This essay is an adapted version of two longer posts on Lisa Selin Davis’ Substack, BROADview. Read the longer version here and here. Killarney, a charming town of 14,000 in southwest Ireland, tucked in the shadows of the McGillycuddy Reeks mountains, is hardly the bustling center of Europe—or of gender medicine for that matter. But this past April, it served as the setting for not one but two conferences on the subject.
Anyone interested in this topic -- anyone who looks into the actual evidence and sees how quickly “affirmation” (and all that goes with it) replaced “watchful waiting” in absence of evidence -- replacing a psychology-based approach with a medical-based and extremely profit-generating approach -- can see this is a “medical reversal” waiting to happen.
What is a medical reversal?
It’s an unfortunately common occurrence where newly hypothesized but evidence-lacking treatments are implemented on many thousands of people, with many millions of dollars spent, and then “oops!” we realize that the treatment actually doesn’t help, doesn’t represent an improvement in the old way of doing things, and in fact sometimes causes more harm than good.
Some familiar examples include estrogen replacement for menopausal women, fen-phen, Vioxx, cholesterol-lowering drugs, flecainide for heart arrythmias, stents for people with stable coronary artery disease, low-fat diets, the usefulness (or not) of various vitamins, and the timing and usefulness of prostate cancer screening and mammography.
It’s very important to understand: These mistakes are not rare occurrences and they often result in serious harm or even death (fen-phen, flecainide, and stents).
It happens so often that we are right to be skeptical of new treatments of any kind.
But we are especially right to be skeptical of the new approaches to “gender.” These are permanent, irreversible medical interventions but we’re assured -- despite multiple other nations concluding the evidence is lacking -- that intensive and life-long medicalization is the best approach to a psychiatric diagnosis. (Just on the face of it, that makes no sense.) The more immediate, the sooner, the younger the patient, the better the results, we’re told.
Parents or other loved ones who express doubts are told (incorrectly, based on the available evidence) that their loved one will kill themselves. They are also told that they are bigoted, abusive, hateful, right-wing, and behind the times: the doctors know best.
So, medicalization for a psychiatric diagnosis, in absence of evidence, carried out on thousands of patients including children with many psychiatric comorbidities (sometimes after a single visit to the doctor) is supposedly the best approach.
And when anyone raises questions, they’re shut down with emotional blackmail -- your loved one will die without this care; you’re a bad, bigoted, unloving person if you’re not immediately in full agreement.
What could possibly go wrong? I think we’ve seen what can possibly go wrong.
If this were an “emotionally neutral” harmful treatment, like stents or fen-phen, it would already be discredited or abandoned.
But this ridiculous medical practice is tied up in our culture wars. It’s tied up in many people’s sense of whether they are good, loving, open-minded, supportive people.
They go along with it.
And it’s therefore incredibly dangerous.
I urge people to look carefully at the (lack of) evidence that led to gender affirmation and medicalization replacing watchful waiting. I urge you to look at it as neutrally as if you were evaluating any other drug or medical procedure. Please leave your feelings about whether others will think you’re a bigot at the door.
The stakes are too high to let our personal feelings about social ostracism get in the way: people are being harmed by these practices.
What I've always found fascinating about some of this is many of the same people who advocate so strongly for children being able to make these kind of decisions on their own will loudly protest against children being charged as adults for crimes. The standard defense is their brains aren't fully developed yet. So their brains are developed enough to make potentially life-altering decisions about their physical health but not developed enough to understand that stabbing someone to death isn't ok? The same could said of other instances where the mitigating factor is always lack of mental maturity. But they're somehow mentally mature enough to make these decisions?
Children can no more “consent” to have their healthy breasts and genitalia removed than they can “consent” to have sex with an adult and those who commit such acts on children must ultimately be held to account for their actions no matter how well intended. The necessary rule is fairly simple. No chemical or physical intervention until age eighteen. That means no interference in puberty. After you are an adult you are free to do to your body whatsoever you choose.
This is more evidence of a delusional utopian movement hell-bent on wishing reality away. And with this issue, when wishing falls short, a surgical knife will do. Especially tragic for children.
The work you’ve committed to will undoubtedly help dispel this delusion for many.
Thank you for this lively and comprehensive written account. I have watched some of the video shorts being put up on YouTube, but it was good to read your piece too. I want to feel hope, but in so many places (e.g. Australia, New Zealand, blue states in the USA, etc.) they are digging in their heels and practically removing dysphoric kids from parental care and transitioning them. It's hard to feel any hope for THOSE kids in the coming few years . . .
"He painted the backlash as part of the general “anti-woke” movement against immigration and vaccination, with far right groups jockeying for political clout. He compared critics of gender-affirming care to flat-earthers and climate change deniers. "
No, most of us on the Left believe in climate change, are pro-migrant, and fervently pro-vaccine. We just don't want our kids lives ruined because of an opportunistic, utopian, zealously idealist cultural movement which has emerged in the last 10 years. It shall pass.
Anybody who has had kids or works with them knows one thing: they are like cute, odorous animals, with brains exploding in all directions. As per a comment below, its telling to me how many at the fore of this movement do not have kids themselves, or are clearly traumatized by their own childhood. The latter deserves our sympathy; the former is disqualifying.
If at age 21, a person wants to address trauma, discomfort or desire by altering any part of their body, all good. Go ahead and pay for it.
But until then, kids don't know enough about this complex issue to make the right choice.
Anyone interested in this topic -- anyone who looks into the actual evidence and sees how quickly “affirmation” (and all that goes with it) replaced “watchful waiting” in absence of evidence -- replacing a psychology-based approach with a medical-based and extremely profit-generating approach -- can see this is a “medical reversal” waiting to happen.
What is a medical reversal?
It’s an unfortunately common occurrence where newly hypothesized but evidence-lacking treatments are implemented on many thousands of people, with many millions of dollars spent, and then “oops!” we realize that the treatment actually doesn’t help, doesn’t represent an improvement in the old way of doing things, and in fact sometimes causes more harm than good.
Some familiar examples include estrogen replacement for menopausal women, fen-phen, Vioxx, cholesterol-lowering drugs, flecainide for heart arrythmias, stents for people with stable coronary artery disease, low-fat diets, the usefulness (or not) of various vitamins, and the timing and usefulness of prostate cancer screening and mammography.
It’s very important to understand: These mistakes are not rare occurrences and they often result in serious harm or even death (fen-phen, flecainide, and stents).
It happens so often that we are right to be skeptical of new treatments of any kind.
But we are especially right to be skeptical of the new approaches to “gender.” These are permanent, irreversible medical interventions but we’re assured -- despite multiple other nations concluding the evidence is lacking -- that intensive and life-long medicalization is the best approach to a psychiatric diagnosis. (Just on the face of it, that makes no sense.) The more immediate, the sooner, the younger the patient, the better the results, we’re told.
Parents or other loved ones who express doubts are told (incorrectly, based on the available evidence) that their loved one will kill themselves. They are also told that they are bigoted, abusive, hateful, right-wing, and behind the times: the doctors know best.
So, medicalization for a psychiatric diagnosis, in absence of evidence, carried out on thousands of patients including children with many psychiatric comorbidities (sometimes after a single visit to the doctor) is supposedly the best approach.
And when anyone raises questions, they’re shut down with emotional blackmail -- your loved one will die without this care; you’re a bad, bigoted, unloving person if you’re not immediately in full agreement.
What could possibly go wrong? I think we’ve seen what can possibly go wrong.
If this were an “emotionally neutral” harmful treatment, like stents or fen-phen, it would already be discredited or abandoned.
But this ridiculous medical practice is tied up in our culture wars. It’s tied up in many people’s sense of whether they are good, loving, open-minded, supportive people.
They go along with it.
And it’s therefore incredibly dangerous.
I urge people to look carefully at the (lack of) evidence that led to gender affirmation and medicalization replacing watchful waiting. I urge you to look at it as neutrally as if you were evaluating any other drug or medical procedure. Please leave your feelings about whether others will think you’re a bigot at the door.
The stakes are too high to let our personal feelings about social ostracism get in the way: people are being harmed by these practices.
What I've always found fascinating about some of this is many of the same people who advocate so strongly for children being able to make these kind of decisions on their own will loudly protest against children being charged as adults for crimes. The standard defense is their brains aren't fully developed yet. So their brains are developed enough to make potentially life-altering decisions about their physical health but not developed enough to understand that stabbing someone to death isn't ok? The same could said of other instances where the mitigating factor is always lack of mental maturity. But they're somehow mentally mature enough to make these decisions?
Excellent and honest article. Bravo!
Children can no more “consent” to have their healthy breasts and genitalia removed than they can “consent” to have sex with an adult and those who commit such acts on children must ultimately be held to account for their actions no matter how well intended. The necessary rule is fairly simple. No chemical or physical intervention until age eighteen. That means no interference in puberty. After you are an adult you are free to do to your body whatsoever you choose.
This is more evidence of a delusional utopian movement hell-bent on wishing reality away. And with this issue, when wishing falls short, a surgical knife will do. Especially tragic for children.
The work you’ve committed to will undoubtedly help dispel this delusion for many.
There is no substitute for actually doing the work of going to these conferences and reporting on your experience. Thanks!
Rank-and-file clinicians need to read your words, Lisa!
Thank you for this lively and comprehensive written account. I have watched some of the video shorts being put up on YouTube, but it was good to read your piece too. I want to feel hope, but in so many places (e.g. Australia, New Zealand, blue states in the USA, etc.) they are digging in their heels and practically removing dysphoric kids from parental care and transitioning them. It's hard to feel any hope for THOSE kids in the coming few years . . .
Thank you this was quite informative
"He painted the backlash as part of the general “anti-woke” movement against immigration and vaccination, with far right groups jockeying for political clout. He compared critics of gender-affirming care to flat-earthers and climate change deniers. "
No, most of us on the Left believe in climate change, are pro-migrant, and fervently pro-vaccine. We just don't want our kids lives ruined because of an opportunistic, utopian, zealously idealist cultural movement which has emerged in the last 10 years. It shall pass.
Anybody who has had kids or works with them knows one thing: they are like cute, odorous animals, with brains exploding in all directions. As per a comment below, its telling to me how many at the fore of this movement do not have kids themselves, or are clearly traumatized by their own childhood. The latter deserves our sympathy; the former is disqualifying.
If at age 21, a person wants to address trauma, discomfort or desire by altering any part of their body, all good. Go ahead and pay for it.
But until then, kids don't know enough about this complex issue to make the right choice.