transgender

Philly Follow-up

This is a followup to the recent no-platforming of our two workshops at the Philadelphia Trans Health Conference. More details here:

There has been a lot of discussion across various forums about the detransition panel. A lot of people providing support and criticism. Some of it for things I actually believe, and a lot of it for things I actually don’t believe. This unfortunately is par for the course for Internet discourse and for discourse in general in the West. I actually think this is a much larger problem than detransition issues and sometimes I think I should focus on that instead. People dividing more and more into ideological camps and being unable to communicate with each other is a huge problem. People always have different ideologies and disagree about stuff. People with different ideologies observe the same world differently. They literally have different facts. That is part of what makes communication difficult. The challenge lies in interpreting the statements of the other charitably, assuming that they have a good intention even if it alien to you. This can be challenging but is an important practice. Some people really don’t have good intentions, in which case the best thing to do is maybe not communicate with them at all. However even many people that are lashing out in some way there is usually a pain or hurt behind that, and the person will soften if you acknowledge it. For Game of Thrones fans this is the exact opposite of Littlefinger’s advice. ☺

If you are critical of things I say I welcome dialogue, I hope that you would approach me with the lens that I am flawed human being trying to do what is best for others and myself in the world, and I promise to approach you in the same way.

One of the things that I find a particular blessing in my work is that I come in contact with a lot of people with a lot of different worldviews. People I would not have encountered in the past as I have spent most of my life in a liberal bubble. I feel my perspective has broadened in talking to people of all different orientations from all different walks of lives. I have come to see the value of the conservative viewpoint as well as the liberal. I also agree that our political views are mostly related to the moral intuitions that come from our different temperaments that again creates another barrier for us to communicate with each other. Though I am a liberal by temperament, I see these other views as important and valuable. I am not a relativist, I believe that things are better than other things, It is just that neither the left nor the right has a monopoly on that. If anything, my number one political issue is stand against those who seek to impose their views by authoritarianism and censor others against those that believe in ideological pluralism. That is not a left vs. right issue.

Now I would like to respond to some of the common themes I have seen in the discussion. I don’t speak for my co-panelists, only for myself:

“This presentation is a secret front to promote TERF ideology”

This idea came up a few times. The idea was that we were actually using detransition as a distraction to promote radical feminist ideology. There was no political intention behind the presentations at all. As I said, I am not in any way a radical feminist and therefore don’t promote their ideology. The presentations were about exactly what they said, no more no less. Some of my co-presenters may or may not have radical feminist views, there was no political litmus test to participate in the panel, nor should there be. Detransitioners are in a very difficult place regardless of their political affiliation.

If you wish to dislike me because of my political beliefs, you can dislike me for not being a pure Leftist. Most people in this discussion are on the Left. (trans people, detransitioners, radical feminist, clinicians). Ideological monocultures are dangerous when looking for scientific truth, because they lead to groupthink and blind spots. We all have blind spots; hopefully we can find people with different blind spots and dialogue with them.

“Detransitioners are a hoax perpetuated by radfems / detransitioners have been brainwashed by radfems which is why they are all AFAB (natal female) and young.”

This comes in two different flavors from people who have noticed that the majority of detransition blogs are from younger AFAB people and many of them have radical feminist leanings. This is definitely true. Not all AFAB detranstioners are radical feminists, but many of them are. It also true that the majority of detransitioners are AFAB.

I saw two different criticisms to explain this, the first was that these people are fake and are a hoax perpetuated by radical feminists to discredit trans people. They are not a hoax, there are a growing number of their videos on the Internet to prove that they exist. I have myself been accused of non-existance a couple of times, which is one of the reasons I made a couple of videos.

The second criticism is that they have been “brainwashed” by radfems in order to stop them from transitioning or their detransition is legit but they have been co-opted by radfems. This is getting cause and effect backwards I think. They can tell their own stories, but I think for many of them they found that the radical feminist ideology served the same function as their trans identity did as the past, to make sense of difficulties around being female in our society, and from bad experiences with men. I think the fact that there does seem to be a pattern of detransition centered around this demographic is concerning, especially because this is the exact same demographic that has greatly increased in presenting to gender clinics. So much so that it has flipped the sex ratio of these clinics. This wave of detransitioners comes before the peak of this trend, so if there is a true pattern here it is likely to grow a lot larger. If that happens, it is pretty important for the trans and detrans communities to work together to find constructive solutions to this, or otherwise there will be the kind of arbitrary gatekeeping that no one wants. It is not a good outcome if someone undergoes medical interventions, decides they don’t want them, and suffers from permanent lifetime consequences.

It is also clear that there are young AFAB folk that are happy with their transitions and interventions, so I am not saying this is true for all of them.

I am AMAB (natal male) and middle aged so I am not part of the typical demographic of detransitioners. I am also encountering more male detransitioners than I did in the past, but it doesn’t seem to be a systemic thing like it does with the AFAB folk. I think trans identity in AMAB and AFAB folk don’t parallel each other for the most part, and we shouldn’t take generalizations from one and automatically assume they are true for the other.

“This presenter is anti-trans and wishes to stop people from transitioning.”

Even though I say it nearly every post, people keep seeming to think I have the secret agenda to stop people from transitioning and throwing roadblocks in their way. Someone even used a post where I literally said some people should transition as proof that I “opposed transition”.

It is true that I am interested in finding ways for people to work with dysphoria without transitioning. I wish I had learned what I learned before I did it. But, the whole point of that is to create additional options for people, not to take options away. I support you 100% if you choose to transition in the way you see fit. I also thinking finding ways to work with dysphoria is applicable for people who undergo medical transition as well, because many of them still have dysphoria, even if their transition significantly helped reduce it. I think any of us that have dealt with dysphoria know how difficult it is, which is a difference between most detransitioners and other critical folk.

I do think we should try where possible to sort out who might be at a higher risk of eventual detransition, or who have other issues which interact with their dysphoria, or who can deal with their issues in other ways. That doesn’t mean they shouldn’t have agency over their own lives. Adults at least, are ultimately responsible for their own choices. Also, we don’t really know how to do this, so the only practical thing you can do is try to clear out as many confounding issues as possible, while keeping in mind that the person might be unable to do that depending on the severity of their dysphoria.

The whole reason I create this blog is to try to help people with gender dysphoria live the best possible lives. The evidence is clear that transition and medical interventions help some people, I just think we are throwing caution to the wind, particularly as there many, many more people presenting as trans than there used to be, and the reasons for this aren’t fully worked out.

“These presenters are bunch of crackpots who think you can cure dysphoria with yoga and dance which is false and unprofessional.”

This came up a lot, someone even referred to it as “yoga for dysphoria”. I think people completely misunderstood the intention for this panel. I wrote the description so that is my responsibility. I don’t think anyone would suggest that you can do yoga and poof your dysphoria will go away, that would be silly.

The intention behind the panel was to attempt to make a bridge between the detransitioner and trans communities because many of us have or continue to deal with dysphoria. Even many people who transition and find it helpful in dealing with their dysphoria still have dysphoria. Even many people who detransition still have dysphoria. Detransitioners have found some ways to work with their dysphoria, and I think some people who are happy transitioners have also found some ways to deal with their dysphoria. It was intended to be a bridge between the two communities so we could talk about what worked for us. I think people interpreted it as if I thought people could “cure” themselves with yoga or dance or something which is not the case. For people who are happy with their transition, the goal was to help people find ways to work with their remaining dysphoria, this is something that is almost never discussed in the trans community. There is also no research on it that I know of.

The specific things that were listed were things that many detransitioners have reported were underlying causes to their dysphoria. For me, personally when I am talking about dance, what I am actually talking about is embodiment, which is the antidote to dissociation. When treating dissociation we often get people engaged with their sensory experience some way, in a safe space. Dance for me was the vehicle for embodiment; I am not saying “dance your dysphoria away”. Many people report becoming less dissociated after transitioning, but some people report being more dissociated. I think reducing or eliminating dissociation is a sign that you are on the right track.

In any case the main point was to talk about coping with dysphoria whether you are happy with your transition, considering transition, or detransitioned, not to “cure” you of your transness.

“This presenter is bad because he is supported by radfems, this is proof of his evil intentions. He should denounce them and not associate with them.”

This is the guilt by association piece, saying that I am responsible for who likes my blog. I have also had people think I am responsible for the full contents of every article I have ever linked to. When I link to an article I am not always endorsing it, and even when I endorse an article it doesn’t mean I think that every point in that article is 100% correct.

For the second point, absolutely not! One big problem is that is happening right now is that there are all of these decentralized groups running around on the Internet, they are leaderless and people become members just by identifying with them. Opponents of these groups find the worst members of the group and then treat their actions as representative of the group. The “leaders” of the group are whoever is most popular, which is basically whoever the Internet decides are there prominent spokespeople. One thing I have found when interacting with groups whether they are trans activists, radfems, liberals or conservatives is that they are very diverse, and contain both extremists and reasonable people. I am open to dialogue with any reasonable people, and have had good conversations with radical feminists. They are not a monolith. The same holds true for trans people, I don’t hold all trans people responsible for the actions of the activists that cancelled my presentation. Likewise no one elected me a spokesperson for detransitioned people, so the things I believe should not be taken as representative of all detransitioners.

I will however condemn people who engage in hate. Those who mock, shame and belittle trans people. Those who call trans people mutilated, and condemn them as freaks and sexual deviants. That I do denounce, clearly and fully. Some of these same people call detransitioned people mutilated too, and use our stories to make political points.

“We are okay with detransitoners speaking, just not these ones who are promoting toxic ideas.”

This is a great piece talking about the “good detransitioner vs. bad detransitioner” framework. In other words, detransitioners are welcome as long as they don’t have any problem with what happened to them, and don’t criticize what is currently going on. As long as detransition is just a personal choice it is okay to talk about, if we are critical of some of what happened to us then it is not okay to talk about. Only certain kinds of detransitioners are acceptable. Many of us feel harmed by what happened to us, and are critical of things told to us by the community or therapists and that is part of hearing our stories.

“Detransition is just another stage on some people’s “gender journeys” and should be supported. We should honor their journeys and find speakers who see it that way.

This is similar to the above point. Detransition is much less threatening if it is framed as part of someone’s “gender journey”. In other words, this framing said we had a different kind of gender journey, adopting a trans identity and then a different one. Preferably a non-binary one. There are some people who have exactly this journey. It is also not much of a problem if this happens.

However, there people who feel profoundly harmed by what happened to them. Sometimes I communicate with detransitioners who are so full of regret that they are at the point of despair and suicidality. To call what happened to them a “gender journey” is an deep insult, and trivializes the pain that they are in. It is affirming something as a “journey” that was destructive to them.

This presenter is dangerous because the ideas in his blog might delay people getting traditional medical treatment causing them harm.

This is a potentially serious criticism. In reading the discussion around our conference, someone reported that my blog caused them to delay the treatment that helped them. This person eventually went through medical and social transition and reported that this was highly beneficial to them, and that they had delayed treatment based on the blog. They said I was being irresponsible because “transition is the only way to deal with gender dysphoria.” I was really troubled by this, because the last thing I want to do with my blog is make people suffer more.

There is both scientific evidence and many self-reports that people’s lives are improved by gender transition. I do not think that all people can deal with their dysphoria by means other than transition and medical treatment. There are many people for who that is the only way, and even for the people that are looking for other ways we are just beginning that process and just have the ideas that have worked for us. That is what this is.

However, the statement that “transition is the only way to deal with gender dysphoria for all people” is not true. Dysphoria is on a spectrum, it ebbs and flows, and has more or less intensity. There have always been people who had dysphoria and have not transitioned or felt the need to. Some of these people cross-dress, some of them just have fantasies, some of them take low-dose hormone therapy, anti-androgens, or anti-depressants, some of them choose a different name, some of them find the drawback of medical transition to outweigh the advantages, some of them just cope with their dysphoria and find it manageable. Some of these people identify as non-binary and trans, some don’t. At least a couple of dozen people have told me directly they have found the things I said to be very helpful in dealing with their dysphoria, as an alternative to transition, so they are out there.

So, my position is that it is true that at this time there are people for whom transition is the only way or the best way. It is not however true that this is true for all people with dysphoria. Also it shouldn’t be a requirement that this be true for someone to undergo medical transition. Having more agency and choice in ones life is always a good thing.

It is also true that sometimes parents and loved ones read my blog and are distressed by their loved one’s impending transition and think that the blog will help them. Maybe or maybe not, it is not some magical cure. If you do feel like something I said was harmful, please let me know. I would like to know how to present things in the best way in order to help the people that will be helped by what I say and not harm the people that it will not.

No platformed!

Carey Callahan and I were scheduled to present two panels at the Philly Trans Health Conference. One of these panels was on detransition and the other panel was on alternative ways to work with gender dysphoria. We additionally gathered some other detransitioned and re identified people to present with us. The descriptions are below:

Detransition Panel

Detransition (reversing transition and returning to presentation as natal sex) has historically been a rare phenomenon. However, the numbers of detransitioners are growing. For the first time there are communities of detransitioners. Detransitioners face similar challenges to those that are transitioning as well as some that are unique to detransition. People detransition for a variety of reasons. Some people detransition for social reasons. Some people detransition because they discovered that transition was not right for them or did not help with their dysphoria. Some people detransition because they discover their original desire to transition was secondary to trauma or other issues. This panel will include personal stories, reasons for detransition, challenges faced by detransitioners, as well as the fledgling research into this community. Finding care can be difficult for detransitioners as there is little research or knowledge about the community. This topic can often be difficult to discuss in the trans community, leading to a sense of isolation and confusion among some considering detransition. This panel is for those that are hoping to learn more about this community, those that care for gender variant people, those exploring their own gender and those that are seeking cultural competence with the detransition community. This panel is open to anyone.

Alternative Ways of Working with Gender Dysphoria

There is much research available that shows that gender transition and medical treatments are effective in reducing gender dysphoria. However, some people find that transition does not reduce their gender dysphoria. Others are happy and satisfied with their transitions but still find they have lingering dysphoria and might want additional tools to work with their dysphoria. This workshop will cover various ways that those of us in the detransitioner and re-identifying communities have found to work with our dysphoria that can either be an alternative to transition or in addition to transition. Some of these methods include mindfulness, embodiment practices such as dance and yoga, expanding and transcending our sense of identity, working through trauma, working with internalized gender schemas, internalized homophobia, internalized misogyny or internalized limiting beliefs about various genders. This workshop will include a discussion of techniques that those in gender variant communities, no matter where they are on the transition spectrum, have found to cope with their dysphoria. It is intended to be a non-judgmental space where we can all come together and share what has worked for us.

I was wary of proposing these panels because I was worried about how they would be received, but a member of the planning committee repeatedly encouraged me to propose these panels, and I was hopeful that this would be a place for good dialogue. I am very interested in trans folk and detransitioned people working together to figure out the best ways to work with dysphoria. Both USPATH and the Trans Health Summit in 2015 had the courage to allow and even encourage such discussions to take place and they were well received. I thank them for their courage and particularly the people who encouraged us to do the panel.

Our panels were approved with no problem and we were making preparations to for the panels. We have spent hours working on the content and some of us have made travel arrangements paying for things out of our own pocket. We thought everything was set to go.

The first I found out that something was amiss was by reading a thread on Reddit’s r/asktg which was questioning whether the panels should be presented at the conference or not because they were presented by people that had “TERF-leaning” blogs. I am not a radical feminist, but they tend to place anyone who holds views they oppose in this category. One of them claimed to receive the following reply from the conference:

“Thank you so much for bringing this to my attention! Our workshops are chosen by our community run planning committee. They did not know the toxic nature of this workshop. We have decided to cancel their workshop and they will not be allowed to submit workshops in the future. We here at Mazzoni and at the Philadelphia Trans Health Conference extend our apologizes for letting this slip through. Thank you so much for keeping us accountable.”

We had not heard any news of this, so I asked my contact at the planning committee about it and she hadn’t heard anything either. Eventually it turned out this was not official, and the planning committee decided to vote on whether we should be included or not as they had received calls and emails complaining about our inclusion in the conference. The committee met and voted over the next few days.

A couple of hours ago I received word that the committee voted to cancel our workshops. We had worked very hard on this and much energy went into it. Additionally, some of us are out our travel costs as we were expecting these workshops to go on until just now, less than two weeks before the conference.

We were hoping to have a good dialogue and discuss these issues with the intent of sharing what we have learned, to help to discuss what we have learned and so that we can all figure out better ways to work with dysphoria and figure out more about who benefits from transition and who doesn’t. I say over and over again that I am supportive of trans people transitioning but that is not enough. Transition caused profound harm in my life, and I am not going to be quiet about it, but I also support those who do transition or take hormones, or engage in medical interventions. It is precisely because I care about people with gender dysphoria having the best outcomes that I take the risk to write this blog, risking my career and reputation by writing about very personal stuff and taking on all the risks of having “politically incorrect” research interests and views. As a graduate student, I am particularly vulnerable to this. I had made this blog semi-anonymous for this reason, but that is no longer the case as I do my academic work under my real name. I knew it was inevitable that this would happen, but it is even more important to not be silenced.

This is a risk that should not exist in a free society, our different views should engage with each other. People have said they thought my views are wrong. It is almost certainly true that some of my views are wrong, the trouble is I don’t know which ones. The way to figure that out is precisely through dialogue, through research and through debate. There is more and more no-platforming going on through our society preventing just this process.

Additionally, detransitioners are particularly vulnerable both being attacked by members of the trans community, and facing some of the exact same challenges that people in the trans community do. Many of us are gender-variant in some ways either in appearance or demeanor, many of us have to deal with the same kind of name changes and bureaucratic challenges, and having our name and gender changes exposed on background checks. We face much the same discrimination and trans rights are our cause too. Those that wish to silence us are censoring a marginalized minority group just because we are politically inconvenient.

I still hope that we can work together and dialogue with each other to create greater understanding and better ways to work with gender dysphoria for both those that transition and those that don’t. However, I am less hopeful of that than before.

Also, please share this widely if you care about the well-being of detransitioned people and those looking for ways to work with gender dysphoria, or if you care about academic freedom, and the open exchange of ideas.

UPDATE: The conference did offer to pay our non-reimbursable travel expenses.

TWT – Now on video!

I haven’t written much recently. A lot of that has to do with being in grad school, the last thing I want to do is even more writing. 🙂 So I’ve decided to start creating some videos. This is the intro video where I tell my story and I eventually hope to make more videos about detransition and alternative ways to deal with gender dysphoria.

Transcript:


Hello, my name is TW. I am the author of the blog Third Way Trans and I thought I would make a video about detransition and also about different ways to deal with gender dysphoria. This is inspired by several of the detransitioned women that have been recently making videos and so I decided that there should be videos from the detransitioned men as well.There’s already a few and there should be more. This is going to be the first in a series.

This is just an introduction. One of the reasons is to help other people who are transitioning so they feel like they’re not alone and they can have someone to talk to. So if you are ready to detransitioning or considering detransitioning you can definitely email me at the address that is given by the video and you know i would be happy to chat with you. A second reason is also to help people deal with their dysphoria. One of the things that I discovered in this journey is that there were other ways to deal with my dysphoria that would work better and also would have been less harmful. I had to go through this whole transition first in order to figure all that out and I had to spend 20 years being transitioned. I transitioned when I was 19 and detransitioned when i was 39. I’m 42 now. I spent all this time transitioned and modified my body in many ways which is still causing problems to this day and I want to help people be able to deal with these issues without having to go through that. To be clear, I don’t oppose transition and I really understand how debilitating gender dysphoria can be.  So I don’t propose to ban transition or eliminate it, or to eliminate treatments like hormones and medical treatments.

I don’t think these treatments should be eliminated but at the same time we should help as many people as possible to work through these issues without having to go through that because it’s a horrible thing to go through, and it’s imperfect and leads to social problems and potential medical problems including sterility. The last is very important. Having children is very important to many people and may not seem so important when you are young.

Transition has become much more visible as many more people are identifying as trans than there used to be. I remember when I first looking at these issues back 20-25 years ago the reported incidence was about somewhere between 1 in 10,000-100,000. 10 years later the incidence numbers look more like 1 in 1200 – 3,000. Recent numbers used at this point are 0.3% or about 1 in 300, and a recent survey shows something like 0.6% which is about 1 in 150 or 1 in 125 or so. The question is what is this? Is this because of greater social acceptance as some people say? Some people say, oh it’s great people can be themselves. Or is there an element of social contagion which is leading more and more people to jump on the bandwagon of trans. I think it can be both.

I definitely think that there are benefits to having more social acceptance because a lot of the issues to do with being trans have to do with lack of social acceptance and all of the
stigma. That will help trans people to live better lives but at the same time I think there’s also some elements of social contagion. People who would have not transitioned in other times but in this time consider it, are probably the ones who maybe have better ways to deal with their issues and so I think there’s definitely a problem going on. I think it’s a problem with therapists that rubber-stamp people’s transitions. For example, seeing them once and approving them for hormones which I think is pretty bad practice. Especially because I have training as a therapist. I have a master’s degree in psychology and I am now in a PhD program in clinical psychology. I worked in three different clinics seeing a lot of clients including trans clients.

One of the things I learned in my clinical training is just in general how little you know about someone when you see them once or twice or three times. There’s so much we don’t know.  They don’t really trust you as much in the beginning.  If you’ve been a client in therapy you probably know  what it is like to work with a new therapist or psychologist.  You don’t really know them and it takes time to be comfortable with them and to be able to tell them things. As the therapist it also takes time to figure out what is going on. It takes time. I mean, the places I work we don’t even make a treatment plan until three or four sessions because we don’t really know you, like we have to figure it out. If you are writing a letter to somebody after one session you don’t know them. You don’t know enough There’s no way even really great therapists can know enough. Again, I do think people benefit from this practice, and I do think it should exist, but I also think there needs to be a lot more exploration beforehand.

Particularly, people who transition often talk about issues of trauma. They talk about abuse, sometimes there is sexual abuse. Sometimes there is kind of aversion to being their sex because they hate their sex. For example if you’re a woman that hates being a woman because they don’t like dealing with men or things like that. These are things that can be worked with psychologically sometimes.  OCD can be there sometimes too. I think there needs to be a lot more of this kind of exploring beforehand and definitely more than just 1-2 sessions. I don’t know how someone can have the clinical training I have and think that is good practice. Especially someone who has been with clients and known how much complexity they have and how much depth they have and how much you don’t know about them.

I guess I’ll also talk about my own story. When I was a child I experienced trauma issues with bullying. When I was young I was physically the slowest boy but also very intellectually advanced like a child prodigy. By fourth grade I was going to the high school to take high school math, and on the other hand I was the weakest. So I was singled out for being a kind of super nerd. This didn’t make me popular at all. It made me popular with the adults actually but not my peers. So I suffered a lot of bullying and violence. It peaked in middle school where every day I would have some sort of violence directed at me.

When I was a child I started to have this fantasy of being a girl, because it meant I could be safe and not suffer from this violence due to being at the bottom of the male hierarchy. I could also be more soft. I used to cry a lot and that was also something that was not seen as good for a boy. I could be free of all of that and also still be intellectual because everyone was saying that girls can be smart too.  Of course I did’t understand the complexity of society then and all the prior sexism behind that message because I was six. It became a fantasy that kept me comfortable, not something that could really happen, more like a fantasy I had.

Then when I got to adolescence it continued and became tied to sexuality. I was also attracted to women so it was confusing, and my dating life didn’t got well when I was a young teenager. I was a late bloomer but eventually once I got to be a junior in high school I did have some success in dating and had several different girlfriends. After that my gender dysphoria declined.

When I got to college, in the first few months I didn’t meet any women and it felt like a real step back and my gender feelings resurfaced again.  Now I understand that one of the reasons I was successful in dating as a high school senior was because I was at the top of the heap and then when I became a freshman in college I was at the bottom of the heap. This was in 1993, so I was on the early pre-WWW internet and at the same a trans newsgroup was created on Usenet, and I heard people who had similar feelings to mine and it was like a revelation! Other people had these feelings too and I could relate to them. It meant you could really do this. It could really happen!

One of the first things I did was go to my university counseling enter and talk to the intern there. He seemed freaked out. Then I went back a second time and he said this was beyond the scope of the counseling center but we have these referrals to give and they gave me a referral to a gender clinic. I was kind of mad at that because I had to pay for it. The counseling was free at school, I didn’t have much money as I was a student. Ok, I went to the clinic and told the psychologist my story and that I wanted to be female. I didn’t talk about bullying and I was unaware that it was related in any way. This is something I sorted out later when I was in real therapy.

So, I was just like this is who I am and this who I want to be and they were like that’s great. There was no kind of anything, just two session and I was given hormones. One thing I’d like to point out that is kind of ironic is that at the time this was not considered good practice and a violation of the standards of care. At that time they said you had to have at least 12 sessions of therapy for hormones. That’s not true any more. Lots of people are doing it after just one, two or three sessions. This thing that was harmful in my life has now become standard practice in the clinical community.

This really became my identity, and I was young and there were very few young transitioners then, so it wasn’t actually that hard to become seen as a woman, and I started to get a lot of positive attention. That felt really good, I felt like things were going well, but objectively that wasn’t the case. I always got really good grades, but I was put on these really high doses of hormones which were crazy. We don’t do stuff like this any more but I was on the equivalent of 17 birth control pills/day at some point. Just unbelievable! It seemed like the medical community was like okay we are just going to do weird stuff with you people and not follow any good practices. That has actually gotten a lot better over the years.  I think there is a lot more understanding now of hormone practices.

This caused me a lot of problems like my brain wasn’t working right. I was not able to do my work in school. It was also hard because my transition was very visible at a small school and this wasn’t common then. Also there were still things that were wrong. This was supposed to cure my dysphoria, however what I found is that it didn’t actually do that.  It just made me uncomfortable with different parts of my body that weren’t feminine. I had really big hands and a big jaw and so I still had the same problem of hating parts of my body.

Now, I had additionally the problems of being trans in the world, like a lot of social problems. Sometimes people would be aware I was trans and sometimes they wouldn’t and all of those were problems. If they weren’t aware there was a sense of I can’t tell them about it, and that really closes off intimacy because you can’t share this really important part of your life. If they did know about it there would be lots of different reactions. Some people were fine. A lot of people were fine on the surface, but they would really act differently towards me. It almost felt like having no gender at all and being outside of humanity. It was a really awful feeling.

I really thought this was was my identity and what I had to do. Even though there problems I thought it was something I had to do because it was my truth. There were other problems too. My body was really tense all the time and I was disconnected from my body a lot and had a lot of dissociation. I wasn’t even aware it was dissociation, it was just kind of the way I was. It is only now that I am in my body that I understand the difference. So yes, there was a lot of problems.

I had difficulty romantically too. There were actually a lot of people interested in my but I was not able to bond with people. This was really frustrating and eventually I started to go to therapy. I wasn’t working on my gender, but on why I couldn’t have relationships and why my body was so tense.  I started to do therapy and all of these embodied practices. I got involved in meditation. I got involved in doing dance practice. I got involved in doing a practice called Biodanza which is a sort of practice where you learn to connect to yourself and other people. I eventually became aware I was really disconnected to my body. I eventually came to the realization that a lot of this had to do with my attempt to present myself female which was unnatural for my body. I was holding my shoulders in and holding my butt out, and doing all sorts of things that were outside the natural movement of my body. This was causing strain and stress on my body.

I came gradually to the realization that this was actually a problem. That this whole transition was actually a problem. It was still difficult because I still had this feeling like maybe I should be a man, but it was totally unsafe emotionally and I couldn’t do it. I did a lot more therapy and eventually came to understand the roots of this with the bullying and feelings unsafe about being myself and a man in the world. I didn’t see things this way in an intellectual sense, but in a visceral. So, it was a long process and eventually I worked through. It was also a big revelation because I thought my gender identity of being female was fundamental. It seemed like an absolute truth and an absolute axiom, and then it turned out not be that at all. It turned out to be something that could be change.

This was very surprising to me because there is all this thought around gender identity being something that can’t be changed and that it is permanent. Although now it is getting kind of confused because it’s permanent but it also can be fluid and it can also change but it doesn’t change and there is no real kind of consistency in the whole ideology behind it.  Having learned that it could be changed, its really something I would not have wanted to do through because it’d be much better have dealt with my issues without changing my body so that I wouldn’t have the difficulties I have now.

I can’t really get my hormones right. I take testosterone but it doesn’t work right, its always a problem because I can’t find the right balance of it and never get it right. I know I can’t recover my body all the way. For example I look way younger than I am which people think is positive. I don’t like it because it reminds me it isn’t right. I want to look like a 42 year old man because that is where I am and not being seen as that is frustrating sometimes. There is also breast growth and stuff like that. I could get rid of it but it also feels like that is just changing my body more so it brings issues.

If you’re interested in the clinical implications I experienced this and other people have experienced this and they are talking about they have dealt with dysphoria A lot of women have gone back, and there are some men as well that found ways to deal with dysphoria. They found ways to work with it, and it is very important for the clinical community to be aware there are ways to work with it. We should be working on this a lot more even if we support transition. I do support it for some people. We should still simultaneously be working on how we can help people deal with these issues without doing that because it would save people a lot of trouble and a lot of expensive imperfect medical interventions.

One of the reasons I went on to a PhD program because I want to research those ideas and also ways to work with dysphoria. In this series I am going to start making some videos and focus on the ways I’ve seen other deal with dysphoria as well as just some general psychological principles. Sometimes it seems like we just throw out the basic principles of psychology, and we need to put back some of these ideas. It takes a while to know someone and human nature is complex. I think things would be better if we kept that in mind. That’s all I have for today. It is just an intro to tell you about myself and I’ll be making more videos. Also feel free to read my blog which is listed in the comments and email me if you have any questions. Either questions about dealing with dysphoria, or maybe you don’t want to transition or have questions about detransition and want support about that. Thank you.

Identity is not the same as authenticity

I have been again thinking about identity, because it seems to lie at the heart of all the recent discussion of transgender issues. I have also been thinking about how the way we treat identity with respect to gender dysphoria is very different from that with other conditions. In fact, the way we treat identity with respect to gender dysphoria is the polar opposite of the way we look at most other conditions. In many different contexts, I was taught the importance of not making an identity out of someone’s condition.

For example, we try not to say “schizophrenic” instead we say “person with schizophrenia”. We try not to say “a depressive” and instead say “person with depression”. However, with gender issues it is the reverse, we are encouraged to say “trans person” rather than “person with gender dysphoria” and also to affirm those identities.

The reasons for this disidentification process are several. One is to avoid distorting our perception of the person so we do not see them as just their condition. We must remember that they are so much more than that. Another reason for this practice is to avoid stigmatizing them, so they are not seen as being just that particular condition, they are a full dynamic human being with many different parts

Another reason for this, relates to the person seeking to work with their condition themselves. When someone identifies with something it becomes frozen. It is much harder to treat someone for depression if they identify with it. If they say “being depressed is just who I am, it cannot change.” that is much harder to work with that than someone who says that they “have depression”. One technique for those who are too identified with their depression is to externalize the depression. We try to get them to see the depression as not their whole self, and to perhaps say “that is the depression talking”. This tries to bring their whole self into the picture, rather than just the depression, as the rest of the self can get lost when an identity is formed.

I have talked about identities as self-concept in the past. However, another important aspect of identity which I neglected is group identity. A lot of identities involve identification with a group. When people talk about identities they are often talking about things like race, class, national identity, political identities and certainly gender. Group identities divide us into groups. They say who is “us” and who is “not us”. The desire to be part of a group is a very basic human desire. We are tribal creatures. However, when group identities come into play, they tend to override objective reasoning. There is a sense that our group is right and the other group is wrong. Reason is no longer used to explore the truth, but is instead used to support our moral position. Arguments become moral, rather than rational, and moral reasoning trumps objective reasoning. This is part of what makes discussion of trans issues so difficult. Identity comes into play, and discussion becomes very difficult.

Another problem with group identities is that they can result in a loss of individuality. Connecting with a group and being a part of a group can be such a good feeling, especially if it is a group of people that reflects parts of oneself that have not been reflected before. A lot of my own impulse to transition 20 years ago arose in part from my encounter with the community. It felt so good to encounter people that shared the same feelings about gender that I did, as my gender feelings felt like a deep secret that I would never share with anyone and did not share with anyone “real”. Talking to people who had the same feelings and could relate to my experience was so great. I do think it played a role in my adopting the transgender identity. I am not saying that I adopted this identity due to peer pressure, as the reason I adopted this identity also related to the deeply held feelings that I had. It is rather the intersection between my deep feelings ,and the group that led to my development of this identity. I think this is true of most identities, they are the intersection between biological factors, temprament, and social identity. Cross-gender feelings exists in all cultures but how they are expressed is different depending on cultures. In one culture one might be considered a shaman, in another an abomination, in another a transsexual. Cultures and subcultures say these feelings mean certain cultural identities and the ultimate expression lies at the intersection between the cultural ideas and the internal feelings.

In a way, there is something strange about talking about people “discovering their authentic identities”, because I actually see authenticity as something that opposes identity. I see it as something that lies beyond identities. Identities freeze things into place, and are almost like heuristics. They are shortcuts for who we are, that help explain who we are to others, but are always partial. So, affirming someones identities, is in a way taking them away from authenticity. It is not surprising that many of the people who write of detransition cite mindfulness as an important factor, because mindfulness is precisely a method for loosening identities and the holds they place on us.

I am not trying to say identities are all bad, indeed they are important. They are important because they allow us to feel a part of a group. They are important precisely because they act as heuristics. If we had to feel authentically into each moment of every day that would be a very slow, inefficient process, and probably quite difficult to pull off. Also there are problems associated with lack of stable identity, such as borderline personality disorder for example. Like Jack Engler said “you have to be someone before you can be no one”. Sometimes being authentic can be very difficult or impossible due to the pain associated with it, that can be a reason to live in identities. There is nothing wrong with that, it can be what is right for that time and it can serve an important protective function. Exploring identity is generally seen as part of normal adolescent development, because it relates to being in the world and playing roles in society. However, it seems like we have taken to reifying identities and mistaking them for the person themselves, when they can only be an approximation.

Can transition be the best solution? Yes, but I believe the answer lies under identity and not in identity, because that is where the creativity lies. So, I think it would be much better when looking at these issues to see someone as a person with gender dysphoria, rather than a trans person or a potential trans person. The same applies when exploring one’s own issues. This means the whole person doesn’t get lost and many solutions are possible. It also changes the question from “determining if someone ‘is’ transgender” to determining what the best way to move them towards wholeness.

taking dysphoria literally vs. symbolically

This article by Dr. Schwartz posted on the 4thWaveNow blog discusses the need for caution when working with transgender children. In particular, one thing he talks about is looking at the things that children are saying about their gender symbolically rather than literally. He says that differences in treatment philosophies arise from which lens the clinician views the child’s gendered self, as a literal truth or a symbolical one. In particular he says the following:

“It is possible to respond to children in a manner that is either organized around their literal narratives, or around psychological interpretations of those narratives, which themselves take into account such inner contradictions and perplexities as described above. Toward which path the clinician leans may be strongly influenced by the degree to which he or she shares the child’s apparent view of gender, that is, holds the assumptions of essential gender, or not. Simply put, if you believe gender is an internal reality, you will likely be guided or motivated to accept a literal hearing of the child’s narrative, since it matches that view. The child’s self-presentation may then seem straightforwardly comprehensible enough to guide you in clinical decision making. On the other hand, if your prejudice is to hear any claims about real, inner gender as necessarily—necessarily because you do not believe gender is real in the sense described above— composed of symbolic or metaphoric representations, then the child’s story instigates an active interpretive process, and clinical decision making proceeds differently”

Later on he goes on to say:

“There is much more to children than what they say. We owe to them a deeper listening than a literal one.”

This article is talking about children, but much of what he is saying applies to adults as well, who also have symbolic psychological processes, which just might be a little more buried. Giving this kind of deep listening and taking the time to do so is something that is not happening much with therapeutic work with gender issue currently. There is a sense of “well that is just your identity, and it shouldn’t be questioned.” This kind of deep listening also takes time, and is not something that can be done in a couple of sessions of therapy.

Indeed, I think this focus on taking gender thoughts literally is precisely what makes cross-gender roles in modern Western culture different from those of other cultures. Lots of cultures have cross-gender roles of some kind, but only in the West do we have the idea that one literally becomes the other sex, and that indeed the whole point of transition is to do just that. This also brings with it the idea of “passing”, proving your membership in the identified sex by becoming indistinguishable from natal members of that sex. This is also something that is not considered part of the gender-variant roles of other cultures.

If taking gender dysphoric thoughts and feelings symbolically, seems strange or a form of denial, it is helpful to see that this is something that we do all the time, and in fact it is quite important that we do so.

Consider being angry at someone for wronging you in some way. You might feel anger, and have the associated thought “I am going to kill that person”. Taking that thought literally would cause a great deal of trouble. There are lots of responses that you can have to the feeling of anger, and the thought “I am going to kill that person”, some of them healthy and some of them are not.

One possible response to the anger is to feel shame, that you are a “bad person” for having such angry thoughts, and a good person wouldn’t be angry and have the thought about killing someone. This would just add to the emotional pain and would not do anything to assuage the anger.

Another possible response is distraction, to pretend that it isn’t happening and distract yourself. This sometimes is a healthy response, as the emotion might be too overwhelming to deal with right now, or be related to some temporary chemical issue like meds or hormone levels. However, it does nothing to meet the underlying need of the anger, and even if something is heightened by brain chemistry issues, there still might be a real need underneath that. Anger is an important signal and shouldn’t be ignored. Distraction shouldn’t be an always thing, and many mechanisms of distracting from feelings escalate over time, such as numbing behaviors like drug use.

Another possible response is to try to repress it, saying “I’m not really angry”. This tends to only strengthen it.

It is also possible to construct an identity around it. “I’m an angry person, that is just how I am” This will make it a lot harder to work with as you take it as an essential part of your identity rather than as an emotion. This will also strengthen it.

Another response is to accept it, this doesn’t mean you literally do what it says, but that you acknowledge and accept it. The function of anger is to provide energy to deal with an obstacle. There is likely a real obstacle that needs to be dealt with in some way. Once you have acknowledged and accepted the anger you might get some insight into what that is, and sometimes it is obvious. Once you know you can act appropriately to meet that need, perhaps there is different way to meet the need, or perhaps you have to negotiate with that person, or perhaps you do need to engage in appropriate consequences for them. This can be hard in the moment of course. The important thing is that the anger is a real signal of your real needs and is not always unhealthy.

To take dysphoria symbolically is similar. There is a feeling of dysphoria, which is distress and dissatisfaction combined with thoughts such as “I should be a woman”, or “I am a woman” or “I hate being a man” “Being a man is disgusting”, etc. Like anger, this distress is on a spectrum and can go from mild to quite overwhelming. To take it literally, is to go through transition / hormones / surgery. This may be the right thing, but it is not the only thing. There are other responses besides taking it literally.

Shame and repression have similar effects here that they do with anger, and denying it by saying “I’m really a manly man” or something like that and attempting to live that will also make things worse. Dyphoria points to the fact that something is wrong and needs to change, it is an emotional response that says something is wrong. The associated thoughts give a proposed solution, but like the “I want to kill this person” thought, it is not necessarily the case that they be taken literally. Constructing an identity around it also strengthens it like with the anger.

The question is what are the underlying needs? They may be sexual, but they may not be, and I think it is ultimately the psychological needs that drive one to transition (vs. just having a fetish) Ironically, one of those needs might be to avoid the shame of having a fetish. In any case, there are real and valid needs that are underneath the dysphoria and it is important to meet them. It is only important that they be met somewhere in your life, it is impossible to meet all of our needs in all aspects of our lives, and indeed we must make compromises in order to have relationships and connection with people, and that is the single largest determiner of happiness.

Sorting this stuff out is something that can take time, and indeed something I think there needs to be more of. Yes, adults at least should have the right to transition, and transitioning does improve some people’s lives. However I think there is the need for more exploration, I sure wish I had that. I was approved for hormones after just 2 sessions of therapy, working out everything took 150 sessions.

Here is a story of someone who worked through things symbolically. Here is a
story
from a man who work on integrating his own feminine side but wasn’t transgender. I also recommend the site Transcend Movement in which he talks about a similar process of working through things symbolically. I am not saying that everyone can deal with their gender issues through such a process, but I am saying that more people can than currently are.

The obstacles presented by ideology in discussing trans issues

One thing that makes discussion of trans issues very difficult is that it that it lies at the intersection of ideology and truth. Science strives to seek truth and to be ideology-free. It can never meet this goal because it is done by humans who are incapable of being ideology-free. Still, it is the best method we have for minimizing the effects of bias and trying to get at an accurate picture of the world.

Jonathan Hadit, who is one of my favorite psychological writers, studies moral reasoning. He wrote an excellent book about it called The Righteous Mind. One of the things he talks about is that people have certain values that they hold sacred. He talks about the ideological differences between liberals and conservatives as being largely due to the fact that they hold different values sacred. When the tribal values are threatened people are far more concerned with neutralizing the threat then what is true or not. These sacred beliefs essentially become religious beliefs and anything that challenges them feels like heresy.

This is just part of the natural condition of humanity, and the same people that can be very capable of reason and nuance about questions that do not concern their sacred values suddenly become incapable of it when they do. I remember having a co-worker who was a decent programmer. He was also a Scientologist, and would occasionally talk about how “L. Ron Hubbard was an incarnation of the Buddha, and a messiah” or other Scientology related topics. I found it perplexing that he could have the logical chops necessary to be a good programmer and simultaneously be a Scientologist, but once beliefs acquire a religious character they are immune to logic. It is much the same with political ideologies.

One of the other things Hadit talks about is the importance of diversity of ideologies in creating good science. Scientists, like all people have ideologies and sacred beliefs. Scientists are often quite passionate about their theories. They are far from neutral, disinterested observers. So, any one scientist runs the risk of having their bias interfere with their observations. Science has tools for neutralizing bias from double-blind studies to peer review. Peer review relies on other scientists looking over the science, but they too have biases. If you have an ideologically diverse set of scientists then the effect of their biases are minimized. However, to the degree that they are not ideological diverse, groupthink and other phenomena can prevail. This effect is increased if the scientific study in question contradicts the sacred tribal values of that particular group of scientists.

In the therapy world we are also concerned with the biases of therapist interfering with the therapy and making it hard to see the client clearly. This phenomenon is called countertransference, which is where the therapist projects their own stuff onto the client and does not see the client clearly. Being aware of this is a start, but therapists are people too and are often blind to their own biases and personal hooks. One way to counteract this is through consultation groups, to get the opinions of others who do not have the same biases that you do, and therefore can see things clearly that you can’t see. However, if the therapists in the group share the same ideological beliefs and biases, then this does not help, and can even make things worse as phenomena such as groupthink take over.

Having a strong conviction that the “other side” is absolutely wrong about everything is a sure sign of being engaged in tribal thinking. The truth is messy and cuts across ideologies. It can be very difficult to let go of tribal thinking as it gives a sense of belonging, which is a primal need. If one does commit to the truth wherever it leads you, you are likely to be denounced by all ideological tribes. That can be a very lonely path. Speaking out for truth that goes against your tribal values is very difficult. I recently read Alice Dreger’s excellent book Galileo’s Middle Finger where she talks about the conflict between truth and activism. Indeed, Dreger, as someone committed to truth over ideology, is often denounced for both being a “crazy liberal” and “neo-reactionary conservative”. I once read two articles denouncing her in these opposite ways within 10 minutes of each other.

The community of psychologists and therapists is far from ideologically diverse. Hadit, who is a social psychologist, gave a talk to a group of around one thousand social psychologists and asked them how many identified themselves as conservative or moderate. As described in this article in the New Yorker,
only 20 or so identified as centrist and only 3 identified as conservative. There might have been more conservatives that feared the career ramifications of openly identifying themselves as conservative. Further research in the article confirms that 37.5% of those social psychologists surveyed would be less likely to hire a conservative colleague, so their feelings would be entirely justified. This article describes social psychologists specifically, but similar phenomena exist with clinical psychologists, social workers and other mental health professionals.

I have come to the reluctant conclusion that it is progressive ideology itself that is the one of the things that gets makes it difficult to work on these issues. As a life-long liberal, and former card-carrying member of the ACLU back when that was a thing, it has been tough to come to that realization. I have long considered liberals to be my tribe and to see this ideology as itself being a problem makes me feel like I am without a tribe. However, since tribalism itself is the issue, perhaps that is a good thing. I want to emphasize that all ideologies get in the way of seeing the world clearly, it is just that the particular ideology that dominates the psychological profession is on the left. In particular, the following aspects of progressive ideology, particularly the specific progressive ideology of the psychological profession come in to play:

Privilege / Power Dynamics

Progressive ideology views the world in terms of privilege and power dynamics. People are divided into privileged and marginalized people across various axes. Why this is relevant is that is trans people are seen as a marginalized class while cis people are seen as a privileged class. This brings in to play various aspects of progressive ideology which is concerned with equalizing power dynamics. Indeed, helping marginalized people have a voice is a noble goal, however sometimes this ideology can cause harm to the very people it is trying to support.

One for the related ideas is that a marginalized class has been silenced and it is important that their voices be heard, particularly about their own experience. The privileged class is deemed to not understand the experience of the marginalized class and should listen to them. This is indeed true, and there is a long history of medicine centering men and treating women as afterthoughts and other examples of only paying attention to the dominant class. So it is indeed good and important for trans voices to be heard about their own experience.

However, this ideology leads to trans narratives being taken at face value by clinicians, and digging underneath them to be seen as being against the tribal values of the clinicians working on these issues. This is a well-meaning attempt to bring social justice to the marginalized people.

However, digging underneath things can be very important. Psychology is full of ideas about how people have defenses, self-serving rationalizations and all kinds of ways in which they don’t necessarily understand their own motivations. This is just as true whether someone is privileged or marginalized, and to ignore this when working with marginalized people is to do them a disservice. Indeed it is giving them lesser care, than you give to privileged people.

Primacy of narrative / lived experience

Another part of this ideology is the primacy of narrative and lived experience. This means the subjective is more important than the objective, and that lived experience trumps scientific research. This goes triple when it intersects with the ideas of privilege/oppresion referenced above. This is another idea that has good roots but can be taken too far. Narratives and lived experience are indeed important. As a therapist it is important to bracket aside theory and make sure that you are not treating a client as an object, or a theoretical construct and seeing the person as an individual. People are messy and do not fit cleanly into boxes.

However, the theoretical constructs and scientific research matter also. There is a vast deal of difference in degree of scientific orientation among psychologists and therapists. One problem in psychology is that the academic community of research psychologists and the community of clinicians and therapists often don’t talk to each other. Some sections of the the clinical community are even actively anti-science. Some professors in my master’s program would use the term “evidence-based practice” almost as a swear word, like it meant un-evolved. The narrative is not the only thing that matters.

Nothing is pathological

Progressives are absolutely allergic to the idea of pathology and tend towards the idea that calling anything pathology is “stigmatizing”. So there are movements to talk about how everything from bipolar to schizophrenia is a healthy variation of human experience. Many even question the very idea of mental illness. They are quite correct that stigmazing causes harm. I think it is harmful to stigmatize people based on their conditions, however we should never lose track that some things are healthier than others. For me the question of whether something is healthy is not whether it is normal but rather whether it is functional. Even being functional in some environments is sufficient, that is just a matter of getting to the right environment.

I recently read the excellent book Buddha and the Borderline by Kiera Van Gelder. This book tells of a woman’s journey in healing from borderline personality disorder. She describes how much of her community as well as many of those therapists and psychologists that treated her did not want to give her the borderline label for the reason that it would be stigmatizing. She acknowledges that it can indeed be stigmatizing when she is labeled borderline by others, but it it is also helpful to acknowledge it as an illness and that helps her in working with it.

I think refusing to understand that there is a such thing as health and a such thing as pathology causes problems, especially if you are in a profession where you are supposed to be an agent of health. Pathology should not be mistaken for diversity.

The insider experience is the only one that matters

Progressive ideology centers the insider experience, and holds that the words of a member of a group are those that are valid about a group. For example, only trans people should speak about trans experience, only women should speak about women’s experience, only black people should speak about black experience etc. It is indeed quite true that people that don’t have a certain experience are likely to get things wrong about that experience. Women are likely to see things about their experience that men don’t see, etc. Problems arise when the people studying something are all of one group and they are studying a different group. This idea also intersects with the idea of priviledge/power, and so applies in a much larger way when it is a privileged class studying a marginalized class.

This is an important idea, and tremendous harm has been caused by the lack of representation of minority groups in health. It is a very good thing that their voices are being heard in respect to their own health. However, while it is true that the insider can see what the outsider cannot see, it is also true that the outsider can see what the insider cannot see. Fish can’t see water. How many times have you encountered someone who had some false idea about themselves that everyone but they could see? This is precisely why the outsider perspective is important also. It is best to see something from as many perspectives as possible. All groups whether marginalized or privileged are prone to cultural blind spots and groupthink. Particularly in the case of groupthink, an outsider perspective is precisely what is needed.

Identitarianism

I have written quite a bit about my views on identity here, and here The identity politics wing of progressivism strongly encourages a focus on identity, both the importance of personal identity and an identification with particular groups and classes. In addition to the critiques I made earlier, one problem with identiarianism is that it exacerbates the kind of tribal thinking that clouds truth. Once people feel their group is threatened they focus on defending their group rather than truth. This is just hard-wired into human psychology.

Conclusion

The nature of tribalism, identity and ideology increase the difficultly of find scientific truth on trans issues. The tense nature of these discussions drive away many people who might be interested in working on these issues, and also causes harm to trans people, as they are deprived of scientific advances and the best possible care. Understanding these effects and working towards minimizing them can help to reduce the tension in the ongoing discussion and help us work towards a future where all those who are dealign with these issues receive the best possible care.