Ever more healthy young people diagnosed with gender dysphoria (GD) are lining up for un-trialled, irreversible surgical and hormonal therapy in order to ‘change their gender’.
There is a distinct possibility that the current protocols for managing GD could turn out to be a dreadful mistake.
For this reason, to give some context to the ‘mistake’ concept, I list a few (of the many) historical examples:
Frontal Lobotomy:
Portuguese neurologist Egas Moniz performed the first such procedure to treat refractory psychiatric conditions in 1935. The last recorded lobotomy in the Western world was in the U.S. in 1967. Lobotomy left many patients worse off following surgery, many died and many who survived were left in a vegetative state.
Number of damaged patients: Probably in excess of 100,000.
Time to abolition: 31 years
Thalidomide:
First marketed in West Germany in 1956 as an over the counter medication to treat anxiety, insomnia and hyperemesis gravidarum (‘morning sickness’). Concerns regarding birth defects in infants born of mothers taking the drug soon became apparent; this included stillbirth, grotesque limb malformations and major organ system damage.
Number of damaged patients: 10,000 – 20,000.
Time to abolition: 5 years
Pelvic mesh implant:
A very recent disaster: This device was approved by the FDA in 2002 for repair of pelvic organ prolapse, a not uncommon problem following pregnancy. Some 150,000 women in Australia were treated thus. Delayed outcomes revealed a litany of disastrous irreversible effects including erosion into the bladder and vagina, dyspareunia, urinary fistula and systemic immune conditions.
The device was withdrawn by the Australian TGA in November 2017.
An Australian class-action suit (the largest of its kind) began in 2017 while the current global total settlements approaches US$8 billion.
Number of damaged patients: 150,000 -200,000
Time to abolition: 15 years
The above three examples had not undergone any form of clinical trial to establish efficacy and safety.
I worry that 4 center study will not follow up long enough ("Data on routine anthropometric and physiologic parameters are collected through chart abstraction, questionnaires, and research interviews in the 24-month study period."). Regret and detransition times observed in several cohorts are longer, so it is not clear that relevant long term outcomes for these interventions will be clear in just 24 months.
That does seem short for follow-up. And as far as I know, they are not testing gender-affirming treatments against any alternative treatment approach.
Ever more healthy young people diagnosed with gender dysphoria (GD) are lining up for un-trialled, irreversible surgical and hormonal therapy in order to ‘change their gender’.
There is a distinct possibility that the current protocols for managing GD could turn out to be a dreadful mistake.
For this reason, to give some context to the ‘mistake’ concept, I list a few (of the many) historical examples:
Frontal Lobotomy:
Portuguese neurologist Egas Moniz performed the first such procedure to treat refractory psychiatric conditions in 1935. The last recorded lobotomy in the Western world was in the U.S. in 1967. Lobotomy left many patients worse off following surgery, many died and many who survived were left in a vegetative state.
Number of damaged patients: Probably in excess of 100,000.
Time to abolition: 31 years
Thalidomide:
First marketed in West Germany in 1956 as an over the counter medication to treat anxiety, insomnia and hyperemesis gravidarum (‘morning sickness’). Concerns regarding birth defects in infants born of mothers taking the drug soon became apparent; this included stillbirth, grotesque limb malformations and major organ system damage.
Number of damaged patients: 10,000 – 20,000.
Time to abolition: 5 years
Pelvic mesh implant:
A very recent disaster: This device was approved by the FDA in 2002 for repair of pelvic organ prolapse, a not uncommon problem following pregnancy. Some 150,000 women in Australia were treated thus. Delayed outcomes revealed a litany of disastrous irreversible effects including erosion into the bladder and vagina, dyspareunia, urinary fistula and systemic immune conditions.
The device was withdrawn by the Australian TGA in November 2017.
An Australian class-action suit (the largest of its kind) began in 2017 while the current global total settlements approaches US$8 billion.
Number of damaged patients: 150,000 -200,000
Time to abolition: 15 years
The above three examples had not undergone any form of clinical trial to establish efficacy and safety.
I worry that 4 center study will not follow up long enough ("Data on routine anthropometric and physiologic parameters are collected through chart abstraction, questionnaires, and research interviews in the 24-month study period."). Regret and detransition times observed in several cohorts are longer, so it is not clear that relevant long term outcomes for these interventions will be clear in just 24 months.
Thank you for the great essay (again!).