WPATH Statement About Dr. McHugh Editorial

Many of you have read the editorial that Dr. McHugh wrote in the Wall Street Journal on June 12^th where he criticized Medicare coverage of Gender Confirming Surgery, WPATH just published a statement and republishing Dr. Dan Karasic reply to Dr. McHugh editorial.

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.

In Dr. Karasic’s letter he wrote,

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.

Also from WPATH…

We are delighted to inform the WPATH membership that on Monday, June 9th, 2014 the American Medical Association joined the World Health Organization in adopting a policy declaring that transgender individuals should not be required to undergo genital surgery or forced sterilization in order to change legal identification documents, including birth certificates.

Now to see if we can get Connecticut to change their policy and allow birth certificates to be changed without surgery.