By Robert Koshnick, M.D.
The adolescent transgender medicalization movement will arrive soon in your state and medical society, if it has not already.
Transgender medicine is not based on science but on ideology. The Society for Evidence Based Gender Medicine points out six methodological errors and several untoward ramifications of gender ideology in medicine in an article titled “The Dutch Studies and the Myth of Reliable Research in Pediatric Gender Medicine.”
Gender refers to the norms, behaviors, and roles associated with women, men, girls, and boys that are socially constructed and culture-specific. One way of dealing with variations is to accept whatever behavior an individual has as part of the bell curve of behaviors of their natal sex. A gender non-conforming person would then not require sexual transition.
The other way is to believe in rigid sex roles, medicalize gender variations, and offer sexual transition early in adolescence to those who “feel they are in the wrong body.” Gender identity is very fluid in adolescence (as opposed to sexual orientation). Gender ideologists believe adolescents have the right to match their physical sexual appearance with their perceived gender in order to conform to gender norms, behaviors, and roles.
Dutch Model
The adolescent sex transition movement accelerated after the publication of the “Dutch Studies” in 2011 and 2014. The experiment was funded by the pharmaceutical company Ferring, which markets the puberty blocker Triptorelin.
The study started with a sample of 196 adolescents. This was cut down to 70 in the 2011 paper. It was further cherry cherry-picked to 55 transitioners in the 2014 paper. There was no explanation of what happened to the dropouts, one of whom died of surgical complications.
This was not a random controlled trial. There were no controls. The effects of mental health counseling and support were not separated from the sex transition component. There were only 18 months of follow-up.
The thesis was that sexual transition through hormonal manipulation by puberty blockers, hormone reversal, and surgery could benefit adolescents. This was then codified by an organization called the World Professional Association for Transgender Health (WPATH) into what they called standards of care (SOC). The latest edition (SOC-8) is the bible for gender ideologists.
Gender Ideologist Position
Gender ideologists start by manipulating language. Their chosen term is “gender affirming care.” This is an example of what Herbert Marcuse, the father of critical race theory, called “liberating tolerance.”
Liberating tolerance means that only views supporting liberation are tolerated and censorship, repression, and, when necessary, violence are justified against anyone who opposes them. This is the theoretical justification of the cancel culture. Anyone opposed to sexual adolescent transition needs to be silenced, canceled, shunned, and humiliated for their views.
The policy goal of the transgender movement is to remove all barriers to medical gender transition. SOC-8 advocates for the elimination of age minimums for sexual transition if “The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated.”
This normally occurs between 8 and 13 years in girls and 6 to 12 months later in boys. The only other SOC-8 exception is that “Given the complexity of phalloplasty, and current high rates of complications in comparison to other gender-affirming surgical treatments, it is not recommended this surgery be considered in youth under 18 at this time.”
SOC-8 recommends chemical or surgical castration and sex transition as early as Tanner stage 2. That has irreversible lifelong physical and social implications. Ethical considerations such as “first do no harm” should be at the forefront of this discussion.
Yet, SOC-8 eliminated the chapter on ethics. SOC-8 only mentions the word “ethics” twice in its chapter on adolescents, both referring to their right to self-determination. This is despite our understanding that the prefrontal cortex, where cause and effect reasoning occurs, does not complete development until age 23 in females and 25 in males.
Turning Point?
The major organization opposing WPATH is Genspect. On November 4-5, 2023, Genspect held a conference called “The Big Picture,” in Denver, where it released a 334-page “Gender Framework.” The Gender Framework does not recommend medical sex transition until adulthood (age 18). That document may represent a turning point for the adolescent sexual transition movement.
Genspect points out that there is no quality evidence to support the use of puberty blockers for children, and no studies showing sexual transition in adolescents leads to long-term positive mental, physical, social, or romantic outcomes compared to “watchful waiting” or counseling and psychotherapy. Thus, Genspect recommends these conservative approaches for adolescent gender confusion, not sexual transitioning.
On the legal front, nine lawsuits have already been filed in the United States by detransitioners. One significant lawsuit is against the American Academy of Pediatrics (AAP) and Jason Rafferty, M.D., who authored the 2018 AAP policy statement and has been one of the biggest advocates of gender-affirming hormones.
This is the opening volley of what is likely to be a tsunami of detransitioner lawsuits from the 51,000 people on the reddit website, r/detrans.
European countries, which have already abandoned gender transitions in adolescents, may or may not have laws that protect state-run gender clinics from lawsuits. It will be open season on gender clinics in America, whether private or public.
This is highly likely going to be the greatest medical litigation explosion ever seen, and one of the greatest medical scandals of all time.
Robert Koshnick, M.D. (bob.koshnick@gmail.com) is a retired primary care physician from Detroit Lakes, Minnesota. Koshnick was chair of the policy committee of the Minnesota Medical Association in 2023 and author of Empower-Patient Accounts Empower Patients!