From the Jurassic Clarke to the SOC8: Repsychopathologization of Trans Youth

Kelley Winters, Ph.D. January 11, 2022
Revised 2022Jan13

Nonviolent protest at 2017 USPATH symposium, attribution: Sand Chang

Download full paper with tables in pdf format:

Recently released draft chapters for the WPATH Standards of Care, version 8, offer forward progress for access to confirming medical care for Transgender and Nonbinary adults. However, chapters on child and adolescent assessment and care are rife with conflicting and contradictory language that promotes archaic pscyhopathologized stereotypes of gender diversity and extensive psychogatekeeping to adolescent puberty suppression or confirming hormonal care. They employ patterns of misleading language to oblige long-term psychotherapy for Trans and Nonbinary youth—linguistic tactics that have been historically proposed to euphemize discredited, disaffirming or gender-conversion psychotherapies and circumvent laws and policies that prohibit their practice. On matters of human oppression, historical context matters.

Part 1. Weaponization of Misleading and Deceptive Language

In December, 2021, the World Professional Association for Transgender Health (WPATH, 2021) released draft chapters of the 8th Version of the Standards of Care (SOC8) for public and provider commentary. With 356 pages in the draft chapters and 148 Statements of policy and practice, version 8 is enormously bloated from the 112 pages and couple dozen treatment criteria in the SOC7. Of growing concern to Trans and Nonbinary communities and affirming providers, the draft SOC8 lacks consistency on fundamental ethical principles of Trans health care, such as depsychopathologization of gender diversity, medical necessity of confirming treatments for those who need them, harm reduction, trauma-informed care, and rejection of gender-conversion psychotherapies (SOC7). The new text contains stunning contradictions from chapter to chapter, statement to statement, and even sentence to sentence (ITH, 2021). More troubling, contradiction and ambivalence on established principles of Trans health care in parts of the SOC8 follow a pattern of inaccurate appropriation of Trans health terminology. These same language manipulations were previously presented by Drs. Kenneth Zucker and Richard Green (deceased) at WPATH and USPATH symposia—as tactics to euphemize and normalize psychological treatments that attempt to discourage or suppress non-birth-assigned gender identities and expression (known as gender conversion). These tactics were opposed with historically significant condemnation and nonviolent protest by Trans and Nonbinary communities at the latter conference. Yet such disaffirming tactics have apparently influenced key parts of the Adolescent and Child chapters of the draft SOC8.

At the 2016 WPATH Symposium in Amsterdam, Richard Green and Kenneth Zucker presented a workshop titled, “Gender Laws: The Case of Trans* Children and Adolescents,” on recent legislation in the U.S. and Canada to prohibit the practice of both sexual-orientation-conversion and gender-conversion psychotherapies on minor Trans and Nonbinary youth. In stark contradiction to the association’s position that “Such treatment is no longer considered ethical” (WPATH, 2011, p. 16), this session was a tutorial on how to circumvent such laws and policies. The stated purpose of their session was to promote childhood gender-conversion practices by limiting the impact of laws and policies that prohibit them: “Contribute to the debate and political actions that may keep such regulations within appropriate limits” (WPATH, 2016).

Appearances by Green, a psychiatrist and attorney, and Zucker, a psychologist, at the WPATH Symposium drew concern among Trans communities and affirming providers (Williams, 2017). Both held prominent historical roles in promoting mental illness stereotypes and harmful gender-conversion practices for young Trans and gender diverse children. Green (1987) is most remembered for his role in the notorious “Sissy Boy” experiments at UCLA in the 1970s. Zucker is possibly the most prolific researcher and promoter of gender-conversion psychotherapies, intended to make gender diverse children cisgender or to prevent them from being Trans. (Zucker, 1990; Winters, 2008; Speigel, 2008). Regressive Trans health practices and policies at Zucker’s home institution, the Toronto Centre for Addiction and Mental Health (CAMH, 2015; formerly known as the Clarke Institute of Psychiatry) earned the name, “Jurassic Clarke,” throughout Trans communities (Denny, 2013). Closure of Zucker’s Child and Youth Gender Identity Services program at CAMH (2015) was widely seen as a positive historical inflection point in global Trans health care (Ansara, et al., 2016).

The following year, the USPATH subsidiary of WPATH scheduled two presentations by Dr. Zucker at its first symposium in Los Angeles. His first, titled “Gender variations during childhood” (2017), drew nonviolent protests led by Trans Women of Color—including Trans Advocates for Justice and Accountability co-founder Dani Castro and TransLatin@ Coalition CEO Bamby Salcedo (Blumrosen, 2017; Jacobs, 2017). At issue were Zucker’s history of promoting gender-conversion psychotherapies on trans and gender diverse children (Zucker, et al., 2012; Herriot, 2020), the discredited axiom of 80% “desistance” of childhood gender dysphoria (Drummond, et al., 2008; Newhook, et al. 2018; Newhook, et al. 2021), and WPATH’s decisions to provide a recurring platform for discredited gender-conversion practices and psychopathologized biases.

Zucker’s second USPATH presentation, “The ‘Active Exploration’ Model,” in a session titled, “Gender diverse pre-pubertal children deconstructing the trinary conceptualization of treatment of moving towards an affirmative individualized approach,” was canceled from the conference program. However, his published abstract and the title for the session were deeply troubling in their intent to blur, obfuscate, or “deconstruct” the differences between extremely disparate practices of (1) Zucker’s punitive gender-conversion psychotherapies (Speigel, 2008), (2) the so-called “Dutch Approach” (de Vries and Cohen-Kettenis, 2012) of “watchful waiting” (keeping prepubescent gender incongruent children in birth-assigned/closeted gender roles), and (3) respectful, gender affirmative support (Ehrensaft, 2018). The presenters’ abstract stated,

participants will…understand that applying a distinct approach to a specific gender diverse child is difficult and more of a theoretical conceptualization than a realistic possibility considering the complexity and overlap that exists. (Zucker, 2017)

This erasure of the differences between coercive gender-conversion therapies and respectful affirmation crosses the line from pretense to propaganda. In hindsight of similar tactics and duplicitous language in the draft SOC8 chapters on child and adolescent care, the 2016 WPATH session and the 2017 USPATH session abstract represent history that needs to be remembered.

Nonviolent protest at 2017 USPATH symposium banquet, photo by author

Part 2. When “Active”/“Therapeutic Gender Exploration” is a Loophole for Punitive Discouragement

Gender exploration, in plain language, is a positive process for all youth, cis, Trans, and/or NonBinary, and should be encouraged without shame or disapproval (Ehrensaft, et al., 2018). In contrast, Zucker’s (2016) WPATH presentation condemned laws and medical policies that prohibited gender-conversion treatments. He emphasized that many had exclusions for exploration, to allow youth to freely explore their own gender identities. Zucker suggested that these exclusions be exploited as a loophole to circumvent such laws and policies by simply relabeling disaffirming or punitive treatments as “identity exploration.” His astonishing outburst that followed, left little ambiguity:

So, I asked a lawyer the following: ‘The bill says treatment cannot seek to change the gender identity of a patient under 18 years of age but it is OK to engage in identity exploration. What’s the difference?’ The lawyer had a very detailed analysis: ‘No one the fuck knows.’ (Zucker, 2016)

Zucker presentation to 2016 WPATH Symposium, attribution unknown

In truth, persecuted Trans youth know the difference with certainty. Most of Green’s 2016 WPATH presentation was read from a manuscript later published in the J Am Acad Psychiatry Law (2017). He did not duplicate Zucker’s remarks about the gender “identity exploration” loophole tactic to evade prohibitions on gender-conversion practices, but Green’s law article emphasized it:

…the ‘identity exploration and development’ permitted in the recent legislation has not been tested and may be a gray area for exchange among therapists minors and parents.

In his USPATH session abstract, Zucker (2017) went so far as to label his Clarke Institute/CAMH gender-conversion approach for Trans and gender diverse children as “The ‘Active Exploration’ Model.” The implication is that punitive gender-conversion psychotherapies that “seek to change the gender identity of a patient” might be exempted from legal or professional prohibition if simply given misleading titles that appropriate “exploration” language of affirming care.

The draft Child and Adolescent SOC8 chapters contain similar language of “gender exploration” therapies and “therapeutic exploration of gender diversity” in contexts that are open to interpretation as a disaffirming treatment loophole. Examples are highlighted yellow in Tables 1, 2, and 3.

However, the draft chapters are confusing and contradictory. They also use exploration terms in affirming contexts of “protected space to explore” and “afforded opportunities to continue to explore,” where gender exploration is led by the youth, not imposed by a psychotherapist. In a positive example, the Child chapter begins with some exemplary text that repeats WPATH policies of depsychopathologization and opposition to gender-conversion psychotherapies:

…childhood gender diversity is not a pathology or mental health disorder…conversion therapies for gender diversity in children (i.e., any “therapeutic” attempts to compel a gender diverse child through words and/or actions to identify with, or behave in accordance with, the gender associated with the sex assigned at birth) are harmful and we repudiate their use. (WPATH, 2021)

Statement 8 in the Child chapter contains positive, affirming language as well. On the other hand, Statement 2 correctly asserts that, “Gender diversity is not a mental health disorder,” but adds an ominous “however” and an implication that gender exploration requires a presumption of mental disorder and “highly recommended” mental health expertise.” Statement 5 text asserts that the clinician, rather than the individual child, “needs to explore gender-related issues.” Both imply that “gender exploration” means extensive psychotherapeutic treatment.

In the wake of the Zucker/Green gender-exploration loophole, Statement 13 is troubling. It recommends that health providers and parents “support children to continue to explore their gender,” even those already established and well-adjusted in their authentic, non-birth-assigned gender roles. Fortunately, the supporting text to Statement 13 clarifies that “not all children wish to explore their gender. Cisgender children are not expected to undertake this exploration and therefore attempts to force this with a gender diverse child, if not indicated or welcomed, can be experienced as pathologizing and cisnormative.” However, the fine print of this clarifying text will easily be overlooked by disaffirming providers and health system policymakers. For them, the word, “support,” in the actual Statement 13 can be twisted to compel long-term psychotherapy to “explore” returning to the birth-assigned gender. Further clarification in the statement itself is urgently needed.

The draft Adolescent chapter (WPATH, 2021) also includes some language that respects WPATH’s official opposition to gender-conversion psychotherapies:

We recommend against efforts aimed at trying to change an adolescent’s gender identity and lived gender expression to become more congruent with sex assigned at birth, also referred to as reparative and conversion therapy. (Statement 5)

However, contradictions appear in the supporting text, where the Zucker/Green “exploration” loophole is mimicked:

It is important to note that therapeutic exploration of gender diversity, and potential factors driving a young person’s experience and report of gender incongruence, is not considered a reparative therapy effort in the context of supporting an adolescent with self-discovery, so long as there is no a priori goal to change or promote one particular gender identity or expression. (Statement 5)

In other words, this statement ambiguously allows disaffirming, punitive long-term psychotherapies that place the gender identities of Trans or Nonbinary adolescents on trial—so long as the clinician plays along with chosen pronouns and does not admit to an “a priori goal” of cisgender outcome.

Finally, the SOC8 draft fails to disclose the historical context of Green’s and Zucker’s tactic to circumvent laws and policies prohibiting gender-conversion psychotherapies. The Adolescent and Child chapters require substantial revision to clearly eliminate the Green/Zucker “exploration” loophole. All references to gender exploration or self-discovery should specify that:

any exploration/self-discovery should be led by the client, with neither pressure, coercion or compulsion involved, on the part of providers. The provider should also assure themselves that there is no pressure, coercion or compulsion on the part of parents or other significant persons in the client’s family. (Winter, 2021)

Part 3. When “Social Transition Model” is code for Scaremongering Childhood Gender Authenticity

A second theme in Zucker’s and Green’s 2016 WPATH presentations and Zucker’s 2017 symposium announcement was gaslighting parents and providers who affirmed prepubertal Trans and Gender Diverse children in their authentic social gender roles. They weaponized the term, “social transition,” associating it with frightening, exaggerated risks. Green and Zucker conflated correlation with causation, suggesting that social transition, in itself, was responsible for gender incongruence and Transgender outcomes.

At the WPATH Symposium in Amsterdam, Green (2016, 2017) suggested that forcing gender incongruent children into birth-assigned closets could reduce, rather than exacerbate, distress. He stated, “Short term benefits of reduced cross-gen expression could include reduced distress with discontent over birth sex and reduced stigma from peers over cross gender expression.” He then offered a stunning endorsement of gender-conversion practices that demonized “transsexual outcome” as a “risk” of affirming social gender authenticity in childhood:

A longer term risk of childhood transition include promoting a transsexual outcome that might have been averted/diverted with…social and treatment obstacles.

Green also repeated a stereotype from the so-called “Dutch Approach” (de Vries and Cohen-Kettenis, 2012; Steensma, et al., 2011) that social pressure to remain in non-birth-assigned gender roles was inexplicably more powerful than the ubiquitous punishment of global societal transphobia and would prevent cisgender children from returning to their birth-assigned roles, once changed. He speculated about “…potential problems associated with returning to live as a person of the birth sex,” as an “intermediate term risk.” I have termed this the “Magic Sticky Flypaper Theory” (Winters, 2014).

Zucker, in his (2017) USPATH session abstract, misrepresented social role affirmation of Trans and Gender Diverse children as a clinical approach “to the treatment of gender diverse children.” He referred to childhood gender authenticity as “The ‘Social Transition’ Model.” This linguistic sleight-of-hand implied that allowing prepubescent Trans and Gender Diverse children to simply be themselves without punishment or shame was a medical intervention instead of a human right. In fact, Zucker had previously referred to social gender role authenticity among Trans children as both an “experiment” and a cause of being Trans in adulthood:

My impression is that the early gender transition approach will result in more children persisting in their desire to live as a member of the other gender, which is, in effect, a rather interesting social experiment of nurture (Drescher, 2013).

In contrast, no one considers affirmation of cisgender-privileged children in their socially authentic gender roles as a “treatment approach,” “model,” or “social experiment.” It is taken for granted as a societal norm and a given, for healthy development.

Tables 1 and 2 list examples of disparagement and fearmongering of childhood gender authenticity, or social transition, in the draft Child chapter (highlighted orange). They are disturbingly similar to Green’s and Zucker’s earlier assertions at WPATH and USPATH symposia. For example, Statement 14 exaggerates “risks of a social transition.” It repeats the Magic Sticky Flypaper stereotype, raising “fear that a child will be locked into a [non-birth-assigned] gender expression” and “concern…that a child may suffer negative sequelae if they detransition.” The statement also repeats the causality fallacy (highlighted pink), warning of “potential developmental effect of a social transition in a child.” In other words, Statement 14 spreads fear, uncertainty, and doubt that allowing social authenticity for young Trans children would turn cisgender youth Trans.

Part 4. When “Thorough Comprehensive Biopsychosocial Assessment” is HyperPsychoGatekeeping

In the USPATH session abstract, Zucker (2017) appropriated an innocently-toned term, “comprehensive assessment,” to suggest long-term psychotherapy for Gender Diverse pre-pubertal children on the presumption that Trans and Gender Diverse children have underlying mental pathology:

Through comprehensive assessment that is both affirming of a child’s assertion, yet takes into account the complexity of a multitude of other dynamic factors–some known and some unknown–focusing the treatment on psychological, social, and emotional development will inherently involve evaluating the degree to which a child’s gender nonconformity is impacting these other aspects of the child’s developing sense of self over time.

Unpacking the language of this statement, it is clear that “assessment” is misleading code for “focusing the treatment”; that a child’s gender identity is disparaged as mere “assertion”; that gender diversity is assumed to be a developmental disorder; and, once again, that allowing social gender nonconformity, itself, is a causal factor to adult Trans outcomes. Even more troubling, the word, “affirming,” is colonized and re-contextualized to its opposite meaning.

Tables 2 and 3 list frequent examples of “thorough” / “standardized” / “extended” / “comprehensive”/ “biopsychosocial” “assessment” that appear in the draft Child and Adolescent chapters (WPATH, 2021) of the draft SOC8 (highlighted blue). These statements and assertions are consistent with Zucker’s USPATH assessment dictum and contradict the WPATH depsychopathologization policy. In the Child chapter, they recommend that Trans and Gender Diverse children, not yet eligible for any related medical interventions and only seeking authentic social gender affirmation, continually prove and re-prove their competence and gender identities in compulsory long-term psychotherapy. Statement 5 emphasizes a protracted process of “multiple assessment domains” and “multiple forms of information gathering.” These include “standardized measures related to: gender…,” which are often archaic, offensive, and traumatizing to Trans subjects. Statement 6 repeats the causality fallacy, suggesting that gender diverse children need “assessment” to “consider development factors” and presuming that gender diversity is a developmental pathology. In contrast, if a cisgender child were subject to such punishing psychotherapeutic interrrogation and presumption of sickness for simply needing to express their birth-assigned gender, concerns of abuse would be raised.

The Adolescent chapter (WPATH, 2021) recommends protracted “comprehensive biopsychosocial assessment” of gender diverse adolescents by “mental health professionals,” and not just when specialized mental health support is indicated by evidence. Once again, the draft SOC8 disregards the WPATH Depsychopathologization principle and presumes that gender diversity and need for puberty suppression and confirming care constitute mental disorder. Moreover, WPATH principles of harm reduction, medical necessity, and informed consent protocols (allowing a greater role by medical doctors and clinical staff to perform assessments) are contradicted by the SOC8 requirement that this long-term “assessment should occur prior to any medical interventions being considered (e.g., puberty blocking medication…),” and not concurrently when necessary. Tragically, the Adolescent chapter introductory text also gaslights and disparages culturally competent community and non-profit health clinics that successfully employ harm reduction and informed consent treatment protocols, outside of an ideological psychopathology framework. Both of these policy regressions will place more adolescents experiencing natal puberty in crisis and will cause more mature youth needing confirming hormonal care to seek it on the streets and internet.

WPATH’s highest priority for the SOC8 should be placed on substantial revision of the Adolescent chapter, with emphasis on consistency and comportment to core principles of depsychopathologization of gender diversity, medical necessity of care, harm reduction, trauma-informed care, and clear, unconditional rejection of gender-conversion psychotherapies in all of their obfuscated forms.

Summary

I have long observed that WPATH leadership and the Standards of Care have been a battleground between policymakers who see gender expansive people and cultural traditions as a dimension of natural human diversity and those who see gender diversity as mental sickness to be contained or controlled (Winters, 2008). In spite of this chasm of medical ethics, Standards of Care prior to the version 8 draft have followed a trend of slow progress toward better understanding and acceptance of gender diversity and more affirming and culturally competent approaches to care. The SOC have gradually evolved from a blunt instrument of denial of medical care toward the direction of an actual standard of medical and mental health care for an underserved population. However, this arc of forward progress seems to have stalled in much of the draft SOC8—especially those sections applying to pre-pubertal children and adolescents. WPATH can do better than this. For the sake and survival of the next generation of Trans, Nonbinary, and Gender Diverse children and youth, WPATH must do better.

See link at top of page to Download full paper with tables in pdf format:


References:

Ansara, Y. G., Bouchard, G., Brill, S., Bryson, M., et al. (2016). Support Affirmative Care for Trans and Gender Diverse Kids! Open letter to the Board of Trustees of the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. https://www.ipetitions.com/petition/support-affirmative-care-for-trans-kids

Ashley, F. (2019). Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth. Clin Child Psychol Psychiatry 24, 223–236. https://doi.org/10.1177/1359104519836462

Blumrosen, D. (2017). USPATH video uploads, February 6. https://www.youtube.com/channel/UC0F_D-PI6sPQQKVEy4ihsUQ/videos

Centre for Addiction and Mental Health (2015). CAMH to make changes to Child and Youth Gender Identity Services, December 15, Toronto. Captured, 2015 at http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Pages/CAMH-to-make-changes-to-Child-and-Youth-Gender-Identity-Services.aspx
Archived at
https://web.archive.org/web/20160216201827/http://www.camh.ca/en/hospital/about_camh/newsroom/news_releases_media_advisories_and_backgrounders/current_year/Pages/CAMH-to-make-changes-to-Child-and-Youth-Gender-Identity-Services.aspx

de Vries, A., Cohen-Kettenis, P. (2012): Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach, Journal of Homosexuality, 59:3, 301-320

Denny, D. (1998). The Clarke Institute of Psychiatry: Canada’s shame. Body of Work blog. April 13. http://dallasdenny.com/Writing/2013/08/15/the-clarke-institute-of-psychiatry-canadas-shame-1999/

Drescher, J. (2013). Sunday Dialogue: Our Notions of Gender; When a child identifies with the other gender, what to do? Opinion Letters, New York Times, June 29. Comment by K. Zucker. https://www.nytimes.com/2013/06/30/opinion/sunday/sunday-dialogue-our-notions-of-gender.html

Drummond, K., Bradley, S., Peterson-Badali, M., & Zucker, K. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34-45.

Ehrensaft, D. (2018). Exploring gender expansive expressions. In: The Gender Affirmative Model: An Interdisciplinary Approach to Supporting Transgender and Gender Expansive Children. Keo-Meier, C. and Ehrensaft, D., (Eds). Washington, D.C: American Psychological Association, 101-124

Green, R. (1987). The “Sissy Boy Syndrome” and the Development of Homosexuality, Yale University Press, New Haven CT.

Green, R. (2017) Banning Therapy to Change Sexual Orientation or Gender Identity in Patients Under 18. J Am Acad Psychiatry Law 45:7–11. Also presented to the World Professional Association for Transgender Health 24th Scientific Symposium, June 20. Amsterdam.

Herriot, M. (2020). Social death for trans and queer people: How Canada’s conversion therapy bill fails to protect trans Canadians. The Pigeon, December, 14. Captured 2020 at https://the-pigeon.ca/2020/12/14/federal-conversion-therapy-bill/. Archived at https://web.archive.org/web/20210116094614/https://the-pigeon.ca/2020/12/14/federal-conversion-therapy-bill/

International Transgender Health Group (2021). Collective Analysis: SOC8 Statement Feedback Worksheet. December 15. Archived online: https://transpolicyreform.wordpress.com/2021/12/15/commentary-to-the-wpath-soc8-draft-from-the-international-transgender-health-group/

Jacobs, L. (2017). Trans Issues Today: Dr. Zucker, Time to Retire to Sunny Boca? Huffington Post, March 21. https://www.huffpost.com/entry/trans-issues-today-dr-zucker-time-to-retire-to_b_58c5c2d2e4b0a797c1d39e63

Speigel, A. (2008). Two Families Grapple with Sons’ Gender Preferences, National Public Radio, All Things Considered,” http://www.npr.org/templates/story/story.php?storyId=90247842, May 7.

Steensma, T.D., Biemond, R., de Boer, F. & Cohen-Kettenis, P.T. (2011). Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clinical Child Psychology & Psychiatry, 16(4):499-516.

Temple Newhook, J., Winters, K., Feder, S., Holmes, C., Jamieson, A., Pickett, S., Pyne, J., Sinnott, M-L., Tosh, J. (2021). An author group responds to harmful stereotypes about Trans and Gender Diverse youth in the draft SOC8. Archived online: https://transpolicyreform.wordpress.com/2021/12/17/an-author-group-responds-to-harmful-stereotypes-about-trans-and-gender-diverse-youth-in-the-draft-soc8/

Williams, C. (2017). DiscoSexology Part III: The Report Controversy. The Trans Advocate, January 26. https://www.transadvocate.com/part-iii-the-report-controversy-the-rise-and-fall-of-discosexology-dr-zucker-camh-conversion-therapy_n_19672.htm

Winters, K. (2014). Methodological Questions in Childhood Gender Identity ‘Desistence’ Research. WPATH 22nd Scientific Symposium, Bangkok, Thailand, February 16. https://gidreform.wordpress.com/2014/02/25/methodological-questions-in-childhood-gender-identity-desistence-research/

Winters, K. (2008). Gender Madness in American Psychiatry: Essays from the struggle for Dignity, GID Reform Advocates. Available: amazon.com

Winter, S. (2021). Private correspondence.

World Professional Association for Transgender Health (2011). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. https://wpath.org
also commonly cited as:
Coleman E, Bockting W, Botzer M, et al. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012;13(4):165–232. https://wpath.org

World Professional Association for Transgender Health (2016). WPATH 24th Scientific Symposium, Program Announcement, June 17-21. Amsterdam. Captured 2016: http://wpath2016.conferencespot.org/62620-wpathv2-1.3138789/t002-1.3139895/f0240-1.3140049/0706-000039-1.3140052

World Professional Association for Transgender Health (2021). WPATH Standards Of Care V8 (SOC8) – Public Comment Period Open Now. December 2. https://wpath.org/soc8

World Professional Association for Transgender Health (2021B). SOC8 Chapter List, Chair Leads, Chapter Leads, and Workgroup Members. https://www.wpath.org/media/cms/Documents/SOC%20v8/List%20for%20Publication_FINAL.pdf?_t=1623770909

Zucker, K. (1990). Gender Identity Disorder and Psychosexual Problems in Children and Adolescents. Canadian journal of psychiatry, September, DOI: 10.1177/070674379003500603, https://www.researchgate.net/publication/20948042

Zucker, K., Wood H., Singh, D., & Bradley, S. (2012): A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder, Journal of Homosexuality, 59:3, 369-397
http://dx.doi.org/10.1080/00918369.2012.653309

Zucker, K. (2016). The Clinical Practitioner’s Perspective. World Professional Association for Transgender Health 24th Scientific Symposium, June 20. Amsterdam.

Zucker, K. (2017). Gender variations during childhood. In Development of gender variations: Features and factors, U.S. Professional Association for Transgender Health First Scientific Symposium, Los Angeles, CA, February.

Zucker, K. (2017). Gender Diverse Pre-pubertal Children: Deconstructing the Trinary Conceptualization of Treatment and Moving Towards an Affirmative Individualized Approach. Published abstract for session not presented, U.S. Professional Association for Transgender Health First Scientific Symposium, Los Angeles, CA, February.

Copyright © 2022 Kelley Winters

An author group responds to harmful stereotypes about Trans and Gender Diverse youth in the draft SOC8

Julia Temple Newhook, Kelley Winters, Steven Feder, Cindy Holmes, Ally Jamieson, Sarah Pickett, Jake Pyne, Mari-Lynne Sinnott, and Jem Tosh

SOC8

As the undersigned group of co-authors, we wish to unequivocally express our serious concern and opposition to the misuse of our 2018 papers in the International Journal of Transgender Health, as being supportive of harmful statements contained in the Adolescent Chapter of the WPATH SOC, version 8.

Cited under Statement 12B, our paper is misrepresented as being supportive of the “requirement” that there be “evidence of persistent gender incongruence or gender nonconformity/diversity of several years” – a stipulation to which we are vehemently opposed. Statement 12B, rather than reaching for the gold standard of care that optimizes outcomes for youth, instead and upon biased interpretation of data, propagates the concept of gatekeeping. The inherent reduction in access to care poses more risk than benefit to youth. This recommendation, unsupported by scientific research, will prevent access to medical support that can in some cases be life-saving.

While the text under this statement refers to our papers as noting some “methodological challenges” with studies of “desistance” and “persistence”, the main point of our article was in fact to point out that these studies are being misinterpreted and misused to create barriers to affirming children’s gender identities. In this case, the WPATH Standards of Care version 8 are misusing those problematic studies to create unnecessary, unethical, and harmful barriers to care for adolescents. Further to that, the text minimizes the extent to which our papers, amongst other key citations, extensively refute the stereotypes and assumptions propagated by those studies. The presentation of this topic here is biased and implies fear, uncertainty, and doubt about affirming medical care and social acknowledgment of trans and gender diverse adolescents that is not supported by evidence. For example, this SOC8 text cites aging research claims about prevalent “desistance” of gender dysphoria in pubescent youth to imply widespread “discontinued gender diversity” in adolescents and teens at more mature ages. This is misleading.

There is absolutely no reason to set out a standard of care that demands that a young person must display resistance to gender stereotypes for their assigned gender in order to have their internal sense of gender taken seriously by their parents and health care providers. Requiring a young person to adopt a particular gender expression in order to access medical care for several years, despite their own sense of how they express their gender or their concerns for safety in their own familial, school, and cultural environment, is nothing less than dangerous. It is not supported by current research, and setting any specific duration or time limits upon gender identity to access gender affirming care is arbitrary, and potentially life-threatening. We are adamantly opposed to Statement 12B and we repudiate any connection of our work to support this statement.

The literature review throughout the Adolescent chapter is highly biased, including low-quality research and making a case for creating additional barriers to care for adolescents that rests on transphobic and politicized pseudoscience, rather than on current research and practice that is actually founded in supporting young people to be healthy and well. There is frequent referral to side effects, which are rare, of medical therapies for trans youth, without any acknowledgement of the well-documented high levels of harm suffered by young people through delay or withholding of gender-affirming care and support. Moreover, such withholding of affirming care negates the agency, knowledge and self-determination of gender diverse and trans youth. These recommendations undermine the evidence base of the Standards of Care and jeopardize confidence in the integrity of the process through which the Statements were derived.

Julia Temple Newhook, Kelley Winters, Steven Feder, Cindy Holmes, Ally Jamieson, Sarah Pickett, Jake Pyne, Mari-Lynne Sinnott, and Jem Tosh.

References:

Julia Temple Newhook, Jake Pyne, Kelley Winters, Stephen Feder, Cindy Holmes, Jemma Tosh, Mari-Lynne Sinnott, Ally Jamieson & Sarah Pickett (2018) A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children, International Journal of Transgenderism, 19:2, 212-224, DOI: 10.1080/15532739.2018.1456390
https://www.tandfonline.com/doi/abs/10.1080/15532739.2018.1456390
(Full manuscript available at
https://transpolicyreform.wordpress.com/2018/06/15/accepted-manuscript-a-critical-commentary-on-follow-up-studies-and-desistance-theories-about-transgender-and-gender-non-conforming-children/)

Kelley Winters, Julia Temple Newhook, Jake Pyne, Stephen Feder, Ally Jamieson, Cindy Holmes, Mari-Lynne Sinnott, Sarah Pickett & Jemma Tosh (2018) Learning to listen to trans and gender diverse children: A Response to Zucker (2018) and Steensma and Cohen-Kettenis (2018), International Journal of Transgenderism, 19:2, 246-250, DOI: 10.1080/15532739.2018.1471767
https://www.tandfonline.com/action/showCitFormats?doi=10.1080%2F15532739.2018.1471767
(Full manuscript available at
https://transpolicyreform.wordpress.com/2018/06/20/accepted-manuscript-learning-to-listen-to-trans-and-gender-diverse-children-a-response-to-zucker-2018-and-steensma-and-cohen-kettenis-2018/)

World Professional Association for Transgender Health (pending). Standards of Care Version 8.
https://wpath.org/soc8

Commentary to the WPATH SOC8 draft from the International Transgender Health Group

Kelley Winters, Ph.D.

This is an archive copy of commentary from the International Transgender Health (ITH) Group on the draft Standards of Care, Version 8 (SOC8), published by the World Professional Association for Transgender Health (WPATH). These comments were submitted to WPATH on December 15, 2021.

The International Trans Health group of nearly 9000 global members, currently residing on Facebook, serves the radical purpose of creating a safe space for Trans and gender diverse people around the world to discuss health care policies and practices that impact our lives and well-being with affirming providers, researchers, and policymakers. The very idea of Trans communities, still stereotyped as mentally defective in North America and much of the world, freely discussing our own health issues is threatening to some powerful hierarchies. The boundaries that make this group safe are grounded in basic principles of human dignity, mutual respect, common courtesy, affirmation of non-birth-assigned (including NonBinary) gender identities, and the established medical necessity of transition-related care for those who need it.

This commentary to the SOC8 draft is sourced from nearly 40 hours of ITH collaborative Zoom review sessions, led by Dr. Antonia D’orsay over the past two weeks. Given the very short time that community members were given to submit feedback to WPATH, this table is not perfect nor complete. However, it describes the highest priority concerns and endorsements with the SOC8 draft.

The ITH Facebook Group (facebook.com/groups/transgenderhealth) is currently a Private Status group.

Transgender Affirmation in Retrograde: Historical Context for the Littmanian “ROGD” Media Blitz

Kelley Winters, Ph.D.
updated 2021Dec19, 2022Jan08

A campaign of media disinformation, false stereotyping, and faux science against Trans and Non-Binary adolescents experiencing anatomic/somatic gender dysphoria, their affirming families, and supportive medical providers has escalated in recent months. Much of it is sourced from the political left, in an ideology known as Trans-Exclusive Radical Feminism (Serano, 2016; Williams, 2016), or TERFism. Rooted in the anti-trans writings of Janice Raymond (1980) and antithetical to established principles of feminism (Gleeson, 2021), this movement has long opposed fundamental civil rights and access to Trans-related health care for Trans people, especially targeting Trans women. This is a sad example of what I have termed horizontal minority scapegoating—when some members of an oppressed minority class willingly participate in oppressing an even more marginalized class of human beings, or even their own class.

In the midst of multinational rollbacks of Trans human rights and medical care access during the latter half of the 20-teens, TERFist factions redoubled psychopathologized stereotyping of Trans and gender-diverse people, shifting its focus to Trans men and Transmasculine youth. In an article in the pay-to-play journal, ”PLOS ONE”, Lisa Littman, M.D. (2018) introduced the pseudo-diagnostic term, “rapid onset gender dysphoria,” or “ROGD,” and the stereotype of “social contagion.” The former conflated closeted childhoods, whenever Trans youth are threatened by familial or societal intolerance, with cisgender childhoods that appeared to spontaneously transform into Trans adolescence—as reported by “surprised” parents who were surveyed exclusively from trans-intolerant social media groups (Winters, 2018). The latter asserted that Trans experience and gender dysphoria represent a communicable, mental disease that somehow infects cisgender youth through social media. Littman also speculated that childhood trauma and various mental illnesses are causally related to gender dysphoria and being Trans. Though widely discredited for biased sampling, slipshod scientific methodology, and faulty reasoning (WPATH, 2018; Ashley and Baril, 2018; Ashley, 2020; Serano, 2018), Littman’s defamatory stereotypes found enthusiastic audiences among anti-trans social media groups, such as “4thwavenow” (U.S.), “Transgender Trend” (U.K.), and “Youth Trans Critical Professionals” (the actual sources of Littman’s own study cohort); anti-trans pseudo-medical associations, such as the cynically-named “Society for evidence based gender medicine” and “Gender dysphoria working group;” and conservative extremist news and social media.

In June of (2020), transmisist writer Abigail Shrier (2020) popularized Littman’s “ROGD” and “social contagion” myths with publication of ”Irreversible Damage: The Transgender Craze Seducing Our Daughters”. She mischaracterized rising numbers of Trans and NonBinary people coming out of birth-assigned closets at earlier ages as a social fad or mentally-suspect “craze.” Shrier’s bias and vitriol toward Trans communities were illustrated by her cover graphic, which misgendered and demeaned all Trans men and Transmasculine youth as a vintage paper doll figure of a feminine, rosy-cheeked little girl with an enormous hole punched out of the torso.

In May of 2021, Dr. Erica Anderson, President of the U.S. Professional Association for Transgender Health (USPATH: a subsidiary of the World Professional Association for Transgender Health, or WPATH), and Dr. Laura Edwards-Leeper, of the WPATH Child and Adolescent Committee, were interviewed by host Lesley Stahl (2021) on the CBS 60 Minutes news series. The title of the segment concerned an unprecedented GOP attack on Trans health care in conservative state governments. However, Stahl quickly pivoted away from hate-biased laws, and instead launched her own attack on Trans health care. She positioned narratives of detransition community advocates to gaslight and scandalize modern, affirming medical practices. The implication of the CBS piece was that gender dysphoric Trans and NonBinary individuals who need care should be resisted with more “pushback” rather than affirmation—more of the psychopathological stereotyping of the past, with more compulsory psychotherapy, more prolonged psycho-gatekeeping assessment, and more barriers to medical care. NonBinary writer, James Factora (2021), observed that the Stahl report, “paints an incomplete — and biased — picture of the state of trans healthcare in America.” They continued, “the 60 Minutes segment will only be used to justify further gatekeeping trans people from the care they need to survive.”

In early October, Trans communities and affirming families, allies, and providers were shaken by Shrier’s (2021) interview of WPATH President-elect, Dr. Marci Bowers, and USPATH President, Anderson (both, publicly affirmed Trans women) on the anti-trans Bari Weiss blog site. Bowers and Anderson were quoted by Shrier with disparaging remarks about established, affirming Trans health care and puberty suppression policies (Winters, 2021). Shrier’s blog post associated Bowers’ and Anderson’s inflammatory statements with their positions of authority within the U.S. and World Professional Associations for Transgender Health. However, the WPATH and USPATH (2021) leadership and boards of directors quickly disputed the Shrier interview with a public statement that stood by the “appropriate care of transgender and gender diverse youth, which includes, when indicated, the use of ‘puberty blockers’ such as gonadotropin releasing hormone analogs and other medications to delay puberty, and, when indicated, the use of gender- affirming hormones such as estrogen or testosterone.”

In the Shrier blog post, Dr. Anderson revealed that the New York Times had rejected an op-ed that she had co-authored– “warning that many transgender healthcare providers were treating kids recklessly.” The recently-formed anti-trans web group, Genspect stated, “Dr. Edwards-Leeper is the coauthor of an opinion piece with Dr. Erica Anderson passed over by the New York Times…” (2021). It appears likely that the most recent November 24 ”Washington Post” hit piece by Edwards-Leeper and Anderson may be the same text that was turned away by the NYT or was derived from it.

On the same day as Shrier’s blog post, Dr. Edwards-Leeper was interviewed by Meghan Duam (2021) on The Unspeakable Podcast. The host exclusively referred to Trans/gender dysphoric teens in misgendering terms and pronouns. Edwards-Leeper did not challenge or question Ms. Duam’s disrespectful language. Edwards-Leeper emphasized psychotherapy as a first step for gender dysphoric adolescents, “to understand where it is coming from,” followed by a “comprehensive assessment” that “should always happen before any medical intervention.” In some ways, Edwards-Leeper was more moderate and less dogmatic about protracted psycho-gatekeeping in this particular interview. For example, she acknowledged that “sometimes it makes sense” to initiate blocker care before completing a “comprehensive assessment” for youth facing puberty, when assessment cannot be done in a timely manner. However, her remarks lacked comprehension and empathy for the intense, unbearable suffering that many gender dysphoric youth experience when urgently needed blocker or, as medically appropriate, hormonal care are denied or deferred for long periods of time. She flippantly dismissed this concern, remarking, “teenagers get very frustrated for having to wait.”

Edwards-Leeper acknowledged that the “ROGD” label may be influencing parents to “more quickly dismissing the idea that their child may actually be trans.” However, she uncritically repeated Littman’s “contagion” slur and defended the “ROGD” axiom, describing a hypothetical teen who “never even thought about being trans until a recommended YouTube video popped up.” “All teenagers are impressionable,” Edwards-Leeper repeated. It seems remarkable that Trans individuals, who face oppression and punishment at every turn in an intolerant world, are not similarly impressionable to reverse their gender identities, whenever a cis-normative YouTube “pops up.”

On October 19, Dr. Littman (2021) published an article in the ”Archives of Sexual Behavior,” describing an online survey of 100 individuals who had detransitioned from previous hormonal (or, very rarely, surgical) care. The ASB is reputed for anti-trans bias and ad hominem attack against Trans scholars who dissent from psychopathologized stereotyping (Serano, 2021). The journal’s editor is Dr. Kenneth Zucker, a historical figure in his opposition to affirming treatment of Trans youth and promotion of mental illness stereotypes and punitive methods to attempt to coerce cisgender outcomes (Winters, 2008). Littman declared that “prevalence of detransitioning after transition is unknown,” ignoring a large body of prior study that estimates these rates of detransition and regret as quite low, from less than 1% to 13.1% (MacKinnon, et al, 2021). She again emphasized her previous stereotypes of “ROGD,” trauma and mental illness causality, and “peer contagion.” Some of her respondents agreed with these axioms, as they were presented in survey questions. However, other than cessation of hormonal care, few clear patterns of validation were apparent in this very gender-diverse cohort. For example, only half (51%) of respondents identified exclusively with their birth-assigned genders after detransition. The other half identified as NonBinary, Trans, or some combination of the three. 17% of respondents described narratives of social pressures to transition; 29% described narratives of discrimination and external pressure to detransition. Notably, the latter, cis-normative influences were not termed as “contagion” in Littman’s paper.

On October 21, Arkansas Republican Senator Tom Cotton (2021) introduced a bill that would compel elementary and high schools to deny respectful, affirming pronouns, names, and access to facilities without express parental permission and to out Trans and gender-diverse students to even the most intolerant, abusive, and violent parents.

The previous day, Abigail Shrier appeared on the Fox News Tucker Carlson show to describe her central role in lobbying for Cotton’s hate-biased legislation (Daviscourt, 2021; Carlson, 2021):

“We have to fight gender ideologies in the schools…We have to get all this mumbo-jumbo out of the schools…We have to fight for girls sports and women’s protective spaces. We have to stop schools from undermining parents and giving kids gender identities that the parents don’t know about. And we have to reform pediatric gender medicine.”

Carlson responded to Shrier, “I hope you’re leading this effort. You already are and doing such a great job.”

Drs. Edwards-Leeper and Anderson teamed up a second time for a November 18 interview by Alicia Ault (2021) on the global online physician’s web portal, Medscape (Owned by the WebMD corporation). Under the sensational headline of “Transgender Docs Warn About Gender-Affirmative Care for Youth,” They reasserted fear, uncertainty, and doubt about established, affirming and harm reduction Trans health policies and practices, while propping up Littmanian “ROGD” and “social contagion” tropes with vague speculations and specious logic. For example, Anderson suggested that “peer influence is a factor for sexual or gender identity” because “teenagers influence each other.” Conflating correlation with causality, she failed to acknowledge that gender-nonconforming youth, under relentless threat of shaming, bullying, and violence, might be drawn together into the same peer circles for survival.

On November 20, Dr. Littman (2021A) was one of the featured speakers for Genspect, an anti-trans extremist group that promotes TERF axioms of psychopathology, trauma causality, and “ROGD.” The group opposes social and medical affirmation of Trans and NonBinary youth and adults below the age of 25. Littman spoke at Genspect’s online conference, dedicated to her own dubious “ROGD” stereotype. She listed her academic affiliation as The Institute for Comprehensive Gender Dysphoria Research. Littman stated her “ROGD” hypothesis as, “Psychosocial factors (such as social influence, maladaptive coping mechanisms, internalized homophobia, trauma, and mental health conditions) can cause or contribute to the development of gender dysphoria in some individuals.” This construction did not leave a lot of space for falsifiability. However, scientific rigor was not likely her priority. Her presentation relied uncritically on Zucker’s discredited 80% “desistance” stereotype for gender dysphoric children (Temple Newhook, et al., 2018). She brushed aside social pressures that have historically kept almost all young Trans children in birth-assigned closets before the most recent generations. Littman announced a new online survey of detransitioned subjects, not yet published. To inflict the greatest possible disrespect and indignity toward Trans communities, Genspect and Littman held their “ROGD” convention on the International Transgender Day of Remembrance. This is the one sacred day of the year that Trans and gender-diverse people around the world mourn and honor our murdered dead.

Four days later, anti-trans TERF wars against affirming health care for gender dysphoric adolescents took yet another turn in the pages of the Washington Post. An op-ed by Drs. Laura Edwards-Leeper and Erica Anderson (2021) doubled down on TERF-associated stereotypes of mental illness, trauma causality, and “social media, Internet and peer influences.” The authors’ positions of authority within the WPATH and USPATH associations were once again leveraged to legitimize their position to turn back the clock on adolescent Trans health policy to archaic psychopathology stereotypes and long-term psycho-gatekeeping—euphemized as “comprehensive assessment.” Compulsory psychotherapy that puts non-birth-assigned gender identities on trial for “months” or “years” would once again be prerequisite to medically necessary blocker or hormonal care.

On December 2, the World Professional Association for Transgender Health (WPATH) released draft chapters of the Standards of Care Version 8 (SOC8) for public commentary (2021). Initially, only two weeks were allowed for public review and response to WPATH, but after widespread outcry the deadline was extended another month to January 16, 2022. The draft document is enormously larger than previous versions, with 359 pages (so far), containing 17 chapters and 148 statements of recommended practice. The latter replace a much more concise set of “readiness criteria” for hormonal, surgical, and puberty suppression care in prior versions. There is a stunning degree of inconsistency and contradiction between chapters, statements, and supporting text of the draft SOC8. Established WPATH principles of depsychopathologization of gender diversity and medical necessity of pubertal suppression and transition-related care are emphasized in parts of the document and flagrantly undermined in others (ITH, 2021). The Adolescent chapter is particularly alarming, citing Littman’s discredited “ROGD” PLOS ONE paper and repeating for emphasis that “social influence on gender is salient,” “relevant in their experience of their gender during adolescence,” and “a relevant issue and an important differential” (WPATH, 2021). While the text offers a cursory acknowledgment of controversy around Littman’s methodology and reasoning behind the “ROGD” and “social contagion” stereotypes, its intended gaslighting of affirming approaches to adolescent care and promotion of psychopathologized stereotyping and protracted psycho-gatekeeping could not be more apparent.

Clearly, the draft SOC8 represents an unresolved, unmediated free-for-all between affirming policymakers and disaffirming, psycho-gatekeeping factions within WPATH. The heavy infiltration of Littmanian stereotypes of “ROGD” and “social contagion” in the draft SOC8 adds key historical context to the media campaign that preceded its release.

On January 3, Erica Anderson (2022) published yet another prominent op-ed that undermined affirming approaches to Trans and Nonbinary adolescent care and promoted Littman’s axiom of gender diversity as “contagion.” In fact, the actual URL (web address) of the piece was, “are-we-seeing-a-phenomenon-of-trans-youth-social-contagion.” The editorial demonized peer support among Trans and Nonbinary adolescents as “influencers” with inexplicable power to turn cisgender-privileged teens into marginalized and persecuted Trans youth by “specifically encouraging them to explore their gender identity freely.” Although Anderson carefully avoided Littman’s “rapid onset” term, the “ROGD” stereotype was clearly described and implied in her text. The op-ed offered no attempt to acknowledge the scientific and logical shortcomings in Littman’s research or her “ROGD” or “social contagion” stereotypes.

Since their emergence in mid-20th Century medicine, Trans health policies have always been influenced by exaggerated fears and myths about detransition and regret. While the data have shown detransition and regret incidence to be very low, medically necessary (and often life-saving) transition-related care is still commonly rationed, delayed, deferred, and denied to those around the world who need it most, because of these very fears and defamatory stereotypes. There is a place for psychosocial intake assessment and evaluation of capacity for informed consent in medical care for all human beings, Transgender and cisgender-privileged. However, returning to the days of psycho-inquisition gatekeeping, which prolongs suffering and burdens Trans individuals to continually demonstrate their mental competence and gender validity, would be a dark future, indeed.

References

Anderson, E. (2022). Opinion: When it comes to trans youth, we’re in danger of losing our way. San Francisco Examiner, January 3. https://www.sfexaminer.com/opinion/are-we-seeing-a-phenomenon-of-trans-youth-social-contagion/

Ashley, F. (2020). A critical commentary on ‘rapid-onset gender dysphoria.’ The Sociological Review Monographs, Vol. 68(4) 779 –79. https://www.florenceashley.com/uploads/1/2/4/4/124439164/ashley_a_critical_commentary_on_rapid-onset_gender_dysphoria.pdf

Ashley, F. and Baril, A. (2018). “Why ‘rapid-onset gender dysphoria’ is bad science,” The Conversation, Mar 22, https://theconversation.com/why-rapid-onset-gender-dysphoria-is-bad-science-92742

Ault, A. (2021). “Transgender Docs Warn About Gender-Affirmative Care for Youth,” Medscape Medical News, Nov. 18. https://www.medscape.com/viewarticle/963269

Carlson, T. (2021) Tucker: Biden open border policy resulted in a fentanyl crisis. Transcript, Tucker Carlson Show, Fox News Network, Oct. 20. https://www.foxnews.com/transcript/tucker-drugs-continue-to-pour-through-the-border

Cotton, T. (2021). Cotton Introduces Bill to Prevent Schools from Concealing Gender Transitions from Parents. Press release. Office of U.S. Senator Tom Cotton, Oct. 21. https://www.cotton.senate.gov/news/press-releases/cotton-introduces-bill-to-prevent-schools-from-concealing-gender-transitions-from-parents

Daviscourt, K. (2021). Abigail Schrier tells Tucker Carlson how to win America’s gender war. The Post Millenial, Oct 20. https://thepostmillennial.com/abigail-schrier-tucker-carlson-americas-gender-war

Duam, M. (2021). What Do We Mean By “Gender Affirming Care?” A Conversation with Dr. Laura Edwards-Leeper. The Unspeakable Podcast, October 4.
https://podcasts.apple.com/ca/podcast/the-unspeakable-podcast/id1524832743

Gleeson, J. (2021). Judith Butler: ‘We need to rethink the category of woman.’ The Guardian, Sept. 7, https://www.theguardian.com/lifeandstyle/2021/sep/07/judith-butler-interview-gender.
Uncensored full text:
https://web.archive.org/web/20210907102452/https://www.theguardian.com/lifeandstyle/2021/sep/07/judith-butler-interview-gender

Edwards-Leeper, L. and Anderson, E (2021). The mental health establishment is failing trans kids: Gender-exploratory therapy is a key step. Why aren’t therapists providing it? Washington Post, Nov. 24.

Factora, J. (2021). Dear 60 Minutes, There Is No “Both Sides-Ing” Trans Healthcare. Them, May 25. https://www.them.us/story/60-minutes-platforms-detransitioners-trans-healthcare

Genspect. (2021). Dr. Laura Edwards-Leeper: The urgent need for comprehensive assessment. Attributed to an anonymous “Guest Author,” Genspect, Oct. 6. https://genspect.org/dr-laura-edwards-leeper-the-urgent-need-for-comprehensive-assessment/

International Transgender Health Group (2021). ITH Group Collective Analysis: SOC8 Statement Feedback Worksheet. December 15. Archived: https://transpolicyreform.wordpress.com/2021/12/15/commentary-to-the-wpath-soc8-draft-from-the-international-transgender-health-group/

MacKinnon, K., Ashley, F., Kia, H., Lam, J.,Krakowsky, Y. and Ross, L. (2021). Preventing transition “regret”: An institutional ethnography of gender-affirming medical care assessment practices in Canada. Social Science & Medicine, Volume 291, 114477, ISSN 0277-9536.
https://doi.org/10.1016/j.socscimed.2021.114477.

Littman, L. (2018). Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PLOS ONE 13(8): e0202330. doi.org/10.1371/journal.pone.0202330

Littman, L. (2021). Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners. Archives of Sexual Behavior, 50:3353–3369. https://doi.org/10.1007/s10508-021-02163-w

Littman, L. (2021A). Gender dysphoria and psychosocial factors: emerging theories. Genspect, Nov. 20. https://genspect.org/conferences/
See also https://www.youtube.com/watch?v=tInYPMCHOzo

Raymond, Janice G. (1980). The transsexual empire. London : The Women’s Press

Serano, J. (2016). Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity, 2nd Edition. Seal Press. https://www.amazon.com/Whipping-Girl-Transsexual-Scapegoating-Femininity/dp/1580056229

Serano, J. (2018). Everything You Need to Know About Rapid Onset Gender Dysphoria. Medium, Aug. 22, medium.com/@juliaserano/everything-you-need-to-know-about-rapid-onset-gender-dysphoria-1940b8afdeba

Serano, J. (2021). The Dregerian Narrative (or why “trans activists” vs. “scientists” framings are lazy, inaccurate, and incendiary). Medium, Mar. 29. https://juliaserano.medium.com/the-dregerian-narrative-or-why-trans-activists-vs-276740045120

Shrier, A. (2020). Irreversible Damage: The Transgender Craze Seducing Our Daughters. ‎Regnery.

Shrier, A. (2021). Top Trans Doctors Blow the Whistle on ‘Sloppy’ Care. Blog post, Common Sense with Bari Weiss, October 4. https://bariweiss.substack.com/p/top-trans-doctors-blow-the-whistle

Stahl, L. (2021). State bills would curtail health care for transgender youth. 60 Minutes, CBS News, May 23. https://www.cbsnews.com/news/transgender-health-care-60-minutes-2021-05-23/

Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Pickett, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children, International Journal of Transgenderism, 19:2, 212-224, DOI: 10.1080/15532739.2018.1456390

U.S. Professional Association for Transgender Health and World Professional Association for Transgender Health (2021). Joint Letter from USPATH and WPATH. Oct. 12. https://www.wpath.org/media/cms/Documents/Public%20Policies/2021/Joint%20WPATH%20USPATH%20Letter%20Dated%20Oct%2012%202021.pdf

Williams, C. (2016). Radical Inclusion: Recounting the Trans Inclusive History of Radical Feminism. TSQ: Transgender Studies Quarterly, Volume 3, Numbers 1–2, May. https://www.academia.edu/25141233/Radical_Inclusion_Recounting_the_Trans_Inclusive_History_of_Radical_Feminism

Winters, K. (2008). Blinded Me With Science: The Burden of Proof. Blog post, GID Reform Weblog, Oct. 21. https://gidreform.wordpress.com/2008/10/21/blinded-me-with-science-the-burden-of-proof/

Winters, K. (2018). The Slipshod Science in the “Rapid Onset Gender Dysphoria” Cliché and Psychology Today’s Attack on Young Trans Men. Blog post: Trans Policy Reform. November 29, https://transpolicyreform.wordpress.com/2018/11/29/the-slipshod-science-in-the-rapid-onset-gender-dysphoria-cliche-and-psychology-todays-attack-on-young-trans-men/

Winters, K. (2021). Transgender Affirmation in Retrograde: A Crossroad in the History of Trans Health. Blog post: Trans Policy Reform. October 9. https://transpolicyreform.wordpress.com/2021/10/09/transgender-affirmation-in-retrograde/

World Professional Association for Transgender Health (2018). “WPATH Position on ‘Rapid-Onset Gender Dysphoria (ROGD),’” Sept. 4. http://www.wpath.org/policies

World Professional Association for Transgender Health (2021). WPATH Standards of Care V8 (SOC8) – Public Comment Period Open Now. December 2. https://www.wpath.org/media/cms/Documents/SOC%20v8/SOC8%20Chapters%20for%20Public%20Comment/Letter%20eBlast%20-%20SOC8%20Public%20Comment%20Period%20December%202021%20FINAL.pdf

Copyright © 2021-2022 Kelley Winters

International Transgender Day of Remembrance 2021

Kelley Winters, Ph.D. Updated Nov. 19, 2021

As the International Transgender Day of Remembrance (TDOR) approaches on November 20, there is often confusion in the press and our community about disparate lists and totals from different organizations. Every year, I put together a comparative table of U.S. trans murders from the leading organizations and individuals who compile them, so that organizers and community members can better understand and explain those differences.

This year, my table includes remembrance lists from the Transgender Europe (TGEU) Trans Murder Monitoring (TMM) project, the TransGriot Blog, the International Transgender Day of Remembrance Trans Lives Matter site, the Human Rights Campaign, and the National Coalition of Anti-Violence Programs. I deeply appreciate the emotional labor and sacrifice made by the individuals and organizations who compile these lists. What they do is essential and difficult work.

Monica Roberts, founder of the iconic TransGriot blog, passed away on October 5, 2020, and her absence from this work this year leaves an empty void in my community and my heart.

Some of the differences between TDOR compilations are substantial. For example, some lists are based on the calendar year. The European TMM and U.S. Trans Lives Matter lists begin on Oct 1. Others begin on Nov 20. Some lists exclude murders not confirmed by local coroners. Others exclude suicidal deaths. Others exclude police killings. Some exclude deaths while incarcerated (or linked to ICE medical neglect or CBP deportation). Finally, some lists accidentally omit names, where cases were solved or victims were identified late in the year.

Excerpt from 2021 U.S. TDOR meta-table

This meta-table is a side-by-side, tabular compilation of the most respected remembrance lists for 2021 in the U.S., including PR. It is intended to help TDOR organizers to make informed choices for their community observances. Here is the complete, downloadable pdf meta-list document:  [Revision C updated 20201114]

Tragically, trans women of color still suffer the overwhelming majority of anti-trans hate-murders in the U.S. and worldwide. Like so many others, I dream of a world where intersectional hatred of gender and racial diversity no longer necessitate a Transgender Day of Remembrance observance for our fallen sisters, brothers, and siblings. Until that day, we say their names, in clear voices, to an intolerant world that allowed no space for their authentic lives. I wish you peace on this International Transgender Day of Remembrance and safe passage through the next year. Please feel free to copy and share this meta-list of trans murder victims from multiple sources with TDOR organizers and participants in your area. I will continue to correct and update this post until November 20.

Formatted reading list of U.S. names, merged from the meta-list table, above, for dates Nov 21, 2020 to Nov 20, 2021:

This work is licensed under the Creative Commons Attribution 3.0 United States License. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/us/. I encourage Trans community members, allies, and allied organizations to copy and share it widely, with CC attribution.

References

Transgender Europe (TGEU) Trans Murder Monitoring (TMM) project
https://transrespect.org/wp-content/uploads/2021/11/TvT_TMM_TDoR2021_Namelist.pdf

TransGriot Blog, founded by the late Monica Roberts
https://transgriot.com/posts/the-murders/

“Remembering Our Dead,” Trans Lives Matter
https://tdor.translivesmatter.info/

Human Rights Campaign
https://www.hrc.org/resources/fatal-violence-against-the-transgender-and-gender-non-conforming-community-in-2021

National Coalition of Anti-Violence Programs,
Lives Lost to Fatal Anti-LGBTQ and Intimate Partner Violence
https://avp.org/in-memoriam/

Transgender Affirmation in Retrograde

A Crossroad in the History of Trans Health

Kelley Winters, Ph.D. Oct 09, 2021

Transgender and Non-Binary communities, families, allies, and providers have been deeply shaken this week by the appearance of WPATH President-elect, Dr. Marci Bowers, and USPATH President, Dr. Erica Anderson, in an interview by transmisist author Abagail Shrier (2021) on the trans-intolerant Bari Weiss blog site. Drs. Bowers and Anderson gave inflammatory criticism of affirming health care policies and puberty suppression care on the anti-trans Bari Weiss blog site. Their choice of such a biased venue to voice their concerns is particularly troubling. I have been contacted by parents of Trans children on multiple continents, who are fearful of the implications of this incident for the future of their childrens’ medical care. Trans and N-B youth, their loving parents, and their providers urgently need reassurance of continued support for affirming, evidence-based health policies from the World Professional Association for Transgender Health, WPATH, and its US affiliate, USPATH.

The following list describes just a few of the concerns that have been shared with me:

  1. Agenda of Intolerance. Malice and disinformation from Abigail Shrier about Trans and NB people and their health care are very well known in Trans and intersectional communities (GLAAD, 2021). Her book, Irreversible Damage: The Transgender Craze Seducing Our Daughters (2020), has inflicted enormous harm to Trans youth and was particularly offensive and defamatory toward Trans-masculine youth (Eckert, 2021; Turban, 2021). Dr. Bowers later stated, on her Twitter page (2021) and in correspondence reported by D’orsay (2021), that “my comments were no doubt taken out of context and used to fit a narrative on the part of Ms. Shrier”. However, anyone with expertise on contemporary Trans health issues should have been familiar with Shrier’s reputation and anti-trans agenda. In the blog piece, Ms. Shrier consistently misgendered trans-masculine youth as “girls.” She misrepresented punitive elements of gender-conversion psychotherapies, discredited by WPATH and unlawful in a growing number of jurisdictions, as commonly accepted mental health practice before the last decade. She conflated it with Dutch terminology of “watchful waiting” that has a different meaning (de Vries, 2012). Shrier uncritically promoted the harmful and discredited 70-80% “desistance” myth that “nearly seven in 10 children initially diagnosed with gender dysphoria” would spontaneously become cisgender in adolescence (Temple Newhook, 2018). It is mystifying and concerning that executive officers of WPATH and USPATH would choose Shrier as a reporter and Weiss’ malicious blog platform, rather than reputable media, medical, or WPATH/USPATH channels.
  2. Defaming Diversity. Ms. Shrier’s book and writings are based on dogmatic stereotypes of “Rapid Onset Gender Dysphoria” and “social contagion” of non-birth-assigned gender identities that were published by Dr. Lisa Littman in the pay-to-play PLOS ONE journal (2018). The ROGD axiom was denounced by WPATH (2020), and Littman’s methods and reasoning were critiqued by myself (2018) and numerous Trans scholars, including Julia Serano (2018), Brynn Tannehill (2018), Florence Ashley and Alexandre Baril (2018), and Zinnia Jones (2017). In the Shrier interview, Drs. Anderson and Bowers acknowledged that ROGD is not a formal mental health diagnosis. However, Bowers boosted the stereotype: “As for this ROGD thing, I think there probably are people who are influenced. There is a little bit of ‘Yeah, that’s so cool. Yeah, I kind of want to do that too.’” She amplified unfounded fears that cisgender girls with eating disorders are being somehow afflicted with gender dysphoria by the verbal influence of affirming clinicians: “and then they see you for one visit, and then they recommend testosterone — red flag!” It is difficult to imagine any context in which these statements are not harmful. Dr. Bowers subsequently acknowledged that “trans kids DO know who they are at a very early age” (D’orsay). However, such an abrupt, unexplained contradiction seems more confusing than clarifying. It defies reason to imply that large numbers of cisgender youth are accessing puberty suppression care for the “coolness” of membership in the most oppressed, most excluded, most homeless, most unemployed, most bullied, and most murdered minority class on Earth.
  3. Harm Reduction. The objectives for puberty suppression treatments in the WPATH Standards of Care, Version 7 (SOC7), are described in terms of harm reduction: giving gender dysphoric youth more time to explore their identities and gain maturity and “preventing the development of sex characteristics that are difficult or impossible to reverse if adolescents continue on to pursue sex reassignment” (Coleman, 2012, p. 19). These risks may include permanent disfigurement, social impairment, preventable future surgeries, and mortality. Turban, et al. (2020) reported “significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment.” Yet Dr. Bowers’ interview and subsequent remarks were focused on orgasm and sexual function (Shrier, 2021; D’orsay). WPATH represents the health interests of global Trans and gender-diverse populations and the many medical, mental health, and social science specialties that serve them. This peculiar prioritization of risk factors in a harm reduction health policy begs clarification.
  4. Nuances of Informed Consent. The SOC7 criteria for puberty suppression require informed consent, in its traditional context of medical ethics, by gender dysphoric youth and their legal guardians (p. 19). This section of the SOC7 does not refer to the “Informed Consent Model Protocols,” in the Callen Lorde, Fenway, and Tom Waddell community clinic traditions. Those are described later in the document for older, more mature adolescents and adults receiving sex hormone treatments that will lead to puberty congruent with their gender identities (pp. 35-36). Both contexts require psychosocial intake assessment, but the former is intended for younger, pubescent youth who require parent or guardian participation and greater professional support to meet an informed consent standard. The two uses of the phrase, “informed consent,” in the SOC7 are not the same. However, Dr. Bowers’ interview statements lack specificity and are confusing. They decry “our ‘informed consent’ of children undergoing puberty blockers” (Shrier, 2021) and assert that the “informed consent process needs a reappraisal” (D’orsay, 2021). This ambiguity can be easily inferred as a widespread problem that Informed Consent Model Protocols intended for more mature adolescents and adults are mistakenly applied to young, pubescent youth receiving very different care. These remarks beg clarification by WPATH and USPATH organizations.
  5. Politicalization of Affirmation. The psychological and quality-of-life benefits of affirming approaches to Trans and N-B youth care have been longitudinally studied (Olson, et al., 2016) and well established in policy (Murchison, 2018). Moreover, principles of affirming authentic gender expression, bodily integrity, and self-determination have been internationally acknowledged as fundamental human rights (Cabral, 2015). However, Dr. Bowers’ interview statements have mocked affirming principles of care in bombastic, politicized terms: “There are definitely people who are trying to keep out anyone who doesn’t absolutely buy the party line that everything should be affirming, and that there’s no room for dissent.” And this: “I think maybe we zigged a little too far to the left in some cases” (Shrier, 2021). These platitudes of “to the left,” and “party line,” misrepresent the past three decades of scientific inquiry and clinical evidence that are reflected in modern, affirming approaches to Trans health care. She later added statements that, “Medical and surgical treatment is safe and effective. Not only is regret rare but it is on the decline” (D’orsay). While these points are valid and consistent with WPATH policy, they do little to mitigate the damage and confusion of the prior political rhetoric on affirming Trans health care.
  6. Ambiguous Condemnation. Dr. Anderson is quoted in the interview as describing Trans-masculine youth at UCSF as “natal females,” rather than with respectful terminology. She criticized modern affirming approaches to youth care with vague and histrionic terms of “‘sloppy,’ sloppy healthcare work,” “rushing people through the medicalization,” and “failure — abject failure — to evaluate the mental health of someone historically in current time…” (Shrier, 2021). The latter suggested a call to return to archaic practices that presumed underlying psychopathology for gender-diverse youth, but, once again, she was not specific. Anderson did not clarify if sparing a gender dysphoric youth the trauma and potentially permanent disfigurement of incongruent pubertal development constituted “sloppy” work or “rushing…medicalization.” Ambiguity in her interview with Shrier left her intentions open to broad interpretation. Again, Dr. Anderson’s choice of Shrier and a malevolent blog site to make such statements is astonishing.

Trans and Non-Binary youth in the U.S. and many other nations are experiencing unrelenting attack on their health care and fundamental human rights in state governments, school districts, courtrooms, health plans, social media, the press, and religious institutions (Krishnakumar, 2021). The Shrier interview incident has spread fear, uncertainty, and doubt on affirming Trans health practices and placed the most vulnerable youth at greater risk. A clarifying response from the WPATH and USPATH Boards of Directors is needed now.


References:

Ashley, F. and Baril, A. (2018). “Why ‘rapid-onset gender dysphoria’ is bad science,” The Conversation, Mar 22, theconversation.com/why-rapid-onset-gender-dysphoria-is-bad-science-92742

Bowers, M. (2021). Twitter personal page: Marci bowers, @marcibdoc, first woman in history to perform gender affirming vaginoplasty. Posted October 5, https://twitter.com/marcibdoc/status/1445285681572589573

Cabral, M. (2015). Statement from GATE – Global Action for Trans* Equality,Reproductive Health Matters, 23:46, 196-196, DOI: 10.1016/j.rhm.2015.11.014, https://doi.org/10.1016/j.rhm.2015.11.014

Coleman E, Bockting W, Botzer M, et al. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgend. 2012;13(4):165–232. https://wpath.org

de Vries, A., Cohen-Kettenis, P. (2012): Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach, Journal of Homosexuality, 59:3, 301-320

D’orsay, A. (2021). Group forum update, International Transgender Health Facebook Group. https://www.facebook.com/groups/transgenderhealth/posts/4770401826337539/

Eckert, A.J. (2021). Irreversible Damage to the Trans Community: A Critical Review of Abigail Shrier’s Irreversible Damage (Part One). Blog post: Science-Based Medicine. July 4. https://sciencebasedmedicine.org/irreversible-damage-to-the-trans-community-a-critical-review-of-abigail-shriers-book-irreversible-damage-part-one/

GLAAD Accountability Project. (2021). Abigail Shrier, Wall Street Journal Opinion Columnist. https://www.glaad.org/gap/abigail-shrier

Jones, Z. (2017). “Fresh trans myths of 2017: ‘rapid onset gender dysphoria,’” Gender Analysis with Zinnia Jones blog, July 1, genderanalysis.net/2017/07/fresh-trans-myths-of-2017-rapid-onset-gender-dysphoria/

Krishnakumar, P. (2021). This record-breaking year for anti-transgender legislation would affect minors the most. CNN, April 15. https://www.cnn.com/2021/04/15/politics/anti-transgender-legislation-2021/index.html

Littman, L. (2018). “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” PLOS ONE 13(8): e0202330. doi.org/10.1371/journal.pone.0202330

Murchison G, Adkins D, Conard LA, Ehrensaft D, Elliott T, Hawkins LA, et al. (2018). Supporting and caring for transgender children. Washington, DC: Human Rights Campaign, American Academy of Pediatrics, American College of Osteopathic Pediatricians. http://www.hrc.org/resources/supporting-caring-for-transgender-children. Accessed 2018 Mar 14.

Olson, K., Durwood, L., DeMeules, M., McLaughlin, K. (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, March, 137 (3), https://pediatrics.aappublications.org/content/137/3/e20153223

Serano, J. (2018). “Everything You Need to Know About Rapid Onset Gender Dysphoria,” Medium, Aug. 22, medium.com/@juliaserano/everything-you-need-to-know-about-rapid-onset-gender-dysphoria-1940b8afdeba

Shrier, A. (2020). Irreversible Damage: The Transgender Craze Seducing Our Daughters. ‎Regnery.

Shrier, A. (2021). Top Trans Doctors Blow the Whistle on ‘Sloppy’ Care. Blog post, Common Sense with Bari Weiss, October 4. https://bariweiss.substack.com/p/top-trans-doctors-blow-the-whistle

Tannehill, B. (2018). “’Rapid Onset Gender Dysphoria’ Is Biased Junk Science,” Advocate, Feb. 20, http://www.advocate.com/commentary/2018/2/20/rapid-onset-gender-dysphoria-biased-junk-science

Temple Newhook, J. Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M.L., Jamieson, A., and Pickett, S. A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender-nonconforming children. International Journal of Transgenderism, Volume 19, 2018 – Issue 2,
https://www.tandfonline.com/doi/full/10.1080/15532739.2018.1456390

Turban, J., King, D., Carswell, J., Keuroghlian, A. (2020) Pubertal Suppression for Transgender Youth and Risk of Suicidal Ideation, Pediatrics, 145 (2) e20191725; DOI: 10.1542/peds.2019-1725, https://pediatrics.aappublications.org/content/145/2/e20191725

Turban, J. (2020). New Book “Irreversible Damage” Is Full of Misinformation. Blog post: Psychology Today, December 6, https://www.psychologytoday.com/us/blog/political-minds/202012/new-book-irreversible-damage-is-full-misinformation

Winters, K. (2018). The Slipshod Science in the “Rapid Onset Gender Dysphoria” Cliché and Psychology Today’s Attack on Young Trans Men. Blog post: Trans Policy Reform. November 29, https://transpolicyreform.wordpress.com/2018/11/29/the-slipshod-science-in-the-rapid-onset-gender-dysphoria-cliche-and-psychology-todays-attack-on-young-trans-men/

World Professional Association for Transgender Health (2018). “WPATH POSITION ON ‘Rapid-Onset Gender Dysphoria (ROGD),’” Sept. 4, http://www.wpath.org/policies

Copyright © 2021 Kelley Winters

McHughist Malice and Harmful Conflation of Gender Dysphoria with Body Dysmorphia

Kelley Winters, Ph.D. Sep. 22, 2021

Gender dysphoria (from a Greek root for distress or excessive pain) and body dysmorphia (formally, Body Dysmorphic Disorder in the DSM-5 in North America) are not synonymous. However, they sound alike and are commonly confused in the media, by some ill-informed mental health clinicians, and by hate groups who mean us harm.

Gender dysphoria, in common, plain-language usage was defined by Fisk in 1974 as “discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth” (WPATH Standards of Care/SOC7, Version 7, p.2). There are two prevalent components to gender dysphoria: one, anatomical, and one, social. The first is distress with physical sex characteristics (or, for youth, impending pubertal changes in sex characteristics) that are painfully incongruent with an individual’s internal gender identity. The second is distress with birth-assigned or socially ascribed social gender roles. Not all Trans or Non-Binary people experience both, or either. For those who do, the focus of the distress of gender dysphoria is on social and physical realities that are objectively verifiable.

In my personal and community experience, gender dysphoric Trans and NB people are almost always deeply grounded in the harsh, bitter realities or our incongruent bodies and/or incongruent social situations. This is the opposite of the meaning of “dysmorphia.”

It is important to note that the distress of gender dysphoria (in the Fisk and WPATH context of distress) and need for transition-related medical care are no longer classified as mental illness by the World Health Organization in the International Classification of Diseases (ICD-11). They are instead categorized as non-psychiatric “conditions related to sexual health” with codings of Gender Incongruence (HA60, HA61, and HA62; see link below).

Body Dysmorphic Disorder (BDD), on the other hand, is a mental health condition–a disorder of self-perception. It is defined in the chapter of Obsessive-Compulsive and Related Disorders in the DSM-5 as mental preoccupation “with 1 or more perceived defects or flaws in physical appearance that are not observable by or appear slight to others” (Criterion 1). The focus of dysmorphic disorder is on perception of physical characteristics that are not objectively verifiable as real or significant. This perception can range from distorted in minor ways to significantly delusional (See link, below).

Tragically, opponents of Trans equality and medically necessary transition-related care, as well as proponents of harmful gender-conversion (or gender-reparative) psychotherapies, frequently conflate gender dysphoria with body dysmorphia to falsely stereotype Trans and NB people as “confused,” “deluded,” “preoccupied,” or otherwise mentally ill. This weaponized stereotype is historically associated with anti-trans extremist, Dr. Paul McHugh:

“…gender dysphoria—the official psychiatric term for feeling oneself to be of the opposite sex—belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder. Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction.” (McHugh, 2015)

It is certainly possible for some Trans and NB people to experience Body Dysphmorphic Disorder, as well as all of the mental health conditions experienced by cis-privileged populations. However, it is important to understand the difference between the anatomic aspect of gender dysphoria and body dysmorphia and the harmful history of stereotyping that results from conflating the two terms.

In North America, there is a second, conflicting, definition of gender dysphoria that causes further confusion–as the title of a mental disorder category in the DSM-5. The meaning and social context of “gender dysphoria” in the original Fisk definition is very different than that of the “Gender Dysphoria in Adolescents and Adults” and “in Children” codings in the DSM-5. It’s important to note that the WPATH SOC7 uses “gender dysphoria” terminology in the plain-language Fisk context and does not require a DSM-5 “Gender Dysphoria of Adolescents and Adults” for access to medical transition care. Finally, the DSM-5 practice of coding the need for trans related care and services as mental illness is considered outdated in global health policy outside of the U.S. and Canada.

Links to references:

https://www.psychiatryadvisor.com/home/topics/anxiety/obsessive-compulsive-and-related-disorders/body-dysmorphic-disorder-a-distorted-lens/

https://www.thepublicdiscourse.com/2015/06/15145/

https://icd.who.int/browse11/

Copyright © 2021 Kelley Winters

International Transgender Day of Remembrance 2020

Kelley Winters, Ph.D. Nov. 20, 2020

[UPDATED 20201120]]

As the International Transgender Day of Remembrance (TDOR) approaches on November 20, there is often confusion in the press and our community about disparate lists and totals from different organizations. Every year, I put together a comparative table of U.S. trans murders from the leading organizations and individuals who compile them, so that organizers and community members can better understand and explain those differences.

This year, my table includes remembrance lists from the Transgender Europe (TGEU) Trans Murder Monitoring (TMM) project, Monica Roberts’ TransGriot Blog, the International Transgender Day of Remembrance site, the Remembering Our Dead / Trans Lives Matter site, the Human Rights Campaign, and the National Coalition of Anti-Violence Programs. I deeply appreciate the emotional labor and sacrifice made by the individuals and organizations who compile these lists. What they do is essential and difficult work.

Monica passed away on October 5, 2020, and the partial list of names in her column of the meta-table were reported in her TransGriot blog at the time of her death. She was my friend, advocate, teacher, and cherished community sister. Her death leaves an empty hole in my community and my heart, this TDOR season.

Some of these differences between TDOR compilations are substantial. For example, some lists are based on the calendar year, but the European TMM list begins on Oct 1. Others begin on Nov 20. Some lists exclude murders not confirmed by local coroners. Others exclude suicidal deaths. Others exclude police killings. Some exclude deaths while incarcerated (or linked to ICE medical neglect or CBP deportation). Finally, some lists accidentally miss names, where cases were solved or victims were identified late in the year.

I’ve found that a side-by-side, tabular compilation of the most respected remembrance lists can help TDOR event organizers to make informed choices for their community observances.

Here is the complete, downloadable pdf meta-list document (2020, U.S., including PR):  
[Revision E updated 20201120]

Here is a formatted, readable list of names for the U.S. (including Puerto Rico), inclusively based on the meta-list table from five prominent reporting sources:

International Transgender Day of Remembrance 2019

tdor2016

Kelley Winters, Ph.D. Nov. 20, 2019

[Updated Nov. 18; I will continue to update this post until the 20th]

As the International Transgender Day of Remembrance (TDOR) approaches on November 20, there is often confusion in the press and our community about disparate lists and totals from different organizations. Every year, I put together a comparative table of U.S. trans murders from the leading organizations and individuals who compile them, so that organizers and community members can better understand and explain those differences.

This year, my table includes remembrance lists from the Transgender Europe (TGEU) Trans Murder Monitoring (TMM) project, Monica Roberts’ TransGriot Blog, the International Transgender Day of Remembrance Trans Lives Matter site, the Human Rights Campaign, the National Coalition of Anti-Violence Programs, and the Wikipedia “List of unlawfully killed transgender people.” I deeply appreciate the emotional labor and sacrifice made by the individuals and organizations who compile these lists. What they do is essential and difficult work.

Some of these differences between TDOR compilations are substantial. For example, some lists are based on the calendar year, but the European TMM list begins on Oct 1. Others begin on Nov 20. Some lists exclude murders not confirmed by local coroners. Others exclude suicidal deaths. Others exclude police killings. Some exclude deaths while incarcerated (or linked to ICE medical neglect or CBP deportation). Finally, some lists accidentally miss names, where cases were solved or victims were identified late in the year.

I’ve found that a side-by-side, tabular compilation of the most respected remembrance lists can help TDOR event organizers to make informed choices for their community observances.

Here is the complete, downloadable pdf document:  201911tdorcalcF

201911tdorcalcF1

201911tdorcalcF2

 

 

201911tdorcalcF3

This table is licensed under the Creative Commons Attribution 3.0 United States License and may be copied, forked, and distributed freely, with CC attribution. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/us/

The 2016 “Berlin Statement” on childhood Gender Incongruence diagnosis: An archive copy

Citation04_colorsA

Winter, S., Riley, E., Pickstone-Taylor, S., Suess, A., Winters, K., Griffin, L., …De Cuypere, G. (2016). The ‘‘Gender Incongruence of Childhood’’ diagnosis revisited: A statement from clinicians and researchers. https://transpolicyreform.wordpress.com/2019/07/22/the-2016-berlin-statement-on-childhood-gender-incongruence-diagnosis-an-archive-copy/

Retrieved 2019 July 22, from https://docs.google.com/forms/d/1aSlSKqyZi6zC3-gWm320dFRYawDEwlkM8KerkyN3pg4/viewform

 

The “Gender Incongruence of Childhood” diagnosis revisited: A statement from clinicians and researchers.
(the ‘‘Berlin Statement’’)

2016 May 07

This is an open letter to the World Health Organization (WHO), an agency of the United Nations, from researchers and clinicians working in trans health and rights regarding proposed revisions to the International Statistical Classification of Diseases and Related Health Problems, Version 11 (ICD-11) that relate to healthcare for trans adults and adolescents, as well as gender diverse (GD) children.

We commend WHO for proposed revisions that would move diagnostic categories related to gender transition processes (currently ICD-10’s “F64 Gender identity disorders”) from the chapter of Mental and Behavioural Disorders to a new chapter on Conditions Related to Sexual Health. We also welcome the proposal to eliminate “F65.1. Fetishistic transvestism” and “F66. Psychological and behavioural disorders associated with sexual development and orientation” from the ICD-11 altogether. However, we are concerned about the proposed Gender Incongruence of Childhood (GIC) diagnosis and call on the WHO to reconsider its inclusion. Instead, we urge consideration of less stigmatizing proposals by the GATE Civil Society Expert Working Group and other global experts to facilitate access to psychological support for gender diverse children.

[Archival document–no addition signatures may be added] To add your name and voice to this letter, please fill out the form at the bottom. You will be able to view other signatories, after you sign. [Erratum 20150516. Should read, “You will be prompted to view other signatories after you submit your response, or follow the link in the signature section.”] For questions about this open letter, please write Sam Winter <sjwinter@hku.hk>. For questions about this web form, contact Kelley Winters <kelley@wintersgap.net>.

* Required

General comments on ICD proposals related to gender expression and identity

1. We follow with interest the progress of the ICD revision process. We look forward to seeing the publication of ICD-11, which we are confident will remain, like ICD-10 (http://goo.gl/MlUnk8), the major diagnostic manual used worldwide.

2. From the ICD-11 Beta Draft (http://goo.gl/tOhj9R) current at time of writing we note a number of revisions relevant to the provision of healthcare for transgender people, defined here as those individuals who identify in a gender other than the one that matches their sex assigned at birth.

3. We support the proposal to abandon the diagnoses of fetishistic transvestism (F65.1) and all diagnoses in the block entitled disorders of sexual preference (Block F66). [Erratum 20150516. Should read, “Psychological and behavioural disorders associated with sexual development and orientation (Block F66).”] We agree that these diagnoses are problematic, in that they have no clinical utility, serve no credible public health need, reinforce defamatory stereotypes, and are potentially harmful to the health and wellbeing of those diagnosed.

4. We support the proposal to remove from the Mental and Behavioural Disorders chapter the diagnoses most commonly used to facilitate gender affirming healthcare for transgender people, and to locate them instead in a chapter called Conditions Related to Sexual Health.

5. We believe the proposal for a new chapter placement is in line with contemporary clinical understanding, affirmed by professional associations such as WPATH (the World Professional Association for Transgender Health, http://goo.gl/89zAwa), that the gender identities of transgender people are not properly viewed as psychopathological. We note that the psychopathologising perspective does not match (and has in fact sometimes undermined) the provision of effective gender affirming healthcare approaches used in contemporary times to support transgender people who have healthcare needs. Indeed it has contributed to potentially harmful approaches aimed at modifying their gender identities. The WPATH Standards of Care Version 7 (http://goo.gl/rven2O) note that such approaches are unethical. We believe too that the psychopathologising perspective has needlessly increased the stigma faced by transgender people, undermining the right to legal gender recognition.

6. We support the abandonment of the term gender identity disorder, currently used as an overarching name for the block of diagnoses (F64) most commonly used to facilitate gender affirming healthcare for transgender people. We see the proposed replacement term, gender incongruence, as an attempt to reduce the overly pathologising language inherent in the term gender identity disorder. We note however that the term gender incongruence is not universally supported within transgender communities. See recent press releases by STP (International Campaign Stop Trans Pathologization, http://goo.gl/0GRvA6), and GATE (Global Action for Trans* Equality, http://goo.gl/GHpzog), the latter in association with STP.

7. We note that there are currently two proposed gender incongruence diagnoses, one for adolescents/ adults, and one for children under the age of puberty. We note with approval language in the descriptions of these diagnoses which avoids binary thinking, and is more inclusive of the diversity in people’s gender identities.

8. We note that other aspects of the wording of the diagnostic descriptions have attracted criticism. However we focus in the following sections on the proposal for a gender incongruence of childhood (GIC) diagnosis.

Specific concerns about the proposed gender incongruence of childhood diagnosis.

9. First, we note with concern that, regardless of where in ICD-11 the proposed GIC diagnosis is placed, it pathologises the experiences of young children below the age of puberty who are either exploring their identity, or are incorporating their gender identity into a broader sense of who they are, becoming comfortable expressing that identity, and managing any adverse reactions from others. We note that in a number of cultures worldwide these experiences, which we call here gender diversity, would not be regarded as pathology.
10. We also note that many children who express pronounced and unwavering convictions regarding gender identity, and who have supportive families, do not display any level of distress. Rather, distress occurs when the child feels that their genitals ought to dictate their identity and behaviour.

11. We note too that, unlike transgender adolescents and adults, gender diverse children below the age of puberty have no need of somatic gender affirming healthcare. These children do not need puberty suppressants, masculinising or feminising hormones, surgery, or indeed medical intervention of any type. They simply need the opportunity and freedom to explore, incorporate and express their gender identity; they need the support and information that enables them to do these things, as well as manage any adverse reactions of others. In our opinion these developmental challenges do not warrant a diagnosis. Furthermore, a diagnosis wrongly signals to the child and their family that there is something wrong or improper with the child.

12. We note that the WHO Working Group generating the GIC proposal (http://goo.gl/8JiJi2), and the WHO secretariat, have taken a very different diagnostic approach to persons experiencing developmental processes linked to their sexual orientation. There are currently several diagnoses in ICD-10’s Block F66 (for example sexual maturation disorder and egodystonic sexual orientation) that have the effect of pathologising young people exploring same-sex sexual orientation, incorporating their sexual orientation into their sense of self, learning to express their sexual orientation and dealing with adverse reactions from others. To its credit, the Working Group took the view that developmental processes of this sort – exploration, incorporating, expression and reaction-management in regard to sexual orientation – should not be pathologised. The Group recommended that these diagnoses be removed. The ICD-11 beta draft reflects these recommendations. We are perplexed that the Working Group, and WHO secretariat in preparing the ICD-11 beta draft, have not taken the same approach with young gender diverse children, who engage in similar developmental processes, but linked to gender identity.

13. We note that the Working Group has recommended that healthcare helping young people who experience discrimination on grounds of their sexual orientation can be provided by way of non-pathologising codes in Chapter 21 of ICD-10 entitled Factors Influencing Health Status and Contact with Health Services. These are the so-called Z Codes in Chapter 21 of ICD-10 (currently Q Codes in the ICD-11 Beta Draft, and placed in Chapter 24). Certain Z Codes may be useful in cases where a person is seeking healthcare for reasons associated with stigma and prejudice. We believe a similar Z Code approach should be taken with gender diverse children below the age of puberty (and their caregivers) who require support from the healthcare system.

An alternative proposal and call to WHO

14. We note the proposals that arose out of the Civil Society Expert Working Group (https://goo.gl/O1NrbJ) that met in Buenos Aires in April 2013. The meeting was convened by GATE, an international organization focused on promoting trans people’s human rights, including to health. The proposals (GATE, 2013) [Erratum 20160516. Should read, “(https://goo.gl/wuPMkI)”%5D are for facilitating healthcare for gender diverse children below the age of puberty through the use of Z Codes – in most cases minor amendments of already existing Z Codes. Such Z codes would detail the nature of the support being offered to these children and to the adults responsible for caring for them. These codes could facilitate children’s (and caregivers’) access to supportive counselling and information services, as well as to medical examinations linked to approaching puberty. These codes could also be used to facilitate children’s access to school in authentic (gender affirmative) roles. Finally, in those few cases in which young gender diverse children experience distress of an extent and nature demanding clinical mental health care, these Z Codes could be used as markers, attached to generic diagnoses such as depression or anxiety, signaling that the child’s mental health issues are linked to experiences of discrimination on grounds of their gender diversity (with implications for the sort of care needed).

15. We take the view that arguments for the GIC diagnosis – for example that it will provide a foundation for research and training – appear flawed. We do not believe that research or training in relation to childhood gender diversity would suffer if there were no GIC diagnosis in ICD-11. We note that research into same sex attraction and relationships has thrived since homosexuality diagnosis was removed from the diagnostic manuals decades ago. We believe too that knowledge about the healthcare needs of gay and lesbian youth is better now than it was when homosexuality was a diagnosis.

16. We note too that key transgender health and rights organisations worldwide other than GATE have spoken out against this proposal. They include ILGA (International Lesbian, Gay, Bisexual, Trans and Intersex association), ILGA-Europe, STP (Stop Trans Pathologization) and TGEU (Transgender Europe). We note also statements arising out of two international meetings examining transgender health, one in Cape Town, South Africa, and the other in Taipei, Taiwan. Finally, we note that the European Parliament in the so called Ferrara Report published in July 2015 called on the European Commission to “intensify efforts to prevent gender variance in childhood from becoming a new ICD diagnosis”. This call was reaffirmed in a European Parliament Resolution passed in September 2015. We are aware of a recent member survey by WPATH that found that a majority of participants were opposed to the proposed diagnosis, with this majority much greater among members outside the USA.

– GATE (https://goo.gl/wuPMkI)
– ILGA (http://ilga.org/)
– ILGA-Europe (http://goo.gl/Z1k636)
– STP (http://goo.gl/oERkcm)
– TGEU (Transgender Europe, http://goo.gl/KRJLlI)
– Cape Town, South Africa (http://goo.gl/vIMwYH)
– Taipei, Taiwan (http://goo.gl/cW4Jxf)
– European Parliament Resolution (http://goo.gl/rBAJRA)
– Member survey by WPATH (http://goo.gl/mAVmgu)

Taking into account all the above, we the undersigned, a group of scholars, researchers and clinicians working in transgender health and rights, call on WHO to abandon the proposed GIC diagnosis and incorporate the use of Z Codes as a means of facilitating and guiding support for gender diverse children below the age of puberty. We commend to WHO the GATE Civil Society Expert Working Group proposal (https://goo.gl/NfdDmg).

Original Signatories

Sam Winter, BSc, PGDE, M.Ed., PhD
Associate Professor, School of Public Health, Curtin University, Perth, Australia.
Discipline: Psychologist.
Years working in field of transgender health and rights: 16.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 14 years.
Clinical services for gender diverse children: Yes.
Elizabeth Riley BSc, GDCouns, MA(Couns), PhD
Counsellor, Clinical & PhD Supervisor, Trainer, Sydney, Australia
Disciplines: Health Sciences & Counselling
Years working in field of transgender health and rights: 18
Clinical services offered for transgender people: Yes
Years doing this sort of work: 20 years.
Clinical services for gender diverse children: Yes

Simon Pickstone-Taylor, MBChB
Honorary Senior Lecturer, Gender Identity Development Service, Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa.
Discipline: Child & Adolescent Psychiatrist and General Adult Psychiatrist.
Years working in field of transgender health and rights: 13.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 13 years.
Clinical services for gender diverse children: Yes.

Amets Suess, PhD, MA, BA
Researcher, Area of International Health, Andalusian School of Public Health, Granada, Spain
Discipline: Sociology, Social Anthropology, Art Therapy, Bioethics
Years working in field of transgender health and rights: 14

Kelley Winters, Ph.D.
Gender Diversity Medical Policy Analyst; author, Gender Madness in American Psychiatry: Essays from the Struggle for Dignity (2008)
Discipline: Interdisciplinary scholarship.
Years working in field of transgender health and rights: 21.

Lisa Griffin, Ph.D.
Virginia Commonwealth University, Richmond, Virginia, United States.
Discipline: Psychologist.
Years working in field of transgender health and rights: 21.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 21.
Clinical services for gender diverse children: Yes.

Diane Ehrensaft, PhD
Associate Professor, Department of Pediatrics, University of California San Francisco
Discipline: Developmental and Clinical Psychologist
Years working in field of transgender health and rights: 25
Clinical services offered for transgender people: Yes
Years doing this sort of work: 30 years.
Clinical services for gender diverse children: Yes.

Darlene Tando, LCSW
Gender Therapist, Private Practice
San Diego, California
United States
Discipline: Licensed Clinical Social Worker
Years working in field of transgender health and rights: 10
Clinical services offered for transgender people: Yes
Years doing this sort of work: 10
Clinical services for gender diverse children: Yes.

Hershel Russell M.Ed, (Couns. Psych)
Registered Psychotherapist,Counsellor, Clinical Supervisor, Trainer, Toronto, Canada
Discipline: Psychotherapist.
Years working in field of transgender health and rights: 15.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 20 years.

Brenda R. Alegre,PhD.
Registered Psychologist and Psychometrician
Assistant Lecturer Faculty of Arts, University of Hong Kong SAR, China
Discipline: Clinical Psychology
Years working in the field of transgender health and rights: 10+ years
Clinical Services offered for transgender people: Yes
Years doing this sort of work: 10+ years
Clinical services for gender diverse children: yes

Griet De Cuypere, M.D. Ph.D.
Former Head of the Gender Team Gent, Belgium
Discipline: Psychiatrist – psychotherapist.
Years working in field of transgender health and rights: 30.
Clinical services offered for transgender people: Yes
Years doing this sort of work: 30 years.

Additional Signatories

2016BerlinStatementSignatories [link to pdf file containing 222 additional signatories]

El Diagnóstico “Incongruencia de Género en la Infancia” revisado: una declaración de profesionales de la salud e investigador*s. [translation appended 20160516]

07 de mayo de 2016

Translation: Karen Bennett
Revision: Amets Suess ​

Esta es una carta abierta a la Organización Mundial de la Salud (OMS), una agencia de las Naciones Unidas, de investigador*s y profesionales de la salud que trabajan en salud y derechos trans, con respecto a las revisiones propuestas para la Clasificación Estadística Internacional de Enfermedades y Problemas de Salud Relacionados, versión 11 (CIE -11), que se relacionan con la asistencia médica para adult*s y adolescentes trans, como también para niñ*s de género diverso (GD).

Felicitamos a la OMS por las revisiones propuestas, que moverían las categorías diagnósticas relacionadas con los procesos de transición de género (actualmente “F64 Trastornos de identidad de género” de la CIE-10) desde el capítulo de “Trastornos mentales y del comportamiento”, a un nuevo capítulo sobre “Condiciones vinculadas a la salud sexual”. También damos la bienvenida a la propuesta de eliminar completamente “F65.1. Travestismo fetichista” y “F66. Trastornos psicológicos y del comportamiento asociados con el desarrollo y la orientación sexual” de la CIE-11. Sin embargo, estamos preocupad*s por el diagnóstico propuesto de “Incongruencia de Género en la Infancia” (IGI) y hacemos un llamamiento a la OMS para que reconsidere dicha inclusión. En lugar de ello, instamos a la consideración de propuestas menos estigmatizantes elaboradas por el Grupo de Trabajo de Expert*s de la Sociedad Civil de GATE, y otr*s expert*s mundiales para facilitar el acceso a apoyo psicológico a niñ*s de género diverso.

Para añadir tu nombre y tu voz a esta carta, por favor completa el formulario en la parte inferior. Podrás ver las otras firmas después de haber firmado. Para consultas acerca de esta carta abierta, puedes contactar con Sam Winter <sjwinter@hku.hk>. Para consultas sobre este formulario Web, contacta con Kelley Winters<kelley@wintersgap.net>.

*Obligatorio

Comentarios generales sobre las propuestas de la CIE relacionados con la expresión e identidad de género

1. Seguimos con interés el progreso del proceso de revisión de la CIE. Esperamos ver la publicación de la CIE-11, que estamos confiad*s se mantendrá, al igual que la CIE-10 (http://goo.gl/MlUnk8),el manual de diagnóstico principal utilizado en todo el mundo.

2. A partir del Borrador Beta de la CIE-11 (http://goo.gl/tOhj9R), vigente al momento del escrito, apuntamos una serie de revisiones pertinentes a la prestación de asistencia sanitaria para las personas trans, definid*s aquí como aquell*s individuos que se identifican con un género distinto al sexo que les fuera asignado al nacer .

3. Apoyamos la propuesta de abandonar el diagnóstico de “Travestismo fetichista” (F65.1) y todos los diagnósticos de los trastornos en el bloque titulado “Trastornos de preferencia sexual” (Bloque F66). Estamos de acuerdo en que estos diagnósticos son problemáticos, ya que no tienen utilidad clínica, no sirven para ninguna necesidad creíble de salud pública, refuerzan estereotipos difamatorios, y son potencialmente perjudiciales para la salud y el bienestar de las personas diagnosticadas.

4. Apoyamos la propuesta de eliminar del capítulo “Trastornos Mentales y del comportamiento” los diagnósticos más comúnmente usados para facilitar la asistencia médica de reafirmación de género para personas trans, y ubicarlas en su lugar en un capítulo llamado “Condiciones relacionadas con la salud sexual”.

5. Creemos que la propuesta de la colocación de un nuevo capítulo está en línea con el entendimiento clínico contemporáneo, reafirmado por asociaciones profesionales tales como WPATH (Asociación Profesional Mundial de la Salud Trans, (http://goo.gl/89zAwa), que la conceptualización de las identidades de género de las personas trans como psicopatológicas no es apropiada. Observamos que la perspectiva psicopatologizante no coincide con (y de hecho ha socavado a veces) la provisión de una asistencia sanitaria efectiva de reafirmación de género, utilizada en el momento actual para apoyar a las personas trans con necesidades de atención sanitaria. De hecho, ha contribuido a intentos potencialmente dañinos dirigidos a modificar sus identidades de género. Los Estándares de Cuidado Versión 7 de WPATH (http://goo.gl/rven2O) señalan que estos enfoques no son éticos. Creemos también que la perspectiva psicopatologizante ha aumentado innecesariamente el estigma que sufren las personas trans, lo cual socava el derecho al reconocimiento legal de género.

6. Apoyamos el abandono del término trastorno de identidad de género, actualmente utilizado como un concepto paraguas para el bloque de diagnósticos (F64) más comúnmente utilizados para facilitar la atención sanitaria de reafirmación de género para personas trans. Vemos la propuesta del término sustituto, incongruencia de género, como un intento de reducir el lenguaje excesivamente patologizante inherente al concepto de trastorno de identidad género. Sin embargo, observamos que el concepto de incongruencia de género no es universalmente apoyado dentro de las comunidades trans. Ver los últimos comunicados de prensa por STP (Campaña International Stop Trans Patologización, http://goo.gl/0GRvA6), y GATE (Global Action for Trans* Equality, http://goo.gl/GHpzog), esta última en asociación con STP.

7. Observamos que en la actualidad hay dos propuestas de diagnósticos de incongruencia de género, uno para adolescentes / adult*s y otra para niñ*s pre púberes. Observamos con aprobación el lenguaje en las descripciones de estos diagnósticos que evita el pensamiento binario, y es más inclusivo con la diversidad de las identidades de género de las personas.

8. Observamos que otros aspectos de la redacción de las descripciones de diagnóstico han atraído críticas. Sin embargo, nos centramos en los siguientes apartados en la propuesta de diagnóstico de incongruencia de género en la infancia (IGI) .

Preocupaciones específicas sobre la propuesta de diagnóstico de incongruencia de género en la infancia

9. En primer lugar, observamos con preocupación que, independientemente del lugar en el cual se sitúe la propuesta de diagnóstico IGI en la CIE-11, éste patologiza las experiencias de niñ*s debajo de la edad de pubertad que están o bien explorando su identidad, o están incorporando su identidad de género en un sentido más amplio de quiénes son, sintiéndose cada vez más cómod*s expresando dicha identidad y el manejo de reacciones adversas de l*s demás. Observamos que en varias culturas en todo el mundo, estas experiencias que aquí denominamos diversidad de género, no se considerarían como patología.

10. Observamos también que much*s niñ*s que expresan convicciones pronunciadas e inquebrantables con respecto a su identidad de género, y que tienen familias que l*s apoyan, no muestran nivel de angustia alguno. Por el contrario, la angustia se produce cuando el* niñ* siente que sus genitales deben dictar su identidad y comportamiento.

11. Observamos también que, a diferencia de adolescentes y adult*s trans, l*s niños de género diverso pre púberes no tienen necesidad de asistencia sanitaria somática de reafirmación de género. Est*s niñ*s no necesitan supresores de pubertad, ni hormonas de masculinización o feminización, ni cirugías o, de hecho, intervención médica de algún tipo. Simplemente necesitan la oportunidad y la libertad para explorar, incorporar y expresar su identidad de género; necesitan el apoyo y la información que les permita hacer estas cosas, así como manejar las reacciones adversas de l*s demás. En nuestra opinión, estos desafíos de desarrollo no justifican un diagnóstico. Por otra parte, el diagnóstico indica erróneamente al* niñ* y su familia que hay algo incorrecto o inapropiado con el* niñ*.

12. Observamos que el Grupo de Trabajo de la OMS generador de la propuesta IGI (http://goo.gl/8JiJi2), y la Secretaría de la OMS, han tomado enfoques de diagnóstico muy diferentes para personas que experimentan procesos de desarrollo vinculados a su orientación sexual. Actualmente existen varios diagnósticos en el bloque F66 de la CIE-10 (por ejemplo: trastornos de la maduración sexual y orientación sexual egodistónica) que tienen el efecto de patologizar a jóvenes que exploran la orientación sexual hacia el mismo sexo, incorporando su orientación sexual dentro su percepción de sí mism*s, aprendiendo a expresar su orientación sexual y el manejo de las reacciones adversas de l*s demás. A su favor, el Grupo de Trabajo consideró que los procesos de desarrollo de este tipo – la exploración, la incorporación, la expresión y el manejo de la reacción con respecto a la orientación sexual – no deben ser patologizados. El Grupo recomendó que se eliminen estos diagnósticos. El Borrador Beta de la CIE-11 refleja estas recomendaciones. Estamos perplej*s que en la preparación del Borrador Beta de la CIE11, el Grupo de Trabajo y la Secretaría de la OMS, no han tenido el mismo enfoque con niñ*s de género diverso, que se inscriben en procesos de desarrollo similares, pero vinculados a la identidad de género.

13. Observamos que el Grupo de Trabajo ha recomendado que la asistencia sanitaria que ayuda a jóvenes que padecen discriminación motivada por su orientación sexual, puede ser proporcionada a través de los códigos no patologizantes en el capítulo 21 de la CIE-10, titulados “Factores que influyen en el Estado de Salud y el Contacto con Servicios de Salud”. Estos son los llamados códigos Z en el capítulo 21 de la CIE-10 (actualmente códigos Q en el Borrador Beta de CIE-11, y colocados en el Capítulo 24). Ciertos códigos Z pueden ser útiles en los casos en los cuales una persona busque atención sanitaria por razones asociadas al estigma y los prejuicios. Creemos que un enfoque similar de Código Z debe ser tomado para niñ*s de género diverso pre púberes (y sus tutor*s) que requieren del apoyo del sistema de salud.

Una propuesta alternativa y un llamamiento a la OMS

14. Tomamos nota de las propuestas que surgieron del Grupo de Trabajo de Expert*s de Sociedad Civil (https://goo.gl/O1NrbJ) que se reunió en Buenos Aires en abril de 2013. El encuentro fue convocado por GATE, una organización internacional centrada en la promoción de los derechos humanos de las personas trans, incluyendo la salud. Las propuestas (GATE, 2013) son para facilitar la atención sanitaria para niñ*s pre púberes de género diverso mediante el uso de códigos Z – en la mayoría de los casos, modificaciones menores de códigos Z ya existentes. Tales códigos Z detallarían la naturaleza de la ayuda que se ofrece a est*s niñ*s y a l*s adult*s responsables de cuidar de ell*s. Estos códigos podrían facilitar el acceso de l*s niños (y sus tutor*s) a servicios afirmativos de asesoramiento e información, así como a los exámenes médicos vinculados a abordar la pubertad. Estos códigos también podrían utilizarse para facilitar el acceso de l*s niñ*s a la escuela en roles auténticos (de reafirmación de género). Por último, en los pocos casos en los que l*s niñ*s de género diverso que experimenten angustia de alcance y naturaleza que requieran atención clínia de salud mental, estos códigos Z podrían ser utilizados como marcadores, adjuntos a diagnósticos genéricos tales como la depresión o la ansiedad, señalando que las cuestiones de salud mental del* niñ* están vinculadas a las experiencias de discriminación fundadas en su diversidad de género (con implicaciones para el tipo de cuidado requerido).

15. Somos de la opinión de que los argumentos para el diagnóstico IGI – por ejemplo, que proporcionará una base para la investigación y la formación – parecen fallidos. No creemos que la investigación o formación relacionadas con la diversidad de género en la infancia sufran por la inexistencia de un diagnóstico IGI en la CIE-11. Observamos que la investigación sobre atracciones y relaciones entre el mismo sexo ha prosperado desde que el diagnóstico de homosexualidad fue retirado de los manuales de diagnóstico hace décadas. Creemos también que el conocimiento sobre las necesidades de asistencia sanitaria de jóvenes homosexuales y lesbianas es mejor ahora de lo que era cuando la homosexualidad era un diagnóstico.
16. Observamos también que organizaciones clave en salud y derechos trans en todo el mundo aparte de GATE, se han manifestado en contra de esta propuesta. Éstas incluyen a ILGA (Asociación Internacional Lesbiana, Gay, Bisexual, Trans e Intersex), ILGA-Europa, STP (Campaña Internacional Stop Trans Pathologization) y TGEU (Transgender Europe). También tomamos nota de las declaraciones surgidas de dos encuentros internacionales que examinaron la salud trans, uno en Ciudad del Cabo, Sudáfrica, y el otro en Taipéi, Taiwán. Por último, observamos que el Parlamento Europeo en el así llamado Informe Ferrara publicado en julio de 2015 pidió a la Comisión Europea de “intensificar los esfuerzos para evitar que la diversidad de género en la infancia se convierta en un nuevo diagnóstico de la CIE”. Este llamamiento se reafirmó en una Resolución del Parlamento Europeo aprobada en septiembre de 2015. Somos conscientes de una encuesta reciente de miembros de WPATH, que mostró que la mayoría de participantes se opuso al diagnóstico propuesto, siendo esta mayoría mucho mayor entre miembros fuera de los EE.UU.
– GATE (https://goo.gl/wuPMkI)
– ILGA (http://ilga.org/)
– ILGA-Europe (http://goo.gl/Z1k636)
– STP (http://goo.gl/oERkcm)
– TGEU (Transgender Europe, http://goo.gl/KRJLlI)
– Ciudad del Cabo, Sudáfrica (http://goo.gl/vIMwYH)
– Taipei, Taiwan (http://goo.gl/cW4Jxf)
– Resolución del Parlamento Europeo (http://goo.gl/rBAJRA)
– Encuesta de Miembros de WPATH (http://goo.gl/mAVmgu)
En virtud de lo arriba expresado, l*s abajo firmantes, un grupo de académic*s, investigador*s y profesionales de la salud que trabajan en salud y derechos trans, llaman a la OMS a abandonar la propuesta de diagnóstico IGI, e incorporar el uso de códigos Z como un medio para facilitar y asistir en el apoyo a niñ*s pre púberes de género diverso. Encomendamos a la OMS la propuesta de Grupo de Trabajo de Expert*s de Sociedad Civil de GATE (https://goo.gl/NfdDmg)

 

Errata [list added 20160516]

Intro, para. 3: [Erratum 20150516. Should read, “You will be prompted to view other signatories after you submit your response, or follow the link in the signature section.”]
Item #3: [Erratum 20150516. Should read, “Psychological and behavioural disorders associated with sexual development and orientation (Block F66).”]
Item #14: [Erratum 20160516. Should read, “(https://goo.gl/wuPMkI)”]