CCBI News: Gender Identity – Part 3

December 1, 2023

Dear Friends of CCBI,

Gender Identity – Part 3
Ethical Questions in Gender-Affirming Care

In our previous NEWS we related that Dutch research recommending puberty blockers and cross-sex hormone treatments for young adolescents has received serious critique in the past five or six years. Researchers have found serious flaws, concluding that the studies are not only wrong in many areas but should never have been relied upon in the first place. Zeal to embrace social change in a climate of social and political ‘correctness’ coupled with a morality based on individual relativism has led to overly hasty acceptance of some treatments and endorsement of ‘gender-affirmation’ policies.

In 2019 we published a Bioethics Matters paper, “Born this way: not borne out,” showing disagreements with some treatment protocols, which, we emphasized, were not based solely on Catholic teaching but on issues raised by psychologists and medical people in the field. New research has provided what is essential in the sciences, in bioethics, law, and indeed in Catholic teaching: evidence-based research that is quantifiable and assessable over time. The human body has evolved over millennia, therefore short-term research and any ‘jumping on the bandwagon’ that follows are unlikely to be accurate. “Do the math!” or in this case, do the research! For example, are there any biologists who reject the fact that humans are binary? When someone self-describes as ‘non-binary,’ is society to accept that as factual, or as an assertion? Despite the person’s self-understanding, it is clear that the person is a male or a female person, anatomically, genetically and chromosomally, unless, on the surface, the person is well disguised, as in a Shakespearean play.

Recall of Gender Affirmation Programs

Reacting to flaws in the Dutch studies, Finland, Denmark, Sweden, the UK and others have reviewed their protocols for gender-affirmation treatments and have stopped using the methods, instead referring their young patients to psychotherapists for treatment of underlying conditions. One Finnish psychiatrist was asked to open a national pediatric gender program in 2011, having already been involved in gender identity services for adults. Adult transitioning was not in principle a moral problem for her, and she led the opening of a new clinic for youth, looking to the Dutch studies for guidance. The clinic expected to see mainly young boys, since gender identity issues claiming to be resolved by the Dutch studies had involved a small number of very young boys (age 4-7) asserting they were girls, with an even smaller number of young girls who said they felt they were really boys. 

The psychiatrist, Dr Riittakerttu Kaltiala, relates that, unexpectedly, patients arrived ‘in droves,’ and were mainly girls, aged 15-17, therefore a completely different cohort from that studied by the Dutch. Not only that, but the majority had severe psychiatric conditions, with many on the autism spectrum. Dr Kaltiala found that few had experienced gender dysphoria when they were very young, unlike the Dutch experience. Many had thought they might be in the LGBTQ stream but were told they were experiencing gender identity problems. The clinic’s research found that a significant number had found information about gender transition online, and this had been highly influential on them.

Dr Kaltiala contacted other clinics in Europe and discovered some others were having similar experiences: caseloads of teenage girls with multiple psychiatric problems. They, too, were finding out that results promised by the Dutch studies were not borne out and that their patients were worsening after treatment. By any standards, why would clinics continue such treatments when it becomes clear that they were not helping, but hindering, patients’ wellbeing? The Finnish researchers reviewed the records of  their patients who had received puberty blockers and hormone treatment, discovering that over a quarter were actually on the autism spectrum. They published these results in 2015 to draw attention to the flaws found in the Dutch protocols and to warn of dangers to youth. This and similar publications did not result in all countries changing course on treatment, although others did stop it and began to re-evaluate their protocols. Perhaps as a consequence of today’s ‘cancel culture’ in which there is concern about careers and reputation, let alone loss of employment if they disagree with policies in delicate areas, many clinicians did not speak up, or they even ignored these findings. By 2015, for example, the United States had opened over a hundred gender clinics and had established a new treatment standard, ‘gender-affirming care,’ whereby clinicians should accept a child’s self-identification as being transgender and proceed with medical treatment. The same approach still seems to be the case in Canada.

Social Contagion

After opening, the Finnish clinic was surprised to find an upsurge in requests for treatment from groups of teenage girls, aged 15-17, many of whom came from the same town or even the same schools. This had never been observed before, and it turned out that these girls had not experienced gender dysphoria when they were younger, making the clinicians suspect that other factors were at work. They discovered that these young people were ‘networking,’ participating in multiple online discussions and information sharing on transgender issues. The clinicians labelled this ‘social contagion,’ whereby easily influenced young people followed the example of ‘leaders’ in self-identifying as transgender, turning to medical interventions to aid their distress. The Finnish clinic discovered that this was also happening in other countries, but those chose not to speak at that point. Finland, however, was first to take action in stopping transitioning treatment on the basis of self-identification. Clinic patients were referred for psychiatric treatment or psychological counselling to receive an accurate diagnosis and treatment for their underlying problems.

There was pushback from some physicians, parents and activists who demanded treatment as a matter of right, but this particular clinic held true to a basic principle in medical ethics: medical treatment should be based on medical evidence and when a treatment does not work it should be stopped. Practitioners should be informed of its inefficacy and of potential dangers if continued.

Regret and Detransitioning

The authors of the Dutch studies had stated that regret for decisions made was small, but a few years ago, several young people returned to the Finnish clinic expressing regret for their transition and complaining that their gender dysphoria had not been resolved. Research into this showed that the Dutch data was further flawed in not having included the numbers of people who changed their minds after transition, thus presenting a ‘rosier’ picture than was the case. Experience shows it can take several years before those who transition discover the full impact of possible sterility and/or difficulty in sexual functioning. Although it had been pointed out that new transitioning policies lacked long-term studies, many countries ventured into medical interventions somewhat blindly. In 2020, Finland’s national medical body, COHERE, published new recommendations re gender transition for youth, declaring it as still experimental treatment and that youth and their families should know about: “…the reality of a life-long commitment to medical therapy, the permanence of the effects and the possible physical and mental adverse effects of the treatments.” The report echoed another serious concern that many of us share: young people’s brains are still maturing and they do not have the capacity to assess consequences that could affect them for the rest of their lives. Note that these are factual, evidence-based statements, not morally ‘judgmental’ and cannot be dismissed as such by supporters of these practices. Rather, speaking out about these types of medical intervention is intended to protect the life and welfare of individuals, as well as protecting tested values that encourage human thriving. These values include respect for our God-given bodies along with the practice of the virtue of prudence to enable us to see what is effective and what is necessary in any given situation. That means making evidence-based medical and social decisions that are clear-sighted in their compassion for young people, not simply exhibiting a type of compassion that allows them to undertake paths that are deemed experimental and may have dire consequences. Are people aware that sex-reassignment surgery means their reproductive organs may not function properly? Are they even aware that puberty blockers can induce permanent sterility, as do sex-altering hormones which also pose problems when used over a lifetime? These are not ‘Catholic’ questions but should be asked by everyone in society since they pose challenges to prudence, common sense and capacity for consent, needing evidence-based answers for their resolution. It is fortunate that that most members of the medical and scientific communities view such challenges as a necessary part of their work, seeking objectivity, declaring their own bias and relying on evidence-based research. In turn, results of research often result in changes in national or even global protocols and policies, and this is what is currently happening in decision making about acceptable treatments for gender identity issues.

To summarize, not only Finland, the UK and others have stopped treatments based on the ‘gender-affirming’ approach. They are referring children for psychiatric or psychological diagnoses to help identify any underlying conditions before a diagnosis of  gender dysphoria might ever be made. More attention is being paid to long-term studies that show a late adolescence reversal rate of acknowledging one’s bodily sex and gender occurs in about 80 % of cases, IF medical interventions have not taken place. I would add here that this fact has been known in the medical community since at least the early 1990’s, thanks to work done by Dr Ken Zucker and others, though systematically ignored and debunked by many in the transgender community. This continues to be the case in some countries, despite its obvious staying power. Dr Zucker was the subject of an attack on his research and reputation by colleagues and activists, as well as experiencing the closure of his gender-identity clinic at CAMH in Toronto. Forced to resign, Zucker pursued the issue legally, was vindicated and his research validated. No professional should suffer the injustice of malign attacks, but the truth is that his evidence-based work holds fast, while some politically-motivated treatments are now being re-assessed for their medical and ethical worth.

Next week’s NEWS will review some other factors of importance in transgender issues, as well as looking a little further into the concept of ‘social contagion,’ which apparently is occurring in some local high schools, Catholic and otherwise. What is behind all this?

Resources
Outline (ccbi-utoronto.ca)
‘Gender-Affirming Care Is Dangerous. I Know Because I Helped Pioneer It.’ | The Free Press (thefp.com)…
Finnish_Guidelines_2020_Minors_Unofficial Translation.pdf (segm.org)
Dr Kenneth Zucker Research — Kenneth J. Zucker (kenzuckerphd.com)

Pope Francis’ Intentions for December
For People with Disabilities

“Let us pray that people with disabilities may be at the center of attention in society, and that institutions offer inclusion programs that enhance their active participation.”

Moira and Bambi