More Anti-Trans Nonsense - This Time From Discovery Institute

 So, Discovery Institute's blog "Evolution News" has published a lengthy series of essays on transgender people, and the diagnosis and treatment of transgender youth in particular.  It's 7 or so essays, each one probably a good 1,000 words or more.  I'm not going to dissect each essay in detail.  There is so much twisting of both the science and the realities of how treatment progresses that I only need to take one apart to give you a flavour for how bad these really are.  The following essay has been selected in part because it seems representative of the level of twisting going on.  

Evolution News: Some Effects of Transgenderism

Let's get started, shall we?

Lie #1:  

In 2019, psychologists Richard Bränström and John Pachankis published a study of 9,747,324 Swedes. The goal was to determine whether “gender-affirming [cross-sex] hormone and surgical treatment” improved the mental health of people with gender incongruence.

Bränström and Pachankis found no evidence of improvement from cross-sex hormones. But they concluded that the evidence “lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.” Critics objected that this conclusion was not warranted by the data. So the authors revised their article. The journal editor published a correction, stating that “the results demonstrated no advantage of surgery.”

First of all, the study itself is extremely broad, and it starts off asking the question whether someone who has had gender affirming treatment has less need for mental health treatment.  That's an extremely broad question with so many confounding factors in it, I'm surprised the authors even proceeded with it.  Gender affirming treatment relieves anxiety specifically about one's gender and physical sex. It has very little to do with anything else.  

When I mentioned confounds, there are a whole bunch of things that can cause the statistics to skew. First, having experience with mental health practitioners means that transgender people are more likely to access those services when they are having difficulties.  Second, we should not underestimate the consequences of minority stress on transgender people, and the long term anxieties that can emerge as a result of trying to function in society that is generally unsupportive of transgender people.

To be clear, I am not saying that the study is invalid, rather I am cautioning anyone reading it to recognize that there are enormous question marks that the study is unable to adequately explore and address.  Therefore, drawing absolute conclusions about gender-affirming treatment from it is hugely problematic. 

Lie #2:

A 2020 study surveyed 20,619 transgender Americans between 18 and 36. They were asked if they had ever wanted puberty blockers as adolescents. About 17 percent said yes. Of these, only 2.5 percent actually received the medication. The goal of the study was to compare “adult mental health outcomes” of those who received puberty blockers with those who wanted them but didn’t get them. The authors adjusted the data to account for age, biological sex, and household income, among other things. They concluded that giving puberty blockers to teens who want them reduces the risk of suicidal thoughts.

The journal that published the 2020 study also published some comments about it. One comment, by pediatricians Scott Field and Den Trumbull, was very critical. They pointed out that the data were collected by survey. So “there is no way of knowing how many would-be participants in either group actually succumbed to suicide.”

Again, it's important to recognize some of the confounding factors at play here.  First of all, the transgender community is notoriously hard to get people to participate in studies.  That in itself is a confounding factor.  That the sample size is over 20,000 for this study is impressive.  Surveys are also known to be problematic for a variety of reasons, including respondents being self selecting, and potentially telling the researchers what they think the researcher wants to hear.  

Again, the lesson here is that drawing conclusions from a study like this is probably not ideal.  It makes observations that are interesting, but much more rigorous studies need to be conducted to draw any kind of conclusions.  Of course, the writer of the essay on Evolution News wants us to conclude that puberty blockers are ineffective in treating gender dysphoria.  I would be very cautious about drawing such a conclusion. 

Lie #3:

A total of 6,793 people visited the gender clinic of the Vrije Universiteit Amsterdam from 1972 to 2015. A 2018 study reviewed their medical records for regrets about having “bottom surgery.” About 0.6 percent of the males regretted having their testicles removed. About 0.3 percent of the females regretted having their ovaries removed.

This evidence seems to suggest that regret is rare. But the evidence comes only from medical records kept by the professionals who recommended and performed the sex reassignments. How likely is it that sex-reassigned people would later report their regrets to those professionals? We don’t know. How much follow-up did those records include? We don’t know. So the quantitative evidence pertaining to regret is quite thin.

Yet there is growing anecdotal evidence for it.

Now we get into the whoppers.  The evidence cited clearly doesn't show what the author wants to show - namely that "a lot of people experience regret" after surgery, so he throws in at the end a snipe about anecdotal evidence.  

Anecdotal evidence is important in research because it helps identify questions that should be asked.  That said, anecdotes are individual stories, not population-wide data.  Sub-1% regrets hardly seems like a huge "put on the brakes" problem.  In fact for most medical treatments, failure rates in that range would be considered beyond fantastically good.  

Lie #4:

In 1983, after 16 years of marriage, Heyer went to see a gender therapist. On his second visit, the therapist gave him a prescription for estrogen. The therapist also gave him an authorization for sex-reassignment surgery. He trusted the therapist, so he divorced his wife and had sex-reassignment surgery soon afterwards. He lived eight years as a woman, but he regretted having transitioned. At the age of fifty he “de-transitioned.”

Okay, speaking of whoppers, every time the subject of "regret" comes up, this guy gets trotted out as the "expert".  Walt Heyer is no expert.  In fact, I think it is far better to view Walt Heyer as a poster child for how not to conduct a gender transition.  For those interested, I wrote a lengthy essay some time ago about Walt Heyer and his story:  Walt Heyer, Detransition, and the WPATH SOC.  

Using Heyer's own autobiography as a source, there is precious little evidence that he actually lived full time as a woman.  Concluding anything from his story is perhaps better seen as an exercise in 

Lie #5:

The idea that the other 0.02 percent should routinely have genital surgery was promoted by sexologist John Money. The idea that “gender” is different from biological sex also owes its popularity to John Money. The idea resulted in tragedy for David Reimer, though Money never publicly admitted it.

This is the last of the whoppers, and it's truly a doozy.   The anti-transgender crowd should really understand that using Dr. Money and David Reimer as cannon fodder for their hatred is utterly stupid. 

First, let me start off by saying that what happened to David Reimer was an utter tragedy, a failure of both professional ethics as well as a deeply flawed understanding of human development.  

There are a number of reasons why using this case to bolster an anti-transgender position is guaranteed to fail:  

1.  Dr. Money's hypothesis

Dr. Money was working from a perspective that can be broadly understood as "tabla rasa" (or blank slate).  His idea was that gender identity is largely based on learned behaviours, and when the David Reimer case came to his attention, he persuaded the family to participate in his experiment, which was to raise David as a girl after a botched circumcision destroyed infant David's penis.  His experiment failed, with tragic results.

2.  David Reimer was not transgender 

Let's be abundantly clear, David Reimer wasn't transgender when a circumcision destroyed his penis.  Nor was he even subject to any known intersex condition.  In other words, we have no evidence that David had anything in common with any transgender child prior to Dr. Money's involvement.  

It is perhaps a bit of an irony that Dr. Money may have _made_ David into a transgender person by having him subjected to GRS as a child, and David proceeded to gravitate towards being masculine even when pressured enormously to be feminine. 

3. The Result of Dr. Money's Experiment 

Although the long term outcome of the David Reimer story is profoundly tragic, from a purely experimental perspective, it actually demonstrates some important points: 

1. The blank slate hypothesis is fundamentally false. There is more to gender than a series of learned behaviours. This is something which transgender people have argued for years on the basis of their lived experiences. 
2. There are aspects of gender which are set long before we are able to express them.  
3. David's persistence that he was not a girl when being raised as one is exactly parallel to the experience of many transgender people.  They know they don't really belong to their birth-assigned sex even as they live that role.

4.  Impact On Transgender Treatment and Research 

Dr. Money's ideas haven't been significantly influential among transgender researchers for decades. The impact of the Reimer case was more keenly felt among the Intersex community who for years were subjected to "corrective" surgeries as a result of the initial reports.  

Citing Money as if he defined how transgender people should be treated is completely missing the point.  There are others whose work was much more influential and important.   

 Conclusion

I'm not going to write a lot here - the underlying point is that like most "anti-transgender" writings, the series of articles on Evolution News is filled with cherry-picked data that appears to support the author's position, until one looks more closely at it. Never assume these people are going to treat data honestly, or even recognize how they are twisting it. 

 

Really, Dr. McHugh?

For reasons somewhat beyond my comprehension, the Wall Street Journal has decided to give Dr. Paul McHugh another podium from which to spew his nonsense.  "Transgender Surgery Isn't The Solution" is yet another attempt by McHugh to justify his hostility towards providing transsexuals access to gender reassignment surgery.  

I've taken McHugh's previous writings apart in Debunking Dr. Paul McHugh, but this is a new column, and he's tried to throw a few new angles in.  Unlike most anti-trans writers, McHugh tries to actually use some objective research to support his position ... like a lot of such people, he tries to twist it to suit his ends.

Yet policy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention. This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes.

For all that many in the Trans* community direct their ire at CAMH's Dr. Zucker, they should be at least somewhat thankful that it was Zucker not McHugh sitting on the DSM V Gender Issues committee.  I fear the results of McHugh being on that board would have been far, far worse.

It's Not Just About Trust

One of my news feeds dropped the following article this morning:  "Gender Transition isn't a Whim, so Why the Mistrust?".

After reading through it, the article is more or less the standard "I know I need this surgery, so why can't I get it on demand?" argument.

To a certain extent, I am sympathetic to this.  People who are transsexual usually know from an incredibly early age that they are, and what they need.  This is beyond question in my mind.

The notion of informed consent is pervasive in Western Medicine, and in general terms it works fairly well.  But, informed consent is a point solution to a specific problem.  Informed consent does tackle the understanding of what the effects of a specific form of medical intervention are.  Usually in terms of physiological issues, potential complications and so on.

When it comes to gender transitions, trans patients are often inappropriately held to higher account when compared to people opting for other kinds of medical care. Standards of care are effectively constructed on the assumption that trans patients are less able to provide informed consent. This is a serious problem. Beneath it lies the wider distrust society still has in why people want to transition and in whether they know their own mind. 

Typically, the standard for surgeries — from cosmetic plastic surgery to vasectomy, tubal ligation, and abortion — is simply informed consent. A doctor or surgeon talks with the patient and explains what they expect to happen, along with all of the risks and benefits and the relative likelihoods of them happening. This process also involves explaining available alternatives and the risks or benefits of doing nothing. After the patient confirms that they understand all of this, the doctor is said to have received informed consent for the procedure. 

A patient is required to be competent to make this decision and if they are unable to understand for some reason – if they are too young for example – another person, such as a parent, may be required to step in.

It took me a few minutes to figure out what bugs me about this claim.  The issue is not merely that it is a case of "informed consent" for Gender Reassignment Surgery (GRS), but rather that gender transition is a complex process that encompasses a wide range of actions and treatments.

Any one step of transition requires a degree of informed consent.  For example, starting cross-sex hormone treatment requires that the doctor and patient have a clear, coherent discussion of the effects of hormones - both short and long term, as well as possible side effects.  However, taking hormones is merely a facilitating step in the process of transitioning across genders.  One step of many that a patient is ultimately undertaking.

Gender transition is not one step.  Hormones and GRS are the tangible markers that most people can grasp.  What is much harder to understand is the long term process of social transition.  For some, it is an easy, almost seamless process, for others it can be much more difficult to make the adaptations they desire.

And it’s the gatekeeper model of healthcare in the US, UK and many other jurisdictions, typically involving a psychologist of psychiatrist, that creates an additional barrier. Although some (private) clinics in the US have finally begun to adopt a model where all that’s required for a patient to begin hormone therapy is their informed consent, genital surgery still requires psychologist or psychiatrist approval. Many surgeons require two letters — as set out in WPATH’s standards — at least one of which must be from a psychologist or psychiatrist with a PhD. 

In reality, the requirements for trans patients are even more stringent: in order to be permitted genital surgery – even if the patient elects to pay for it – patients have to demonstrate that they’ve been living in their transitioned gender role for a minimum of a year.

 I can appreciate the perception that there is a "gatekeeper" mentality in some areas.  Let's face it, your average GP or Endocrinologist simply doesn't have a lot of training in dealing with cross-gender patients, and as a result may feel profoundly uncomfortable providing treatment without the input of a psychologist who specializes in such matters.

Western Medicine has become very "siloed" in the last fifty years or so.  Most GPs don't have the tools to make specialized diagnosis and refer patients to specialists all the time.  Specialists are often so focused in their own domain that they really do not feel comfortable making assessments outside of that domain.

To some extent this can be addressed by training, but it doesn't necessarily resolve the ethical and practice guidelines considerations that all of these professionals are bound by.  It would be very nice indeed if there was more uniformity in this regard, but there isn't.  Even more unfortunate is that in some localities, physicians have been known to turn trans patients away on the basis of personal beliefs on the matter rather than practical medical guidance.

Is it "gatekeeping" for a GP to say that they want an assessment from a psychologist before providing hormone therapy?  If we are talking about a situation where the psychologist is trying to make the availability of the referral letter contingent on a long term therapeutic relationship, one might be a little bit concerned.

However, the WPATH SOC v7 addresses this quite explicitly:

The SOC do not recommend a minimum number of psychotherapy sessions prior to hormone therapy or surgery. The reasons for this are multifaceted (Lev, 2009). First, a minimum number of sessions tends to be construed as a hurdle, which discourages the genuine opportunity for personal growth. Second, mental health professionals can offer important support to clients throughout all phases of exploration of gender identity, gender expression, and possible transition – not just prior to any possible medical interventions. Third, clients differ in their abilities to attain similar goals in a specified time period.  

Further, the SOC sets out fairly clearly the basic criteria for GRS referral:

Criteria for metoidioplasty or phalloplasty in FtM patients and for vaginoplasty in MtF patients: 

1.  Persistent, well documented gender dysphoria; 

2.  Capacity to make a fully informed decision and to consent for treatment; 

3.  Age of majority in a given country; 

4.  If significant medical or mental health concerns are present, they must be well controlled; 

5.  12 continuous months of hormone therapy as appropriate to the patient’s gender goals (un- less the patient has a medical contraindication or is otherwise unable or unwilling to take hormones). 

6.  12 continuous months of living in a gender role that is congruent with their gender identity;
Although not an explicit criterion, it is recommended that these patients also have regular visits with a mental health or other medical professional. 

Rationale for a preoperative, 12-month experience of living in an identity-congruent gender role: 

The criterion noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity – is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery. As noted in section VII, the social aspects of changing one’s gender role are usually challenging – often more so than the physical aspects. Changing gender role can have profound personal and social consequences, and the decision to do so should include an awareness of what the familial, interpersonal, educational, vocational, economic, and legal challenges are likely to be, so that people can function successfully in their gender role. Support from a qualified mental health professional and from peers can be invaluable in ensuring a successful gender role adaptation (Bockting, 2008). 

The duration of 12 months allows for a range of different life experiences and events that may occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school experiences). During this time, patients should present consistently, on a day-to-day basis and across all settings of life, in their desired gender role. This includes coming out to partners, family, friends, and community members (e.g., at school, work, other settings). 

Health professionals should clearly document a patient’s experience in the gender role in the medical chart, including the start date of living full time for those who are preparing for genital surgery. In some situations, if needed, health professionals may request verification that this criterion has been fulfilled: They may communicate with individuals who have related to the patient in an identity-congruent gender role, or request documentation of a legal name and/or gender marker change, if applicable. *Emphasis Added

Ms. McKinnon goes on to critique these requirements as follows:

More explicitly, such policies aim to force patients to experience and adjust to life in their transitioned gender role before providing treatment. The implied rationale, then, is that without living in your transitioned gender role, which may include changing your name or the style of clothes you wear, you can’t really know whether you want the surgery – and therefore can’t really provide informed consent. This “real life test”, as it very recently used to be called, is for the patient’s own good; if someone lived through the proscribed period of time and still wanted surgery, then the gatekeepers could be confident that surgery would be in the patient’s best interest. 

This is deeply problematic, though. This isn’t an informed consent model of healthcare, which is the universal model (in western cultures) for everything except healthcare for transgender people.

Here is where I beg to differ with Ms. McKinnon's assessment of the situation.  She seems to have conflated GRS with gender transition.  The two are NOT the same thing, although they are closely related to each other.  The claim being made is fundamentally that as long as the patient is able to give "informed consent" to GRS, they should be able to have access to it.

Superficially, this seems almost reasonable.  However, there are two enormous "buts" that must be discussed here.

First, unlike every other surgical procedure out there, GRS unequivocally changes the patient's status in many different aspects of their life, not merely in the relative privacy of our bedrooms.  As part of a broader picture of gender transition, it also affects the patient's social context and status, friendships, workplace and goodness knows what else.  Informed consent for GRS has to account for these realities somehow.

Second, we know that there are those who attempt to gain access to GRS who either are unsuitable candidates, or have not yet adapted to their chosen gender role in society.  Whether we are talking about characters like Walt Heyer (how he ever got approval for GRS is beyond me, but that was the early 1980s, a different era), or the person who early in their journey decides that they desperately need surgery *now* (I've seen it, and I personally have talked more than one such person out of their tree - at least half of them backed away from transition after that, and I respect them for having the strength and wisdom to recognize when to step away from the precipice)

One of the things that makes gender transition quite different from other conditions that doctors deal with is that it lacks clear diagnostic criteria that they can examine objectively.  In fact, there are no physiological symptoms that they can examine directly.  Is it unreasonable that the surgeons insist upon an objective third party assessment?

We also cannot ignore the political dimension of those who choose GRS and then discover that they made an awful mistake.  People like Mr. Heyer run around spouting a pack of lies a mile deep about about GRS, and ultimately make it more difficult for the rest of the trans* community to access the treatment they need.  This cannot be ignored, nor can we ignore the consequences for both transsexuals seeking treatment as well as the practitioners that they rely on.

But to argue that this contravenes the notion of "informed consent" is to assume that "informed consent" is a one way street.  It is not.  Informed Consent merely means that the practitioner has discussed with you the treatment that is proposed and its consequences.  In general, it starts from the presupposition that the practitioner has performed sufficient diagnostic assessment to be confident that this treatment will address the diagnosed condition, something which few surgeons will feel that they have the appropriate diagnostic skills for in the case of GRS.

What has changed is that although a psychologist's assessment is needed for a surgery referral, there is no explicit requirement for a long term therapeutic relationship.  (This didn't really exist in the previous SOC, but the current SOC is much clearer about it)

In short, Ms. McKinnon's position is based in large part on a misunderstanding of the nature of the WPATH SOC, and even more troublingly a failure to understand the ethical issues that a surgeon faces in providing GRS.  She tries to draw analogies with other "on demand" surgical options, but fails to acknowledge the unique aspects of gender transition in general.  No other medical process has such a profound impact on the life of the patient.

To proceed with caution has merits for both practitioners and patients in the long run.  A vasectomy can be reversed, a woman who has an abortion has the opportunity to become pregnant again.  gender transition is a process that is far more broad in its impact than just the patient.  Their social context changes, the people around the patient are very directly impacted, and so on.  "Undoing" all of that is difficult to say the least - at least as difficult as transition itself, and then there is the physical impossibility of "undoing" GRS.  To look at one part of the process - surgery - apart from all of the other aspects involved is incredibly short-sighted.

It may be frustrating, but a successful gender transition really does require many experts to contribute their expertise.  I would love to argue in favour of more open access, but the potential for serious harm to happen to someone whose motives for transition are unclear or they are ill-prepared for it is far greater than the implications of having a few cross checks in the system.  The world needs fewer Walt Heyers, not more.

Wente Is Getting It Wrong ... Again

I suppose it should come as little or no surprise that Margaret Wente is getting things wrong again.  This time, she is expounding on the treatment of transgender children.

Suddenly transgender kids are everywhere – in the news, on Dr. Phil and in your neighbourhood. School boards have developed detailed transgender policies. Clinics to treat transgender kids have sprung up. A condition that used to be vanishingly rare, perhaps one in 10,000 children or less, now seems common. In a random sampling of 6th- to 8th-graders in San Francisco, kids were asked if they identified as male, female or transgendered – 1.3 per cent checked off the transgendered box. 

She concludes with:

It’s a mark of social progress that we are increasingly willing to accept people on their terms, for who they are. But maybe we’re manufacturing more problems than we’re solving. If we really want to help people, we should remember the old rule: First, do no harm. 

Through the entire article, she relies on two authorities - Dr. Kenneth Zucker and Alice Dreger.   Zucker, along with his colleague at CAMH Ray Blanchard, have long been seen by the transgender community as deeply problematic - for good reason.

Ken Zucker is a psychologist at the Clarke Institute (aka "Jurassic Clarke") in Toronto. Zucker is famous for forcing gender-variant children into reparative therapy to conform to his expectations for male and female behavior in children. He considers transsexual women a "bad outcome" for gay men. 

Zucker is a darling of the "ex-gay" movement because of his work "curing" gender-variant children. Here is a piece featuring his work via ex-gay group NARTH (National Association for Research & Therapy of Homosexuals): 

http://www.narth.com/docs/gid.html 

Zucker promotes his NARTH-like notions of reparative therapy for kids with gender variance, reviewed here on another ex-gay site: 

http://www.leaderu.com/orgs/narth/childhood.html

We already know that so-called "reparative therapy" doesn't work for homosexuality, what on earth makes Zucker, or anyone else, think that it has any validity for transgender people.

As for Ms. Dreger, anyone silly enough to get into bed with J. Michael Bailey and defend the atrocious work that he wrote called "The Man Who Would Be Queen" has a serious credibility problem in the first place.

Quoting from Ms. Dreger, Wente draws the following:

Here’s more unwelcome news from Ms. Dreger. A child’s gender issue may merely be a symptom of other family problems. “The dirty little secret is that many of these families have big dysfunctional issues. When you get the clinicians over a beer, they’ll tell you the truth. A lot of the parents aren’t well in terms of their mental health. They think that once the child transitions, all their problems will magically go away, but that’s not really where the stress is located.” Clinicians won’t say these things publicly, she says, because they don’t want to sound as if they’re blaming gender problems on screwed-up families. 

Can we dredge any more old tropes?  We used to blame the parents for their kids being gay, now we're replaying that same ridiculous script when someone's child turns out to be transgender?  Give me a break.  If Ms. Wente had bothered to even do a little bit more research, she would have found that Ms. Dreger is grossly distorting the picture.

The WPATH SOC V7 provides the following guidance to mental health professionals:

Provide family counseling and support- ive psychotherapy to assist children and adolescents with exploring their gender identity, alleviating distress related to their gender dysphoria, and ameliorating any other psychosocial difficulties. 

This is extremely important when examining what Dreger is saying.  Namely that she is implying that the treatment community has a mass conspiracy afoot to deny that there are "other problems" that are at the root of being transgender.  If that was the case, the WPATH SOC would not contain language like this.  Dreger's claims are very similar to those of Walt Heyer - whose misadventures negate his own claims of misdeeds and malice on the part of the treatment community.

Wente's argument also draws the following from Dreger:

For some people, including some adolescents, transgender treatment is lifesaving. But these treatments are neither simple nor benign. They may, among other things, retard maturation, suppress your growth or render you sterile. And in the end, medical science cannot create a body that makes you forget you were born the other sex. “Some kids need it, but for the kids who don’t, it’s dangerous,” she says. “All else being equal, it’s better to avoid long-term hormone therapy and major surgery that removes a lot of tissue.” 

Disturbingly, data on long-term outcomes for transgender kids are scarce. No one is tracking the evidence on puberty-blocking intervention either. “We are doing major interventions and we have shockingly little idea what the outcomes are,” Ms. Dreger says. You get the sense that what we have is not so much a rational approach to a psychosocial issue as a radical ideological experiment. 

Let's see ... the percentage of the population that is transgender is tiny to begin with.  It's going to be an even smaller percentage who are going to be able and willing to express those desires before they reach puberty.  Ironically, most transsexuals know that they are trans long before the age of puberty.  If the option not to go through "the wrong puberty" exists, dear god, but it would be a blessing for so many.

Dreger's claim that there is a lack of long term consequences data available is also highly questionable.  Given the fact that Dr. Spack has been been running his clinic in Boston since 2007, the criticism about "long term consequences" is debatable.  The fact is that just about every transsexual who has transitioned wishes that they had done so earlier than they did.  We already know the consequences of insisting that transsexuals go through puberty the wrong way, and then try to undo it through transition as adults - the psychological trauma is no small thing to deal with, and the cost of living life in the wrong body is impossible to calculate.

Quoting Zucker:

Gender dysphoria (formerly known as gender identity disorder) means being at odds with your biological sex. It’s not the same as being born with ambivalent genitalia, or being gay. The popular shorthand is “being born in the wrong body,” although that formulation probably does more harm than good. Sex-reassignment treatment is appropriate for some (although by no means all) adults who are unhappy with their gender identity, and some go on to live significantly happier lives. 

But for kids, especially younger ones, the issue is much more problematic. Gender confusion is often temporary. About three-quarters of little kids who have issues with their gender – boys who want to be princesses, girls who throw their dresses in the garbage – will be comfortable with it by adolescence, according to Dr. Zucker. (Many of them will grow up to be gay or bi.) Gender confusion can also be a handy label for whatever ails a child (or her family). That’s why Dr. Zucker takes a watch-and-wait approach. He even advises parents of princessy six-year-olds to say, “You’re not a girl. You’re a boy.” 

The point that needs to be made (again), is that the WPATH SOC is similarly clear about caution regarding the introduction of physical interventions:

Before any physical interventions are consid- ered for adolescents, extensive exploration of psychological, family, and social issues should be undertaken, as outlined above. The duration of this exploration may vary considerably de- pending on the complexity of the situation.  ...

In order for adolescents to receive puberty- suppressing hormones, the following minimum criteria must be met: 

1. The adolescent has demonstrated a long- lasting and intense pattern of gender non- conformity or gender dysphoria (whether suppressed or expressed);
2. Gender dysphoria emerged or worsened with the onset of puberty;
3. Any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment;
4. The adolescent has given informed consent and, particularly when the adolescent has not reached the age of medical consent, the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process. 

These are not trivial claims, and an ethical practitioner is going to be very careful in making this kind of assessment and recommendation ... and that is for a reversible intervention.

Here is where Ms. Wente makes me quite annoyed.  Her article makes it sound like there is a sudden epidemic of children who are transgender springing up, and that these children are being "exploited" by greedy treatment providers.

Of course, she engages with Zucker and Dreger, two people who are going to validate her assumptions.  Does she expand her research to include Dr. Spack?  No.  Does she even take the time to review the WPATH SOC?  No.

Ms. Wente should be ashamed of doing such sloppy research, and the Globe and Mail should be embarrassed for publishing such tripe.

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.

Wow, Walt - Generalize Much?

If the latest utterances from Walt Heyer were the first you had ever heard from him, you could easily be forgiven for believing that the man had never had anything to do with the transgender community.  

Women—Simply Men with no Snoopy 

The real war on women today is being waged on the female gender by men who remove their tallywacker (Snoopy) and declare they are full-fledged women. 

These people, transgenders who are just men with no Snoopy, can use your restrooms and change the gender designation on their birth records and other ID to female. They’ll show you birth gender females a swinging thing or two by legally proving that you females are the same as men, just with no Snoopy. 

Transgender women, manufactured from men by surgery, have more protections under the law then you pesky women who were born female. 

Depending on what your view of female is, you may see transgender females (i.e., men who removed their tallywacker) as lovable little fuzzballs who need to be protected from the wacko, transphobic, homophobic, bigoted gender normals who were born male and female. 

Perhaps you see transgender women as men who enjoy what looks like childish play gone psycho with dress-up taken to extreme–copious amounts of makeup, flamboyant mannerisms, surgical breasts, facial work and yes, the removal of the old useless trouser snake known as "Snoopy." 

This post was prompted by talking with a woman I know who is outraged that birth gender women do not march by the thousands against lawmakers. She is appalled that a man without a dangling participle is made legally equivalent to a birth female. She feels that laws that protect surgically-produced replicas of women denigrate and ridicule real women and the female gender. 

In effect, the lawmakers are now saying that women are simply men with no Snoopy. Like it or not, it is the sign of our times.   

Walt Heyer

Apparently in Heyer's fevered mind, trans people are now part of the "war on women".  I'm not sure how he arrives at this, since it is conservative Republicans who are busily passing laws that disproportionately affect women for the worse, making reproductive health care all the harder to access, or forcing unwanted invasive procedures on women.

His characterization of transgender people as a whole sounds like something out of a couple of nights spent getting drunk in a drag bar, on par with the research that Bailey did for his book a few years ago.  It's funny how Heyer comes up with all sorts of generalizations about trans people, and yet I would wager he wouldn't be able to identify half of the trans people he interacts with on a daily basis.  

If recognizing women of transsexual history as women is somehow "denigrating" or "ridiculing" natal women, I'd love to hear just how that works.  I have yet to meet a transsexual whose life and experience could be argued as "denigrating" of women.  The only people that make such arguments are usually Radical Feminists and ultra-conservative religious demagogues who seem to think that womanhood (or manhood) are defined by chromosomes.  I have never seen a coherent argument which supports the contention that a MtF transsexual is somehow co-opting the female experience.

If Heyer was to actually think things through, what he would realize is that in many respects the places where law has engaged with the language of gender, it is no longer useful to do so.  Does it matter if your driver's license stipulates gender?  Probably not.  Last I checked, women can be just as lead-footed as men, and the speeding ticket is the same either way.  Outside of certain statistical applications, gender is utterly irrelevant.

Of course, in areas such as health care, women have specific needs that must be met that a male bodied person will never need.  I know of no transsexuals who stand in opposition to proper medical care for women.

Frankly, I'm beginning to suspect that Heyer is just jealous of the successful transitions that others have made simply because of his own failings.  

Book Review: Sex Change - It's Suicide by Walt Heyer

I have spent the last few days wading through Walt Heyer's latest self-publish book entitled "Sex Change - It's Suicide".

I'd like to say that it brings something new to the table.  It doesn't.

Frankly, this book is a mess.  It consists largely of the author pounding on the table and blaming the high suicide ideation/attempt rate identified in the 2010 NTEC study on the treatment community.

He doesn't really make any new arguments relative to what he argued in "Paper Genders".

Heyer has tried to make the case that the current treatment for transsexuals is horribly flawed.  This is largely predicated on his own disastrous attempt to transition in the early 1980s.  More or less, his claim is that because he transitioned while suffering from an undiagnosed dissociative disorder that everybody else who attempts transition is suffering from something other than what they think.

Unfortunately, Heyer makes enormous leaps of inference and asserts his position as fact without substantiating his position.  The majority of his evidence is anecdotal, or it is made in reference to deeply flawed research which has been largely debunked.

Heyer is no friend of the transgender community.  Although he speaks the words of compassion and advocacy for appropriate treatment, his underlying agenda is to prevent transgender people from having access to the treatment programs that are known to be effective.

[Update 16/08/13]
Heyer seems to have pulled the original Sex Change - It's Suicide title, and re-released under the title "Gender Lies and Suicide"

The summary of the book appears to be more or less identical to "Sex Change - It's Suicide" version, so I doubt there's anything particularly new other than a change of title.
[/Update]

[More after the jump]

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's Distortions - Subtle And Significant

I think I have already made it fairly clear that I think the "ex-Trans" narratives are largely nonsense, and in particular that Walt Heyer is filled with internal inconsistency that speaks volumes to the conditions that are involved.

Heyer is particularly vocal on his blog that he thinks that GRS and other treatments for transsexuals should not be available.  He regularly tries to cite various medical papers as supporting his position.  However, he does this by engaging in a semantic sleight of hand act that deserves to be examined and called out.

The pattern of Heyer's arguments is largely along the following lines:

- Find a paper which talks about transsexuals which addresses some aspect of transsexualism
- Infer that the paper supports his contention that being transsexual is a result of untreated trauma or other condition
- Conclude that this is justification for eliminating access to current treatment methods such as GRS

Consider the following post from May:  Sex Change Transitioning May Become Obsolete

This particular post is concerning for a couple of reasons.  First, Heyer appears to be republishing an e-mail from some anonymous physician.  In general, I find "anonymous authority" sources like this to be suspect at best.  If this physician has real insights into these issues which would suggest at the very least ethical failures on the part of the treatment community, then why are they not raising these issues in a forum where they can be discussed fully, with the engagement of that physician as well as other stakeholders?

However, let's go a little further, shall we?  Heyer's anonymous authority makes the following claims regarding what this paper shows:

Dear Walt, this just came out electronically ahead of print 1 week ago, It demonstrates that the main factor in the brain that is responsible for brain growth and changes of the brain in those with GID:

1) Parallels the same brain neurochemistry and neurophysiology that is known to underpin various mental disorders in general

2) Is directly the result of the way transsexuals are treated mainly in traumas and psychological abuse

I can't pick and choose the objectivity of the facts. I now need to present you the objective findings that neurochemistry and the neurophysiology of GID brains demonstrates that the brain is indeed changeable and that there is substantial evidence that GID brains are the result of psychological trauma and that the changes are the changes seen in those with an array of psychiatric disorders.

Wait a second.  Papers like this seldom make such clear causal declarations.  Sadly, I don't have the full text of the paper at my disposal right now, just the abstract as published on PubMed which reads as follows:

Gender Identity Disorder (GID) is characterized by a strong and persistent cross-gender identification that affects different aspects of behavior. Brain-derived neurotrophic factor (BDNF) plays a critical role in neurodevelopment and neuroplasticity. Altered BDNF-signaling is thought to contribute to the pathogenesis of psychiatric disordersand is related to traumatic life events. To examine serum BDNF levels, we compared one group of DSM-IV GID patients (n = 45) and one healthy control group (n = 66). Serum BDNF levels were significantly decreased in GID patients (p = 0.013). This data support the hypothesis that the reduction found in serum BDNF levels in GID patients may be related to the psychological abuse that transsexuals are exposed during their life. [Emphasis Added]

Ah, welcome to the typical bit of sleight of hand that takes place in how Heyer (or his allies) interpret these things.

According to Heyer, the correlation is that someone who is transsexual is transsexual as a result of psychological trauma.  Yet, the abstract of the paper uses very different language which does not draw a causal relationship between BDNF levels and the condition of being transsexual.  Instead, the last statement merely refers to transsexuals experiencing psychological abuse during their lives.

These are not logically equivalent statements.  Heyer is claiming a direct causal relationship between someone being traumatized and that person being transsexual.  In contrast, it's fairly clear from the abstract that the paper is talking about a correlation between someone being transsexual and being exposed to trauma.

The distinction here is that the paper is NOT asserting that trauma causes transsexualism, where Heyer and his anonymous authority clearly are.

I have a number of problems with this.

First, Heyer and his allies are twisting the objective data.  Claiming a causal connection when what we actually have is a correlation is extremely weak logic.

Second, it is entirely possible that the condition of being transsexual may in fact be traumatic in its own right.  In other words, one would expect to see some evidence of clinical trauma in transsexuals simply because of the consequences of their condition.  For example, it is a fairly common aspect of the narrative of transsexuals to have found their first puberty to be a horrifying experience.

Third, the language of the abstract is clear in pointing out that transsexuals are subject to a great deal of discrimination simply because they are transsexual.  This can be extremely traumatic in the long term, and would also play into the development of consistent symptoms.

Putting the cart before the horse is fundamentally lousy logic.  However, this kind of logic is often used by the propagandists to justify their positions.  Were this the first time on Heyer's blog that I have seen this kind of semantic twisting of facts, I might be willing to view it as an isolated incident and possibly a misunderstanding.  Sadly it isn't.

Back in April, he went on quite a bender citing research papers to justify his claims that transsexuals are "made, not born", and further Heyer likes to assert that regrets from GRS treatment are directly related to the high rates of suicide among transgender people.

On Psychological Care In Managing Gender Dysphoria

This will be a somewhat lengthy post.  In part, because I find the space I am about to discuss multi-faceted, and the discussion around each facet of the conversation is non-trivial.  The involvement of mental health professionals in the process of Gender Transition (I will use the term "transition" from here on in) is complex and the subject of many strongly-held opinions within the transgender community.    This essay will be my attempt to lay out for readers my perspective on things.

Readers should note that these are my opinions today.  Time, evidence and rational counterpoint may well convince me to revise my position.

[Warning:  Lengthy Essay Follows The Jump]

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]