I truly appreciate what you’re trying to do! But respectfully, informed consent is kinda a joke. I remember “consenting” a very intelligent high powered attorney (she had her work laptop with her, typing away, while in her hospital gown in the gurney ) for a gallbladder removal. Went over in detail all the side effects, alternatives etc… then at the end she asked, completely straight, “but if you take my bladder out how will I be able to pee?”

We medical people think things are obvious sometimes, but they’re not, and real informed consent is illusory. The patients trust us and trust our judgment and training.

Which is why even opening this mutilatory medicine up to the legitimizing language of informed consent is the wrong approach, I think. Just stop castrating/sterilizing children! Embrace the power of “no”…

And don’t play along with the National lampoon theory of suicidality:


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Sadly too many of your colleagues are all-in with castrating and mutilating children. How they got there, I have no idea, but here we are.

Given this horrific situation, informed consent laws are one tool that can be used to try to stop (or at least slow down) this terrible and ongoing crime against humanity.

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Informed consent is impossible for a child, because children can't take the long view. Insight and self-awareness are traits that evolve as the brain develops. If you don't know who you are, you are literally uninformed and cannot possibly give informed consent. For this reason alone, children should never be allowed to medically transition. There's one important thing we can do right now to change the picture, and that is to challenge the ban against psychotherapy, which WPATH has cynically redefined as "conversion therapy."

One of the common complaints detransitioners have is that they were unaware, until after they had medically transitioned, that their so-called gender dysphoria was really caused by trauma and negative attitudes they had suppressed. Childhood sexual abuse and incest are common drivers. So too internalized homophobia and misogyny. The large percentage of autistic kids desiring to transition is well-known, but the kids themselves don’t always know it.

The transition process usually begins by visiting a "rubber stamper," otherwise known as a gender therapist. After one or two short visits, the would-be trans person receives affirmation of their gender identity plus a prescription for puberty blockers or cross-sex hormones. No discussion of underlying motivations will be initiated by the therapist, because that would be conversion therapy. The chance to gain any insight into what might be driving the momentous decision to transition is denied. Thus, hopeful, trusting, young people end up flying blind into a brick wall. Only after they're a bit older and wiser are they shocked into awareness. The emotional devastation, despair, rage, and feelings of betrayal that these detransitioners experience as they try to figure out how to go forward with a broken body, are grounds enough for malpractice. Let me repeat: if you don’t know yourself, you are not informed.

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Holy smokes! I have a good friend who is a plaintiffs attorney and I’ve been telling him that it’s the plaintiffs bar that is going to be the force that brings some sanity into this crazy medically transitioning minors phenomenon. I’m thrilled to see your post! (And I’m an experienced medicolegal expert, been to court many times, but largely on the defense side since plaintiffs attorneys are most often FOS. Lol.)

In pain medicine we use the paradigm ‘biopsychosocial’; complex problems like gender dysphoria have biological, psychological, and social dimensions. For a supposed expert in gender dysphoria to say that gender is a simply a social construct is astoundingly ignorant. You have to be so ideologically blinded to ignore the issues of social contagion and co-existing psychological illness. You get the right medical expert and it’s $$$$! And for a just cause, too.

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This is a very compelling and thought-provoking essay. I think litigation would be beneficial in reining in some of these abuses. However, informed consent requires that the medical profession actually know what it is that they're addressing. As I've argued elsewhere, however, the whole idea of "gender identity" has been profoundly confused even by many in the medical profession. On the one hand, some see it as biologically-based and, consequently, immutable. Hence, they support rapid medical transition. On the other hand, some claim there is no biological evidence for "gender identity" and argue against (or at least for postponing) medical intervention. However, both of these positions are wrong and are undermining our ability to discuss the issue thoughtfully. "Gender identity" is, indeed, biologically based because it's a product of brain activity. As are all cognitive states. But that does not mean that it's immutable or deterministic. A thorough discussion of this point can be found in this essay "There is "Biological Evidence for Gender Identity..." but it’s not what you think"


As a Biological Psychologist, I would like to see some movement toward a sane understanding of the neurobiological underpinnings of this issue. There’s one additional point I would like to make about a statement from the SEGM (Society for Evidence-Based Gender Medicine) website: “There is no brain, blood, or other objective test that distinguishes a trans-identified from a non-trans identified person.”

That is true and, most likely, it’s always going to be true. But it does not mean that "gender identity" does not have a biological basis. The reason is that “trans-identified” and “non-trans identified” do not refer to specific, discrete groups of people. They are broad categories each of which contains a very diverse group of individuals with very different motivations, personality characteristics, self-perceptions, and points of view. Consider this analogy: There is no single diagnostic test that can determine if someone is on the autism spectrum or has Alzheimer’s, but that doesn’t mean that these conditions don’t exist, or that they’re not biologically based. And, of course, the fact that a particular psychological self-perception has a biological basis does not mean that a hormonal or surgical intervention is appropriate or will be successful.

Until these and other more subtle misunderstandings of this phenomenon are understood, there will be no basis on which to reach a rational resolution to the controversy or, for that matter, propose any meaningful informed consent guidelines.

Thank you for a great essay, Frederick

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The condition that exists is called "gender dysphoria", and the appropriate treatment is psychological, or possibly pharmacological with on-label usage (for e.g. related depression).

Powerful drugs used off-label ("puberty blockers"), with unknown but likely severe long-term deleterious consequences, and/or mutilating surgeries, are absolutely not appropriate as treatments for the psychological condition of gender dysphoria.

In summary, there is no "subtle misunderstanding" here. Gender dysphoria is a psychological condition like many others (all of which of course have an ultimate biological basis), but it is the only one treated with powerful and dangerous off-label drugs and mutilating surgeries.

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I agree with you in principle. However, in addition to your points, there are, indeed, subtle misunderstandings and complex underlying concepts that shape the way people understand subjective, psychological constructs (which are often conflated). Sadly, too, over the history of psychology, drugs and surgeries have been used to try to "fix" psychological conditions... from trepanning, to lobotomies, to the over prescription of amphetamine salts to youngsters. Again, however, I agree with your fundamental points. Thank you for your comment, Frederick.

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