by James C. Sherlock

Reuters led off a progressive-leaning but unusually balanced and in-depth report on transgender children with the words:

Across the United States, thousands of youths are lining up for gender-affirming care. But when families decide to take the medical route, they must make decisions about life-altering treatments that have little scientific evidence of their long-term safety and efficacy.

“Gender-affirming.” Progressives who read that entire article will find lots of statements by people that agree, no insist, on hormones-on-demand for such kids. They just won’t find anyone who offers evidence that such treatments are appropriate or safe. Not one.

This is not a new subject to readers of Bacon’s Rebellion. We have reported a major international trend to be entirely more careful in this process than is the norm in the United States. We provided another example in an article about Swedish protocols.

Now England’s National Health Service (NHS) is significantly tightening the guidelines for treatment of gender-incongruent minors.

The NHS report does two things:

• It clearly lays out the scientific evidence for alterations of existing policies and protocols; and
• It makes major changes toward more careful, structured and broad-based clinical decision making, data collection and patient safety.

The new changes, currently published for public comment until Dec. 4, prioritize emotional health over medical treatment.

They do not completely ban medical treatment but will permit GnRHa (puberty blockers) only in the context of a formal research protocol. The research protocol, when complete, will set out strict eligibility criteria for participation.

As in America, the new U.K. system will be centered at children’s hospitals.

But, unlike the U.K., the fact that current medical treatments for gender- dysphoric minors are unsupported by scientific evidence of long-term safety and other health effects fails to be even a consideration at some children’s hospitals in the Commonwealth.

That is both reckless and unethical.  And needs to be stopped.

U.K. Case for change. The stated case for change includes:

• “A significant and sharp rise in referrals” from 250 in 2011/12 to over 5,000 in 2021/22;
• “Marked changes in the types of patients being referred which are not well understood.” Used to be mostly boys wanting to be girls.  Now two-thirds are girls wanting to be boys;
• “Scarce and inconclusive evidence to support clinical decision making. This has led to a lack of clinical consensus on what the best model of care for children and young people should be; and a lack of evidence to support families in making informed decisions about interventions that may have life-long consequences.”

New Rules.

The new rules, all labeled as substantive changes, emphasize emotional health over medical treatment.

1. They require expanded multidisciplinary teams that, in addition to gender dysphoria specialists, will include experts in pediatric medicine, autism, neuro-disability and mental health. The reason for this proposal is to respond to evidence that there is a higher prevalence of other complex presentations in children and young people who have gender dysphoria;
2. The clinical lead will be a medical doctor;
3. They describe a more structured approach that requires referrals to transgender clinics from general practitioners. A meeting with the GP is required to determine that the patient meets the access criteria for the gender clinic;
4. The specification also proposes that not all children and young people who meet the access criteria will need to be seen directly by a gender clinic. Those who can should be given support by local clinicians, including support in formulation of needs and risks in individualized care planning;
5. The clinical approach in regard to pre-pubertal children will reflect evidence that in most cases gender incongruence does not persist into adolescence; and that for adolescents the provision of approaches for social transition should only be considered where the approach is necessary for the alleviation of, or prevention of, clinically significant distress or significant impairment in social functioning, and the young person is able to fully comprehend the implications of affirming a social transition.

Unregulated drugs.

The NHS feels so strongly about the use of puberty blockers and cross-gender hormones from unregulated sources or from on-line providers that it will ban users from NHS endocrine care.

These are called by the NHS first steps to implement the findings of the Cass Review. The final version is expected in 2023/24.

Reuters on suicide risk

Experts in gender care say more specific research is needed to determine whether medically transitioning as a minor reduces suicidal thoughts and suicides compared with those who socially transition or wait before starting treatment.

Some gender-care professionals complain that suicide risk is too often used to pressure and even frighten parents into consenting to treatment. “I think it’s irresponsible for clinicians to do that,” said Anderson, the former president of WPATH’s U.S. chapter. “As a clinical psychologist, I don’t do a suicide assessment by membership in a class. The level of risk varies tremendously across individuals.”

De Vries, the Dutch researcher, told Reuters there is no evidence that “providing care immediately leads to a decline in self harm or would prevent suicide.”

Virginia law and regulation.

I oppose the continuing legality of endocrine treatment of minors for gender dysphoria.

But if they are to be allowed to continue, they must be subject to the same well-reasoned structure and limitations that the U.K. is adopting.

That is a matter of regulation. In Virginia, the regulator in this case is the Board of Health. I can find no law restricting the ability of the Board to impose regulations similar to those of the NHS as a matter of patient safety.

Code of Virginia § 32.1-127. B. 21 states the regulations promulgated by the Board of Health “shall require that each hospital … shall develop a policy governing determination of the medical and ethical appropriateness of proposed medical care.” The regulations shall specifically require a process for obtaining a second opinion and the active participation of an interdisciplinary medical review committee.

It would be reasonable to inquire whether the interdisciplinary medical review committees have acted in this case.

I searched and cannot find that the Board of Health has published a regulation answering that requirement in law. I may have missed it.

But it is reasonable to ask how parents can give informed consent when no practitioner can know either the efficacy or safety of puberty blockers or cross-gender hormones in the treatment of minors with a diagnosis of gender dysphoria.

Bottom line. From Reuters:

Puberty blockers and sex hormones do not have U.S. Food and Drug Administration (FDA) approval for children’s gender care. No clinical trials have established their safety for such off-label use. The drugs’ long-term effects on fertility and sexual function remain unclear. And in 2016, the FDA ordered makers of puberty blockers to add a warning about psychiatric problems to the drugs’ label after the agency received several reports of suicidal thoughts in children who were taking them.

The National Institutes of Health told Reuters that “the evidence is limited on whether these treatments pose short- or long-term health risks for transgender and other gender-diverse adolescents.”

Even the Endocrine Society, which somehow supports the hormone treatments, itself acknowledges the “low” or “very low” certainty of evidence supporting its recommendations.

On the other hand, the puberty blockers can cost tens of thousands of dollars a year and the cross-gender hormone treatments create lifelong patients for endocrinologists.

So there’s that.

The term “gender-affirming,” as used in the dark corners of the United States medical community engaged in gender transition of minors, represents an ideological construct, a heedless predisposition and headlong rush towards a specific treatment, not a medical conclusion.

Some have become pushers of the hormones.

Reuters interviewed parents of 39 minors who had sought gender-affirming care. Parents of 28 of those children said they felt pressured or rushed to proceed with treatment.

It is almost impossible to understand how this has somehow become a political issue, but then everything has.

Some, and only some, progressives have decided these medical experiments on children are “gender-affirming” with absolutely no evidence of their efficacy or safety, and have labeled opposition as “hate.”

To hell with them.

Enough of this.