I know this is an older post, but I just saw it. I definitely agree with your points insofar as I think there needs to be a lot more space for time and consideration and a slow process built into gender transition in general and especially for minors and young people, particularly those with other mental health challenges.
Here's where I struggle with this idea myself: at some point, if a person is tormented by mental ills, a healthy body is irrelevant because they can't use and enjoy it, and in some cases their mental illness will destroy it-completely, in cases of suicide, but also partially through substance use, inactivity, eating issues of all kinds, and so on. Having worked in health care for years, I've see that serious mental problems can be just as debilitating as physical problems. I've also noticed that there is a tendency among those who aren't the patient to look at mental problems with sort of a "just get over it and move on" type of attitude that generally isn't extended to physical issues, even those that have a behavioral (issues that worsen with inactivity) or psychological (such as pain of any type and especially chronic pain) component. (Please don't jump on me! I'm NOT saying pain is in people's heads, at all! But there is significant proof that pain of any kind is absolutely influenced by psychological aspects, which is why certain types of psychotherapy are among the primary modes of treatment for severe and-or chronic pain). My observation-including in myself-has been that people who aren't dealing with a given mental issue often have great difficulty empathising with those who are, and often believe that the person has control over their mental state more than they really do.
So, it seems to become a slippery slope. I can see, to an extent at least, how some mental health professionals advocate so much for patient self report being the primary means of diagnosis. Because, that's really the best tool they have for any mental illness, even things like schizophrenia. (There are certainly cases where people fake symptoms of psychosis for various reasons, usually secondary gain, but I don't think too many people would argue that we should thoroughly investigate or interrogate someone claiming to hear voices commanding them to hurt someone before treating them.) Certainly there ARE cases where patients will deny such symptoms yet are still obviously disabled. But when patients report any symptoms, it's quite difficult to "disprove" it, not to mention severely damaging for the majority who actually do have the symptoms they report.
The reason this relates to what your saying (brevity is not my strong suit and I'm so sorry) is that medical treatment for any mental illness causes physical side effects, many of them serious. Antidepressants are known to cause increased suicide risk at the start of treatment, especially in young people. However, once that was publicized widely and prescriptions dropped for young people, the suicide rate in that demographic actually increased, possibly because people who needed the treatment weren't getting it. ECT can cause permanent and significant memory loss, including of things like one's wedding day or the birth of one's child. It also can bring someone out of a catatonic state, in which they can't interact with anyone including their spouse or child. It's difficult to balance these risks and easy to say "well, if he wanted to snap out of it, he could!" because we can't SEE any cause that is preventing the person from improving. Antipsychotics cause tremendous weight gain and all the problems that go with it-cardiac, metabolic, orthopedic and so on. They also can cause permanent abnormal facial movements that persist even if the med is stopped. Again, it's very easy for people who love the patient to think "well, he just needs to understand that the voices aren't real! Then he won't need to suffer all those physical effects!" But the voices ARE real, to the patient. And they're often much more disabling than the physical problems. (I do think part of the reason for that is that we generally have a much better approach to management of chronic physical illness than chronic psychiatric illness, but that's a different topic).
So it's difficult for me to balance my own sense that many people with gender issues, especially those who are young and whose issues are relatively recent, could use more time and introspection before jumping into any physical modifications, with my observation that for whatever reason many people with mental difficulties of all kinds simply seem to be unable to overcome them without some form of medical intervention. Along with the observation that the patient is typically the best source of information about what is going on with them, physically but especially mentally. I haven't yet figured out how to reconcile all that.
Jen, thank you for this. I agree with you. You bring up so many important aspects of this, and a good response will be way too long, but I will try to give a somewhat concise response (brevity also not being my strong point).
First, I don't think the idea of "balance" is incompatible with prioritizing a healthy body. Nobody (or very few people) always fully prioritizes "health" in the sense of the physical aspects of our bodies over "balance," which takes into account mental health, joy (directly related to mental health), and practicality (such as cost and time). Rather, we consider both simultaneously in most decisions. For instance, I love chocolate chip cookies. If, every time I wanted one, I instead ate a carrot or a celery or an apple or some grapes, that would probably be healthier for my body. On the other hand, the sheer joy I derive from eating a gooey delicious cookie - especially a home-made one with dark chocolate chips and a mix of whole wheat and white flour and some sea salt - has a very positive influence on my life and my overall "health," although it is taking a small toll on my body.
That mental health itself must be taken into account in "treating" anyone is apparent. What is totally missing in the discussion of medical transition is the heavy toll on the body and the weak and incoherent link between the interventions involved and the actual mental health of the patients. In fact, many people nowadays even claim there is no mental health issue. They claim this is about a "Gender Identity" (You can read my essay on that topic as well), and that anyone whose body doesn't "match" their "Gender Identity" would have to be unhappy and in need of changes to their body - because the "Gender Identity" is unchangeable (even though they also acknowledge that some people don't "discover" their "Gender Identity" until they are teens, young adults or older adults, which, logically, means some people think they have one "Gender Identity" when they are younger and another one when they are older, and they are ignoring detransitioners).
Anyway, the point is that many people don't think medical transition is about a mental health problem, but that it is more like an inevitable preference, like my love for chocolate chip cookies, but much, much stronger. There is no proof of the existence of this "Gender Identity" and it likewise cannot be disproven, which renders this claim in the nature of a religious notion involving faith. Yet we are treating this like a medical issue, even though we don't have the necessary proof that these interventions actually - on balance - make people more healthy (mentally and physically). It's a mess, and there is no room for caution, hence a lack of prioritization of a healthy body.
I hope that clarifies what I'm trying to say, which is not that we should never help people with mental health issues. We should - when they are real (not teenagers suffering normal angst but being convinced that it is something else, not children who are gender non-conforming being told this means they are "really" the opposite sex) - help people with mental health challenges. There are many ways to do that, including psychotherapy to explore why they are so distressed and why they hate the sexual aspects (primary and/or secondary sex characteristics) of their body. Giving people physical activities to connect their mind to their body and make them realize how wonderful a healthy body can be when used to interact with the world might help as well. Time is also a factor, particularly for young people.
I do happen to believe we jump too fast to give meds for depression as well, but I understand that some people might truly benefit from a course of anti-depressants, at least in the short-term - before it can do much physical damage.
As for schizophrenia, it has a chemical basis so is not just based on self-report, and it's difficult to fake that, but, more importantly, would be highly unlikely to be mere confusion (ie. someone thinking they are having hallucinations when they are not), while "gender dysphoria" is often linked to confusion rather than some inherent disdain for one's sexed body. Even with schizophrenia, though, there can be over-medicating, which can lead not only to physical problems, as you noted, but other mental health problems, like being totally numb or dull in affect. Also, children don't seem to do well with medications for schizophrenia, although I am no expert on that, and am not sure what the alternative treatments are - but I would want to explore those alternatives if I were in that field. So medication for mental illness is a fraught issue, with many subtleties.
Medical transition is based on an unclear mental condition, involves huge medical costs, and has almost no scientific basis behind it, yet society is pushing for the huge increase in these interventions - for young, vulnerable individuals - without question.
I know there may still be some adults who, even with the proper help in the form of psychotherapy or things like equine therapy or exercise and art programs, may, for whatever reason, not be able to accept their sex. If such an adult gets to a point of feeling so overwhelmed with their hatred or disgust with their sexed body and identity as a member of their sex, and if that adult is otherwise relatively healthy and is aware that they will only be approximating the opposite sex in order to change their appearance and how others see them, that adult might just benefit from cosmetic interventions such as hormones and surgeries to appear the opposite sex. However, this is chancy and guesswork, given that nobody can know how it will feel to live in a medically altered body, and the potential health problems are unpredictable in many ways as well. I see this is a Hail Mary effort to help someone who is distressed inconsolably without explanation and who cannot seem to accept their physical reality. I don't see this is an option for children, teens or vulnerable young adults who have not lived in their sexed bodies long enough to know if they will become comfortable with them, particularly if they have been binding or tucking and pretending to be the opposite sex as teens and through their young adult years.
I could go on and on, but the bottom line is that we have to re-think the "gender affirmation model" of care. It fails entirely to take a healthy body into account, and doesn't even consider whether these heavy medical interventions actually benefit the mental health of the patients involved.
Thank you for the reply and the clarification. And thank you for reading through my Great American Novel of a post!! I agree with most everything you said. One tiny and only tangentially relevant exception being that the chemical basis for schizophrenia is actually just a theory, based mostly on the actions of the meds that seem to help the symptoms, there have also been studies showing structural changes in the brains of some-but not nearly all-who are affected but it's unclear what exactly they mean in terms of causation
Many psychiatrists now believe that most of the serious mental illness, including depression and schizophrenia, actually are not one illness at all but that they are just symptoms of numerous illnesses-sort of like a fever. It's a real thing but not an illness in itself, and can mean many different things that require very different treatment or sometimes none at all. Which is much like my interpretation, and it sounds like yours too, of gender dysphoria, particularly in youth. Regardless, the diagnostic process for schizophrenia is actually based almost if not entirely on report of the patient, and ideally on collateral information from one or more important people in their lives. There is no physical test for that anymore than for any other mental illness. In all psychiatric diagnoses patient interview is the primary tool, and many times the only one used before treatment is initiated. (For the record I also believe that psych meds in general are overused in many cases, and often used for far too long, and the research actually is not as strong as many people think in showing any effect that actually improves people's lives of most meds, in most cases, though there are a few exceptions.)
In any case I completely agree that the evidence that medical treatments for gender issues improve anything at all is quite weak and when it does exist it likely only applies to a small subset of the current patient cohort. The whole thing is indeed a mess, and patients deserve better. I think that applies to the mental health system as a whole, at least in the US. If you haven't already, and you have the time, you and some of your other readers might enjoy browsing through some of the writing by "psychiatric survivors" and critical psychiatrists. "Mad in America" is a good place to start; there is a wide variety on there and I don't think too many people will resonate with all of it, but there is a lot about studies showing that current psych interventions aren't that effective or are harmful, a lot of patient experiences of harm, as well as interesting pieces on some alternatives that show promise. It reminds me a lot of some of the GC and detransition stuff out there, only the psych critical movement is somewhat older and larger. I do think that some of the solutions they've come up with might be modified to work with different subgroups of current gender dysphoria patients.
I'm also thinking about anorexia and bulimia: previously (like 60+years back) they were seen but quite rarely. Then, about 30 years ago, they began to explode among women and young people especially. There was a significant level of social contagion there, although that wasn't the case with everyone. Initially, the treatment basically excluded the parents of teens.
However, since then, I believe around the late 90s or early aughts, a couple researchers developed and tested Family Based Therapy (previously known as the Maudsley Method) for minors with anorexia who met certain criteria (no abuse or severe non-anorexia-related conflict in the family, at least one parent able and willing to essentially act as a residential treatment center, no life-threatening medical issues, no unstable severe comorbid psych issues, etc). It was very controversial among clinicians and patients, but has demonstrated good results with a certain cohort and has since been expanded on a smaller scale to treat bulimia, and also to treat adults.
Patient selection is vital here as with any treatment method; people with EDs along with many other mental illnesses are much more likely to have suffered trauma, and this therapy is clearly not appropriate for anyone who has been abused-in any way including mentally-by their parents. However, it does seem to have worked beautifully for some of the young people who were swept up in the contagion and then lost control.
I do wonder if something like this could be developed to work with kids with the ROGD profile (perhaps even kids with a more traditional GD-GID profile although they would likely need a different form of the treatment). Again, it wouldn't work with all families, or all kids (although I note that FBT for anorexia in minors, though not adults, has been successfully used in many cases where the child was unwilling to participate and didn't want to get better, initially and often for 1 or more years after starting). It would certainly be an uphill battle for the clinicians developing and testing it. But it only took one institution in this case to start what has become a respected international treatment method. (Interestingly one of the clinicians who has been most instrumental in developing and disseminating this treatment has spent significant time at Stanford and may still be there-I think it's Daniel LeGrange). I have no idea how they would implement such a thing, but what gave me the idea is the similarities between the ED and GD epidemics, as well as the similarities I've noted between parents who've described using this treatment successfully, and many of the GC parents whose writing I've read.
Of note many FBT parent stories involve the child becoming verbally and physically aggressive and threatening and attempting suicide and self-harm. There are specific protocols for handling these behaviors, and most of the kids remain at home even if threatening suicide, with the parents providing 24-7 monitoring and support in lieu of psychiatric hospitalization. This is ideal in this case because hospital stays are generally 3 days to 2 weeks for suicidal kids, but in many cases these behaviors wax and wane for many months before subsiding in this type of situation. So you avoid a revolving door that doesn't help in most cases anyway other than as a band aid, as well as the very real chance of the child picking up other types of behavioral symptoms that are known to be socially contagious.
Anyway, I see a lot of parallels here. So I do wonder if some of the GC clinicians might be able to put their heads together and make use of some of these existing models for other problems that bear a resemblance to ROGD.
There is a parent FBT forum called Around the Dinner Table, and a book called Eating With Your Anorexic (along others) that describes a real life experience if anyone is interested.
Interesting idea. I do think family therapy could be a useful tool with GD, as family dynamics may be, in one way or another, a cause of GD for many, though certainly not all, of these kids. I also think it's - generally speaking - better to keep people at home if they have a loving support network, rather than jumping to institutional interventions - again, with exceptions for extreme situations. The parallel between GD and anorexia/bulimia to me seems clear, but that's another area where discussion is usually squashed, as "social contagion" seems to evoke a gag reflex for some people, as it implies that transition may not be in-born and inevitable.
Yes, agreed that the whole industry, if we want to call it that, of psych meds is also a bit out of control. As was noted by MP's comment and my response, there are also issues with treatments for physical illnesses. There is a lot of guesswork involved in medicine, and it is pure arrogance to assume any long-term treatment is perfect and beyond question, particularly when so many people suffer terribly negative side effects. Of course, that doesn't mean we shouldn't appreciate doctors and medicine and all of the good things it can, and in many (but far from all) cases does, do.
There really needs to be more research done on the health effects of gender "care," especially on chronic pain. The population seeking these treatments has higher rates of trauma and emotional distress, which are huge risk factors for chronic pain. I would not be surprised if the majority end up in chronic pain after hormones/surgery. That is something patients needs to be warned about (informed consent!!), and parents need to be aware of before they start down this path. Even if we believe the lie that the treatments will solve emotional problems in the long term, if it's a trade off of chronic physical pain is it really worth it?
Thanks for another heartfelt and well-reasoned essay, hippiesq. It's hard not to see the long arm of capitalism at work here. The naked profit motive behind so many drugs and so many, many treatments is tough to ignore--in this realm and others. Also, we're inured to it: the industrialized medicalization of so many conditions, physical and emotional. I say this as a cancer "survivor" who often wonders about breast amputation as the main treatment for breast cancer.
Thanks, MP. I agree totally. I also wonder about chemotherapy, about life-time drugs to control blood pressure, cholesterol and many other medical "innovations."
A speech at Vanderbilt University made very clear the profit motive involved in transition. It's worth watching (just 2 minutes):
Another great article. Can you share your source for the claim that exogenous testosterone in females increases the risk of heart attacks? Been trying, and failing, to track down evidence. Thanks.
"Mens sana in corpore sano" -- a sound mind in a sound body as my own mother -- Gawd rest her soul -- used to say. Though I see it goes back to Juvenal:
Might be nice if we could actually change sex -- not least for being able to walk a mile or two in other people's shoes. But that so many "doctors" are peddling ersatz, biologically impossible, and health-damaging "sex changes" has to qualify as biggest Big Lie of this or even of the last century.
Even people like Stella O'Malley contribute to the problem by suggesting such changes are even possible:
So many fictions go into the insidious movement that is gender ideology. While the term "sex change" was originally an imprecise term meant to indicate that someone was changing their appearance to that of the opposite sex, so they could live as if they were the opposite sex, somewhere along the line, this was taken literally - which just proves your point. Once you play fast and loose with language, it can lead to all sorts of unintended negative consequences.
It might be nice to be able to choose your body, pick it out or design it yourself, both in terms of the sex and all the other characteristics, but that would be a very different experience of life and the world than we currently have, and I cannot anticipate all the ways that might not be good or might work against us. I think we need to be okay with the fact that our bodies are what they are; acceptance seems to me a better strategy than trying so hard to use technology to shape our bodies to what we think we might want. Right?
Many diseases, genetic and otherwise, which might reasonably justify "born in the wrong body" and efforts to rectify them. Apropos of which and ICYMI, you might enjoy Genome which actually gave some justification for eugenics in the case of Tay-Sachs disease:
I know this is an older post, but I just saw it. I definitely agree with your points insofar as I think there needs to be a lot more space for time and consideration and a slow process built into gender transition in general and especially for minors and young people, particularly those with other mental health challenges.
Here's where I struggle with this idea myself: at some point, if a person is tormented by mental ills, a healthy body is irrelevant because they can't use and enjoy it, and in some cases their mental illness will destroy it-completely, in cases of suicide, but also partially through substance use, inactivity, eating issues of all kinds, and so on. Having worked in health care for years, I've see that serious mental problems can be just as debilitating as physical problems. I've also noticed that there is a tendency among those who aren't the patient to look at mental problems with sort of a "just get over it and move on" type of attitude that generally isn't extended to physical issues, even those that have a behavioral (issues that worsen with inactivity) or psychological (such as pain of any type and especially chronic pain) component. (Please don't jump on me! I'm NOT saying pain is in people's heads, at all! But there is significant proof that pain of any kind is absolutely influenced by psychological aspects, which is why certain types of psychotherapy are among the primary modes of treatment for severe and-or chronic pain). My observation-including in myself-has been that people who aren't dealing with a given mental issue often have great difficulty empathising with those who are, and often believe that the person has control over their mental state more than they really do.
So, it seems to become a slippery slope. I can see, to an extent at least, how some mental health professionals advocate so much for patient self report being the primary means of diagnosis. Because, that's really the best tool they have for any mental illness, even things like schizophrenia. (There are certainly cases where people fake symptoms of psychosis for various reasons, usually secondary gain, but I don't think too many people would argue that we should thoroughly investigate or interrogate someone claiming to hear voices commanding them to hurt someone before treating them.) Certainly there ARE cases where patients will deny such symptoms yet are still obviously disabled. But when patients report any symptoms, it's quite difficult to "disprove" it, not to mention severely damaging for the majority who actually do have the symptoms they report.
The reason this relates to what your saying (brevity is not my strong suit and I'm so sorry) is that medical treatment for any mental illness causes physical side effects, many of them serious. Antidepressants are known to cause increased suicide risk at the start of treatment, especially in young people. However, once that was publicized widely and prescriptions dropped for young people, the suicide rate in that demographic actually increased, possibly because people who needed the treatment weren't getting it. ECT can cause permanent and significant memory loss, including of things like one's wedding day or the birth of one's child. It also can bring someone out of a catatonic state, in which they can't interact with anyone including their spouse or child. It's difficult to balance these risks and easy to say "well, if he wanted to snap out of it, he could!" because we can't SEE any cause that is preventing the person from improving. Antipsychotics cause tremendous weight gain and all the problems that go with it-cardiac, metabolic, orthopedic and so on. They also can cause permanent abnormal facial movements that persist even if the med is stopped. Again, it's very easy for people who love the patient to think "well, he just needs to understand that the voices aren't real! Then he won't need to suffer all those physical effects!" But the voices ARE real, to the patient. And they're often much more disabling than the physical problems. (I do think part of the reason for that is that we generally have a much better approach to management of chronic physical illness than chronic psychiatric illness, but that's a different topic).
So it's difficult for me to balance my own sense that many people with gender issues, especially those who are young and whose issues are relatively recent, could use more time and introspection before jumping into any physical modifications, with my observation that for whatever reason many people with mental difficulties of all kinds simply seem to be unable to overcome them without some form of medical intervention. Along with the observation that the patient is typically the best source of information about what is going on with them, physically but especially mentally. I haven't yet figured out how to reconcile all that.
Thanks for letting me share my thoughts.
Jen, thank you for this. I agree with you. You bring up so many important aspects of this, and a good response will be way too long, but I will try to give a somewhat concise response (brevity also not being my strong point).
First, I don't think the idea of "balance" is incompatible with prioritizing a healthy body. Nobody (or very few people) always fully prioritizes "health" in the sense of the physical aspects of our bodies over "balance," which takes into account mental health, joy (directly related to mental health), and practicality (such as cost and time). Rather, we consider both simultaneously in most decisions. For instance, I love chocolate chip cookies. If, every time I wanted one, I instead ate a carrot or a celery or an apple or some grapes, that would probably be healthier for my body. On the other hand, the sheer joy I derive from eating a gooey delicious cookie - especially a home-made one with dark chocolate chips and a mix of whole wheat and white flour and some sea salt - has a very positive influence on my life and my overall "health," although it is taking a small toll on my body.
That mental health itself must be taken into account in "treating" anyone is apparent. What is totally missing in the discussion of medical transition is the heavy toll on the body and the weak and incoherent link between the interventions involved and the actual mental health of the patients. In fact, many people nowadays even claim there is no mental health issue. They claim this is about a "Gender Identity" (You can read my essay on that topic as well), and that anyone whose body doesn't "match" their "Gender Identity" would have to be unhappy and in need of changes to their body - because the "Gender Identity" is unchangeable (even though they also acknowledge that some people don't "discover" their "Gender Identity" until they are teens, young adults or older adults, which, logically, means some people think they have one "Gender Identity" when they are younger and another one when they are older, and they are ignoring detransitioners).
Anyway, the point is that many people don't think medical transition is about a mental health problem, but that it is more like an inevitable preference, like my love for chocolate chip cookies, but much, much stronger. There is no proof of the existence of this "Gender Identity" and it likewise cannot be disproven, which renders this claim in the nature of a religious notion involving faith. Yet we are treating this like a medical issue, even though we don't have the necessary proof that these interventions actually - on balance - make people more healthy (mentally and physically). It's a mess, and there is no room for caution, hence a lack of prioritization of a healthy body.
I hope that clarifies what I'm trying to say, which is not that we should never help people with mental health issues. We should - when they are real (not teenagers suffering normal angst but being convinced that it is something else, not children who are gender non-conforming being told this means they are "really" the opposite sex) - help people with mental health challenges. There are many ways to do that, including psychotherapy to explore why they are so distressed and why they hate the sexual aspects (primary and/or secondary sex characteristics) of their body. Giving people physical activities to connect their mind to their body and make them realize how wonderful a healthy body can be when used to interact with the world might help as well. Time is also a factor, particularly for young people.
I do happen to believe we jump too fast to give meds for depression as well, but I understand that some people might truly benefit from a course of anti-depressants, at least in the short-term - before it can do much physical damage.
As for schizophrenia, it has a chemical basis so is not just based on self-report, and it's difficult to fake that, but, more importantly, would be highly unlikely to be mere confusion (ie. someone thinking they are having hallucinations when they are not), while "gender dysphoria" is often linked to confusion rather than some inherent disdain for one's sexed body. Even with schizophrenia, though, there can be over-medicating, which can lead not only to physical problems, as you noted, but other mental health problems, like being totally numb or dull in affect. Also, children don't seem to do well with medications for schizophrenia, although I am no expert on that, and am not sure what the alternative treatments are - but I would want to explore those alternatives if I were in that field. So medication for mental illness is a fraught issue, with many subtleties.
Medical transition is based on an unclear mental condition, involves huge medical costs, and has almost no scientific basis behind it, yet society is pushing for the huge increase in these interventions - for young, vulnerable individuals - without question.
I know there may still be some adults who, even with the proper help in the form of psychotherapy or things like equine therapy or exercise and art programs, may, for whatever reason, not be able to accept their sex. If such an adult gets to a point of feeling so overwhelmed with their hatred or disgust with their sexed body and identity as a member of their sex, and if that adult is otherwise relatively healthy and is aware that they will only be approximating the opposite sex in order to change their appearance and how others see them, that adult might just benefit from cosmetic interventions such as hormones and surgeries to appear the opposite sex. However, this is chancy and guesswork, given that nobody can know how it will feel to live in a medically altered body, and the potential health problems are unpredictable in many ways as well. I see this is a Hail Mary effort to help someone who is distressed inconsolably without explanation and who cannot seem to accept their physical reality. I don't see this is an option for children, teens or vulnerable young adults who have not lived in their sexed bodies long enough to know if they will become comfortable with them, particularly if they have been binding or tucking and pretending to be the opposite sex as teens and through their young adult years.
I could go on and on, but the bottom line is that we have to re-think the "gender affirmation model" of care. It fails entirely to take a healthy body into account, and doesn't even consider whether these heavy medical interventions actually benefit the mental health of the patients involved.
Thank you for the reply and the clarification. And thank you for reading through my Great American Novel of a post!! I agree with most everything you said. One tiny and only tangentially relevant exception being that the chemical basis for schizophrenia is actually just a theory, based mostly on the actions of the meds that seem to help the symptoms, there have also been studies showing structural changes in the brains of some-but not nearly all-who are affected but it's unclear what exactly they mean in terms of causation
Many psychiatrists now believe that most of the serious mental illness, including depression and schizophrenia, actually are not one illness at all but that they are just symptoms of numerous illnesses-sort of like a fever. It's a real thing but not an illness in itself, and can mean many different things that require very different treatment or sometimes none at all. Which is much like my interpretation, and it sounds like yours too, of gender dysphoria, particularly in youth. Regardless, the diagnostic process for schizophrenia is actually based almost if not entirely on report of the patient, and ideally on collateral information from one or more important people in their lives. There is no physical test for that anymore than for any other mental illness. In all psychiatric diagnoses patient interview is the primary tool, and many times the only one used before treatment is initiated. (For the record I also believe that psych meds in general are overused in many cases, and often used for far too long, and the research actually is not as strong as many people think in showing any effect that actually improves people's lives of most meds, in most cases, though there are a few exceptions.)
In any case I completely agree that the evidence that medical treatments for gender issues improve anything at all is quite weak and when it does exist it likely only applies to a small subset of the current patient cohort. The whole thing is indeed a mess, and patients deserve better. I think that applies to the mental health system as a whole, at least in the US. If you haven't already, and you have the time, you and some of your other readers might enjoy browsing through some of the writing by "psychiatric survivors" and critical psychiatrists. "Mad in America" is a good place to start; there is a wide variety on there and I don't think too many people will resonate with all of it, but there is a lot about studies showing that current psych interventions aren't that effective or are harmful, a lot of patient experiences of harm, as well as interesting pieces on some alternatives that show promise. It reminds me a lot of some of the GC and detransition stuff out there, only the psych critical movement is somewhat older and larger. I do think that some of the solutions they've come up with might be modified to work with different subgroups of current gender dysphoria patients.
I'm also thinking about anorexia and bulimia: previously (like 60+years back) they were seen but quite rarely. Then, about 30 years ago, they began to explode among women and young people especially. There was a significant level of social contagion there, although that wasn't the case with everyone. Initially, the treatment basically excluded the parents of teens.
However, since then, I believe around the late 90s or early aughts, a couple researchers developed and tested Family Based Therapy (previously known as the Maudsley Method) for minors with anorexia who met certain criteria (no abuse or severe non-anorexia-related conflict in the family, at least one parent able and willing to essentially act as a residential treatment center, no life-threatening medical issues, no unstable severe comorbid psych issues, etc). It was very controversial among clinicians and patients, but has demonstrated good results with a certain cohort and has since been expanded on a smaller scale to treat bulimia, and also to treat adults.
Patient selection is vital here as with any treatment method; people with EDs along with many other mental illnesses are much more likely to have suffered trauma, and this therapy is clearly not appropriate for anyone who has been abused-in any way including mentally-by their parents. However, it does seem to have worked beautifully for some of the young people who were swept up in the contagion and then lost control.
I do wonder if something like this could be developed to work with kids with the ROGD profile (perhaps even kids with a more traditional GD-GID profile although they would likely need a different form of the treatment). Again, it wouldn't work with all families, or all kids (although I note that FBT for anorexia in minors, though not adults, has been successfully used in many cases where the child was unwilling to participate and didn't want to get better, initially and often for 1 or more years after starting). It would certainly be an uphill battle for the clinicians developing and testing it. But it only took one institution in this case to start what has become a respected international treatment method. (Interestingly one of the clinicians who has been most instrumental in developing and disseminating this treatment has spent significant time at Stanford and may still be there-I think it's Daniel LeGrange). I have no idea how they would implement such a thing, but what gave me the idea is the similarities between the ED and GD epidemics, as well as the similarities I've noted between parents who've described using this treatment successfully, and many of the GC parents whose writing I've read.
Of note many FBT parent stories involve the child becoming verbally and physically aggressive and threatening and attempting suicide and self-harm. There are specific protocols for handling these behaviors, and most of the kids remain at home even if threatening suicide, with the parents providing 24-7 monitoring and support in lieu of psychiatric hospitalization. This is ideal in this case because hospital stays are generally 3 days to 2 weeks for suicidal kids, but in many cases these behaviors wax and wane for many months before subsiding in this type of situation. So you avoid a revolving door that doesn't help in most cases anyway other than as a band aid, as well as the very real chance of the child picking up other types of behavioral symptoms that are known to be socially contagious.
Anyway, I see a lot of parallels here. So I do wonder if some of the GC clinicians might be able to put their heads together and make use of some of these existing models for other problems that bear a resemblance to ROGD.
There is a parent FBT forum called Around the Dinner Table, and a book called Eating With Your Anorexic (along others) that describes a real life experience if anyone is interested.
Interesting idea. I do think family therapy could be a useful tool with GD, as family dynamics may be, in one way or another, a cause of GD for many, though certainly not all, of these kids. I also think it's - generally speaking - better to keep people at home if they have a loving support network, rather than jumping to institutional interventions - again, with exceptions for extreme situations. The parallel between GD and anorexia/bulimia to me seems clear, but that's another area where discussion is usually squashed, as "social contagion" seems to evoke a gag reflex for some people, as it implies that transition may not be in-born and inevitable.
Yes, agreed that the whole industry, if we want to call it that, of psych meds is also a bit out of control. As was noted by MP's comment and my response, there are also issues with treatments for physical illnesses. There is a lot of guesswork involved in medicine, and it is pure arrogance to assume any long-term treatment is perfect and beyond question, particularly when so many people suffer terribly negative side effects. Of course, that doesn't mean we shouldn't appreciate doctors and medicine and all of the good things it can, and in many (but far from all) cases does, do.
There really needs to be more research done on the health effects of gender "care," especially on chronic pain. The population seeking these treatments has higher rates of trauma and emotional distress, which are huge risk factors for chronic pain. I would not be surprised if the majority end up in chronic pain after hormones/surgery. That is something patients needs to be warned about (informed consent!!), and parents need to be aware of before they start down this path. Even if we believe the lie that the treatments will solve emotional problems in the long term, if it's a trade off of chronic physical pain is it really worth it?
Excellent point!
Thanks for another heartfelt and well-reasoned essay, hippiesq. It's hard not to see the long arm of capitalism at work here. The naked profit motive behind so many drugs and so many, many treatments is tough to ignore--in this realm and others. Also, we're inured to it: the industrialized medicalization of so many conditions, physical and emotional. I say this as a cancer "survivor" who often wonders about breast amputation as the main treatment for breast cancer.
Thanks, MP. I agree totally. I also wonder about chemotherapy, about life-time drugs to control blood pressure, cholesterol and many other medical "innovations."
A speech at Vanderbilt University made very clear the profit motive involved in transition. It's worth watching (just 2 minutes):
https://x.com/MattWalshBlog/status/1572313523232931840?s=20
Thank you, I'll check it out!
Another great article. Can you share your source for the claim that exogenous testosterone in females increases the risk of heart attacks? Been trying, and failing, to track down evidence. Thanks.
I have seen this, but it’s been a while so I will have to find them. I’ll get back to you on this.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761990/
Thanks!
SEGM has links to studies. A link to the SEGM studies is here:
https://segm.org/studies
I have seen others, but SEGM is a pretty good source.
A quick Google search revealed this study, also from NIH (not the same study as provided by RyeBread98):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8907681/#:~:text=Overall%2C%20the%20available%20data%20indicate,sex%20assigned%20at%20birth%20men.
"Mens sana in corpore sano" -- a sound mind in a sound body as my own mother -- Gawd rest her soul -- used to say. Though I see it goes back to Juvenal:
https://en.wikipedia.org/wiki/Mens_sana_in_corpore_sano
Might be nice if we could actually change sex -- not least for being able to walk a mile or two in other people's shoes. But that so many "doctors" are peddling ersatz, biologically impossible, and health-damaging "sex changes" has to qualify as biggest Big Lie of this or even of the last century.
Even people like Stella O'Malley contribute to the problem by suggesting such changes are even possible:
https://stellaomalley.substack.com/p/episode-3-feminine-boy-to-gay-man/comment/47375106
So many fictions go into the insidious movement that is gender ideology. While the term "sex change" was originally an imprecise term meant to indicate that someone was changing their appearance to that of the opposite sex, so they could live as if they were the opposite sex, somewhere along the line, this was taken literally - which just proves your point. Once you play fast and loose with language, it can lead to all sorts of unintended negative consequences.
It might be nice to be able to choose your body, pick it out or design it yourself, both in terms of the sex and all the other characteristics, but that would be a very different experience of life and the world than we currently have, and I cannot anticipate all the ways that might not be good or might work against us. I think we need to be okay with the fact that our bodies are what they are; acceptance seems to me a better strategy than trying so hard to use technology to shape our bodies to what we think we might want. Right?
Right! More or less. 🙂
Many diseases, genetic and otherwise, which might reasonably justify "born in the wrong body" and efforts to rectify them. Apropos of which and ICYMI, you might enjoy Genome which actually gave some justification for eugenics in the case of Tay-Sachs disease:
https://en.wikipedia.org/wiki/Genome_(book)
The problem is that there are some slippery slopes in such methods and techniques. Nature of the beast ... 🙂