PCUSA declares support for trans surgeries for kids

The wording that was passed was:

"The PC(USA) supports all individuals to have access to all medically necessary, evidence-based gender-affirming healthcare."

This is very vague wording. I have been deep into this topic over the last 6 months and know way more about transgender than I probably ever thought I would. A few comments:

First, there is very poor data around the treatment of transgenderism. This includes both those that are for it and those that are against it. I have personally read almost every single study done on both sides of the fence. Many are driven by a activist, again on both sides of the fence. Practically all have serious flaws in their methodology, such as observational only, high drop out rates during the study, lack of any long term follow up, small sample sizes... So, the definition of evidence-based is very low. The biggest driver for medical transition is that there is a thought that it alleviates incongruency and improves the mental state. The challenge is that the data is not great one way or the other, that this is the case. Individuals who identify as transgender have high rates of neurodivergency and are typically struggling with a host of mental conditions. It is not clear if medical transition assisted in their mental conditions or through medical transition they received mental health assistance. In addition, while suicide decreased after medical transition it was still significantly higher than the general population. Given the weakness of the studies it is not clear.

Second, there is no standard in the US around care. The US leans toward a more aggressive approach to transgender affirming care, and consent driven assistance is what is more often pushed. That means they are handed a sheet of paper and if they understand the benefits and the risks and sign the consent form, they can receive medical care.

Third, the more progressive countries in the world take a more measured approach to medical care for transgender people, especially children. The Dutch, Swedish and Finnish approach is that medical transition is an extremely rare action taken and only under extreme circumstances for those under 18. The focus is on mental health until the age of 18. In some cases they will prescribe puberty blockers for those who have not entered puberty, but will not provide hormone therapy until 18. And their preference is until 25. This was actually closer to WPATH's approach until it was removed from their guidance under pressure from the Biden administration. This pressure was revealed in court documents in a case in Alabama, where the emails were revealed to show that an activist in the Biden administration put pressure on WPATH to remove age guidelines. In addition, many of the progressive countries have gender clinics that outlined standards of care and patients need to traverse the clinic to receive medication. In the US, you can go to places like Planned Parenthood, your GP, a psychiatrist, a gender clinic and so on.

I saw all of this, because what the PCUSA has passed is so vague and so debated it is not clear what they passed. They took out the wording around minors, but in the end this is what was the crux of what was passed as adults already have access to gender affirming healthcare in the US without restrictions.

It is also interesting that the more the PCUSA tries to become relevant by enjoining with progressive movements, causes and ideas it is declining fairly rapidly, with churches shrinking and aging. While the PCA looks to become more theologically conservative and sees itself increasing at almost the same rate that PCUSA is declining.

There are times when pressure to make a political statement ought to be answered with "what do we actually know about this?", and this is clearly one of those times for the PCUSA.

Regarding the issue of minors getting transition surgeries, or really any transition surgeries, my thought is that historically, there was an awareness that body parts in the specimen bag do not reattach or grow back, and hence one had to jump through a lot of hoops before any surgeries were performed--living as the opposite sex (dressing as such, etc..) for a year, intensive counseling, and such. Even in those days, you had those like Walt Heyer who felt they were rushed into life-changing surgeries. (my guess is that the oft-stated 2% regret/detransition rate reflects the old regime, FWIW)

Today, that presumption is overturned, even as it appears we have more and more evidence that gender dysphoria has huge overlaps with other psychological conditions like autism (like my niece, FWIW). I'm not quite sure whether it would be better for legislators to enact minimum standards for transition, or whether the best option would be to simply extend statutes of limitations (civil and perhaps criminal) for transition surgeries and therapies to 20 or 30 years.

I'm leaning towards the latter; legislators can understand that life-altering surgeries ought to have long statutes of limitations for damages, and when the actuaries at the malpractice insurance companies start watching the verdicts roll in, they're going to make it very clear to the doctors doing these procedures that their choice is to either put protections back in place against hasty transition, or lose their malpractice insurance--and thus risk bankruptcy or even loss of their medical license.

(a parallel note from the history of medicine; it was the actuaries at life insurance companies that really started nudging their customers towards better diet and exercise as far back as the 1960s, when they noticed that a huge portion of their insurance payouts were guys carrying an extra 50-100 lbs and making it through their day at the office on coffee and cigarettes)

So I think there's more than ample precedent in medicine and insurance for simply reworking statutes of limitations to reflect the fact that transition surgeries are permanent with catastrophic effects when done hastily.

To be honest, despite what anyone says, no one truly knows the regret/detransition rate. The pro activist will tell you it is very low and will site studies. The anti activitist will tell you it is high. Again, the studies are terrible, when you have 50% of the patients dropping out of the study, you have no clue what the rate is anymore. There is no rigor here. Most will cite old studies that go back to the 1980's, and people have to realize that if this was lets say 1991 and you decided to transition, the regret rate was probably low because the barriers were so high to get a medical procedure for this. This explosion just started around 2015. Anyone can walk into a Planned Parenthood clinic. Sign a piece of paper and get their hormone blockers and hormones right away. We have no idea really at this point. Anecdotally, it appears that detransition is rising, but again, no really good studies.

It rings true that as relatively new as all this is, the data would be messy and full of gaps. Which, to me, is an obvious argument for restraint. I mean, that’s usually how medical ethics works. If a treatment is not known to be safe to a high level of confidence, it is generally presumed to be unsafe—as far as regulatory rules go.

But that hasn’t been the attitude in the U.S. Interestingly, other countries have been more ethical. But it kind of makes sense. The U.S. has a long tradition of being less centralized, and so things become sensitive to public opinion—or perceived public opinion—in ways you don’t see in more ‘governmental’ nations. Tradeoffs. Sometimes it’s that political sensitivity that improves things. Sometimes it makes them worse.

It strikes me that since people with gender dysphoria have horrendous rates of suicide attempts, and I'd presume "successful" suicides, part of the "regret" rate is hidden six feet under, sad to say. It strikes me that the same factor will likely make studies like the Swedish linear study a little less authoritative, or at least a little more difficult.

If memory serves, the Swedish (?) linear study found that ten years after castrating 19 men, one less man than expected was still seeing a counselor/psychotherapist. So even one suicide would throw that into doubt--never mind the question of whether the ROI equation is backwards when you're maiming 19 men so one doesn't need therapy.

Bert,

To be honest it isn't even clear whether people with gender dysphoria have higher suicide rates, or that people with significant mental health challenges have higher suicide rates. A large number of individuals who suffer from gender dysphoria have multiple mental health issues. The very best scientific statement you can make is that "some studies show associations between access to gender-related care and improved mental-health outcomes, but the casual mechanism remains uncertain". That is as far as you can push the data. The best study is the Finnish study. It is the largest and most comprehensive one out there. And it stated, "Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for". This is why Finland and other progressive countries are increasingly becoming cautious on medicalization. The strongest push to start medicalized gender affirming care quickly, was the statement, "if you don't do this do you want your child to commit suicide?", which just isn't the case.

It rings true that as relatively new as all this is, the data would be messy and full of gaps. Which, to me, is an obvious argument for restraint. I mean, that’s usually how medical ethics works. If a treatment is not known to be safe to a high level of confidence, it is generally presumed to be unsafe—as far as regulatory rules go.

I agree, Aaron. This is an excellent common sense statement, yet when it came to Covid vaccines and trans care so many ignored that thinking. My theory is that progressive propaganda shifted how so many people thought about issues. That is likely what is at the heart of the PCUSA as well.

JD, I agree. Aaron’s statement should in fact be obvious, but those who are highly motivated, whether about surgery or Covid, have been shown to easily ignore this truth. In both these cases, it certainly does seem like progressive propaganda was a large influence, but I would tend to think it’s more an issue of human nature. If it’s something we really want, for whatever reason, humans are more likely to try to ignore any fences in the way, no matter how sensible they are.

Dave, I could understand why people would want the vaccine. What I did not understand is why people ignored the common sense that Aaron clearly articulated in his post above. If the vaccine worked, then it would not have mattered if I chose not to take it or if I didn't campaign to force it on others. I think 5 years ago it was both propaganda and fear. Now that the fear has subsided many are making common sense statements again.