Plastic surgeons are now questioning the wisdom of providing surgical intervention for teens experiencing gender dysphoria.

"From our first days in plastic surgery residency training, we were taught that there are no surgical solutions to psychological problems and that remains true today" one plastic surgeon says.

The Catholic Star Herald says the American Society of Plastic Surgeons (ASPS) told the Manhattan Institute's quarterly City Journal about their concerns in performing "chest and genital surgical interventions for the treatment of adolescents with gender dysphoria".

Author Leor Sapir quoted ASPS as saying "the existing evidence base (for the practice) is viewed as low quality/low certainty".

There is "considerable uncertainty as to the long-term efficacy" of such procedures.

Lawsuits

"Plastic surgeons are increasingly finding themselves in the hot seat of gender medicine lawsuits" Sapir reported.

Those seeking to reverse the interventions are filing lawsuits.

There are "at least seven" ASPS members named as defendants in almost "two dozen lawsuits" Sapir added.

One plaintiff was 13 when an ASPS member performed a double mastectomy on her.

The plaintiff had received less than two hours evaluation by the surgeon and a psychologist before the procedure, Sapir wrote.

This was despite the plaintiff demonstrating a long history of mental and emotional distress.

Sapir's article said ASPS comments marked the "first big fracture" in the apparent US medical consensus over gender intervention for teens.

The World Professional Association for Transgender Health (WPATH) and the Endocrine Society was strongly in favour of that consensus among US medical professionals.

New insights

In Europe, a trend to halt the use of puberty blockers, hormones and surgeries in adolescents with gender dysphoria is emerging.

The Cass Review - an independent analysis of the UK's National Health Service - discovered evidence supporting gender intervention for children and teens was both insufficient and fraught.

The Review also noted WPATH and the Endocrine Society had been citing each other's statements rather than "conducting a scientific appraisal of the evidence".

Psychology vs ideology

The WPATH, the Endocrine Society and the American Medical Association are making "the suffering of these patients worse, and are contrary to the treatments now adopted in New Zealand, Australia and many European countries".

"These countries have prioritised psychological care over medical gender-affirming interventions" the Catholic Medical Association says.

The Association explains gender dysphoria is a psychological diagnosis.

Gender ideology however "is a belief system based on a false human anthropology which undermines the intrinsic value and uniqueness of the human person".

The Catholic Medical Association says "gender ideology is blind to the abundant scientific data already published on the treatment of gender dysphoria".

Physicians promoting it ignore the harm this belief causes to thousands of confused young patients. Those patients deserve compassionate, excellent medical care the Association says. It says systematic studies show compassionate psychological care enables 85-90 percent of teens to resolve their dysphoria without "harmful and irreversible effects...".

Source

• Catholic Star Herald

Dr Hilary Cass says she's been told not to travel on public transport because of fears for her safety.

Detractors - including an MP - have been spreading "vile disinformation" around her report for Britain's National Health Service (NHS).

Despite online threats, Cass wants to help implement her review's 32 recommendations.

Children at risk

Cass says disinformation about her transgender research started the day before the report's publication.

A social media influencer published a list of papers, claiming Cass's researchers rejected them because they weren't randomised control trials.

But Cass says the list had "absolutely nothing to do with" the report or any of the papers.

Deliberately trying to undermine an evidence-based report about children's healthcare is unforgivable she adds.

Despite being untrue, the influencer's claims about Cass's report spread.

Social media activists soon took up the influencer's cause.

They claimed the report included only two of 100 studies.

Without verifying this, Labour MP Dawn Butler told the House of Commons: "There are around 100 studies that have not been included in this Cass report and we need to know why."

In fact, researchers had appraised all 103 papers. From these, they pulled data from 60 - those of high and medium quality, Cass says.

Shaky foundations

Cass's NHS review found that an entire field of medicine aimed at enabling children to change gender had been "built on shaky foundations".

She found no evidence supporting the global clinical practice of prescribing hormones to under-18s. These hormones pause puberty or enable the young person to transition to the opposite sex.

The treatment "was not a safe or viable long-term option" Cass's 2022 interim report said.

As a result, Cass says the Gender Identity Development Service (Gids) was ordered to close.

After Liz Truss became Tory Party leader and prime minister, Cass says "the debate got more aggressive".

Aggression continues

Cass's newly released final report involved transgender patients, families, academics and doctors.

While most had not "weaponised" her report, some activist groups are "pretty aggressive" Cass says.

Last week NHS adult gender clinics agreed to share data about 9,000 children treated at the Tavistock clinic.

Cass says the Tavistock clinic and five others had refused to co-operate with her research. The refusal was "co-ordinated" and "ideologically driven" she says.

Tbe Tavistock clinic also refused to provide data on detransitioners whom a psychiatrist had examined.

The review team had wanted to see if risk factors in a patient's history could be linked to detransition.

Ideological capture

The House of Commons Equalities minister says there had been an ideological capture of institutions, including the NHS. This needs correcting if Cass's recommendations were to be fully delivered.

Meanwhile, long waiting lists for treating children with gender dysphoria have seen several private clinics opening.

Cass finds this concerning, saying young people would not get the level of holistic care NHS clinics provided.

• The Times

Most of my fellow students at the University of California Berkeley went to Ivy League schools as undergraduates. They were well read, articulate and confident.

When they asked where I went to school, I responded, "St. Louis," and they presumed I meant Washington University, and I had to specify St. Louis University.

"Isn't that a Catholic school?" I was asked. My response was, "Worse yet, it is Jesuit."

As a result, I always felt like a tortoise among the hares. The only advantage I had was that I was older and knew I was not a genius.

Not knowing

One of the dangers of being young and smart is that you think you have all the answers.

Aaron Wildavsky, one of the smartest teachers I ever had, once asked a class, "What are the hardest three words to pronounce in the English language?" His answer, "I don't know."

In political, academic and ecclesial life, saying "I don't know" is the equivalent of committing professional suicide.

It is an admission that you do not have all the answers.

If you don't have the answers, why should anyone listen to you. We will move on to the person who claims to have the answers.

For a doctor, politician, scholar, columnist or priest to say "I don't know" is so humiliating that they will often give a "nonresponse response" that hides ignorance in a fog of words.

Better to pretend certitude than acknowledge ignorance. And if you later discover you were wrong, never admit it. Plow forward and pretend your new position is consistent with everything you said in the past.

Gender debate - certainty or uncertainty

I have been thinking about plowing forward and pretending recently in the context of the debate over dealing with gender dysphoria. That's the term given when the gender you identify with is different from the gender you were assigned at birth.

Most people in the debate speak with utter conviction and certitude.

Would that we had more voices that said, "I don't know," or at least said, "It's complicated."

The American Medical Association and the American Academy of Pediatrics support gender-affirming care.

This care may include medical and surgical treatments for gender dysphoria and gender incongruence, as determined by shared decision making between the patient and physician.

On the other hand, European countries, who were the first to do gender-affirming care, are now backing away from it, especially for children. New research has questioned earlier studies that supported gender-affirming care.

England's National Health Service (NHS) has banned puberty blockers for youth after a review found a lack of evidence that medication helped gender dysphoria.

For adults, it will allow prescriptions only via clinical trials or for existing patients.

The British approach is a reasonable effort to follow the first principle of medicine: "Do no harm." It is also a positive effort to gain more information through clinical trials.

Those who prioritise personal autonomy and choice above all other values will see such restrictions as an assault on personal freedom.

Those who think gender dysphoria is not real will see even clinical trials as an assault on human dignity.

Both sides have their "experts" and spokespersons. Both sides present anecdotal evidence and research that supports their views. What should be a conversation about medical treatment has become fuel for the culture wars.

I am a member of the "I don't know" and "It is complicated" club.

Research matters

The NHS approach sounds reasonable to me. I worry about people, especially kids or their parents, making decisions that will seriously impact the rest of their lives

Clinical trials will help discover what works and what does not, who should receive treatment and who should not.

I question anyone who does such treatments without serious follow-up studies.

On the other hand, telling people in pain to "stand by until further notice" seems heartless.

Those opposed to gender-affirming care must follow the example of Pope Francis and welcome and love the transgender people in their communities.

Experiencing discrimination and isolation only makes matters worse.

In addition, they should be helped by dealing with the maladies that often accompany gender dysphoria such as depression. One cannot deny gender-affirming care without offering something else in its place.

Being a member of the "I don't know club" means you will be attacked by both sides.

It does not mean you have nothing to say.

It means you should ask the questions that need to be answered. There is no such thing as a stupid question; there are only stupid answers.

• First published by Religion News Service
• The Rev. Thomas J. Reese, a Jesuit priest, is a Senior Analyst at RNS

ACPeds President Dr. Michael Artigues said the organization's review of the referenced research points to "what many who practice medicine intuitively understand, that young patients experiencing gender dysphoria deserve help in accepting and loving themselves as they are, not interventions that destroy their healthy bodies and put them on track of medicalization for life."

The principal authors of the research review, led by ACPeds Vice President Jane Anderson, expressed their grave concern.

They said "that parents, along with health care and educational professionals who support the transgender ‘transition' of children and adolescents are, in fact, contributing to increased depression.

"They do this by appearing to validate to the children that ‘something is wrong with their body and biological sex.'"

The paediatricians concluded that "there is no long-term evidence that current ‘gender affirming' medication and surgical protocols benefit their mental well-being.

"High rates of suicide attempts and/or completions in those who have received ‘gender affirming' interventions indicate that at minimum, long-term controlled trials should be conducted if these interventions are to be continued."

In lieu of social affirmation, medical intervention, or surgical mutilation of children and adolescents identifying as transgender or gender nonconforming, the pediatricians recommended:

That "intensive psychotherapy for the individual and family to determine and hopefully treat the underlying etiology of their gender incongruence."

The pediatricians also said "more attention and support should be afforded to individuals seeking help in detransitioning after having made a decision during their formative adolescent years with lifelong consequences."

"We urge medical professionals and parents to affirm the truth about childhood gender dysphoria in the presence of harmful thoughts and address the underlying mental illness, adverse events, and family dysfunction," Anderson emphasised.

Burgeoning mental illness

Youth who identify as a gender other than their biological sex have high rates of mental health issues "regardless of any affirmation of their gender identities," the group said.

"This is particularly serious given the exponential increase in the number of adolescents identifying as ‘transgender' in the past decade," they continued. Continue reading

• Joseph Bukuras is a journalist at the Catholic News Agency.

Speaking at The Catholic University of America, Favale said that the Catholic Church was "carrying the torch on the dignity of the body" in a way that nobody else was.

She suggested that the church's teaching on the sacramentality of the human body could provide a useful foundation for discussion on gender.

Favale, author of "The Genesis of Gender: A Christian Theory," stressed the importance of recognising that gender is "affecting real people" and that it requires a deeper understanding than just biology.

Professor Favale urged her listeners to balance compassion for those grappling with gender issues with fidelity to church teaching.

She compared the process to inviting someone into one's home while guarding the identity of the household.

"You offer hospitality, you earnestly listen to what is on their mind," she said, "but this doesn't mean you compromise the identity of your home or ask them to sign a statement they believe everything you believe."

Favale approaches questions about gender "from a deeply Catholic perspective but one that does not lose sight of the humanity and very real suffering of people who experience gender discordance," she said.

Gender refers to the whole person

"In a Catholic understanding, we can distinguish between sex and gender, but not separate them. Sex is to female as gender is to woman," Favale said.

"Gender is a category that refers to the whole person, the unity of body and soul that includes sex. It's not strictly reducible just to biology."

Favale stressed the need for "accompaniment" for those struggling with gender issues, suggesting that this required "seeking to understand the person and really listen to their experience and what they're going through."

The professor was critical of the narrative surrounding gender transitioning surgery, suggesting that it implied "my body doesn't reveal who I am and that causes me stress."

She argued that "the body reveals the person," but that the error came from "not believing the body is already revealing the person and that the body is a gift."

Favale's remarks were delivered as part of a speaker series launched by Peter Kilpatrick, Catholic University's president. The professor gave opening remarks to an audience of 350 people before answering questions posed by Kilpatrick and audience members both present in the hall and participating via livestream.

Sources

The Dialog

Detroit Catholic

The drama is "gender dysphoria" and it is about children believing they belong to the opposite sex.

It is about parental anguish and commitment, court battles to instigate some therapies, laws to prevent others, cross-dressing, drugs that will block puberty, others that will transform an adolescent towards the opposite sex, pending feats of surgery that will castrate while turning a penis into an opening like a vagina, or producing a penis from a forearm in a foray into reproduction unrivalled since the days of eugenics.

It is no wonder this drama is repeated on the media, especially as its players may be toddlers whose future is in the hands of the audience. Accept the pathways of "medicine", we are urged.

Welcome transgender as but one hue in a natural rainbow. Or the children will kill themselves.

But is this massive intrusion into the minds and bodies of children necessary?

What will happen if parents do nothing but "watch and wait" while their child muses on its gender?

Can the child grow out of it?

The answer astonishes.

While proponents argue for massive intervention, scientific studies prove that the vast majority of transgender children will grow out of it through puberty if parents do little more than gently watch and wait.

Studies vary but from 70 to 97.8 per cent of gender-dysphoric male and 50 to 88 per cent of gender-dysphoric female children have been reported to "desist" prior to the onset of puberty.

This likelihood of "growing out of it" is declared in no less than the current, official Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-5), and is supported by a number of independent studies.

The Western medical profession boasts that it rests on "evidence-based medicine" but the tiny fraction involved with "affirmation" of gender identity in confused children is proceeding without supportive evidence for claims of high incidence, the need and safety of medical and surgical intervention, the avoidance of self-harm, and for the concept that the process will produce a happier human being in a happier society.

Faith is needed for affirmation.

During a discussion on these matters, a leading endocrinologist declared to this writer, twice, that the issues of gender dysphoria are "utterly arbitrary … utterly arbitrary", and that his greatest fear was that a mistake would be made by intervention.

If most gender-dysphoric children desist without treatment, the "utterly arbitrary" medical pathways are also utterly unnecessary.

How common is childhood gender dysphoria?

No one really knows because there is "an absence of formal prevalence studies" and estimates vary greatly.

The leader of Toronto's Transgender Youth Clinic at the Hospital for Sick Children, Dr Joey Bonifacio, says estimates based on adult dysphoria clinics range from 0.005 to 0.014 per cent for men convinced they are women and 0.002 to 0.003 per cent for women convinced they are men, but believes they are "likely modest underestimates".

Bonifacio's statistics are the same as those declared in the bible of psychiatry, DSM-5. Continue reading

• John Whitehall is Professor of Paediatrics at Western Sydney University.
• Image: Bettina Ardnt