Pamela Paul on Transmania

Last week the New York Times published a defense of transmania by a San Francisco psychiatrist named Dr. Jack Turban.

I offered my own comments in these pages.

Two days ago, Pamela Paul used her Times column to review the issue, and especially to ask the salient question. How does it happen that enlightened European cultures have rejected what is called gender-affirming care while the American medical establishment continues to practice it? How did we persuade ourselves to continue to mutilate children?

At a time when we tell our enlightened selves that we follow the science, more than a handful of us have latched on to a series of practices that constitute pagan human sacrifice.

Obviously, Dr. Turban has objected to Paul’s reasoning, not to mention to the Cass Report. He talks the good talk about assessing children who want to transition, but he argues in a new book that puberty blockers should be as easy to get as Prozac. And he does not believe that children should need parental approval before mutilating themselves.

For her part Pamela Paul begins by explaining the conclusions reached by Hilary Cass in Great Britain. One notes that the new Labour government has used this report to ban puberty blockers altogether.

Paul writes:

It’s been three months since the release of the Cass Review, an independent assessment of gender treatment for youths commissioned by England’s National Health Service. The four-year review of research, led by Dr. Hilary Cass, one of Britain’s top pediatricians, found no definitive proof that gender dysphoria in children or teenagers was resolved or alleviated by what advocates call gender-affirming care, in which a young person’s declared “gender identity” is affirmed and supported with social transition, puberty blockers and/or cross-sex hormones. Nor, she said, is there clear evidence that transitioning kids decreases the likelihood that gender dysphoric youths will turn to suicide, as adherents of gender-affirming care claim. These findings backed up what critics of this approach have been saying for years.

Paul continues, noting that governments in other European countries have joined with Britain in banning what is called gender affirming care:

After the release of Cass’s findings, the British government issued an emergency ban on puberty blockers for people under 18. Medical societies, government officials and legislative panels in Germany, France, Switzerland, Scotland, the Netherlands and Belgium have proposed moving away from a medical approach to gender issues, in some cases directly acknowledging the Cass Review. Scandinavian countries have been moving away from the gender-affirming model for the past few years. 

And yet, the American government still allows this form of child mutilation:

Why would our government and medical institutions continue to frame gender-affirming care as medically necessary and lifesaving despite Cass’s assessment? Especially given growing concerns about the risks and irreversible consequences of gender interventions for youths, including bone density loss, possible infertility, the inability to achieve orgasm and the loss of functional body tissue and organs including breasts, genitals and reproductive organs?

Paul considers that the divide in America is based on politics. In truth, it seems to be the case, yet, the notion that only religious and social conservatives reject these practices is a rank distortion.

But in the United States, the issue is held hostage to each political party’s tendency to bend to its extremes. Republicans are beholden to religious and social conservatives. Democrats have bowed to transgender advocacy groups. The result is a struggle between those who believe they are trying to “save” children from transgenderism and those trying to “protect” children from transphobes.

People who believe the science reject the notion of gender affirming care. Surely, the British Labour Party did not ban puberty blockers because its members are religious and social conservatives.

In America, the horror of child mutilation is being promoted by the Biden administration. Perhaps because they consider it a matter of rights. Perhaps because they believe that ideas should prevail over reality. Perhaps they are simply mired in Western idealism, to the point that they reject the verdict of reality.

The Biden administration has essentially ceded the issue to the progressive wing of the Democratic Party, incorporating gender-affirming protocols into Department of Health and Human Services policy. Moreover, recently revealed emails indicate that President Biden’s assistant secretary of health, Dr. Rachel Levine, a pediatrician and transgender woman, successfully pushed WPATH to remove age requirements from its guidelines for gender medicine before their publication, because — mixing political and public health concerns — she thought supporters of gender treatment bans might cite them to show that the procedures are harmful. 

In the past psychiatry understood gender dysphoria to be a delusional belief. Thus, a mental health condition. Studies have long since shown that children grow out of it.

The Cass Review concluded that gender dysphoria is real and can cause significant distress, but that it is often temporary. 

Research has shown it tends to resolve with puberty and sexual maturation. Many kids who experience gender distress during childhood or adolescence grow out of it and are often gay or bisexual.

The solution is counseling, the kind that allows the child to overcome the delusional belief:

The Cass Review recommends a more holistic approach to treating gender dysphoria in kids. This involves untangling gender discomfort from common pre-existing conditions like autism spectrum disorder and A.D.H.D. and treating it alongside frequent comorbidities, which include anxiety, self-harm and eating disorders. A mental health counselor can help children with any difficulties during puberty and in coming to terms with their sexual orientation — without pathologizing either.

Then, Paul makes an important point. Gender dysphoria is the only clinical condition where a child’s word is taken to be legal tender. Surely, it is the only condition where children are encouraged to mutilate themselves, to the point where they cause their bodies irreversible damage:

It’s hard to imagine another clinical protocol in which such serious medical decisions, with potential risks and permanent consequences, are so heavily grounded in a young patient’s self-diagnosis. In this light, gender transition treatments for minors can even be considered unethical.

The most frightening part concerns the American medical profession. It has adopted the model of gender affirming care and routinely allows physicians to mutilate children.

Already the gender-affirmation model is taught in leading medical schools, and all the major professional medical organizations in the United States have officially embraced it in their guidelines, a fact often cited by advocates as evidence of their validity.

Paul suggests that the basis for this madness lies in the simple fact that American medicine is a for-profit enterprise:

This wholesale adoption of gender-affirming care is also a result of the differences between a centralized public health system like Britain’s and a privatized, diffuse health care system like ours. “Doctors are paid for each intervention, and thus have an incentive to give patients what they ask for,” The Economist noted in a recent editorial urging the United States to catch up with recent developments in gender medicine.

And considering how many procedures have been performed, if the medical profession changes its mind, it might well be attacked by armies of lawyers.

If the medical profession turns away from the notion that transitioning young people is necessary and lifesaving, it could open itself up to malpractice suits. Consider that in Britain, a lawsuit by a gay girl named Keira Bell against Britain’s leading gender clinic instigated the investigation that led to the Cass Review.

Clearly, something is radically wrong with American medicine. It may feel redundant to keep returning the issue, but children are being sacrificed in a pagan rite, so there is no such thing as too many denunciations.

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