We Don't Know What We're Doing: A Doctor's Perspective on the Transgender Movement

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And now here is our host of Family Policy Matters, Tracy Devitt Griggs. Thanks for joining us this week for Family Policy Matters. The United States is far and above a leader in exposing children as young as four to intense medical interventions for gender transition. Our country has 60 pediatric gender clinics and 300 clinics that provide hormonal interventions to minors. That's according to a new report from medical advocacy group Do No Harm. The report entitled Reassigned is a 12-country policy review that lifts the veil on just how far out of step our country is with the rest of the world on this topic and the risks to our younger generations if we continue down this dangerous path. Dr. Stan Goldfarb is chairman of Do No Harm, and we're grateful to have him with us today. Dr. Stan Goldfarb, welcome to Family Policy Matters. Thank you.

It's great to be with you. All right, let's just start off. What is quote unquote gender affirmation care and where did that idea even originate? Well, the idea has a long history, actually.

The notion in the United States is that any time a child expresses confusion about their gender, and this is a fairly common event for children, that in the United States the notion is that we should affirm that confusion and accept whatever gender that they decide they seek out and support them in that through both so-called social transitioning, blocking puberty, if that makes sense for them, starting them on hormones that will change their physical appearance, and ultimately even exposing them to surgical procedures which will change their lives irrevocably. This idea began really back around 1980 in Europe, particularly in the Netherlands. And then when drugs became available to block puberty, which happened in the United States in 2010, this procedure was initiated at the Boston Children's Hospital, actually, by a physician named Norman Spack. And subsequently, this has sort of gone like wildfire in the United States. And as you pointed out in your opening, there are hundreds of clinics in the United States where this treatment has been given.

And that's part of the problem. And the United States has been done in such different geographic localities and on such a scale that all of the controls that have been recommended by investigators that began this whole treatment have sort of gone by the wayside. Are you saying that some of the people that originated these kinds of treatments aren't in full support of what's happening these days? Well, let me just say that in Europe, in three countries now, in Norway, in Finland, and in the United Kingdom, this whole approach to supporting children that decide to go through this process has been now banned and is only going to be used under very extreme circumstances and only in the context of a clinical trial. And the reason for this is that the original protocols that were proposed have been abandoned by a number of different organizations.

And the whole process has been really corrupted, is the only way to put it. And what was originally a process to deal with a very unusual condition in which very young children expressed the so-called gender dysphoria from very early periods in their lives. And then those children persisted in that approach, were evaluated carefully by psychiatrists, were found not to have other mental disturbances, and were started down this path. This has transformed into a situation where, particularly in the United States, there's virtually no careful psychological evaluation.

It's been performed much more commonly on young girls who, rather than have a lifelong sense of this so-called gender dysphoria, develop this right before they go through puberty or in the early stages of puberty. And these children have not been screened carefully and treated for underlying mental conditions before they're begun on a path that can eventuate in the surgical procedures that I mentioned. Well, we talked about how far the U.S. is as far as being an outlier on these things.

Can you give us some statistics to spell it out for us? Yeah, I think the only country that's even close to us officially is France, where the rules are not that different from the United States, although the practice is quite different from the United States. But other countries, for example, don't allow surgery almost exclusively until children are at least 18 years of age. In most of the countries, they don't begin puberty blockers until the children are at least 12 years old. The United States, it can be done much earlier.

I mentioned the four-year-old. There's a sense in the United States that there are children that should be begun on these kinds of treatments well before they reach the early stages of puberty. And in fact, what we now know is that in the United States, this has been done in some clinics. They've done surgery on children as young as 12 years old. They've started children on puberty blockers as young as eight years old, and they've started children on various sex hormones that will change their physical appearance as early as 14 years old. So this is a procedure that's gone on in the United States in a much less careful fashion than has gone on in various European countries.

And as I mentioned, those three countries have actually put a stop to this whole procedure. And I should point out, I think this is useful for your audience, is that yesterday, an article appeared by a woman who portrays herself as a woman of the left. She says I'm more left than Bernie Sanders. And she worked at the gender clinic at the University of Washington University in St. Louis. And it calls herself a whistleblower. She said I cannot support this any longer because at that institution under her, she claims, in a signed affidavit, that institution was performing surgeries on children that were, even though they claim they don't perform surgery on children in that facility, and that they were starting children without any careful screening and evaluation, and they were even pushing hormones on children who decided that they really didn't want the hormones anymore, but then persisted in treating them.

This has led to a call for investigations by the Attorney General of Missouri, as well as by Senator Hawley from Missouri. So I think that gives us a little peek into the kind of free-for-all that's gone on in American institutions regarding the so-called gender-affirming care. As if this is not infuriating enough, some states where this goes on, they remove the parents, and they don't even give the parents rights to have a say in this process. Isn't that correct?

That's correct. You know, California has a law now that, and they see themselves as some sort of sanctuary state for children who wish to go through this transition, and if parents oppose it, California is going to, quote-unquote, protect these children against their parents. And, you know, one of the members of our organization, Do No Harm, is a woman named January Littlejohn from Florida. Her daughter was started down this path at school where the daughter expressed some gender confusion, and the schools told her that she should change her name, she should change her pronouns, and she should start being treated as a boy, and this was without any information passed along to Mrs. Littlejohn, and she subsequently sued the school board, and that case is still working out as her daughter decided to detransition. And this is a very important point. Historically, about 80 to 90 percent of children that express this confusion about their gender when they're small children, ages 5 and 6, and so 80 to 90 percent of them go on to go through puberty perfectly normally and do not continue to express this so-called gender confusion. So starting children on some sort of irreversible hormonal or surgical treatment, when in fact the vast majority of them are going to decide that they don't need that kind of treatment, if just left alone and supported throughout their puberty, this just shows the real terrible error that's being made in the so-called gender-affirming care, which, by the way, our federal government in the form of our president has told people that this is the right way to be treated and that any child that expresses that sort of confusion about their gender ought to be supported in that and go through this so-called gender-affirming care. So this is a great problem for our country right now. You know, it's puzzling because, especially during the pandemic, we were told by certain people on the left to trust the science, you know, and here you're giving us a lot of science that does not support this kind of radical intervention. So how did we get this far down the road? Why are we listening and continuing in this path?

You know, that's a very good question. And, you know, I think some of it is a misunderstanding of the science. Some of it has been a corruption of the science. Some of it has been, frankly, activities that have gone on because of monetary gain by the clinicians that are supporting this. The medications that are used, particularly the puberty-blocking drugs, are very, very expensive drugs and generate lots of revenue for drug companies and even for institutions that use those drugs. The hormone therapy is not very expensive, but the gender-blocking drugs are very expensive. And the surgical procedures are very expensive.

And if institutions have a fair number of patients that are going through these procedures, that's a revenue source as well. But I think the big problem has been, you know, sort of this political ideology that everybody's truth should be their truth, that there are no standards in the world, that there are no objective reality, that, you know, you can be any gender you want, you can be any kind of person you want, despite the fact that the cost of that is truly unknown. And that's been the biggest problem in this field is that we have no sense of what the risk associated with putting children through these procedures. And we have no idea of how many children really decide this is a terrible idea after they've gone through it. One young woman, Chloe Cole, who also works with our organization, she's now an 18-year-old woman. When she was 12, she was started on puberty blockers. When she was 16, well below the age of surgery in other countries, her breasts were removed. And now she's 18 years old. She's a beautiful young woman. She decided that that path was an erroneous path for her.

And now she's left without breasts, and she's left with complications of the surgery that she had. And she has been going around the country and testifying in front of legislatures and in front of groups with our support in order to explain to people how this is something that's injured her terribly, and that she warns other children not to go through this path. What should the motivating principles be then for medical professionals who are caring for individuals, especially younger people, who are struggling with these gender issues?

Well, I think the first thing is to be compassionate and empathetic. Clearly, they are struggling. That's the right word. And they need to be supported in their struggle. But the kind of support they need is really careful psychological evaluation and treatment.

It turns out that 20 to 30 percent of the young girls that present for gender-affirming care actually are on the autism spectrum. Many of them are depressed. They have anorexia. They have other eating disorders. You know, these are young girls that are uncomfortable in their bodies, uncomfortable with the kinds of changes that they're going through. And as one of the people that we work with, Dr. Miriam Grossman, points out, they see this as a possibility of leaving their troubles behind, going into a new life, one that's going to be free of the problems that they've experienced.

But of course, that's not the case. The problems can persist. The problems often do persist. So I think the most important thing is when a child presents with these ideas that they undergo really careful psychological evaluation before any kind of a medicalization is instituted. And what's really unfortunate is that this kind of evaluation has been termed conversion therapy, as if these children all should be on this pathway to changing their gender, and anybody who tries to do anything to suggest that this might be a mistake for them is somebody who's encouraging something that's now become illegal in some places.

So I think the most important thing is to make sure that the child has really strong psychological support and that the family has this support, and they're given the opportunity to take their time, go through a careful evaluation before any kind of medicalization is instituted. So you mentioned the doctors who disagree with this gender affirmation model. What is it like for those doctors who are working with patients who are struggling with these issues? Unfortunately, the ones I've been acquainted with, and there have been several of them, they've basically said, I'm not going to give these children these hormones anymore.

These are endocrinologists, pediatric endocrinologists and other endocrinologists. And the psychiatrists are really struggling with this, and it's really a great problem. But I think anybody who has really been willing to look carefully at the outcomes of these children, chance to think about and review the literature to show how uncertain it is that there's any benefit associated with these treatments, these people are struggling now. And I think what we saw in Europe is what eventually will come to the United States is that there'll be the realization that we really don't know what we're doing by pushing children through these protocols. We have no idea what the outcome is, and that any kinds of use of these medications, these sex-changing hormones or these surgeries ought to be reserved for adults who can make a free decision. The idea that a 12-year-old girl can decide something that's going to influence the rest of her life, her chances of having children, her chances of having sex, of having pleasure in sex, she can make that decision in any kind of irrational way is really a fantastic notion.

We don't allow children to drink, we don't allow them to drive, we don't allow them in the military, and yet we're allowing them to make decisions about the whole future of their lives. It's really insane. It's the only word for it. Well, I wish we had more time, but we are about out of time for this week. Dr. Goldfarb, where can our listeners go if we want to read this report, reassigned, and follow your other important work? Well, thank you.

Yeah, that's great. Our website is DoNoHarmMedicine.org. I also wrote a book called Take Two Aspirins and Call Me By My Pronouns, where many of these issues are discussed, not the gender issues, but our issues about, quote, medicine and how we're trying to combat that. But our website is the best place.

All right. Dr. Stan Goldfarb, thank you so much for being with us today on Family Policy Matters. You've been listening to Family Policy Matters. We hope you enjoyed the program and plan to tune in again next week. To listen to this show online and to learn more about NC Family's work to inform, encourage, and inspire families across North Carolina, go to our website at NCFamily.org. That's NCFamily.org. Thanks again for listening, and may God bless you and your family.