Canada - Judge delays double mastectomy

[Dimpsey]

Saw this on twitter and thought I would share: vancouversun.com/news/b-c-supreme-court-judge-orders-surgeon-to-deny-trans-teens-mastectomy-wish?utm_term=Autofeed&utm_medium=Social&utm_source=Twitter#Echobox=1604974077

Mother of the child asking the surgeons to provide evidence of the protocol they have followed to demonstrate that the operation is in the child's best interests.

Yes, I agree BlackWaveComing

@BlackWaveComing

Tbh, I wish men and transwomen would butt out of female experience. Being dysphoric about your breasts and wanting them removed is a female experience. Males cannot understand it and have no experience of it.

This is women's and transmen's business.

Women

I completely agree.

My niece is a transman who's had a double mastectomy.

She needed intense psychotherapy, not testosterone and surgery. But the former isn't available. And no, it isn't 'conversion therapy'.

Of course not. It's criminal that good quality psychotherapy is only available to those with means...and the ability to parse out a trustworthy provider.

I find it remarkable really. If the answer to the question “how can the medical affirmative pathway in children be justified?” is in fact, just more questions, how can anyone come to a conclusion that everything is ok?

Until these added questions of gender clinics can be answered satisfactorily by science, this pathway should be immediately ceased.

Sadly BACP is all about affirmation. Even counselling has been captured.

There's more on this case in yesterday's issue of The Australian - I accessed the article through a link on the author's twitter:

mobile.twitter.com/Bernard_Lane/status/1326777667027349505

Sorry - not linked by the author of the piece, but by one of The Australian's regular writers. The piece itself was reprinted from The Times.

In Canada children as young as ten can take puberty-blocking hormones, and cross-sex hormones - oestrogen and testosterone - may be administered at age 16, according to clinical guidelines

I hope that these kids eventually sue the socks off the adults who did this to them.

The 17 year old has been on hormones since July.

Less than four months

I know how urgent things seem when you’re 17, I really do remember that sense of burning injustice at having to wait for anything, and how stupidly slow, over cautious and clueless adults seemed. Thank fuck the adults around me protected me better than this poor child.

I see that the mother has sued the doctors, and that’s how the case has arisen (though I can’t see on what grounds still). Good. Someone fucking well should be suing them. I have to say I don’t care for the quote from her on “I have no rights” - framing this as a rights-based issue is what has got us into this whole mess to begin with, and she doesn’t have “rights” over the 17 year old - what she has is a duty of care, IMO.

17 year old with anxiety and depression. On hormones for less than four months. Irreversible double mastectomy of healthy breasts. How have we got to a point where saying “hang on a minute, is this ethical?” is being framed (on a website for parents no less) as bigoted and unacceptable?

Isnt depression one of the potential side effects of taking testosterone?

Seems a risky thing to do to prescribe a drug that can cause or exacerbate depression to someone already suffering from depression.

Poor child

@Cocothefirst

Poor child

totally agree

Agree with you Sophocles about parental rights framing not being helpful. A parent could agree with this course of action and that would still harm the child.

The principle for parents must be preserving the child’s natural physical integrity for future choices, not closing them off while they are still children. All children have a right to to an open future.

Health services should be providing abundant psychological support and years of watchful waiting before any physical intervention. Names, clothing whatever all absolutely fine to present socially as the child wishes but always explicitly holding on to the reality that sex can’t actually be changed.

No permanent-impacting treatments unevidenced for safety or effectiveness should be given and especially not when they already have very serious known side effects on mental health, bone density, IQ, cancer risk.

And when they are NOT reversible but have been sold that way, that is unforgivable. A double mastectomy could permanently remove nerve endings providing skin sensation including sexual pleasure and also future breastfeeding potential in one fell swoop.

Yes with further pain and risk and expense some women can potentially have breast reconstruction but by definition it’s not the same as a natural breast. I’m not even mentioning the psychological impact of repeated invasive surgeries on secondary sexual characteristics. I hope I’m not offending anyone by saying any of that, I am very concerned at how society already minimises and consumerises breast surgery as ‘boob jobs’, while sexualising children‘s and young people’s bodies, meaning that many dysphoric young people will have been groomed into a heavily misogynised mindset around theIr own bodies. Full adult maturity, for making decisions of this gravity is also in my view not gained on anyone’s 18th birthday.

The principle for parents must be preserving the child’s natural physical integrity for future choices

I meant to add professionals, society and the courts to that- wasn’t only thinking of parents.

Do you really believe that it's in the best interests of the 80% who would grow out of it to commit them to a transgender identity for life for the benefit of the 20%?

I once asked that from a trans activist. Their answer was that it is deeply transphobic to think that the 80% have a worse life as transgender people even if they weren't "originally" trans.

I once asked that from a trans activist. Their answer was that it is deeply transphobic to think that the 80% have a worse life as transgender people even if they weren't "originally" trans.

That is deeply troubling. That a female or male that goes down the medicalised pathway to transition, and a lifetime of drugs and medical support due to the effects of those drugs, to then detransition with the same needs should not be considered to be in a worse position than if watchful waiting with extensive mental health support had been the treatment plan.

@Kettlingur

Do you really believe that it's in the best interests of the 80% who would grow out of it to commit them to a transgender identity for life for the benefit of the 20%?

I once asked that from a trans activist. Their answer was that it is deeply transphobic to think that the 80% have a worse life as transgender people even if they weren't "originally" trans.

That’s a common theme. Answers seem to be:

They’re not infertile [they are] but so what if they are? Is that so bad?

They’re not asexual [they are] but so what if they are? Is that so bad?

They were all meant to be trans [they weren’t] but so what if they weren’t? Is that so bad?

These children are all the same and can all consent to this [they cant] but so what if we’re wrong? Is that so bad?

It’s horrific.

@SophocIestheFox

The 17 year old has been on hormones since July.

Less than four months

I know how urgent things seem when you’re 17, I really do remember that sense of burning injustice at having to wait for anything, and how stupidly slow, over cautious and clueless adults seemed. Thank fuck the adults around me protected me better than this poor child.

I see that the mother has sued the doctors, and that’s how the case has arisen (though I can’t see on what grounds still). Good. Someone fucking well should be suing them. I have to say I don’t care for the quote from her on “I have no rights” - framing this as a rights-based issue is what has got us into this whole mess to begin with, and she doesn’t have “rights” over the 17 year old - what she has is a duty of care, IMO.

17 year old with anxiety and depression. On hormones for less than four months. Irreversible double mastectomy of healthy breasts. How have we got to a point where saying “hang on a minute, is this ethical?” is being framed (on a website for parents no less) as bigoted and unacceptable?

the speed is very concerning in this and so many other cases that we hear about. The person I know only realised that they might have some identity issues earlier this year (having previously come out as a lesbian), went to the Gender Clinic in April (during lockdown so presumably not face to face) and started 'T' in July. The double mastectomy crowdfunder is nearly at its target.

I notice that the 17 yr old was on anti-depressants so if she was taking hormones as well - has anyone considered the effect of the two things combined?

Knowing how much hormones (I didn't get on well with the contraceptive pill) can affect your mood/sense of well being, it seems reckless to allow someone to make such life changing decisions with no counselling or even a cooling off period especially being under 18.

It mentioned that the surgery was days away from taking place - if the doctor can't answer some fairly basic questions about why he was preparing to do this surgery I think he should be prosecuted - surely Canadian doctors swear to the Hippocratic oath??

That is deeply troubling. That a female or male that goes down the medicalised pathway to transition, and a lifetime of drugs and medical support due to the effects of those drugs, to then detransition with the same needs should not be considered to be in a worse position than if watchful waiting with extensive mental health support had been the treatment plan

Thing is there should be options within transgender treatment anyway. The same way that a dr wouldn't necessarily jump to surgery with a bad break. Not operating straight away doesn't mean they don't believe your arm is broken or you will wake up tomorrow all fixed. It just means that the less invasive and non surgical route is worth a try before they risk infection amd aneasthetic etc

Wouldn't it be the same with this? That you can be recognised as transgender but given some time and space before going the medication route because the medication is more risky.

Thise options should he available within the care plan as opposed to seen as transphobic ..

And I dont see the harm in counselling. Surely you can be transgender alongside having other problems that might be responsive to therapy ? What is there to he afraid of? Therapy won't make a well person sick but it might make someone who is ill a little bit better?

It does seem like there is a lack of holistic oversight with surgeons providing surgery aiming to ease emotional symptoms on the basis of recommendations from psychiatrists.

So the surgeons have to take the psychiatrists’ word for it that whatever they do will help. And surgeons will naturally counsel the patients mainly on the physical risks of having procedure vs not having it done, they aren’t so expert on talking emotional side of it. And apparently nobody is learning from detransitioned people’s experiences because (in the UK) they aren’t under the care of GIDS any more and inexplicably are not being sought out by the NHS for research participation about their experiences and as patient pathway advisors. So it’s a partial picture for patients at best.

Then if the psychiatrists are politically captured then that’s not a good preparation for the patient for supporting their valid informed consent nor are they in a position to give a reliable recommendation for surgery as the best solution to the patient’s problems anyway. It’s a complex and sensitive area where there should be a higher level of scrutiny, not a silo where political prescribing can happen with permanent results for patients but no follow up.

To stop the affirmative medical pathway for children and to revert back to a therapy approach - which the evidence says is the best approach - would be to admit the affirmative medical pathway carried out on children over the last 10 years has been wrong.

I don’t think those involved will make that decision to revert back. Too much pride. Too much at stake. They will have to be regulated into it by authorities who finally step up to their responsibilities to protect children.

And the thing with psychiatrists Chatty is that there is no way they don’t know that the American Journal of Psychiatry had to publish a correction just in August, confirming that surgery confers no improvement to the mental health of trans people. That means any patient they’re seeing right now, they are being completely dishonest with. They aren’t counselling them with facts.

[quote MaudTheInvincible]This was recently posted on Twitter. It's regarding Finland's PALKO, whose twitter bio (in translation) says 'PALKO is an institution appointed by the Government, whose task is to make recommendations on which services belong to the range of health care services', and their recent recommendations about the clinical treatment of trans and NB people, and compares it to the situation in Canada. genderreport.ca/finland-strict-guidelines-for-treating-gender-dysphoria/[/quote]
This is a really useful report

@Kettlingur

Do you really believe that it's in the best interests of the 80% who would grow out of it to commit them to a transgender identity for life for the benefit of the 20%?

I once asked that from a trans activist. Their answer was that it is deeply transphobic to think that the 80% have a worse life as transgender people even if they weren't "originally" trans.

In that case, then surely a trans person won't have a worse life as a non trans person even if they were originally trans.

It must work both ways.

@ChattyLion

It does seem like there is a lack of holistic oversight with surgeons providing surgery aiming to ease emotional symptoms on the basis of recommendations from psychiatrists.

So the surgeons have to take the psychiatrists’ word for it that whatever they do will help. And surgeons will naturally counsel the patients mainly on the physical risks of having procedure vs not having it done, they aren’t so expert on talking emotional side of it. And apparently nobody is learning from detransitioned people’s experiences because (in the UK) they aren’t under the care of GIDS any more and inexplicably are not being sought out by the NHS for research participation about their experiences and as patient pathway advisors. So it’s a partial picture for patients at best.

Then if the psychiatrists are politically captured then that’s not a good preparation for the patient for supporting their valid informed consent nor are they in a position to give a reliable recommendation for surgery as the best solution to the patient’s problems anyway. It’s a complex and sensitive area where there should be a higher level of scrutiny, not a silo where political prescribing can happen with permanent results for patients but no follow up.

The tendency to work in silos rather than more holistic care has been mentioned by GIDS when questioned about how many children have been prescribed puberty blockers. Their reply is that they don't know, because they don't actually prescribe them, just refer them to the endocrinology team. The endocrinologists in turn assume that all appropriate psychological assessments have been carried out and the physical treatment is in the child's best interests in terms of their mental health.

The picture I get is of everyone pointing a finger at some other part of the process when questions are asked and saying 'it wasn't me, it was them'.