Physician Patient

Archive for June, 2019

What are we thinking about Gender Dysphoria and Why?

Monday, June 24th, 2019

Katherine Kersten’s (June 21) Opinion article raises this important question: How can consumers (patients and families), taxpayers, and third party payers (employers, health plans, and government) evaluate the (growing) business of gender assignment, reassignment, and medical (hormonal) or surgical treatment for gender dysphoria? At Minneapolis Children’s Hospital a new program is doing this:

The motivation for professional gender dysphoria diagnosis and treatment may be altruistic, economic or other. But how scientific and clinically sound is this new business?

As a retired adult and addiction psychiatrist with no clinical experience treating gender dysphoric children (although I’ve heard concerns from a few of their parents), my chief concern is how the gender dysphoria diagnosis is conceptualized as a medical or mental disorder and the consequences to patients, the medical profession and society when our US health care system embraces “standards of care” such as
Society and politicians need to be informed about the ethical and economic underpinnings of the rationale by our major health care institutions such as Minneapolis and Boston Children’s Hospitals which now sponsor and promote insurance and government supported programs for hormone and surgical interventions geared to help gender dysphoric children (and adults). To my knowledge, these diagnostic assessments and treatments are based on psychological assessments of gender identity often in flux, as described by professor Eli Coleman at the University of Minnesota
Moreover, we need to know much more about the consequences of implementing these hormonal and surgical interventions on suicide and medical morbidity, and we we need to consider advice to the public (and professions) about “best practices” for psychotherapy. Beware of government edicts.
On what assumptions and evidence are crucial psychological assessments of gender dysphoria based? We should ask psychiatrists and psychologists in the academic and practicing communities  familiar with these questions to offer their recommendations.
We also need to ask the patients and their families about their experiences. Hopefully they will receive more and more social acceptance, more economic skin in the game, and more and better health care choices in the future.