When I was in medical school, I was captivated by the work being done at my medical school where Julianne Imperato, a fellow in pediatric endocrinology, discovered a cohort of villagers in the Dominican Republic, where there was a lot of "consanguinity" i.e. interbreeding, in some remote villages. This meant that genetic recessive traits could be expressed and diseases not seen commonly could occur more often.
In those days, medical students did exploratory rotations and a group of these students discovered a group of remote villages where mothers gave their children gender neutral names--the Spanish equivalent of "Pat" or "Chris"--because, as they explained to the students, the mothers were never sure which of the children who looked like girls at birth would "grow a penis at 12."
Imperato McGinley sent the students back to the villages to draw blood on these "penis at 12" kids and they traced the family trees. (This was before genotyping could be done, back in 1970.) Her report was the first of five alpha reductase deficiency, a phenomenon which caused individuals who had female appearing external genitalia at birth but who "grew a penis" (the clitoris enlarged) at puberty, when the tidal wave of male hormone overwhelmed the blockage caused by an enzyme deficit.
Cornell, in those days, was a hotbed of "pseudohermaphrodism" research with Maria New, who was Imperato's mentor, and a steroid lab which was capable of analyzing which sex hormones were present in the blood of patients.
Now endocrinology, this science of biochemistry and hormones, has run aground on the rocky shoals of "transgender medicine."
The problem is, you cannot question the prevailing doctrine without running into both an emotional and political response and all dispassionate discussion is drowned by a tsunami party line. If you question any aspect of "transgender medicine" as it is currently practiced, you are assailed as one of those people who denigrate, dismiss and degrade the patients, subject them to more suffering and abuse.
Personally, I hope all physicians want to avoid making anyone feel badly about their sexual orientation, or gender identity, but, the fact is, "transgender medicine" and transgender clinics are now big business. Careers are being launched on transgender patients and their needs.
Paul McHugh is currently one of the disciples of the devil as his story is told in transgender circles, because he raised the issue of the meaning of suicide in this group. When he left Cornell as head of psychiatry to take the job of head of psych at Johns Hopkins, he was asked to take over the psychiatric part of their transgender program and he was alarmed to discover that 30% of the patients in this program committed suicide. He promptly stopped psychiatry's participation in the program.
And Hopkins was not an anomaly. The suicide rates at virtually every transgender clinic, near as I can tell, stubbornly persists in this same range, even 30 years later, around 30%.
The transgender medicine folks shrug this off as the result of the hostility from society and from some unsympathetic medical people which weighs heavily on the transgender patients.
But one has to ask: If you were running a program for cardiovacular surgery or for joint replacement or for transplantation, or for any other medical problem, which suffered a 30% suicide (or death) rate, would you not stop this program? Would you not want to investigate and mitigate this startling finding?
The other things you have to ask about the doctors who care for these patients:
1. How can you recommend uterine transplants for male to female transgenders who want to give birth to babies? What is the risk of the mother's immunosuppressive drugs to the babies?
2. When you have a female to male transgender who wants to freeze eggs, how do you justify the risks of extraction and the expense of preservation?
3. When you have a male to female transgender, how do you justify the expense of freezing sperm? And to whom would this new woman be donating this sperm? If it is to a lesbian mate, does that mean this new woman prefers the same women as she did prior to becoming a woman?
4. When you have a male to female transgender who has not had castration who is in a relationship with a lesbian what sort of sex do they have?
5. When you have a female to male transgender who has not had surgery and has an intact uterus and ovaries and whose hormonal therapy has not suppressed ovulation and she asks for an IUD, what sort of sex is that individual having?
Presumably, vaginal sex. So this new male now is continuing to have sex as a female but function in some other ways as a male?
If that transgender individual who identifies as male is still having vaginal sex, what does that say about gender identification?
6. For a couple who has a male to female transgender in a relationship with a lesbian, is the risk and expense of IVF warranted?
Most of these questions concern the expense, the load to the system. Some have to do with unknown risks.
But mostly, these whole series of questions suggests to me that transgender medicine is possibly being driven by something beyond compassion and that is spelled "m-o-n-e-y."
Is this a subspecialty or an industry?
The medical profession is often operating in the realm of making value judgments: 1. We do not abet opioid drug abuse except as a way of trying to change the behavior of the drug abuser. 2. We try to "treat" pedophiles, and prevent them from acting on their urges toward children who we perceive as inappropriate sexual partners. 3. As psychiatrists if we find ourselves treating people who are compulsive rapists or murderers we intervene to try to stop this behavior which we consider harmful to others. 4. When behavior is simply harmful to the patient, as in anorexia nervosa, we try to intervene even when the patient does not see her illness as a problem. We are often judgmental in medicine. But any whiff of "being judgmental" of "shaming" when it comes to dealings with transgenders is verboten.
At a recent Endocrine Society meeting, one of the expert panelists mentioned that for female to male transgender patients he often uses testosterone doses in excess of what we would typically describe as androgen abuse in male patients, "gym rats" who simply want to have bigger and bigger muscles. For those male patients trying to build huge physiques, these doses of testosterone are seen as abuse. For the transgender patient the same doses are not "abuse" but simply qualifies as allowing patients to achieve the gender identity they seek.
The big question here is: What have we wrought?
Secondarily, has the medical profession exerted the control over practice it should have done and if the medical profession as not exerted salutatory control, then who will?
In those days, medical students did exploratory rotations and a group of these students discovered a group of remote villages where mothers gave their children gender neutral names--the Spanish equivalent of "Pat" or "Chris"--because, as they explained to the students, the mothers were never sure which of the children who looked like girls at birth would "grow a penis at 12."
Imperato McGinley sent the students back to the villages to draw blood on these "penis at 12" kids and they traced the family trees. (This was before genotyping could be done, back in 1970.) Her report was the first of five alpha reductase deficiency, a phenomenon which caused individuals who had female appearing external genitalia at birth but who "grew a penis" (the clitoris enlarged) at puberty, when the tidal wave of male hormone overwhelmed the blockage caused by an enzyme deficit.
Cornell, in those days, was a hotbed of "pseudohermaphrodism" research with Maria New, who was Imperato's mentor, and a steroid lab which was capable of analyzing which sex hormones were present in the blood of patients.
Now endocrinology, this science of biochemistry and hormones, has run aground on the rocky shoals of "transgender medicine."
The problem is, you cannot question the prevailing doctrine without running into both an emotional and political response and all dispassionate discussion is drowned by a tsunami party line. If you question any aspect of "transgender medicine" as it is currently practiced, you are assailed as one of those people who denigrate, dismiss and degrade the patients, subject them to more suffering and abuse.
Personally, I hope all physicians want to avoid making anyone feel badly about their sexual orientation, or gender identity, but, the fact is, "transgender medicine" and transgender clinics are now big business. Careers are being launched on transgender patients and their needs.
Paul McHugh is currently one of the disciples of the devil as his story is told in transgender circles, because he raised the issue of the meaning of suicide in this group. When he left Cornell as head of psychiatry to take the job of head of psych at Johns Hopkins, he was asked to take over the psychiatric part of their transgender program and he was alarmed to discover that 30% of the patients in this program committed suicide. He promptly stopped psychiatry's participation in the program.
And Hopkins was not an anomaly. The suicide rates at virtually every transgender clinic, near as I can tell, stubbornly persists in this same range, even 30 years later, around 30%.
The transgender medicine folks shrug this off as the result of the hostility from society and from some unsympathetic medical people which weighs heavily on the transgender patients.
But one has to ask: If you were running a program for cardiovacular surgery or for joint replacement or for transplantation, or for any other medical problem, which suffered a 30% suicide (or death) rate, would you not stop this program? Would you not want to investigate and mitigate this startling finding?
The other things you have to ask about the doctors who care for these patients:
1. How can you recommend uterine transplants for male to female transgenders who want to give birth to babies? What is the risk of the mother's immunosuppressive drugs to the babies?
2. When you have a female to male transgender who wants to freeze eggs, how do you justify the risks of extraction and the expense of preservation?
3. When you have a male to female transgender, how do you justify the expense of freezing sperm? And to whom would this new woman be donating this sperm? If it is to a lesbian mate, does that mean this new woman prefers the same women as she did prior to becoming a woman?
4. When you have a male to female transgender who has not had castration who is in a relationship with a lesbian what sort of sex do they have?
5. When you have a female to male transgender who has not had surgery and has an intact uterus and ovaries and whose hormonal therapy has not suppressed ovulation and she asks for an IUD, what sort of sex is that individual having?
Presumably, vaginal sex. So this new male now is continuing to have sex as a female but function in some other ways as a male?
If that transgender individual who identifies as male is still having vaginal sex, what does that say about gender identification?
6. For a couple who has a male to female transgender in a relationship with a lesbian, is the risk and expense of IVF warranted?
Most of these questions concern the expense, the load to the system. Some have to do with unknown risks.
But mostly, these whole series of questions suggests to me that transgender medicine is possibly being driven by something beyond compassion and that is spelled "m-o-n-e-y."
Is this a subspecialty or an industry?
The medical profession is often operating in the realm of making value judgments: 1. We do not abet opioid drug abuse except as a way of trying to change the behavior of the drug abuser. 2. We try to "treat" pedophiles, and prevent them from acting on their urges toward children who we perceive as inappropriate sexual partners. 3. As psychiatrists if we find ourselves treating people who are compulsive rapists or murderers we intervene to try to stop this behavior which we consider harmful to others. 4. When behavior is simply harmful to the patient, as in anorexia nervosa, we try to intervene even when the patient does not see her illness as a problem. We are often judgmental in medicine. But any whiff of "being judgmental" of "shaming" when it comes to dealings with transgenders is verboten.
At a recent Endocrine Society meeting, one of the expert panelists mentioned that for female to male transgender patients he often uses testosterone doses in excess of what we would typically describe as androgen abuse in male patients, "gym rats" who simply want to have bigger and bigger muscles. For those male patients trying to build huge physiques, these doses of testosterone are seen as abuse. For the transgender patient the same doses are not "abuse" but simply qualifies as allowing patients to achieve the gender identity they seek.
The big question here is: What have we wrought?
Secondarily, has the medical profession exerted the control over practice it should have done and if the medical profession as not exerted salutatory control, then who will?
Mad Dog,
ReplyDeleteYes, a complicated subject as you so reasonably and thoughtfully explain. It's unfortunate that both the far right and the far left have co-opted the issue. Many on the latter side are so insistent on political correctness that any question about treatment is viewed as small minded prejudice. Then we have those on the far right delighted to deny transgender individuals the most basic rights. The transgender ban on military service or attendance at the Naval Academy etc, based solely on sexual preference, is a disgrace. Also, who pays for the transition is a separate subject and should be treated as such.
In any case, one can't help but wonder what the accepted treatment will be fifty years from now and how the current treatment will be viewed.
Maud
Maud,
ReplyDeleteAll good questions.
But the essential point is, unlike homosexuality, which is likely a genetic trait, "gender dysphoria" with its high suicide rate is , in fact, a "disease" or euphemistically, a "condition" for which "patients" seek "treatment." As such, the military is likely justified in treating it differently.
Not to say transgenders should be banned, ridiculed, disparaged. Nobody should be humiliated for sexual preference, gender problems.