by James C. Sherlock
I published a series of articles earlier this year that criticized the University of Virginia Children’s Hospital on its approach to gender transition in minors as young as 11.
As a result, the hospital made at least some movement towards change by announcing it was assigning pediatric clinical psychologists to join that program, previously dominated by endocrinologists.
I saw that move as an indication that the minors who came to the clinic would be treated first for anxiety, depression and ongoing emotional issues before being considered for insertion into the hormone-to-surgery pipeline.
That now may be the case, though there is no case flow diagram published. But nothing else has apparently changed except for the elimination of the public information on which I based my criticisms.
There is growing concern among many doctors and other healthcare professionals as to whether medical transition is the best way to proceed for those under aged 18. I have written extensively that several countries have pulled back from medical treatment and instead are emphasizing psychotherapy first.
UVa Children’s is a state hospital. Hiding information from the public to avoid scrutiny cannot be an option.
I call on the Board of Visitors to direct the hospital to improve transparency in the UVa Children’s Hospital web presentations on gender transitions in minors.
Without this, the hospital is guilty of misleading the public. The removal of previously-available public information shows they are doing this on purpose.
The website can be accessed here. We find:
We offer transgender health services for youth ages 11 to 25.
Comprehensive services may include:
- Therapy for anxiety, depression and ongoing emotional issues
- A community health educator who works with transgender patients to put resources together, such as how to change your name or get voice therapy
- Help finding resources for information and support
- Sex and contraceptive education
- Referrals to a licensed mental health professional for evaluations of gender dysphoria, which is the criteria [sic] for hormones or surgery
- Puberty blockers, to delay the onset of puberty
- (Note: Services for Cross-sex hormones are referenced here)
- Surgery referrals
Frequently asked questions There is a third web page for frequently asked questions here.
Apparently no one asks frequently about the near- and long-term effects of puberty blockers and cross-sex hormones in minors.
I note that the same clinicians who are introducing testosterone into minor females for gender transition are
enrolling girls ages 7 – 17 who have symptoms of high male hormones (excess hair growth, irregular periods). The purpose of the study is to determine how certain hormones contribute to the development of polycystic ovary syndrome (PCOS).
So they have questions about that. But apparently they are not curious about the effects of puberty blockers and artificially introduced testosterone in those same girls.
Are they not frequently asked about post-transition regret? Apparently, few ask “supportive” advocates about the regrets of their patients.
Messianic mind-set in parts of the medical community. All of that is certainly “supportive,” I guess.
UVa Children’s offers to provide a list of “appropriate” mental health providers to provide the gender dysphoria diagnosis needed before hormone treatment.
- They do not say that their own clinic can make the diagnosis, so I will presume they do not, even though they now have clinical psychologists assigned.
- They do not say that the Child and Adolescent Psychiatrists (CAPs) at the hospital apparently won’t provide the diagnosis. But when one checks the Pediatric Psychiatry page, he will not find gender dysphoria among the list of disorders, because the “supportive” transgender medical community removed it from the list of mental disorders.
The thread throughout the American Psychiatric Association (APA) discussion on the subject is that children can be gender dysphoric no matter what emotional problems they may suffer simultaneously. The clear message is that a gender dysphoria diagnosis should be considered the default diagnosis for a child/parent that seeks one.
What is missing? Missing are:
- The video walk-through’s of the philosophy and affirming/messianic (“Puberty blockers are Great!”) nature of the clinic. Those videos were what caused me to investigate further in my earlier series of articles. They are gone.
- The lists of clinicians assigned to the clinic that showed me they earlier had no mental health professionals assigned. They are gone. They need not name names in order to show the professional mix.
- Descriptions of the short- and long-term effects and hazards of puberty blockers and cross-sex hormones and any reference to the steps being taken in Europe to pause and assess the entire pediatric gender transition process because of those hazards. Those have never been disclosed on this web site.
What are the actual procedures at UVa Children’s? Short answer: We have no idea. There is no case management information.
Does UVa Children’s move ahead with hormone treatments while mental health therapy is underway? We don’t know. They just added the clinical psychologists, and have not published that information.
Notably, the video for adult transgender hormone therapy is still up. It advertises two days after a blood test to start hormones. Is it the same in the child clinic? We don’t know.
We also note that UVa Hospital is far more forthcoming about the effects of hormone treatments for gender dysphoria than is its Children’s Hospital. Why is that?
The World Professional Association for Transgender Health provides the following criteria for hormonal and surgical treatment of gender dysphoria:
- Persistent, well-documented gender dysphoria;
- Capacity to make a fully informed decision and consent to treatment;
- Legal age in a person’s country or, if younger, following the standard of care for children and adolescents;
- If significant medical or mental concerns are present, they must be reasonably well controlled.
Are those the criteria at UVa Children’s?
The Mayo Clinic:
A pre-treatment medical evaluation is done by a doctor with experience and expertise in transgender care before hormonal and surgical treatment of gender dysphoria. This can help rule out or address medical conditions that might affect these treatments This evaluation may include:
- A personal and family medical history
- A physical exam
- Lab tests
- Assessment of the need for age- and sex-appropriate screenings
- Identification and management of tobacco use and drug and alcohol misuse
- Testing for HIV and other sexually transmitted infections, along with treatment, if necessary
- Assessment of desire for fertility preservation and referral as needed for sperm, egg, embryo or ovarian tissue cryopreservation
- Documentation of history of potentially harmful treatment approaches, such as unprescribed hormone use, industrial-strength silicone injections or self-surgeries
Are those the pre-treatment procedures at UVa Children’s?
Does UVa Children’s offer behavioral health therapy to the same extent as Mayo Clinic?
We cannot find out from its web site.
Bottom line. It is the “transgender health services for youth age 11” part which I and many others oppose. We may or may not ever ban such “services” for minors in Virginia.
But UVa Children’s, our flagship state children’s hospital, must be transparent about:
- The sources and criteria for a gender dysphoria diagnosis in minors;
- How exactly they manage cases and treat their patients;
- The off-label nature and potential negative consequences of the puberty blocker and cross-gender hormone treatments;
- The near statistical certainty that a minor who takes puberty blockers will take cross-gender hormones; and
- the instances and prevalence of post treatment regret in their patients.
The Board of Visitors, embarrassed by the in-your-face removal of necessary and previously available public information from the UVa Children’s web site, should take that for action at once.
Hiding information necessary for decision making is profoundly unethical.