Letter to the BMJ re gender services

[pattihews]

Courtesy of Glinner:
Dear Editor,
The Clinical Advisory Network on Sex and Gender (CAN-SG) (1), a group of UK and Ireland based clinicians calling for greater understanding of the effects of sex and gender in healthcare, welcomes Dr Hilary Cass’s interim report and recommendations (2). Serious concerns about the Tavistock Gender Identity Development Service (GIDS) were raised by parents, staff and governors, an initial Judicial Review judgement (3), the Care Quality Commission (4) and an Employment Tribunal involving the Trust’s Lead for Child Protection (5).

The origin of poor governance and lack of data collection needs to be openly addressed as GIDS is not unique. Globally, there are significant difficulties in discussing, let alone challenging, the practice of gender clinics, due to the belief systems of those who adhere to gender identity theory – a non-clinical ideological perspective for which there is little to no empirical support. This position requires clinicians to believe that everyone has an innate, subjective gender identity and that individuals whose bodies do not match this should be provided with ‘gender-affirming’ medical interventions regardless of the harms and lack of evidence of benefit (6,7,8). However, a child or adolescent’s sense of gender is part of a complex inner sense of self that can change during the process of development. Medicalising young people on the basis of unsubstantiated theory is unethical: there are many reasons why they might feel dysphoria, disgust, dissociated or ‘cut off’ from their physical bodies, including internalised homophobia, histories of trauma, cognitive difficulties and mental health problems. Each person suffering from such distress requires space and time to understand their feelings.

Offering puberty blockers, cross-sex hormones and radical surgery with the implicit promise of almost magical transformation may cause, and has caused, serious harms. With inadequate follow up by GIDS, no comprehensive long-term observational studies, and no reliable clinical trial data, there is simply no evidence on which to base these interventions (2,6,7,8). It is unsurprising that ‘detransitioners’ (disillusioned people who wish to reverse the effects of ‘treatments’) are coming forward; some may want legal redress and plaintiffs’ firms are seeking them out (9). Without outcome information - let alone understanding how any pre-pubertal child could make a decision to alienate adult functions they cannot understand (like sexual pleasure) - patients and their parents were never in a position to give properly informed consent to uncontrolled experimental interventions (6) clinicians failed to properly describe. These initial cases may herald more as increasing numbers of patients, parents and clinicians question the so-called ‘affirmative model’.

We would advise that the NHS proactively set up clinical services to support detransitioners, and that the NHS Litigation Authority and Medical Defence Organisations prepare. The government should look closely at materials provided by advocacy groups (such as Stonewall, Mermaids, Gendered Intelligence, and others) that teach children and clinicians (e.g. GPs, nurses, medical students and mental health professionals) gender identity theory as if it is fact, without referencing the concerns and uncertainties in the evidence. Until this is addressed young people will be at increased risk of misinterpreting their complex difficulties as proof they are ‘trans’ and believing there are simple and medical solutions to their distress.

Dr Louise Irvine, General Practitioner; Dr Juliet Singer, Child and Adolescent Psychiatrist; Dr Aileen O'Brien, Consultant Psychiatrist; Dr Seth Bhunnoo, Consultant Psychiatrist; Dr Tessa Katz, General Practitioner; Dr Jane Martin, retired Consultant Psychiatrist; Stella O’Malley, Psychotherapist; Dr David Bell, retired Consultant Psychiatrist, former President British Psychoanalytic Society; Dr Bob Withers, Jungian Analyst; Dr Antony Latham, General Practitioner, Chair of Scottish Council on Human Bioethics; Dr Angela Dixon, General Practitioner; Dr Sinead Helyar, Registered Nurse; Dr Robin Ion, Registered Nurse; Dr Az Hakeem, Consultant Psychiatrist.

On behalf of CAN-SG

This is the link that provides the original and all the footnotes/ references etc
www.bmj.com/content/378/bmj.o2016/rr?utm_source=substack&utm_medium=email

@MangyInseam

totally agree👏🏻

@pattihews

I was referring to the Thai ‘operation’ which was referenced earlier, which I believe did involve complete castration. Certainly the most prominent example of this practice in the West bears a striking physical similarity to engravings of famous castrati opera singers.

this is a very interesting thread, thank you for starting it.

It is interesting that castration was done on young boys to preserve their voice and Napoleon banned the practice on pain of death which caused the demise of the castrati. I find it amazing now that in our so-called ‘enlightened’ age such practices are still being carried out.

Excellent letter.

You seem to be something of an expert. What do the Thais use to line the surgical cavity?

My former friend the Consultant Paediatrician is a bit like that. She'd argue with me in a highly scientific way about the chemical make-up of the human body and hormones and when I countered with large gametes and small gametes and the human race (and all mammals) being binary she'd just say 'it's more complicated than that' with the strong implication that someone like me could never hope to understand.

That response isn't a "clever person" thing! TRAs without two brain cells to rub together do exactly the same condescending thing- it's more complicated than your basic biology knowledge, educate yourself. It seems to be something they learn at bullshit school.

The reason that a consultant paediatrician can claim that biological sex is complicated and that mere mortals are too stupid and unsophisticated to understand that is because it's simply an intellectual game to them: they will never experience the consequences of muddying biological sex. They are never going to be locked up in prison with a violent male sex offender; they are never going to be in a domestic abuse refuge with a guy who walks round with his dick hanging out; they are never going to play a team sport against a 6 ft 6in tall 20 stone male-bodied person. They can let other women and girls suffer the consequences while they show off about how terribly clever and sophisticated they are.

Not entirely true in her case. Occasionally another medic would enter the conversation and would disagree with her about something highly technical/ scientific. They were heading towards discussing stuff on a molecular level. The other medic wasn't GC, just didn't agree with the Consultant Paediatrician's scientific conclusions. They both seemed to work on the basis that if you could trace something back far enough, to molecular level, you'd find the answer there. Whereas I was asking them to demonstrate evidence of something other than male and female in Homo sapiens. They both went for the intersex option, of course, but I was ready for that!

Yes, it has, but something like that is necessary. Kathleen Stock had an interesting essay a few weeks ago about the softening of philosophy departments.

Frankly, even a good faith school is often better, because they explicitly teach from a set of first principles. Students can of course reject those, but the process itself involves recognizing a system you disagree with, articulating where you think it's gone wrong, and replacing it with something else. Knowing how to articulate even one coherent system goes a long way towards teaching how thought works. The recognition that first principles are usually not evidenced is important.

It's interesting that you mention the softening of philosophy teaching. The older people I know who studied philosophy seem to me to be formidably intelligent and analytical. I occasionally meet much younger people with philosophy degrees and I've rarely had that same sense of an acute mind at work.

The desire to be kind and fair and what happens to those who are found guilty of wrongthink do affect these developments, in my view, not just how good individuals are in critical thinking.

But "thinking backward" (from desired outcomes to the evidence which might support that (and only that) conclusion) really is extremely common, especially in political arguments from all sides.

Starting from all evidence, and continuing with judging its quality and then considering it all before reaching a conclusion is not that common. I have been trained to do this and yet I still sometimes stumble.

Despite all this, I don't really forgive professionals who take the easy and socially currently approved route as that route will one day be seen as lined with all the horrible collateral damage of this ideological war.

she'd just say 'it's more complicated than that' with the strong implication that someone like me could never hope to understand.

So how do they expect a child, or a teenager barely beyond childhood, to understand the implications of removing some sexual characteristics while retaining others, and then taking permanent medication to make themselves artificially 'intersex'?

That’s an excellent point Dodopatrol I’m going to borrow that next time I hear this argument used.
If it’s all so very very complicated to understand nobody should have any medical or surgical intervention until they are over 25 when the brain is fully matured and then sit an exam on it just to make sure they do understand it….

What an excellent letter.

I agree it's a good letter. It concerns me that no paediatricians are signatories. Paeds doctors are stereotypically #bekind types and there is huge institutional capture, thank goodness for Dr Cass