Since everybody's finally talking about WPATH
Yes, that’s what WPATH really is. They’ve been showing the world for years.
So I went to WPATH
There’s a lot to say about my journey through the looking glass and I’m still processing. But one of the things that fascinated me about the World Professional Association for Transgender Health conference was how persuasive the feeling that you're making progress is. The language is always changing and so you're Always Learning. The frontiers of identi…
Where Benjamin and I talk about doctors transitioning patients who claim to have multiple personalities, hand-waving psychosis (after all, we let psychotic patients consent to stool softeners!), the shift to ‘embodiment goals,’ and much much more at WPATH’s 2022 conference in Montreal:
My reporting from WPATH, EPATH, and USPATH:
On WPATH’s private forums, clinicians occasionally express reservations about what they’re being expected to do, such as the social worker who wondered whether she should write letters for surgery for “several trans clients with serious mental illness… Even though these clients have a well-established trans gender identity, their likely stability post initiation of HRT [hormone-replacement therapy] or surgery is difficult to predict. What criteria do other people use to determine whether or not they can write a letter supporting surgical transition for this population?”
Her colleagues quickly put her in her place: “My feeling is that, in general, mental illness is not a reason to withhold needed medical care from clients,” an “affirming, anti-oppressive” gender therapist responded. “My assumption is that you’re asking this question because you’re taking seriously your responsibility to care for and guide your clients. Unfortunately, though, I think the broader context in which this question even exists is one in which we, as mental health professionals, have been put inappropriately into gatekeeper roles. I’m not aware of any other medical procedure that requires the approval of a therapist. I think requiring this for trans clients is another way that our healthcare system positions gender-affirming care as ‘optional’ or only for those who can prove they deserve it.”
Another gender clinician referred dismissively to the recommendation that mental illness should be “well controlled” before initiating hormonal and surgical interventions: “I am personally not invested in the ‘well controlled’ criterion phrase unless absolutely necessary… in the last 15 years I had to regrettably decline writing only one letter, mainly [because] the person evaluated was in active psychosis and hallucinated during the assessment session. Other than that, everyone got their assessment letter, insurance approval, and are living [presumably] happily ever after.” Everything hinges on that “presumably”.
For years, gender clinicians have reassured patients and parents that the evidence would eventually bear out the lofty promises of transition: that transition is life-saving; that psychotherapeutic approaches to gender distress don’t work and instead constitute unethical “conversion therapy”. But as the data starts to come in, transition appears unlikely to live up to these high expectations.
During the Ireland conference, researchers bracketed discouraging findings with upbeat statements of belief such as: “We all know gender-affirming care is effective.” A Swedish researcher who found that psychiatric hospitalisation increased after patients initiated puberty blockers or cross-sex hormones told the audience that she was “really concerned”, not about the results themselves, but “about how results will be interpreted” because, “as you all know, there are improved mental health outcomes following puberty blockers and gender-affirming hormones” — even when the research can’t find those benefits.
With Mia and Benjamin:
The triumph of incongruence over dysphoria
When I first noticed the shift from gender dysphoria to gender incongruence seemed to me to be primarily about normalizing an ever-widening range of body modifications. (And don’t get me wrong: that’s still a big part of it!) But watching the discouraging data about patient mental health outcomes—data that researchers and clinicians refuse to translate …
"Don't stop believin'": Three days at EPATH
I wrote about my experience at the European Professional Association for Transgender Health conference for Genspect. Here’s an excerpt—but please read the whole thing (says every writer ever, I know)! So many questions aren’t asked, so many presentations end with no questions from the audience at all. Instead, there’s an awkward pause where inquiry and …
"We're giving these girls mastectomies. You have to be curious about what's going on."
In this podcast, Corinna Cohn, Lisa Selin Davis, Wesley Yang, and I discuss our experiences at the European Professional Association for Transgender Health and Genspect conferences in this recording from the last day of our time together in Ireland.
USPATH Bingo (though honestly you could use this for any trans conference pr awareness week)
Very human problems in the field of gender medicine
I wanted to respond to two major themes in the responses to my piece on the questionable beliefs and practices of gender clinicians, which can be summed up as “These people are evil” and “These people are idiots.” I am not going to deny there are bad actors—and
Great reporting for years allowing continued progress to end this medical scandal. Thank you for all your hard work and exposure.
I've been following you for about a year and read most of your great articles. I've also read the reduxx article about high profile scientists engaging in horrific stuff and also advising wpath. again males are suddenly established as the whistle blowers, while women have done the digging (hello matt). Even findings of reduxx's are found in their aritcles without any citation. really disappointing.
significant amounts of work and time have been spent into doing this over a long period of time. I see you and am thankful for your work.