There goes the much-vaunted "medical consensus"

[HildegardP]

Good piece from Leor Sapir on a new statement from the ASPS re "gender affirming surgeries" for adolescents. The full statement is linked in the article.

"In a major development, the American Society of Plastic Surgeons, a medical association representing some 11,000 members and over 90 percent of the field in the U.S. and Canada, has come out unequivocally against “gender-affirming” surgeries in adolescents under age 19. “Systematic reviews and evidence reassessments,” the ASPS states, “have . . . identified limitations in study quality, consistency, and follow-up alongside emerging evidence of treatment complications and potential harms.”

I particularly enjoyed the part of the statement explaining patient autonomy, I do hope Gordon Guyatt finds it a useful refresher.

www.city-journal.org/article/american-society-plastic-surgeons-gender-affirming-care-minors

I wonder if the $2M settlement awarded to a US detransitioner decided the timing of this statement 🤔

It really angers me that self interest rather than patient care is what might move the opinion on this issue.

Agreed. But if that's what it takes then bring it on.

@UtopiaPlanitia This has been coming for a while now, I first became optimistic that we might hear something solid from them when the former ASPS head gave this interview to Ben Ryan in September last year; https://benryan.substack.com/p/top-plastic-surgeon-wont-commit-to (also linked in the article).

It's a nine page position statement so I'm sure it's been in the works for a while. I doubt the $2M verdict from two days ago had anything to do with it. But I'm sure the threat of lawsuits in general did.

I doubt that the likes of Sibhdh Gallagher have been doing ASPS members many favours either, & every dumb statement & horrific, avoidable outcome has been carefully archived.
Either they put clear blue water between the ASPS & the ghouls or the entire sector's reputation goes down the pan with them.

Absolutely. I think we all knew it would come down to that.

I find it so interesting that this is coming from plastic surgeons, which in many cases is not what I would call the most ethically focused branch of medicine.

Why them, rather than endocrinologists, for example?

Is it because they are used to thinking about liability? Or are very result focused?

Surgeons are a very visible part of the chain. Patients fixate on them and remember them and if they eventually regret the surgery they blame the surgeon. There's less emotions attached to taking prescribed pills than surgery

Being fair to plastic surgeons, a lot of them work on reconstruction & maintenance for burns victims, cancer survivors & others in similar circs. When I was a kid, a relative got cancer of the jaw, the whole thing was removed & though she lived on for some years, I never saw her again because she didn't want us to remember her like that. She also said, "I don't want to frighten the children", the poor bloody woman, it pains me whenever think of that.

When my neighbour got the same cancer many years later, medical progress in diagnosis & treatment meant that he was able to retain some of the bone & plastic surgeons were able to make him a new & convincing jaw from his fibula. It's stuff like that that's the bread & butter of many PSs.

Yes, I am not at all suggesting that all plastics people are dodgy.

But there is a significant element in that speciality that are making a living doing medically unnecessary surgeries for money. So their professional organisations are, it seems, ok with that kind of thing.

The National Review has a statement from the AMA supporting the ASPS

The AMA said in a statement to National Review that because “the evidence for gender-affirming surgical intervention in minors is insufficient for us to make a definitive statement . . . the AMA agrees with ASPS that surgical interventions in minors should be generally deferred to adulthood.”

I would link it but MN has hidden my link on the Medical Evidence archive thread so I will link a twitter post instead.

https://x.com/leorsapir/status/2018888126974812652?s=46

Bit by bit this crumbles. I find it hard to not remember the children impacted though.

I remember seeing so often the reply ‘regret rates are higher for knee replacement’ and being horrified that there are posters who declare they have expertise in ‘this topic’ actively dismissing any criticism of ‘Gender Affirming Care’. I suspect that those posters will simply declare this is a political move now and that in the future it will all change again.

I also note the ‘generally deferred’ and wonder what exceptions they support.

I’d imagine the response will be to say that surgery like this on minors is very rare, as if that doesn’t beg the question- if it’s a good thing, why is it rare? What level do you think it should be? And also ignoring the cultural and educational issues - a child spending years focused on the undesirability and incongruity of certain body parts and watching numerous influencers promoting these changes, and booking in for surgery on their 18th/19th birthday, isn’t AOK either and that’s unaffected by this change. However, it’s an earthquake tremor that may undermine the eagerness of commercial medicine to sink its fangs into children and young adults and to normalise the wholesale selling of body modification as a type of seasonal fashion.

Also, this is another brick crumbling. Maybe we will now see a stop to the ‘life saving treatment’ argument. Particularly after Strangio’s admission about suicide in the Skrmetti trial. It feels like we have to follow crumb trails at the moment, but these crumbs all point to admissions that those in influence know that the weak evidence they tried to hide behind emotional reasoning and manipulative tactics wouldn’t remain hidden.

https://x.com/benryanwriter/status/2018183879035629603?s=46

”Dr. Loren Schechter, the head of gender-affirming surgery at Rush University Medical Center in Chicago and the president-elect of the World Professional Association for Transgender Health (WPATH), testified that gender-transition surgery is not form of suicide prevention.”

This quote below is from Ryan’s reporting of the testimony in the Fox Varian case.

” Schechter, the plastic surgeon, testified that Einhorn had misconceived the purpose of gender-transition mastectomies. "Surgery in and of itself is not a treatment or a mechanism to prevent suicide," he said.”

theres a lot of psychological analysis that goes hand in hand with plastic surgery.

for example, my lumpectomy was so large that they performed surgery on both sides to make my breasts look as equal as possible - but had announced they don’t do unnecessary surgery on healthy breasts (!!!) when I proclaimed id happily go flat to avoid any future issues. All based on carefully gathered evidence from both physical and psychological outcomes.

and it’s now well established that body dysmorphia is best treated via psychological therapy and not surgery.

they probably have known much more about the issues of all this than they’ve verbalised publicly for a long time but I bet there’s enough trans plastic surgeons and also those making trans surgery their entire careers that it’s been impossible to be clear.

the litigation cases were also way what we said would swing the madness back

I just found this quote from Schechter in this good summary from Bernard Lane.

https://www.genderclinicnews.com/p/consensus-shatters?utm_campaign=post-expanded-share&utm_medium=web&triedRedirect=true

“However, in a previous Florida case involving a minor seeking trans surgery, Dr Schechter gave evidence in 2022 that such surgery was “medically necessary” and that “the denial of necessary medical care is likely to perpetuate gender dysphoria and create or exacerbate other medical issues, such as depression and anxiety, leading to an increased possibility of self-harm, negative health outcomes, and even suicide.””

(Schechter testimony noted here: lambdalegal.org/wp-content/uploads/2022/09/dekker_v.marstiller-_dkt.11-4-_expert_declaration_of_dr._loren_s._schechter.pdf)

Bernard has again pulled it together well.

Insurance company(s) would be on notice long before that.
The risk was always there but the numbers were not material.
Throw in a ex-child saying that she/he can not have a adult relationship children etc.

Expensive insurance was always going to happen and its bad PR for the profession

As one of its members is an expected witness trying to explain how another doctor must have properly explained the facts.

Its seen as a cosmetic elective not lifesaving and that matters when it comes down to children.

Such small steps isn't it? Good to see some medics being honest but isn't it wearying watching the world come to its senses about all this in relation to children.

Yes. It feels like having to pull down a huge structure brick by brick with our fingernails. That’s each of us writing to politicians and other influencers, putting money into crowdfunders, speaking the truth in our everyday lives, supporting those heroines and heroes on the front line, and everything else we can do to oppose the insanity.

Each brick takes so much effort and seems to make so little difference.

But at last we’re starting to see the accumulated results of work by so many ordinary people just trying to protect children and reinstate women’s rights.

Each brick that crumbles is a victory. Immensely encouraging!

I strongly believe that children's safety and well being should be our major focus. For too long self interested adults have been allowed to gaslight and groom the young via the NHS, schools and universities into believing that sex change is the cure to their uncomfortable growing bodies. That girls and women have no right to boundaries and self determination if males require access to their unclothed bodies. And that brutal experimental surgery is required to cure their mental health challenges

These people have run amok in the NHS, with many in very senior positions of influence. They exert coercive control and intimidation to silence all talk of safeguarding and children's rights to safety. They need to be stopped.
It's good to see the first signs of this in the USA.

I think the situation is nuanced. I'm sure they've been following the case - they would have had time to draft guidance contingent on the outcome, so the timing itself, if anything, makes the release more suspicious. I personally doubt that the guidance is contingent on the outcome of the latest case, but the cases that are making their way through US courts are making claims of conspiracy both of researchers and medical associations, which raises the spectre that they could be made liable and certainly undercuts the credibility of the profession.

It is positive but I can already see the TRA position - “Medical association influenced by far right and is transphobic”.

It was always going to be that way. This was led by dollars and (I hope) will be destroyed the same way.

I believe the positioning statement has been well into development for a while with at least prepublication readiness since last month. If anything, they probably waited until the final report from the USA review before starting to finalise the statement.

@Helleofabore Blimey, been away from t'internet all day & that is big news. Without the AMA, the Endocrine Society & the American Academy of Pediatrics are enmeshed in little more than a folie à deux.

Sure, as organisations the shrinks & the psychologists might try to cling on, but how much do their members want to be seen as the last to defend a medical fad as daft as radium underwear?

Long ago and far away there was a poster who insisted that affirmative only care had to be the only acceptable care because of consensus. It would appear that the consensus can change.

Can't be arsed to track down the actual thread.