#affirmation model

By: Beth Bourne

Published: Feb 27, 2024

Kaiser gender specialists were eager to approve hormones and surgeries, which would all be covered by insurance as “medically necessary.”

On September 6, 2022, I received mail from my Kaiser Permanente Davis Ob-Gyn reminding me of a routine cervical screening. The language of the reminder stood out to me: “Recommended for people with a cervix ages 21 to 65.” When I asked my Ob-Gyn about this strange wording, she told me the wording was chosen to be “inclusive” of their “transgender” and “gender fluid” patients.

Based on this response, several thoughts occurred to me. Could I expose the medical scandal of “gender-affirming care” by saying and doing everything my daughter and other trans-identifying kids are taught to do? Would there be the type of medical safeguarding and differential diagnosis we would expect in other fields of medicine, or would I simply be allowed to self-diagnose and be offered the tools (i.e. hormones and surgeries) to choose my own gender adventure and become my true authentic self?

If I could demonstrate that anyone suffering from delusions of their sex, self-hatred, or identity issues could qualify for and easily obtain body-altering hormones and surgeries, all covered by insurance as “medically necessary” and potentially “life-saving” care, then maybe people would finally wake up. I certainly had.

I was prepared for failure. I wasn’t prepared for how easy success would be.

* * *

I am a 53-year-old mom from Davis, CA. My daughter began identifying as a transgender boy (social transition) and using he/him pronouns at school during 8th grade. Like several of her peers who also identified as trans at her school, my daughter was a gifted student and intellectually mature but socially immature. This shift coincided with her school’s sudden commitment to, and celebration of, a now widespread set of radical beliefs about the biology of sex and gender identity.

She “came out” as trans to her father (my ex-husband) and me through a standard coming-out letter, expressing her wish to start puberty blockers. She said she knew they were safe, citing information she had read from Planned Parenthood and the World Professional Association for Transgender Health (WPATH). To say I was shocked would be an understatement. I was also confused because this announcement was sudden and unexpected. While others quickly accepted and affirmed my daughter’s new identity, I was apprehensive and felt the need to learn more about what was going on.

Events began escalating quickly.

During a routine doctor’s visit scheduled for dizziness my daughter said that she was experiencing, the Kaiser pediatrician overheard her father using “he/him” pronouns for our daughter. The pediatrician seemed thrilled, quickly asking my daughter about her “preferred pronouns” and updating her medical records to denote that my daughter was now, in fact, my son. The pediatrician then recommended we consult the Kaiser Permanente Oakland Proud pediatric gender clinic, where she could get further information and (gender affirming) “treatment.” Now I was the one feeling dizzy.

As I began educating myself on this issue, I discovered that this phenomenon—minors, most often teen girls, suddenly adopting trans identities—was becoming increasingly widespread. It even had a name: rapid onset gender dysphoria, or ROGD. Thankfully, after learning about the potential side-effects of blockers and hormones, my ex-husband and I managed to agree not to consent to any medical interventions for our daughter until she turned 18 and would then be able to make such decisions as an adult.

Over the past five years, my daughter’s identity has slowly evolved in ways that I see as positive. Our bond, however, has become strained, particularly since I began publicly voicing my concerns about what many term as “gender ideology.” Following my daughter’s 17th birthday family celebration, she sent me an email that evening stating she would be cutting off contact with me.

While this estrangement brought me sorrow, with my daughter living full-time with her father, it also gave me the space to be an advocate/activist in pushing back on gender identity ideology in the schools and the medical industry.

I decided to go undercover as a nonbinary patient to show my daughter what danger she might be putting herself in—by people who purport to have her health as their interest, but whose main interest is in medically “affirming” (i.e., transitioning) whoever walks through their door. I am at heart a mother protecting her child.

* * *

My daughter’s sudden decision to become a boy was heavily on my mind in early September of 2022, when mail from my Kaiser Permanente Davis Ob-Gyn reminded me of a routine cervical screening with “Recommended for people with a cervix ages 21 to 65.” I was told that the wording was chosen to be “inclusive” of transgender and “gender fluid” patients.

Throughout the whole 231-day process of my feigned gender transition, the Kaiser gender specialists were eager to serve me and give me what I wanted, which would all be covered by insurance as “medically necessary.” My emails were returned quickly, my appointments scheduled efficiently, and I never fell through the cracks. I was helped along every step of the way.

Despite gender activists and clinicians constantly claiming that obtaining hormones and surgeries is a long and complex process with plenty of safety checks in place, I was in full control at every checkpoint. I was able to self-diagnose, determine how strong a dose of testosterone I received and which surgeries I wanted to pursue, no matter how extreme and no matter how many glaring red flags I purposefully dropped. The medical workers I met repeatedly reminded me that they were not there to act as “gatekeepers.”

I was able to instantly change my medical records to reflect my new gender identity and pronouns. Despite never being diagnosed with gender dysphoria, I was able to obtain a prescription for testosterone and approval for a “gender-affirming” double mastectomy from my doctor. It took only three more months (90 days) to be approved for surgery to remove my uterus and have a fake penis constructed from the skin of my thigh or forearm. Therapy was never recommended.

Critics might dismiss my story as insignificant on the grounds that I am a 53-year-old woman with ample life experience who should be free to alter her body. However, this argument for adult bodily autonomy is a standard we apply to purely cosmetic procedures like breast implants, liposuction, and facelifts, not “medically necessary” and “lifesaving” treatments covered by health insurance. Or interventions that compromise health and introduce illness into an otherwise healthy body. And especially not for children.

My story, which I outline in much more detail below, should convince any half-rational person that gender medicine is not operating like any other field of medicine. Based on a radical concept of “gender identity,” this medical anomaly preys upon the body-image insecurities common among pubescent minors to bill health insurance companies for permanent cosmetic procedures that often leave their patients with permanently altered bodies, damaged endocrine systems, sexual dysfunction, and infertility.

* * *

Detailed Timeline of Events

On October 6, 2022, I responded to my Ob-Gyn’s email to tell her that, after some thought, I’d decided that maybe the label “cis woman” didn’t truly reflect who I was. After all, I did have some tomboyish tendencies. I told her I would like my records to be changed to reflect my newly realized “nonbinary” identity, and that my new pronouns were they/them. I also voiced my desire to be put in touch with an endocrinologist to discuss starting testosterone treatment.

Fifteen minutes later I received an email from another Kaiser doctor informing me that my medical records had been changed, and that once my primary doctor returned to the office, I’d be able to speak with her about hormone therapy.

I responded the following day (October 7, 2022), thanking her for changing my records, and asking if she could connect me with someone who could help me make an appointment for “top surgery” (i.e., a cosmetic double mastectomy) because my chest binder was rather “uncomfortable after long days and playing tennis.”

She told me to contact my primary care MD to “get things rolling,” and that there were likely to be “preliminary evaluations.”

Six days after contacting my primary care MD for a referral, I received an email from one of Kaiser’s gender specialists asking me to schedule a phone appointment so she could better understand my goals for surgery, so that I could get “connected to care.” This call to review my “gender affirming treatment options and services” would take 15-20 minutes, after which I would be “booked for intake,” allowing me to proceed with medical transition.

This wasn’t an evaluation of whether surgical transition was appropriate, it was simply a meeting for me to tell them what I wanted so that they could provide it.

On October 18, I had my one and only in-person appointment in preparation for top surgery. I met in Davis with my primary care physician, Dr. Hong-wen Xue. The assessment was a 10-minute routine physical exam that included blood tests. Everything came back normal. Notably, there was not a single question about why I wanted top surgery or cross-sex hormones. Nor was there any discussion of the risks involved with these medical treatments.

The following week, on October 24, I had a phone appointment with Rachaell Wood, MFT, a gender specialist with Kaiser Sacramento. The call lasted 15 minutes and consisted of standard questions about potential drug use, domestic violence, guns in the house, and whether I experienced any suicidal thoughts. There were no questions from the gender specialist about my reasons for requesting a mastectomy or cross-sex hormones, or why I suddenly, at 52, decided I was “nonbinary.”

After the call, Kaiser emailed me instructions about how to prepare for my pre-surgery intake video appointment to evaluate my mental health, scheduled to take place on November 15. The email stated that prior to my appointment, I should research hormone risks on the WPATH website, and to “research bilateral mastectomy and chest reconstruction surgery risks and recovery” on Kaiser’s website.

I decided to request a “gender-affirming” double mastectomy and phalloplasty. Kaiser sent me a sample timeline for gender transition surgery preparation (see below) that you can use as a reference for the process. I also asked for a prescription for cross-sex hormones (testosterone) as needed and recommended by Kaiser.

[ Source: Kaiser Permanente, Top Surgery - EXPLORING YOUR SURGICAL OPTIONS ]

Pre-Surgery Mental Health Video Appointment, Part I

This “Mental Health Visit” assessment was conducted over Zoom. The Kaiser gender specialist started with questions addressing my marital status, race, gender identity, and other demographics. She asked whether I was “thinking of any other surgeries, treatments in the future.” The list she read included “gender-affirming” hysterectomies, bottom surgeries such as metoidioplasty and phalloplasty, vocal coaching, support groups, and body contouring. “Anything else you might be interested in doing?” she asked. I said that I’d perhaps be interested in body contouring. I was also assured that all the procedures would be covered by insurance because they were considered “medically necessary.”

I dropped in several red flags regarding my mental health to see the reaction, but all were ignored. For instance, I revealed that I had PTSD. When the therapist asked me about whether I had experienced any “childhood trauma,” I explained that I grew up in Mexico City and had been groped several times and had also witnessed men masturbating in public and had been grabbed by men in subways and buses. “I was a young girl, so [I had] lots of experiences of sexual harassments, sexual assault, just the kind of stuff that happens when you are a girl growing up in a big city.” “So, you know,” I finished, “just the general feeling that you are unsafe, you know, in a female body.”

The therapist did not respond to my disclosure that trauma could be the cause of my dysphoria. Instead of viewing this trauma as potentially driving my desire to escape my female body through hormones and surgery, she asked whether there is anything “important that the surgery team should be aware of” regarding my “history of trauma,” such as whether I’d be comfortable with the surgeon examining and marking my chest prior to surgery.

When asked about whether I had had any “psychotic symptoms,” I told her that while I had had no such symptoms, my mother had a delusional nervous breakdown in her 50s because she had body dysmorphia and became convinced she had a growth on her neck that needed to be removed. I told her that my mother was then admitted to an inpatient hospital for severe depression. I asked her whether she ever sees patients with body dysmorphia and whether I could have potentially inherited that from my mother. She told me that psychosis was hereditary, but that it was “highly unlikely” that there was any connection between body dysmorphia and gender dysphoria.

I enthusiastically waved more mental health red flags, waiting to see if she would pick up on any of them.

I’m just wondering if my feelings, or perseverating, or feeling like these breasts make me really unhappy and I just don’t want them anymore!...I’m just not sure if that’s a similar feeling to body dysmorphia? How do you decide which one is gender dysphoria and general body dysmorphia, and just not liking something about your body? Feeling uncomfortable with your body? And I did have an eating disorder all through college. I was a distance runner in college so I had bulimia and anorexia, you know. So I don’t know if that’s related to gender dysphoria?

The therapist replied, “I completely appreciate your concerns, but I am going to ask you questions about your chest, about your expectations. And then I’ll be able to give you an assessment.” She also said the main difference between my mom’s situation and mine was that my mom didn’t really have a growth on her neck, whereas it’s “confirmed” that I actually have “chest tissue.” Furthermore, she said that while “historically there has been all this pressure on patients to be like ‘Are you really, really sure you want hormones? Are you 100% sure?’ We are a little more relaxed.” She continued, “As long as you are aware of the risks and the side-effects, you can put your toe in the water. You can stop ‘T’ [testosterone], you can go back and do it again later! You can stop it! You can stop it! You know what I mean?”

Because we ran out of time, I scheduled a follow-up phone meeting on December 27, 2022 with a different gender specialist to complete my mental health assessment for top surgery.

Pre-Surgery Mental Health Video Appointment, Part II

During this meeting, Guneet Kaur, LCSW, another Kaiser gender specialist (she/her/they/them pronouns) told me that she regretted the “gatekeeping vibe” of the meeting but assured me that since I have been “doing the work,” her questions are essentially just a form of “emotional support” before talking with the medical providers.

She asked me about what I’d been “looking into as far as hormones.” I told her that I’d be interested in taking small doses of testosterone to counterbalance my female feelings to achieve “a feeling that’s kind of neutral.”

When she asked me about me “not feeling like I match on the outside what I feel on the inside,” I dropped more red flags, mentioning my aversion to wearing dresses and skirts.

I don’t own a single dress or a skirt and haven't in 20 years. I think for me it’s been just dressing the way that’s comfortable for me, which is just wearing, jeans and sweatshirts and I have a lot of flannel shirts and, and I wear boots all the time instead of other kinds of shoes. So I think it’s been nice being able to dress, especially because I work from home now most of the time that just a feeling of clothing being one of the ways that I can feel more non-binary in my everyday life.

She responded, “Like having control over what you wear and yeah. Kind of that feeling of just, yeah, this is who I am today. That’s awesome. Yeah.”

She then asked me to describe my dysphoria, and I told her that I didn’t like the “feeling of the female form and being chesty,” and that because I am going through menopause, I wanted to start taking testosterone to avoid “that feeling of being like this apple-shaped older woman.” “Good. Okay, great,” she responded, reminding me that only “top surgery,” not testosterone, would be able to solve my chest dysphoria. (Perhaps it was because all these meetings were online, they didn’t notice I’m actually fit and relatively slender at 5’-5” and 130 pounds, and not apple-shaped at all.)

She told me that we had to get through a few more questions related to my medical history before “we can move on to the fun stuff, which is testosterone and top surgery.”

The “fun stuff” consisted of a discussion about the physical and mood changes I could expect, and her asking me about the dose of testosterone I wanted to take and the kind of “top surgery” technique I’d prefer to achieve my “chest goals.” She told me that all or most of my consultations for surgeries and hormones would be virtual.

The gender specialist told me after the appointment, she would submit my referral to the Multi-Specialty Transitions Clinic (MST) team that oversees “gender expansive care.” They would follow up to schedule a “nursing call” with me to review my medical history, after which they’d schedule my appointment with a surgeon for a consultation. Her instructions for this consultation were to “tell them what you’re wanting for surgery and then they share with you their game plan.”

[ Decision-making slide to help me identify my goals for top surgery–flat chest, nipple sensation, or minimal scarring. Source: Kaiser Permanente, Top Surgery - EXPLORING YOUR SURGICAL OPTIONS ]

She told me that Kaiser has a team of plastic surgeons who “only work with trans and nonbinary patients because there’s just so much need for them.” She asked about my priorities for chest surgery, such as whether I value flatness over nipple sensation. I learned about double incision top surgery with nipple grafts, as well as “keyhole,” “donut,” “buttonhole,” and “Inverted-T” top surgeries.

By the end of the hour-long appointment, I had my surgery referral and was ready for my “nursing call” appointment.

Nursing call with Nurse Coordinator from the Transgender Surgery and Gender Pathways Clinic at Kaiser San Francisco

On January 19, 2023, I had my nursing call with the Nurse Coordinator. He first said that “the purpose of this call is just for us to go through your chart together and make sure everything’s as accurate as possible.” Once that was done, my referral would be sent to the surgeon for a consultation.

He asked me about potential allergies and recreational drug use, and verified that I was up to date on mammograms, pap smears, and colon cancer screenings, as well as vaccines for flu and COVID. I verified my surgical history as well as my current medications and dietary supplements.

He told me about a “top surgery class” available for patients where one of the Kaiser surgeons “presents and talks about surgical techniques and options within top surgery,” and includes a panel of patients who have had top surgery. I signed up for the February 8th class.

Within 10 minutes he told me that he had “sent a referral to the plastic surgery department at Kaiser Sacramento,” and that I should be hearing from them in the next week or two to schedule a consultation.

Appointment for Testosterone

On January 27, I had a 13-minute online appointment with a primary care doctor at Kaiser Davis to discuss testosterone. The doctor verified my name and preferred pronouns, and then directly asked: “So, what would you like to do? What kind of physical things are you looking for?”

I told her I wanted facial hair, a more muscular and less “curvy” physique, and to feel stronger and androgynous. She asked me when I wanted to start, and I told her in the next few months. She asked me if I was menopausal, whether I had ovaries and a uterus, although that information should have been on my chart.

The doctor said she wanted me to come in to get some labs so she could check my current estrogen, testosterone, and hemoglobin levels before starting hormones. Then “we'll set the ball in motion and you'll be going. We’ll see you full steam ahead in the direction you wanna go.”

That was it. I made an appointment and had my lab tests done on February 12. My labs came back on February 14, and the following day, after paying a $5 copay at the Kaiser pharmacy, I picked up my testosterone pump. That was easy!

Top Surgery Consultation

On the same day I received my labs, I had a Zoom surgery consultation with Karly Autumn-Kaplan, MD, Kaiser Sacramento plastic surgeon. This consultation was all about discussing my “goals” for surgery, not about whether surgery was needed or appropriate.

I told the surgeon that I wanted a “flatter, more androgynous appearance.” She asked me some questions to get a better idea of what that meant for me. She said that some patients want a “male chest,” but that others “want to look like nothing, like just straight up and down, sometimes not even nipples.” Others still wanted their chest to appear slightly feminine and only “slightly rounded.” I told her that I’d like my chest to have a “male appearance.”

“What are your thoughts about keeping your nipples?” she asked. “Are you interested in having nipples or would you like them removed?” I told her that I’d like to keep my nipples, but to make them “smaller in size.” She asked me if I’d like them moved to “the edge of the peck muscle” to achieve “a more male appearance.” I said yes.

I was asked to show my bare chest from the front and side, which I did. Then she asked me how important it was for me to keep my nipple sensation. I replied that it was important unless it would make recovery more difficult or there were other associated risks. She highlighted the problem with the free nipple graft, saying that removing the nipple to relocate it means “you're not gonna have sensation in that nipple and areola anymore.” However, some nipple sensation could be preserved by keeping it attached to “a little stalk of tissue” with “real nerves going to it,” but that would require leaving more tissue behind. I told her I’d go for the free nipple graft to achieve a flatter appearance. It was also suggested I could skip nipple reconstruction entirely and just get nipples “tattooed” directly onto my chest.

She told me I was “a good candidate for surgery,” and put me on the surgery wait list. She said that the wait time was between three and five months, but a cancellation could move me up to a sooner date. Also, if I wanted surgery as soon as possible, I could tell the surgery scheduler that I’d be willing to have any of the other three surgeons perform my mastectomy. Outpatient top surgery would cost me a copay of $100.

They contacted twice, in February and March, notifying me of cancellations. If I had accepted and shown up on those dates, they would have removed my breasts. This would have been less than five months from the time I first contacted Kaiser to inform them of my new “nonbinary” gender identity.

How Far Can I Go?

I decided to see how easy it would be for me to get approved for a phalloplasty. Known euphemistically as “bottom surgery,” phalloplasty is the surgical creation of an artificial penis, generally using tissue from the thigh or arm.

I sent an email on March 1, 2023, requesting to have a phalloplasty and concurrent hysterectomy scheduled alongside my mastectomy.

Two weeks later, on March 16th, I had a 16-minute phone call with a gender specialist to discuss my goals for bottom surgery and obtain my referral.

During the call, I explained to the specialist that I wasn’t sure about taking testosterone anymore because I was already quite athletic and muscular, and that taking testosterone didn’t make much sense to me. Instead, I wanted bottom surgery so that I wouldn’t feel like my “top” didn’t match my “bottom.” I told her:

But what I really wanted was to have bottom surgery. So this way when I have my top surgery, which sounds like it could be very soon, that I’ll be aligned, that I won’t have this sense of dysphoria with one part of my body and the other part feeling like it matched who I am. So yeah. So I just did a little bit more research into that. And I looked at the resources on the Kaiser page for the MST clinic and I think I know what I want, which is the hysterectomy and then at the same time or soon after to be able to have a phalloplasty.

I told her that I wanted to schedule the top and bottom surgery concurrently so that I wouldn’t have to take more time off work and it would save me trips to San Francisco or Oakland, or wherever I had to go for surgery.

None of this gave the gender specialist pause. After a brief conversation about some online resources to look over, she told me that she would “submit the referral now and we’ll get this ball rolling.”

Bottom surgery would cost me a copay of $200, which included a couple of days in the hospital for recovery.

Phalloplasty Surgical Consultation with Nurse Coordinator

On May 16, 2023, I had a short surgical consultation with a nurse coordinator to go through my medical history. This was similar to the consultation for top surgery but included information about hair removal procedures for the skin on my “donor site” that would be fashioned into a makeshift penis. They also went over the procedures for determining which donor site—forearm or thigh—was more viable.

After only 15 minutes, she submitted my referral to the surgeon for another surgical consultation.

On May 25 I received an email from my phalloplasty surgeon’s scheduler, informing me that they have received my referral and are actively working on scheduling, but that they are experiencing delays.

I ended my investigation here once I had the referral for the top and bottom surgery. I never used my testosterone pump.

Final Thoughts

In fewer than 300 days, based on a set of superficial and shifting thoughts about my gender and my “embodiment goals” triggered by the mere mention of “gender” in a form letter from my primary care physician, and driven by what could only be described as minor discomforts, Kaiser Permanente’s esteemed “multi-disciplinary team” of “gender specialists” was willing, with enthusiasm—while ignoring mental health concerns, history of sexual trauma, and rapidly escalating surgical requests—to prescribe life-altering medications and perform surgeries to remove my breasts, uterus, and vagina, close my vaginal opening, and attempt a complex surgery with high failure and complication rates to create a functionless representation of a penis that destroys the integrity of my arm or thigh in the process.

This describes the supposedly meticulous, lengthy, and safety-focused process that a Kaiser patient must undergo to embark on a journey to medically alter their body. No clinician questioned my motivations. No one showed concern that I might be addressing a mental health issue through radical and irreversible interventions that wouldn’t address my amorphous problems. There were no discussions about how these treatments would impact my long-term health, romantic relationships, family, or sex life. I charted the course. The clinicians followed my lead without question. The guiding issue was what I wanted to look like.

No other medical field operates with this level of carelessness and disregard for patient health and welfare. No other medical field addresses issues of self-perception with surgery and labels it “medically necessary.” No other medical field is this disconnected from the reality of the patients it serves.

Kaiser has traded medicine for ideology. It’s far beyond time we stop the ruse of considering “gender-affirming” interventions as anything approaching medical care.

This isn’t the first time Kaiser Permanente has been in the news for completely disregarding medical safeguards in the name of “gender-affirming care.” As girls, Chloe Cole and Layla Jane became convinced that they were born in the wrong body and were actually boys on the inside. Doctors at Kaiser ignored their underlying conditions and instead prescribed testosterone and removed their breasts. Both Cole and Jane have since detransitioned and are currently suing Kaiser.

The fact that children and vulnerable adults are being exploited in this massive ideological experiment is not just tragic; it’s deeply disturbing, especially considering it has evolved into a billion-dollar industry.

I hope that by sharing my story, I can bring more focused scrutiny to the medical scandal unfolding not just at Kaiser but also at medical centers and hospitals across the Western world. These institutions have completely abandoned medical safeguards for patients who claim to be confused about their “gender,” and I aim to awaken more parents and assist them in protecting their children.

--

==

This is completely insane.

Apologists online are running around saying, but she didn't mean it, she was lying, she was pretending...

It doesn't matter.

Any kind of security, penetration or integrity test is insincere too. When security researchers compromise Microsoft's operating system or Google's browser or whatever, "but they didn't mean it" is not a defence to a discovered security flaw. It doesn't matter that the security researchers didn't plan to steal data or money or identities. The flaw in the system is there regardless.

It doesn't matter that it was insincere. Because the workers didn't know that. They never checked, never asked questions, never tested. They had been taught and instructed to never ask any questions. They did what they were supposed to. And the system failed spectacularly. Because that's what "gender affirming care" means.

Additionally, the claim that Beth Bourne committed fraud is an outright lie. A patient cannot bill. They do not have the authority. The medical clinic is the only one that can bill, and they must supply a diagnosis and a medical necessity.

If they didn't diagnose her and just wrote down what she said, then they committed fraud. If they claim they did diagnose her, then they committed fraud, because the diagnosis they concocted was bogus. This, by the way, is actually going on. Clinics are reporting fake endocrine and other disorders to get blockers, hormones and other interventions. Jamie Reed and other whistleblowers have documented evidence of this. Beth Bourne is not responsible for what the clinic does. They have medical licenses and legal responsibility. Not her.

(Note well: My hope this will be an ever-growing list, as people find their own recommendations, or original works, to add; I was hoping this initial post was going to be longer, but getting lost in the weeds of hunting down the origin of the social model, not to mention the medical model, has stolen my spoons. But I want to have something to post before the end of July)

(Image credit goes to @intervex)

[Based on what I can find, the first listing under each model (Marked by a color emoji, corresponding to its stripe in the flag) will be the first source for the use of that label]

Debility Model:

🔴The Right to Maim: Debility, Capacity, Disability, by Jasbir K. Puar. Duke University Press. November, 2017. [The first 70 pages available as a PDF on the publisher's webpage]

"Disability Identity Work among Student Veterans with Service-Connected Injury" by Heather Powers Albanesi. Disability Studies Quarterly. 4 June, 2025.

"Crip Life Amidst Debilitation: Medicalization, Survival, and the Bhopal Gas Leak" by Jiya S. Pandya. Disability Studies Quarterly. 1 December, 2023.

Affirmation Model:

🟨"Towards an Affirmation Model of Disability" by John Swain & Sally French. Disability & Society. April, 2000. [Published Online 1 July, 2010; abstract only available for free]

Social Model:

(According to the History section of Wikipedia's article on the Social Model of Disability, the "Social Interpretation of Disability" was first spelled out in a 1975 pamphlet put out by the Union of the Physically Impaired Against Segregation. But most of the links in the References to that Social Model article have succumbed to link rot. Following the trail of people quoting people, I finally found what I think is a quote from said 1975 pamphlet:

♿"What is Disability?" (A webpage hosted by a cultural trust organization in Sri Lanka, it turns out.)

Political-Relational Model

💚Feminist, Queer, Crip, by Alison Kafer. Indiana University Press. May, 2013

Other:

By: Chloe Cole

Published: July 28, 2023

On Thursday, her 19th birthday, Chloe Cole testified to Congress with a “final warning” that medical treatments to change the gender of confused children is horrific. Cole, who was given surgery as a teenager to become male and soon regretted it, said what she needed most was therapy, not a scalpel. Here is what she told lawmakers:

My name is Chloe Cole and I am a de-transitioner.

Another way to put that would be: I used to believe that I was born in the wrong body and the adults in my life, whom I trusted, affirmed my belief, and this caused me lifelong, irreversible harm. 

I speak to you today as a victim of one of the biggest medical scandals in the history of the United States of America. 

I speak to you in the hope that you will have the courage to bring the scandal to an end, and ensure that other vulnerable teenagers, children and young adults don’t go through what I went through. 

Deceit & coercion 

At the age of 12, I began to experience what my medical team would later diagnose as gender dysphoria.

I was well into an early puberty, and I was very uncomfortable with the changes that were happening to my body. I was intimidated by male attention. 

And when I told my parents that I felt like a boy, in retrospect, all I meant was that I hated puberty, that I wanted this newfound sexual tension to go away.

I looked up to my brothers a little bit more than I did to my sisters. 

I came out as transgender in a letter I sent on the dining room table.

My parents were immediately concerned.

They felt like they needed to get outside help from medical professionals. 

But this proved to be a mistake.

It immediately set our entire family down a path of ideologically motivated deceit and coercion.

The general specialist I was taken to see told my parents that I needed to be put on puberty-blocking drugs right away. 

They asked my parents a simple question: Would you rather have a dead daughter or a living transgender son? 

The choice was enough for my parents to let their guard down, and in retrospect, I can’t blame them.

This is the moment that we all became victims of so-called gender-affirming care.

I was fast-tracked onto puberty blockers and then testosterone. 

The resulting menopausal-like hot flashes made focusing on school impossible.

I still get joint pains and weird pops in my back.

But they were far worse when I was on the blockers. 

Forever changed 

A month later, when I was 13, I had my first testosterone injection.

It has caused permanent changes in my body: My voice will forever be deeper, my jawline sharper, my nose longer, my bone structure permanently masculinized, my Adam’s apple more prominent, my fertility unknown. 

I look in the mirror sometimes, and I feel like a monster.

I had a double mastectomy at 15.

They tested my amputated breasts for cancer.

That was cancer-free, of course; I was perfectly healthy.

There is nothing wrong with my still-developing body, or my breasts other than that, as an insecure teenage girl, I felt awkward about it.

After my breasts were taken away from me, the tissue was incinerated — before I was able to legally drive. 

I had a huge part of my future womanhood taken from me.

I will never be able to breastfeed.

I struggle to look at myself in the mirror at times.

I still struggle to this day with sexual dysfunction.

And I have massive scars across my chest and the skin grafts that they used, that they took of my nipples, are weeping fluid today, and they’re grafted into a more masculine positioning, they said. 

After surgery, my grades in school plummeted.

Everything that I went through did nothing to address the underlying mental health issues that I had.

And my doctors with their theories on gender that all my problems would go away as soon as I was surgically transformed into something that vaguely resembled a boy — their theories were wrong.

The drugs and surgeries changed my body, but they did not and could not change the basic reality that I am, and forever will be, a female. 

Depths of despair 

When my specialists first told my parents they could have a dead daughter or a live transgender son, I wasn’t suicidal.

I was a happy child who struggled because she was different. 

However at 16, after my surgery, I did become suicidal.

I’m doing better now, but my parents almost got the dead daughter promised to them by my doctors.

My doctor had almost created the very nightmare they said they were trying to avoid. 

So what message do I want to bring to American teenagers and their families?

I didn’t need to be lied to.

I needed compassion.

I needed to be loved. 

I needed to be given therapy that helped me work through my issues, not affirmed my delusion that by transforming into a boy, it would solve all my problems. 

We need to stop telling 12-year-olds that they were born wrong, that they are right to reject their own bodies and feel uncomfortable with their own skin. 

We need to stop telling children that puberty is an option, that they can choose what kind of puberty they will go through, just like they can choose what clothes to wear or what music to listen to. 

Pseudoscience 

Puberty is a rite of passage to adulthood, not a disease to be mitigated.

Today, I should be at home with my family celebrating my 19th birthday.

Instead, I’m making a desperate plea to my elected representatives.

Learn the lessons from other medical scandals, like the opioid crisis. 

Recognize that doctors are human, too, and sometimes they are wrong. 

My childhood was ruined along with thousands of de-transitioners that I know through our networks.

This needs to stop. You alone can stop it. 

Enough children have already been victimized by this barbaric pseudoscience.

Please let me be your final warning. 

Thank you.

Might as well call her a murtad and kufr.

"The medical industry mutilated me, maybe don't mutilate other kids," shouldn't require bravery or renouncing an ideology.

By: Andy L.

Published: Apr 14, 2024

It has now been just little under a week since the publication of the long anticipated NHS independent review of gender identity services for children and young people, the Cass Review.

The review recommends sweeping changes to child services in the NHS, not least the abandonment of what is known as the “affirmation model” and the associated use of puberty blockers and, later, cross-sex hormones. The evidence base could not support the use of such drastic treatments, and this approach was failing to address the complexities of health problems in such children.

Many trans advocacy groups appear to be cautiously welcoming these recommendations. However, there are many who are not and have quickly tried to condemn the review. Within almost hours, “press releases“, tweets and commentaries tried to rubbish the report and included statements that were simply not true. An angry letter from many “academics”, including Andrew Wakefield, has been published. These myths have been subsequently spreading like wildfire.

Here I wish to tackle some of those myths and misrepresentations.

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Myth 1: 98% of all studies in this area were ignored

Fact

A comprehensive search was performed for all studies addressing the clinical questions under investigation, and over 100 were discovered. All these studies were evaluated for their quality and risk of bias. Only 2% of the studies met the criteria for the highest quality rating, but all high and medium quality (50%+) studies were further analysed to synthesise overall conclusions.

Explanation

The Cass Review aimed to base its recommendations on the comprehensive body of evidence available. While individual studies may demonstrate positive outcomes for the use of puberty blockers and cross-sex hormones in children, the quality of these studies may vary. Therefore, the review sought to assess not only the findings of each study but also the reliability of those findings.

Studies exhibit variability in quality. Quality impacts the reliability of any conclusions that can be drawn. Some may have small sample sizes, while others may involve cohorts that differ from the target patient population. For instance, if a study primarily involves men in their 30s, their experiences may differ significantly from those of teenage girls, who constitute the a primary patient group of interest. Numerous factors can contribute to poor study quality.

Bias is also a big factor. Many people view claims of a biased study as meaning the researchers had ideological or predetermined goals and so might misrepresent their work. That may be true. But that is not what bias means when we evaluate medical trials.

In this case we are interested in statistical bias. This is where the numbers can mislead us in some way. For example, if your study started with lots of patients but many dropped out then statistical bias may creep in as your drop-outs might be the ones with the worst experiences. Your study patients are not on average like all the possible patients.

If then we want to look at a lot papers to find out if a treatment works, we want to be sure that we pay much more attention to those papers that look like they may have less risk of bias or quality issues. The poor quality papers may have positive results that are due to poor study design or execution and not because the treatment works.

The Cass Review team commissioned researchers at York University to search for all relevant papers on childhood use of puberty blockers and cross-sex hormones for treating “gender dysphoria”. The researchers then graded each paper by established methods to determine quality, and then disregarded all low quality papers to help ensure they did not mislead.

The Review states,

The systematic review on interventions to suppress puberty (Taylor et al: Puberty suppression) provides an update to the NICE review (2020a). It identified 50 studies looking at different aspects of gender-related, psychosocial, physiological and cognitive outcomes of puberty suppression. Quality was assessed on a standardised scale. There was one high quality study, 25 moderate quality studies and 24 low quality studies. The low quality studies were excluded from the synthesis of results.

As can be seen, the conclusions that were based on the synthesis of studies only rejected 24 out of 50 studies – less than half. The myth has arisen that the synthesis only included the one high quality study. That is simply untrue.

There were two such literature reviews: the other was for cross-sex hormones. This study found 19 out of 53 studies were low quality and so were not used in synthesis. Only one study was classed as high quality – the rest medium quality and so were used in the analysis.

12 cohort, 9 cross-sectional and 32 pre–post studies were included (n=53). One cohort study was high-quality. Other studies were moderate (n=33) and low-quality (n=19). Synthesis of high and moderate-quality studies showed consistent evidence demonstrating induction of puberty, although with varying feminising/masculinising effects. There was limited evidence regarding gender dysphoria, body satisfaction, psychosocial and cognitive outcomes, and fertility.

Again, it is myth that 98% of studies were discarded. The truth is that over a hundred studies were read and appraised. About half of them were graded to be of too poor quality to reliably include in a synthesis of all the evidence. if you include low quality evidence, your over-all conclusions can be at risk from results that are very unreliable. As they say – GIGO – Garbage In Garbage Out.

Nonetheless, despite analysing the higher quality studies, there was no clear evidence that emerged that puberty blockers and cross-sex hormones were safe and effective. The BMJ editorial summed this up perfectly,

One emerging criticism of the Cass review is that it set the methodological bar too high for research to be included in its analysis and discarded too many studies on the basis of quality. In fact, the reality is different: studies in gender medicine fall woefully short in terms of methodological rigour; the methodological bar for gender medicine studies was set too low, generating research findings that are therefore hard to interpret. The methodological quality of research matters because a drug efficacy study in humans with an inappropriate or no control group is a potential breach of research ethics. Offering treatments without an adequate understanding of benefits and harms is unethical. All of this matters even more when the treatments are not trivial; puberty blockers and hormone therapies are major, life altering interventions. Yet this inconclusive and unacceptable evidence base was used to inform influential clinical guidelines, such as those of the World Professional Association for Transgender Health (WPATH), which themselves were cascaded into the development of subsequent guidelines internationally.

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Myth 2: Cass recommended no Trans Healthcare for Under 25s

Fact

The Cass Review does not contain any recommendation or suggestion advocating for the withholding of transgender healthcare until the age of 25, nor does it propose a prohibition on individuals transitioning.

Explanation

This myth appears to be a misreading of one of the recommendations.

The Cass Review expressed concerns regarding the necessity for children to transition to adult service provision at the age of 18, a critical phase in their development and potential treatment. Children were deemed particularly vulnerable during this period, facing potential discontinuity of care as they transitioned to other clinics and care providers. Furthermore, the transition made follow-up of patients more challenging.

Cass then says,

Taking account of all the above issues, a follow-through service continuing up to age 25 would remove the need for transition at this vulnerable time and benefit both this younger population and the adult population. This will have the added benefit in the longer-term of also increasing the capacity of adult provision across the country as more gender services are established.

Cass want to set up continuity of service provision by ensure they remain within the same clinical setting and with the same care providers until they are 25. This says nothing about withdrawing any form of treatment that may be appropriate in the adult care pathway. Cass is explicit in saying her report is making no recommendations as to what that care should look like for over 18s.

It looks the myth has arisen from a bizarre misreading of the phrase “remove the need for transition”. Activists appear to think this means that there should be no “gender transition” whereas it is obvious this is referring to “care transition”.

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Myth 3: Cass is demanding only Double Blind Randomised Controlled Trials be used as evidence in “Trans Healthcare”

Fact

While it is acknowledged that conducting double-blind randomized controlled trials (DBRCT) for puberty blockers in children would present significant ethical and practical challenges, the Cass Review does not advocate solely for the use of DBRCT trials in making treatment recommendations, nor does it mandate that future trials adhere strictly to such protocols. Rather, the review extensively discusses the necessity for appropriate trial designs that are both ethical and practical, emphasizing the importance of maintaining high methodological quality.

Explanation

Cass goes into great detail explaining the nature of clinical evidence and how that can vary in quality depending on the trial design and how it is implemented and analysed. She sets out why Double Blind Randomised Controlled Trials are the ‘gold standard’ as they minimise the risks of confounding factors misleading you and helping to understand cause and effect, for example. (See Explanatory Box 1 in the Report).

Doctors rely on evidence to guide treatment decisions, which can be discussed with patients to facilitate informed choices considering the known benefits and risks of proposed treatments.

Evidence can range from a doctor’s personal experience to more formal sources. For instance, a doctor may draw on their own extensive experience treating patients, known as ‘Expert Opinion.’ While valuable, this method isn’t foolproof, as historical inaccuracies in medical beliefs have shown.

Consulting other doctors’ experiences, especially if documented in published case reports, can offer additional insight. However, these reports have limitations, such as their inability to establish causality between treatment and outcome. For example, if a patient with a bad back improves after swimming, it’s uncertain whether swimming directly caused the improvement or if the back would have healed naturally.

Further up the hierarchy of clinical evidence are papers that examine cohorts of patients, typically involving multiple case studies with statistical analysis. While offering better evidence, they still have potential biases and limitations.

This illustrates the ‘pyramid of clinical evidence,’ which categorises different types of evidence based on their quality and reliability in informing treatment decisions

The above diagram is published in the Cass Review as part of Explanatory Box 1.

We can see from the report and papers that Cass did not insist that only randomised controlled trials were used to assess the evidence. The York team that conducted the analyses chose a method to asses the quality of studies called the Newcastle Ottawa Scale. This is a method best suited for non RCT trials. Cass has selected an assessment method best suited for the nature of the available evidence rather than taken a dogmatic approach on the need for DBRCTs. The results of this method were discussed about countering Myth 1.

Explainer on the Newcastle Ottawa Scale

The Newcastle-Ottawa Scale (NOS) is a tool designed to assess the quality of non-randomized studies, particularly observational studies such as cohort and case-control studies. It provides a structured method for evaluating the risk of bias in these types of studies and has become widely used in systematic reviews and meta-analyses.

The NOS consists of a set of criteria grouped into three main categories: selection of study groups, comparability of groups, and ascertainment of either the exposure or outcome of interest. Each category contains several items, and each item is scored based on predefined criteria. The total score indicates the overall quality of the study, with higher scores indicating lower risk of bias.

This scale is best applied when conducting systematic reviews or meta-analyses that include non-randomized studies. By using the NOS, researchers can objectively assess the quality of each study included in their review, allowing them to weigh the evidence appropriately and draw more reliable conclusions.

One of the strengths of the NOS is its flexibility and simplicity. It provides a standardized framework for evaluating study quality, yet it can be adapted to different study designs and research questions. Additionally, the NOS emphasizes key methodological aspects that are crucial for reducing bias in observational studies, such as appropriate selection of study participants and controlling for confounding factors.

Another advantage of the NOS is its widespread use and acceptance in the research community. Many systematic reviews and meta-analyses rely on the NOS to assess the quality of included studies, making it easier for researchers to compare and interpret findings across different studies.

As for future studies, Cass makes no demand only DBRCTs are conducted. What is highlighted is at the very least that service providers build a research capacity to fill in the evidence gaps.

The national infrastructure should be put in place to manage data collection and audit and this should be used to drive continuous quality improvement and research in an active learning environment.

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Myth 4: There were less than 10 detransitioners out of 3499 patients in the Cass study.

Fact

Cass was unable to determine the detransition rate. Although the GIDS audit study recorded fewer than 10 detransitioners, clinics declined to provide information to the review that would have enabled linking a child’s treatment to their adult outcome. The low recorded rates must be due in part to insufficient data availability.

Explanation

Cass says, “The percentage of people treated with hormones who subsequently detransition remains unknown due to the lack of long-term follow-up studies, although there is suggestion that numbers are increasing.”

The reported number are going to be low for a number of reasons, as Cass describes:

Estimates of the percentage of individuals who embark on a medical pathway and subsequently have regrets or detransition are hard to determine from GDC clinic data alone. There are several reasons for this:

Damningly, Cass describes the attempt by the review to establish “data linkage’ between records at the childhood gender clinics and adult services to look at longer term detransition and the clinics refused to cooperate with the Independent Review. The report notes the “…attempts to improve the evidence base have been thwarted by a lack of cooperation from the adult gender services”.

We know from other analyses of the data on detransitioning that the quality of data is exceptionally poor and the actual rates of detransition and regret are unknown. This is especially worrying when older data, such as reported in WPATH 7, suggest natural rates of decrease in dysphoria without treatment are very high.

Gender dysphoria during childhood does not inevitably continue into adulthood. Rather, in follow-up studies of prepubertal children (mainly boys) who were referred to clinics for assessment of gender dysphoria, the dysphoria persisted into adulthood for only 6–23% of children.

This suggests that active affirmative treatment may be locking in a trans identity into the majority of children who would otherwise desist with trans ideation and live unmedicated lives.

I shall add more myths as they become spread.

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[I was] a mentally ill teenager who had been groomed and preyed upon and sexually exploited online to the point of authorities getting involved.

I spiralled into a hatred of myself and my body, and was told that it was just because I was a boy born in the wrong body, and that this would fix me.

I was affirmed down a path where I wasn't given any other choice as to what would help me. The very first medical intervention I ever had was a double mastectomy at 16. And then a few months later, I was put on testosterone.

I'm now 21, and I will live with the impacts of that so-called care for the rest of my life. In the past 4 or 5 months, I have watched as my body has fallen apart in front of me. My joints constantly hurting, my vocal chords aching, watching as parts of me atrophy away before my very eyes.

And yet, at 16, they looked me in the eyes and they told me this was care. They told me it would save me.

Despite the fact I was never suicidal, my parents were baited with the idea of "would you rather have a dead daughter or a living son?" Bullied into going along with it, their biggest crime being trusting those who they thought took an oath to "do no harm."

It's not about "hate," detransitioning, it never has been. It's about keeping kids whole. I've worked with children, I've seen them explore the world, and I've seen that magic that they have. And doing something like transitioning them takes that away.

How can you look me in the eyes and tell me that a child can consent to being chained to an experimental medical industry before they're even old enough to drive, or understand the impacts of what that means in the first place?

Kids deserve to be kids. They deserve to get to explore the world as a safe and loving place.

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It's disturbing that the position "don't mutilate kids" requires bravery.

By: Anonymous

Published: Oct 16, 2023

When my first son claimed he was trans, I eagerly ‘affirmed’ him. When his three-year-old brother decided he wanted to be trans, too, I realized I’d made a terrible mistake.

I was a social-justice organizer and facilitator before social justice took over the progressive world. I was at the nascent movement’s forefront, introducing the concept of intersectionality to organizations and asking people to share their pronouns.

My friends and I felt like we were the cool kids, on the vanguard of the revolutionary wave that would change the world. We were going to achieve what people in that milieu call “collective liberation.”

Within this context, I came out as a lesbian and identified as queer. I also fell in love, entered a committed relationship, and gave birth to a son. Two years later, my spouse gave birth to our second son.

Having children and experiencing the love and devotion I felt toward them, was a game changer for me. I began to experience internal tensions. My thinking was split between what I felt instinctively as a mother; and what I “should” be feeling and doing as a white anti-racist social-justice parent.

Because I’d felt victimized by my parents’ rejection of my sexuality, I wanted to make sure to honor my own children’s “authentic” selves. In particular, I was primed to look for any clues that might suggest they could be transgender.

My spouse and I raised our sons with gender-neutral clothes, toys, and language. While we used he/him pronouns, and others called them boys, we did not call them boys, or even tell them that they were boys.

In our everyday reading of books or descriptions of people in our lives, we did not say “man” or “woman”; we said “people.” We thought we were doing the right thing, both for them and for the world.

Even when our first son was still young, he already struck us as different from other boys—being both extremely gifted and unusually sensitive. By age three or so, he started to orient more toward the females in his life than the males. “I like the mamas,” he would say.

We started to attribute some of this difference to the possibility that he was transgender. Instead of orienting him toward the reality of his biological sex by telling him he was a boy, we wanted him to tell us if he felt he was a boy or a girl. As true believers, we thought that we should “follow his lead” to determine his true identity.

At the same time, I was taking a deep dive into the field of attachment and child development. This made me understand that attachment is hierarchical; and that parents, not children, are meant to be in the lead. This obviously conflicted with my insistence on letting my child decide his gender. Sadly, it was the latter impulse that won the day.

At around age four, my son began to ask me if he was a boy or a girl. I told him he could choose. I didn’t use those words—I imagined that I was taking a more sophisticated approach. I told him, “When babies are born with a penis, they are called boys, and when babies are born with a vagina, they are called girls. But some babies who are born with a penis can be girls, and some babies born with a vagina can be boys. It all depends on what you feel deep inside.”

He continued to ask me what he was, and I continued to repeat these lines. I’d resolved my inner conflict by “leading” my son with this framework. Or so I told myself.

His question, and my response to it, would come back to haunt me. In fact, I remain haunted to this day. To the extent I was “leading” my son anywhere, it was down a path of lies—an on-ramp to psychological damage and irreversible medical interventions. All in the name of love, acceptance, and liberation.

About six months later, he told my spouse that he was a girl and wanted to be called “sister” and “she/her.” I received a text message about this at work. On the way home that night, I resolved to put all my own feelings away and support my transgender child. And that is what I did.

We told him he could be a girl. He jumped up and down on the bed, happily saying, “I’m a girl, I’m a girl!” We—not our son—initiated changing his name. We socially transitioned him and enforced this transition with his younger brother, who was then only two years old and could barely pronounce his older brother’s real name.

When I look back at this, it is almost too much to write about. How could a mother do this to her child? To her children?

Once we made this decision, we received resounding praise and affirmation from most of our peers. One of my friends, who’d also socially transitioned her young child, assured me that this was a healthy, neutral way to allow children to “explore” their gender identity before puberty, when decisions would have to be made about puberty blockers and hormones.

We sought out support groups for parents of transgender children, so that we could find out if we’d done the “right thing.” It hadn’t escaped my notice that our son hadn’t exhibited any signs of actual gender dysphoria. Was he actually transgender?

At these support groups, we were told, again, what good parents we were. We were also told that kids on the autism spectrum (which our son likely is) are gender savants who simply know they are transgender earlier than other kids.

At one of the support groups we attended, we were also told that transgender identity takes a few years to develop in children. The gender therapist running things told us that during this period, it’s important to protect the child’s transgender self-conception—which meant eliminating all contact with family or friends who didn’t support the idea that our son was a girl. I believed her.

Looking back, I now see her comments in a shockingly different light: this was part of an intentional process of concretizing transgender identity in children who are much too young to know themselves in any definitive way. (One set of parents attending the group had a child who was just three years old.) When identity is “affirmed” in this manner, children will grow up believing they are actually the opposite sex.

The therapist endorsed the same approach that many adolescents use on their parents, who are urged to write letters to grandparents, aunts, and uncles to announce the child’s transgender identity. In these letters, the conditions of continued social engagement are made clear: Recipients must use the new name and new pronouns, and embrace the new identity, or they will be denied contact with the child.

After about a year of social transition for our older son, our younger son, who was by now only three years old, began to say he was a girl, too. This came as a complete shock to us. None of the things that made our older son “different” applied to our younger son. He was more of a stereotypical boy and didn’t show the same affinity for the feminine side of things that his older brother did.

The urge for “sameness” is a primal attachment drive in many family members. We felt that our younger son’s assertion of being a girl likely reflected his desire to be like his older sibling, in order to feel connected to him.

His claim to be a girl became more insistent when both brothers went to school part-time, because their program included pronoun sharing. Why could the older sibling be a “she” when the younger sibling couldn’t? Our younger son became more insistent, and we became more distressed.

We made an appointment to see the gender therapist whom we’d met at the support group. We truly believed that she would be able to help us sort out who, if anyone, was actually transgender.

To our shock, the therapist immediately began referring to our younger son as “she,” stating that whatever pronouns a young child wants to use are the pronouns that must be used.

She patronizingly assured us that it might take us more time to adjust, since parents have a hard time with this sort of thing. She added that it was transphobic to believe there was anything wrong with our younger son wanting to be like his older transgender sibling.

When I pushed back and asserted that I wasn’t yet convinced our younger son was in fact transgender, she told me that if I failed to change his pronouns and honor his newly announced identity, he could develop an attachment disorder.

We were unconvinced. But, again, we wanted to do what was right for our son and for the world. We decided to tell him he could be a girl. And that night at dinner, we told him that we would call him “she/her.”

Right after dinner, I went to play an imaginary game with him, and I wanted to be affirming. So I put a big, warm smile on my face and said, “Hi, my girl!”

At this, my younger son stopped, looked at me, and said, “No, mama. Don’t call me that.” His reaction pierced me to my core. I didn’t turn back after that.

For the next two years, my partner and I dug deeper, agonized, and then continued digging again. Everything we thought we knew or believed that had led us to socially transition our older son began to unravel.

I continued to study the attachment-based developmental approach to parenting and learned more about autism and hypersensitivity. We decided not to socially transition our younger son. Not only was he not transgender, we now realized, but our older son probably wasn’t either.

He was just a highly sensitive, likely autistic boy who saw a girl identity as a form of psychic protection. It also provided him a way of attaching to me through sameness.

My spouse and I decided that since we’d been the ones who’d led him down this path, we were the ones who needed to lead him off of it.

A year ago, just before our older son’s eighth birthday, we did just that. And while the initial change was hard—incredibly hard—the strongest emotion exhibited by our son turned out to be relief.

In the days following my first conversation with him about going back to his birth name and pronouns, during which I told him that males cannot be females and that we were wrong to tell him he could choose to be a girl, he got very mad at me, then sad. Then, the next day, I felt my son rest. I felt him release a burden, an adult burden that he, as a child, was never meant to carry.

Since that time, we’ve all been healing. My son is now happy and thriving. We’ve watched him come to a deeper peace with himself as a boy.  

Our younger son is also thriving. Once his older brother became his older brother again, he happily, and almost immediately, settled into his identity as a boy.

I feel like someone who’s escaped a cult—a cult whose belief system is supported by our mainstream culture, the Internet, and even the state.

I fear for the future—the future of sensitive, feminine, socially awkward boys. I fear what the world will tell them about who they are.

Published: Jul 13, 2023

As experienced professionals involved in direct care for the rapidly growing numbers of gender-diverse youth, the evaluation of medical evidence or both, we were surprised by the Endocrine Society’s claims about the state of evidence for gender-affirming care for youth (Letters, July 5). Stephen Hammes, president of the Endocrine Society, writes, “More than 2,000 studies published since 1975 form a clear picture: Gender-affirming care improves the well-being of transgender and gender-diverse people and reduces the risk of suicide.” This claim is not supported by the best available evidence.

Every systematic review of evidence to date, including one published in the Journal of the Endocrine Society, has found the evidence for mental-health benefits of hormonal interventions for minors to be of low or very low certainty. By contrast, the risks are significant and include sterility, lifelong dependence on medication and the anguish of regret. For this reason, more and more European countries and international professional organizations now recommend psychotherapy rather than hormones and surgeries as the first line of treatment for gender-dysphoric youth.

Dr. Hammes’s claim that gender transition reduces suicides is contradicted by every systematic review, including the review published by the Endocrine Society, which states, “We could not draw any conclusions about death by suicide.” There is no reliable evidence to suggest that hormonal transition is an effective suicide-prevention measure.

The politicization of transgender healthcare in the U.S. is unfortunate. The way to combat it is for medical societies to align their recommendations with the best available evidence—rather than exaggerating the benefits and minimizing the risks.

This letter is signed by 21 clinicians and researchers from nine countries.

FINLAND Prof. Riittakerttu Kaltiala, M.D., Ph.D. Tampere University Laura Takala, M.D., Ph.D. Chief Psychiatrist, Alkupsykiatria Clinic

UNITED KINGDOM Prof. Richard Byng, M.B.B.Ch., Ph.D. University of Plymouth Anna Hutchinson, D.Clin.Psych. Clinical psychologist, The Integrated Psychology Clinic Anastassis Spiliadis, Ph.D.(c) Director, ICF Consultations

SWEDEN Angela Sämfjord, M.D. Senior consultant, Sahlgrenska University Hospital Sven Román, M.D. Child and Adolescent Psychiatrist

NORWAY Anne Wæhre, M.D., Ph.D. Senior consultant, Oslo University Hospital

BELGIUM Em. Prof. Patrik Vankrunkelsven, M.D. Ph.D. Katholieke Universiteit Leuven Honorary senator Sophie Dechêne, M.R.C.Psych. Child and adolescent psychiatrist Beryl Koener, M.D., Ph.D. Child and adolescent psychiatrist

FRANCE Prof. Celine Masson, Ph.D. Picardy Jules Verne University Psychologist, Oeuvre de Secours aux Enfants Co-director, Observatory La Petite Sirène Caroline Eliacheff, M.D. Child and adolescent psychiatrist Co-director, Observatory La Petite Sirène Em. Prof. Maurice Berger, M.D. Ph.D. Child psychiatrist

SWITZERLAND Daniel Halpérin, M.D. Pediatrician

SOUTH AFRICA Prof. Reitze Rodseth, Ph.D. University of Kwazulu-Natal Janet Giddy, M.B.Ch.B., M.P.H. Family physician and public-health expert Allan Donkin, M.B.Ch.B. Family physician

UNITED STATES Clin. Prof. Stephen B. Levine, M.D. Case Western Reserve University Clin. Prof. William Malone, M.D. Idaho College of Osteopathic Medicine Director, Society for Evidence Based Gender Medicine Prof. Patrick K. Hunter, M.D. Florida State University Pediatrician and bioethicist

Transgenderism has been highly politicized—on both sides. There are those who will justify any hormonal-replacement intervention for any young person who may have been identified as possibly having gender dysphoria. This is dangerous, as probably only a minority of those so identified truly qualify for this diagnosis. On the other hand, there are those who wouldn’t accept any hormonal intervention, regardless of the specifics of the individual patients.

Endocrinologists aren’t psychiatrists. We aren’t the ones who can identify gender-dysphoric individuals. The point isn’t to open the floodgates and offer an often-irreversible treatment to all people who may have issues with their sexuality, but to determine who would truly benefit from it.

Jesus L. Penabad, M.D. Tarpon Springs, Fla.

[ Via: https://archive.today/IRShy ]

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