July 10, 2015

"But, under a first-in-the-nation policy quietly enacted in January that many parents are only now finding out about, 15-year-olds are now allowed to get a sex-change operation."

"Many residents are stunned to learn they can do it without parental notification — and the state will even pay for it through its Medicaid program, the Oregon Health Plan."
In a statement, Oregon Health Authority spokeswoman Susan Wickstrom explained it this way: "Age of medical consent varies by state. Oregon law — which applies to both Medicaid and non-Medicaid Oregonians — states that the age of medical consent is 15."...

The Oregon Health Authority could not say how many Medicaid recipients have been treated for gender dysphoria since the new policy took effect in January. Oregon has 935,000 people enrolled in the Oregon Health Plan. [The Health Evidence Review Commission] assumes between 14 and 112 of them may be gender dysphoric. It estimates the total cost of adding cross-sex hormone therapy, puberty-suppressing drugs and sex reassignment surgeries to the coverage will be no more than $150,000 per year.

But HERC also believes the state will save money due to fewer suicide attempts....
ADDED: The article has a somewhat hysterical "Fox News" attitude. Reading between the lines, I'm thinking that the health authorities are setting things up to draw in teenagers who need psychological treatment and suicide intervention and who will only in very rare cases break through the filters to sex-reassignment surgery. It's something that's possible and that can, perhaps, break the lure of suicide, but it's unlikely to be the actual treatment a young person will receive from the medical professionals he makes contact with. If I'm wrong about that, I'd like to read about it in a less hysterical presentation of the news.

98 comments:

The BubFather said...

What could possibly go wrong when an impulsive 15 year old decides to lop his penis off?

H said...

"The pro-transgender advocates do not want to know, said McHugh, that studies show between 70% and 80% of children who express transgender feelings “spontaneously lose those feelings” over time. Also, for those who had sexual reassignment surgery, most said they were “satisfied” with the operation “but their subsequent psycho-social adjustments were no better than those who didn’t have the surgery.”

“And so at [Johns] Hopkins we stopped doing sex-reassignment surgery, since producing a ‘satisfied’ but still troubled patient seemed an inadequate reason for surgically amputating normal organs,” said Dr. McHugh."

http://cnsnews.com/news/article/michael-w-chapman/johns-hopkins-psychiatrist-transgender-mental-disorder-sex-change

Scott said...

Another abomination in the Obama Nation.

Peter said...

How beauteous mankind is! O brave new world,
That has such people in't!

Coupe said...

I found out I had to have my prostate removed and this was very expensive. So I asked them if I could have a vagina instead. Well yes, they said, and that doesn't cost anything because it is covered by welfare.

Can I keep my penis and have a vagina too?

Sure!

Marc Puckett said...

If Oregon would secede from Portlandia, this sort of nonsense would stop happening.

EDH said...

Surely this is just another paranoid right-wing nightmare scenario.

Pamela said...

Let me get this straight, (pardon the pun). So a 15 year old can get a sex change, but can't bring tylenol or aspirin to school?

CWJ said...

Oregon seems to do a lot of this "first in the nation" stuff.

Terry said...

A doctor that does this to a minor should be in prison.

kcom said...

First over the cliff.

"Follow me, lemmings!"

lgv said...

I am amazed by the many contradictions in what decisions people are allowed to make for themselves based on age.

You need a permission slip from your parents in order to go to the museum, but you can walk into a clinic and start gender reassignment treatments. Why not allow marriage, gay or hetero at age 15, too.

I'm also thinking they don't need this law anyway. You can be a woman by just declaring you are one now, without lopping off your penis. The bar has been lowered for transgender. It now overlaps transvestite.

Coupe said...

It would be better/cheaper for society if all mental patients were euthanized, and I include people who are confused about their sexuality.

But this may be my suppressed German genes playing their role.

What I know about money though, is that since it is no longer based on gold or silver, but instead on debt, then it makes sense to print more money, as the debt rises.

I think we can do that through the next Presidency before the country collapses. Plenty of time to enjoy the good life. Fuck the Greeks, they just spent too fast.

n.n said...

They already had the right to indiscriminately kill wholly innocent human lives under the pro-choice doctrine. Choosing their sex or gender is a logical progression from that source.

sean said...

Pretty weird, but a logical consequence of the various movements and ideological agendas Prof. Althouse has embraced over the years.

Tank said...

Coupe said...
I found out I had to have my prostate removed and this was very expensive. So I asked them if I could have a vagina instead. Well yes, they said, and that doesn't cost anything because it is covered by welfare.

Can I keep my penis and have a vagina too?

Sure!


Giving new meaning to a common epithet LOL.

rhhardin said...

It was over when the MSM took down the Confederate flag on "the debate is already over" grounds in a day.

MSM + morons watching = ratings + social disaster

Anonymous said...

Don't worry, this is all fox news quality hysteria. There's only going to be a few 15 year old boys doing this. Just a few.

Bigots.

Michael K said...

Anybody who stays in Oregon longer than what is necessary to drive through it, has no excuse for what happens.

madAsHell said...

I may be completely off base....but I thought someone (a study has shown) produced numbers (and echoed here at Althouse) showing that after sex-reassignment.....they were still suicidal.

kcom said...
This comment has been removed by the author.
traditionalguy said...

So Sweet Fifteen is the re-birthday for many a good human in rebellion.

Todd said...

So these kids are "mature" enough to "know" they are the wrong sex and get it "fixed" but too young to actually have sex?

Coupe said...

The best way to drive to Washington from California, is to detour through Nevada and Idaho.

Any state that doesn't let you pump your own gas is not going to let you live your own life either.

Birches said...

So a 15 year old can do gender reassignment surgery without telling their parents and the Oregon Health Board thinks this will actually make things better for the kid? To me, that sounds like a suicide waiting to happen.

There's a reason why only crappy doctors do gender reassignment surgeries. We've heard that the Sex Change Capital of the world was in Trinidad, Colorado. Why? Well, the poor doc had to figure out someway to make money living in such a hole of a place. Of course, those days are probably ending now that equality and all that....I do wonder how many doctors in Oregon will actually do a gender reassignment surgery?

Todd said...

If they are old enough to get a penis added or removed, they surely are old enough to have a beer!

Coupe said...

P.S. There's an exclamation mark in Dickshooter, Idaho !!

madAsHell said...

Oh, yeah....one other thing!! The local news has told us that the Oregon health web site is the most fuckered health web site in the country, and that they dumped it to join the federal web site.

http://www.latimes.com/nation/politics/politicsnow/la-pn-oregon-drops-broken-healthcare-exchange-20140425-story.html

So, how can you have Oregon rules on a federal website??

Rick M said...

Oregon has the country's first bisexual Governor, Gov. Brown, a woman. (Am I allowed to say that in Oregon?)

CJinPA said...

I'm on a school board that's trying to implement policy for dealing with transgender kids. The first thing I noticed is that board members are frightened to ask questions. Such as, "Do we know what we're doing?" And, "Could we make things worse?"

While I support the overall goal, it's pretty shocking to see so many adults frightened into silence on such a huge, unprecedented initiative. We have more discussion on the lunch menus.

Coupe said...
This comment has been removed by the author.
Amadeus 48 said...

Althouse--I read the news story after reading your update, but I don't see the hysteria (an interesting characterization in itself, is it not?). Your between the lines read (we'll lure them in with the promise of a dramatic change in their situation and then counsel them to well-being) hits me as being overly optimistic-- bureaucrats usually intend to do what they say they are going to do. This is a very strange policy that Oregon has adopted.
We all know of people who have made the transition apparently successfully (Jan Morris, Deirdre McCloskey, Jennifer Pritzker), but those people did it much later in life. The doctor from Johns Hopkins has the better point of view on this, I think.

Todd said...

Another [of a long list of] absurdity with this is that "collage" girls can't have a guilt free sexual tryst even with a "yes means yes" contract but a 15 year old get a penis?

Terry said...

You realize, of course, that if you want a second penis added to your body they will still think you are crazy. There are social barriers the insufficiently gendered have yet to overcome.
This is all fallout from the 1960s and 1970s when pop culture decided that the crazy people weren't crazy, society was crazy. How can you not be driven insane when people your age are being drafted to fight in a war! How can you not be driven insane when some Texas judge can put you away for twenty years for smokin' a little weed! How can you not be driven insane when they advertise roll-on deodarant on TV!

Gahrie said...

The article has a somewhat hysterical "Fox News" attitude.


Isn't the possibility of a fifteen year old mutilating themselves behind their parents' back at taxpayers' expense worth being hysterical about? If not, what is?

Gahrie said...

may be completely off base....but I thought someone (a study has shown) produced numbers (and echoed here at Althouse) showing that after sex-reassignment.....they were still suicidal.

Johns Hopkins, who were the first hospital in the country to do sex reassignment surgery, and now no longer provide this service.

Gahrie said...

The first thing I noticed is that board members are frightened to ask questions.

Of course they are. The Leftwing lynch mob is in full roar.

MaxedOutMama said...

The first step in gender reassignment is hormone therapy, which has a lot of effects which may not be reversible and may be more impactful for persons that age. In addition, hormone therapy does generally whack the brain around a bit, which is problematic for someone that age.

Counseling yes, but 15 year-olds are not really ready for this type of decision IMO. I doubt they have the mentality to truly assess the risks/rewards of such a choice.

The legal age of consent in Oregon is 18. There is a deep disparity in logic here.

exhelodrvr1 said...

Fox News hysteria? Really?

Moose said...

transgender surgery is not the "miracle drug" its made out to be. Mostly the outcome is poorly understood.

http://www.theguardian.com/society/2004/jul/30/health.mentalhealth

The Cracker Emcee said...

"A doctor that does this to a minor should be in prison."

Within 10 years, he'll be sued for the mutilation he inflicted on a emotionally/mentally vulnerable patient.

Within 12 years, insurance companies will refuse to provide malpractice coverage to physicians who perform this kind of surgery.

Within 13 years, there won't be a medical facility in the U.S. that will perform this kind of surgery.

Within 15 years, the T will be, discreetly but definitely, separated from the LGB. Much incoherent libsplaining will ensue. An elderly Bruce Jenner will explain that it was all just performance art.

Within 30 years, people will laugh and shake their heads in wonder at the ignorant society that actually thought mutilation was an appropriate treatment for mental illness. The procedure will be seen in much the same way we think of frontal lobotomy now. Total amnesia will descend on everyone who ever was an advocate.

The Drill SGT said...

Giving new meaning to a common epithet LOL.

Only if your member is fairly limp, I would think?

The Drill SGT said...

Michael K said...
Anybody who stays in Oregon longer than what is necessary to drive through it, has no excuse for what happens.


Don't you still live in California?

I Have Misplaced My Pants said...

Yes, what Gahrie said. I think this warrants a little alarm.

Echoing Pamela, when I was a teenager in Washington in the mid 90s, I was delighted and a bit frightened when I had my first gynecological exam at 15 and the doctor confidently told me that since I was over 14, she could treat me for anything related to my sexuality including having an abortion "and your parents never have to know a thing." And yet I wasn't allowed to carry aspirin to school, even as a senior at age 18.

My daughter is 13 and last year I had to drop everything and drive to her school to collect her "medicated" chapstick when a teacher saw her using it, or she'd be suspended. *facepalm* And yet if my reading of the Texas family code is correct, she can consent to any medical treatment related to pregnancy or STDs, with the exception of abortion, without any parental notification.

Clayton Hennesey said...

In the presentation of it on Bret Baier's Fox News show I saw, the head of psychiatry at John Hopkins effectively branded the policy as insane. Which, I suppose, could be construed as an hysterical reaction.

Anonymous said...

Blogger The Drill SGT said...
Michael K said...
Anybody who stays in Oregon longer than what is necessary to drive through it, has no excuse for what happens.

Don't you still live in California?


I know this isn't to me, but I used to live in California and now live in Washington. All of these left coast states suck. But Oregon is a special kind of stupid. We took vacation there a few weeks back and you can't pump your own gas. Now, this is a small thing, except when you're on vacation during a busy time of the year. We had to wait about 30 minutes in a line at Fred Meyer just to get gas.

I wasn't happy, to say the least. Why can't we pump our own damn gas?

I'd never want to live in Oregon.

Amadeus 48 said...

In its next advance, Oregan will be offering hysterectomies to address psychological problems in females. Oh, wait...

lgv said...

They rationalize the cost of such coverage by saying it will reduce suicides, which cost the state money. Isn't it a bit ironic that they care about reducing suicide, yet have legalized assisted suicide? Can a 15 year old get legally assisted suicide, covered by insurance? Will it only be covered after they have changed genders?

Birches said...

In addition, hormone therapy does generally whack the brain around a bit, which is problematic for someone that age.

"Free birth control pills and hormone therapy for EVERYONE, but you'd better keep my food antibiotic, hormone, and GMO free you Monsanto Pig!" --- Liberal Elites

MaxedOutMama said...

I also didn't see the hysteria in the article. It appeared that there was an attempt to talk to people who know something about the field.

The policy change is not to cover counseling, which was always available under Oregon's Medicaid rules, especially for suicidal teenagers. The policy change is to cover very specific therapies without parental consent. I find, therefore, your characterization of the real change in therapy to be inaccurate.

The hysteria might be more substantial on the "convert-em-young" side. I have never been able to find a neutral study that reported good outcomes for gender reassignment surgery.

Here's one cite:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/

Their conclusion was that the treatment offered doesn't cure the sexual dysphoria, and that better treatments should be developed and offered.

This doesn't mean that sexual reassignment surgery is not the appropriate choice for some - it may well be. But expecting persons at the age of 15, 16 and 17 to be competent to make this choice seems more than a bit whacky.

This is very irrevocable. You're sterilizing these people, and longer term use of high dose sexual hormones causes cardiovascular, cancer, diabetes and other risks. For this reason, the gonads should be removed pretty quickly.

http://www.hormone.org/patient-guides/2009/endocrine-treatment-of-transsexuals

To understand the real risks these adolescents may experience, you have to look at early steroid therapy which causes many of the same effects.

For FTM, the effects are similar, but worse, than the effects of PCOS, which is a severe risk for cardiovascular problems, cancer and diabetes, not to mention depression and mental disorders:
http://womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html#j

The Drill SGT said...

"Free birth control pills and hormone therapy for EVERYONE, but you'd better keep my food antibiotic, hormone, and GMO free you Monsanto Pig!" --- Liberal Elites

LOL, don't get me started on the female hormones introduced into the water supply due to the "Pill"

Fritz said...

I lived in Oregon for 9 years or so, about the time the cream of the crop of fruits and nuts moved in from California (and yes, I was from California).

If you were to cut the Willamette Valley out of the state, it would almost be normal.

Smilin' Jack said...

It estimates the total cost of adding cross-sex hormone therapy, puberty-suppressing drugs and sex reassignment surgeries to the coverage will be no more than $150,000 per year.

But HERC also believes the state will save money due to fewer suicide attempts....


Because "cross-sex hormone therapy, puberty-suppressing drugs and sex reassignment surgeries..." are so much cheaper than cremation?

tim maguire said...

Amadeus 48 said...
Althouse--I read the news story after reading your update, but I don't see the hysteria (an interesting characterization in itself, is it not?). Your between the lines read (we'll lure them in with the promise of a dramatic change in their situation and then counsel them to well-being) hits me as being overly optimistic--


It's not unusual for the professor to invent out of whole cloth "context" that helps her process something that doesn't seem believable to her. Each time I see it in action, I'm reminded that it was this same mental habit that led her to vote for Obama in 2008.

UNTRIBALIST said...

Isn't attributing hysteria where there is none hysterical?

Fred Drinkwater said...

Dear Misplaced Pants:
Perhaps your daughter should claim that the chapstick is part of an anti-STD regimen?
Just state this to the relevant administration drone, keeping a perfect poker face the whole time, and then stop talking. Maybe stare blankly at them for a few seconds, like you can't understand what their problem is.
(If you do this, PLEASE video it for us!)

CJinPA said...



I should note that we have yet to go public with anything. They were afraid to look politically incorrect in front of their peers in executive session.

I had to be the bad guy and ask such bigoted questions such as "What if the parents disagree?" And "Will a teacher be punished for using the wrong pronoun?"

Fernandinande said...

Gahrie said...
Isn't the possibility of a fifteen year old mutilating themselves behind their parents' back at taxpayers' expense worth being hysterical about? If not, what is?


Cakes and flags.

Smilin' Jack said...

I have never been able to find a neutral study that reported good outcomes for gender reassignment surgery.

Actually, if you just google "trannys" you'll find pics of quite a few who turned out pretty hot. Usually they just get the top done, though.

HoodlumDoodlum said...

"Hysteria" is sexist. For shame.

Gahrie said...

It's not unusual for the professor to invent out of whole cloth "context" that helps her process something that doesn't seem believable to her.

The key is transcendence. You have to transcend the literal meaning of the words and grok the meaning of the text instead.

Stephen A. Meigs said...

What got me was how hard the headline was trying to play down what the article actually said. The headline was "Oregon allowing 15-year-olds to get state-subsidized sex-change operations". But the most disturbing part is definitely the no-parental-approval-required part. It's like the article out of some false fear of being hysterical was trying so hard to not be hysterical-seeming that it didn't put the totally disturbing part in the headline or first sentence. Or maybe the upper-echelon chief editors at FOX are very conservative when it comes to taxes but are basically as screwed up as the liberal media when it comes to sodomy issues, and they are too lazy or full of a sense of self-importance to read more than the headline and first sentence. It doesn't take a brilliant observer to see that pretty much the whole mainstream media is blatantly pro-sodomy compared with typical people.

Sodomizers of males tend to like them young, and they tend to like them castrated. It helps in warping a victim from his natural sexual state to get at him before he has had much time to get in touch with his natural sexual tendencies and to destroy those parts of him that might cause him to become more in touch with those tendencies.

Coupe said...

I was thinking how funny it would be if the kid woke up in the recovery room with a vagina taken from a 65 year old woman, who had five kids.

Can you wait around and request a vagina from a 12 year old that's never been used, after getting rubbed out on the freeway?

Is this covered under your donor card gift?

weretort said...

HYSTERIA
"... from Greek hysterikos, from hystera womb; from the Greek notion that hysteria was peculiar to women and caused by disturbances of the uterus."

Easily cured, at least in Oregon.

EMD said...

" I'm thinking that the health authorities are setting things up to draw in teenagers who need psychological treatment and suicide intervention and who will only in very rare cases break through the filters to sex-reassignment surgery. "

Yeah, I'm sure that's it.

Coupe said...

Hysteria was how most doctors made a living until about 1900. Women would go to the doctor to have the doctor "rub one out" and this orgasm was said to prevent hysteria.

One doctor even invented the vibrator, as he had a lot of patients and his hand wore out.

The problem though, back then most power was DC instead of AC, and sometimes the doctors accidentally electrocuted the patient.

hysteria and the strange history of vibrators

madAsHell said...

Johns Hopkins, who were the first hospital in the country to do sex reassignment surgery, and now no longer provide this service.

Thank you, Gahrie.

Mountain Maven said...

So if a child wants to walk to school unsupervised the parent is liable for child abandonment. Then a few years later, after being brainwashed at school, he wants to geld himself, parents don't have a say.
From Nanny State to Big Brother, the War on Families rolls on.

Kyzernick said...

Really glad that most of the commenters here are so very much more intelligent than the prof. I mean that without sarcasm. If it were not the case, I'd go elsewhere. Sometimes I don't even bother reading the content. I go right to the comments after clicking the links, and reading the story, to find sane voices discussing it all.

Trannies are mentally ill. Oregon would be just as progressive if they treated anorexics with "air snacks" or "imaginary cheeseburgers" so they could ignore that pesky hunger they feel.

I have forcibly disassociated myself from 2 people in my life who were trannies. Both times, I was better off for it. Gladly, none were family, but that would not have stopped me. Trannies are all timebombs waiting to go off, and if society won't treat them as the mentally ill messes they are, then I'm going to and to hell with anyone calling me a bigot. If that makes me a bigot, then your tolerance of trannies makes you f-ing retarded.

Rick said...

The article has a somewhat hysterical "Fox News" attitude. Reading between the lines, I'm thinking that the health authorities are setting things up to draw in teenagers who need psychological treatment and suicide intervention and who will only in very rare cases break through the filters to sex-reassignment surgery

It is beyond strange to think someone is hysterical for objecting to what the law allows. Obviously any sex change is "rare", so rarity can hardly be a justification for not examining the law.

Plus consider how Althouse would react if someone claimed after the fact they only agreed to the law because they expected it to be used in a certain limited way when the law was clearly not thus limited. I would expect "stupid" and "ridiculous" to feature highly in the word count.

Marc Puckett said...

So this is the first NPR article about this nonsense Google returned, from January; I believe I used the terms NPR, Oregon, transgender, gender reassignment surgery. Nothing about the medical age of consent being 15, for some reason.

eteam said...

Fox news hysteria? No, not in this instance. It's a sober article with several viewpoints represented (and with attribution).

If you want additional context, Oregon's recent policy trajectory seems to be dominated with radical decisions made by bureaucrats, not elected representatives. Such policy-making by appointed bureaucrats is -- essentially -- legislature by individuals or small groups of the like-minded. The problems with this is, of course, are low 'visibility', unaccountability, and undue power and influence of well-connected small minority groups with fringe viewpoints and philosophies. Such bureaucratic power is an antithesis of representative democracy.

Of course, the ideology of the bureaucracy is a reflection on the Governor. Oregon has gone many many years since electing a Republican governor.

Peter said...

"HERC also believes the state will save money due to fewer suicide attempts."

That's what they claim to "believe," but what will they do if/when there are not fewer suicide attempts, and the state also does not save money?

Why, they'll invent new rationalizations to continue doing what they want to do.

Kyzernick said...

The beliefs of the state do not often match reality, even after they attempt to legislate those beliefs into being.

Anonymous said...

Blogger Kyzernick said...
Really glad that most of the commenters here are so very much more intelligent than the prof. I mean that without sarcasm. If it were not the case, I'd go elsewhere. Sometimes I don't even bother reading the content. I go right to the comments after clicking the links, and reading the story, to find sane voices discussing it all.


Interesting that you've written the above. I feel the same way. I almost never come here to read what Althouse has to say on a subject. I find her opinion to be pretty superficial most times. And I don't mean that to be mean or anything, but she focuses on how words are used, or some aspect of a story that I could care less about.

But the comments usually ignore that and go straight to the story. And even those I disagree with here, like MadisonMan, are intelligent and reasoned in their positions, which I like. Granted, there are still the Garage Mahals and what have you, but it's the MadisonMan types and the Michael K's that I come here to read.

Kathyb said...

In a Wall ST Journal article by Johns Hopkins doctor re suicide in transgender reassignment surgery related statistics indicated increased rate of suicide years after surgery. Johns Hopkins stopped doing for that reason.

KenK said...

Prevent suicides you say? I seem to remember Oregon leading the way on that progressive inovation too

LilyBart said...

The article has a somewhat hysterical "Fox News" attitude.

Wow, the bias!

sydney said...

Sporus could not be reached for comment.

Moneyrunner said...

The post has a hysterical Ann Althouse attitude. But then, it's about aberrant sex; something about which Ann is sensitive.

sydney said...

Reading between the lines, I'm thinking that the health authorities are setting things up to draw in teenagers who need psychological treatment and suicide intervention and who will only in very rare cases break through the filters to sex-reassignment surgery. It's something that's possible and that can, perhaps, break the lure of suicide, but it's unlikely to be the actual treatment a young person will receive from the medical professionals he makes contact with.

That's a nice thought, but you give too much credit to "health authorities." I was surprised this was Oregon. I expected it to be Massachusetts, which has a very aggressive transgender movement. I have listened to doctors from Massachusetts talk about clearly mentally ill teenagers being approved for sex reassignment by their state-appointed psychologists. (kids with mental health issues, living in state supported group homes with state appointed mental heatlh "professionals." ) This will ruin lives.

Laslo Spatula said...

A seventeen-year-old Cheerleader giving up on a Vagina that still had New Car Smell?

I don't get this.

I am Laslo.

Joe said...

A teen under 18 cannot consent to oral sex in Oregon, but can consent to a sex change. Even weirder, 20 year-old in Oregon cannot legally buy a beer, but a 15 year-old can consent to a sex change.

This is truly fucked up.

MAX Redline said...

Don't worry, this is all fox news quality hysteria. There's only going to be a few 15 year old boys doing this. Just a few.

Bigots.


You're an idiot.

Why do you imagine that the select committee, appointed by a governor who resigned rather than be thrown out for corruption and who remains under federal investigations (yes, plural), made this change without public input, without legislation, without voter approval?

If this is such a great idea, one might imagine that they'd be holding press conferences and "educating" the public about its benefits. But not only are they not doing that, they're hiding from the press.

There's nothing like good old Oregon "transparency".

Freeman Hunt said...

I don't think faith in The System as it relates to handling children is well placed.

Something like trusting a woodchipper to hold the baby.

MayBee said...

After hearing for decades how bad salt is for us, only to find out studies show it isn't really bad for us....I feel certain not enough science is behind the current transgender push. Not enough research. At least, I don't read about any vigorous research into the issue. It seems to me this is emotion pushing ahead of where the science is, and political correctness keeping us from really questioning if this is the right thing to be doing.
These surgeries are serious business, as are the hormone treatments, and we are really rushing forward. Is it really what's best for the patients?

Zoe Brain said...

What is most important though is not the political nonsense in Op-Eds, it's the facts, the numbers, what treatment actually entails.

If a patient turns 15, it means that they can request initial evaluation for Gender Dysphoria despite parental objection.

This entails a minimum 3-month psychological assessment to ensure the symptoms are present, and not the result of florid psychosis (for example).

Assuming this first hurdle is passed,then assessment by specialists begins, and the administration of puberty-delaying drugs should be considered, to prevent not completely reversible biological changes until the situation is clarified. Basically, they give a breathing-space for further assessment, as to get the diagnosis wrong would be catastrophic. Either a false negative or false positive could be fatal.

Around age 16-17, cross-sexed hormones may be administered. The effects are mostly reversible after 6 months, but after that, and by age 18-19, not completely. So a conservative approach is vital.

Once the patient turns 18, a second team of specialists must re-evaluate the case de novo, and if both original team and this mandated second opinion from post-doctoral specialists in the area concur, then surgery may be authorised.

Ideally, assessment should begin - with full parental informed consent - before age 15. But many parents not merely know nothing about the issue, they know a lot of things that are just plain wrong.

McHugh's factually error-filled opinion piece didn't help.

For those interested in the issue of treating adolescents, I recommend the following PDF:

The treatment of adolescent transsexuals: changing insights. Cohen-Ketternis et al, J Sex Med. 2008 Aug;5(8):1892-7.

"Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue."

Zoe Brain said...

Regarding "rigorous research" - there's a list of a few hundred papers in dozens of medical journals, with URLs to the originals in PubMed and other medical databases, both biological mechanism and effective therapies.

The short, over-simplified answer to mechanism behind it:

A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.
Our study is the first to show a female brain structure in genetically male transsexuals...

In more detail:

Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35
The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.

It's more complex than that, but that captures the essence.

hoyden said...

Ann says, "It's something that's possible and that can, perhaps, break the lure of suicide, but it's unlikely to be the actual treatment a young person will receive from the medical professionals he makes contact with."

Back in 1981-82 at age 28 I understood never to talk about my suicide plans because the therapists would get all distracted by that bit of too much information. Better to stay focused on the goal of getting the green light for SRS or coming to understand of my own free will how I could live life without SRS. I was not open to any other options. I understood talking about suicide was a distraction.

Zoe Brain said...

The WSJ did not see fit to publish this reply to McHugh's article in its entirety, heavily redacting it (the text in bold was omitted)

--

Dr. Paul McHugh (“Transgender surgery isn’t the solution”) writes about the study at Johns Hopkins in the 1970’s showing poor outcomes from transgender surgeries, leading to McHugh shutting down Johns Hopkins’ transgender program in 1979, and the US Department of Health and Human Services declaring transgender surgery experimental, and therefore not covered. Two weeks ago, HHS reversed its 1981 decision, and removed transgender health exclusions from Medicare. McHugh seems unaware of the work in transgender health in these last 30 years that led to this reversal by HHS.

McHugh does cite one study from 2011, by Cecilia Dhejne, MD and colleagues at Karolinska Institute in Stockholm. However, he misunderstands Dr. Dhejne’s work. In the paper, Dr. Dhejne states that the study was not designed to draw conclusions on the efficacy of transgender surgeries, yet McHugh does exactly that. A closer reading of the paper shows that the increased mortality is in those who had surgery before 1989, and that mortality in trans people after 1989 is not statistically different from the general population. A recently published paper by Dr. Dhejne and colleagues shows that the regret rate for those having surgery from 2001-2010 is only 0.3%. Dr. Dhejne’s work shows that outcomes for transgender surgery have improved tremendously in the past 30 years, which supports the HHS decision to remove trans exclusions.

McHugh also mischaracterizes the treatment of gender nonconforming children. As McHugh states, most gender nonconforming children do not identify as transgender in adulthood. However, those who receive puberty blocking drugs do not do so until puberty, when trans identity is likely to persist. These drugs allow adolescents and their parents to work with doctors to achieve the best outcome. This approach was demonstrated to be successful in research in the Netherlands before being adopted widely in the U.S.

The American Psychiatric Association and the World Professional Association for Transgender Health no longer view transgender identity as inherently pathological. Dr. McHugh’s views are stuck in the past.

Dan Karasic, MD
Health Sciences Clinical Professor of Psychiatry, UCSF
Member, American Psychiatric Association Workgroup on Gender Dysphoria
Member, Board of Directors, World Professional Association for Transgender Health

--

Zoe Brain said...

From a document sent out to the WPATH membership:

--

It is important to remember that the opinions of Dr McHugh fly in the face of currently accepted medical practice and the positions of many major medical associations. The American Medical Association, the American Psychological Association, the American College of Obstetrics and Gynecology, the American Psychiatric Society, the American Public Health Association, and the World Professional Association for Transgender Health have all adopted positions supporting the medical necessity of transition-related care, including hormonal and surgical interventions, as well as expressing support for insurance coverage of these interventions. Despite his authoritative sounding title at a respected medical institution, Dr McHugh’s opinions do not represent the views of the mainstream medical establishment .

--

McHugh came to his conclusions on ideological grounds some 40 years ago, without examining the issue, and hasn't changed since, regardless of evidence.

From McHugh's work, Psychiatric Misadventures :
I happen to know about this (sex-reassignment surgery) because Johns Hopkins was one of the places in the United States where this practice was given its start. It was part of my intention, when I arrived in Baltimore in 1975, to help end it.

Marc Puckett said...

Zoe Brain, Thanks for supplying the objectivity absent from the linked article with its "somewhat hysterical 'Fox News' attitude". I am being facetious.

Do you really imagine that citing to sources assembled under the aegis of the World Professional Association for Transgender Health is going to convince many people that it is morally/politically appropriate that 15 year olds should, without parental involvement, begin the medical process that may well end in gender reassignment surgery? Or that many reasonable people imagine that the HHS Department is an objective arbiter of anything?

It looks to me like you are expecting us to take Dr Karasic's word that Dr Dhejne's studies are either misinterpreted or ignored by Dr McHugh: I don't know, I shrug my shoulders. Let other scientists replicate Dr Dhejne's findings, such as they are.

"Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group."

That is the 'conclusion' in the 2011 study's abstract. It may well be that a very small percentage of the persons in Dr Djehne's more recent study 'regret' their gender reassignment surgeries; but that doesn't tell us a thing about the 'considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity', I think, which haven't just vanished into the ether. Nor does it address the possibility that an improved treatment regime with better hormone therapies, drugs etc etc will enable persons to live more satisfying lives without surgery.

I understand that you all are so very certain that this is the right way to proceed in these cases, and that the feds have given their blessing, and the same medical people who gave us Oregon's so-called 'physician assisted suicide' regime are on board. We shall see.

My guess is that the supine legislators in Salem will indulge your project as best they can.

hoyden said...

SRS and related therapies are valid because they address relevant conditions. The John Hopkins point of view is one data point.

A friend of mine said the following in response to my question about suicide rates:

"First of all, definitions. People who cite these statistics rarely define the population they're talking about. People who have completed their transition? People who have partially transitioned? People who have taken hormones? People who have talked with a therapist about being transgender? People who identify as transsexual? As transgender? Crossdressers included?

Second, who's counting? There is no registry for any of the above groups, so we don't know how many there are. Even in ways trans people could be counted (by therapists, by surgeons, by cross-gender hormone prescriptions, etc), it isn't being done. No one is counting trans people. The best we have is estimates, and those vary widely. In order to express a rate of suicide, you have to know how many trans people there are. We don't. Or you have to study a huge random sample of trans people over time. No one has.

Third, how do we know if someone who commits suicide is trans? In many cases we don't. However, a trans person would more often be assumed to be cis than the other way around, which would tend to underestimate the trans suicide rate.

Fourth, what counts as a suicide? Are we counting attempts or successful suicides? Accidents that were probably suicides? Self-inflicted injuries? This is problematic for both trans and cis populations. Counting suicides isn't as straightforward as it might seem. This isn't necessarily a problem for comparative statistics, but you need to make sure suicides are being counted the same way for both cis and trans.

Fifth, are we talking about an annual rate or a lifetime rate? It's a different thing to say 1 of 20 trans people ends up killing themselves than it is to say that the annual suicide rate among trans people is 5%. Suicide rates for the general population are usually expressed as the number of suicides per 100,000 people in a given year (an annual rate). That can't be directly compared with a lifetime rate for trans people.

The fact that the trans population is much smaller than the cis population is irrelevant, because the number of suicides is expressed as a rate or a percentage. So if there are 10,000 trans people in the US, and the suicide rate is 1%, that means there are 100 suicides among those people. If the cis population is 300 million and the suicide rate is 1%, there would be 3 million suicides, which means that for every 10,000 cis people there are 100 suicides. So it's the same rate regardless of the different population sizes.

Personal experience isn't a good basis for judging whether a given rate seems reasonable. First, the people you know aren't a random sample of trans people. Second, people you have known over the years but aren't currently in touch with could have killed themselves and you wouldn't know about it.

I have seen all kinds of "statistics" about suicide among trans people (some higher than 1 in 20), but no reliable studies. Suicide attempts are easier to study than actual suicides, and the rate of suicide attempts among trans people, as well as LGB people, is higher than in the general population. Reasons for this include parental rejection, job discrimination, harassment and abuse, religious condemnation, relationship problems, poverty, substance abuse, societal rejection, and more. There's no evidence I know of that trans people are intrinsically more likely to have psychiatric disorders than other people -- being treated badly by others can affect anyone."

Zoe Brain said...

The best thing to do, rather than asking rhetorical questions about the reliability or otherwise of DHHS decisions and replication of medical articles, sample sizes etc is to read them and judge for yourself.

Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment De Vries et al Pediatrics peds.2013-2958;
--
A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated.
--


DAB No. 2576 - NCD 140 3 Transsexual Surgery
--
The Board has determined that the National Coverage Determination (NCD) denying Medicare coverage of all transsexual surgery as a treatment for transsexualism
is not valid under the reasonableness standard the Board applies. The NCD was based on information compiled in 1981. The record developed before the Board in response to a complaint filed by the aggrieved party (AP), a Medicare beneficiary denied coverage, shows that even assuming the NCD's exclusion of coverage at the time the NCO was adopted was reasonable, that coverage exclusion is no longer reasonable. This record includes expert medical testimony and studies published in the years after publication of the NCO. The Centers for Medicare Medicaid Services (CMS), which
is responsible for issuing and revising NCDs, did not defend the NCD or the NCO record in this proceeding and did not challenge any of the new evidence submitted to the Board.
...
We note that in addition to stating that transsexual surgery was experimental, the NCD and the 1981 report stated that transsexual surgery was "controversial." (NCD Record at 18 (1981 report stating that "[ o ]ver and above the medical and scientific issues, it would also appear that transsexual surgery is controversial in our society")). The AP and the new evidence dispute the relevance of this statement. The AP objected that this point relies on two "polemics" that are "are either completely unscientific or fall far outside the scientific mainstream," and Dr. Ettner stated that the views expressed therein "fall far outside the mainstream psychological, psychiatric, and medical professional consensus, and call into question the objective reasonableness of the NCD. (AP Statement at 15-16; Ettner Supp. Decl. at,;,; 17-18.) CMS has not asserted that the Board's decision may be based on factors over and above the medical and scientific issues involved. Considerations of social acceptability (or nonacceptability) of medical procedures appear on their face to be antithetical to Medicare's medical necessity inquiry, which is based in science, and such considerations do not enter into our decision that the NCD is not valid
--

Zoe Brain said...

hoyden provided an excellent summary of some of the difficulties and uncertainties involved. I intend to plagiarise from that comment extensively in future (giving attribution of course).

I occasionally get called in by professors of medicine and psychology to teach this stuff to 3rd year med students.

(Insert comment about "the blind leading the blind" here)

Regarding the study that McHugh used to justify his pre-determined views, and that he mentioned in the WSJ, that's available online. Meyer & Reter, 1979 as a chapter in Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961-1991 Pfaellin & Junge.

Sample size is 15.

The critique that appeared when it was first published is still valid today.
The tables and figures shared by the authors do not seem serious because after the scoring table a maximum of only eight minus and five plus points can be achieved, but in the results table (p. 1014) a range from -18 to +19 points is given. How these figures came about remains totally in the dark.

When a paper recording a metric with minimum value -8, maximum +5 contains values of 18 to +19, it's difficult seeing how it could have passed even the most cursory peer review, and the fact that its results have never been replicated in the last 35 years is unsurprising. It would be astounding if they had been.

Zoe Brain said...

As regards the situation in Oregon...

"A KOIN 6 News public information request found Oregon taxpayers have paid nearly $30,000 on gender reassignment surgery through Medicaid.

But no one under the age of 18 who gets Oregon Health Plan benefits had sex reassignment surgery. At this time, 10 adults with the plan had the surgery.

The state Health Review Commission approved paying for the operations in January. It requires a year of hormone therapy for someone to qualify for a state-funded operation.

A total of 17 teenagers are approved for getting hormone treatment.

Even though the age of medical consent in Oregon is 15, state officials and transgender activists both said nothing in Oregon law requires a health care provider to give medical care to a minor or keep information from parents."

KOIN

I have no idea if those figures are accurate or not, but they are plausible and within my expectations. A bit low, perhaps, an MtoF surgical transition costs on the order of $25,000, but the psychological assessment beforehand costs rather more.

Seamus said...

Even though the age of medical consent in Oregon is 15

Not if you're trying to change your sexual orientation: http://www.cnn.com/2015/05/20/politics/oregon-outlaws-gay-conversion-therapy/

Because apparently therapy that involves talking to a minor is more traumatic than permanent body-altering surgery.

Zoe Brain said...

"Because apparently therapy that involves talking to a minor is more traumatic than permanent body-altering surgery."

It does increase the mortality rate from 40% to 60% yes. It's probably not the "talking" part of the treatment regime that's solely responsible though.

The figures - transition - decrease from 40% to <4%. "Talking cures" by unlicensed therapists, including beatings, electric shocks to genitals etc - increases from 40% to 60%.

See for example https://en.wikipedia.org/wiki/Death_of_Leelah_Alcorn

Not atypical unfortunately, just far more well publicised than most.