Showing posts with label Gender Identity Disorder. Show all posts
Showing posts with label Gender Identity Disorder. Show all posts

Monday, 24 July 2017

Justine Greening’s transgender proposals are unscientific and dangerous but also part of a greater social strategy

Men and women will be able to change their gender without a doctor’s report and amend their birth certificate accordingly under new government proposals.

Yesterday Justine Greening (pictured), the education secretary and minister for women and equalities, said (£): ‘What we want to try to do is streamline the process, make it easier, de-medicalise it and make it less intrusive.’

She told Sophy Ridge on Sunday on Sky News that the state needed to ‘stop treating people changing their gender as if it’s some medical problem that needs fixing. Actually this is a choice that people are making and we need to try and make that choice more straightforward than it already is.’

Currently, under the Gender Recognition Act 2004 people need to be over 18, have been diagnosed with gender dysphoria, have lived in their new gender identity for two years and have obtained a certificate from a gender recognition panel before being able, legally, to change their gender.

But Greening wants to scrap all that and has the support of both the PM Theresa May and the opposition leader Jeremy Corbyn, ironically making this perhaps the first issue of public policy that the two have agreed on since the general election.

The government will launch a consultation on the Gender Recognition Bill, to be published in the autumn. The consultation will also consider whether a person whose gender is ‘non-binary’ — neither exclusively male nor female — should be able to define themselves as ‘X’ on their birth certificate.

I have written on the highly controversial issue of gender dysphoria before on this blog (also here and in much more detail here).

The key issue is that Greening is begging the question of what gender dysphoria actually is.

Is a ‘trans woman’ really a woman trapped in a man’s body? Or is ‘she’ really just a man who has an unshakeable false belief that he is a woman? Is a biological male who has had female hormones and gender reassignment surgery really a woman, or is he just a feminised man?

As recently as 2013 doctors called this condition ‘gender identity disorder. Many doctors, like me, feel it should still be called that. We believe that giving sex hormones and gender reassignment surgery to transgender people is not only clinically inappropriate but an abuse of professional privilege.

The key question is this. If there is a disconnection between the body and mind, do you shape the body to fit the mind or do you shape the mind to fit the body? Do you try to help the person to become reconciled with their body through counselling and psychotherapy? Or do you give them hormones and surgery so that their body conforms to their chosen gender identity?

Well, it depends on whether you think the real problem is in the body or the mind. And I, like many other doctors, am in the latter category. I think we’re being seduced and even coerced into thinking that the body, rather than the mind, is the real problem when there is actually no scientific evidence to back that up.

Everyone can see that a woman with anorexia nervosa is not fat, but she has an unshakeable belief that she is, so she is radically dieting and regularly purging herself. How do we help someone in this situation?

Well, we certainly don’t affirm her belief that she is fat or encourage her to diet or, least of all, offer her liposuction. And yet anorexia nervosa has a lot of similarities to gender dysphoria. You have a person who is deeply dissatisfied with the body that they’ve been given and may be obsessively preoccupied and distressed by it.

A high proportion of people who suffer from gender identity disorder also suffer from other mental health conditions like depression, anxiety, substance abuse, self-harm, suicidal thoughts, personality disorders and autism (see also here and here). In many of them these problems do not resolve with gender reassignment. In fact hormones and surgery deal only very superficially with what is often a very deep psychosocial problem that doesn’t lend itself to quick technological fixes.

Christians are not alone in these concerns. Stephanie Davies-Arai, of Transgender Trend, a parents’ support group, told The Sunday Times: ‘This has huge implications for women. There will be legal cases. The most worrying thing is if any man can identify as a woman with no tests and gain access to spaces where women might be getting undressed or feel vulnerable — like women’s hospital wards, refuges and rape crisis centres — women will just stop going to these facilities.’

Feminist Sarah Ditum, in a recent blog post outlines some of the problems self-declaration of gender could cause: ‘The issues break down into three sections: monitoring (how does self-identification change the way we can measure discrimination according to sex), services (how does self-identification change the way we deliver sex-segregated services), and cultural (the most nebulous category, dealing with how we collectively understand gender).’

And social commentator Melanie Phillips argues in the Spectator that it’s dangerous and wrong to tell all children they’re ‘gender fluid’. ‘What started as a baffling skirmish on the wilder shores of victim culture’, she says, ‘has now turned into something more menacing’.

By contrast, Greening, who has no medical or psychiatric training at all, thinks gender dysphoria is not a medical condition at all.

What she is proposing is effectively to bring in the key proposals of a highly controversial report by the Women and Equalities Committee of the House of Commons on Gender Equality, which was originally published in January 2016.

In essence the report recommends reducing the age limit for hormone treatment and surgery to 16 and completely removing the process of gender recognition from its current medical and legal framework – basing gender change on self-declaration alone.

Imagine what chaos would arise if people could ‘self-declare’ on other biological realities: a Caucasian man declaring himself black, a 50 year old declaring himself 65 in order to collect a pension early or a five foot ten man declaring himself to be a six foot four Chinese woman (watch this).

Where has this new thinking come from?

Justine Greening and Maria Miller, and a small group of feminist MPs, are using their influence to politicise the radical and controversial ideology of Judith Butler (pictured right), the American philosopher and gender theorist responsible for popularising ‘queer theory’ (watch university students fed this ideology trying to explain it here).

We are being sold the notion that gender has no biological basis at all but is simply a social construct and the product of a biased society. The cultural, medical and legal changes which we are now observing – resulting in the promotion of transgender ideology at all levels of society - are being driven by a process insiders know as ‘gender mainstreaming’.

This latest move to normalise ‘gender dysphoria’ is unscientific and dangerous but needs to be understood as part of a greater social strategy whereby powerful elites are claiming the authority to change men’s and women’s sexual identity through political strategies and legal measures.

Gender dysphoria is a real medical condition which needs careful diagnosis and even more careful management.

It is extraordinary that the leaders of both major political parties are unwittingly backing this bizarre social experiment which will simply open a Pandora’s box of confusion, abuse and litigation.

This move by the education secretary is quite simply lunacy and the fact that May and Corbyn are backing it so uncritically betrays an astonishing lack of discernment amongst our political leaders. 

Sunday, 18 May 2014

Offer of sex change drugs to nine year olds should make us question therapists’ ideological presuppositions

Children as young as nine are to be prescribed drugs which delay the onset of puberty as the first step towards a sex change operation (Mail on Sunday and Daily Telegraph).

Doctors at the Tavistock and Portman NHS Foundation Trust said a trial of the treatment on ‘gender dysphoria’ patients aged 12 to 14 had been successful and it could now be offered even earlier.

Monthly injections of the drugs, known as hypothalamic blockers, are used to slow the development of the children’s sexual organs by blocking the production of the hormones testosterone and oestrogen.

The rationale is that by delaying the onset of sexual maturation this gives more time for gender conflicted youngsters to decide whether they wish to embark on hormone treatment and surgery aimed at changing their gender. 

Most people will be shocked at this news but it is actually a logical consequence of accepting four prior ideological presuppositions – that gender is a social construct, that personal autonomy should trump other considerations, that emotional suffering should be avoided at all costs and that technology should be used to achieve these ends. 

There are obvious safety concerns - although the gender treatment is reversible, the long-term effects on brain development, bone growth and fertility have not yet been fully evaluated.

But safety considerations aside, using hormones to suppress puberty in transgender children is highly controversial, not least because of deep societal disagreements about the causes and nature of transsexuality and the effectiveness and appropriateness of transgender therapies per se.  This means that therapists remain strongly divided about the best way of handling the issue.

Transgender people are born with the anatomy and physiology of one sex but believe that they belong to the opposite sex.  Should therapy therefore be aimed at changing bodies (using hormones and surgery) to match a person’s beliefs or should it rather be aimed at helping people to adjust mentally to accepting the bodies they were born with? Even more fundamentally, is ‘gender dsyphoria’ a mental disorder or is it just a normal variant like eye or skin colour?

Up until recently ‘gender identity disorder’ was classified as a mental disorder (in the Psychiatric diagnostic inventory DSM-IV) but it has now been reclassified and renamed ‘gender dysphoria’ (in the DSM-V).  This change was strongly ideologically driven and many psychologists and psychiatrists dispute the reclassification. They still see ‘gender identity disorder’ as a kind of body dysphoria, whereby a person has an unshakeable false belief that they are one sex when in fact they are the other. It has been likened to anorexia nervosa, where the affected individual is convinced she is fat whilst being grossly underweight.

Those who supported the reclassification however, take the view that gender identity is biologically fixed and determined and that it is harmful to affected individuals to deny them sex change therapy or to 'force' them to live with the body they were born with. Some even hold to the strongly postmodern view that gender, regardless of what one’s genes or hormones suggest, is simply a social construct, even a matter of choice. If you wish to appreciate how passionately these views are held, then try expressing a traditional understanding on twitter using the hashtag #lgbt!  

Is gender identity fixed as male or female or is it more of a spectrum or continuum? Can it change over time? How effective is therapy is changing the strength and orientation of one’s beliefs? How might suppression of puberty using hormonal treatment affect bone, brain and sexual development?

Research is still at an early stage with many of these questions and strong ideological convictions one way or the other mean that scientific objectivity about the real effects of sex change therapy may always be a matter of contention.  It is perhaps not surprising that both opinion and research in this whole area is often driven by powerful ideological vested interests.

Complicating this is the fact that gender identity may change in an individual over time, and that it may be very difficult to predict the outcome of for any particular person. Some children are much more appropriately described as ‘gender nonconforming’ or ‘gender-fluid’ rather than transgender. In many others gender identity may change with time.

Toronto specialist Ken Zucker, who opposes the use of sex change therapies, claims that only about 12% of boys and girls with gender dysphoria will still have persistent dysphoria as adults. This fact alone should lead even the most committed supporters of early intervention to err strongly on the side of caution.

The CMF File ‘Gender Identity Disorder’ goes into the issue in more detail and also looks at biblical principles which can be applied.

The Bible teaches that human beings are created in God's image and of two sexes – male and female (Genesis 1:27). Jesus drew on this when he commented, 'haven't you read, that at the beginning the Creator “made them male and female”, and said, “For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh” (Matthew 19:4-5).

The Old Testament command 'you shall not commit adultery' also indicates that sexual intercourse should only occur within the framework of marriage (Exodus 20:14). Sex outside the marriage bond is wrong, whether with someone of the same or opposite sex (Leviticus 18:22, 20:10).

The ideal pattern for existence was spoilt at the Fall when mankind rebelled against God's rules. One consequence of this is that moral values, sexual patterns and also biology (genes and hormones) have become distorted.

The good news at the centre of Christianity is that Jesus, through his death and resurrection, gives people new life and power to change. On top of this, there will be a time in the future when all rebellion against God's plans will come to an end and a perfect relationship with God can be fully restored. This brings the hope that transsexual people may find support as they seek to live in ways that are honest to the way God made them, and open to God's ideals.

It's worth noting that the Bible regards celibacy as a high calling. Jesus was fully human and male, but never married nor had sexual intercourse. He also taught that marriage is not for everyone (Matthew 19:12).  It is important to acknowledge this, as for some people, battling with gender conflict may be a life long process. 

Tuesday, 26 March 2013

GMC backs down on requiring doctors to provide 'gender reassignment' as lobby group brings 98 patient complaints


The General Medical Council has backed down on requiring doctors to provide 'gender reassignment' just as a lobby group has brought forward 98 patient complaints. 


The blog was prompted by new draft guidance issued by the General Medical Council which implied that doctors who refused to provide ‘gender reassignment’ risked being struck off the medical register.

The draft guidance, ‘Personal beliefs and medical practice’ allowed doctors to opt out of providing procedures or treatments to which they had a conscientious objection provided that they made sure that ‘the patient has enough information to arrange to see another doctor who does not hold the same objection as you’.

But it made an exception in the case of ‘providing gender reassignment’ (P5 footnote) for which it said doctors had no right not to be involved.

It justified this stance on the grounds that these ‘procedures’ are ‘only sought by a particular group of patients (and cannot therefore be subject to a conscientious objection)’ under the Equality Act 2010. 

Understandably the report generated some media interest at the time.

The GMC has now published its definitive guidance and has backtracked significantly apparently as a result of responses to its consultation.

In its consultation it asked specifically:

‘At paragraph 5, we explain that gender reassignment is only sought by a particular group of patients who have ‘protected characteristics’ as defined in the Equality Act. Gender reassignment cannot be withheld because of doctors’ personal beliefs, without breaching the Act. Is this guidance on gender reassignment clear? If no or not sure, please say why.’

In fact the statement was not only unclear but legally incorrect.  We made the following response in our official CMF submission:

‘Answer – No

a. The guidance is not clear on gender reassignment and appears not accurately to reflect the requirements of the law. We recommend that the confusing footnote to p5 on gender reassignment be removed.

b. In the footnote to paragraph 5 it states that doctors have no right to ‘opt out of providing’ ‘gender reassignment’ but it does not clearly define what ‘providing gender reassignment’ actually entails. Does it include just gender reassignment surgery and/or hormone treatment or does it also entail being part of the referral pathway?

c. The treatment of gender identity disorder (alternatively gender dysphoria) is extremely controversial and many doctors do not believe that surgery or hormone treatment is clinically appropriate or ethical in many (or even any) cases. To force such doctors to ‘provide’ such ‘treatment’ with no option to opt out is inappropriate.

d. The argument that provision of ‘gender reassignment’ is required is we believe a misapplication of the Equality Act 2010. The natural reading of the law is that doctors should not refuse to treat patients who have already undergone gender reassignment for conditions that they would treat other patients for (eg. Infections, heart disease).

e. It does not mean that doctors are required to provide ‘gender reassignment’ to those diagnosed with gender identity disorder. This interpretation would place doctors under an obligation to provide treatments that they regarded as unethical to the other eight groups protected under the Equality Act 2010 also and would undermine their professional status by making them servants of the state. It could also be open to legal challenge.’

I was therefore most gratified to see that the GMC which issued its definitive guidance earlier this week had completely rewritten the section on gender reassignment.

The definitive guidance (para 8 page 2) now reads as follows:

‘You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them.’

A footnote (footnote 3 page 2) now makes it clear that this does not mean that doctors must provide ‘gender reassignment’, but rather that they must not withhold treatments from transgender patients which they would provide to others (eg antibiotics, pain killers, infertility treatment etc):

‘For example, this means that you must not refuse to provide a patient with medical services because the patient is proposing to undergo, is undergoing, or has undergone gender reassignment. However, you may decide not to provide or refer any patients (including patients proposing to undergo gender reassignment) for particular services to which you hold a conscientious objection, for example, treatments that cause infertility.’

This now protects doctors who have a conscientious objection to providing gender reassignment ‘treatment’.

It seems that this change has come not a moment too soon.

According to Pulse magazine (and Gaystar News) transgender activists have assembled a list of 98 patient complaints after a survey of transgender patients about their experience of dealing with medical professionals which it submitted to the GMC earlier this month.

The regulator has confirmed that a meeting with a group of transgender rights activists has resulted in 39 cases warranting an initial investigation, although they are at a ‘very early stage’.

Campaigner Helen Belcher, a member of the UK Parliamentary Forum on Gender Identity, said 15 GPs may be investigated by the GMC as a result.

The complaints include reports of sexual abuse, humiliation, inappropriate diagnoses, and denial of treatment. Patients also complained their transgender status was brought up when they were seeking treatment for entirely unrelated health concerns.

It is interesting that news of this campaign hit the media on the very day that the GMC released their revised guidance.

Was this in anticipation of the possibility that the revised guidance might aid such a campaign? I wonder.

It appears however that given the GMC’s revised wording it will be much harder now for activists to target doctors who simply wish not to be involved in providing ‘gender reassignment’.

People who have been discriminated against, sexually abused, humiliated or denied medical treatment because they belong to a minority group deserve justice and protection. Doctors found guilty of such misdemeanours must be dealt with promptly and effectively.

But to force doctors to collude in ‘treatments’ which they consider to be inappropriate or unethical is another thing altogether.

If there are any cases of this latter kind in the dossier of cases these activists have presented to the GMC then I hope the GMC will give them short shrift.

‘Gender reassignment’ - through hormones and/or surgery -  is legal in this country but remains very controversial. Many doctors in this country, for a variety of reasons, do not wish to be part of providing this ‘treatment’, either through prescribing hormones, or acting as surgeons or anaesthetists or as part of the referral pathway or pre-operative assessment.

It is good that the GMC has now recognised that these doctors do actually have a legal and ethical right not to be involved, while still offering the same standard of medical care to transgender patients as they do to any other patients.

(A much fuller treatment of Gender Identity Disorder is available on the CMF website)

Saturday, 21 April 2012

The GMC needs to explain why it is forcing doctors to provide sex change operations

The Mail on Sunday has today quoted my blog in a story titled ‘Doctors “forced to carry out sex-change ops” under rules meant to “marginalise Christian medics”’.

The article picks up on comments I made last week about new draft guidance issued by the General Medical Council which says that doctors who refuse to provide sex-change operations risk being struck off the medical register.

The new draft guidance, ‘Personal beliefs and medical practice’, was issued on Thursday and is subject to consultation. It warns that ‘serious or persistent failure’ to follow it ‘will put your registration at risk’.

The guidance recognises that ‘in some areas the law specifically entitles doctors to exercise a conscientious objection’ and opt out of ‘particular treatments or procedures’. It cites participating in abortion as a specific example.

It also allows doctors to opt out of providing other procedures or treatments provided that they ‘make sure that the patient has enough information to arrange to see another doctor who does not hold the same objection as you’.

However, the GMC makes a clear exception to this rule, with regard to sex-change operations.

Section 5 reads as follows:

‘You may choose to opt out of providing a particular procedure because of your personal beliefs and values.*’


But the asterisk refers to a footnote which states:

‘*The exception to this is gender reassignment since this procedure is only sought by a particular group of patients (and cannot therefore be subject to a conscientious objection – see paragraph 5). This position is supported by the Equality Act 2010 which prohibits discrimination on the grounds of gender reassignment.’

It then goes on to add the following:

‘But you must not refuse to treat a particular patient, or group of patients because of your personal beliefs or views about them†

Another appended footnote reads:

‘†The Equality Act 2010 prohibits discrimination on the grounds of nine protected characteristics: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation. ‘

The Daily Mail quotes an unnamed GMC spokeswoman saying that the new guidelines only reflected the ‘law of the land’. She said the Equality Act 2010 already prohibited doctors from discriminating against people who are undergoing gender reassignment treatment.

But do you see the problem here? She has not actually addressed the real question.

On the one hand the guidance says that doctors should not refuse to treat people because of their personal beliefs or views about them.

Absolutely right! If I have a patient who needs treating for pneumonia and or diabetes then I must treat them without any partiality or discrimination regardless of their ‘age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation’. It would be profoundly negligent to do otherwise.

But the guidance also says that doctors have no right to opt out of ‘providing’ the ‘procedure’ of ‘gender reassignment’ (ie. A sex change operation). Furthermore it claims that the Equality Act 2010 upholds this duty.

Gender identity disorder (GID) is the formal diagnosis used by psychologists and physicians to describe persons who experience significant gender dysphoria (discontent with their biological sex and/or the gender they were assigned at birth). It is classified as a medical disorder by both the ICD-10 CM and the DSM-IV TR and that is how many doctors still regard it.

On the other hand many transgender people and researchers support the declassification of GID as a mental disorder for a variety of reasons.

In other words there is a major debate going on currently between leading professionals about what Gender Identity disorder actually is. But the GMC has disregarded this and instead chosen to take one controversial view held by some people on the subject as the only acceptable view.

Gender reassignment surgery is legal in this country but remains very controversial. Many doctors in this country, for a variety of reasons, do not wish to be part of providing this procedure, either as surgeons or anaesthetists or as part of the referral pathway or pre-operative assessment.

But the GMC is now saying that they have a duty to provide it and have no right to opt out of doing so. It is also threatening them with being struck off if they do not comply.

That is a bridge too far.

This draft guidance not only imposes a duty on doctors which violates their professional freedom. But I suspect it also significantly over-interprets the law.

The GMC has some serious explaining to do. And quickly.

(A much fuller treatment of Gender Identity Disorder is available on the CMF website)