Transgender care — shall we follow the science?

Started by JEdwards, April 10, 2024, 07:20:37 PM

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John Mundinger

Quote from: Dan Fienen on April 11, 2024, 10:06:17 AMI fault both the anti-trans resistance and the pro-trans activists for making this more of a culture war front than a caring for troubled teens.

Generally, I agree with that observation, Pr. Fienen.  However, I think "troubled teens" is not the most constructive way to talk about youth who self identify as transgender.
Lifelong Evangelical Lutheran layman

Whoever, then, thinks that he understands the Holy Scriptures, or any part of them, but puts such an interpretation upon them as does not tend to build up this twofold love of God and our neighbour, does not yet understand them as he ought.  St. Augustine

Dan Fienen

Quote from: John Mundinger on April 11, 2024, 06:57:10 AM
Quote from: Donald_Kirchner on April 10, 2024, 08:12:32 PM
Quote from: JoshuaMc on April 10, 2024, 07:55:24 PMSecond, what a shame that we don't have a centralised, socialised health service in this country that can do things like commission this sort of inquiry in order to guide care for everyone in a responsible way.

I think you've missed the point. Or, are you setting up John Mundinger for another legalistic/judgmental rant?

Actually, I think he is correct on both points.
There is a lot that we do not know about the transgender issue.  Two things that we do know:
1) there is need for more information - information collected systematically and analyzed objectively.
2) there is a need for greater empathy.  Before jumping to legalistic/judgmental rants against transgendered individuals and those who provide for their care, individual who are so inclined should try to understand the issue from the perspective of those who identify as transgender.

We may not have a centralized health system like the British National Health Service, but we do have the NIH and CDC who are supposed to be researching national health issues. This study and subsequent report is just the sort of thing that I think the NIH or CDC should be undertaking. But, as Covid showed us, our NIH and CDC are not immune to political pressure and maneuvering.

I agree John, there is a need for greater empathy all around. Those individual presenting with gender dysphoria are troubled and should be helped carefully and with compassion. But empathy does not always mean jumping to a popular conclusion. Gender dysphoria should not be legalistically dismissed as illusionary. But neither should it be jumped on as necessarily the whole problem.

People who care for those so troubled, especially their parents, should also be granted empathy and sympathetically be educated and worked with so that they can make informed decisions for their children for whom they have responsibility and be a part of the child's support system rather than being systematically excluded and treated as the presumed enemy. Parents also need time to come to terms. There are bad parents, just as there are bad therapists and bad counselors. There may, at times be a need to exclude parents who end up not having their children's best interests in mind. But that should be a regretful last resort rather than a gleeful presumption.
Pr. Daniel Fienen
LCMS

John Mundinger

I think the following study is relevant to the conversation:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/

Conclusions:  Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.

And, interestingly, the following study suggests that far fewer transgender males regret breast removal surgery when performed as a gender-affirming procedure, than do cis-gender females regret breast removal surgery as a cancer preventative procedure. 

https://jamanetwork.com/journals/jamasurgery/article-abstract/2813212

Lifelong Evangelical Lutheran layman

Whoever, then, thinks that he understands the Holy Scriptures, or any part of them, but puts such an interpretation upon them as does not tend to build up this twofold love of God and our neighbour, does not yet understand them as he ought.  St. Augustine

John Mundinger

Quote from: Dan Fienen on April 11, 2024, 10:19:46 AMWe may not have a centralized health system like the British National Health Service, but we do have the NIH and CDC who are supposed to be researching national health issues. This study and subsequent report is just the sort of thing that I think the NIH or CDC should be undertaking. But, as Covid showed us, our NIH and CDC are not immune to political pressure and maneuvering.

NIH and CDC are, indeed, subject to political pressure.  There is abundant evidence to suggest that political pressure may affect the work that those agencies are allowed to perform and, especially, how their work is received.  But, I have seen little evidence to suggest that it biases the work that they actually do.

Quote from: Dan Fienen on April 11, 2024, 10:19:46 AMI agree John, there is a need for greater empathy all around. Those individual presenting with gender dysphoria are troubled and should be helped carefully and with compassion. But empathy does not always mean jumping to a popular conclusion. Gender dysphoria should not be legalistically dismissed as illusionary. But neither should it be jumped on as necessarily the whole problem.

You are using the term "gender dysphoria" incorrectly.  Self-identifying as transgender is not gender dysphoria.  Gender dysphoria is specific to the psychological stress that persons who self-identify as transgender experience.  And, given the way that society has politicized the issue, the cause of much of that stress is understandable.  I think empathy includes being cognizant of both the distinction and some of the causes of the stress.  That said, I agree that care for people who self-identify should be deliberative.  And that would be consistent with the recommendations in the report that began this conversation.

Quote from: Dan Fienen on April 11, 2024, 10:19:46 AMPeople who care for those so troubled, especially their parents, should also be granted empathy and sympathetically be educated and worked with so that they can make informed decisions for their children for whom they have responsibility and be a part of the child's support system rather than being systematically excluded and treated as the presumed enemy. Parents also need time to come to terms. There are bad parents, just as there are bad therapists and bad counselors. There may, at times be a need to exclude parents who end up not having their children's best interests in mind. But that should be a regretful last resort rather than a gleeful presumption.

I agree.

We have had an interesting recently involving the custody of a transgender teenager.  There is a lot to this story which, for confidentially reasons, we are not entitled to know.  But, what we do know is pretty disturbing.

https://montanafreepress.org/2024/02/21/montana-judge-dismisses-high-profile-child-protection-case-and-contempt-hearing-for-glasgow-couple/

Lifelong Evangelical Lutheran layman

Whoever, then, thinks that he understands the Holy Scriptures, or any part of them, but puts such an interpretation upon them as does not tend to build up this twofold love of God and our neighbour, does not yet understand them as he ought.  St. Augustine

JEdwards

#19
Quote from: John Mundinger on April 11, 2024, 10:24:28 AMAnd, interestingly, the following study suggests that far fewer transgender males regret breast removal surgery when performed as a gender-affirming procedure, than do cis-gender females regret breast removal surgery as a cancer preventative procedure. 

https://jamanetwork.com/journals/jamasurgery/article-abstract/2813212
This is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.  While studies of this type may have a role in the debate, a lot of questions come to mind.  How comparable were all of the underlying studies in terms of follow-up time?  Gender affirming surgery is relatively new.  Does regret tend to develop after one year, five, twenty?  Also, when interpreting a meta-analysis, one of the first items on the checklist is to look at the heterogeneity of the underlying studies.  As seen in the figure from the meta-analysis of studies of regret after gender affirming mastectomies (linked below), heterogeneity was very high.  In this scenario, standard techniques for pooling data from disparate studies may give an unwarranted sense of precision to the findings. 

https://pubmed.ncbi.nlm.nih.gov/33968550/#&gid=article-figures&pid=fig-2-uid-1

Peace,
Jon

Dan Fienen

Even if the percentage of patients who later regret having gender reassignment surgery is low, it does happen. And for those patients who do regret, does their feelings, their experiences count for nothing. The system that diagnosed their condition and prescribed that treatment failed them. Is it not worth investigating those failures and improving the process to reduce those failures? There has also be instances reported of teens who identified as transgender and received abundant support from the trans community who later decided that they were not trans after all and were treated as traitors and outcasts. Would that not be a failure to care for the individual as much as for the cause of transgenderism on the part of that community?

I would not advocate abolishing gender affirming care and treatment. But it does seem to me that there is a need for better diagnostic and treatment guidelines, especially when it comes to permanent, life altering therapies, and more openness to caring for parents who are dealing with shocks and adjustments, and working with them so that they can be informed part of the child's support system rather than treating them from the beginning as enemies. It will probably be likely that they will have a steep learning curve and difficult adjustments and even need some therapy of their own but could we start with the assumption that they really do love their children and want the best for them, even if it takes time and education to convince them what that best is? As it is, it seems that the assumption from the beginning of any process is that the school counselor absolutely knows what is best for the child and cares for the child's well-being much better than the parents who are to be excluded from the process for as long as possible. Is the intent to take these children away from their parents as much as possible?
Pr. Daniel Fienen
LCMS

John Mundinger

Quote from: JEdwards on April 11, 2024, 10:50:15 AMThis is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.

I can't access anything except the abstract because I do not have a subscription to that journal.  But, note it is a study and not just an opinion piece.  It is not original research.  It is a review of several other pieces of original research.

One point on which I think both of us can agree.  There is a lot we do not know about the transgender issue.  There is need for more objective information on the subject.
Lifelong Evangelical Lutheran layman

Whoever, then, thinks that he understands the Holy Scriptures, or any part of them, but puts such an interpretation upon them as does not tend to build up this twofold love of God and our neighbour, does not yet understand them as he ought.  St. Augustine

JEdwards

Quote from: John Mundinger on April 11, 2024, 11:12:58 AM
Quote from: JEdwards on April 11, 2024, 10:50:15 AMThis is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.

I can't access anything except the abstract because I do not have a subscription to that journal.  But, note it is a study and not just an opinion piece.  It is not original research.  It is a review of several other pieces of original research.

One point on which I think both of us can agree.  There is a lot we do not know about the transgender issue.  There is need for more objective information on the subject.
Quote from: JEdwards on April 11, 2024, 10:50:15 AM
Quote from: John Mundinger on April 11, 2024, 10:24:28 AMAnd, interestingly, the following study suggests that far fewer transgender males regret breast removal surgery when performed as a gender-affirming procedure, than do cis-gender females regret breast removal surgery as a cancer preventative procedure. 

https://jamanetwork.com/journals/jamasurgery/article-abstract/2813212
This is not a study; it is specifically labeled "viewpoint".  It cites separate meta-analyses of observational studies of regret after mastectomies for gender affirming purposes versus for cancer prevention purposes.  While studies of this type may have a role in the debate, a lot of questions come to mind.  How comparable were all of the underlying studies in terms of follow-up time?  Gender affirming surgery is relatively new.  Does regret tend to develop after one year, five, twenty?  Also, when interpreting a meta-analysis, one of the first items on the checklist is to look at the heterogeneity of the underlying studies.  As seen in the figure from the meta-analysis of studies of regret after gender affirming mastectomies (linked below), heterogeneity was very high.  In this scenario, standard techniques for pooling data from disparate studies may give an unwarranted sense of precision to the findings. 

https://pubmed.ncbi.nlm.nih.gov/33968550/#&gid=article-figures&pid=fig-2-uid-1

Peace,
Jon
An opinion piece with footnotes is still an opinion piece.  As most medical journals do, JAMA organizes the contents of each issue by the type of contribution.  In the same issue, there a separate article listed as a review.  The article you cited is classified as an opinion piece.  It is not standard to describe such articles as "studies."

Peace,
Jon

SomeoneWrites

Quote from: Charles Austin on April 11, 2024, 08:51:27 AMIs the objection that gender transformation is being done for teenagers, or is the objection that it is being done at all?

This is an important observation. 
I don't think it's about "the science."  If it was, the chats about evolution would be much less spirited in this forum. 
LCMS raised
LCMS theology major
LCMS sem grad
Atheist

John Mundinger

#24
Quote from: JEdwards on April 11, 2024, 11:32:33 AMAn opinion piece with footnotes is still an opinion piece.  As most medical journals do, JAMA organizes the contents of each issue by the type of contribution.  In the same issue, there a separate article listed as a review.  The article you cited is classified as an opinion piece.  It is not standard to describe such articles as "studies."

Technically, it is a review paper, drawing conclusions based on the review of multiple published studies.  It may be the journal's practice of publishing review papers as a "point of view".  But, that is not the same as an "opinion" published on an editorial page.  And, if you disagree with the authors' "opinion", the correct approach to express that disagreement is not to dismiss the review article as an opinion.  Rather, read the same articles that the authors reviewed and point out the discrepancies that you discovered.
Lifelong Evangelical Lutheran layman

Whoever, then, thinks that he understands the Holy Scriptures, or any part of them, but puts such an interpretation upon them as does not tend to build up this twofold love of God and our neighbour, does not yet understand them as he ought.  St. Augustine

Brian Stoffregen

It seems to me that "science" is simply an observation by a whole lot of smart people. When they agree about what they have observed, they call it "true." Native Americans "observed" more than two genders and had words for the other ones.

How many of our arguments come from people who have not personally observed anything about which we are talking about? How many have had a youth decide to transition to the other gender or just come out as homosexual?  In many cases friends and family suspected it long before the child acknowledged it.
I flunked retirement. Serving as a part-time interim in Ferndale, WA.

DCharlton

#26
Quote from: Charles Austin on April 11, 2024, 08:51:27 AMIs the objection that gender transformation is being done for teenagers, or is the objection that it is being done at all?

Conversion Therapy has been banned in many states.  It would logically follow that if one were opposed to Conversion Therapy for minors, one would be opposed the Gender Transition Therapy/Surgery for minors. 

I believe that adults should be able to receive both Conversion Therapy and Gender Transition Therapy if they choose and can find a clinician/clinic that will provide it.   On the other hand, I do not believe that minors are capable of fully understanding the irreversible consequences of undergoing hormone therapy and surgery.  Plus, there is the danger of Munchausen by Proxy. 
David Charlton  

Was Algul Siento a divinity school?

SomeoneWrites

Quote from: DCharlton on April 11, 2024, 12:20:58 PM
Quote from: Charles Austin on April 11, 2024, 08:51:27 AMIs the objection that gender transformation is being done for teenagers, or is the objection that it is being done at all?

Conversion Therapy has been banned in many states.  It would logically follow that if one is opposed to Conversion Therapy for minors, one would be opposed the Gender Transition Therapy/Surgery.

I believe that adults should be able to receive both Conversion Therapy and Gender Transition Therapy if they choose and can find a clinician/clinic that will provide it.

This is not an appropriate comparison.   If they identify as Homosexual, one shouldn't convert them to heterosexual.  If one identifies as a gender, they should be affirmed in that regard.  It would be inappropriate to try and convert their mind to be what they don't identify as. 
LCMS raised
LCMS theology major
LCMS sem grad
Atheist

Matt Hummel

Quote from: Charles Austin on April 11, 2024, 08:51:27 AMIs the objection that gender transformation is being done for teenagers, or is the objection that it is being done at all?

Charles-

A fair question. It is for me something of a both.

I object to it, but I realize that the price of admission to a small l liberal small d democratic society is that some adults get to do stupid or evil things with which I disagree and I am constrained by law in how to respond.

But when a child can get ears pierced w/o consent but the government and schools collude to hide things like "gender affirming" therapies or other issues like abortion, I REALLY object. And that is what it is like in the Democratic People's Republic of Bidenistan Delaware
Matt Hummel


"The chief purpose of life, for any of us, is to increase according to our capacity our knowledge of God by all means we have, and to be moved by it to praise and thanks."

― J.R.R. Tolkien

MaddogLutheran

#29
Quote from: SomeoneWrites on April 11, 2024, 12:26:51 PMIf one identifies as a gender, they should be affirmed in that regard.
Why?  Seriously, why?

I don't have the right to demand anyone else "affirm" any of my beliefs.  Please don't confuse this with being actively hostile.  I'm not going to berate you for being an atheist.  I accept your freedom to believe as you choose.  I don't have to affirm that, any more than you need to affirm my Lutheranism.  This talk of affirmation remains nonsense.

As I've stated here before, I am not hostile to recognizing someone's identity preference.  I am happy to use whatever pronouns an individual prefers.  Nobody should get their nose out of joint if such a person's presentation is initially confusing so that I presume their (obvious) sex without other social cues.

It seems like what most of what is controversial about "gender affirming care" is not gender affirming, it's biological sex modification.  Again, not necessarily a bad thing from my perspective.  As Fr. Hummel write, people should be free to do even dumb things.  Unless someone (not you, Someone) insists I have to pay for it.
Sterling Spatz
ELCA pew-sitter

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