This is amazing. The public relations firm Mediasource, representing the American Society of Plastic Surgeons issued a glowing and newsworthy press release this week titled “Gender Confirmation Surgeries Rise 20% in First Ever Report”.

ARLINGTON HEIGHTS, Ill. – For the first time, the American Society of Plastic Surgeons (ASPS) is reporting on the number of gender confirmation surgeries in the United States. ASPS—the world’s largest plastic surgery organization—found that more than 3,200 transfeminine and transmasculine surgeries were performed in 2016. The procedures can include anything from facial and body contouring to gender reassignment surgeries.”

The press release went on to cite Chicago plastic surgeon Dr. Loren Schechter(*):

“There is no one-size-fits-all approach to gender confirmation,” said Loren Schechter, MD, a board-certified plastic surgeon based in Chicago. “There’s a wide spectrum of surgeries that someone may choose to treat gender dysphoria, which is a disconnect between how an individual feels and what that person’s anatomic characteristics are.

Access to gender confirmation procedures has improved in recent years. In just the first two years of collecting data, ASPS found the number of transgender-related surgeries rose nearly 20 percent from 2015 to 2016. “In the past several years, the number of transgender patients I’ve seen has grown exponentially,” said Dr. Schechter. “Access to care has allowed more people to explore their options, and more doctors understand the needs of transgender patients.”

(*Regular readers will remember Dr. Schechter as the business associate of psychologist Randi Ettner and her husband, who provide dubious and highly paid “diagnosis” and supporting testimony for convicted male murderers who wish to obtain prison funded “sex changes” and subsequent transfer to women’s facilities.)

Anyway, Reuters ran with the story and it took off internationally.

Gender Confirmation Surgeries on the Rise in US” read the headlines. “US Gender Confirmation Surgeries Up 19% in 2016, Doctors Say”.

Media outlets stuck with the same narrative that ASPS/Reuters provided: Surgeries to alter sex characteristics showed a 20% annual increase, likely due to increased media exposure of transgender issues, the removal of Medicare’s blanket ban on coverage, and increased insurance coverage of such procedures under the Affordable Care Act. Some news outlets added testimonials from satisfied customers who felt reborn after surgical procedures.

CBS News used commentary from Gearah Goldstein, a late-transitioning self-employed activist dedicated to medicalizing gender in children and eliminating private sex-segregated facilities for girls in public schools. Goldstein described his psychological relief after undergoing facial feminization surgery performed by Dr. Schechter. New York Magazine’s science writer Jesse Singal tweeted Goldstein’s testimonial as evidence of the efficacy of cosmetic facial feminization surgery for men who identify as transgender.

https://twitter.com/jessesingal/status/867117853320806401

Washington Post science writer Amy Ellis Nutt, who believes that identification with a sex role, or “Gender Identity”, is a biological process that occurs in utero, used a rebirth testimonial from 74 year old Denee Mallon: “When I woke up from surgery, I felt a certain sense of peace and tranquility.”

Business Insider quoted HRC press officer Sarah McBride (formerly Tim McBride):

 “Sarah McBride, a press secretary for the Human Rights Campaign agreed the data is novel and important, adding that “there’s been a real dearth” of statistics about the transgender community until recently.”

Articles quoted various supporting statistics directly from the American Society of Plastic Surgeons survey. Business Insider placed some of the data into a helpful graph. Have a look at the findings:

[this graph has now been removed from the Business Insider article. The article itself has not been redacted]

Even a cursory glance at this “supporting data” reveals that these numbers are meaningless. Equal numbers of male facial feminization and female facial masculinization procedures?! Nonsense. Only a hundred or so mastectomies or breast augmentations?! Only fifteen genital surgeries recorded nationally by the ASPS?! What exactly is being measured here? Not much.

Elizabeth Nolan Brown at Reason.com writes a detailed breakdown of the problem with the ASPS survey and conclusions:

http://reason.com/blog/2017/05/23/gender-confirmation-surgery-2016-stats

Retraction Watch also covered this story:

http://retractionwatch.com/2017/05/23/reuters-removes-story-gender-confirmation-surgery-firm-mistakenly-released-data/

You can read the original (now retracted) Reuters story at NBCNews, which is still running the story with the following notice:

“Editor’s Note: Reuters has withdrawn this story because of questions surrounding the data supplied by the American Society of Plastic Surgeons.”

http://www.nbcnews.com/feature/nbc-out/u-s-gender-confirmation-surgery-19-2016-doctors-say-n762916

Have transgender related surgeries increased by 20% in the past year? We have no idea. They could have spiked by over 300% (insert any figure). Or they could have dropped as more genderists adopt a “non-binary” belief system (or for whatever reason). We just don’t know.

But that won’t stop the international media from pushing the narrative, uncritically, with fake data supplied by the medical gender industry.

Indeed, as of today they are still reporting it.

Story continues to spread. Published today by Mirror Daily

 

From the EPATH Conference website

The Second Biennial conference of the European Professional Association for Transgender Health (EPATH) has issued a last minute “code of conduct” as it prepares to deal with stalking, harassment, threats, and abuse of presenters from attendees following the activist hijacking of the USPATH conference earlier this year. The EPATH and USPATH conferences are regional events sponsored by the World Professional Association for Transgender Health (WPATH), a medical lobbying group comprised of individuals who make a living off the medicalization of sex-roles among individuals that identify as transgender.

The Code of Conduct issued for the April 6- 8th EPATH conference, being held in popular medical tourism hotbed of Belgrade, Serbia, reads as follows:

 

CODE OF CONDUCT

This year, in line with good governance arrangements, all attendees, speakers, sponsors and volunteers at the 2nd biennial EPATH conference are required to agree with the following code of conduct. We expect cooperation from all participants to help ensure a safe environment for everybody.

The 2nd biennial EPATH conference takes place in a friendly environment where everyone should feel welcome, safe and comfortable to share ideas and engage in open discussion without threat of intimidation or public humiliation.

We expect all conference participants to be respectful in person and online towards other delegates, speakers, organisers, staff and volunteers.

We expect all conference participants to behave and to use language that is respectful, non-pathologising and consistent with human rights standards, taking into account its shifting and complex contextual and cultural character. Ultimately this caution applies equally to transgender health and all other formal and informal settings in which human interaction takes place. Please refer to our Language Policy.

We are committed to providing a harassment-free conference and training experience for everyone, regardless of gender, gender identity and expression, sexual orientation, disability, physical appearance, body size, race, or religion.  Harassment of participants, speakers, staff or volunteers in any form will not be tolerated.

Harassment includes offensive verbal comments, and other forms of using disrespectful and pathologising language inconsistent with human rights standards, deliberate intimidation, stalking, following, harassing, photography or recording without explicit consent, sustained disruption of talks or other events, inappropriate physical contact, and unwelcome sexual attention. Conference participants asked to stop any harassing behaviour are expected to comply immediately.

These policies apply in every space at the venue related to conference, and to all participants in every role.

If a participant engages in harassing behaviour, EPATH may take any action they deem appropriate, including warning the offender or expulsion from the conference with no refund.

If you are being harassed, notice that someone else is being harassed, or have any other concerns, please contact a member of conference staff immediately. Timo Nieder of the EPATH board and Guy Bronselaer, onsite manager, are available as a first point of contact: +32 486 688 579. Conference staff can be identified, as they’ll be wearing branded clothing and/or badges.

We will be happy to assist those experiencing harassment to feel safe for the duration of the event, for example by providing escorts. Contacting police should be the last resource if this is required.

We expect conference participants to follow these rules at all event venues and related social events.

We trust that this code of conduct mirrors the views of the vast majority of our participants.

 

[end]

 

TPATH (Transgender Professional Organization for Transgender Health), an organization comprised of transgender medical activist members of WPATH, has issued an “expression of concern” about the code of conduct. They communicated their “alarm” that the code “might be used to curb the freedom of all participants to communicate the harm caused by certain presenters and methodologies. such as by filming for documentation or acts of protest like speeches and silent picketing. These methods, steeped as they are in the tradition of WPATH and history, may indeed be “disruptive”, but any “public humiliation” experienced by the recipients might better be attributed to their own failure to respond to more ‘reasonable’ dialogue over the years and decades that preceded these actions.”

 

Read TPATH’s full complaint below the fold:

 

Read the rest of this entry »

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From the protesters:

The British Medical Association has recently issued some guidelines discouraging their own staff to call pregnant women “mothers” in order to not offend the transgender community.

We demonstrate to express our opposition to that move in the strongest terms.
We see that move as a way to deny women the right to talk about their experience of birth and motherhood.

The word for adult human female is “woman”.
The word for adult human female who is pregnant is “mother”.
THESE ARE NOT DIRTY WORDS !

Only the female of the species can get pregnant and we will not pretend otherwise.
“People” do not get pregnant.
“Men” do not get pregnant.
Noticing and naming biological differences between the sexes is called science, these are biological facts.
Naming biological facts is not “exclusive”
Naming biological facts is not hate speech.
Naming biological facts is not bigotry.
Naming biological facts is not transphobia.
Yet we are all supposed to behave as if knowing and saying how babies are made is hate speech !

Recently women have been told they cannot use the word “Woman” to describe themselves because it’s not inclusive enough.
For years women have been shamed for using the word “Lesbian” to describe themselves because it’s not inclusive enough.
Recently we have been told the words “vulva” “vagina” and even “pussy” are not to be used because “some women don’t have female genitals”.

The “inclusive” answer to the question “what is a woman ?” Is “anyone who identifies as a woman”.
The circular logic of this statement is clear for all to see :
One cannot identify with something we cannot define on the first place.

On the name of inclusivity we see yet another clear attempt to silence our experience as women as well as our oppression.

By erasing our rights to name our selves, our anatomy and our oppression we are effectively being silenced.
Women describing their experience of rape, sexual harassment, female genital mutilation or birth are called hateful bigots.

Motherhood happens to women because of our biology. Motherhood is a political issue that needs to be discussed in those terms :
In the UK each year, there are at least 70 000 women suffering from post natal depression.
54 000 women are being unlawfully dismissed from their jobs because they are pregnant.
Mothers of young children are one of the most discriminated against groups in the work place.
30% of all domestic violence starts in pregnancy.
Mothers are still the main carers for their children, adding to the housework they already perform on top of every other duties, including paid work.
Abortion rights are being threatened and eroded everywhere.

The consequence of the move from the British Medical Association is that women cannot regroup under the term “mother” to describe what is happening to them when they have children.
The move from the British Medical Association is clearly anti-women and this is why we oppose it.

We demand that the British Medical Association retract these guidelines which are both absurd and anti-women

We call on all women today to refuse to comply with that policy.
We call on all women to carry on using our language to describe our experiences.
We call on all women to come together and reclaim our existence from being erased.

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Dr. Olson Kennedy: She just wants to help. You sterilize your kid.

Dr. Olson Kennedy: She just wants to help. You sterilize your kid.

 

“Even in these major metropolitan areas such as Los Angeles, San Fransciso, Boston, Chicago, and to a certain extent New York, where there are trans services available for young people, we are not seeing trans youth of color in the blocker age group. So the younger kids (I’m talking about in the 8 to 14-year-old age range) we are seeing a disproportionate number of caucasian patients coming in, and the huge lack of- certainly not representative at all of the diversity of those cities.  And I think it’s not just limited to Black and Latino families that we’re not seeing but it’s also Asian, Pacific Islander, Native American. All kinds of- we’re just not seeing the diversity represented. So for example, in my cohort of young people who are on blockers, which is probably 70 or 75 kids, we have about three African American patients and every single one of them is adopted by white parents.

We have about 14% of our kids that are of Latino origin, they are not adopted so they are coming from their primary families of origin, but that’s still massively un-proportional compared to- disproportionate compared to there being 50% of Los Angeles being Latino in heritage and ethnicity. So something’s happening where we’re not able to reach into communities of color and provide information and accesses to resources for those families.

And let me tell you why I think it’s so critical. It’s not news that people that are at the highest risk for violence and death are trans women of color. And what makes them at risk? What makes them at risk is being identifiably trans. The opportunity to be blocked and not be identifiably trans- it’s a conundrum, right? Because I don’t have a desire to eradicate trans identities? But I do have a desire to keep people safe and protected and if having the gift of selective disclosure does that, then I want to be able to give that gift to people. But we’re not able to do that right now. There are many, many, barriers to access, some of which we understand and some which we have no idea about.”

 

From here: https://www.youtube.com/watch?v=DUIfEc5yBQY

[image added by me- GM]

[image added by me- GM]

By Dr. Kelly Winters, Ph.D., member of the International Advisory Panel for the World Professional Association for Transgender Health (WPATH) Standards of Care:

WPATH: clarify and correct the childhood “desistance” myth statement in the SOC7

WPATH: Issue a public policy statement discrediting the practice of gender-conversion psychotherapies that is consistent with the SOC7

APA: clarify and correct the childhood “desistance” myth statement in the DSM-5

APA: remove “Transvestic Disorder” category from the DSM-5

WHO: initiate substantive conversation on converging the Adult/Adolescent Gender Incongruence categories in the proposed ICD-11 with the childhood category to refute the historical stereotype of childhood gender “confusion” and practice of gender conversion psychotherapies

US Dept. of HHS: align transition related categories in ICD-10-CM to ICD-11 in 2018

US Dept. of HHS/CMS: issue a National Coverage Determination for surgical transition care that is recognized as medically necessary by US and international medical authorities

 

From here: https://gidreform.wordpress.com/2016/09/19/gender-madness-in-psycho-politics-transgender-children-under-fire/

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A historic first in the annals of gender: a preliminary survey of over two hundred female detransitioners has been completed. Read the results here:

http://guideonragingstars.tumblr.com/post/149877706175/female-detransition-and-reidentification-survey

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On June 2, 2016 the Centers for Medicare & Medicaid Services (CMS) denied national coverage for gender reassignment surgery after the agency conducted a  year long review which determined that there is no medical evidence of a therapeutic outcome for patients who have undergone these procedures.

 

Excerpts from their report:

 

On December 3, 2015, CMS accepted a formal complete request from a beneficiary to initiate a national coverage analysis (NCA) for gender reassignment surgery.

CMS opened this National Coverage Analysis (NCA) to thoroughly review the evidence to determine whether or not gender reassignment surgery may be covered nationally under the Medicare program.

————————————————————————————————–

 

In general, when making national coverage determinations, CMS evaluates relevant clinical evidence to determine whether or not the evidence is of sufficient quality to support a finding that an item or service is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. (§ 1862 (a)(1)(A)). The evidence may consist of external technology assessments, internal review of published and unpublished studies, recommendations from the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC), evidence-based guidelines, professional society position statements, expert opinion, and public comments.

 

The overall objective for the critical appraisal of the evidence is to determine to what degree we are confident that: 1) specific clinical question relevant to the coverage request can be answered conclusively; and 2) the extent to which we are confident that the intervention will improve health outcomes for patients.

————————————————————————————————–

 

CMS staff extensively searched for primary studies evaluating therapeutic interventions for gender dysphoria. There was particular emphasis on the various surgical interventions, but other treatments including hormone therapy, psychotherapy, psychiatric treatment, ancillary reproductive and gender modifying services, and post-operative surveillance services for natal sex organs were also included because of their serial and sometimes overlapping roles in patient management. The emphasis focused less on specific surgical techniques and more on functional outcomes unless specific techniques altered those types of outcomes.

 

The reviewed evidence included articles obtained by searching literature databases and technology review databases from PubMed (1965 to current date), EMBASE, the Agency for Healthcare Research and Quality (AHRQ), the Blue Cross/Blue Shield Technology Evaluation Center, the Cochrane Collection, the Institute of Medicine, and the National Institute for Health and Care Excellence (NICE) as well as the source material for commentary, guidelines, and formal evidence-based documents published by professional societies. Systematic reviews were used to help locate some of the more obscure publications and abstracts.

————————————————————————————————–

 

CMS reviewed and considered potential objective measures of function including mortality, psychiatric treatment, and attempted suicide. None of the longitudinal studies in which patients served as their own control, however, comprehensively tracked changes in these events as objective measures of function before and after surgery. Events such as suicide and institutionalization were mentioned incidentally when describing patients excluded from a follow-up study or during the study (Heylens et al., 2014; Ruppin, Pfafflin, 2015). Other times investigators tracked these functional outcomes (e.g., psychiatric out-patient treatment, psychiatric in-patient treatment, and substance abuse) for the most current prior year (Ruppin, Pfafflin, 2015).

 

The most comprehensive study with functional endpoints, the Swedish study that followed all patients who had undergone reassignment surgery (at mean age 35.1 years) over a 30 year interval and compared them to 6480 matched controls, identified increased mortality and increased psychiatric hospitalization (Dhejne et al., 2011). The mortality was primarily due to completed suicides (19.1-fold greater than in control Swedes), but death due to neoplasm and cardiovascular disease was increased 2 to 2.5 times as well. The divergence in mortality from the Swedish population did not become apparent until after 10 years. The risk for psychiatric hospitalization was 2.8 times greater than in controls even after adjustment for prior psychiatric disease (18%). The risk for attempted suicide was greater in male-to-female patients regardless of the gender of the control. Unfortunately, the study was not constructed to assess the impact of gender reassignment per se. The finding of this study, again, demonstrated that reassignment surgery does not return patients to a normal level of morbidity risk and that the morbidity risk is significant, because of its clinical importance, its persistence over the interval of data collection and the increase in risk over time for the individual.

————————————————————————————————–

 

The currently available evidence has limitations:

 

  • There were design deficiencies. All but one of the studies were observational in nature. All but two were non-blinded. The accompanying loss to follow-up suggests that there is selection bias and that the population that seeks treatment for gender dysphoria is not the same population that undergoes reassignment surgery without hesitation or regret.
  • The psychometric and psychosocial function endpoints are not well validated.
  • There were limitations of the psychosocial endpoints and of the data collection of other hard functional outcomes. Evidence on mortality and especially suicide was stronger. The mortality and psychiatric hospitalization rates even after vetting in highly structured programs are of concern.
  • There are insufficient data to select optimal candidates for surgery.
  • The results were inconsistent, but negative in the best studies, i.e., those that reduced confounding by testing patients prior to and after surgery and which used psychometric tests with some established validation in other large populations. (Atkins et al., 2004; Balshem et al., 2011; Chan, Altman, 2005; Deeks et al., 2003; Guyatt et al., 2008a-c; 2011a-e; Kunz, Oxman,1998; Kunz et al., 2007 and 2011; Odgaard-Jensen et al., 2011).

Data on reassignment surgery performed on geriatric patients or follow-up data in geriatric patients who had reassignment surgery in the distant past is anecdotal (Orel, 2014).

————————————————————————————————–

 

Based on a thorough review of the clinical evidence available at this time, there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria. There were conflicting (inconsistent) study results – of the best designed studies, some reported benefits while others reported harms.

 

The quality and strength of evidence were low due to the mostly observational study designs with no comparison groups, potential confounding and small sample sizes. Many studies that reported positive outcomes were exploratory type studies (case-series and case-control) with no confirmatory follow-up. Due in part to the generally younger and healthier study participants, the generalizability of the studies to the Medicare population is also unclear. Additional research is needed. This proposed conclusion is consistent with the West Midlands Health Technology Assessment Collaboration (2009) that reported “[f]urther research is needed but must use more sophisticated designs with comparison groups.” WPATH also noted the need for further research: “More studies are needed that focus on the outcomes of current assessment and treatment approaches for gender dysphoria.” Further, as mentioned earlier, patient preference is an important aspect of any treatment. With that in mind, CMS is interested in knowing from the patients with gender dysphoria what is important to them as a result of a successful gender reassignment surgery.

 

Knowledge on gender reassignment surgery for individuals with gender dysphoria is evolving. The specific role for various surgical procedures is less well understood than the role of hormonal intervention. Much of the available research has been conducted in highly vetted patients at select care programs integrating psychotherapy, endocrinology, and various surgical disciplines and operating under European medical management and regulatory structures. Standard psychometric tools need to be developed and tested in the patients with gender dysphoria to validly assess long term outcomes. As such, further evidence in this area would contribute to the question of whether gender reassignment surgery improves health outcomes in adults with gender dysphoria.

 

Because CMS is mindful of the unique and complex needs of this patient population and because CMS seeks sound data to guide proper care of the Medicare subset of this patient population, CMS strongly encourages robust clinical studies with adequate patient protections that will fill the evidence gaps delineated in this decision memorandum.

————————————————————————————————–

 

Currently, the local Medicare Administrative Contractors (MACs) determine coverage of gender reassignment surgery on an individual claim basis. The Centers for Medicare & Medicaid Services (CMS) proposes to continue this practice and not issue a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria. Our review of the clinical evidence for gender reassignment surgery was inconclusive for the Medicare population at large.

————————————————————————————————–

 

Read the complete evidence review and text of Medicare’s denial of a national coverage determination for ‘Gender Reasignment Surgery” here:

https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=282

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