Copy of I Wonder: "What Do Docs Really Think About Childhood Medical Transition? Dr. Silenced Fills

A rare occasion when I don't have anything to say...It's a miracle, quite frankly!

So in the words of my 6'4, 300-pound hairy Irishman of a father, I am going to take his line and say: "I'm just gonna sit here and look pretty." <----He said that about himself FYI - Hilarious

WOW!

-Scott Newgent

An email I received from a physicians. The physician is remaining anonymous, but TReVoices has verified that this is a real physicians. Hold Tight

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Dear Scott,

I wish I could come out in public support of your work (Jane is my political pseudonym), but as a physician I feel that the issue of pediatric transgender care has become so political that I would face cancel culture and career annihilation should I speak out. I read the article you published in Newsweek and it very much enlightened my practice as a physician and I would like to thank you for bringing to light an issue that is historically unquestionable in medical circles. I also wanted to share my small part of the story as I hope it will encourage you in your work.

First and foremost, as a former family medicine resident physician, I would like to apologize for the grave injustices you faced going through your gender transition process. It sickens me to know that even as an adult no one truly gave you INFORMED consent for your procedures and also required you to go back to the same physician who mistreated you for ongoing care. You are most correct that transgender hormonal and surgical therapy is experimental (for children and for adults) and your physician was oath-bound to ensure that you understood what consequences were already known, what were still theoretical, and what was still unknown. Your physician violated their Hippocratic Oath to "first do no harm" and I am so very sorry that you had to pay such high consequences for their actions.

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Secondly I wanted to share with you my physician experiences of the medical culture surrounding transgender care. I am a heterosexual female physician and while I do not pretend to know all the social issues surrounding LGBTQ+ care, I do not think that pediatric transgender hormonal delay and surgical therapy is appropriate for the very same reasons you outline in your article -- it's experimental, we don't know the long term consequences, it is unethical to experiment on a child who cannot fully consent to the procedure due to lack of understanding, and we have not sufficiently ruled out other psychological co-morbidities or even let the child's psyche fully develop before we present them with a absolute decision about their gender.

I have interacted with the pediatric transgender clinic system only peripherally, but what I have found has largely been disturbing. Occasionally a transgender pediatric patient will be admitted to the hospital, usually due to a psychiatric crisis, and as their primary physician in the care team I feel it is my duty and my professional right to know everything about them as it pertains to their admission to the hospital. However, often as I search their chart, the only documentation I find for their transgender care is a sparse note from the endocrinologist. There are no psychological assessments, surgical planning notes, or any other detailed information on where the child is in the process of their transition despite the fact that the pediatric transgender clinic is a part of the same system as the hospital itself (i.e. they should share the same documentation system). Additionally, supposed transgender psychologists visit the patient while they are in the hospital, but I have yet to even see one of these elusive professionals on the floor nor see one of their inpatient care notes despite my nurses saying that they visited the patient. The secrecy surrounding these pediatric transgender clinics, even to other physicians who are supposed to be looking out for the best interest of the child, disturbs me to my core. If the pediatric transgender clinic thinks it is really doing what is best for the patient, why do they feel they have to hide information?

Additionally, before I approve ongoing transgender care to the patient, I want to know that the patient has had a full and un-biased psychiatric evaluation and ongoing assessment to rule-out comorbid psychologic conditions or alternative diagnoses. There are many things that can masquerade as gender dysphoria, my main concern being Borderline Personality Disorder. BPD is a condition that causes the patient to seek attention in increasingly extreme ways -- through increasingly elaborate suicide and self-harm schemes or through claiming gender dysphoria and seeking transgender care when they are not gender-dysphoric. Personality disorders cannot be diagnosed in children because the child's personality is still forming, but as a physician you develop a sixth sense for predicting which teens are likely to manifest BPD in adulthood. Since BPD cannot be diagnosed in childhood, but GD can, it poses a problem that a child can undergo hormonal and surgical therapy before their psyche is fully developed and can be properly evaluated. Psychiatric evaluations exploring other possible diagnoses are rarely documented and it is my belief that in the fervor around seeking gender-affirmation, such possible diagnoses are overlooked.

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In my residency program, I have faced consequences for standing up for what I (formerly) believed to be best for pediatric transgender patients. For example, I had a 17yo transgender patient on my outpatient panel who had completed both hormonal and surgical therapy by the time they became my patient. As they were a pediatric patient, I could not ethically support their transgender treatment plan and yet nothing could be done to change it as they had already completed therapy. I did not feel that I could sign prescriptions and consults or coordinate their care without ethical distress. Therefore, I felt the most ethical thing to do would be for my residency program to transfer the patient to someone who was supportive of the transgender treatment plan and could sign the necessary orders without ethical distress. I subsequently received severe backlash from one of my supervising physicians who was (or claimed to be) a transgender advocate. He stopped using my name, questioned all of my work, gave me bad evaluations, and told me that he didn't think I should be a physician. After reading your article, I wish I had made a different decision than to have my patient transferred, because I now realize that I essentially fed my transgender patient to a wolf who was going to continue a dialog of toxic affirmation rather than let the patient fully explore their identity in an unbiased way. So I want to thank you for changing my practice of medicine and making me a better doctor for the future.

Also, I want you to know that there are many in medicine who share your same goal but without a voice to do so. There is a growing "elitist" group of physicians in medicine who pretend to understand LGBTQ+ issues and look down on those they think do not understand the LGBTQ+ community as they do. These "elitist allies" can often be identified by rainbow buttons on their lapel, an over-affirming attitude toward any gender issues, and a disgust for anyone who does not also wear a rainbow button. They often think bigotry is any sort of disagreement with them and they have a considerable amount of power in silencing dissent. While you likely have at least 50+% of the medical community who think the way you do about pediatric trans therapy, I fear that you will have a hard time getting statements from individual physicians due to their fear of job loss from this elitist faction (as you can see, I didn't use my real name either). Additionally, groups of physicians will want to preserve the reputation and influence of the organization they represent and in today's political climate ward off accusations of institutional bigotry. Cancel culture in medicine is not unique to transgender issues (notice the COVID-19 lab-leak theory is very quietly not gaining any traction), but it is those of you on the outside of medicine who are poised to make the biggest difference and unsilenced the true state of science around transgender care. I thank you so much for your bravery.

I wish I had a magic bullet to make cancel culture go away, but do know that there are secret allies on the inside of medicine covertly working toward the same goal of protecting our gender questioning youth. I wish you all the best in the fight for truth and justice and hope that one day I too can break my relative silence.

Dr. Silenced