This is not my typical article. It will not contain asides, barbs, witticisms, or snide observations.
This article is a simple comparison between the medical protocols for getting gender affirming services, including surgery, and having bariatric surgery performed.
Both have preliminary steps and timelines. – and here they are. Links to the supporting documentation – bypass information from the American Diabetes Association and the World Journal of Psychiatry, gender information from the Journal of the American Medical Association and from B.C (British Columbia) Children’s Hospital publications- are at the end of the article.
BARIATRIC –
The beginning of the process involves mental health review:
“Although variability exists in preoperative psychosocial evaluations, there is general agreement regarding the psychologist's role in identifying emotional, psychiatric, cognitive, and behavioral factors that might influence bariatric surgery success and providing psychoeducation and treatment to help patients better prepare for surgery. Most psychological evaluations involve a clinical interview and, often, psychological testing to assess bariatric knowledge, adherence, eating behaviors, mood, substance use, cognitive functioning, and psychiatric history.”
And:
“One critical issue is the importance of mental health assessment and care of bariatric patients. Bariatric surgery is not a hit-and-run technical operation like many other surgical procedures. Rather, it is a “voyage” affecting patients’ life for years. After surgery, patients experience major changes in their physiological functions, psychological processes, lifestyle habits, and social interactions. Therefore, they need extensive and prolonged interactions with mental health professionals that should start in the preoperative stage and continue throughout the postoperative years. In spite of their importance in the multi-disciplinary teams that take care of patients seeking weight-loss surgery, often psychologists and psychiatrists still play a marginal or poorly defined role in preoperative assessment and postoperative follow-up.”
This occurs because:
“Patients need to have a competent understanding of the surgery and the lifelong behavior changes that must occur to achieve long-term success. Realistic expectations about weight loss and an understanding that surgery is only a tool are important for patient satisfaction with outcome.”
The psychosocial evaluation should cover all potential issues:
“Although it is generally agreed that the psychosocial bariatric assessment should include an addiction component, this does not suggest that all bariatric-seeking patients have an addiction or will necessarily engage in addictive behaviors postoperatively. When identified, substance abuse should be treated, and achievement of stable sobriety is often recommended before surgery.”
And:
“…patients with serious mental illness or cognitive dysfunction because they are often excluded from surgery or research protocols.”
While psychiatric issues do not automatically bar a person from surgery:
“The most common reasons for deferring bariatric surgery are significant psychopathology such as active psychosis (including thought disorder symptoms), current substance dependence, untreated eating disorders (specifically anorexia nervosa or bulimia nervosa), untreated depression and/or active suicidal ideation.”
And very importantly:
In the preoperative phase, it is important to discuss and correct naïve hopes that surgery would simply “fix” things including bad eating habits without personal effort.
Beyond the assessment, it has also been reported (to me personally) that surgery candidates are asked to go through a form of group therapy with other candidates prior to being approved for the procedure.
And beyond the mental health review, physical protocols and standards are also determined and behaviors (more exercise, less eating, etc.) are changed during the process.
That process can take up to a year before the actual operation and then last for years beyond to make sure everything went well and the patient is working on their health in general. As noted above, bariatric surgery “is a voyage.”
GENDER
A candidate is referred for care by their primary physician. They are then evaluated by a “trans-competent mental health assessor prior to seeing a pediatric endocrinologist.”
Additionally:
“Children and adolescents require a multidisciplinary approach, which considers developmental stage, neurocognitive function, language skills; offers mental health support; discusses risks and benefits of social transition; and includes parental/guardian involvement in GAMST (gender-affirming medical and/or surgical treatment) in almost all situations.”
The JAMA article does note that:
“In a population-based study, transgender and gender diverse participants self-reported mean poor mental health of 14.8 (95% CI, 13-16.7) days per month compared with 6.0 (95% CI, 5.2-6.8) for cisgender participants. Gender-affirming medical and surgical treatment (GAMST) can mitigate psychologic distress and reduce suicide risk by aligning physical characteristics with gender identity when there is marked, persistent incongruence with the sex assigned at birth (gender dysphoria).1 The guidelines address various gender identities and recommend comprehensive health care beyond hormonal or surgical treatments, including primary care, reproductive and sexual health care, mental health care, voice therapy, hair removal, and prosthetics.”
During the evaluation, the trans-competent mental health assessor “can discuss options for mental health assessments during the intake appointment. If you would like to connect with an assessor prior to the intake appointment, we can help you find a trans-competent mental health assessor. The intake visit takes approximately 1 hour, but plan on being at the hospital for 1½ hours.
The next step is an appointment with a pediatric endocrinologist:
“Based on your visit and your referring doctor’s information, the endocrinologist will discuss the next step of the process with you. Occasionally, further tests (blood tests) are done elsewhere in the hospital or possibly at an outside lab. Your first medical visit will be a minimum of 2 hours. Plan on being at the hospital for at least 2½ hours. Younger siblings will find this tiring, and we highly suggest alternative babysitting arrangements to make your visit more comfortable.”
After this appointment, the candidate will discuss future options, such as hormone treatment and/or surgery. The time from the request for the first doctor’s referral to beginning to take hormones could be as short as three months. The next step is the decision regarding surgery, which typically takes place after – often well after, if ever - the hormones have begun to take effect, which can also be about three months.
And:
“At least 6 months of exogenous hormone therapy before gender-affirming surgery is optimal, but not mandatory”
One of the the reasons for the comparatively rapid timeline is this:
“Similarly, a systematic review of gender-affirming surgical outcomes found that individuals with gender dysphoria who underwent a variety of surgical interventions experienced significant improvements in quality of life and psychological well-being.
Numerous other studies have shown that that claim is dubious.
The reason for this article is to show how differently the trend of trans is being treated by the medical community. It is fast-tracked and it is permitted almost always on merely the word or whim of the patient.
In other words, to get a time-tested operation to lose weight and improve health takes at least a year.
You can get your breasts cut off because your sad or trendy in less than six months.
That cannot possibly be right.
The links:
American Diabetes Association: https://diabetesjournals.org/spectrum/article/25/4/211/32493/Psychosocial-Evaluation-Preparation-and-Follow-Up
World Journal of Psychiatry (via the National Institutes of Health ): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783166/
B.C. Children’s Hospital (a single web page to start but links throughout to other gender topics and services, such as where to purchase fake phalli to “pack” your underwear, how to bind your chest, etc.) http://www.bcchildrens.ca/our-services/clinics/gender#Your--first--visit
JAMA (note – this follows the Standards of Care-8 published by the World Professional Association for Transgender Health): https://jamanetwork.com/journals/jama/fullarticle/2805345
Additional related article links:
First, how the passing fad of “TikTok Tourette’s” was treated as compared to sudden onset gender dysphoria: https://thomas699.substack.com/p/similar-differences
Second, the role of medical professionals: https://thomas699.substack.com/p/doctors-without-ethical-borders
Third, the problem of self-diagnosis of gender dysphoria: https://thomas699.substack.com/p/the-plague-of-self-diagnosis
Fourth, a more in depth look at BC Children’s Hospital: https://thomas699.substack.com/p/if-you-are-sick-do-not-come-to-our