... and the Screeching Begins

Yesterday, I wrote about the Globe and Mail's article on young transsexuals and their families.

Sure enough, almost like clockwork, the denizens of right wingnuttia came out of their caves squawking about the subject. In this case, the screeching starts at Tristan Emmanuel's No Apologies blog.

Of course, the writers at No Apologies talk in broad generalizations and conveniently fail to cite any real facts to substantiate their bogeyman fears about allowing young transsexuals to transition while still adolescents:

Glossing over the serious moral and ethical dilemmas of gender reassignment, the piece briefly addresses not only the emotional strain of gender confusion among adolescents, but the serious consequences of promoting gender reassignment surgery at young ages.

What "moral and ethical dilemmas" might these be? The fact that transsexuals tend to make the religious right wing horribly uncomfortable? Or perhaps it's the uneasy fear they have that transsexual youth might come to regret their decision later in life?

Being transsexual is, by nature, emotionally stressful. How could it not be? (and it is no easier for the family of the transsexual than it is for the transsexual - nobody expects their child or sibling to pop up one day and announce their intention to transition)

There is an implicit accusation that the treatment community has ignored addressing the very real ethical issues that providing treatment to someone who declares that they are transsexual raises.

Referring to the Endocrine Society's recently published guidelines on the treatment of transsexuals (I only seem to have access to the draft still), we find the following:

Transsexual persons seeking to develop the physical characteristics of the appropriate gender require a safe and effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person’s genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person’s gender. A mental health professional (MHP) must recommend endocrine treatment and participate in the ongoing care throughout the endocrine transition. The endocrinologist must confirm the diagnostic criteria the MHP used to make this recommendation and collaborate with the MHP in making the recommendation for surgical sex reassignment. We recommend treating transsexual adolescents (Tanner stage 2) with suppression of puberty with GnRH analogues until age 16 years old, only after which time cross-sex hormones may be given. We suggest suppression of endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and surveillance for known risks and complications in adult transsexual persons.

There are two key points that I wish to emphasize here. First is the requirement for direct involvement of an appropriately trained mental health professional (e.g. psychiatrist or psychologist). Second, I will also point out that treatment options recommended for those under the age of 16 are puberty blocking drugs, not cross-sex hormones or surgery.

This dovetails quite nicely with the guidelines in the WPATH Standards of Care which addresses the mental health aspects of treatment more fully.

The piece reveals just how few medical and psychological experts in the field of mental health and education are willing to address the negative long-term effects of gender confusion and gender reassignment surgery.

What negative long term effects? As I discussed here, the research is quite clear that the long term outcomes for GRS are generally positive, with only a small handful of unsatisfactory results or regrets - and that's over some 30 years to 1992. I am unaware of any research since that suggests the Pfaefflin survey has been proven incorrect.