cross-sex hormones – @STILLTish. Gender Abolition

Talk by Polly Carmichael.

Part Two on the tension between different approaches for dealing with “Gender Dysphoria”. Hopefully part one provided some background for any neophytes. Tavistock Clinic: Part One.

Dr Carmichaels speech is : here The summary is taken from a transcription provided by Mumsnet volunteers; for which I am very grateful.

The talk took place in the following context:

4500% rise in the number of referrals, to the Tavistock, over a decade.
Rise in females (reversing sex ratio in less than a decade)
Tavistock pilot to place younger children on puberty blockers.

This change in protocol followed work done by Dutch Gender Identity Services. As you will see, from my earlier blog, the Tavistock were under some pressure to revise their treatment protocols to allow earlier medical interventions.

The evidence from introducing puberty blockers, at an earlier age, has resulted in children invariably progressing to cross sex hormones and entrenched on a medical pathway. The pro-medicalisation Lobby argue this is because they are 100% accurate in identifying those children who would persist. The alternative perspective is that the act of blocking puberty somehow locks in the Gender Incongruence. If this is correct we are medicalising those who would have desisted and, historically, many of those would simply be gay. I cover this here The Woke Gay Conversion Therapy?

There are many people working in this field who have raised this as a concern:

We don’t know whether these children would have desisted and reconciled to biological sex. The pro-interventionists have another perspective. They argue this is evidence the screening is working and it may be unfair to the children not put on this clinical pathway! This is also the argument used against setting up a control group. From the perspective of the Tavistock it would be unethical to leave a cohort untreated if they meet the diagnostic criteria for intractable Gender Dysphoria. I do wonder if anyone has thought to include parents, who oppose medical intervention, to see what the long term outcome is for our children?

Another startling admission is that we simply don’t know what the long term implications are on developing brains. 👇This is a clear admission this is an experimental treatment. Have politicians,and parents, been persuaded to take this risk because activists claim our children are at a high risk of suicide? Have activists managed this by leveraging questionable data on likely suicide? (I blogged about this here Suicide in the Trans Community)

This paragraph is important because there are still documents out there calling this intervention a “pause”. Indeed here is Polly herself from the CBBC children’s programme “Becoming Leo”.

Many people working in this field have postulated that going through a natural puberty resolves gender incongruence in the majority of cases. Dr Carmichael is clearly aware of this research and emphasises that the treatment, at Tanner Stage 2, means that these children will at least have had a partial puberty.

She concedes the paucity of long term data on outcomes. She also anticipates concerns about competing mental health diagnoses. In this way the “Gender Dysphoria”, it is implied, has to be treated to resolve these other difficulties. This neatly avoids any suggestion mental health issues underpin the “Gender Dysphoria”, or desire to find a label/treatment.

The framing of this discussion is entirely reliant on whether you believe in an “innate gender”. If you do believe a child can be born in the wrong body it necessitates treatment. If you believe gender is a social construct then societal sex stereotypes are the problem. These seem to be irreconcilable belief systems. Worth having a look at how Mermaid’s diagnostic criteria works. Would anyone not meet the diagnosis threshold given this criteria?

Dr Carmichael , below, frankly admits that the evidence has yet to catch up with practice. She further acknowledges there is no consensus and there is concern about the long term health impact. The only way this treatment can even approach an ethical justification is if you are confident that:

a) Gender Identity is innate

b) The Tavistock have a reliable system for targeting irreversible treatments only on children who would, in any case, have persisted.

c) You believe data that suggests there is a suicide epidemic in trans-identified youth. {This makes intervention a life saver & justifies pharmaceutical interventions}.

So what has effected this change? Political Interest and Lobbying. Let us not forget the role of the Women & Equalities Committee. Since it morphed, from a Women’s committee, it has been successfully colonised. In its original incarnation it focussed on women’s issues. As predicted, women’s concerns have been pushed to one side with a wider focus on “Equalities”.

The quote below👇 touches on the real change in the landscape surrounding “Transgender” children. Dr Carmichael acknowledges that some children are being socially transitioned at pre-school age. This is also a reference to the growing condemnation of “watchful waiting” , now badged as a practice akin to #GayConversionTherapy. The memorandum of understanding (MOU) she references commits to a ban on therapeutic work to resolve Gender Incongruence. BACP (British Association for Counselling and Psychotherapy) & the BPS (British Psychological Society) have signed up to a ban on Gender Identity “conversion”. The Royal College of GPs has also signed this MOU.

The fact most desisters are predicted to be gay seems to have escaped their notice. Counselling, to reconcile to biological sex, is now officially condemned by these, erstwhile, esteemed professional bodies. As of May 2020 there are is a further move to outlaw any therapy to address “Gender Dysphoria” by, once again, conflating it with Gay Conversion Therapy. See here ⇒ Gender Identity Conversion Therapy

There’s a huge amount to unpack here. 👇

Dr Carmichael is not happy the Tavistock are being accused of not being sufficiently affirmative. She does appear to be trying to raise awareness of the changing nature of the child referrals. Her interpretation of the parents, mentioned above. does not accord with my own perspective. Socially transitioning a three year old and then attempting to report a young child for the Hate Crime of misgendering another child! Is this the behaviour of parents who are simply being protective! If I was relaying this story, verbally, my incredulity would be at such a high pitch only dogs would be able to hear me!

In the section below there are a lot of erms as Dr Carmichael hesitates over the admission the treatment compromises fertility . She is anxious about this, but not for the reasons you might expect. She is concerned about young people who defer medicalisation to try to salvage their reproductive health. The reason for this is they may not “pass” ,if they delay long enough to have a chance at parenthood. This is not an uncommon viewpoint. One practitioner in this field praises the children who are kind enough to see themselves as future child adopters.

Sacrificing fertility is quite a significant thing to ask children to consent to and yet her concern is one of “presentation”. Polly is aware this is indicative of that great sin of “binary thinking”. {Its almost as if she knows, on some level, there are only two sexes!} No doubt Polly would consider me a “biological essentialist” but, like many women (and men), I was in my thirties before I desired children. I would not have made a mature decision, to place my fertility at risk, at age 12.

And that last sentence! Actually wondering how the Tavistock can support children to feel comfortable enough to live with their bodies! Klaxon Klaxon Klaxon!! This is what parents would like to know! Shouldn’t the first line of treatment be body-positive? In less than a decade we seem to have normalised a bodily dis-associative disorder and completely over-turned decades of work, especially for the female body.

Another thing that is hard to keep up with is the removal of any reference to mental health issues. The diagnostic criteria for Gender Dysphoria has now officially been re-classified to remove suggestions it is a Mental Health issue. I sense Dr Carmichael really wants to find a way to talk about co-morbidities here. However activists have successfully rebadged Gender Dysphoria as a naturally occurring variation and references to mental health are removed from the official diagnostic manual.

How many of these children/teens placed on an irreversible pathway may have benefited from some good therapeutic exploration of their motivations? Therapeutic Interventions to resolve Gender Dysphoria

This is a good summary of what the impact of this Conversion versus Affirmation model does to practitioners in this field. I diverge on many points with Dr Carmichael but she is right that we are favouring medical solutions to resolve psychological issues. The lack of psychological support has also been raised by Tavistock staff who have now left and are whistleblowing.

To balance the pressure for medical intervention we need a diversity of voices. These should include detransitioners, It should include parents of children struggling with this “condition”. It should include people who understand the concept of an iatrogenic “illness”. It should include people who have expressed concern about what we are doing to young people. We need a countervailing voice to Lobby groups like Mermaids, Stonewall and Gendered Intelligence.

The above is not a bad summary.

We need more empirical data, less opinion.
We need to look at contextual factors. (School teaching on Gender Identity, for one)
I disagree about taking a lead from young people. Detransitioners have taught us that.

We need to urgently take measures to make certain we are not medicalising children who could have lived a life without hormone dependency and surgical interventions.

The problem with this service is that it seems to be driven by people who see this as a social justice cause, They are excited at disruptive thinking, eroding or destroying social norms. I will leave you with this quote from Bernadette Wren, who also works at the Tavistock. This is from the Transgender Equality Inquiry in 2015. I sense that Dr Wren should have been more careful. Sometimes a social revolution doesn’t take the form you, naively, imagine it will:

This article shows how a good therapist can identify underlying issues and attempt to resolve Gender Dysphoria without medicalised responses to bodily discomfort. The therapist is fluent in Gender Identity speak but does have the courage to honestly interrogate what “Gender” means to the clients they see. It is important to note that any therapist may, or perhaps will, feel compelled to speak in approved language to get published. Additionally our young people have imbibed the new lexicon so the therapist may need to speak in the approved language, to establish a dialogue with Gender Dysphoric youth.

The article: Psychoanalyst on Transitory Trans Identity Author Alessandra Lemmas

Psychoanalysis pays attention to unconscious motivations in the formation of “identity”. This is in marked contrast to Gender Identity proponents of a medicalised response. Lemmas talks of the need for “a posture of implicit scepticism” when dealing with claimed identities. This is in marked contrast to Gender Identity medical practitioners who prioritise a subjective sense of self and demand only “belief”. This is an excerpt from a response to an article in the British Medical Journal about how to treat Gender Dysphoria. The response is from Dr Helen Webberly, currently suspended from the General Medical Council, who is not alone in her stance: Helen Webberly .

The belief that people can, literally, be born in the wrong body underpins the lack of a therapeutic approach to young people presenting with Gender Identity Issues. Merely to suggest that this may be an incorrect, self-diagnosis, generates outrage that we are denying the “lived experience” of the transgender community. Yet we know, as Lemmas, and many others, point out most desist, reconcile to biological sex and many are simply gay. 👇

The author subscribes/pays lip service to the idea that sex is assigned at birth, rather than merely observed, as it is in 99% + cases. She subshumes both Lesbians and Gay men underneath the “transgender” umbrella. The statistics on post-operative satisfaction accept the narrative from within the Gender Identity community with no acknowledgment of the methodological flaws with the phenomenon of “loss to follow up”. {This is where a patient loses contact with the Gender Identity Service they are using. Detransitioners say they don’t return to the services which, they feel, actively harmed them, so this cohort disappear from the “follow up”}

The three case studies, in this article, cover many of the issues raised by parents dealing with our gender Dysphoric offspring. All claimed a transgender identity with no prior history sound puberty. We are told about the huge spike in referrals to the UK’s main Gender Identity Clinics and a wider social context emphasising choice and very much of a piece with the atomising of the individual in neoliberal, capitalist, societies.

The first case is illustrative of the complicity of transgender identity. More on “Anita” below. 👇. As you can see Anita claims multiple identities encompassing male, gay & female as well as “drag queen”. Already taking cross sex hormones but with no intention to progress to more surgical changes.

The dialogue seems to settle on the idea that gender identity can be fluid and an exploratory phase. Nevertheless Anita is already medicalising, We leave this case here, though I will just add that I have never seen a satisfactory explanation of what “living as a woman” means. It seems to depend on circular reasoning /a retreat to sex stereotypes.

Janes case is more complex and, arguably, requires a more robust interrogation since Jane seems to fully intend a full transition to “live as a man”. The sessions are challenging and, on more than one occasion, the analyst reports the anger triggered by the exploration of underlying issues. What emerges is a young girl whose parents have traditional gender roles in the household. Janes perception is that her mother is a “hostess” with little power, standing in the household. On being pressed much of Janes “Identity” seems built about rejecting all the signs associated with being a “girl” such as make-up and long hair. Here are some of Jane’s thoughts on what being a girl means to her:

Tellingly., Jane reveals that they did not feel they measured up to the expected level of attractiveness as a girl. Even more revealing is an expression of same sex attraction. Not as a lesbian but as a male attracted to females. Another common theme in detransitioners is the yearning for passing privilege as a male and how this, in retrospect, seemed to become more unattainable as they sought to identify as male.

Jane is also adopted and vehemently rejects any idea this relates to their gender identity issues, However it later emerges that the birth mother was from a culture which prized male children, in preference to girls. This prompts some self reflection and the realisation / admission that maybe this was bound up with the idea that her mother may have kept a male child.

Janes situation resolved itself without medical intervention. She is in a same sex relationship and has found a way to identify as a strong woman in her on line world after previously observing that she felt “insubstantial” and, significantly, failed to garner the same respect when she was coded female.

The third case study is Alex, who is a female who identified as male at 16. Alex was not interested in being dissuaded from hormones and surgery, as is common with our Gender Dysphoric youth. Alex’s parents affirmed the new identity and accepted their daughter as a son. Alex, however,still wished to access therapy, but still underwent a double mastectomy at age 19. Post surgery Alex was, initially “happy” but then became depressed and suicidal and revisited the sexual abuse that they had endured at age 10, and realised the link between the abuse and the desire to remove their breasts . Tellingly, the parents were not aware of the sexual abuse and it did made me reflect on their role as affirming parents and, if they had been aware of this history, would it have made them exercise more caution? I do NOT say this to judge those parents. Any one of us could have genuinely advocated for this stance in the belief, pushed relentlessly by our media and advocated by public bodies, that this is the right thing to do.

I am conflicted about the “woke” language. By espousing the idea that someone can born “in the wrong body” {which is the belief system underpinning transgender ideology} the danger is our Gender Confused children are getting mixed messages. On the one hand the implication is that they may be hard-wired with a conflict between sexed bodies and an opposite sex brain. At the same time it is clear that some of these cases are complicated by sexual orientation, history of sexual abuse and family dynamics. There remains no diagnostic test that can separate the influence of “neuroplasticity” from the notion of an opposite sex brain. In an ideal world we would start from the clear premise that there is no solid evidence that there is a biological basis for this incongruence between sexed bodies and a “gender identity”. That does NOT mean that Gender Dysphoria does not exist or that it cannot, in a minority of extreme cases, be extremely debilitating and, for adults, may lead to an inescapable desire for medical intervention.

Irrespective of these misgivings this is a good article and those of us dealing with Gender Dysphoric teens know how hard it is to navigate this terrain. Some solid therapeutic work seems to have built up sufficient trust to garner some solid insights from these young people. Of course I wish that self-awareness pre-dated significant surgery but for parents struggling with this, especially, I do recommend this piece.

Tag: cross-sex hormones

Tavistock. Part Two: Clinical Dilemmas: Polly Carmichael

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Therapeutic Interventions to resolve Gender Dysphoria

Talk by Polly Carmichael.

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