naija

5th Element.

it's a real question what his tolerance level will be for sitting through sensitivity training yearly. my guess is that they dial it back when nobody is paying attention anymore...

.. yeah, like Ja Morant wrote his own apology too.

Obesity rate must be close to zero in the silo. Apparently no elevators. All the nitpicking aside, I enjoyed the last episode. That was sufficiently tense and well-done.

Thanks.

troph, not everyone who questions something about transitioning is against transitioning. I'm not. I will in fact wager, that I'm probably one of the few posting on this thread who has participated in gender affirming surgeries. And it wasn't because a shotgun was held to my temple. If you weren't posting, I would not volunteer that information. now, to some of what you've written above. why 3 to 5 years. How is that not an arbitrary mark? You might posit it as a gut feeling, but really what is your 3 to 5 years based on? Why should a kid suffer for 5 years to satisfy this criteria? Nothing should be off limits? Does that include bottom surgery? And if you say it doesn't, then again, why not? Some might want to use the point about detransitioning as their argument for blocking all forms of treatment, but can you consider that isn't the only reason to seek better data on detransitioning or regret? And I say better, because the studies that have even bothered to broach this are mostly not doing so with great statistics. For one thing, they tend to forego the intention to treat model and simply discount patients who fall out of the study or chose not to respond as null respondents, when in actuality some are probably one of the two. So why else should there be interest in that data? Because it simply helps the physician/team/surgeon have a fuller, more informed conversation about what the risks are with the patient. This is not a small thing. Part of why surgeons choose which operations they will perform, sometimes has less to do with technical ability and more to do with one's tolerance for complications. If this goes wrong, what can or can't I live with. This is why Pediatric Neurosurgeons and Cardiothoracic Surgeons are a cut above. And please, let's not go with the argument that it is the patient who alone bears the burden. I have personally known two uber-talented, altruistic people walk out of medicine because of surgical misadventures. The full title of the specialty that most often deals with transgender surgery is after-all Plastic & Reconstructive Surgery and that second word isn't just for show. People don't go into this because they like extirpative procedures, and transgender surgery involves two of the most irreversible, yet-not-fatal, procedures you can perform. You won't know it, because the resident and fellowship applicant pool is brimming with people who are excited about developing gender-affirming practices, but there are also a number who started and have pulled back or are hesitant to start at all because there is that feeling that they can't turn the same questioning stance on aspects of this as they can with other procedures. It is likely impossible to have all the data on any procedure, but you don't want to be left feeling like your ability to critique and refine is hampered. When you couple that with the removal of what were held as some safeguards, i.e, mandatory mental health evaluation (which needs to be taken into account when people quote detransitioning or regret percentages), and the increase in the prevalence of LGBTQIA kids, there is a concern that more people are going to get operations they shouldn't have. And for some surgeons, an n of 1, is a complication they aren't willing to deal with. Anyone is free to think those people are cowards. So that's one reason, if not THE reason, for the interest. It really is to be better at this.

Except, the paper doesn't say that.

By the way, boys and men with gynecomastia don't just walk into an office and get mastectomies without questioning either. First, most don't even get mastectomies, they get reduction mammaplasty (sorry if you think that's semantics). Second, since, it is usually covered by insurance, there are several things that must be documented before it will get approved. Same with girls/women with macromastia. Want isn't the only prerequisite required for surgery. Medicine and medical doctors should mostly be left at it alone, but I can't think of a single industry where some outside participation, if not oversight, is not a good thing. The medical profession is no exception. A society should have interest in what its doctors are doing. Beauchamp's and Childress' 4 principles of biomedical ethics, respect for autonomy, nonmaleficence, beneficence and justice mostly evolved from concerns over what doctors were doing, unmonitored. If I said, police departments should have civilian monitoring or oversight, that's probably an opinion that would elicit positive reactions on this board. The two are not the same, but they aren't entirely dissimilar either.

How do you know its faux concern? Is it even possible for you to swallow the invective and use a slice of reason? Know why it's not just semantics? Because this particular scenario played out in a children's hospital when an administrator was responding to questions about the hospital performing gender affirming surgery with emphatic "no's" (being either unaware that top surgery was being performed at all, or that it was considered gender affirming surgery), and during the clarification/walk-back process, made the surgeons at that hospital look like they were hiding something and increased the threats they were getting. It's not semantics. Say, yes, gender-affirming surgery is performed on adolescents. And here are the reasons why. This is the multidisciplinary team we employ to ensure we run a good clinical practice.

well, if you think I've never posted in the Cloak Room, or in any of its previous iterations, or been involved in any of the other hot-button topics across this board and the others, you are wrong, and fucking stupid.

I can only assume you didn't actually read what the bold part refers to. It is the idea that the only prerequisite for surgery should be a desire or want of it. Maybe you need to read that again. Forget gender affirming surgery for a second. Surgery should not be practiced that way. Across all surgical subspecialties. Have you ever sat through an Indications Conference? The reason that you operate on someone can't simply be, they wanted it.

I dislike Devin Booker but what a playoffs he is having.

and you know I don't care about outcomes from spinal surgery how (which is a rather broad catchall term and involves more procedures than are available for gender transition)? I didn't care when I had two procedures? care to guess my thoughts on cranial vascular bypass surgery as well? To point out and discuss some of the practice complexities of gender affirming surgery does not equate to being against gender affirming procedures. It's this sort of binary thinking that rather proves the point about the minefield it can be to just even talk about it. Someone upfield made a statement that no such surgeries were being performed on minors. Somehow pointing out that this is not true, means I harbor some prejudice against the practice. I didn't comment on how often or the volume, just that it happens. Then you get responses to a point I never made, as if stating a fact is the same as condemnation. Incredible and yet, not surprising.

More Trans Teens Are Choosing ‘Top Surgery’ There is also an article, if you are able to find it on PubMed, called Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults. The age range of population was 13 to 24.

I took a look at that first link in this post. I noticed really quickly that in at least two of articles listed in the first 4 or 5, the authors conclusions do not quite match up with what that gentleman has summarized. Take the Finnish article for example. This is what the Finnish authors put in their abstract This is what he wrote in his summation of the article It is really easy to read what he wrote and come to conclusion that that particular study was part of the positive ledger for gender-affirmation, when the authors don't even think it was. I did not go through all the articles cited, but when someone is willing to play games like that, and seemingly is depending on the likelihood that the majority of people will not track each article down and pore through the original data themselves, it puts a dent in the credibility.

Top surgery happens in adolescents. This is not a cosmetic procedure. The push for this to be covered by insurance points to that. Second, if you were to relate what they are undergoing to a cosmetic procedure, you will find that transgender patients would have very strong views about that. Ethical guidelines by the Aesthetic societies do ask that the practitioner not discount the number of patients one might encounter who are best served with a psychological assessment. As for the patients and surgeons having a say, I would reference a portion of an Op-Ed written in the NYTimes about 4.5 years ago by someone who transitioned and when I read it at the time, didn't sit right with me. I just fundamentally have a problem with that mindset, and I think anyone who wields a scalpel should.

It's the Economist article

Yes, medicine proceeds afoot without definitive evidence all the time. But it becomes more of an issue when the consequences of said treatment can be very dire. Gender-affirming surgery, if incorrectly assigned to an individual, certainly falls under that rubric. It is impossible to claim that politics doesn't play a part here. It certainly does. You'd be blind as a clinician to not think it does. The WPATH guidelines reflect this. Removing the need for a mental health examination reflects this. There was no solid reason, other than the offense it gave to some, to remove that guideline. Again, when the effects of a treatment can be dire, you should err on the side of caution. The demands on well-meaning gender-affirming surgeons are only going to grow. As with many other things in this country, the loudest voices are now being deployed by people at the extremes of the position, even in medicine. People who lay somewhere in the middle, and just want to get good data on the topic are quietly leaving the stage. You certainly aren't going to see many people get up at a national meeting, and start questioning the de facto position, that gender-affirming surgery is a good thing.

it's only a matter of time before a doctor gets shot over this at a children's hospital. death threats at CHOP in Philly and Lurie in Chicago

If you are used to not having to get into a car and drive everywhere to do practically anything, then all of Texas can be a beating. It's not an easy to get over. So this guy is in his 40's and still finding himself? The world is full of unserious people these days....

I just have to hand them some sort morbid credit. They are very good at finding whatever crack there is to exploit.

you've got more hope than I do. and it's just that much closer to the nightmare, when the branches of government just start ignoring each other

How can you accurately state something isn't ground breaking when you are watching it for the first time 28 years later? You have likely watched a lot that has been inspired or borrowed from Heat since then and not even known it.

Amazon is shutting down DPReview. Stunning.

This isn't organ donation. I'm not giving up my kid for some hypothetical. The medical part was absurd, but allowances have to be made for what it essentially a fantasy story.