More on Nonprofit Transgender Clinics: Washington University

Kids get surgery all the time, much of it is elective.  Its a safe bet those surgeries are performed only after parents made a decision, and especially in the case of transgender treatment, the child has been appropriately counseled probably over period of years as children and parents try to figure out why the child is so unhappy or worse.  Some surgeries are elective in the medical sense, but no doubt considered essential to a child and his or her parents.  Childhood obesity for example.  A small population of teenagers even get breast augmentation; not all of those kids are transgender, some undergo the procedure for issues of self-esteem I imagine.  So come one, aren’t legislators seeking to make transgender care illegal really just hating transgender people?  I betcha transgender treatment is no more irreversible than a lot of treatments kids receive.  Here is what the NY Times reports about children having surgery for obesity:

The American Academy of Pediatrics released new guidance last week about how to evaluate and treat children who are overweight or obese, issuing a 73-page document that argues obesity should no longer be stigmatized as simply the result of personal choices, but understood as a complex disease with short- and long-term health implications.

Based on that rationale, the guidelines — the group’s first update in 15 years — say there is no evidence to support delaying treatment for children with obesity in the hope that they will outgrow it. Instead of the gradual, staged approach recommended in the past, pediatricians and primary care physicians should take a more proactive tack, offering prompt referrals to intensive health behavior and lifestyle treatment programs, in addition to prescribing weight loss drugs or advising surgery in some cases. 

The recommendations around medication and surgery have generated many discussions on social media and a degree of controversy. Some experts on adolescent health have warned that such interventions may be harmful, noting that the use of anti-obesity medications in children is still relatively new, while surgery requires a long-term commitment to strict nutrition requirements. 

Bariatric surgery is a good intervention for some patients — patients with medical complications such as Type 2 diabetes or nonalcoholic fatty liver disease, for example,” said Dr. Katy Miller, the medical director of adolescent medicine at Children’s Minnesota. “But it is a very serious surgery that carries profound impacts for the rest of a patient’s life.”  Dr. Mona Amin, a pediatrician in Florida who did not work on the guidelines, believes that some of the “uproar” around medication and surgery stems from a misunderstanding that the A.A.P. is promoting these aggressive interventions as a first step.  “In fact — and I really want to clarify this — when you read everything, they’re trying to come up with a multidisciplinary plan for clinicians so they have options,” Dr. Amin said. “They are not advocating for surgery or medication as a first line.”

Notice how the term “gender dysphoria” can be substituted for “obesity” and the excerpt would still make perfect sense.  We don’t pass laws against childhood obesity surgery because we are sensible enough to leave that decision to the doctors, the parents, and the kid.  And I have no doubt that medication and surgery for gender dysphoria are last ditch efforts.  Nonprofits are not prowling the streets trying to make fat kids skinny and straight kids queer.

We don’t attack nonprofit healthcare, either, for elective surgeries offered to children and their parents.  But as we blogged a few weeks ago, lawmakers in Tennessee demanded Vanderbilt Medical Center stop offering transgender treatment to children or risk its tax exempt status.  Now, the same thing is happening to Washington University, where a person described as a whistle blower published the following:

I am a 42-year-old St. Louis native, a queer woman, and politically to the left of Bernie Sanders. My worldview has deeply shaped my career. I have spent my professional life providing counseling to vulnerable populations: children in foster care, sexual minorities, the poor. 

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children’s Hospital, which had been established a year earlier. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

After the whistleblower got representation from a attorney specializing in protecting kids from LGBTQ people, she submitted an affidavit to the state attorney general.  A scientist — described as a noted LGBTQ mental health expert and a Washington U faculty member — responded to the whistleblower’s open letter thusly:

“The rhetoric follows many common tropes peddled by those who oppose the social affirmation and medical treatment of transgender adolescents and adults,” Jeremy Goldbach and Shannon Dunlap write. “By centering the perspective of only one individual, the article leaves medical and mental health professionals, academics, and most importantly, trans adolescents and their families voiceless while purporting to advocate for them.”

The scientists’ response contains much more, but essentially constitutes a plea for a reasoned, evidence based approach to health care.  Scientist can be pushy like that.  The whistle blower, by the way, describes herself as “queer, to the left of Bernie Sanders, and married to a transman.”  Nevertheless, the University still pointed out the possibility that she just doesn’t know what she’s talking about: