Science by consensus dominates the pediatric transgender debate

CONSENSUS IS NOT SCIENCE, whether we’re talking about climate or sexual identity. As often as not, it’s simply greed and stupidity grossly magnified. 

Caitlyn Jenner Transgender
Ce n’est pas une femme

Last week, I argued that transgender warriors can make their case only by denying basic science. To support my position, I cited to the American College of Pediatricians’ official statement on transgenderism. The statement relies upon such studies as are available on transgenderism (a disorder that has been the subject of far too few studies considering its prominence in today’s “news” media and social media), including the most recent comprehensive analysis of transgender hormonal and surgical treatment. I recommend reading the statement, which is written in plain English but, if you don’t want to, these are the main takeaways:

  • People’s sex is genetically determined;
  • Human sex is binary;
  • There are an extremely small number of genetic miscodings that do leave children stuck between the two numbers;
  • Modern transgenderism is a mental disorder;
  • The vast majority of children will align their mental sexual identity with their body by the time they pass through adolescence;
  • Transgender people suffer inordinately high rates of suicide and other depressive ills, Gender “reassignment” does not change this sad statistic; and
  • The humane and loving thing to do for people who identify as transgender is to address the underlying mental disorder, rather than encouraging dangerous hormone therapy and surgically-performed body mutilation.

After I published my post, I received an email from a physician castigating me for relying on a “hoax,” “fake” website. This resulted in an interesting email exchange. When I heard “hoax” and “fake,” my first thought was that I’d erred because there is no such organization as the American College of Pediatricians (“the ACP”) and that the facts at the webpage are false and rely on made-up studies. In other words, I thought the physician’s charge meant that the entire page was made up out of whole cloth.

Worried that I might have misinformed my readers, I hastily searched the internet for more information about the ACP. I heaved a sigh of relief when I learned that it is a real organization, made up of real pediatricians, with real medical degrees. A small group of physicians formed the ACP back in 2002 because they were disturbed by the fact that the American Academy of Pediatrics (“the AAP”), which is the oldest and largest pediatric society in America, had taken a leftward turn, and was abandoning science in favor of trendy Leftist pop culture:

The American College of Pediatricians is a national organization of pediatricians and other healthcare professionals dedicated to the health and well-being of children. It was founded by a group of concerned physicians who saw the need for a pediatric organization that would not be influenced by the politically driven pronouncements of the day. The College bases its policies and positions upon scientific truth within a framework of ethical absolutes. Of particular importance to the founders were (as it is today) the sanctity of human life from conception to natural death and the importance of the fundamental mother-father family (female-male) unit in the rearing of children. The first official meeting of the newly formed college was held in Boston in October 2002. Since its inception, it has grown to have membership representation across the U.S. and in several other countries. The College’s home office is in Gainesville, Florida.

The ACP’s goal is to bring science back to medicine, to value life, and to support traditional nuclear families in the belief that those families are the best things for a child’s well-being:

The American College of Pediatricians:

  1. Recognizes that there are absolutes and scientific truths that transcend relative social considerations of the day.
  2. Recognizes that good medical science cannot exist in a moral vacuum and pledges to promote such science.
  3. Recognizes the fundamental mother-father family unit, within the context of marriage, to be the optimal setting for the development and nurturing of children and pledges to promote this unit.
  4. Recognizes the unique value of every human life from the time of conception to natural death and pledges to promote research and clinical practice that provides for the healthiest outcome of the child from conception to adulthood.
  5. Recognizes the essential role parents play in encouraging and correcting the child and pledges to protect and promote this role.
  6. Recognizes the physical and emotional benefits of sexual abstinence until marriage and pledges to promote this behavior as the ideal for adolescence.
  7. Recognizes that health professionals caring for children must maintain high ethical and scientific standards and pledges to promote such practice.
  8. Recognizes the vital role the College has in promoting quality education for parents, physicians, and other health professionals.

My research satisfied me that the ACP is neither a hoax nor is it fake. I certainly understand the idea of a splinter group breaking away from a mainstream professional organization. Back in my day, most law school graduates ended up in the American Bar Association (“the ABA”) because either their new firm paid or they got it as a gift . . . I can’t remember.

Belong to the ABA was something to put on the resume, although the absence of any requirement for membership other than a check and a license to practice law meant that membership proved nothing about the practitioner’s abilities. One could go to speaker lunches, get discount admissions to continuing legal education, and join practice groups that presumably mailed out relevant material and held local meetings with useful specialty information.

Most attorneys send in a check every year without thinking about it. However, while members weren’t paying attention, Leftists took over at the management level. Suddenly, the ABA was advocating hard Left policies unrelated to core legal practice. Even before 9/11, when I finally realized I really was a conservative, I had grown disgusted with the ABA’s official positions so I let my membership lapse.

You can think of other organizations that have done the same. Teacher’s unions, being unions, always had a slightly leftward tilt, but when my dad started teaching in the late 1960s the union’s focus was on wages and benefits. Less than a decade later, the union was its way into larger public policy matters. I remember when the California Teacher’s Union tried to create a bilingual education program that would place black students into “ebonics-only” classrooms. My Jewish father was called a Nazi when he pointed out that this was the surest way to keep black young people from ever entering the American economic mainstream. The teachers unions have only gotten worse in the ensuing 40 years.

John O’Sullivan summed up the phenomenon perfectly:  “Any organization not explicitly right-wing sooner or later becomes left-wing.”

The AAP, like the ABA and the teacher’s unions, is just another example of O’Sullivan’s rule. Newly minted pediatricians join it to have AAP magazines can impressively litter their waiting rooms, to network, and to have access to a clearinghouse that winnows out studies and theories unrelated to a pediatric practice, making it easier for an individual physician to stay current in modern trends. Joining it is less a conscious decision than a default option, which explains the AAP’s vast membership. A pediatrician is not a better practitioner just because he has an AAP membership nor is the AAP a more reputable organization just because it has so many members.

And boy, is the AAP a Left wing organization. On the Second Amendment, it argues that guns are a medical issue. On immigration, the AAP opposed Donald Trump’s executive order because it’s harmful” to children. The AAP is quiet about the children whom illegal aliens molest* or the ones who are orphans thanks to illegal aliens who drive drunk or commit murder.

The AAP also says that teen girls should be able to get abortions, even without parental permission. Apparently the AAP’s concern for children does not extend to those that are currently in development, so to speak. So I’m not kidding when I say that AAP management is hard Left.

Armed with this data, I responded to the physician, telling him that, while the ACP was definitely smaller and way more conservative than the AAP, it is a real organization and it’s statement is not a hoax because it relies on real data.  I thought that this would be the end of it.

The physician was not done with me, though. His next challenge was that the studies linked in the ACP were out-of-date and therefore unreliable.

Okay. Fair enough. If the studies the ACP cites have been superseded by larger, more reputable studies, bring it on. I asked the physician to send me links to more recent studies and, especially, to the data upon which the AAP relies for its stance that physicians must do everything in their power, including early hormone intervention and surgery, to support a “transgender” child’s assertions regarding sexual identity.  That’s where things got surreal.

In response to my request, the physician told me that he was not going to do my research for me. If I thought I was an expert, I could figure it all out myself. And that’s where our correspondence ended. To me, his abrupt refusal to engage — especially given that his professional expertise made it more likely that he could find relevant information — looked more like an undignified retreat than a principled withdrawal. However, because he had thrown down the gauntlet, I decided to do what research I could.

I started with the AAP’s section on LGBT children. That section (which rejoices under the ungainly acronym “SOLGBTHW”) “is a group of pediatricians and other health care providers interested in LGBT health and wellness.” Since the page purports to have information for both parents and practitioners, I figured that all of the recent research — you know, the research rebutting the facts asserted in the ACP statement –would be located here.

My first stop was the “Resources for Professionals” page where I found two links to AAP statements about LGBT children. The first, a “policy” statement, accurately identifies the fact that LGBT kids are terribly at risk of mental health problems, depression, suicide, substance abuse, and STDs. According to the AAP, the fault for these problems is entirely separate from the children’s own psychology. Instead, these problems arise from the “effects of homophobia and heterosexism.”

I accept the first — homophobia — as something that can indeed damage a child’s mental well-being. Bullying is not nice, and I say that as a child who was fairly relentlessly bullied because I was small, ugly, bat-blind, and a bookworm. I leave it to you, my dear readers, to determine how badly that damaged my mental health. As an aside, the article does not compare the rates of bullying visited upon LGBT kids to the rates of bullying visited upon kids who do not identify as LGBT, although I wasn’t looking hard for that data and may have missed it.

However, I take umbrage at the accusation that “heterosexism” is a problem. That is, the AAP is contending that the mere fact that LGBT children, who are an insignificant minority in the larger population, are forced to live among openly heterosexual people means that they are automatically becoming so damaged that they cannot resist all of the pathologies that plague the LGBT community.

Most of the AAP’s Policy Statement focuses on LGBT kids as a solid, undifferentiated mass. What it says specifically regarding transgenderism boils down to a few indisputable facts: Transgender children are bullied more than even the LGB kids with whom they’re bundled. They also have more mental health issues, suicide, substance abuse, homelessness, prostitution, STDs, hepatitis (from needle sharing), etc. The policy statement assumes that the first fact (bullying) causes the second (self-harming behaviors), although it does not address the distinction between correlation and causation. The only clear thing that emerges (and with which I cannot disagree) is that a loving family helps offset the disaster that can be a transgender child’s life.

When it comes to treatments specifically aimed at transgender youth, the Policy paper refers us to its technical report:

See the technical report for additional details on the medical and surgical transition of transgender youth. Supportive counseling is paramount to assist the teenager with any dysphoria and to explore gender roles before altering the body. The therapy consists of potentially delaying puberty with gonadotropin-releasing hormone analogs, then use of hormonal therapy, and finally surgery. [fn. 5]

A quick look at the technical report showed that it’s concerned with the mechanics of hormonal and surgical treatment. The more interesting stuff is found in “fn. 5.” That footnote sends the reader to the World Professional Association for Transgender Health’s Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, a 2011 publication out of Minneapolis. Keep that 2011 date in mind, because it’s an important one.

When I followed the link for the Standards of Care source upon which the AAP relies, I found myself, not at a a scientific or medical site, but at an advocacy site. This advocacy site wrote and hosts the standards of care paper (“the SOC paper”) on which the AAP relies to justify its claim that children should not only be supported in attaching to their non-biological sexual identity, but should also be given both hormones to delay adolescence and hormones associated with the opposite sex (all of which have sterility and cancer risks) and, eventually, surgery.

The SOC paper is a 120-page booklet. I did not study it closely. Instead, I was looking for recent or comprehensive scientific data that supersedes the ACP’s position paper justifying hormonal and surgical treatment. It’s seems worthwhile to point out here that hormonal and surgical treatments are covered under most insurance plans — indeed, I think they’re covered under all Obamacare insurance plans, and are quite profitable to the care provider.

Here are some of the relevant pronouncements from the booklet:

Gender nonconformity refers to the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex (Institute of Medicine, 2011). Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) (Fisk, 1974; Knudson, De Cuypere, & Bockting, 2010b). Only some gender nonconforming people experience gender dysphoria at some point in their lives.

In other words, if you are troubled by the fact that there is a dramatic schism between your mind and body, you’re mentally ill. However, if you affirmatively embrace this schism, then you’re mentally healthy. Welcome to 21st century scientific analysis.

The SOC paper does acknowledge that those who realize they have a problem can get treatment. Even better, that treatment can assure them that their genetic body is lying and it’s their perceptions that are real:

Gender dysphoria can in large part be alleviated through treatment (Murad et al., 2010). Hence, while transsexual, transgender, and gender nonconforming people may experience gender dysphoria at some point in their lives, many individuals who receive treatment will find a gender role and expression that is comfortable for them, even if these differ from those associated with their sex assigned at birth, or from prevailing gender norms and expectations.

Having established that if you know you have a problem you’re crazy, and if you don’t believe you have a problem you’re normal, the SOC paper presents its entirely non-medical, non-scientific, purely definitional conclusion:

Thus, transsexual, transgender, and gender nonconforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available. The existence of a diagnosis for such dysphoria often facilitates access to health care and can guide further research into effective treatments

Despite our current obsession with transgender people (an obsession that didn’t exist just a couple of years ago), the paper acknowledges that, given the fluid definition of transgender (pun intended), as well as the fact that different cultures have different tolerances for people who think they have a problem as well as those who embrace their mind-body schism, no one really knows how many people are “transgender.”

As I headed into the section of the paper dealing with therapeutic approaches, I had to keep in mind the peculiar definitions governing it. The paper accepts as real, without any scientific proof, that people can be a different sex from their genetic programming and biological reality. That is, it believes that people with normal XX and XY genes and conforming bodies (as opposed to the minute subset with genuine genetic defects) really do have a physical something or other, rather than a cognitive disorder.

Based upon this scientifically, chemically, genetically, biologically unsupported view, the SOC paper regarding treatment again divides people into those same two groups discussed above: those who are troubled by their mind-body schism; and those who are not. Those who are troubled can be gently encouraged to embrace the madness. Those who are not troubled are already set for Phase II, which is hormonal and surgical intervention.

The advocacy paper cites approvingly an endless cascade of pre-2011 studies that all say surgery and hormones are great. This pre-2011 cut-off in a paper published in 2011 (and one, moreover, that could easily have been revised as new information became available) is significant.

By limiting itself to material from 2010 or before, the SOC paper has successfully ignored a 2011 Swedish study that relies upon long-term data to show that surgery and hormones don’t help:

A 2011 study at the Karolinska Institute in Sweden produced the most illuminating results yet regarding the transgendered, evidence that should give advocates pause. The long-term study—up to 30 years—followed 324 people who had sex-reassignment surgery. The study revealed that beginning about 10 years after having the surgery, the transgendered began to experience increasing mental difficulties. Most shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. This disturbing result has as yet no explanation but probably reflects the growing sense of isolation reported by the aging transgendered after surgery. The high suicide rate certainly challenges the surgery prescription.

To my lawyer’s mind, the SOC paper’s oversight is the same as citing the infamous Dred Scott case, in which the Supreme Court decisively held that slavery was constitutional, and ignoring entirely the subsequent 13th and 14th amendments to the Constitution. If you’re advocating a position, you can’t just pretend that later, contradictory authority does not exist.

Having established to its satisfaction, but not to mine, that there’s a real “thing” here, despite any proof that without clear genetic defects brain and body can separate this way, and having ignored data showing that hormone and surgery treatments do not make transgender people either less miserable or at risk, the SOC paper just glides into a detailed discussion about the kinds of therapy available. These therapies encompass everything from hormones that slow puberty (and that can cause cancer), to hormones to force a display of opposite sex physical characteristics (that can cause cancer and sterility). Once the hormones have done their work, that poor child is ready for mutilating surgery that includes things such as slicing off healthy breasts or completely removing an equally health penis and testes. (The AAP’s technical paper also discusses types of treatment, rather than whether hormonal and surgical intervention is appropriate.)

One more thing: in neither the AAP materials nor the SOC paper mentions one of the most interesting facts in the ACP’s statement:

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.

Maybe I’m being naive, but I find it staggering that the AAP, which is America’s largest pediatric organization, when presented with a child denying its sex identity and a worried parent, chooses not to counsel the parent to treat the child as an individual, with love and respect, and not to get hung up on questions of which sex the child is. After all, anyone who has been a child or has had children knows that children tend to make issues of things when parents make issues of things. The pediatrician and the parent can say the same to the school: treat my child as a person, not a sexual identity.

Then, wait and see. Assuming that the above-quoted statistics about children reconciling their bodies and their “gender identity” are valid, loving patience is the surest way for the physician and parent first to do no harm. Instead, greedy, misguided physicians, in thrall to a 97% majority (or whatever) view of science, are destroying young people’s hormones and slicing and dicing their bodies.

In pursuit of social justice, the destruction of Western sexual norms, and (I have no doubt) profit, Western physicians, especially pediatricians, have abandoned the Hippocratic Oath’s mandate that their first obligation is to do no harm. No wonder the Swedish study showed the poor victims of Western medicine offing themselves in numbers just as great after medical intervention as they did before. The first thing Western medicine is doing is harm!

All of which gets me to the original premise of this post which is that crowd consensus dominates medicine as surely as it does the so-called science behind the anthropomorphic climate change scam. The doctor with whom I corresponded accused me of falling for a hoax because I looked to a small organization for scientific data that was based upon traditional scientific principles (theory, data collection, analysis, etc.). According to him, the only reputable source for information about treating allegedly “transgender” kids is the AAP. Why? Because the AAP is big and it’s old and it’s well-known.

But you know what I found? To justify its recommended approach to treating body dysphoria in young people, the AAP is relying on a position paper from a transgender advocacy group rather than well-sourced data from a medical institution. Moreover, that position paper assiduously ignores a recent study from a country that is more open to transgender identity than any other country in the world, that pioneered transgender treatment, and that has a vast and deep collection of data on which to draw — and that concluded that hormone and surgical treatments do not address the underlying despair that drives to suicide those who identify as transgender. It also ignores the possibility that the vast majority of children who play around with the notion of being the opposite sex during a fluid time of life eventually return to their genetic sex identity.

No wonder the physician who wrote to me didn’t want to give me links. Even as he was defending the AAP’s position, he must have known that it was a consensus, not a scientific, view. CONSENSUS IS NOT SCIENCE, whether we’re talking about climate or sexual identity. As often as not, it’s simply greed and stupidity grossly magnified.


*I have an unseemly passion for The Daily Mail, which is a pleasant mix of semi-conservative news, stories that reach the other media days later, gossip, and bizarre and/or titillating headlines. Over the years, I had noticed in passing that, whenever The Daily Mail ran a story that didn’t involve vast pedophilia rings, but instead involved a single person have sex with a teenager or child (or, horribly, even infants), those individuals fell into one of two categories: (1) Teachers (often women) have sex with junior high or high school students and (2) illegal immigrant men having pedophile sex with small children.

I assumed that my en passant observation arose from the fact that The Daily Mail had concluded that these two types of stories generate the most traffic. Ann Coulter’s column, however, indicates that there really may be an assiduously ignored connection between illegal immigration and opportunistic pedophile child molestation.