Breakthrough Against Malpractice of Gender Affirming Care

After years of the American medical community insisting that gender-affirming care is appropriate, in spite of the reversals in European countries on this opinion, one prestigious American medical organization is taking a stand against the treatment:

The American Society of Plastic Surgeons (ASPS) is now stating that there is ‘considerable uncertainty as to the long-term efficacy for the use of chest and genital surgical interventions’ in minors and ‘the existing evidence base is viewed as low quality/low certainty,’ according to a piece this week by the Manhattan Institute’s Leor Sapir.

In Finland, France, Norway, Sweden and the UK, gender-affirming care is no longer the standard.

So why does the U.S. persist in this assessment? Claims have been made repeatedly that high-level research has been conducted, but the facts show otherwise:

Instead, it is the result of a small number of ideologically driven doctor-association members in LGBT-focused committees, who exploit their colleagues' trust. Physicians presenting different viewpoints are silenced or kept away from decision-making circles, ensuring the appearance of unanimity.

Clarification of “low quality” research has also been offered, to assure the medical profession that this is not an arbitrary term:

As one expert in evidence-based medicine put it, low quality ‘doesn’t just mean something esoteric about study design, it means there’s uncertainty about whether the long-term benefits outweigh the harms.’ As evidence for those harms--which include infertility, sexual dysfunction, and the agony of regret continues to mount and ethical concerns get harder to ignore, European countries are increasingly prioritizing psychotherapy and are reclassifying endocrine and surgical approaches as experimental.

In other words, physicians should be relying on psychological treatments rather than invasive or hormonal treatments.

The ASPS has declared that their members can’t simply ignore their roles as part of a treatment team, and must be expected to take the well-being of patients into account:

ASPS responded that surgeons are ‘members of the multidisciplinary care team’ and as such ‘have a responsibility to provide comprehensive patient education and maintain a robust and evidence-based informed consent process, so patients and their families can set realistic expectations in the shared decision-making process.’

And resistance to these changes in treatment dominates U.S. medicine. Double mastectomies continue to be done on young women:

An estimate of U.S. ‘gender-affirming’ double mastectomies published in 2023 in the Journal of the American Medical Association reported 3,125 cases of ‘breast or chest procedures’ in patients ages 12 to 18 between 2016 to 2020. The study did not differentiate between 18-year-olds and minors. A new analysis by the Manhattan Institute, using a more up-to-date all-payer national insurance database from 2017 to 2023, found evidence of 5,288 to 6,294 “gender-affirming” double mastectomies for girls under age 18. This includes 50 to 179 girls who were 12.5 or younger at the time of their procedure. (‘Top surgery’ on 12-year-old girls has been reported in the medical literature.)

When will medical professionals come to their senses? When will they stop pursuing child abuse and ignoring the most credible data? When will they acknowledge the lifelong damage this kind of treatment can cause? Sheila Nazarian in Beverly Hills has spoken out:

Sheila Nazarian, the Beverly Hills surgeon, told me that surgeons in her professional network who perform gender surgeries typically defer to mental-health professionals and endocrinologists to determine for them whether minors should receive procedures like double mastectomy. That approach, she believes, is misguided, and reduces surgeons to mechanics. ‘We are not highly trained technicians,’ Nazarian told me. ‘We are physicians with responsibility for the health and well-being of our patients. We can get input from other clinicians, but ultimately the responsibility for determining medical readiness lies with us. That means that we have to examine all the data and studies available to us. Furthermore, you can’t help people by ignoring the reasons they want to go under the knife. With every patient, I exercise discretion as a professional and determine whether the procedure they are seeking is in their ultimate best interest.’ The idea that surgeons should defer heavily to the prior assessments of clinicians struck Nazarian as wrong. ‘You can’t outsource your professional judgement to other clinicians. It’s your responsibility as the last in a chain of treatment to ensure you are doing what is best for the patient now and in the long term.’

For more information on how our judicial system is exacerbating the problem, read my previous post here.