1 00:00:02,400 --> 00:00:05,320 Speaker 1: Welcome to Wellness Unmasked. I'm doctor Nicole Sapphire and this 2 00:00:05,360 --> 00:00:09,080 Speaker 1: is your weekly rundown. Well Today's headline. It's one I'm 3 00:00:09,080 --> 00:00:13,200 Speaker 1: going to call important but painfully overdue. The American Society 4 00:00:13,200 --> 00:00:17,800 Speaker 1: of Plastic Surgeons, the largest US professional group for plastic surgeons, 5 00:00:18,160 --> 00:00:22,560 Speaker 1: has now recommended delaying gender related surgeries until at least 6 00:00:22,720 --> 00:00:26,960 Speaker 1: nineteen My first reaction is simple, where have you been 7 00:00:27,400 --> 00:00:31,080 Speaker 1: and finally welcome to reality. The ASPS position statement, it's 8 00:00:31,120 --> 00:00:34,200 Speaker 1: pretty direct and to the point. They cite the low 9 00:00:34,280 --> 00:00:39,120 Speaker 1: certainty of evidence for not just surgical interventions, but pediatric 10 00:00:39,320 --> 00:00:42,960 Speaker 1: endocurrent interventions. You know, the medications that they're starting to 11 00:00:42,960 --> 00:00:46,560 Speaker 1: give kids to stop puberty altogether and try and give 12 00:00:46,640 --> 00:00:50,640 Speaker 1: them characteristics of the opposite sex, and the overall just 13 00:00:50,720 --> 00:00:54,640 Speaker 1: growing uncertainty really about the benefits and the concerns about 14 00:00:54,680 --> 00:01:00,160 Speaker 1: the irreversibility and potential long term harms. Imagine that they're 15 00:01:00,200 --> 00:01:05,200 Speaker 1: going to do a surgical or endocrine intervention that's completely irreversible, 16 00:01:05,680 --> 00:01:07,600 Speaker 1: and at the time they were doing it and they 17 00:01:07,600 --> 00:01:10,080 Speaker 1: were like, well, let's just do it all in the 18 00:01:10,200 --> 00:01:13,240 Speaker 1: name of ideology. Of course, there's going to be damage. 19 00:01:13,680 --> 00:01:18,560 Speaker 1: So the ASPS has now concluded there's insufficient evidence of 20 00:01:18,600 --> 00:01:23,240 Speaker 1: a favorable risk benefit ratio for kids and adolescents, therefore 21 00:01:23,280 --> 00:01:29,319 Speaker 1: recommending surgeons delay chest, genital and facial procedures until the 22 00:01:29,360 --> 00:01:33,160 Speaker 1: age of nineteen. Now, let's break down the way they 23 00:01:33,200 --> 00:01:39,399 Speaker 1: worded it, insufficient evidence of a favorable risk benefit ratio. 24 00:01:39,959 --> 00:01:44,920 Speaker 1: That is the most wordy, garbage way of saying, we've 25 00:01:44,959 --> 00:01:48,480 Speaker 1: been doing something and there's no evidence that this is 26 00:01:48,520 --> 00:01:51,360 Speaker 1: actually for the good. And by the way, we're actually 27 00:01:51,400 --> 00:01:54,000 Speaker 1: causing a lot of harm. There you go. I set 28 00:01:54,040 --> 00:01:57,360 Speaker 1: it for you in Layman's terms. Now, their language is 29 00:01:57,400 --> 00:02:01,480 Speaker 1: not fringe language. It's a major medical says anxiety, essentially saying, 30 00:02:02,080 --> 00:02:05,400 Speaker 1: all right, we moved too fast with too little data 31 00:02:05,880 --> 00:02:10,760 Speaker 1: on irreversible interventions for developing bodies and brains full stop. 32 00:02:11,200 --> 00:02:14,120 Speaker 1: So the evidence problem what they are talking about, the 33 00:02:14,200 --> 00:02:17,640 Speaker 1: lack thereof good evidence and what harm may look like 34 00:02:17,720 --> 00:02:20,800 Speaker 1: in real life. So let's be precise. One of the 35 00:02:20,840 --> 00:02:25,360 Speaker 1: biggest issues here is that the best summaries of the literature, 36 00:02:25,760 --> 00:02:28,480 Speaker 1: when they try to look at all of these gender reassignments, 37 00:02:28,680 --> 00:02:32,840 Speaker 1: just repeatedly come back to the same theme uncertainty. A 38 00:02:32,919 --> 00:02:37,639 Speaker 1: recent large systematic review of puberty blockers concluded, well, there 39 00:02:37,680 --> 00:02:43,600 Speaker 1: remains considerable uncertainty about the effects across key outcomes, including 40 00:02:43,840 --> 00:02:47,000 Speaker 1: mental health measures and bone mineral density. Do you know 41 00:02:47,080 --> 00:02:50,720 Speaker 1: when in research we say, well, you know, we just 42 00:02:50,800 --> 00:02:55,880 Speaker 1: need more research. There's uncertainty. We essentially looked at things 43 00:02:55,880 --> 00:02:58,520 Speaker 1: and it didn't give us the outcome we wanted. So 44 00:02:58,560 --> 00:03:01,280 Speaker 1: we're like, we're going to keep finding it. You know, 45 00:03:01,600 --> 00:03:03,600 Speaker 1: Eventually we're going to get a study that's going to 46 00:03:03,760 --> 00:03:05,760 Speaker 1: prove what we're doing is right, even if it is 47 00:03:05,800 --> 00:03:10,000 Speaker 1: an entirely biased and poorly designed study. That's what they've 48 00:03:10,000 --> 00:03:12,480 Speaker 1: continued to do. So now let's just talk about the 49 00:03:12,520 --> 00:03:15,320 Speaker 1: harm for a minute. It's not just a spreadsheet of 50 00:03:15,360 --> 00:03:19,919 Speaker 1: side effects. It's the reality that these pathways can involve sterility, 51 00:03:20,440 --> 00:03:26,799 Speaker 1: sexual function changes, surgical complications, not to mention monetary financial strain, 52 00:03:27,240 --> 00:03:31,720 Speaker 1: but yes, regret and detransitioning for some patients later on. 53 00:03:32,360 --> 00:03:35,360 Speaker 1: You think that all fourteen fifteen, sixteen year olds know 54 00:03:35,480 --> 00:03:38,040 Speaker 1: exactly what they want when they are in that peak 55 00:03:38,080 --> 00:03:42,560 Speaker 1: adolescent peak piertal time, of course not. That's why they 56 00:03:42,800 --> 00:03:46,320 Speaker 1: can't drive cars, they can't vote, they can't get a tattoo, 57 00:03:46,640 --> 00:03:48,960 Speaker 1: they can't do any of these other things that mutilate 58 00:03:49,000 --> 00:03:52,480 Speaker 1: their body because we don't trust their decision making. I 59 00:03:52,520 --> 00:03:55,960 Speaker 1: don't know how or why medical professionals thought all of 60 00:03:56,000 --> 00:03:59,200 Speaker 1: a sudden, doing a mastectomy on a girl at the 61 00:03:59,240 --> 00:04:02,440 Speaker 1: age of fourteen was a good decision. She can't pierce 62 00:04:02,440 --> 00:04:04,360 Speaker 1: her tongue. But you're gonna do a masectomy? Are you 63 00:04:04,440 --> 00:04:08,520 Speaker 1: kidding me? Gosh, I just cannot believe how far we 64 00:04:08,600 --> 00:04:13,120 Speaker 1: went on this. So what the eighth SPS statement is 65 00:04:13,200 --> 00:04:17,400 Speaker 1: explicitly acknowledging right now is the whole real world landscape 66 00:04:17,480 --> 00:04:22,120 Speaker 1: clinicians must grapple with. You are actually causing harm with 67 00:04:22,320 --> 00:04:26,080 Speaker 1: no proven long term studies of benefit. That is the 68 00:04:26,120 --> 00:04:28,800 Speaker 1: exact opposite of the hippocratic oath that we all took. 69 00:04:29,440 --> 00:04:32,440 Speaker 1: And so this brings us to the whole medical legal reality. 70 00:04:33,320 --> 00:04:36,640 Speaker 1: Lawsuits no longer hypothetical. We used to say, well, what 71 00:04:36,720 --> 00:04:40,640 Speaker 1: happens in the future when if they regret their decision? 72 00:04:41,000 --> 00:04:45,880 Speaker 1: Well we know now because just this week in a 73 00:04:45,960 --> 00:04:49,680 Speaker 1: New York case reportedly described a jury awarding two million 74 00:04:49,760 --> 00:04:52,719 Speaker 1: dollars to a young woman in a malpractice suit tied 75 00:04:52,760 --> 00:04:56,760 Speaker 1: to gender related care received as a minor. She essentially 76 00:04:56,760 --> 00:04:59,600 Speaker 1: had a mastectomy at the age of sixteen, because I 77 00:04:59,720 --> 00:05:02,679 Speaker 1: guess at that time she just didn't want to breast anymore. 78 00:05:02,800 --> 00:05:06,760 Speaker 1: She thought she was a boy. Shocking, as soon as 79 00:05:06,760 --> 00:05:09,760 Speaker 1: her frontal lobe started to form a bit more, she 80 00:05:09,880 --> 00:05:13,400 Speaker 1: changed her mind. Whether you agree with every argument or not, 81 00:05:13,920 --> 00:05:18,080 Speaker 1: this signal something big. Medicine is being asked in court 82 00:05:18,320 --> 00:05:20,919 Speaker 1: to defend the wriger of its process, not just the 83 00:05:20,960 --> 00:05:26,360 Speaker 1: sincerity of the intentions, which means having some political ideology 84 00:05:26,560 --> 00:05:29,520 Speaker 1: is not going to save you from medical malpractice suits. 85 00:05:29,800 --> 00:05:32,600 Speaker 1: So you better be only doing things that are evidence based. 86 00:05:32,680 --> 00:05:36,000 Speaker 1: And guess what gender transition surgery and the hormone balkers 87 00:05:36,520 --> 00:05:40,000 Speaker 1: are anything but that, which is why you've already seen 88 00:05:40,120 --> 00:05:43,040 Speaker 1: other countries have hit the brakes on this. They're ahead 89 00:05:43,080 --> 00:05:45,320 Speaker 1: of the United States and England. The NHS stopped the 90 00:05:45,400 --> 00:05:49,280 Speaker 1: routine prescription of puberty walkers for under eighteen in March 91 00:05:49,320 --> 00:05:53,839 Speaker 1: twenty twenty four, following a big review's concerns about the 92 00:05:53,920 --> 00:05:56,600 Speaker 1: lack of evidence, and the UK government later moved to 93 00:05:56,640 --> 00:06:01,760 Speaker 1: make restrictions more Durabletional Board of Health and Welfare issued 94 00:06:01,839 --> 00:06:05,400 Speaker 1: updated guidance for miners that moves towards stricter criteria for 95 00:06:06,000 --> 00:06:09,560 Speaker 1: any sort of gender related stuff and greater caution, essentially 96 00:06:09,600 --> 00:06:11,960 Speaker 1: a warning saying we're not sure this is the right 97 00:06:12,000 --> 00:06:16,440 Speaker 1: thing to do. Even Reuters noted the broader trend UK, Sweden, Finland, 98 00:06:16,680 --> 00:06:20,200 Speaker 1: they've all shifted towards restriction and reassessment when it comes 99 00:06:20,279 --> 00:06:25,400 Speaker 1: to gender transitioning. So while US medical societies were projecting certainty, 100 00:06:25,960 --> 00:06:28,720 Speaker 1: Europe was rechecking the math. And now here we are 101 00:06:28,839 --> 00:06:31,560 Speaker 1: we are starting to see an about face, and all 102 00:06:31,560 --> 00:06:35,280 Speaker 1: of a sudden, we're seeing some medical societies change. So 103 00:06:35,839 --> 00:06:39,560 Speaker 1: the plastic surgery one was the first. The American Medical 104 00:06:39,560 --> 00:06:43,400 Speaker 1: Association actually came out with a comment to the National 105 00:06:43,480 --> 00:06:47,279 Speaker 1: Review saying that because the evidence for gender affirming surgical 106 00:06:47,320 --> 00:06:50,839 Speaker 1: intervention in miners is insufficient for us to make a 107 00:06:50,880 --> 00:06:56,159 Speaker 1: definitive statement, the AMA agrees with the ASPS that surgical 108 00:06:56,200 --> 00:07:01,159 Speaker 1: interventions in minors should be generally deferred to adulthood. Wow, 109 00:07:01,800 --> 00:07:05,560 Speaker 1: where was the AMA for the last five years? Why 110 00:07:05,560 --> 00:07:08,360 Speaker 1: didn't they speak up about the harm or not even 111 00:07:08,400 --> 00:07:09,920 Speaker 1: the harm? You know what, you don't even have to 112 00:07:09,920 --> 00:07:12,240 Speaker 1: go that far. Why don't you just say we don't 113 00:07:12,240 --> 00:07:15,200 Speaker 1: have data showing that there's benefit here, but we know 114 00:07:15,360 --> 00:07:18,720 Speaker 1: that there is at least some sort of irreversible harm 115 00:07:18,800 --> 00:07:22,360 Speaker 1: being done, not to talk about the potential long term 116 00:07:22,360 --> 00:07:26,520 Speaker 1: sequela of physical and mental health issues that come from this. 117 00:07:27,080 --> 00:07:30,280 Speaker 1: So I'm going to end this. Compassion is not the 118 00:07:30,320 --> 00:07:33,640 Speaker 1: same as science. If you're going to permanently alter a 119 00:07:33,720 --> 00:07:37,120 Speaker 1: child's body, you'd better be able to answer one question 120 00:07:37,200 --> 00:07:40,560 Speaker 1: with clarity. Where is the high quality, long term data 121 00:07:40,880 --> 00:07:43,760 Speaker 1: proving this helps more than at harms because the quote 122 00:07:43,800 --> 00:07:47,000 Speaker 1: unquote we meant well, this is not an outcomes measure, 123 00:07:47,320 --> 00:07:50,520 Speaker 1: and not only are you harming the children, but physicians, 124 00:07:51,200 --> 00:07:54,040 Speaker 1: you are going to be liable for some of these damages. 125 00:07:54,200 --> 00:07:57,840 Speaker 1: And parents, stop doing this to your children. I know 126 00:07:58,040 --> 00:08:02,320 Speaker 1: that sometimes adolescents are sough and they're confused, but don't 127 00:08:02,440 --> 00:08:05,880 Speaker 1: jump to something that has irreversible damage. Help get them 128 00:08:05,920 --> 00:08:10,720 Speaker 1: through that with whatever sort of counseling, therapy, social structure 129 00:08:11,000 --> 00:08:14,239 Speaker 1: in the household, outside of the household, whatever they need 130 00:08:14,600 --> 00:08:17,280 Speaker 1: to get to a better place mentally. And if they 131 00:08:17,400 --> 00:08:20,040 Speaker 1: still have a certain desire as they are older and 132 00:08:20,080 --> 00:08:22,960 Speaker 1: their brain is more formed, let them make that decision. 133 00:08:22,960 --> 00:08:26,360 Speaker 1: Then when they are children, let's guide them as adults 134 00:08:26,480 --> 00:08:29,720 Speaker 1: and let kids be kids. I'm doctor Nicole Safire. This 135 00:08:29,800 --> 00:08:32,880 Speaker 1: has been your weekly rundown on Wellness Unmasks. Make sure 136 00:08:32,920 --> 00:08:36,319 Speaker 1: to listen to Wellness unmass on iHeartRadio, Apple Podcasts, or 137 00:08:36,320 --> 00:08:38,760 Speaker 1: wherever you get your podcasts, and I'll see you next time.