Doctors question aspects of Missouri transgender care limits

[riversedge]

Source: clickorlando.com




Published: March 21, 2023 at 4:50 P

Missouri’s attorney general has said he will issue an emergency regulation that at least temporarily puts strict limits on transgender medical treatment for youth. The planned rule comes as legislators in that state and many others seek bans or other restrictions on the treatment.

Doctors and advocates for the transgender community contend the planned rule contains misleading or incorrect information straight from the playbook of anti-trans activists. Here’s a look at what the rule does and what's behind some of its assertions.


WHAT DOES THE MISSOURI EMERGENCY RULE DO?

Republican Attorney General Andrew Bailey’s rule will target treatment for gender-questioning children, which typically begins with puberty-blocking drugs to temporarily pause sexual development. They are offered early in puberty, sometimes before the age of 10. Sex hormones — estrogen or testosterone — are offered next, generally in the teen years, allowing transgender boys and girls to physically transition. Some older teens choose to have transgender surgeries.

Bailey’s rule had not been formally filed as of Tuesday, but his office issued a press release outlining what he called “guardrails” for the treatments. The rule will require an 18-month waiting period, 15 one-hour therapy sessions and treatment of any mental illnesses before Missouri doctors can provide that kind of care to transgender children, according to the release. It also requires disclosure of information about puberty blocker drugs......................

Read more: https://www.clickorlando.com/news/politics/2023/03/21/doctors-question-aspects-of-missouri-transgender-care-limits/

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Glenda Starke wears a transgender flag as a counterprotest during a rally in favor of a ban on gender-affirming health care legislation, Monday, March 20, 2023, at the Missouri Statehouse in Jefferson City, Mo. (AP Photo/Charlie Riedel) (Charlie Riedel, Copyright 2023 The Associated Press. All rights reserved.)

[RKP5637]

1. They don't give a damn about the youth or medical advice ... just what will keep them in office

and keep the money train of power and money coming.

[sakabatou]

3. BINGO!

[Initech]

2. Imagine if they cared this much about kids getting shot.

Damn these fucking morons, and fuck Fox News.

[Hugh_Lebowski]

4. I don't think guardrails are a terrible idea generally, but these seem excessive

18 month waiting period ... for what to happen, exactly? ANY thing, even puberty blockers? Seems like when one needs to start taking them is kinda regulated by, ya know ... puberty. Perhaps 18 months between puberty blocker start and hormone therapy start is reasonable, but the article is unclear.

15 x 1 hour therapy sessions? And what sorts of certs would this person need to have? Are you going to make it so there's like 2 people in the entire state that meet the req's? What if the therapist needs about 2 hours to determine ... yup, this is a trans person? And can this happen over, say, 15 days? Or do they have to be monthly at most?

And 'treatment of any mental illnesses' ... do these have to be deemed 'successful', and if so, by whom? Does 'gender dysphoria' count as a 'mental illness'?

I think there should be some regulations, esp. when you're talking about very young kids, but these seem way above and beyond what's reasonable.

Maybe regulations that call for nothing that creates permanent changes before some age, whatever the experts think is appropriate. Minimum of 14 before hormone treatment, 17 for surgery, that kind of thing, maybe isn't a terrible idea.

[NullTuples]

6. There protocols worked out over decades, and they work!

The American Medical Association, the Pediatric Endocrine Society & the American Psychological Association, all have protocols that have been carefully adjusted over the years since puberty blockers were first administered to trans kids in 1982.

And they follow them. They tend to weed out nearly all kids who should NOT go through a managed puberty. Occasionally, out of the entire nation, a few later assert that they've changed their minds. But the regret rate is around 1%, far below that of nearly any other medical treatment. Why ban or prevent this one and not all lines of medical treatment with higher regret rates, is a question I'd love to ask Republican lawmakers.

But also, a significant percent of trans teens like my daughter knew when they were 3-1/2 years old, and they've never wavered. For them, the least-harm path in medically managing their puberty is to allow them to go through puberty at the same time as their peers. The only difference is which puberty their body goes through.

Likewise: Sometimes, rarely, there are some trans boys who developed large breasts at 12. Imagine being a boy in school with breasts and you'll understand why allowing them to access that surgery before 17 can sometimes be life saving. Again, it's the least-harm path.

That's why the protocols call for being cautious and even somewhat conservative, but also to manage each teen's puberty to fit their particular body and timetable.

And, they work.

Really, politicians should simply not insert themselves between doctors and their patients (obviously unless fraud or similar crimes are being committed).

[Ms. Toad]

9. Legislatively imposed guard rails are NOT appropriate.

The time between puberty blockers and the start of hormone therapy is a MEDICAL issue.
The amount of therapy provided in conjunction with providing medical gender affirming care is a MEDICAL issue.
The time between puberty blockers/horome therapy and surgical transition is a MEDICAL issue.

My daughter at age 14 had the first stage of her appearance altering care, with final surgery at age 17.
My niece, at age 18, had her appearance altering surgery.

Both of these sets of treatment permanently changed their appearances. All of the doctors in this medical care followed the guidance promulgated by the appropriate MEDICAL bodies. Neither was prohibited by artificial age-based, fear-mongering, legislatively imposed guidelines.

Anytime the details of medical care is promulgated by legislation, rather than by those who have medical expertise in providing that care - especially when restrictions contradict the recommendations of the medical experts and are directed at a minority which is being subjected to intense hatred and regulation, treat it as presumptively bigoted. This is especially true when it is being promulgated by hate groups.

Please do not support those who want to legislate trans individuals out of existence by suggesting that legislative guardrails are needed, albeit less extreme, when it would not even cross anyone's mind to impose such restriction for other appearance altering surgery. No one is demanding the legislative bodies to protect my daughter from our decision to allow her to alter her appearance by getting braces and mandibular setback surgery, or to prevent my niece from getting breast reduction surgery - in part to help her cope with depression associated with unwanted male attention directed at her breasts. No one is suggesting legislative guardrails would be a good thing.

Providing gender affirming care belongs between the trans individuals and their doctors, taking into consideratioin the care protocols developed by medical experts, not legislators.

[hmm.....]

5. We've seen this movie before

First mandatory waiting. Then add mandatory counseling. Then require regulatory hurdles for admitting privilege's and equipment. Then ban it altogether.

[Hugh_Lebowski]

8. Only thing missing is the ultrasound, but only because there's no equivalent (nt)

[ShazzieB]

7. Why the hell do so many Repukes think they're qualified to practice medicine without a license?

I just don't understand it, both in relation to gender-affirming care and reproductive care. Repukes act like running for and being elected to public office are the only qualifications they need to start making deeply personal health care decisions that impact the physical and mental wellbeing of total strangers in drastic and even tragic ways. Where the hell do these officious blowholes get such a towering idea of their own self importance? The sheer effrontery is mind blowing. 🤯

If I were a physician, I would be deeply and profoundly offended by these rank amateurs thinking they can just sail in and start telling me how to do my effing job that I spent years in medical school, internships, and residencies and tens of thousands of $$$ learning how to do. Somebody needs to slap some sense (figuratively speaking) into these overweening fools! 😡