Pediatric Gender Affirming Care. Part 1
Dissecting the PGAC Controversy.
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Res Ipsa Loquitur. The thing speaks for itself.
Table 1. Side by Side Comparison of Partisan Views on Pediatric Gender Affirming Care.
Citations of the source materials are given in the square brackets. The complete list of references with the links to those sources are listed at the end of this article. Abbreviations used: PGAC: Pediatric Gender Affirming Care; GI: Gender Identity; TGP: Transgender Person; F2M: Female to Male; yo: years old; c/w: consistent with.
Abstract
This is the first article in the series of papers examining the current deep partisan divide over the Pediatric Gender Affirming Care (PGAC):
Using a side-by-side comparison table (see Table 1 above) we have demonstrated the enormous divergence of opinions between Progressive and Conservative medical experts on this modality.
We have subsequently proposed that the philosophical irreconcilability between Progressive and Conservative camps is the root cause of the current vigorous, frustrating and unsolvable debate over PGAC.
We posit that the current dispute over PGAC is not a purely scientific matter that can be solved by performing more robust research studies, followed by the consensus of experts.
Instead, the PGAC controversy involves a vast array of cultural, ideological, ethical, religious and political aspects - reflecting the irreconcilably different philosophical foundations of the two opposing partisan factions.
Therefore, resolving the discord surrounding PGAC and similar matters by the civil discussion seems unlikely. The sides of the dispute are guided by not compatible value systems, have virtually nothing in common, and are unwilling to compromise their cherished principles.
In this context, we have closed this text with the discussion of the ongoing state legislative efforts of conservatives and progressives aimed at either restricting or preservation of the PGAC by using the state laws and the state administrative agencies - in accordance with the preferences of the political majority at each state.
Introduction
As we have discussed previously in the current era of severe political polarization and politicization of medicine, the concept of Transgenderism became the ultimate cause célèbre of the Left and the dreadful bête noire of the Right.
The polarization of society became so severe that the members of the two opposing political factions rarely have an access to the original texts written by their ideological opponents. Instead, they see their political adversaries through the biased partisan narratives .
To provide the objective, narrative-free information regarding the ongoing Transgender Debate, we have collated the most representative original texts produced by the professional organizations from both sides of this dispute (Ref). Subsequently, for added clarity we have compiled a Summary Table containing side by side comparison of the current partisan opinions on the concept of Transgenderism (Ref).
In this article, using similar tabular side by side format (see Table 1 above) - we present the summary of the strikingly different opinions about Pediatric Gender Affirming Care (PGAC) expressed by the Progressive and Conservative medical experts. Every statement contained in Table 1 can be traced into its original source - through the provided references and links listed at the end of this article.
Deep Partisan Divide over PGAC
Even the perfunctory review of Table 1 leads to the conclusion that there is an enormous divergence of opinions on the validity, purpose, risks and value of Pediatric Gender Affirming Care between Progressive and Conservative clinicians and scientists. This immense disagreement about Pediatric Gender Affirming Care resulted in the current contentious public debate about this modality. Ultimately, the emotionally charged dispute about the role of PGAC in management of Pediatric Gender Dysphoria became one the most significant battles in the ongoing cultural war between Progressive and Conservative blocks (Ref), (Ref), (Ref).
Philosophical Irreconcilability is the Root Cause of the Divide
Interestingly, many participants of the conflict over PGAC - both Progressives and Conservatives are truly surprised that their political opponents hold the views that contradict so strongly their own views. They are further puzzled by the unexpected by them resistance of their adversaries to the arguments - they themselves find compelling and logical.
In fact, each side of this dispute is convinced that only their own position on PGAC is “self-evidently rational and correct” - while the claims that their adversaries make are so deeply irrational that can only be a product of insanity.
Both political factions claim that the opposing them political camp is illogical, arrogant, reckless, cruel, lacks compassion and decency, and is hypocritical, insane as well as perverted. The pejorative terminology used to describe the perceived flaws of the enemy varies between political camps. Yet, both sides accuse each other of virtually the same types of “unforgivable sins”, while no common ground between those two adversaries can be found.
In such situation, the engaged sides of this conflict and the neutral objective observers keep asking: Is there any identifiable root cause for this frustrating impasse?
We argue that the Philosophical Irreconcilability between Progressives and Conservatives constitute main basis for this robust, frustrating and apparently unsolvable by the compromise feud.
We have described this hypothesis previously (Ref). For the Progressives the enthusiastic acceptance of the transgenderism was natural - since this concept is fully compatible with their core philosophy (Ref), (Ref), (Ref), (Ref), (Ref). On the other hand, for many Conservatives - transgenderism and PGAC are destined to trigger the strong reflexive rejection - since those concepts contradict all the primary philosophical principles of conservatism (Ref), (Ref), (Ref), (Ref), (Ref).
Both sides of this polarized conflict have diametrically different values, perspectives and ways of reasoning. Three is no common ground between them. Such discordance negates any probability of reaching the consensus via civil discussion.
Progressive views on PGAC
As can be seen from the table below, Progressives argue that Pediatric Gender Affirming Care is a beneficial, evidence-based, developmentally appropriate, patient-centered, and holistic medical care that results in good outcomes.Progressives point out that PGAC is backed by all major medical organizations and is supported by long line of evidence in form of numerous recently published elegant research studies (see Table 1 and associated citations).
Since perspectives and values of progressives are incompatible with conservative philosophy - they will reject any arguments against PGAC that Conservatives would find very compelling [Source: Personal Communication]. And vice versa Consequently, Progressives will conclude that Conservatives feel deep aversion and anger towards PGAC due to:
The lack of understanding of transgender people due to lack of even cursory interaction with transgender people in real life;
The fear of “unnatural change” that may herald the beginning of the end the world order in which they feel comfortable;
The panic and disgust stemming from witnessing the existence of the phenomenon that challenges their traditional worldview and values;
The belief that gender is fixed and determined unchangeably by biology and/or divine will;
The honest but misguided desire to protect children from perceived harm or influence;
The insincere claims serving their hidden political agendas or strategy to mobilize their base to oppose their political enemies.
Conservative views on PGAC
In a contrast to Progressives, Conservatives see PGAC as an unjustified, ideology driven, misguided, dangerous experimental interventions that constitute form of child abuse, grooming for sexual abuse, political indoctrination that is disgusting, amoral and represents religious blasphemy (see Table 1 and associated citations).
Conservatives in general, reject the claims of Progressives that PGAC is an evidence based treatment supported by settled science. To prove their point, many conservative scientific dissenters - make well intended but futile attempts to invalidate the stream of the complex pro PGAC studies that are being published with the increasing impetus by the Progressive Faculty who are in full control of all Academia today. Such honest but unrealistic efforts are bound to fail due to the Progressive Academic Supremacy that we have previously described (Ref).
For this reason some conservative activists dismiss any necessity of producing complex research studies - as the only way to refute the claims of their opponents who promote PGAC. Those Conservatives assert that thousands of deceptive studies of transgender issues are produced in the Left Wing controlled Academia. Such studies are produced by the well-funded progressive Academicians who are enthusiastic PGAC advocates. Such “research projects” are based on false premise that biological sex is not real, not fundamental, and is changeable. Those conservative skeptics posit that simply: no research studies are necessary to refute the self-evident absurdity of PGAC, an abominable deception that is promoted by well-funded leftist “cult of transgenderism” [Source: Personal Communication]
Conservative Legislations against PGAC
Emergence of PGAC clearly constituted the big shock for conservatives since for the first time many of them started to take the physical actions against it, rather then like in the past complain about annoying for the social changes but remain idle. For instance, recently, many conservative state legislators have focused on passing laws aimed at:
banning the practice of Pediatric Gender Affirming Care that they consider to be mental and physical mutilation of children (Ref).
stopping what they consider to be the “invasion of males masquerading as women” into traditional women spaces e.g.: bathrooms, dressing rooms (Ref).
preventing what the claims is the transgender driven destruction of women’s sports - by banning transgender females from participation in women’s athletic competitions. (Ref).
Progressive Legislations to preserve PGAC
In politics, like in physics, every actions cause reaction. Therefore, as expected in response to conservative legislative efforts to ban PGAC - some of the progressive legislations have been proposed and enacted in the states dominated by progressive forces with the specific goal to protect PGAC from conservative efforts to ban it (Ref), (Ref), (Ref):
California: In 2013, California passed the School Success and Opportunity Act, which allows TGD students to participate in school activities and facilities that match their gender identity.
New Jersey: In 2018, New Jersey passed a law that requires schools to respect the gender identity of students and provide them with access to facilities and activities that correspond to their gender identity.
Colorado: In 2019, Colorado passed a law that prohibits health insurance plans from discriminating against TGD individuals and requires them to cover medically necessary GAC services.
New York: In 2020, New York passed a law that bans health insurance companies from denying coverage for GAC services for TGD individuals under the age of 18.
Massachusetts: In 2020, Massachusetts voters upheld a law that protects TGD people from discrimination in public places, including health care facilities.
Minnesota: In 2023 Minnesota senate voted to pass a House-approved bill that will prevent state courts or officials from complying with child removal requests, extraditions, arrests or subpoenas related to gender-affirming health care that a person receives or provides in Minnesota
References cited in the Table 1.
For the convenience of the readers the Table 1 is reproduced below. The Citations of the source materials are provides in the Table in the square brackets [ ], the names of references and links to those source materials are listed below the reproduced Table 1:
[1] LEFT WING (LW) IDEOLOGICAL BASIS: Sources regarding PROGRESSIVE PHILOSOPHY:
Definition and Role of “Progressives” (Ref)
The Progressive Intellectual Tradition in America (Ref),
The Progressive Era (Ref),
The Progressive Movement and the Transformation of American Politics (Ref).
Deep partisan divide on whether greater acceptance of transgender people is good for society (Ref),
What Is Left vs. What is Right? (Ref),
Conservative and Liberal Brains Might Have Some Real Differences (Ref).
[2] RIGHT WING (RW) IDEOLOGICAL BASIS: Sources regarding CONSERVATIVE PHILOSOPHY:
Definition and Role of Conservatives (Ref),
What Is Left vs. What is Right? (Ref),
Deep partisan divide on whether greater acceptance of transgender people is good for society (Ref),
Conservatives and Transgenderism: A Response to Jennifer Gruenke (Ref).
Cautious conservatives should work to preserve a peaceful and free social order. (Ref),
Conservative and Liberal Brains Might Have Some Real Differences (Ref).
Liberals and conservatives react in wildly different ways to repulsive pictures. (Ref)
Transgenderism: A State-Sponsored Religion? (Ref)
[3] LW DEFINITION of Pediatric Gender Affirming Care:
A. HHS Office of Population Affairs. Gender-Affirming Care and Young People. HHS Webpage, 2022.
B. American Academy of Pediatrics: Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents 2018 (Ref).
[4] RW DEFINITION of Pediatric Gender Affirming Care:
A. American College of Pediatricians. Gender Dysphoria in Children. ACPeds Website 2018.
B. AAPS What Does ‘Gender Affirming’ Mean for Your Child? AAPS Website 2022
[5] SELECTED LW TEXTS LISITING EVIDENCE for Pediatric Affirmative Care
WPAH: Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (2022)
TES: Gender Dysphoria/Gender Incongruence Guideline Resources (2022)
AACE Position Statement: Transgender and Gender Diverse Patients and the Endocrine Community
Olson-Kennedy, J. Management of Transgender and Gender-Diverse Children and Adolescents. In Up To Date. Waltham, MA.: Wolters Kluwer, 2023.
For more resources: Transgender Medicine and Research (Ref)
[6] SELECTED RW TEXTS LISTING RW EVIDENCE against Pediatric Affirmative Care:
American College of Pediatricians. Gender Dysphoria in Children (2018)
AAPS Statement on “Gender-Affirming Care” for Minor Children (2023)
Do No Harm Launches Nationwide Campaign to Protect Minors from Gender Ideology. Press Release (2023)
For more resources: Transgender Medicine and Research (Ref)
[7] POSITIVE OUTCOME ACCORDING TO LW:
A. De Vries, A. L. C. et al. (2014): Young Adult Psychological Outcome after Puberty Suppression and Gender Reassignment. Pediatrics 134, no. 4 696–704. https://doi.org/10.1542/peds.2013-2958.
B. Salas-Humara, C., et al. (2019). Gender affirming medical care of transgender youth. Current problems in pediatric and adolescent health care, 49(9), 100683. https://doi.org/10.1016/j.cppeds.2019.100683
C. Turban, J. L., et al. (2020):: Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation.” Pediatrics 145, no. 2 e20191725. https://doi.org/10.1542/peds.2019-1725.
D. Green, A. E., et al. (2022). Association of Gender-Affirming Hormone Therapy With Depression, Thoughts of Suicide, and Attempted Suicide Among Transgender and Nonbinary Youth. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 70(4), 643–649. https://doi.org/10.1016/j.jadohealth.2021.10.036
E. Olson-Kennedy, J.(2023) Management of Transgender and Gender-Diverse Children and Adolescents.In Up To Date. Waltham, MA.: Wolters Kluwer.
F. Chen, D., et al. (2023). Psychosocial Functioning in Transgender Youth after 2 Years of Hormones. The New England journal of medicine, 388(3), 240–250. https://doi.org/10.1056/NEJMoa2206297
G. Olson-Kennedy J et a.l. (2018): Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults. JAMA Pediatr.;172(5):431-436. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5875384/
H. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 11, 1 November 2017, Pages 3869–3903, https://doi.org/10.1210/jc.2017-01658 : “5.5. We suggest that clinicians delay gender-affirming genital surgery involving gonadectomy and/or hysterectomy until the patient is at least 18 years old or legal age of majority in his or her country.”
[8] NEGATIVE OUTCOME ACCORDING TO RW:
A. ACPeds: Gender Dysphoria in Children. ACPeds Website 2018.
B. SEGM Health risks of medical and surgical affirmation (2023) – Part of Compendium available at: SEGM Compendium of Literature regarding "gender-affirmative" interventions for gender dysphoric youth(2023)
C. Robbins JW, Broyles, VR. The Myth About Suicide and Gender Dysphoric Children https://acpeds.org/assets/for-GID-page-1-The-Myth-About-Suicide-and-Gender-Dysphoric-Children-handout.pdf
D. Transgender Trend: Suicide Facts and Myths. Transgender Trends Website 2023
E. ACPeds: Transgender Interventions Harm Children. No Evidence that Transgender Interventions are Safe for Children. ACPeds Website 2023.
F. ACPeds Deconstructing Transgender Pediatrics. ACPeds Website 2023.
G. Kelsey Coalition. Ban Real “Conversion Therapy” document prepared by Kelsey Coalition.