Both and

It is a fact that there are gender non-conforming children.  It’s not a pathology UNLESS it is a pathology.  Transsexualism is rare.  Gender non-conformity is actually pretty common and quite often, parents and society set out to crush gender non-conforming behaviors creating distress for everyone. We are so afraid of what it might mean.

We need to advocate for letting kids grow up with the parental support and nurturance they need and not direct them in one way or the other, rather we need to track them, keep them safe, let them speak and express,  and work to change the world to make it safer for all kids and all genders.

The vast number of gender non-conforming children only need to be safe and supported and have it explained to them that the world is a particular way and for them to live in it they have choices to make about expressing themselves and living given that context.  That it isn’t them, it’s the bigots.

Some kids need to have puberty blockers.  When kids are older, they may need to start on hormones.  It is extremely rare.  The thing is, there are suicidal seven-year-olds related to their body dysmorphia.  If a kid has supportive parents who let them explore gender and they are still depressed and suicidal?  We are really looking at the need to transition in a child.

When I first encountered transsexual women, as a feminist, I mistakenly thought they were making a mockery of everything I was fighting to overcome.  I am not someone who would wear a dress or make up.  I did not want male attention or the male gaze. The energy that so many women put into shoes confounded me and made me pissed off because of what they are not putting energy and money towards.  What I believed to be a man co-opting women’s experience and making it into a 1950’s television show enraged me.  Then I got to know transsexual women and men and genuinely listened to them and their stories and experiences. Listening changed everything for me.
Continue reading

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“Socialized Trans”

This is an important blog for therapists to read. Socialized Trans

This was a brave post for many reasons. This issue is one of the reasons I began writing this blog on regret and detransition. I believe that there are natal females who are male. I also believe that there is pressure in the queer women’s community to explore masculinity and for some people, that means using testosterone and for others chest surgery or breast reductions or mastectomies. There are certainly natal females who began testosterone and then changed their minds. The reasons they started were complex. Some people transition for reasons that are far afield from the stereotype of born in the wrong body. Gender identity is more complicated than that. For some of those folks, it’s the right decision and for others it is not. We need to embrace complexity. We also need to do a better job of supporting masculine girls and women and gender nonconforming people across the board.

I do not agree with the frame crashchaoscat places on what she says. I don’t believe we can socialize a person to be trans, but I do agree that that her experience is absolutely legitimate and crashchaoscat is speaking about an experience many women and particularly young women are having. crashchaoscat states that being trans can be a phase. Like many other things, people experiment and there should be space for people to accommodate gender experimentation and exploration. Technology and science have changed the nature of that exploration for good or bad.

We need to start talking about this in a responsive way. I agree we need to provide support and listen to the voices of women who detransitioned and women who are gender non-conforming and don’t want to change themselves, rather they want to simply be safe to be in society. As gender specialists, we need to be working to make the world safe for everyone’s gender. If a person doesn’t feel they fit into the box that women are permitted to live in, in the binary, it is wrong to assume they must be male. They might be but not necessarily. This is why the binary is problematic. As we know, most gender non conforming kids grow up to be cisgender.

Patriarchy, politics and practical issues effect some people who move in this direction.
I also agree that misogyny and patriarchy cannot be underestimated. Further, I would posit that the abuse of the concept of feminism among many young women and men make being female undesirable. That’s another issue, though.

As a parent, it has deeply disturbed me that both girls and boys read books about boys, but boys generally do not read books about girls. Boys are apparently inherently more interesting. It even continues in adulthood. The Countis fascinating. It looks at major journals and the percentage of stories by men and by women and who the editors are. For instance, Harpers reviewed books by 54 men and 11 women. 65-75 percent of what we read is written by men. Women are socialized to appreciate and value men and men’s thoughts much more than men are socialized to appreciate and value women. (By the way, women read more so it makes no sense.)

Women are socialized to not like their bodies. More than 90% of girls want to change at least one aspect of their body. Women see on average 400-600 advertisements a day. One study showed that 69% of girls reported models influenced their beliefs about the perfect body. Boys are not immune to this either, eating disorders are increasing in boys. Advertising that sexualizes women has increased and advertising that sexualizes men has decreased.

What if you are a young women who doesn’t want to be sexualized and it is part of our culture that you should be? What if you have interests that are stereotypically “boy” interests? There was the viral story about the man who ripped off a little boys pink headband. Boys should not wear pink. Girls can wear blue. Pink is bad. Pink is for girls. It is all around us. Men run the country. Women’s control over their body has been under attack. There are many reasons a woman might think being a man is better. Male privilege is real.

Large breasts are practical issues that arise for many active women. http://espn.go.com/espnw/news-commentary/article/9451835/female-athletes-biggest-opponents-their-own-breasts-espn-magazine; http://jezebel.com/out-of-control-boobs-are-keeping-female-athletes-down-733592839.

Sports bras crush breasts to keep them in place so that a woman can play tennis, run, etc. Women with breasts who run are often uncomfortable and wear two bras or do whatever they can to simply move. Women with large breasts have to buy incredibly expensive bras to be comfortable. Further, they are the targets of male hostility in the form of sexual harassment. Again, this is a feminist issue of men controlling access to public space and thus controlling women’s activity. The more harassed women are, the less space they take up outside. If women don’t feel blessed by large breasts, they are constantly told they are not regular women.

Then there is crap like this: http://bleacherreport.com/articles/386180-the-20-most-boobtastic-athletes-of-all-time

So if a woman doesn’t want her breasts because they get in the way, they hurt, or she hates what they bring to her in her life, what does that mean about her?

The world has changed. Women can use medicine and surgery to alter themselves. When I was younger, people got upset about youth getting tattoos because they were seen as irreversible. Now people can modify their body in a variety of way.

CrashChaoscat also says that transsexuality isn’t one thing. That is very true. People transition for a variety of reasons. There is no one size fits all. The other thing is there is no one trans community. There are people who try to represent the voices of the trans community and they cannot. The trans communities are varied. There are people who say ridiculous and stupid things everywhere. Being trans identified doesn’t stop people from being wrong or insensitive or scared or insecure or racist or transphobic or sexist.

As I said, there are many important ideas in that blog. There are several more I want to address in the coming posts.

Posted in detransition, Gender Dysphoria, Gender Identity, Gender Identity Disorder, gender non-forming, genderqueer, misogyny, patriarchy, Psychotherapy, regret, regretters, sexism, transgender, transsexual | Tagged | Leave a comment

The bind

Like most everything related to transgender people, we don’t have good data on regret.  Often the people who are talking about regret, have a specific agenda.

Often too, the people who are NOT talking about it have a specific agenda as well. I was unhappy I transitioned so no one should be permitted to transition.  It’s all a fraud.  Conversely,  You’ll feel better if you transition.  It really worked for me.  I also have heard that MD’s have suggested transitioning to patients based on the MD’s own beliefs.  Sometimes, these encouragements are from simple ignorance-wanting to be supportive and thinking that this is the best way to be helpful.  Bad things happen.  They just do.

No one should put all of their decision-making in another person’s hands.  Not a therapist’s, not a doctor’s, not a best friend’s, not even a parents.  The information you get from other people is simply information for you to weigh and consider. It is true that therapists and MD’s have a lot of power, but ultimately the decision is an individuals.  A medical provider can prescribe, a therapist can approve or refer, a nurse can administer an injection, but ultimately it is up to to the individual to show up for that injection, to fill and take the prescription hormones or to choose not to. If medical or mental health professionals could make people do things, no one would smoke, we’d all be exercising, and eating better.

Sometimes people who regret transition move from one side to the other politically. There are important discussions to be had about feminism, about masculinity, about human rights, about identity, etc. They will not work when we are reactionary and polarized. We generally look at the world through the glasses we have created from our own personal experience. My experience is not yours, and vice versa.

Research-wise, even a therapist tells you that statistically most people do not regret their transition, it doesn’t mean that you won’t. Continue reading

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Don Ennis

Just like there are cisgender people who have significant mental health issues, there will be transgender people who do as well.  We have no idea exactly what occurred.  In May of this year, Donald Ennis, a producer at ABC, came out as Dawn Ennis, and received support from co-workers and family. Now he is reporting not that he made a mistake, rather he “was misdiagnosed.” He had an episode of amnesia and was no longer female. 

 He said, “I’m asking all of you who accepted me as a transgender to now understand: I was misdiagnosed. 

“I am already using the men’s room and dressing accordingly,” he noted.  “It’s so odd to be experiencing this from the other side; as recently as last Friday, I felt I was indeed a woman, in my mind, body and soul.”

Here is an individual who says she felt she was indeed a woman, in mind, body and soul and that she was misdiagnosed.  I would love to know more about who diagnosed her and what information they had about her. What did she tell her diagnostician about her life and her needs and her situation?  She says she struggled for over seven years with her gender.  She had the support of her family.  Mind, body and soul?  

 Because some people want to deny the reality of transgender people, this will get used against the trans community.  There certainly will be people who transition who should not. The question is, how do we differentiate?  Further, who is responsible for a choice that someone makes?  Gender specialists are not trying to make people transition, rather, help them sort out the risks and benefits, what are the choices in expression and behavior and medically and to explore what the person expects and what will change and how to make life work as best as that person can make it.  To be authentic, resilient, and prepared.  Not so much to tell an individual who they are.  

I worry where people will take this.  The people who don’t understand gender identity and use their own beliefs and filters to apply to people who they do not understand.  I dont have an issue with Mr. Ennis transitioning back, it’s reading the comments on these news stories and knowing that transgender people are under a microscope.

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Musings: What is the therapist’s responsibility in an individuals regret over the decision to transition?

 

Increasingly, the idea that no one size fits all is a critical reminder.  As therapists we are working with people, not labels or categories.

What is the therapist’s responsibility in a person making a decision that they later regret?  Gender Specialists are not in the business of telling people that they should transition.  We can’t know what someone else SHOULD do. What we can do, is provide information that we have learned and share our experiences with people so that they can make a decision based on the most recent research and whatever wisdom we have picked up from our clients and friends along the way.  Our job is to assist people to make the best decision regarding gender expression and behavior for themselves at this moment, in this context.  We do not make it for them. 

We do not stamp clients with a pink seal or a blue seal, affirming that they are male or female.  Only an individual can know this about themselves. We do evaluations, not write letters.  Letters are the result of an evaluation.  Evaluations are complicated and serious experiences.  

As a therapist, I rely on the information that a client gives me.  If he/she/ze gives me a false narrative designed to convince me to sign a letter for transition related care, I cannot do my job. The issue of gatekeeping is truly problematic.  In truth, I do not care what decisions any adult makes about their body.  I do care if I am asked to be involved in their process.   If I am the therapist or assessor, I provide information, education and experience to them and we work together to understand their experience and their situation so that I am comfortable that my assessment or evaluation is as accurate as it can be for this moment in time and this context.  I need to be comfortable providing them with an assessment that says they are capable of informed consent and knowledgeable about the process and that the procedures will likely decrease their dysphoria.  I cannot know that this is true and that is why it is likely and not will. 

Not everyone who wants to transition will benefit from a cookie cutter approach.  First socially transition, then hormonally transition, then legally transition and then surgically transition.  There is no correct way to transition.  It’s all individualized. 

For instance, if a person does not feel like a girl that doesn’t necessarily mean they are a boy or that if one doesn’t feel like a boy, that they are a girl.  They MAY be.   They may also be a pink boy or a girl who has interests or behaviors that are outside of sex stereotypical interests and behaviors.  We live in a context of sexism and a gender binary. We would have to get to know that person and do an assessment WITH the person about who they are and what they understand and what they expect and what they want.

We should be in the business of assisting people to find themselves on the gender spectrum.  That they may be at one of the poles on the gender spectrum or they may be somewhere in the middle.  Only the individual themselves can know this.  Our society has a propensity to need to have people in categories so we know how to relate to them. The first things we identify are gender and race here in the US because we relate to men and women differently and to people of different ethnic or racial identities differently.  If one belongs to the GLBT community, we might also try to figure that out early because they will relate to people in that group differently than in heterosexual groups. (This DOES NOT mean we do this with everyone all the time.  This is a generalization.)  

If a clinician has an older binary view of that every transgender person is a person born in the wrong body, they will make problematic recommendations.  If a clinician has a view that people should all just adjust to the body they are born into, they will make problematic recommendations as well.   Action can be a problem and inaction can be a problem. It is appropriate action and response that is the goal of good therapy.  

Clinicians need to have a spectrum oriented view. There are people who believe they were born in the wrong body and since childhood have known this.  They are a boy or they are a girl and when they are able to access transition related activities, the distress they feel about their bodies is greatly reduced.  This doesn’t mean they will be 100% well-functioning and never feel depressed or dysphoric again.  Being able to access transition related activities and procedures does not repair a life time of trauma nor a lifetime or being mis-seen, misunderstood, mis-mirrored.  It cannot fix whatever has already happened.  It also does not mean that the social context within which the person lives, will change.  It may mean a person has the legal right to be treated and seen as themselves but that will not make people abide by that.  Parents who rejected a child and said perhaps, you are a boy you will never be a girl, you have a penis, you don’t have breasts, you are a boy, likely will not embrace that child once that child has breasts and no longer has a penis but has a vagina. 

It’s critical in our work to ensure that we are assisting a client to understand the repercussions of the decision that they are making to the best of our abilities.  Quite often, people will have a fantasy view that changing their body will fix all that has been wrong in their lives.  It changes what is between their legs or how their chest will appear. It does not change the social context.  There is no magic in changing ones body.

If it improves what it feels like to be in shower, what it feels like to be in a locker room, what it feels like to be with friends, with sexual partners, what it feels like to be that individual inside a body that better resembles their gender identity then that is generally a positive choice for an individual to make.  Does it decrease dysphoria?  

If one expects it to improve how other people behave, that ranges from unlikely to depends on the context and if one is perceived to be transgender or transsexual.  If someone is perceived to be the gender that they are, they very likely will experience less distress.  They may have different distress related to the fear of being “outed” or discovered.  That can be an entirely new anxiety an individual experiences. 

Regret:  feel sorrow or remorse for an action one has taken or not taken.

Regret is a complicated issue.  Regret generally does not cause clinically significant distress. It causes sadness, disappointment, sorrow—compunction.  Growing up my father would talk about how my brother had to learn things the hard way.  Often people have to have a certain experience to know they do not want to have that experience.  Some people only learn by doing.  Some people cannot imagine what an experience will be like whether it is living as male or having children or moving to Florida.  They cannot imagine, predict, anticipatorily experience  a different state of being or experience. 

For some people regret over a choice they made about gender expression is like that.  They cannot know what it will help or address and what it will not until they do it. 

There is a difference between making a decision at twenty that with forty year old eyes and 40 year old wisdom, one wishes that one did not make. 

If at twenty, there was information that was then known and available, that at twenty one would have made a different choice then that is an area where something failed in the education and informed consent process.  For instance, if a person was not adequately informed that taking hormones will likely adversely effect sexuality or sterility, something failed in the informed consent process.  If they did not know their wife would leave them five years into their transition after promising that transitioning wouldn’t effect their relationship that is not a failure in informed consent, that is an issue about the partner’s self-knowledge or the relationship.  Often what people regret, when it’s not the appearance of their body, is that they lost relationships and community and jobs because of the transition. 

If I have seen someone and they give me a typical trans narrative and not the truth of their experience, then the evaluation will be in error.  There may be no way to discover the information is not fully accurate.  If I see someone and they later change their mind, am I at fault because I did not identify that they might change their mind?  

Additionally, I know that clients have signed paperwork that describes the risks and benefits of hormones and at the time they begin to take hormones, they are so excited or so anxious, they do not pay attention to what they are signing or what their medical provider has said.  This is true for many procedures or experiences. For instance, as general mental health practitioner, I often have to coach people about what to say when they see a psychiatrist.  When the psychiatrist asks, how are you, they say fine and not that they have been morbidly depressed most days in the past month.  They are not being deceptive, simply answering the question asked in that moment.  They are anxious and forget what it is they want to talk with the doctor about.  

So what should therapists be held responsible for when people regret making a decision about changing their body?  It is a very complicated question I think.  If we tell someone unequivocally that transitioning will improve their life, we are not doing our jobs. If we do not tell them that there are procedures that could improve their dysphoria, we are not doing  our job.  If we write a letter without an evaluation, we are not doing our jobs.  If we only know about the binary and not the spectrum we are likely not doing our jobs.  We should also know the details of the surgery and truly be able to describe the risks and benefits in a way that the individual client understand and truly can provide informed consent. 

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Change always involves loss

This blog is facetiously named in many ways. There are almost always regrets when people make life-changing decisions.  They wished they had gone to a different school, moved to a different city, had another child and the regrets get bigger or smaller depending on the types of decisions.

The choice to pursue medical transition related to gender identity is a significant life changing decision. I’ve spent the last few years thinking about the concepts of “regret,” “de-transitioning,” “re-transitioning,” and language like MTFTM or FTMTF.

I’ve always been a little bit backwards thinking.  I’m interested in failures.  Understanding why something doesn’t work, helps me understand how to improve what it is that we do have. As a therapist, I am trying to understand how best to provide information to people so they can make informed choices.  I do believe that there are people who should transition surgically, hormonally, socially and psychologically.  I also believe that some people regret the decisions they made to transition, however they transitioned.

I realize that in talking about this, I am headed into dangerous waters.  I am neither advocating for anyone to transition or to not transition.  I am advocating for accurate information and self-determination.  Often, I think that because something succeeded for one person or failed for one person, we use that to say that whole groups of people should follow suit.  There are different types of and degrees of regret.

This blog is going to attempt to explore some of that in an effort to support both people who want information about transitioning and people who will no longer follow the path of gender transition.

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Transition, transitioning back, de-transition and regret

This is an important and often upsetting topic. I want to brainstorm about it and get feedback about these ideas.  I am trying to talk about these ideas in a cooperative consultative way so I am entirely open to constructive criticism.

Mostly, I don’t hear or see people talking about it unless they are using it to take a political or clinical position against gender transition or to denigrate people who transition back. People will use quotes from articles like the one below to support their positions:

International research suggests that 3-18% of them come to regret switching gender.  http://www.guardian.co.uk/society/2004/jul/31/health.socialcare

I want to point out that 100-3 is 97% and 100-18 is 82%.  So 82-97% of people don’t regret surgery following their numbers.  The vast majority.  I’m still interested in those 3 -18% but don’t want to lose sight of the vast majority who are happier and their quality of life has improved.

I am interested primarily in determining if there are ways to identify people for whom surgical and perhaps hormonal transition are the wrong direction. I believe that medical and social transition is vital for some people and am not open to dismissing it as delusional.  At the same time,  if there are ways to identify people for whom a therapist or doctor should say  no, or not yet or have you thought about X?  Are there experiences that therapists misunderstand or mislabel or simply miss.  Essentially, can we do better?

The people who see it as politically or clinically wrong tend not to be that helpful on this front, but are often the only voices out there.  When a biased idea is the only game in town, it can be a significant problem for a community.  I have seen a couple of balanced blogs about this issue and will make reference to them as this goes along.  It also turns up in the news periodically when something terrible happens like Christine Daniels/Mike Penner’s suicide.

Of course, there are people who regret transition. While I do not mean to make light of this, I have to say there are people who regret having children, who regret not having children, who regret marrying the person they married, who regret the choice of college they attended, who regret that they did not attend college, who regret bariatric surgery—who regret very significant choices in life.  What was known about bariatric surgery or Lasik surgery at the time a person made the decision is quite different now and increasing numbers of people regret those decisions.

Often people who start hormonal transition and change their mind are thrown into the pile of regretters and detransitioners as well.  There are also people who would make a different decision now than they did last year, five years ago, ten years ago, etc.  That’s a different concept.  There are people who are fluid and move back and forth between genders.  If a person’s gender identity doesn’t fit the frame that some people may apply, it doesn’t make them people who are unhappy about their choices.  It is not a heterogenous group.

Not all of people who regret transition are truly people who made a wrong decision for them at the time they made it.  Sometimes people make the right decision at a particular time for all the right reasons and then ten years down the road, they are older, more experienced, more educated, or the world has changed and they would make another decision today.  A wise friend elaborated this concept for me recently and it’s something hadn’t applied in this context.  I regularly use this idea in therapy when people are critical of choices they made as children and as youth.  They are looking at those choices as though they had all the knowledge and wisdom they have developed over their lifetimes.  They were six, fifteen or nineteen, not forty or sixty yet they are judging their youthful experiences as if they should have known at six, fifteen or nineteen what they now know at forty or sixty.

To my knowledge, there is NO actual reputable research on regret or de-transitioning. I have seen some people pull out statistics out of context and use them as proof that GCS/SRS is an inappropriate intervention.  Available research gets distorted.  Similarly, people will often pull Renee Richards out as an example of a person who regrets transitioning.  As an avid tennis fan, I have watched, read and listened to everything I could find on Renee Richards for decades and think people have focused on statements she made at different times and statements taken out of context.

Dr. RICHARDS: Well, I guess that’s right. I mean, I’ve always been competitive, and I’ve always been unafraid of taking on new challenges. But it was a very difficult decision, and when people talk about, oh, well, Renee Richards has all these regrets, they only think that it’s the regrets about the sex change, and that’s really not what the regrets are about. The regrets are about that decision to try to take the battle to the courts to be allowed to play and then actually playing as a professional. http://http://www.npr.org/templates/story/story.php?storyId=7277665

</blockquote>
There are a number of explanations about regret and these are broad, sweeping sorts of statements that need more explanation. &nbsp; I’m going to focus on genital surgery–which has improved over the past decade.  It is also possible people who regretted the surgery in the past wouldn’t, if they had it today.

The point of surgery is to decrease gender dysphoria and improve or further consolidate gender identity.  It is not to fix anything else. Regretting transition and regretting the consequences of transition are two different things. In most change, there is some loss.  Whatever the status quo or homeostasis was before transition will be gone and people have to adjust, like getting married or moving in with someone, there will always be loss with change, even good change. Sometimes people cannot anticipate the losses or the degree to which the losses will burden them.

Off the top of my head, these are some reasons that people regret surgery or detransition.

1) People who expected that the surgery would change everything that was wrong in their life, only to discover that what it changed was what was between their legs.

2) It doesn’t make discrimination go away. It won’t fix their social life. It won’t make some people accept them as women or as men. (One’s parents are not likely to change their mind and accept a person as a son or daughter if their child changes their body.)

3) People who are having the surgery to keep a partner or spouse and not doing it for themselves.

4) People who did not like the aesthetics of the surgery. &nbsp;They were disappointed in how they look.

5) People lost function. &nbsp;Orgasm. Peeing was hard.  Remember that surgery has improved greatly over time.

6) People who had complications post operatively.  (By and large most people who did have post-op complications, still do not regret transitioning.)

7) People who lost family, friends, community.

8) People who lose partners. &nbsp;Partners say it is okay with them for a person to transition and then the partner discovers they didn’t know themselves well enough to honestly say that or the partner changes their mind.

9) People who do not realize that it can be difficult to find a partner.

10) People who didn’t really understand the outcome of the surgery. &nbsp;I find this one particularly disturbing because true informed consent mean they DO understand the outcomes of surgery.

11) The individual was not transgender.  There were mental health issues that were undiscovered or intentionally kept from whomever did the evaluation.  The assessor missed something or no evaluation was done.  The big one is body dysmorphic disorder. Another one is trauma co-occuring with other mental health issues. The trauma one is hard to talk about because a trauma history could be used against people inappropriately.  Any mental health issue can be, though.

Examples of trauma related issues might be dissociative disorders, where a male bodied person was multiply raped or molested as a child and the only way the person can make sense of this is that they must be a woman, where a female bodied person transitions to male in an effort to protect themselves against male violence. The latter two issues do not mean that the person will necessarily regret transitioning.  Transitioning may be the exact thing they need to do to make sense of their lives and to be able to move on and live. This would be more an issue where providing information and clarity about a person’s thought process is important.

12) The person did not know that non binary identities, for instance, genderqueer (as an umbrella term) was an option.  They thought they had to have the whole process.  Maybe when they had the surgery, there was no other choice other than the binary.

13) The person lost social status or privilege and struggles with that loss. There are privileges that no one should have and rights that we should all have.  When people transition, they lose privilege. Losing privilege is a significant experience.  Becoming a visible minority is a big deal.

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