Religion is a Mental Illness

Finland Takes Another Look at Youth Gender Medicine

A recent interview with the country's top gender expert shows how out of step the American medical establishment is with its European counte

Tablet Magazine

Dr. Riittakerttu Kaltiala knows gender medicine. She is the top expert on pediatric gender medicine in Finland and the chief psychiatrist at one of its two government-approved pediatric gender clinics, at Tampere University in Helsinki, where she has presided over youth gender transition treatments since 2011. Her research has even been cited—though not accurately—by American supporters of “affirming care” for gender-dysphoric youth. She is one of the last people in the world who could be accused of being “reactionary,” a “transphobe,” or uninformed on the subject of trans health care.

Earlier this month, however, just a few days before Finland passed a law granting its adult citizens the right to have their self-defined gender recognized in government documents, Dr. Kaltiala gave an interview with Helsingin Sanomat, Finland’s liberal newspaper of record. Her comments were a sobering reminder of just how out of step the American medical establishment is with its European counterparts when it comes to treating minors who reject their sex.

The background to this interview is important. Finland was among the first countries to adopt the “Dutch protocol” for pediatric gender medicine, which prescribes—in certain restricted cases—the use of puberty blockers and cross-sex hormones to treat adolescent gender dysphoria. By 2015, however, Finnish gender specialists, including Kaltiala, were noticing that most of their patients did not match the profile of those treated in the Netherlands and did not meet the Dutch protocol’s relatively strict eligibility requirements for drug treatments. Due to the extremely high rate at which children with gender issues come to terms with their bodies (or “desist”) by adulthood, the Dutch protocol requires patients to have gender dysphoria that begins before puberty and intensifies in adolescence. It also requires them to have no serious co-occurring mental health problems, to undergo at least six months of psychotherapy, and to have the support of their family for hormonal treatments.

Within a few years of their country adopting the Dutch protocol in 2011, however, Finnish researchers noticed a sharp rise in the number of patients referred for services. Most of these patients were teenage girls with no history of dysphoria in childhood, and some 75% had a history of severe psychopathology prior to the emergence of their gender-related distress. During this same time period, the U.K.’s largest pediatric gender clinic, at the Tavistock Centre, witnessed a 3,360% surge in patient referrals between 2009 and 2018. Most of the new patients were females—whose representation in the clinic rose 4,400% during this time frame—with a history of serious psychological problems and no gender dysphoria prior to adolescence. Similar trends were being observed in other countries with pediatric gender clinics, including the United States. In 2018, the American physician-researcher Lisa Littman published a study suggesting that teenage girls with high rates of mental health problems were suddenly declaring a transgender identity, often in friend groups and after prolonged exposure to social media.

A year later, Kaltiala and her Finnish colleagues observed in a peer-reviewed article that “[r]esearch on adolescent onset gender dysphoria is scarce, and optimal treatment options have not been established ... The reasons for the sudden increase in treatment-seeking due to adolescent onset gender dysphoria/transgender identification are not known.” This lack of research, and lingering doubts about the Dutch protocol itself (the only attempt to replicate it in the U.K. failed), led health authorities in Finland, Sweden, and the U.K. to conduct systematic reviews of evidence for the benefits and risks of hormonal interventions.

Systematic reviews represent the highest level of evidence analysis in evidence based medicine. The three European countries that did these reviews independently came to the same conclusion: Due to their severe methodological limitations, studies cited in support of hormonal interventions for adolescents are of “very low” certainty. For health authorities in these countries, this meant that the studies were too unreliable to justify the risks and uncertainties of “gender affirming care.” Sweden, Finland, and England have since placed severe restrictions on access to hormones. Although these countries now allow hormones in a very carefully selected cohort of patients who fulfill the criteria of the Dutch protocol, they do so against the findings of their own systematic reviews. That is because the systematic reviews found the Dutch study, on which the Dutch protocol is based, also provides “very low” certainty evidence. Finland’s Council on Choices in Healthcare recognizes medical transition for minors as “an experimental practice.”

Kaltiala was a major force behind the decision to reverse course in Finland. More recently, she testified before the Florida medical boards in support of their decision to restrict access to puberty blockers, cross-sex hormones, and surgeries for minors.

Asked by Helsingin Sanomat what she thought of gender self-identification for minors—a proposed element of the new Finnish law that did not ultimately pass—Kaltiala emphasized that it is “important to accept [children] as they are,” but this means neither pressuring a child to conform to behaviors traditionally associated with the child’s sex nor “negating the body” by confirming that the child’s gender self-identification is real. “In either case,” said the psychiatrist, “the child gets a message that there is something wrong with him or her.” Evidence from a combined 12 studies to date demonstrates that when children with cross-gender or gender variant behavior are left to develop naturally, the vast majority—“four out of five,” according to Kaltiala—come to terms with their bodies and learn to accept their sex. When they are socially transitioned, virtually none do.

That most children desist from cross-sex identification does not necessarily mean that they will no longer experience any distress associated with their bodies; rather, it means that even if such distress lingers, it will not prevent them from becoming reasonably well-adjusted and living a good life. The notion that no human should ever have to experience any discomfort associated with male or female embodiment, including during the turbulent period of puberty, is the utopian promise fueling much of the gender transition industry. There has been a growing movement among gender activists to frame puberty as something that the autonomous, disembodied, self should have a “right” to choose. “Neither puberty suppression nor allowing puberty to occur is a neutral act,” writes the World Professional Association for Transgender Health in the seventh version of its Standards of Care.

Unlike progressive elites in the United States, who seem to regard social affirmation of “transgender children” as little more than an act of kindness, Kaltiala sees it as a powerful intervention in a young person’s psychosocial development with potential for iatrogenic harm (i.e., harm caused by the treatment itself). Gender self-identification in youth is not a mere clerical “formality.” In Kaltiala’s words, “it’s a message saying that this is the right path for you.” Kaltiala thus concurs with NHS England, which recently noted that social transition—using a child’s preferred name and pronouns—is “not a neutral act” but rather one that can solidify what is otherwise likely to be a passing phase into a more permanent state of mind, or “identity,” and put the minor on a path to drugs and surgeries. The NHS now warns of the risks of social transition in children and recommends it only for adolescents who have been diagnosed with gender dysphoria and have provided informed consent.

As for adolescents, Kaltiala distinguishes between the minority whose dysphoria began in childhood and intensified during puberty and those whose dysphoria first appeared after the onset of puberty. For members of the first group, who qualify under the Dutch study, Kaltiala suggested that gender identity discordance may be more stable—although it should be emphasized that there are no controlled, longitudinal studies confirming this observation, and some experts believe that medicalizing teenagers even in this cohort creates a self-fulfilling prophecy. As for teenagers whose dysphoria began in puberty, these are, to repeat, primarily females with extremely high rates of co-occurring mental health conditions. Since “the phenomenon is new” and “there is no scientific knowledge about the constancy of this experience,” Kaltiala explains, it would be irresponsible to cement their gender self-identification in state documents.

Advocates of the American “affirmative” approach tend to ignore the broader trends of mental health collapse among teenagers over the past few decades, a deeply concerning trend that seems to affect girls in particular and is linked to social media use. Utilizing a “minority stress” framework developed in research on homosexuality and borrowed for this purpose, activists insist that co-occurring mental health problems including anxiety, depression, ADHD, and eating disorders are caused by “unaffirmed” gender and can be solved or mitigated through social and medical transition. Autism in particular seems to be especially common in youth who identify as transgender and seek medical transition. A 2019 study on patients at the U.K.’s largest pediatric gender clinic found that 48% were in the autism range. In her book The Gender Creative Child, “gender affirming care” advocate Dr. Diane Ehrensaft suggests that gender transition can even be a “cure” for autism.

“The developmental mission of youth is not helped by the fact that young people’s self-expression is supported and directed from the outside,” Kaltiala said. “The environment should also not commit to identity experiments in a way that might make a later change of direction anxiety-inducing.” These comments are consistent with findings from the Netherlands, where social transition was linked with persistence of gender dysphoria and difficulty coming to term with one’s body and sex.

On the question of why so many minors are rejecting their sex (up to 9.1%, one U.S. study found), Helsingin Sanomat suggested that “many young people grab the idea available in the media and social media that their problems are caused by gender identity and will be solved if others start to see them as members of the other sex.” But that does not work, according to Kaltiala. “A balance of mind does not come from making others do and see what you want.” The Genevan philosopher Jean-Jacques Rousseau called this amour propre: self-love conditional upon how one is viewed by others. The problem Kaltiala is describing is characteristic of identity politics more broadly: If not just your dignity as a human but your very existence depends upon others agreeing with your self-characterization, you are destined for chronic existential dread. This is not a recipe for authenticity, let alone happiness.

Turning to the question of suicide, which has become virtually the only argument that “gender affirming” activists make in support of their preferred practice, Kaltiala did not pull her punches. The popular “transition or suicide” narrative used by activists to push back against state reform efforts is, in Kaltiala’s words, “purposeful disinformation, and spreading it is irresponsible.”

Much of the public confusion about the suicide issue stems from a simple correlation-causation fallacy. While there is evidence that teenagers who identify as transgender have elevated rates of suicide and suicidality (a behavior that, researchers emphasize, often involved thoughts of suicide or nonfatal self-harming gestures and should not to be confused with actual suicide or serious attempts to end one’s life), there is no evidence that their elevated risk is because of unaffirmed gender identity or that social and medical transition will reduce their risk for self-harm. Studies purporting to find that hormones reduce suicidality are typically designed in such a way that valid inferences about cause and effect cannot be drawn. Considering that roughly three-quarters of teenagers who present to gender clinics these days have preexisting mental health conditions like depression and autism, which are themselves risk factors for suicidality, it is probably more accurate to say that teenagers with suicidal inclinations are more likely to gravitate toward a trans identity.

Thankfully, moreover, suicide is extremely rare even among transgender-identified youth. There was no epidemic of suicides among gender-distressed teenagers before “gender affirming” hormones became available roughly 15 years ago. A study from the U.K. found that the suicide rate among minors seeking medical transition between 2010 and 2020 was 0.03%—nothing close to the 41% risk commonly cited by American activists. Suicide, according to Helsingin Sanomat, was a “very rare occurrence in about ten years among young people seeking gender identity diagnoses. On the other hand, in a large Swedish study, suicide mortality had clearly increased among adults who had received gender reassignment treatments.” For Kaltiala, “it is not justified to tell the parents of young people identifying as transgender that a young person is at risk of suicide without medical treatments and that the danger can be alleviated with gender reassignment.”

Indeed, the suicide discourse that has come to dominate gender transition activism may itself contribute more to youth self-harm than the bans on hormones and surgeries currently being passed in U.S. states. As Alison Clayton has argued in a peer-reviewed paper, “an excessive focus on an exaggerated suicide risk narrative by clinicians and the media may create a damaging nocebo effect (... “self-fulfilling prophecy” ...) whereby suicidality in these vulnerable youths may be further exacerbated.” Tell kids that being suicidal is inherent to being transgender and that only hormones will solve their problem, and many may indeed become suicidal. The “affirm or suicide” discourse also runs counter to the recommendations of the Centers for Disease Control, which emphasizes that “[s]uicide is never the result of a single factor or event” and warns against “presenting simplistic explanations for suicide.” It’s hard to think of a better example of “simplistic explanations” than “trans kids kill themselves when not given hormones.”

Why the obsessive emphasis on the suicide issue? The obvious reason is that if suicide is the expected outcome, any risk from hormones and surgeries is probably worth it. The suicide discourse has the effect, and probably also the intent, of preventing patients and clinicians from doing a careful weighing of pros and cons when deciding on treatment options. It strikes fear into the hearts of parents who worry about the risks and uncertainties about blocking their children’s natural puberty, pumping them full of synthetic hormones, and amputating their healthy breasts as early as age 13. It is also powerful tool for silencing critics and—crucially—deterring those who have questions about hormonal interventions from raising them in the first place.

Kaltiala thinks that the suicide discourse is being pushed by “adults who have themselves benefited from gender reassignment, have a desire to go out and save children and young children. But they lack understanding that a child is not a small adult.” Activists are driven by a combination of motives including misguided empathy, a savior complex, and projection.

Unlike American doctors who dare question “gender affirmative” orthodoxies, Kaltiala has the backing of professional medical groups in her country. The Finnish Paediatric Society, the counterpart to the American Academy of Pediatrics, has come out against governmental support for gender self-identification in minors in a statement to the Finnish parliament. Likewise, the Finnish Medical Association wrote that “the decision to limit legal gender recognition to adults is a good one.” These statements run directly counter to the American Academy of Pediatrics’ policy since 2018, which, drawing on a highly distorted interpretation of the available research, recommends immediate and uncritical “affirmation” of minors, regardless of age. It also conflicts with the de facto practice in American schools of socially transitioning children upon request, often without knowledge or consent from parents.

When it comes to pediatric gender medicine and related social policy, things are far from perfect in Finland. Compared to the United States, however, it is an oasis of sanity and accountability.

To My Daughter's Therapist: You Were Wrong

pitt.substack.com|PITT

To my daughter’s gender therapist: you were wrong.

It has been some months since you and my daughter had the last of four sessions. In the third session I was invited to sit in on a discussion of the effects of T, testosterone, on a human female body. You smiled calmly as you led us through a series of Powerpoint slides, explaining that my daughter’s reproductive organs would atrophy, that she would grow a beard, that her voice would deepen, and that “the phallus” would become enlarged. I sat listening, summoning all of my own skills as a clinical psychologist to not let a tirade loose at you in front of my brittle and fragile 17 year old.

Between your third and fourth (and final) sessions with my daughter you and I had a one-on-one conversation wherein I believe you recognized that this mother and this family were not going to easily or willingly surrender this child to whatever gender transition services you were prepared to refer her for after just three forty-five-minute meetings.

I asked what it was specifically about my daughter that convinced you that medical transition would be the right course of action to relieve her distress. You said, “He has Gender Dysphoria.” I said, “She has an eating disorder, body dysmorphia, and ADHD, all of which seem to have some overlapping features with Gender Dysphoria. Why wouldn’t you assess for and treat those before triggering any kind of medical intervention?”

I asked you what happens if my daughter, upon taking T and going through the changes you described, is not relieved of her dysphoria. What if her feelings and symptoms of self-loathing, dissociation, anxiety, depression, and self harm become exacerbated? You visibly cringed at my questions and responded that most people who transition are satisfied with their results and don’t regret their decision. I asked where I might find peer-reviewed longitudinal studies that suggest that affirming and facilitating social and medical gender transition produce happy, well-adjusted teens and young adults. You said you would gladly send me links to those studies. The links never came.

I was clear, perhaps brutally so, that affirmation of male gender identity would not be the focus of your subsequent sessions and that you would instead help her explore her discomfort with her now almost fully developed, curvy female body. You would talk with her about her anxiety, her depression, her giftedness, her sense of alienation from her peers at a highly competitive suburban high school, and the impact of the pandemic at such a pivotal point in her life. In other words, you would work to slow the transition train way down.

Thinking back to that conversation I feel a delayed sense of dread as that was before I knew that major medical and mental health associations, the law, and key players in our state and federal government had also adopted a gender identity affirming stance, albeit for their own personal and political purposes. At the time I was unaware that in some instances parents had been reported to Child Protective Services just for refusing to address a child with his or her chosen name and preferred pronouns. In a way, though, I’m glad for my ignorance because I believe my forceful early pushback saved my child’s life. I would not take any of it back.

With an abundance of unconditional love, real psychotherapy, solid psychiatric care, and some long-overdue changes in her personal and social life, my daughter is coming into her own as a quirky, witty, gender non-conforming young adult. She is grieving as she sheds her preoccupation with chemically and surgically transforming her body into something that would never result in her being male. She will not have to live out her life in a Frankenbody. No dry and shriveling vagina. No beard or male-pattern baldness. No irreversibly thickened vocal chords. And no enlarged and exposed clitoris. You called it a phallus, but she would never pee or ejaculate from her clitoris. It is anatomically impossible.

A critically important thing that we learned along the way is that my daughter, as many other young people who declare transgender identity in adolescence, is on the autism spectrum. She was diagnosed by an experienced child and adolescent psychiatrist and is now coming to understand how certain aspects of her autism resulted in collapsing and narrowing her focus into gender identity as a way of explaining and coping with what made life so difficult for her during her middle and high school years. She is learning to reconcile with being socially awkward and having idiosyncratic interests and will be better for it as she inhabits her full adult self sometime in her late 20’s. She is a brilliant and beautiful human being whose entire future came so close to being stolen from her by the gender transition industry. It is alarming that an entire generation of gifted children who may be on the autism spectrum is being sterilized in what amounts to a eugenics experiment with the participation of big-name medical and professional institutions, and to the benefit of a novel category of mental health practitioners: gender therapists like you.

Had my daughter continued on the path she was on when you were her therapist, she would be well into a regimen of weekly testosterone injections and eventual surgeries that would not have resolved her Gender Dysphoria, a diagnostic category that was included in the DSM-5 (APA, 2013) as a way of validating the experiences of a very small percentage of the population who suffer with lifelong feelings of discomfort and disconnection with their biological sex, all while creating billable codes for gender clinics and mental health professionals (see Drescher, 2013: “…it is difficult to find reconciling language that removes the stigma of having a mental disorder diagnosis while maintaining access to medical care”). I know this because one of the experts on the DSM-5 workforce on Gender Dysphoria is a long-time friend who is, himself, appalled at what has come from this diagnostic category that he, no doubt with the most compassionate of intentions, helped forge. It is disappointing that he is hesitant to come out on the side of best and safe practice and to publicly state that gender exploratory therapy is NOT conversion therapy; that, in fact, putting so many young LGB people on a fast-moving conveyer belt to medical transition is the latest iteration of gay conversion practices.

Our daughter was not “assigned female at birth”. She was born with the full complement of normal female sex organs and all the eggs that her ovaries will release over the course of her fertile years, regardless of whether or not she ever chooses to become a mother. We expected as much because prenatal DNA testing let us know unequivocally at ten weeks’ gestation that we were having a baby with XX sex chromosomes in every cell of her body. And no, she isn’t “intersex”. Her phenotypical features reflect her Southwest Asian genetic heritage and she is fine and healthy just as she is. Nothing about her body is or has ever been out of place. If the gender transition industry is anything it is profoundly racist and disturbingly sexist.

I believe that the medical fast tracking of trans-self-identifying children and young adults is a contemporary twist on American individualism taken to its point of absurdity. We are now in a situation where corporate wolves are passing effortlessly as progressive sheep. Even Planned Parenthood, perhaps seeing the writing on the wall that was confirmed with the recent Texas abortion ruling, may be hedging its bets by offering “Gender Affirming Hormone Therapy”. Institutions’ needs for staying relevant and projecting themselves into the future trump any fidelity to stated guiding principles. And a parent’s need to protect her child’s mind and body trumps any and all political affiliations. Our wallets and our votes will speak for us.

*   *   *

It is now September and my daughter and and I have been living in a city in the former Soviet Union as of mid August. She is connecting to her roots, her land, and her cultural heritage; to rich and lasting sources of identity that synthetic hormones and manufactured gender ideology were threatening to undermine and replace. She recognizes that going down the path of medical transition would have made her into a lifelong patient as well as holding her back from so much joy and freedom that she now has access to. She is coming to terms with the inevitable losses that growing up brings and discovering facets of herself that she never would have if we had taken your advice and initiated medicalization. Gender ideology would have had to become the central focus of her intellect and creativity for the rest of her life.

It helps that the local language, which my daughter is quickly absorbing and starting to speak, is devoid of gendered grammatical markers. I think she is relieved to not have to ask or answer questions about “preferred pronouns” and such. Here, no one is compelled to participate in a mass delusion that requires thought control and speech policing. They had more than enough of that during seven long decades under Soviet rule. Simply put, people have more pressing daily challenges and live highly interconnected social lives as a result. When you fall passers-by stop to help you up and dust you off. As other young people my daughter feels confident walking around the city on her own at all hours. She increasingly feels safe and at home in this city and in her body. And I grow more hopeful every day that removing her from a culture that would pathologize normal developmental struggles and push costly and irreversible medical treatments, will enable and reinforce long-term remission of gender dysphoria and trans ideation from her life.

I took the unpopular risk of holding my child’s ambivalence and keeping it alive rather than surrendering her to a process that would make her the docile object of bogus “affirmation” and “celebration”. And while I became the target of so much hatred and rage for many exhausting months (affirming and facilitating social and medical transition, by far the less conflictual path for parents who have the financial means, would have gained me temporary status as the heroic mother), she never lost sight of the fact that her father and I were the ones who truly had her back; that social-media groomers’, glitter families’, and gender clinicians’ approval could never be a replacement for her own self esteem and her family’s unwavering love.

Let me close by saying that things are changing in parts of Europe and in the UK. In the US a growing movement of parents and ethical clinicians, most of whom are lifelong progressives and active supporters of LGBTQ people and causes, are organizing and becoming vocal with their outrage and rejection of gender ideology and the unsupported diagnostic claims and harmful treatment practices it has given rise to. When the lawsuits start coming this will be exposed as one of the biggest medical scandals in history.

It is only a matter of time.

The Medical Leash of Hormone Replacement Therapy

Gender medicine isn’t ‘experimental,’ because in an experiment someone is collecting data.

www.realityslaststand.com|Corinna Cohn

Nearly everyone is born with healthy and functioning endocrine systems. The cells in our bodies depend on both testosterone and estrogen to some degree. Of course, men's bodies depend more on the former and women's on the latter. When a child is put on to puberty blockers, also called gonadotropin-releasing hormone agonist (GnRH), the child’s natural endocrine system is stopped. For a child about to enter puberty, this causes an indefinite delay.

According to WPATH SOC8, gender clinicians may exercise the judgment to start hormone blockers in children at Tanner Stage 2 in their development (i.e. the first signs of puberty). For girls, this may be age 9. For boys, age 11. Most children who start puberty blockers then proceed on to be prescribed cross-sex hormones, also called gender-affirming hormone therapy (GAHT). This whole protocol replaces and works in contradiction to the child’s natural endocrine system. At this point, irreversible changes have occurred.

Let’s talk about the drugs. The most common GnRH (puberty blocker) is Lupron. Lupron is not designed for children who identify as transgender—it’s more commonly used to treat cancer. It costs at least hundreds of dollars a month, but I’ve normally heard it costing thousands. Lupon can have devastating side effects, and even the gender clinicians are aware of this, which is why some suggest rushing children off puberty blockers and on to cross-sex hormones as quickly as possible.

As hormone replacement continues, permanent changes intensify. Girls who are put on this path inject testosterone, causing them to masculinize. Her body hair will become thicker, she will grow facial hair, her voice will deepen, and she will accumulate more muscle. Testosterone can act as a mild anti-depressant. Girls taking testosterone report having more energy. Testosterone is also expensive.

Boys on this path take estrogen. Their skin will soften and they will begin to develop breasts. At this point, the body’s natural endocrine system is suppressed and smothered by prescription drugs. Estrogen is sometimes used to treat sex offenders to reduce their sex drive. Estrogen is cheaper in oral form, but is associated with higher risk of stroke. From my own experience, I was not ready to handle male puberty, and estrogen acted like a governor on my sex drive. It helped me avoid learning about my body.

But no amount of “cross-sex” hormones, taken for any length of time, will cause a female body to become male, nor will a male ever become female.

Hormone imbalances can exacerbate anxiety, depression, and even suicidal ideation. However, gender clinicians do not monitor these symptoms from medical side effects. In fact, when these symptoms arise (which is common), they are attributed to minority stress, not the medication itself.

After a period on hormone replacement therapy, some of these boys will follow a surgical path that includes castration and the construction of a vagina-like orifice using the penis as material. Without testicles, a boy will become dependent on external hormones for the rest of his life. Girls on this path will experience vaginal atrophy from testosterone, and eventually her other sex organs will be destroyed as well. Because of this, a girl on testosterone will eventually require a hysterectomy, after which she will become dependent on external hormones for the rest of her life.

For boys and girls in this situation, and for people like me, maintaining our health is wholly dependent on the medical system. We must have regular blood tests (at least once a year), and we must report in to our providers to obtain renewals for our cross-sex hormone prescription. These hormone treatments are no longer optional: we have no gonads. Without these hormones our bones will become frail and we will experience other physical symptoms, including mental health problems, because hormones regulate our entire bodies.

I am permanently leashed to a medical provider. My only freedom is that I can pick who holds the leash. The children who are being transitioned are being needlessly put onto this leash. They typically start the process with healthy bodies, but then so-called medical professionals assist these children in deliberately—permanently—damaging them. Why? For aesthetics.

I’m unusual in that I’m vocal about my criticism of the system. I have heard from so many trans people that they would like to say something, but they’re terrified that the people holding their leashes will jerk on the reins.

Planned Parenthood is one of the most generous of the leash-holders. They will essentially let anyone sign up to get a leash, and they don’t ask very much from their pets. How does this sound? Maybe not so bad? What is the medical discipline that understands the endocrine system? It’s endocrinology! And yet nobody writing prescriptions at Planned Parenthood is an endocrinologist. My local gender clinic, which sees perhaps 1000 patients, has no endocrinologist on staff.

Not only are we on medical leashes, but the people who hold the leashes aren’t even experts in the field. They are learning as they go and then experimenting on us. However, as someone once pointed out to me, it’s not really an experiment, because in an experiment someone is collecting data.

It should never be considered normal or preferable to treat problems like autism spectrum disorder, anxiety, traumas, depression, or other social disorders by placing children on puberty blockers or cross-sex hormones.

It is not a treatment path. It is a collar and a chain.

What Detransitioners Actually Need

Detrans Mans opinion on what the detransitioned population really need

tullipr.substack.com|@TullipR Detrans Male

When the world fully awakens to the horrors that have been carried out in the name of ‘gender affirmation care’, there will be no pause for celebration, no parades to mark the hard-won victories, only the gaping shock at the sheer number of botched surgeries and unforeseen consequences of cross-sex hormones.

‘Gender-affirming surgeries’ are high-risk, dangerous, and experimental medical procedures, in which their efficacy is often drastically oversold, and has led many people down a path of permanent physical pain and unending suffering.

There is no true reversal, you will never get back what you had to begin with, whether it was a mastectomy, facial feminisation, penile inversion, hysterotomies, or the long-term use of cross-sex hormones.

Behind the scenes, many hundreds of detransitioners who are not in the limelight, are dealing with this new reality, alone and in isolation. Abandoned not only by medical professionals, detransitioners often face a cold reception from the community they once called home and face equally negative reactions from family members who stuck by them. Those who supported their transition are now confused as to why they are now going back after all that.

Many of us are asking; how do we fix this? What are the solutions? And in doing so have attempted to use old solutions to a new problem.

An Emerging Health Crisis

We need experts, and quickly. The links between multiple sclerosis, osteoporosis, dementia, and auto-immunity issues sparked from cross-sex hormones use are rearing their ugly head.

The number of trans men who suffer from fatigue should be cause for alarm in itself. Yet, the link between cross-sex hormones and ailments is never openly acknowledged or discussed, they are treated as unrelated issues. In trans women, the absence of testosterone leaves many feeling fatigued and more susceptible to common illnesses and infections, as well as heightened levels of anxiety and depression, which are all, of course, attributed to transphobia.

Alzheimer’s disease is devastating for anyone, and hearing about stories of trans patients in care homes, who frequently wake up screaming, deeply distressed, and confused about why they’re wearing women’s clothes or don’t have a penis, isn’t just horrifyingly tragic, but deeply worrying.

Those who have been on puberty blockers are finding themselves with underdeveloped organs, hollow bones, and inhibited cognitive development. Mix in the mental health issues that come with this, and we’re beginning to draw a grim picture of the future.

The Medical Leash

Depending on when a person started hormones and for how long will determine whether or not their gonads (if not removed) can restart. For many, it’s a simple case of tapering down their HRT and allowing their body’s natural functions to kick in.

For those like myself, who no longer have gonads, I am reliant on hormone replacement therapy for life. Some have no reservations about switching back to testosterone and feel immediately more healthy, active, and more themselves. Testosterone does however come with facial hair growth, balding, libido increase, and all the other side effects I spent years running away from.

If I hadn’t gone through surgery, this wouldn’t be an issue. No matter what anyone says, not having the genitals I used to is emasculating, but it doesn’t make me a woman either. I’m something else, and though I loathe the word, I am by all definitions a male eunuch, and with that comes its unique challenges.

The bottom line is, the reaction I’ve faced to not wanting to switch to full testosterone is synonymous with the belief that Estrogen and testosterone are the essences of male/female, when in fact we have both, so rather than having one or the other, we should at least have both to some degree.

Idealistically, I’d rather break away from the medical leash, but for someone like me, that is not possible without risking extreme bone density issues. My whole detransition experience in medical care has been far more illuminating at just how little people know, as opposed to the far-cry of affirmation, that is so certain, so positive it eliminates all forms of doubt.

The reality is, we are still learning what the impact of cross-sex hormones on males and females looks like long term, and for the most part, it’s not positive. We need real studies, carried out by academics with no personal stake one way or the other.

Sex-specific-based requirements are amplified in detransition. Whilst male and female detransitioners have unending respect and empathy for each other, the paths that brought them here are fundamentally different. Whether it’s addressing their mental issues or health requirements, our requirements are very clearly defined by our sex.

Surgery Fatigue

Most of us never want to see a scalpel ever again, and there is a running misconception held about detransitioners, that we somehow desire ‘reversal’ surgeries.

For detrans men, not one of us who had a penile inversion is interested in phalloplasty or any other type of Frankenstein-Esque ‘reversal’ procedures. We are more concerned about functionality and health, rather than embarking on another savage, and deeply traumatising medical intervention. Those with implants often seek to get them removed, whilst others may seek less invasive treatments for extensive gynecomastia.

To get assistance for breast removal or hair removal, in the United Kingdom; a detransitioner must go through the gender clinic system again. Regardless of the long wait times, it’s highly unlikely a detransitioner, would actively engage with Gender Clinics given past medical trauma. Instead, many are looking to self-fund correctional surgeries to fix bleeding, urinary, and tissue corrections outside of mainstream healthcare providers.

Detrans women, even only after a few months on testosterone will experience facial hair growth. Laser hair removal in the UK and Europe is relatively cheap when weighed against other medical procedures, but can drastically improve the quality of life of someone with unwanted facial hair. Some attempt to engage in voice therapy, but find themselves unable to use the same techniques that work for males, this could be down to how the larynx settles in females who take testosterone.

In the United States, detransition-related surgeries and treatments are often not covered by healthcare providers, and often pay out of their own pocket, at high expense.

The Cataclysm of Shame

Those of us unable to maintain the story we’ve told ourselves to deal with regret, are overcome with shame at the realisation of what we’ve done and advocated for. I refused surgery time and time again until I was eventually convinced that this would be the penultimate fix for my gender dysphoria.

I went from being pensive, and doubtful to extremely optimistic all within a relatively short period. Therapists and psychiatrists alike all told me fantastical things about Gender Reassignment Surgery. One psychiatrist claimed that the tissue heals in a way that mimics a natal woman’s vagina, and another told me after expressing concerns for regret that I should “see the bigger picture” and that I was an “ideal candidate for gender reassignment surgery”.

That brain worm was powerful. All doubt was attributed to internalised transphobia and the fact multiple specialists were essentially telling me I was a case example of transsexualism, which eventually made me believe it.

Yet regardless of how many sessions I had at the gender clinic, ultimately I’m still the one who walked into the hospital. Whilst supporters are quick to assure me the blame isn’t mine, I think it’s healthy to still accept my fair share.

I know, I wasn’t holding scalpels, I didn’t do the assessments, and I should have gotten the help I was asking for, not a modern-day sexual lobotomy. I understand that, yet I’m not alone in feeling the overpowering weight of shame, forever present and tiring to carry around.

More so, when a person does speak out, detrans or not; they are met with a vicious reception. You don’t have to go far through a detransitioners profile to witness the vitriol firsthand, and trans people who raise the alarm are no exception to the rule. KC Miller posted a viral Twitter video that has been mocked and ridiculed by just about every pro-trans name.

[ Link: https://twitter.com/KCMiller1225/status/1579132480975941633 ]

Therapy - A Dead End for detransitioners?

Not everyone has the same experience with therapists. In transition, it’s not uncommon for people to have only one or two sessions with a gender therapist before taking hormones or having any surgery, though, others like myself had a radically different experience.

During my time in the Gender Clinic, including sessions with gender affirmation therapists, voice therapists, psychiatrists, and medics, I had over 150 appointments from 2014 to 2020. Add in blood work, surgery-related care, and laser hair removal sessions and I’m well over 200 appointments within that period.

In the detrans sphere, a theme is emerging with men and women, that those of us who have tried to reengage with a therapist, regardless of their skillset and experience, are finding it extraordinarily difficult to maintain.

We are exhausted and fatigued from therapy.

This is especially true for detransitioners who are expected to engage with Gender Clinics and therapists who set them on this path, to begin with, akin to ‘taking them to church’ as the song goes. Why on earth would I or any other detransitioner want to engage with these people? Especially if we were harmed. Why should we?

Whilst much work tirelessly, without expectation for reward, and often at great risk to their career, others see it as a potential niche or gap in the market, and just like the affirming therapists of the past decade, they waste no time in attempting to commoditize the detrans experience with self-proclaimed expertise on a topic, they could only guess at. And with that comes a notion, that the best way to help a detransitioner is to ignore the possibility that transition may of be any benefit to them whatsoever in the present or future.

Is this not exactly how we got here, to begin with? Affirming a detransitioner based on a belief that transition is harmful is no better than a gender-affirming therapist affirming someone’s transition at any cost.

Self pro-claimed gender therapists, who have operated freely, without restriction are one of the key drivers in the gender-affirmation market. The job seems easy, especially if a conversion therapy law prevents you from even questioning a client, all you have to do is bop your head and take the money, and no medical expertise is required. That is the problem. We should not be mixing theory-driven therapy with detransitioners, we need and deserve someone with far more expertise and medical background.

Adopting the same approach, but in reverse is unhelpful.

Counseling and therapy need better regulation and controls for these reasons. How about a break from therapists, surgeons, and self-proclaimed experts? How about we try something different?

Though, that being said…

Whilst others are burnt out from therapy, some have never been exposed to it. For the most part, I found myself just going back out of loyalty and routine, as opposed to returning for any real personal benefit.

Sure, there are benefits, and I certainly gained an understanding of some of my issues, but after all the years I’ve been present in talking to therapists, I very rarely achieved the promised ‘light bulb moments that I yearned for.

However, some may benefit from unpacking childhood trauma and gaining a new understanding of themselves, I would never want to deny a detransitioner or discourage them from seeking help on that because I or others may be weary.

The option should always remain open, and we deserve expertise rather than guesswork.

ROGD Parents and Detransitioners

It may seem cliché, but many of our issues stem from poor relationships with our parents. Not all of course, yet using the detrans male support group as an example, we have found that an overwhelming number have experienced a disconnect with their fathers.

To begin with, we allowed one or two therapists in the group to facilitate conversations, yet it hasn’t had the impact we had hoped it would. While attempting to find the right person to help us, the answer has unexpectedly revealed itself. With exception, we allow on occasion, ROGD fathers to join the detrans male group.

We have found time and time again, that their presence is not only mutually beneficial, but essential in becoming confident in ourselves as men. As a result, an unexpected symbiotic relationship has formed between detransitioning males and ROGD fathers. They provide us with something we’ve yearned for our entire lives, an older male we can look up to, and we provide them with a lens into their son’s transition experience.

ROGD mothers from Bayswater and Parents of Inconvenient Truths have become, perhaps the fiercest advocates for detransitioners too, and it makes sense for the groups to work closely. Life Detranstions and Genspect have paved the way forward with this and are already seeing success, whether it’s detransitioner check-ins, parent groups, or otherwise.

It makes sense that many detransitioners are disengaging with therapy and are more wildly drawn to group-style chats. Just like cult survivors, former addicts, and abuse survivors, facilitated group discussions with the right facilitator appear to be the more popular option for detransitioners.

Sorry, we can’t save your sons/daughter

No, we can’t save your kids.

Some ROGD parents can sometimes become overbearing to detransitioners, unintentionally bombarding them with requests, links, and calls to action. This is not the type of support that we’re looking for, though we appreciate the activism, it can be quite tiring.

I won’t claim to understand the urgency parents feel, but often our messages are flooded with parents asking or looking for that golden phrase as if it’s some spell that can be broken by uttering the right words.

Final Thoughts

We most certainly don’t want to burn bridges, when so few have been built. However, as it stands we are at the precipice of something new, and if we do it right we can help everyone, but we cannot afford to create a carbon copy of what we had before.

We need better.

It’s deeply important to me and many others that we do not swing the pendulum from one extreme to another. No detransitioner is calling for bans on all trans healthcare, we’re calling for informed research and examination, just like the Cass Review is doing.

We aim to improve services not just for ourselves, but anyone who may need them.

The Hidden Transgender Consensus

Americans have major reservations about “gender-affirming” care for minors and teaching gender-identity ideology in schools.

www.city-journal.org

“Hormone replacement therapy.” A person administered cross-sex hormones (testosterone or estrogen), usually through periodic injections, is not having his or her hormones “replaced;” rather, hormones are introduced to counter the effects of the body’s natural hormone production.

“Gender dysphoria.” For those going through or after puberty, the relevant experience here is usually a strong aversion to one’s body parts (such as breasts) or to the body’s natural processes (for example, menstruation).

“Cisgender.” Activists define this as “identifying with the sex one was assigned at birth,” but what this word really means in practice is the lack of debilitating distress associated with one’s sexed body. To be “cisgender” means to feel comfortable, or comfortable enough, with your body and its natural processes such that you don’t seek to make it appear like that of the other sex.

“Children know their gender identity.” This language obscures the key question of whether even sincere and stable cross-gender feelings—or indeed any feelings—in fact amount to “knowledge.”

“LGBTQIA+.” The sole purpose of this acronym is to enable activists making radical claims about human nature and society to piggyback off the far more broadly accepted claims of gay rights.

The Distortions in Jack Turban’s Psychology Today Article on ‘Gender Affirming Care’

Turban's public statements on pediatric gender medicine have been less than honest.

www.realityslaststand.com|Leor Sapir

For those not following the debate over pediatric gender medicine, Dr. Jack Turban is one of the leading proponents of the controversial protocol known as “gender affirming care” and has been outspoken in the American media promoting puberty blockers and cross-sex hormones to manage gender-related distress in youth. He is quoted widely and frequently by mainstream, left-of-center outlets including the Washington Post and the New York Times. This, despite the fact that he is fresh out of his residency and has far less clinical experience than many of the experts with whose more cautious approach to managing gender dysphoria in youth he disagrees.

One of Turban’s most widely cited articles is the one published by Psychology Today back in January of this year. The article, it should be noted, was published after health authorities in Sweden, Finland, and the U.K. had conducted systematic reviews of evidence for puberty blockers and cross-sex hormones and concluded, unanimously, that the risks and uncertainties outweigh any known benefits. Sweden and Finland have already severely limited the practice, and the U.K. seems to be moving in the same direction following the damning Cass Report. Medical authorities in France and New Zealand have also sounded the alarm, with France’s National Academy of Medicine now urging “the greatest caution” when using hormones to treat gender-related distress in minors.

Turban has thus far chosen to ignore these developments. In the case of the U.K., he has misleadingly suggested that the decision to shut down the country’s gender clinic (which was also the largest gender clinic in the world at the time) was prompted only by concern over long wait times and that the NHS was still on board with the “affirmative” model of care. Even a cursory reading of the Cass Report shows that this is demonstrably false. Cass explicitly cites the “affirmative model,” which “originated in the USA” and pressures clinicians not to question a minor’s gender self-identification and desire for transition, as a probable reason behind the lack of child “safeguarding” and the rushing of minors to medicalization.

This fits a broader pattern of Turban spreading misinformation and, at times, demonstrating ignorance about the basic facts of studies he cites. For example, as an expert witness on behalf of the ACLU in Brandt et al v. Rutledge et al, which challenged Arkansas’ ban on the use of hormones and surgeries for minors, Turban testified that there are two Dutch studies, consisting of two distinct, if overlapping, cohorts. He says something similar in his Psychology Today article. In fact, however, there was only one cohort of Dutch patients from which two studies were produced. Not just “some” (as Turban says in Brandt) or “many” (as he says in Psychology Today), but all participants in the second study participated in the first study—a fact the significance of which will be discussed shortly.

Why the misleading statement? Perhaps Turban thinks that the higher the number of studies, the more likely a judge is to rule against state efforts to regulate gender medicine, and the more likely readers of Psychology Today are to agree with his conclusions. Regardless, either Turban is unaware of the Dutch study’s details, or he has deliberately misled a federal judge.

According to Turban’s Psychology Today article, “sixteen studies to date have examined the impact of gender-affirming medical care for transgender youth” and the evidence from these studies “suggests that gender-affirming medical care results in favorable mental health outcomes.” The language of “results in” can easily lead the reader to believe that hormonal interventions cause improved mental health. As I go through these studies one by one, I’ll show not only that such claims of causality are not supported by the evidence (as made clear, at times, by the authors themselves), but also that some of the studies Turban cites actually show no or even negative association between hormones and mental health.

*  *  *

*  *  *

From his assessment of the sixteen studies, Turban concludes that “these interventions result in favorable mental health outcomes.” Here is what Turban should have said, had he written as a scientist rather than an activist:

To date, some studies have shown positive correlations between receiving hormones and improved mental health, but the improvements tend to be modest and regardless, there is no ability to know whether they are because of the hormones or some other factor (such as psychotherapy of familial support). Other studies have shown no or even a negative association between hormones and mental health. Given the gravity of these interventions and their known and believed side-effects, there is an urgent need to know more about the risks and benefits of hormonal interventions for adolescents who experience gender-related distress. It is time for the United States to follow its European counterparts and conduct a systematic review of the evidence, meantime putting all hormonal interventions on hold.

Turban's public statements on pediatric gender medicine policy in the United States have been less than honest. In the main, he has ignored developments in Scandinavia while assuring his readers that those who disagree with “gender affirming care” (as he defines it) wish to adopt blanket bans on all hormonal and surgical interventions for minors. While Turban is correct that this is the approach favored by some Republican states, his statement is hardly an accurate characterization of the wider debate over pediatric gender medicine in the United States. I suspect that Turban knows this but finds engagement with critics who favor a more incremental retrenchment inconvenient. Turban also likes to say that “all experts agree” with the “gender affirming” model—a statement that is only true if you define “expert,” in No True Scotsman-like fashion, as only someone who agrees with Turban.

Flawed articles like the one by Turban in Psychology Today should be the basis of debate, not a reason for shutting it down. Unfortunately, activists use these articles to argue that when it comes to the health care needs of transgender-identified youth, there is no room for debate. Current efforts underway to use the federal government to crack down on “disinformation” surrounding pediatric gender medicine are dangerous. They undermine the basic conditions for scientific inquiry and put evidence-based medicine beyond reach.

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@heterodorx: Children who are medically transitioned become attached to a medical leash. 🧵 Nearly all of us are born with healthy and functioning endocrine systems. The cells in our bodies depend on both testosteron...…

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Children who are medically transitioned become attached to a medical leash.

Nearly all of us are born with healthy and functioning endocrine systems. The cells in our bodies depend on both testosterone and estrogen to some degree. Of course, men's bodies depend more on the former and women's on the latter.

When a child is put on to puberty blockers, also called gonadotropin-releasing hormone agonist (GnRH), the child's natural endocrine system is supplanted. It is stopped. For a child about to enter puberty, this causes an indefinite delay.

According to WPATH SOC8, gender clinicians may exercise the judgment to start hormone blockers in children at Tanner Stage 2 in their development. For girls, this may be age 9. For boys, age 11.

Most children who start puberty blockers then go on to be prescribed cross-sex hormones, also called gender-affirming hormone therapy (GAHT). This whole protocol works in contradiction to the child's natural endocrine system. At this point, irreversible changes have happened.

If hormone replacement continues, permanent changes occur. Girls masculinize. Her body will grow more hair, her voice will deepen, and she will accumulate more muscle. Boys will have their skin soften and they will begin to grow breasts.

Even with hormone replacement, a body that is meant to follow a female sexual developmental pattern will not become male. And males will not become female. At this point, the body's natural endocrine system is suppressed and smothered by prescription drugs.

Let's talk about the drugs. The most common GnRH (puberty blocker) is Lupron. Lupron is not designed for children who identify as transgender—it's more commonly used to treat cancer. It costs at least hundreds of dollars a month, but I've normally heard it costing thousands.

Lupon can have devastating side effects, and even the gender clinicians are aware of this, and some have talked about rushing children off puberty blockers and on to cross-sex hormones as quickly as possible.

Girls who are put on this path inject testosterone. Testosterone can act as a mild anti-depressant. Girls taking testosterone report having more energy. Testosterone is also expensive.

Boys on this path take estrogen. Estrogen is sometimes used to treat sex offenders to reduce their sex drive. From my own experience, I was not ready to handle male puberty, and estrogen acted like a governor on my sex drive. It helped me avoid learning about my body.

Boys are expected to follow a path that includes castration and the construction of a vagina-like orifice using the penis as material. At this point, the boy will become dependent on external hormones for the rest of his life.

Girls on this path will experience vaginal atrophy from testosterone, and eventually her other sex organs will be destroyed by the testosterone. After hysterectomy, the girl will become dependent on external hormones for the rest of her life.

For boys and girls in this situation, and for people like me, our health is wholly dependent on the medical system. We must have regular blood tests (at least once a year), and we must report in to our providers to get renewals for our external hormones. We have no gonads.

These hormone treatments are not optional. Without them, our bones will become frail, and we will experience other physical symptoms, including mental health problems—hormones regulate our entire bodies.

I am leashed to a medical provider. The best I can do is pick who holds the leash. The children who are being transitioned are being put on to a leash. They are typically starting the process with healthy bodies. But then our bodies are deliberately damaged. Why? For aesthetics.

I'm unusual in that I'm vocal about my criticism of the system. I have heard from SO MANY "TRANS" PEOPLE that they would like to say something, but they are terrified that the people who hold their leashes will jerk on the reins.

Planned Parenthood is one of the most generous of the leash-holders. They will essentially let anyone sign up to get a leash, and they don't ask for very much from their pets. How does this sound? Maybe not so bad?

What is the medical discipline that understands the endocrine system? It's endocrinology! And yet, nobody writing prescriptions at Planned Parenthood is an endocrinologist. My local gender clinic, which sees perhaps 1000 patients, has no endocrinologist on staff.

Not only are we on medical leashes, but the people who hold the leashes aren't even experts in the field. They are learning about best practices and then experimenting on us.

However, as someone once pointed out to me, it's not an experiment. In an experiment, someone is collecting data.

It should never be considered normal or preferable to treat problems like autism spectrum disorder, anxiety, traumas, depression, or other social disorders by placing children on puberty blockers or cross-sex hormones. It is not a treatment path. It is a collar and a chain.