In the month since I started TransMuted, I've written about some confounding aspects of "trans," like how it's covered, or not, in the media; why it's impacting curiously discrete populations (adolescent girls from liberal families, little boys from conservative ones, middle-aged men but not middle-aged women); and why people don’t want to talk about it. Those posts were intended to describe the present situation as I've experienced it.
Now I want to turn to the fundamental question of how we got to this place. You won't find a tidy answer in this post, but there are some threads I've been wanting to pull which, examined individually, might weave themselves into a plausible theory of the case. I’ll pull one thread at a time so as not to get bogged down.
First we should define the case that needs solving. This is how it appears to me:
Humans come in two sexes. Most people, and all doctors, know this.
Some doctors perform surgical or endocrine procedures on healthy subjects who wish to look like the opposite sex.
Within the past decade, subjects presenting to these doctors have increased dramatically in number while their average age has decreased such that the vast majority are now children or adolescents. Prior to this period, subjects were few and almost exclusively men of middle age.
This alarming trend prompted the wider community of doctors, psychologists, ethicists and social scientists to undertake a broad-based study of the psycho-social factors that might have contributed to this seismic epidemiological shift.This prompted a rapid expansion of youth gender clinics and practitioners to meet the growing demand.
The fork in the road is where the struck-through paragraph didn't happen and the next one did. The "why?" of the road taken vs. the road not taken: this is the case I want to crack.
Several of the most powerful "aha" moments I've had in my exploration of all this came from a single podcast episode: Gender: A Wider Lens Ep. 60 (1/28/22), which was an interview with Dr. Stephen Levine.
Dr. Levine is a psychiatrist and sexologist whose work with trans-identifying adults began in 1973. I recommend listening to the whole interview, as he shares a wealth of knowledge and insight into all aspects of identity, some of which you won't hear anywhere else. For now, I'm interested in his concept of the "chain of trust."
Here are some quotes of Dr. Levine from the interview:
"Medical education involves a chain of trust. And what we have to trust is that someone has done the research; some group of very scholarly people – thoughtful, informed people – have said 'this is the treatment for this condition.'
"It's based on science, it's based on the evolution of understanding, it's based on tradition, but mostly it's based – because in medicine science is the soul of progress – it's based upon scientific study. And there is a chain of trust so that we have at this high level somebody [who] makes the policy based on science, and it trickles down.
"Now when you're a medical student or a psychology graduate student you have a lot to learn about many, many things. You don't have time to look at the basis of the learning, so you need this chain of trust; you need to trust what you're taught."
That might sound axiomatic: a version of everyone's experience of learning. But what if a weak link broke into the chain without proper vetting? Could that happen?
Imagine this scenario:
A group of chiropractors have announced an exciting discovery: children who were taught to walk backward rather than forward showed impressive gains over their peers in several key metrics including IQ, hearing, and muscular-skeletal coordination.
The enterprising chiropractors, seeing an opportunity to elevate their careers — while of course helping children — formed a new professional society to publish their scientific research. Their studies were all stamped “approved” by a conveniently located in-house peer review committee. Which was acceptable because nobody else was doing their kind of work, so who else could review it?
Soon our hero-chiropractors were heralded as the unquestioned authorities in the groundbreaking discipline of Pediatric Backwalking. As such, they claimed their rightful place in the chain of trust, where they continued to make their mark helping children, by teaching them to walk backward.
That was a sneaky parable designed to introduce WPATH, the World Professional Association for Transgender Health, into the conversation. Next week we'll take a closer look at WPATH’s quixotic origin story and its weighty contributions to medicine, society, and the chain of trust. Stay tuned!