Distort Things Much?

Over at his blog (where he has conveniently turned off comments), we find Walt Heyer madly scribing away, and getting it horribly wrong.

He refers to three cases of what he supposes are gender transition regret:

1) Like the physician who wrote me. He became a “trans woman.” Yes, a physician! Even after following all the standards of care, he found regret and detransitioned back to his male birth gender. This physician looks back and now says, “If I could only go back to the day before my surgery in March of 2005--I would run from that surgeon’s knife.” Sadly, the approval process for surgery does nothing to reduce such stories.

2) Like the ABC news guy who wanted everyone to accept him as a transgender woman. Don Ennis, an ABC News editor, suffered a gender identity crisis, switched his gender twice in a three-month period, and posted a workplace memo attributing his actions to amnesia. Don became Dawn. Amnesia or multiple personality disorder? Anyway this is like many of the regret letters I get from guys who were completely convinced they were women trapped in a men’s bodies only to discover later they had some psychological problems. http://www.nypost.com/p/news/national/guy_again_eKq3Jw6LjgsjpBdmZklrtM

3) Like the NFL cheerleader, Texas native Philip Porter, who made the decision to transition back to his male birth gender after a whopping 32 years living as a transgender woman.

“I was born male, and always felt more female than male as a child growing up, to the point of before I could talk, [I thought] ‘I should be over there with the girls in dresses. After 34 years on female hormones, Philip started having discomfort with “hot flashes” so he discontinued using them. “I just said ‘Ok, I’ll stop taking these for awhile but it’s not going to change back after 34 years of taking them.’”

“And after that, it just started happening,” he continued. “After about 6 months to 9 months being off of them, ‘you know, you never gave yourself a chance to sort of live as a male. What would that be like?’ And it kind of was something in my mind that started as just a little thought that kind of like snowballed. And you know, I mean that’s just kind of how it happened.

It was just that simple, even after 32 years. So what is a “real” transgender? Is 32 years not long enough? 

His first case, I am somewhat suspicious of.  Heyer keeps on referencing this person, but they appear to have no public profile whatsoever.  The story cannot be verified independently, and given Mr. Heyer's propensity in the past for fabrication, and distortion, I am deeply suspicious of its veracity as presented on Heyer's blog.

The second case Mr. Heyer refers to actually shows us a case of the WPATH SOC working in the manner described.  The story of Don Ennis has been fairly widely publicized.  Exactly what motivated him to step back from transition is unclear to me.  In any case, he attempted transition and stepped away from it after a fairly brief time period.  This is not particularly unusual, nor does it represent any kind of failure of the treatment protocol itself.

As for Philip Porter, his story is unusual.  I am not at all sure that his choice to detransition after 30 years tells us anything other than people can, and do change.  Nothing in his story speaks of "regretting" his transition or time as a woman, so it seems more than a little specious to claim that as some kind of proof that the SOC as a treatment protocol is a failure.

Detransitions are now becoming BIG BUSINESS. The Sava Perovic Foundation website reports that worldwide more than 1,500 persons who got sex change surgery later decided they had made a mistake.
According to a doctor I know, Dr. Sava Perovic was the greatest urogenital surgeon of our time treating probably every anomaly of the reproductive organs and the urinary system that you can think of. Dr. Perovic was also responsible for teaching SRS to surgeons in Thailand. His foundation is now offering reversal surgery for regretters. 

Mr. Heyer needs to do a much more careful reading of the Sava Perovic Foundation's website.  Yes, it does mention GRS reversal procedures - but it is also abundantly clear that those surgeries are provided based on the same kind of psychological assessment that the WPATH SOC requires in the first place.  In short, the WPATH SOC exists for a reason, and their surgeons won't provide surgery for someone seeking GRS (or reversal of GRS) without appropriate psychological assessments.  I think it is important (if not vital) to note that the Sava Perovic Foundation also provides GRS services - and is rightly quite insistent that the WPATH SOC be followed.

There are only a limited number of ways that the WPATH SOC will fail to protect a patient - and most of them are the direct result of the patient attempting to "game" the system instead of being brutally honest with themselves.  I would be willing to bet that the vast majority of those "inappropriate" GRS procedures are the direct result of the patient managing to lie their way through the evaluation process.  As I have noted before, Mr. Heyer admits in his own autobiography that he lied routinely in his pursuit of GRS.  A reality that calls into question the accusations he makes of the treatment community.

More From The "I Regret GRS" Club

Another pseudo-anonymous letter allegedly from a transsexual who regrets having GRS has been posted on Walt Heyer's blog.

Why do I say "pseudo-anonymous"?  Because, frankly, I'm not at all sure that Heyer hasn't written it himself - there are some significant overlaps with aspects of Heyer's own story which I have critiqued in detail already.  I am not at all convinced that we aren't looking at a sock puppet.

However, even if it is a 'sock puppet', it is worth taking a closer look at what is said - in part because it attempts to critique the latest edition of the WPATH Standards of Care.

I have tragically come to realize my story is fairly typical of most MtF persons. I was molested by my "trusting" grandfather at age 3, father was killed at age 5 and while my mother remarried; you could essentially say I grew up without a "father figure" or role model.

There are a couple of things here that set off alarm bells for me.  First is the "I was sexually molested" line, and the attempt to link it to "most MtF" transsexuals.  The religious right wing, aided and abetted by people like Heyer love to try and associate transsexuality with some kind of flawed upbringing - in particular sexual abuse or the absence of an appropriate father figure - both are common tropes, with no basis in evidence.  Yes, a percentage of transsexuals were sexually abused as children, but so are a percentage of non-transsexuals.  Any attempt to declare a causal link here is sloppy reasoning or wishful hypothesizing.

By my late thirties, this feeling of a "feminine core" continued. It led me to purchase online and experiment with Estrogen and an Anti-Androgen. My body slowly started to feminize. I dieted and exercised feverishly and got my body down to an acceptable female weight. I felt great; this must be who I am?

I remarried again in my early forties to a wonderful woman. Yet, the programming in my mind was so scrambled by then that it was difficult to differentiate between reality and fantasy. By the time I started seeing a gender therapist and a surgeon they were as convinced as I was that I was female.

Since I was already on estrogen, the endocrinologist felt morally/ethically obligated to continue that same protocol and at least monitor it and prescribe it legally. I received my first letter for surgery after a year and the second after two years. My childhood issues were jotted down by the therapists almost as if a side note. (A very common failure in approving surgery.) At no time did I tell my family, consider my career or even consider talking to the love of my life of my plans. This "sickness" and it is a sickness, consumes and takes over your life! You will lie to everyone around you as you continue to lie to yourself to get it done.

Thought number one here:  The person seems to have started by self-medicating - taking hormones apparently without the supervision of a doctor or even a psychologist.  I've seen this line before - almost always from people who attempted transition that shouldn't have in the first place.

The second point here is that the person does not appear to have engaged with a therapist until they had walked a long ways along the physical transition path.  This is consistent with Heyer's own biography, in which he clearly did not engage with a therapist on any consistent basis.  It has long been my opinion that there is nothing wrong with regularly being in contact with a therapist during gender transition.  While it is not essential to transitioning successfully, an objective cross-check cannot hurt.

The author does not tell us how long he engaged with therapists to gain the letters for surgery, and ethically, the therapist is only obliged to do an assessment.  Unresolved issues related to past abuse are ultimately up to the patient to decide if they are willing to pursue and resolve them prior to having surgery.

Lastly, and perhaps most importantly, the author clearly could not be living full time at the point where they acquired the letters for surgery.  Not only were they not working in their chosen gender, but even their spouse was not aware of their plans.  Given the dramatic effects of hormones, I am somewhat puzzled how this could possibly be, unless communication in the relationship had broken down to the point that the couple were keeping separate rooms.  I find this particular aspect of the story far too close to Heyer's own story.

The recently published WPATH Version VII has simply allowed the medical community to open the "floodgates" for this very tragedy to unfold. To get on cross gender hormones and then have surgery has become almost as simple as going to the convenience store for a pack of gum. If the client wants it, give it to them. "Real Life Test"? Maybe, maybe not, depending on your circumstances, occupation, etc. It is a billion dollar industry that thrives on your illness.

The most recent edition of the SOC does not make it "easier" to get access to hormones - an assessment and referral letter is still needed.  Whether or not all doctors who see transsexual patients implement this requirement is another matter entirely.

A careful reading of the current SOC is pretty clear, and there is a lot of clinical flexibility in the system.  Given the incredible diversity of gender variant people that are being identified, and the fact that they all have somewhat different needs, this is not surprising.  Again, for someone considering transition, it is more important than ever to engage with a treatment team that includes experienced professionals who understand the subtleties and shades of grey appropriately.

Get help. Don't mutilate your body. The psychiatrist, psychologists, and surgeons will enjoy a wonderful life. You, however, could end up with a tortured life, ending up penniless, possibly unemployed, without family or friends and maybe even homeless. And that's if you haven't tried or committed suicide by then! All so you can become the girl you "think" you are inside and wanted to be! People, God or whatever you believe in made you in the correct gender. It is encoded in your very DNA. If you think differently, get real help; but, DON"T CHANGE IT.

Gender is not just physical sex;  even if all aspects of it are somehow encoded in our DNA, such a perspective is a gross oversimplification.  It is well known that genes are expressed differently in each individual.  The biochemical system that is the human body is not absolute and deterministic in nature or function.

Lastly, the implicit notion that transsexuals are somehow lying to themselves has been tested and disproven repeatedly.  Even the DSM IV test clearly established the difference between delusion and the transsexual's experience.  A story like this is, to me, a cautionary tale - one that tells us all that when undertaking something as subtle and complex as gender transition, that there is much to be said for being cautious in how you approach the subject.   If you find yourself having to lie, or cover things up, then you better get to a place where those lies are no longer necessary and see if you can live with yourself openly.

More On Distorting Study Results

The resident ex-Transsexual-for-publicity Walt Heyer is at it again.  This time, he's busy citing a bunch of studies that he claims are "proof" that cross-gender identified children do not become transsexuals.

The studies he cites are as follows:

Dr. Bernard Zuger found that feminine acting young boys do NOT become transsexual.
http://www.ncbi.nlm.nih.gov/pubmed/3180761
(no more proof needed than this)

http://www.ncbi.nlm.nih.gov/pubmed/6693867

Dr. Fred Whitam finds the same thing Zuger found
http://www.ncbi.nlm.nih.gov/pubmed/849142
http://www.ncbi.nlm.nih.gov/pubmed/7396690

Dr Colette Chiland finds the same thing as Zuker and Whitan found
http://www.ncbi.nlm.nih.gov/pubmed/3051066

The first thing I want to point out is a design issue with all of these studies.  Both Zuger and Whitam are exploring the question of whether certain childhood behaviours are predictive of adult homosexuality, and do not appear to even ask the question of transsexuality as an outcome at all.  It is also important to recognize that sexual identity is not correlated with gender identity directly.  Any study which fails to recognize this distinction is almost guaranteed to very limited in its usefulness in understanding the frequency of transsexualism in the population.

Second, as is often the case with studies involving sexual minorities, the sample size is small to begin with,  and given the extreme rarity of transsexualism to begin with, it only makes sense that small-n sample sizes have a relatively low probability of containing representative transsexuals.  Further, the odds are that the data involving a transsexual would have been discarded altogether, or possibly rolled into the male homosexual grouping during data consolidation.

Further, these are fairly old studies - dating from 1977 to 1988.  While it would have been nice if the studies had included cross-gender identity outcomes in their design, they clearly did not.  While transsexualism should have been a visible domain to researchers during that time, I doubt very much that it was widely understood as a distinct phenomenon from homosexuality, and study designs would reflect that gap of understanding.

Ironically, a few minutes exploring the PubMed database turns up the following:

Korte et. al.: Gender identity disorders in childhood and adolescence: currently debated concepts and treatment strategies
http://www.ncbi.nlm.nih.gov/pubmed/19578420
Full Text:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697020/

This is a 2008 publication (so already 5 years old), but it points out that there is precious little research material out there which covers the probability of childhood cross-gender identity becoming adult transsexualism.  Fundamentally, the study itself basically states that we do not know the aetiology of transsexualism, much less do we have adequate studies to fully understand whether a child who expresses cross-gender identity is in fact transsexual as an adult.  Appropriately, it does sound a note of concern around the application of puberty suppressing drugs.

Given that on this blog, the earliest references to Spack's work date back to 2007, and a quick scan of PubMed for articles bearing Dr. Norman Spack's name turns up comparatively recent articles, it isn't terribly surprising that there is a note of caution around the administration of puberty-suppressing drugs.

However, in the 2012 published WPATH Standards of Care v7 document we find the following:

An important difference between gender dysphoric children and adolescents is in the proportion for whom dysphoria persists into adulthood. Gender dysphoria during childhood does not inevitably continue into adulthood.5 Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6-23% of children (Cohen-Kettenis, 2001; Zucker & Bradley, 1995). Boys in these studies were more likely to identify as gay in adulthood than as transgender (Green, 1987; Money & Russo, 1979; Zucker & Bradley, 1995; Zuger, 1984). Newer studies, also including girls, showed a 12- 27% persistence rate of gender dysphoria into adulthood (Drummond, Bradley, Peterson-Badali, & Zucker, 2008; Wallien & Cohen-Kettenis, 2008).
In contrast, the persistence of gender dysphoria into adulthood appears to be much higher for adolescents. No formal prospective studies exist. However, in a follow-up study of 70 adolescents who were diagnosed with gender dysphoria and given puberty suppressing hormones, all continued with the actual sex reassignment, beginning with feminizing/masculinizing hormone therapy (de Vries, Steensma, Doreleijers, & Cohen-Kettenis, 2010).
Another difference between gender dysphoric children and adolescents is in the sex ratios for each age group. In clinically referred, gender dysphoric children under age 12, the male/female ratio ranges from 6:1 to 3:1 (Zucker, 2004). In clinically referred, gender dysphoric adolescents older than age 12, the male/female ratio is close to 1:1 (Cohen-Kettenis & Pfäfflin, 2003).  [WPATH SOC V7 p. 11]

WPATH is quite frank in raising the issue of adequate long term follow-up studies of transsexuals in general, and those diagnosed in youth in particular.  I do not expect that this will change anytime soon.  More likely, it will be decades before there is an adequate body of research to be conclusive about such matters.

In the meantime, I think we can assess Heyer's most recent slam of Dr. Spack as being one more ill-informed attempt to project his own sad outcomes on all who are transsexual.

Walt Heyer, Detransition and the WPATH SOC

Running around the internet, and speaking in various venues is a somewhat rare creature by the name of Walt Heyer who claims to be an "ex-Transsexual".  For the most part, I would ignore the man's claims, but I think it is important to review his position, as he continues to be a very vocal opponent of the treatment options open to transsexuals today - in particular he is overtly hostile to the idea of GRS (referring to it as "fraudulent", but also he is overtly hostile to the legal accommodations such as changing of gender markers on legal identification documents.  

As such, he represents a significant problem to the advocacy for equal rights for transgender people as a whole.  I spent a considerable amount of time a while ago reviewing Mr. Heyer's autobiography and his "Paper Genders" book.

Mr. Heyer’s case presents an excellent example of the importance of the principles embodied in the more recent standards of care, as well as serving as a counter-argument to those who argue that medical treatments related to cross-gender identity should be available “on demand”.

Mr. Heyer presents himself as a “former transsexual” or “ex-transsexual”.  He claims to have transitioned, had Gender Reassignment Surgery and subsequently de-transitioned after several years living as a woman.  He is actively campaigning against the treatment currently made available for transsexuals, mostly within the circles of the religious right wing of American political discourse.

However, much of Mr. Heyer’s assertions need to be understood in the context of his own history, and how his past aligns with respect to the WPATH SOC. 

[Warning - This is a lengthy essay]