The disciplinary hearing of British Columbia nurse Amy Hamm, who is being investigated for allegedly transphobic off-duty activity such as putting up a billboard saying "I love JK Rowling", reconvened Tuesday with the continued cross-examination of Dr. Greta Bauer, an expert witness for the British Columbia College of Nurses and Midwives (BCCNM).
During the second day of her cross-examination, Bauer, a Professor of Epidemiology and Biostatistics at the Schulich School of Medicine and Dentistry, stated that she believes it is transphobic to question the practice of doctors performing experimental sex changes on minors, arguing that interventions such as puberty blockers and cross-sex hormones are necessary medical care recommended by a range of medical groups.
The sole allegation against Hamm is that she “made discriminatory and derogatory statements regarding transgender people while identifying herself as a nurse.” These statements include expressing the belief that there are only two sexes, which the BCCNM alleges denies the existence of transgender people, and speaking out against pediatric medical transition.
In her decade-long nursing career, Hamm has never had a single complaint about her conduct as a nurse by either a patient or a colleague. These complaints were made by third parties.
Lisa Bildy, legal counsel for Hamm, picked up the cross-examination with the subject of gender-affirming care for minors. Bauer has expressed the belief that Hamm’s public support for a father who opposed his child’s medical transition is evidence that she is transphobic and therefore unfit to be a nurse, so Bildy walked Bauer through each aspect of gender-affirming care.
Bauer expressed no concern about the fact that her research shows 62.4 percent of minors are put on puberty blockers on the very first appointment at gender clinics here in Canada, arguing that prior to that appointment, these children would have had numerous appointments elsewhere. However, she confessed that her research did not measure how much therapy these children had received before embarking on this experimental medical pathway. Anecdotal evidence suggests many have had none.
There was also little concern about the potential harmful effects of puberty blockers and cross-sex hormones. Bildy suggested to Bauer that putting teenage girls into menopause is a significant intervention. This is one of the consequences of puberty-blocking drugs.
“People may have hot flashes and things like that,” replied Bauer. “I think the experience might be a little bit different in adolescents who are excited about that. But there’s definitely hot flashes and irregular menstruation, cessation of menstruation.”
When asked if these teenagers would have vaginal atrophy, Bauer commented that this side effect was “interesting” and “not well studied,” but that her team was currently doing research looking at “vaginal microbiome” in a group of trans-identified females who are on testosterone and have not had a “vaginectomy.” Bauer admitted that while it was not clear, there were some concerns.
The expert witness had no concerns about the high rates of autism observed by gender clinics in other nations, arguing that in her research, only 1.9 percent of the female patients were autistic. Autism in girls is much harder to diagnose clinically.
During the independent review of the soon-to-be-closed Tavistock clinic in England, Dr. Hilary Cass noted that approximately one-third of the patients were on the autism spectrum. When asked if it was possible, as some experts have suggested, that Canadian clinics were missing autism diagnoses, Bauer admitted that it was possible but unlikely.
Then the discussion moved on to surgery, and while Bauer couldn’t comment on how many teenage girls progress from testosterone to bilateral mastectomies, she stated that in her recent research five under-18s had undergone “chest masculinization surgery.” This is a double mastectomy, with the removal of the nipple and replacement of it to appear more like a male chest. Scars remain visible on the patient's chest.
Bildy then showed the panel gruesome photographs of phalloplasty surgeries, which involve surgeons stripping the skin and flesh of a female patient’s forearm or thigh and using it to construct a non-functional “neo-penis.” While Bauer stressed that very few trans-identified females undergo such surgery, she confirmed that it did fall under the category of gender-affirming care available to over-18s in Canada.
“Is it transphobic, in your opinion, to question whether children and adolescents should be allowed to have these procedures?” Bildy then asked Bauer.
“Probably. It’s medical care that is recommended by a range of medical groups by the people who need it. So if we’re talking about saying that nobody should have access to needed medical care, then I would say yes,” was Bauer’s reply.
“Even though there are no long-term studies to say that this is all perfectly safe and that it’s going to alleviate their problems? It’s not something that we should reasonably be debating, is what you’re saying,” pressed Bildy.
“Denying everybody care, we should not be debating whether we’re denying everybody care for this, yes,” Bauer responded.
Bildy then asked Bauer if it was transphobic for a parent not to want his or her child to undergo such procedures, to which Bauer replied, “I don’t know. It could be transphobic or it could not be, depending upon the particularities.”
To justify such invasive and harmful interventions, Bauer, like other advocates for adolescent sex changes, argues that without access to gender-affirming care, these young people are at a high risk of suicide. When Bildy pointed to a long-term Swedish study that showing a high suicide rate a decade after transition, Bauer suggested that the risk remains high because of transphobia in society.
When Bildy suggested to Bauer that England’s Cass review had highlighted significant gaps in the research and evidence base for gender-affirming care, Bauer offered a different interpretation.
She felt that the interim report did not indicate major concerns with the affirmative model of care but instead that the issue was one of waiting lists.
“My understanding from reading the report is that the problem was that referrals increased dramatically, that they developed long wait lists, and as a result of the pressure from the waitlist that providers there felt pressure to pass people through and kind of rubber stamp approvals for things because they needed to get the waitlist down and they were under a lot of pressure from management,” she explained.
When asked if she felt that the politicization of the issue of pediatric medical transition is harmful to the evidence-based practice of nursing, Bauer made the remarkable statement that she is “not seeing politicization of nursing practice in Canada."
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