The scary tranny thread

[Lokmar]

Most of you fukerz think I'm too extreme, wanting these fuckers dead. 

[Prof Emeritus at Fawk U]

Most of you fukerz think I'm too extreme, wanting these fuckers dead. 

It is kind of a surprise because you're such a good-hearted liberal.   

[DKG]

During a recent talk at the invitation of the University of Alberta, Dr. Karine Khatchadourian offered a candid appraisal of the evidence underpinning Canada's approach to treating gender-distressed youth.

The field is in a highly consequential grey zone with contradictory findings at best, the Ottawa doctor told a virtual audience. The evidence doesn't allow doctors to say with confidence whether puberty suppression has psychological benefits or not and today's rapidly changing demographics — predominantly biological females with accompanying complex mental health problems and no known history of gender distress when they were younger — make it difficult-to-impossible to predict if someone's gender dysphoria or incongruence will persist.

"We have to constantly be reassessing what we're doing, what we're treating, based on new evidence that's coming forward," Khatchadourian said. 

Doctors are encouraged to look at emerging data objectively, be open to scrutiny and pivot where necessary, she said. However, gender-affirming care is different; a field so turbulent and charged with emotion that providers are reluctant to express doubts for fear of being alienated by colleagues and condemned by activists as transphobic.

Which is what makes Khatchadourian's openness to share that her own messaging has changed so remarkable.

"The message to patients, providers, the public has to include that what we're seeing now with the data is this uncertainty of the evidence," she told the February gathering hosted by the U of Alberta-based Women and Children's Health Research Institute. Her assessment echoes the findings of a recent series of deep systematic dives into the literature that concluded the evidence supporting gender medicine interventions is, as the editor-in-chief of the influential British Medical Journal summarized, "threadbare, whichever research question you wish to consider."

Khatchadourian was one of the first doctors in Canada to provide hormone treatments to transgender-identifying and gender dysphoric youth, in 2014. By her estimate, some 250 to 300 gender-distressed children and teens have been under her care over the years.

After 12 years of experience, she said she now understands the population more. "I can say that, with everything I now know, as of now, I would challenge medicalizing the majority of youth that are presenting to clinics," Khatchadourian, an assistant professor of pediatrics at the University of Ottawa, said in an interview. 

"I strongly believe in this care," she stressed.

After 12 years of experience, she said she now understands the population more. "I can say that, with everything I now know, as of now, I would challenge medicalizing the majority of youth that are presenting to clinics," Khatchadourian, an assistant professor of pediatrics at the University of Ottawa, said in an interview. 

"I strongly believe in this care," she stressed.

"But it must be approached with rigour and caution, given the high stakes in this field."

McMaster University researchers faced persecution from both extremes of the trans debate last year after publishing two systematic reviews that found the evidence is of such low, or very low, certainty that it's impossible to conclude whether puberty blockers are helpful or harmful. 

Lead author and celebrated scientist Dr. Gordon Guyatt and colleagues faced backlash from activists on one side over a funding source (the Society for Evidence-Based Gender Medicine, a group concerned with low-evidenced interventions that's been accused of being an anti-trans think tank by transgender rights groups) and, on the other side, critics who accused Guyatt of shirking his own evidence-based approach to science by later issuing a letter criticizing opponents for using his work to justify treatment bans. 

"Everybody's been kind of frightened," Guyatt told National Post columnist Michael Higgins. "I was not as vividly aware as to what an extreme political environment it is."

In their letter, Guyatt and four colleagues wrote that it's misguided to cast medical interventions based on low-certainty evidence "as bad care or as care driven by ideology."

However, under the GRADE scoring system co-developed by Guyatt, "very low certainty" means it's hard to have confidence where the true effect lies.

Privately, other Canadian doctors like Khatchadourian are becoming more cautious.

Writing for healthydebate.ca, scientist, gastroenterologist and U of Toronto professor of medicine, Dr. Laura Targownik, who is a transgender woman, said several providers working in the field have shared that they're becoming "more circumspect, recognizing that they can no longer function as enablers of transition in all cases." 

Public support for gender care for minors is in "free fall," she wrote, "not only among conservative voters, but also among those who describe themselves as moderate or liberal." 

But the issue has become such a political minefield doctors fear that any expressed concern will be weaponized and used to shut down "and rob youth" of all care, even for those who would benefit, Targownik said in an interview.

Canadian physicians want what's best for kids, she said. But they're also concerned about leaving kids suffering from serious dysphoria with nothing.

Several European countries and American states are already pulling back. Puberty blockers have been banned indefinitely in Britain for under 18s after the country's health service declared them an "unacceptable safety risk." Alberta invoked the Charter's notwithstanding clause to uphold its bill prohibiting doctors from prescribing puberty blockers or cross-sex hormones to under 16s.

Meanwhile, numerous medical organizations, including the Canadian Paeditric Society, continue to endorse an affirming approach to gender dysphoria.

Khatchadourian was one of the first pediatric endocrinologists to train in the field of pediatric gender medicine in Canada. She was the first author of the first Canadian study (and second paper in North America) on the medical management of youth with gender dysphoria, published in 2014. Between 2022 and 2024, she was co-medical lead of the Children's Hospital of Eastern Ontario's (CHEO) gender diversity clinic. 

While still relatively small, the number of children and adolescents identifying as transgender or gender-diverse has grown dramatically over the last decade. Pediatricians and family doctors across Canada are seeing them in their practices. Kids are being treated not only in specialized hospital-based clinics, but also by primary care providers in the community, some after virtual assessments.

In an interview, Khatchadourian said she worries that the increase in teens (mostly natal females) identifying as non-binary — neither identifying as female nor male — may be socially driven. "We know social media and peers have greater influence during adolescence," she said. 

 "I didn't see anyone identifying as non-binary ten years ago when I was training." She questions the influx now. 

"It's so hard to know when you see a patient how much of this story is really that person's story and how much is based on the influence of peers and social media," she said. 

"We get to a point where we accept certain definitions and certain things, but we should continuously ask why: 'Why is this happening? What are your theories? Does this warrant medical treatment?'" 

Youth can instantly connect with dozens of others who feel the way they do and start down a medical transitioning path. But Khatchadourian worries "we're changing trajectories for these youth" based on unconvincing and limited data, and with too few mental health assessments by psychologists or psychiatrists trained in the child and adolescent medicine space.

"The expertise has not kept pace with the demand, and that worries me," said Khatchadourian. She's advocating for a national review in Canada — one involving those working in the field, trans-identified individuals, parents and families and, as well, de-transitioners — to ensure practices are aligned with the best available evidence.

Targownik also supports getting better data because, whether a populist or pragmatist, government leaders "are going to start asking for receipts," she said.

"Someone is going to come and say, 'I know you believe this care works. If you believe so strongly in this, show me that it actually works. Show me your outcomes. Show me that the kids you're transitioning are doing well a year later, two years, five years later. Give me your best estimate of what the detransition rate in the modern cohort actually is, and the risk factors."

There's been a reluctance to ask those questions in the past when the practice was completely unhindered and support for gender care at its peak, she said.

Now, more countries are questioning that blanket, blind "just affirm" approach.
https://nationalpost.com/news/canada/evolution-transgender-care-doctor

Canada is an outlier. But, even in this country there is hope that science is replacing ideology on the issue of aiding teens to transition.