My Slides from USPATH panel on Detransitioning

Here is a 30 minute video of me talking through my slides as a primer for clinicians based on my perspective on some things I believe it would be helpful for clinicians to be mindful of when working with clients interested in detransition. As I say in the video, this is only my “slice” from my own perspective and there are many other important ideas and suggestions (in some cases contradictory from mine) from others who need to be listened to. I will append transcription to this post when I can.  A lot of this is really basic stuff and if you had been reading this blog when it had a lot more of my content there is not much new here.


Collecting my thoughts from USPATH

I wanted to do a quick post on a things from the USPATH conference.  First of all, thanks to my fellow presenters and to USPATH for having us.  I thought the other presenters did an amazing job and I was really pleased to have people who attended the symposium come up to me throughout the conference to sincerely thank us for providing fresh perspectives on the subject of detransitioning.  I think it is a huge step in the right direction. Thank you to all who came out (or wanted to come but had schedule conflicts.)  It was really heartening to see you there.

I am sure pretty much everyone who reads this blog knows Dr Kenneth Zucker (who was one of those who came out to our panel) had his own symposium cancelled the following day following a large protest by those who perceived his participation as an act of violence (through inflicted trauma) against the Trans community.  I posted the following on the WPATH facebook page and usually when I post there I don’t repost it here for lack of context , but in this case I will repost it here.

“I have to say that I am disappointed in WPATH’s no-platforming an invited speaker. I saw the protest, and for me it was a sad and chilling reminder that voices that run counter to traditional Trans talking points are often silenced by the community. As a detransitioner, I have experienced it directly time and time again. I am thankful that the detransition mini-symposium was low profile enough not to be the subject of a similar ban as I know that there are those who feel the voices of detransitioners are not “helpful” to the community and need to be minimized. While I respect the passion and advocacy of the protesters (many of whom were represented in a powerful symposium on the academic and clinical marginalization of WOC within the field of Trans care which was one of the best sessions I attended) I see the actions of calling for no-platforming those that they disagree with as a step backwards, not forwards.”

Today, some of the ideas for the 8th iteration of WPATH’s Standards of Care were discussed.  I applaud a lot of these ideas, such as moving more towards making the document much more evidenced based and also the solicitation of a more diverse group that is representative of the population served is determining the standards.

I know that a call was made to remove the data on desistance from the document because of “bad data”. This comment was met with some of the strongest applause of the session today (discussing the upcoming SOC). I strongly urge WPATH and its membership to aggressively pursue trying to get better data on this and keeping it as an important part of the standards.  Unfortunately, because desisters often fall off the radar, this is historically difficult to track.  And that is part of the problem …

We have to do better not to let them fall through the cracks.  We need to be better prepared to anticipate desisters. We need to have Standards of Care in place to meet the needs of those who “desist” or detranstion. Any substantive discussion of the issue  is sorely lacking at this point. The subject was not even brought up in the opening remarks of what needs to be added to the SOC, which did actually surprise me because my impression was that this was on the radar for WPATH as an emerging issue.   To not even get a mention was disheartening and worrying.

I have offered whatever assistance I can to WPATH in helping move forward in developing standards for this population and I encourage other detransitioners to do the same because yours is the input they need the most.  I am ever the optimist (sometimes to my own detriment) and I know that others might worry that this as an exercise in futility. I get that and understand.  But at least I believe it is important to try so I will offer whatever I have.

I encourage those who work with the population to work with researchers to aggregate better data on who is desisting.  Longitudinal studies are key (and will continue to take time of course)  but case studies are still helpful here as well, because it is important to learn what happened and begin to consider what interventions, supports and resources may be helpful to this population.  Of course we need more researchers on this topic as well so who wants to sign up or collaborate with a (soon to be) MSW? We should not be afraid to be curious on this most important topic. We need to be prepared to have some ideas of what to do when youth (and adults) begin to desist/detranstion. I have a feeling that a lot of clinicians are lost here just because there is so little information on the topic and so few venues to share information and discuss this topic openly and without fear of professional marginalization.   (Full disclosure, I am nervous even writing this here as someone who is going to be entering the job market in a few months.)

It was also worrying to hear the continued devaluation of the skills of mental health professionals in this field (ironically often coming from clinicians themselves.)  One of the ideas floating was opening up who can do gender related assessments to ANY providers who work with the Trans youth population (partly due to the shortage of available clinicians and the growing demand.)  For a lot youth, there are other issues going on (i.e. family systems, environmental factors, risk for suicidality, DV, trauma and other cognitive or  neurodevelopmental issues) that I believe ARE important to be assessed for that I do think that only clinicians have the training and the professional obligation to be uniquely qualified to perform. To forfeit the opportunity to provide a holistic and thorough assessment seems like a profound disservice.  And to be clear, I agree that most youth who identify as Trans certainly don’t need to be subjected to a distressful battery of tests such as the MMPI, TAT etc., but basic clinical assessment and judgement I believe is an ethical responsibility. This is especially so within the context that many are advocating that the requirements for minimum age for surgical procedures should also be eliminated.  (Another interesting proposal was the elimination of requiring testosterone for adolescents requesting chest surgery … which on one hand I support as less invasive but also worry that the magnitude of such surgery is minimized in the process.  I have heard from some that in retrospect this became too became a source of regret.)

That is all I have for tonight. I do want to emphasize once again that I believe that most of the providers I met with are working tirelessly to provide the best care they are able for a population desperately in need.  I also believe that this conversation must proceed in a way that does not inhibit the needs of those who (I believe) need access and benefit from these services. Unfortunately the political reality is that this population is especially vulnerable right now, so of course due diligence in how information is used and disseminated is more important than ever!  But that does not mean we need to silence the conversation … we just need to move carefully and mindfully, with respect and compassion.  And while continued passionate activism from the Trans community is absolutely essential and helpful, it cannot dictate the science itself as that does not do anyone a service.

I am going to upload my presentation slides from USPATH in the next day or so for anyone curious … they are mainly bullet points of what I was talking about so I may or may not do a quick video version.  I also want to make an effort to republish a small portion of reader comments from my blog from those who have so eloquently described their own experiences, which is the content that I feel needs to be heard the most so unlike my own postings I recently restored temporarily I may leave those up for awhile.


Putting some of my site back online temporarily

I am at USPATH conference and it was really fantastic today to see people come out for the detransition minisymposium.  I didn’t talk too much about my own journey there, but I have decided to re-publish a few of my posts on a temporary basis in case anyone is curious about what this blog was all about.  I’m leaving a lot out  .. mostly these are just random snapshots from the lifespan of this blog when it was a going concern.