#Gender-Affirming Psychiatric Care

[religion-is-a-mental-illness]

By: Christina Buttons

Published: Feb 10, 2024

The American Psychiatric Association (APA) released its Gender-Affirming Psychiatric Care (GAPC) textbook and it’s crazier than I thought. In a recent op-ed, @Miriam_Grossman and @LHSchwartzMD call it a “political manifesto posing as a scientific guide for mental health care.”🧵 

The authors of the GAPC claim the sex binary is “mythical,” created by “European colonial influences," and that scientific neutrality is a “fallacy.”

It says trans-identified youth are oppressed from “living in a cis heteronormative society” created by “cisgender people in power.”

Grossman and Schwartz argue, “If a brain surgeon told you that scientific neutrality is a fallacy and brain anatomy is a result of European colonial influence, you would probably look for another surgeon.”

Unsurprisingly, nearly 90% of the guide’s 56 authors identify as “transgender, non-binary, and/or gender-expansive.”

“Only those committed to the radical ideas and practices announced in the book are considered experts,” say Grossman and Schwartz.

The GAPC demands that medical and surgical interventions be readily available to all patients, regardless of age or psychiatric conditions, including psychosis, stating, “Psychosis alone is not a contraindication to gender-affirming services.” (!)

--

Op-ed:

By: Miriam Grossman and Lauren Schwartz

Published: Feb 3, 2024

In a world of confusing and contradictory messages about the meaning of male and female, where can families, health professionals and the public turn for guidance?

We are psychiatrists who care for transgender-identified youths, and we believe the answer should be simple: the American Psychiatric Association. The association calls for the “highest ethical standards of professional conduct.” Its publishing house claims to offer clinicians “authoritative, up to date ... information.” But with the publication late last year of Gender-Affirming Psychiatric Care, the American Psychiatric Association has abandoned its professed mission of promoting ethical, evidence-based care.

Gender-Affirming Psychiatric Care is a political manifesto posing as a scientific guide for mental health care. According to the authors, the man-woman binary is “mythical,” and more sex categories would flourish if not for “European colonial influences.” Scientific neutrality is “a fallacy,” they assert, unaware or unconcerned that if the public took that assertion seriously, it wouldn’t seek help from clinicians who listen to the American Psychiatric Association.

Gender-Affirming Psychiatric Care further asserts that psychiatry and psychology have perpetuated the oppression of transgender youths whose depression, anxiety, eating disorders and suicidality are due to the stress of “living in a cis heteronormative society.” These individuals lack access to quality care, we are told, because of “cisgender people in power.”

This faddish ideological language would not be acceptable in any other field of medicine. If a brain surgeon told you that scientific neutrality is a fallacy and brain anatomy is a result of European colonial influence, you would probably look for another surgeon.

Nearly 90% of Gender-Affirming Psychiatric Care’s 56 authors, we learn in the forward, are “transgender, non-binary, and/or gender-expansive.” This is not “representation” but a litmus test: Only those committed to the radical ideas and practices announced in the book are considered experts.

The authors demand that we clinicians rubber-stamp even the youngest child’s self-diagnosis, placing them on a path toward permanent disfigurement and possible sterility. Rest assured, we shall not.

Omitted from the 26 chapters is any mention of recent systematic reviews — these constitute the most reliable method of evidence analysis in evidence-based medicine. All such reviews to date have consistently demonstrated that the touted benefits of “gender-affirming care” are highly uncertain. Relying on these evidence reviews, health authorities in countries as progressive as Sweden have said that the health risks of gender-affirming care in minors “currently outweigh the possible benefits.” Along with other European countries, Sweden now recommends psychotherapy as the preferred treatment for youth gender dysphoria. It confines puberty suppression to research settings, recognizing it as “an experimental practice.”

Among innumerable examples of medical misinformation, the Gender-Affirming Psychiatric Care textbook claims that puberty blockers are a “fully reversible intervention that allows young patients time to mature.” This is false. Research has consistently shown that nearly every child placed on blockers continues to cross sex hormones. Only a minuscule number step off the assembly line toward life-long dependance on pharmaceuticals. Estrogen and testosterone have a laundry list of serious side effects, and when puberty has been prevented at an early stage, they cause sterility. We were astonished to see blockers described as benign and fully reversible. We have never given them to physically healthy children, and we lack long-term data on their impact on bone health, fertility, sexual functioning and IQ.

“Affirming care” calls for the increase of a girl’s or woman’s normal testosterone level by up to 1,900%. Such high levels in females are typically caused by tumors. Gender-Affirming Psychiatric Care makes the astonishing claim that this “treatment” is safe and effective in most cases, referencing a 2017 systematic review. But the authors of that review admit the evidence they used was “low quality” and warned “caution is necessary” when prescribing testosterone to transgender-identifying females. In fact, the ovaries of women given testosterone are similar to those seen in a disorder called polycystic ovaries, which itself is associated with increased cancer risk and metabolic abnormalities.

Long-term use of testosterone by females causes vaginal atrophy and possible infertility and is associated with cardiovascular events. Remember, we are speaking of doctors prescribing a controlled substance to physically healthy young women whose trans identity may be temporary.

Even the World Health Organization, a group known for endorsing progressive viewpoints, recently conceded that the evidence base for the medical interventions endorsed with confidence in the APA textbook is “limited and variable.”

We are also deeply troubled by the authors’ insistence that medical and surgical interventions be available on demand to every patient, regardless of age and other psychiatric conditions. Anorexic? Autistic? Suicidal? No problem. The Gender-Affirming Psychiatric Care authors will place even patients with psychosis — meaning they are detached from reality — on medical interventions.

“Psychosis alone is not a contraindication to gender-affirming services,” the authors write.

The American Psychiatric Association asserts its publishing house uses peer-review at the time of selection and again at final approval of any project. But no credible peer-review process could possibly overlook the many errors and omissions that fill this publication. Gender-Affirming Psychiatric Care is neither an ethical nor a trustworthy source of clinical guidance. In fact, it increases the risk of iatrogenic harm and puts clinicians at risk for lawsuits and loss of license.

With several other physicians, we composed an open letter to the leadership of the American Psychiatric Association calling for the withdrawal of Gender-Affirming Psychiatric Care until our concerns are addressed and the errors and omissions corrected. The letter was sent at the end of the year and, to date, it has more than 6,500 signatories, with a preponderance of medical professionals, including association members, national and international gender experts, psychologists, and researchers. Others who signed are school counselors, patients, parents and concerned citizens.

We call on the American Psychiatric Association to be accountable for its actions, and remind its members of their responsibility to patients, families, medical and mental health professionals, and the public. We deserve the truth. The association has discredited itself by caving to dangerous groupthink.

Dr. Miriam Grossman is a practicing child and adolescent psychiatrist and a senior fellow at Do No Harm. Her most recent book is “Lost in Trans Nation: A Child Psychiatrist’s Guide Out of the Madness.” Dr. Lauren Schwartz is a practicing board-certified psychiatrist, a fellow of the American Psychiatric Association, a fellow of FAIR in Medicine and a member of Do No Harm.

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Open letter:

An Open Letter to the American Psychiatric Association Regarding the Publication of Gender-Affirming Psychiatric Care

January 2024

On November 8, 2023, Gender-Affirming Psychiatric Care was released by the American Psychiatric Association’s official publishing house.

We the undersigned strongly support the following Open Letter to the APA. Our letter calls on the APA to explain why it glaringly ignored many scientific developments in gender-related care and to consider its responsibility to promote and protect patients’ safety, mental and physical health.  

On Dec 28, 2023, this Open Letter was sent to the leadership of the APA, asking for a substantive response. We invite you to sign below to support our continued efforts to demand medical and mental health excellence from the APA.

-

We are a group of clinicians, educators, and researchers committed to treating every patient with respect and compassion while upholding excellence in medical and mental health care. We seek an unbiased scientific investigation and discussion of the harms and benefits of all types of care offered to those with gender related distress. We have grave concerns about the American Psychiatric Association’s GAPC textbook. Until those concerns are addressed and the textbook’s errors corrected, we call on the APA for its withdrawal. 

GAPC, released on November 8, 2023 by the American Psychiatric Association’s official publishing house, is touted as “the first textbook dedicated to providing affirming, intersectional, and evidence-informed psychiatric care for transgender, non-binary, and/or gender-expansive (TNG) people.” APA Publishing claims to use a system that “is unique in the extent to which it uses peer review in both the selection and final approval of publishing projects.”  Considering the serious concerns about “affirming care” of minors raised by multiple international systematic reviews, we do not understand how such a review process could grant the imprimatur of the APA. We ask that APA Publishing disclose details of the peer review process for this book and explain why it glaringly ignored scientific developments in gender-related care. 

The book’s claims of being evidence-informed are untenable. GAPC omits any in-depth analysis of the evidence to date, dismisses “scientific neutrality” as “a fallacy” (p. xix), and chooses authors with the correct “lived experiences” and “community impact of prior work over academic titles” (p. xx).   

At the time of publishing, the gender affirmation model promoted in GAPC is under scrutiny from clinicians and scientists worldwide. After conducting careful systematic reviews of the evidence, Finland, Sweden, and the United Kingdom are drastically retrenching from their earlier affirmation model for treating gender dysphoria in minors. In Norway, the Netherlands, Denmark, France, Australia and New Zealand we see either critical reviews by public health agencies, or pushback by professional societies and in mainstream medical journals. Having omitted these international developments and heated debates, GAPC was out of date before its publication.  

Not only do the authors ignore the most current systematic reviews, which count as the most reliable source of scientific information in evidence-based medicine, they also repeatedly undermine well-established standards of care in multiple mental and medical practices. We highlight just two examples of many.  

First, GAPC neglects to address the many known risks of puberty blockers (see Cass Review 2020, Jorgensen et al. 2022, FDA 2022), and cross-sex hormones while presenting fundamentally flawed research to support their gender-affirmative approach. The authors falsely state that “Use of GnRHas in pubertal suppression is a fully reversible intervention that allows young patients time to mature, explore their gender identity, and understand better the risks and benefits of GAHT” (p. 52). It is astonishing to see such an outdated fallacy appear in this book, especially referring to a case presentation of a 10-year-old child. According to Jorgensen et al. 2022, “Over 95% of youth treated with GnRH-analogs go on to receive cross-sex hormones. By contrast, 61-98% of those managed with psychological support alone reconcile their gender identity with their biological sex during puberty.” This contradicts both the reversibility and exploratory nature of puberty suppression claimed by GAPC.  

The authors continue, “This often leads to improvement in psychiatric symptoms, behavioral problems (de Vries et al. 2011), and suicidal ideation (Turban et al. 2020)” (p. 52). The studies cited by the authors have been extensively critiqued by the aforementioned reviews and other investigators (see Biggs 2022, SEGM 2023, Abbruzzese et al. 2023). The European systematic reviews found the de Vries study to be at high risk of bias. The Turban et al. study is cross-sectional, and by the authors’ own admission “does not allow for determination of causation. Longitudinal clinical trials are needed to better understand the efficacy of pubertal suppression.” Additional, equally profound critiques include a) downplaying serious known side effects b) profound methodological flaws that exaggerate and misrepresent reported efficacy and benefits c) inclusion of only the most successful cases in outcome-reporting d) lack of applicability to the currently predominant cohort of minors experiencing gender dysphoria (adolescent-onset natal female patients with severe psychiatric comorbidities) and e) absence of randomized, controlled trials and long-term studies (Ludvigsson 2023).

Second, the authors are disturbingly nonchalant about the high rate of co-occurring mental and behavioral health challenges seen in the context of gender dysphoria. Autism, ADHD, eating disorders, anxiety, depression, suicidality, substance use disorders and obsessive-compulsive disorder are all dramatically over-represented in gender dysphoric youth. The Minority Stress Model is used to dismiss such phenomena, unscientifically, as the result of “the psychosocial stressors associated with having to exist within a cisheteronormative society” (p. 50). Minority stress is not sufficient to explain away all psychological distress in the gender nonconforming population, as research has shown no significant change in suicide rates over time in this cohort despite increasing societal acceptance. Rather than comprehensively exploring and addressing these co-occurring conditions, GAPC charges ahead with medicalized gender transition in children and young adults with autism and ADHD (chapter 8), substance use disorders (chapters 1, 13 & 16), eating disorders (chapter 15), and severe mental illness (chapter 18).  

GAPC overlooks the risk that rapid affirmation concretizes patients’ dysphoria or contributes to patients’ regret post-treatment, with some even attempting to return to their natal sex. Such detransitioned individuals are now suing surgeons, endocrinologists, and psychiatrists for damages, claiming their doctors encouraged them to follow measures that are not backed by rigorous science and did not address their co-morbid conditions. They are suing health systems employing such doctors and the professional organizations (the American Academy of Pediatrics in the Isabelle Ayala lawsuit) that uncritically endorse unproven and irreversible treatments. It appears that the APA is either unaware of or has chosen to ignore such risks and outcomes for patients and for those that promote, teach and provide these treatments. 

GAPC condemns any attempt to prevent such iatrogenic harm through careful evaluation, wrongly dismissing widely-accepted, less invasive psychotherapeutic treatments as “conversion therapy” (p. 291). Instead, GAPC proposes that patients struggling with gender-related distress be taken at their word that “gender” is the source of the problems and rushed to treatments that may lead to irreversible sterility, anorgasmia, surgical complications, and life-long dependence on exogenous hormones and medical interventions. This aggressive approach discounts the possibility that many of these children, if not initiated on blockers and hormones, would eventually conclude that their early gender dysphoria was the developmental prelude to a healthy, non-heterosexual adult orientation.

The American Academy of Pediatrics (AAP) has similarly advocated for gender-affirming care by publishing a policy statement in 2018, a stance it recently reaffirmed. The AAP now finds itself named in the Ayala case, cited above, on claims that it improperly endorsed harmful care that is not backed by evidence. Its publishing house was accepting pre-orders for a book promoting gender-affirming care until December 6, 2023 when the book was removed, with refunds offered, pending further review. We hope the APA heeds the AAP’s example and retracts GAPC. 

Encouraging any physician, trainee, program or provider to view this book as “cutting-edge” “best practices” is unacceptable, unethical and unsafe. We urge APA Publishing to consider its responsibility to promote and protect patients’ safety and their mental and physical health, and to uphold its own claim to be “the world’s premier publisher of books, journals, and multimedia on psychiatry, mental health, and behavioral science”. To avoid discrediting itself as a professional organization and a reliable source of gender related psychiatric care, and to minimize the risk of legal liability to itself, we call on the APA to withdraw this book. 

==

“Psychosis alone is not a contraindication to gender-affirming services,” the authors write.

Jesus fucking Christ. Being delusional and divorced from all reality doesn't disqualify you from having your breasts or testicles cut off.

These people are complete fucking lunatics.

[socialistexan]

Questions for people who oppose gender affirming care for minors, we'll touch on adults later.

"A child can not consent to life changing surgery."

That's true, children can't - and honestly shouldn't be able to - consent to a lot of things. However, medical consent is a very different beast, this consent is gotten from their legal guardian, not the child.

Putting aside that while surgery for a trans minor does happen it is extremely rare, why is this standard only applied trans children and their medical care?

Do you think the 3200 cigender girls ages 13 to 19 who received a breast enhancement in 2020 gave the proper consent? Do you believe the 4700 cis girls in the same age group and time who received breast reduction in 2020 should be barred from that treatment? Why is 230 trans kids receiving a gender affirming surgery not okay, but the others are?

Can a minor consent to any surgery at all? Like, say, knee surgery which has a much higher regret rate than Gender Affirming surgery?

"Puberty Blockers and Hormone Replacement Therapy can have lifelong medical effects!"

So can any medication.

Should children be able to receive chemo? That has lifelong effects. Pain killers, those can be addictive and put your body, especially a child's body, under extreme stress, should children receive that care? Should a child receive psychiatric medication, those absolutely have side effects that could be long lasting? Tylenol can cause stomach bleeds that can have life long effects, should they receive that medication?

I'm allergic to penicillin, does that mean penicillin should be pulled from the shelves? It saves millions of people's lives, but it could kill me, so why would you legislate access away from the millions to accommodate the exception, me?

"What about detransitioners? What if they regret it? What if they realize they haven't

It's terrible that sometimes this happens. It is extraordinarily rare in an already small population, but it does happen. We should love and respect and give support to detransitioners, they have gone through medical trauma and a personal journey that few can relate to. It is awful they have to deal with the potential affects of treatment that they later regreted.

But trans people who went through the wrong puberty also experience these exact issues. Trans women who went through male puberty have deeper voices and all the same issues that a detransitioned cis woman who underwent HRT. And adult trans women who underwent male puberty had no say in whether they went through that, while a detransitioners at least had the opportunity to make a choice. Why do you have sympathy for one of those kinds of women and not the other?

Also, doctors sometimes get things wrong in any kind of medical treatment. Misdiagnosis happens, incorrect treatment happens. Sometimes a doctor is just plain bad or greedy. Does that mean you throw out all access to a form of medical treatment just for a few mistakes and improper treatment?

[she-is-ovarit]

Trans research and scientific consensus

(2020) - Study of 139,829 students finds that in comparison to other students, transgender identity, especially non-binary identity, is associated more with perpetrating bullying than being bullied. Non-binary identity was most strongly associated with involvement in bullying, followed by [transgender] opposite sex identity and cisgender identity. 

(2023) 21 leading experts on pediatric gender medicine from 8 countries wrote a letter to Wall Street Journal expressing disagreement over how gender dysphoria in youth is treated, voicing concerns against things such as the affirmative model and research conducted outside of the US has found hormonal interventions for gender dysphoria to be without reliable evidence. Among these international experts is Dr. Rita Kaltiala, chief psychiatrist at Tampere university gender clinic and author of several peer-reviewed studies on trans medicine and Finland's top authority on pediatric gender care.

(2023) Landmark study from Denmark on 3,800 transgender patients pulled data from hospital records and applications from legal gender changes and discovered 43% of this group had a psychiatric illness compared with 7% of non-trans group, and despite "gender affirming care" and legal gender changes, still had 7.7 the rate of suicide attempts and 3.5 times the rate of suicide deaths. Researchers state this rate is likely even higher due to missing data.

(2016) Study finds association with increased risk of multiple sclerosis for trans women taking estrogen/reducing testosterone levels.

(2023) Metadata study shows, at best, no improvement for patients in gender-affirming care. "The conclusions of the systematic reviews of evidence for adolescents are consistent with long-term adult studies, which failed to show credible improvements in mental health and suggested a pattern of treatment-associated harms. Three recent papers examined the studies that underpin the practice of youth gender transition and found the research to be deeply flawed. Evidence does not support the notion that “affirmative care” of today’s adolescents is net beneficial."

(2011) Long term follow up of 324 transgender people having undergone sex reassignment surgery in Sweden, found that trans women retained male patterned incidents and rates of violence and had a greater significance and rate of rape and sexual violence than cisgender men. The study also found, "Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."

(2020) Largest study to date on 641,860 people finds association with autism and "gender diversity", "Gender-diverse people also report, on average, more traits associated with autism, such as sensory difficulties, pattern-recognition skills and lower rates of empathy — or accurately understanding and responding to another person’s emotional state".

(2022) US study examining 10 years of data on 952 people finds large percentages of young adults prescribed hormones for trans identity no longer getting the drugs 4 years later. Discontinuation rate for both sexes combined = 30%. Female discontinuation rate as high as 44%. The standard disinformation pushed is that only 1-2% of people who begin medical transition end up desisting. But these figures show that in this cohort of young adults, the overall rate of discontinuing hormone treatment ranged from a low of 10% to a high of 44% within a space of just 4 years.

Abruzzese et al. 2023 'The Myth of “Reliable Research” in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies—and research that has followed'

More to come.

[justinspoliticalcorner]

Trudy Ring at The Advocate:

The Department of Defense’s health insurance plan, Tricare, must cover gender-affirming surgery for transgender dependents of active and retired service members, a federal judge has ruled. The exclusion of coverage for this care violates the equal protection guarantees of the U.S. Constitution, U.S. District Judge Nancy Torresen ruled November 1. The suit was brought by two transgender women in their 20s, identified by the pseudonyms Jane Doe and Susan Roe, who are both daughters of retired military members and are covered by Tricare. Doe and her father filed suit in 2022 in U.S. District Court in Maine, and Roe was added to the suit last year. Doe lives in Maine and Roe in Florida. Both of the women’s fathers served more than two decades in the military.

Defense Secretary Lloyd Austin, the Defense Department, the department’s health agency, and Tricare were named as defendants. The women challenged a 1976 federal law that excluded coverage for “surgeries ‘justified solely on psychiatric needs including, ... sex gender changes’ and other services deemed ‘not medically necessary,’” Torresen wrote in her ruling. “Congress considered all ‘cosmetic’ procedures (including ‘sex gender changes’) to be ‘nonmedical’ in the sense that they were ‘psychologically’ or ‘psychiatrically’ justified, and not strictly medically necessary,” she continued. But Torresen found that such surgery is indeed medically necessary and that the Defense Department had not shown that any important governmental interest was advanced by denying the coverage.

Good news: Judge Nancy Torresen issued a ruling on November 1st in Doe v. Austin that Tricare is required to cover gender-confirmation surgery for transgender dependents of active and retired service members.

[mariacallous]

AUSTIN, Texas (AP) — The Texas Supreme Court upheld the state’s ban on gender-affirming care for transgender youths Friday, rejecting pleas from parents that it violates their right to decide on and seek medical care for their children.

The 8-1 ruling from the all-Republican court leaves in place a law that has been in effect since Sept. 1, 2023. Texas is the largest of at least 25 states that have adopted laws restricting or banning gender-affirming medical care for transgender minors.

The Texas law prevents transgender people under 18 from accessing hormone therapies, puberty blockers and transition surgeries, though surgical procedures are rarely performed on children. Children who had already started the medications had to taper off their use.

“We conclude the Legislature made a permissible, rational policy choice to limit the types of available medical procedures for children, particularly in light of the relative nascency of both gender dysphoria and its various modes of treatment and the Legislature’s express constitutional authority to regulate the practice of medicine,” Justice Rebeca Aizpuru Huddle wrote in the court’s decision.

The lawsuit that challenged the Texas law argued it devastates transgender teens who are unable to obtain critical treatment recommended by their physicians and parents. The Williams Institute at the UCLA School of Law estimates about 29,800 people ages 13-17 in Texas identify as transgender.

The only justice dissenting with Friday’s ruling said the Texas Supreme Court was allowing the state to “legislate away fundamental parental rights.”

“The State’s categorical statutory prohibition prevents these parents, and many others, from developing individualized treatment plans for their children in consultation with their physicians, even the children for whom treatment could be lifesaving,” Justice Debra Lehrmann wrote in a dissenting opinion. “The law is not only cruel — it is unconstitutional.”

A lower court had ruled the law unconstitutional, but it was allowed to take effect while the state Supreme Court considered the case.

Texas’ Republican attorney general, Ken Paxton, vowed in a post on the social platform X after the ruling that his office “will use every tool at our disposal to ensure that doctors and medical institutions follow the law.”

Advocates criticized the ruling.

“It is impossible to overstate the devastating impact of this ruling on Texas transgender youth and the families that love and support them,” said Karen Loewy, senior counsel and director of Constitutional Law Practice at Lambda Legal, which was among the groups that sued the state on behalf of doctors and families.

“Our government shouldn’t deprive trans youth of the health care that they need to survive and thrive,” said Ash Hall, policy and advocacy strategist for LGBTQIA+ rights at ACLU of Texas. “Texas politicians’ obsession with attacking trans kids and their families is needlessly cruel.”

The law includes exemptions for children experiencing early puberty or who have “a medically verifiable genetic disorder of sex development.”

Such exemptions underscore the law’s discriminatory nature, said Dr. Jack Drescher, a psychiatry professor at Columbia University who edited the section about gender dysphoria in the American Psychiatric Association’s diagnostic manual. Gender dysphoria is the psychological distress experienced by those whose gender expression does not match their gender identity and is a required diagnosis before treatments can begin.

“They’re saying if you’re not a transgender child and you need these drugs, you can have them, but if you’re a transgender child who might benefit from these drugs, then sorry, you have to move to another state,” Drescher said.

The restrictions on health care are part of a larger backlash against transgender rights, touching on everything from bathroom access to participation in sports. Former President Donald Trump has vowed to pursue other measures that would restrict the rights of transgender people if he wins the November election, including a ban on gender-affirming care for minors at the federal level.

As more states move to enforce health care restrictions, families of transgender youths are increasingly forced to travel out of state for the care they need at clinics with growing waiting lists. At least 13 states have laws protecting care for transgender minors.

Most of the states that have passed restrictions face lawsuits, and the U.S. Supreme Court recently agreed to hear an appeal from the Biden administration attempting to block state bans on gender-affirming care. The case before the high court involves a Tennessee law that restricts puberty blockers and hormone therapy for transgender minors, similar to the Texas law.

Gender-affirming care for transgender youths is supported by major medical organizations, including the American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association and the Endocrine Society.

In a concurring opinion, one justice dismissed the position of the medical groups.

“The fact that expert witnesses or influential interest groups like the American Psychiatric Association disagree with the Legislature’s judgment is entirely irrelevant to the constitutional question,” Justice James Blacklock wrote. “The Texas Constitution authorizes the Legislature to regulate ‘practitioners of medicine.’”

Texas officials defended the law as necessary to protect children and noted a myriad of other restrictions for minors on tattoos, alcohol, tobacco and certain over-the-counter drugs.

Several doctors who treat transgender children testified in a lower court hearing that patients risk deteriorating mental health, which could possibly lead to suicide, if they are denied safe and effective treatment.

The ban was signed by Republican Gov. Greg Abbott, the first governor to order the investigation of families of transgender minors who receive gender-affirming care.

[sophieinwonderland]

"I'm going to have to disagree with the psychiatric community on what a mental illness is." –A Religious Traditionalist

Here was one of the interactions in my r/askconservatives post about plurality:

The religious traditionalist flair on this is just so... unsurprising.

It seems a weird theme with far-right evangelicals that they think they're more qualified to speak on medical matters than actual doctors.

This is the same basis they use to claim being transgender or being gay is a mental illness.

It feels like there shouldn't be this overlap between religion and armchair psychiatry, but yet there is.

Here's my theory: When Christofascists discuss mental disorders, what they actually are talking about is divergences from God's creation.

That there is a model human beings were designed to fit, and anything that strays too far from that model is wrong. The role of medical treatment then is the same as a priest. Rather than being about making the individuals more healthy, it's to help bring you closer to how God meant for you to be made.

If you believe god designed everyone to be a singlet, then anyone being plural must be "mentally ill."

And when the treatment for being transgender is gender-affirming care, that takes you further away from God's model.

These rightwing evangelicals don't care about mental illness. They care about making people be as they think God intended.

(All while their God Himself is canonically plural.)

[probablyasocialecologist]

So far this year, Republicans across the U.S. have introduced over 560 anti-trans bills — more than the number introduced in the last four years combined. Many states have banned gender-affirming care for minors; some have banned trans people from using the bathrooms that align with their gender identity; others have stripped transgender people of legal recognition; and still, more have banned trans women from competing in women’s sports. In Florida, Gov. Ron DeSantis, who is running for president, banned gender-affirming care for adults and youth and signed a law allowing the state to take a child away from their parents if they’re caught receiving such care. All told, the bills are an effort at mass, state-sanctioned conversion therapy — an attempt to permanently push trans people back in the closet, forcing almost 1% of the population to not live as themselves, and guaranteeing that many will dwell in the depression and suicidal ideation attendant to gender dysphoria. Trans youth who receive gender-affirming care are 60% less likely to have depression and 73% less likely to experience suicidality. There is an overwhelming scientific consensus supporting the gender-affirming model of treatment, which is endorsed by the American Medical Association, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association, the American Psychiatric Association, the American Academy of Pediatrics (AAP), and the Endocrine Society. But the GOP is uninterested in these endorsements. Their bills are often cookie-cutter pieces of legislation crafted by a coalition of Christian dominionists determined to reshape America according to a far-right, fundamentalist interpretation of scripture. Earlier this year, leaked emails obtained by Mother Jones showed groups like the Alliance Defending Freedom, a Christian legal powerhouse that has advocated sterilizing trans people, collaborating with Republican legislators to draft the bills currently sweeping through statehouses. Although there has always been a strong current of transphobia in conservative American politics, it has intensified dramatically in recent years, with GOP strategists clearly coming to the consensus that manufacturing a moral panic about trans people will energize its evangelical base enough to retake the White House and the U.S. Senate.

[stephobrien]

For a long time now, transgender people, allies, and medical and psychiatric professionals have been warning that attacks on gender-affirming care, privacy, and bodily autonomy harm kids.

Now, those warnings have been horrifyingly validated.

Researchers have found that states that passed anti-trans laws saw suicide attempt rates rise by up to 72% among transgender and nonbinary youth aged 13 to 17, and by 44% among those aged 13 to 24.

This study surveyed over 61,000 transgender and nonbinary people, and controlled for factors such as state by state differences, race, age, and the impact of COVID-19.

You can read the full article here:

It's been said many times, and now there's yet another piece of proof:

Transphobia is not about protecting kids.

Transphobes like terfs pretend they're trying to save children from some sort of evil "gender ideology," but - as usual - science proves that their bigotry only hurts the people they're pretending to protect.

And yet, right-wing politicians keep doubling down on their anti-trans attacks.

They've been warned again and again that their hate-based legislation hurts kids. They don't get to claim ignorance as an excuse.

They're knowingly choosing to endanger children's lives for the sake of their own bigotry and careers.

Remember this when casting your votes.

[transmutationisms]

no sorry this is too irritating i can't leave it lmfao

"deliberate, knowing self harm" <- please unpack that, define yr terms, &c

you are just simply misinformed if you think no one has a chronic eating disorder or that "eating disorder" is prima facie synonymous with "starves self to death"

this is exactly the sort of thing i'm talking about when i say: stop fucking trying to morally justify transition care by claiming it will make your life 'better' or facilitate 'recovery' or psychiatric normality. if you transition and your life sucks for any number of reasons, you are still allowed to be trans! you don't need to perform or attain health or normalcy in order to justify access to gender-affirming care!

you do, in fact, have the right to have an eating disorder, just as you have the right to self harm and the right to transition and the right to scratch your ass. xoxo

[evidence-based-activism]

Hi, @peaktransd, you asked a question on this post about "studies about hormones and the placebo effect". I've looked into this and found some relevant information!

---

No high quality research on transgender affirming hormone care

The first, important, aspect here is that there is little to no high quality research on the use of hormones for transgender affirming care.

By this point we've all heard of the Cass review [1, emphasis mine] which found:

For puberty blockers: "The review of the evidence looked at nine studies that met the inclusion criteria. A key limitation of all the studies examined was the lack of reliable comparative studies, as well as of clear expected outcomes. All the studies were small uncontrolled observational studies, and all the results were of low certainty. Many did not report statistical significance."

For hormones: "Ten uncontrolled observational studies met the inclusion criteria. Again, the key limitation to identifying the effectiveness and safety of gender-affirming hormones for children and adolescents with gender dysphoria was the lack of reliable comparative studies."

Notably the important point here is that all of the research is uncontrolled observational studies, which do not allow for the examination of the placebo effect. Also, to preempt any objections, the Cass review team has created a website with FAQs [2] to address the mis- and disinformation being spread about the review.

Further, this article [3] argues "that although [gender affirming treatment] for [gender dysphoric] youth lacks a rigorous evidence base, it is undertaken as routine medical treatment in a strongly placebo effect enhancing environment", highlighting why we absolutely need good quality evidence into this topic.

The state of research for adults is similar. There are no comprehensive reviews about adult treatment, and some of this is by design. By this I mean, WPATH (the World Professional Association for Transgender Health) has purposefully suppressed unfavorable evidence.

There's a compounding issue here; in the reviews that do exist they tend to find very little evidence base for supporting hormone use and then make a recommendation in support of hormones anyway. These studies are often used as evidence by proponents who do not read past the abstract of the study.

Some studies on hormones and mood in transgender adults [all emphasis mine]:

This 2016 review [4] indicated: "Hormone therapy interventions to improve the mental health and quality of life in transgender people with gender dysphoria have not been evaluated in controlled trials. Low quality evidence suggests that hormone therapy may lead to improvements in psychological functioning."

This 2016 review [5] claimed a positive conclusion ("gender dysphoria-related mental distress may benefit from hormonal treatment") but proceeds to note that "results mentioned earlier need to be considered in light of certain limitations". These limitations include: single site studies, small sample size, type/dose of hormone restatement usually not reported (and poor consistency when reported), “more than half the studies did not mention/control for psychiatric comorbidity”, and “recruitment/follow-up attrition represented an issue". They also hide this key point: "most importantly, as no study used a blinded randomized controlled trial design, results could have also different explanations because of the study design" in the limitations section. Given the extent of the issue, these limitations should have at least been mentioned in the abstract and the researchers should not have suggested such a definitive conclusion.

This 2018 review [6] indicated that "although the existing body of research supports [gender-affirming hormone therapy] improving mental wellness, many studies used cross-sectional and uncontrolled observational methods relying on self-report." Again, this important caveat was hidden in the conclusion; with the abstract making far bolder claims than supported by evidence.

This 2019 review [7] concluded that "because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made."

This 2021 review [8] came to the same conclusion stating "certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions."

Even for the very few "controlled" studies, they are not randomized control trials. Instead they are before treatment – after treatment comparisons for transgender individuals or cross sectional studies comparing transgender and "cisgender" comparison groups. Notably, neither of these designs allow the researcher to elucidate the origin of observed effects (e.g., is improvement coming from hormone therapy or social affirmation?).

(And as a side note, this Cochrane (the "gold standard" for those unaware) review [9] concluded: "We found insufficient evidence to determine the efficacy or safety of hormonal treatment approaches for transgender women in transition. This lack of studies shows a gap between current clinical practice and clinical research. Robust RCTs and controlled cohort studies are needed".)

---

Confounding factors: the effect of hormone therapy on non-transgender individuals

There's a particularly important confounding factor here; we have evidence that hormone therapy is associated with improved mood. As such, improved mood with gender affirming care may simply be the result of this natural physiological effect.

This 2023 systematic review and meta-analysis [10] with "14 eligible randomized controlled trials (RCTs) ... to investigate the effect of exogenous estrogen on depressive mood in women" found "strong evidence that exogenous estrogen exerts its antidepressant effect by stabilizing estrogen levels".

This 2009 systematic review and meta-analysis [11] with "seven studies (N=364) ... that included a placebo-control group in a double-blind design" found "[testosterone] may have an antidepressant effect in depressed [men], especially those with hypogonadism".

This 2014 systematic review and meta-analysis [12] of "sixteen trials with a total of 944 subjects ... showed a significant positive impact of testosterone on mood" and ultimately concluded "Testosterone may be used as a monotherapy in dysthymia and minor depression or as an augmentation therapy in major depression in middle-aged hypogonadal men".

This 2019 systematic review and meta-analysis [13] of "27 randomized placebo-controlled clinical trials involving a total of 1890 men found that testosterone treatment was associated with a significant reduction of depressive symptoms, particularly in participants who received higher-dosage regimens."

Further, the fact that these results were all the strongest in people with lower endogenous hormone levels, lends support to the hypothesis that this effect would be substantial in cross sex supplementation given the naturally low endogenous hormone levels for these individuals. (Please note, however, that this hypothesis has not yet been investigated.)

This isn't a placebo effect, since the randomized controlled trials above indicate that the effect on mood is above and beyond any placebo effect. However, I believe it's a related point.

---

Hormones on cognitive function

To address the other point in that post, there really isn't evidence that women would "get smarter" if they take testosterone or men would "get dumber" if they take estrogen. Again, there's no high quality studies on transgender individuals, but there is some adjacent evidence for non-transgender individuals.

There is evidence that the reduction of estrogen levels in older women may be associated with cognitive decline. [14]

This review [15] and this study [16] both link higher endogenous testosterone levels in women (i.e., in women with PCOS) with lower cognitive performance.

That being said, this "randomized, placebo-controlled trial" [17] manipulated the levels of testosterone in women with PCOS and did not record changes in their cognitive function. This may be because the sample size was simply too small (n=29), or there could be a "critical window" in which testosterone effects women's cognitive performance, or any number of other possibilities.

These reviews [18, 19] found low testosterone levels are associated with with cognitive impairment in men although the effects of testosterone substitution are mixed. This appears to support the hypothesis that testosterone suppression may reduce cognitive performance, but in reality "the ability of the body to convert testosterone into estrogen suggests that part of the actions of testosterone could be mediated by estrogen". So, any decrease due to testosterone suppression would likely be offset by estrogen supplementation. In fact this review [20] discusses the evidence for this.

---

The stereotype threat

As suggested by @mycodyke, an important factor here is the stereotype threat. This refers to how "behavior can be a consequence of priming effects, ... when a stereotype becomes activated, stereotype-consistent behavior may follow automatically from that activation" [21].

The study she linked [22] goes into this, finding that men performed the same in a cognitive task regardless of priming condition, whereas women performed worse only when primed with female condition. This replicated an earlier study [23] that found "no sex differences were observed" when the task instructions didn't emphasize sex-stereotypes.

Other similar studies:

This study [24] found "sex difference was reliably elicited and eliminated by controlling or manipulating participants’ confidence"

This meta-analysis [25] suggested that "male superiority on spatial ability tasks ... is related to the implementation of time limits".

This study [26] also suggested this, finding that "the magnitude of gender differences was linearly related to the amount of time available for test completion".

All of this indicates that sex differences on this task (and likely in other similar situations) are the result of individual expectations about their performance. This is also commonly brought up for self-fulfilling prophecies; that is, if someone believes they will succeed/fail they are more likely to succeed/fail.

And this has real-world consequences. For example, in this study [27], "in a simulated job interview, [participants] … were confronted with either sexist … or non-sexist … behavior … [and] results indicated that female participants in the sexist condition performed significantly worse on the mathematical test than female participants in the control condition … suggest[ing] an influence of psychological and interpersonal processes on seemingly objective test outcomes."

---

Conclusion

I hope this helps! To sum up:

There is little to no high-quality research into the effects, benefits, or harms of hormone therapy for transgender adults or adolescents

There is evidence suggesting that hormone supplementation effects mood in non-transgender adults, indicating an important confounding factor for transgender hormone research

There is no evidence that testosterone makes women smarter or that estrogen makes men dumber; there is, in fact, some limited evidence suggesting the opposite

The belief in the above is likely a result of the stereotype threat; transgender individuals who have started hormone therapy are likely to perform worse/better because they believe they should perform worse/better as a result of ingrained stereotypes

References below the cut:

Cass, H. (2024). Independent review of gender identity services for children and young people.

Final report – FAQs. (n.d.). The Cass Review. https://cass.independent-review.uk/home/publications/final-report/final-report-faqs/

Clayton, A. (2023). Gender-affirming treatment of gender dysphoria in youth: a perfect storm environment for the placebo effect—the implications for research and clinical practice. Archives of Sexual Behavior, 52(2), 483-494.

White Hughto JM, Reisner SL. A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals. Transgend Health. 2016 Jan;1(1):21-31. doi: 10.1089/trgh.2015.0008. Epub 2016 Jan 13. PMID: 27595141; PMCID: PMC5010234.

Costa, R., & Colizzi, M. (2016). The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatric Disease and Treatment, 1953-1966.

Nguyen HB, Chavez AM, Lipner E, Hantsoo L, Kornfield SL, Davies RD, Epperson CN. Gender-Affirming Hormone Use in Transgender Individuals: Impact on Behavioral Health and Cognition. Curr Psychiatry Rep. 2018 Oct 11;20(12):110. doi: 10.1007/s11920-018-0973-0. PMID: 30306351; PMCID: PMC6354936.

Rowniak, S., Bolt, L., & Sharifi, C. (2019). Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review. JBI Evidence Synthesis, 17(9), 1826-1854.

Baker, K. E., Wilson, L. M., Sharma, R., Dukhanin, V., McArthur, K., & Robinson, K. A. (2021). Hormone therapy, mental health, and quality of life among transgender people: a systematic review. Journal of the Endocrine Society, 5(4), bvab011.

Haupt C, Henke M, Kutschmar A, Hauser B, Baldinger S, Saenz SR, Schreiber G. Antiandrogen or estradiol treatment or both during hormone therapy in transitioning transgender women. Cochrane Database of Systematic Reviews 2020, Issue 11. Art. No.: CD013138. DOI: 10.1002/14651858.CD013138.pub2.

Zhang, J., Yin, J., Song, X., Lai, S., Zhong, S., & Jia, Y. (2023). The effect of exogenous estrogen on depressive mood in women: A systematic review and meta-analysis of randomized controlled trials. Journal of psychiatric research, 162, 21-29.

Zarrouf, F. A., Artz, S., Griffith, J., Sirbu, C., & Kommor, M. (2009). Testosterone and depression: systematic review and meta-analysis. Journal of Psychiatric Practice®, 15(4), 289-305.

Amanatkar, H. R., Chibnall, J. T., Seo, B. W., Manepalli, J. N., & Grossberg, G. T. (2014). Impact of exogenous testosterone on mood: a systematic review and meta-analysis of randomized placebo-controlled trials. Ann Clin Psychiatry, 26(1), 19-32.

Walther, A., Breidenstein, J., & Miller, R. (2019). Association of testosterone treatment with alleviation of depressive symptoms in men: a systematic review and meta-analysis. JAMA psychiatry, 76(1), 31-40.

Sherwin, B. B. (2003). Estrogen and cognitive functioning in women. Endocrine reviews, 24(2), 133-151.

Perović, M., Wugalter, K., & Einstein, G. (2022). Review of the effects of polycystic ovary syndrome on Cognition: Looking beyond the androgen hypothesis. Frontiers in Neuroendocrinology, 67, 101038.

Sukhapure, M., Eggleston, K., Douglas, K., Fenton, A., Frampton, C., & Porter, R. J. (2022). Free testosterone is related to aspects of cognitive function in women with and without polycystic ovary syndrome. Archives of Women's Mental Health, 25(1), 87-94.

Schattmann, L., & Sherwin, B. B. (2007). Effects of the pharmacologic manipulation of testosterone on cognitive functioning in women with polycystic ovary syndrome: a randomized, placebo-controlled treatment study. Hormones and Behavior, 51(5), 579-586.

Mohamad, N. V., Ima-Nirwana, S., & Chin, K. Y. (2018). A review on the effects of testosterone supplementation in hypogonadal men with cognitive impairment. Current drug targets, 19(8), 898-906.

Zhang, Z., Kang, D., & Li, H. (2021). Testosterone and cognitive impairment or dementia in middle-aged or aging males: causation and intervention, a systematic review and meta-analysis. Journal of Geriatric Psychiatry and Neurology, 34(5), 405-417.

Janowsky, J. S. (2006). The role of androgens in cognition and brain aging in men. Neuroscience, 138(3), 1015-1020.

Spencer, S. J., Logel, C., & Davies, P. G. (2016). Stereotype threat. Annual review of psychology, 67(1), 415-437.

Ortner, T.M., Sieverding, M. Where are the Gender Differences? Male Priming Boosts Spatial Skills in Women. Sex Roles 59, 274–281 (2008). https://doi.org/10.1007/s11199-008-9448-9

Sharps, M. J., Price, J. L., & Williams, J. K. (1994). Spatial cognition and gender instructional and stimulus influences on mental image rotation performance. Psychology of Women Quarterly, 18(3), 413-425.

Estes, Z., Felker, S. Confidence Mediates the Sex Difference in Mental Rotation Performance. Arch Sex Behav 41, 557–570 (2012). https://doi.org/10.1007/s10508-011-9875-5

Maeda, Y., Yoon, S.Y. A Meta-Analysis on Gender Differences in Mental Rotation Ability Measured by the Purdue Spatial Visualization Tests: Visualization of Rotations (PSVT:R). Educ Psychol Rev 25, 69–94 (2013). https://doi.org/10.1007/s10648-012-9215-x

Voyer, D. Time limits and gender differences on paper-and-pencil tests of mental rotation: a meta-analysis. Psychon Bull Rev 18, 267–277 (2011). https://doi.org/10.3758/s13423-010-0042-0

Koch, S.C., Konigorski, S. & Sieverding, M. Sexist Behavior Undermines Women’s Performance in a Job Application Situation. Sex Roles 70, 79–87 (2014). https://doi.org/10.1007/s11199-014-0342-3

[religion-is-a-mental-illness]

By: Benjamin Ryan

Published: May 3, 2024

Psychiatrists learned the wrong lesson from the gay rights movement.

Five decades ago, the world’s most powerful psychiatric association changed the course of LGBTQ civil rights history when it removed homosexuality from its influential bible of mental health disorders.

At annual meetings of the American Psychiatric Association during the early 1970s, activists and internal reformers compelled the association to host panels and discussions on the merits of the relevant research, fostering a rigorous debate about whether homosexuality should still be considered a pathology. The science won in 1974 and set in motion a parade of legal victories for the gay rights movement, including the right for same-sex couples to wed.

APA members gather in New York on Saturday for this same crucial meeting. The summit should again serve as a watershed moment in the care of LGBTQ people. This time, the pressing question facing American psychiatrists is how best to treat children who are distressed about their gender. In response to emerging analyses of the available research, health officials in several European nations have sharply restricted the use of puberty blockers and cross-sex hormones in this population— in some countries to research settings only. But the APA still endorses the use of these drugs as a front-line intervention for minors.

In 1974, the science lined up neatly with the demands of gay rights activists. But today, the science of pediatric gender medicine is uncertain, so it doesn’t back the cause the of groups leading the contemporary LGBTQ civil rights movement in the United States.

GLAAD has gone so far as to insist that the science is settled regarding pediatric gender transition. It is not. In fact, the field of pediatric gender medicine is woefully compromised by a critical lack of quality research. Evidence-based-medicine experts insist that we simply do not know whether gender-transition treatment is safe and effective for minors.

Understandably, APA leaders — and other empathetic everyday people — are wary of repeating the mistakes of the past and are inclined to stand with LGBTQ advocates, particularly as conservative groups fight for all manner of restrictive laws that target kids who identify as transgender.

During the past decade, nations across the globe saw a surge in children and adolescents with gender-related distress, a population with a high rate of other psychiatric conditions, autism and self-harm. This phenomenon has occurred amid an overall crisis in youth mental health. It is not a betrayal of gender-distressed young people’s complex needs to demand the highest possible quality of evidence to determine whether prescribing them medications that could rob them of their fertility and sexual function are in their best interest. It is the APA’s responsibility, free from ideology or politics, to make such demands — which are, in fact, in service of these young people’s well-being.

The APA’s signaling on best practices for the care of such young people is of paramount importance. The offices of psychiatrists and other mental health professionals are often the entry point into gender-transition medicalization. And in U.S. gender clinics, a therapist typically must approve a minor’s referral to an endocrinologist for puberty blockers or cross-sex hormones.

The APA has been notably silent on a landmark report published last month that was commissioned by the British National Health Service. Called the Cass Review, it concluded that pediatric gender-transition treatment is based on “remarkably weak evidence.” The report is supported by seven independently conducted systematic literature reviews — the gold standard of scientific evidence. Their findings were in line with those of six previous such reviews, conducted by European and North American investigators and published since 2019.

The program for the 2024 APA annual meeting lists only one panel that touches on pediatric gender-transition treatment, titled “Channeling Your Passion and ‘Inner Outrage’ by Promoting Public Policy for Evidence-Based Transgender Care.”

The panel notably includes Jack Turban, a University of California at San Francisco child psychiatrist and a vocal supporter of broad access to gender-transition treatment. This week, he lashed out at the Cass Review on X and asserted that the associated literature reviews “scored some of the studies incorrectly.” Turban didn’t mention the reviews deemed a few of his own widely referenced papers to be low quality.

The APA’s meeting has a proud history of transforming open debate over LGBTQ-related research and care and should do the same for trans-identifying kids. This should include asking themselves whether LGBTQ activism that once enhanced the understanding of science about this population is now clouding it.

The 1972 APA meeting included a panel featuring a gay psychiatrist who wore a gruesome costume mask and wig that disguised his identity. He opened his mouth and regaled a rapt crowd with his searing story about the agony of working from within the closet.

At the 1973 APA meeting, one psychiatrist panelist proclaimed, “All my gay patients are sick!” to which another replied, “All my straight patients are sick!” This rejoinder pointed to a fatal flaw in the research that had supported considering homosexuality a mental illness: Those supposedly scientific papers were largely based on psychiatric patients, not the general gay public; therefore their conclusions were weak and inconclusive.

The APA board was finally convinced. At the end of that year, it voted that homosexuality was not a mental disorder. The organization’s full membership effectively ratified this decision when a majority voted down a referendum to overturn it on April 8, 1974.

In March, I asked APA President Petros Levounis, who like me is a gay man, if the organization was taking into consideration the recent review papers on pediatric gender medicine.

“We do look very closely to international research,” Levounis, a psychiatrist, told me. “But this is something that has to also come through U.S. channels before we finalize our opinion.”

Now is the time for rigorous and open scientific debate in the United States about this vital subject among the nation’s psychiatrists. The APA needs to remember the power of its annual meeting to foster such a transformative free exchange of ideas. It needs to trade silence for science.

Benjamin Ryan is an independent journalist and has been covering LGBTQ health for over two decades.

[ Via: https://archive.today/IMBqE ]

[villafordefeatedvillains]

i love having opinions on mental health that so many people would have me drawn and quartered for because i think we (the mentally ill people) have bigger problems than other people like us. for example, psychiatrists. anyway did you know that if you're diagnosed with DID they can use it to withhold gender affirming care? did you know many professionals don't even believe DID exists at all? did you know that when you spend eight entire months of your life in a long-term psych ward you realize that the psychiatric institutions are the enemy and not people who believe differently about the same fucking condition? :) did you know that??? that having pissing contests about who's a Good And Pure Mentally Ill and who's an Evil Lying Faker is just repackaged queer label discourse????? that fighting each other on the internet is not going to help anyone and that we should be holding outdated and abusive institutions accountable? but no sure have your stupid trauma pissing contests so you can feel morally superior

[so-i-did-this-thing]

Trans Floridians: "Informed Consent" guidelines are shaping up to be worse than the Harry Benjamin days

The Florida Board of Medicine is discussing the "informed consent" standards today. These will affect trans people, including adults, who are both starting and continuing care.

In short, the guidelines require a prohibitively expensive and difficult to access number of regular assessments for the life of "treatment". (Which, for most of us on HRT is the rest of our lives.) The guidelines look for any opportunity to deny care, from lack of social support to "co-morbidities" that are likely targeting autism, depression, etc.

The specific requirements for you to receive and continue HRT treatment include the following: 1. Meets the current DSM or ICD criteria for gender dysphoria; 2. Mental health and physical conditions that could negatively impact the outcome of treatment have been assessed, with risks and benefits discussed 3. Gender dysphoria is marked and sustained; 4. Demonstrates capacity to consent for the specific gender dysphoria hormone treatment; 5. Does not suffer from psychiatric comorbidity that interferes with the diagnostic work- up or treatment; 6. Has adequate psychological and social support during treatment; 7. Demonstrates knowledge and understanding of the risks, benefits, and expected outcomes of HRT as well as the medical and social risks and benefits of sex reassignment surgery; 8. Understands the effect of gender-affirming hormone treatment on reproduction and they have explored reproductive options; 9. Undergoes an evaluation by the prescribing physician at least every 3 months 10. Undergoes a suicide risk assessment by a licensed mental health care professional at least every 3 months; 11. Undergoes laboratory testing, including blood tests, at least every 6 months; 12. Bone (DEXA) scan once a year to allow monitoring of your bone density (bone strength) during treatment, which can be altered by HRT; 13. Annual mental health assessments by a board-certified Florida licensed psychiatrist or psychologist; and 14. Continued counseling with a licensed mental health care professional during the treatment period, with the frequency recommended by the licensed mental health care professional.

Erin covers here:

From Representative Anna V. Eskamani:

Beginning on page 264 of the meeting packet is the draft informed consent forms for tomorrow's meeting. In part it reads -- "Before beginning or continuing HRT, the individual needs to undergo a thorough psychological and social evaluation performed by a Florida licensed board-certified psychiatrist or a Florida licensed psychologist. The psychiatrist or psychologist must submit a letter to the prescribing physician confirming this." https://ww10.doh.state.fl.us/.../06232023_JRL_Publicbook.pdf Licensed mental health counselors and licensed social workers are trained to write evaluation letters. They know most providers have an LCSW or mental health on staff. This is cruel for the sake of bring cruel and designed to make access more difficult.

I experienced the gatekeeping during the Harry Benjamin days, including the mandatory one year "real life test" where you have to live as your gender in all aspects of your life without the benefits of HRT. It was a very stressful and dangerous practice that was designed to crush us.

This is so much worse. Even with my current salary, health benefits, and work from home schedule, I don't see how I could afford the time and money for all the assessments, nevermind how insulting and discriminatory they are.

Trans Floridians should watch this story closely as the Board of Medicine discusses and finalizes these requirements. As of today, these are not final, but in the current state, would mean the end of informed consent in Florida, and all but bans care entirely.

[biocrafthero]

The Supreme Court is allowing Idaho to enforce its ban on gender-affirming care for transgender youth while lawsuits over the law proceed, reversing lower courts. The justices’ order Monday allows the state to put in a place a 2023 law that subjects physicians to up to 10 years in prison if they provide hormones, puberty blockers or other gender-affirming care to people under age 18. Under the court’s order, the two transgender teens who sued to challenge the law still will be able to obtain care

Idaho Attorney General Raúl Labrador said in a statement that the law “ensures children are not subjected to these life-altering drugs and procedures. Those suffering from gender dysphoria deserve love, support, and medical care rooted in biological reality. Denying the basic truth that boys and girls are biologically different hurts our kids.” Gender-affirming care for youth is supported by every major medical organization, including the American Medical Association, the American Academy of Pediatrics and the American Psychiatric Association.

[justinspoliticalcorner]

Christopher Wiggins at The Advocate:

In a Tuesday interview with NBC News’s Hallie Jackson, Vice President Kamala Harris stood firm in supporting LGBTQ+ rights but faced pressure to clarify her position regarding access to gender-affirming care. Harris reiterated her belief in equality and respect for all people while countering a deluge of anti-transgender attack ads from former President Donald Trump’s 2024 campaign.

Harris, when asked by Jackson about whether transgender Americans should have access to gender-affirming care, responded, “That is a decision that doctors will make in terms of what is medically necessary.” Every major medical association, including the American Medical Association and the American Psychiatric Association, has stated that gender-affirming care is medically indicated and necessary care. Harris criticized Trump’s campaign for focusing heavily on attacking transgender rights in attack ads, calling it a diversion from substantial issues. “Trump is running tens of millions of dollars in ads to talk about two cases to distract from the fact that his policy and plan is also to take away the Affordable Care Act,” Harris said. Trump’s campaign ads push misinformation about gender-affirming care and portray Harris as extreme on the issue. These ads, which have aired widely in battleground states, focus on transgender athletes, gender-neutral bathrooms, and health care access for incarcerated trans individuals – something the Trump administration provided under law to people in government custody. When Jackson pressed Harris on the contrast between her message in May — when she told trans Americans, “We see you, and we love you” — and her current remarks, Harris reiterated, “I believe that all people should be treated with dignity and respect, period, and should not be vilified for who they are.”

In her interview with NBC News’s Hallie Jackson on Tuesday, Kamala Harris stood up for gender-affirming care for trans Americans.

From the 10.22.2024 edition of NBC News Now's Hallie Jackson Now:

[catboybiologist]

Oh, i absolutely am thinking about stuff like breast implants for cancer patients after a masectomy. like yeah, that is pretty much the same question, just, i thought to ask about the aspect of it you have the most, idk, experience in. And idk, like, i do think of how much those types of things improve people's lives, that is probably a higher priority than, idk, oil subsidies and the war. But still, ig that's a debate we are far from needing to have, as if theres a line there, we wont reach it soon.

Yeah, of course ask about what I have experience in! It's unfortunately a question that's highly context dependent and beyond me, but at the very least, we should alter the framework to bring gender affirming care into that discussion overall.

Unfortunately, a lack of gender affirming care access is oftentimes an issue of arbitrary bans that take extra money to implement, so removing those, all other things equal, would probably save money. I wonder how much money the UK has wasted on psychiatric analysis and waiting list management for HRT access. So you're right, we aren't at that point yet.