Is it necessary?

I am thankful for the practice of journaling.

Natalie Goldberg said, “Whether you’re keeping a journal or writing as a meditation, it’s the same thing. What’s important is you’re having a relationship with your mind.”

These are excerpts from a journal that I was keeping in the last year of my tenure in the gender center, primarily from late March and early April of 2022.

I blew the whistle February 2023.

March 31, 2022

A.I. can assess the hospital data and predict which patients are most at risk of developing sepsis, simply from the data in the chart.

We cannot determine which young people who are seeking medical transition will benefit from that care in the long run. Since we cannot make that determination, is it ethical to continue?

Medical ethics—to avoid unnecessary harm.

Right now we have unnecessary medical harm occurring because we are overtreating young people who are seeking serious life-altering medications for transition.

Unnecessary medical harm because of these treatments.

What are the questions I need to consider?

What are the answers?

The questions:

• Is it necessary?

• Are there alternatives to try?

• Does the patient have the capacity and competency to fully weigh the risks/benefits/alternatives?

• Is the patient free to consent, or are they under any undue influence?

April 3, 2022

Is it necessary?

No.

Why is it not?

• Young people existed for decades without blockers and hormones without dire consequences.

• Blockers and hormones are not necessary at all for natal girls in order to exist as a passing adult if they so desire.

• Most natal girls do not even present until well past puberty, so blockers are essentially out of the equation. There are so few patients at that stage that the argument that it prevents future surgery in the girls is irrelevant.

• Testosterone is absolutely potent enough; if an adult wants to pass, they can do so.

• Blockers and hormones might really even only be a debate regarding the boys if they want to exist as a passing adult.

April 7, 2022

Is it necessary?

No.

Why is it not?

• Blockers and hormones do not treat mental health conditions and can make it worse.  

• Blockers and hormones do not prevent suicide.

Is it necessary?

No.

Why is it not?

• It is overtreatment.

• There are alternatives that leave the body intact and functional, and fertility is a question for adult minds to consider, not children.

April 12, 2022

Is it necessary?

No.

Why is it not?

• Distress and pain are known parts of the human condition.

• Puberty is part of being human.

• Being human can be hard, but young people are resilient.

Is it necessary?

No.

• Blockers, hormones, and surgery for children and young people is not necessary at all for the girls.

• Define “necessary.”

• Required to be done, needed, and essential.

• Then no—not at all for the girls, so now what?

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