An American Society of Plastic Surgeons task force charged with examining the issue of such surgeries was, to their chagrin, cut out of the loop when the ASPS board issued its new policy last week.
Great reporting, Benjamin. Thank you! Not surprised to learn that the task force were not consulted after all of the similar shenanigans that have gone on in other medical and psychology professional associations, but I’m somewhat relieved to learn that the task force has been discussing and possibly pushing for 25 as the age restriction to commence medical/surgical treatments. A distressed gender dysphoria teen with often several mental health issues is not capable of giving informed consent at 18, and certainly not if they’ve been on puberty blockers since 12!
But i have to say that i’m truly shocked to learn this:
“Most notably, the American Academy of Pediatrics’s foundational 2018 policy statement on the gender-affirming care method was written by a single AAP member, Dr. Jason Rafferty, when he was still a resident, and then edited by a small committee. Dissidents have pressured AAP leadership to put the controversial and highly contested statement to a vote by the organization’s more than 60,000 members, to no avail.”
Utterly astounding that 60,000 paediatricians responsible for and experienced in providing the care for these kids cannot debate, contribute to or vote on appropriate care guidelines.
What’s most astounding about the AAP statement is that it’s riddled with false claims that are contradicted by its own citations and the AAP has never acknowledged this.
Given that there were several WPATH members on the task force, I doubt that Dr. Montante would have actually succeeded at pushing it to age 25 if they had been consulted. The WPATH task force members would have probably stopped that from happening...
Sorry to hear that. Just as an interesting aside, my father-in-law is a retired paediatrician here in Ireland, and was clinical director of a major regional hospital for many years. When i tell him what’s been going on with this trans stuff, particularly the Tavistock scandal in the UK, and the ways that so many medical and psychotherapy professional associations, such as the that of the US paediatrics’ AAP, have been captured by the trans lobby, he won’t believe me. I have other close friends who are medical doctors in various specialties outside of paediatrics and endocrinology who also struggle to accept what i’m telling them is really going on. And i get it - it’s so insane that it beggars belief! When i tell my father-in-law that the 60,000 paediatricians have never been consulted on GAC or asked to debate or vote on anything, he simply will not accept that because it sounds like bonkers nonsense that i picked up on the internet.
Something that you may find interesting: Ireland is the only Western country that has not adopted the same quick to medicalise GAC model in the medical arena. Psychiatrists and endocrinologists have pushed back from the beginning of this trend. The government health agency responsible for managing/funding the public hospital system, the Health Service Executive (HSE), side-stepped the issue by referring adolescent/teen patients and concerned parents to the UK’s Tavistock clinic, effectively moving these “problematic” patients out of the Irish health system. And when Tavistock gender clinic was closed down to new patients, the HSE started referring these patients to attend a Belgium gender clinic which as a similar track record to the negligence practiced at Tavistock gender clinic. Two lead consultants, psychiatrist Paul Moran and Endocrinologist Donal O’Shea, set up the National Gender Service in Ireland in 2018. I’ll include an excerpt here from an excellent article which provides an overview of their ongoing battle against the HSE:
"The two most experienced clinicians involved in transgender healthcare in Ireland have made a formal complaint to the Health Information and Quality Authority (HIQA) about the Health Service Executive's (HSE) treatment of children with gender identity issues....Professor Donal O’Shea and psychiatrist Dr Paul Moran of the National Gender Service (NGS) allege that the HSE has been directing children to services overseas that adhere to a so-called 'gender-affirming’ Model of Care. Prof O’Shea and Dr Moran say that the gender-affirming model can damage children and is associated with a greater readiness to start on inappropriate medical treatment for patients presenting with gender identity issues....
Dr Moran and Prof O’Shea, better known as National Lead for Obesity, set up the National Gender Service in 2018. They agree that when properly assessed, prepared and appropriate, "very good outcomes" can come from medical treatments for gender dysphoria. However, if other problems that the child experiences or the adult are not addressed, it can exacerbate those problems, such as, for example, social avoidance, functional impairment," Dr Moran said.
According to Prof O’Shea, from around 2016, the National Gender Service in Ireland began to see cases of patients referred to them as adults who had been poorly assessed at the Tavistock clinic and who had started on courses of treatment that were not appropriate.
"They were coming to us as young adults. They were clearly not ready for the hormonal phase of their transition to start, but that had been started," Prof O’Shea said.
"Individuals that we did not think were ready were well under way with their transition and having great mental health difficulties as a result of that."
Dr Moran and Prof O’Shea also allege that the HSE is in thrall to the gender-affirming Model of Care promoted by transgender activists that is based around the concept of informed consent.
"It is driven by the patient," Prof O’Shea said. "They use the term ‘informed consent,’ which is the patient has informed themselves and consents to the treatment."
"That's not the informed consent model that works in medicine, that we're obliged by the Medical Council to adhere to, where we inform the patient in detail of the risks and benefits, and then make a joint decision."
Dr Moran and Prof O’Shea had long raised concerns about the Tavistock with the HSE.
In March 2019, Dr Moran wrote to the HSE - ccing NGS colleagues including Prof O’Shea - requesting that it stop referring patients to the Tavistock.
"Terminating the Tavistock service as quickly as possible," was a priority the email stated.
Both doctors say that their concerns were ignored. "
My apologies for the VERY long comment, Benjamin. But I thought you might find this interesting, and might even want to reach out to these doctors for your further reporting. The article that I've referred to can be found here:
I should also add that despite the medical arena pushing back on the problematic GAC model, the news media and all major political parties and government are still fully on board with the trans ideology like all these other Western nations.
I highly doubt that. It sounds like Dr. Montante was the only one on the board that wanted it to be age 25.
Plus if task force’s WPATH members had pressured the board for the early release of the guidelines, why would the task force’s WPATH members be sending the letter criticizing the board for not listening to them? That makes no sense because in that scenario, the board would have listened to them!
18 is bad enough, 25 is ludicrous. Should we bar people under 25 from cosmetic surgery? From getting married? Having children? Should we let them go free after committing crimes, if they're not mature enough to be held responsible for their mistakes?
25 is an entirely arbitrary number anyways, the oft-repeated myth that "the brain stops developing at 25" is based on nothing. The brain changes throughout your entire life. Meanwhile, research shows that adolescents aged 14-15 have adult-level abilities to reason about complex issues and make medical decisions: https://theonepercentdetrans.substack.com/p/are-adolescents-capable-of-providing
We used to understand this. Throughout most of human history, people were granted adult status and responsibilities between the ages 13-17. It's only very recently that the definition of adulthood has crept higher and higher, a trend driven by the type of people who are so scared of their own freedom they would be happier as a zoo animal than a human being. That, and authoritarian hypocrites who seek only to restrict other people's choices.
Related is the trend of treating "mental illness" as an excuse to absolve someone of personal responsibility. "Mental illness" was once considered to compromise decision-making capabilities only when it involved florid psychosis or substance abuse, as in, someone detached from reality, not someone with a little anxiety.
One could argue, however, that there is a circular relationship between societal expectations of adult-level maturity and the performance of adulthood-level maturity by people in their late teens and twenties.
I don't understand. If someone has the capacity for adult-level reasoning, they should be treated as equally responsible for their decisions, even if they choose to act "immature" due to societal expectations.
Or are you arguing that people develop capacity for reasoning later in life in modern society? This is contradicted by the research.
Indeed. It's always...enlightening to see how the sausage gets made & how invested in process rather than ethics or common sense these organizations are.
Thank you for reporting on this developing situation!
5 of the task force concerned members (of the 7 letter signers) helped write SOC-8, indeed (as in on the different chapter committees, aside from Dr. Montante and Dr. Poh, if that is the full list there). They might have some conflict of interest....
I think the ASPS was already looking at it in May 2024?
"Not all relevant professional groups have joined the consensus. Scot Glasberg, past president of the American Society of Plastic Surgeons, now president of the Plastic Surgery Foundation, told The BMJ that the organisation will issue “trustworthy, high quality” guidelines, but “like Dr Cass, we’ve found that the literature is of low quality and low value to dictate surgical care . . . We are trying to be very measured and not get into the difficulty that some of the other organisations have gotten into.” "
I am glad Dr. Glasberg is keeping the detransitioners in mind. This group is going to grow as this huge wave of young people grows up.
I had been holding my breath for their conclusions since then.....was really glad to see them summarize and analyze what they've found after all this time.
If ASPS is recommending an age minimum, whether it is 19 or 25, would that mean surgeons who operate on younger patients would be more vulnerable to lawsuits?
I was lucky enough to start testosterone at 16 and get a mastectomy at 18. Otherwise, I'm not sure how I could've had a normal social life in college. Should I have been the only guy in my frat who couldn't walk around shirtless without tits flopping out? Gone to the gym with my buddies while so weak I couldn't be trusted as a spotter? Interviewed for jobs or gone on dates while looking like a prepubescent boy?
The guys I knew in college were great people, and took it in stride when I eventually told them I was raised a girl. But they couldn't, arguably shouldn't, have treated me like any other man if I looked nothing like one.
I emphasize the social impacts here because they are easier to explain than the dysphoria itself.
Medical gatekeepers deny trans boys and men of healthy developmental experiences, prevent us from living normal lives until 16, no 19... no, 25!, then wonder why we turn out maladjusted. For some ideologues, conversion therapy is the goal, they want to make our lives painful and humiliating to coerce us into detransition. But for those genuinely concerned about safeguarding vulnerable youth, ask yourself: what demands are you making on trans people? How long do you expect us to put our lives on hold? If you were in our position, distressed and socially isolated because of readily correctable defects, would you tolerate suffering for years to satisfy the concerns of activists?
Are you protecting future detransitioners, or are you creating them?
It wasn't so long ago that 16 was considered old enough to get a job, start a family, or go to war. Now we are helpless children until 18 and beyond. The metastasis of childhood is a uniquely modern pathology, a symptom of a society terrified of personal responsibility.
Okay, I am not sure what to say about the rare moderate. Isn’t it common to present one image in public versus another in practice?
I attended this AACAP meeting in 2018. I believe it was Dr. Littman’s first time presenting her research to adolescent psychiatrists. Dr. Leibowitz introduced her. The audience was skeptical of the research. One commenter mentioned that “shouldn’t we all be recalling Erik Erikson’s stages of identity development?” Yes, we should!
My understanding of Leibowitz’s practices at Children’s National is that a substantial proportion of the kids seeking blockers and hormones were told no.
Great reporting, Benjamin. Thank you! Not surprised to learn that the task force were not consulted after all of the similar shenanigans that have gone on in other medical and psychology professional associations, but I’m somewhat relieved to learn that the task force has been discussing and possibly pushing for 25 as the age restriction to commence medical/surgical treatments. A distressed gender dysphoria teen with often several mental health issues is not capable of giving informed consent at 18, and certainly not if they’ve been on puberty blockers since 12!
But i have to say that i’m truly shocked to learn this:
“Most notably, the American Academy of Pediatrics’s foundational 2018 policy statement on the gender-affirming care method was written by a single AAP member, Dr. Jason Rafferty, when he was still a resident, and then edited by a small committee. Dissidents have pressured AAP leadership to put the controversial and highly contested statement to a vote by the organization’s more than 60,000 members, to no avail.”
Utterly astounding that 60,000 paediatricians responsible for and experienced in providing the care for these kids cannot debate, contribute to or vote on appropriate care guidelines.
What’s most astounding about the AAP statement is that it’s riddled with false claims that are contradicted by its own citations and the AAP has never acknowledged this.
Given that there were several WPATH members on the task force, I doubt that Dr. Montante would have actually succeeded at pushing it to age 25 if they had been consulted. The WPATH task force members would have probably stopped that from happening...
I’m sure you’re right.
I doubt it. The members who would've argued that were few.
Sorry to hear that. Just as an interesting aside, my father-in-law is a retired paediatrician here in Ireland, and was clinical director of a major regional hospital for many years. When i tell him what’s been going on with this trans stuff, particularly the Tavistock scandal in the UK, and the ways that so many medical and psychotherapy professional associations, such as the that of the US paediatrics’ AAP, have been captured by the trans lobby, he won’t believe me. I have other close friends who are medical doctors in various specialties outside of paediatrics and endocrinology who also struggle to accept what i’m telling them is really going on. And i get it - it’s so insane that it beggars belief! When i tell my father-in-law that the 60,000 paediatricians have never been consulted on GAC or asked to debate or vote on anything, he simply will not accept that because it sounds like bonkers nonsense that i picked up on the internet.
Something that you may find interesting: Ireland is the only Western country that has not adopted the same quick to medicalise GAC model in the medical arena. Psychiatrists and endocrinologists have pushed back from the beginning of this trend. The government health agency responsible for managing/funding the public hospital system, the Health Service Executive (HSE), side-stepped the issue by referring adolescent/teen patients and concerned parents to the UK’s Tavistock clinic, effectively moving these “problematic” patients out of the Irish health system. And when Tavistock gender clinic was closed down to new patients, the HSE started referring these patients to attend a Belgium gender clinic which as a similar track record to the negligence practiced at Tavistock gender clinic. Two lead consultants, psychiatrist Paul Moran and Endocrinologist Donal O’Shea, set up the National Gender Service in Ireland in 2018. I’ll include an excerpt here from an excellent article which provides an overview of their ongoing battle against the HSE:
"The two most experienced clinicians involved in transgender healthcare in Ireland have made a formal complaint to the Health Information and Quality Authority (HIQA) about the Health Service Executive's (HSE) treatment of children with gender identity issues....Professor Donal O’Shea and psychiatrist Dr Paul Moran of the National Gender Service (NGS) allege that the HSE has been directing children to services overseas that adhere to a so-called 'gender-affirming’ Model of Care. Prof O’Shea and Dr Moran say that the gender-affirming model can damage children and is associated with a greater readiness to start on inappropriate medical treatment for patients presenting with gender identity issues....
Dr Moran and Prof O’Shea, better known as National Lead for Obesity, set up the National Gender Service in 2018. They agree that when properly assessed, prepared and appropriate, "very good outcomes" can come from medical treatments for gender dysphoria. However, if other problems that the child experiences or the adult are not addressed, it can exacerbate those problems, such as, for example, social avoidance, functional impairment," Dr Moran said.
According to Prof O’Shea, from around 2016, the National Gender Service in Ireland began to see cases of patients referred to them as adults who had been poorly assessed at the Tavistock clinic and who had started on courses of treatment that were not appropriate.
"They were coming to us as young adults. They were clearly not ready for the hormonal phase of their transition to start, but that had been started," Prof O’Shea said.
"Individuals that we did not think were ready were well under way with their transition and having great mental health difficulties as a result of that."
Dr Moran and Prof O’Shea also allege that the HSE is in thrall to the gender-affirming Model of Care promoted by transgender activists that is based around the concept of informed consent.
"It is driven by the patient," Prof O’Shea said. "They use the term ‘informed consent,’ which is the patient has informed themselves and consents to the treatment."
"That's not the informed consent model that works in medicine, that we're obliged by the Medical Council to adhere to, where we inform the patient in detail of the risks and benefits, and then make a joint decision."
Dr Moran and Prof O’Shea had long raised concerns about the Tavistock with the HSE.
In March 2019, Dr Moran wrote to the HSE - ccing NGS colleagues including Prof O’Shea - requesting that it stop referring patients to the Tavistock.
"Terminating the Tavistock service as quickly as possible," was a priority the email stated.
Both doctors say that their concerns were ignored. "
My apologies for the VERY long comment, Benjamin. But I thought you might find this interesting, and might even want to reach out to these doctors for your further reporting. The article that I've referred to can be found here:
https://www.rte.ie/news/primetime/2023/1214/1422073-leading-doctors-complain-hse-to-hiqa-over-transgender-care/
I should also add that despite the medical arena pushing back on the problematic GAC model, the news media and all major political parties and government are still fully on board with the trans ideology like all these other Western nations.
I highly doubt that. It sounds like Dr. Montante was the only one on the board that wanted it to be age 25.
Plus if task force’s WPATH members had pressured the board for the early release of the guidelines, why would the task force’s WPATH members be sending the letter criticizing the board for not listening to them? That makes no sense because in that scenario, the board would have listened to them!
18 is bad enough, 25 is ludicrous. Should we bar people under 25 from cosmetic surgery? From getting married? Having children? Should we let them go free after committing crimes, if they're not mature enough to be held responsible for their mistakes?
25 is an entirely arbitrary number anyways, the oft-repeated myth that "the brain stops developing at 25" is based on nothing. The brain changes throughout your entire life. Meanwhile, research shows that adolescents aged 14-15 have adult-level abilities to reason about complex issues and make medical decisions: https://theonepercentdetrans.substack.com/p/are-adolescents-capable-of-providing
We used to understand this. Throughout most of human history, people were granted adult status and responsibilities between the ages 13-17. It's only very recently that the definition of adulthood has crept higher and higher, a trend driven by the type of people who are so scared of their own freedom they would be happier as a zoo animal than a human being. That, and authoritarian hypocrites who seek only to restrict other people's choices.
Related is the trend of treating "mental illness" as an excuse to absolve someone of personal responsibility. "Mental illness" was once considered to compromise decision-making capabilities only when it involved florid psychosis or substance abuse, as in, someone detached from reality, not someone with a little anxiety.
One could argue, however, that there is a circular relationship between societal expectations of adult-level maturity and the performance of adulthood-level maturity by people in their late teens and twenties.
I don't understand. If someone has the capacity for adult-level reasoning, they should be treated as equally responsible for their decisions, even if they choose to act "immature" due to societal expectations.
Or are you arguing that people develop capacity for reasoning later in life in modern society? This is contradicted by the research.
These medical society reversals are going to be entertaining to watch.
Indeed. It's always...enlightening to see how the sausage gets made & how invested in process rather than ethics or common sense these organizations are.
Thank you for reporting on this developing situation!
5 of the task force concerned members (of the 7 letter signers) helped write SOC-8, indeed (as in on the different chapter committees, aside from Dr. Montante and Dr. Poh, if that is the full list there). They might have some conflict of interest....
I think the ASPS was already looking at it in May 2024?
https://www.bmj.com/content/385/bmj.q1141
Block, in the BMJ:
"Not all relevant professional groups have joined the consensus. Scot Glasberg, past president of the American Society of Plastic Surgeons, now president of the Plastic Surgery Foundation, told The BMJ that the organisation will issue “trustworthy, high quality” guidelines, but “like Dr Cass, we’ve found that the literature is of low quality and low value to dictate surgical care . . . We are trying to be very measured and not get into the difficulty that some of the other organisations have gotten into.” "
I am glad Dr. Glasberg is keeping the detransitioners in mind. This group is going to grow as this huge wave of young people grows up.
Thank you!
Thanks for reminding me that Glasberg wrote that, I’d totally forgotten.
I had been holding my breath for their conclusions since then.....was really glad to see them summarize and analyze what they've found after all this time.
Thank you a ton for covering all this!
If ASPS is recommending an age minimum, whether it is 19 or 25, would that mean surgeons who operate on younger patients would be more vulnerable to lawsuits?
probably, yes.
I was lucky enough to start testosterone at 16 and get a mastectomy at 18. Otherwise, I'm not sure how I could've had a normal social life in college. Should I have been the only guy in my frat who couldn't walk around shirtless without tits flopping out? Gone to the gym with my buddies while so weak I couldn't be trusted as a spotter? Interviewed for jobs or gone on dates while looking like a prepubescent boy?
The guys I knew in college were great people, and took it in stride when I eventually told them I was raised a girl. But they couldn't, arguably shouldn't, have treated me like any other man if I looked nothing like one.
I emphasize the social impacts here because they are easier to explain than the dysphoria itself.
Medical gatekeepers deny trans boys and men of healthy developmental experiences, prevent us from living normal lives until 16, no 19... no, 25!, then wonder why we turn out maladjusted. For some ideologues, conversion therapy is the goal, they want to make our lives painful and humiliating to coerce us into detransition. But for those genuinely concerned about safeguarding vulnerable youth, ask yourself: what demands are you making on trans people? How long do you expect us to put our lives on hold? If you were in our position, distressed and socially isolated because of readily correctable defects, would you tolerate suffering for years to satisfy the concerns of activists?
Are you protecting future detransitioners, or are you creating them?
It wasn't so long ago that 16 was considered old enough to get a job, start a family, or go to war. Now we are helpless children until 18 and beyond. The metastasis of childhood is a uniquely modern pathology, a symptom of a society terrified of personal responsibility.
Thanks for this perspective and for maintaining a civil exchange on here.
So the task force is upset that they weren’t consulted yet they had no issue with with the ASPS’s statement itself? I honestly don’t get it…
Leibowitz clearly was upset over the contents of the statement, but for whatever reason wouldn’t say so in the open letter.
Not surprised Leibowitz was upset. There is no evidence that will deter Scott from promoting "GAC".
He does nevertheless tend to be a rare moderate on this issue within this field and will acknowledge certain nuances that others will not. https://benryan.substack.com/p/leaked-secret-american-psychiatric
Okay, I am not sure what to say about the rare moderate. Isn’t it common to present one image in public versus another in practice?
I attended this AACAP meeting in 2018. I believe it was Dr. Littman’s first time presenting her research to adolescent psychiatrists. Dr. Leibowitz introduced her. The audience was skeptical of the research. One commenter mentioned that “shouldn’t we all be recalling Erik Erikson’s stages of identity development?” Yes, we should!
https://www.sciencedirect.com/journal/journal-of-the-american-academy-of-child-and-adolescent-psychiatry/vol/57/issue/10/suppl/S, October 2018, Pages S73-S74
51.2 Peer Group and Social Media Influences in Adolescent and Young-Adult Rapid-Onset Gender Dysphoria
Author links open overlay panelLisa Littman MD, MPH
My understanding of Leibowitz’s practices at Children’s National is that a substantial proportion of the kids seeking blockers and hormones were told no.
Good!