The New Gender Paradigm

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WPATH's stated mission is "to promote evidence based care, education, research, advocacy, public policy, and respect in transgender health." 

...And they certainly have the authority, respect and political connections to make great strides toward achieving those goals.  So how much have they accomplished after almost 40 years of dedicated effort?


THE POTTY CRISIS

21 states are considering laws to restrict trans people's access to restrooms.  And 46% of the American public think that transgender people should check their birth certificate before using a restroom.  (CBS/NYT Poll May 2016)   ...Because they believe transsexual women are Really Men.   Hmmm.  WPATH agrees with them -- which may explain why WPATH hasn't taken a stand on the issue.


THE SUICIDE CRISIS

Murder & suicide within the trans community are the highest they've ever been.  ...Partially related to the Potty Crisis and other anti-trans legislative actions.  Being transgender has the highest risk of harassment, dropping out of school and being homeless.  Yet transgender people don't even show up in public statistical records.


DIAGNOSIS

Forty years ago, psychiatrists complained that they couldn't tell the difference between transsexuals (who were destined to transition) and non-transsexuals (who won't or shouldn't transition.)   Nothing has changed in those forty years.


TREATMENT

Forty years ago, transsexuals were treated with any estrogen plus spironolactone.  Four decades later, WPATH still recommends minimum doses of any estrogen plus spironolactone.  Supposedly no treatment regimen has been shown to be better than the others.  The best endocrinologists in the country still justify their treatment choices by saying:

“The Task Force placed a very high value on avoiding harm from hormone treatment to individuals who have conditions other than GID and placed a low value on any potential benefit these persons believe they may derive from hormone treatment.”  (Endocrine Guidelines p 11)

"[The possibility of reversion] justifies the strong recommendation in the face of very low quality evidence."  (Endocrine Guidelines p )


Why are treatment choices still being made on the basis of avoiding regret and lousy evidence?  Whatever happened to a concern about the best possible outcome for the trans patient?


CHILDREN

After forty years, children are still restricted from receiving any type of treatment or support.


The fact is, after forty years of debate, WPATH hasn't even decided whether transsexuality is a medical condition that needs treatment or a social catastrophe.  ...Although they seem to lean toward the latter.

Dr Harry Benjamin, Pioneer

There was a time when the healthcare system was supportive of the transsexual population.  The modern era of transsexual treatment began with the endocrinologist Dr Harry Benjamin (1885–1986), who first came in contact with a transsexual child in 1948.  The mother begged the doctor to help her child instead of condemning her as previous physicians had done.  Dr Benjamin provided estrogen and arranged for surgery – to the delight of the child and her parents.


​Many patients followed, the most famous being Christine Jorgensen (1926 - 1989).  The doctors, the media and the world initially accepted her as "100% woman".   Here are headlines from the New York Daily News during February 1953:

Healthcare Denial

WPATH

Intersex Outrage

The 1960's & 1970's were the heyday of the "Gender is a Social Construct" myth.    Not only did psychiatrists think that they could reform gender in trans people, they were sure they could rescue intersexual Infants with Congenital Adrenal Hyperplasia (CAH) & Cloacal Exstrophy.  "Ambiguous genitalia" at birth would surely induce "Gender Confusion" as the child grew up.

Surgery gave male newborns female genitals, so they would be raised as girls.  (Often the parents weren't even informed of what had happened.)

It didn't work.  As the babies grew up, they were quite aware of their innate male gender identity, in spite of their artificially female genital appearance.  Investigations quickly turned up the truth -- both child and parents were incensed when they found out about the surgery.   The Intersex Society of North America (ISNA) led the campaign to halt unnecessary surgery on newborns.

ISNA was highly successful -- to the point that most people today believe that ALL intersex people have "ambiguous genitals" and underwent secret surgery after birth.

Unfortunately the ban on genital surgery was extended to the transsexual community.  During the 1980's, the Intersex Scandal added fuel to WPATH's anti-transitioning campaign -- providing a pulpit for a few well-connected extremists who were dedicated to the eradication of transsexuality. 

Compare ISNA

The Intersex Society of North America (ISNA) was founded by Cheryl Chase in 1993 to stop neonatal gender change surgery in some forms of intersexuality.  In 2006, both the National Institutes of Health (NIH) and the American Academy of Pediatrics separately published policy changes that reflected ISNA's medical goals.  Currently, public opinion is aware of and overwhelmingly condemns the practice -- even going too far:  Many currently believe that neonatal surgery encompasses the entire field of intersexuality!

ISNA closed its doors in 2007 (quietly replaced by Accord Alliance.)   It took them just 14 years to completely reverse public and professional opinion.  

Psychiatry Section
Everyone's been told that transsexuality is a mental illness -- a belief that has brought a great deal of misery to the trans community.  Here's how the whole crazy thing works:

(1)  Psychiatry's DSM is supposed to provide a diagnosis
        It sort of tells who's transsexual and who isn't.

(2)  This page describes WPATH
         They're the people who dictate how transsexuality should be treated.

         They also determine public policy regarding the gender community.

(3)   Few experts actually believe it
         The fact is, no expert really believes that transsexuality is a mental illness.

         ...Even though those same experts are writing the mental illness policies.

(4)  Actually, the Mental Illness Myth reflects the religious beliefs of a few well-placed individuals

Aftermath:  The Situation Today

These events have led to the current approach to transsexual medical care.    HBIGDA is now WPATH – the World Professional Association for Transgender Health.  ...But the membership still reveres the DSM; the mental illness myth continues, and psychiatrists are still in the driver's seat.

In 2011, WPATH released the 7th Version of their "Standards of Care" -- the cutting edge of transgender healthcare.  (At least from their point of view.)   The authors considered it to be kinder and gentler than previous versions:


"Version 7 represents a significant departure from previous versions.  Changes in this version are based upon significant cultural shifts, advances in clinical knowledge, and appreciation of the many health care issues that can arise for transsexual, transgender, and gender nonconforming people beyond hormone therapy and surgery."  (Page 1)


Supposedly, the treatment guidelines are "based on the best available science and expert professional consensus."   They're intended to "assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment."

 
WPATH commits to "advocacy for changes in public policies and legal reforms that promote tolerance and equity for gender and sexual diversity and that eliminate prejudice, discrimination, and stigma."


Unfortunately, the mellowing of the WPATH Guidelines has been achieved not by changing the underlying philosophy, but by adding layers of sweetness to its poisonous core:

--  REALLY MEN  Transsexual women are Really Men who refuse to conform.

--  CONFORM  Anyone who doesn't conform to the stereotypical gender characteristics of their assigned sex needs a psychiatrist.  (Pp 3-4)

--  TREATMENT BY ELIMINATION  "Treatment" involves a series of steps that are arranged according to reversibility, not according to the likelihood of a successful outcome or to minimize risk.

--  ELIMINATE TRANSSEXUALITY  Transitioning is supposedly the worst possible outcome; a treatment failure. 

--  NO YOUTH  Treatment of trans youth is forbidden until they become legally liable for the outcome.


For more details regarding WPATH Healthcare, go HERE.

The Avenger:  Paul R McHugh

Enter Paul R McHugh (born 1931), the chairman of  the psychiatry department at Johns Hopkins University School of Medicine.  He was the official advisor to the Vatican on matters of pedophilia, homosexuality & transsexuality.  He was advisor to President George H W Bush on Bioethics.  In 1979, Dr McHugh took advantage of all of his political resources to launch a successful campaign to halt all medical care for transsexuals.

 

"I concluded that to provide a surgical alteration to the body of these unfortunate people was to collaborate with a mental disorder rather than to treat it." 

                    -- Paul R McHugh


By 1990, there were only three centers still offering hormones & surgery.  They operated independently, shunned by universities & major research centers.  After McHugh testified before Congress, medical treatment had been specifically excluded from coverage by the Veteran’s Administration and by the federal Centers for Medicare & Medicaid Services (CMS, NCD 140.3) -- and subsequently by the health insurance industry in general.

For more, see HERE.

...That is, as long as psychiatrists stayed out of the picture.  Here's what Dr Benjamin had to say about psychiatry's contribution to transsexual medicine:

"Psychoanalytic theories are something like a cult, if not a religion, and are often quite incomprehensible to ordinary clinicians.  To them, their explanations and analyses many times appear far-fetched, even absurd, in spite of their often intriguing and sometimes poetic quality."

           -- Dr Harry Benjamin, The Transsexual Phenomenon, Julian Press (1966)  p 32

 

"Psychotherapy with the aim of curing transsexualism, so that the patient will accept himself as a man, it must be repeated here, is a useless undertaking with present available methods.  The mind of the transsexual cannot be changed in its false gender orientation.  All attempts to this effect have failed." 

            -- The Transsexual Phenomenon, p 76

 

Psychiatric Retribution

Alas, organized psychiatry was not willing to stay out of the picture.  In 1973, the American Psychiatric Association  (APA) responded to a groundswell of animosity regarding their handling of GAYS.  Its membership voted to remove homosexuality from the diagnostic coding book, the DSM.  In 1980, the APA leadership countered by having  so-called "Gender Identity Disorder" added to the book to replace the former "homosexuality" entry.  Their explanation was that transsexuals were supposedly gays who became women in order to have sex with men.  In other words, only the manly gays were now "normal", while effeminate gays were the ones with the mental illness.


In conjunction with the political posturing, a group of psychiatrists organized into the Harry Benjamin International Gender Dysphoria Association (HBIGDA -- 1979).  The DSM provided the diagnosis; HBIGDA guided treatment.  (At the time, there were about 40 major treatment centers for transsexuality in Europe & America).  The HBIGDA Guidelines considered Gender Identity Disorder  (or Gender Dysphoria) to be purely a psychiatric problem, without any biologic basis:

"Gender Dysphoria herein refers to that psychological state whereby a person demonstrates dissatisfaction with their sex of birth and the sex role, as socially defined, which applies to that sex, and who requests hormonal and surgical sex reassignment."  

               --  Guidelines, Version 1 ¶ 3.4 -- all quotes in this section are from this document

 

Diagnosis could only be made by a psychiatrist (¶ 3.5), since,

"The analysis or evaluation of reasons, motives, attitudes, purposes, etc., requires skills not usually associated with the professional training of persons other than clinical behavioral scientists."   (¶  4.2.1)

 

As such, psychotherapy was designated to be the treatment of choice.  Hormones & surgery couldn’t be offered until the psychiatrists had given up  (see ¶¶ 4.6.2, 4.8.1, 5.1.2).  Once that happened, the decision to offer hormones & surgery became a “moral” issue (¶ 4.2.4) that needed to be justified to peers & a hostile public  (¶ 4.12.1):

          --  Why give hormones & surgery for a mental illness?

          --  Can hormones & surgery change a person's gender?

          --  What if the patient changes their mind

          --  Is it morally acceptable to "remove healthy tissue"?

          --  Is it morally acceptable to interfere with  propagation of the species?


Beyond those issues, the medical treatment itself was said to carry inordinate risks that couldn't be comprehended by the patients who demanded it (¶ 4.1.1, 4.1.2, 4.1.4, 4.5.1, 4.7.2, 4.14.2).  Those patients suffered from “short-term delusions”.  Theorists hoped the patient would wake up one day, look at their genitals and say, What was I thinking?!!!    If they had undergone hormones and surgery, it would be too late.  That person would be a Regretter -- someone whose life had been destroyed by single bad choice.   It was psychiatry's divine calling to prevent even a single repentant Regretter from slipping past unnoticed -- even if it meant having hundreds of frustrated delusional patients go without treatment.  (¶ 4.1.1, 4.1.3)


"Gatekeepers"

In other words, HBIGDA put psychiatrists in the role of "gatekeepers":    Transitioning couldn't begin until psychiatry had given permission.  And not just the dedicated stonewalling of one psychiatrist, but TWO. 

This policy of denial ignited a war between transsexuals and the health care community.  The best interests of the patient was the least of anyone's concerns.  Doctors became enforcers of gender orthodoxy, not patient advocates.  Desperate transsexuals did anything they could, just to get past the psychiatrists -- including fabricated symptoms and life histories, spiced with a generous dose of black market medicine. 

As transsexuals' pleas and begging grew louder, psychiatrists added ever greater hurdles for the foolish applicants to overcome.