Comments

Comments

1. There is no scientific evidence that gender reassignment has a positive health effect.


Several studies show that it cannot be established that, in general and on the average, there is a positive health effect of gender reassignment treatments:


  • In 2011, Dr. C. Dhejne, head of investigations (2019) of gender incongruence/ dysphoria in the department of ANOVA, Karolinska Hospital, Sweden, published a study (2011) which shows that the risk of suicide does not decrease after gender reassignment.
  • Dr Stefan Arver, head of the ANOVA department, Karolinska (2019), coauthored a report ordered by the Norwegian Directorate of Health, "Right to the right gender" (2015). The report states clearly that very little is known about the health effect of gender reassignment treatment.
  • In an interview in "Världen idag" (Sweden), 2018, Arver states that gender reassignment does not reduce psychiatric problems of transpersons. This deserves attention due to the 75% high co-morbidity of psychiatric issues observed in a recent study of persons suffering from gender dysphoria.
  • A team from the Sahlgrenska Hospital, Gothenburg, Sweden, who perform "gender-correcting" plastic surgery presented a meta-study (70 studies) aiming to evaluate the benefit of  so called Sex-reassignment-surgery (SRS).  They found that most transpersons who underwent the surgery perceived the changes as positive. Nevertheless, the authors, who themselves are positive to SRS and thus cannot be suspected of bias against it, also concluded that the data show that the SRS does not lead to an improved quality of life.
  • The University of Birmingham established a professional statistics center, "ARIF". One of their tasks was to serve as a consultant to the West Midlands Health Service to objectively analyze current and novel medical treatment of disease. In a meta-study (100 studies) they concluded (2004, summary of the report can be found on this web page under "Video & pdf") that there is no statistically significant positive health effect from "gender correction" treatment. Furthermore, they write that many studies which present claims to the contrary are of a very low quality, with deficiencies in methodology and with an obvious "agenda" (political or ideological).
  • Chief Psychiatrist Dr. Paul McHugh, Johns Hopkins University Medical Center, USA, (one of the worlds most renowned medical centres and founder of child psychiatry as a medical disciplin) was active in the clinic that were the first in the US to refer transpersons to "sex reassignment surgery (SRS)". After 40 years of SRS,  he writes (Wall St. J., 2017) that "We have made a mistake" (in performing SRS treatments) and acts to put a stop to SRS at the Johns Hopkins hospital (the largest hospital in the world).

  • The British Medical Journal published an editorial (2019) in which they concluded that gender-reassignment / affirmative treatment of children and adolescents must be considered experimental and is not evidence-based.

  • The UK Tavistock clinic is the only clinic in GB which offers investigation and treatment of prepubertal children with gender dysphoria. Five workers recently resigned from this British National Health Service (NHS) clinic giving ethical grounds for their defection. They assert that the current treatment of children and adolescents is not based on medical science or experience. A Psychologist "whistle blower" at the GIDS unit claims confused children are wrongly being labelled transgender and referred to sex-reasisgnment surgery.

  • An extensive study in Denmark (2016) which includes all individuals that underwent gender reassignment in Denmark concludes that mental health is not improved by gender reassignment, nor is suicide risk reduced.

  • GIDS, UK, report that suicide amongst children referred to the clinic is extremely rare.  This shuld be judged in light of the largest study of suicidality amongst Transgender persons ever (USA, 27000 in survey) which concludes that lifetime suicide attempts amongst Transgender persons is 40%.

  • The Royal College of General Practitioners, the GP's association in the UK, recently published a report where they warn that the current treatment of children and adolescents with gender dysphoria in GB lacks medical scientific evidence. The Daily Mail presented a summary of the 12-page report. (7 July 2019).

         REFERENCES

2. There are large unknowns on the number of regretters. (Long-term follow-up is lacking, but early "euphoria" that turns into regret is documented.)


The psychologcal barrier for a transperson, who transitioned with sex reassigment, to "come out" and admit he regrets, is enormous. Even so called desisters who only went through a social transition report that they considered commiting suicide rather than facing friends and society after admitting that they realized they had been confused, they got it wrong, that they are in fact content with ther biological sex/gender.


The Karolinska Hospital, Sweden, states in media (both in Norway and in Sweden) that they find very few regretters, about 2%, in their studies. This number lacks proper scientific critical analysis and anchoring. Typically, such claims are shrouded in smoke screens; "Only 2% say they regret". is an obvious attempt to evade rigorous investigation and objective analysis. Conclusions are disseminated about what the limited and biased group of patients who have been in contact with the hospital "say". Those who committed suicide or did not agree to participate or who cannot be located, say nothing in this study.


Karolinska's figures, however, relate only to the small group of patients who formally asked to do "detransition". This arbitrary and obviously false definition of who are "regretters" is deplorable. It is known that the majority of regretters blame themselves for their erroneous "gender correction". They don't, generally, blame the healthcare sector, the psychiatrists and investigators. The regretters are ashamed or do not dare take the step to ask for a detransition. They also experience pressure from and loyalty conflicts with previous friends in the trans-activist environment.


The statement from Karolinska is also not credible by other, more objective criteria. Comparable figures from the US and GB show around 10% regretters of this same category of transpersons, i.e the small subclass of regretters who formally contact the healthcare sector to ask for a detransition procedure. Behind the British and American investigations are investigations involving tens of thousands of transpersons. Karolinska offers no explanation of why their numbers for the same category of "regretters" are a factor of five lower than these huge studies.


Recent numbers on official detransitioners indicate higher frequencies of detransition. If one asumes equal percentages of friends, close of kin and supporters both in "transgender" and "Detransitioners" groups, then the number of offical detransitioners would be of the order of 15% (i.e also not including the "hidden regretters).


Furthermore, Karolinska Hospital's investigators have systematically sent out questionnaires prematurely to their own transgender patients who underwent SRS. Typically, surveys have been sent less than 6 months after surgery, with questions about whether they are satisfied with the gender reassignment. Long-term follow-ups are missing (even though these are required by Swedish legislation). It is well known that during the first year after gender reassignment, the patients who underwent SRS experience "Euphoria" which then slowly turns into regret. The typical time for regret, however, is 5 years but can often stay "hidden" for others except the closest family for 10-15 years. The team at the Karolinska/ ANOVA does not mention the problems that lie in their very inadequate definition, in the investigations and lacking follow-up. This makes Karolinskas objectivity questionable.  REFERENCES

3. Co-morbidity of psychiatric problems is very high, recent studies conclude 70-80%.


Many studies show that there is a very high degree of co-morbidity with psychiatric problems among those with gender dysphoria. (Activists for transgender people's right to gender reassignment treatments oppose the term co-morbidity, but this is only a semantic issue that is not medically relevant here). More recent studies from Finland and the US, conclude that the co-morbidity with significant psychiatric issues is 75-80%. Previous studies from non-Scandinavian countries also show very high numbers. A new development is that previously were psychiatric issues higher for men/ boys (transwomen).The study from Finland shows that the co-morbidity of mental issues for women/ girls (transmen) has "caught up" with those for transwomen (boys at birth).


It is strange that ANOVA, the Karolinska Hospital, Sweden, present a low incidence (about 4%) with mental problems (C Dhejne et al., 2016) in their summary of investigations of co-morbidity of transpersons. This they find from "meta studies" without presenting their own data, and neglecting to present teh limitations in their summary. Again, Karolinska seems to build a report with "smoke screens" and lacking credibility. Their statistics is so distinctly different from another Scandinavian study and from what has become international consensus.


It is remarkable that the summary in the publication fails to mention that autism spectrum disorders (ASD) in those with gender dysphoria are not included in the compilation. It is startling for a summary that authorities and interest groups will read and which characterizes mental illness, as it is well known that ASD is the most dominant psychiatric issue correlating with gender dysphoria. The British NHS reports about 35% comorbidity, the Helsinki study indicates an order of 25%. This psychiatric co-occurence is of course well known to Dhejne et al., it has been known since the early 1990s, with hundreds of published articles. It is noteworthy that Karolina's summary does not mention this important limitation in an article dealing with the frequency of mental illness seen in transgender persons.


Equally noteworthy is the claim in the summary and paper, that mental health problems decrease after gender correction, sex-reasignment. This is in contradiction with international consensus.


Mental problems in girls have increased dramatically over the past ten years. At the same time, gender dysphoria of that group has increased along the same timeline. Research attempts to clarify the causal link for these rapid negative developments are yet to be presented. 


In recent years psychiatric problems for young girls have increased dramatically and gender dyspghoria has increased even faster. GD for boys has has also had an avalanch-like increase but the GD for boys lags a few years, in their debute age, behind that of the girls. Research is yet to unravel the cause of these explosive developments. 

In Sweden the Karolinska hospital (KS) stipulate that the exceptional increase  is a result of the change in Swedish legislation in 2013, when it became possible to change official gender without the demand of sterilization. This explanation is not compatible with the observations that 


a) the same development is seen in all Western countries, Europe and USA.

b) There is a correlated dramatic increase also in psychiatric related probems in the same age group  (anxiety, self-harm, anoreixa, depression)

c) There are large differences in debute age of the development of GD for boys and girls that remain the same after 2013 (Marchiano, 2017 Fig.1 and figure above).  Had the KS hypothesis been valid then changes in 2013 should have been parallel for boys and girls.


It is worrying that KS don't dicuss the problems with a hypothesis which hinders evaluation of the roles of social contagion, elements of mass psychogenic illness and the influence of social network availability to youngsters.

REFERENCES

4. Gender reassignment (hormones and or surgery) does not reduce psychiatric problems.


The Norwegian media has repeatedly reported (Aftenposten 2018, "At Torp" (Benestad), NRK, 2019) that mental problems disappear after gender reassignment treatment. These completely erroneous claims are spread by so-called activists in Norway with an ideological agenda that they give priority over the medical research conclusions. They wish to take over treatment from the Hospital (NBTS, Norway) also of children and adolescents. There is an international consensus of that the claims are false, i.e.  the psychological problems do not disappear, they don't even diminish, after sex reassignment treatment. See discussion section (1).

REFERENCES

5. Suicide risk does not decrease after gender reassignment treatment.


Misleading information is regularly provided by activists that providing gender reassignment treatment, hormones, puberty blockers is justified due to the risk that people who suffer from gender dysphoria are more likely to commit suicide if they do not receive "gender confirming" health care (i.e. involving adaptation to the perceived sex). The arguments are false, since repeated studies abchave established that suicide risk does not diminish with gender reassignment. See section (1) above. There is again international consensus for this conclusion.


A detailed analysis of studies of suicidality of transgender persons reveals many caveats, se review by Zucker,  many  with selection bias. One study, included in a metastudy, fitered out those transgender persons who had psychiatric comorbidity issues (75-80% !).


In a  big study in the USA the conclusion was that lifetime risk of transpersons suicide attempt was 40%. This contrasts with reports from the GIDS unit for referral of all children and youth in the UK, that  suicide during investigation (i.e. prior to transitioning) is "extremely rare". This indicates that suicide risk after transitioning increases, there is little evidence that it decreases.

 REFERENCES

6. One must begin by investigating psychiatric issues. Affirmative treatment must not start before evaluation.

7. Only teams of experts with long clinical experience in making psychiatric diagnoses should investigate children/ adolescents.  


The Endocrinological Society has written "International Guidelines" for the investigation and care of the gender incongruence / transsexualism / gender dysphoria. They emphasize that all treatment of children and adolescents must be preceded by extensive psychiatric investigation by professional psychiatrists. These are their starting sections 1.1 and 1.2 in the "International Guidelines". Guidelines are written by research and clinical groups with long experience and they are the leading research groups in the world today (four-digit numbers of peer-reviewed articles). The Guidelines document was thus written with strong groups behind it and not just individuals with uncertain credentials in research and in the clinic. The Endocrinological Society writes that only psychiatrists with (long) experience of giving clinical psychiatric diagnoses should perform the psychiatric evaluation of children and adolescents and that investigations should be done by teams of experts.


Consistent with these direvtives is the warning by the renomated group in Amsterdam that also an affirmative treatment involving only "social transitioning" is deprecated since it may consolidate Gender dysphoria.


"The World Professional Association for Transgender Health (WPATH)" has also published guidelines, the so called "Standards of Care". In comparison with the "International Guidelines" it should be noted that "Standards of Care" have been written by individuals who do not necessarily have the support neither of research groups, nor experienced healthcare providers or clinical investigators of transpersons. Standards of Care also does not distinguish between basic qualifications in psychiatric competence as required for the investigation of children/ adolescents on the one hand and the basic qualifications required for the investigation of adults. This is critically differenct to the directives in the Endocrinological Society guidelines which maintain higher standards and specific requirements for investigators of children and adolescent gender dysphoria.


It is also odd that "Standards of Care" states that basic qualifications for psychiatric competence for investigation are also obtained by, for example, "A couple's counsellor" or a nurse. No specification of specialty medical psychiatric expertise, University level education in psychology, or experience is provided by "Standards of care". This means that according to "Standards of Care", a couple's therapist or a nurse who has passed the basic nurse education exam filter also has the required basic qualifications to do psychiatric investigation also of children and adolescents. There are no guidelines fin "Standards of Care" or objective requirements on psychiatric competence that must be set for the investigator's competence.


"The American Association of Pediatrics (AAP)" has also written guidelines for the care of gender dysphoria. These are written by, in principle, a single person.


(See the entire WPATH "Standards of Care", and the Endocrinological Society "International Guidelines" under "Articles").

  REFERENCES

8. Children/ adolescents grow out of the gender incongruence (80 - 90%) while on the other hand ...


Many studies show that children grow out of sex incongruence during puberty. "Activists" have tried to reject these studies, they claim that they are loaded with errors, but the attempts to disqualify the studies have not passed the "peer review" process; the criticisms are arbitrary and without scientific basis. For example, some arguments address problems in the selection of the children that were included in the studies and uncertainties in which are to be regarded as having gender dysphoria. The claim is that some will turn out to be homosexual but do not have identity problems. The critique is irrelevant. Such ambiguities are always in the investigation of children before puberty, but even with very restrictive interpretations of which children should be considered to show gender dysphoria before puberty, the proportion that grow out of gender dysphoria is very high, if not 90% then 80%. Corrections that "possibly" should be taken into account only mean minor adjustments in the high numbers for children who grow out of gender dysphoria without interference from the health care sector.


One argument put forward is that only children who, after puberty, are still showing gender dysphoria should have been counted among the group of children who, before puberty, suffered from "true" gender dysphoria, i.e. that the others included in the group were clearly mistakenly included. The unreasonable assumption in the argument is that with such a "retrospective" adjustment of who should be considered to have suffered from the gender incongruence/ dysphoria, then evaluation of gender incongruence's lacks prognostic value for prepubertal children. The "activists" thus can manipulate the figures "to show" that the number of children that grow out of gender dysphosira is - 0%! 


Similar irrelevant arguments have been put forward to claim that only those who, after puberty has already begun, still show gender dysphoria should have been included in the study. This is just another twist of the above false argument. Statistically, it is clear that the small group (10-20%) who in the end will have lasting gender dysphoria, will obviously take up a greater and greater part of the "non-desisters" as puberty proceeds. Their  proportion will be falsely increased the longer puberty progresses, fter more and more children have desisted, leaving ony the ones that did not. It is irrelevant with such an analysis to evaluate how many people become desisters. The interest mecial science has is in the uncertainty of the initial psychiatric evaluation. The important point remains, up to 90% of all prepubertals with the gender incongruence will grow out of it. 

  REFERENCES

9. .... treatment with puberty blockers confirms gender incongruence in 100% of treated children/ adolescents  


It is grave that many care givers who act for the rights of transpersons do not admit or fully consider the risk of making an error, which is huge, if one starts treating children before puberty with puberty blockers. Recent research shows that "affirmative" treatment leads to irreversible fortification of the gender dysphoria.


In Sweden and Norway, so called "trans activists" are actively pursuing the unchallenged affirmative treatment of transpersons. This is also the situation at the Karolinska Hospital's Department for Children gender dysphoria investigation (KID), also at the children and adolescent Psychiatric clinic, a number of private clinics with uncertain expertise, psychiatrists and psychologists. The risk that affirmative treatment "consolidates" the child gender dysphoria is enormous, since the risk (see section 8) is between 8: 1 and 9: 1 that the child would have become a desister without affirmative interference.


The procedure followed by those who support affirmative treatment of gender dysphoria in children is contrary to the findings in all recent research and is not evidence-based. There is no psychiatric or other medical evidence that supports these treatment protocols.

 REFERENCES

10. Treatment with puberty blockers increases mental health problems in girls. Gender dysphoria does not decrease.

11. There are serious medical risks and side effects of puberty blockers and hormone treatment.


More and more reports are coming that not only hormone treatemnent but also puberty blockers are not reversible and harmless, but on the contrary are strongly associated with medical and mental health risks. The myths that puberty blockers are harmless are old hypotheses before studies and follow-up investigations.


In addition to these studies (see REFERENCES), the British NHS has recently made follow-up studies of the effects of puberty blockers on children. It turned out that psychiatric problems (suicidal thoughts, self-harm, anxiety, gender incongruence - i.e. dissatisfaction with some gender aspects of their body characteristics) increased in girls after treatment with puberty blockers.


Oestrogen treatment of transwomen increases the risk of ischemic stroke by 250%. Testosterone treatment of transmen can give extreme acne problems. Are these medical issues properly discussed with patients?


Regardless of the medical findings in recent research, the treatment with puberty blockers is unethical since (see section 9 above) puberty blockers consolidates gender dysphoria in children who would otherwise "grow out" of it. One risks destroying the lives of children who would otherwise grow into a "normal" adult role.

 REFERENCES

12. It is a myth, disproven by solid peer reviewed research, that specific brain regions of trans persons are more like those of the self-identified gender.


A false argument put forward (also in an interview with the chief investigator at ANOVA, Karolinska Hospital, Sweden, in the program "The transtrain and the teenage girls"), is that certain brain structures in transgender persons have characteristics that are more similar to the "perceived" gender than the "assigned" gender. This is a myth and refuted by technically advanced methods in morphological studies of brains in transgender and control groups.


There are differences between men's and women's brains, statistically. For example, male brains are on the average 10% larger than female brains. Women have a higher density of "gray matter" (abundance of neuronal cell nuclei) and, correspondingly, the volume of "white matter" (abundance of non-neuronal glia cells) in men is larger. The cerebral cortex of men is thinner than that of women. (Surprisingly, the proportion of non-neuronal, astrocyte glia cells to nerve cells is much higher in human than in other animal species, only elephants and dolphins have similar high amounts of glia cells) and there is no simple relationship between the number of nerve cells, glial cells and brain function).


Extensive studies have been made of transgender brains with so-called Functional Magnetic Resonance Imaging (fMRI). Brains in transmen (born female) are not by fMRI measurably different to the control group. In transwomen (born male) one finds differences to the control group of men, but the differences observed have nothing to do with likeness to a female brain. With advanced statistical methods, a large number of parameters and complex relationships have  been studied but no correlation has been found between the transwoman brain and the female brain.


Similar studies have been made of changes in brain structures for different professional occupations. For example, a long-term study of comparison between stewardesses (airplane) and taxi drivers (in London) showed that the profession over time can have a major impact on the size of brain structures, such as the hippocampus a brain structure known to be critical to memory and spatial orientation processing. Also, studies of various mental disorders (e.g. schizophrenia, depression, sleep deprivation) also show significant differences to control groups.


The changes seen in these cases are consistent with seeing changes in brain parameters of transwomen (born boys with gender dysphoria). We judge they are more likely to be related to the correlated psychiatric disorders and psychosocial stress, greater for transwomen (born males) than for transmen. It is well known that transwomen have more difficulty in adjusting to the transgender role and of being accepted by society, compared with transmen. Transwomen experience a greater mental strain in their changed role. In summary, there is no evidence that the transwoman brain is more like the control group women's brains, nor are there any corresponding differences in the transmen brains. Both claims are false citations of science data spread by "activists" and many clinical investigators.


In children, the brain is not fully developed and is programmed to change with age, genetically and when exposed to sex-specific hormones. During puberty, for example, testosterone in males leads to the cerebral cortex being thinned in relation to that of females and only then becomes "male" in its characteristics.


AS a consequence it may also be noted that, thus, one cannot know, before puberty, details of how the brain will develop during and after puberty (up to the age of 25). It is therefore impossible, even theoretically, to use fMRI in children to try to draw conclusions about whether the child suffers from gender dysphoria or suffers from other psychological/ psychosocial issues.

REFERENCES.


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