Comment by eesmith | Hacker News Reader

Comment by eesmith | Hacker News Reader

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FWIW, that's assistant secretary for health.

Also, Harvard and Tulane educated, residency at Mount Sinai, faculty at Penn State, Pennsylvania's physician general, then Secretary of Health for Pennsylvania (unanimously confirmed by the Senate) before Biden's nomination.

Why do you think that background wasn't an important part of her nomination, and only her trans status?

> has tried to force states to allow or even provide medical/surgical transition to minors, in some cases without parental consent, etc

I ... do not believe the assistant secretary for health has the power to force states to do something.

By "medical transition" you mean hormone therapy, right? Hormone therapy is associated with a lower rate of depression and suicidality in minors, and transgender youth have a high rate of suicide than non-LGBT youth. https://www.jahonline.org/article/S1054-139X(21)00568-1/full...

Which is, as I understand, why hormone therapy is part of the standard for gender-affirming care for minors, as set by (for example) WPATH and the Endocrine Society, and supported by the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, the American Medical Association, the American Psychiatric Association, and from the American Psychological Association. https://www.npr.org/sections/health-shots/2022/04/29/1095227...

This shouldn't be so easily coupled with a "/" to surgical transition, which as her department's fact sheet points out at https://opa.hhs.gov/sites/default/files/2022-03/gender-affir... is "Typically used in adulthood or case-by-case in adolescence".

Gender affirming care also includes Social Affirmation and Puberty Blockers.

> From what I can tell the evidence for who and when and how to treat is still unclear and ideologues are trying quite hard to suppress any debate

From what I can tell, those standards of care come from evidence-based research and been around for a while - long before the current political decision to make a brouhaha of the topic.

Here's the WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People - https://wpath.org/publications/soc

It's the "7th version of the Standards of Care since the original 1979 document." It's about 10 years old. The NPR link says a SOC should be coming out this year.

Giving typical males with low testosterone supplemental same-sex hormones is not even settled medicine, so it seems quite unlikely that giving cross-sex hormones and puberty blockers would be at all settled as that has not been done at scale for nearly the same length of time. For years studies have been going back and forth about whether the benefits of exogenous testosterone outweigh the risks for biological men with low T. Exogenous T also very commonly permanently destroys a man’s natural T and sperm production. Many endocrinologists will straight up refuse to give it to get a man to get them within normal levels and they have to resort to those shady “men’s health” clinics. I’m less familiar with the issues, but giving postmenopausal women estrogen has many issues as well, one of them I have unfortunately seen in action is the potential to accelerate nascent breast cancer. Even if puberty blockers don’t have the effects they’re said to(bone and other physical development issues, possible destruction of sexual function and the ability to orgasm in the future) they haven’t been studied long enough for my taste. Even if huge benefits can be shown for certain transgender individuals, there’s still the issue of how to determine which individuals will continue wanting to live as a trans person long term. As these interventions are made widely accessible you can bet that there will be significant numbers of people that regret their decision, but in many cases the effects of medical intervention will be partially or fully irreversible. Imagine how many people may have such regrets if this is done at scale without long and careful study.

> Why do you think that background wasn't an important part of her nomination, and only her trans status?

Because Biden has unabashedly doubled down on intersectional identity politics. For example for the supreme court justice and his VP pick he explicitly said he would pick black females.

> As these interventions are made widely accessible you can bet that there will be significant numbers of people that regret their decision, but in many cases the effects of medical intervention will be partially or fully irreversible. Imagine how many people may have such regrets if this is done at scale without long and careful study.

There's quite a lot to unpick here.

1) Rates of regret for transition are lower than most other medical treatment. You're applying a lot of scrutiny to regret, which is fine, but you're only applying that scrutiny to trans care. You're not applying the same scrutiny to eg cancer treatment.

2) Why is regret such a horrific prospect to you? You see someone going through gender affirming care, and then regretting it, and then being forced to live with the result, and this is horrific to you. I don't understand why you don't apply the same standard to the people who are denied access to gender affirming care - the people who are forced to live with the results of not getting the care they need. Why is one situation so terrible and the other is good?

3) In general we allow capacitous people to make choices about healthcare. We tell them what's involved, we tell them about the risks, and then we let them make the decision. We allow people to make unwise decisions, even if those decisions will cause their death. If a person has a necrotic gangrenous leg their doctors will say "we need to amputate this or you will die" but that person is allowed to say "I'd rather die than have you amputate my leg". Why are people okay with bodily autonomy unless it's a trans person getting trans healthcare?

There's also quite a few points you've made that are based on out of date, or misinterpreted, information. Stuff like bone density has been debunked - trans people have reduced bone density before they start gender affirming medical treatment. At the moment people think that the bone density problems are caused by lack of access to sport and exercise.

> Giving typical males with low testosterone supplemental same-sex hormones is not even settled medicine

Which is relevant to this discussion because .. why? Just because there isn't an accepted evidence-based standard of care for X doesn't mean there can't be an accepted evidence-based standard of care for Y.

(I don't know what "settled medicine" means here, given that standards of care can and do change.)

> giving postmenopausal women estrogen has many issues as well

Yes, that standard of care has changed based on evidence.

> puberty blockers

Which are reversible. As my linked-to fact sheet points out.

> they haven’t been studied long enough for my taste

I think I'm warranted in trusting the opinion of the 7 or so medical organizations I listed far over your opinion.

How long will be enough to make you happy? There's been, what, 100 years of studies on the topic? And I pointed out the relevant WPATH Standards of Care started in 1977.

How long is enough?

> there will be significant numbers of people that regret their decision

How many is "significant"?

Do significant numbers of people regret their tattoos? Their plastic surgery? Their chemotherapy? Their lottery pick? Does that justify stopping all of those activities?

And, as I pointed out, by NOT getting the standard of care, the amount of depression and suicide ideation increases. How many regret NOT being able to get the medically recognized appropriate standard of care because politicians prevented it due to transphobia?

> Because Biden has unabashedly doubled down on intersectional identity politics

Every single one of those people had a background which, had they been white straight men, would have been generally acceptable for their position.

That's a far cry from a claim that they must be incompetent and were picked only for theig "intersectional identity politics".

> Their chemotherapy?

This surprise lots of people, but rates of regret for patients getting chemotherapy or other cancer treatment are quite high. They're much higher than rates of regret among people getting gender affirming care.

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