms. The real question is whether the guardrails are sufficient, or excessive, or insufficiently attended to, or overattended to. And how to remedy the inevitable defects in these regards, with honest attention to both sides of the defects.
And at the present time, how to avoid a dangerous overshoot, ideologically motivated and politically enforced, against trans medical treatment, in reaction to the perceived and sometimes real overshoots on the other side.
And, parenthetically, the problem is how to avoid misdirecting the blame -- when there is an overshoot on the medicalization side -- by projecting it primarily onto trans people, or onto doctors; instead of directing it, primarily and accurately, on the larger elites in our media and academic classes, with their own excessive ideological commitments, and with their excessive concern to use minorities for the sake of accusing society and shaming the general public. It may feel like great ideological sport, for each side to attack the other side and pretend to be speaking about the individuals who are hurting, but those individuals are in fact caught in the crossfire and are increasingly victims of both sides of this ideological warfare.
I couldn't agree more with this excellent article. Thank you for writing it.
This is an outstanding article, and I wish that every doctor would read it and give it serious consideration.
I am a clinical psychologist and my professional association has been taken over by the same pathological mass movement that supports gender ideology. Psychologists, psychiatrists and other mental health professionals have played a major role in convincing surgeons that a psychiatric condition, gender dysphoria, can be cured with surgery. There is of course a history of this practice in psychiatry, e.g., lobotomies, so the concept of "sexual reassignment surgery" was not as shocking to us as it should have been.
The healthcare professions are all morally responsible for perpetrating, facilitating or intentionally ignoring the destruction of so many childrens' lives in the name of helping them to be "their true selves."
Not all Psychiatrists. Not me.
I did not mean to imply that all psychiatrists were involved in the medicalization of transitions. Very few were or are, which is also true for psychologists. The mental health professionals who have been involved in gender care, however, played a major role in facilitating medicalized transitions of adults who requested hormones and surgeries. The Benjamin standard of care that was used prior to the current WPATH guidelines required that patients obtain letters of approval from mental health professionals before physicians and surgeons would provide hormones or surgeries.
In the current "affirmative care" process, physicians play the primary role in deciding who can get hormones and surgeries, and the role of mental health professionals has been reduced. Very recently, plastic surgeons have begun to say that they do not think the decision to proceed with gender should be made by them, and that mental health professionals should be responsible for those decisions. I have not read any opinion on this subject from Marci Bowers or any of the other well known gender surgeons.
The American Psychiatric Association and the American Psychological Association both support medicalized transitioning:
https://www.psychiatry.org/File%20Library/About-APA/Organization-Documents-Policies/Policies/Position-2018-Access-to-Care-for-Transgender-and-Gender-Diverse-Individuals.pdf
https://www.apaservices.org/advocacy/news/gender-affirming-care-transgender-youth
Well said, and it needed to be said, Dr. Rosen. Thank you.
Perfectly written article, and a model for modesty in claiming medical miracles (sorry for alliteration).
Many writers claim that trans is the result of ideas as diverse as gay rights, feminism, postmodernism, critical theory, pedophilia, wokeness and Marxism and liberalism.
I claim that the current state of trans lies entirely at the feet of the medical profession. It is the only delusion which is treated by medieval surgery on body parts unrelated to the source of delusion, and the only delusion with follow-up treatment consisting of the rest of the world being forced legally to confirm the delusion.
It only requires the appropriate medical bodies to recognize the delusion and offer treatment consistent with all other delusions to not confirm them, but to learn to live with them while being happy and functioning as an adult.
Do publish and share this meditation on duty of care.
It has been totally lost.
The major medical institutions that support this do not listen to the voices of most practitioners. Endocrinologists and surgeons who make loads of money off this are the main culprits. Most Pediatricians and Psychiatrists are actually against it. Follow the money.
The money is quite mild actually; total revenue in the US I estimate is at most perhaps $10- $20m annually - there simply aren’t that many people transing themselves. The reports of $3B are nonsensical. NIH reports 71 clinics in the entire US, vs 10,000 clinics for plastic surgery.
The liability has skyrocketed, I doubt it will be insurance against malpractice much longer.
My primary criticism is at psychiatrists. Gender is not an objective medical fact. Any reference to it is nonsensical, and pseudoscience. I’m beginning to understand how medieval psychiatry actually is.
If you follow other recent postings of insurance claims for trans - a big one repeated often of $120M over 5 years, my estimates were high. Only about 30-40% of claims are paid due to “adjustments”, or pre-approved prices with insurors. That puts the payments at $7 - $10M a year for the last 5 years or so - that’s quite a bit less than $2-$5B, like 200x less.
That is in line with procedures which cost $5-$10K not the $150K - $3M
Agree--but if a cucumber over the age of 25 (when the brain has finished developing) wants to become a pickle, okay. I'd prefer over the age of 30. With all the safeguards that used to be routine--living for a year in the chosen sex, therapy to explore the reasons the person wants to change their appearance, what it means to that person to "live as a woman" or "as a man."
No. An Adult, any Adult, who presents to a doctor saying: "I feel like I am the opposite sex. I want you to help me to achieve my dream" is deluded and if he/she persists he/she is psychotic, cut off from reality.
No one can change sex. No doctor should tell a patient a lie.
Any "treatment" which promotes this patient's delusion is unethical and a breach of the Hypocratic Oath "Do No Harm" because any intervention, even just "social transition" is absurd and dangerous.
So NO. No "pickles" for anyone. Just REALITY.
"I believe in facing reality even if it hurts very much". This is what I wrote in 2007 just after my Trans then-H had left us after 10 years of gas-lighting, and I still believe it.
Truth matters.
I agree with you, Una-Jane.
It's one thing for someone to want these dangerous, mutilating drugs and surgeries.
It's quite another for a licensed medical professional to provide them.
Hello Gen Crit in N. California
Thank you!
I am coming to visit my son in San Francisco starting Sept 14th, for one month. Maybe we could meet up? Are you on Twitter? If you are and you tell me your handle we could DM each other?
I hope so.
Una
Take a look at Buck Angel, who calls himself a transsexual. He is well aware that he's a woman and that he has merely changed his outward appearance. Even as a child, people asked him "Are you a boy?" and when (then she) got bottles thrown at her for being a masculine lesbian, she decided to transition. Read Jennifer Finney Boylan's She's Not There. These are adults who made decisions that made their lives easier. Yes, in reality they have not changed their sex, only their appearance. But they live more easily as a result and that's their business--they are adults. But no child should be medically altered in any way.
I have watched Buck Angel many times. SHE is a very extrovert, very butch lesbian. The most butch lesbian I have ever seen. SHE is still a woman. She keeps telling everyone about how her life is curtailed by the drugs she took and the completely unnecessary surgery which she had. She keeps telling others passionately NOT to do what she did. All she should have done was cut her hair really short and wear men's clothes. If others want to see her as a man, that is their choice. But her health should have been the primary consideration of the medical professionals. But it was not.
Buck Angel has no regrets about transitioning and is completely against child and adolescent transition
Sorry. It is another trans-identifying woman. It's "Scott Newgent" . She has been chucked off Twitter on both her accounts @ScottNewGent and @Notscottnewgent because she has attacked the "transing industry" for kids. Read the story of her "phalloplasty" and its life-threatening consequences. https://www.genderdysphoriaalliance.com/post/meet-scott-newgent
Yes, I've seen interviews with Scott Newgent--very sad story, and sad that she was censored.
I used to agree with the position that adults can do what they want in terms of body modification as long as they can find cosmetic surgeons who agree to do it. I currently am struggling with conflict about this position. When a culture endorses the belief that people can "change sex," and adults are lauded by presidents for pretending to be the other sex, children certainly will want to have the same option. I know of a number of cases where children had gender surgeries arranged to occur as soon as possible after their eighteenth birthdays.
The entire idea that people can change sex, or that they can have some inner identity that doesn't match their body, is not a sane belief. Maybe if children are consistently educated about the inaccuracy of this belief, rather than being intensely indoctrinated to absorb it, they would have a chance of resisting the temptation to choose fantasy over reality. Unfortunately, as we all know, this is not what is currently happening in Western culture.
You're on the right track, "with all the safeguards that used to be routine." Importantly, one of those safeguards used to be the knowledge that, in the end, a man would still be a man or a woman would still be a woman. And children were raised to believe that sex inhered in biology, not in gender stereotypes. Ultimately, however, self-hatred should never have started to be "treated" by changing the core self to try to appease the hatred.
What about body integrity dysphoria? Do you believe doctors should willingly cut off the limbs of healthy adults because those adults identify as amputees? Just wondering where the line is for what the medical establishment should be expected to accommodate.
I do think the gender stuff is in a different category from voluntary amputees. It's worth reading Jennifer Finney Boylan's memoir "She's Not There"--she remembers playing "Girl Planet" in the woods behind her home as a child--she was five or seven and pretended she'd landed on a planet where the atmosphere turned you into a girl. I feel strongly that medical treatment at that age would have been a crime--because (1) All possibility of reproduction or orgasm would have been destroyed--not to mention several neurological disturbances and other problems and (2) because at that age it's impossible to know how the child will feel at adolescence--and so many boys who want to be girls or vice versa just turn out to be gay, and comfortable with their bodies, by adolescence.
Dr. Haim, you write, "It is this fear of harm that serves to build and maintain all the best attributes of a doctor." Don't many or most of the gender-affirming doctors/surgeons claim they do what they do out of a fear that the "transgender child" will kill themself if they don't get the medications and surgery, they say they must have to fix being in "the wrong body"?
Thank you for mentioning moral principles. I don't believe some doctors have them anymore when they remove healthy body parts and healthy reproductive organs without first conducting a differential diagnosis and offering non-invasive treatment options. My daughter had her breasts removed without her parents agreement and without treating her underlying comorbidies of mental distress, trauma, pain, autist traits, maladaptive copying and much more. What happened to first do no harm? Thank you for advocating for better care that is comprehensive.
Given the writer's many premises, the conclusions are inevitable. The problem is the multiplicity of undemonstrated premises, some of them arbitrary and highly implausible, whether for reasons ideological, socially habituated, or other. The result is a polemic rather than a logical or scientific article.
Thus the invocation of what many people instinctively feel about the "inherent absurdity" of transition, as if that were dispositive. A major unstated premise is that there are no real trans people, it is in all cases a delusion. That's a highly implausible premise, one usually based on religion, sometimes on the universal young children's level of knowledge of sexual biology, or on the many polemically misleading accounts of sexual biological science that are made nowadays to try to uphold the simple assumptions we all learned by the time we got to first grade and that are enshrined in religious texts written up thousands of years ago.
A further premise: tjat surgery is solely about the normal health of the non-mental part of the body, as if the brain were not a part of the body. Ignoring the evidence from studies that have shown that the trans brains they were able to study do vary from the cis brain and are closer to the brains of the opposite rest-of-body sex; something that in those cases makes the trans person a newly understood form of intersex, based on gene expression rather than gene name.
Another unstated premise that all people's bodies were originally free of contradictions, and thus the sole purpose of medicine is to bring them back to that original simply-consistent normal condition. In reality many bodies have medical contradictions within them from the start. Probably all do, on small scales. Some do on large scale.
Transgender surgeries are in each case a complex question, simplified in this article in dangerously misleading forms. The real question is whether the guardrails are sufficient, or excessive, or insufficiently attended to, or overattended to. And how to remedy the inevitable defects in these regards, with honest attention to both sides of the defects.
And at the present time, how to avoid a dangerous overshoot, ideologically motivated and politically enforced, against trans medical treatment, in reaction to the perceived and sometimes real overshoots on the other side.
And, parenthetically, the problem is how to avoid misdirecting the blame -- when there is an overshoot on the medicalization side -- by projecting it primarily onto trans people, or onto doctors; instead of directing it, primarily and accurately, on the larger elites in our media and academic classes, with their own excessive ideological commitments, and with their excessive concern to use minorities for the sake of accusing society and shaming the general public. It may feel like great ideological sport, for each side to attack the other side and pretend to be speaking about the individuals who are hurting, but those individuals are in fact caught in the crossfire and are increasingly victims of both sides of this ideological warfare.