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Culture War Roundup for the week of November 11, 2024

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Removing obstacles from a path is not "putting them on a path". Do you object to roads, because they put criminals on the path towards bank robbery?

Which "mutilations" had the minimum age requirements changed? What are the new requirements?

Do you object to roads, because they put criminals on the path towards bank robbery?

I'm sorry, but analogies are really not your strong suit.

That public roads can be used by bank robbers to escape from robberies is an unintended, unfortunate but unavoidable side effect of the existence of said roads.

Small children receiving "gender-affirming" surgeries is not an unintended consequence of Levine calling for the age limits on minor transition to be removed. That outcome is the sole purpose of Levine having done so. It is exactly the outcome Levine is trying to bring about.

Removing obstacles from a path is not "putting them on a path". Do you object to roads, because they put criminals on the path towards bank robbery?

It sounds like arguing semantics to me. If one hand the public health administration is removing obstacles, and on the other the education system is telling kids they might be "born in the wrong body" if they don't fit into a given mold, and than hide the information about the child's transition from parents, that sounds like it all adds up to putting children on a path to transition.

Which "mutilations" had the minimum age requirements changed? What are the new requirements?

Draft of SOC8:

The following recommendations are made regarding the requirements for gender affirming medical and surgical treatment:

(...)

F. The adolescent has reached Tanner 2 stage of puberty for pubertal suppression.

G. The adolescent is the following age for each treatment:

  • 14 years and above for hormone treatment (estrogens or androgens), unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 15 years and above for chest masculinization; unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 16 years and above for breast augmentation, facial surgery (including rhinoplasty, tracheal shave, and genioplasty) as part of gender affirming treatment; unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 17 and above for metoidioplasty, orchidectomy, vaginoplasty, and hysterectomy and fronto-orbital remodeling as part of gender affirming treatment unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame.
  • 18 years or above for phalloplasty, unless there are significant, compelling reasons to take an individualized approach, considering the factors unique to the adolescent treatment frame"

H. The adolescent had at least 12 months of gender affirming hormone therapy, or longer if required to achieve the desired surgical result for gender-affirming procedures including, Breast augmentation, Orchiectomy, Vaginoplasty, Hysterectomy, Phalloplasty metoidioplasty and facial surgery as part of gender affirming treatment unless hormone therapy is either not desired or is medically contraindicated.

vs. published SOC8

6.12.f- The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated.

6.12.g- The adolescent had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.

There's also points A-E, but everything about minimum ages has been removed.

Edit: I think they mention the 18 years for phalloplasty when they elaborate on the chapter.

So, again, for starters: none of that is mutilation, just regular surgery.

Second, right there in the guidelines: this is the section for adolescents. Children is section 7. When your actual source makes the distinction between kids and teenagers, I feel like it's a bit disingenuous to keep calling them "kids"

Third, that's the section on "treatments requested by the patient". It's not putting someone on a path when they are already on that path and merely asking for help.

I don't see how this is different from anyone else trying to get medical treatment for their illness. Would you be horrified to learn that we also let children be treated for cancer and depression? Should there be a minimum age for those, too?

  • -15

none of that is mutilation, just regular surgery.

There is nothing "regular" about surgery to remove healthy organs and tissue with the ultimate goal of ameliorating psychic distress. You're welcome to defend this practice, but don't pretend it isn't a major departure from the common practice of surgery as generally understood.

So, again, for starters: none of that is mutilation, just regular surgery.

Unnecessary surgery that removes healthy body parts is mutilation, as are unnecessary hormonal treatments.

Second, right there in the guidelines: this is the section for adolescents. Children is section 7. When your actual source makes the distinction between kids and teenagers, I feel like it's a bit disingenuous to keep calling them "kids"

When people say "kids" they mean "minors", performing these treatments on even younger children is even worse, but a mastectomy performed on a 16 year old girl is still atrocious.

Third, that's the section on "treatments requested by the patient".

No one cares, the patient is a minor that doesn't know anything about what they're talking about.

I don't see how this is different from anyone else trying to get medical treatment for their illness.

There is no evidence that any illness is involved. The only criteria necessary to get a dysphoria diagnosis is:

  • Say you're trans

  • Don't change your mind for a few months

Even those loose criteria aren't always followed.

Would you be horrified to learn that we also let children be treated for cancer and depression?

Cancer has proper diagnostic criteria, so no on that, but if a doctor insisted I have to give drugs to 14 year old for "depression" (or "anxiety" or ADHD) I'd find it absurd.

Should there be a minimum age for those, too?

Probably. Psychology is very unrigorous, and we should not let these kind of doctors make decisions about children, that go against the wishes of parents.

Unnecessary surgery that removes healthy body parts is mutilation, as are unnecessary hormonal treatments.

I certainly didn't think it was unnecessary. What makes you the expert here?

No one cares, the patient is a minor that doesn't know anything about what they're talking about.

That might be believable if there was a huge number of people who regretted these decisions, but people actually seem pretty consistent. I challenge the idea that a 16 year old doesn't have any idea what they want - 16 is young enough to be tried as an adult or apply for emancipation. In most states, two 16 year olds can have sex, get pregnant, and have a child - a massively life changing decision that involves significantly more severe medical risks. We even allow kids to drive! Traffic accidents are one of the top ten leading causes of death, but we trust kids with it.

Are you saying that's all a mistake? We need to keep kids away from any sort of responsibility or freedom until they're a legal adult?

There is no evidence that any illness is involved.

There's plenty of evidence that this intervention results in positive outcomes. You're talking to one of the positive outcomes right now. I'm not sure what else to call it when you do a medical intervention and it fixes a problem?

I certainly didn't think it was unnecessary. What makes you the expert here?

I think the burden of proof is on the person arguing for the removal of healthy body parts, and the arguments haven't been convincing.

That might be believable if there was a huge number of people who regretted these decisions, but people actually seem pretty consistent.

There is a decent amount of people loudly regretting these surgeries, and there are obvious reasons for why others might not want to do it so loudly - the ones that did come out have been rather ruthlessly attacked. I don't know how you determine that people seem consistent, there isn't good long-term data on the outcomes of these interventions, particularly on the new cohort of patients that showed up around 2015.

I challenge the idea that a 16 year old doesn't have any idea what they want - 16 is young enough to be tried as an adult or apply for emancipation

All of these require extraordinary circumstances that need to be argued in front of a judge. 16 is not enough to vote, not enough to drink a beer, and not enough to sign a contract without the parents' consent, not even enough to get a tattoo. All of these things are far less risky than any part of gender-affirming care, except social transition.

At 16 you're either still going through puberty, or barely out of it. You're still figuring out basic things about your place in the world.

In most states, two 16 year olds can have sex, get pregnant, and have a child - a massively life changing decision that involves significantly more severe medical risks.

The long-term consequences of pregnancy is precisely why this behavior is discouraged in teenagers. People with my worldview even discourage sex outside of marriage, even if it can be reasonably assured it will not result in pregnancy, and that's regardless of whether we're talking about teenagers or adults.

That said, the big differences is that sex resulting in reproduction is part of the healthy life-cycle of any sexually reproducing species on this planet, not a medical intervention. A better analogy here would be a 16 year old going through IVF, and in that case I'd say it's absurd, and any doctor encouraging it has no business in medicine or psychology.

We even allow kids to drive! Traffic accidents are one of the top ten leading causes of death, but we trust kids with it.

You need to pass a test proving you're competent, and that you understand the rules of the road, in order to be allowed to drive. The high amount of deaths is a result of the raw number and frequency of people driving, rather than the risk to the person once they make a decision to drive with a car.

Are you saying that's all a mistake? We need to keep kids away from any sort of responsibility or freedom until they're a legal adult?

No, like you see, I think most of these are bad analogies. These examples also conveniently ignore the far less consequential things we do legally forbid teenagers from doing.

There's plenty of evidence that this intervention results in positive outcomes.

There actually isn't. The evidence for positive outcomes if often inconclusive, where it's positive it's low-confidence. The lack of long-term follow up is endemic in the literature.

You're talking to one of the positive outcomes right now. I'm not sure what else to call it when you do a medical intervention and it fixes a problem?

People also swear on the effectiveness of homeopathy, crystal healing or reiki, but that is not enough to declare these therapies as effective. There are people who seek out exorcists, and likewise swear that it helped them, but we don't usually take that as evidence of demonic posessions.

When it comes to physical illnesses we have developed a robust protocol to assess effectiveness. The fact that physical ailments are externally verifiable - so we can tell that the patient has it and isn't just imagining things, or is free of it and the treatment actually worked - is of great help. None of that is available for psychological issues, and so the evidence tends be pretty poor. Even for non-political issues like depression you often end up with stuff like "oops, our miracle drug turns out to be no better than placebo".

Things get even worse when body image issues are involved. An anorexic is going to report satisfaction from losing weight, but we tend to not accept that as a valid reason for going along with their decision.

we should not let these kind of doctors make decisions about children, that go against the wishes of parents.

What if the parents are wrong?

Not much.

Even in cases involving rigorous medicine, where we can be near-certain that a doctor is correct and the parents are wrong, informed consent and parental authority are recognized as necessary. Psychology is nowhere near that level of rigor and certainty, so I don't know on what grounds you wish to overrule parental authority or ignore the lack of informed consent from the child.

on what grounds you wish to overrule parental authority

On the grounds that a child or adolescent is not the property of their parents, because they are a human being, and a human being cannot be the property of another human being (Grant v. Lee, 1865).

I never said that they are, so I don't see how that implies a psychologist should get to overrule them.

Generally we allow people to refuse treatment, even if that will have negative consequences for them. We also generally recognize children lack the maturity to make long-term decisions, so we grant the power to make medical decisions about them to their parents (or whoever has custody of them). Even with adults, if someone is unconscious, it's their next of kin that generally make medical decisions for them, not the doctors. None of that implies owning another person as property.

Also how consistent are you with "rightness" overruling parental authority. If the evidence for pediatric transgender care is determined to be very poor, are you ok with a blanket ban on transgender care, even if the child, parents, and a bunch their doctor agree that it's right?

Generally we allow people to refuse treatment, even if that will have negative consequences for them.

When an adult refuses medical care for themselves, the negative consequences fall on the person making the decision. When an adult refuses medical care for a child, the adult does not experience those consequences.

We also generally recognize children lack the maturity to make long-term decisions, so we grant the power to make medical decisions about them to their parents (or whoever has custody of them).

And there are many examples of that going wrong, usually from parents who think of their children as their property and refuse to distinguish between 'my child's long-term interest/coherent extrapolated volition' and 'my personal preferences/non-universal ideology'.

Even with adults, if someone is unconscious, it's their next of kin that generally make medical decisions for them, not the doctors. None of that implies owning another person as property.

Because the next of kin is expected to make the decision based on 'what the patient would decide if conscious' and not 'what the next of kin wants'.

Also how consistent are you with "rightness" overruling parental authority[?] If the evidence for pediatric transgender care is determined to be very poor, are you ok with a blanket ban on transgender care, even if the child, parents, and a bunch [of] their doctor[s] agree that it's right?

  1. Overruling parents in the case of 'parents and child agree; we think both are wrong' should be a higher bar to clear than 'parents disagree with child; we think child is right and parents are wrong.'
  2. The case for giving any authority to parents rests on the assumption that they are usually right, for a value of 'right' that can be falsified, i. e. not defined as right a priori by dint of their status as parents. In cases where parents are often wrong, I believe society currently gives them too much unchallenged authority, and there need to be more checks and balances.
  3. What do you mean by 'the evidence for paediatric transgender care is determined to be very poor'? A literal reading would be 'the evidence seems to support it, but we have low confidence in that assertion.' akin to the evidence for ivermectin vs. COVID-19, or aducanumab vs. Alzheimer's disease. In that case, where we cannot predict long-term effects, we should do what results in the least immediate suffering. If you meant 'the evidence shows with strong confidence that it is harmful', akin to the evidence regarding 31 g of aspirin vs. the 1918 influenza, then I could be convinced to support a moratorium until experiments on adults show that they have found a less harmful method of changing genders.
  4. 'Blocking transgender care that is desired by a minor patient and approved by both parents and doctors' is not the mirror image of 'allowing transgender care that is desired by a minor patient and approved by doctors but opposed by the patient's parents'; the mirror image of that is 'blocking transgender care that is desired by the parent(s) but opposed by the patient and the doctors.' e. g. the often raised spectre of the blue-hair-and-pronouns parent attempting to transition their cisgender child in order to gain the status of 'ally to the trans community'. (I am not sure whether this has ever happened, but it would certainly justify overruling the parent's wishes, even in a society in which gender transition is instant, perfect, side-effect-free, and reversible.)
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