I read a handful of items linked from Freddie deBoer's subscriber writing each month, and normally when I don't like one I just move on, no need to be bitchy. But this honestly sent me:
"The World Professional Association for Transgender Health (WPATH) is the body from which treatment guidelines emanate. Trans-identifying men are prominent among the ‘experts’ who hand down the guidance of care for all gender-questioning patients. This departs from the principle of clinical neutrality that governs good science."
I'm sorry but that just seems very dumb. Do you think that therapists who have benefited from therapy themselves are too conflicted to count as "experts" in advising on clinical processes? Do you think trans people, specifically, just shouldn't be allowed to treat trans people because of this conflict? Because one board (which is not, as you imply, the exclusive body from which treatment guidelines emanate for trans people) has some trans women on it?
If you want your """""concerns""""" to be taken seriously, maybe you could present them in literally any other way than how Matt Walsh (the world's dumbest man) would present them
"In fact, a closer inspection of the available research shows a much greater likelihood of suicide among post-op transgender patients than among youth whose desire for medical transition is postponed or denied."
I think this is a critical issue that would greatly benefit from some objective facts.
As a trans adult myself, I think a lot of us get very wrapped up in the idea of what our lives could have been if we had transitioned earlier. It colors our attitudes towards children who may or may not be in the same situation! The whole thing requires so much nuance and care, that our culture-war-addled society is not able to give.
In some ways I'm glad that I didn't "get help" as a kid, either from gender medicine or from psychiatry. It was a rough path to adulthood, and I might not have made it, but I at least got the chance to understand myself in ways deeper than pronoun pins and DSM labels can express, and without the often-inept meddling of doctors.
Anyway, thanks for writing this. I don't agree with all of it (which shouldn't be a prerequisite for engaging with a piece of writing, but here we are) and I do wish you had provided citations for your more quantitative claims.
Thank you, Keegan, for the thoughtful comment, and it's a fair point about citations. This was a chapter in a recently-published book which includes thorough citations. For my own Substack I omitted them, but should have put them back before submitting the piece to Freddie DeBoer's, which I assume is where you found it. Please see my reply to Julia below, about how I plan to correct this error later this week.
I found this post through an advertisement on another blog, so apologies if I'm intruding. But as a trans woman myself I can't in good conscience leave without giving my thoughts. Plus much of the information written here is plain wrong.
>Trans-identifying men are prominent among the ‘experts’ who hand down the guidance of care for all gender-questioning patients. This departs from the principle of clinical neutrality that governs good science.
This framing of this point implies that trans people cannot be experts in their own conditions. Cisgender people have a very hard time understanding what gender dysphoria feels like -- what better person to explain that than someone who actually lives with it? Trans people have suffered for decades trying to receive medical care to alleviate their dysphoria from doctors who don't understand their suffering and are often times forced to lie in order to conform to cis expectations of what trans people ought to be. "From a prepubertal age I always played with the opposite of my assigned gender's toys"; "I am only attracted to the opposite sex and would never enter a homosexual relationship post-transition"; "I enjoy putting on makeup and wearing dresses and heels and I strive to be as feminine as possible"; "I am disgusted by my genitals and want to have the body of my identified gender in order to have heterosexual sex". Fortunately the world is changing and with informed consent practices and trans-positive healthcare, trans people are able to be more truthful with their doctors.
>Children given puberty blockers followed by cross-sex hormones will reach adulthood without having experienced puberty at all.
This is not true. An AMAB child who takes puberty blockers and then estrogen will go through a female puberty. An AFAB child who takes puberty blockers and then testosterone will go through a male puberty. Even a trans person goes through their assigned gender's puberty, they can go through a "second puberty" when starting HRT. Speaking from experience, your body and emotions change in a very similar way as during your "first puberty", only... it's the other way around.
>Teenage girls may embark on a lifelong relationship with synthetic testosterone administered weekly or bi-weekly.
Why would a girl take testosterone? It only makes sense for trans men to take testosterone, not cis girls Misgendering the article's subjects is unhelpful.
>Known side effects include: elevated risk of heart attack, type 2 diabetes, thyroid disease, autoimmune disease, bone loss, premature menopause, impaired sexual function, cognitive impairments, and mood disorders including suicidality.
This is all true (I assume). But other effects may be: lowered risk of breast cancer, increased libido (which may be a good or bad thing), cognitive improvements due to increased happiness and reduced depression, and the cessation of suicidality due to alleviating gender dysphoria. It's a two-way street. Yes, hormones, especially testosterone, can have negative effects. But they are only prescribed because the positive effects are deemed to outweigh the negative effects.
>This treatment is not shown to resolve dysphoria.
Um, yeah, sure. It works for me. Sometimes transitioning can make dysphoria temporarily worse as people take a closer look at their bodies. But that most often is the hard part before it gets easier and hormones start having their intended effects. And the alternative is repressing it until..., I guess until you die? If you have a reputable study in mind that shows that HRT doesn't resolve dysphoria I'd be happy to look at it but my feeling is that no such study exists.
>Even when genital surgeries go as planned, female patients don't get a functioning penis, nor do male patients gain anything resembling a woman's internal genitalia, but rather an empty cavity. Common complications are severe and include anal or rectovaginal fistulas, severe bowel injuries, infections, inflammation and, of course, sterility.
Bottom surgery is a big deal. But no one undergoes it without knowing the risks, and rates of regret are surprisingly low compared to other "cosmetic" surgeries (nose jobs, liposuction, etc.). Again, misgendering your article's subject is unhelpful and disrespectful. This section is sensationalist and unconvincing to me. I will note that "functioning penis" and the subsequent description of vaginoplasty is subjective and many trans people are happy with their postop genitalia, even if they cannot get an erection, conceive a child, or menstruate. I don't think bottom surgery patients undergo surgery thinking they're about to get the vagina/penis of their wildest dreams. Our desires have to come up against the limits of current medical technology somewhere
>Testosterone will cause her female genitalia to atrophy.
In fact the opposite is true. Testosterone causes the clitoris to grow bigger. Many trans men feel euphoric from this and choose to think of it as a small penis rather than a clitoris.
>As her estrogen secretion is suppressed, early menopause ensues, and a hysterectomy may be indicated. Should she undertake these 'therapies', she will likely never experience an orgasm, much less bear a child. Image is, literally, everything.
...What? It doesn't really make sense to think of someone on testosterone as going through menopause. Women who experience negative symptoms from menopause do so because they have no significant estrogens *or* androgens in their body. As a result, many begin HRT, a perfectly natural remediation.... but that's besides the point. As for trans men being unable to experience an orgasm, I've never heard of anything crazier, and I can speak from personal (ok, strictly speaking secondhand) experience here, lol. Trans men can get pregnant as well, there are many breathless tabloid articles about it you can find with a quick google search.
>In fact, a closer inspection of the available research shows a much greater likelihood of suicide among post-op transgender patients than among youth whose desire for medical transition is postponed or denied.
Citation, please. My impression is the data shows the complete opposite.
I won't pick out any quotes in particular but the push to "drop the T" from LGBT makes me very sad. Cisgender gay and bi people will not make themselves more genuinely accepted by marginalizing trans people. They will achieve a veneer of acceptance from the right-wing but will quickly find themselves on the chopping block when it becomes politically expedient. It's true that trans people are different from cis gay people, but gay men and gay lesbians are also different, yet they have (for the most part) chosen to band together as political allies because they experience the same hatred and can find community with each other.
I hope you will take my response with grace and respect as I hope I have done the same for you.
Julia, I've read your comment carefully, and first I really want to thank you for writing it. I started to reply but found I wasn't able to insert links in this field. With your permission, I'd like to paste your whole comment, and my reply, and publish the conversation as a stand-alone post. It will take me a few days to make sure I address all your points, so maybe I'll post it on Thursday, with thanks for the possibility of honest, respectful discourse on such a fraught, polarized topic. Are you okay with that?
Thank You! And it's not just the Netherlands, Sweden, Finland and England:
France: "NAMF cautions practitioners that the growing cases of transgender identity in young people are often socially-mediated and that great caution in treatment is needed. Hormonal and surgical treatments carry health risks and have permanent effects, and that it is not possible to distinguish a durable trans identity from a passing phase of an adolescent's development."
Norway: "The NHIB/UKOM has deemed puberty blockers, cross-sex-hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised."
Denmark: “By 2022, only 6% of the youth referred to the centralized gender clinic in Denmark were prescribed hormonal treatments, and surgical transitions for minors were completely discontinued.”
And the psych practitioners' group in Australia: "NAPP has just released new guidelines regarding the treatment of children and teens with gender dysphoria. They warn of the dangers of medical treatment and encourage a cautious and therapy-based approach rather than a ‘gender affirming’ model."
Thanks, Hazel. All the dynamic progress in the politics and research show us the limitations of the book publishing process -- and conversely the great benefit of a real-time publishing platform like this one!
Thank you so much for this. It is so spot on but no less horrific for that. Are you in touch with PITT (Parents with Inconvenient Truths about Trans)? They are compiling stories from heartbroken parents about this whole issue. I’ll tweet your whole article to them.
Thanks Liz! Yes, I've been a fan of PITT essays since they first appeared, and just published my first PITT piece ('Some Thoughts on Speaking Out') last Monday. It's an amalgam of two posts by the same title from my own Substack, and it brought me a huge number of new subscribers, for which I'm so grateful. They are a powerful and important voice.
I see 51K members on detrans reddit. Where did you see 100,000? Is there another forum? (I am on your side ,btw, it's a brilliant essay, I am just trying to clarify the numbers).
I know, and thank you for the kind words. I need to try and find some emails between me and the book editor, but it's very likely the 100,000 figure is an error that I made in an early draft that was corrected in the final draft. I didn't use the final for this post because it's written in UK vernacular, whereas American feels more appropriate here. I will update with a correction if I screwed up, which I have a sinking feeling is the case!
No worries! Besides the biggest subreddit r/detrans, there is https://www.reddit.com/r/actual_detrans/ , a smaller forum started because some felt that r/detrans was "too transphobic".
FWIW, the rules at r/detrans say that the only non-detrans allowed to join the forum are medical/health professionals working in the field.
I think the rules were looser when I first looked at it; I remember noting that I could join as a loved one (or family member, or something like that) without violating their rule. Whatever they prefer, it's impossible to know how many members are abiding by the preference, but I think the pace of growth is noteworthy even if membership is not tightly regulated.
Thank you for sharing. You compiled so many important facts and figures into one concise piece. I’ll save this for sharing with others who are curious to learn more.
I read a handful of items linked from Freddie deBoer's subscriber writing each month, and normally when I don't like one I just move on, no need to be bitchy. But this honestly sent me:
"The World Professional Association for Transgender Health (WPATH) is the body from which treatment guidelines emanate. Trans-identifying men are prominent among the ‘experts’ who hand down the guidance of care for all gender-questioning patients. This departs from the principle of clinical neutrality that governs good science."
I'm sorry but that just seems very dumb. Do you think that therapists who have benefited from therapy themselves are too conflicted to count as "experts" in advising on clinical processes? Do you think trans people, specifically, just shouldn't be allowed to treat trans people because of this conflict? Because one board (which is not, as you imply, the exclusive body from which treatment guidelines emanate for trans people) has some trans women on it?
If you want your """""concerns""""" to be taken seriously, maybe you could present them in literally any other way than how Matt Walsh (the world's dumbest man) would present them
Do you have a cite for this sentence?
"In fact, a closer inspection of the available research shows a much greater likelihood of suicide among post-op transgender patients than among youth whose desire for medical transition is postponed or denied."
I think this is a critical issue that would greatly benefit from some objective facts.
Yes, and you’ll find it in a post I’m working on for Thursday in response to Julia’s comment below. Please stay tuned, and thanks for asking.
As a trans adult myself, I think a lot of us get very wrapped up in the idea of what our lives could have been if we had transitioned earlier. It colors our attitudes towards children who may or may not be in the same situation! The whole thing requires so much nuance and care, that our culture-war-addled society is not able to give.
In some ways I'm glad that I didn't "get help" as a kid, either from gender medicine or from psychiatry. It was a rough path to adulthood, and I might not have made it, but I at least got the chance to understand myself in ways deeper than pronoun pins and DSM labels can express, and without the often-inept meddling of doctors.
Anyway, thanks for writing this. I don't agree with all of it (which shouldn't be a prerequisite for engaging with a piece of writing, but here we are) and I do wish you had provided citations for your more quantitative claims.
Thank you, Keegan, for the thoughtful comment, and it's a fair point about citations. This was a chapter in a recently-published book which includes thorough citations. For my own Substack I omitted them, but should have put them back before submitting the piece to Freddie DeBoer's, which I assume is where you found it. Please see my reply to Julia below, about how I plan to correct this error later this week.
I found this post through an advertisement on another blog, so apologies if I'm intruding. But as a trans woman myself I can't in good conscience leave without giving my thoughts. Plus much of the information written here is plain wrong.
>Trans-identifying men are prominent among the ‘experts’ who hand down the guidance of care for all gender-questioning patients. This departs from the principle of clinical neutrality that governs good science.
This framing of this point implies that trans people cannot be experts in their own conditions. Cisgender people have a very hard time understanding what gender dysphoria feels like -- what better person to explain that than someone who actually lives with it? Trans people have suffered for decades trying to receive medical care to alleviate their dysphoria from doctors who don't understand their suffering and are often times forced to lie in order to conform to cis expectations of what trans people ought to be. "From a prepubertal age I always played with the opposite of my assigned gender's toys"; "I am only attracted to the opposite sex and would never enter a homosexual relationship post-transition"; "I enjoy putting on makeup and wearing dresses and heels and I strive to be as feminine as possible"; "I am disgusted by my genitals and want to have the body of my identified gender in order to have heterosexual sex". Fortunately the world is changing and with informed consent practices and trans-positive healthcare, trans people are able to be more truthful with their doctors.
>Children given puberty blockers followed by cross-sex hormones will reach adulthood without having experienced puberty at all.
This is not true. An AMAB child who takes puberty blockers and then estrogen will go through a female puberty. An AFAB child who takes puberty blockers and then testosterone will go through a male puberty. Even a trans person goes through their assigned gender's puberty, they can go through a "second puberty" when starting HRT. Speaking from experience, your body and emotions change in a very similar way as during your "first puberty", only... it's the other way around.
>Teenage girls may embark on a lifelong relationship with synthetic testosterone administered weekly or bi-weekly.
Why would a girl take testosterone? It only makes sense for trans men to take testosterone, not cis girls Misgendering the article's subjects is unhelpful.
>Known side effects include: elevated risk of heart attack, type 2 diabetes, thyroid disease, autoimmune disease, bone loss, premature menopause, impaired sexual function, cognitive impairments, and mood disorders including suicidality.
This is all true (I assume). But other effects may be: lowered risk of breast cancer, increased libido (which may be a good or bad thing), cognitive improvements due to increased happiness and reduced depression, and the cessation of suicidality due to alleviating gender dysphoria. It's a two-way street. Yes, hormones, especially testosterone, can have negative effects. But they are only prescribed because the positive effects are deemed to outweigh the negative effects.
>This treatment is not shown to resolve dysphoria.
Um, yeah, sure. It works for me. Sometimes transitioning can make dysphoria temporarily worse as people take a closer look at their bodies. But that most often is the hard part before it gets easier and hormones start having their intended effects. And the alternative is repressing it until..., I guess until you die? If you have a reputable study in mind that shows that HRT doesn't resolve dysphoria I'd be happy to look at it but my feeling is that no such study exists.
>Even when genital surgeries go as planned, female patients don't get a functioning penis, nor do male patients gain anything resembling a woman's internal genitalia, but rather an empty cavity. Common complications are severe and include anal or rectovaginal fistulas, severe bowel injuries, infections, inflammation and, of course, sterility.
Bottom surgery is a big deal. But no one undergoes it without knowing the risks, and rates of regret are surprisingly low compared to other "cosmetic" surgeries (nose jobs, liposuction, etc.). Again, misgendering your article's subject is unhelpful and disrespectful. This section is sensationalist and unconvincing to me. I will note that "functioning penis" and the subsequent description of vaginoplasty is subjective and many trans people are happy with their postop genitalia, even if they cannot get an erection, conceive a child, or menstruate. I don't think bottom surgery patients undergo surgery thinking they're about to get the vagina/penis of their wildest dreams. Our desires have to come up against the limits of current medical technology somewhere
>Testosterone will cause her female genitalia to atrophy.
In fact the opposite is true. Testosterone causes the clitoris to grow bigger. Many trans men feel euphoric from this and choose to think of it as a small penis rather than a clitoris.
>As her estrogen secretion is suppressed, early menopause ensues, and a hysterectomy may be indicated. Should she undertake these 'therapies', she will likely never experience an orgasm, much less bear a child. Image is, literally, everything.
...What? It doesn't really make sense to think of someone on testosterone as going through menopause. Women who experience negative symptoms from menopause do so because they have no significant estrogens *or* androgens in their body. As a result, many begin HRT, a perfectly natural remediation.... but that's besides the point. As for trans men being unable to experience an orgasm, I've never heard of anything crazier, and I can speak from personal (ok, strictly speaking secondhand) experience here, lol. Trans men can get pregnant as well, there are many breathless tabloid articles about it you can find with a quick google search.
>In fact, a closer inspection of the available research shows a much greater likelihood of suicide among post-op transgender patients than among youth whose desire for medical transition is postponed or denied.
Citation, please. My impression is the data shows the complete opposite.
I won't pick out any quotes in particular but the push to "drop the T" from LGBT makes me very sad. Cisgender gay and bi people will not make themselves more genuinely accepted by marginalizing trans people. They will achieve a veneer of acceptance from the right-wing but will quickly find themselves on the chopping block when it becomes politically expedient. It's true that trans people are different from cis gay people, but gay men and gay lesbians are also different, yet they have (for the most part) chosen to band together as political allies because they experience the same hatred and can find community with each other.
I hope you will take my response with grace and respect as I hope I have done the same for you.
Julia, I've read your comment carefully, and first I really want to thank you for writing it. I started to reply but found I wasn't able to insert links in this field. With your permission, I'd like to paste your whole comment, and my reply, and publish the conversation as a stand-alone post. It will take me a few days to make sure I address all your points, so maybe I'll post it on Thursday, with thanks for the possibility of honest, respectful discourse on such a fraught, polarized topic. Are you okay with that?
Yes, that sounds alright.
Great. I'll reply again where when it's published so you know.
Happy TG! The post is live now.
Very well written, I shared.
Thank You! And it's not just the Netherlands, Sweden, Finland and England:
France: "NAMF cautions practitioners that the growing cases of transgender identity in young people are often socially-mediated and that great caution in treatment is needed. Hormonal and surgical treatments carry health risks and have permanent effects, and that it is not possible to distinguish a durable trans identity from a passing phase of an adolescent's development."
https://www.academie-medecine.fr/la-medecine-face-a-la-transidentite-de-genre-chez-les-enfants-et-les-adolescents/?lang=en
Norway: "The NHIB/UKOM has deemed puberty blockers, cross-sex-hormones & surgery for children & young people experimental, determining that the current “gender-affirmative” guidelines are not evidence-based and must be revised."
https://twitter.com/segm_ebm/status/1634032333618819073
Denmark: “By 2022, only 6% of the youth referred to the centralized gender clinic in Denmark were prescribed hormonal treatments, and surgical transitions for minors were completely discontinued.”
https://segm.org/Denmark-sharply-restricts-youth-gender-transitions
And the psych practitioners' group in Australia: "NAPP has just released new guidelines regarding the treatment of children and teens with gender dysphoria. They warn of the dangers of medical treatment and encourage a cautious and therapy-based approach rather than a ‘gender affirming’ model."
https://napp.org.au/2022/03/managing-gender-dysphoria-incongruence-in-young-people-a-guide-for-health-practitioners-2/
Thanks, Hazel. All the dynamic progress in the politics and research show us the limitations of the book publishing process -- and conversely the great benefit of a real-time publishing platform like this one!
Thank you so much for this. It is so spot on but no less horrific for that. Are you in touch with PITT (Parents with Inconvenient Truths about Trans)? They are compiling stories from heartbroken parents about this whole issue. I’ll tweet your whole article to them.
Thanks Liz! Yes, I've been a fan of PITT essays since they first appeared, and just published my first PITT piece ('Some Thoughts on Speaking Out') last Monday. It's an amalgam of two posts by the same title from my own Substack, and it brought me a huge number of new subscribers, for which I'm so grateful. They are a powerful and important voice.
I see 51K members on detrans reddit. Where did you see 100,000? Is there another forum? (I am on your side ,btw, it's a brilliant essay, I am just trying to clarify the numbers).
Update: I no longer have the emails from the editing process but I've updated the post, with a note apologizing for the error. Ugh.
I know, and thank you for the kind words. I need to try and find some emails between me and the book editor, but it's very likely the 100,000 figure is an error that I made in an early draft that was corrected in the final draft. I didn't use the final for this post because it's written in UK vernacular, whereas American feels more appropriate here. I will update with a correction if I screwed up, which I have a sinking feeling is the case!
No worries! Besides the biggest subreddit r/detrans, there is https://www.reddit.com/r/actual_detrans/ , a smaller forum started because some felt that r/detrans was "too transphobic".
FWIW, the rules at r/detrans say that the only non-detrans allowed to join the forum are medical/health professionals working in the field.
I think the rules were looser when I first looked at it; I remember noting that I could join as a loved one (or family member, or something like that) without violating their rule. Whatever they prefer, it's impossible to know how many members are abiding by the preference, but I think the pace of growth is noteworthy even if membership is not tightly regulated.
Brilliant, and spot on! Thank you Jenny!
Wow! Fabulous and thorough explanation of the situation.
Very well done, Jenny!!!! I love the painting analogy. Can’t wait to read the book!
I can’t wait for the book!
Thank you for sharing. You compiled so many important facts and figures into one concise piece. I’ll save this for sharing with others who are curious to learn more.
Great writing. Thank you!
Thank you for that kind comment, Viviane. I look forward to reading your Substack!