www.washingtonpost.com
Open in
urlscan Pro
104.110.15.84
Public Scan
URL:
https://www.washingtonpost.com/opinions/2024/03/08/transgender-medicine-report-evidence/?utm_campaign=wp_post_most&utm_medium=e...
Submission: On March 09 via api from BE — Scanned from DE
Submission: On March 09 via api from BE — Scanned from DE
Form analysis 1 forms found in the DOM
<form class="w-100 left" id="registration-form" data-qa="regwall-registration-form-container">
<div>
<div class="wpds-c-QqrcX wpds-c-QqrcX-iPJLV-css">
<div class="wpds-c-iQOSPq"><span role="label" id="radix-0" class="wpds-c-hdyOns wpds-c-iJWmNK">Enter email address</span><input id="registration-email-id" type="text" aria-invalid="false" name="registration-email"
data-qa="regwall-registration-form-email-input" data-private="true" class="wpds-c-djFMBQ wpds-c-djFMBQ-iPJLV-css" value="" aria-labelledby="radix-0"></div>
</div>
</div>
<div class="dn">
<div class="db mt-xs mb-xs "><span role="label" id="radix-1" class="wpds-c-hdyOns"><span class="db font-xxxs gray-darker pt-xxs pb-xxs gray-dark" style="padding-top: 1px;"><span>By selecting "Start reading," you agree to The Washington Post's
<a target="_blank" style="color:inherit;" class="underline" href="https://www.washingtonpost.com/information/2022/01/01/terms-of-service/">Terms of Service</a> and
<a target="_blank" style="color:inherit;" class="underline" href="https://www.washingtonpost.com/privacy-policy/">Privacy Policy</a>.</span></span></span>
<div class="db gray-dark relative flex pt-xxs pb-xxs items-start gray-darker"><span role="label" id="radix-2" class="wpds-c-hdyOns wpds-c-jDXwHV"><button type="button" role="checkbox" aria-checked="false" data-state="unchecked" value="on"
id="mcCheckbox" data-testid="mcCheckbox" class="wpds-c-cqTwYl wpds-c-cqTwYl-bnVAXI-size-125 wpds-c-cqTwYl-kFjMjo-cv wpds-c-cqTwYl-ikKWKCv-css" aria-labelledby="radix-2"></button><input type="checkbox" aria-hidden="true" tabindex="-1"
value="on" style="transform: translateX(-100%); position: absolute; pointer-events: none; opacity: 0; margin: 0px; width: 0px; height: 0px;"><span class="wpds-c-bFeFXz"><span class="relative db gray-darker" style="padding-top: 2px;"><span
class="relative db font-xxxs" style="padding-top: 1px;"><span>The Washington Post may use my email address to provide me occasional special offers via email and through other platforms. I can opt out at any
time.</span></span></span></span></span></div>
</div>
</div>
<div id="subs-turnstile-hook" class="center dn"></div><button data-qa="regwall-registration-form-cta-button" type="submit"
class="wpds-c-kSOqLF wpds-c-kSOqLF-hDKJFr-variant-cta wpds-c-kSOqLF-eHdizY-density-default wpds-c-kSOqLF-ejCoEP-icon-left wpds-c-kSOqLF-ikFyhzm-css w-100 mt-sm"><span>Start reading</span></button>
</form>Text Content
Accessibility statementSkip to main content Democracy Dies in Darkness SubscribeSign in Advertisement Close The Washington PostDemocracy Dies in Darkness OpinionsColumns Editorials Guest opinions Cartoons Submit a guest opinion Today's Opinions newsletter OpinionsColumns Editorials Guest opinions Cartoons Submit a guest opinion Today's Opinions newsletter OPINION WHEN TREATING TRANSGENDER YOUTH, HOW INFORMED IS INFORMED CONSENT? By Megan McArdle Columnist| Follow author Follow March 8, 2024 at 7:45 a.m. EST Prescription hormone therapy drugs. (Whitney Curtis for The Washington Post) Listen 6 min Share Comment on this storyComment1539 Add to your saved stories Save In the debate over transgender medicine for youths, two radically opposing views take up most of the airtime. People who support the currently dominant gender-affirming model of care for children see kind practitioners trying to do their best for vulnerable patients who often have severe mental health issues due to living in a transphobic society. WpGet the full experience.Choose your planArrowRight Those who oppose this model see overconfident practitioners experimenting on these same vulnerable patients, many of whom might not be capable of giving truly informed consent for treatments such as puberty blockers, cross-sex hormones and surgeries, which can have lifelong consequences. Both views will find vindication in a new report from the think tank Environmental Progress, which contains a leaked cache of internal discussions from within WPATH, the World Professional Association for Transgender Health, a group that brings together clinicians from various specialties involved in treating gender-dysphoric patients. These discussions reveal both caring people trying hard to do things right and a medical culture that appears to be operating without adequate guardrails against things going wrong. Advertisement Story continues below advertisement One exchange is at once the most reassuring and the most worrying for those who are trying to sort out the competing narratives: In a workshop discussing transition and the challenge of obtaining minors’ informed consent for gender-affirming procedures, participants come across as deeply thoughtful folks doing their best to grapple with complexities. But some also seem to acknowledge that their patients cannot actually give fully informed consent. Many haven’t completed puberty — or high school biology. And even the brightest 16-year-old cannot yet understand the full implications of treatments that can mean, in some cases, a lifetime of infertility and medical maintenance. Follow this authorMegan McArdle's opinions Follow This is not a novel problem in medicine. As therapist Dianne Berg points out in that discussion, if children have diabetes, they are given insulin even if they haven’t learned how the pancreas works. If they have depression, they might be given drugs that could increase their risk of suicide or permanently alter their developing brains to help them toward happier futures. And if a kid has a pediatric cancer, doctors don’t wait for her to be old enough to give fully informed consent to amputation or infertility — because without treatment, she might never reach that age. Youth gender medicine is increasingly treating puberty as though it were a life-threatening condition like cancer or diabetes, and natal sex organs as though they were potentially dangerous growths. This is, of course, entirely appropriate if they are threatening, and letting nature take its course will end in suicide or a lifetime of emotional agony. Of course, with that kind of diagnosis you want to be very sure — and unlike doctors treating cancer or diabetes, who can rely on blood tests and imaging, gender-medicine doctors ultimately have only the patient’s feelings to go by. Advertisement Story continues below advertisement In the popular discourse, and apparently at some gender clinics, it’s often taken for granted that that’s enough — that we know transgender medical interventions are saving lives, because trans people are at higher risk for suicide. And for adults, who are entitled to decide what to do with their bodies, it is. Yet for children, it’s more complicated, because this risk, while real, does not approach the magnitude of cancer or diabetes, and might persist even after treatment. In a large-scale Dutch study, trans patients were found to have almost four times the suicide risk of the general population. The researchers saw 49 suicides among more than 8,000 patients, many of which occurred during or after transition. A nationwide study of suicide rates among trans people in Denmark similarly found 12 suicides in a population of 3,759. It would be ideal if doctors could drive that rate to zero — perhaps by identifying future trans adults, blocking their puberty and eventually treating them with hormones and possibly surgery so that their adult appearance would more closely resemble their gender identity. Unfortunately, though, we don’t yet know to what extent these treatments actually improve mental health or prevent suicide. The data on their long-term efficacy is more limited than it should be, even for adults. The evidence regarding youth interventions is even less clear. Several European health authorities have reviewed the available studies and rated the evidence for using puberty blockers and cross-sex hormones in dysphoric youth as “very low certainty,” “deficient” and “limited by methodological weaknesses.” A recent systematic evidence review by German researchers concludes that the current body of evidence is “based on very few studies with small samples and problematic methodology and quality. Adequate and meaningful long-term studies are equally lacking.” Advertisement Story continues below advertisement In other words, though WPATH says these interventions are “not experimental,” youth gender medicine is still, well, effectively experimental. Now, this is true, as well, of many pediatric oncology treatments, because when a child’s life is in danger, doctors pull out all the stops. About 60 percent of juvenile cancer patients are enrolled in a clinical trial, according to CureSearch, a funder of children’s cancer research. But gender medicine does not yet approach the same level of rigor as an FDA-supervised clinical trial. This puts clinicians in a difficult position, and this is what we see in the WPATH files: well-intentioned doctors and therapists groping through the considerable gaps in current medical knowledge. Yet one can also see this work being made more difficult because, as an editorial in the journal Acta Paediatrica recently put it: “The discourse surrounding the use of puberty blockers in gender dysphoria is often framed as a political human rights issue rather than as a medical issue.” In a discussion of detransitioning, one writer calls the whole idea “problematic” because “it frames being cisgender as the default, and reinforces transness as a pathology.” (As though it were inherently bigoted for someone to prefer, where possible, the option that doesn’t require drugs or surgery.) Others rather blithely suggest we should reframe detransition as “learning” or part of a “gender journey” rather than a “mistake.” Advertisement Story continues below advertisement Many other conversations in the WPATH files, of course, portray sensitive, intelligent caregivers doing their best — beset by many uncertainties, yet ultimately in little doubt that they’re doing the right thing for most of their patients. I’m glad such people are trying to help some of our vulnerable people alleviate terrible distress. But I also came away wishing they seemed willing to entertain a few more doubts. Share 1539 Comments Popular opinions articles HAND CURATED * Opinion|Biden is failing at the most important task of his presidency March 7, 2024 Opinion|Biden is failing at the most important task of his presidency March 7, 2024 * Opinion|Donald Trump, the luckiest politician who ever lived March 5, 2024 Opinion|Donald Trump, the luckiest politician who ever lived March 5, 2024 * Opinion|What’s behind the Supreme Court’s furious agreement on Trump in Colorado March 4, 2024 Opinion|What’s behind the Supreme Court’s furious agreement on Trump in Colorado March 4, 2024 View 3 more stories Loading... Subscribe to comment and get the full experience. Choose your plan → Advertisement Advertisement TOP STORIES World news Essential reporting from around the world Canada and Sweden resume UNRWA aid funding Philippines strikes security deals as tensions rise with China at sea The Taliban once smashed TVs. Now it fosters YouTubers to promote its image. Refresh Try a different topic Sign in or create a free account to save your preferences Advertisement Advertisement Company About The Post Newsroom Policies & Standards Diversity & Inclusion Careers Media & Community Relations WP Creative Group Accessibility Statement Sitemap Get The Post Become a Subscriber Gift Subscriptions Mobile & Apps Newsletters & Alerts Washington Post Live Reprints & Permissions Post Store Books & E-Books Print Archives (Subscribers Only) Today’s Paper Public Notices Coupons Contact Us Contact the Newsroom Contact Customer Care Contact the Opinions Team Advertise Licensing & Syndication Request a Correction Send a News Tip Report a Vulnerability Terms of Use Digital Products Terms of Sale Print Products Terms of Sale Terms of Service Privacy Policy Cookie Settings Submissions & Discussion Policy RSS Terms of Service Ad Choices washingtonpost.com © 1996-2024 The Washington Post * washingtonpost.com * © 1996-2024 The Washington Post * About The Post * Contact the Newsroom * Contact Customer Care * Request a Correction * Send a News Tip * Report a Vulnerability * Download the Washington Post App * Policies & Standards * Terms of Service * Privacy Policy * Cookie Settings * Print Products Terms of Sale * Digital Products Terms of Sale * Submissions & Discussion Policy * RSS Terms of Service * Ad Choices * Coupons 5.12.2 Already have an account? Sign in -------------------------------------------------------------------------------- TWO WAYS TO READ THIS ARTICLE: Create an account or sign in Free * Access this article Enter email address By selecting "Start reading," you agree to The Washington Post's Terms of Service and Privacy Policy. The Washington Post may use my email address to provide me occasional special offers via email and through other platforms. I can opt out at any time. Start reading Subscribe €2every 4 weeks * Unlimited access to all articles * Save stories to read later Subscribe WE CARE ABOUT YOUR PRIVACY We and our 45 partners store and/or access information on a device, such as unique IDs in cookies to process personal data. You may accept or manage your choices by clicking below, including your right to object where legitimate interest is used, or at any time in the privacy policy page. These choices will be signaled to our partners and will not affect browsing data. If you click “I accept,” in addition to processing data using cookies and similar technologies for the purposes to the right, you also agree we may process the profile information you provide and your interactions with our surveys and other interactive content for personalized advertising. If you do not accept, we will process cookies and associated data for strictly necessary purposes and process non-cookie data as set forth in our Privacy Policy (consistent with law and, if applicable, other choices you have made). WE AND OUR PARTNERS PROCESS COOKIE DATA TO PROVIDE: Actively scan device characteristics for identification. Create profiles for personalised advertising. Use profiles to select personalised advertising. Create profiles to personalise content. Use profiles to select personalised content. Measure advertising performance. Measure content performance. Understand audiences through statistics or combinations of data from different sources. Develop and improve services. Store and/or access information on a device. Use limited data to select content. Use limited data to select advertising. List of Partners (vendors) I Accept Reject All Show Purposes