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Medical gender transition in New Zealand: How common is it really?

Written By: - Date published: 6:05 am, November 25th, 2022 - 40 comments
Categories: Ethics, gender, health - Tags: , , , ,

Guest Post by Laura López. Laura is the mother of two girls and holds a graduate degree in psychology. She writes about gender at Arguments With Friends on Substack. Comprehensive sources for the findings highlighted in this article can be found in Laura’s full-length report here.

Many New Zealanders now know that the UK’s gender clinic for children is being closed down (The Times) and sued for criminal negligence. A damning independent review by paediatrician Hillary Cass found that the clinic was “not a safe or viable long-term option” (PDF) for the treatment of gender questioning youth. The families harmed by the clinic say that patients were “rushed into taking life altering puberty blockers​ without adequate consideration or proper diagnosis”, resulting in “physical and psychological permanent scarring”.

Is the practice of gender medicine in New Zealand better or worse than the appalling situation Dr Cass discovered in the UK? Some people claim that New Zealand has taken a more conservative approach to medical gender transition than our international peers. Others dispute this, claiming that New Zealand has been particularly incautious (PDF). Our mainstream media seem reluctant to provide balanced or critical reporting on transgender issues, making it difficult for people to know exactly what is happening in our country.

Facebook comment claiming that New Zealand has taken a conservative approach to medical gender transition

I decided to explore and analyse the available evidence on medical transition in New Zealand. What I found was shocking:

  • There has been a huge rise in the number of New Zealanders seeking medical transition. This rise has been largest among natal females. The chart below shows that between 1990 and 1995, only one person sought female-to-male gender transition at Wellington Endocrine Service. By 2016, 41 people were seeking female-to-male gender transition in a single year.

Number and median age of people seeking female-to-male gender transition at Wellington Endocrine Service. Adapted from Delahunt et al. (2018), New Zealand Medical Journal

  • Available data suggest that New Zealand’s rates of medical transition continued to climb until at least 2018, and have now reached remarkably high levels. Roughly 42 per 100,000 people served by Capital and Coast DHB started ‘gender affirming care’ in 2018. To put this into context, 46 out of every 100,000 people served by this DHB were hospitalised for traffic injuries in the same year. There is reason to believe that rates of medical transition may have risen further since 2018, and may continue to rise in the future.
  • Puberty blockers are prescribed over ten times more frequently in New Zealand than in the UK. One prominent Christchurch medical practice appears to be prescribing puberty blockers to about 13% of all its patients.
  • In some regions, medical transition is available without a mental health assessment. Even where a mental health assessment is required, it seems unlikely that this screens out many patients, since New Zealand’s Guidelines for Gender Affirming Healthcare state plainly that “having… mental health concerns does not mean gender affirming care cannot be commenced”.
  • Increasingly young patients are being medically transitioned. The chart above shows that between 1990 and 2016, the average age of people seeking female-to-male transition in Wellington fell from 30 to 22 years old. The researchers note that children as young as 11 years old have started presenting to Wellington Endocrine Service.
  • Some doctors appear to be prescribing cross-sex hormones to patients in their early teens. New Zealand’s Guidelines for Gender Affirming Healthcare suggest this practice may be acceptable if needed to prevent patients from growing up to be the wrong height. The New Zealand medical website Family Doctor suggests that it is sometimes acceptable to prescribe cross-sex hormones to under-16s without parental consent.
  • There appears to be very little proactive monitoring of the frequency, safety, or effectiveness of youth medical transition in New Zealand. Our Ministry of Health has said that it does not track statistics on gender transition or transition regret.
  • Medical transition is a journey that often ends in chronic pain, or high-risk surgeries in poorly-regulated gender clinics in Thailand. Trans activists argue that these physical health costs are outweighed by supposed mental health benefits. In reality, increased medical transition has occurred in concert with a tripling in youth psychological distress. This suggests that the social influences driving increased medical transition are not entirely beneficial.

Percent of New Zealanders aged 15 to 24 reporting significant psychological distress, compared with the number of first appointments for ‘gender affirming care’ at Wellington Endocrine Service (WTN) and across Capital and Coast District Health Board as a whole (CCDHB). Based on data from multiple sources; see full report for details.

In short, the available evidence suggests that medical transition is even more poorly overseen here in New Zealand than it was until recently in the UK. One probable reason for this failure is the lack of critical media scrutiny of this area of medicine in Aotearoa.

As mentioned earlier, the UK government eventually took notice of public outcry, and organised an independent review of how their health system was managing the medical transition of children. We are in desperate need of a similar independent review in this country. I have every confidence that this will happen eventually. The scale of the damage to our children will one day be revealed to all New Zealanders.

Further information can be found in Laura’s full-length report.

40 comments on “Medical gender transition in New Zealand: How common is it really? ”

  1. Sabine 1

    radical double masectomy

    penectomy

    orchiectomy

    vaginectomy

    Nullo, or Eunuch procedures

    People end up castrated, sterilized, unable to reproduce and if shit goes wrong will end up more often then not in a nullo aka nulification surgery, removing everything leaving only an opening for the urethra to be able to piss. And if that does not work cause issues with the kidney and such, well its a bag, for life.

    Jazz Jennings, USA most favorite transchild is now on Nr. 4 of revision surgeries on their 'vagina' and that was done by Dr. Marcia Bowers – foremost surgeon for these types of surgeries and a transwoman.

    You can listen to the good doctor speak about such inconsequential matters here

    This is not a benign medical procedure such as removing some warts or such and frankly should not be presented as such. Nor should it called ‘medical transitioning’. It should be called the surgical, planned castration and sterilisation of children and adults who are in great emotional and mental distresses. Other words come to mind, but it would be unpolite to mention these.

    Genitals are removed, of the left over tissues some 'doctor' will try to build something that loosely resembles the sexual organs of the other sex, non of them work really well, if at all, most cause infections, sepsis, and in some cases end in a person not only being a eunuch in the old fashioned sense – a person sans testes, but literally in barbie/ken doll esthetics of nothing.

    So one can hope that these surgeries are as rare as can be, but i doubt. I personally know at least two people who no longer have boobs, and one young man. And they are young.

    We can not treat mental health issues, and adulting angst and fear of the future in the case of girls who don't like how society treats and views them with radical surgeries that will leave people with all sorts of issues and life long patients to pharma and money hungry surgeons without conscience and hearts.

    NZ government is lying as is the Scottish government, the welsh government, the Irish government, never mind Canada, UK, US.

    This is happening to our eternal shame.

    • Anker 1.1

      ' every single child that is truly blocked at Tanner Stage 2 ( 9 – 11 years old) has never experienced an orgasm". Marci Bowers, President of Wpath (who is transgender herself and a trans surgeon).

      This and this alone should make every single one of us pause, then lobby long and hard to the Ministry of Health and health professionals who are allowing this.

    • gsays 1.2

      It is mind boggling that, 30 years ago I first heard of genital mutilation in some sub-Saharan countries, fast forward 3 decades and it is occurring here.

      For much the same reasons, cultural and parents 'beliefs'.

  2. Katrina Biggs 2

    Excellent reading in the full-length report. Very damning, and potentially explosive for those here in NZ who are not treading cautiously around affirming a young person's gender identity. Affirmation may be done with the belief that it's a 'kindness', but medical and other professionals are supposed to transcend the emotional knee-jerk reaction of wanting to be kind, and apply logical and broad thinking as well.

    • Molly 2.1

      The full report is depressing but essential reading.

      It's so important to have NZ specific articles for raising awareness.

  3. Molly 3

    And this is the process by which medical transition can be gained.

    https://www.hauoratairawhiti.org.nz/your-health/healthy-living/sexual-health/hormone-therapy-for-transgender-people/

    It might look considered, but for those who have been following overseas developments where identical procedures were in place, there are several areas of concern:

    Under 2. Clinical Psychologist:

    "Discussions will take place around your mental health and you will be asked whether you would like some support to work through any mental health issues you have. "

    If the answer is in the negative, does this mean no comprehensive assessment takes place? If the psychologist suspects co-morbidities but the patient does not indicate they want assistance, does this delay or prohibit medical transition in any way?

    "3. Referral to a hormone doctor

    If you do not need to work through any mental health issues, and the psychologist you are working with feels comfortable with how things are going for you, they will write a referral to the hormone doctor. You are more than welcome to request to have a look at the referral and make any recommended changes that you wish. "

    What do the bolded sections mean?

    "4. See a Hormone Doctor

    An appointment will then be arranged for you to meet with the hormone doctor at the Community Clinic. Once again you may bring along one or two support people if you wish. The Psychologist that you have been working with may also be able to attend. During this appointment, you can ask any questions you may have about:

    the hormones that you will be taking
    other medical interventions with your transition such as top surgery"

    It is important to find out what information is given at this time, given the findings of several medical literature review. I suspect it is both incomplete, and informed by discredited sources.

    Note: Before receiving the first prescription, the goal has already moved to surgery. The coy reference to "top surgery" is compounded by the "such as" which refers to surgery that will most likely require pharmaceutical assistance for life, and has high rates of failure.

    "Process for children under 16

    If you are under 16 your GP or the Community Clinic will refer you to the Child & Adolescent Health Service (CAMHS). As with the adults, they will talk with you to understand whether you have any mental health issues.

    If you do not have any mental health issues you will be referred to the paediatrician. The paediatrician may put you on hormone-blocking drugs to delay puberty until you are over 16 so that you have more time to make the decision."

    Such an unkind and cruel lie, that continues to be perpetrated here. Puberty blockers have known significant effects (and most likely significant unknown or unrecorded effects). The added cruelty here, is that uninhibited puberty often resolves issues regarding self identity.

    The severity of this crime against our children is easily found in the words of Dame Sue Bagshaw, who has "many transgender patients at her Christchurch youth practice".

    https://www.rnz.co.nz/news/national/475757/puberty-blocker-use-jumps-as-expert-backs-results

    Amongst her contradictions, there is this admission, as clear as day:

    "If you're going to say 'let's not use them' [puberty blockers], we're going to have redouble our efforts to ensure the mental health of transgender diverse young people is looked after," Bagshaw said.

    "And at the moment, it's not."

    Offering psycho-social support as first-line treatment for gender dysphoria in young people was challenging, she said.

    "It's actually quite difficult to help them to understand that they're being listened to without doing something, and that's the nature of brain development and it's also the nature of short appointment times."

    Psychological interventions were also expensive, she said."

    • Molly 3.1

      I went looking for Dr Sue Bagshaw's practice.

      This infantilising Meet the Team page is from the website of Youth 298:

      https://www.298.org.nz/medical-team

      First names only -why?, obligatory pronouns, and the use of kitten filters for photos.

      This does not reassure me that they would provide an unbiased professional patient-centred service.

  4. Andy 4

    I'm grateful that these horrible stats and facts are posted here. I think this is a terrible thing we are doing to our children and we need a serious discussion out in the open before more damage is done to young and vulnerable people.

  5. Anker 5

    This is a wonderful article. Although this is only heresay, I know of a psychologist who saw two clients referred (as in no 2 of Mollys summary).After some sessions they decided not to transition cause they realised they were gay. The psychologist got quite a lot of push back from gender affirming care people. While I do not know this psychologist, I consider this information has come from a reliable source.

    The msm are failingNZders by not reporting on these issues with any sort of balance.

    I

    • Hanswurst 5.1

      That description seems equally consistent with the system working, though; someone goes over their issues with a psychologist, and decides against a transition; there is some follow-up to ascertain whether the decision was reached in an appropriate manner. Of course, there could be a lot more to it than that, but your description doesn't make it at all clear that there was.

      • Anker 5.1.1

        The key thing about my comment is the psychologist got push back. In other words the referrer had an agenda for these young people i.e. that they would be supported to transition.

        • Hanswurst 5.1.1.1

          "Push back" is at once a vague and a loaded term, though. When one looks over the way gender is dicussed here, with the mischaracterisation of a Media Council ruling just below, and the general tendency to throw all manner of, at best, tenuously related arguments against a greater affirmation of trans rights (trans rights are about trying to erase women; trans rights are associated with medically dangerous practices; trans rights are about erasing homosexuals; trans activists are suppressing academic freedom), with almost no exploration of alternative narratives, such descriptors simply become meaningless.

          If a psychologist, confronted with someone who is feeling depressed and wants to undergo a transition, then they would be neglecting to do their job if they didn't try to ascertain the causes of the depression, and the likely outcomes of various different methods of managing it. It would be inappropriate for them to advise against transition on entrenched ideological grounds. Both approaches could be characterised as pushing back.

          Similarly, in the case of people who knew the patient and their situation intimately, and believed that a transition was what they needed, it would be negligent of them to take the advice of any given psychologist at face value without questioning it. Questioning would be wise, trying to strong-arm them would be unacceptable. Both could he characterised as pushing back. I'm not sure whether I think it's appropriate for third parties to be getting in touch with the psychologist at all; regardless, however, unless the patient ends up being pressured to undergo (or forgo) a transition against their own genuine judgment, it's a case of the system working, and certainly not evidence that there is somehow a powerful trans lobby exerting undue influence.

          • Anker 5.1.1.1.1

            Nobody is arguing against Transgender peoples rights here.

            What we are saying is that gender ideology and queer theory promote/push things such as medicalisation of young people, male bodied people being allowed to be in women only spaces, and changes in language that impact on women and girls.

            The affirmation approach to working with young gender dysphoric teens is highly problematic, so much so that Professor Hilary Cass a Senior Paedatrician in the UK ordered that the Tavistock NHS Gender Clinic be closed. This is almost unheard of.

            Mine was an anedocote and given as such. I know that Professional Bodies such as NZAC and the New Zealand Psychological Association promote the affirmation model of gender medicine. This automatic acceptance of a troubled teen who has gender dysphoria (and other likely mental health problems) gender identity is not good therapy. Therapists job is to both empathize with clients distress but hold a bigger picture of what might be going on. For example a client who present hating their sexed body, due to sexual abuse, and who has determind that the solution to their problems is to be trans. It would be unethical for any therapist to automatically affirm that clients gender identity, but this is what affirmation gender medicine requires.

            • Hanswurst 5.1.1.1.1.1

              Nobody is arguing against Transgender peoples rights here.

              True, but the vast majority of prominent posts and comments on here proceed from the assumption that there is an enormous repressive apparatus lobbying for them, and presents an argument against this presumed juggernaut. I'm honestly just as sceptical of how real that juggernaut is as I was when it was/is Maori or radical feminists purportedly silencing all right-minded members of liberal society who dared to speak up.

              What we are saying is that gender ideology and queer theory promote/push things such as medicalisation of young people, male bodied people being allowed to be in women only spaces, and changes in language that impact on women and girls.

              Perhaps, but your anecdote doesn't provide any evidence for that. It just reinforces the general assumption that any right-minded person must naturally see that something is clearly amiss – and that on account of how the story is presented, rather than any specific occurrences within it.

          • Molly 5.1.1.1.2

            Posted above, but repeated here because there is an assumption that co-morbidities are explored:

            https://www.rnz.co.nz/news/national/475757/puberty-blocker-use-jumps-as-expert-backs-results

            Dr Sue Bagshaw, Youth 298 clinic Christchurch:

            "If you're going to say 'let's not use them' [puberty blockers], we're going to have redouble our efforts to ensure the mental health of transgender diverse young people is looked after," Bagshaw said.

            "And at the moment, it's not."

            Offering psycho-social support as first-line treatment for gender dysphoria in young people was challenging, she said.

            "It's actually quite difficult to help them to understand that they're being listened to without doing something, and that's the nature of brain development and it's also the nature of short appointment times."

            Psychological interventions were also expensive, she said."

  6. Delia 6

    Stuff regards any questioning around this issue as wrong. However all adults in New Zealand have a responsibility to question govt action around the health and welfare of children. If parents are legally responsible for children, they also have the right to have their concerns and questions answered. Thank you for your article.

  7. Scott 7

    I read this article and thought it relevant.

    https://www.stuff.co.nz/nelson-mail/300746078/nz-media-council-upholds-complaint-against-the-nelson-mail

    Stuff argued that they should be allowed to write in an unbalanced and untruthful way about the gender dysphoria issue because the Media Council allowed the site to get away with doing the same thing on climate change.

    The Media Council upheld the complaints, and Stuff were forced to correct and apologise.

    • Andy 7.1

      That's right. Only one view is allowed in the woke world we inhabit.

      Climate change, trans issues, Ukraine, CV jabs, to name a few.

      If you step outside The Narrative you will be severely punished

      Who didn't see this coming?

    • weka 7.2

      unfortunately Stuff and Nelson Mail appear to have deleted the article that the complaint was made about.

    • Nic the NZer 7.3

      This is of course a complete miss-representation of the Media Councils decision.

        • Nic the NZer 7.3.1.1

          Sure. Though the Council decision already clearly doesn't back Scotts comment up just from reading the Stuff article about it.

          • weka 7.3.1.1.1

            I agree, they only upheld one of the complaints (the mistake in reporting). The second one (lack of balance) wasn't upheld because CATA didn't respond in time to an interview request, and because Hickson's Opinion Piece apparently wasn't appropriate.

            However the Council did also say,

            However coverage of the debate about the treatment of gender dysphoria in children is slightly different. This is a sensitive, complicated and important topic, where there appears to be evolving scientific debate. The Council rejects Stuff’s argument that it is analogous to climate change. In the case of climate change there is an overwhelming consensus of scientific opinion, whereas on the issue of childhood gender dysphoria there seems to be a variety of genuinely held and differing opinions internationally.

            Ms Hickson asserts that the balance of Stuff’s coverage is firmly in favour of the “transgendersupportive perspective”. The Council does not have the resources to carry out its own research to verify this but hopes Stuff and other media outlets will consider whether they are taking a balanced approach overall. It is important that all reasonable views are allowed to be heard, given the seriousness of the matters under consideration. Despite these reservations, the Council believes that there is insufficient evidence to uphold a complaint under Principle (1) and trusts that Stuff and other media outlets will keep a watching brief on developments in this area and cover it in a balanced manner.

            I don't follow the Media Council's rulings, but this to me looks like a significant shift in MSM and gender/sex issues. This seems to be tracking with small but steady changes in coverage to shift from bias to covering the actual issues. Makes sense that discussions around child transition would lead on this.

  8. Ad 8

    So a long article gets to the answer and it is:

    15 total NZ surgery transitions between 2020 and 2022.

    Otherwise all that is cited is data about intentions, for one DHB, which of course they have stopped data for.

    In NZ we have over 300 people die in road crashes per year and rising,

    over 500 a year from suicide,

    1,600 die of lung cancer, and we have

    over 400,000 major accidents per year in sport.

    Versus 15 surgeries nationwide.

    • Molly 8.1

      The 15 surgeries figure/annum is related to state provision, not those privately performed – either here or overseas. And they involve the removal of healthy body parts (or creation of faux body parts) – for cosmetic reasons.

      Iatrogenic harm is not limited to surgeries. Significant physical consequences arise from medical interventions, which NZ appears to have an exceptionally high prescription rate for.

      There are also psychological and mental health harms that can range from mild to debilitating.

      NZs health system is under stress. So, scrutiny of the use of resources for interventions that are likely to cause iatrogenic harm in healthy bodies, and promotion of lifelong medication is not only advisable, but necessary.

    • weka 8.2

      you missed that transitioning also includes puberty blockers and cross sex hormones.

      And that people with a range of serious problems are getting serious medicalisation without psychological or needs assessment.

      And that there are increasing numbers of people transitioning especially young people. And of those, girls/women are overly represented. And that there are important reasons for all of that.

      Which makes me wonder why you would minimise the problems in this way. Because your comment appears to be saying who cares about such a low number when lots more people are harmed by these other things.

      Or maybe you just think the damage doesn't matter. Have you listened to the stories of detrans people at all?

    • Andy 8.3

      Anecdotally speaking, I meet a lot of people who seem to know someone or is someone who has a child undergoing at least the first steps in this process.

      Like many in this thread, I am deeply concerned about the mental and physical harm we are doing to our kids and young people.

      Gender dysphoria is real, as is autogynephilia

      Teenagers have a raft of mental health issues and we need to be very careful not to make these worse through ill thought out ideas.

      • Visubversa 8.3.1

        Unfortunately, in some quarters the "trans child" is the new Gucci handbag. Signals how "progressive and enlightened" you are.

    • TeWhareWhero 8.4

      "15 total NZ surgery transitions between 2020 and 2022."

      Not sure if you misread the article, Ad, or are deliberately misrepresenting that figure but it refers to the "15 genital reconstruction surgeries" that are funded under the centrally administered, high cost surgery budget – the one which also funds such surgeries as liver and heart transplantations.

      The article acknowledges this is a very low number because there's only one surgeon in NZ who performs these complex and very costly procedures.

      So-called "top surgery" ie mastectomy, and other gender affirming surgeries performed by DHBs are not included in that figure, and as Weka points out, nor is chemically induced transition, ie the prescription of GNRH agonists and synthetic cross-sex hormones.

    • Anker 8.5

      Yes but it is not just the surgeries Ad. It is the kids being prescribed drugs that cause irreversible harm. Sabine posted a quote the other day, by Dr Marci Bowers the Head of WPATH (World Professional Assn of Transgender Health). In Dr Bowers who is transgender herself stated that children Tanner aged 2 put on puberty blockers are not able to organism. At all. I think that is a very problematic side effect

    • M 8.6

      Thank you. I love when numbers slice through overgrown rhetoric.

      • weka 8.6.1

        While I appreciate that commenting on this topic brings higher than normal risk and that some people do like to be careful with their username, we strongly prefer that people don't change their username when commenting on TS. Please choose a consistent one for your next comment. It can be whatever you like, but please stick to it.

  9. Em 9

    I find this article to be quite problematic. Many times I went to click on the links provided by the author that were intended to back up her claims and it just took me straight to her other article that she wrote for her own blog site and not to any actual research or statistics. For example, when she states that "Some doctors appear to be prescribing cross-sex hormones to patients in their early teens." I clicked the link associated with this and it just took me to her other blog site article, and I couldn't find any overt evidence in that article to back up that claim. This is rather suspicious, and very poor article writing/research etiquette.

    These sorts of claims without anything substantial or concrete to back them up is concerning as it is providing highly misleading information to the reader.

    Also this comment the author makes: "Medical transition is a journey that often ends in chronic pain, or high-risk surgeries in poorly-regulated gender clinics in Thailand."

    I looked into the article on chronic pain that she linked… and nowhere did it say that medical transition "often ends" in chronic pain. It actually stated that "Pelvic pain is a common condition with many contributing factors. For the FtM (female to male) patient, pelvic pain may be present at any point in the transition process. Pain conditions may be pre-existing or occur as a result of medical or surgical treatment of gender dysphoria.

    Although it states that chronic pelvic pain may arise from medical or surgical treatment, it also stated that chronic pelvic pain could be pre-existing prior to any form of gender transition. And the article most certainly didn't state that medical transition "often" resulted in chronic pain.

    In fact, later on in this chronic pain article, it stated that:

    "Musculoskeletal conditions are often associated with other chronic pelvic pain conditions such as endometriosis, bladder pain syndrome, irritable bowel syndrome, and pelvic neuralgias. Currently, there is no estimate on the prevalence of this condition in the FtM population."

    Therefore, her claim that "Medical transition is a journey that often ends in chronic pain" seems to be completely unfounded as the authors of the article that she linked to back up her claim state themselves that there is currently no estimate within the trans male population.

    Her statement about the surgeries in Thailand, whilst probably true, have absolutely nothing to do with trans health care practices in NZ, so I'm very confused as to why she has included it. It's almost as if she needed to put something inflammatory out there about surgical practices to spark outrage about genital surgery, as this is a topic that often gets a lot of hype and is considered "click bait". If anything, this comment should actually prove a point that we should increase funding and access for surgeries in NZ to prevent Kiwi's from getting unregulated and unsafe surgeries overseas.

    Also, the way the authors article was written seems to be angled to provide a platform for many inflammatory comments in the comments sections below. Such as people becoming concerned with genital surgery on children all of a sudden and proclaiming that we are performing "genital mutilation practices" on our youth (even though genital surgery is very uncommon in NZ as it is incredibly expensive and the waitlist for funded surgery is about 30 years long, and it would never be performed on youth).

    Lastly, she makes a correlation between youth psychological distress increasing and the number of people seeking gender affirming care also increasing. Correlational statistics and inferences are incredibly dangerous and problematic because they don't actually tell you anything.

    There was nothing in her article that actually LINKED these two phenomena together, it was just simply stating that both have increased. There are a number of other possibilities for why youth are experiencing increased psychological distress – it could be due to increased use of social media (which has incredibly damaging effects on the neuroanatomy of developing brains and on mental health). It could be due to increased use of the internet resulting in more cyber bullying. It could be because we as a generation have become more concerned with mental health and so are therefore conducting more studies which measure psychological distress more often. It could also be because it's more acceptable to talk about psychological distress now than it has been in the past and so it just seems more prevalent in today’s society, but in actual fact it's occurring at the same rate, but it is just more acceptable to acknowledge and talk about.

    Her inferences that it is somehow linked to more people seeking gender affirming care have absolutely no scientific basis. Yet the outcome of her inferences is so problematic, because the common reader who does not know the difference between correlation and causation would just read that graph and assume the two phenomena are linked.

    Please be careful what you read folks and make sure you look into actual scientific articles or authorised websites before believing articles such as these which have such a blatant agenda.

    Regardless of what I have stated above, I do feel sorry for the handful of people that the author has talked about who have sought gender affirming care thinking it would help them and it hasn't. But what the author's article failed to provide was a balanced argument, which also highlights the positives of gender affirming health care. The other side of the argument being that many many people are incredibly happy with their gender transition, they have absolutely no regrets, and they state that it has saved their lives from suicide.

    • Molly 9.1

      There is a lack of scientific evidence – which has to be considered in regards to the following:

      • Many existing established gender clinics worldwide did not follow up on patients so data was not collected for research or clinical outcome purposes,
      • Current affirming healthcare approach – based on a skewed interpretation of the Dutch Protocol and the WPATH guidelines, is also not based on clinical evidence – because as mentioned, it does not exist.

      What we do have is questions about the long-term impacts of social, medical and surgical interventions, and some of those questions carry significant weight.

      The reality is, that despite what people are told, and encouraged during an affirmation healthcare model, there are many unknowns and complications.

      What is also relevant, is that an otherwise heathy body, sexual function and endocrine system is being interfered with. If medical transition is "successful", the result is a lifelong dependency on medication. If surgical transition is "successful", it is coupled with the aforementioned lifelong medical reliance, and infertility and possible loss of sexual responsiveness.

      The impact on the state medical system is life long, and may be compounded by other long-term health impacts. This use of health resources to create lifelong reliance on medical treatment from healthy bodies is unjustifiable when – as you say – evidence is non-existent.

      With affirming healthcare, there is no diagnosis needed for identifying any distress caused by gender incongruence, just a declaration. For some, we are paying for cosmetic surgery and medication on demand. This is a waste of state funded healthcare.

      As mentioned by one of the clinicians in Christchurch's gender clinic Youth 298, the access to mental healthcare is so bad, that it is easier to affirm and medicate rather than explore co-morbidities.

      The issue around surgical interventions is worth exploring as well. While advocacy continues for easier access to surgery in NZ, there needs to be investigation as to whether people who feel that they have stalled on their transitions do make the trip overseas for surgeries. There are many GoFundMe pages for such surgeries, and it would be worthwhile to see if NZers are among them.

      "Her inferences that it is somehow linked to more people seeking gender affirming care have absolutely no scientific basis. Yet the outcome of her inferences is so problematic, because the common reader who does not know the difference between correlation and causation would just read that graph and assume the two phenomena are linked."

      The research is needed. And research grants sought to investigate possible causations around the correlations are difficult to apply for in the current climate. Lisa Littman, who coined the term Rapid Onset Gender Dysphoria, was unsuccessful in getting a grant for further exploration for quite a while. (IIRC, she has one now.) James Caspian Bath Spa University, failed in his attempt to secure a grant to follow up with detransitioners:

      "James Caspian, a psychotherapist who specialises in working with transgender people, proposed the research about “detransitioning” to the university in south-west England, which, he said, initially approved the application.

      When he went back with his preliminary findings that suggested growing numbers of young people, particularly women, were regretting gender reassignment, Bath Spa said his proposal would have to be resubmitted to the ethics committee, which rejected it.

      Caspian, who enrolled on an MA course at the university, said he was “astonished” by the decision and had sought legal advice.

      “The fundamental reason given was that it might cause criticism of the research on social media, and criticism of the research would be criticism of the university. They also added it’s better not to offend people,” he told BBC Radio 4’s Today programme on Monday.

      “A university exists to encourage discussion, research, dissent even, challenging ideas that are out of date or not particularly useful.”

      According to Caspian, the university said: “Engaging in a potentially politically incorrect piece of research carries a risk to the university. Attacks on social media may not be confined to the researcher, but may involve the university.

      “The posting of unpleasant material on blogs or social media may be detrimental to the reputation of the university.”"

      "I looked into the article on chronic pain that she linked… and nowhere did it say that medical transition "often ends" in chronic pain. It actually stated that "Pelvic pain is a common condition with many contributing factors. For the FtM (female to male) patient, pelvic pain may be present at any point in the transition process. Pain conditions may be pre-existing or occur as a result of medical or surgical treatment of gender dysphoria."

      The link to pelvic pain in the article, was to a paywalled article – so it is difficult to ascertain what was read. However, a quick search does bring up several hits, including this one from a gender affirming clinic, with more detail about pelvic pain.

      https://transcare.ucsf.edu/guidelines/pain-transmen#:~:text=Pelvic%20pain%20in%20transgender%20men,months%2C%20has%20a%20large%20differential.

      The loss of estrogen is known to cause atrophy in the female reproductive system, which can cause severe pain. So, it is not unexpected. However, once again, there is little data being collected or offered in terms of percentages or long term outcomes.

      I repost your quote here, with alternate emphasis, just to show how non-conclusive medical language, is just that non-conclusive:

      "Pain conditions may be pre-existing or occur as a result of medical or surgical treatment of gender dysphoria."

      As we know from the increasing numbers of countries or medical authorities that have taken time to conduct medical literature reviews, there is no robust evidence that shows that affirming healthcare is of net benefit to those to whom it is delivered.

      That should cause every medical practitioner to ask for clear evidence before proceeding further with the affirming healthcare approach.

      (I believe the Cass Review has sought for some form of regulatory change, that will allow it to conduct follow up interviews with past patients in order to try and get better evidence regarding the short and long-term outcomes.)

      SEGM (regardless of whether it is considered an "authorised website") has links to the medical authorities in the different countries that have conducted medical literature reviews, so you end up at source.

      Contains links to the Cass Review UK, Florida State, France, Sweden, Finland etc.

      “The other side of the argument being that many many people are incredibly happy with their gender transition, they have absolutely no regrets, and they state that it has saved their lives from suicide.”

      This suicidal alternative is a common thread. There has been research to show that the threats are not exceptionally higher than for other mental health issues, in fact there were indications that it was lower.

      However, I would think this is data that needs to be collected and analysed for the new cohort of transgender people. It is likely to be further influenced by the constant repetition of the suicide threat, by support organisations, advocates and medical personnel – despite this being a known encouragement of suicidal ideation. Coupled with a constant theme of being hated by society at large, and misunderstood, there is a lot to unpack in terms of what this means for mental health, resilience and well-being.

      It appears that some advocacy may create more distress than it alleviates. This would be an important research project to undertake if funding could be found.

      • Em 9.1.1

        How many trans and non-binary people do you know? How many trans and non-binary people have you spoken to about taking gender affirming hormone therapy? Or about the struggles they have endured on a daily basis?

        "What is also relevant, is that an otherwise heathy body, sexual function and endocrine system is being interfered with. If medical transition is "successful", the result is a lifelong dependency on medication. If surgical transition is "successful", it is coupled with the aforementioned lifelong medical reliance, and infertility and possible loss of sexual responsiveness."

        What you may view as a "healthy" body may not be what others may see as a healthy body, or it may be a body that is functional but caused someone severe amounts of distress, and therefore undergoing medical transition is the better option for them. New Zealand operates under the informed consent model with regards to prescribing gender affirming hormones. Therefore, just like taking any other form of medication that can have undesirable side effects in the body, the individual is informed about all of the known side effects of the treatment before deciding to start.

        "For some, we are paying for cosmetic surgery and medication on demand. This is a waste of state funded healthcare." – Once again I ask, do you know anyone who is trans or non-binary? If you did and actually talked to them I don't think you would hold this view. This kind of surgery is not cosmetic, surgery can help to alleviate very intense and overwhelming distress, and can be a matter of life or death.

        "The loss of estrogen is known to cause atrophy in the female reproductive system, which can cause severe pain. So, it is not unexpected. However, once again, there is little data being collected or offered in terms of percentages or long term outcomes.

        I repost your quote here, with alternate emphasis, just to show how non-conclusive medical language, is just that non-conclusive:

        "Pain conditions may be pre-existing or occur as a result of medical or surgical treatment of gender dysphoria."

        Once again, under the informed consent model, the individual is made aware of all of these risks going in to seeking gender affirming health care. If they are aware of these risks and still chose to go ahead, why is this a problem? If your response is that it is a "waste of public health care funding" please go and pick a bigger battle, there are so many other things to get upset about that cause much more of a financial drain on public health care funding than gender affirming care. Shift your priorities away from attacking a vulnerable and marginalised group.

        • Molly 9.1.1.1

          "How many trans and non-binary people do you know? How many trans and non-binary people have you spoken to about taking gender affirming hormone therapy? Or about the struggles they have endured on a daily basis?"

          I've engaged with people who have declare gender identities at every opportunity, and so have had a few conversations with them. I take time to listen, and answer questions when they are asked, and submit my own.

          So, far, none of the conversations have given me any indication that there is clinical evidence supporting transition for all who seek it. On the contrary, the references to medical literature are seldom made, but self-referential demands are usually forthcoming.

          There is a fallacy at the heart of the current transgender movement.

          It is that anyone knows what it means to be the other sex.

          This is followed by a series of language appropriation and appeals to empathy. There is an assumption that telling people the truth is bigotry and prejudice.

          "What you may view as a "healthy" body may not be what others may see as a healthy body, or it may be a body that is functional but caused someone severe amounts of distress, and therefore undergoing medical transition is the better option for them."

          A healthy body, is a healthy body. Psychological distress is addressed by treating the mind, not changing the body. And if you are up to date on the transgender current ethos: it is that distress is not a necessary component for treatment. A diagnosis is also considered an unnecessary imposition on someone who knows their true identity.

          As above, we know that clinicians that provide transition acknowledge that psychological treatment and investigation of co-morbidities should be taking place, however, they are blithely going ahead, I'll repost from my comment above because you might have missed it:

          The severity of this crime against our children is easily found in the words of Dame Sue Bagshaw, who has "many transgender patients at her Christchurch youth practice".

          https://www.rnz.co.nz/news/national/475757/puberty-blocker-use-jumps-as-expert-backs-results

          Amongst her contradictions, there is this admission, as clear as day:

          "If you're going to say 'let's not use them' [puberty blockers], we're going to have redouble our efforts to ensure the mental health of transgender diverse young people is looked after," Bagshaw said.

          "And at the moment, it's not."

          Offering psycho-social support as first-line treatment for gender dysphoria in young people was challenging, she said.

          "It's actually quite difficult to help them to understand that they're being listened to without doing something, and that's the nature of brain development and it's also the nature of short appointment times."

          Psychological interventions were also expensive, she said."

          "New Zealand operates under the informed consent model with regards to prescribing gender affirming hormones. "

          The problem is – it is not informed consent. Because the information that is to hand, is inadequate for the purpose for which medication is being prescribed. So, the psychological desire is what takes precedence.

          From the little research – on an older completely different demographic, in cases where there was distress and years of therapy for co-morbidities, there were few long-term beneficial outcomes.

          In cases, where there is no distress – NZ is essentially providing access to medication on demand, and cosmetic surgery.

          "Therefore, just like taking any other form of medication that can have undesirable side effects in the body, the individual is informed about all of the known side effects of the treatment before deciding to start."

          Patients with ailments do not get provided medication or surgery on demand.

          My FOI asking for the clinical evidence that the Ministry of Health used to determine the "affirmation healthcare" approach, gave the not unexpected news that they followed the WPATHA guidelines, which many know to be purely advocacy based, and not clinically advised.

          I consider this political use of limited health resources and money to be a disgrace, when other patients are left wanting. It appears this is not a consideration for many advocating for affirming healthcare.

          We have encouraged a population of people to believe that their mental distress will be alleviated by dissociating from the body they inhabit.

          It is one of the most egregious lies that we could tell someone who is already feeling uncomfortable with their body. We compound it by telling them they will be suicidal if they don't get to transition. And further tell them, that anyone who questions this created problem, and terrible solution is someone that hates them and wants them to not exist. "

          "Shift your priorities away from attacking a vulnerable and marginalised group."

          Safeguarding and care extends to all.

          Transgender people are neither vulnerable or marginalised in NZ. They are fully supported by government, institution policy, legislation and NGO's. They are well funded in terms of support, and promotion.

          Marginalised are those who speak of the contradictions of the gender ideology, and the failures of many who should be the adults in the room. They continue to speak because they have become aware of the harm, and the poor reasoning and evidence behind the current approach.

          My priorities are for the health and wellbeing of those in the transgender community, as well as those without.

          Capitulation to emotive demands, does not achieve that. What will achieve it, is the right questions being asked. And robust and well-evidenced answers being provided.

          (I apologise if I seem abrupt, but clarity is important, and I have little patience for equivocating when it is necessary to be as clear as possible for a discussion.)

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