When two worldviews collide.

[Paidiske]

The SOC states that therapy is NOT required. How on earth can you say that careful assessment is being done when it's only considered beneficial and not required?

Assessment and therapy are two different things.

In others words they are to accept and affirm the child is trans and advocate for them rather than take on a therapeutic stance of finding out what's really going on with the person.

That's not what the standards of care actually say, though. I quoted this in my previous post, but since it seems you missed it, let me remind you:

There are also recommendations such as that health care providers: "Are able to identify co-existing mental health or other psychosocial concerns and distinguish these from gender dysphoria, incongruence, and diversity. ...assessment is best provided by an HCP who possesses some expertise in mental health in order to identify conditions that can be mistaken for gender incongruence. Such conditions are rare and, when present, are often psychological in nature."

There is NO pathway in any of the guidelines that allows for a child to not be transgendered if they make the claim they are.

Sure there is. See the paragraph I just quoted above.

The information you provided is not based on facts.

It is demonstrating the fact that this is one reason why puberty blockers might be prescribed at that hospital.

There are no RCTs involved.

There are good reasons for that. RCTs are not appropriate for every possible treatment. As explained here:

"The gold standard for medical and social research is the randomized controlled trial, where study participants are randomly assigned to receive an intervention or to act as a control. An ideal study would be randomized, controlled, and have a large number of participants for statistical validity/generalizability. There are a number of reasons for the dearth of randomized controlled trials. Historically, there hasn’t been a lot of funding for trans health. There also aren’t all that many trans people in any given place, so statistically powerful research would require a wide geographic reach (and thus be more expensive). And there are ethical problems with true randomization. We can’t ask non-trans (or “cisgender”) people to get genital surgery just for comparison’s sake. It’s similarly difficult to ask gender dysphoric people, who suffer in contemporary social conditions, to wait on transition just so they can act as a control group. We can use cisgender people as controls instead, but this can have an impact on the specificity of research results.

Who's in denial of reality when claiming boys can be girls?

Let me just note for the record that absolutely no one in this thread, has said this.

 

[rjs330]

Then here's an idea. You keep promoting the idea that countries like Sweden and Finland have come to different conclusions. So here's the Finnish recommendation. https://palveluvalikoima.fi/documen...f92/Summary_non-binary_en.pdf?t=1592318035000

I doubt that you've read it - you haven't quoted any of it but just seem keen to keep mentioning it because you think that they do things better than do the Endocrine Society, WPATH and the AAP. So I guess that you're happy with it. Why else keep on about it?

Which is now the question. If a couple of Scaninavian countries have it right, as far as you are concerned, then shall we use the Finnish one for example as a basis for what we should be doing?

I have read it and also read on the Swedish models. They are far more restrictive that Wpath is. Sweden doesn't allow any surgeries, blockers or hormones for adolescents who claim being trans around puberty. They receive psychotherapy instead. Prepubescent kids may be referred to a clinic and may receive blockers if they have shown years of severe gender dysphoria.

My claims are they have backed away from what they were doing. And WPATH instead is moving forward with less restrictive and more affirming guidance and these other countries are moving to a more restrictive and less affirming models. This is a step in the right direction. And in their own guidelines they continue to state that more research needs to be done on this. And the Fins are doing just that for sure as this is part of their requirements.

We will see what happens in the next years to come. But suffice it to say, that the breaks are beginning to be applied to this ideology. And that is a good thing.

So yes they have come to different conclusions. Heres hoping the US/Canada and the rest of the world follow along and end this madness.

 

[stevevw]

Let me add that a third worldview which tries to reconcile these two. In that world view there is indeed God who created and designed for a purpose. But part of that purpose is human growth and spiritual development. And that requires human empowerment, free will, self determination, much like a child needs to learn to make his or her own decisions and choices, choosing the life that is right for him or her rather than the parents' plan.
When a child is born with a cleft palate or any other physical abnormality, we often have no problem with surgical correction. we take it upon ourselves to change the way God created that child.

I was with you up to choosing the plan thats right for self rather than the parents plan. I would assume this can be applied to choosing the plan or Will for self as opposed to Gods plan and Will. I think what you are talking about is about being practical and dealing lifes realities that directly affect us. God gave us free will but the choices we make depend on our beliefs.

Correcting a cleft pallet is a practical issue to do with bodily function, to help people live better or even to keep them alive. But that is different to say using that knowledge and tech to recreate Gods nature which I think stems from our belief about the world, nature and reality.

 

[Bradskii]

I have read it and also read on the Swedish models.

Then you know that they allow puberty blockers in some circumstances. When the case dictates that they do. When each case is considered on it's merits.

So what we have now is you saying that we should listen to these people. They are doing it right. They are setting a good example. I'm not inclined to disagree. So let's use them as an example of correct procedures.

The thing is, now you've dug up information, by experts, who you say we should trust, your response to that, to the very people you quote, 'I don't agree with them'.

Can your position be any more nonsensical?

 

[rjs330]

Assessment and therapy are two different things.

And how can you possibly do an assessment without therapy? There is no way to do that and that is evidenced by what the European countries now recognize. It's no longer advocacy and affirmation but it's actual therapeutic assessments which are a totally different thing. Have you listened to those clinical therapists yet? You need to cause you are way off base on this and are listening to the trans activists of WPATH. Who by the way are now including eunuchs in their SOCs.

 

[oikonomia]

I disagree with much of what you said here. For example, I don't think western society has based on a Christian worldview.

If there is another person in history you think has had more impact on the world besides Jesus Christ, who would you submit is that person?
It doesn't matter to me east or west, north or south. I would like to compare that person to Christ.

 

[rjs330]

There are also recommendations such as that health care providers: "Are able to identify co-existing mental health or other psychosocial concerns and distinguish these from gender dysphoria, incongruence, and diversity. ...assessment is best provided by an HCP who possesses some expertise in mental health in order to identify conditions that can be mistaken for gender incongruence. Such conditions are rare and, when present, are often psychological in nature."

You left out some things. Here's what it says.

The need to include an HCP with some expertise in mental health does not require the inclusion of a psychologist, psychiatrist, or social worker in each assessment. Instead, a general medical practitioner, nurse, or other qualified HCP could also fulfill this requirement if they have sufficient expertise to identify gender incongruence, recognize mental health concerns, distinguish between these concerns and gender dysphoria, incongruence, and diversity, assist a TGD person in care planning and preparation for GAMSTs, and refer to a mental health professional (MHP), if needed.

You don't need a mental health professional? What!? All you need is a general practitioner with expertise. So where are these guidelines to determine if these general practitioners have sufficient expertise? It's like saying my general practitioner can do brain surgery on me with sufficient expertise.

How much expertise do they need? Under what conditions do we have that they are qualified to to be experts in the field of psycho analysis?

They are not even qualified to determine gender dysphoria let alone other mental health issues that could be confused with it.

Please provide us with the qualifications and licensing required for this.

 

[Paidiske]

And how can you possibly do an assessment without therapy?

Again, assessment and therapy are two different things. To give an example from a different field (just one I happen to be quite familiar with), when a child is suspected of having autism, there are a bunch of appointments and assessments which result (usually) in a conclusion about whether, in fact, autism is part of the picture for that child. Then, there is ongoing speech therapy, occupational therapy, or the like, aimed at supporting that person.

Two different things, even though the same person might have the skills to do both.

You need to cause you are way off base on this and are listening to the trans activists of WPATH.

Except none of the sources I've provided for you, have come from them.

You left out some things. Here's what it says.

The need to include an HCP with some expertise in mental health does not require the inclusion of a psychologist, psychiatrist, or social worker in each assessment. Instead, a general medical practitioner, nurse, or other qualified HCP could also fulfill this requirement if they have sufficient expertise to identify gender incongruence, recognize mental health concerns, distinguish between these concerns and gender dysphoria, incongruence, and diversity, assist a TGD person in care planning and preparation for GAMSTs, and refer to a mental health professional (MHP), if needed.

You don't need a mental health professional? What!? All you need is a general practitioner with expertise.

All they're saying here is, the assessment needs to be done with someone with sufficient expertise, and that person might come from a range of disciplines. This is not unusual. For example, again in an unrelated field, prenatal care is often done by midwives or ob/gyns. But it can be done (and in rural areas, particularly, often is) by a GP who's done some extra training in obstetrics.

So where are these guidelines to determine if these general practitioners have sufficient expertise?

Well, they set out some clear criteria right there.

 

[Ana the Ist]

Therapy isn't just about fixing disorders. It can be about exploring emotions, identifying and evaluating possible actions, identifying resources and supports, building coping mechanisms, and so on.

I don't know what psychotherapy costs in your country, but it's not cheap here, and so the very idea that you would regularly pay someone hundreds of dollars for a service that doesn't help you deal with or solve a problem of some sort is basically a foreign idea.

I would further add, that the things you're describing here are generally seen as reactions to problems. I don't need to develop coping mechanisms for being a man, for example, because it isn't a problem.

If someone comes in saying "I think maybe I'm trans," and a HCP tells them outright that they're not, that's not good care. But saying, "Okay, let's explore why you think that," and providing space to look at experiences, feelings, potential causes, and so on, is good care.

Ok....great. We've got a sort of baseline idea of what you think good care is. What if the response of the person is "I'm not interested in exploring why I think that, I'm confident in who I am, and I want medication to prevent my puberty."?

What should the doctor do then? Provide medication or deny treatment?

What I'm arguing for, in this thread, as regards care for transgendered people, is conservative/traditional/Christian people (to borrow @stevevw's not unproblematic grouping) not seeking to limit treatment options

But surely you can understand why some of these treatment options are wrong.....right? You wouldn't castrate a 8yo boy because he says he's a girl and likes wearing dresses. You wouldn't even do it if his parents approved....right?

You're acting like there's no reason to consider limitations on treatment and the very moment I suggested genetic alterations in the womb as a possible treatment.....you suddenly begin to waver in your idea of what's acceptable.
Clearly we both understand that we have certain ideas about what is acceptable treatment and what a child could consent to even if we don't agree. You aren't actually arguing for an unlimited number or type of treatments. You don't approve of conversion therapy for example. Granted I'm only familiar with those types of treatments being given by non doctors....but if doctors were doing it, you wouldn't suddenly change your mind would you?

based on a refusal to accept that being transgendered is a real phenomenon.

The sad thing is....I don't think they really cared, and all those treatments were available, until the trans activists wanted to push these things upon children. When it was grown adults....no real problems with the treatments.

Had trans activists both stayed away from other people's children and the classroom generally....and had they not demanded tyrannical changes in language and access to women's spaces....we wouldn't be talking about this.

Along the way, I've gotten tangled up in debunking a fair few, either misleading or outright false statements, which have been offered as arguments for such ideological limiting; but I'm not really interested in the details of treatment protocols or the like.

Unfortunately, I think treatment guidelines and protocols are a huge part of this....since they determine whether or not a doctor was providing quality care or committing malpractice.

Sure. Don't we have processes to deal with that?

Yes....but sadly, they lack much viability and transparency. To put it one way, it would be easier to win a lawsuit against the police....despite the medical community being prone to more mistakes including fatal ones.

I believe I linked to the Australian standards of care and treatment guidelines already in this thread, but here they are again.

Ty, I'll take a look.

It appears they endorsed the 2020 document. But so what? If the standards of care don't say what opponents say they do (eg. promoting fast tracking of children into surgery as a matter of course), but rather promote careful assessment and cautious treatment, then isn't it good that a professional association endorses them?

What matters in regards to guidelines is what is required....not what is promoted. There are any number of reasons why you might choose to ignore something promoted....but ignoring what is required is what gets you involved in malpractice lawsuits and losing your license as a provider.

In every iteration of the affirmative care model I've seen....you basically aren't able to deny treatment, or claim someone isn't what they believe they are. This essentially creates a problem of false positives if we were talking about a condition one is diagnosed with. We can simplify the discussion a lot by just focusing on requirements.

Again, if the guidelines are robust and appropriate, so what?

Again, see above. They may appear robust....but ultimately, if the doctor cannot disagree on the trans identity of the youth, and thereby deny treatment, without fear of consequences....

It doesn't matter if it promotes a thousand treatments. They don't matter at all, legally.

From what I can see, some people in this thread are arguing that certain treatment options simply shouldn't be available at all.

Indeed.

That position seems to be based on a belief that such treatments are never justified (underpinned by an ideological disagreement with the reason for the treatment).

I don't think a child can consent to their own sterilization. In the words of the current president of WPATH, a surgeon with possibly more experience in trans surgery than any other in western societies....nearly 100% of mtf children who begin blockers at Tanner Stage 2 and continue to HRT through adulthood are unable to achieve climax, and experience significant sexual dysfunction.


An opinion they appear to have changed once appointed president of WPATH.


Why? Maybe they have valid reasons or a study....but they don't appear to be interested in explaining the difference in opinion. I'm not saying that there aren't legitimate medical reasons for a procedure that might have that result being performed on a child...but they had better be life threatening or severely impairing.

There's no evidence of any problem with trans-youth suicide. There's certainly no evidence that the affirmative care model helps any such claims about trans youth suicide.

In fact, the suicide rate of children and teens in the nations that have banned the affirmative care model is no different from before or during the adoption of the model. It's not a problem that exists.

Since I don't necessarily agree with that, I want to leave room for their use when it is justified. I am arguing against limiting the scope of practitioners based on the opinions of a bunch of ill-informed randoms on the internet.

Right, and I can't really describe how bizarre it is to wake up to headlines suggesting that patient zero for Covid 19 came from the Wuhan Covid lab...and then by evening be involved in a discussion with someone who seems to believe that we have no reason to question medical practitioners.

I don't know if you're familiar with Dan Crenshaw. He's one of our elected officials who is most notable for the eyepatch he wears due to his time in the military. He was involved in a discussion with Yale's top expert (or close enough to the top expert) on trans medical treatment and the affirmative care model. In basically any situation between these two....it's not as if I would guess Dan looking smart and the Yale medical expert looking completely and embarrassingly foolish. Yet, that's what happened. He cited evidence against the model....she told him he was cherry picking research and that's not how they approach creating models of care. He agreed, then cited a comprehensive review and meta analysis of literally all the available research....which found it to be of low quality, and insufficient for making medical recommendations. He then asked if she had any contrary review or even research which supported the affirmative care model.

If you want to watch a medical professional get caught for foolishness I'll gladly link it. She tries to start by referring to the Standards of Care, but he simply interrupts her by pointing out that isn't research....and appears to be based on very low quality research. He points out that if we intend to allow this to happen to children, we should expect it to be based on higher quality evidence than what we have now....which is the lowest quality evidence. He repeats the question....and she's stumped. This guy isn't some mega genius. He probably wouldn't have been accepted to Yale....let alone their medical school. Yet, like me, he understands how to read a research paper and what sort of methodologies exist and the other various ins and outs of well done research.

I would suggest to you that not everyone against something is against it because of a religious belief or some conspiracy theorist. I would also remind you that even though we may not like to think about it, everyone has multiple interests. We'd like to imagine doctors and researchers are only motivated by helping others.....but other interests like money, prestige, or even political activism for a group can corrupt them.

It was funny to me that you briefly mentioned eugenics in reply to a post of mine. Are you aware that eugenics was a platform of the progressives in the early 1900s? Are you aware that it also had a majority consensus in the scientific community? Are you aware that it often involved sterilization of children?

I don't claim expertise but frankly, I don't need to. I've got ample reason to doubt the medical community on this issue and it's not only based on science and evidence....but it's also rooted in the contradictory shifting claims of the trans activists themselves.

The progressive left hasn't been on a winning streak when it comes to policies lately.....and this appears to be another L.

 

[rjs330]

Then you know that they allow puberty blockers in some circumstances. When the case dictates that they do. When each case is considered on it's merits.

So what we have now is you saying that we should listen to these people. They are doing it right. They are setting a good example. I'm not inclined to disagree. So let's use them as an example of correct procedures.

The thing is, now you've dug up information, by experts, who you say we should trust, your response to that, to the very people you quote, 'I don't agree with them'.

Can your position be any more nonsensical?

I don't think surgery is ever necessary for this. And I'm entitled to my opinion. And I have valid reasons for believing so due to the increase of regret.
The point I'm making is we have gone way too fast on transing the kids. And professionals agree with me. So I'm not as off base as you would like to imply. The Swedes specifically mention this in their guidelines. How there was a huge increase which we all have been saying and they have backed off as well as the UK and the Fins and French are doing in this rapid transitioning method. They are slowing way down and that's what many of us thought should be going on. There was a huge Trans Train documentary regarding all of this done by the Swedes. You ought to watch it.

So if I'm so full of nonsense and then why am I being proven correct? Why don't you wait about 10 years and come talk to me again. Because more research is being done by the Fins and others regarding this. That's what the clinics are doing there. The Swedes aren't allowing any surgeries at all for kids and the Fins only under the rarest of circumstances. They are very restrictive. Far more restrictive than the US and WPATH. Perhaps even more so than you Aussies. The UK is going that way as well. So we are being vindicated by this.

Funny now that you can't disagree with other countries who are doing what we thought should be done now you are getting nitpicky. Even they are addressing the issues of trans regret.

Yeah I don't agree with the Fins on surgeries. And neither do the Swedes. So not so nonsensical after all.

 

[rjs330]

Again, assessment and therapy are two different things. To give an example from a different field (just one I happen to be quite familiar with), when a child is suspected of having autism, there are a bunch of appointments and assessments which result (usually) in a conclusion about whether, in fact, autism is part of the picture for that child. Then, there is ongoing speech therapy, occupational therapy, or the like, aimed at supporting that person.

Yet for a mental health diagnosis you need a mental health professional.

In your scenario the professional explores why the person thinks they are and that takes time. But the person doesn't get to tell the professional they are or aren't. Just like I can't go to my doctor and tell them I have a heart condition and need heart medicine and surgeries. The mental health professional gets to make then assessment on whether or not the person is transgender or not or may have other issues instead. But that's not the affirmative model. In the affirmation model the kid drives the diagnosis and the doctor has to affirm them. And as a GP doing so they don't have the expertise to do that. They need a profession therapist to explore the issues. Even other countries recognize this. That's why they are not giving blockers and hormones or surgeries to kids anymore.

You should be celebrating that instead or arguing against it. This isn't just me in a forum saying this. It's professionals in other countries that did it your way or the way you support and have discovered it was a mistake.

 

[rjs330]

All they're saying here is, the assessment needs to be done with someone with sufficient expertise, and that person might come from a range of disciplines. This is not unusual. For example, again in an unrelated field, prenatal care is often done by midwives or ob/gyns. But it can be done (and in rural areas, particularly, often is) by a GP who's done some extra training in obstetrics.

A mental health assessment that is a life long treatment with serious consequences. We are not talking about something minor here. You don't have GPs recommending brain surgery or open heart surgery.

You don't have midwives recommending serious life altering drugs for the unborn.

It is one thing to deal with minor things. Your GP doesn't get to diagnose and subscribe medications for bi-polar disorder. Yet you think they are qualified to assess something as difficult as gender dysphoria and put kids on drugs that will permanently alter their entire body?

No they are not.

 

[Paidiske]

I don't know what psychotherapy costs in your country, but it's not cheap here, and so the very idea that you would regularly pay someone hundreds of dollars for a service that doesn't help you deal with or solve a problem of some sort is basically a foreign idea.

Cost is a problem here, too. But that doesn't change the reality that therapy might be undertaken with a range of aims.

Ok....great. We've got a sort of baseline idea of what you think good care is. What if the response of the person is "I'm not interested in exploring why I think that, I'm confident in who I am, and I want medication to prevent my puberty."?

There would still, I would think, be various explorations done.

Again, (to give an example from an area I have more direct experience of), when a kid presents with communication difficulties and autism is suspected, they're still routinely sent for a hearing test, to rule out hearing difficulties as an underlying cause. So it's a case of, "You may be right, but we still need to make sure there aren't other things going on."

But surely you can understand why some of these treatment options are wrong.....right?

Not my call to make. But FWIW, what I see in the literature is a desire to only proceed to more extreme treatment in cases where less extreme treatment isn't sufficient (which is normal in medicine; the less intervention needed, the better). I am content to let patients, their caregivers, and their treating team, make those decisions.

You're acting like there's no reason to consider limitations on treatment

Ah, no. I'm acting like we don't need those limitations arbitrarily legislated (or worse still, decided by a bunch of internet randoms. I mean, after reading some threads, for real, I wouldn't trust some folks on this site to make a sensible choice of analgesic for me if I had a mild headache; why on earth would I trust them with this?). I guess I'm saying the norms of medical ethics are limitation enough, in my view.

Granted I'm only familiar with those types of treatments being given by non doctors....but if doctors were doing it, you wouldn't suddenly change your mind would you?

Conversion therapy isn't treatment at all.

In every iteration of the affirmative care model I've seen....you basically aren't able to deny treatment, or claim someone isn't what they believe they are.

I believe it would be more accurate to say, that the HCP would need to be able to demonstrate some other cause or contributing factor. Rather than just refusing to assess someone.

I don't think a child can consent to their own sterilization.

But kids aren't being sterilised. Your own quote talked about the results of treatment "through adulthood."

 

[Bradskii]

I don't think surgery is ever necessary for this. And I'm entitled to my opinion.

We all knew it was just your opinion. But yeah, you are entitled to it. And now you've quoted medical experts to back up your opinion, and then told us that you still think that what they do do is wrong, there's really not much else you can add.

Let's face it, this has been an exercise in futility. I knew that from the outset, as soon as you started to quote people on gender who are expert (and in many cases not anywhere near remotely expert) when you don't even accept the very concept itself. It's like someone quoting NASA officials to back up their flat earth theory.

You've been saying all along that people shouldn't transgender (oh, except if they are adult and they can 'mutilate' themselves as they see fit) simply because you believe that there are only two genders. As much as you want to avoid the reason, it's because of a religious belief. But you know that's not going to carry much weight, even in a religious forum. So we've had all this smoke and all these mirrors. And what do we end up with?

'I'm entitled to my opinion.'

 

[rjs330]

Assessment and therapy are two different things.

That's not what the standards of care actually say, though. I quoted this in my previous post, but since it seems you missed it, let me remind you:

There are also recommendations such as that health care providers: "Are able to identify co-existing mental health or other psychosocial concerns and distinguish these from gender dysphoria, incongruence, and diversity. ...assessment is best provided by an HCP who possesses some expertise in mental health in order to identify conditions that can be mistaken for gender incongruence. Such conditions are rare and, when present, are often psychological in nature."

Sure there is. See the paragraph I just quoted above.


It is demonstrating the fact that this is one reason why puberty blockers might be prescribed at that hospital.

There are good reasons for that. RCTs are not appropriate for every possible treatment. As explained here:

"The gold standard for medical and social research is the randomized controlled trial, where study participants are randomly assigned to receive an intervention or to act as a control. An ideal study would be randomized, controlled, and have a large number of participants for statistical validity/generalizability. There are a number of reasons for the dearth of randomized controlled trials. Historically, there hasn’t been a lot of funding for trans health. There also aren’t all that many trans people in any given place, so statistically powerful research would require a wide geographic reach (and thus be more expensive). And there are ethical problems with true randomization. We can’t ask non-trans (or “cisgender”) people to get genital surgery just for comparison’s sake. It’s similarly difficult to ask gender dysphoric people, who suffer in contemporary social conditions, to wait on transition just so they can act as a control group. We can use cisgender people as controls instead, but this can have an impact on the specificity of research results.

Let me just note for the record that absolutely no one in this thread, has said this.

The gold standard would not require regular folks to undergo transitional surgeries. Don't be silly.

Don't you believe that if we are going to permanently alter a child's body and life we ought to base this on the best research available? Don't you think that before we decide that kids receive surgeries that we ought to make sure that we are basing the surgery on the very best research available? What about drugs? Should we be experimenting with drugs on kids? Or should there be rigorous and best research done first? Especially when we are talking about permanency?

RCT can be done with transgendered people. The fact is it hasn't been done. All the information out there will tell you that the research is of the poorest quality and is NOT conclusive in the least.

And this is what you want to rely on?

 

[Ana the Ist]

Therapy isn't just about fixing disorders. It can be about exploring emotions, identifying and evaluating possible actions, identifying resources and supports, building coping mechanisms, and so on.

If someone comes in saying "I think maybe I'm trans," and a HCP tells them outright that they're not, that's not good care. But saying, "Okay, let's explore why you think that," and providing space to look at experiences, feelings, potential causes, and so on, is good care.

What I'm arguing for, in this thread, as regards care for transgendered people, is conservative/traditional/Christian people (to borrow @stevevw's not unproblematic grouping) not seeking to limit treatment options based on a refusal to accept that being transgendered is a real phenomenon. Along the way, I've gotten tangled up in debunking a fair few, either misleading or outright false statements, which have been offered as arguments for such ideological limiting; but I'm not really interested in the details of treatment protocols or the like. That's for patients and their treating teams, and medical governing bodies, to work out.

Sure. Don't we have processes to deal with that?

I believe I linked to the Australian standards of care and treatment guidelines already in this thread, but here they are again.

It appears they endorsed the 2020 document. But so what? If the standards of care don't say what opponents say they do (eg. promoting fast tracking of children into surgery as a matter of course), but rather promote careful assessment and cautious treatment, then isn't it good that a professional association endorses them?

Again, if the guidelines are robust and appropriate, so what?

From what I can see, some people in this thread are arguing that certain treatment options simply shouldn't be available at all. That position seems to be based on a belief that such treatments are never justified (underpinned by an ideological disagreement with the reason for the treatment). Since I don't necessarily agree with that, I want to leave room for their use when it is justified. I am arguing against limiting the scope of practitioners based on the opinions of a bunch of ill-informed randoms on the internet.

After a quick peek....a lot of disturbing things jumped out of those standards of care. First off, yes, WPATH basically wrote these standards. I don't consider an activist group that cites websites with child rape fiction as a reliable or unbiased source but maybe you do. In case you missed it, page 27 appendix 1 has this written above.

As mentioned above, the recommendations made in this document are based primarily on clinician consensus, along with previously
published standards of care from the World Professional Association for Transgender Health (WPATH),12 treatment guidelines and
position statements,13-19 and findings from a limited number of non-randomised clinical studies and observational studies.8-11,20-26 It is
clear that further research is warranted across all domains of care for trans and gender diverse children and adolescents, the findings
of which are likely to influence future recommendations.

So yes...we're discussing WPATH. That also explains why it appears that the requirements for treatment are....

1. A diagnosis of gender dysphoria.

2. Consent of a child deemed mentally capable of consent.

3. If the child is deemed incapable of consent, a parent or guardian can consent for them.

That's really it. Anything beyond that is not required. Recommendations are just recommendations. If you don't understand why a GP may forgo many of those recommendations....consider the following scenario....

A child comes in seeking treatment, and after a psychological assessment, the doctor decides the child is under peer pressure or parental pressure but not really trans. The child leaves, kills themselves, and the family sues for malpractice upon learning their child sought treatment before the suicide. They all blame the GP who they say misdiagnosed their child.

Since that is a very easy scenario where the GP could lose the malpractice case....why risk the possibility of being sued or losing your license? Skip the psychological assessment that would normally take weeks or months....the kid showed up, gave consent, claimed to experience gender dysphoria.

That's all that's required for pills to be prescribed. See the problem there?


Edit- also...lots of recommendations for fertility specialists. Yet no explanation why. Do puberty blockers make you infertile? Does HRT? Why all this consulting of fertility specialists before "bottom surgery" is even allowed? They want you to believe the main concern with puberty blockers is bone density....but I bet if we took a poll, most parents would be more concerned with chemically nuetering their child.

 

[Paidiske]

Yet for a mental health diagnosis you need a mental health professional.

No you don't. GPs diagnose mental health conditions routinely.

In the affirmation model the kid drives the diagnosis and the doctor has to affirm them.

This is a clear misrepresentation. I'm sure I've linked to this already in this thread, but see here, particularly the section on "How is it determined that someone needs and is eligible for these procedures?"

And as a GP doing so they don't have the expertise to do that.

Unless they do. GPs do engage in ongoing professional development, after all.

You should be celebrating that instead or arguing against it. This isn't just me in a forum saying this. It's professionals in other countries that did it your way or the way you support and have discovered it was a mistake.

In case you missed this point the many times I made it, I am not advocating for any particular protocol or standard of care. I'm arguing against Christians/conservatives/whatever seeking to limit treatment options on an ideological basis. I'm happy to let the medical professionals work through medical issues.

 

[Paidiske]

The gold standard would not require regular folks to undergo transitional surgeries. Don't be silly.

Lol. If I disapprove of a decision, it can't be the gold standard, and anyone who thinks differently is being "silly"!

Don't you believe that if we are going to permanently alter a child's body and life we ought to base this on the best research available? Don't you think that before we decide that kids receive surgeries that we ought to make sure that we are basing the surgery on the very best research available? What about drugs? Should we be experimenting with drugs on kids? Or should there be rigorous and best research done first? Especially when we are talking about permanency?

And guess what? I don't believe that people here are in any position to assess that research and set clinical protocols. Part of the reason I don't believe that is that I have seen people in this thread routinely apparently fail to read, misread, misunderstand, and misrepresent, very basic information.

As mentioned above, the recommendations made in this document are based primarily on clinician consensus, along with previously
published standards of care from the World Professional Association for Transgender Health (WPATH),12 treatment guidelines and
position statements,13-19 and findings from a limited number of non-randomised clinical studies and observational studies.8-11,20-26 It is
clear that further research is warranted across all domains of care for trans and gender diverse children and adolescents, the findings
of which are likely to influence future recommendations.

So this group you disapprove of were one source among a range of sources. I'm still saying, you need to critique the standards of care on their merits.

That also explains why it appears that the requirements for treatment are....

1. A diagnosis of gender dysphoria.

2. Consent of a child deemed mentally capable of consent.

3. If the child is deemed incapable of consent, a parent or guardian can consent for them.

Specifically, the requirements for hormone treatment. And you left out the bit about medical assessment and fertility preservation counselling.

(And I note that the full requirement about diagnosis says: "A diagnosis of Gender Dysphoria in Adolescence, made by a mental health clinician with expertise in child and adolescent development, psychopathology and experience with children and adolescents with gender dysphoria." That looks like a pretty robust requirement).

And the problem with this is? If they're diagnosed with gender dysphoria, and there's consent to treat them, what other requirement do you think there should be?

A child comes in seeking treatment, and after a psychological assessment, the doctor decides the child is under peer pressure or parental pressure but not really trans. The child leaves, kills themselves, and the family sues for malpractice upon learning their child sought treatment before the suicide. They all blame the GP who they say misdiagnosed their child.

Since that is a very easy scenario where the GP could lose the malpractice case....why risk the possibility of being sued or losing your license? Skip the psychological assessment that would normally take weeks or months....the kid showed up, gave consent, claimed to experience gender dysphoria.

That's all that's required for pills to be prescribed. See the problem there?

Errrm. No, it's not all that's required. Not even based on what is in the document you're critiquing.

But given that the doctor can be sued for getting it wrong either way, where's the incentive not to do their best to get it right?

 

[Ana the Ist]

I'm not characterising them as anything. I was describing Australian standards of care which they happen to have endorsed. That they have endorsed them doesn't say anything about those standards of care, which ought to be examined and taken on their merits.

As for trans activists... whatever. I don't think the situation is going to be helped by Christian/conservative/traditional activists.

It's the same group...WPATH is cited as the main contributors of your nation's guidelines. For all we know, they wrote the whole thing.

And I'll accept the likelihood that you wouldn't have said this had you noticed it in the standards of care you linked. You probably didn't realize that these trans activists and child abuse fetishists were so deeply involved in what you are defending.

But you see it now, right? Perhaps next time you should double check before speaking down to the internet randos.

 

[Ana the Ist]

So this group you disapprove of were one source among a range of sources. I'm still saying, you need to critique the standards of care on their merits.

This is typical of your new religion. Remember way back when the OP was asked for evidence, and he provided some....and then without addressing any of the evidence, a poster simply dismissed it as hateful, biased, ideological, etc.

You gave your approval on that dismissal....didn't you?

Yet when I dismiss a group of blatantly biased activists.....suddenly I need to address the evidence regardless?

It's a very "rules for you that don't apply to me" bad faith sort of argument, but this an easy one....so I'll back up what I've stated anyway....

Specifically, the requirements for hormone treatment. And you left out the bit about medical assessment and fertility preservation counselling.

Here's the requirements. They are described as "criteria for treatment" rather than requirements whereas the stuff you believe are requirements are under the headline of "roles for practitioners" or some similar nonsense.

This is done deliberately, to trick the slow witted into thinking "roles" have some sort of legal standing. They don't. If you don't like the care you received and want to pursue legal action against your medical professional....they'll be looking to see if they met the "Criteria for Treatment". It's a short list....

1. Assessment of gender dysphoria. This typically is met by asking the child why they came to the clinic.

2. Tanner stage 2 puberty is reached. Stage 1 is a prepubescent child....so if they are starting puberty, you can administer puberty blockers.

3. Telling the child that because they aren't exactly sure what will happen when they give them puberty blockers....they might not be able to have children. Sorry I didn't include this in the previous list....I don't think it matters because I don't think children can consent to things like....

A. Their own sterilization.
B. Working dangerous jobs.
C. Sex.
D. Tattoos or any permanently disfiguring practice.
E. Elective surgery in general or plastic surgery that carries no utilitarian purpose.
F. Driving a car, or otherwise operating large mechanical vehicles without strict supervision.
G. Voting. In fact, it increasingly seems like they should stay out of politics well into adulthood lol.

Shall I continue? I don't really need to explain why I don't think 11 or 12yo children should be able to consent to their own sterilization, do I? I don't need to explain why someone who hasn't experienced sexual climax should have that experience permanently removed from their lives, do I?

(And I note that the full requirement about diagnosis says: "A diagnosis of Gender Dysphoria in Adolescence, made by a mental health clinician with expertise in child and adolescent development, psychopathology and experience with children and adolescents with gender dysphoria." That looks like a pretty robust requirement).

That depends upon how gender dysphoria is diagnosed. Typically, it can be diagnosed in a short 15 minute conversation. It's not as if there's any means of verifying the problem of gender dysphoria....so anyone who says that they have it, essentially is considered to have it.

And the problem with this is? If they're diagnosed with gender dysphoria, and there's consent to treat them, what other requirement do you think there should be?

I don't see how anyone would think it's ok for an 11yo to get themselves sterilized for life is acceptable. If you don't think that's an issue or they aren't being rendered infertile....explain in as much detail as possible why they need to consult these fertility experts before treatment.

I mean seriously....why is this ok in your eyes? Is there anything you think a child cannot consent to, you know, because they're a child?

Errrm. No, it's not all that's required. Not even based on what is in the document you're critiquing.

See the evidence above. I provided the full list.

But given that the doctor can be sued for getting it wrong either way, where's the incentive not to do their best to get it right?

No....doctors don't guarantee that you get the outcome you want. He can try to treat your cancer....but you can't sue if he fails to cure it. He gets paid for the attempt.

This isn't even cancer....nor is it in any way necessary. You aren't advocating for saving children's lives. You're advocating for destroying their ability to have children and the likelihood of anything resembling a normal healthy relationship with another adult.

You apparently intend to blame the children who consent to this after the 20 or 30 years it takes before these children are old enough to realize what's been done to them and either kill themselves or take it out on the rest of society.

Honestly, if you don't care about what options are available to children....that's fine. Stay out of the discussion. I think children are too vulnerable and too easily manipulated and harmed to see this as acceptable.