Dr. Marcy Bowers
Appearances
The Protocol
The Review
So... Okay, that sounds good. I know you want to get this right. I know you, I really do feel that in my heart.
The Protocol
The Review
You know, they have this... Yeah, you know what? I do. I do know you, and I do trust you, and I do want you to get it right. But I will say that... Yeah, so go ahead if you want to do that. But the first thing I have to say about gender-forming care, though, is that it is... It is like the Holocaust. There are not two sides to the story.
The Protocol
The Review
And everyone who reports on this issue seems to feel the need to present two sides to the story. Now, beneath that, there's lots of nuance. What age? How early we intervene? How thorough the mental health evaluation? But the thing that unifies every person who is knowledgeable and Hillary Cass has never worked with a trans person.
The Protocol
The Review
So that's a really important exclusion, um, is that gender affirming care is overwhelmingly efficacious. So there are not two sides to this issue. There really are not. There are subtleties, but there are not two sides. Um, and, uh, All right. That was my long-winded intro. It was pent up. I haven't talked to you in so long, and I've just said, I've kind of had it.
The Protocol
The Review
And yet you see the tens of thousands of members of the Endocrine Society, the American Academy of Pediatrics, the AMA, and the APA, all with extensive experience treating this population. Why are they somehow biased and she is not?
The Protocol
The Review
Why is it happening? Because, you know, it feels like the same environment that enabled Paul McHugh to shut down, effectively shut down all the research in the United States for 35 years when they shut the Hopkins Clinic in 1979.
The Protocol
The Review
Trans people were not felt to be objective enough to judge the outcome of their own well-being. I mean, that's what's so preposterous. And it's a force we've been battling ever since. So now we have suddenly in the last 10 years, universities, institutions putting money towards this, and guess what happens? The same phenomena.
The Protocol
The Review
An outsider who, for whatever personal or political or religious or whatever their trans skepticality is about, you know, they want to shut it all down. Can I ask a question?
The Protocol
The Review
Okay. Well, the evidence is there. And it isn't her level of evidence. You know, she dismissed what she didn't like, and this is just what they did back in, you know, in the original Hopkins stuff. All of the arguments, they're all the same. I mean, just to show you her, you know, how does she come up with the, you know, describing the onset due to things like pornography?
The Protocol
The Review
How does she speculate that as a responsible pediatrician? How does she use an endpoint like getting a job in a world that is discriminatory? How do you measure get out of the house and call that the kind of scientific endpoint that we should be looking at? What about self-reporting? This is what she won't listen to.
The Protocol
The Review
Azeem, I wish you could have been in my clinic last week. Two individuals who came about a year after their surgery, these girls were, when I first met them, they couldn't even look me in the eye. They could barely lift their head. They were barely alive. Their parents had deep circles under their eyes. They were doing poorly in school. They were, you know, it's all the cliche.
The Protocol
The Review
I mean, luckily they hadn't taken their lives because they had supportive parents and they had access to treatment. But they went through surgery and these girls are different. They are alive. And the personality that comes up, that is something that Dr. Cass has never seen.
The Protocol
The Review
That is something that seeing once, she would change her mind. Her skepticism would melt. And that is what the AAP, the APA, and the AMA all know.
The Protocol
The Review
Those are two separate things, but let's just say this is how medicine has always been conducted, is that you first treat the patient based on a hypothesis and your breadth of knowledge and what available science there is there. This is how innovation comes in any field. And then you can look back and record evidence of what you found.
The Protocol
The Review
This is why it's so clear in the minds of so many is that there is a vast amount of experience and a vast amount of deep understanding of this population.
The Protocol
The Review
Well, this is now the update here, but let me get to that. But this is the problem with the, you know, with the Hopkins shutdown of all of the major U.S. academic institutions. Remember, after Hopkins' closure in 1979, trans care continued. But where did it continue? It continued in the hands of private practitioners like Stanley Biber, my predecessor, because these patients didn't go away.
The Protocol
The Review
They needed care. And he didn't look at studies. He didn't look at guidelines or data because there was none. He treated the patient first. He took the basic responsibility of medicine, and that is to treat the patient first. Now, what's going on now, what the skeptics call social contagion, and then the flip from Birth identified males, birth identified females.
The Protocol
The Review
You know, that's the stuff that we have to drill down on. And that's the stuff that requires the WPATH standards to be really, really adhered to. But remember, we lost 35 years from this Hopkins closure. So expecting it to all return. And 80% of the literature in trans medicine has been published in the last 10 years. I mean, that's a number I've heard many, many times.
The Protocol
The Review
It's astounding how much is actually published. So for it to be dismissed by a haughty old retired pediatrician who frankly doesn't know the population and hasn't seen the light in the eye return to the patients they treat, that's what really makes it in a way, fatally flawed. Not that it can't be learned from, not that she had malintent.
The Protocol
The Review
It's just that, you know, it's going to make it harder for people and it's going to lead to more misery. And it's being picked up by and misrepresented and taken out of context, but by the conservative states that want to just, you know, be done with trans people altogether.
The Protocol
The Review
Everyone cares about the Republicans. My concern is with doing the right thing for the children and adolescents and families that this affects. That's what I'm interested in. And when reports come out that show this two-sided thing and the skepticism and the fact there's no evidence, this just adds steel to their fire. Yeah, but that's what I mean.
The Protocol
The Review
Instead of saying that this is a nascent field, relatively speaking, and that it is, you know, its research has been essentially squelched for the last 35 years because of a similar backlash in 1979. This is Johns Hopkins, 2.0.
The Protocol
The Review
And it's all there because it doesn't lie. The truth really doesn't lie. The research and the data, it's certainly coming.