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Culture War Roundup for the week of June 24, 2024

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Yet Another Part Of the WPATH Saga

Unsealed Court Documents Show That Admiral Rachel Levine Pressured WPATH To Remove Age Guidelines From The Latest Standards Of Care

You may have heard about the controversy around the latest Standards Of Care removing the age minimums for various transgender care procedures. What I didn't make clear in that post was this wasn't about the difference between SOC7 and SOC8, the removal took place between different versions of the SOC8 itself. Shortly after the original guidelines were published, a correction notice was issued, and WPATH republished the SOC with the minimum ages removed (among other changes). Curiously the current version of the notice says the original version was published by mistake, and contains no details about the text that was changed.

The now unsealed documents show that this was the result of pressure from none other than Admiral Rachel Levine:

The issue of ages and treatment has been quite controversial (mainly for surgery) and it has come up again. We sent the document to Admiral Levine. . . She like [sic] the SOC-8 very much but she was very concerned that having ages (mainly for surgery) will affect access to health care for trans youth and maybe adults too. Apparently the situation in the USA is terrible and she and the Biden administration worried that having ages in the document will make matters worse. She asked us to remove them. We have the WPATH executive committee in this meeting and we explained to her that we could not just remove them at this stage.

Another quote from the article says that "we have made changes as to how the minimal ages are presented in the documents", but this wasn't just a simple change in presentation, all age limits, other than for phalloplasty, are gone, and replaced with procedural steps the patient should go through. They claim this makes the standards more restrictive, but in my opinion that's contradicted by the statements from admiral Levine.

Jesse Singal also points out standards were supposed to be determined by the "Delphi process":

As the document itself explains: “Consensus on the final recommendations was attained using the Delphi process that included all members of the guidelines committee and required that recommendation statements were approved by at least 75% of members.”

This process was violated according to SOC contributors themselves:

I don’t see how we can simply remove something that important from the document—without going through a Delphi—at this final stage of the game [. . . ] I realize that those in favor of the bans are going to go right to the age criteria and ignore the fact that we actually strengthened the strictness of the criteria to help clinicians better discern appropriate surgical candidates from those who are inappropriate [. . . ] It’s all about messaging and marketing.

So between the "correction notice" shenanigans, and outright admission that rules were broken to push through that particular change, it seems like a pretty slam-dunk case for the Biden administration putting political pressure to loosen criteria for transgender care for minors.

This all just feels like moving deck chairs on the titanic. If being trans is real and we can indeed reliably detect it then all of this is pointless. If it's not then deciding what age to do the surgeries is the least of our issues. I don't see how there can be some middle road where we are confident it's real and detectable and yet should move cautiously.

There's a few problems here. For one, I don't think people at he forefront of the trans movement are even using the same framework as you are, where it's a diagnosable disorder that should be treated - see my previous WPATH post. Secondly, they're not really making any claims about detectability, because that would allow us to resolve the matter in a simple blinded test, and I don't think it would come out well for the pro-trans side.

Now, I believe (and think I have enough examples to back it up) this "medicalized narrative" has absolutely been used to persuade the broader public. Even as they were avoiding making specific claims about detectability, they were speaking with enough confidence that the detectability felt implied, and this is why this conversation is not pointless. Most people know children are developing, go through phases, and are generally more malleable, so recommending irreversible treatments will at the very least give people pause. This is why this is such a big part of the conversation, it highlits the tensions and contradictions in the discourse.

Another thing is that I don't think the story is so much about the state of Trans Science, as it is about the political pressure on science. The pro-trans side claims the anti-trans are playing dirty by passing bills limiting transgender care for children, they claim this should be left to the doctors. As it turns out, they're putting substantial political pressure themselves to force "the science" to say what they want it to say, except they do it covertly.

Yeah, I think there's a pretty critical underlying value disagreement. Even were a choir of angels to descend from heaven with a device that could guarantee not only whether a specific person was trans, but even whether they'd be happier to transition or not, I don't think social conservatives and the pro-trans side would be able to agree even in the most convenient world.

And in the world we're in, it's looking increasingly like that magical device might change from 'yes' to 'no' for a single person over time in some cases, which is pretty far from convenient. Social conservatives reject the framework that this change reflects internalization of transphobia or the harsher limits of later transition (usually, I think, in favor of seeing it as 'puberty naturally solving the discomfort'), but even accepting it doesn't actually change the value conflict: social conservatives absolutely will bit the bullet in favor of distress for a couple years to avoid sizable surgical interventions, even well outside of the trans sphere.

social conservatives absolutely will bit the bullet in favor of distress for a couple years to avoid sizable surgical interventions, even well outside of the trans sphere.

Yeah, half of the transhumanists balk when I point it out, but transhumanism really is at the core of the issue.

But even then I think I disagree there's no compromise to be had. I think even a decent chunk of conservatives could tolerate people going full-cyborg when they're adults, it's insisting that it's necessary for children that crosses the line.

And then it doesn't help that this is combined with all sorts of demands to rearrenge the social order.

The children thing is weird, and like most things I think we have a pretty good handle on it by "do what you want after 18, before then, NO. Having big time drugs or surgery before then is a large mistake currently because it is irreversible, if that isn't the case in the future it will obviate this entire problem. If a child or adult can be one sex at 9 am and another at 10 am why would anyone care about any of this anymore?

The children thing is weird, and like most things I think we have a pretty good handle on it by "do what you want after 18, before then, NO.

Except we don't actually have that handle on it. Trans activists explicitly claim that these interventions for children are medically necessary, and care providers privately share tips with each other on how to wear down reluctant parents' resistance.

I can grant that the issue goes both ways, as there are also more conservative parents that want to ban it for everyone, but I'm regularly surprised at people's assumption that this issue is currently being handled the same way as tattoos or cosmetic surgery.