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