Sunday 27 September 2015

It’s telling when people claim the current scientific consensus is an ideology

Heya everybody,

I have come across a blog called The truth about autygynephilia, which reminded me that I really need to find the time to finish my write-up on autogynephilia. The objective of the blog seems to be to aggressively push the autogynephilia hypothesis.

Interestingly, the subtitle by far the most common reason why male transgenderists attempt to become ‘women’ already seems to shift the goalposts of the hypothesis as defined by Ray Blanchard in the 1990s. I guess the proponents of the hypothesis have accepted that a gender-identity driven pathway to transsexualism exists and now offer autogynephilia merely as an additional, alternative pathway. I so wish they would write a proper peer-reviewed article on what their hypothesis actually is! Anyway, if that is their claim, they need some studies to support the existence of this additional pathway leading to transsexualism.

But I didn’t want to write about autogynephilia today, what has raised my interest is the latest blog post on that website, called Top pediatricians REJECT puberty-blockers, ‘ideology-driven social experiment on vulnerable children and their families’. It quotes a letter written by three American pediatricans, two of them in leading positions, to the journal Pediatrics. In this letter, they object to treating gender-dysphoric adolescents with puberty blockers.

At face value, this seems to be an entirely reasonable thing to do. It is the essence of science that the pros and cons of positions are being discussed in order to come to a conclusion on what describes reality best. Here, the issue is that we have adolescents who have a condition (gender dysphoria) that reduces their quality of life (both self-reported and objectively measurable), and that we need to find a treatment that reduces their suffering.

The current scientific consensus is that some of these adolescents are transsexual. Hormone blockers are prescribed to block puberty (a reversible procedure) until the patient in question is mature enough to be confident that his or her gender identity will not change and is fully able to understand the impact of non-reversible procedures, such as surgery. If these conditions are met, the treatment for transsexuality is applied (i.e. irreversible hormone treatment and surgery). For the effectiveness of hormone and surgical treatment for transsexualism, please have a look here.

What do the letter writers offer in terms of evidence for their position? In their first paragraph, they are off to a bad start, labelling gender dysphoria as a delusion and attacking the current consensus on prescribing puberty-blocking hormones because it treats puberty as if it were a disorder. This is a clear straw-man argument. Nobody says puberty is a disorder. The disorder is the conflict between biological sex and psychological gender identity. This introduction to their letter already casts some doubt on their neutrality and expertise.

So what evidence do they cite? Unfortunately, and fatally for their point of their view it is the well-discussed Swedish study by Dhejne, Lichtenstein, et al, published in 2011. The study with 324 participants looked at transsexuals after surgery and found they were worse off than controls. However, the study was not designed to compare the situation of transsexuals before and after treatment. That was simply not part of the study design, and to imply otherwise is dishonest.

However, we do have studies that do just that (check whether transsexuals are better off after treatment). For example one by Dhejne, et al from 2014 with 767 transsexuals (including the same individuals from the 2011 article) showing that 97.8 % of transsexuals were satisfied with having the surgery done – implying they judge their situation to have improved. For more information, see here. There is more I have written about the study quoted, but it’s tiring having to discuss the same issue over and over again.

In addition, they criticise the lack of a good body of research on the subject (see here for relevant studies) and propose the hypothesis that puberty brings relief for the vast majority of children receiving therapy for GID, because hormone surges propel the development of their brains as well as their bodies and they come to identify with their biological sex.
To support this claim they quote two studies (Zucker, 2005 and Vigil, Oreallana, et al, 2011). The second study doesn’t address gender identity at all, and the first is simply an overview of measures pertaining to gender and sexual orientation. I fail to see how these two studies prove their point. Ideally, they’d need to have two large age-matched groups of gender variant children, one with early onset of puberty, one with late onset (natural or through puberty blockers) and show that the former group becomes more gender-conforming earlier than the latter one, all the while controlling for social and cultural factors.

Anyway, from what I understand the content of their letter is highly dubious and it might not even have been argued in good faith. Show me some evidence that a different type of treatment helps transsexuals more than the current treatment, and I’ll be all ears.

Christian conference on transgender issues rejects the existence of gender identity

Heya everybody,

I have added about twenty studies today, and hope to do the upload soon! Before I give a short overview of the most relevant studies added, I just wanted to mention a different subject:

In a few weeks, a Christian conference on transgender topics will meet in Kentucky, USA (see here and here). It’s organised by the Association of Certified Biblical Counselors and the Council on Biblical Manhood and Womanhood.

I’m not writing about this because I think this conference will have major relevance, I just want to point out what keeps baffling my mind – it’s the way some people think, and how fundamentally different it is from thinking grounded in reality. Apparently, there has been a statement last year by all the speakers rejecting that a human being could possess a gender other than the one indicated by biological sex.

There is a number of problems with this statement.
Firstly, it ignores that biological sex can be ambiguous, i.e. the body has many sexually dimorphic traits, and they can develop in contrasting directions. Biological sex is not a black-or-white issue, as people with disorders of sex development (DSD) demonstrate. These people exist, some with visibly ambiguous sex characteristics. If biological sex determines the gender identity of a person, what is the gender identity of people with DSD?
Secondly, in order for this statement to have meaning, you need a definition of what is meant by gender. I fail to see how one could define the term without relating to the psychological state of a person, i.e. the gender a person feels he or she belongs to and/or has psychological similarities with. If that’s the definition of gender, you’ll find some people claim they have a gender identity different from their natal sex. This is fatal to the claim that gender identity is always identical to physical sex, unless you can show that all transsexuals are mistaken.

We have many studies showing that brains of transsexuals and their psychology exhibit characteristics of their experienced gender and that gender identity exists and is influenced by hormones during the development of the brain.

Let’s wait and see what evidence this conference presents to support its claims. My guess is none.

Saturday 19 September 2015

More evidence that surgery is beneficial

Heya everybody,

It’s the weekend and the sun is shining!

I have been busy updating my list of studies, but I just wanted to quickly focus on new studies and articles about the effectiveness of treatment.

  • Italian researchers Prunas, Hartmann, et al. have published a study called “Psychosocial outcome and quality of sexual life after sex reassignment surgery: An Italian multicentric study” in the Journal of Sexual Medicine (2015). Their long-term follow-up of about 77 transsexual respondents showed that regrets after surgery are exceedingly rare (less than 1.5 %), satisfaction is high and quality of life increases.
    While the results are very positive, the study suffers from the same issue many long-term studies have – low response rates. Only 37 % of questionnaires were returned. With low response rates it’s anybody’s guess whether the participants of the study were representative of the overall population of treated transsexuals. However, this is the data available.

  • Finnish scientists Mattila, Heinonen, et al. have published an article in Duodecim (2015) stating that Gender dysphoria is effectively alleviated by sex reassignment treatments. Quality of life is improved among the majority of patients, and regrets are rare.

  • Lauren Schmidt and Rachel Ravine from Yale respectively Pennsylvania State University in the US have published a review of longitudinal outcome data evaluating psychological well-being and quality of life among transgender individuals who have undergone cross-sex hormone treatment or sex reassignment surgery in Endocrinology and Metabolism Clinics of North America (2015). Unfortunately, the published abstract doesn’t include results and I have not been able to get hold of a full-text copy. If you know what their conclusions are, please send me a mail.

Oh, and in other news the Vatican has stated transsexuals can’t become godparents. Because Jesus said so. No wait, he didn’t. But it’s something they are really sure of, like they are or were of the existence of demons, geocentrism, infallibilty of the pope, unbaptised children going to hell or limbo, etc. Anyway, naturally, your body’s appearance must determine your fate – the soul, the mind, the person, the inner qualities are all completely irrelevant in this theology.

Well, back to the real world – I haven’t yet uploaded the latest additions to my reference pages, but am hopeful to do that this weekend. Take care!

Sunday 13 September 2015

Are we becoming better at accepting reality for what it is?

Heya everybody,

XKCD cartoon “Settled”

I love the cartoon above – it’s so true, and yet nobody is talking about the fact it illustrates.

For decades, we have seen miracles, magic and the paranormal retract at the same rate humanity gets better at documenting things. These days, most people carry around devices that can instantaneously record photos and videos. However, UFO, alien, bigfoot and ghost sightings, sun miracles, Marian apparitions, etc. have just not kept up the pace![1]

I wonder whether our technical progress will lead to less superstition and gullibility in the future. I also hope the Internet might have the same effect. Some people claim the reason why sects such as Mormons, Jehova’s Witnesses or Scientology are finding it more and difficult to gain converts is that the web exposes their claims, and allows them to be evaluated in the open. Open access to knowledge reduces mysteries and secrets and tears the veil from poorly-evidenced statements and assertions.

Gutenberg’s invention of the printing press led to one of the major revolutions in history – first came the reformation, then enlightenment and humanism. Let’s work towards the Internet having a similar effect!

Peace and Light 👻 👼 👽 👾 👿 😏

[1] That’s not to say I reject such claims out of hand – I’m fascinated with the unusual, the extraordinary and the paranormal, and I would like to be the first person to know if something exists outside of our current accepted school knowledge. However, existence needs to be proven with evidence. I’m thankful for anybody working on trying to expand and improve our knowledge.

Saturday 12 September 2015

Diagnostic Manual DSM-5

Heya everybody,

Finally I have been able to put some work in and caught up on something I meant to do for a while!

I got hold of the full text of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, which was published in 2013 by the American Psychiatric Association (APA), making it the most up-to-date medical categorisation manual available. It replaced DSM-IV from 1994. The handbook sets standards for both the definitions and diagnoses of mental illnesses and health-related conditions.

I have put the chapter about gender dysphoria on my website and also quoted the subcategory about transvestism, to provide a differentiation. The text is excellent not only for symptoms and diagnostic criteria, but also for definitions and explanations. If you want to know the latest scientific consensus on what gender dysphoria is, have a read! If I have time, I’ll write an article on the changes from the old DSM, and my interpretations of the current status.

The DSM-5 will also provide an important basis for the International Statistical Classification of Diseases and Related Health Problems (ICD), maintained by the World Health Organization (WHO). The WHO is currently updating the ICD-10, which was published in 1990. ICD-11 is expected for 2017.

Have a good weekend ✨