Saturday, March 19, 2016

Why You Should Ignore The American College of Paediatricians

The latest tactic in the far right fight against Transgender rights and equality is to cite various declarations from the American College of Paediatricians (ACP).  At first glance, this sounds like a reasonable source to cite.

Except it isn't.  ACP is a splinter group that was formed in protest when the American Academy of Paediatrics (AAP) decided to issue a position statement in favour of allowing gay couples to adopt children.  A few minutes poking around their website turns up links to sites advocating for "reparative therapy", and (unsurprisingly) to NARTH (I've written about this lot before ... a lot ... and none of it is good news).

Lurking on their website is a position statement on gender identity issues

This steaming turd of a position statement is signed by 3 people:  Dr. Cretella, Dr. van Meter and Dr. Paul McHugh.  None of these people have published a single paper on transsexualism, or even more particularly on paediatric transsexualism (go look on PubMed - there's nothing relevant for any of them).  Their lack of expertise shows, too. 
1. Human sexuality is an objective biological binary trait: “XY” and “XX” are genetic markers of health – not genetic markers of a disorder. The norm for human design is to be conceived either male or female. Human sexuality is binary by design with the obvious purpose being the reproduction and flourishing of our species. This principle is self-evident. The exceedingly rare disorders of sexual differentiation (DSDs), including but not limited to testicular feminization and congenital adrenal hyperplasia, are all medically identifiable deviations from the sexual binary norm, and are rightly recognized as disorders of human design. Individuals with DSDs do not constitute a third sex.
Their opening statement starts off with muddying the waters between sex and sexuality.  Sex is the physical body, sexuality is an entirely different matter - how people express their sexual identity and desires is "sexuality".  The fact that they start off talking about sex and sexuality is a clue to how little they have bothered to understand the matter.

They then fall into a sloppy bit of reasoning which tries to dismiss non-binary states as "extremely rare", therefore, human sex should be viewed as strictly male/female binary.  Whether or not someone's gender identity is a form of DSD is a matter of ongoing debate and research.  However, at this point in time, dismissing gender identity because DSD's are rare seems to be a non sequitur.
2. No one is born with a gender. Everyone is born with a biological sex. Gender (an awareness and sense of oneself as male or female) is a sociological and psychological concept; not an objective biological one. No one is born with an awareness of themselves as male or female; this awareness develops over time and, like all developmental processes, may be derailed by a child’s subjective perceptions, relationships, and adverse experiences from infancy forward. People who identify as “feeling like the opposite sex” or “somewhere in between” do not comprise a third sex. They remain biological men or biological women.
Wait a second here.  This entire statement is deeply flawed.  First of all, the human brain is not fully developed at birth.  It develops in stages during gestation, and then as we grow up and through early adulthood.  Perhaps most troubling for ACP's writers is a paper by D. F. Swaab written in 2007 which shows that the brain differentiates along masculine/feminine lines at a different gestational stage than does the body (which, mysteriously, starts off female only develops male attributes at a later stage of development).
3. A person’s belief that he or she is something they are not is, at best, a sign of confused thinking. When an otherwise healthy biological boy believes he is a girl, or an otherwise healthy biological girl believes she is a boy, an objective psychological problem exists that lies in the mind not the body, and it should be treated as such. These children suffer from gender dysphoria. Gender dysphoria (GD), formerly listed as Gender Identity Disorder (GID), is a recognized mental disorder in the most recent edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V). The psychodynamic and social learning theories of GD/GID have never been disproved.
First of all, as has been pointed out time and again.  Transsexuals are not confused.  They are intensely aware of their experience and what doesn't fit together.  They may suffer from a series of confusing and difficult messages in life, and it can take time and effort to sort those out.  That however is a comprehensible confusion.  One thing I have been impressed by is the consistency with which transsexuals are not confused about their gender status.

To argue that psychodynamic and social learning theories of Gender Dysphoria "have not been disproved" is a  red herring.  There are no psychodynamic characterizations of gender dysphoria that are being actively researched.  There is research into the application of psychodynamic techniques in treating transsexuals, but the aetiology of the condition is not generally considered to be explained by psychodynamic theory.  As for social learning theories, those are inherently incomplete.  Most transsexuals have perfectly typical upbringings within their birth genders.  Do they learn their gender roles by example?  Sure.  But gender role is not gender identity.
4. Puberty is not a disease and puberty-blocking hormones can be dangerous. Reversible or not, puberty- blocking hormones induce a state of disease – the absence of puberty – and inhibit growth and fertility in a previously biologically healthy child.5. According to the DSM-V, as many as 98% of gender confused boys and 88% of gender confused girls eventually accept their biological sex after naturally passing through puberty. 6. Children who use puberty blockers to impersonate the opposite sex will require cross-sex hormones in late adolescence. Cross-sex hormones are associated with dangerous health risks including but not limited to high blood pressure, blood clots, stroke and cancer.
This little group of statements is a classic case of exaggerating the truth, while not explaining the literature involved properly.  Puberty blocking drugs, like any other drug carry risks.  These are known and documented.  As for the risks associated with cross-sex hormones, those are the same risks that our bodies deal with naturally.  

They raise the issue about the number of transgender-identified youth who "desist" and cease to be transgender.  As Brynn Tannehill points out, those statistics do not differentiate between those who have persistent cross-gender identity and those who do not.  After reviewing the DSM 5 entry for Gender Dysphoria, they are also conveniently misrepresenting the statistics in that document.  The DSM 5 presents the following ranges for persistence beyond puberty across a range of studies:  males:  2.2% - 30%; females 12%-50%.  The WPATH Standards of Care documents provide an even more nuanced picture of these statistics.
7. Rates of suicide are twenty times greater among adults who use cross-sex hormones and undergo sex reassignment surgery, even in Sweden which is among the most LGBQT – affirming countries. What compassionate and reasonable person would condemn young children to this fate knowing that after puberty as many as 88% of girls and 98% of boys will eventually accept reality and achieve a state of mental and physical health?
Talk about "blaming the victim".  Suicide among the trans community is not a function of being trans.  It is a function of not being able to access needed treatment, and the consequences of discrimination and hostility from a society which doesn't understand or accommodate them.
8. Conditioning children into believing a lifetime of chemical and surgical impersonation of the opposite sex is normal and healthful is child abuse. Endorsing gender discordance as normal via public education and legal policies will confuse children and parents, leading more children to present to “gender clinics” where they will be given puberty-blocking drugs. This, in turn, virtually ensures that they will “choose” a lifetime of carcinogenic and otherwise toxic cross-sex hormones, and likely consider unnecessary surgical mutilation of their healthy body parts as young adults.
Based on a stack of unsubstantiated conjecture, they conclude that treating gender identity in children and youth is "child abuse".   I am going to point out that except for one reference to the DSM-5, not a single assertion in this position paper references actual substantiating research.  Instead, the entire document is largely framed in terms of the overt lies which have been used against transgender people for some time now.  The fact that the authors start off by confusing sex, sexuality and gender identity tells me that they have not even bothered to educate themselves meaningfully on the subject of transsexualism, much less on the very specialized work on transsexualism in children.

In contrast, I point you to the AAP policy statement on providing treatment to transgender youth.  Unlike the ACP statement, the AAP policy references some 50 sources of supporting evidence, and declares those references so that they can be reviewed by the reader if desired.  When the ACP issues a policy or position statement, they are making a political position statement.  The AAP is clearly making an evidence-based approach.  Who would you believe?


rww said...

Another reminder to never trust the citation of a source by how official and reputable the name appears to be.

MgS said...

By all means, be skeptical of what you read, no matter the source. That said, I'd trust a source that is willing to cite its sources fully and openly rather than one that posts its opinions without citing sources in a reasonable manner.