Medicalising trans people

Trans people should not have to pass, but we do.

We should not be medicalised, having to undergo major operations. Trans men should be able to keep their breasts, if they want, for any reason. Trans women should be accepted as women however little effort we devote to our appearance just as all women should be valued no matter what they look like. But there is pretty privilege- that is not the world we live in.

We suffer hostility when we don’t pass. We are noticed, and that is enough to be ill-treated by some random bigot or just an ordinary person having a bad day. Transphobia and transmisia are ordinary. So we should be able to choose whichever hormonal or surgical intervention we desire.

Trans children treated with puberty blockers and cross-sex hormones, PBs and CSH, may pass- the voice broken or unbroken as appropriate, the hips the right shape, facial hair, or not, as needed. There are trans people transitioning now, without the support of PBs because they never got through the waiting lists, hips wrong, voice wrong, face wrong. Their chance of passing was taken away in a long, slow, disorienting lie- yes, you might get what you want more than anything else in the world, but not yet; tantalised by the thought of Blockers, always out of reach.

The trans person who got blockers in time is infertile. Fertility matters. I would have been an awful father, making a real mess of my children, controlling, perfectionist and self-hating. And, had I been able to transition and do the work of self-acceptance I am now doing, I might have been a good parent. I like children.

There are reverters. There’s Keira Bell, and Pamela Paul found two more willing to speak to her. Searching for that, I found this 2022 Los Angeles Times article pointing out that Paul is a transphobe: I can’t imagine anyone having the energy for that, or the LAT printing it, now.

Six weeks after I first read Paul’s article, that detransitioner lives with me. She goes to a doctor, who says her sex looks congruent enough. She asks, Wait, what sex do you think I am? Of course, the doctor thinks her male- because PBs and CSH work!

Perhaps she thought transition would be the answer to all her problems, that everything will be perfect. And now it is the Great Mistake of her life which has ruined everything. Her mission was a successful transition, and now her mission is a successful detransition, and until she completes it her life is on hold. Again.

In 2018 I wrote, Don’t have GRS. At the time I regretted surgery, having been told by two women separately “I could find a man like you attractive- but- no penis!” In practically the same words. I have sexual problems arising from the operation, and my choices are: blame myself, blame the cruel, hard world, or move on. None of these please me. Wanting the world to be other than it is is humanity’s greatest source of misery and the only thing that changes it.

So I would give every child who asked for them, PBs and CSH, because every decision that matters closes off possibilities that matter, and things must be grasped, or the possibility withers unfertilised, a dead mockery. Trans adults have been trans children and remember knowing they are trans as children.

In this imperfect world, being a trans person who passes is an acceptable outcome, and fertility might be an acceptable price to pay for that. Hilary Cass rejected all the peer-reviewed, academically published studies showing that PBs and CSH had a good outcome because they were not double-blind. That is only justifiable if you consider the only possible reason for treating trans children with hormones is reducing mental distress at the time of treatment, rather than achieving the result the child wants. But then, that is the reason those prescribing give. Cass would also prevent children from socially transitioning without a doctor’s permission. It is “not a neutral act”, people say, thinking their wrath against trans allies thereby proven wise and good. In reality, nothing that matters is a “neutral act”.

I would agree with Cass that fertility really matters and it should not be risked lightly, if I did not also believe some people are trans, and with intense societal transmisia passing really matters. There are no perfect outcomes for trans people. We can’t have it all. Let us choose, and live with the consequences, however young we are. And anyone who would restrict treatment because of the testimony of detransitioners does not sufficiently value the facts that some people are trans, and that passing matters. Then they should listen to retransitioners, including those who lashed out in rage at their doctors when they detransitioned.

Do trans children “desist”? Much research alleging they do was based on a gender identity disorder diagnosis of children who did not say they were trans, and whose breaking of gender stereotypes was called pathological. This matter is furiously disputed. Regret rates in adults are low. In any event, the suffering of trans children forced to undergo the wrong puberty, forced into a life where passing is deliberately made difficult, should not just be dismissed.

More Larkin: he moved me to tears this morning.

…we should be careful

of each other, we should be kind
while there is still time.

The Cass report is welcomed by the Government, the Opposition, all the press with The Observer particularly delighted; and to find critiques you need small blogs and obscure websites, like my own. So here are some I like. Sonia Sodha’s vile ranting and gloating in The Observer led me to Dazed, which led me to Gender GP, which led me to the figures from Cass’s own review of the patients.

Of 3499 patients discharged from the gender identity development service 727 went on puberty blockers, and 489 went on cross-sex hormones. Fewer than ten detransitioned.

Of 2415 of those patients never referred to endocrinology, 0.5% detransitioned. Unless you believe trans is a bad thing to be, and the best result for a trans person to be living in their gender assigned at birth, this shows that transition is right for trans people.

Opposing transition because nobody detransitions is like opposing gay sex because after it someone might never have straight sex.

Cass’s arguments against social transition are like the arguments for a gay age of consent of 21: causing pain, and producing no benefit. The figures are on pp168-9 of the report.

Cass makes a lot of a large increase in referrals in 2014, calling it “exponential”. However the number of referrals in 2020/21 was lower than that in 2017/18. Thanks to David Allsopp.

Also see Dr Natacha Kennedy. She cited Cal Horton on how Cass harms trans children through “(1) prejudice; (2) cisnormative bias; (3) pathologization; and (4) inconsistent standards of evidence”. Here are responses from Australia and Aotearoa/New Zealand.