Dr. Norman Spack, evangelist-in-chief for early medical intervention

[GrinitchSpinach]

I think many of us have been wondering just how medical practices for dealing with gender identity issues in children have changed so rapidly over the past decade or so. Who is pushing earlier and earlier use of puberty blockers, cross-sex hormones, and surgery in children, without controlled clinical trials (and apparently ignoring the evidence that does exist that many children will desist if allowed to go through their natural puberty)?

One Norman Spack appears to have played a major role. Spack is a pediatric endocrinologist who founded the Gender Management Service (GeMS) at Boston Children's Hospital in 2007. It bills itself as "the first major program in the United States to focus on transgender children and adolescents."

The Daily Mail called Spack "evangelist-in-chief for early medical intervention" and "the guiding light of Mermaids and a friend of both Susie Green and Dr Webberley."
www.dailymail.co.uk/news/article-3973036/Jackie-Green-heart-controversy-children-young-nine-given-drugs-change-sex.html

from that article:
He wants children who identify as transgender to routinely be given hormone-blocking drugs around the onset of puberty, and then move to high doses of hormones to change their sex, after which they can consider surgery.

The Spack philosophy is that age limits are arbitrary and often cruel. ‘Why wait?’ is his mantra. He says he has put ‘about 200 children’ onto hormone blockers, and claims 100 per cent have gone on to take cross-sex hormones because ‘no one changes their mind’.

Here is a Q & A with the doctor published in 2008:
archive.boston.com/bostonglobe/ideas/articles/2008/03/30/qa_with_norman_spack/?page=full

Some bits that stood out to me (Spack in italics, my own comments in brackets):

All I know is that when I see preadolescents, they have been dressing in the underwear of the other sex for years. These kids are almost certainly transgendered. [As we know, the clothes make the man/woman/boy/girl.]

The puberty-blocking drugs work best at the beginning of the pubital process, typically age 10 to 12 for a girl and 12 to 14 for a boy. Stopping puberty is, in itself, a diagnostic test. If a girl starts to experience breast budding and feels like cutting herself, then she's probably transgendered. If she feels immediate relief on the [puberty-blocking] drugs, that confirms the diagnosis. [Gee there are no possible other reasons girls in our society might feel distress at body changes during puberty, huh?]

You have to explain to the patients that if they go ahead, they may not be able to have children. When you're talking to a 12-year-old, that's a heavy-duty conversation. Does a kid that age really think about fertility? But if you don't start treatment, they will always have trouble fitting in. And my patients always remind me that what's most important to them is their identity. [So he understands that his patients are incapable of truly informed consent to sterilization...]

My own rabbi said it best: The transgendered are also created b'tzelem Elohim, in the image of God. [If they are created in the image of God why do they need medical and surgical alteration???]

I need to do a little more looking to find out who funded this marvelous groundbreaking clinic that now has worldwide influence...

Sadly, for some parents, the chance to become the hero crusader for their child is evident. Munchausens by proxy doesn't seem too wild a guess for a few, tbh.

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

“I was salivating,” he recalled. “I said we had to do this.”

The puberty-blocking protocol gained legitimacy in 2009, when it was endorsed by the Endocrine Society, the leading association of hormone experts, on the recommendation of a task force including Dr. Spack.

www.nytimes.com/2015/06/17/nyregion/transgender-minors-gender-reassignment-surgery.html?_r=3

I'm afraid I do believe parents are behind a lot of this in young children. I simply do not believe there is such a thing as a trans child. Where did they get the idea? This literally didn't exist until recently. A variety of Munchausens seems highly likely in many cases, along with general attention seeking, self validation and in some cases homophobia.
Working in the NHS I know all too well what chronic illness means, how lives can be devastated by cancer or a tragic accident. I have always taught my children to value good health and take good care of their bodies which doesn't mean being health freaks (I'm sitting here having and cheese nibbles left over from Christmas) but choosing surgery and drugs for a healthy body is the way of madness in my view. How could anyone want that for their child?

Susie Green's TedTalk December 2017 (319,981 views)

'Transgender: a mother’s story'

from 10:00 onwards Susie Green describes taking her child to see Dr Norman Spack in the USA , "who would prescribe totally reversible blocking medication which would pause puberty. If taken away, puberty resumes"

I have a memory of seeing a program with Jackie & Susie Green in conversation with her US doctor. I think the doctor described how he also prescribed oestrogen (?) so that Jackie did not grow taller than most women. It may have been in the documentary about Beauty Pageants

Spack gave a Ted talk too, but I haven't had a chance to watch it yet.

It's just horrible. Imagine deliberately stunting the entirely normal growth of a child ito fit what you've decided it should be?

It's all abusive IMO. There will be lawsuits.

OMG THIS GUY.

I'm trying to watch the video and it is excruciating. Lots of nonsense but I had to just pause it to comment on this: he says something like "The male-to-female [genital] surgery is so convincing it's fooled gynecologists!"

Please, Dr. Spack, let us know which gynecologist cannot differentiate between an actual vagina and a surgically constructed cavity unattached to any other parts of a female reproductive tract---so we can all make sure that blazingly incompetent MD never treats a woman patient!

"Once they gave them the hormones consistent with the gender they affirmed, they looked beautiful. They looked normal."

So Spack confirms it: his protocol exists because gender non-conformity is a pathology to be cured. He will use medicine and surgery to turn your non-conforming kid "beautiful" and "normal."

This man is terrifying.

Spack says Jackie Green's genes would have made JG 6'5", boasts of limiting JG's adult height by blocking testosterone and administering estrogen at age 13.

Oh this is all shocking. I never knew all this was going on.
I feel for my children’s generation. What an I do to help things?

Vegilante thanks for your post. Oh blimey. I really thought school based health care for US children was at least in some states top notch. It's deeply scary if Dr Spack is an early stop on the pathway, just as I would be terrified if Dr H Weberley were the first medical professional a gender questioning adolescent met here.

"Oh this is all shocking. I never knew all this was going on.
I feel for my children’s generation. What an I do to help things?"

I'm worried as there's a trans-identified kid in my daughters' year (she's 5 years old). So, it is certain to come up soon. Gender ideaology is likely to be taught (informally) to my kid in school before sex education is.

I'm working hard with my daughter to remain empathetic and refer to everyone how they wish, but to clarify how wrong (we say "silly" at this age) it is for people to think boys or girls have to act or dress a particular way. Like most kids at this age she believes gender stereotypes are real because other kids and adults have told her so, and I have to push back hard against it.

Gizmo it is shocking. I am glad that this year has seen more people speaking out, and more media outlets looking at this ideology critically. Unfortunately I'm worried a lot of kids will suffer irreversible harm before eventually the scandal really comes into focus for the public at large.

Final thoughts on the video:

1. in the beginning he cites figures I've never heard before. He says that of kids who identify as the opposite sex in childhood, 80% will eventually desist (so far so good; I know the studies I've looked at chime with this). But he says that if the children haven't desisted by the ONSET of puberty (so 8-14 right?) they are certain to remain trans. I have never seen this claim made before; the 80-85% desistance rate cited in other research measures desistance AFTER going through natural puberty.

2. Suicide, suicide, suicide. The dodgy-statistic-backed emotional blackmail with which we've become familiar: Putting your kids through this treatment is the only way to prevent their near-certain suicide. No evidence to back this claim.

3. Wants gender dysphoria "out of the DSM. It is no more a psychiatric condition than being gay or lesbian." At the same time, admits on the children's hospital blog that there is no objective diagnostic criterion:

I think that there is an absolutely tremendous need for tools with which to discern which of the kids are really among the 20 percent who are definitely going to be transgender... These tools are going to be based on analysis from the neck up, not blood levels of anything I can think of—unless it’s maybe a genetic test, but I doubt it. My theory is that we just don’t know enough about the brain... There have already been a few inferences as to the differences between a male and a female brain not caused by hormones, but they’re somewhat crude. I’m convinced that sooner rather than later, someone’s going to figure something out related to the brains of the 20 percent transgender kids.
thriving.childrenshospital.org/norman-spack-saving-transgender-lives/

So fundamentally he believes that there is such a thing as a "girl brain" born into a boy's body by mistake (and vice versa). He admits no objective markers have been found for diagnosis, but is certain that forging ahead with irreversible treatments on minors' healthy bodies is the solution. What a piece of work.

'’I'm convinced that sooner rather than later, someone’s going to figure something out related to the brains of the 20 percent transgender kids."

Jesus! Can you say 'evidence-based practice', kids?

But ladies, pointing out that Spack & his ilk are modern-day Dr. Frankensteins who got their medical ethics from Dr. Mengele is just so mean!

To those wondering what happened to medicine that was based on evidence & science & grounded in ethics, the wokest uni students in the English-speaking world today believe "Science as a whole is a product of Western modernity and the whole thing should be scratched off." Because they don't just believe in magical thinking - they believe in magic:

What kind of person comments on, much less diagnoses based on, what kind of underwear a pre-adolescent child wears?

This is madness. People must believe that gender is real, rather than a set of social constructs which are arbitrary and designed to impose hierarchies. This is the bit I cannot get my head around. I mean, they know that gender stereotypes change and do not define you, don’t they?

I mean, they know that gender stereotypes change and do not define you, don’t they?

They really seem not to...

Worryingly, Dr. Spack and three likeminded colleagues have a $5.7 million US government grant to study longitudinal outcomes in trans kids.

www.thepublicdiscourse.com/2018/01/20844/

The article outlines the problems with the grant. All four researchers studying the outcomes are clinicians engaged in aggressive prescription of puberty blockers and hormones, and advocates of surgery. What are the chances, do you think, that these four will come back with the conclusion, "We've been doing it wrong'?

ps No control group (untreated by blockers or hormones) is included. Much science! So evidence!
pps Study will only follow kids for five years. So if drugs are administered at puberty onset age 10, we won't see any longer-term effects past age 15. Totally old enough to know whether you're happy with infertility and no or limited sexual sensation, yes?

Pat as there's no centralized health care service like the NHS in the US, young people with adequate insurance or $$ can also flit from one therapist to another to yet another & another until they finally find one who gives them what they want, as this NB youngster in search of validation & hormones shows:

hellogiggles.com/lifestyle/health-fitness/im-non-binary-my-therapists-think-i-dont-exist/

Also, all the kids learn from YouTube exactly what to say to therapists & doctors to get put on hormones right away. And the therapists & doctors comply. It's all a charade, one with tragic consequences.

I'd bet my mortgage Spack calls his patients his children.

Me too. shudders

There's a section of the video in which Spack waxes on about how his patients develop "normal breast size!" The way he repeats it and his delighted tone give me the fucking creeps...

Related if you bear with me: Galileo's Middle Finger by Alice Dreger has a section on her fight to prevent the practice of prescribing prenatal Dexamethasone to pregnant women who are at a genetic risk of having a girl with CAH. It's an experimental off-label treatment. It's being used to interfere with the pathways of fetal development, so unsurprisingly there seem to be some unwanted outcomes for many kids, although that's not being tracked properly. It's prescribed to every pregnancy of a mother who has the gene, so most of the time there is no benefit of using it even in theory, as most pregnancies aren't CAH girls. The primary goal of the treatment is to prevent the clitoris from being too large.

There were some interesting details in the saga about how loopholes in ethics committee processes are being exploited. Dreger and her allies weren't able to prevent the practice, despite it being obviously unethical and unsupported by evidence, and despite the network and experience that Dreger has (her husband is head of a medical school and she has campaigned on intersex issues for years.) All they were able to do in the end, after years of activism and investigation, was get information about it high up on the Google search results so that parents stood a better chance of informed consent.

I recommend the book to anyone who is looking at this story and wondering how on earth such respected institutions can be behaving in such unethical ways. Sheds some light. (There's also an excellent section in the book about Dreger's tussle with TRAs.)

The main driving force in the prenatal dex story is also a rogue pediatric endocrinologist, oddly enough. Her motivation seemed to be centred around wanting the CAH girls to be more gender-conforming. It's amazing how much havoc a powerful and influential doctor can wreak in service of their personal prejudices.

EJennings excellent points as always. It is curious why caution & all the old rules have been thrown out the window just for transgender interventions.

Re Medicare: one of the things that peak-transed me was a glowing front-page feature in the NYTimes about Jerome Thunderpussy Kricket Nimmons, a jobless repeat-thief, street hustler & jailbird with untreated HIV from Georgia who moved to NYC where he was given free housing on account of trans/HIV & then quickly became NY's first person to get SRS on Medicaid! (Not Medicare, but close.)Since Thunderpussy didn't comply with the post-surgery regimen of care for his (thunderful) new front hole, a second surgery was required. Aargh! You probably recall the story:

www.nytimes.com/2015/12/13/us/kricket-nimmons-transgender-surgery.html