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Trans-ing children is repeating the medical scandal history of lobotomies

Lulu, a transgender girl, reads a book in her room at her home in Buenos Aires July 25, 2013. | Reuters/Stringer

During my career as an ICU nurse, when we were treating patients, the medical team always had a detailed debate on the risks and benefits of every intervention when developing a patient's plan of care.

All medical interventions, from complex surgical care to common pharmacological prescriptions, carry risk. Medicine is practiced under that guiding principle of providing the patient with the least invasive interventions possible, so as to minimize risk of additional complications and potential harm.

This principle is utilized broadly in health care with one glaring exception: the treatment of gender dysphoria in minors.

Gender Dysphoria is defined by the DSM-5 as, “a marked incongruence between one’s experienced/expressed gender and their assigned gender” (Patients cannot receive insurance reimbursements for medical interventions without this diagnosis).

While there are non-invasive, successful options to treat Gender Dysphoria, highly invasive interventions that can lead to permanent fertility loss, among other things, are being pushed onto families as the first-line standard of care through the “gender-affirming” model of care.

For example, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association are all strong advocates for pediatric “gender-affirming” care.

While the medical community is all in on pediatric “gender-affirming” care, state legislators across the country are now debating the ethics and necessity of these treatments.

In 2020, the Pennsylvania House Subcommittee on Health Care held two hearings, in March and September, discussing treatment standards for minors experiencing Gender Dysphoria.

At the March hearing Dr. Stephen Levine, a clinical professor of psychiatry, gave an impactful testimony describing three different models of care for the treatment of gender dysphoria in children.

Dr. Levine describes the first approach as “watchful waiting” saying,

“A watchful waiting approach cooperates with this fluid, changeable nature of gender identity in children, the fluid changeable nature of gender identity, and seeks to allow time, safety, and support for the process to happen. In the meantime, the professional will often seek to treat any associated mental illness in the child or symptoms in the child but without focusing on gender at all, separation anxiety, compulsivity, compulsions, and so forth.”

He further noted that multiple studies show that the “large majority of young children who present with gender dysphoria, if left untreated, uninvolved with will evolve to a gender identity continent with their biological sex by the end of adolescence.”

The second approach he discussed is the psychotherapy model that focuses on working with patients to identify causes of psychological distress and applying standard psychotherapeutic approaches to resolve it.

The third model of care he identified is known as “gender-affirmation” care, which includes a range of interventions from “social affirmation,” such as name and pronoun changes, to the administration of puberty blockers, sterilizing cross-sex hormones, and irreversible surgical interventions, like double mastectomies.

The hearing in September 2020 was focused entirely on the “gendering-affirming” model of care.

Public records from February 2020 show Dr. Rachel Levine, as Pennsylvania’s Secretary Health, reaching out to Nadia Dowshen and Linda Hawkins, the co-founders and co-directors of the Children’s Hospital of Philadelphia’s (CHOP) Gender and Sexuality Clinic, asking if they’d testify at the hearing writing,

“I would very much like you both to join me if you are able…

…I am mindful that the committee might also invite other individuals to testify who do not have the level of knowledge and experience that you and your team bring from CHOP. I am also mindful that other testifiers might have a quite divergent opinion than ours on the efficacy of transgender confirmation health care.”

Dowshen responded, “I am pleased to do anything I can to stand with you...”

At the September hearing, Dowshen testified in favor of gender-affirming care for over an hour.

In her testimony, Dowshen supported giving puberty blockers to prepubescent children and cross-sex hormones to minors.

When asked how young she referred children for sex reassignment surgery, sometimes called “bottom surgery,” Dowshen did not provide a clear answer. However, in a 2017 email written to Rachel Levine, Dowshen states one of her patients received “bottom surgery” at age 17. In her testimony, she admitted to referring girls as young as 14 to receive double mastectomies.

Giving these invasive and experimental medical treatments to children is a new phenomenon. We don’t know the long-term physical and psychological impacts of these treatments nor the depths of regret transitioned children will face.

For example, regularly-prescribed puberty blockers such as Supprelin LA and Lupron Depot have not been approved as a gender dysphoria treatment and are being prescribed off-label by many pediatric gender clinics.

In December 2022, Texas Attorney General Ken Paxton announced that he was investigating the makers of these drugs under the Texas Deceptive Trade Practices Act. Saying in a press release,

“The manufacture, sale, prescription, and use of puberty blockers on young teens and minors is dangerous and reckless…”

“These drugs were approved for very different purposes and can have detrimental and even irreversible side effects. I will not allow pharmaceutical companies to take advantage of Texas children.”

Not only are these interventions experimental, but they’re also expensive. In a 2018 NIH presentation, Nadia Dowshen stated that cross-sex hormone treatments can cost as much as $40,000 a year; and taxpayers are often footing the bill. A public records request by the Pennsylvania Family Council found that since 2015, Pennsylvania taxpayers spent more than $16.7 million on, “sex reassignment and transition related services and drugs for service.”

As the first generation of pediatric gender-affirmation patients is moving into adulthood, we are seeing a wave of detransitioners, such as Chloe Cole, who are speaking out against pediatric “gender-affirming” care.

The high-risk stakes of “gender-affirming” care beg a simple question: Why is American mainstream medicine almost exclusively recommending the most invasive treatment pathway to children struggling with Gender Dysphoria, when there are successful, less invasive options? Have they not abandoned their duty to “First, do no harm?”

Meanwhile, several European nations are recognizing these risks and halting their pediatric gender-affirmation programs whereas American institutions are moving full-steam ahead, continuing to push on families the false choice of “having a dead daughter or a living son,” delivering care under that incorrect notion that invasive medical treatments are the only solution to a complex psychiatric condition.

We must take note that history repeats for those who don’t learn from it.

In 1935, neurosurgeon Dr. Egas Moniz discovered a psychiatric illness cure-all, the lobotomy (he’d go on to win a Nobel Prize for this “advancement”). Over two decades, thousands of patients received these barbaric surgeries under the guise of psychiatric healing, until the madness and danger of this surgery were widely recognized and the procedure was eventually stopped.

In one of the most poignant lines of his testimony, Dr. Levine, who is presently the federal Assistant Secretary for Health and Human Services, said,

“And since doctors gave up performing lobotomies to treat psychiatric disorders many decades ago, gender dysphoria is the only psychiatric diagnosis which doctors are attempting to treat by surgery.”

Those who fail to recognize history are doomed to repeat it. 

Meg is a photographer, former nurse, and a grassroots parental rights activist living in the Philadelphia suburbs with her husband and two kids. She is passionate about protecting the well-being of children.

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