Rand Paul

Senator Rand Paul tried to bully Dr. Rachel Levine in her confirmation hearing. Sen. Paul did not have much success as Dr. Levine is quite a bit more intelligent than Paul.

via YouTube

The usual religious zealots cannot gush enough over Rand Paul’s questioning of Dr. Rachel Levine. However, if you break down his diatribe (diatribe because he asked rhetorical questions), Paul doesn’t make much sense at all. Dr. Levine handled Paul just right by rising above the acrimony.

The following quotes were from a closed captioning transcript of this video. The transcript lacks punctuation and capital letters at the start of each sentence. Inserting those are the only changes I made.

Genital mutilation has been nearly
universally condemned.
Genital mutilation has been condemned by
the WHO,
the United Nations Children’s Fund …
According to the WHO, genital mutilation
is recognized internationally as a
violation of human rights.
Genital mutilation is considered
particularly egregious
because as the WHO notes it is nearly
always carried out on minors …

Oh gee, how clever. Paul telegraphs ridiculous myths. Truth:

  1. The United Nations and the W.H.O. are referring to female genital mutilation usually performed in Islamic nations in order to make intercourse less pleasurable for the woman.
  2. As you have undoubtedly concluded, Paul is going to claim that gender confirmation surgery is mutilation.
  3. Children are not candidates for gender confirmation surgery.
  4. Gender confirmation surgery (for adults) is performed by highly skilled surgeons who do not mutilate anyone.

American culture is now normalizing the
idea that minors can be given hormones
to prevent their biological development
of their secondary sexual
characteristics.
Dr. Levine you have supported both
allowing minors to be given hormone
blockers
to prevent them from going through
puberty as well as surgical destruction
of a minor’s genitalia
like surgical mutilation hormonal
interruption of puberty can permanently
alter and prevent secondary sexual
characteristics?
The American College of Pediatricians
reports that 80 to 95 percent
of pre-pubertal children with gender
dysphoria will
experience resolution by late
adolescents if
not exposed to medical intervention and
social affirmation.
Dr. Levine do you believe that minors are
capable of making such a life-changing
decision as changing one’s
sex?

Before I get to Dr. Levine’s answer, Paul asks two compound questions before allowing Levine to answer. “American culture” in Paul’s screed is misleading and irrelevant. “Normalizing” in that context is prejudicial language used by anti-LGBTQ religious zealots.

Interventions for pediatric gender dysphoria are the result of intense research by medical scientists irrespective of “American culture.”.

According to the Pediatric Endocrine Society and the Endocrine Society, puberty blockers are fully reversible. Again, Paul is not asking questions, he is propagandizing.

The American College of Pediatricians is a minuscule hate group in Gainesville, Fl. It has never published research to a peer-reviewed academic journal. It is a religious organization formed in protest of the American Academy of Pediatrics’ statement that children raised by same-sex couples are healthy and happy.

Every study of same-sex parenting has determined that the AAP is correct and ACPeds was wrong.

Paul’s (ACPed’s) 80% to 95% is misleading and exaggerated. A majority of children will, in fact, outgrow gender dysphoria. Persistence of the condition directly corresponds to its severity. The kids who desist will never transition in the first place. Only the most acutely affected children transition.

The facts are quite clear. ACPeds turns science upsidedown by claiming that persistence of the condition is caused by transitioning and social acceptance by others.

Paul is begging the question and thus creating a logical fallacy. He is also suggesting that transitioning and puberty blockers are the result of a child’s unilateral decision. Paul knows perfectly well that these decisions are by consensus: The child, a pediatrician or psychiatrist, an endocrinologist and the child’s parents.

Dr. Levine rises above the bullshit:

Well senator, thank you for your
interest in this question.
Transgender medicine is a very complex
and nuanced field with robust research
and standards of care that have been
developed and if I am fortunate enough
to be confirmed as the assistant
secretary of health I will look forward
to working with you
and your office and coming to your
office and discussing the
particulars of the standards of care for
transgender medicine.

Paul asked a closed question (yes or no). To answer with either yes or no would be misleading. Dr. Levine is explaining that the subject is too complex to be explained in a binary fashion. She was quite a bit more civil than Paul; expressing a willingness to meet with him and his staff.

Rand Paul tries again. I am going to print the quote in full so that you can appreciate that Paul is testifying in contrast to questioning:

The specific question was about minors.
Let’s be a little more specific since
you evaded the question.
Do you support the government
intervening to override the parents
consent
to give a child puberty blockers
cross-sex hormones
and or amputation surgery of breasts and
genitalia?
You have said that you’re willing to
accelerate the protocols
for street kids. I’m alarmed that poor
kids with no parents
who are homeless and distraught you
would just go
through this and allow that to happen to
a minor.
I would hope that you would have
compassion for Kyra Bell
who’s a 23 year old girl who was
confused with her identity
at 14. She read on the internet about
something about transsexuals she thought
well maybe that’s what i am.
She ended up getting these puberty
blockers cross-sex hormones she had her
breasts amputated.
But here’s what ultimately she says now,
and this is a very insightful from
decision from someone who made a mistake
but was led to believe this was a good
thing by the medical community.
I made a rash decision as a teenager as
a lot of teenagers do
trying to find confidence and happiness
except now the rest of my life will be
negatively affected she said
adding that the medicalized gender
transitioning
was a very temporary superficial fix for
a very complex
identity issue. What I(‘m alarmed at is
that you’re not willing to say
absolutely minors shouldn’t be making
decisions to amputate
their breast or to amputate their
genitalia.
For most of our history we believe that
minors don’t have full rights and the
parents need to be involved
so I’m alarmed that you won’t say with
certainty that minors should not have
the ability
to make the decision to take hormones
that will affect them for the rest of
their life.
Will you make a more firm decision on
whether or not minors should be involved
in these decisions?

Again, Paul has asked a misleading question. Minors do not make medical decisions for themselves unilaterally.

In the above, Paul claims that he is alarmed by Dr. Levine’s unwillingness to be manipulated. Dr. Levine never evaded the question. Levine is a very smart woman and a board certified pediatrician. Paul is an opthamologist with no board certification.

Dr. Levine is not going to be bullied:

Senator, transgender medicine is a very
complex
and nuanced field and if confirmed to
the position of assistant secretary of
health
I would certainly be pleased to come to
your office and talk with you and your
staff
about the standards of care and the
complexity of this field.

Rand Paul has not given Dr. Levine much choice. She is not going to answer a closed question in the abstract.

Paul is getting frustrated and combative:

Let it go into the record that the
witness refused to answer the question.
The question is a very specific one.
Should minors be making these momentous
decisions? For most of the history of
medicine
we wouldn’t let you have a cut sewn up
in the ER but you’re willing to let a
minor
take things that prevent their puberty
and you think they get that back.
You give a woman testosterone enough
that she grows a beard you think she’s
going to go back looking like a woman
when you stop the testosterone?
You have permanently changed them
infertility is another problem
none of these drugs have been approved
for this they’re all being used off
label.
I find it ironic that the left that went
nuts over hydroxychloroquine when
being used possibly for covid
are not alarmed that these hormones are
being used off label. There’s no
long-term studies.
We don’t know what happens to them. We do
know that there are
dozens and dozens of people been through
this who who regret this happening and a
permanent change happened to them
and you know if you’ve ever been around
children 14 year olds can’t make this
decision.
In the gender dysphoria clinic in
england
10 of the kids are between the ages of 3
and 10.
We should be outraged that someone’s
talking to a three-year-old about
changing their sex.

Paul continues to dishonestly beg the question. He is suggesting that children make these decisions and that is simply not the case. A minor is informed about what the medication is intended to do. They are told about possible side effects and are urged to immediately report side effects to their doctor.

If, in fact, children between the ages of three and ten are patients of the Tavistock clinic (Paul doesn’t cite a source), the only treatment that they are receiving is counseling. They will not be eligible for any medications for a number of years. Puberty blockers are prescribed after an adolescent enters puberty

Every medication provided as part of transgender medicine has been rigorously studied. Just not for the treatment of gender dysphoria which is why they are considered off label. (About one-fourth of all prescriptions in the United States are off label).

For example, puberty blockers (GnRH agonists) have been used for decades to treat children with precocious puberty (early onset) and a host of other conditions. They have proved to be safe and effective. Contrary to Rand Paul’s tirade, we do know precisely how puberty blockers affect children.

Paul’s reference to hydroxychloroquine is misleading and irrelevant. “The left” did not object to the use of hydroxychloroquine. Medical science made that determination in regards to COVID-19.

In fact, Paul is contradicting himself. Were hydroxychloroquine prescribed to treat COVID-19, then that would be off label.

There is no medical intervention that yields a 100% success rate. I do not know for certain but, in reading about Kyra Bell, I believe that she has been exploited by the religious right. Either way, Paul cites one example. Presumably Bell had the approval of numerous clinicians and her parents.

Rand Paul has tried to exploit Dr. Levine. I doubt that he would ask the same questions of a cisgender nominee.

Dr. Levine is a highly accomplished physician and she has a solid record of public service. Dr. Rachel Levine was unanimously confirmed for her current position as Pennsylvania’s Surgeon General. She is highly qualified for a position as an assistant secretary of health. She just happens to be transgender and that should be entirely irrelevant. I expect that she will be confirmed by the Senate.

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