Wall Street Journal Editorial Critiques Transgender Health July 2, 2014
On June 13th, a Wall Street Journal op-ed by conservative psychiatrist Paul McHugh smeared transgender identity as disordered,ignoring medical consensus and arguing that transgender patients should be denied medically necessary treatment as he attempted to make a case against supporting hormonal and surgical transition for transgender individuals. McHugh lamented the growing attention to transgender rights in public policy and the media, warning that these developments signal a troubling trend toward affirming transgender identities rather than treating them as "confusions" and illnesses.
Psychiatrist and WPATH Board Member, Dr. Dan Karasic, responded quickly to the WSJ, and his letter was one of a few selected for publication. We are including the full text of Dr. Karasic’s response below, though it is important to note that the WSJ editors chose to omit his clarification of Dr. Dhejne’s research. WPATH members should be aware of the facts concerning these debates.
Dr. Paul McHugh ("Transgender surgery isn’t the solution”) writes about the study at Johns Hopkins in the 1970’s showing poor outcomes from transgender surgeries, leading to McHugh shutting down Johns Hopkins’ transgender program in 1979, and the US Department of Health and Human Services declaring transgender surgery experimental, and therefore not covered. Two weeks ago, HHS reversed its 1981 decision, and removed transgender health exclusions from Medicare. McHugh seems unaware of the work in transgender health in these last 30 years that led to this reversal by HHS.
McHugh does cite one study from 2011, by Cecilia Dhejne, MD and colleagues at Karolinska Institute in Stockholm. However, he misunderstands Dr. Dhejne’s work. In the paper, Dr. Dhejne states that the study was not designed to draw conclusions on the efficacy of transgender surgeries, yet McHugh does exactly that. A closer reading of the paper shows that the increased mortality is in those who had surgery before 1989, and that mortality in trans people after 1989 is not statistically different from the general population. A recently published paper by Dr. Dhejne and colleagues shows that the regret rate for those having surgery from 2001-2010 is only 0.3%. Dr. Dhejne’s work shows that outcomes for transgender surgery have improved tremendously in the past 30 years, which supports the HHS decision to remove trans exclusions.
McHugh also mischaracterizes the treatment of gender nonconforming children. As McHugh states, most gender nonconforming children do not identify as transgender in adulthood. However, those who receive puberty blocking drugs do not do so until puberty, when trans identity is likely to persist. These drugs allow adolescents and their parents to work with doctors to achieve the best outcome. This approach was demonstrated to be successful in research in the Netherlands before being adopted widely in the U.S.
The American Psychiatric Association and the World Professional Association for Transgender Health no longer view transgender identity as inherently pathological. Dr. McHugh’s views are stuck in the past.
Dan Karasic, MD
Health Sciences Clinical Professor of Psychiatry, UCSF
Member, American Psychiatric Association Workgroup on Gender Dysphoria
Member, Board of Directors, World Professional Association for Transgender Health
The full text of the McHugh op-ed and the letters published in response are available for WSJ subscribers through these links (subscriptions are available online for instant access):
Many more responses and blogs relating to this article have been published; however, we thought we would provide you with a link to the response prepared by Mari Brighe: "Clinging to a dangerous past: Dr Paul McHugh’s selective reading of transgender medical literature.”
Mari gets to the facts in her response, stating: "It is important to remember that the opinions of Dr McHugh fly in the face of currently accepted medical practice and the positions of many major medical associations. The American Medical Association, the American Psychological Association, the American College of Obstetrics and Gynecology, the American Psychiatric Society, the American Public Health Association, and the World Professional Association for Transgender Health have all adopted positions supporting the medical necessity of transition-related care, including hormonal and surgical interventions, as well as expressing support for insurance coverage of these interventions. Despite his authoritative sounding title at a respected medical institution, Dr McHugh’s opinions do not represent the views of the mainstream medical establishment, rather they are the erroneous, bigoted beliefs of a scientist who appears far too invested in his own antiquated, disproven theories and his anti-LGBT political position than the current state of medical affairs”.
See the full text of Mari’s response at http://www.transadvocate.com/clinging-to-a-dangerous-past-dr-paul-mchughs-selective-reading-of-transgender-medical-literature_n_13842.htm
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