I'm a pediatrician. How transgender ideology has infiltrated my field and produced wide scale....

Cute Tink said:

In point 4, her conclusion that the medical protocol leads children to identify as transgender is unsupported and ignores the reality of the requirements for medical treatment (mainly that the child already persistently, consistently and insistently identify as transgender). It's rather a bizarre way to look at the cases.

Click to expand...

Given the overall point of the article she was indicating that the child should be allowed to mature to the point of being able to make a competent decision and assess long-term risks. Once you have been on hormone blockers since 11 that does influence any later decisions. You are already part way down the path, you have experienced some biological/hormonal changes from what you would have undergone, etc. and yes you would think of yourself as at least on the path to transition. She is suggesting to wait as she indicates dysphoria can resolve. If a person persistently identifies as transgender but then it later resolves, that points out the need to wait until a child is fully developed physically and mentally so they can make their own choice.

Cute Tink said:

Point 7 demonstrates a lack of awareness of the studies done. Keep in mind she wrote this article in July 2017 and notes here that "there is no evidence" that affirmation helps children. Yet there is. The study is over a year before this article. "no evidence" indeed.

Click to expand...

Her point 7 addresses suicide. Your study does not address suicide, but looks at other mental health factors apart from dysphoria, and whether dysphoria itself is a complication of other physcopathologies.

Moreover, that study is following children and adolescents:

A community-based national sample of transgender, prepubescent children (n = 73, aged 3–12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures.

As noted in the earlier study the mortality rate started to diverge about 10 years after transition.

Also note this warning from the study:

Importantly, although these socially transitioned prepubescent children are doing quite well in terms of their mental health at this point, parents and clinicians of such children should still be on the lookout for potential changes in the status of their children’s mental health. In general, the prevalence of depression is relatively low in prepubescent children and rises dramatically during adolescence.47 It is possible that transgender children will exhibit greater anxiety and depression than their peers during the adolescent transition because of the sources of distress mentioned earlier, which will likely become worse with time (a possibility we aim to test with prospective follow-up of this sample). Thus, while adolescence is a time of increased perceptions of stress for many adolescents,48 many of these issues are exacerbated for transgender teens. Transgender adolescents, whether they do or do not delay puberty through medical intervention, often experience body dysphoria (as their bodies do not match the bodies of their same-gender peers), making sex and relationships even more worrisome than among their nontransgender peers.49

tall73 said:

Quote the whole paragraph:

Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period 1973-1988 or 1989–2003. Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period 1989–2003. The Kaplan-Meier curve (Figure 1) suggests that survival of transsexual persons started to diverge from that of matched controls after about 10 years of follow-up. The cause-specific mortality from suicide was much higher in sex-reassigned persons, compared to matched controls.

They note that higher mortality rates start to kick in after 10 years or so. Suicide is a key factor.

Also from the study:

Sex-reassigned persons had a higher risk of inpatient care for a psychiatric disorder other than gender identity disorder than controls matched on birth year and birth sex (Table 2). This held after adjustment for prior psychiatric morbidity, and was true regardless of whether sex reassignment occurred before or after 1989.

and

Mortality from suicide was strikingly high among sex-reassigned persons, also after adjustment for prior psychiatric morbidity. In line with this, sex-reassigned persons were at increased risk for suicide attempts. Previous reports [6], [8], [10], [11] suggest that transsexualism is a strong risk factor for suicide, also after sex reassignment, and our long-term findings support the need for continued psychiatric follow-up for persons at risk to prevent this.

Click to expand...

Additional emphasis mine. You missed the key part of the paragraph.

Additionally, from the author:

If one divides the cohort into two groups, 1973 to 1988 and 1989 to 2003, one observes that for the latter group (1989 – 2003), differences in mortality, suicide attempts and crime disappear.

Click to expand...

She also notes that she is frustrated with her study being misrepresented. The full interview is at the link. She also notes some further reasons why trans people might be suicidal that medical treatment cannot address:

However trans people as a group also experience significant social oppression in the form of bullying, abuse, rape and hate crimes. Medical transition alone won’t resolve the effects of crushing social oppression: social anxiety, depression and posttraumatic stress.

What we’ve found is that treatment models which ignore the effect of cultural oppression and outright hate aren’t enough. We need to understand that our treatment models must be responsive to not only gender dysphoria, but the effects of anti-trans hate as well. That’s what improved care means.

Click to expand...

Cute Tink said:

Additional emphasis mine. You missed the key part of the paragraph.

Click to expand...

I did not miss the key point at all. I noted the very next sentence which indicates that mortality started to change about ten years after. In other words, the group you indicated has not had as long to actually manifest these issues, if indeed they do. So future analysis is needed.

She puts the two possibilities in plain language later:

The poorer outcome in the present study might also be explained by longer follow-up period (median >10 years) compared to previous studies. In support of this notion, the survival curve (Figure 1) suggests increased mortality from ten years after sex reassignment and onwards. In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.[35]

Additionally, from the author:



She also notes that she is frustrated with her study being misrepresented. The full interview is at the link. She also notes some further reasons why trans people might be suicidal that medical treatment cannot address:

Click to expand...

Undoubtedly that could play a role. However, that is all part of the decision to transition.

Cute Tink said:

Point 2 she talks about the supposedly high desist rate of "trans children". That information is challenged in this paper, which I don't have full access to, but quoting part of what I can see:

Click to expand...

Well we would have to pay 12 bucks to see the paper to get much out of it. However, it is not surprising that they didn't meet modern criteria. I was reading one of the articles from the 1960's and they were just identifying the problem, let alone understanding it.

However, this does not change the overall assertion the author of the OP article was making, which is wait until the child is of an age to make a competent decision before making life altering decision.

Cute Tink said:

One further point on twin studies:

She says, in her point 1 that "Identical twins contain 100 percent of the same DNA from conception and are exposed to the same prenatal hormones."

Is that true?

Well, according to a study from 2008 (that's roughly 9 years before her article), identical twins do not necessarily have identical DNA. Oops. That should call into question the conclusions she makes based on the faulty premise.

Click to expand...

Note the following from the article:

"It's pretty unlikely they're going to significantly change any of the results found so far," counters Kerry Jang, a psychologist at the University of British Columbia in Vancouver, who runs Canada's largest twin study.

Twin studies largely work because the genome is mostly the same. The difference here of 72 percent is so large as to make this almost certainly not the reason for the difference. Note also that even the pediatrician in the OP notes that 28 percent indicates SOME genetic pre-disposition, but that other factors are involved.

Well in the twins study referenced here he finds that in fact that may be the case even in differences in the genome of twins:

Bruder speculates that such variation is a natural occurrence that accumulates with age in everyone. "I believe that the genome that you're born with is not the genome that you die with—at least not for all the cells in your body," he says.

Charles Lee, a geneticist at Brigham and Women’s Hospital in Boston, agrees. Genetic variations can arise after a double strand of DNA breaks when exposed to ionizing radiation or carcinogens. "It reminds us to be careful about our environment because our environment can help to change our genome," he says.

So even here it is believed that it is the environmental factors that cause these changes over time. Either way you can't escape the impact of environment.

tall73 said:

I did not miss the key point at all. I noted the very next sentence which indicates that mortality started to change about ten years after. In other words, the group you indicated has not had as long to actually manifest these issues, if indeed they do. So future analysis is needed.

She puts the two possibilities in plain language later:

The poorer outcome in the present study might also be explained by longer follow-up period (median >10 years) compared to previous studies. In support of this notion, the survival curve (Figure 1) suggests increased mortality from ten years after sex reassignment and onwards. In accordance, the overall mortality rate was only significantly increased for the group operated before 1989. However, the latter might also be explained by improved health care for transsexual persons during 1990s, along with altered societal attitudes towards persons with different gender expressions.[35]

Click to expand...

I acknowledge that the paragraph states that there is an increased mortality rate over 10 years, but you are still discounting that the paragraph, even where you emphasis it, states that it only significantly increased for the group operated before 1989. Given the study was published in 2011, that's still enough time to note an increase for those operated on between 1990 and 2001, and they note that it's not significantly increased for that group and then the sentence after opines as to why that is.

You'll also note that the recommendation is not finding an alternative for surgery, but "improved psychiatric and somatic care after sex reassignment".

Undoubtedly that could play a role. However, that is all part of the decision to transition.

Click to expand...

No it's not. It about society. Abuse is not generated by transition. Abuse is caused by other people's decisions.

Cute Tink said:

No it's not. It about society. Abuse is not generated by transition. Abuse is caused by other people's decisions.

Click to expand...

Yes, but good luck changing every person's decisions. At this time it is still a reality that needs to be taken into account. I agree no one should be abused. But you can't make it totally disappear at this time.

Cute Tink said:

I acknowledge that the paragraph states that there is an increased mortality rate over 10 years, but you are still discounting that the paragraph, even where you emphasis it, states that it only significantly increased for the group operated before 1989. Given the study was published in 2011, that's still enough time to note an increase for those operated on between 1990 and 2001, and they note that it's not significantly increased for that group and then the sentence after opines as to why that is.

Click to expand...

Since the study itself noted both possible rationales it seems we have to wait to see. The cohort included those both in and out of the 10 year range, so it might not in fact be "significant" because only part of the group would fall in the risk zone which itself was an extrapolation from historical data. But the fact that the researching group thought it a likely enough possibility to include it first means that we need more data to know, and they considered it a strong possibility. You can't say to look at the studies instead of ignoring them and then ignore what the researchers indicated. They thought it a likely explanation.

Cute Tink said:

I acknowledge that the paragraph states that there is an increased mortality rate over 10 years, but you are still discounting that the paragraph, even where you emphasis it, states that it only significantly increased for the group operated before 1989. .

Click to expand...

Note also it stated it started to diverge after 10 years. But that doesn't mean that it would suddenly manifest in each case after 10 years.

The larger study from 2011 on nearly 1k you posted in regards to safety of hormones noted mortality from suicide and found some higher incidence in the 25-39 age range, quite a bit higher incidence in the 40-64 age range , though finally diminished in very late life.

The increased mortality in MtF in the 25–39 years of age group (SMR 4.47; 95% CI: 4.04–4.92) was mainly due to the relatively high
numbers of suicides (in six), drugs-related death
(in four), and death due to AIDS (in 13 subjects).
In 40–64 year age group, the SMR of total mortality
was increased with 1.42 (95% CI: 1.35–1.48).
The higher rate as compared with the general
population was largely explained by eight suicides
(where only one was expected on the basis of mortality
data in the general population) and 17 deaths from
cardiovascular diseases (where only eight were
expected). In the relatively small MtF group over 65
years of age, total mortality was not increased (SMR
0.95, 95% CI: 0.86–1.06) as compared to the general
population.

tall73 said:

Well we would have to pay 12 bucks to see the paper to get much out of it. However, it is not surprising that they didn't meet modern criteria. I was reading one of the articles from the 1960's and they were just identifying the problem, let alone understanding it.

However, this does not change the overall assertion the author of the OP article was making, which is wait until the child is of an age to make a competent decision before making life altering decision.

Click to expand...

That might be arguable if parental consent wasn't a part of the situation, along with ongoing treatment with medical and mental health professionals. The adolescent is not making this decision in a vacuum.

Given that the current recommendation is for cross-sex hormones to wait until age 16, we are waiting until an age we consider competent in many situations and I think that the medical and mental health professionals who are actually treating these individuals, with the informed consent of their parents, are capable of evaluating whether the individual understands the risks and situation they are presented with better than someone who has never even met them. Youth do not receive these treatments on a first time appointment basis. It is an ongoing, long term process.

As to "modern criteria", the study I linked to that neither of us can fully read, did not refer to modern criteria. She used the term "gender identity disorder" - not the updated diagnosis of gender dysphoria.

tall73 said:

Note the following from the article:

Click to expand...

I noted everything you quoted. Note this as well:

But twins can also begin their lives with differences, according to Bruder's study, and that calls into question their very name.

Click to expand...

The point being that the pediatrician in question starts with the assumption that twins are, and yes this is a direct quote:

Identical twins contain 100 percent of the same DNA from conception and are exposed to the same prenatal hormones.

Click to expand...

They don't have to be 100% different for her assumption to fall apart.

tall73 said:

Note also it stated it started to diverge after 10 years. But that doesn't mean that it would suddenly manifest in each case after 10 years.

Click to expand...

It didn't manifest at the significantly increased rate for the entire group. That's the point. She affirms that position in her interview I linked to.

tall73 said:

Since the study itself noted both possible rationales it seems we have to wait to see. The cohort included those both in and out of the 10 year range, so it might not in fact be "significant" because only part of the group would fall in the risk zone which itself was an extrapolation from historical data. But the fact that the researching group thought it a likely enough possibility to include it first means that we need more data to know, and they considered it a strong possibility. You can't say to look at the studies instead of ignoring them and then ignore what the researchers indicated. They thought it a likely explanation.

Click to expand...

I'm not ignoring what they are saying. I'm pointing out what they are saying and what the author later repeated in her interview.

I do appreciate you actually looking at the information, however, even if we disagree on the significance.

Cute Tink said:

That might be arguable if parental consent wasn't a part of the situation, along with ongoing treatment with medical and mental health professionals. The adolescent is not making this decision in a vacuum.

Given that the current recommendation is for cross-sex hormones to wait until age 16, we are waiting until an age we consider competent in many situations and I think that the medical and mental health professionals who are actually treating these individuals, with the informed consent of their parents, are capable of evaluating whether the individual understands the risks and situation they are presented with better than someone who has never even met them. Youth do not receive these treatments on a first time appointment basis. It is an ongoing, long term process.

Click to expand...

The pediatrician noted puberty blockers at age 11 or 12, as 16 would often be too late to block. The child cannot really understand all the implications at that time.

And there are limits to what a parent should be able to decide when it comes to lifelong implications.

Cute Tink said:

As to "modern criteria", the study I linked to that neither of us can fully read, did not refer to modern criteria. She used the term "gender identity disorder" - not the updated diagnosis of gender dysphoria.

Click to expand...

The paper I read was hosted at the same site as the paper you are referencing but was just noting the existence of gender identity disorder and perhaps not even in those terms. In other words, they were making the criteria as they went.

tall73 said:

Her point 7 addresses suicide. Your study does not address suicide, but looks at other mental health factors apart from dysphoria, and whether dysphoria itself is a complication of other physcopathologies.

Click to expand...

She tied it to depression herself.

Many gender dysphoric children simply need therapy to get to the root of their depression, which very well may be the same problem triggering the gender dysphoria.

Click to expand...

And then she goes on to make an unsubstantiated link between depression and dysphoria, but whatever.

Moreover, that study is following children and adolescents:

Click to expand...

Which is why I pulled it, because the point is about children and adolescents.

As noted in the earlier study the mortality rate started to diverge about 10 years after transition.

Click to expand...

After surgery, not after just transition. The Swedish study is about following after surgery, specifically "sex reassignment surgery", which children and adolescents do not receive.

This study we are currently quoting from notes as follows, related to anxiety, depression and suicidality:

These elevated rates of psychopathology are likely the result of years of prejudice, discrimination, and stigma11,17; conflict between one’s appearance and stated identity18; and general rejection by people in their social environments, including their families.19,20 There is now growing evidence that social support is linked to better mental health outcomes among transgender adolescents and adults.21–26

Click to expand...

Additionally, in response to your quote, noting again, it's not inherent to being transgender, but to society's response thereto:

Despite receiving considerable support from their families, these children likely still experience relatively high rates of peer victimization or smaller daily micro-aggressions, particularly if their peers know that they are transgender42 which can in turn lead to marked elevations of anxiety symptoms and anxiety disorders.43–45 Additionally, any transgender children who are living “stealth” or “undisclosed” (ie, whose peers are unaware of their transgender status), may experience anxiety about others discovering their transgender identity; previous work with adults has suggested that concealing a stigmatized identity can lead to psychological distress.46

Click to expand...

My position is further supported by the authors of the study, who I'd guess took their own warnings into consideration and still came to the conclusion that I pointed out as my reason for sharing the study itself.

Cute Tink said:

I noted everything you quoted. Note this as well:

Click to expand...

Yet that is rare enough that the twin study director doesn't see an issue. Even in the original article by the pediatrician it was noted that direct biological causation would result in CLOSE to one hundred percent.

And this is not even close. 28 percent is nowhere near 100. And to suggest that the possibility of some variance, from birth would explain that amount of divergence seems to be stretching things considerably.

The point being that the pediatrician in question starts with the assumption that twins are, and yes this is a direct quote:

Click to expand...

The point being that the pediatrician's assessment is not the real issue. The real issue is that despite some variance twin studies are still helpful because they often are identical, when they are not it is only in small areas, and still there should be obvious statistical trends.

They don't have to be 100% different for her assumption to fall apart.

Click to expand...

Her assumption is for her to worry about. The study still found only 28 percent of twins were both trans.

The variance described in the article on twin studies would not account for only a 28 percent incidence of both being trans.

Cute Tink said:

It didn't manifest at the significantly increased rate for the entire group. That's the point. She affirms that position in her interview I linked to.

Click to expand...

Cute Tink said:

It didn't manifest at the significantly increased rate for the entire group. That's the point. She affirms that position in her interview I linked to.

Click to expand...

She affirmed the role of bullying in the interview, is that what you are referring to? Or was there some further statistical discussion, I didn't see it in regards to this in scanning the interview.

Cute Tink said:

She tied it to depression herself.

Click to expand...

Yes, she did. My point is that the study you presented looks at depression but not suicide rates, etc. Both the pediatrician and the study reference the alleged possibility that it is depression and other factors that could also be the root of dysphoria, and the paper notes that this may not be the case as they did not have the same depression, etc. when socially transitioned in a supportive situation.

However, the pediatrician references later suicide, and this study simply doesn't look at that aspect as it is pre-physical transition socially transitioned children.

So this study indicates further research is necessary going forward (perhaps with the same sample) as to outcomes regarding suicide, depression, etc. in later life when it usually manifests.