Here is a link to a TikTok from a doctor I follow regarding statistics on how many of 5.1 million young transgender individuals over a four-year period (2018-2022) actually received gender-affirming medical care (puberty blockers, hormones). The number was 0.05 percent. (Turn on the sound at the lower right corner.)
The information is from a JAMA Research Letter. You may find Dr Eric to be a trifle partisan, especially toward the end.
I didn't know the statistics, but I did know that the right wing used culture war issues, particularly LGBT+ issues, to gin up fear disproportionate to the number of people affected, as a cudgel in this election cycle. Actually I thought Dr. Eric stated the case pretty well.
ReplyDeleteKind of ironic that the party of small government and fiscal conservatism now advocates government interference in personal lives and elected a president who wants to buy Greenland (??!). Elect a clown and you get a circus.
And pass the popcorn for the Steve Bannon and Elon Musk fight.
I can’t listen to podcasts or TikTok videos. But I agree with you that this issue seemed to be mostly to raise fear in the far right community. I do find the civil war in the trump ranks to be entertaining - at least at the moment.But since both factions are big trouble it probably won’t be entertaining for long.
DeleteBig story in the latest Atlantic mag about the New Apostolic Reformation, conservative Christians pushing a Christian nationalist, anti democracy utopia. Utopia for them, I guess. Sounds like an effing nightmare to me.
DeleteLots of Catholics buying into their ideas. Guessing Rod Dreher and that Burch guy who ran CatholicVote.org and Trump appointed as Vatican ambassador are on board.
Anyway, not sure why the reporter did not link the state laws against trans treatment with this larger movement.
5 million trans-identifying children seems like a lot for the US; I am assuming that is a worldwide number, or a number comprising multiple countries?
ReplyDeleteWhether or not a minor should be able to undergo medical treatment toward a transition is just one of the cluster of trans-related issues I'm aware of. Issues that seem to have some political or cultural salience in the US:
* Whether transgender girls (biological boys) should be able to participate against biological girls in high school sports
* Whether restrooms in schools must be shared
* Whether parents should be permitted to be stakeholders in educational and medical decisions regarding trans minors
* Whether medical clinics that work with trans minors are giving objective medical advice in line with the Hippocratic oath, or are deferring to ideology
* To what extent teachers and others at school are obligated to respect minors' nonstandard pronoun preferences
Some of these issues don't directly touch on actual transition-enabling or puberty-blocking medical treatments. I don't know whether the number reported in the JAMA study is good, bad or indifferent; if I am doing the math correctly, it works out to something like 2,500 patients over that five-year period. Is that a lot of patients, or is it a tiny number? I suppose it depends on one's perspective.
JP: 5 million trans-identifying children seems like a lot for the US; I am assuming that is a worldwide number, or a number comprising multiple countries?
DeleteNo, the study was done in the United States using data from private insurance. [LINK]"The researchers analyzed private insurance claims data from 2018 to 2022, representing more than 5.1 million young patients ages eight to 17. They identified transgender or gender-diverse patients based on a gender-related diagnosis and then checked if they received puberty blockers or gender-affirming hormones."
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The author of the study is quoted as saying, "The politicization of gender-affirming care for transgender youth has been driven by a narrative that millions of children are using hormones and that this type of care is too freely given. Our findings reveal that is not the case."
So that is what the study, the TikTok, and this post are about. Not all the other issues you bring up. We can certainly discuss those, but those who believed Donald Trump, and presumably voted for him, apparently believed all that was necessary for a minor to receive puberty blockers and hormone therapy was to announce they identified with the sex opposite the one on their birth certificate. In fact, Trump claimed numerous times that boys sent off to school could be returned a day or so later having undergone sex-change surgery. A preposterous lie. So I am just pointing out with the information from this study that mere symptoms of gender dysphoria or the like were, statistically speaking, rarely addressed by the prescription of puberty blockers or hormones.
According to Statista, there were ~50 million children in the US between the ages of 6 and 17 in 2022. So for >5 million children to identify as trans or gender-diverse means that >10% of the 8-17 age group is identifying as being among those categories. That is eye-opening, at least for me.
Deletehttps://www.statista.com/statistics/457786/number-of-children-in-the-us-by-age/
Regarding the study's claim that the politicization of gender-affirming care "is driven by a narrative that millions of children are using hormones" - I suppose that's possible; I'm not always aware of everything Trump and his acolytes say. But my impression (which admittedly may not be worth much) is that that claim isn't really the main driver of the cultural conflict around trans youth.
That said: I have seen a number of stories in conservative media over the past year or so, criticizing youth gender-affirming treatment centers in the US for allowing pro-trans ideology to influence medical decisions. (Andrew Sullivan certainly is one writer sounding this alarm.) So the TikTok guy's numbers are good perspective.
FWIW, during the recent election contest, the Trump campaign ran ads attacking Harris for supporting government-funded trans surgeries for prisoners; that ad ended with the tagline, "Kamala is for they/them; President Trump is for you" (I think I have that right). In the wake of the election, some analysts believe that was an effective ad in driving the election outcome.
https://host2.adimpact.com/admo/viewer/b6eed563-fb14-406f-af83-4c93086fa049/
I don't think the TikTok guy is wrong for pointing out the numbers; I just don't believe that study's particular claim is driving the collective conflict/freak-out about transitioning.
Possibly Jim brings these issues up as reasons WHY transgender procedures are not instituted before adulthood?
DeleteISTM that until more is understood about gender identity (and that can't happen until the radical Christians stop being allowed to pass laws that favor prejudices that they claim are Bible-based), trans kids and their families will not get early interventions.
The New Apostolic Reformation is not about evangelizing individuals, but about shaping a society with laws that conform to their brand of Christianity. They claim everyone will be happier and more fulfilled in this way. Organized religion in America is aligning itself with some pretty unAmerican (and unChristian) ideas, if you ask me.
Jean “ The New Apostolic Reformation is not about evangelizing individuals, but about shaping a society with laws that conform to their brand of Christianity. They claim everyone will be happier and more fulfilled in this way. Organized religion in America is aligning itself with some pretty unAmerican (and unChristian) ideas, if you ask me.”
DeleteI agree. I have been trying to sound the alarm on Christian nationalism for years now. They organized and operated very covertly for a long time before finally starting to show their hand. Of course all the articles I sent to warn family and friends about this fell on deaf ears.They thought it was a tiny movement, not worth paying attention to. The RC played right into their hands by supporting definitions of “ religious freedom” that essentially gutted civil rights protections for the LGBTQ community, opened the door to allowing Christian prayer in public schools, and is now opening the door to have taxpayer money support religious schools - all of which violate separation of church and state . Catholics might be surprised at some point when these extreme right wing christian nationalist groups decide to kick the Catholics out of their bed if they take control and don’t need the heft of the RCC as a partner in crime anymore.
"Transgender" and "gender diverse" bring up a number of interesting philosophical and theological questions. But as a matter of public policy, I think the least bad option is to entrust the decision for gender-affirming care for minors their parents. That means that, as a matter of law, the parents' wishes must override the preferences of school administrators, state legislatures, activists and others - including the minor her/himself. We won't get happy people and perfect outcomes, but as I say, I think the alternatives are even worse.
DeleteYah, Catholics don't get that they won't be equal partners in the New World Order because evangelicals don't accept that Catholics are Christian. Trad Rad Catholics who want to cozy up to MAGA Christians should kiss goodbye their Communion wine, sacrament of Reconciliation, infant Baptism, saints, statues, ikons, rosaries, Latin, Transubstantiation, Adoration, and the books of Sirach, Tobit, Judith, Wisdom, and Maccabees. That's all gonna be heresy in the New World Order.
DeleteThere is a different way to look at this issue.
ReplyDeleteWe are talking about a new medical diagnosis and its consequences. It is not simply a matter of patients and their doctors. It becomes a part of the culture with many unintended consequences.
Some people will decide they have the diagnosis and begin seeking doctors who will confirm that diagnosis or at least agree to treat the patient in the meantime.
Drug companies will begin to search for old or new drugs that might treat the condition, and in the USA will advertise directly to potential users, encouraging them to ask their doctor.
People might decide there are secondary benefits to having the diagnosis. It helps them to relate in a different way to their families, friends and the general public.
Families, friends and the general public will begin to diagnose other people who may or may not have the diagnosis and attribute to them the disorder with either favorable or unfavorable consequences.
All part of the medical-industrial complex.
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DeleteMy viewpoint can explain why there are so many cases at the same time the Medical Industrial Complex is collecting data that assures us that they are doing little or no harm.
DeleteGender dysphoria is not new is it? It seems to be more mainstream to talk about and accept that it happens and to allow people recourse to a solution instead of staying hidden. Are some people confused or traumatized into thinking they're trans? I don't know.
DeleteThe profit motive in pharmaceuticals therapies is a separate issue and a constant problem.
Decades ago, when I was still working, I read an article in a medical journal that made the point that each of us is our own primary diagnostician and therapist. We decide whether or not our symptoms are important enough to see a doctor and whether or not to accept the doctor's opinion of what they mean and whether or not to comply with the doctor's treatment plan. Now with the internet, all this is even more likely especially about rare diagnoses.
DeleteAre some people confused into thinking they are trans? My answer is that this data seems to say that not only some, but many, young people are beginning to think that the solution to their confusion may be a dysphoria diagnosis. However not many cases are resulting in surgical or pharmacological interventions. That means there is a lot of skepticism about their self-diagnosis among physicians, parents and patients.
I am sorry that both liberals and conservatives have made this into a cultural war issue. That has not served either patients or physicians.
What I see in Cancer World where I spend a lot of time are
Deletea) people who will not accept that they have cancer and are visiting "naturopaths" for quack cures and
b) people whose conventional treatment has stopped working to the point where they demand treatments with less than a 50-50 chance of working and that might kill them in a worse way than the cancer
My guess is that similar scenarios could play out for people with gender dysphoria (quack cures or desperate measures), but I've only known a few people who were trans, and I know nothing about the details of their care.
For the last 20 years of my life analyzing data for the mental health system, I had what at the time were state of the art computer systems and a data base maintained by a full-time research assistant. When I first started, I was skeptical that I could provide any valuable data to clinicians since most of the data was gathered by them. Surely, they knew their clients far better than my computer did.
ReplyDeleteTurns out the computers in many cases had ten years of data on their clients, including all the times they were seen by other clinicians and other mental health agencies. Clinicians see so many people that they don't have time to get to know many of them. They can't see the forest for the trees, and the trees they see are usually only the current episodes not the whole history of the person
I suspect the clinicians in this study had no idea how likely trans gender people were to have puberty blockers or hormones. They would probably overestimate their prevalence since they would be seeing those who do a lot. One of the clinicians in our system was very good at group therapy. But you have to be in individual therapy before you can be in group therapy. When I analyzed her data, I found that 90% of the clients that were assigned her did not join a group; they all left before three sessions. Neither she nor her supervisor had any idea this was going on.
Maybe ninety percent of trans people are leaving after a few sessions or are going from provider to provider searching for help in their confusion? Maybe they really are not trans although they have been given the diagnosis for insurance purposes? We could be having many confused people who are inappropriately being labeled as trans without many professionals knowing it.
I suspect the clinicians in this study . . . .
ReplyDeleteThe study was done using "private insurance data across all 50 states." It is not clear to me who the "clinicians" would be.
They would probably overestimate their prevalence . . .
The thrust of the study is how rarely used puberty blockers and hormones were among diagnosed patients. If anyone generating the data that was used really overestimated the use of puberty blockers and hormones, then the study would underestimate how rare their use actually is.
I am being brief because of my Parkinson's tremor. I may have to start posting videos!
The private insurance data comes from clinicians who enter diagnoses into computer systems which bill private insurance. They also enter data into medical records systems that justify their diagnosis. Much of the supporting data comes from the patients themselves or their family members. These are the basis for estimating the number of trans persons.
DeleteUnlike physical disorders there are no physical tests to prove or disprove the diagnosis. While the clinicians may have sufficient verbal and behavior data (dressing, mannerisms, etc.) to indicate a trans condition, very few of the diagnoses result in surgical or drug interventions. This suggests to me that most of these diagnoses are tentative diagnoses, much like when a clinician sees many symptoms of depression but hopes that the patient's symptoms will lessen or disappear before prescribing drug therapy. Maybe just talking it out will resolve the issue for the patient. A lot of that appears likely to be happening. I don't think we can say that these patients are going untreated, the causes of their distress might lie elsewhere than in this diagnosis.
Jim said: "... as a matter of public policy, I think the least bad option is to entrust the decision for gender-affirming care for minors their parents."
ReplyDeleteI pretty much agree with you, but parental decisions don't exist in a vacuum. ISTM that the purpose of exclusionary laws and policies against trans girls/women in particular is to actively discourage parents from deciding on certain treatments.
These regulations basically say, "Put your boy in a dress and call him 'Cindy,' and we reserve the right to treat him like a weirdo, a pervert, and a sexual predator. And we reserve the right to lock you up for abuse and give 'Cindy' to good Christians who will beat some sense into him."
I don't think most parents make good decisions for their kids when they are under pressures like that. They likely persist with some kind of talk therapy that will keep the kid in the closet and in limbo about his identity until he's an adult.