Althouse | category: surgery



an endless succession of beans and nuts.

"I now feel happy and satisfied with my legs, but I’m hit by a wave of hate on the Internet. It hurts me a lot."

"With the leg-lengthening procedure, I found myself and finally overcame my old trauma from being bullied. And now I’m being bullied again. Why am I subject to so much hate?"

Why would you think bullying will stop if you respond by changing yourself? Here, a woman has had painful surgeries to add 5.5 inches to her legs. And she wasn't even short. She was 5'6" (if my reading and math are correct). Now, she's 6' tall, disproportionately leggy. As the headline shows, there is an absurd sex claim: "I have become very flexible with my legs and have more room to maneuver in bed."

"Each time Ed had another encounter with his 'pal, the surgeon'—whom he did not begrudge for having 'to maintain his skills'..."

"... he’d promise to quickly 'be back with fervor at the drawing board, conjuring up malevolent, wicked delights and pleasures for your eyes.' And sure enough, his shaggy Vermonters and Manhattanites, his farmers’-market devotees and NPR donors—by way of ​​Snuffleupagus by way of Daumier—whose pretensions and obsessions he affectionately lampooned, would soon be parading into my in-box. In his final months, he didn’t have the energy to draw as large, or with such obsessive, scratchy detail, as before, but he still couldn’t resist reworking one final cartoon—featuring the Grim Reaper, as a poet—before sending it off to me last week.... On a recent call with Ed, when I expressed awe at the fact that he was still sending in cartoons for me to review, he quoted Mark Twain: 'The secret source of Humor itself is not joy but sorrow.' Neither of us mentioned the second half of that line—'there is no humor in heaven.'"

Writes Emma Allen in The New Yorker's "Postscript" — "Edward Koren, the Cheery Philosopher of Cartoons/The artist, who was first published in The New Yorker in 1962, never stopped marvelling at the miracle of a cartoon’s creation."

“My trajectory was a comedy of manners,” Mr. Koren said in an interview for this obituary in 2018. “I was drawn to sociology and cultural anthropology. My work was a bit tame, I suppose. I avoided sex. It was political in a different sense. I examined the middle class, and everywhere I looked people were outraged. I did not want to manifest that in my work. I just gravitated toward animals.”

Elaborating on his anthropomorphic creatures, Mr. Koren said: “Animals are gentle and funny. There is a long tradition in English and French literature, going back to the 19th century, of using animals in humor. For me, it was a framework, a way of getting above the political fray and the passing controversies of the day.”

"The presumption that gender-diverse identities are not real — that young people will eventually come to accept their birth assigned gender as their minds catch up to their maturing bodies..."

"... is not supported by the evidence and is likely harmful...."

Writes Marci L. Bowers, a gynecologic and reconstructive surgeon and president of the World Professional Association for Transgender Health, in "What Decades of Providing Trans Health Care Have Taught Me" (NYT).

I was surprised to see the term "birth assigned gender." What's "assigned" at birth isn't "gender" but sex. Earlier in the column, the doctor does refer to "gender identities [that] do not match... sex assigned at birth."

But what is the science of this "matching"? Is it a medical problem not to "match"? 

Most of this column is about the medical practices that have been taking place for decades and statistics showing that adults who have received drug and surgical treatments have felt better off.

It seems that Bowers' answer to my question — Is it a medical problem not to "match"? — is that if the solution works, the thing worked on is to be understood as a problem. This is the more general doubt that we often see with respect to new psychiatric drugs. 

Here's a 2008 NYT article (which I blogged at the time), "Psychiatrists Revise the Book of Human Troubles":
“This is not cardiology or nephrology, where the basic diseases are well known,” said Edward Shorter, a leading historian of psychiatry whose latest book, “Before Prozac,” is critical of the manual. “In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial.

“What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”...

This article, addressing the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders," anticipates coming debates about gender identity:

Soon after the psychiatric association named the group of researchers working on sexual and gender identity, advocates circulated online petitions objecting to two members whose work they considered demeaning.

Transgender people are themselves divided about their place in the manual. Some transgender men and women want nothing to do with psychiatry and demand that the diagnosis be dropped. Others prefer that it remain, in some form, because a doctor’s written diagnosis is needed to obtain insurance coverage for treatment or surgery.

15 years ago, there were 2 camps, one of which stressed insurance coverage for drugs and surgery. 

“The language needs to be reformed, at a minimum,” said Mara Keisling, executive director of the National Center for Transgender Equity. “Right now, the manual implies that you cannot be a happy transgender person, that you have to be a social wreck.”

Have to be... because that ties to reimbursement of medical expenses? There's more pragmatism and economics to this than science, and Bowers is a gynecologic and reconstructive surgeon. This must be a field that is lucrative and highly dependent on insurance. But she is presented as the expert who knows the most, because of decades of practice.

To stay with the 2008 NYT article:

Dr. Jack Drescher, a New York psychoanalyst and member of the sexual disorders work group, said that, in some ways, the gender identity debate echoed efforts to remove homosexuality from the manual in the 1970s.

After protests by gay activists provoked a scientific review, the “homosexuality” diagnosis was dropped in 1973. It was replaced by “sexual orientation disturbance” and then “ego-dystonic homosexuality” before being dropped in 1987.

Ego-dystonic homosexuality? I don't remember that term, but it seems to mean homosexuality that you feel bad about. 

“You had, in my opinion, what was a social issue, not a medical one; and, in some sense, psychiatry evolved through interaction with the wider culture,” Dr. Drescher said.

Compare that to the current controversy over transgenderism. Is it a social issue? How did it come to be regarded as a medical problem as opposed to a social issue? I would like Dr. Bowers to show us the science of how that happened and to be forthcoming about any financial conflict of interest.

Bowers opposes legislation that limits treating children:
Anti-treatment bills will not protect children, and they will not help the medical community provide better care for patients in need. We should instead take anti-transgender legislation for what it is: thinly veiled cruelty to a specific minority population of the country....

To say this is "what is is" is not to speak like a scientist, but another politician. The meanies are always on the other side.

The field of transgender medicine is evolving rapidly, but it is every bit as objective- and outcome-driven as any other specialty in medicine. Allow the remaining scientific questions to be answered by knowledgeable researchers, without the influence of politics and ideology.

Please scientifically demonstrate that you and those in your group — the World Professional Association for Transgender Health — are free of "the influence of politics and ideology" (and financial incentives). It really doesn't work anymore to simply claim to be the science. Where did you establish that your field is "as objective- and outcome-driven as any other specialty in medicine"? And does that phrase elicit the kind of trust it once had? I think, post-pandemic, people are going to expect a lot more showing of one's work and a lot less demanding that we leave it to the experts.

Sure, it's annoying and complicated to have legislators meddling in your business, especially if you believe you're an empathetic helper of humanity and you have highly developed knowledge and skill, but you haven't built the trust, you haven't demonstrated the science, and people are powerfully motivated to rescue children from what may be harm.

200 journalists and writers release an open letter to the NYT to raise "serious concerns about editorial bias in the newspaper’s reporting on transgender, non-binary, and gender nonconforming people.”

Hell Gate reports.
The open letter, whose signees include regular contributors to the Times and prominent writers and journalists like Ed Yong, Lucy Sante, Roxane Gay, and Rebecca Solnit, comes at a time when far-right extremist groups and their analogues in state legislatures are ramping up their attacks on trans young people....
In recent years and months, the Times has decided to play an outsized role in laundering anti-trans narratives and seeding the discourse with those narratives, publishing tens of thousands of handwringing words on trans youth—reporting that is now approvingly cited and lauded, as the letter writers note, by those who seek to ban and criminalize gender-affirming care.
Hell Gate has an interview with Jo Livingstone, "an award-winning critic and writer who helped organize the open letter."

Here's the open letter. I'll highlight what I think are important parts:
The newspaper’s editorial guidelines demand that reporters “preserve a professional detachment, free of any whiff of bias” when cultivating their sources, remaining “sensitive that personal relationships with news sources can erode into favoritism, in fact or appearance.” Yet the Times has in recent years treated gender diversity with an eerily familiar mix of pseudoscience and euphemistic, charged language, while publishing reporting on trans children that omits relevant information about its sources.

For example, Emily Bazelon’s article “The Battle Over Gender Therapy” uncritically used the term “patient zero” to refer to a trans child seeking gender⁠-⁠affirming care, a phrase that vilifies transness as a disease to be feared.

Are persons seeking "gender⁠-⁠affirming care" not "patients"? If they are not suffering from a condition to be feared, then why is treatment provided? Why are they not told they are fine as they are?

We discussed the Bazelon article on this blog, here

Back to the open letter:

Bazelon quoted multiple expert sources who have since expressed regret over their work’s misrepresentation. Another source, Grace Lidinksy⁠-⁠Smith, was identified as an individual person speaking about a personal choice to detransition, rather than the President of GCCAN, an activist organization that pushes junk science and partners with explicitly anti⁠-⁠trans hate groups.

In a similar case, Katie Baker’s recent feature “When Students Change Gender Identity and Parents Don’t Know” misframed the battle over children’s right to safely transition.

I blogged that story here.

Back to the open letter: 

The piece fails to make clear that court cases brought by parents who want schools to out their trans children are part of a legal strategy pursued by anti-trans hate groups. These groups have identified trans people as an “existential threat to society” and seek to replace the American public education system with Christian homeschooling, key context Baker did not provide to Times readers.

The natural destination of poor editorial judgment is the court of law.

I had a lot of trouble understanding that last sentence. I doubt if you would understand it without reading what comes next, but let me translate. The idea is that the NYT articles have been cited in court cases dealing with legislation about children seeking transgender treatments.

Last year, Arkansas’ attorney general filed an amicus brief in defense of Alabama’s Vulnerable Child Compassion and Protection Act, which would make it a felony, punishable by up to 10 years’ imprisonment, for any medical provider to administer certain gender⁠-⁠affirming medical care to a minor (including puberty blockers) that diverges from their sex assigned at birth. The brief cited three different New York Times articles to justify its support of the law: Bazelon’s “The Battle Over Gender Therapy,” Azeen Ghorayshi’s “Doctors Debate Whether Trans Teens Need Therapy Before Hormones,” and Ross Douthat’s “How to Make Sense of the New L.G.B.T.Q. Culture War.” As recently as February 8th, 2023, attorney David Begley’s invited testimony to the Nebraska state legislature in support of a similar bill approvingly cited the Times’ reporting and relied on its reputation as the “paper of record” to justify criminalizing gender⁠-⁠affirming care....

David Begley! 

As thinkers, we are disappointed to see the New York Times follow the lead of far-right hate groups in presenting gender diversity as a new controversy warranting new, punitive legislation.

I think the NYT is showing leadership and not allowing itself to be led around by the doctrinaire left.

Puberty blockers, hormone replacement therapy, and gender⁠-⁠affirming surgeries have been standard forms of care for cis and trans people alike for decades....

Please cite the science. Is there some idea that medical treatments, once they've gone on for a while, must be correct and above question? Obviously not.

In that view, read this: "What the world can learn from a lobotomy surgeon’s horrible mistake." That's in the Washington Post, published yesterday, written by Megan McArdle.

Back to the open letter:

You no doubt recall a time in more recent history when it was ordinary to speak of homosexuality as a disease at the American family dinner table—a norm fostered in part by the New York Times’ track record of demonizing queers through the ostensible reporting of science.

In 1963, the New York Times published a front⁠-⁠page story with the title “Growth of Overt Homosexuality in City Provokes Wide Concern,” which stated that homosexuals saw their own sexuality as “an inborn, incurable disease”—one that scientists, the Times announced, now thought could be “cured.”

And, now, we're in a time when doctors are providing treatments for transgender persons. What is the lesson here?  

The word “gay” started making its way into the paper. Then, in 1975, the Times published an article by Clifford Jahr about a queer cruise (the kind on a boat) featuring a “sadomasochistic fashion show.” On the urging of his shocked mother, Times publisher Arthur Ochs Sulzberger sent down the order: Stop covering these people. The Times style guide was updated to include the following dictum, which stood until 1987: “Do not use gay as a synonym for homosexual unless it appears in the formal, capitalized name of an organization or in quoted matter.”

New York Times managing editor and executive editor A. M. Rosenthal neglected to put AIDS on the front page until 1983, by which time the virus had already killed 500 New Yorkers. He withheld planned promotions from colleagues he learned on the grapevine were gay. Many of his employees feared being outed. William F. Buckley published his op-ed arguing that people with HIV/AIDS should all be forcibly tattooed in the Times. Obituaries in the Times ascribed death from HIV/AIDS to “undisclosed causes” or a “rare disorder,” and left the partners of the deceased out entirely from its record of their lives. This era of hateful rhetoric also saw the rise of the term “patient zero,” used to falsely accuse an HIV/AIDS patient of deliberately infecting others. This is the same rhetoric that transphobic policymakers recently reintroduced to the American lawmaking apparatus by quoting Emily Bazelon’s Times article.

Yes, there is some bad history there. The NYT should be on guard not to make more mistakes — either similar mistakes or new mistakes overreacting to its famous old mistakes. 

Some of us are trans, non⁠-⁠binary, or gender nonconforming, and we resent the fact that our work, but not our person, is good enough for the paper of record.

What does it mean to say the NYT rejects your "person"?  

Some of us are cis, and we have seen those we love discover and fight for their true selves, often swimming upstream against currents of bigotry and pseudoscience fomented by the kind of coverage we here protest.

I do not see where they have pointed out "bigotry and pseudoscience." Perhaps they mean that the Times articles were not "bigotry and pseudoscience," but they "fomented" "bigotry and pseudoscience" in others.

All of us daresay our stance is unremarkable, even common, and certainly not deserving of the Times’ intense scrutiny. A tiny percentage of the population is trans, and an even smaller percentage of those people face the type of conflict the Times is so intent on magnifying. There is no rapt reporting on the thousands of parents who simply love and support their children, or on the hardworking professionals at the New York Times enduring a workplace made hostile by bias—a period of forbearance that ends today.

The "period of forbearance... ends today."  That made me want to go back to the Hell Gate interview to see what, specifically, this end of forbearance would look like.

The interviewer asks: "Are y'all asking the people who signed on to, for example, agree to not contribute to the Times until there is a response? Is there anything concrete like that being planned?"

Livingstone responds that there was no agreement to do anything other than to sign the letter. She adds that "there will be more letters and more kinds of venues for nonprofits and institutions to sign on" and says, "We made a gathering space that people have just come to us, ready to support."

She concludes: 

And I am proud of and grateful for everybody who is taking a risk on their future engagement by this employer, to stand with us. So when I think about all of that bravery, I feel okay, and can take a nap.

"When you operate, especially if the operation is dangerous, you live very intensely. You live entirely in the present..."

"... and the world outside the operating theatre simply disappears. You are never bored. You cannot afford to make any mistakes. And making a mistake with your hands – your instruments slipping, for instance, or your hands shaking – is incredibly rare.... Working on the doll’s house in my workshop is a very different experience. My mind wanders and I often struggle against boredom, especially if the work is very repetitive, such as making multiple bannisters for a miniature staircase. I often get things wrong and have to saw up a new piece of wood and, cursing myself furiously, start all over again – not a luxury you have when operating."

Writes Henry Marsh in "After a long career in brain surgery, I’m trying my hand at making doll’s houses/To my surprise I don’t miss neurosurgery now I’ve retired, but still find joy in making things for my grandchildren" (The Guardian).

"[Those] seeking bigential anatomy—or, both a penis and a vagina—call themselves 'Salmacians'..."

"... [a term] derived from the Greek myth of Salmacis and Hermaphroditus, wherein the nymph Salmacis begs the gods to unite her with her male object of desire, Hermaphroditus, and the gods merge the two into a single androgynous being.... [One Salmacian] said they’ve received messages telling them they’re 'making a mockery' of the community by 'only going halfway.' They described a torrent of derogatory comments from self-proclaimed 'trans-medicalists'—those who believe transness is contingent upon a diagnosis of gender dysphoria and a full medical transition. 'That was the hardest hate mail to take—other trans people saying, "No, you're doing it wrong"'..."

From "Trans People Are Seeking Nonbinary Bottom Surgeries/Across the gender spectrum, some patients are looking for mixed sets of genitals, or none at all. Actually receiving this affirming care isn't easy" (Vice).

"The vast majority of trans people never receive genital reconstruction surgery.... Most of those who do undergo genital surgery end up with 'binary' external genitalia—a penis or a vagina.... Patients seeking bigenital surgery aren’t the only trans people receiving less common forms of gender-affirming care. Mels, a 34-year-old office manager in Delaware, is agender and asexual. She wanted a full gender nullification procedure—a wholly smooth exterior. 'It used to always be at the forefront of my mind—anytime I'd go to the bathroom, take a shower, or change my clothes, so multiple times a day,' Mels said. 'But now that I don't have any genitals, it's not something I think about, which is the goal.'"

"I was so angry and just irritated at seeing man after man — you know, typically, male politicians — grandstanding about abortion."

Said Gabrielle Blair, quoted in "Gabrielle Blair Would Like a Word With Men/After 16 years of making a name for herself as a blogger and home decor expert, Design Mom has written her manifesto — about reproductive health" by Kase Wickman (NYT).

The NYT article seems to be a reaction to the fact that a book Blair created out of a 64-post-long Twitter thread has debuted at No. 2 on The New York Times’s paperback nonfiction best-seller list.

Here's the Twitter thread, and here's the book: “Ejaculate Responsibly: A Whole New Way to Think About Abortion.” 

Now, my readers may be saying tough luck for Althouse. She could have written a book called "Don't Be a Splooge Stooge," but Blair got to the best-seller list first. Of all my unwritten books, that's the one I'm least sad about not devoting a year of my life to.

Blair's point isn't exactly the same as mine. I was responding to the argument that men — because they don't have the right to choose to end a pregnancy — shouldn't have to pay child support for children they didn't want. I said both men and women have a right to decide what happens within their own body, and, anatomically, for men, the right ends when he ejaculates. You need to exercise care and control while you can. You can't extend your power into the sovereign domain of the woman's body, and, if your child is born, it deserves the economic support of both of its parents.

Blair addresses opponents of abortion. She's mad at abortion opponents who are male and who go after women for failing to adequately guard their body from pregnancy. Men need to focus on what men can do, which is to insure that they never impregnate a woman. If you had to never impregnate a woman, you could, she says. Read the book — or the Twitter thread — to see her advice in full. In short: Unless you want to create a new life — or unless you've had a vasectomy — you should never ejaculate into a woman's vagina.

She does not address the one circumstance that led to my "splooge stooge" series: The woman retrieves a used condom from the trash and uses it to impregnate herself.

By the way, Blair has 6 children. The first tweet in her "ejaculate responsibly" series is:

I’m a mother of six, and a Mormon. I have a good understanding of arguments surrounding abortion, religious and otherwise. I've been listening to men grandstand about women's reproductive rights, and I'm convinced men actually have zero interest in stopping abortion. Here's why….

Why is she "convinced men actually have zero interest in stopping abortion"? Because they keep ejaculating into women's vaginas!

What should male abortion opponents do?

Stop protesting at clinics. Stop shaming women. Stop trying to overturn abortion laws. If you actually care about reducing or eliminating the number of abortions in our country, simply HOLD MEN RESPONSIBLE FOR THEIR ACTIONS.

It gets really intense and punitive. I was just saying men owe child support. Blair says:

What if there was a real and immediate consequence for men who cause an unwanted pregnancy? What kind of consequence would make sense? Should it be as harsh, painful, nauseating, scarring, expensive, risky, and life-altering… as forcing a woman to go through a 9-month unwanted pregnancy?

In my experience, men really like their testicles. If irresponsible ejaculations were putting their balls at risk, they would stop being irresponsible. Does castration seem like a cruel and unusual punishment? Definitely.

It's a thought experiment.

But is it worse than forcing 500,000 women a year to puke daily for months, gain 40 pounds, and then rip their bodies apart in childbirth? Is a handful of castrations worse than women dying during forced pregnancy & childbirth?

Put a castration law on the books, implement the law, let the media tell the story, and in 3 months or less, tada! abortions will have virtually disappeared.

This argument also works as a cure for all sorts of misbehavior. The government could cut off the hands of thieves and execute tax evaders. But, obviously, Blair isn't really coming after you with pruning shears.

Can’t wrap your head around a physical punishment for men? Even though you seem to be more than fine with physical punishments for women?

The "punishments for women" come from nature. We're the ones with the self-punishing anatomy (if you want to characterize pregnancy and childbirth as punishment).

Okay. Then how about this prevention idea: At the onset of puberty, all males in the U.S. could be required by law to get a vasectomy.

Reverse your vasectomy if and when you decide you want to be a father. There's your right to choose. I mean it would be if you were choosing the vasectomy, but Blair envisions forced vasectomy.

Again, it's a thought experiment. Blair is trying to come up with ideas that lie within the power of men, to give something for men to do instead of trying to control women. Men can get a vasectomy. But she wants to express anger and outrage at men for directing their efforts at the things women do to their bodies, so she's jacking up the aggression and visualizing cutting off men's testicles and forcing vasectomies on little boys.

And there is a market for this book, so some people are finding these visualizations interesting, funny, or exciting.

"The study compared two groups of patients ranging in ages from 14 to 24: one group of 36 patients received top surgery..."

"... and a control group of 34 patients received gender-affirming care, but did not get top surgery. Three months after surgery, the patients who had the procedure experienced significantly less chest dysphoria than they had prior to surgery, while patients in the control group experienced around the same levels of chest dysphoria as they had at the start of their care. Prior studies have also shown that chest dysphoria is a pervasive issue for trans and gender non-conforming youth.... American Civil Liberties Union lawyer Chase Strangio went viral on Twitter Monday after sharing his own experience with top surgery, which he received in his mid-20s. 'There is not a day that goes by that I don't think about how it was the best thing I have ever done for my survival,' the tweet read."

From " U.S. /Top surgery drastically improves quality of life for young transgender people, study finds" (CBS News).

Joe Rogan and Lex Fridman react to the claim that the #1 cause of obesity is genetics.

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