Part Two: From 'Tucking' to 'Functional Genitalia'

Pills, implants, hormones, puberty blockers...and the scalpel

So chill out, daddy-o, as they used to say in simpler times. The advice handed out by the Doernbecher Children’s Hospital Gender Clinic in its handy hand-outs…

• “About Chest Binding”

• “Safe Tucking”

• “Changing Your Name”

…may cause indigestion among certain citizens who are past their sell-by date, but we can quickly stipulate that it’s nobody’s business how a kid dresses. Or “binds.” Or “tucks.”

These are, essentially, cosmetic solutions for adolescent transgender wanna-be’s. Reversible, should a youthful exploration of sexual identity bring a kid back to where he or she (words not used on the Doernbecher Children’s Hospital’s Gender Clinic web site) began.

Thus a kid might read in “Binding…”

You might want to push your breasts towards your armpits instead of letting the binder push them flat. Some people recommend pushing “down and out,” and others prefer “up and out.” Try different things to see what looks and feels best to you.

Or, “Tucking:”

Tucking is moving the penis, testicles, or both out of the way. This makes the genital area look smoother and flatter. Tucking can reduce any concerns you have about your body, how your clothes fit and how safe you feel in public. People of all genders can tuck.*

It’s probable that Doernbecher’s chatty advice to teens is probably well known by media-saturated kids before they enter the clinic; the cutting-edge types probably think this stuff is old hat, like Facebook.

Nor in the history of teens getting on adult nerves (and sometimes living to regret it) does “binding” rank up there among delusions such as enlisting in Antifa and throwing Molotov cocktails at the federal courthouse.

But questions, as posed by Samuel Paul Veissière Ph.D., a columnist for Psychology Today, remain to be answered…

As attested by current controversies, rates of transgender identity appear to be on the rise, particularly among young people. Increased social acceptance of a previously stigmatized condition likely plays a role in this process, but other findings are clearly puzzling: Transgender identity is now reported among young natal females at rates that clearly exceed all known statistics to date.

He was pondering this in 2018. It is, even today, an issue that has as many theories as there are academics, pundits, and politicians propounding them.

An organization such as Gender Health Query, in the UK, can say, “We support the normalization, full social acceptance, and protection of all gender nonconforming children, teens, and adults,” and then throw shade on studies showing…

With the changing demographics of gender dysphoria it is worth considering that cases are becoming more complicated and that there may be other issues going on with a young female person that may not be solved by transition. 

While males and females experience similar rates of body dysmorphic disorder, overall it is well-established that women/girls are more prone to issues of body dissatisfaction or even outright body hatred than males.

That is not the way Doernbecher’s web site and instruction sheets present the issues. There’s no hint that their statements are open to vigorous debate—and not just by a certain GOP candidate** who wants to ride the latest knee-jerk argument by jerks.

Instead Doernbecher presents views such as this as settled fact…

Gender dysphoria can worsen emotional issues that often come with puberty, such as anxiety and depression. Teens with gender dysphoria are twice as likely to have suicidal thoughts as other teens, research shows.

…but the “research” isn’t cited. In fact, you could spend the better part of the day Googling and DuckDucking through dozens of research references (as your writer did) and find no study that is universally accepted as a “case closed.” Many studies were obviously done with a certain, ahem, outcome in mind, such as the Trevor Project, billed as “world’s largest suicide prevention and crisis intervention organization for lesbian, gay, bisexual, transgender, queer & questioning young people.” It found…

Even more worrisome, 40% of those surveyed reported having seriously considered attempting suicide during that period.

Even though Amit Paley, CEO & executive director, the director of the Project, added a soupçon of fine print…

“…we still do not fully grasp the disproportionate impact it has on LGBTQ young people because of insufficient national data collection.”

He’s right on that point. The Centers for Disease Control (CDC) surveys youth suicide and found that, yes, suicides and attempts by females are increasing. But the CDC doesn’t list causes for that. Their assertion about transgender kids’ suicide attempts are a result of…

CDC collects data from a nationally representative sample of public and private school students in grades 9–12 in the 50 U.S. states and the District of Columbia.

Kids are asked if they have planned or attempted suicide, but CDC has no way of determining whether such a self-reported answer is truthful.

Just about every contemporary study or commentary on teen suicide also notes a fact that Doernbecher’s jaunty web pages miss entirely:

The country’s economy and schools were locked down for two years. As the CDC observed:

Young persons might represent a group at high risk because they might have been particularly affected by mitigation measures, such as physical distancing (including a lack of connectedness to schools, teachers, and peers); barriers to mental health treatment; increases in substance use; and anxiety about family health and economic problems, which are all risk factors for suicide.

While adding…

“…this study was not designed to identify the risk factors leading to increases in suspected suicide attempts.”

A Substack author, Suzy Weiss, made an obvious connection:

Teenagers need a social life. Every single study and report and piece of data tells us so. But we don’t need studies to tell us what we all already know. Ask yourself: What would it have been like if you had spent your thirteenth year in solitude?

Doernbecher’s (and OHSU’s) way with data is illustrated by their impassioned endorsement of the recent Transgender Day of Remembrances…

“…as a way to recognize and memorialize those who have been murdered as a result of transgender violence.”

…and…

The Human Rights Campaign released a report in 2018 regarding data collected regarding anti-transgender violence and cites in the United States 82% of those killed were transgender women of color and 64% were under the age of 35. 

This litany of murder was based on research from the pro-trans Human Rights Campaign Foundation that presented their scare-stats based on percentage changes from a minute base. In smaller print they admit that “22 transgender people have been killed in the United States since the beginning of 2018.” A brief spin through the thumbnail profiles of the murdered indicates that most cases have no suspects or arrests, thus no way of determining a motive.

Coincidence, as they say, is not causality.

These examples, scattered through the many pages of the Gender Clinic’s web pages raise the possibility that the dedicated docs at Doernbecher have made up their minds long before a kid presents on the exam table. We are reminded that Doernbecher is, essentially, advertising on its web presentation. For example, with “Patient Stories,” showing happy customers, including one (with picture) who…

…savors victories large and small now that his outside more closely aligns with his inside.

Is every Doernbecher patient a success story?

If anyone at Doernbecher has any doubts, much less any patients who changed their thinking (sometimes after having some anatomy removed), they aren’t mentioned on their web pages.

Which brings us two the final two Doernbecher PDFs we haven’t mentioned yet:

• “Preserving Your Fertility”

• “About Puberty Blockers”

And here we’re deep in the looking-glass world where children are making decisions that go far beyond the cosmetic.

Forget flattening prepubescent breasts or smoothing a crotch-line; this is where an implant containing a powerful hormone (estrogen; testosterone) slides beneath an 11-year-old’s arm or a scalpel meets the flesh of...and here we meet Doernbecher’s reluctance to assign a minimum-age for what amounts to the removal or remodeling of genitals.

Medicine that is not a “pause.”

That are, in practical terms, not reversible, although Doernbecher’s attitude borders on the flippant….

It is possible for hormone medications to permanently change your ability to have children.

Doctors do not yet know exactly how hormone medications affect your ability to get pregnant, make sperm or carry a child. They are also not certain how these medications affect an unborn child.

You may want to use frozen eggs, sperm, or both.

Doernbecher adds…

Researchers have not finished studying how safe puberty blockers are in the long term. So, there might be some risks that doctors do not yet know about.

…which glides past the fact that any use of puberty-blocking drugs, such as Lupron Depot, Supprelin LA, and Vantas are “off-label,” and have never been subjected to any double-blind “gold standard” research or any long-term follow-up studies. The FDA has approved them only for treatment of “early puberty.” Which has nothing to do, even remotely, with reassigning gender as early as 10-11 years old.

Not to worry:

We sometimes say that taking these medications is like “pushing the pause button on puberty.”

Not everyone agrees with this.

• The Karolinska Hospital in Sweden…has ended the practice of prescribing puberty blockers and cross-sex hormones to gender-dysphoric patients under the age of 18.

• Finland’s national health service tightened rules about hormone or surgical intervention: ”The initiation of hormonal interventions that alter sex characteristics may be considered before the person is 18 years of age only if it can be ascertained that their identity as the other sex is of a permanent nature and causes severe dysphoria.”

• The French Academy of Medicine endorsed the Swedish puberty-blocker ban, and noted, “there is no test to distinguish a ‘structural’ gender dysphoria from transient dysphoria in adolescence.”

• Britain’s National Institute for Health and Care Excellence conducted two studies of puberty-blockers. ”Its major finding,” said the Society for Evidence-Based Gender Medicine, “is that GnRH agonists lead to little or no change in gender dysphoria, mental health, body image and psychosocial functioning.”

• Also in the UK, Transgender Trend, reported: “Over the last two years a number of clinicians have resigned from the Tavistock Gender Identity Development Service on grounds of conscience…. All five clinicians believed that too little information was provided about the effects of hormone treatments on fertility and sexual function in adulthood.”

• From the New York Times… “An international group of experts focused on transgender health (WPATH) last month released a draft of new guidelines, the gold standard of the field that informs what insurers will reimburse for care. …the guidelines take a more cautious stance on teens. A new chapter dedicated to adolescents says that they must undergo mental health assessments and must have questioned their gender identity for “several years” before receiving drugs or surgeries.”

Doernbecher says it adheres to the WPATH (The World Professional Association for Transgender Health) guidelines, but makes no mention in its web pages of how they will change their practice if the new guidelines go through. It will almost certainly slow down the 600 children treated yearly (another Doernbecher web page says it’s 800).

It’s a hefty number, particularly when you consider the staff pictured on their web site. There is one person listed under the classification of “mental health care.” By contrast there are seven doctors, including the Clinic’s director, listed in varieties of hormone therapy.

And, make no mistake, there are doctors waiting to do genital surgery on kids—“tops” and “bottoms,” in the parlance, but also the creation of new genitals and removal of rejected organs; procedures such as “hysterectomy and oophorectomy,” “orchiectomy,” and “phalloplasty and erectile implants.”

Doernbecher does not mention age-limits on these surgeries; nor do they enumerate what criteria must be met for doing surgeries that go beyond “pausing” puberty.

For example, the web site lists five conditions for receiving vaginoplasty, the removal of male genitalia and their refashioning into what the web site calls, “natural-appearing and functional female genitalia— the vagina and external parts (vulva). We use techniques we believe are as safe as possible to protect your sexual, urinary and bowel function, and look natural.”

(Ponder whether any refashioned penis can be turned into “functional” female genitalia—unless the surgeon has forgotten the key function of creating a child.)

“We ask that you follow these five steps before your visit,” says the hospital: “Read our vaginoplasty booklet, watch a video, write down questions, plan to discuss hair removal, plan to discuss our strict nicotene restrictions.”

Then…off you go.

There are boo-birds out there, much despised by the transgender lobby, who might say, “You will not have a vagina; you will have a replica of that organ.” Merely uttering those words will get an academic deplatformed at best.

The Doernbecher booklet kinda-sorta hints at this:

“I want my results to look like this ...”

You may have been waiting your entire life for this, and you may have an image in mind of what you want your results to look like. Some people have brought in pictures from the internet of what they think results should look like. Others have told us they felt their results didn’t look like a “normal woman” or “natural.” We want you to be happy with your results, but we may not be able to meet 100 percent of your expectations.

As stated at the beginning of this exploration of the transgender looking-glass world and its many, constantly proliferating variations, adults (in the writer’s opinion) have a right to do whatever they want with their bodies.

As St. Sinatra said, “Whatever gets you through the night.”

But kids? Your writer-explorer isn’t the only person with queasy feelings.

A recent book, “Irreversible Damage: The Transgender Craze Seducing Our Daughters,” by Abigail Shrier, has been a best-seller for well over a year; the author now has her own Substack, “The Truth Fairy.” Predictably, as she told Princeton University students…

The question I get most often—the thing that most interviewers want to know, even when they’re pretending to care about more high-minded things—is:  What’s it like to be so hated?  I can only assume that’s what some of you rubberneckers want to know as well:  What’s it like to be on a GLAAD black list? What’s it like to have top ACLU lawyers come out in favor of banning your book? What’s it like to have prestigious institutions disavow you as an alum? What’s it like to lose the favor of the fancy people who once claimed you as their own?

It’s not that transgender advocates want to be seen as right—but that anyone opposed to their view is evil. And must be silenced. They’re not alone in this—America is now dotted with people and groups who want to shove other people around. And who are shocked!!! when their targets push back.

And so…

• Arizona governor Doug Ducey signed two bills into law, one that limits participation in the female category of sports to females only, and another that prohibits the use of puberty blockers, cross-sex hormones, and “top surgery” (mastectomies) to treat gender-related distress in minors.

• Thirty-one states have introduced bills that ban transgender athletes from participating in sports consistent with their gender identities. Three states—Arkansas, Mississippi and Tennessee—have already signed bills into law this year.

• Twenty states have introduced bills that prohibit or impede the administration of gender-affirming therapy to minors. One bill recently introduced in Alabama would make it a felony for medical providers to provide transition-related care to transgender minors.

• "The Arkansas Save Adolescents From Experimentation Act (SAFE)," was originally vetoed by Gov. Asa Hutchinson after passing both chambers of the legislature, but the veto was overridden days later. It's the first bill in the US to become law that would prohibit health care professionals from administering gender-affirming care.

Doernbecher? There’s not a hint on their pages that the Gender Clinic is at the eye of a storm. Their web sites radiate confidence and a rock-solid point of view. Ask any potentially troubling questions and they will simply ignore them. It comes down to the old capitalist tradition: don’t like what we’re selling? Shop somewhere else.

But Doernbecher makes it clear, on every web page, that the Gender Clinic is part of something much bigger than a kid with a problem. They’re part of a movement, a sort of crusade, a “community,” a step toward a non-binary future.

Is this dispassionate, science-based medicine?

There’s something else that might be worth a passing thought.

A person’s bumps and lumps and utilitarian biological gadgets—a penis to deliver sperm, a uterus where a gamete can become a new human being, a nipple to feed a baby—isn’t really part of Doernbecher’s equation. They’re problems to be solved.

But the world is a cruel mother who doesn’t care if you are happy or comfortable with your body or have the right “identity.” Your species has survived and now it’s your turn to keep it going. Nature does not issue guarantees—except: reproduce or go extinct.

Humans have evolved many and varied illusions; the idea that we can change nature’s rules being one of them.

Good luck with that…

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*That last sentence was probably added to keep the transgender true believers at bay—or maybe the physicians at Doernbecher really believe that…and since they don’t use the words “male” or “female” or “boy” or “girl” in any of their communiques, they’re home free.

**The Oregonian reported that “Schools have no business telling kindergarteners they can pick the gender and the bathroom of their choosing,” [GOP candidate for governor Stan] Pulliam said in a statement on his campaign website. “It’s absurd and it’s not their job. Parents know best, not school district administrators.” Then the writer, Hillary Borrud, spend the rest of the alleged news article arguing that what Pulliam said was bunk.

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