Welp. The end may be in sight at last.

The main justification for “gender-affirming care” for minors in the United States has been that “all major U.S. medical associations” support it. Critics of this supposed consensus have argued that it is not grounded in high-quality research or decades of honest and robust deliberation among clinicians with different viewpoints and experiences. Instead, it is the result of a small number of ideologically driven doctor-association members in LGBT-focused committees, who exploit their colleagues’ trust. Physicians presenting different viewpoints are silenced or kept away from decision-making circles, ensuring the appearance of unanimity.

So doctors get the same kind of bullying and silencing we civilians do. How interesting (and horrifying).

As the U.K.’s Cass Review pointed out, the World Professional Association for Transgender Health (WPATH) and the U.S. Endocrine Society were especially important in forging this consensus, and they did so by citing each other’s statements, rather than conducting a scientific appraisal of the evidence.

I’ll quote you if you quote me, and you can quote me because I will quote you. It will all go perfectly.

But the U.S. consensus now appears to have its first big fracture. In July, the American Society of Plastic Surgeons, a major medical association representing 11,000 members and over 90 percent of the field in the U.S. and Canada, told me that it “has not endorsed any organization’s practice recommendations for the treatment of adolescents with gender dysphoria.” ASPS acknowledged that there is “considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions” and that “the existing evidence base is viewed as low quality/low certainty.”  

…

Sheila Nazarian, a plastic surgeon who practices in Beverly Hills, California, told me that colleagues in her field are increasingly expressing concern about the use of hormones and surgeries to help minors who experience distress associated with their sex. Many, however, fear that voicing these concerns will bring professional and social blowback. “It’s a real problem when colleagues are afraid to debate any medical treatment or procedure, and especially when minors are the patients,” Nazarian says. “I have been following the international debate on youth gender medicine for some time now and know we [in the U.S.] are far behind in recognizing the lack of evidence for long-term benefits, something that our European colleagues have done.”

So it turns out that doctors work pretty much the same way the frothing lunatics at Pharyngula do – they keep each other in line via shouting and bullying, with the result that nobody thinks but everybody shouts and bullies.

One obstacle to having productive discussions, Nazarian said, is the partisan divide over youth gender medicine, which leads physicians to believe that disagreement with the “gender-affirming” approach is driven by political or ideological considerations. This perception is understandable, given that the debate is in fact polarized along partisan lines, though it has become less so in the last two years as a number of Democrats in state legislatures have voted in favor of (or abstained from voting against) age restriction laws. It’s possible that advocates of “gender-affirming” interventions see benefit in the partisan framing, as it may deter liberal doctors from examining the issue in greater depth and speaking up when they detect problems.

Why yes, it may, and that’s why the partisans frame it that way.

The U.S. is one of the few Western countries where minors can receive gender surgeries, according to a new report. Teens under 18 cannot undergo double mastectomy in Belgium, Finland, Germany, Luxemburg, Sweden, the U.K., and three Canadian provinces. Countries that allow these procedures typically do so only in “rare cases,” after age 16, and with parental consent. In the U.S., WPATH Standards of Care, Version 8, widely followed and endorsed by the Biden administration, specifies no age minimums for gender surgeries, with the exception of phalloplasty (but even that can be performed if “significant, compelling reasons” exist to do so). In June, unsealed court documents revealed that WPATH eliminated age minimums for political reasons, and under pressure from U.S. Assistant Secretary for Health Rachel Levine, a transgender woman.

That punchline is a horror show all by itself.

To be continued.

H/t J.A.