October 2, 2015
With a name sounding more like something out of a sci-fi film, the US National Institutes of Health in partnership with former medical leaders of transgender industry group WPATH (World Professional Association for Transgender Health) have formed “TransNet”, a research consortium merging commercial, academic, and government interests in data collection, funding, and regulation of the medicalization of gender. The project aims to set the groundwork for the mainstreaming of transgender medical care by conducting research that supports the practice.
Recent Obama administration changes to Medicare/VA/IRS regulations allow for taxpayer subsidized cosmetic breast implants, facelifts, genital re-shaping and off-label drugs as treatment for transgender individuals. These patients seek to alleviate distress caused by possessing what they believe are innate psychological or mental traits related to the reproductive biology of the opposite sex. The goal of the treatments is an attempt to create the appearance that their bodies are the opposite sex: the sex the patient believes is congruent with their experienced personality traits. But such interventions (and beliefs) have no established scientific rationale. While there is indeed a political will behind performing these treatments, a very profitable medical/psychiatric/therapeutic industry to accommodate them, and an increasing number of patients demanding the treatments, there is an absence of science to support them.
Self-diagnosed consumer-driven “pathology” that mainly afflicts objectively healthy patients seeking off-label care has been a boon for providers and suppliers such as cosmetic surgeons, pharmaceutical companies, rogue physicians and gate-keeping therapists but there comes a point- say, when government bureaucrats become involved, that certain boxes need to be checked and forms filled out.
None of the only fifty or so “sex-change” surgeons worldwide that provide genital reconfiguring for this population accept Medicare reimbursed clients. And why would they? Their specialty has thrived as an underground economy. Their procedures are incredibly risky with high rates of complication. Long-term outcomes are, objectively, poor. Yet their clients will pay through the ear, and sign waivers to boot, and are lined up on waiting lists.
You would think surgeons would be clamoring to get aboard this gravy train but they aren’t. New York State and Massachusetts provider networks have been aggressively recruiting surgical providers for over a year since their states’ Medicaid began covering these procedures, to no avail. The only surgical group that stepped up in California when the Department of Corrections mandated the high-profile state-funded surgery for incarcerated murderer Jeffrey “Michelle” Norsworthy was Brownstein and Crane, whose practice specializes in bilateral mastectomies for healthy genetic females who believe their personalities are in conflict with their secondary sex characteristics.
The mainstreaming of medical body modification for those who clamor to look like members of the other sex has outpaced the usual steps that precede any generic medical care: basic scientific research. While authorities in medicine, government, and the highest courts have jumped on an opportunity to “correct” those who struggle at conforming to social sex-roles (not coincidentally rolling-back decades of gains made by the women’s liberation movement), they did so using the aegis of WPATH, the World Professional Association of Transgender Health, a transgender industry lobbying group comprised of two groups: those who seek such body modification and those who make a good income providing it.
WPATH had never based their suggested practices on any scientific study, which was unnecessary to represent the interests of their two codependent groups of constituents. The American Psychiatric Association however, who invented the pathology of Gender Identity in the first place, lurched awake in 2008 after thirty years of slumber and decided that maybe now was the time for some follow up to their Diagnostic and Statistical Manual GID (Gender Identity Disorder)/ GD (Gender Dysphoria) diagnosis. Some sort of data or guidelines related to the care of this population would be appropriate, in light of the explosion of numbers of patients now presenting with this diagnosis. WPATH, whose last transgender “Standards of Care” had been issued in 2001, realized that they needed to start presenting themselves as an evidence-based authority. They publicly resolved to create new, updated, plausibly authoritative Standards, this time including research citations.
But there was no science. The WPATH board was infested by grifters such as Randi Ettner,PhD who specializes in pseudoscientific “energy” and “body meridian” psychology and her husband Frederic who runs a family practice for anti-vaxxers and sponsors testosterone mills (“Low T?”) for men desiring rejuvenation.
In 2009 two mainstream doctors, both providers to transgender clients, saw the pseudoscientific writing on the wall and attempted to stay the inevitable WPATH disaster. They collaborated to produce a document pointedly suggesting evidence-based revisions to the WPATH standards of care. These physicians were Dr. Jamie Feldman, a family practitioner specializing in transgender care and doctorate of anthropology and associate professor at University of Minnesota and Dr. Joshua Safer, an endocrinologist and associate professor at Boston University.
Their paper: “Feldman, J., & Safer, J. (2009). Hormone therapy in adults: Suggested revisions to the sixth version of the standards of care.” was cited 22 times in the eventual 7th edition WPATH standards of care [PDF].
Despite the efforts of Feldman and Safer, the APA announced they rejected WPATH Standards due to the overall lack of scientific research supporting them, and would begin the long process of formulating their own evidence-based recommended treatment guidelines. The APA issued press releases to calm the resulting panic in the transgender patient population. They affirmed APA support of the Gender Identity diagnosis and their intent to continue authorizing medical body modification services to those so afflicted. “The quality of evidence pertaining to most aspects of treatment in all subgroups was determined to be low; however, areas of broad clinical consensus were identified and were deemed sufficient to support recommendations for treatment in all subgroups.”
Doctors Jamie Feldman and Joshua Safer are at the helm of the new NIH TransNet project.
Project Goals at the initial TransNet meeting, “TransNet: Developing a Research Agenda in Transgender Health and Medicine”, which was held this May in Washington DC, included:
“1) further develop a productive transgender health and medicine research consortium that would become a national forum for an evolving comprehensive research agenda in transgender health, as well as a mechanism for interdisciplinary collaboration in research on cross-sex hormone therapies, surgical interventions, STI/HIV prevention, and trans-appropriate primary and mental health care; 2) develop new research methodologies effective in conducting clinical research with transgender people, a stigmatized, vulnerable, and underserved population; 3) develop and use of standardized approaches to data collection, management, and analysis across a variety of clinical and non-clinical settings; and 4) incorporate community engagement in the research process within the structure and function of the consortium, including transgender community advisory representatives, LGBT community health centers, and community engagement procedures throughout the research process.”
|Project Number:||1R13HD084267-01||Contact PI / Project Leader:||FELDMAN, JAMIE|
|Title:||TRANSNET: DEVELOPING A RESEARCH AGENDA IN TRANSGENDER HEALTH AND MEDICINE|
One of the interesting implications of the TransNet project is the development of a National Institutes of Health “national database of transgender persons”. From the Daily Free Press:
“Members of the NIH are hoping to develop a national database of transgender people to see what trends appear from different types of intervention. “They want to know what kind of things we could be learning over the next five or ten years depending on how much money is available for research, and the purpose of this conference is to set that strategy and create some priorities for NIH,” [Dr. Joshua Safer] said.”
Such a database has been a long-running goal for Dr. Safer, author of “Out of the Shadows: It is Time to Mainstream Treatment for Transgender Patients (2008)”.
Safer created one himself at Boston Medical Center but due to HIPAA regulations patients were required to give informed consent to being listed in the registry:
“[O]ur work includes the development of a Transgender Health Registry at BMC. All transgender-identified individuals who have had hormone therapy or other transgender health care management at Boston Medical Center (BMC) who give consent to participate will have their name, date of birth, and medical record number recorded in a registry. By compiling a list of those treated here at BMC, researchers (approved by the Institutional Review Board) will be able to access more complete data when studying the long term effects of hormonal treatment and/or other aspects of care. It is our hope that by establishing the first BMC registry of Transgender Health, we will be able to better serve individuals who identify as transgender within our community both now and in the future.” [sic]
The coming TransNet national database of transgender people, operating and funded by the National Institutes of Health under the authority of the Department of Health and Human Services, using standardized and regulated data collection, promises to be the most vast and comprehensive pool of research subjects ever studied in the history of the medical industry practice of treating gender.
Our daughter in college just announced her/hir intent to start taking Testosterone. What should we do?
April 23, 2015
Request for advice and guidance from a concerned parent:
Our almost 21 year child just announced yesterday her/hir intent to start taking T and said that she was considering top surgery eventually as well but “that’s all”. Ze has been wearing men’s clothes for a couple of years now, hates having a period, and appears very butch. Seems most interested in/connected with other butch/lesbian individuals. We have tried to understand and have asked if hir intent is to transition to a male, but she claims not; stating that she’s just tired of being seen as a female, despite the butch clothes etc but does not want to be a “full male”..more like androgynous or “non-binary”.
It’s a long story, like many, but it started when she went to college and found her “place/home” in the LGBTQ community, and then changed her major to “Gender & Women’s Studies”. We are so concerned about whether this T medical treatment and surgery is truly what will make her happy versus being pressured by the environment she is currently in. She wants to change her name legally this summer. She seems attracted to other lesbians from what I can tell which may not be much! I know this may not be PC but what we’ve seen develop in her school experience feels “cultish” to us. Maybe we’re in denial? We are so very concerned about the permanent nature of this “transition” and that it is being done without any in-depth psychological evaluation or counseling. There is a possible history of abuse from a male babysitter when she was 4, but it was never possible to establish exactly what happened..she was examined and no physical evidence of anything was found. We did take her to counseling of course. She was also bullied in both middle and high school. She does suffer from anxiety and has trouble handling “stress” She has done extremely well academically and is very bright. She has always been quite nurturing and wonderful with babies and young children and even thought about becoming a preschool/elementary school teacher up until fairly recently.
What should we say to her about this upcoming transition? Should we give her any advice or information? We have tried to be accepting/loving parents but we are so afraid she is making a mistake that she could seriously regret later in life once the changes are permanent and that her decision to do this is encouraged so much by the community she is now involved with.
Thank you so much for reading this and any suggestions you can make would be very welcome.
From comment left HERE.
Insurers struggle to justify the sex discrimination of legally mandated “transgender care” while surgical providers continue to decline
October 30, 2014
Less than 50 physicians worldwide are willing to provide transgender surgical “sex reassignment” or “sex change” procedures, and as the few existing practitioners retire, no one is replacing them. Modern cosmetic and reconstructive surgeons at large are opting not to do these procedures, even when they are state mandated and funded.
Now, insurers are struggling to fulfill state mandates covering transgender surgical procedures for men that are excluded for women based on sex discrimination. Transgender state medical mandates pushed by lobbyists insist that procedures such as breast implants and “face lifts” are medically necessary for men who wish to look more like women, while denying coverage for those same procedures to actual women. Transgender advocates have successfully lobbied for such government provided “care” on the grounds that without such procedures men may become depressed or abuse alcohol or other substances, and that such men have a state-protected right to avoid being mocked or socially ostracized for their appearance. Males must declare a “transgender identity” to receive coverage.
From the Boston Herald:
Four months after the state Division of Insurance put health plans on notice that denying medically necessary treatment to transgender people is prohibited sex discrimination, insurers are still grappling with what constitutes medical necessity, and patients are struggling to find doctors who’ll treat them.
“We were concerned people were having to go all over the country for this surgery,” Dr. Joel Rubenstein of Harvard Pilgrim Health Care said yesterday at a Division of Insurance informational session. “We’re hopeful somebody would step up to put together the surgical piece so it could all be in one place.”
On the other hand, he said, Harvard Pilgrim does not want to approve procedures such as facial feminization for transgender people if those procedures would be considered merely cosmetic for other people.
But Ruben Hopwood of Fenway Health said facial feminization is not about wanting a “cuter nose.” A transgender person’s appearance is more likely to be the difference between getting a job or not getting one, and walking down the street unafraid or being attacked, Hopwood said.
Getting the proper treatment also can save money that might otherwise be spent on treatment for alcohol or substance abuse or depression, said Pam Klein, a nurse at Boston Health Care for the Homeless.
[bolding by me-GM]
October 22, 2014
From a reader:
I just wanted to make you aware of something that is going on a lot in the various trans communities on reddit: they are falling all over themselves encouraging underage kids to order and take puberty blockers/hormones without doctor supervision and without their parents knowing.
“Just do your best to get a job, or ask your parents for allowance and order meds online. You probably can’t buy much with the amount a 14 year old would make, but it’s better than nothing, since you’re that upset about it.”
A fourteen year old kid (same kid that is featured here btw: http://bbrightstar.tumblr.com/post/98511520156/thirdwaytrans-atranspaige-does-anyone), is encouraged to get puberty blockers without his parents knowing about it.
In this post, commenters tell the kid that “puberty blockers have no side effects” (http://www.reddit.com/r/asktransgender/comments/2jitun/im_not_allowed_to_transition_even_socially_im/clchmu1)
They also tell him to “Just DIY secretly. Make friends with a transgender who lives near your area and ask them to help you get hormones.” (http://www.reddit.com/r/asktransgender/comments/2jitun/im_not_allowed_to_transition_even_socially_im/clcacyk)
Telling 14 year old kids to befriend random adults for favors is absolutely appaling.
And lastly: yesterday, that same kid made a post titled “What’s the safest way to DIY hormones(mtf, age 14)” (http://www.reddit.com/r/asktransgender/comments/2jx9hm/whats_the_safest_way_to_diy_hormonesmtf_age_14/)
And again, the posters are being very “helpful”, telling the kid to go ahead and import presciption drugs illegaly and behind the backs of his parents. Some posters tell him that it is dangerous, but they are downvoted. The kid also explicitly says that his pediatrician has advised against blockers and hormone treatment, but that is apparently not relevant to the good posters at r/asktransgender.
I’ve read a lot of this kids’ posts, and not surprisingly his parents are extremely rigid enforcers of gender stereotypes. He’s not allowed to grow out his hair or paint his nails.
September 8, 2014
In the UK, Children as young as three years of age are now being admitted to state medical clinics for “corrective treatment” of sex-role noncompliance, with the aim of upholding social norms of gender and to prevent the development of “visibly transgendered” adults. Such treatments involve administration of drugs which halt normal child development (“Puberty Blockers”) followed by the lifetime administration of cross-sex hormones, resulting in sterilization. In the US, the first federally-funded state eugenics program in over thirty years will be launched in Oregon on October 1, 2014, specifically targeting pre-pubertal children deemed by parents and providers to be “transgender”. Surgeons now routinely perform complete “Sexual Reassignment Surgeries”: removing the genitals and reproductive systems of children as young as sixteen.
The following are excerpts from an interview featured in this month’s issue of LGBT Health Journal, discussing the “Current Practice and Future Possibilities” of sterilized transgender children:
“Dr. Eyler: So there are treatments for trans adults who want to become parents. Would the two of you like to discuss the needs of transgender youth, particularly children who may not complete pubertal development in the natal sex, and possibilities for future fertility for them?
Dr. Pang: My experience has been only with postpubertal individuals. The youngest transgender person whom I have treated was 22 years old, so I do not have any experience with children who are either early postpubertal or prepubertal. I think that more transgender young people are becoming interested in potentially being parents. Last year, I was contacted by the mother of a transgender teenager, a 15-year-old transgender son. Her son is interested in fertility preservation; they had questions so I explained to them what it would involve. The technologies that I have to offer are useful only for postpubertal youth, such as someone his age, but I am sure that you, Anderson, might have ideas about how to help prepubertal children.
Dr. Clark: In the trans community, more and more trans youth are being treated at younger ages, such as at Dr. Norman Spack’s clinic at Children’s Hospital in Boston. Some gender variant children are treated with puberty suspending medications, GnRH analogs, similar to the treatment of children who are experiencing precocious puberty. This keeps them from going through the full puberty of the birth sex, spares them from developing secondary sex characteristics that are misaligned with their psychological gender, and gives them some time to mature.
Dr. Eyler: Cognitively and emotionally.
Dr. Clark: Yes, to be able to decide, when they get older, whether they want to medically transition. Some gender variant children are not actually transsexual or transgender as such, and will eventually decide to stop treatment and experience the puberty of the birth sex. Others, with the support of their parents and clinical team, find that they need cross-sex hormone treatments to proceed with the puberty that is aligned with their gender.
The Endocrine Society Guidelines1 support puberty-suppressing treatment beginning as early as Tanner (sexual maturity rating) stage 2, so this can precede significant hormonal and sexual development. Some adolescents, therefore, don’t develop the ability to produce viable gametes (eggs and sperm). Adolescent trans girls may lose fertility from estrogen treatment, even if they developed the ability to produce sperm before this was started. When they reach the age of majority, trans youth may also proceed with gender-affirming surgery that includes removal of the gonads.
For children and young adolescents, it is often the parents who are thinking about future reproductive capacity, because they would like the possibility of grandchildren, and because they are looking after the future interests of their children. When I speak at community conferences, they often come to ask about reproductive options for their children.
Dr. Eyler: Yes, and as a biologist, you are prepared to discuss the significance of the gametes not maturing and what future reproduction might involve.
Dr. Clark: Yes. The most applicable research has been performed on behalf of children who are treated for cancer and are rendered infertile. The Society for the Preservation of Fertility focuses on the needs of both postpubertal and prepubertal youth who may experience sterility from cancer treatments.