Duke Health emerges as Southern hub for youth gender transition
Editor’s note: Graphic language
The debate around childhood gender transitions has become a cultural flashpoint in 2022. Arkansas, Alabama, Arizona, and Texas passed bans on youth gender surgeries and hormone treatments — with 15 other states considering such bans — while California and New York are considering laws making themselves places of “refuge” for youth gender transition.
The tide in Europe seems to be turning strongly against providing puberty blockers, hormones, and surgeries to minors experiencing gender dysphoria. This summer, the United Kingdom announced it would shut down its only gender clinic for minors, the Tavistock Clinic, over fears the treatments were dangerous, experimental, and provided without enough scrutiny. Sweden and Finland also made strong moves against the practice, banning hormones, puberty blockers, and gender reassignment surgeries as treatments for gender dysphoria.
Amidst this contentious cultural landscape, North Carolina’s own Duke Health has emerged as a Southern regional hub of “gender-affirming care” for minors experiencing gender dysphoria. Many are choosing to travel long distances from Southern states with stricter laws to seek treatment at Duke.
“Duke is the only medical school in the southern states with a child and adolescent gender clinic, an adult gender clinic, a sexual and gender minorities primary care clinic, a top public policy school and global health institute,” said a February 2020 Duke Health statement announcing the opening of the Duke Sexual and Gender Minority Health Program.
The statement said that “The vision for the Duke Sexual and Gender Minority Health Program (DSHP) is to transform research and healthcare for millions of sexual and gender minority individuals—that is, members of the LGBTQIA+ community—and to become the leader in research, patient care, education and policy for sexual and gender minority health in the southern U.S. and the Global South.”
And the effort is quickly bearing fruit. At the DSHP’s 2022 Sexual and Gender Health Symposium, co-director of adult gender medicine Carly Kelley laid out the explosion of interest in the clinic among both adults and children. The DSHP has already had more than 1,000 patients, and both the adult and pediatric practices have a 6-month waiting list. This spike comes as clinics across the world are seeing a recent flood of new interest in gender services, including a 4,000% increase in youth seeking gender transitions in the U.K. over the past decade.
“The demand for gender-affirming treatment is increasing, and you can see from the graphs here, as a result of the demand, our program is growing,” Kelley said.
At the 2022 symposium, there were a number of panels bringing together top minds in the field from across the country and around the world. The “Teen Transitions” panel had Dr. Marci Bowers, who has done more than 2,250 transition surgeries, likely more than anyone else on the planet. Bowers is also the president-elect of WPATH, the global medical body that creates best-practices for youth transgender care, making her a minor celebrity among those in the specialty. Bowers also recently appeared on The Daily Wire’s satirical documentary “What is a Woman?” as one of the experts duped into giving an interview.
During Duke’s panel, Bowers made note of a few major concerns that have cropped up for “gender-affirming” surgeons. One is the increase in “detransitioners,” people who had hormonal and surgical treatments to transition towards their preferred gender and then came to regret that decision. Bowers said that this was not necessarily negative and might just be “part of their journey,” likening the phenomenon to someone had a breast augmentation and later regretted it.
The detransitioner movement has been growing, though, with one online community alone hosting over 37,000 people who claim to regret a gender transition. And many of these detransitioners claim they were not properly made aware of the risks and challenges they would face.
Bowers seemed to acknowledge these challenges, saying that “really about zero” biological males who block puberty at the typical Tanner 2 Stage of puberty (around 11 years old) will go on to ever achieve an orgasm and that their penises will never develop enough tissue “to create a female vulva” surgically later in the transition process.
Bowers suggested that because this was all a new field, these were all “to-be-answered questions” needing more experimentation, possibly solved by allowing puberty to proceed a little further or adding testosterone later in the transition process.
Bowers also said that all this needs to be better communicated with patients as a part of informed consent and that maybe patients should be encouraged to keep their penises and think of them as more of “a large clitoris” instead.
Duke Health’s Dane Whicker, a psychologist at the gender clinic, seemed to push back on this, saying that the risks of not transitioning, like being bullied, outweighed having the risks Bowers mentioned centered during informed consent discussions with the child. He also suggested the sexual dysfunction caused by SSRI medications for depression were analogous to the lack of orgasms and fertility caused by the transition process, and if patients were scared off from transitioning, they may end up on these medications.
Another hot topic at the symposium was the increasing evidence of a link between autism-spectrum disorders and transgenderism. Before the United Kingdom shut down the Tavistock Clinic, there was controversy over a report that of the 1,069 patients under 18 served by the clinic, 372 (or 35%) had moderate to severe autism.
A larger study of 640,000 people found 24% of the transgender population to be autistic, with the remainder being five-times more likely than the general population to believe they have undiagnosed autism. They also had higher rates of all six major psychological conditions tested, including bipolar disorder and schizophrenia.
Only about 1% of the global population is estimated to be autistic (and 2% of the American population according to the CDC), making these numbers orders of magnitude greater than the population at large. With autism being defined as a spectrum of disorders affecting the ability to socialize and communicate, the British government ordered investigations to look into whether this vulnerable community somehow came to see a transgender identity as an easy explanation for their social difficulties.
A panel during the symposium explored this intersection of gender diversity and autism but pushed back at the suggestion that the connection had anything to do with confusion.
Dr. Nick Walker, an autistic male who identifies as a woman, said that these stats are convincing people that the overlap between transgender and autistic people is evidence that “this is some trend that autistic people’s terrible disorder is causing them to fall for.” But Walker suggested this is a weaponization of autistophobia and that the autistic and queer identities are as valid as gendernormativity and neuronormativity and therefore should not be policed.
On Aug. 26, Carolina Journal reached out to Dr. Deanna Adkins, the child and adolescent lead for DSHP; and Dr. Dane Whicker, the mental health and education lead for DSHP — both of whom were on the Teen Transitions panel with Bowers — to ask if they agreed with Bowers’ assessments on lack of sexual functioning after puberty blockers and the need for better informed consent. CJ also asked at what age DSHP begins offering surgeries and hormonal treatments.
Neither Adkins nor Whicker responded in time for publication.