moby dickgirlOn 27 November 2022, Brisbane's SUNDAY MAIL, an edition of #NewsCorp Australia's THE COURIER-MAIL, published an article, "Aussie doc: 'I see 300 trans patients a year'," by Julie Cross.
The article has #SeveralProblems. Here are a few. /1
1. "#Trans patients are swapping tips online on where to find 'friendly' doctors who are willing to prescribe hormones to make them look more like the opposite sex."
First of all, may I say how delightful it is to see Cross taking part in News Corp's long corporate tradition of suggesting that hormones are simply a skin-deep intervention which allow perverted, predatory, subhuman transgenderists to deceive their well-meaning, normal, fully human cisgender peers.
Now, in this context, the word "friendly" is being used to imply bias, like having a "friendly" judge. It might be possible to superficially get away with the use of the word 'friendly' here if it were a direct quote which had this meaning in context.
However, the only context we know Cross to have had is a single #reddit thread, and, for one thing, the word 'friendly' doesn't appear at all in that comment's OP: https://www.reddit.com/r/transgenderau/comments/wot3ad/any_good_websites_on_informed_consent/
It also only appears in one comment, which describes a Brisbane-based trans health provider, Dr #VictoriaFeatherstone, as having a "very comforting and friendly manner": https://www.reddit.com/r/transgenderau/comments/wot3ad/comment/ikg7wl2/?utm_source=reddit&utm_medium=web2x&context=3
The construction of the paragraph suggests that it's decisive proof of bias to prescribe gender-affirming hormones at all. In fact, where they're clinically justified, to not prescribe them would be medical negligence — because it would fall short of the relevant standard of care: https://www.armstronglegal.com.au/commercial-law/qld/tort-law/medical-negligence/
2. "Reddit is one go to site where the trans community shares information on which doctors are open to prescribing cross sex hormones quickly."
Returning to that one reddit thread that we know Cross actually consulted, the OP was asking where to find #InformedConsentModel (ICM) care, because the first appointment he could secure at the #BrisbaneGenderClinic was 11 months away.
Note that this would have been a particularly time-sensitive and urgent matter, because the first appointment would have been the OP's first opportunity to receive any gender-affirming medical care at all. He doesn't say this; what he does say is that he's 15. Forcing him through 11 more months of the wrong puberty could do significant damage which would be permanently impossible to reverse.
Cross is trying to make timely care look shady by asserting trans people are trying to get "friendly" doctors who will prescribe hormones "quickly". "Less than 11 months for medical intervention on a matter of life-altering urgency whose time sensitivity is immediate," however, is an objectively reasonable expectation by any metric.
3. "One person [1] wrote on Reddit how they were prescribed 'gender affirming' drugs at a walk-in clinic in Queensland, after waiting about "'30 minutes for the informed consent and prescription, and another 15-20 minutes for the pharmacy next door to fill it."
"Gender affirming" appears in quote marks, as if there were some debate about the wording. In the literature, gender-affirming therapies are referred to as such even by their most ardent opponents; here are three examples from a major anti-trans pressure group, #segm, which we'll discuss later in this thread:
— https://journals.sagepub.com/doi/10.1177/1039856218775216
— https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2020.19111149
— https://link.springer.com/article/10.1007/s10508-022-02472-8
"Gender-affirming" is very, very standard terminology; News Corp is putting it in quote marks to make a suggestion which it can't make out loud because it doesn't have the authority, and won't because it doesn't have the guts.
While we're on the topic of conveying suggestions, while the word "drugs" is perfectly clinically accurate here and often used in the technical literature, that's not why News Corp uses it; it's used because compared to "hormones" or "medication" it is much scarier, and therefore, for News Corp's purposes, ideal.
It also ties into a common anti-trans narrative theme: namely, projecting artificiality onto trans people, portraying them as somehow unnatural and fake. Calling hormones "hormones" runs the risk of someone pointing out that hey the human body produces those too [2]. Even "hormone blockers" sounds too close to something natural and real. "Drugs"? Now those could be anything. That's the ticket.
Honestly, though, the weirdest part of this paragraph is how Cross leaves in "and another 15-20 minutes for the pharmacy next door to fill it," as if that were suggestive of something nasty. My pharmacy takes about 2 minutes to fill my prescription for #estrogen; 5 on a slow day. Should they artificially take longer because I'm trans? What's the intended outcome here?
NOTES
[1] We know the person in question was u/JamieRoseCleverly: https://www.reddit.com/r/transgenderau/comments/wot3ad/comment/ikcw4ck/?utm_source=reddit&utm_medium=web2x&context=3
[2] It really does! All exogenous hormones (i.e., hormones from outside the body — “hormone drugs,” if you will) currently standardised and widely used in gender-affirming care are bioidentical (i.e., exactly chemically identical to those produced by the body).
4. "There are lists of 'gender affirming' doctors, who all approach patient care differently, being shared on government platforms."
The use of the word "platforms" here is slightly confusing, because it feels like it's suggesting Australian governments are running public #Mastodon instances or something (are they? I hadn't heard). Actually, though, I think this is referring to, at least, the "#GenderIncongruence" page [1] on the #AustralianGovernment's HEALTHDIRECT service, which is mentioned by Cross shortly afterwards.
The page says this: "You can find a list of gender-affirming clinicians at TransHub [2] and AusPATH [3]."
This part of the article seems like another version of the narrative also favoured by the ABC's #MediaWatch [4], to the effect that "it's wrong for government to cite or consult external experts in any way". I personally have only ever seen journalists try that one when attacking trans people — and, I expect, other marginalised groups — because in any context other than discrediting authorities who defend marginalised people, it would be correctly recognised as blatantly absurd.
SECTION NOTES
[1] https://www.healthdirect.gov.au/gender-incongruence
[2] https://www.transhub.org.au/doctors
[3] https://auspath.org.au/providers/
[4] https://severalproblems.press/2022/10/21/several-problems-17-october-2022-acon-the-abc-media-watch-australian-broadcasting-corporation/ (self cite lmao, cringe)
5. "News Corp is not suggesting doctors on these lists are doing anything wrong."
I mean ... it is, though.
6. "The government's own website HealthDirect promotes 'gender affirming care' and states that it is wrong for any health professional to try to change someone's gender or identity."
Healthdirect does indeed "promote[...] 'gender affirming care'". For example, it says at one point: "People with gender dysphoria need to get gtender affirming care." It seems pretty obvious and straightforward to say $PEOPLE_WITH_CONDITION need to get $TREATMENT_FOR_CONDITION. Not seeing a lot of objections to "If people's muscles hurt, they need to get Nurofen."
Healthdirect does indeed also state that "It is wrong for any health professional to try to change your gender or identity in any way." This is also very obviously unassailably true. Part of the impetus to #BanConversionTherapy was the strength of the argument that trying to change someone's identity is wrong even without considering direct observable material harm. This is because people have other human rights like autonomy and freedom of conscience, of which an attempt to forcibly psychologically modify them would deprive them even if they weren't otherwise harmed.
However, #ConversionTherapy *does* do harm; it consistently leaves its subjects with lifelong psychological trauma [1] [2]. Then again — many other therapies which are widely accepted in clinical practice also inflict harms, which are accepted because the benefits outweigh them; anyone who's been through chemo, or knows someone who's been through it, has witnessed this principle in action.
If we accept for some dickhead reason that changing someone else's gender is actually a beneficial thing to do, then are the harms of conversion therapy worth it to achieve that end? No, because conversion therapy doesn't actually do that. It has no demonstrated efficacy [3]. Conversion therapy can't be justified even in the terms in which its advocates claim to believe, *because it doesn't fucking work*.
#NewsCorp's careful misframing here implies that Healthdirect calling conversion therapy "wrong" is emotive and debatable. In reality, not only does conversion therapy have shitty ends, it can't achieve them; Healthdirect calling it "wrong" is as close to objectively correct as any statement about science can get.
SECTION NOTES
[1] https://ajph.aphapublications.org/doi/10.2105/AJPH.2020.305637
[2] https://jamanetwork.com/journals/jamapediatrics/fullarticle/2789415
[3] https://www.tandfonline.com/doi/abs/10.1080/00918369.2020.1840213?journalCode=wjhm20
Sexual Orientation Change Efforts, Adverse Childhood Experiences, and Suicide Ideation and Attempt Among Sexual Minority Adults, United States, 2016–2018
Objectives. To examine how sexual orientation change efforts (SOCE) are associated with suicide morbidity after controlling for adverse childhood experiences (ACEs). Methods. Cross-sectional survey data are from the Generations survey, a nationally representative sample of 1518 nontransgender sexual minority adults recruited between March 28, 2016, and March 30, 2018, in the United States. Self-identified transgender individuals were included in a separate, related TransPop study. We used weighted multiple logistic regression analyses to assess the independent association of SOCE with suicidal ideation and suicide attempt while controlling for demographics and ACEs. Results. Approximately 7% experienced SOCE; of them, 80.8% reported SOCE from a religious leader. After adjusting for demographics and ACEs, sexual minorities exposed to SOCE had nearly twice the odds of lifetime suicidal ideation, 75% increased odds of planning to attempt suicide, and 88% increased odds of a suicide attempt with minor injury compared with sexual minorities who did not experience SOCE. Conclusions. Over the lifetime, sexual minorities who experienced SOCE reported a higher prevalence of suicidal ideation and attempts than did sexual minorities who did not experience SOCE. Public Health Implications. Evidence supports minimizing exposure of sexual minorities to SOCE and providing affirming care with SOCE-exposed sexual minorities.
7. "However, it comes as a growing body of mental health professionals believe the government's current advice is out of step with other countries around the world that have started taking a more cautious approach to medical and surgical intervention."
Oooh, which countries. I assume one of the usual suspects, so is it the United Kingdom [1]? Is it Sweden [2]? Please, go on, tell me more, I'm enthralled.
SECTION NOTES
[1] https://transsafety.network/posts/ehrc-defends-ct-pauses-gra-reform/
EHRC asserts protections for religious and trans conversion therapy, calls for pausing GRA reform
The EHRC has written two letters, one to the Scottish Cabinet asking them to pause GRA reform and another to the UK Government telling them to allow exceptions for religious change efforts, and efforts to 'reconcile patients with their biological sex'
8. "TransHub, which provides resources for trans people and health professionals, promotes the informed consent model as best practice for GPs — which is when the doctor takes the patient's lead and accepts their new gender identity."
I was unable to verify this claim. The summary of the informed consent model (ICM) is close enough that I'm not gonna argue with it here. However, of the strongest assertions I could find by #TransHub about the ICM, which are in its general guidance for clinicians [1]: while they are subjectively very positive, they don't actually appear to amount to an endorsement as a single best practice (i.e., superior to other alternatives), simply a discussion of one option among many.
The strongest assertion I could find by TransHub that was relevant to the #ICM in any way was in the guidance for clinicians regarding diagnoses [2], which asserted that "the requirement of diagnosis [of gender dysphoria] is no longer considered best practice". This doesn't actually enthrone the ICM instead, however. It simply — and correctly — places the traditionalist "gatekept" model which it discusses as, again, one option among many.
SECTION NOTES
9. "In some cases a prescription for cross sex hormones can be handed over in just two or three appointments."
This is pretty clearly trying to tap into the unspoken and inarticulable feeling that many cis people have that there's some minimum number of appointments it *should* take. In reality — like anyone else — trans people are entitled to have medical care no later than they need it.
10. "In many cases, no mental health professional needs to be involved."
The suggestion here is that it's somehow weird or even dangerous that the ICM doesn't ordinarily require signoff from a mental health professional (MHP) in order for medical transition to be intiiated.
Of course, what News Corp is replying on here is cis people's, again, unspoken and perhaps inarticulable assumption (cis assumption) (cissumption?) that being trans inherently means that you're fucked in the head — or, more specifically, that you're fucked in the head such that you can't give #InformedConsent [1]. In reality, no aspect of transness impairs competence to consent in any way.
SECTION NOTES
[1] https://www.sciencedirect.com/science/article/abs/pii/S0277953619301261
11. "For trans children, the parents need to agree to any medical intervention before drugs are prescribed and they need to be assessed by mental health specialists in what can be a significantly longer process."
The movement from the previous paragraph to this one gives this the effect of suggesting that trans kids can also be sloppily and quickly 'rushed' into ICM care.
In reality, the fact that parents and MHPs have to be involved means the kids are by definition not receiving ICM care, so even if ICM care were reckless and negligent the way News Corp needs it to be, the implication would still be a lie.
12. "However, psychologist Roberto D'Angelo said some kids are still only having up to half a dozen sessions before being prescribed drugs."
News Corp somehow forgot to mention that Roberto D'Angelo is a clinical advisor to the Society for Evidence-based Gender Medicine (#SEGM), a pseudoscientific anti-trans pressure group [1] [2] [3], which pretends to be supported by crowdfunding while actually being supported by large donations of opaque origin [4].
News Corp knew this, of course, but even if they hadn't, D'Angelo isn't exactly subtle about his views. His interaction with the public discourse is primarily through contributions to academic journals, so we can get a good idea of it by looking at his public profile on the academic social network ResearchGate [5].
On the list of publications which D'Angelo authored or co-authored, every publication since May 2018 [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] has been open advocacy for trans hostile views. That's 10 of his 13 listed publications since 2003, incidentally; talk about #RileysLaw [16]!
SECTION NOTES
[1] https://www.buzzfeednews.com/article/avivastahl/transgender-trans-kids-healthcare-science
[2] https://dx.doi.org/10.1037/cpp0000456
[4] https://transsafety.network/posts/segm-uncovered/
[5] https://www.researchgate.net/profile/Roberto-Dangelo-8
[6] https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12533
[7[ https://onlinelibrary.wiley.com/doi/10.5694/mja2.51643
[8] https://journals.sagepub.com/doi/10.1177/1039856220928863
[9] https://journals.sagepub.com/doi/10.1177/1039856218775216
[10] https://journals.sagepub.com/doi/10.1177/1039856220917076
[11] https://www.tandfonline.com/doi/abs/10.1080/00207578.2020.1810049?journalCode=ripa20
[12] https://jme.bmj.com/content/46/11/753
[13] https://link.springer.com/article/10.1007/s10508-020-01844-2
[14] https://www.tandfonline.com/doi/abs/10.1080/00332828.2022.2124080?journalCode=upaq20
[15] https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00235-2/fulltext
[16] The maxim that "once you post transphobia you will never post normally again," popularised by Alice Caldwell-Kelly of #TRASHFUTURE, who may have been quoting or summarising a remark by TRASHFUTURE colleague Riley Quinn: https://archive.ph/AGIsx
13. "[D'Angelo's] own assessment of the evidence for the benefits and harms of puberty blockers is that it is too weak and inconclusive for him to support prescribing the to children, even though 'in some cases they can have positive effects'."
Okay but why should anyone else care? It's not clear that D'Angelo's opinion of "the evidence for the benefits and harms of puberty blockers" would be at all relevant even if he weren't being paid to hold it. None of the commonly alleged harms are within his ambit — they're the province of endocrinologists, neurologists, and rheumatologists.
D'Angelo doesn't appear to be qualified in any of those areas, nor does it appear that he's talked to anyone who is. His judgement is no more relevant than mine.
14. "[Charlotte Hespe] said that a lot of the kids are 'troubled' and almost all of the ones she has seen have autism or Attention Deficit Hyperactivity Disorder (ADHD) and so 'it's tricky to navigate safely'."
In the first place, the current global standard for trans healthcare — the World Professional Association for Transgender Health's STANDARDS OF CARE, version 8 [1] (#WPATH #SOC8) — have something to say on this topic and they're pretty clear about it: "There is no evidence to suggest a benefit of withholding GAMSTs [2] from TGD [3] people who have gender incongruence simply on the basis that they have a mental health or neurodevelopmental condition" (Statement 5.3.c, pp. S36–S37).
In the second place, how the hell were "almost all" of Hespe's patients either autistic or #ADHD? It's certainly been observed that trans people seem to have higher rates of autism and ADHD — respectively 3–6× [4] [5] and 3–7× [6] more common. However, the population prevalences of autism and ADHD are 1–1.5% [5] and ~4.1% respectively [7], so in trans people they should be, at most, 9% and 28.7%.
Even if those populations were completely separate — which they're not, lmao [8] — they should make up fewer than 4 patients in 10. Does Glebe Family Medical Practice only accept referrals from the local fidget spinner and model train emporium [9]? What's going on?
SECTION NOTES
[1] https://www.tandfonline.com/doi/full/10.1080/26895269.2022.2100644
[2] (G)ender-(a)ffirming (m)edical and (s)urgical (t)reatment(s).
[3] (T)ransgender and (g)ender-(d)iverse.
[4] https://www.nature.com/articles/s41467-020-17794-1
[8] https://www.spectrumnews.org/features/deep-dive/decoding-overlap-autism-adhd/
[9] I'm autistic and have ADHD so don't worry, it's 100% fine for me to make this joke.
15. "[Hespe] said she tries to make sure her patients make 'wise' rather than 'irreversible decisions'."
The location of the quotation marks here strongly suggests this statement has been creatively chopped and screwed a bit. Whoever's responsible for it, though, the intention is clearly to suggest that in this area, irreversible decisions and wise ones are mutually exclusive.
The reasons why this is a bad take and the reasons why someone would advance it anyway are both clear enough at this point that I don't feel like I need to waste my breath further.
16. "Out of more than 100 patients [Hespe] has seen in 22 years, she said only one person, who wanted to transition as an adult female to a male, regretted the effects of being on testosterone and surgery. They know identify as gender neutral.
"'She had three lots of surgery,' Dr Hespe said. 'Had breasts off, had breasts put back on, had breasts taken off again.'"
In the first place: Are this person's pronouns they, or she, or both?
In the second place: I'm wondering whether this is a permissible disclosure by Dr Hespe. This seems like it would make it exceptionally easy to identify the individual described, which seems — note that I am not a lawyer — as if it might be questionable under the medical privacy provisions of the Privacy Act 1988 (Cth) [1].
In the third place, I think it's significant that News Corp has chosen to report this part. Previously they've largely focused on the suggestion that trans kids are too young to decide to transition, or to stop puberty, and that they'll regret it later. This, on the other hand, seems to mark a further advancement along the narrative line established by, e.g., Natasha Robinson's interview with #OllieHassett né Davies in #TheAustralian in August — beginning to suggest that "they'll regret it later, so they have to be stopped" is true not only of kids, but of adults, too.
This is a logical advancement to push for. After all, if you can bring yourself to levy immense suffering, permanent damage and possible death on *kids* simply because they were unlucky enough to exist around you while being trans, doing it to adults should be a piece of cake.
SECTION NOTES
17. "Dr Hespe said the doctors need to make sure they 'cross every single "t" and dot every single "i".' 'If you don't feel comfortable prescribing then don't.'"
This seems self-contradictory. You should "cross every single 't' and dot every single 'i'" — a saying which typically means being meticulous in your fulfilment of an established requirement, such as a standard of care — but also if the vibes are off you can choose not to?
I feel like I can see what the implied conditional is here:
IF you want to prescribe,
THEN you need to make sure you cross every single "t" and dot every single "i,"
ELSE simply "[not] feel[ing] comfortable" is more than enough.
18. "Meanwhile, Dr D'Angelo believes it can take months or years of therapy for some people to work through all their problems. He said many kids questioning their gender are also struggling with social anxiety, making friends or there's family dysfunction, and think changing their identity will help."
I mean, even if this weren't Roberto D'Angelo, wow, no way: a therapist thinks people might need "months to years of therapy"? Colour me absolutely shocked. Seriously though, this is such a blatant attempt to strip trans people of capacity. "Months to years"? That's "indefinitely". That's "never".
Moreover, "changing their identity" is, as I'm sure D'Angelo knows very well, a blatant and malicious misrepresentation of what it's describing. There's a reason transition care is called "gender-affirming" and not "gender-changing" — it simply supports and upholds what's already there.
19. "'Everyone now looks online when they are not feeling good about themselves,' Dr D'Angelo said. 'Many of these young people feel desperate and are looking for a way to feel better. There's a huge amount of material online which encourages transition which vulnerable, struggling and troubled teenagers may feel offers them a way out of their difficulties. Gender dysphoria and transitioning can sometimes seem like the explanation for their problems.'"
Have we considered that "these young people feel desperate and are looking for a way to feel better" because they're experiencing a dysphoria, the family of conditions literally defined as a clinically significant degree of feeling bad?
Have we considered that "vulnerable, struggling and troubled teenagers may feel" that "material online which encourages transition" "offers them a way out of their difficulties" because it actually does?
Have we considered that "gender dysphoria and transitioning can sometimes seem like the explanation for their problems" because they actually are?
20. "[D'Angelo] said he's worked with several people who have transitioned when they were young but regretted it, saying 'regret can take up to 10 years'."
Well isn't that convenient. I don't know if I've ever met a single person who was confident enough to say they knew exactly where their life would lead them in ten years' time. If any possible regret is waiting so far into the tall grasses of the future that you can't possibly see it when you're standing out on the fringe, then the only rational decision is clearly not to venture in at all. In fact, the decision to go anyway would be demonstrative of such a degree of irrationality that it might very well be considered [ominous voice] insane ...
By the way, isn't probability fun? In the first place, two other doctors quoted in this article report having patient populations in which the rate of autism and ADHD is near 100%, when all the other data we have suggests that the most impossibly high upper bound conceivable should be less than 4 in 10.
Now we have D'Angelo operating under singularly improbable conditions but in a different way: He's a single therapist in private practice. In fact he's a #psychoanalyst, not a specialty known for treating gender-diverse people with acceptance and kindness [1] [2]. And yet, given what he has to say about his patients, it seems as if he must have been lucky enough to pick up not only every detransitioner, but every detransitioner-to-be, on the entire east coast. I wonder how he fares with Scratch-its.
SECTION NOTES
[1] https://www.cairn-int.info/journal-research-in-psychoanalysis-2020-2-page-103.htm
[2] https://www.tandfonline.com/doi/abs/10.1080/00332828.2022.2056378?journalCode=upaq20
Psychoanalytic Transphobia or a Generalized Gender Trauma
Cet article propose une exploration des préjugés psychanalytiques vis-à-vis des subjectivités transgenres. L’auteur se focalise de prime abord sur les infiltrations socioculturelles des concepts métapsychologiques en montrant comment l’opinion populaire contamine la neutralité scientifique. Puis, il structure son argument autour d’un traumatisme général et d’une incertitude universelle de genre. Dans cette perspective, l’idéalisation de l’identité fixe et immuable, cohérente et authentique, est comprise comme une défense contre les angoisses primitives d’empiètement et d’engloutissement par l’autre.
21. "[D'Angelo] said one [of his patients] identified as male and had a mastectomy, a hysterectomy and ovaries removed. 'When she came to see me she was identifying as male and very depressed,' Dr D'Angelo said. 'She could not understand why as she had done everything she thought that could help (surgery), but she felt worse. It took two years to try and understand her history.
"'She came to the conclusion she was not a man and that other things had led her to take these steps. It was eye opening. It was alarming. She only had a handful of appointments with a psychiatrist before transitioning. There were other more complicated issues that had not been adequately diagnosed and had never been addressed. She is now identifying as a woman. She is happy with her gender now but is dealing with enormous grief and is struggling to rebuild her life.'"
While she's not named, this has to be about #JayLangadinos, a minor celebrity in her own right; it's a very specific backstory, and the probability that D'Angelo has two patients who share it is realistically zero. In that case, it seems apropos to introduce the facts that D'Angelo is leaving out; as Langadinos filed suit against her psychiatrist, Dr #PatrickToohey, and #TheAge and #TheSydneyMorningHerald sneeringly reported on it [1], we're lucky enough to have those facts on hand.
In short, the only "complicated issue" which Langadinos has alleged was unaddressed was social phobia, better known as social anxiety disorder [2]. SAD:
* is not a contraindication to transition;
* does not impair capacity to give informed consent [2];
* is — like everything else — not known to generate an illusory or transient sense of gender incongruence; and
* is known to be relieved by transition [3].
Moreover, Toohey urged Langadinos to seek treatment for her SAD, *and she refused*. By Langadinos' own account filed with the Supreme Court of #NewSouthWales, as reported by the HERALD, not only was her phobia clearly and concretely diagnosed, but the reason it wasn't addressed was because /she didn't want it to be/.
D'Angelo is clearly trying to suggest that Langadinos was failed by a system which allowed her transition, but Langadinos made her own choices at every step. No one had even the hint of an opening to stop her.
SECTION NOTES
[2] https://www1.racgp.org.au/ajgp/2020/july/hormone-therapy-for-trans-and-gender-diverse-patie
22. "A GP who prescribes cross sex hormones and puberty blockers to adults and children wishing to change their gender said they have to search for doctors like him that accept 'patients are the experts in their own body'."
Once again, News Corp presents this as a matter of people "changing their gender," rather than what it is, which is them matching their bodies to the gender they have. At this point, it's pretty safe to say it's not accidental.
23. "[Matt Barber] said the vast majority of GPs in Australia have little understanding in this space, which is why people seek out 'gender affirming' doctors."
This seems like it's supposed to at least allow the interpretation that Barber is an arrogant egotist, but it's actually just uncontroversially true. While actual useful data regarding practitioner competence in trans care is thinner on the ground than I would like, the little that exists isn't promising. By way of example,
* Davidge-Pitts et al. (2017) [1] found that in a sample of 411 practitioners in the so-called United States who were members of the #EndocrineSociety, the proportion who said they'd never received training in trans healthcare was circa 81%.
* Christopherson et al. (2022) [2] found that of a sample of 188 GPs and nurse practitioners working with trans patients in #Saskatchewan, so-called Canada, in 2019, the proportion who felt comfortable providing transition-related medical care was 30%.
* Irwig et al. (2016) [3] found that among endocrinologists attending an American Association of Clinical Endocrinologists (#AACE) conference, the fraction able to answer a fairly basic knowledge question about trans endocrine care was an eye-watering **5%** (!!).
If anything, Barber is being charitable in postulating that Australian doctors have even as much as "little" understanding. Statistically, it's likely closer to "fuck-all".
SECTION NOTES
[1] https://academic.oup.com/jcem/article/102/4/1286/2884622
[2] https://www.liebertpub.com/doi/10.1089/trgh.2020.0181
[3] https://www.endocrinepractice.org/article/S1530-891X(20)39209-0/fulltext
24. "[Barber] said in straightforward cases he is happy to prescribe hormones in just two sessions."
I mean I already know the answer but is this supposed to be in some way wrong or bad?
25. "In Australia 'doctors are free to operate under their own opinions and beliefs', Dr Barber said.
"In the UK doctors have to follow new national guidelines for children with gender dysphoria, including carefully exploring any mental ill health issues."
In the first place, this framing makes it sound like it's complete open slather in Australia, which is not the case at all. As the article later admits — in an extremely minimising fashion and with clear reluctance — there are set standards of care; moreover, doctors risk legal action by violating them. Given that doctors' chain of command usually ends at their clinic, however, practitioners across Australia have broadly varying levels of independence in interpreting and implementing those standards as they see fit, subject to what their employer permits.
This is not the case in the United Kingdom. The status quo — which is currently in the process of changing, but toward an unclear end — is that there is only one paediatric gender clinic in the whole of the United Kingdom, the #NHS Gender Identity Development Service (#GIDS). "National guidelines" sound rather less impressive when you realise that they currently apply to a total of one clinic, which also contributes most of the data that underpin them, and which, in large part, directly writes them
In the second place, UK doctors don't yet "have to follow" any "new national guidelines" at all. The guidelines in question, which are the NHS INTERIM SERVICE SPECIFICATION FOR SPECIALIST GENDER DYSPHORIA SERVICES FOR CHILDREN AND YOUNG PEOPLE, and still in consultation and will remain there until 4 December [1]. They have also been the subject of absolutely blistering criticism from every peak body that has at least one keyboard and a semi-functioning internet connection [2].
The intention here is clearly that UK paediatric trans health practices should be understood as disciplined and careful, when they're nothing of the sort — they're an act of gleeful sadism, motivated by the barely concealed inadequacy and resentment of an increasingly ailing UK government and increasingly openly reactionary British state.
SECTION NOTES
[1] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/
26. "[Barber] said almost all of his patients, both adults and children, are neurodivergent — meaning they have autism or ADHD."
In the first place, "neurodivergent" doesn't just mean "has autism or ADHD," as much as I and other autistics and people with ADHD sometimes act as if it did.
In the second place, this claim is no less improbable coming from Barber than it was from Hespe. Then again — Barber's 'home' clinic, #StonewallMedicalCentre, *is* only 500 metres from Windsor traino ... [1]
SECTION NOTES
[1] Once again, this joke is in my lane :)
27. "[Barber] said he follows Australian guidelines promoted by AusPath — a group of health professionals working with trans people — that says gender affirming care is evidence-based and saves lives."
What an absolutely delightful paragraph. For relatively few words, there is so much going on.
#AusPATH are the AUStralian Professional Association for Transgender Health, the Australian affiliate of #WPATH, and the peak body for trans health in Australia. AusPATH are "a group of health professionals working with trans people" in much the same way that the #AustralianArmy are "a group of people in green clothes who like guns".
Being the peak body, AusPATH don't "promote" guidelines; they set them. Nor is their setting of guidelines simply a matter of ineffectually wringing their hands and saying, "well, doctors *should* do this, we'd *like* it if they did, pretty please". As noted above, civil action for medical malpractice rests largely on whether the defendant provided the standard of care which would be reasonably expected from a medical practitioner of that kind acting under those circumstances [1]. Those standards of care are precisely what AusPATH (and WPATH) define.
AusPATH can literally "promote" guidelines in the common meaning alternative to the one used here, i.e., raising them up. They can endorse a protocol used by an individual clinic or in a small area, and distribute it under their own aegis. That just effectively makes it another standard they set, though, not some other thing they're shilling for.
Finally, the fact that gender-affirming care is evidence-based and saves lives isn't a matter of what either Barber or AusPATH "say"; it's simply true [2] [3] [4].
SECTION NOTES
[1] https://www.armstronglegal.com.au/commercial-law/qld/tort-law/medical-negligence/
[2] https://www.wired.com/story/gender-affirming-care-improves-mental-health-and-may-save-lives/
[3] https://www.columbiapsychiatry.org/news/gender-affirming-care-saves-lives
28. "[Barber] said for kids aged 14 to 16 years it's a grey area, as they need parental consent while those aged 16 to 18 should be able to consent."
This also isn't a matter of Barber's opinion. "He said ... those aged 16 to 18 should be able to consent" makes it sound like he's winging it: "Oh well, they should be able to consent, it's fine, she'll be right". That framing suggests his practice is endangering children left and right.
In reality, he's simply accurately — and perhaps even slightly conservatively — summarising Australian and Queensland law. People under 16 have to either get parental consent, or actively prove they're GILLICK competent [1]. People over 16 are assumed competent by default [2].
SECTION NOTES
[1] i.e., that they're competent to give informed consent according to the test stipulated in the UK House of Lords ruling GILLICK v WEST NORFOLK AND WISBECH AREA HEALTH AUTHORITY [1986] AC 112. http://www.bailii.org/uk/cases/UKHL/1985/7.html
#GillickCompetence was incorporated into Australian law by SECRETARY, DEPARTMENT OF HEALTH AND COMMUNITY SERVICES v JWB AND SMB (1992) 175 CLR 2018 (#MarionsCase). http://www8.austlii.edu.au/cgi-bin/viewdoc/au/cases/cth/HCA/1992/15.html
29. "But [Barber] said the rates of people regretting going on gender affirming drugs is 'almost zero' and those taking it see an upswing in their mental health."
Again, this is not simply Barber "said". Not only is it true that regret rates are close to zero, they have remained stable or dropped over time:
* Smith et al. (2004) [1] found that in a sample of 162 trans adults at 2 gender clinics in the Netherlands, the number who "expressed regrets" was 2 (1.4%).
* Davies et al. (2019) [2] found that in a sample of 3,398 British trans adults at 1 #GenderIdentityClinic, the number who experienced transition-related regret was 16 (0.47%) or fewer. [3]
* Turban et al. (2021) [4] found that, among respondents to the 2015 #USTransgenderSurvey, of the 2,242 who reported a history of detransition, 54 (2.4%) endorsed "uncertainty or doubt around gender" as a factor.
The usual argument at this point is "oh but even one is too much!", which is obviously bullshit both on principle and in practice. For instance, Wilson et al. (2017) [5], reviewing patient decisional regret around surgery — all surgery, of any kind — found that in the studies reviewed, the "average prevalence" of "self-reported patient regret," which they described as "relatively uncommon," was 14.4%.
Moreover, the fact that "gender affirming drugs' cause "an upswing in [trans people's] mental health" is not realistically in any doubt.
* St Amand et al. (2011) [6] found "clear evidence that #HRT is associated with improved mental health outcomes".
* Colizzi et al. (2014) [7] found that the percentage of subjects in whom "psychiatric distress and functional impairment were present" was significantly lower after 12 months of HRT.
* Bouman et al. (2016) [8] found that "the use of cross-sex hormones appears to be associated with psychological benefits".
I have about 40 more studies here on this topic and I could go on but 3 is enough because we all already know this. Only News Corp could pretend this is news — I can't imagine I'm the first person to say that sentence.
SECTION NOTES
[2] https://epath.eu/wp-content/uploads/2019/04/Boof-of-abstracts-EPATH2019.pdf (p. 118)
[3] 16 subjects "expressed transition-related regret or detransitioned," which are, while intuitively clearly associated, not mutually inclusive.
[4] https://www.liebertpub.com/doi/10.1089/lgbt.2020.0437
[5] https://link.springer.com/article/10.1007/s00268-017-3895-9
[6] https://www.tandfonline.com/doi/abs/10.1080/19359705.2011.581195
[7] https://www.sciencedirect.com/science/article/abs/pii/S030645301300348X
[8] https://www.jsm.jsexmed.org/article/S1743-6095(16)00086-2/fulltext
30. "[Barber] warned that if Australia followed the UK route and more barriers were put in the way of people seeking to transition it could result in people taking their own lives."
Yet again, this is clearly supposed to be at least open to being interpreted as an activist doctor intentionally overselling the politically correct narrative, and again, it's simply objectively true.
As noted in the withering WPATH-led joint statement in response [1], published 25 November, virtually every change made by the NHS draft service specification [2] is in a direction comprehensively demonstrated to increase the risk of suicide [3]. Among the more significant such changes are:
* "discourag[ing] social transition in pre-pubertal children" [1, s 6], even though denial of social transition is known to increase suicidal ideation [4];
* "severely limit[ing] access to puberty suppression" [1, s 7], even though denial of access to puberty suppression is known to increase suicidal ideation [5] [6];
* refusing to "describe any process for provision of estrogen or testosterone therapies for older adolescents" [1, s 7], even though denial of access to HRT in adolescence is known to increase suicidal ideation over the remainder of the patient's life [7];
* "a 'psychotherapeutic' approach, which was used for decades before being superseded by evidence-based gender-affirming care, [and] has not been shown to be effective" [1, s 9], even though the approach "is tantamount to 'conversion' or 'reparative' therapy" (ibid.), a form of torture [8] which is known to be linked to an increased incidence of suicidal ideation and suicide attempt [9] [10].
Once again, Barber's statement is not a matter of opinion — scientific investigation has repeatedly and exhaustively shown it to be thoroughly factual in every way. News Corp's decision to present it as simply a personal warning from one horse heavily implied to be dubious and biased does not reflect a commitment to inform readers of the truth — but that won't be news to anyone.
SECTION NOTES
[2] https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/
[3] Trans-eliminationists often claim that the data means nothing because it’s based on proxy parameters, typically suicide attempt and/or suicidal ideation. In doing so they’re seemingly relying on their audience not to realise that they’re saying “data about suicide doesn’t count unless you get it by interviewing people who are dead”.
[4] https://psycnet.apa.org/doiLanding?doi=10.1037%2Fcpp0000291
[5] https://acamh.onlinelibrary.wiley.com/doi/10.1111/camh.12437
[7] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261039
[8] https://irct.org/wp-content/uploads/2022/08/Its-Torture-Not-Therapy-2020.pdf
[9] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2749479
[10] https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2020.305701?journalCode=ajph
CLOSING
I usually don't bother wasting the effort required for a #SeveralProblems on any News Corp outlet; "Never wrestle with a pig" [1], etc. There's basically no overlap between people who read my work and people who think News Corp is credible. This particular masthead is so well known for being toilet paper that there's a local proverb about it [2] — which has given rise to multiple songs [3] [4] — which runs: "Is it true, or did you read it in the COURIER-MAIL?"
However, I think it's occasionally useful to check in on them and see how everything is going over there on the other side — see what shape the hate campaign is taking today. News Corp is suggesting trans people are fake, artificial, predatory, a danger to kids, backed by a doctors' plot and a captured state. It's not good news, nor is it surprising, but keeping track of the tropes can be useful in determining where fires are being set, why, how — and, ideally, on whose order.
SECTION NOTES
[1] https://quoteinvestigator.com/2017/07/08/pig/
[3] https://bestwishesrecords.bandcamp.com/track/is-it-true-or-did-you-read-it-in-the-courier-mail
POSTSCRIPT
IF YOU THOUGHT THIS THREAD WAS GOOD OR IN ANY WAY USEFUL — I'm honoured! I hope you will consider supporting my work via #KoFi [1], #Patreon [2], or #PayPal [3], so I can continue to sustain the absolutely obscene and unremitting expense of remaining alive.
IF YOU THOUGHT THIS THREAD WAS BAD — please feel free to let me know via replies or DMs here, or contact me [4] at either of my two email addresses, or any of my four million other social media and messaging accounts. Annihilate me. I need it to be over so I can finally rest.
(Please also feel free to contact me if you thought it was good. Or if you'd like to say hi!)
SECTION NOTES
[1] https://ko-fi.com/epistemophagy
[2] https://patreon.com/eigenvectrix
Also if you'd like this thread in a convenient article format it can be found here: https://severalproblems.press/2022/11/29/several-problems-aussie-doc-i-see-300-trans-patients-a-year/
ALSO because I found out everything I know from following them on Twitter and I want to direct people back along those lines as much as I possibly can, here are some of the folks I cited for this piece:
Liz Duck-Chong @lizduckchong
Meryl Links @minusplnp @minusplnp
Mallory Moore @chican3ry
Liz Duck-Chong @lizduckchong
Meryl Links @minusplnp @minusplnp
Mallory Moore @chican3ry
PARAsocial_work🏳️⚧️@estrapade You’ve sealed my support. You have a new patron.
@PARAsocial_work YAY 😭 💖 !! Thank you so much
MJ (they/them)@estrapade thank you for such a comprehensive, beautifully articulate, and relentlessly savage destruction of the vile bigotry that News Corpse and other media engage in. I couldn't give much but I wanted to support you and your hard work.
@CounsellorMJ it's very kind of you to help out at all. Thank you so much! 💖 💖 💖