Irreversible Procedures--Part 6 of “A Layperson Reads the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8”

Weasel words do not belong in medicine. Here is an example of such. The single biggest misleading phrase used by the transgenderist movement is the term, “medically necessary.” It is never “medically necessary” to remove the healthy breasts of a healthy human female. It is never “medically necessary” to affix an artificial penis to a healthy woman. It is never “medically necessary” to remove the healthy testicles of a healthy human male.

It is astonishing that one even needs to say this. But we live in an age when an advocacy organization masquerading as a medical one exercises enormous influence worldwide and it seems to be up to laypeople to fight it.

So, here we go with this, the sixth installment in our series, “A Layperson Reads the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.”

Today, we will examine Chapter 5 Assessment of Adults of the standards. It is important to read this chapter for three reasons.

First, it delineates the way that troubled people are hustled by transgenderist activists through a medical system increasingly complicit with the movement’s goal of ensuring that as many people as possible submit to mutilating surgical procedures and be tethered to lifelong regimes of hormone and other substance taking. The more mutant pseudo men and pseudo women the better, is the transgenderist strategy.

Second, it contains some danger points for those unable to provide informed consent to these appalling practices.

Third, it shows how little research has been done on the matter of who knows how many people who realize too late what has been done to their bodies in the depths of their gender dysphoria and other mental troubles and who then attempt to detransition. The standards consign these people to an under-studied purgatory. The zealots of WPATH are embarrassed by the existence of those who bitterly regret the horrors that they have inflicted on themselves and the zealots devote only a few paragraphs in the sprawling standards to this tragic group.

Here is how Chapter 5 Assessment of Adults begins:

This chapter provides guidance for the assessment of transgender and gender diverse (TGD) adults who are requesting medically necessary gender-affirming medical and/or surgical treatments (GAMSTs) to better align their body with their gender identity

There is a trunkful of radical gender ideology in that one sentence alone that we need to unpack.

We have already discussed the lie that is the phrase “medically necessary” when it is applied to “transgender medicine.”

The next misleading phrase is the Orwellian term, “gender-affirming.” As we have discussed many times in this series, the term “gender-affirming” is an instance of perverse, topsy-turvy language twisting. A woman who demands that she be treated as if she is, literally, a man (as opposed to women who simply want to be treated fairly but do not pretend to be men) is not “affirming” her gender. She is renouncing it. That is, she is a woman who for whatever reason (e.g., psychiatric problems, political zealotry) is disavowing her actual sex in favor of a medically-aided charade.

The same thing goes for a man who declares that he is a “trans woman” and who engages in “gender-affirming” behaviors such as wearing elaborate wigs, teetering around in high heels, clothing himself in skirts and so forth. All of this, of course, is a travesty and insulting to women.

The phrase “align their body” might seem benign enough. But as mentioned above, many of the “medical” (many of which can be called medical only in that they are performed in medical settings by medical providers, who ought not to be allowed to retain their medical licenses at this point) “treatments” (castrating men is not really a “treatment” at all, unless you have a monstrous cast of mind) are horrifying.

Finally, there is the weird idea that a person’s sex does not even exist. A woman is not a woman—only those who “identify” as women are women, maintain transgenderists.

Why does all of this matter? Because these ideas (which result in the obliteration of the very words “woman” and “women” and “mothers” in favor of terms such as “pregnant people,” “people with uteruses” or “people who have periods”) are not being treated as fringe. They are being mainstreamed in such spheres as public broadcasting and medical education. And it is not just women who face threats to hard-won legal victories and rights in arenas of endeavor such as sports. Men and boys are being forced to open up activities to “penis-bearing daughters.” The WPATH standards are designed to become a go-to source of best practices for medical providers and educators.

What else is in Chapter 5 Assessment of Adults?

One notable aspect of this chapter is the way it slices and dices human beings into an ever-expanding smorgasbord of identities—equating normal men and women with the deeply troubled:

This chapter includes all forms of gender identities and transitions including, but not limited to, male, female, gender diverse, nonbinary, agender, and eunuch.

Indeed, we are not even human beings anymore. Just categories. How many of your friends are, say, “transitions?”

Again, a person’s sex does not exist. One simply has a “gender identity” that one decides for himself or herself—preferably, in the world of radical gender ideology, in close consultation with transgenderist activists who are infiltrating medical care at every level:

An individual’s gender identity is an internal identification and experience. The role of the assessor is to assess for the presence of gender incongruence and identify any co-existing mental health concerns, to offer information about GAMSTs, to support the TGD person in considering the effects/risks of GAMSTs, and to assess if the TGD person has the capacity to understand the treatment being offered and if the treatment is likely to be of benefit. The assessor can also assist a TGD person to consider choices that could improve their GAMST outcomes. The GAMST assessment approach described in this chapter recognizes the lived experience and self-knowledge of the TGD person and the clinical knowledge of the assessing health care professional (HCP). Consequently, with this approach, the decision to move forward with GAMSTs is shared between the TGD person and the assessing HCP, with both playing a key part in collaborative decision-making.

And remember—the assessors are more and more either transgenderist activists or conscientious health care professionals who are coming under ever more pressure to adhere to pro-transgenderist guidelines. If they don’t, they can be charged with being “transphobic” and lose their jobs and the right to remain in health care professions.

And note how the writers of the standards assure us of how effective and medically valuable the practices they tout are even as they admit that they have no real evidence to show that that is the case:

The statements below are based on significant background literature, including literature demonstrating the strong positive impact of access to GAMSTs; available empirical evidence; a favorable risk-benefit ratio; and consensus of professional best practice. The empirical evidence base for the assessment of TGD adults is limited. It primarily includes an assessment approach that uses specific criteria that are examined by an HCP in close cooperation with a TGD adult and does not include randomized controlled trials or long-term longitudinal research

As for the “the strong positive impact of access to GAMSTs,” it is hard to see how any sane person would regard the castration of a healthy man as a positive impact.

Note the pride that the authors of the guidelines take in eliminating protections for patients who are now to be rushed into life-altering, medical unnecessary surgeries:

The creation of this guidance has been a complex undertaking. The criteria in this chapter have been significantly revised from SOC-7 to reduce requirements and unnecessary barriers to care.

Why the hurry to slice breasts off? The writers of the standards don’t like delay:

Avoiding unnecessary delays in care is critically important.

We would not want a young man to hesitate about having his healthy testicles removed, now would we?

Note that the standards advocate for peopling every conceivable medical setting with a growing cohort of transgenderist idealogues, demanding that providers:

5.1.e- Have experience or be qualified to assess clinical aspects of gender dysphoria, incongruence, and diversity.

5.1.f- Undergo continuing education in health care relating to gender dysphoria, incongruence, and diversity.

And add:

5.2- We suggest health care professionals assessing transgender and gender diverse adults seeking gender-affirming treatment liaise with professionals from different disciplines within the field of transgender health for consultation and referral, if required.

Imagine you are a young woman experiencing sexism or feeling homely. The young woman seeks advice at the student health center at her university. She would almost certainly be “counseled” about “gender identity” “options.” It is hardly surprising that she would start to feel that she would be better off as a man. This is all very sexist and very dangerous for vulnerable women.

Think I am exaggerating? Look at how easy it would be for a troubled woman to be manipulated into seeking out the kind of treatments that financially sustain the field of “transgender medicine”:

We recommend transgender and gender diverse adults who fulfill the criteria for gender-affirming medical and surgical treatment require a single opinion for the initiation of this treatment from a professional who has competencies in the assessment of transgender and gender diverse people wishing gender-related medical and surgical treatment.

In other words, a person who is troubled can initiate the process of arranging for surgeries such as the removal of healthy ovaries or a healthy penis on the basis of a single opinion of a pro-transgenderism person who is not even required to be a physician. This is lunacy.

And notice the unfairness here—a person who realizes that he or she has made a ghastly, nightmarish mistake in consenting to “gender-affirming care” has to jump through far more bureaucratic hoops in order to be assisted by the same people who pressured him or her to join the world of the “transgendered” in the first place than a person who goes along with them does:

We recommend health care professionals assessing adults who wish to detransition and seek gender-related hormone intervention, surgical intervention, or both, utilize a comprehensive multidisciplinary assessment that will include additional viewpoints from experienced health care professional in transgender health and that considers, together with the individual, the role of social transition as part of the assessment process.

No single opinion easy-peasy for those who wish to detransition.

And note how the standards want to exclude the idea that say, a man who wants to become a eunuch, might have psychological problems. It is a matter of perfectly normal identity finding, we are assured. The authors of the standards want to keep mental health people well away from troubled people, with general practitioners and others serving as gatekeepers:

The need to include an HCP with some expertise in mental health does not require the inclusion of a psychologist, psychiatrist, or social worker in each assessment. Instead, a general medical practitioner, nurse, or other qualified HCP could also fulfill this requirement if they have sufficient expertise to identify gender incongruence, recognize mental health concerns, distinguish between these concerns and gender dysphoria, incongruence, and diversity, assist a TGD person in care planning and preparation for GAMSTs, and refer to a mental health professional (MHP), if needed.

If the patient manifests symptoms of a non “gender identity” related mental condition, then mental health professionals can be called in:

…the prejudice and discrimination experienced by some TGD people… can lead to depression, anxiety, or worsening of other mental health conditions. In such cases, an MHP can diagnose, clarify, and treat mental health conditions.

In other words, if the big, bad world is mean to “transgender" people a mental health professional can be brought in. But if a man wants an artificial womb, that is perfectly normal.

One of the most deplorable aspects of “trans gender medicine” that is often swept under the carpet is that it performs life-altering body part removals on mentally ill people and after the fact claims that these medically unnecessary operations have some sort of beneficial side effect:

The presence of psychiatric illness or mental health symptoms do not pose a barrier to GAMSTs unless the psychiatric illness or mental health symptoms affect the TGD person’s capacity to consent to the specific treatment being requested or affect their ability to receive treatment. This is especially important because GAMSTs have been found to reduce mental health symptomatology for TGD people…

So, what they seem to be saying is that their troubled patients are not really troubled and if they are, so what? These supposedly non-troubled people will become less troubled if they undergo non-brain-related procedures. This reminds one of the quackery that was perpetrated on “hysterical” women a century ago or of the dark days of lobotomies.

Those who are aware of the shocking ways that the mentally and physically disabled, homosexual men (for example, Alan Turing) or simply average women were treated in such instances will find this passage in the standards chilling:

There may be instances in which an individual lacks the capacity to consent to health care, such as during an acute episode of psychosis or in situations where an individual has long-term cognitive impairment. However, limits to capacity to consent to treatment should not prevent individuals from receiving appropriate GAMSTs. For some, understanding the risks and benefits may require the use of repeated explanations in jargon-free language over time or the use of diagrams to facilitate explanation and aid comprehension. A comprehensive and thorough assessment undertaken by the multidisciplinary health care team can further inform this process. For others, an alternative decision maker, such as a legal guardian or regulator-approved, independent decision maker may need to be appointed. These situations need to be considered on a case-by-case basis with the aim of ensuring the most affirmative and least restrictive health care is provided to the individual.

That is probably the scariest passage we have come across so far in the standards. Remember: in this case “affirmative” can be surgeries straight out of a horror movie: unnecessary genital surgery on physically normal people. Removal of healthy ovaries. Double mastectomies on physically healthy females. Chemical castration of healthy men. None of this should be performed on anyone who is healthy, much less on those unable to consent to it. This is outrageous and no bioethicist of any integrity would sign off on such policies. The term “regulator-approved” is a red flag—what kind of regulator? A WPATH-approved one?

And it is these very zealots who are trying to transform medicine worldwide along transgenderist lines. They want to call the shots when it comes to the training of health care providers and the regulation of the health care professions—that is the whole point of the standards, after all:

As part of their clinical practice, HCPs should commit to ongoing training in TGD health care, become a member of relevant professional bodies, attend relevant professional meetings, workshops or seminars, consult with an HCP with relevant experience, and/or engage with the TGD community. This is particularly important in TGD health care as it is a relatively new field, and the knowledge and terminology are constantly changing … Consequently, keeping up to date in the areas of TGD health is vital for anyone involved in an assessment for GAMSTs.

And guess who creates those professional bodies and runs those meetings, workshops and seminars and get speaking fees for addressing them? Transgenderist activists, that’s who. You know, like members of WPATH.

As we work our through the standards in this series, it is hard not to laugh out loud at times as one encounters some of the jargon that the transgenderist movement generates. Here is an example of such psychobabble:

To access GAMSTs, a TGD person’s gender incongruence must be marked and sustained. This can include a need for GAMSTs and a desire to be accepted as a person of the experienced gender. Consequently, a consideration of the nature, length and consistency of gender incongruence is important. This can include such factors as a change of name and identity documents, telling others about one’s gender, health care documentation, or changes in gender expression.

The experienced gender? As a woman, I can safely that some guy in a dress has not “experienced” my life as a woman—or that of any woman.

And what kind of logic is this? When accessing a person’s need for surgery, the pro-transgenderist provider merely has to ascertain that a patient wants the surgery and has told people that he or she is of the opposite sex and has filled out forms to that effect. No actual illness has to enter into the discussion. That sounds so scientific.

And remember, a good deal of the spending for all of this costly quackery is being funded by taxpayers (e.g., via spending by the military) or putting a pinch of all of us as insurance companies come under pressure to cover “transgender care”—like manufacturing eunuchs. And what is much of this unnecessary spending based on? Well, “telling others about one’s gender.” Or rather, telling others about what one delusionally thinks is one’s gender.

The incoherence of the transgenderist view of the mental stability of those seeking surgery and heavy doses of hormones can be seen here:

While marked and sustained gender incongruence should be present, it is not necessary for TGD people to experience severe levels of distress regarding their gender identity to access gender- affirming treatments. In fact, access to gender-affirming treatment can act as a prophylactic measure to prevent distress… A TGD adult can have sustained gender incongruence without significant distress and still benefit from GAMSTs.

In other words, a man could feel that he is in the “wrong” body but not to a distressing extent. Castrating him could prevent any distress from troubling him in the future. A woman could claim she is a man and not be particularly distressed about that but could still benefit from having her healthy uterus removed. This is what passes for sound medical practice in the world of the transgenderists.

The passages in this chapter about those who choose detransition convey a sense of embarrassment among the crafters of the standards that such a group exists. The authors don’t even acknowledge that for many of their unfortunate patients, having a healthy body part removed and/or an artificial one affixed is traumatizing and that they have not thereby magically become a member of the opposite sex. Rather, they have been mutilated and, in the case of “bottom” surgery often left with lifelong, humiliating, socially isolating, painful genitourinary difficulties. We are told vaguely first:

The decision to detransition appears to be rare

And a mere paragraph later, we are told that this group is but a small proportion of an otherwise happy-as-can be cohort of the surgically altered or drug-takers for life:

While the choice to detransition is proportionally rare, it is expected an overall increase in the number of adults who identify as TGD would result in an increase in the absolute number of people seeking to halt or reverse a transition. However, while the absolute numbers may increase, the percentage of people seeking to halt or reverse permanent physical changes should remain static and low. The existence of these rare requests must not be used as a justification to interrupt critical, medically necessary care, including hormone and surgical treatments, for the vast majority of TGD adults.

Due to the limited research in this area, clinical guidance is based primarily on individual case studies and the expert opinion of HCPs working with TGD adults…

There are several things to note about this passage.

1) It is clear that as more and more people come under the sway of the transgenderist movement, more and more people will suffer the medical consequences of adopting the tenets of the movement and the numbers of people regretting doing so will grow.

2) There is no evidence for this statement, “…the percentage of people seeking to halt or reverse permanent physical changes should remain static and low.”

3) The insistence that these procedures continue no matter what is the sign of zealotry and not responsible medical practice.

4) Those who wish to detransition will have little choice but to be treated by the same “experts” who caused their misery in the first place.

And, again, note the lack of urgency with which the cases of those who wish to detransition are treated versus the high priority given to patients all in on the “gender affirming” program. There is a sense that patients who choose to detransition are making that decision only because they are weak-kneed people who have knuckled under to oppressive “heteronormativity” and are letting their medical people down:

To ensure the greatest likelihood of satisfaction and comfort with a reversal of permanent physical changes, the TGD adult and the multidisciplinary team should explore the role of social transition in the assessment and in preparation for the reversal. In such instances, it is highly likely a prolonged period of living in role will be necessary before further physical changes are recommended. HCPs should support the TGD adult through any social changes, as well as any feelings of failure, shame, depression, or guilt in deciding to make such a change. In addition, people should be supported in coping with any prejudice or social difficulties they may have experienced that could have led to a decision to detransition or that may have resulted from such a decision.

And as a sidenote, this is nonsensical:

a reversal of permanent physical changes

A man can’t be “uncastrated” after surgical castration.

Each chapter of the standards contains something appalling. In the case of Chapter 5 Assessment of Adults, it is the treatment of those who choose to detransition and those who are unable to consent but who are “treated” by these charlatans anyway.

We have quite a few more chapters to go—there are 18 in all. Soon, we will examine those that deal with children and adolescents. Let us hope that bioethicists will start to read through the standards and speak out against them.

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