Sorcerer's apprentice

Swiss medicos go public; Tim Walz under scrutiny; surgery not so rare; Chilean clinics in legal vacuum; US fast-track for hormone docs; long wait in NZ; no advice on"chest-feeding"; pro-trans Germany

Photo by Lloyd Newman on Unsplash

GCN in brief

Time for patience

Switzerland | Doctors are “playing sorcerer’s apprentice” by giving gender-distressed youth puberty blockers with unknown effects, the Geneva paediatrician Dr Daniel Halpérin has warned. “We’re playing sorcerer’s apprentice with young brains and young bodies at an age when we’re imbued with desires, attractions and sometimes contradictory sexual needs. By blocking puberty, we do all sorts of things whose long-term consequences we don’t measure.” Dr Halpérin made the remarks in an interview with the Geneva Tribune newspaper, following the August 22 publication of an appeal for a patient and cautious response to gender distress issued by Dr Halpérin, the former president of the Swiss Medical Association FMH, Dr Jacques de Haller, and the former president of the Swiss Society of Paediatrics, Dr Nicole Pellaud.

In their appeal, they note an increase in transgender mastectomy from one case in 2016 to 114 in 2021 involving girls under the age of 24 in Switzerland. They say gender distress has become “a major social issue” driven more by ideology than science. “We can no longer ignore the growing number of cases of ‘detransition’, in which young people express regret (and sometimes anger) at having allowed themselves to be drawn into these therapies, and we must be clear in admitting that the data in the medical literature supporting the benefits of these interventions are based on a very low degree of certainty.”

“Priority should now be given to an approach that focuses on the child’s best interests for his or her present and future life, an approach that is cautious and patient, addresses the psychiatric co-morbidities so common in this population, and endeavours to understand the origins of [gender incongruence or gender dysphoria] through attentive, empathetic listening over a period of maturation. Hormonal and surgical treatments for gender affirmation should only be considered following an overall scientifically validated assessment, or in the context of duly ethically signposted clinical trials, not in order to deprive patients who need care of it, but on the contrary to protect their development and respect their rights.”

Why did Walz affirm?

America | US vice-presidential candidate Tim Walz, a Democrat, has been challenged to explain his support as Minnesota’s governor for a law designating that state as a “trans refuge.” In the political news magazine The Hill, lawyer and feminist Kara Dansky explained that “the effect of this [trans refuge] law is that Minnesota courts have the power to remove children from their own parents’ custody if the parents (inside or outside of Minnesota) wish to protect their children from harmful hormones or surgeries.” She called on Mr Walz to state why he had backed such a law. “Did Walz simply not know in 2023 that there is an emerging global consensus that so-called ‘gender-affirming care’ for minors is unsafe? And regardless of why Walz signed the bill, does he still stand by that decision, given the now-incontrovertible evidence that ‘gender-affirming care’ harms children?”

California is also getting a reputation as a jurisdiction where state power, including child protection machinery, enforces the gender medicalisation of minors. On August 25, entrepreneur Elon Musk tweeted: “Earlier this year, a friend of mine almost had his young daughter taken from him in California just because he wanted her to wait a few years to permanently transition. He talked the police out of taking her when they came to his house. That day, he left California with his family.” This Musk tweet has had more than 39 million views.

The thing that never happens

International | There were an estimated 5,288 to 6,294 cases of trans mastectomy among girls under age 18 from 2017 to 2023 inclusive, according to a new analysis of US insurance data by the Manhattan Institute. When such procedures are criticised in mainstream debates, gender-affirming activists claim that trans surgery under 18 is rare—or simply does not happen. Even the liberal figure of 6,294 mastectomies is likely to be an underestimate, according to commentator Leo Sapir, who is a fellow of the institute. He explains that the data for 2023 are incomplete, and the analysis does not capture surgery paid for without insurance cover or performed before a diagnosis of gender dysphoria.

In the magazine City Journal Dr Sapir has also reported a statement from the American Society of Plastic Surgeons unusual for a US medical organisation in that it acknowledges the “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions for the treatment of adolescents with gender dysphoria.” The society also recognises that “the existing evidence base is viewed as low quality/low certainty.” The society’s statement refers to a review of some sort and notes the duty of plastic surgeons to ensure “a robust and evidence-based informed consent process”. In his opinion article, Dr Sapir remarks that unlike other medical organisations, the society has not endorsed any gender-affirming treatment guideline, and suggests that the much-invoked US consensus of elite medical policymakers “now appears to have its first big fracture.”

NewsNation has reported that the society’s president, Dr Steven Williams, does not offer gender-affirming surgery to adolescents in his own practice “because I don’t think the data supports it.” “I think that navigating some of the parental-child interactions and trying to figure out motivations for care and that overall social milieu that affects adolescents—I find it incredibly complicated.”

The Australian Society of Plastic Surgeons has applied for full public funding of a range of gender-affirming surgeries for adults, which if successful would mean young people aged 18-25 with still developing brains could undergo “depathologised” trans surgery; access to these procedures would not be contingent on patients experiencing any clinical distress arising from rejection of their birth sex. Meanwhile, in the UK, gender surgeon Dr James Bellringer sat for a Q&A session with LADbible. One question asked what was meant by “gender reassignment.” The Bellringer reply: “It’s a term that shouldn’t be used. I’m not reassigning anything, I’m just helping [patients] live with their experienced gender.”

---

Video: Psychotherapists Stella O’Malley and Sasha Ayad survey the variations of gender distress in males

---

Flying blind

Chile | A parliamentary committee inquiry into gender clinics has been told of the “legal vacuum” in which minors are undergoing “gender-affirming” medical treatments. “There is indeed a legal vacuum that neither regulates nor generates conditions that allow us to know with certainty how public policies are carried out with regard to sex change,” Senator María Loreto Carvajal told the Committee for Family, Children and Adolescents.

She is a member of the centre-left Party for Democracy (PPD). Her intervention is also significant because she was among those who supported Chile’s 2018 gender identity law, according to a spokesperson for the parents’ group Kairós, which is critical of the gender-affirming treatment model. That 2018 law, the Kairós spokesperson said, only allowed a change of officially registered sex, and said nothing about social or medical transition of minors. The parliamentary inquiry follows high-impact coverage of the gender clinic controversy—including England’s Cass report—written by journalist Sabine Drysdale and published in the media outlet BíoBíoChile in May.

“We are starting from the basis of self-criticism to say that we do not have a law [to regulate gender transition of minors],” Senator Carvajal said during the September 2 committee hearing. “There has been no proposal from either the executive or the legislature.” She said the “medical interference” of trans puberty blockers was not to be compared with the more familiar and approved use of these drugs to stop precocious (or premature) puberty. “We are talking about a decision [to suppress normally timed puberty] that is going to accompany the male or female subject for the rest of his or her life.”

Fast medicine

America | A draft law in California would enable fast-track licensing for health professionals intending to offer gender-affirming care. California Assembly Bill 2442, titled “Healing arts: expedited licensure process: gender-affirming health care and gender-affirming mental health care.” In late August, the Bill was awaiting the governor’s signature. Its sponsor, Democrat Rick Zbur, whose district includes Hollywood, said the law would allow “for qualified providers to be quickly licensed to treat transgender residents in California, and transgender visitors seeking refuge [from Republican states with bans on medicalised gender change for minors].”

Coercive affirmation

America | A detransitioner suing the American Academy of Pediatrics (AAP) said doctors had dismissed concerns about her autism, ADHD and post-traumatic stress disorder following a sexual assault. “They basically told my parents, ‘If you don’t put your child on hormones, she is going to die,’” the detransitioner, Isabelle Ayala, told The Dallas Express. “I really do feel like my parents were coerced.” She said she had vaginal atrophy and other complications from testosterone drugs. Transition success stories online had played down the risks. Now more mature, she believed “internalised misogyny” was the driver of her transition. “I was scared about becoming a woman because of how I was perceived sexually by men.”

Defendants in her Rhode Island case include two well-known gender clinicians, paediatrician Dr Michelle Forcier and psychiatrist Dr Jason Rafferty, who was the principal author of the AAP’s “affirmation-only” policy statement.

Ms Ayala’s lawyers allege a conspiracy in which these and other clinicians “saw an opportunity to pioneer new guidance on an emerging field in pediatric medicine—the treatment of the rapidly increasing number of children and adolescents presenting as transgender and gender diverse—that would enshrine as authoritative their ideological beliefs. But finding no evidentiary support for their radical positions, they nonetheless prepared and authored a ‘policy statement’ reviewed, approved, and published by defendant AAP, proposing an entirely new model of treatment, which not only misrepresented or misleadingly presented its purported evidentiary support but was also rife with outright fraudulent representations.”

More than a brief delay

New Zealand | The release of a promised evidence brief on puberty blockers has been put off by New Zealand’s health authorities at least three times, according to a Substack called The Ministry has Fallen. The brief, which does not amount to a proper systematic review, had its origins in late 2022, when health authorities quietly abandoned their online assurance that trans puberty blocker drugs were a “safe and fully reversible” medicine. The reason most recently given for the delayed evidence brief was the need to consider April’s Cass report from England. The Substack commentator, who goes by the pseudonym Garwhoungle, argues that the NZ treatment guidelines for medicalised gender change, published by the University of Waikato’s Transgender Health Research Lab, lack credibility and are not fit for purpose.

As part of the Cass Review, the Waikato guidelines underwent a peer-reviewed evaluation. “Notably, [the Waikato document] achieved only 12 per cent on rigour of development … and zero on editorial independence,” Garwhoungle said.

“Cass gives us more than enough reason to rethink Transgender Health Research Lab’s privileged position in establishing and influencing clinical practice in New Zealand. It’s shoddy. Such a rethink doesn’t seem to be happening. An evidence brief on puberty blockers, first due in April of 2023, has now been postponed at least three times. It’s been reviewed by Dr Sue Bagshaw, a Christchurch doctor and outspoken advocate for puberty blockers. [Health New Zealand] has, meanwhile, commissioned none other than [the WPATH-linked Professional Association of Transgender Health Aotearoa] to update national guidelines and referral pathways for transgender healthcare. Gender-affirming interventions continue apace.”

Irregulator

Comment | A mother has been left nonplussed after seeking guidance from the Australian Health Practitioner Regulation Agency (AHPRA) on the safety of the experimental practice of inducing lactation in males who wish to “chest feed” babies. The mother lodged a complaint about the involvement of a medical practitioner in this practice. The Medical Board of Australia decided the doctor was “meeting accepted standards of practice” and there was “no clear evidence of substandard performance” when a chemically induced male patient sought to feed an infant.

The medical board clearly did not regard this practitioner as a risk to public safety. Yet the same board used its emergency powers to suspend the registration of a Victorian family doctor, Jereth Kok, after two anonymous complaints about his posts on personal social media.

As for the mother who approached AHPRA, she was none the wiser about what the “accepted standards” might be for the experimental practice of giving the drug domperidone to a male already taking exogenous oestrogen and seeking the “validation” of feeding a vulnerable baby with no choice in the matter.

But that was a question better put to the Endocrine Society of Australia or the Royal Australasian College of Physicians, according to an AHPRA official. Both of those learned societies—or their leadership, at any rate—have failed to exercise independent thought when gender ideology is in play. Next, the mother wrote to Australia’s Health Minister, Mark Butler, asking for his position on the rights of breastfeeding mothers and babies. In reply, a health official genuflected towards the benefits of breastfeeding but went on to insist that “individuals may identify and be recognised within the community as a gender other than the sex they were assigned at birth or during infancy, or as a gender which is not exclusively male or female.”

That’s an activist formula unlikely to be challenged by AHPRA. On its LGBTIQA+ Communities webpage, AHPRA declares it is “working with Pride in Diversity to ensure LGBTIQA+ inclusion in our workplace and participate in the Australian Workplace Equality Index.” That index is based on the Diversity Champions scheme of the UK trans activist lobby Stonewall. Many institutions—including the UK Department for Education and the BBC—have withdrawn from the Stonewall scheme because they have recognised it sends a signal that they may be partisans of gender ideology, which is a contested set of beliefs. Can AHPRA be an impartial arbiter in cases where gender-affirming activists have made complaints against health professionals who practise in perfectly ethical ways that are deemed to be not “affirmative” enough? GCN put questions to AHPRA.

Captured officials

America | The US Department of Health and Human Services (HHS) “has conducted an ideologically and politically driven campaign to enshrine affirming care as clinical practice, whether or not the facts fit its narrative,” according to a Florida psychiatrist, Dr Kristopher Kaliebe, giving expert evidence in favour of Alabama’s legislative ban on paediatric gender transition. In a May 2024 report, Dr Kaliebe said internal documents showed the one-sided nature of “listening sessions” run by the Sexual and Gender Minority Research Office within HHS. For one session, the invitees included trans activist lobbies such as the Human Rights Campaign and Trevor Project.

“There is nothing wrong with any of these [trans-affirmative] organizations being invited to share their thoughts with HHS to help inform HHS’s future research agenda. HHS should hear from such groups,” Dr Kaliebe said. “The problem is that only those groups were invited, and only those groups were heard. HHS did not ask any stakeholder with a different viewpoint to come. HHS did not hear from any parents of gender dysphoric teenagers wrestling with their child’s rapid onset of gender dysphoria. It did not hear from any clinicians who saw their patients do worse after transitioning treatments. It did not hear from any organizations studying the literature and concluding, as health departments in other countries have done, that the evidence for transitioning treatments in youth is low quality.”

In an interview earlier this month with The College Fix, Dr Kaliebe said the sudden increase in patients “expressing” gender dysphoria called for open debate. “The prioritization of advocacy and orthodoxy over the search for truth on matters related to gender dysphoria, as well as more broadly, Kaliebe said, can hinder the advancement of knowledge and potentially harm patients,” The College Fix reported.

Risky business

Germany | Females are at risk from a new German law allowing self-declared gender identity, according to the UN Special Rapporteur on violence against women and girls, Reem Alsalem. In a June 13 letter to the country’s foreign minister, Ms Alsalem draws a link between the social and medical transition of children. “The consequences of medical transitioning on the mental and physical health of children, including girls are significant and should not be underplayed,” Ms Alsalem writes. “As noted by the Cass review, rapidly putting girls seeking gender therapy on permanent gender transition pathways that usually begins with puberty blockers could cause temporary or permanent disruption to brain maturation. As the Cass review pointed out, children, including girls seeking gender therapy are entitled to comprehensive support that includes addressing the root causes of their distress, and that considers the high rates of co-existing neurodiversity and mental health issues.”

An August 5 reply from German officials does not address the risks of paediatric transition, but alludes to the transition-or-suicide narrative. The officials say that the new law, passed by Germany’s parliament in April, “solely allows for the administrative procedure of changing a legal gender entry. The change of the legal gender entry of a child is reversible at any time.”