Freedom and rights: Gender affirming care is mental health care that saves lives

Drew Martel
Mar. 5, 2023 

Drew Martel

‘To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment” – Ralph Waldo Emerson, 1859

According to Axios, Republican Lawmakers have proposed 340 bills across the nation targeting LGBTQIA+ individual’s rights in the first two months of 2023 alone. Iowa has led that charge, with a record breaking 19 bills proposed in the legislature.

It’s not just the state targeting vulnerable gender minorities, various religious lobbyist groups, who seek to impose their beliefs on others, as well as Former Vice President Pence’s ironically named Advancing American Freedom advocacy group, which is planning to run ads in Iowa to, well, restrict individual freedoms of gender minority individuals.

Minority Stress Theory posits that negative experiences and health disparities can result from being a member of a marginalized group (when your state systematically targets your rights with multiple bills, you are a marginalized group). Targeted groups are more likely to experience chronic stress due to the social, economic and political inequalities they face, which in turn can lead to a range of negative health outcomes, such as depression, anxiety, substance abuse and physical health problems.

Sexual minority youth, in particular, are especially vulnerable to this stress, with suicide attempt rates 4X higher than heterosexual counterparts, according to the CDC. A study out of Massachusetts found that sexual minority youth were substantially more likely to experience thoughts of suicide, make a suicide plan, and attempt suicide than their heterosexual counterparts. An analysis in the journal Pediatrics found that one third of sexual minority youth reported a suicide attempt in the past 12-month period covered by the study.

A common argument made by those attempting to curtail the individual rights of sexual minority individuals is that mental distress is a function of identifying as a sexual minority. That is to say, that somehow identifying as LGBTQIA+ you inherently are more likely to have thoughts of suicide.

This argument is not supported by any actual evidence, and to the contrary, the leading theory of suicide, The Interpersonal Theory of Suicide (Joiner, 2003) identifies a lack of belonging and the perception of being a burden to others among the factors that drive suicide thoughts and behaviors. No part of the interpersonal theory of suicide identifies sexual identification as a suicide driver.

This presents an inconvenient truth to policy makers, the various bills they are proposing, with the stated purpose of “protecting” youth, are actually marginalizing them. This reductive view is the result of confluence of factors, including ignorance about the etiology of suicide and mental health, a lack of expertise and curiosity on the topic, and a general belief among conservative policymakers that their personal values are the only values worthy of a free society.

On the contrary, a significant body of evidence has demonstrated positive outcomes of gender affirming care for transgender and nonconforming individuals. A study out of The Journal of The American Medical Association in 2022 found that gender affirming care was associated with a 60% decrease in odds of depression, and 73% decrease in odds of experiencing suicidality in a cohort of transgender and nonbinary youth.

This can only lead to one question: What is the actual purpose of these bills? As already outlined, the research indicates substantial harm to the wellbeing of these individuals occurs as a direct result of societal marginalization, while simultaneously indicating access to gender affirming care is a buffer against negative health outcomes.

My grandfather was a World War 2 Veteran, and a tough as nails type of guy. He rarely spoke about his experiences in WW2, which I really only learned about after I was given his service record at his funeral when I was on leave from the military myself.

I remember sitting at his house shortly after the terrorist attacks of 9/11 and watching a news segment showing American’s burning flags, amidst calls to make flag burning a crime. To my surprise, my grandfather muttered “What the hell did I fight for if that’s made a crime..”

It’s not supposed to be about what you personally approve of, agree with, or like, it’s supposed to be about personal freedoms. We are a country that proclaims to be a freedom loving people. We are a country whose trajectory has almost always been in the direction of respect for the individual, and the right to pursue life in the individual ways we see fit. My grandfather knew this, having fought fascism abroad, where the only values and rights allowed were those of the ruling political party.

Gender affirming care and treatment is about freedom, it’s about the right to pursue life at the individual level, and it saves lives.

“Our liberties we prize, and our rights we will maintain” – State motto of Iowa.

Drew Martel is ]chief clinical and training officer at Foundation 2 in Cedar Rapids.

Opinion content represents the viewpoint of the author or The Gazette editorial board. You can join the conversation by submitting a letter to the editor or guest column or by suggesting a topic for an editorial to editorial@thegazette.com

I am a teenager asking you to learn about the experiences of trans youth

Kenna Wolbers
Mar. 5, 2023 

Kenna Wolbers

LGBTQ+ youth are under attack in Iowa.

That might sound like hyperbole, but with the recent bill making its way through the Iowa Legislature, it would be illegal to announce, promote or instruct on LGBTQ+ issues in kindergarten through eighth grade. This effectively silences any communication related to sexuality or gender in the classroom. What’s worse, schools would also be required to communicate any information a student shares about their gender to their parents if it differs from their “biological sex.”

Let me give you some perspective: I’m a gay teenager attending a Catholic high school in Iowa, ground zero for this war against LGBTQ+ kids. I’ve witnessed what spawns from limited education on gender and sexuality. I’ve become jaded to the relentless bullying, assault and death threats brought upon my peers. I haven’t met a gay or trans student who hasn’t thought of harming themselves because of this treatment. Silence isn’t saving children: It’s killing them. Gay and trans people exist. We’re not going away any time soon, which is why hosting open discussions about LGBTQ+ topics, particularly in middle school, is essential to developing healthier communities.

When Gov. Kim Reynolds and legislators peddle the idea of such discussions “corrupting” youth, they treat us like frogs ready for dissection. LGBTQ+ identity is more than clinical language and anatomy. When you talk about a husband and wife, you don’t immediately jump to thinking about their sex life. That’s inappropriate and invasive.

Similarly, acknowledging our existence does not mean you have to explain the logistics of intercourse to a 5-year-old. It’s as simple as saying some girls love other girls or not all girls look the same. Middle school is often the first place we begin thinking about sex and gender. It’s an incredibly vulnerable journey of self-discovery that needs proper guidance in a fact-based, educational environment.

I was fortunate enough to have parents to fill in the gaps of knowledge that Catholic sex-ed could not, but I know others who weren’t as lucky. Some of my friends have parents who’ve kicked them onto the streets for even questioning their gender identity. With this bill requiring teachers to report children’s preferences concerning gender to their guardians, we run the risk of losing more kids to violent abuse and homelessness. What’s the point? Why censor vital education on the realities of LGBTQ+ people?

The answer, as history has often informed us, is fear. By nature, parents agonize over the best choices for their children, leaving them vulnerable to bigoted language from manipulative people seeking personal gain. They’ll fall back on old stereotypes and claim to be protecting your children from “corruption.” They’ll deliver justice. They’ll keep your kids safe. It is easier to hate than to learn, to hear a politician say a certain group is “indoctrinating” children and become consumed by fearful speculation. People like Kim Reynolds know this and use it to fuel their careers.

I too have felt how intoxicating it is to unleash all your anxieties onto someone else. But in the aftermath of that high, there comes the crushing realization that you have hurt another human being. Is this the way we want to live?

I am not a politician with some sinister agenda. I’m not a leftist who wants to brainwash your kids. I am a teenager asking you, the reader, to try. Try learning about the experiences of trans youth. Try talking to acquaintances who are gay, bi, or trans. Try advocating for their rights. I hope you find we’re more than a scary statistic, that we’re, quite possibly, on the same side.

Kenna Wolbers is a student at Wahlert Catholic High School in Dubuque. Her column first appeared in the Dubuque Telegraph Herald.

Opinion content represents the viewpoint of the author or The Gazette editorial board. You can join the conversation by submitting a letter to the editor or guest column or by suggesting a topic for an editorial to editorial@thegazette.com

CASTEISM IS FASCISM

How India's caste system works, and why it's generating US controversy

Cities like Seattle have pursued bans on caste-based discrimination

Associated Press

Caste is an ancient system of social hierarchy based on one’s birth that is tied to concepts of purity and social status. Its history, evolution and current state are complicated.

A move to outlaw caste-based discrimination in Seattle has thrust this complex — and often misunderstood — system into the spotlight. If the Seattle City Council votes Tuesday to approve an ordinance that will include caste in its anti-discrimination laws, Seattle will become the first city in the United States to outlaw such discrimination.

While the definition of caste has evolved over the centuries, under both Muslim and British rule, the suffering of those at the bottom of the caste pyramid – known as Dalits, which in Sanskrit means "broken" — has continued.

SEATTLE BECOMES FIRST US CITY TO BAN DISCRIMINATION BASED ON CASTE

The word "caste" has its origins in Latin (castus), which means chaste or pure. Caste made its way into the Indian lexicon with the arrival of the Portuguese in the 1700s who first used the word "casta" with reference to the social hierarchy in the Indian subcontinent.

How Did the Caste System Originate?

References to a societal hierarchy can be found in the millennia-old Rig Veda where a hymn describes the origin of all life from the Purusha or "supreme being." A verse states that the four categories (varnas) of Hindu society came from this infinite being. The Brahmins (priest class) appeared from the being’s head, the Kshatriyas (warriors) from his arms, the Vaishyas (business class) from his thighs and the Shudras (laborers) from his feet. The hymn does not go into details about these categories or which is superior or inferior.

The varna system initially served to classify individuals on the basis of their attributes and aptitude. However, with time, it evolved into the caste system where a person’s occupation and status in society became determined by birth. Those who were outside the system became known as the outcasts or untouchables, and later as the Dalits.

The term "jati" appears in almost all Indian languages and is closest to the word "caste" because it is related to the idea of lineage. There are more than 3,000 jatis in India. Each region in India has its own ranking of jatis. However, in every region, the Dalits are at the bottom of the hierarchy and over the centuries, have faced discrimination. Members of the Dalit community have also historically performed tasks such as manual scavenging, the dangerous and inhumane practice of removing human waste by hand from sewers. The practice continues in many parts of the country even though the Indian government banned it in 2013.

Jati also occupies a significant role within the arranged marriage system where parents look for partners for their children within their caste. This is common in diaspora communities where online matrimonial sites can be filtered by caste.

India's caste system has long been a decider of social status in the tremendous South Asian nation. (AP Photo/Gurinder Osan, File)

Is Caste Exclusive to India or Hinduism?

While the concepts of varna and jati are referenced in Hindu texts such as the Manu Smriti and the Bhagvad Gita, caste divisions are not exclusive to India or Hinduism. Caste can be found in other countries such as Bangladesh, Bhutan, the Maldives, Nepal, Pakistan, Sri Lanka and in the diaspora worldwide, and in faith communities including Buddhists, Christians, Jains, Muslims and Sikhs. Dalits who have converted to Buddhism, Christianity, Islam or Sikhism still report experiencing segregation and exclusion from places of worship and burial or cremation sites across the region.

COURT: INDIAN CANDIDATES CAN'T USE FAITH, CASTE TO GET VOTES

Is Caste a British Construct?

Under British rule, the caste system, which had previously been more fluid, was made more rigid with use of the census, which classified the entire nation into categories and schedules, said Ananya Chakravarti, associate professor of history at Georgetown University who focuses on South Asia and Latin America.

"While the British by no means invented caste, they did play a part in fixing these caste identities in perpetuity," she said. "As an institution, caste has had a very long life, way before Europeans showed up."

The British also introduced elements of affirmative action in India, which has provided marginalized groups with representation in education, employment, government programs, scholarships and politics. Based on constitutional provisions, central and state governments are allowed to set "reserved quotas or seats" in colleges, workplaces and government agencies for disadvantaged groups such as Dalits. The system of reservations has been the source of animosity between castes, with upper-caste Indians claiming that such programs and policies are antithetical to a merit-based system.

Are Race and Caste the Same?

Chakravarti cautions against equating race and caste, particularly in the U.S. where both are present. She gives the example of BAPS, a prominent Hindu sect, which is facing a lawsuit in New Jersey accusing the organization of forcing hundreds of low-caste workers to labor at temple sites across the U.S. under dangerous conditions for as little as $450 a month.

"In this case, all those involved in the case are the same race," Chakravarti said. "So race does not adequately cover the question of caste."

Cornel West, professor of philosophy at Union Theological Seminary and scholar of African American studies, says he feels kinship with Dalit activists, calling casteism and racism "institutionalized forms of hatred."

"We have no other alternative but to fight both morally, intellectually and politically," he said.

Opinion
How Israel’s culture war turns America’s upside-down


By Jason Willick

Columnist|
March 5, 2023 a

TEL AVIV — Israel and the United States each declared statehood amid wars of independence whose outcome was uncertain, and swiftly embraced the principle of popular sovereignty. As Neil Rogachevsky and Dov Zigler show in a new book, an early draft of Israel’s declaration of independence borrowed heavily from America’s. Both countries drew large-scale immigration first from Europe, and later from other corners of the world, growing more ethnically diverse over time.

So perhaps it was no surprise that I could hear echoes of polarized U.S. politics as I recently watched a major protest against Prime Minister Benjamin Netanyahu’s conservative government and its proposed changes to the judiciary.

The slogan that protesters chanted — de-mo-crat-yah, or “democracy” in Hebrew — is also on the lips of American liberals. As in the United States, a more secular coalition, rooted in the nation’s prosperous coast, is squaring off against a more religious and traditional bloc found in the nation’s inland. The pink Israeli flags at the protest, interspersed in a sea of traditional blue ones, recalled the iconography of the Women’s March in Washington and elsewhere in 2017.

But for all the similarities, Israel’s culture war is being fought on terrain very different from America’s. Recent decades have seen a dramatic decline in Christian identification in the United States, while traditional Jewish practice in Israel has ticked upward. If some Christians fear becoming a minority in the United States, it’s secular Israelis who worry about the country’s increasingly religious demographic trajectory.

In both countries, unelected supreme courts play a key role in calibrating the balance between religious and secular morality. Israel’s 15-member high court is seen as a bulwark of secularism, standing against the tide of religious opinion. It has ruled that more Tel Aviv businesses can open on Shabbat and that Israelis can’t be barred from bringing leavened bread into hospitals on Passover. The court has also limited gender separation in public spaces and circumscribed exemptions to military service for Yeshiva students. For many of Israel’s observant Jews — the ultra-Orthodox are expected to rise to 16 percent of the population by 2030, from 10 percent in 2009 — the court is an anti-democratic obstacle to a more authentically Jewish state.

That’s one key motivation for the Netanyahu government’s judicial overhaul. The prime minister’s career has been defined by security measures and economic policy, not religion, but his Knesset coalition — which broke years of gridlock by winning 64 of 120 seats in last November’s election — depends on increasingly powerful religious parties. Some of the coalition’s proposed judicial reforms are moderate, such as giving the elected government more control over judicial appointments. But one reform would allow a legislative majority to override the court, dramatically aggrandizing the power of the prime minister’s coalition. That proposal is driving the current wave of protests and deepening political crisis.

Judiciaries are designed as a check on political majorities. If Israel’s Supreme Court is defending the prerogatives of secular Jews in a religious country, the U.S. Supreme Court is keeping room for traditional Christian values in a secularizing country. “As recently as the early 1990s,” Pew Research noted last year, “about 90% of U.S. adults identified as Christians. But today, about two-thirds of adults are Christians.” Key Supreme Court decisions in recent years have pared back pandemic restrictions on religious worship, made religious schools eligible for state funding on the same footing as other private schools and, of course, allowed voters to set policy on abortion.

In response to this conservative direction, some Democrats have threatened to pack the U.S. Supreme Court, and the Dobbs v. Jackson Women’s Health Organization abortion ruling overturning Roe v. Wade was preceded by waves of unlawful protests at conservative justices’ homes. The American judiciary is not (yet) under the sort of majoritarian political assault that Israel’s is absorbing. But judicial review doesn’t come naturally in democracies, where power lies with the people. Respect for the legitimacy of unelected courts must be conjured through judicial realpolitik — the balancing of judges’ power against the power of elected officials, which can win popular acceptance over time.

Israel’s modern system of energetic judicial policymaking dates only to the 1990s, when Justice Aharon Barak led a revolution on the high court. That revolution — the project of an older, secular Israeli establishment — might not survive the country’s religious transformation, and it might not deserve to. There’s an obvious path forward: For the ruling coalition to drop the override clause, pass the other provisions and accept a more gradual tempering of judicial power.

That outcome would probably align more closely with the preferences of most Israelis. But the opposition, having sent hundreds of thousands of supporters to the streets, might rather use the issue to bring down the Netanyahu government and win the next election. And Netanyahu, having burned many bridges in his long career, might be too reliant on the coalition partners on his right to credibly negotiate.

Religious versus secular morality, and minority rights versus majority rule — these are the inexorable contradictions of American and Israeli democracy. The two countries’ approaches might be drifting apart. But the test for both is whether the clash of voters’ preferences can create incentives for politicians to reach for something like the public interest. Sometimes it appears that the stronger incentive, especially for political coalitions that believe they are on the right side of history, is instead to see what they can get away with.


Opinion by Jason WillickJ writes a regular Washington Post column on legal issues, political ideas and foreign affairs. Before coming to The Post in 2022, he wrote for the Wall Street Journal and the American Interest. Twitter

THE SCIENTIFIC REASON HUMANS LAUGH

BY RICHARD MILNER/MARCH 5, 2023 7:00 AM EST

A chuckle, a chortle, a guffaw, a titter, a gut-buster — yep, we sure have lots of words for different types of laughs. There's the anxious, forced laugh deliberately employed to reduce tension in awkward or embarrassing situations. There's the piggish snort that makes others laugh, in turn. There's the villainous "mwah ha ha" laugh, preferably in an evil lair while stroking a purring white cat. With so many nuanced shades of laughter, it's safe to say that laughter isn't just an integral part of human life across the globe, but one that serves a lot more functions than a mere reaction to a humorous situation or statement.   

Babies, for instance, laugh before they can utter a single word. But babies aren't laughing at the clever wordplay of a politically-oriented talk show host; for them, it's endless peekaboo and tickling. As Upworthy says, there are even scientists whose entire field revolves around observing laughing babies. Some people think painful accidents are hilarious, like when somewhen falls off a skateboard. And if black-and-white movies are to be believed, physical gags like a pie in the face were once the height of comedy. 

With so many causes of laughter, how can we pinpoint a specific biological purpose? Animals might hold the clue. NPR reports that 65 species of animals exhibit laughter, including various birds and our close primate brethren, gorillas, chimpanzees, and orangutans. All of these animals are social by nature, and often exhibit laughter as a form of play.

THE ULTIMATE SOCIAL GLUE

Taking into account all the myriad reasons why a person might laugh, personal tastes in comedy, and cultural differences in humor, there's one ultimate no-brainer reason that people laugh: to maintain social bonds. How Stuff Works cites anthropologist Mahadev Apte describing a "bonding-laughter-bonding" group dynamic that occurs amongst strangers and friends alike, where people laugh and grow closer, and then because they're closer laugh more. This kind of pattern becomes reinforced through peer pressure and social norms, as folks don't want to be left out of the group. In fact, laughter is so tied to group behavior that people are 30 times more likely to laugh when in a group, as WebMD cites Robert R. Provine, Ph.D., a behavioral neurobiologist at the University of Maryland. Smiling and talking, by contrast, only happen six and four times more in a group.

For animals as social as humans, many researchers believe that laughter is our lynchpin social behavior, like barking to a dog or singing to a bird. Most critically, it extinguishes the fight-or-flight response. Imagine roving through a natural habitat and coming across a band of other people. How do you know they're safe to deal with? Friendliness and laughter. It's almost impossible to laugh and feel aggressive at the same time. As anyone who's been in an argument can tell you, laughter turns rigid, tense bodies to mush. And for those who've passed through dangerous situations, it's a way to calm down and give the all-clear.

SPOTTING A FAKE

If laughter developed as a way to diffuse tense situations amongst early humans, that means that laughter exists more to tacitly control others than to cheer oneself up. On How Stuff Works, Dr. Robert R. Provine says that laughter is deployed by group leaders to regulate the emotional tenor of the group. In fact, socially dominant individuals — like a supervisor in the modern world — use laughter more than members of lower social rank. This means that laughter is also a way for individuals to signify status. Further to the point, speakers laugh a whopping 46% more than listeners, as Scientific American says. This indicates that laughter is less of a response to others and more of an attempt to direct the behavior of others from the top down. 

And yet, not any laughter will do. The best laughter is authentic laughter. In an article published by the Proceedings of the National Academy of Sciences (PNAS), researchers found that people can accurately tell just by listening which laughter comes from close friends rather than people who've just met; no body language, no visual cues, no conversation — just the laughter. This means that laughter is also a way to learn about the relationships of others in a group, and spot which individuals aren't totally integrated. That means it's an excellent way to spot a fake. It also means that people are more adept at discerning fake laughter than they are fake words.

INVOLUNTARY AND VOLUNTARY LAUGHTER

Things get a bit more complicated when figuring out why humans laugh in a physiological and neurological sense. For such a seemingly simple and commonplace action, there's quite a bit going on in the brain that produces laughter as an output. Science ABC tells us that there are actually two types of laughter: involuntary and voluntary. Involuntary laughter involves a simple, reflexive reaction like a baby responding to being tickled. Sensory information only passes through the most basic parts of the brain: the thalamus (an information relay center), the amygdala (related to emotional processing), and the brain stem (connected to automatic response). By contrast, voluntary laughter activates the temporal lobe related to the intake and processing of information. This happens when your mind is deciding in the moment, more or less, whether or not to respond to stimuli with laughter.

But whether involuntary or voluntary, there's no denying that humans are built to laugh. Besides all the aforementioned psychological and neurological causes of laughter, and all the social complications underpinning laughter, people also laugh because people like doing what feels good. The simple act of laughing is enough to make someone want to laugh more. To the point, Mayo Clinic says that laughter released endorphins, stimulates the flow of oxygen and blood through the body, reduces one's heart rate, decreases blood pressure, and over time improves the immune system, elevates mood, and even reduces pain. Isn't that enough of a reason to laugh?

How common is transgender treatment regret, detransitioning?

CONVERSION THERAPY BY ANY OTHER NAME

By LINDSEY TANNER

yesterday

South Dakota Republican Rep. Jon Hansen speaks during a news conference at the state Capitol, Tuesday, Jan. 17, 2023, in Pierre, S.D. Hansen is pushing a bill to outlaw gender-affirming health care for transgender youth. (AP Photo/Stephen Groves, File)

Many states have enacted or contemplated limits or outright bans on transgender medical treatment, with conservative U.S. lawmakers saying they are worried about young people later regretting irreversible body-altering treatment.

But just how common is regret? And how many youth change their appearances with hormones or surgery only to later change their minds and detransition?

Here’s a look at some of the issues involved.

WHAT IS TRANSGENDER MEDICAL TREATMENT?

Guidelines call for thorough psychological assessments to confirm gender dysphoria — distress over gender identity that doesn’t match a person’s assigned sex — before starting any treatment.

That treatment typically begins with puberty-blocking medication to temporarily pause sexual development. The idea is to give youngsters time to mature enough mentally and emotionally to make informed decisions about whether to pursue permanent treatment. Puberty blockers may be used for years and can increase risks for bone density loss, but that reverses when the drugs are stopped.

Sex hormones — estrogen or testosterone — are offered next. Dutch research suggests that most gender-questioning youth on puberty blockers eventually choose to use these medications, which can produce permanent physical changes. So does transgender surgery, including breast removal or augmentation, which sometimes is offered during the mid-teen years but more typically not until age 18 or later.


Reports from doctors and individual U.S. clinics indicate that the number of youth seeking any kind of transgender medical care has increased in recent years.

HOW OFTEN DO TRANSGENDER PEOPLE REGRET TRANSITIONING?

In updated treatment guidelines issued last year, the World Professional Association for Transgender Health said evidence of later regret is scant, but that patients should be told about the possibility during psychological counseling.

Dutch research from several years ago found no evidence of regret in transgender adults who had comprehensive psychological evaluations in childhood before undergoing puberty blockers and hormone treatment.

Some studies suggest that rates of regret have declined over the years as patient selection and treatment methods have improved. In a review of 27 studies involving almost 8,000 teens and adults who had transgender surgeries, mostly in Europe, the U.S and Canada, 1% on average expressed regret. For some, regret was temporary, but a small number went on to have detransitioning or reversal surgeries, the 2021 review said.

Research suggests that comprehensive psychological counseling before starting treatment, along with family support, can reduce chances for regret and detransitioning.

WHAT IS DETRANSITIONING?

Detransitioning means stopping or reversing gender transition, which can include medical treatment or changes in appearance, or both.

Detransitioning does not always include regret. The updated transgender treatment guidelines note that some teens who detransition “do not regret initiating treatment” because they felt it helped them better understand their gender-related care needs.
Research and reports from individual doctors and clinics suggest that detransitioning is rare. The few studies that exist have too many limitations or weaknesses to draw firm conclusions, said Dr. Michael Irwig, director of transgender medicine at Beth Israel Deaconess Medical Center in Boston.

He said it’s difficult to quantify because patients who detransition often see new doctors, not the physicians who prescribed the hormones or performed the surgeries. Some patients may simply stop taking hormones.

“My own personal experience is that it is quite uncommon,” Irwig said. “I’ve taken care of over 350 gender-diverse patients and probably fewer than five have told me that they decided to detransition or changed their minds.”

Recent increases in the number of people seeking transgender medical treatment could lead to more people detransitioning, Irwig noted in a commentary last year in the Journal of Clinical Endocrinology & Metabolism. That’s partly because of a shortage of mental health specialists, meaning gender-questioning people may not receive adequate counseling, he said.


Dr. Oscar Manrique, a plastic surgeon at the University of Rochester Medical Center, has operated on hundreds of transgender people, most of them adults. He said he’s never had a patient return seeking to detransition.

Some may not be satisfied with their new appearance, but that doesn’t mean they regret the transition, he said. Most, he said, “are very happy with the outcomes surgically and socially.”

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Follow AP Medical Writer Lindsey Tanner at @LindseyTanner.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Iran: US in No Position to Lecture Others on Human Rights, Democracy

TEHRAN (FNA)- Iranian Foreign Ministry Spokesman Nasser Kana'ani deplored the US governments’ fake advocacy for human rights, and said supporters of occupation and aggression are not qualified to comment on human rights and democracy.

“There was a time the US was backing the apartheid regime in South Africa, the CIA helped it arrest Mandela,” Kana'ani wrote on his Twitter account on Sunday.

New details being published Monday by TIME appear to strengthen claims that the CIA helped South Africa's racist regime capture anti-apartheid leader Nelson Mandela in 1962. The report adds to evidence that President John F. Kennedy's administration played a role in Mandela's arrest at a time when US officials were coming to grips with an increasingly intense civil rights movement in America.

Mandela wound up spending 27 years in prison for leading the African National Congress (ANC), which opposed apartheid policies that kept South Africa's Black residents segregated, often in inhumane conditions. He finally was released in 1990 as apartheid crumbled, and was elected South Africa's first Black president in 1994, serving for five years. He died in 2013 at age 95.

“Today, it is a strategic ally and supporter of the apartheid Zionist regime. The US does not deserve to defend human rights and democracy," the spokesperson added.

"It does not believe in them at all,” he stressed.

Iran describes Israel as the root cause of the region’s instability and insecurity, but also stresses Israel's US-supported barbarity will not change the inevitable fate of the Tel Aviv regime.

Tehran says the history of the apartheid regime is full of assassinations, massacre, torture and killing of Palestinian kids, and described Tel Aviv regime's atrocities and massacre of Palestinian women and children as indicative of the destitute of Zionists.

The increased attacks of Israeli soldiers and settlers against the occupied territories have made 2022 the deadliest year for the Palestinians since 2005, according to United Nations Office for the Coordination of Humanitarian Affairs (OCHA). The raids have claimed the lives of at least 220 Palestinians, including at least 50 children.

Kana'ani's remarks came after Israeli Finance Minister Bezalel Smotrich stated that the Palestinian village of Huwara "needs to be wiped out", adding that he thought "Israel should do it".

It comes after hundreds of armed Israeli settlers attacked Huwara and nearby villages and torched dozens of houses and cars. One Palestinian was killed during the settler rampage and at least 400 others were injured, with Palestinian media reporting stabbings and attacks with metal rods and rocks.

The Israeli regime's forces and settlers have escalated their deadly acts of aggression against the Palestinians since late December 2022, when Benjamin Netanyahu staged a comeback as the regime's prime minister at the head of a cabinet of hard-right and ultra-Orthodox parties.

Since the start of the year, at least 68 Palestinians have been killed as a result of the violence, including five, who were killed by Israeli settlers' gunfire, 13 children, four elderly people, and one prisoner.

Sufis Aren’t an Apolitical Counterweight to Political Islam, Babadzhanov Says

            Staunton, March 5 – Many post-Soviet analysts and officials have argued that Sufism, the mystical trend in Islam, can serve as a powerful bulwark against followers of political Islam and have even urged that their governments support Sufi orders as allies in the struggle against Islamism.

            (For background on such advocacy, see windowoneurasia2.blogspot.com/2022/03/view-that-sufism-represents-stabilizing.html, windowoneurasia2.blogspot.com/2021/05/sufism-offers-spirituality-traditional.html, windowoneurasia2.blogspot.com/2019/10/sufism-most-effective-means-to-counter.html and windowoneurasia2.blogspot.com/2016/07/sufism-better-than-state-as-bulwark.html.)

            But that attitude and the policies that arise from it are beginning to change, as ever more observers recall the role of militant Sufis in the 19^th century and deal with the problems, often greater than those posed by Islamist groups, that some Sufi orders present across the post-Soviet space.

            (For examples of such problems, see windowoneurasia2.blogspot.com/2022/12/kadyrov-raising-military-unit-based-on.html, windowoneurasia2.blogspot.com/2022/11/chechnyas-kadyrov-takes-up-cause-of.html and windowoneurasia2.blogspot.com/2022/11/russian-officials-accuse-influential.html.)

            Now, Bakhtiyar Babadzhanov, a scholar at Tashkent’s Institute of Oriental Studies, has attacked as “a cognitive mistake” the view that Sufism in principle is “apolitical” and warned officials in Uzbekistan and elsewhere that Sufism is a militant threat (ia-centr.ru/experts/iats-mgu/ostanetsya-li-sufizm-v-tsentralnoy-azii-vne-politiki-/).

            It is likely that he will be accused of ignoring those aspects of Sufism that genuinely are pacific and apolitical in order to make his case; but it seems likely that Babadzhanov’s argument likely presages a shift in policy not only in Uzbekistan against a segment of Islam even the Kremlin thought it could work with.

            To the extent that is true, the Sufis are likely to respond not by withdrawing from politics and militance but by doubling down on both, something that sets the stage for potentially serious consequences not only in areas where Sufis have been traditionally strong but in others where they have been growing in many cases because of state protection. 

Putin has Helped West Overcome Its Mistaken Assumption that Economic Integration Promotes Democratization , Tikhonov Says

            Staunton, Mar. 3 – When communism in Europe collapsed, the cold war ended, and the USSR disintegrated, the West made the mistaken assumption that economic integration would destroy authoritarianism, Aleksey Tikhonov says. In fact, authoritarian leaders like Putin were able to use that integration to strengthen themselves and their dictatorships.

            Putin and others like him might have been able to continue to do so had the current Kremlin leader not so overreached, forcing not only the United States but European countries to recognize that economic integration does not necessarily promote democratization, the Russian commentator says (kasparov.ru/material.php?id=640344461B35B).

            After 1991, Tikhonov continues, “economic integration did not eliminate authoritarianism.” Instead, it had the opposite effect because authoritarians like Putin used it to their advantage. They “built up their economic power through Western markets, investment, and technology but rejected Western democratic values and institutions.”

            As a result of its new and very deep economic ties with the West, “the authoritarian regimes of the 21^st century gained access to all the benefits of Western civilization without having to accept Western values, something that the socialist camp earlier had never been able to do.”

            Indeed, he says, “the chief reason for the collapse of the socialist bloc was the colossal gap between the standards of living in capitalist countries and the socialist ones and the lack in the latter of services and goods available to anyone in the West.” As a result, “no one believed tales about the superiority of the socialist model.”

            But today, “in authoritarian countries” like Putin’s Russia, “the same benefits are available as in the West. And it is “no accident” that “Russian propaganda so actively points out that despite Western sanctions, all modern goods and services remain available in Russia to this day.”

            Moreover, Tikhonov says, “authoritarian countries began to destroy Western countries from within, gradually penetrating them via corrupt tentacles. Both Russia an dchina have actively infiltrated the economy and political system of the West by purchasing businesses, promoting infrastructure projects and corrupting local politicians.”

            That might have gone on for some time given the willingness of some American leaders like Trump to try to get Russia to ally with the US against China without doing anything about its own situation and the willingness of Europeans to go along with Russia despite all that it had been doing.

            But “by invading Ukraine, Putin has shown Europe that the US was right” in its assessments of Russia; and thus “as a result, Putin had done what the US wasn’t: shown Europe that projects of economic integration as a means of struggle with authoritarianism have suffered defeat.”

            Given that and the new commitment of the West to combat Russian authoritarianism and aggressiveness, there is no reason to think the West’s words about supporting Ukraine are for nothing. Indeed, “the longer Putin fights there, the more likely Russia’s disintegration after its defeat becomes’as it is Putin who is “destroying the remnants of Russian influence in Europe.”

            At the same time, Tikhonov points out, “Putin’s actions aren’t helping China either,” although it is not yet clear that Beijing fully appreciates the damage Putin has done to China’s exploitation of economic integration with the West, the maintenance of which is now far more problematic.

Opinion
Minnesota’s vote to re-enfranchise felons is a victory for democracy


By Jennifer Rubin

Columnist|
March 5, 2023 

It is sometimes difficult to tell whether democracy defenders are holding the line against authoritarian forces. But this past week, we saw evidence of real progress in expanding suffrage, a key aspect of democracy. Specifically at issue: restoring voting rights to former felons.

Democracy Docket, the progressive outlet in favor of voting rights, reports, “On Tuesday, the Minnesota state Senate sent a bill to the governor that would restore voting rights to individuals with past felony convictions immediately upon release from incarceration.”

And it’s not just Minnesota. “As of Monday, Feb. 20,” Democracy Docket explains, “at least 73 bills related to felony disenfranchisement have been introduced in over 20 states. Of these 73 bills, 68 of them ease existing felony disenfranchisement laws to differing extents. This means that 93% of bills related to voting rights in the criminal legal system move in the pro-voting direction, a stark comparison to other policies governing voting access.”

It’s no mystery how these laws got on the books. No sooner had Black people received the right to vote after the Civil War did states began enacting felony disenfranchisement. And with the movement toward mass incarceration, which fell disproportionately on Black Americans (including for nonviolent drug crimes), the population of permanently disenfranchised minority Americans ballooned.

The Sentencing Project, which advocated for voting and criminal justice reform last year, reported ahead of the midterms: “Laws in 48 states ban people with felony convictions from voting. In 2022, an estimated 4.6 million Americans, representing 2 percent of the voting-age population, will be ineligible to vote due to these laws or policies, many of which date back to the post-Reconstruction era.”

Reconsideration of this assault on democracy is overdue. Re-enfranchising millions of Americans who have paid their debts to society would be a powerful step in the direction of universal voting, a core principle of democracy.

And expanding voting is popular: A 2022 poll conducted by Lake Research Partners on behalf of State Innovation Exchange, Stand Up America, the Sentencing Project and Common Cause found that 56 percent of voters favor allowing all eligible voters “including citizens completing their sentence, both inside and outside of prison,” to vote. Just 35 percent oppose the idea.

To be certain, there have been high-profile losses on this front, as well. Republicans effectively overturned the will of Florida voters, 65 percent of whom voted in 2018 to allow felons who had served their sentences to regain voting rights. It did not take long for Florida’s Republican lawmakers and governor to “severely” roll back that effort, the New York Times reported. By requiring those who leave prison to repay court fines and fees, the state effectively re-barred these people from voting. Consider it a 21st-century version of a poll tax.

It was telling that five of the six federal judges who voted to strip away voting rights were appointed by President Donald Trump. Making matters worse, Florida Gov. Ron DeSantis (R) unleashed a squad of election police to arrest voters, most of whom were Black, who tried to cast votes thinking they had regained their rights. Those cases soon collapsed.

Fortunately, Florida seems to be swimming against the tide, even among red states. States moving toward liberalizing voting for former felons include Kentucky, Mississippi, Tennessee and Nebraska. Perhaps Florida’s Republicans can be shamed into rethinking their war on enfranchisement.

The battle to preserve democracy won’t succeed in a week or a month or a year. But progress is still being made that can restore rights to millions of potential voters. There is reason for hope.



Opinion by Jennifer RubinJennifer Rubin writes reported opinion for The Washington Post. She is the author of “Resistance: How Women Saved Democracy from Donald Trump.” Twitter

How the Supreme Court Could Break the Internet

Section 230 has been the key to our free and open Internet. Eliminating it now would be a deeply dangerous move.

Sunday, March 5, 2023

 

Elijah Gullett

Online free speech has been under fire from Congress, past presidents, and pundits from both sides of the political aisle. Now, it faces a new threat: the Supreme Court.

Two upcoming Supreme Court cases, Gonzalez v. Google and Twitter v. Taamneh, will present a significant challenge to the liability immunity granted to Internet Service Providers (ISP) as the complainants attempt to hold the tech giants liable for terrorist content posted on their platforms and allegedly promoted by their algorithms. By posing a threat to this broad liability immunity, these cases also pose a major threat to existing speech protections and to the Internet as we know it. The Supreme Court should side with Twitter and Google, upholding the immunity granted by Section 230 of the Communications Decency Act of 1996.

Section 230 protects online speech by shielding platforms like Google and Twitter from liability for the speech of their users. Search engines and social media sites are protected because they are considered “platforms” rather than “publishers.” Under the provision, ISPs can engage in the good faith moderation of content hosted on their sites, but they do not actively curate content. This practice contrasts with the practices of publishers like newspapers that actively curate and edit the content they host. The publisher-platform distinction is important because it carries significant legal consequences. If someone posts libelous content on Twitter, Twitter can’t be held legally liable, but if a newspaper like The New York Times publishes the same content, they could face serious legal consequences.

The protections provided by the “platform” classification of ISPs are what make the modern Internet possible as they allow Internet companies to be economically viable. If a site could be sued or shut down for the content a user posts, the risks would be astronomical, making it nearly impossible for a site, especially a startup, to exist for any extended period of time. A report from the Engine Foundation, a tech policy non-profit, found that tech companies face major costs for lawsuits, with lawyer fees alone costing between $130,000 to $730,000 for a single lawsuit. Therefore, removing liability immunity by repealing or reforming Section 230, and thereby opening up Internet platforms to greater liability and more lawsuits, would have disastrous consequences for the tech industry. Such a change in policy would be a serious hit to big tech, but tech startups and smaller competitors would feel the pinch even more, thereby reducing consumer choice. Conservatives often complain about sites silencing them or shadowbanning their content, but without Section 230, they wouldn’t have alternative platforms like Parlor and Truth Social. Therefore, along with encouraging growth in the tech industry, the Section 230 formula is the secret sauce that keeps our Internet speech free and open.

Without these protections, websites like Twitter would be forced to intensely monitor content, searching for even the smallest infraction that could be seen as illegal or libelous, all to avoid potential lawsuits. Users of all political stripes are already concerned with over-moderation, whether it be anti-conservative bias or minority communities overly policed by content moderators. Removing Section 230 protections would ramp up content moderation tenfold as social media sites scramble to avoid lawsuits, only heightening these existing concerns.

Despite the risks of Section 230 reform, pressure is mounting from all sides to curb online speech through legal means. Republicans like Senator Josh Hawley and Democrats like Elizabeth Warren have united against online speech protections, pushing to repeal Section 230, force ISPs to moderate content as politicians see fit and crack down on “disinformation.” Even Justice Clarence Thomas has suggested that it's time to begin “pairing back the sweeping immunity” tech companies currently experience.

However, these proposals to roll back or even strip ISPs of their immunity protections flies in the face of the American legal tradition of protecting free speech. Section 230, on the other hand, fits neatly within this legal tradition, which includes cases like Smith v. California (1959) where the Supreme Court decided that intermediaries, such as bookstores, are protected against liability for the content of the materials they carry. In past cases, the Court has erred on the side of protecting speech, rather than regulating it, and they should do the same now.

As the ACLU and other civil liberties organizations stated in their recent amicus brief presented to the Court, ruling against the companies in Gonzalez and Twitter could end up “chilling platforms,” forcing them to over-moderate their content to eliminate anything that might bring them before a judge.

Our pursuit of justice should never come at the expense of our most basic civil liberty: freedom of speech. In a world where truth is contested and politics are fickle, a free and open Internet is a necessary part of protecting this freedom. Section 230 has been the key to our free and open Internet, and eliminating it now would be a deeply dangerous move.