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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Transgender. Show all posts
Showing posts with label Transgender. Show all posts

Tuesday, March 26, 2024

Why the largest transgender survey ever could be a powerful rebuke to myths, misinformation

Susan Miller
USAToday.com
Originally posted 23 Feb 24

Here is an excerpt:

Laura Hoge, a clinical social worker in New Jersey who works with transgender people and their families, said the survey results underscore what she sees in her daily practice: that lives improve when access to something as basic as gender-affirming care is not restricted.

“I see children who come here sometimes not able to go to school or are completely distanced from their friends,” she said. “And when they have access to care, they can go from not going to school to trying out for their school play.”

Every time misinformation about transgender people surfaces, Hoge says she is flooded with phone calls.

The survey now gives real-world data on the lived experiences of transgender people and how their lives are flourishing, she said. “I can tell you that when I talk to families I am able to say to them: This is what other people in your child’s situation or in your situation are saying.”

Gender-affirming care has been a target of state bills

Gender-affirming care, which can involve everything from talk sessions to hormone therapy, in many ways has been ground zero in recent legislative debates over the rights of transgender people.

A poll by the Trevor Project, which provides crisis and suicide prevention services to LGBTQ+ people under 25, found that 85% of trans and nonbinary youths say even the debates about these laws have negatively impacted their mental health.

In January, the Ohio Senate overrode the governor’s veto of legislation that restricted medical care for transgender young people.

The bill prohibits doctors from prescribing hormones, puberty blockers, or gender reassignment surgery before patients turn 18 and requires mental health providers to get parental permission to diagnose and treat gender dysphoria.


Here are my thoughts:

A landmark study is underway: the largest survey of transgender individuals in the United States. This comprehensive data collection holds the potential to be a powerful weapon against harmful myths and misinformation surrounding the transgender community. By providing a clear picture of their experiences, the survey can challenge misconceptions, inform policy, and ultimately improve the lives of transgender individuals. This data-driven approach has the potential to foster greater understanding and acceptance, paving the way for a more inclusive society.

Sunday, July 16, 2023

Gender-Affirming Care for Cisgender People

Theodore E. Schall and Jacob D. Moses
Hastings Center Report 53, no. 3 (2023): 15-24.
DOI: 10.1002/hast.1486 

Abstract

Gender-affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of "gender-affirming care" that distinguish it from previous therapeutic models, such as "sex reassignment." Next, we sketch two historical cases-reconstructive mammoplasty and testicular implants-to show how cisgender patients offered justifications grounded in authenticity and gender affirmation that closely mirror rationales supporting gender-affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in "trans exceptionalism" that produces demonstrable harm.


Here is my summary:

The authors cite several examples of gender-affirming care for cisgender people, such as breast reconstruction following mastectomy, penile implants following testicular cancer, hormone replacement therapy, and hair removal. They argue that these interventions can be just as important for cisgender people's mental and physical health as they are for transgender people.

The authors also note that gender-affirming care for cisgender people is often less scrutinized and less stigmatized than such care for transgender people. Cisgender people do not need special letters of permission from mental health providers to access care whose primary purpose is to affirm their gender identity. And insurance companies are less likely to exclude gender-affirming care for cisgender people from their coverage.

The authors argue that the differences in the conceptualization and treatment of gender-affirming care for cisgender and transgender people reflect broad anti-trans bias in society and health care. They call for a more inclusive view of gender-affirming care that recognizes the needs of all people, regardless of their gender identity.

Final thoughts:
  1. Gender-affirming care can be lifesaving. It can help reduce anxiety, depression, and suicidal thoughts.  Gender-affirming care can be framed as suicide prevention.
  2. Gender-affirming care is not experimental. It has been studied extensively and is safe and effective. See other posts on this site for more comprehensive examples.
  3. All people deserve access to gender-affirming care, regardless of their gender identity. This is basic equality and fairness in terms of access to medical care.

Sunday, June 18, 2023

Gender-Affirming Care for Trans Youth Is Neither New nor Experimental: A Timeline and Compilation of Studies

Julia Serano
Medium.com
Originally posted 16 May 23

Trans and gender-diverse people are a pancultural and transhistorical phenomenon. It is widely understood that we, like LGBTQ+ people more generally, arise due to natural variation rather than the result of pathology, modernity, or the latest conspiracy theory.

Gender-affirming healthcare has a long history. The first trans-related surgeries were carried out in the 1910s–1930s (Meyerowitz, 2002, pp. 16–21). While some doctors were supportive early on, most were wary. Throughout the mid-twentieth century, these skeptical doctors subjected trans people to all sorts of alternate treatments — from perpetual psychoanalysis, to aversion and electroshock therapies, to administering assigned-sex-consistent hormones (e.g., testosterone for trans female/feminine people), and so on — but none of them worked. The only treatment that reliably allowed trans people to live happy and healthy lives was allowing them to transition. While doctors were initially worried that many would eventually come to regret that decision, study after study has shown that gender-affirming care has a far lower regret rate (typically around 1 or 2 percent) than virtually any other medical procedure. Given all this, plus the fact that there is no test for being trans (medical, psychological, or otherwise), around the turn of the century, doctors began moving away from strict gatekeeping and toward an informed consent model for trans adults to attain gender-affirming care.

Trans children have always existed — indeed most trans adults can tell you about their trans childhoods. During the twentieth century, while some trans kids did socially transition (Gill-Peterson, 2018), most had their gender identities disaffirmed, either by parents who disbelieved them or by doctors who subjected them to “gender reparative” or “conversion” therapies. The rationale behind the latter was a belief at that time that gender identity was flexible and subject to change during early childhood, but we now know that this is not true (see e.g., Diamond & Sigmundson, 1997; Reiner & Gearhart, 2004). Over the years, it became clear that these conversion efforts were not only ineffective, but they caused real harm — this is why most health professional organizations oppose them today.

Given the harm caused by gender-disaffirming approaches, around the turn of the century, doctors and gender clinics began moving toward what has come to be known as the gender affirmative model — here’s how I briefly described this approach in my 2016 essay Detransition, Desistance, and Disinformation: A Guide for Understanding Transgender Children Debates:

Rather than being shamed by their families and coerced into gender conformity, these children are given the space to explore their genders. If they consistently, persistently, and insistently identify as a gender other than the one they were assigned at birth, then their identity is respected, and they are given the opportunity to live as a member of that gender. If they remain happy in their identified gender, then they may later be placed on puberty blockers to stave off unwanted bodily changes until they are old enough (often at age sixteen) to make an informed decision about whether or not to hormonally transition. If they change their minds at any point along the way, then they are free to make the appropriate life changes and/or seek out other identities.

Friday, March 6, 2020

Transgender and Intersex Kids Must Have a Voice in Health Care Decisions

Scott Nass
thenation.com
Originally posted 13 Feb 20

Here is an excerpt:

We physicians are not allowed to take critical care away from patients, nor to force interventions on them, just because their bodies and needs don’t fit our personal expectations of “normal.” That’s not a part of our oath. Prioritizing patients means focusing on what they say they need, supporting each patient and their family in age-appropriate ways. The answer is very simple: Individuals must take the lead in making decisions about their own bodies.

Just because individuals are minors now does not mean they won’t have wishes for their bodies in the future. Transgender and intersex youth grow up. When they are denied their own choices, families bear the resulting stress and trauma.

If you don’t know any transgender or intersex kids, it may feel easy to shrug this off. But this is about more than just a few bad bills. Intersex and transgender children’s bodies are being used to uphold regressive ideas about gender’s being based on anatomy and fixed at birth, with medicine used to enforce rather than affirm.

It’s clear to me, as a physician who helps intersex and transgender children live healthy lives, that those who supported the South Dakota bill are putting youth at risk. Nearly 45 percent of transgender youth considered suicide in 2017, according to the Trevor Project. Those numbers are highest when children are not allowed to affirm their gender. Of intersex children who had infant clitoral surgery, 39 percent could not achieve orgasm as adults, compared to 0 percent in a control group. Many families are never told about these types of risks.

The info is here.

Thursday, August 25, 2016

Gender, identity, and bioethics

Elizabeth A. Dietz
The Hastings Center Report
First published: 15 July 2016

Abstract

Transgender people and issues have come to the forefront of public consciousness over the last year. Caitlyn Jenner' very public transition, heightened media coverage of the murders of transgender women of color, and the panicked passage of North Carolina's “bathroom bill” (House Bill 2), mean that conversations about transgender health and well-being are no longer happening only within small communities. The idea that transgender issues are bioethical issues is not new, but I think that increased public awareness of transgender people and the ways that their health is affected by systems that bioethics already engages with offers an opportunity for scholarship that works to improve transgender health in meaningful ways.

The article is here.

Monday, April 18, 2016

Bathroom Bills, Bigotry, and Bioethics

Elizabeth Dietz
The Hastings Center Bioethics Forum blog
March 31, 2016

Here is an excerpt:

HB 2 should incite the worry, and the anger, of bioethicists on several fronts. It is unclear how transgender people could even comply with the letter of the law, let alone its spirit. When transgender men who are read as men – but whose birth certificates say “female”–- are compelled to use the women’s restroom, this creates precisely the “problem,”- i.e., the idea of men invading a women’s only space, that the law purports to protect against. The law’s defenders have invented an imaginary threat to shore up support for the legislation, insisting that women are endangered if transgender women, who are routinely misgendered as “men” in this rhetoric, are allowed to share these spaces. While a 2013 survey by the Williams Institute of UCLA School of Law found that “roughly 70% of trans people have reported being denied entrance, assaulted or harassed while trying to use a restroom,” there is no evidence of violence perpetrated by transgender people in restrooms.

The article is here.

Wednesday, May 13, 2015

Born this way? How high-tech conversion therapy could undermine gay rights

By Andrew Vierra and Brian Earp
The Conversation
Originally published on April 21, 2015

Here is an excerpt:

We fully agree with the President and believe that this is a step in the right direction. Of course, in addition to being unsafe as well as ethically unsound, current conversion therapy approaches aren’t actually effective at doing what they claim to do – changing sexual orientation.

But we also worry that this may be a short-term legislative solution to what is really a conceptual problem.

The question we ought to be asking is “what will happen if and when scientists do end up developing safe and effective technologies that can alter sexual orientation?”

Based on current scientific research, it is not unlikely that medical researchers – in the not-too-distant future – will know enough about the genetic, epigenetic, neurochemical and other brain-level factors that are involved in shaping sexual orientation that these variables could in fact be successfully modified.

The entire article is here.

Wednesday, July 18, 2012

Treatment of Gender Identity Disorder: Guidelines from the ApA

by Mary Elizabeth Dallas
MedicineNet.com
Originally published on July 6, 2012

Psychiatrists who see transgender patients need specific guidelines to help determine the best course of treatment, according to new report from the American Psychiatric Association.

The American Psychiatric Association Task Force on Treatment of Gender Identity Disorder also calls for the psychiatrists' group to clarify its position on the health care and civil rights of people who are transgender or transitioning gender, meaning they are in the process of changing their gender through hormones and surgery.

The entire story is here.

The guidelines from the American Psychiatric Association are here.