3 questions for GC women

[ChirpyFinch]

As the title says, three questions for the women in this chat.

1. Do you think the majority of people are gender critical, and why/why not?

2. Globally, the right wing is more vocally gender critical than the left. They are also far more likely to be regressive on a range of women’s issues like abortion and anti-gay. Why do you think they agree with GCs on this one issue but disagree on so much else (if you think they do?)

3. How many trans people do you estimate there are globally?

While we are talking about the lack of evidence that "affirmation" does any good. Which is why the NHS has stopped doing some of it, at least to children, though over 18 still seems to be fair game for unevidenced "healthcare".

Out of interest, why do you think the NHS should "affirm" someone's belief that they are the opposite of what they actually are, including to the point of prescribing drugs and green lighting surgeries that will damage their physical health?

Both of the trans people I know who committed suicide were post op, one many years post op.

There is no evidence that hormones and surgery lessen suicide risk.

I think the mental health considerations are now also taking into account the fact that some. young people who transitioned are detransitioning a few years later, because it hasn't actually made them "better". Which, longer term, will be having a much more negative impact on their health, both mental and physical, than being made to wait for the treatment to be sure it is the right thing for them.

Working on how you feel internally is always going to be a better result mentally than changing how you look externally.

Richie Herron springs immediately to mind. I may have misspelled his name, but you'll find him online quite easily.

A harrowing and devastating story that everyone should know.

What about the effects of refusing gender affirming care, and indeed of family etc refusing the acknowledge a young person’s gender identity - associated suicide risk etc?

@ElleWoods15 What associated suicide risks? Mermaids used to frighten parents by telling them that there was a risk that their children would commit suicide but that was thoroughly debunked years ago.
https://www.transgendertrend.com/the-suicide-myth/
and this one, too, from the Guardian, relating to more suicide claims made since Cass was implemented:
https://www.theguardian.com/society/article/2024/jul/19/review-dismisses-claims-youth-suicide-rose-after-nhs-curbed-puberty-blockers

Have you read the Cass review?

Please do not weaponise suicide here. Particularly since CautiousLurker and others have been very clear about their personal family situation. It has been shown that 'suicide risk' is not diminished by these treatments. That there is just as high a risk after treatment as before.

Surely you would know this with all the evidence you have read?

Therefore, absolutely we are discussing the benefit of these treatments against the lack of evidence that they show long term clear improvement of mental health compared other pathways.

Here are some clinicians saying that young people coming through their clinics are telling clinicians what they expect and how this impacts their treatment success.

The Australian , Natasha Robinson, 17th February 2023

https://www.theaustralian.com.au/science/doctor-scrutiny-on-gender-clinic-reveals-legal-and-safety-fears/news-story/8af81768fde27884caf18fff345ab78a?amp&nk=251396453faa0730705a45251160583c-1676662448

(Plug the above link into archive dot ph)

https://archive.is/DMT87

Senior physicians at the NSW Children’s Hospital Westmead’s gender clinic have studied the physical and mental health of 79 patients in a rare academic study of the outcomes of children who presented with gender distress and gender dysphoria. The findings cast doubt on the scientific basis of the gender-affirming approach followed by the nation’s other children’s hospitals.

In an open access academic paper, CHW psychiatrists, endocrinologists and other physicians, and a senior medical ethics expert, called for a “much more nuanced and complex approach” as analysis revealed 88 per cent of children presenting at Westmead’s gender clinic had at least one co-morbid mental health condition, with more than 50 per cent diagnosed with behavioural disorders or autism. One in five children who consulted the clinic with gender-related distress later had these feelings resolved, and almost one in 10 with a formal diagnosis of gender dysphoria, some who had taken puberty blockers and cross-sex hormones, later discontinued transitioning.

And

The CHW doctors have raised concerns that “many unknowns remain” regarding the long-term effects of puberty blockers, which are described by the Royal Children's Hospital Melbourne as “reversible in their effects”. International evidence is in fact casting greater doubt on whether the effects of these medications are reversible. Endocrine reviews of the CHW patient cohort documented side-effects in 23 of the 49 young people prescribed puberty blockers, including low bone density, hot flushes, weight gain and anxiety. The CHW doctors raised concerns about long-term effects on patients’ sexual function in adulthood.
Within the 9 per cent cohort of patients with a diagnosis of gender dysphoria who had desisted – that is, discontinued the transgender pathway 4-9 years after consulting the gender clinic – three had undergone puberty suppression beginning at the average age of 12. Three had taken cross-sex hormones, one from as young as 15, but not prescribed by CHW. The effects of cross-sex hormones, including infertility, are irreversible.

This is the study the article refers to.

Distress: A Prospective Follow-Up Study

by Joseph Elkadi, Catherine Chudleigh, Ann M. Maguire, Geoffrey R. Ambler, Stephen Scher and Kasia Kozlowska

www.mdpi.com/2227-9067/10/2/314

This prospective case-cohort study examines the developmental pathway choices of 79 young people (13.25–23.75 years old; 33 biological males and 46 biological females) referred to a tertiary care hospital’s Department of Psychological Medicine (December 2013–November 2018, at ages 8.42–15.92 years) for diagnostic assessment for gender dysphoria (GD) and for potential gender-affirming medical interventions. All of the young people had attended a screening medical assessment (including puberty staging) by paediatricians. The Psychological Medicine assessment (individual and family) yielded a formal DSM-5 diagnosis of GD in 66 of the young people. Of the 13 not meeting DSM-5 criteria, two obtained a GD diagnosis at a later time. This yielded 68 young people (68/79; 86.1%) with formal diagnoses of GD who were potentially eligible for gender-affirming medical interventions and 11 young people (11/79; 13.9%) who were not. Follow-up took place between November 2022 and January 2023. Within the GD subgroup (n = 68) (with two lost to follow-up), six had desisted (desistance rate of 9.1%; 6/66), and 60 had persisted on a GD (transgender) pathway (persistence rate of 90.9%; 60/66). Within the cohort as a whole (with two lost to follow-up), the overall persistence rate was 77.9% (60/77), and overall desistance rate for gender-related distress was 22.1% (17/77). Ongoing mental health concerns were reported by 44/50 (88.0%), and educational/occupational outcomes varied widely. The study highlights the importance of careful screening, comprehensive biopsychosocial (including family) assessment, and holistic therapeutic support. Even in highly screened samples of children and adolescents seeking a GD diagnosis and gender-affirming medical care, outcome pathways follow a diverse range of possibilities.

Conclusions

The data from this study show that when young people with gender distress present to health services seeking medical interventions, they end up following a diverse range of developmental pathways. The availability of gender-affirming medical interventions for the treatment of gender dysphoria is a recent one, evolving from the work of clinicians in the Netherlands. Early studies have suggested that medical interventions were associated with positive outcomes. This early body of work consequently served as the foundation for subsequent treatment guidelines and became established in medical systems via streamlined assessment processes and treatment pathways. The concept of medical affirmation was embedded in the broader culture by media and internet channels.

Together, these processes gave young people with gender-related distress a clear message: “This is the best way to proceed,” and “The medical affirmation pathway will take away your gender dysphoria.” For many young people and their families, however, these messages favouring medical interventions, coupled with professionals’ affirmation of this pathway, potentially displaced their consideration of other options or other pathways.

The young people and families who presented to our service typically came to us with settled ideas concerning their prospective treatment pathways. In particular, based on what was known at the time, and given the severity of the young persons’ distress, they and their families considered medical treatment for gender dysphoria to be the single best option. In the last five years, however, the gender-affirming medical model has been questioned by both clinicians (who have highlighted the current lack of a solid evidence base and detransitioners (who have highlighted the potential for adverse outcomes). The current evidence suggests the need for a much more nuanced and complex approach. As research data pertaining to long-term outcomes continues to accumulate, “the best way to proceed” is likely to be seen as ranging over a much more diverse range of treatment options and pathways, with each supported by a stronger evidence base than is currently available.

And have some posters forgotten this gem of a study, from Yale no less.

Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study

https://psychiatryonline.org/doi/10.1176/appi.ajp.2019.19010080

Here is the correction:

https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction

After the article “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Richard Bränström, Ph.D., and John E. Pachankis, Ph.D. (doi: 10.1176/appi.ajp.2019.19010080), was published online on October 4, 2019, some letters containing questions on the statistical methodology employed in the study led the Journal to seek statistical consultations. The results of these consultations were presented to the study authors, who concurred with many of the points raised. Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison. Given that the study used neither a prospective cohort design nor a randomized controlled trial design, the conclusion that “the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them” is too strong. Finally, although the percentage of individuals with a gender incongruence diagnosis who had received gender-affirming surgical treatments during the follow-up period is correctly reported in Table 3 (37.9%), the text incorrectly refers to this percentage as 48%. The article was reposted on August 1, 2020, correcting this percentage and including an addendum referencing the postpublication discussion captured in the Letters to the Editor section of the August 2020 issue of the Journal

Just to pull out the relevant bit:

"While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison."

Can I suggest that you either post evidence to support your claim that this type of treatment is highly likely to be more beneficial to a 19 year old female compared to more explorative therapies that directly then deal with any co-morbidities found? Because I would genuinely love to see this evidence.

Prof Appleby's report is also relevant:

https://healthmedia.blog.gov.uk/2024/07/19/dhsc-response-to-professor-louis-appleby-review/

If , as postulated, the physical body, how it is formed, the functionality thereof is an irrelevant determinator of male or female sex but that the determination of sex is an innate, internal, indescribable, indefinable feeling why are any changes to that body necessary?

Changing the body by cosmetic, chemical or surgical intervention to ape the opposite sex, of which there are only two types, just proves that lie of the innate feeling theory.

I will add this one too.

The Marcus Evans paper

www.cambridge.org/core/journals/bjpsych-bulletin/article/freedom-to-think-the-need-for-thorough-assessment-and-treatment-of-gender-dysphoric-children/F4B7F5CAFC0D0BE9FF3C7886BA6E904B

Many interesting links but worth remembering this:

Evans said: During the 1980s, I led a parasuicide service in King's College Hospital, London, and treated a number of individuals who had self-harmed or attempted suicide after gender reassignment surgery. These patients had a history of serious and enduring mental illness and/or a personality disorder. Having developed a late-onset gender dysphoria, they were often angry at the loss of their biological sexual functioning and aggrieved with psychiatric services, which they felt had failed to examine their motivations for requesting reassignment surgery and/or to adequately investigate their psychological difficulties. A common theme in their presentations was a belief that physical treatments would remove or resolve aspects of themselves that caused them psychic pain. When the medical intervention failed to remove these psychological problems, the disappointment led to an escalation of self-harm and suicidal ideation, as resentment and hatred towards themselves were acted out in relation to their bodies.

And

Winston also highlights how often medical transition may not meet the expectations of patients:

‘He said 40 per cent of people who undergo vaginal reconstruction surgery experience complications as a result, and many need further surgery, and 23 per cent of people who have their breasts removed “feel uncomfortable with what they've done”. He added: “What I've been seeing in a fertility clinic are the long-term results of often very unhappy people who now feel quite badly damaged. “One has to consider when you're doing any kind of medicine where you're trying to do good not harm, and looking at the long-term effects of what you might be doing, and for me that is really a very important warning sign.” He added that the long-term effects of taking hormones “are likely to affect reproductive function”.’

I think it is hugely damaging to spread what amounts to misinformation on a forum such as this.

This really is a time that you should be backing such claims with evidence.

And if you cannot, then maybe you could explain why you cannot post evidence to support your claim that 'consideration at all was given to the mental health and overall impact on the young person in question' and your weaponising of suicide?

How naive is that? Young people can feel great doing all sorts of self-destructive things to themselves. Espeially drugs, Anabolic steroids often make their users feel on top of the world - for a while. Then the damage kicks in.

The placebo effect is a wonderful thing but just because you believe a medical intervention will do you good that doesn't mean it actually will do you any good. And whether it helps their dysphoria or not, that young person will still be suffering from all the mental and physical downsides of that treatment.

For me your definition of being GC is totally at odds with my own.

I'm critical of the concept of gender - the bucket of cultural expectations and stereotypes that come with being a particular sex.

I find it a damaging and limiting concept that is used to hurt people who do not fit neatly into the bucket.

In terms of people changing sex - that's just factually incorrect so nothing to do with being GC and everything to do with believing in scientific evidence.

I believe the majority of people think humans can't change sex.

I think there are lots of people pushing the concept of gender - because it allow people to control others (mostly women) and also to sell lots and lots of gender specific crap (pink tool sets!!!)

I think 'right wing' is a definition that is very difficult to define - to the left it is everyone who doesn't agree with them, which is rather a large group.

Oh and Q3 - apparently I'm 'trans' because I don't fit neatly into the woman bucket of gender stereotypes.

So if you're saying trans = everyone who doesn't fit into their buckets perfectly I'd say that was 80/90% - so not really that special or vulnerable really.

Trans is not a word I use as a descriptor because it is a nonsense word to me - you cannot cross the sex binary.

My question though related to the fact that the response was unequivocally ‘how tragic’, ‘how devastating’ to **’s post, relating primarily to how she and the young person’s parent felt. But no consideration at all was given to the mental health and overall impact on the young person in question.

Here's a 20-year-old survey of research, taken in 2004 before this ideological madness took off:
https://www.theguardian.com/society/2004/jul/30/health.mentalhealth
Here's a 2020 update of a study published in 2019.
https://segm.org/ajp_correction_2020
The study had analysed the outcomes/ data relating to people who'd had sex reassignment surgery in Sweden up to 2015. Based on that data they published a report in 2019 saying that it seemed to improve the mental health of those who'd had the surgery. 'It was presumed that the fewer “mental health events” a person experienced, the better their mental health.' But when independent statisticians took a look at the data they found no evidence to support this statement and it was corrected to conclude that there is no evidence to support the idea that 'gender affirming surgeries' improve mental health.

This is why evidence is important. It's not as if we don't already know all this. There was the lobotomy scandal in the 1940s, for a start.
https://en.wikipedia.org/wiki/Lobotomy

Try telling the women of Afghanistan that.

I think that devout Muslim well-educated women in Afghanistan currently silenced and excluded by male political authority don't need me to tell them that their tragic situation is not caused by their religion.

Ballymena mega-churches and American evangelical money flooding into Northern Ireland and the DUP and the TUV, and the complete failure of successive UK governments to put proper scrutiny and control on donations to political parties, and the narco gangs, and exclusion of women and of minorities (a Belfast church with a multinational congregation was burned down the other day https://www.rte.ie/news/2024/0828/1467075-northern-ireland/ ) and the huge level of domestic violence against women in Northern Ireland - same old same old, more about money and power than about religious faith and the direct product of divide-and-rule policies.

It makes a change from attacking Catholics I suppose.

Thank you to posters for the informative rebuttal of the dangerous suicide claims. Reckless posts weaponising suicide in relation to children and young people are why no posters should be allowed to insist that their posts are free from informed criticism.

Mumsnet exists to "make parents' lives easier by pooling knowledge, advice and support on everything from conception to childbirth, from babies to teenagers". Spreading myths and untruths about such a tragic subject does the opposite of that - as does promoting the use of unnecessary surgery on mentally vulnerable young people.

btw, that's a response to GustyFinknottle's post at 11.03

Not really relevant to my post comparing faith in gender to faith in god, an unprovable or verifiable thing, and the extent to which it is advisable to let either one be a trigger for doing profound damage to ones body.

anorexics and girls who cut themselves can feel great when being profoundly self-destructive.

The way that suicide has been used by some activists as a tool to exert pressure is unforgivable. Its a recognisable pattern if behaviour to anyone familiar with coercive control dynamics.

God knows vulnerable people need proper support; this must be thoughtful, compassionate, and evidence based.

'Affirmation only' when dealing with mental health issues is ... staggering. We should not affirm delusions.

If , as postulated, the physical body, how it is formed, the functionality thereof is an irrelevant determinator of male or female sex but that the determination of sex is an innate, internal, indescribable, indefinable feeling why are any changes to that body necessary?

Yes this.

It makes a change from attacking Catholics I suppose.

Was that aimed at me? I sincerely hope not.

Of course it wasn't aimed at you, it was a reference to centuries of Northern Irish loyalist culture.

Potential analogy there with gender ideology, obviously.

Of course. That analogy (not potential, actual) was the only reason for my post.

How does the young person in question feel about this though.

@CautiousLurker and her friend are devastated, consider it tragic etc. But surely the person whose feelings are key in this debate are those of the young person in question (not clear whether they are NB or a trans man hence using non gendered language)?

@ElleWoods15 I suggest you read the tragic story of Griffin who died following complications after phalloplasty. They always claimed to be happy with the surgery despite all evidence to the contrary.

Their feelings are clearly at odds with reality. Society has a duty to protect people who are so clearly vulnerable and unwell.