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Less Than Affirming: Perspectives Beyond the Gender Affirmative-only Model of Care for Trans* and Gender Dysphoric People

Less Than Affirming: Perspectives Beyond the Gender Affirmative-only Model of Care for Trans* and Gender Dysphoric People
March 24, 2021

By Drs. Preston Sprinkle and Paul Eddy.

 

This is not a traditional blog post, but more of an annotated bibliography that serves as a reference guide that we at The Center for Faith, Sexuality & Gender wanted to make available for public use. The rationale for compiling the following list was sparked by at least two events. First, I (Preston) was engaging in a public dialogue with a transwoman when they raised an important question (to summarize): Isn’t it significant that there is a consensus among the medical community that transitioning is the best way to treat people with gender dysphoria? This is a good question. I disagreed with the premise, that there is such a consensus, and yet I was only able to recall a few names off the top of my head. The names and studies listed below is a more comprehensive list of medical professionals, scholars, and experts in the field who question, on some level, a Gender Affirmative-only Model (GAM) of care for trans*-identified and gender dysphoric people.

 

The second event that triggered this post is the growing assumption in the broader culture that the GAM is the widely agreed upon approach toward trans*-identified people, and that all other models of care (e.g. Watchful Waiting, Bio-Psycho-Social Model, the Exploratory Model) are nothing more than conversion therapy.This cultural phenomenon might be seen most clearly in the recent censoring of books on trans* related issues. Amazon, for instance, no longer sells Ryan T. Anderson’s book When Harry Became Sally, on the grounds that it violates widely accepted views on trans* people and transitioning (though Amazon still sells Adolf Hitler’s Meine Kampf and Casper Smith’s The Earth is Flat: Be Afraid, Be Very Afraid, which raises questions of consistency). Anderson’s book is well-researched and judicially argued, though it disagrees with a Gender Affirmative-only Model of care for trans*-identified people. Other similar books (like Abigail Shrier’s Irreversible Damage) have also received some degree of censorship.

 

The following is a comprehensive (though not exhaustive) list of medical professionals and experts who question the Gender Affirmative-only Model of care for trans*-identified people. Put simply, the GAM assumes that gender identity (GI) – one’s internal sense of self as male, female, both, or neither – is always a more innate, accurate, and authentic description of who a person really is, and if GI conflicts with the person’s biological sex, then the latter should be changed, not the former. To go in the other direction (i.e. help a person conform their gender identity to their biological sex) is viewed as nothing more than “conversation therapy,” similar to trying to change a person’s sexual orientation.

 

The point of this post is not to argue for one model over another. Our purpose is simply to show that there is no consensus among experts, scholars, and medical professionals regarding how best to care for trans*-identified individuals or people with gender dysphoria (GD), nor is there any sort of consensus on what it means to be trans* or the relationship between gender identity and biological sex (i.e. which one is more significant for determining human identity). Treating GD is complicated. Anthropological perspectives on human identity are vast. And there’s an important discussion that needs to be had. Asserting that there is only one tried and true model is scientifically false and actually hinders that discussion—and ultimately hurts trans*-identified individuals.

 

By listing the sources below, we are not at all endorsing them. We would have varying degrees of agreement and disagreement with many of the things stated in the following list of sources. We simply list them to spread awareness that there is a discussion to be had, that there is no consensus on how best to care for people with gender dysphoria.

 

We only annotated some of the sources below, sometimes with extended quotes from the abstracts, other times with our own summary of the article. And we placed in bold some of the most salient aspects of the source’s perspective. The sources below are diverse and come from a vast array of perspectives. The one thing they all have in common is that they would question, on some level, the Gender Affirmative-only Model of care for some, many, or in some cases all trans*-identified people.

 

We’ve grouped these sources under seven different categories: 

  1. Religious Critiques
  2. Psychoanalytic Critiques
  3. Scientific Critiques
    1. Professional Organizations
    2. Individual Researchers / Therapists 
  4. Sociological / Social Constructivist Critiques
  5. Feminist Critiques
  6. Queer Theorist Critiques
  7. Critiques from the Detransition Community and Its Allies, and from Parents of Children with GD 

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1. Religious Critiques

 

A number of the historic (vs. liberal/progressive) expressions of the major world religions, certainly the three Abrahamic faiths, are critical of the social and/or medical transition on principle. The primary principle here is divine creational design for male and female, etc. To reject these religious critiques of transition out of hand is, functionally, to outright reject these historic religious perspectives and convictions regarding the nature of humanity, sexuality, etc. Examples include:

 

Official statements from all three of the major branches of Christianity have registered concern regarding the cultural shift toward a gender affirmative approach. For example:

 

1) From within the Roman Catholic tradition: Pope Francis’s 2016 exhortation Amoris Laetitia, at vatican.va.

 

2) From within the Eastern Orthodox tradition: The Sacred Kinot of Mount Athos, an epicenter of Orthodox monasticism submitted a written protest to Greece’s Ministers of Education and Justice in connection with a law on free gender reassignment. See “Holy Mountain Athos officially opposed the law on ‘free sex change’ [Russian],” AgionOros at agionoros.ru.

 

3) Various Protestant groups have also offered official statements and reports on this issue, including:

 

The Evangelical Alliance, Transsexuality: Report by the Evangelical Alliance Policy Commission (Milton Keynes, UK: Paternoster, 2000)

 

The Southern Baptist Convention, “On Transgender Identity” (Baltimore, MD, June 10-11, 2014) at sbc.net.

 

The Nashville Statement, signed by a sizable number of evangelical Christian leaders (August 2017), cbmw.org

 

From within other religious traditions:

 

1) While the Conservative, Reform, and Reconstructionist forms of Judaism have all posted statements of support for transgender people, Orthodox Judaism – the most conservative expression – broadly rejects transition. See e.g., Abby Stein, Becoming Eve: My Journey from Ultra-Orthodox Rabbi to Transgender Woman (New York: Hachette, 2019);

 

2) From within the Islamic tradition: Sex Reassignment Surgery (SRS) has generally been prohibited (haram) by scholars within both the Sunni and Shi'a branches of Islam. See e.g., Muh. Bahrul Afif, “Islam and Transgender: A Study of Hadith about Transgender.” International Journal of Nusantara Islam 7/2 (2019), 185-98.

- The two notable exceptions to this are the legalization (i.e., rendered halal) of medical transition in the late 1980s in shari'a and/or in state law in Iran (by the fatwa of Ayatollah Khomeini) and in Egypt (by the fatwa of Sheikh Muhammad al-Tantawi). See M. Alipour, “Islamic Shari'a Law, Neotraditionalist Muslim Scholars and Transgender Sex-reassignment Surgery: A Case Study of Ayatollah Khomeini's and Sheikh al-Tantawi's Fatwas.” International Journal of Transgenderism  18/1 (2017), 91-103.


 

2. Psychoanalytic Critiques

 

Historically, the neo-Freudian psychoanalytic tradition has viewed transition with a critical eye.[1]

 

Despite the de-throning of psychoanalytic theory as the reigning paradigm within the American Psychiatric Association (APA), represented by the 1973 decision to eliminate homosexuality from the DSM (and the substitution of a less theoretical, more practical approach to mental illness, fashioned and championed by Robert Spitzer), the psychoanalytic method still exerts significant influence in many quarters of the psychiatric world. Some who operate within the psychoanalytic paradigm have found a way to reconcile it with a gender-affirmative model.[2] However, many psychoanalytic practitioners express one level or another of skepticism toward GAM (e.g., a number of the current and former employees of the Tavistock Centre who have emerged as critics of the use of puberty blockers for children experiencing GD are psychoanalytically trained; e.g., Marina Bonffato, David Bell, Marcus Evans). Psychoanalytic critiques of transition range from explicit and all-out rejection to more subtle probing and questioning. Examples include:

 

Bonfatto, Marina, and Eva Crasnow. “Gender/ed Identities: An Overview of Our Current Work as Child Psychotherapists in the Gender Identity Development Service.” Journal of Child Psychotherapy 44/1 (2018), 29-46.

  • The authors are psychoanalytically trained (Bonffato works at the Tavistock), and thus methodologically predisposed to explore the possibility of childhood gender dysphoria as a psychological phenomenon. They conclude that a common theme among gender dysphoric children and/or their parents is: “a repeated struggle to think symbolically, and a reliance on the body to communicate psychic struggles” (p. 44).
  • “This paper is adapted from a presentation first given at the 2017 Association of Child Psychotherapists (ACP) Conference. We hope to give a feel of our work as psychoanalytic child psychotherapists working in a Tier 4 national assessment service for gender variant children and connect with our colleagues working therapeutically with these families in Child and Adolescent Mental Health Services (CAMHS) and other settings. Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to. To this end, three case studies from the clinic, taken from Under Five, Latency and Adolescent phases of development, are explored. The complexity of the cases is then discussed, followed by parallel issues of development, divergence and difference. These three ‘average’ cases from the Gender Identity Development Services (GIDS) serve to demonstrate the need for child psychotherapy as part of multi-disciplinary thinking about gender variance and how attention must be maintained to each unique story and process of identity development; as well as our clinical task to establish and encourage depressive functioning and secondary processes where possible.”
  • They also register their concern about the increasing prevalence of Rapid Onset Gender Dysphoria (ROGD) (p. 43)

 

Coates, Susan W. “Developmental Research on Childhood Gender Identity Disorder.” In Identity, Gender and Sexuality: 150 Years after Freud, 103-31. Reprint ed. Edited by Peter Fonagy, Rainer Krause, and Marianne Leuzinger-Bokleber. London: Karnac, 2009 [2006].

  • Coates is an American psychoanalyst and a Clinical Professor of Psychology in Psychiatry at the College of Physicians and Surgeons of Columbia University

 

Coates, Susan W. “The Etiology of Boyhood Gender Identity Disorder: An Integrative Model.” In Interface of Psychoanalysis and Psychology, 245–65. Edited by J. Barron, M. Eagle, and D. Wolitzky. Washington, DC: American Psychological Association, 1992.

 

Coates, Susan W. “Intervention with Preschool Boys with Gender Identity Issues.” Neuropsychiatrie de l'Enfance et de l'Adolescence 56/6 (2008), 386-91.

  • “This paper reviews the origins of gender identity issues in preschool boys and presents an overview of treatment strategies for working with parents of boys and with the boy. The goals of treatment are to reestablish a secure attachment relationship with both of his parents, to develop a range of coping mechanisms for handling separation anxiety and aggression, to help the child to understand and enjoy his temperament, to help the child to be able to have same sex friendships, to develop gender flexibility and most importantly, restore his self esteem and his sense of authenticity. Specific treatment interventions are reviewed.”

 

Coates, Susan W. “Ontogenesis of Boyhood Gender Identity Disorder.” Journal of the American Academy of Psychoanalysis 18 (1990), 414 – 38.

  • Updating earlier psychoanalytic interpretations, hypothesizes from the perspective of developmental psychopathology that the development of GID is based on processes involving temperamental vulnerabilities and particular patterns of parent–child interaction

 

Coates, S., R. C. Friedman, and S. Wolfe. “The Etiology of Boyhood Gender Identity Disorder: A Model for Integrating Temperament, Development, and Psychodynamics.” Psychoanalytic Dialogues 1/4 (1991), 481–523.

 

Coates, S., and S. Wolfe. “Gender Identity Disorder in Boys: The Interface of Constitution and Early Experience.” Psychoanalytic Inquiry 15 (1995), 6-38.

 

Corbett, Ken. “Boyhood Femininity, Gender Identity Disorder, Masculine Presuppositions, and the Anxiety of Regulation.” Psychoanalytic Dialogues 19 (2009), 353–70.

  • “This paper details the diagnostic discourse that has accumulated around feminine boys, including the traditional presuppositions of Gender Identity Disorder (GID). The GID discourse is examined for the ways in which it is built upon unquestioned beliefs about masculinity. Distinct from most modern considerations of gender, no effort has been made to critically theorize gender when thinking about feminine boys; masculinity is as masculinity was. Consequently, we are left with modes of diagnosis and treatment that are out of synch with modern social life, and a set of ideas that do not proceed from an adequate understanding of the range that is masculinity. New sustaining ideals are in play, and in accord with these ideals an argument is made for a new mode of psychotherapeutic address. The traditional individual trauma explanation for GID is questioned. Particular emphasis is given to the ways in which this traditional GID discourse fails to reckon with how masculinity is held in place by the strong arm of regulatory anxiety. A new position that incorporates a greater appreciation for the role of social trauma and melancholia is offered. It is argued that a theory that offers insight into the workings of melancholia as it builds the feminine boy affords a more robust set of ideas through which to contemplate the boy. In turn, we come upon a better avenue of psychotherapeutic action—one that does not employ behavioral strategies that reinforce social exclusion.”

 

D’Angelo, Roberto. “The Complexity of Childhood Gender Dysphoria.” Australasian Psychiatry 28/5 (2020), 530-32.

  • D’Angelo – a member of the Society for Evidence-Based Gender Medicine (SEGM) and of the Pediatric and Adolescent Gender Dysphoria Working Group – is indebted to the psychoanalytic tradition
  • Objective: To explore a developmental understanding of childhood gender dysphoria and to compare it to the prevailing paradigm, gender-affirming care. Conclusion: Viewing gender dysphoria through a contemporary developmental frame generates a different understanding of the nature of the phenomenon and its treatment and raises ethical questions about our current gender-affirming approach.”

 

D’Angelo, Roberto. “The Man I am Trying to Be is Not Me.” International Journal of Psychoanalysis 101/5 (2020), 951-70.

  • This paper explores the therapeutic process between analyst and Josh, a trans man whose life had fallen apart after transition. Repetitive enactments involving hiding, deceiving and mystification constituted a prolonged therapeutic impasse. The analyst’s struggle with these binds and with countertransference confusion and anxiety, ultimately illuminated zones that had remained off-limits for a prolonged period of time. Where the couple had been snared in a bind structured by gender, they were now able to access a history of violation and to ask more profound questions about connection, aloneness, authenticity and loss.”

 

D’Angelo, Roberto. “Psychiatry and the Ethical Limits of Gender-Affirming Care.” In Inventing Transgender Children and Young People, 73-92. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

 

D’Angelo, Roberto. “Psychiatry’s Ethical Involvement in Gender-affirming Care.” Australasian Psychiatry 26/5 (2018), 460-63.

  • Raises critical questions for the Gender Affirming approach to GD children.
  • Concludes (p. 463): “Psychiatry has a disturbing history with regard to the human rights of the LGBTI community, and also a history of enthusiastically embracing physical treatments and surgical procedures that were later shown to be problematic or harmful.”

 

D’Angelo, Roberto, and Lisa Marchiano. “Response to Julia Serano’s critique of Lisa Littman’s paper: Rapid Onset Gender Dysphoria in Adolescents and Young Adults: A Study of Parental Reports.” gdworkinggroup.org (Augst 27, 2018), at gdworkinggroup.org.

  • A defense of Lisa Littman’s study of ROGD.

 

D’Angelo, Roberto, Ema Syrulnik, Sasha Ayad, Lisa Marchiano, Dianna Theadora Kenny, and Patrick Clarke. “One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria.” Archives of Sexual Behavior 50/1 (2021), 7-16.

  • All are members of SEGM
  • A critique of Turban, Beckwith, Reisner, and Keuroghlian’s (2020) article that equates all non-Gender Affirming therapeutic approaches to GD as “conversion therapy” that leads to poor mental health/suicidality.
  • For their more popular-level critique see: D’Angelo, Roberto, Ema Syrulnik, Sasha Ayad, Lisa Marchiano, Dianna Theadora Kenny, and Patrick Clarke. “Jack Turban’s Dangerous Campaign to Smear Ethical Psychotherapy as Anti-Trans ‘Conversion Therapy’.” Quillette (November 1, 2020), at quillette.com.

 

Evans, Marcus. “Why I Resigned from Tavistock: Trans-Identified Children Need Therapy, Not Just ‘Affirmation’ and Drugs.” Quillette (January 17, 2020), at quillette.com.

  • Evans is a Psychoanalyst in private practice and formerly served as Consultant Psychotherapist and Associate Clinical Director of Adult and Adolescent Service at the Tavistock and Portman NHS Trust.

 

Gilmore, K. “Gender Identity Disorder in a Girl: Insights from Adoption.” Journal of the American Psychoanalytic Association 43/1 (1995), 39-59.

  • “Gender identity disorder in girls is reported far less frequently than in boys. The analysis of a six-year-old adopted girl with gender identity disorder is presented to show the importance of the mother-infant relationship and of parental, especially maternal, attitudes toward gender in the normal development of gender identity and gender role definition. This child's unusual history included a late adoption, with clear evidence of separation trauma, and the ongoing influence of maternal infertility. Her symptoms of gender identity disorder appeared before her second birthday and were well established by three years of age. The analysis, from age six to thirteen, achieved a better adaptation to her gender. Her masculine strivings gradually became incorporated into an essentially feminine orientation.”

 

Lemma, Alessandra. “Present Without Past: The Disruption of Temporal Integration in a Case of Transsexuality.” Psychoanalytic Inquiry 36 (2016), 360-70.

  • Includes a critique of puberty suppression due to the claim that, in some instances, it can “result in a marked distortion in the young person’s relationship to time” (p. 361).
  • “In this article, I examine the impact of extensive modification of the body on the temporal link, which is an important feature of human identity, as it provides continuity between different representations of the self over time. I illustrate this with a case of a young boy who underwent sex reassignment surgery in late adolescence after the artificial suspension of puberty through sex hormones. I argue that when hormones are used in this way, one can observe in some cases not only the desired suspension of physical time during which the body's given biological trajectory is artificially halted, but also of psychological time. In some instances, this biological and psychic detour can result in a marked distortion in the young person's relationship to time and impacts on their psychological adaptation following surgery.”

 

Lemma, Alessandra. “Research Off the Couch: Re-visiting the Transsexual Conundrum.” Psychoanalytic Psychotherapy 26 (2012), 263-81.

  • “This paper outlines the findings of a qualitative study involving interviews with eight transsexual individuals who had volunteered to take part in a television (TV) documentary about transsexuality. The participants were interviewed before taking part in the documentary and after its screening on national TV. The author proposes that for either biological and/or psychological reasons, some transsexual individuals experience early on a profound and disturbing incongruence at the level of the bodily self. In turn, this experience of incongruity is not contingently mirrored by primary attachment figures and remains unmentalized, thus disrupting self-coherence. In an attempt to restore self-coherence, the individual searches for the ‘right’ body that is anticipated to relieve the felt incongruity. The way this modified body relieves the incongruity is through the certainty it imparts that the image in the ‘mirror’ will match the subjective experience of the body. In this study, the experience of being mirrored through the group process during filming and the audience's response to the TV series, which was very positive, appeared to be associated with an attenuation in the urgency with which planned body modifications were being discussed post-TV screenings.”

 

Lemma, Alessandra. “Trans-itory Identities: Some Psychoanalytic Reflections on Transgender Identities.” International Journal of Psychoanalysis 99/5 (2018), 1089-1106.

  • “The capacity of transgender to incorporate all gender variance and sexual preferences has become a powerful tool of activism and personal identification. Rather than being an index of marginality “trans” has become a central cultural site. In this paper, I will argue that this identity label encompasses a complex range of internal psychic positions in relation to consciously stated sexual preferences and gender identifications. My aim is to explore what can appear to be in some cases a premature embracement of the empowering potential of the transgender identification through my work with under 18-year-olds who are seeking medical intervention for gender dysphoria. This can undermine the painful psychic work required to establish what transgender means for any given young person. In an external culture where to ask “why transgender” (as opposed to “how transgender”) is felt to be pathologising, working with these young people can prove difficult for the analyst. The challenge is to tread the fine line between a dialogue based on an equidistant curiosity about meaning and function that is core to an analytic approach, and a posture of implicit skepticism.”

 

Meyer, Jon K. “The Theory of Gender Identity Disorders.” Journal of the American Psychoanalytic Association 30/2 (1982), 381-418.

  • Meyer was a psychoanalyst at John Hopkins who was at odds with Money on transsexual surgery. With articles in the 1970s, he challenged SRS. Along with Paul McHugh, he was a key figure in the 1979 ending of SRS at John Hopkins.

 

Meyer. Jon K., and Donna J. Reter. “Sex Reassignment. Follow-up.” Archives of General Psychiatry 36/9 (1979), 1010-15.

  • The (in)famous study that helped sway a number of psychologists and psychoanalysis against sex reassignment surgery (SRS), and served as a research basis for Johns Hopkins to end SRS. Meyer announced the study publicly in a press conference held in October 1979. The press conference was timed when John Money, the gender clinic’s principal proponent, would be out of the country. The clinic was closed shortly after. Reter was apparently Meyer’s secretary. The study has been criticized by gender-affirmative advocates for using questionable statistical procedures, and for researcher bias motivated by a political agenda.

 

Millot, Catherine. Horsexe: Essay on Transsexuality. Translated by K. Hylton. New York: Autonomedia, 1990.

  • A Lacanian psychoanalyst undertakes a study of transsexual desire, with chapters on the female drive in psychosis, “SheMales” (her term), the sex of angels, the Eastern European Skoptzy sect of castrati, SRS operations, and more. Millot proposes that transsexuals occupy a “psychotic” position based on the fantasy of a sex that is not lacking, a sex that is complete and outside sexual difference. She goes on to propose that surgical transitioning is thus a harmful confirmation of the fantasy.

 

Olver, Thomas. “Disaffirming Gender: Somatic Incongruence as a Co-function of Ideological Congruity.” Psychoanalytic Review 106/1 (2019), 1-28.

  • “The activist conjunction of sexual orientation and gender identity is questioned by demonstrating how the concerns of the transgender movement run contrary to an agenda of liberation from gender ideology. The confused vocabulary of trans discourse articulated in the language of somatic incongruence (so-called gender dysphoria) is exposed, using an analysis of the concept of somatic incongruence and the various interventions through which bodies are apparently restored to ideological congruence constructed upon, inter alia, gender, race, and age. The paper rejects transgender medical treatment and surgery as nothing but the most brutal affirmation of gender stereotypes and, in conclusion, calls for a radical and total disaffirming of gender, analogous to the termination of racial classification and segregation.”

 

Quinodoz, D. “A Fe/male Transsexual Patient in Psychoanalysis.” International Journal of Psychoanalysis 79/1 (1998), 95-112.

  • “The author describes the analysis of a transsexual who had undergone a vaginoplasty as a young man and had since been living as a woman. The complexity of the psychic reality is epitomised by the analyst's difficulty in deciding whether to use masculine or feminine grammatical forms to refer to this patient. The author tells how she assumed the fantasy role of parents expecting a baby whose sex they did not yet know. She discusses at length her hesitation about accepting a transsexual patient into analysis and reports how she overcame her misgivings after analysing her own countertransference and consulting the literature. Noting that this borderline analysand resorted to both psychotic and neurotic mechanisms, the analyst decided to rely on the capacity for symbolisation and mental representation evinced in the latter. On the psychotic level, the delusional neo-reality of the appearance of a woman sought to replace the unbearable reality of being a man, whereas the neurotic part was aware that s/he could never really be a woman. The author observes that in this analysand sexualisation served to conceal a fundamental narcissistic fault. She also describes how she worked with her own madness to help the patient emerge from a situation of paradoxical fusion with the mother in madness.”

 

Quinodoz, D. “Termination of a Fe/male Transsexual Patient’s Analysis: An Example of General Validity.” International Journal of Psychoanalysis 83/4 (2002), 783-98.

  • The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by "heterogeneous patients". To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.”

 

Ray, Denise. “Frank in Mind: A Journal to Self.” Journal of Child Psychotherapy 44/1 (2018), 73-89.

  • A psychoanalytic approach to a gender dysphoric natal male adolescent named Lou. Goal of therapy is “integration” of his split-off masculinity – due to parent-child relationship problems (father abandonment by a MtF dad; emeshment with mom). Uses the Frankenstein story as a comparative metaphor. Outcome: While she doesn’t explicitly say one way or the other whether the GD was resolved, she writes that Lou said he was “going to ‘live life normally and find a girlfriend . . .’,” and that he had moved “forward towards a more integrated reality” (p. 87). Lou slowly came to understand and link mind and psyche in the brain and body and what it means to be truly alive” (p. 88).

 

Schwartz, David. “Listening to Children Imagining Gender: Observing the Inflation of an Idea.” Journal of Homosexuality 59/3 (2012), 460-79. Reprinted in: Treating Transgender Children and Adolescents: An Interdisciplinary Discussion, 166-87. Edited by Jack Drescher and William Byne. New York: Routledge, 2013.

  • “Using three of the clinical articles in this special issue of the Journal of Homosexuality as examples, the author attempts to show how their views of gender may influence clinicians' conceptualizations and treatment choices in response to children diagnosed with gender identity disorder (GID), or gender dysphoria. In particular the author argues that the belief that gender is a psychophysiological entity that is organismic and transhistorical, that is, the view known lately as essentialism, promotes more invasive interventions (e.g., endocrinological and surgical) and mistakenly deemphasizes psychological therapies as a clinical response to the suffering of trans children. He tries to show that the drawbacks of essentialism and its correlated treatment approaches are twofold, that a) they promote treatments with insufficient attention to our limited knowledge regarding their safety and efficacy, and b) they advance a reified differentiation of the genders that is politically problematic. The author suggests that a better response to trans children would be one that emphasizes the child's broadly subjective role in his or her construction of transgressive, gender-related psychological and interpersonal phenomena (both painful and not), thus, offering a deeper validation for trans children's challenges to our gender system.”

 

Tsoukala, Konstantina. “‘Un-certainty’: Working Therapeutically with a Transgender Young Person and Learning to Hear the Unknown.” Journal of Child Psychotherapy 44/1 (2018), 90-107.

  • A psychoanalytic perspective (contra the Gender Affirmative-only model). Begins by admitting this was not a “straightforward” case of GD. Emphases on the possibility that GD was really projected anger about his mother onto his body – a “somatic symptom” of an inner conflict (p. 94; cf. 100). A constant referral back to neo-Freudian writers and theories. A therapeutic goal was to help the trans youth to move from a place of enter a place of the certainty associated with concrete thinking to a place of uncertainty / open-mindedness associated with a (higher level) symbolic thinking. In her conclusion, writes: “The fear of political correctness and regressive thinking sometimes overshadows and can almost paralyse our thinking” (p. 104).

 

Withers, Robert. “Be Careful What You Wish For: Trans-Identification and the Evasion of Psychological Distress.” In Inventing Transgender Children and Young People, 121-32. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

 

Withers, Robert. “Clinical Commentary by Robert Withers, Jungian Analyst and Psychotherapist.” Journal of Child Psychotherapy 44/1 (2018), 135-39.

  • “I welcome the chance to comment on this case, which raises a number of difficult, interlinking clinical and ethical issues. It would be impossible to discuss a case like this without being acutely aware of the fraught political climate currently surrounding gender dysphoria. On the one hand clinical protocols designed to protect trans-people from the danger of ‘conversion therapy’ and ensure access to medical treatment have recently been established. On the other hand there is a danger that effective psychoanalytic work with gender dysphoric individuals could be closed down for fear of falling foul of such protocols and/or being accused of transphobia (see Withers, “The View from the Consulting Room,” in Transgender Children and Young People: Born in Your Own Body, 2018). The therapist working with Alex faces the difficult task of attempting to sensitively navigate a path between these dangers.

 

Withers, Robert. “The View from the Consulting Room.” In Transgender Children and Young People: Born in Your Own Body, 181–200. Edited by Heather Brunskell-Evans and Michele Moore. Newcastle-upon-Tyne, UK: Cambridge Scholars, 2018.

  • A psychoanalytic critique of Gender Affirming ideology. Proposes that GD is often tied to childhood trauma, and that therapy – not physical transitioning – is generally the best treatment

 

3. Scientific Critiques

 

Critiques of – or at least significant hesitancy toward – medical transition is being expressed by a variety of people and organization with the wider scientific community. These scientific critiques come from various disciplinary perspectives, including biological, psychological, anthropological, and medical fields. These scientific critiques have emerged both from within research and practitioner spheres. One example, where both research and practitioner spheres coalesce, is that of the Bio-Psycho-Social Model (which overlaps in some ways with what some are now referring to as the Exploratory Model), which approaches children/adolescents experiencing GD with a focus on psycho-social treatments before ever (if ever) considering a path of medical transition for them prior to adulthood. For many, their hesitancy is tied to the lack of a scientifically established robust evidence-base. Hesitancy among biologists can attach to neo-Darwinian convictions that anything that potentially undercuts species propagation – which cross-sex hormone therapy (CSHT) and SRS certainly do – must be considered less than ideal. Hesitancy among psychologists can be fueled by the fact that high rates of mental illness are found among those who experience GD. For some, the Minority Stress Model proposed by gender-affirmative advocates (whereby they functionally attribute this correlation entirely to the effects of social stigma) simply doesn’t explain all of the data – rather, they conclude that at least some of this correlate is ground in an inherent psychological distress related the GD phenomenon itself. Hesitancy among physicians can be as simple as wondering if the surgical removal of healthy organs is really the best way to approach GD when one’s professional commitment is to “first, do no harm.” These less-than-fully-affirmative scientific approaches are held by both individuals and professional organizations. Examples include:

 

 

a. Professional Organizations

 

American College of Pediatricians (ACP) – a smaller, conservative gender-critical break-away group from the larger American Academy of Pediatrics (AAP), which is largely gender-affirmative. Dr. Michelle Cretella is the executive director. The ACP describes itself as: “a growing medical association of more than 600 physicians and other healthcare professionals from across the nation (47 states) who are dedicated to the well-being of children. The vast majority of the ACPeds members are board-certified pediatricians in active practice.”

  • https://acpeds.org/
  • http://factsaboutyouth.com/ - an ACP-sponsored site about homosexuality that supports “change therapy.”
  • For their Joint Letter to HHS, DOJ, and DOE (December 4, 2018), whose signatories include Michelle Cretella, Susan J. Bradley, J. Michael Bailey, Paul McHugh, Michael Laidlaw, Paul W. Hruz, and Tony Perkins (President, Family Research Council), see: acpeds.org.

 

First, Do No Harm: Youth Gender Professionals – a website hosted by two “left-leaning, pro gay rights” professionals who are concerned about the increasingly common trend to gender transition youth. The group is called Youth TransCritical Professionals

 

The International Association of Therapists for Desisters and Detransitioners (IATDD) – “an international group of therapists working together to better understand the needs and challenges faced by desisting and detransitioning people. We believe individuals facing desistance or detransition should have access to high quality psychotherapy with qualified practitioners who are well informed about their experiences. We also provide information, peer consultation and clinical supervision to other therapists working with desisting or detransitioning clients.” (The iatdd appears to have started in the latter half of 2020)

  • Members include: Sasha Ayad, Kirsty Entwistle, Anna Hutchinson, Jerry T. Lawler, Stella O’Malley, and Anastassis Spiliadis
  • https://iatdd.com/

 

National Association of Practising Psychiatrists (NAPP) – an Australian organization formed in 1996 by “concerned psychiatrists who saw an increasing emphasis on cost-cutting and managerialism becoming a danger to effective care of their patients. Political advocacy on behalf of patients and psychiatric professionals became an enduring priority.” Among their stated purposes is “to maintain, improve, advance and promote the ethical standards, integrity and reputation of Australian psychiatry.”

  • Morris, Philip. “Management of Gender Dysphoria.” National Association of Practicing Psychiatrists (November 23, 2020), at napp.org.au

 

Pediatric and Adolescent Gender Dysphoria Working Group: An International Discussion Space for Clinicians and Researchers

  • http://gdworkinggroup.org
  • Members include: J. Michael Bailey, Ray Blanchard, Susan Bradley, James Cantor, Robert D’Angelo, Dianna Kenny, Michael Laidlaw, Lisa Marchiano, Tania Marshall, Debra Soh, Ken Zucker
  • From the Website: “In the past decade, the affirmative model of care has quickly become the standard when treating gender dysphoric or gender nonconforming (GNC) children and youth. This shift in treatment approach has coincided with a significant rise in the number of children and teens presenting with gender dysphoria. At the same time, the political nature of gender dysphoria has led to an increasingly polarized view of the diagnosis, making rigorous debate difficult. This site has been established as a space where clinicians and researchers can explore the evidence for different models or treatment. Our knowledge about gender dysphoria in children, adolescents, and young adults is still very incomplete. The affirmative model has become standard of care before there is enough evidence to determine the long-term risks and benefits of this approach. Our aim is to share a wide range of informed views on the key research findings so that clinicians are empowered to evaluate these critically. In this way, we hope to widen the dialogue in this important field of health care.”

 

ReIME - Rethink Identity Medicine Ethics – devoted to questioning the gender affirmative model and exploring alternatives for gender variant children and adolescents. Lisa Marchiano, Susan Bradley, and William Malone are involved.

 

Royal College of General Practitioners (RCGP) – the professional body for the UK’s general practitioners and primary care physicians. The RDGP issued a statement in June 2019: “The Role of the GP in Caring for Gender-Questioning and Transgender Patients: RCGP Position Statement,” rcgp.org.uk. One of the sub-statements raises some concerns – or at least hesitancy – regarding aspect of the gender affirmative treatment model:

  • “The significant lack of evidence for treatments and interventions which may be offered to people with dysphoria is a major issue facing this area of healthcare. There are also differences in the types and stages of treatment for patients with gender dysphoria depending on their age or stage of life. Gonadorelin (GnRH) analogues are one of the main types of treatment for young people with gender dysphoria. These have long been used to treat young children who start puberty too early, however less is known about their long-term safety in transgender adolescents. Children who have been on GnRH for a certain period of time and are roughly 16 years of age can be offered cross-sex hormones by the NHS, the effects of which can be irreversible. There is a significant lack of robust, comprehensive evidence around the outcomes, side effects and unintended consequences of such treatments for people with gender dysphoria, particularly children and young people, which prevents GPs from helping patients and their families in making an informed decision” (p. 5)

 

Society for Evidence-Based Gender Medicine (SEGM) – Formed in early 2020. Stated goal: “Our aim is to promote safe, compassionate, ethical and evidence-informed healthcare for children, adolescents, and young adults with gender dysphoria.”

  • https://www.segm.org
  • Members include: Sasha Ayad, Michael Biggs, Richard Byng, Patrick Clarke, Robert D’Angelo, Marcus Evans, Dianna T. Kenny, William Malone, Lisa Marchiano, Julia Mason, Ema Syrulnik, et al.
  • Board of Directors: William Malone, Julia Mason, Marcus Evans, and Stephen Beck
  • Based in Twin Falls, ID; SEGM is “an international group of over 100 clinicians and researchers concerned about the lack of quality evidence for the use of hormonal and surgical interventions as first-line treatment for young people with gender dysphoria. We represent expertise from a range of clinical disciplines. Our objectives include evaluating current interventions for gender dysphoria, providing balanced evidence summaries, promoting the development of effective and supportive psychosocial approaches for the care of young people with gender dysphoria and generating good, answerable questions for research.”

 

b. Individual Researchers / Therapists (see also the Psychoanalytic section above)

 

Ayad, Sasha.

 

Bailey, J. Michael. The Man Who Would Be Queen: The Science of Gender Bending and Transsexualism. Washington DC: Joseph Henry, 2003.

 

Bailey, J. Michael. “The Minority Stress Model Deserves Reconsideration, Not Just Extension.” Archives of Sexual Behavior 49/7 (2020), 2265-68.

 

Bailey, J. Michael, and Ray Blanchard. “Gender dysphoria is not one thing.” 4th Wave Now (December 7, 2017), at 4thwavenow.com.

  • Here, they add ROGD as a third type of GD alongside homosexual and autogynephilic types

 

Bailey, J. Michael, and Ray Blanchard. “Suicide or transition: The only options for gender dysphoric kids?” 4th Wave Now (September 6, 2017), at 4thwavenow.com.

 

Bailey, J. Michael, and Kiira Triea. “What Many Transgender Activists Don’t Want You to Know, and Why You Should Know It Anyway.” Perspectives in Biology and Medicine 50/4 (2007), 521-34.

  • “Currently the predominant cultural understanding of male-to-female transsexualism is that all male-to-female (MtF) transsexuals are, essentially, women trapped in men's bodies. This understanding has little scientific basis, however, and is inconsistent with clinical observations. Ray Blanchard has shown that there are two distinct subtypes of MtF transsexuals. Members of one subtype, homosexual transsexuals, are best understood as a type of homosexual male. The other subtype, autogynephilic transsexuals, are motivated by the erotic desire to become women. The persistence of the predominant cultural understanding, while explicable, is damaging to science and to many transsexuals.”

 

Baker, Lauren L. “True Autonomy/False Dichotomies? Genderqueer Kids and the Myth of the Quick Fix.” American Journal of Bioethics 19/2 (2019), 63-65.

  • “Much of the current bioethical conversation surrounding the ethics of medical intervention for gender diverse children rests on a binary understanding of identity in which transition is understood as an all-or-nothing endeavor. But for many trans persons, the desire for medical intervention is not so clear-cut . . . .  [F]or some trans-identified youth, opting to forego or postpone medical transition during early adolescence may be desirable.”

 

Bewley, Susan, Margaret McCartney, Lucy Griffin, and Richard Byng. “Safeguarding Adolescents from Premature, Permanent Medicalisation.” BMJ (2019), doi: https://doi.org/10.1136/bmj.l245.

  • “While respecting individuals’ right to a different viewpoint, it is neither mandatory to affirm their beliefs nor automatic that transition is the goal, particularly when dealing with children, adolescents and young adults. These risk closing the ‘open future’, as well as life-long physical problems including lack of sexual function, infertility and medical dependency. With 85% desistance amongst referred transgender children(8) and increasing awareness of detransitioning (9, 10), unquestioning ‘affirmation’ as a pathway that leads gender dysphoric patients to irreversible interventions cannot be considered sole or best practice. More good-quality research trials are required to provide reliable evidence of clinical and cost-effectiveness of a range of approaches, including patient selection. These will surely include exploration of underlying unhappiness with the goal of achieving body/mind reintegration. In contrast to previous medical scandals that pathologised homosexuality, something different may be happening here. In effect, transitioning children who would otherwise have grown up lesbian, gay or bisexual may introduce another form of conversion (6). A well intentioned but permanent medical pathway for all is unlikely to achieve the best long-term outcomes. Confirming disgust in natal sex or external sexual organs, especially for those with prior childhood trauma, risks medical collusion with, or reenacting of, abuse.”

 

Biggs, Michael. “Britain’s Experiment with Puberty Blockers.” In Inventing Transgender Children and Young People, 40-55. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

  • Bigg’s critique of the GIDS’ (as-yet-unpublished as of January 2021) notorious Early Intervention Study. In the course of the Keira Bell v Tavistock case, the judges asked why it was never published, and GIDS now claims it is moving ahead with publication.

 

Biggs, Michael. “Puberty Blockers for Gender Dysphoria: The Dutch Protocol.” YouTube (December 14, 2020), https://www.youtube.com/watch?v=9VHlkE40cFk

 

Biggs, Michael. “Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria.” Archives of Sexual Behavior 49/7 (2020),2227-29.

 

Blanchard, Ray. “Deconstructing the Feminine Essence Narrative.” Archives of Sexual Behavior 37 (2008), 434-38.

  • Blanchard’s offers his own view on the sex-brain theory: he says that androphilic transsexualism probably does involve “sex-dimorphic structures” in the brain. While he doesn’t think autogynephilia is caused by the same sex-dimorphic structures as the androphilic group, he does suspect that “the brains of both types “probably differ from the brains of typical heterosexual men” (p. 437)

 

Bonfatto, Marina, and Eva Crasnow. “Gender/ed Identities: An Overview of Our Current Work as Child Psychotherapists in the Gender Identity Development Service.” Journal of Child Psychotherapy 44/1 (2018), 29-46.

  • Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to.”

 

Byng, Richard, Susan Bewley, Damian Clifford, and Margaret McCartney. “Trans Health Needs More and Better Services: Increasing Capacity, Expertise, and Integration.” BMJ (August 17, 2018), at bmj.com.

  • Richard Byng is a member of the Society for Evidence-Based Gender Medicine (SEGM)
  • Proposed ‘terminology’ may mislead and fudges the reality of biological sexual dimorphism. Sex is not “assigned”, but determined at conception and in early embryonic life. Biological characteristics of male and female have “historically” been observed at birth and likely this will continue. Sex should not be confused with gender - a social construct. Although internal subjective identity, legal status and external appearance can change or be re-aligned, a person’s underlying biological sex cannot.” The absence of robust independent evidence of the type normally expected by the BMJ when contemplating significant medical interventions was disappointing. “Diagnosis” is portrayed as a straightforward application of criteria which then leads to treatment, with little understanding of why people seek help. Research is needed to explore the interplays between gender dysphoria, mental health problems, autism spectrum disorders, sexual orientation and unpalatable roles in our highly gendered society.(4) More understanding is required into the complex interactions between autogynephilia (a male’s propensity to be sexually aroused by the thought of himself as a female) (5), sexuality and sexual preference, male to hyper-sexualized female transgenderism, and hormonal or surgical treatment. Good Medical Practice requires doctors both to discuss uncertainties about the effects of treatments (6) and also to work with trans communities to create new knowledge together . . . . ”

 

Byng, Richard, William J. Malone, and David Curtis. “Misinterpretation of the Findings of this Study May Limit Safe, Ethical Treatment Options for Gender-questioning and Gender-diverse People [Comment].” JAMA Psychiatry (October 8, 2019), at jamanetwork.com.

  • Online critical comment on: Turban, Jack L., Noor Beckwith, Sari L. Reisner, and Alex S. Keuroghlian. “Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults.” JAMA Psychiatry (September 11, 2019), doi: at doi.org.
  • “The study by Turban and colleagues reports that previous exposure to “gender identity conversion efforts (GICE)” is associated with suicidality among transgender-identifying adults. While the large sample size is a strength, the authors underplay the serious methodological weaknesses, particularly the likely confounding effects of co-existing mental health problems. They then take this association and in the abstract and conclusion seek to imply causation. Hence, the findings could mislead frontline clinicians and public policymakers alike. The key limitation is that the study did not control for comorbid psychiatric illness, the greatest single predictor of suicidality. While mental health conditions are acknowledged as confounders, they are declared unlikely based on the spurious idea that this would require internalized transphobia.”

 

Cantor, James M. “Transgender and Gender Diverse Children and Adolescents: Fact-Checking of AAP Policy.” Journal of Sex and Marital Therapy 46/4 (2020), 307-13.

  • A scathing critique of the AAP’s statement on Transgender and Gender Non-Conforming (TGNC) children and Adolescents (i.e., Jason Rafferty, et al. [2018)]. Accuses it of systematic misinformation and inexcusable claims without any evidence whatsoever.

 

Churcher Clarke, Anna, and Anastassis Spiliadis. “‘Taking the Lid of the Box’: The Value of Extended Clinical Assessment for Adolescents Presenting with Gender Identity Difficulties.” Clinical Child Psychology and Psychiatry 24 (2019), 338–52.

  • As the number of young people referred to specialist gender identity clinics in the western world increases, there is a need to examine ways of making sense of the range and diversity of their developmental pathways and outcomes. This article presents a joint case review of the authors caseloads over an 18-month period, to identify and describe those young people who presented to the Gender Identity Development Service (GIDS) with gender dysphoria (GD) emerging in adolescence, and who, during the course of assessment, ceased wishing to pursue medical (hormonal) interventions and/or who arrived at a different understanding of their embodied distress.”

 

Entwistle, Kirsty. “An open letter to Dr Polly Carmichael from a former GIDS clinician. ” medium.com (July 18, 2019), at medium.com.

 

Entwistle, Kirsty. “Debate: Reality Check – Detransitioners’ Testimonies Requires Us to Rethink Gender Dysphoria.” Child and Adolescent Mental Health (2020), at doi.org [Epub ahead of print].

 

Heneghan, Carl. “Doubts over evidence for using drugs on the young,” The Times (April 8, 2019), http://archive.is/Txx1O.

  • Heneghan is Professor of Evidence Based Medicine, University of Oxford.

 

Heneghan, Carl, and Tom Jefferson. “Gender-affirming Hormone in Children and Adolescents.” BMJ EBM Spotlight (February 25, 2019), at blogs.bmj.com.

 

Horváth, Hacsi. “A Deeply Flawed Analysis [Comment].” JAMA Psychiatry (October 6, 2019), at jamanetwork.com.

  • Online Comment on: Turban, Jack L., Noor Beckwith, Sari L. Reisner, and Alex S. Keuroghlian. “Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults.” JAMA Psychiatry (September 11, 2019), doi: at doi.org.

 

Hruz, Paul W. “Deficiencies in Scientific Evidence for Medical Management of Gender Dysphoria.” Linacre Quarterly (2019), at doi.org. (9 pp.)

 

Hruz, Paul W., Lawrence S. Mayer, and Paul R. McHugh. “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria.” The New Atlantis (Spring 2017), 3-36.

 

Hutchinson, Anna, Melissa Midgen, and Anastassis Spiliadis. “In Support of Research Into Rapid-Onset Gender Dysphoria.” Archives of Sexual Behavior (July 17, 2019), at doi.org [e-pub ahead of time].

  • Tavistock clinicians who advocate for more work on ROGD

 

Kenny, Dianna T. “Gender Development and the Transgendering of Children.” In Inventing Transgender Children and Young People, 93-107. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

  • Kenny is Professor of Psychology at University of Sydney, AU.

 

Kenny, Dianna T. “Is Gender Dysphoria Socially Contagious?” diannakenny.com.au (September 16, 2019), at diannakenny.com.au.

 

Laidlaw, Michael K “Gender Dysphoria and Children: An Endocrinologist’s Evaluation of I am Jazz.” Public Discourse (April 5, 2018), at thepublicdiscourse.com.

 

Laidlaw, Michael, Michelle Cretella, and G. Kevin Donovan. “The Right to Best Care for Children Does Not Include the Right to Medical Transition.” American Journal of Bioethics 19/2 (2019), 75-77.

  • A response to Maura Priet’s target article in this issue: “Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm.” Contra Priest, they claim that a “watchful waiting” approach to gender-dysphoric children and adolescents – not the “gender affirmative therapy” model – is the “current standard of care worldwide” (p. 75). They argue that “the consequences of PBA/GAT (puberty blocking agents/gender affirmative therapy) are not trivial and include potential sterility, sexual dysfunction, thromboembolic and cardiovascular disease, osteoporosis, and malignancy,” citing Hembree, et al., 2017 (p.75).

 

Levine, Stephen B. “Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria.” Journal of Sex & Marital Therapy 44/1 (2018), 29-44.

  • “The sociological momentum to recognize and accommodate to trans phenomena has posed ethical dilemmas for endocrinologists, mental health professionals, and sexual specialists as they experience within themselves the clash between respect for patient autonomy, beneficence, nonmaleficence, and informed consent. The larger ethical clashes are cultural and therefore political. There is a distinct difference between pronouncements that represent human rights ideals and the reality of clinical observations. Some interpret this clash as a moral issue. This article delves into these tensions and reminds apologists from both passionate camps that clinical science has a rich tradition of resolving controversy through careful follow-up, which is not yet well developed in this arena.”

 

Levine, Stephen B. “Transitioning Back to Maleness.” Archives of Sexual Behavior 47/4 (2018), 1295-1300.

  • Case study of a MtF trans who chose to transition back to male after living as a female for 31 years. Cites psychological motivations for the original transition.

 

Malone, William J. “No Child is Born in the Wrong Body … and other thoughts on the concept of gender identity.” 4thWaveNow (August 19, 2019), at 4thwavenow.com.

 

Marchiano, Lisa. “The Language of the Psyche: Symptoms as Symbols.” In Transgender Children and Young People, 107-22. Edited by Heather Brunskell-Evans and Michele Moore. Newcastle upon Tyne, UK: Cambridge Scholars, 2018.

  • A trans-critical clinical social worker and Junian analyst. She proposes that trans* experiences among young people are best understood as historically-contingent examples of the human developmental universal of young people needing to psychologically individuate by rejecting parental authority through forming a new tribal/social identity. Drawing from data on body dysmorphia, she argues that changing one’s body does not alter one’s inner sense of dissatisfaction. She concludes that therapy is the best route to address GD.

 

Marchiano, Lisa. “Layers of meaning: A Jungian analyst questions the identity model for trans-identified youth.” 4thwavenow.com (September 29, 2016), at 4thwavenow.com.

 

Marchiano, Lisa. “Misunderstanding a New Kind of Gender Dysphoria.” Quillette (October 6, 2017), at quillette.com.

  • Pro ROGD

 

Marchiano, Lisa. “Outbreak: On Transgender Teens and Psychic Epidemics.” Psychological Perspectives 60/3 (2017), 345–66.

 

Marchiano, Lisa. “Outbreak: On Transgender Teens and Psychic Epidemics.” Gdworkinggroup.org (August 29, 2018), at gdworkinggroup.org.

  •  Defends Littman’s ROGD theory

 

Marchiano, Lisa. “The Ranks of Gender Detransitioners are Growing. We Need to Understand Why.” quillette.com (January 2, 2020), at quillette.com.

 

Marchiano, Lisa. “Transgender Children: The Making of a Modern Hysteria.” In Inventing Transgender Children and Young People, 56-72. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

 

Mason, Julia W. “Not All Therapy is Conversion Therapy [Comment].” JAMA Psychiatry (September 27, 2019), at jamanetwork.com.

  • Mason is a pediatrician with Calcagno Pediatrics, Gresham, OR, and is on the board of directors of SEGM

 

Mason, Julia W. “A Physician is Worried about Gender Transition in Pediatrics.” KevinMD.com (October 7, 2019), at kevinmd.com.

 

Mayer, Lawrence S., and Paul R. McHugh. “Sexuality and Gender: Findings from the Biological, Psychological, and Social Sciences.” The New Atlantis 50 (Fall 2016), 13-58, 117-28. at thenewatlantis.com.

 

McCartney, Margaret, Susan Bewley, Damian Clifford and Richard Byng. “Gender Incongruence in Children, Adolescents, and Adults: Response to Dr White.” British Journal of General Practice 69/685 (2019), 379; DOI: at doi.org.

  • “The site states ‘Attempted suicide amongst trans people in the UK is 48% ...’. This figure (not confirmed via medical records) comes from a subgroup of 27 people responding to a survey, whose average age was 38, with a third considering themselves disabled. This is unlikely to be a representative, relevant, or generalisable relevant sample. We support children being able to dress and present in the way they wish. The study White cites as supporting children in their socially preferred gender role, and showing benefit of social transition, is exactly that: it refers to social, not medical, transition. No medical treatments were used. If anything, it suggests that medical intervention in this group was not necessary and points to socially assigned gender roles being harmful. It is vital that doctors do not foreclose discussion by distorting the little evidence base that does exist. Admitting uncertainty is uncomfortable, but is the vital step to obtaining better research data to improve the care of current and future patients.”

 

McHugh, Paul R. “Psychiatric Misadventures.” American Scholar 61 (1992), 497-510.

  • Covers Transsexualism and SRS on pp. 501-04

 

McHugh, Paul R. “Surgical Sex: Why We Stopped Doing Sex Change Operations.” First Things (November 2004). At firstthings.com.

 

McHugh, Paul R. “Transgender Surgery Isn't the Solution.” Wall Street Journal (June 12, 2014). At wsj.com

 

McHugh, Paul R. “Transgenderism: A Pathogenic Meme.” Public Discourse (June 10, 2015). At thepublicdiscourse.com.

 

Meyer-Bahlburg, Heino F. L. “Diagnosing Gender? Categorizing Gender-Identity Variants in the Anthropocene,” Archives of Sexual Behavior 48/7 (2019), 2027-35.

  • While not critical of GAM per se, Meyer-Bahlburg emphasizes the importance of considering multiple pathways to trans identification. He takes ROGD and psychiatric conditions associated with trans seriously. Argues that different contexts and questions can embrace different lenses on trans experience.

 

Nieder, Timo O. Jana Eyssel, and Andreas Köhler. “Being Trans without Medical Transition: Exploring Characteristics of Trans Individuals from Germany Not Seeking Gender-Affirmative Medical Interventions.” Archives of Sexual Behavior 49/7 (2020), 2661-72.

  • A study that focuses on the experiences of people who identify as trans* and yet choose not to pursue medical transition

 

O’Malley, Stella. “Trans Kids: It’s Time to Talk.” In Inventing Transgender Children and Young People, 150-66. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

  • O’Malley is a psychotherapist and member of the International Association of Therapists for Desisters and Detransitioners (IATDD)

 

Pilgrim, David, and Kirsty Entwistle. “GnRHa (‘Puberty Blockers’) and Cross Sex Hormones for Children and Adolescents: Informed Consent, Personhood and Freedom of Expression.” New Bioethics 26/3 (2020), 224-37.

  • “Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone analogues (GnRHas) and cross sex hormones to children and adolescents respectively. We place those clinical concerns in a wider societal context and invite consideration of two further relevant ethical domains: competing rights-based claims about male and female personhood; and freedom of expression about those claims. When reflecting on the assessment and medicalization of children and adolescents presenting at gender clinics, the matters of informed consent and iatrogenic risk should be the most pressing for clinicians. However, this is not just a matter of medical ethics, it also implies the need for a full ethical debate on competing notions of personhood and the defence of freedom of expression about transgender and its implications within contemporary democracies.”

 

Sevlever, Melina, and Heino F. L. Meyer-Bahlburg. “Late-Onset Transgender Identity Development of Adolescents in Psychotherapy for Mood and Anxiety Problems: Approach to Assessment and Treatment.” Archives of Sexual Behavior 48/7 (2019), 1993-2001.

  • Another multi-focused and measured assessment of trans adolescents by Meyer-Bahlburg. Argues that “late-onset” adolescent GD is a distinct phenomenon, and in the two cases investigated here, minority stress thesis does NOT account for their psychiatric problems (p. 6-7). Claims there is no compelling etiological theory of trans, apart from those involving intersex conditions (p. 7). Pro “gender exploration” paradigm apart from full transitioning (p. 7). Notes the strong role of the internet in young people’s lives today (p. 7).

 

Soh, Debra W. “Are gender feminists and transgender activists undermining science?” Los Angeles Times (February 10, 2017), at latimes.com.

  • Soh, PhD sexologist turned journalist, critiques gender feminists and transgender activists for rejecting clear data about biological sex differences, etc.

 

Soh, Debra W. “Don’t Treat All Cases of Gender Dysphoria the Same Way.” The Globe and Mail (January 24, 2018), at theglobeandmail.com.

  • Pro ROGD

 

Soh, Debra W. The End of Gender: Debunking the Myths about Sex and Identity in Our Society. New York: Threshold Editions, 2020.

  • Dr. Soh believes in societal rights for trans* people and is supportive of transitioning for some trans* adults. She’s critical, though, of a Gender Affirmative-only model of care for trans*-identified teens, especially those who would fit an ROGD profile.
  • See a critical review of Dr. Soh’s book here.

 

Spiliadis, Anastassis. “Toward a Gender Exploratory Model: Slowing Things Down, Opening Things Up, and Exploring Identity Development.” Metalogos 35 (2019), available here.

  • Spiliadis is a member of the International Association of Therapists for Desisters and Detransitioners. He proposes a third alternative – the Gender Exploratory Model (GEM) – that offers something of a middle path between the polarized binary of Gender Affirmative Model (GAM) and the classic therapeutic model. Orients around multiple interpretations and identities of gender dysphoric experience, and helping clients to entertain different narratives related to this experience.

 

Zucker, Kenneth J.  “#GIDYVR: Gender Identity and Kids.” A presentation given at the Croatian Cultural Centre Auditorium, May 9, 2019, https://www.youtube.com/watch?v=FHREA4Q4V4Q

  • His presentation included a significant section on trans youth and suicidality. His key conclusion: Yes, trans kids have a higher rate of suicidality than kids in the general population. But trans kids have “fairly similar” suicidality rates to the wider population of kids who are clinically referred for “some type of mental health issue other than gender dysphoria.”

 

Zucker, Kenneth J. “Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues.” Archives of Sexual Behavior 48/7 (2019), 1983-92.

  • Reflections on five areas touching on adolescent GD: (1) rise in prevalence rates; (2) altered sex ratio (rise in natal female rates); (3) co-occurring psychopathologies and suicidality; (4) ROGD (which he believes is a real thing); and (5) the best practices debate (3 models)

 

Zucker, Kenneth J. “Debate: Different Strokes for Different Folks.” Child and Adolescent Mental Health (May 2019), at doi.org.

  • “A gender social transition in prepubertal children is a form of psychosocial treatment that aims to reduce gender dysphoria, but with the likely consequence of subsequent (lifelong) biomedical treatments as well (gender‐affirming hormonal treatment and surgery). Gender social transition of prepubertal children will increase dramatically the rate of gender dysphoria persistence when compared to follow-up studies of children with gender dysphoria who did not receive this type of psychosocial intervention and, oddly enough, might be characterized as iatrogenic. Parents who bring their children for clinical care hold different philosophical views on what is the best way to help reduce the gender dysphoria, which require both respect and understanding.”

 

Zucker, Kenneth J. “The Myth of Persistence: Response to ‘A Critical Commentary on Follow-up Studies and ‘Desistance’ Theories about Transgender and Gender Non-conforming Children” by Temple Newhook et al. (2018).” International Journal of Transgenderism 19/2 (2018), 231-45.

 


 

4. Sociological / Social Constructivist Critiques

 

The line between these next three categories can be permeable. This is due to the fact that social constructivism – a perspective that arose within 20th century sociology – has been put to use within particular disciplinary theories and their associated communities . Two such communities that have a theoretical stake in the medical transition debate are feminist theorists and queer theorists (see below). The idea of the socially constructed nature of gender suggests that there is no fixed or essential connection between one’s biological sex and either cultural gender roles or socially constructed gender identities. With this conviction, it is easy to see that social constructivists would be predisposed to seeing GD as neither a biological issue (e.g., they would tend to reject the brain-sex theory) nor an individual psychological issue (e.g., a mental illness), but rather as a sociological issue – one in which the socially constructed and reinforced gender conventions and stereotypes of a particular society have been reified and internalized by its members to such a degree that they are now experienced by individuals within that culture as “natural” and “essential” aspects of their biological sex. Seen in this light, it is understandable that sociologists and anthropologists guided by the dictates of social constructivism tend to see medical transition as a needless capitulation to arbitrarily constructed gender norms. While some support transition as a choice for those who desire it, others are more explicit in their criticisms of it. Examples include:

 

Billings, Dwight B., and Thomas Urban. “The Socio-Medical Construction of Transsexualism: An Interpretation and Critique.” In Blending Genders: Social Aspects of Cross-Dressing and Sex-Changing. Edited by Richard Ekins and Dave King. New York: Routledge, 1996.

  • A social constructivist critique of the claim that transsexualism is primarily a biological-medical phenomenon

 

Ekins, Richard. “The Career Path of the Male Femaler.” In Blending Genders: Social Aspects of Cross-dressing and Sex-changing, 39-47. Edited by Richard Ekins and Dave King. New York: Routledge, 1996.

  • Richard Ekins and Dave King are leading theorists at the intersection of social constructivism and transgender experience
  • A strong social constructivist – but non-queer theory – etiology approach to TS that would be quite offensive to trans activists, since ‘he’ and ‘she’ are always in scare quotes. Ekins writes of “male femaling” in three modes: “body femaling, erotic femaling and gender femaling” (p. 39)

 

Ekins, Richard. Male Femaling: A Grounded Theory Approach to Cross-Dressing and Sex-Changing. New York: Routledge, 1997.

  • The glamour of transvestite fashion is the epitome of 90s style, but the significance of cross-dressing and sex-changing goes much deeper than the annals of fashion. Ekins vividly details the innermost desires and the varied practices of males who wear the clothes of women for the pleasure it gives them (cross-dressers), or who wish to change sex and are actively going about it (sex-changers). This book transforms an area of study previously dominated by clinical models to look instead at cross-dressing and sex-changing as a highly variable social process. Giving precedence to the processual and emergent nature of much cross-dressing and sex-changing phenomena, the book traces the phased femaling career path of the 'male femaler' from 'beginning femaling' through to 'consolidating femaling'. Based upon seventeen years of fieldwork, life history work, qualitative analysis, archival work and contact with several thousand cross-dressers and sex-changers, the book meticulously and systematically develops a theory of 'male femaling' which has major ramifications for both the field of 'transvestism' and 'transsexualism', and for the analysis of sex and gender more generally. Male-Femaling provides social and cultural theorists with a lively case study for the generation of new theory. Social psychologists and sociologists interested in seeing grounded theory applied to a particular case study will be well rewarded.

 

Ekins, Richard. “On Male Femaling: A Grounded Theory Approach to Cross-dressing and Sex-Changing.” The Sociological Review 41 (1993), 1-29.

 

Ekins, Richard, and Dave King. “The Emergence of New Transgendering Identities in the Age of the Internet.” In Transgender Identities: Towards a Social Analysis of Gender Diversity, 25-42. Edited by Sally Hines and Tam Sanger. New York: Routledge, 2010.

  • Two sociologists who strongly argue for gender identity as socially constructed. Emphasizes that the currently dominant gender affirmative trans-activist “feminine essence” narrative is contested by a number of alternative gender narratives, ones that the dominant narrative tried s to silence through the collaboration of “members” of the trans community and “experts” who serve as their legitimizing cultural allies. Alternative “unwelcome" trans narratives include (1) autogynephilia, (2) sissification (or “forced feminization”; i.e., emasculation and feminization – not merely as a “fetish” but as a consolidated identity) , (3) gender critical feminism, and (4) “religious” counter-narratives. Most of the article focuses on  the first two: (1) autogynephilia (i.e., an identity that forms at the intersection of gender identity and sexual orientation) and (2) sissification (i.e., an identity that forms at the intersection of the trans and kink/BDSM communities).

 

Ekins, Richard, and Dave King. “Is the Future Transgendered?” In Conference Report on the 4th International Gender Dysphoria Conference. Edited by A. Purnell. London: BM Gendys, 1996.

 

Ekins, Richard, and Dave King. The Transgender Phenomenon. London: Sage, 2006.

  • One trans advocate says: “This book pathologizes, misdescribes, and indulges in a kind of sociological equivalent of what Blanchard/Zucker/Bailey do.”

 

Ekins, Richard, and Dave King. “Transgendering, Migrating, and Love of Oneself as a Woman: A Contribution to a Sociology of Autogynephilia.” International Journal of Transgenderism 5/3 (2001), at symposium.com.

 

Ekins, Richard, and Dave King, eds. Blending Genders: Social Aspects of Cross-dressing and Sex-changing. New York: Routledge, 1996.

  • A mid-1990s book that operates with the umbrella term understanding of transgender(ism) – or “gender blending” – focused on the “social and cultural constructions of gender” (p. 1)

 

Gonsalves, Tara. “Gender Identity, the Sexed Body, and the Medical Making of Transgender.” Gender & Society 34/6 (2020), 1005-33.

  • In this article, I argue that the medical conceptualization of gender identity in the United States has entered a “new regime of truth.” Drawing from a mixed-methods analysis of medical journals, I illuminate a shift in the locus of gender identity from external genitalia and pathologization of families to genes and brain structure and individualized self-conception. The sexed body itself has also undergone a transformation: Sex no longer resides solely in genitalia but has traveled to more visible parts of the body, implicating racialized aesthetic ideals in its new formulation. The re-imagining of gender identity as genetically and neurologically inscribed and the expanding locus of sex correspond to an inversion of the relationship between gender identity and the sexed body as well as shifts in medical jurisdiction. Whereas psychiatrists in the 1960s, ’70s, and ’80s understood gender as stemming from genital sex, the less popular idea that gender identity precedes the sexed body has gained traction in recent decades. If gender identity once derived from the sexed body, the sexed body must now be brought into alignment with gender identity. The increasing legitimacy of self-defined gender identity, the expanding definition of racialized sex, and the inversion of the sex–gender identity relationship elevates the role of surgeons in producing racialized and sexed bodies.”

 

Johnson, Austin H. “Normative Accountability: How the Medical Model Influences Transgender Identities and Experiences.” Sociology Compass 9/9 (2015), 803-13.

  • An early article working toward the concept of “transnormativity”
  • “The medicalization of gender variance is a key force in transgender people's experiences of embodiment, identity, and community. While most directly dictating experiences of diagnosis and medical classification, it is important to acknowledge that the effects of medicalization are widespread across social contexts and institutions. I explore the medical model of transgender identity, with special attention to its current diagnostic classification, in order to highlight how transgender people's interactional experiences of gender are shaped by medical authority. I review literature that highlights the operation of the medical model as a normative accountability structure in its influence across multiple institutions of social life including health and healthcare, transgender community groups, and legal classification.”

 

Johnson, Austin H. “Transnormativity: A New Concept and Its Validation through Documentary Film about Transgender Men.” Sociological Inquiry 86/4 (2016), 465-91.

  • Johnson’s key article in which he unveils the concept of “transnormativity,” which he defines as “a hegemonic social framework by which transgender people's presentations and experiences of gender are held accountable based on a medicalized binary framework.”
  • “While prior research has called attention to how medically based, normative understandings of sex and gender place undue restrictions on transgender people's autonomy, there has yet to be an attempt to consolidate this research into a recognizable concept that is situated within existing theoretical frameworks. This article uses documentary films focused on transgender men as an empirical example to develop the concept of transnormativity. Transnormativity describes the specific framework to which transgender people's presentations and experiences of gender are held accountable. Drawing on research specific to transgender community groups, medicalization, and legal transition, I argue that transnormativity structures transgender experience, identification, and narratives into a hierarchy of legitimacy that is dependent upon medical standards. This ideology, as I show via a content analysis of documentary films, circulates in media depictions of transgender people in ways that eclipse alternative explanations of gender non‐conformity. While medical transition is a central component of many transgender people's gender trajectory, I argue in this article that the privileging of the medical model over others creates a marginalizing effect for gender‐non‐conforming people who cannot or do not wish to medically transition.”

 

Mohammadi, Mohammad Reza, and Ali Khaleghi. “Transsexualism: A Different Viewpoint to Brain Changes.” Clinical Psychopharmacology Neuroscience 16/2 (2018), 136-43.

  • A study based on S. Han and Y. Ma’s CBB (culture-behavior-brain) Loop model: see Han, Shihui, and Yina Ma. “A Culture-Behavior-Brain Loop Model of Human Development.” Trends in Cognitive Science 19 (2015), 666-76; Han, Shihui. The Sociocultural Brain: A Cultural Neuroscience Approach to Human Nature. New York: Oxford University Press, 2017.
  • Both authors are connected with the Tehran University of Medical Science in Iran, and the perspective of the article is clearly one of GD as a pathology. However, the CBB Loop model that they are using leads to a strongly Social Constructionist, Anti-Essentialist view of sexuality broadly, and trans* experience specifically, and it could be disengaged from their anti-Trans perspective.
  • “Transsexualism refers to a condition or belief which results in gender dysphoria in individuals and makes them insist that their biological gender is different from their psychological and experienced gender. Although the etiology of gender dysphoria (or transsexualism) is still unknown, different neuroimaging studies show that structural and functional changes of the brain result from this sexual incongruence. The question here is whether these reported changes form part of the etiology of transsexualism or themselves result from transsexualism culture, behaviors and lifestyle. Responding to this question can be more precise by consideration of cultural neuroscience concepts, particularly the culture-behavior-brain (CBB) loop model and the interactions between behavior, culture and brain. In this article, we first review the studies on the brain of transgender people and then we will discuss the validity of this claim based on the CBB loop model. In summary, transgender individuals experience change in lifestyle, context of beliefs and concepts and, as a result, their culture and behaviors. Given the close relationship and interaction between culture, behavior and brain, the individual's brain adapts itself to the new condition (culture) and concepts and starts to alter its function and structure.”

 

Sadjadi, Sahar. “Deep in the Brain: Identity and Authenticity in Pediatric Gender Transition.” Cultural Anthropology 34/1 (2019), 103-29.

  • Questions “the hegemony of the interior origins of authentic self and identity and the rejection of possible external, including social, origins of identity”; notes that from her anthropological perspective, “narratives of the self are not anchored in a deep inner core but are relational and situational.” “Statements about a child ‘born with the brain of the opposite gender’ were articulated as self-evident facts by clinicians, as well as by the media and some advocates. As a physician and anthropologist of medicine,  . . . I was perplexed by this merging of science, magic, and religion in explaining children’s gender transition. As another example, I encountered the word soul in an article published by a team from a pediatric gender clinic at Harvard, who are pioneers of new developments in this field . . . .  This use of soul as interchangeable with the brain in the clinical literature is remarkable . . . .  I show how the current clinical enactment of gender identity has relied on processes of (psycho-)medicalization, individualization, thingification, and internalization.” (p. 104).
  • Abstract: “Based on an ethnography of clinical practices around gender-nonconforming and transgender children in the United States, this article explores the cultural and scientific notions of identity that shape this field. It examines the practice of diagnosing true gender identity in the clinic and situates the search for the foundation of identity in the inner depths of the self, and in children as harbingers of authenticity, as part of a broader cultural history. It addresses the scientific substantiation of the faith in innateness (“born this way”) and interiority (“from within”) of identity, as well as their political appeal. This article challenges the often taken-for-granted association of science with materialism—and the distribution of matter-idea along the nature–culture axis—by demonstrating the idealism that drives the siting of identity in the brain. Finally, it questions the assumption that it is the appeal of nature and biology that underlies the cultural attachment to entities such as the gene and the brain as locations for the origin of identity in the contemporary United States. Rather than the nature–culture dyad, this article argues that the internal-external dyad more accurately captures and explains this cultural attachment.”

 

Sadjadi, Sahar. “The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?” Journal of Medical Humanities 34/2 (2013), 255-60.

  • “In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children brought under clinical purview.”

5. Feminist Critiques

 

A significant number of feminists have naturally questioned the Gender Affirmative-only Model. Feminists within this stream, often identified as “radical feminists” or “gender critical feminists” (their opponents use the phrase  “trans-exclusionary radical feminists,” or TERFs, which is considered to be a derogatory slur by these feminists) are generally inspired by the convictions of second-wave feminism that emphasize the socially constructed – and sexist – basis of traditional gender roles rooted in the sex binary. They see those within the trans* community who seek to medically transition as buying into and reinforcing the mistaken notion that masculine and feminine gender identities and their expression are inherently and “essentially” linked with the female and male sexes, when, in fact, they are merely socially constructed gender norms foisted upon a given culture. In addition, they reject the idea that medical transition can actually transform a male into a female, despite the subjective experience of the person. They believe that such transition simply contributes to the erasure of women-only spaces and, in doing so, compromises their safety. Examples include:

 

Allen, Dr. Sophie, Dr. Elizabeth Finneron-Burns, Dr. Jane Clare Jones, Dr. Holly Lawford-Smith, Dr. Mary Leng, Dr. Rebecca Reilly-Cooper, and Dr. Rebecca Simpson. “Derogatory Language in Philosophy Journal Risks Increased Hostility and Diminished Discussion,” DailyNous (August 27, 2018), at dailynous.com.

  • Written by a group of gender critical feminists (their preferred term) in which they register a public complaint against the journal Philosophy and Phenomenological Research for publishing Rachel McKinnon’s and Jason Stanley’s pieces that each used the term “TERF,” which they consider a derogatory slur.

 

Barrett, Ruth, ed. Female Erasure: What You Need To Know About Gender Politics' War on Women, the Female Sex and Human Rights. Pacific Palisades, CA: Tidal Time, 2016.

  • Female Erasure is a collection of diverse voices speaking out against gender identity politics, exposing the origins and harmful effects of transgender ideology on the lives of women and children today as a continuation of female erasure and silencing.

 

Bartosch, Josephine. “‘Trans’ Kids: LGB Adults Come Out.” In Transgender Children and Young People, 87-106. Edited by Heather Brunskell-Evans and Michele Moore. Newcastle upon Tyne, UK: Cambridge Scholars, 2018.

  • A feminist activist explores coming-out stories of older same-sex attracted women who, looking back, can identify with much of the GNC feelings and behavior of today’s “TG kids,” but who see it as an indicator of their lesbianism. They worry that today’s rush to TG interpretations of GNC children leads to both bodily harm and the derailing of a lesbian identity for same-sex attracted girls.

 

Bindel, Julie. “Gender Benders, Beware.” The Guardian (January 30, 2004), at theguardian.com.

  • Bindel is a noted British trans-critical lesbian feminist. This is her infamous piece that drew significant public attention. Many considered the language offensive and demeaning. The Guardian received more than two hundred letters of complaint from transsexual people, doctors, therapists, academics and others.

 

Canadian Women’s Sex-Based Rights (caWsbar) – “is a cross-Canada, non-partisan coalition of women and male allies working together to preserve the rights and protections of women and girls, as enshrined in the Canadian Charter of Rights and Freedoms (Section 15). These sex-based Charter rights and protections are currently at risk in Canadian public policy, due to confusion between sex and “gender identity or expression.” We call on all Canadians, regardless of political or religious affiliation, to join us in standing up for women's and girls' fundamental sex-based rights to bodily privacy, dignity, fairness and security.”

 

Ditum, Sarah. “How TERF Works.” Feminist Current (July 29, 2014), at feministcurrent.com.

  • A feminist who questions certain aspects of trans ideology and speaks out against the pejorative TERF label, etc.

 

Gender Identity Watch - Watching Legal Developments that Erase Female Identity

 

Greer, Germaine. The Whole Woman. New York: Anchor, 1999.

  • A well-known second-wave British feminist and noted gender critical feminist

 

Hanisch, Carol, Kathy Scarbrough, Ti-Grace Atkinson, and Kathie Sarachild. “Forbidden Discourse: The Silencing of Feminist Criticism of ‘Gender’: An open statement from 48 radical feminists from seven countries.” (August 12, 2013), 3 pp., at meetinggroundonline.org.

  • A radical feminist manifesto, signed by 48 feminists, critiquing contemporary academic “gender theory” that leads to the affirmation of MtF transsexuality

 

Jeffreys, Sheila. Gender Hurts: A Feminist Analysis of the Politics of Transgenderism. New York: Routledge, 2014.

  • A critique of the transgender phenomenon by a leading gender critical feminist. Argues that queer theory and politics, which are sympathetic to transgender, is a betrayal of radical political lesbianism / feminism. Uses a social constructivism account of gender to claim that gender is a male-created hierarchy system with regards to which transgender persons are either unconscious victims or complicit allies of the gender system.

 

Jeffreys, Sheila. “Let us be free to debate transgenderism without being accused of ‘hate speech’.” The Guardian (May 29, 2012), at theguardian.com.

 

Jeffreys, Sheila. “Transgender Activism: A Feminist Perspective.” Journal of Lesbian Studies 1/3-4 (1997), 55-74.

 

Jeffreys, Sheila. Unpacking Queer Politics: A Lesbian Feminist Perspective. Cambridge, UK: Polity, 2003.

 

Michaelson, Jay. “Radical Feminists and Conservative Christians Team Up Against Transgender People.” Daily Beast (September 3, 2016), at thedailybeast.com.

 

Morris, Bonnie J. The Disappearing L: Erasure of Lesbian Spaces and Culture. Albany: SUNY, 2016.

  • A lesbian feminist defense of womyn-only spaces that is sympathetic to the exclusion of transwomen from lesbian spaces

 

Overall, Christine. “Transsexualism and ‘Transracialism’.” Social Philosophy Today 20/3 (2004), 183-93.

  • A feminist-oriented argument that claims if transsexual surgery is morally acceptable . . . then transracial surgery should be morally acceptable” (p. 184). She defends this claim against eight possible objections.

 

Purple Sage: Lesbian, Feminist, Gender Abolitionist. See here

 

Raymond, Janice. “The Politics of Transgenderism.” In Blending Genders: Social Aspects of Cross-dressing and Sex-changing, 215-23. Edited by Richard Ekins and Dave King. New York: Routledge, 1996.

 

Raymond, Janice. The Transsexual Empire: The Making of the Shemale. Reprint ed. New York: Teachers College Press, 1994 [1979]. [Originally published: Boston: Beacon, 1979]

  • The classic second wave feminist critique of transsexualism.

 

Reilley-Cooper, Rebecca. “Gender is Not a Spectrum.” (2016).

  • A trans-critical political philosopher who argues that TG ideology’s claim that gender is “non-binary” is philosophically incoherent.

 

Reilley-Cooper, Rebecca. “Why I no longer hate ‘TERFs’.” Feminist Current (November 10, 2015), at feministcurrent.com.


6. Queer Theorist Critiques

 

Inspired by Michel Foucault in his History of Sexuality, queer theorists from the early 1990s onward have put social constructivism to good postmodern use in their effort to liberate sexuality and gender from (primarily) the norms of the dominant Western culture epitomized in Christendom. Queer theory (QT) has had a complicated relationship with trans experience from the beginning (i.e., Judith Butler’s work). On one hand, certain forms of trans experience fit well with QT, especially those forms that serve to “interrogate and transgress” dominant society gender norms (e.g., nonbinary genders, cross-dressing, etc.). However, many QTs view the choice to transition to the opposite binary sex (transsexual identity) as a capitulation to the dominant society’s binary gender system. Just as with Feminism, an increasing number of QTs are now embracing all forms of trans experience. But a significant number continue to at least subtly critique transition to the opposing sex as an affirmation of the binary itself. Examples include:

  

Butler, Judith. “Doing Justice to Someone: Sex Reassignment and Allegories of Transsexuality.” The Transgender Studies Reader, 183-93. Edited by Susan Stryker and Stephen Wittle. New York: Routledge, 2006.

  • An essay in which she deals head-on with the David Reimer – John/Joan case, which would seem to put Butler’s queer theory-based social constructivist view in jeopardy, since: (1) the social constructivist in this story – John Money – was both wrong and dishonest about it; and (2) the ones who were right are those who hold to an essentialist biological-hormonal basis for gender (Diamond, Colapinto). Conceptually, Butler (and all queer theorists really) is between a rock and a hard place on this one. Butler critiques both Money and Diamond on the one place they seem to agree – namely that there should be medical decisions – and the resultant interventions, including surgeries – about which sex to raise intersex infants prior to their own informed knowledge and consent (Money bases it on which gender is easiest to reconstruct surgically, thus – raise them as a girl since penises are easy to remove but not add; Diamond says it’s the presence of a Y chromosome that determines a male, and thus the raising of a boy). She argues that neither view necessarily follows from the evidence at hand and aligns herself with Intersex advocates who claim the proper path is to do nothing to intersex infants until they have a voice. So, Butler pulls out of this potential queer tailspin by bending over backwards to say she honors John’s self-report of feeling male, and nods to Intersex activism. But Butler then poses questions showing that John’s experience of self was always-already shaped by language with in-built concepts and norms of gender, etc.
  • In their opening statement/summary, Stryker and Whittle (p. 183) offer their own critique of Butler’s essay from a trans* perspective: “For many transgender readers, Butler’s insistence that gender is always ultimate about something else devalues their experience of gender identity’s profound ontological claim – that it is precisely about the realness and inalienability of that identity, rather than about anything else . . . .  it begs another question: if gender is not real, how real can its oppression be?” See also Jay Prosser’s similar critique of Butler in “Judith Butler: Queer Feminism, Transgender, and the Transsubstantiation of Sex,” in The Transgender Studies Reader, 257--80. Edited by Susan Stryker and Stephen Wittle. New York: Routledge, 2006.

 

Hausman, Bernice L. Changing Sex: Transsexualism, Technology, and the Idea of Gender. Durham: Duke University Press, 1995.

  • Hausman takes a historicist approach that rejects seeing transsexualism (TS) as a universal, trans-historical phenomenon. Rather, TS is only possible in light of modern surgical technologies that make “sex change” possible (pp. 2-3, 11-19). Modern medical discoveries also made possible the modern concept of gender and its distinction from sex, i.e., in the context of medically addressing intersex conditions (p. 7ff.). “Gender” was then quickly adopted by 2nd wave feminists to contrast fixed, biological sex with socially constructed gender roles (8ff.). Eventually, 3rd wave feminism (viz. queer theory) would even render biological sex as a social construct and thus not natural (i.e., J. Butler, et al.). “Body” served as a constraint upon sex/gender ideology, but modern surgical technologies are now sued to discipline the body into ideological submission (p. 14). She argues that the medical institution sought to make heterosexual subjects out of intersex persons and indicates how gender operates semiotically to maintain heterosexuality as the norm of the human body.

 

Engdahl, Ulrica. “Wrong Body.” TSQ: Transgender Studies Quarterly 1/1-2 (May 2014), 267-9.

  • A queer critique of transsexual’s interpretation of their experience as being “in the wrong body,” which is attributed to “essentialism” and the “gender binary.” Ironically, in the name of defending “trans person’s first person authority,” the queer assessment of trans people who choose to transition critiques and reinterprets trans peoples’ own account of their self-reported first person experience

 

Hooley, Jesse. “Queering Gender Identity: Interventions in Discourse about Male to Female Transsexualism.” PhD dissertation, University of Sydney, 2003. Available here

  • A queer “critique of different discursive constructions of male to female (or MTF) transsexualism”

 

Latham, J. R. “Axiomatic: Constituting ‘Transexuality’ and Trans Sexualities in Medicine.” Sexualities 22/1-2 (2019), 13-30.

  • “This article argues that medicine misunderstands the necessarily complex ways trans people experience sexuality. Despite revisions to treatment guidelines and diagnostic descriptions, transgender medicine continues to be based on a paradigmatic narrative of ‘being born in the wrong body’. This narrative performatively reproduces sex, gender and ‘gender dysphoria’ as static, predetermined and independent of medical encounters. This article explores how medicine understands and constitutes ‘transsexuality’ as a singular phenomenon that limits trans sexualities. I argue that medicine constitutes transsexuality and understands trans sexualities via four axioms: 1) Transexuality is a disjuncture between mind and body; 2) Transsexuality is hating having the wrong genitals; 3) Transsexuality is painful and debilitating; and 4) Transsexuality is resolvable with hormonal and surgical body modifications. In so doing, medicine flattens out the complexities of trans people’s experiences of gender and sexuality, and simultaneously disavows many trans people’s sexual lives.”

 

Namaste, Viviane. Invisible Lives: The Erasure of Transsexual and Transgendered People. Chicago: University of Chicago Press, 2000.

  • While Namaste herself is a strong advocate for transsexuals, she calls attention to the ways in which queer theory fosters the erasure of transsexuals within the wider Queer-influenced transgender movement. So, ironically, while Queer theory challenges second wave feminism’s rejection of transsexuals based on “sex = biology,” Queer theorists are nonetheless involved in their own form of ideologically-based trans erasure by critiquing transsexuals who desire to transition to the opposite sex as having naively bought into the hegemonic “binary sex” construct of the dominant cisnormative society.

 

Namaste, Viviane. “Tragic Misreadings: Queer Theory’s Erasure of Transgender Subjectivity.” In Queer Studies: A Lesbian, Gay, Bisexual and Transgender Anthology, 183-203. Edited by Brett Beemyn and Mickey Eliason. New York: New York University Press, 1996.

 

Namaste, Viviane, and Lynne Trépanier Réalisé. 1998. “How to Become an American Transgender Theorist (a Recipe).” YouTube video; posted December 7, 2008 on youtube.com.

  • Namaste’s satirical video critique of postmodern, queer theory-based trans theory and its elitist jargon

 

Namaste, Viviane, et al. “How to Become an American Transgender Theorist (A Recipe), Part 2: The Psychoanalysis Lesson.” (2011), https://vimeo.com/360954790

  • The satire continues . . .

 

Prosser, Jay. Second Skins: The Body Narratives of Transsexuality. New York: Columbia University Press, 1998.

  • Like Namaste, Prosser is a strong advocate for transsexuals and likewise calls attention to the ways queer theory fosters the questioning of the legitimacy of transsexuals’ experience.

 

Rubin, Henry. Self-Made Men: Identity and Embodiment among Transsexual Men. Nashville: Vanderbilt University Presss, 2003.

  • With Namaste and Posser, Rubin is a strong advocate for transsexuals and likewise calls attention to the ways queer theory fosters the questioning of the legitimacy of transsexuals’ experience.

 

Wilton, Tamsin. “Out/Performing Our Selves: Sex, Gender and Cartesian Dualism.” Sexualities 3/2 (2000), 237-54.

  • I.e., a Queer Theory / radical feminist critique of the medicalized “wrong body” rhetoric of (MtF) trans experience. Argues that the standard (MTF) transsexual “wrong body” narrative was foisted upon the TS community by medical gate-keepers in order to jump through their regulatory medical hoops to be granted access to CHT and SRS, and that they have now embraced that binary gender narrative, which strengthens the gender binary, rather than troubling and transgressing it.
  • “Elements of feminist and queer theories and of phenomenology are used to engage with Cartesian dualism, in order to clarify the political implications of medicalized male-to-female (MTF) discourses. Particular attention is paid to descriptions of MTF as being in the ‘wrong body’. The author argues that this idea depends on a ‘shallow' model of corporeality, and suggests that a chronotopic model, by which the body is conceptualized as a process existing in both time and space, is more useful in counter-hegemonic theory.”


7. Critiques from the Detransition Community and Its Allies; from Parents of Children with GD; et al.

 

This final group are critical of a Gender Affirmative-only Model, but their critiques are rooted not in a disciplinary theory but rather in deeply personal experience. For detransitioners and their allies, it is the simple fact that, for many people, the transition experience does not deliver on its promise. Rather, it can lead to a range of problems that can lead to regret and the decision to attempt a second transition – a detransition – back to their original sex. Most detransitioners probably wouldn’t hold a hard-core anti-transition stance for all people with GD, but they do warn against a naïve optimism about the gender affirmative paradigm. For parents, it is the experience of walking with their own children through the confusion and painful labyrinth of GD that has led many of them to a skeptical stance vis-à-vis the affirmative view. Examples include:

  

a. Articles, Blogs, etc.

 

Bell, Keira. “Protect Gender Dysphoric Children from the Affirmation Model.” crowdjustice, at crowdjustice.com.

  • Bell, who detransitioned, was the lead claimant in the 2020 legal case against the London-based Tavistock Gender Identity Development Service

 

Butler, Catherine, and Anna Hutchinson. “Debate: The Pressing Need for Research and Services for Gender Desisters/Detransitioners.” Child and Adolescent Mental Health 25/1 (2020), 45-47.

  • However, some people choose to stop this journey, ‘desisters’, or to reverse their transition, ‘detransitioners’. It has been suggested that some professionals and activists are reluctant to acknowledge the existence of desisters and detransitioners, possibly fearing that they may delegitimize persisters’ experiences (International Journal of Transgenderism, 2018, 19, 231). Certainly, despite their presence in all follow‐up studies of young people who have experienced gender dysphoria (GD), little thought has been given to how we might support this cohort.”

 

Callahan, Carey. “Gender identity is hard but jumping to medical solutions is worse.” The Economist: Open Future (December 3, 2019), at economist.com.

  • Callahan is a detransitioned female

 

Callahan, Carey. “Unheard Voices of Detransitioners.” In Transgender Children and Young People, 166-80. Edited by Heather Brunskell-Evans and Michele Moore. Newcastle upon Tyne, UK: Cambridge Scholars, 2018.

 

de Vries, Annelou L. C. “Challenges in Timing Puberty Suppression for Gender-Nonconforming Adolescents.” Pediatrics 146/4 (2020), e2020010611; DOI: at doi.org.

  • de Vries is one of the leading Dutch researchers of GD. In this article she states notes the rising phenomenon of late-onset adolescent GD and that such cases may involve a “new developmental pathway,” one that “raises the question whether the positive outcomes of early medical interventions also apply to adolescents who more recently present in overwhelming large numbers for transgender care, including those that come at an older age, possibly without a childhood history of GI. It also asks for caution because some case histories illustrate the complexities that may be associated with later-presenting transgender adolescents and describe that some eventually detransition.”  She admits that “given these uncertainties, providing early medical treatment to transgender adolescents remains a challenging area to work in. Prospective longer-term follow-up studies of clinical samples like the study of Sorbara et al. are needed to inform clinicians so that an individualized approach can be offered that differentiates who will benefit from medical gender affirmation and for whom (additional) mental health support might be more appropriate.”

 

Djordjevic Miroslav L., Marta R. Bizic, D. Duisin, M. B. Bouman, and M. Buncamper. “Reversal Surgery in Regretful Male-to-Female Transsexuals after Sex Reassignment Surgery.” Journal of Sexual Medicine 13 (2016), 1000-07.

  • Purpose: To analyze retrospectively seven patients who underwent reversal surgery after regretting their decision to undergo male-to-female SRS

 

Entwistle, Kirsty. “Debate: Reality Check – Detransitioners’ Testimonies Requires Us to Rethink Gender Dysphoria.” Child and Adolescent Mental Health (2020), at doi.org [Epub ahead of print].

  •  A former Tavistock employee

 

Evans, Charlie. Founder of the first Detransition conference in UK (December 2, 2019), see lifesitenews.com.

  • Evans is founder of the UK-based Detransition Advocacy Network

 

Evans, Charlie, with Claire Heuchan. “I Am No Less of a Woman: Charlie Evans Interview.” afterellen.com (January 23, 2020), at afterellen.com

 

Herzog, Katie. “The Detransitioners: They Were Transgender, Until They Weren’t.” The Stranger (June 28, 2017), at thestranger.com.

  • A good, balanced pro-detransition piece

 

Heyer, Walt. Trans Life Survivors. N.p.: Bowker Identifier Services, 2018.

  • A collection of 30 personal narratives of people experienced gender dysphoria, and who eventually concluded that transitioning was not the answer.

 

Heyer, Walt. “Transgender Identities are Not Always Permanent.” Public Discourse (September 27, 2016), at thepublicdiscourse.com.

  • Heyer detransitioned with the help of his Christian faith. He starts the article off by talking about Alexis Arquette’s (formerly Robert Arquette) story of detransition (Arquette, a transgender performer and activist, returned to living as a man before his death on September 11, 2016, at the age of 47)

 

Horváth, Hacsi. “The Theatre of the Body: A detransitioned epidemiologist examines suicidality, affirmation, and transgender identity.” 4th Wave Now (December 19, 2018), at 4thwavenow.com.

 

Jax, Rene. Don't Get on the Plane: Why a Sex Change Will Ruin Your Life. N.p.: Rene Jax, 2016.

  • Jax is a MtF transsexual. This is a statement on Transition Regret. Jax continues to live as a woman because she says that when Walt Heyer detransitioned, he was written off as “merely a cross dresser” by the trans activist community. Jax wants to avoid her transcritical perspective being undercut by trans activists using a similar tactic.

 

Korpaisarn, Sira, and Katherine Modzelewski. “Trans-transgender Female: Gender Identity Reversal Following Irreversible Gender Affirming Surgeries.” Journal of the Endocrine Society 3/Supp. 1 (2019), MON–195, at doi.org.

  • “Clinical case: A 29-year-old biological female lived as a transgender male for 10 years after realizing male gender identity during puberty. She began to live as a male at age 16 and was diagnosed with GD by an adolescent mental health practitioner. She started transmasculine hormonal therapy at age 17, had a mastectomy at age 18, and hysterectomy-oophorectomy at age 20. At age 25, she was hospitalized for schizophrenia. Around that time, she developed dysphoria about being a transgender male. She later reversed her gender identity and gender expression back to female . . . . She reports regret about her hysterectomy-oophorectomy, but no regrets about her chest surgery as it was essential to her male gender expression at the time of transition. This patient met all of the Endocrine Society criteria for genital gender-affirming surgery . . . . Meticulous mental health evaluation should be completed in transgender individuals who consider irreversible gender-affirming surgeries. In this case, the patient had no documented mental health disorder until after transitioning, making this evaluation more challenging, but on repeat mental health evaluation had GD, leading her to ultimately detransitionConclusion: This case emphasizes the importance of mental health evaluations in transgender care. Although not universally required for initiation of transgender hormone therapy, evaluations by two separate MHPs who are experienced in transgender care are needed prior to irreversible gender-affirming surgeries to ensure GD and decrease the likelihood of detransitioning.”

 

Levine, Stephen B. “Transitioning Back to Maleness.” Archives of Sexual Behavior 47/4 (2018), 1295-1300.

  • Case study of a MtF trans who chose to transition back to male after living as a female for 31 years. Cites psychological motivations for the original transition.

 

Patrick. “Detransition was a Beautiful Process.” In Inventing Transgender Children and Young People, 175-79. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

 

Pick, Thomasin. Transcript of the “Detransition: The Elephant in the Room” conference. Manchester, UK, November 30, 2019. Charlie Evans (chairperson). Available here.

 

Pollock, Nicolas. “‘I Wanted to Take My Body Off’: Detransitioned.” The Atlantic [a documentary video] (June 18, 2018), at theatlantic.com.

  •  A short documentary about Carey Callaghan, a detransitioned female

 

Shute, Joe. “The New Taboo: More People Regret Sex Change and Want to ‘Detransition,’ Surgeon Says.” National Post (October 2, 2017), at nationalpost.com.

 

Singal, Jesse. “It Would Be So Easy For Liberal Outlets To Do A Better Job Covering Gender Dysphoria.” jessesingal.substack.com (February 5, 2019),at jessesingal.substack.com.

  • Much of this piece is on detransitioners; including excerpts of an interview he did with Carey Callahan. The gist of his criticism with liberal media reports of trans experience is that they only report on people’s experiences that align with the sanctioned trans activist community’s narrative. Other people’s experiences – like detransitioners – are either entirely ignored or our-right rejected. In his words: “But there are other stories too, and as is all too common in this subgenre of journalism, Slate and [Devon] Price ignore them entirely.” I.e., he is simply calling out the ironic hegemony of trans activism’s “happy transitioner” narrative. He emphasizes what he calls detransitioners’s experiences of “whack-a-mole gender dysphoria”: “One thing that detransitioners commonly report is a sort of whack-a-mole gender dysphoria in which, after they address some aspect of their dysphoria with a medical or cosmetic intervention, their dysphoria either comes back after the initial glow of the procedure or treatment in question wears off, or pops up in a different place on their body: You get a double mastectomy and no longer feel dysphoric about your chest, for example, but find you are newly and intensely worried about your hips, which remain pretty “womanly” and which you worry will cause people to clock you as female. (I think detransitioners have a cleverer name for this phenomenon than ‘whack-a-mole dysphoria,’ but I’m blanking on it so I’ll go with this one.) To some detransitioners, this whack-a-mole dysphoria served as a warning sign that medical interventions weren’t providing the relief they hoped for — that maybe physically transitioning wasn’t, in fact, the right solution to the complicated problems they were grappling with.”

 

Sullivan, Renee. “A Different Stripe: For eight years, Renee Sullivan identified as transgender. Then it got more complicated.” psychologytoday.com (March 7, 2018), at psychologytoday.com.

  • Sullivan is a detransitioner

 

Stella, Cari. “Female Detransition and Reidentification: Survey Results and Interpretation.” Available on tumblr

  • On FtM transpersons who have de-transitioned back to female. Stella herself is a detransitioned female

             

Twitter.com/ftmdetransed and twitter.com/radfemjourney. “Our Voices Our Selves: Amplifying the Voices of Detransitioned Women.” In Inventing Transgender Children and Young People, 167-74. Edited by Michele Moore and Heather Brunskell-Evans. Newcastle upon Tyne, UK: Cambridge Scholars, 2019.

 

Yardley, Miranda. “A Full Life Uninterrupted by Transition.” In Transgender Children and Young People, 139-165. Edited by Heather Brunskell-Evans and Michele Moore. Newcastle upon Tyne, UK: Cambridge Scholars, 2018.

  • Yardley is a British natal male who has chosen to live as a woman, but who nonetheless takes something of a trans-critical approach by embracing a gender-abolitionist stance that sees gender ideologies as damaging everyone. Yardley rejects the use of the word “woman” for himself, preferring the term “transsexual.”

 

Yoo, Alexander. “Transition Regret and Detransition.” In Lesbian, Gay, Bisexual and Transgender Americans at Risk: Problems and Solutions, Vol 2: Adults, Generation X and Generation Y, 181-91. Edited by Chuck Stewart. Santa Barbara, CA: Praeger, 2018.

  • A strong defense of those who were once within the trans community and then experience transition regret and choose to detransition. Poses difficult questions for the anti-detrans wing of the trans activist community as to why they feel they must paint the number of people who regret transition as “almost negligible” and “irrelevant,” why they show such hatred and vitriol toward them – in short why they “eat their own” (pp. 188-89).

 

 

b. Support Organizations, Etc.

 

4thWaveNow – a parent group for those “skeptical of the transgender child/teen trend and their allies”

 

Bayswater Support Group – a UK-based support group for parents of GD/Trans kids that takes a gender-skeptical stance 

 

Canadian Gender Report – Run by Pamela Buffone, this site states: “We are a group of parents and professionals concerned about the medical transition of children, the introduction of gender identity teaching in our schools and the changing legal landscape that replaces biological sex with the subjective notion of gender self-identity. We are a non-partisan group that believes more open discussion is needed on these issues. We are not influenced by religious or political affiliations and would rather focus on objective research and evidence on the topic of gender transition for children and young people. This site is for everyone who is concerned about why the numbers of gender non-conforming children being referred to gender clinics is skyrocketing in high-income countries around the world. The site is for everyone who questions why adolescents may suddenly identify as a different gender and how the identity politics movement is being promoted to children and youth in our schools and on social media. It is for anyone concerned about the new trend to teach ideology as fact and the emergence of policies and laws that people are fearful of challenging because they may be labelled “transphobic”.

 

Detrans Canada Highway – “Detrans, desisted & reidentified Canadians! A few of us have started an association to hopefully advocate for change. As an association, we will have the power of our membership while keeping individuals safely anonymous.”

 

The Detransition Advocacy Network (TDAN) – a UK-based detransition advocacy and support group founded in November 2019 by Charlie Evans, a former FtM who detransitioned back to female (whose Twitter account was deactivated for “violating Twitter rules”)

 

Detransition Info: https://detransinfo.tumblr.com/

 

Detransitioners Anonymous (meets twice a month)

 

Gender Apostates – a gender-critical site involving both trans and cis women

 

The Gender Care Consumer Advocacy Network (GCCAN) – founded in late 2019, the GCCAN seeks to empower recipients of gender transition-related care to become healthy and whole. It aims to do this by developing a database of resources for consumers to better inform their decisions, establishing a network of support groups where members can explore their options and experiences, and forming a meetup in the spring of 2020 to connect directly with consumers in the community. Two of the three board members are detransitioned; one of GCCAN’s foci is to call for more attention to be given to detransitioners

  • gccan.org
  • GCCAN developed the Gender Care Consumer Bill of Rights

 

Gender Critical Resources

 

Gender Health Query

  • A U.S.-based organization whose mission statement is: “To prevent the over-medicalization of gender nonconforming youth. To prevent harm resulting from medical treatments on trans-identified minors. And to address confusion and rights conflicts that arise from new ideologies about gender (within and outside of the LGBT community). This will be done through outreach to the mental health and medical community, LGBT orgs, parents, schools, media, and the public.”
  • https://www.genderhq.org/

 

Gender Identity Watch - Watching Legal Developments that Erase Female Identity

 

Gender Minefield

            - https://mindergenfield.tumblr.com/

 

GNC Centric

  • Youtube channel run by Benji, a detransitioned female who tells some eerie stories she experienced in the trans community.

 

The Kelsey Coalition – a non-partisan, unfunded, volunteer-run organization whose mission is to promote policies and laws that protect young people from medical and psychological harms. Our inspiration is the courageous FDA pharmacologist Dr. Frances Kelsey, whose refusal to authorize thalidomide for market use in 1961 prevented thousands of serious birth defects and helped strengthen FDA oversight of the pharmaceutical industry. Dr. Kelsey's bravery in the face of immense corporate and political pressure has inspired us to speak truth to power, regardless of the personal cost or strength of our opposition. In recent years, an unprecedented number of young people have begun to self-identify as transgender. Preliminary research has identified potential social and psychological factors fueling this rise. However, children’s self-proclaimed gender identities are often quickly affirmed by therapists and clinicians who have not examined possible underlying issues. Even more concerning is the growing practice of treating young people with powerful puberty-blocking drugs, hormones, and irreversible surgeries . . . .

 

LGB Alliance – a UK-based gender-critical LGB advocacy group (the group is considered “transphobic” and a “hate group” by many within the LGBTQ community)

  • “We are a group of lesbians, gay men and bisexuals who, by and large, have spent our entire lives campaigning for equality for people with same-sex sexual orientation. Among our ranks are doctors, academics, psychiatrists and lawyers with expertise in safeguarding . . . . We have come together now because we believe our hard-won victories are under threat. We believe that biological sex is observed in the womb and/or at birth and not assigned. In our view, current gender ideologies are pseudo-scientific and present a threat to people whose sexual orientation is towards the same sex, in the case of bisexuals, to both sexes. In addition, we believe that these ideologies are confusing and dangerous to children.”
  • https://lgballiance.org.uk/

  

Our Duty – a UK-based trans-critical parents’ support and activist group

  • https://ourduty.group/
  • “About Us”: “Any loving parent knows instinctively that a ‘sex-change’ is not right for their child. Our duty is to bring our children to adulthood healthy in body and mind. Our Duty has no religious or political affiliation. Our mission to help parents does not discriminate. A great many children who consider themselves transgender would, if they avoid transition, grow up to be homosexual. Consequently, we take our lead on LGB matters from LGB Alliance. There are useful resources online that can help provide parents with information, such as Transgender Trend. However, parents need more than excellent information. Parents need to know that they are not alone. They need to know that there are other parents who feel the same as they do – that medical transition is harmful, that there really is no such thing as a transgender child. Often, parents just need somebody to talk to. Our Duty was formed in December 2018 to address that need. We have grown in size and influence since then. In October 2019 we took our case to The Tavistock and Portman NHS Foundation Trust, that, and our parents’ support meeting the same week received coverage in The Sunday Times.”

 

Parents of ROGD Kids

 

Pique Resiliency Project

 

Post Trans – “A project giving space for female detransitioners and desisters to share their journeys” (created by two detransitioned women living in Germany)

 

r/detrans – a detransition subreddit

 

Sex Change Regret website

 

Transgender Reality: What Trans People are Really Saying Online

 

Transgender Trend – Parents Questioning the Trans Narrative (UK based)

 

TreVoices—A network of trans* adults who are deeply critical of a Gender Affirmative-only Model for trans*-identified/GD children/adolescents.

 

 

 

c. Media, Presentations, Etc.

 

“#GIDYVR: Gender Identity and Kids.” A seminar given at the Croatian Cultural Centre Auditorium, May 9, 2019, at youtube.com.

  • The three presenters are: (1) Meghan Murphy, a leading Canadian feminist; (2) Dagny, a member of the Pique Resiliency Project; and (3) Dr. Ken Zucker, one of the world’s leading specialists in children with GD.

 

“Detransition: Normalizing the Conversation.” – a presentation by Joel Nowak as part of the Detransition panel at WPATH's USPATH conference, UCLA (February 3, 2017), at youtube.com.

 

“Detransitioning: Reversing a Gender Transition.” BBC Newsnight (November 26, 2019), at youtube.com.

  • Includes Charlie Evans (who says in the film: “I’m not advocating detransition; I’m advocating for detransitioners”); Debbie (who became a transman but eventually detransitioned back to female); psychotherapist James Caspian (who wanted to write a thesis on "detransition" as part of his master's degree in counselling and psychotherapy at Bath Spa University, but was told not to for political reasons); a representative of Mermaids (defending transition); Anna Hutchinson (a clinical psychologist at GIDS from 2013-2017; and who in the film identifies the detransitioners as “the vulnerable group within the vulnerable group”); and Elizabeth van Horn, consultant psychiatrist at GIDS, Tavistock, who the BBC interviewer pushes uncomfortably hard about the lack of an evidence base for a solid % of positive transition outcomes vs. future desisters.

 

“I Want My Gender Back: Transgender People Who Regretted Changing Sex.” RT documentary (2018), at youtube.com.

  • A video on transition regret. Interviewees include Rene Jax (regertful, but still lives as a woman); Walt Heyer and Billy Burleigh (who sought Heyer’s help) who were both sexually abused as kids and who have now both detransitioned back to male; and Dr. Miroslav Djordjevic on reversal surgery for those who regret transition. Because of the likely negative attacks from transactivists and allies, Jax and Heyer asked that their cities not be identified.

 

NHS child gender clinic: Staff welfare concerns ‘shut down,’” BBC Newsnight (June 18, 2020), at youtube.com.

 

“The Trans Train” [“Uppdrag Granskning”] Mission: Investigate (released April 2, 2019)

 

“The Trans Train 2” [“Uppdrag Granskning 2”] Mission: Investigate (December 14, 2019), available here.

 

“Transgender Kids: Who Knows Best?” BBC documentary (2017).

  • Available at: vimeo.com.
  • The controversial BBC documentary that includes (and shows sympathy to the views of) Kenneth Zucker and Ray Blanchard. December 14, 2017 - Only hours before it was set to air, the Canadian Broadcasting Corporation (CBC) cancelled the planned broadcast of a BBC documentary after transgender activists accused the film of being “transphobic” and “harmful.” Transgender Kids: Who Knows Best? has faced condemnation for including in its coverage the argument that some children diagnosed as transgender may simply be suffering from treatable mental-health issues. “It disseminates inaccurate information about trans youth and gender dysphoria, and will feed transphobia,” wrote Joshua Ferguson, a trans filmmaker, in a Tuesday tweet to the CBC. Although a prior investigation by the BBC had deemed the film to be impartial, CBC removed it from its schedule within hours of receiving complaints on social media.

 

 

 




[1] On the historically tense relationship between the psychoanalytic movement and the transsexual/transgender community, see Patricia Elliot, “Psychoanalysis,” Transgender Studies Quarterly 1/1-2 (2014), 165-68; Barry Reay, “The Transsexual Phenomenon: A Counter-History,” Journal of Social History 47/4 (2014), 1042-70; Joanne Meyerowitz, How Sex Changed: A History of Transsexuality in the United States (Cambridge, MA: Harvard University Press, 2002), 107. For examples of psychoanalytic critiques see:

Colette Chiland, Transsexualism: Illusion and Reality (Disseminations: Psychoanalysis In Contexts; Trans. Philip Slotkin; Middletown, CT: Wesley Unievrsity Press, 2003 [1997]);

Among those who have adopted a distinctly Lacanian approach to the psychoanalytic enterprise, the assessment of transgender experience can be quite different. See e.g., Patricia Gherovici, Please Select Your Gender; idem, Transgender Psychoanalysis: A Lacanian Perspective on Sexual Difference (New York: Routledge, 2017).

[2] E.g., Leezah Hertzmann and Julet Newbigen, eds., Sexuality and Gender Now: Moving Beyond Heteronormativity (Tavistock Clinic Series; New York: Routledge, 2020).