By Faith Kuzma
Affirming Chaos Into Reality
The recognition of celebrity persuaders operating within the context of social media marketing to build a patient base for trans-medicine is now the major subtext of a legal case based in the United States. Medical professionals at the Nebraska Medical Center and Nebraska Medicine are currently charged with malpractice and negligence, including ignoring the effect of social media’s influence on Luka Hein, whose lawyers contend “may have been swept up in a social contagion and/or unduly influenced by social media.” Luka Hein, who was then 16, explains, "I was going through the darkest and most chaotic time in my life, and instead of being given the help I needed, these doctors affirmed that chaos into reality...I was talked into medical intervention that I could not fully understand the long-term impacts and consequences." This highlighting of the powerful role of trans-influencer markets on social media is a game changer.
What are family doctors told of this role? You might be surprised to learn Canadian Medical Association CMA guidelines direct family physicians to “take an unconditional ‘affirming’ approach.” Meanwhile, an article detailing this instruction also observes a common pattern of “youth who, a couple of weeks ago, decided that, after talking with a friend or researching on the Internet that maybe they’re transgender.” Given the waiting list to get started on gender medicine, Canadian Family Physicians urges colleagues to write their own scripts rather than refer patients out. Arguing that treating such patients is well within the reach of family practice, they also note: "It is attitudes and fear of doing harm that limit this essential care being provided to TGD [transgender and gender-diverse] patients." Essential care here references starting on the gender protocol of elective hormones and surgeries (rather than proven watchful waiting). So when about half of family doctors express "attitudes" and "fear of doing harm," they are acknowledging the ethical dilemma they face.
To understand the response of family care physicians to the attempted mainstreaming of gender medicine, it is crucial to discern that their reluctance stems from starting youth down the medical path – not caring for patients afterwards. In an AAFP American Academy of Family Physicians article claiming family practice can entail exciting cutting edge medicine, MaryAnn Dakkak M.D. cites two studies, one showing only half of the surveyed doctors were willing to prescribe hormones in response to claims of a gender identity. Such patients are known to benefit from watchful waiting or exploratory counselling. By far, the majority (85.7% according to the second study Dakkak mentioned) are willing to provide primary healthcare to individuals identifying as trans, a fact that goes against the prevailing narrative that prejudice motivates doctors.
Why does the CMA direct this “unconditional affirmation” messaging to family providers? One reason could be the exploding demand from a constantly fueled social media trans mania. The affirm-only guidance to family doctors is levied to address the tidal backlog of Canadian youth waiting in line, overburdening both private gender clinics and public hospitals.
Although Canadian data is hard to obtain because collected within the provinces, gender clinic stats show a tenfold increase in referrals to clinics over the last decade. According to the CMAJ, those years coincide with a dramatic jump in mental health problems such as distress among girls associated with cell phone use. Meanwhile, Facebook, now called Meta, is facing litigation that claims known mental harms associated with its product were overlooked in the interest of profits.
Acceptance Isn’t Enough: Mutual Emulation
A new era of acceptance is not enough to explain longer lines to modify healthy bodies. Dr. Google and social media influencers are more likely the answer. Indeed, therapists acknowledge medical misinformation is rampant on social media. However, their survey of layperson medical opining falls just short of examining the biggest growth sector of gender misinformation. Feeding this leading growth industry, billionaire backers of Trans Inc. pipe seed money, as Jennifer Bilek has brilliantly charted, through a titanic network of foundations, charities, endowments, and other philanthropic organisations.
And then too are the attention-whore influencers. The celebrity surgeon Dr. Sidhbh Gallagher, defends her gimmicky lingo and calling herself “Dr Teetus Deletus” as reaching her community. As if starstruck by their own sudden elevation to star status among the trans fan club, grandstanding surgeons utilize social platforms as a stage, preening before the camera or leaning in for an intimate briefing with young naïve groupies. For enticing teens into sex-change operations using creepy TikTok videos, Gallagher was reported last December to the FTC, the government’s consumer watchdog agency. The FTC complaint alleges Gallagher "engaged in unfair, false, and deceptive practices in the aggressive advertising and marketing to minors of their plastic surgery services, namely mastectomies of healthy female breasts, as proven safe, effective, and medically necessary."
Meanwhile, another clinic has been held to account for some of their in-your-face marketing theatre to draw clicks. In Ontario, the Mclean clinic was ruled noncompliant with the Medicine Act, with regard to Dr McEvenue bizarrely grinning in a Santa hat while holding up buckets labelled “breast tissue.” Additionally, their “pre and post op” photographs are found to be equivalent to testimonials, and are contrary to the Advertising Regulation: “the clinic has allowed comments and replies to postings on social media platforms, such as Instagram and YouTube. Again, some of these comments are equivalent to testimonials or in bad taste.” McLean Clinic advertising does not comply with the Medicine Act regulating the conduct of physicians in Ontario. The College of Physicians and Surgeons of Ontario (CPSO) identified misleading and deceptive claims including post-surgery testimonials and this holiday-themed image of a physician deemed undignified.
"In the Committee’s view, after reviewing the sample images provided to us from the McLean clinic’s Instagram account and website, the Committee concludes that some of the material does not comply with the Advertising Regulation." - College of Physicians and Surgeons of Ontario
It is conceivable that social media serves as the biggest catalyst to trans-medicine. The enthusiasm is there, and in fact the majority of plastic surgeons use social media to “educate” and relate to patients. Emphasising the need to be approachable, they deny the ipso facto advertising function of producing relatable content seen by prospects. In their professional organisations, these trusted professionals have downplayed or ignored the reality that there are no social media sites covering risks in an evidence-based, balanced way. While acknowledging a study that raised legitimate concerns in Plastic and Reconstructive Surgery: Journal of the American Society of Plastic Surgeons, these whizzes minimise the reported lack of “any unbiased, noncommercial videos from board-certified plastic surgeons explaining procedures and associated risks and benefits.” And though acknowledging the reality that social media-referred patients are not fully or reliably informed about the risks of “trans-affirming” medicine, these cognoscenti anticipate “a greater presence on social media in the future.”
Thus, one of the biggest “creative assets” for Trans Inc. is social media, especially in the explosion of opportunities related to gender subcultures the public has been instructed to see as solely social networking venues for protected Civil Rights categories. The pivotal role social media plays in perpetuating cross-sex ideation originated with the landmark study by physician-scientist Lisa Littman, who identified the carving out of a new cohort-client-customer base really, for Trans Inc., a younger aged, predominantly female peer group who talked one another into double mastectomies. Following the activist attack on her research, Littman’s findings have been rigorously corroborated. At this point, the trajectory is well understood: a predominance of female youth, exhibiting deteriorating mental health within the fulminating matrix of social media. The study recently found near real-time corroboration from Jamie Reed, who was responsible for patient intake and oversight as a case manager at The Washington University Transgender Center at St. Louis Children’s Hospital from 2018 to 2022. Reed observed clusters of female friend groups from particular high schools in the area. When she remarked on this to clinic doctors, she also mentioned their typical propensity toward making a whole slew of false self-diagnoses. Although the doctors agreed, they drew a sharp exception for gender identification. Recognising the dark force of what looked like a social spread, Reed left the clinic.
Knock-on Consequences for Blinkered Providers
Last year, Fae Johnstone, a Canadian activist consulting on transgender health, lamented basically that family practitioners in rural areas were not submitting in sufficient numbers to the “unconditional affirming” approach. In fact, that approach had “fallen entirely off the radars of most provincial and territorial governments.” Could it be that family doctors have retained relative independence from national pressures and still believe in first-do-no-harm?
Private physicians need to stand their ground, and maintaining an awareness of the severe harms those who’ve fled the “gender path,” should and can anchor them. In Ontario, for instance, Michelle Zacchigna, filed against eight providers for ignoring her evident mental health condition in order to affirm her trans ideation and fast track hormones and surgeries. Her case represents Canada’s first malpractice case against gender affirming doctors and raises a huge red flag warning to all those on their own journey of carving out careers from young people who have dissociated from their own healthy human bodies and detest their own sexed traits enough to demand their urgent surgical destruction.
Fae Johnstone
Image via: https://www.reddit.com/r/TwoXvsThePatriarchy/comments/162dbsd/fae_johnstone_looking_lovely/
While malpractice lawsuits are typically outgunned by the massive legal funds available to Canadian doctors, Zacchigna represents part of an expanding bevy of young adults who can no longer be hidden, who came of age with the Internet, and who saw their histories collide inextricably with powerful vested interests. Collectively, they can no longer go unseen.
One thing’s for sure, the seeming impenetrability of Trans Inc. is shifting, with five re-identified women taking their American medical affirmers – and in two cases, their insurance provider Kaiser Permanente – to court. Even as these court cases go forward, celebrity docs and clinic influencers will probably be less enchanted by their own notoriety. At the very least, as the Economist noted in May this year: “Legal victories for detransitioners could have knock-on consequences, by making insurers come to regard gender-transition treatments as a liability. That would push up the costs of providing the treatment, and make providers more careful about advertising.”
Dr. Faith Kuzma is a retired Assistant Professor of English. Kuzma has written for Salvo, The Canadian Patriot, Psych Reg, and Mercator Net and elsewhere. Find her @faithkuz