Better guidance for transgender treatment

MARY REICHARD, HOST: Coming up next on The World and Everything in It: Reversing course on gender dysphoria treatments.

South Carolina is expected to pass a law to protect children from medical attempts to change traits of their sex. That’ll be the 24th state to do so.

Transgender activists challenge many of these laws in court, claiming denial of healthcare. But over in the United Kingdom, a recent report says so-called “gender-affirming care” lacks supporting evidence.

MYRNA BROWN, HOST: Last month, Dr. Hilary Cass submitted her final report on the UK’s gender identity services. Her four years of research led her to recommend that England’s National Health Service, or NHS, stop giving children puberty blockers.

The UK stopped prescribing the drugs for gender confusion and shut down the only NHS gender clinic in the country.

REICHARD: What’s changed in the UK since the Cass Report, and can the US follow suit? WORLD Radio’s Mary Muncy has the story.

MARY MUNCY, REPORTER: Camille Kiefel’s struggle with gender identity started after her best friend was sexually assaulted in the sixth grade. Kiefel, an American, started feeling uncomfortable in her body and didn’t want to be seen as a woman.

CAMILLE KIEFEL: I was in a lot of pain, like I wasn't functional, like I had to have my mom help me out of bed in the morning.

Doctors recommended a lot of medications and therapy, but none of it helped.

So, in college, she started identifying as non-binary. And by the time she was 30, she decided a double mastectomy would be a good next step.

KIEFEL: It was, I think, June, when I reached out to my doctor, and by August 27, 2020, the surgery was performed on me.

Now, four years later, she’s detransitioned, and she’s suing the doctors who performed the surgery. She says they should have addressed other underlying concerns before they started cutting.

KIEFEL: If I said, “I think there's something wrong with my heart, I need heart surgery.” Like the doctor would be like, “Okay, let's let's investigate this. Let's look and see if this is actually really your issue.” And that's really the doctor’s job to investigate it. But this isn't happening in this case.

Dr. Hilary Cass, who wrote the Cass Review, saw the same issue in the United Kingdom. She told the BBC that children presenting with gender confusion were immediately referred to the UK’s Gender Identity Development Service, or GIDS.

BBC, HILARY CASS: Rather than doing the things that they would do for other young people with depression or anxiety or perhaps undiagnosed autistic spectrum disorder, they’ve passed them on to the GIDS service.

Cass says doctors didn’t have guidance on gender confusion and were afraid that if they tried to address underlying issues, they’d be criticized for not affirming their patients’ identity.

JULIE MAXWELL: The Cass Review has really, really clearly highlighted the lack of evidence that the basically the whole treatment of gender questioning children was being based on.

Julie Maxwell is a pediatrician in the UK.

She says increasingly, parents and children come to her with their own diagnoses and expect her to affirm them.

For the most part, it’s okay if she disagrees, but there’s a different attitude around gender confusion.

MAXWELL: I have had the situation where people have come to me with children with, you know, questioning their gender. And I have raised questions about it. And that has resulted in in complaints, actually.

Some of Maxwell’s colleagues have gone along with gender dysphoria diagnoses to avoid those complaints, but she says that’s changing in the UK.

MAXWELL: They are now able to, say, “the Cass Review states,” and quote the evidence that’s in the Cass Review.

So could something like the Cass Review prompt changes in the U.S.?

Dr. Andre Van Mol is a family physician in California. He says the way Americans view their doctors has changed over the past few decades.

ANDRE VAN MOL: People very much expect the healthcare professional to be the vending machine that gives them what they want.

He says that’s not the case for every area of medicine, but it is growing, and it’s often true of gender-confused patients.

VAN MOL: Part of the problem here is false expectations built up in people that things that aren't shown to be safe or effective, in fact, are and, you know, then if they come in expecting that, and you're not forthcoming with it, they view that as obstructionist or, you know, they're not getting proper care when in fact they are.

In the UK, the Cass Review has helped dispel the idea that transgender treatment is safe and effective. But Van Mol says the U.S. has been one of the main drivers of so-called gender-affirming care.

VAN MOL: It is a combination of big ideology meets big industry.

Since the U.S. doesn’t have a centralized medical system, several activist and medical groups have created the guidelines for transgender treatment.

Van Mol says these groups are unlikely to change their stance, but if the industry weren’t lucrative, clinics wouldn’t be able to operate anymore.

VAN MOL: We're seeing lawsuits from different parts of the country – several from California, Oregon, Texas, the East Coast, challenging these big organizations and these big names.

Van Mol says insurance premiums for gender clinics are already forcing some to shut down and as more people like Camille Kiefel bring lawsuits, it will only cost more.

VAN MOL: Insurance actuarials don't care about ideology, they care about math and dollars. And they see the writing on the wall. They do the calculations. And the insurance rates are going up for these clinics, because what they're doing is not benign. And it's going to be rewarded with lawsuits for what they've done to these kids.

Reporting for WORLD I’m Mary Muncy.

WORLD Radio transcripts are created on a rush deadline. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of WORLD Radio programming is the audio record.