Experts question whether young patients can fully grasp the risks and consequences of gender transition procedures
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Do teens going through cross-gender hormones and surgeries know what they’re doing? A leak of internal conversations by the World Professional Association for Transgender Health (WPATH) shows even some doctors administering the procedures have serious doubts.
The U.S. advocacy organization Environmental Progress, led by president and founder Michael Shellenberger, made the leaks public.
“The WPATH Files show that what is called ‘gender medicine’ is neither science nor medicine,” Shellenberger said in a press release.
A short list of excerpts highlighted many telling comments.
Child psychologist Dianne Berg, who co-authored the child chapter of the eighth edition of WPATH Standards of Care, said young girls don’t understand what it means to get male hormones.
“[It is] out of their developmental range to understand the extent to which some of these medical interventions are impacting them. They’ll say they understand, but then they’ll say something else that makes you think, oh, they didn’t really understand that they are going to have facial hair.”
Canadian endocrinologist Dr. Daniel Metzger acknowledged, “We’re often explaining these sorts of things to people who haven’t even had biology in high school yet.”
Metzger said neither he nor his colleagues were surprised at a Dutch study that found some young post-transition adults regretted losing their fertility.
“It’s always a good theory that you talk about fertility preservation with a 14-year-old, but I know I’m talking to a blank wall. They’d be like, ew, kids, babies, gross,” Metzger said.
“I think now that I follow a lot of kids into their mid-20s, I’m like, ‘Oh, the dog isn’t doing it for you, is it?’ They’re like, ‘No, I just found this wonderful partner and now want kids.’ … It doesn’t surprise me.
“Most of the kids are nowhere in any kind of a brain space to really talk about [fertility preservation] in a serious way.”
While youth keeps some from grasping the lifelong consequences of their actions, mental illness does the same for others. But that doesn’t always mean the doctors refuse to transition them.
One gender therapist administered cross-sex hormones to a patient with dissociative identity disorder. The therapist said asking the split personalities if they approved the treatment was ethical. Otherwise, a lawsuit could follow.
In one case, a nurse practitioner struggled with how to handle a patient with PTSD, major depressive disorder, observed dissociations, and schizoid typical traits who wanted to go on hormone therapy. Somehow, the clear moral dilemma was lost on Dr. Dan Karasic, lead author of the mental health chapter of WPATH Standards of Care 8.
Karasic replied, “I’m missing why you are perplexed … The mere presence of psychiatric illness should not block a person’s ability to start hormones if they have persistent gender dysphoria, capacity to consent, and the benefits of starting hormones outweigh the risks … So why the internal struggle as to ‘the right thing to do?’”
Testosterone injections carry cancer risks for those born female. In one case, a doctor acknowledged a 16-year-old had two liver masses, one 11 centimetres by 11 centimetres and another seven centimetres by seven centimetres, and “the oncologist and surgeon both have indicated that the likely offending agent(s) are the hormones.”
The friend and colleague of one doctor received close to 10 years of male hormones, leading to hepatocarcinoma – a type of liver cancer that originates in the liver cells. “To the best of my knowledge, it was linked to his hormone treatment … it was so advanced that he opted for palliative care and died a couple of months later,” the doctor said.
Some female-born transitioning patients had terrible pain during orgasms, while males on estrogen complained of erections “feeling like broken glass.”
The future may be even stranger, according to one doctor.
“I think we are going to see a wave of non-binary affirming requests for surgery that will include non-standard procedures. I have worked with clients who identify as non-binary, agender, and Eunuchs who have wanted atypical surgical procedures, many of which either don’t exist in nature or represent the first of their kind and therefore probably have few examples of best practices,” the doctor said.
Unsurprisingly, some people regret their medical transitions and want to change back. Some WPATH members want to discount this altogether. WPATH President Marci Bowers admitted “that de-transition exists even to a minor extent is considered off limits for many in our community.”
An unnamed researcher thought it was just a matter of perspective, saying, “What is problematic is the idea of detransitioning, as it frames being cisgender as the default and reinforces transness as a pathology. It makes more sense to frame gender as something that can shift over time, and to figure out ways to support people making the choices they want to make in the moment, with the understanding that feelings around decisions [may] change over time.”
Should our physical being be substantially altered and re-altered according to our feelings? Is transitioning a matter of mental health or self-expression?
Lee Harding is a research fellow for the Frontier Centre for Public Policy.
Explore more on Gender politics, Gender dysphoria, Transgender, Child abuse, Mental health
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