A “sinister mental trap”: One man’s journey back to himself

Potentilla is a detransitioned male who spends his days farming, making gardens, practicing herbalism, and reading Carl Jung. He is interested in history, human nature, and the occult, and greatly enjoys giggling with strangers, the utter improbability of life, taking long walks, and making music with friends. He is available to interact in the comments section of this post. Potentilla can also be reached at potentillacinquefoil@gmail.com, where he is happy to discuss these issues privately with concerned parents and people contemplating transition or detransition.


by Potentilla

I was born male and lived for the first five or so years of my life totally OK with that. As I got older and was taught postmodernism, white guilt and misandry, I started to hate my male body and wanted my maleness to be destroyed. I became suicidal and practiced self harm, including towards my genitals. I wanted to magically turn into a girl, and thus be redeemed.

Growing up, it was hard for me to conform to the norms of American masculinity. Part of this is that my dad is a reflective and empathetic man, and so my natural model is someone who himself doesn’t necessarily conform to gender norms. Nevertheless, I was ok with my body until maybe the age of 19, when I realized I’m attracted to other men and am both a “bottom” and somewhat swishy. Around 20 I had multiple crises; I moved to a gay hippie commune, I broke up with my first serious boyfriend, I did too many drugs, became homeless, and had several very confusing sexual relationships with women.

Slowly I came to believe that I was a repressed woman. It is a testament to my credulity that I could honestly assess my own life situation, and yet come to that conclusion. But that is exactly what happened. Trans let me explain away all my problems with a new and compelling narrative. This promise held enormous emotional appeal. At the time, I was living in a trans/genderqueer space where there was a cult-like atmosphere in regard to transitioning. Being trans made you an insider and conferred upon you sympathy, respect, and resources. Being merely gay was frowned upon.

For the past 10 years ago or so, I’ve “lived as a woman.” For the first 8 years of that, I was on cross sex hormones, when I began to use herbs to manage my health.  I had an orchiectomy about 7 years ago. After my surgery, every punk house was open for me to live in. I had become a protected class.

Even though I didn’t pass as a natal female, being trans made my life easier to navigate socially. People seem much more comfortable with a somewhat feminine man becoming a transwoman than a somewhat feminine male owning his maleness. It is fascinating that this is the case, that it was and is scarier for me not to pretend I’m a woman.

So, I had some very compelling reasons to transition, those being:

  1. unprocessed trauma concerning my gender
  2. poor mental health and poor reality testing
  3. social pressure
  4. social rewards
  5. a postmodern ideology that rewards transition

I believe that the trans movement has qualities that make it very similar to a cult. I became trans for the very same reason that people join cults; and similarly to those who escape cults, I’ve found profound healing in my slow path towards detransition.

Now, almost ten years later, it is clear that I am not a woman. In fact, it is obvious that I am still very much a male, but now with breasts and mutilated genitalia. That is an uncomfortable position to be in; not only was I mistaken; everyone knows it. But his uncomfortable reality is still preferable to the intense self-delusion and narcissism that I lived in and with for many years.

The Curse of Trans

While there is a certain temptation to accept all of this as personal failings; while there are certainly many ways that I have been weak and unstable, it doesn’t feel particularly genuine to try to explain my immersion into trans as solely a personal choice and experience. To understand trans sensu lato means understanding the ways it resembles a cult. I transitioned only after heavy indoctrination into genderist ideology. Most pertinent was the pernicious “cis” and “trans” dichotomy.

I believe this binary ideology to be a very profound curse to susceptible individuals. “Cis” is defined as someone who is okay with their body as it is, while “trans” means someone who isn’t okay with their gendered body, regardless if they physically transition or not. Given this definition, most people have at certain points of their lives been functionally trans. This is usually especially pronounced at puberty, and it is horrifyingly predictable that we’re now seeing a trend of trans children, given the intersection of pubescent dysphoria and genderist ideology.

When I encountered this false dichotomy, naturally I put myself on the side of “trans” because I have a long history of hating my gendered body. Once I accepted this as true, I was locked into the certain path of claiming I was a woman. This led to faith-based beliefs that “gender is innate” and “I am a woman,” which in turn led to the blind faith that “hormone replacement therapy will solve my problems” and “I’ll be so much happier after I’m castrated and no longer male.” This was compounded by the widespread belief that transgender feelings grow worse with time and inevitably lead to insanity or suicide if there is not medical intervention.

And away I went, my mind totally taken with genderist ideology, with full faith that transitioning was the only way to save my life.

This is why I consider “trans” to be a curse. I imagine the evil trans witch standing over the gender-nonconforming children lost in the woods, reassuring them that “cis people are comfortable with their bodies and trans people aren’t. I can help you become at home in your own body” as the children follow her deeper into the woods to be transformed. What the children don’t realize is that they must pay for this with a piece of the glowing, golden ball that is in their hearts. Later, only a few become disillusioned and decide to retrieve the piece of their heart that they lost. They wander alone hither and thither in the dark woods for many years to find the sacred springs where they wash off their deception, fear and helplessness, and find that the golden ball never actually left. They are still themselves, only disfigured and disoriented by the deal they made with the evil witch. But they are finally able to leave the dark forest and again become part of the human family.

glowing heart

I’m open to the idea that some individuals need to transition to live their authentic selves. There may very well be folks who genuinely and beautifully find themselves in transition. That being said, though, I believe it is inevitable that these stories of self-discovery through sex change, no matter how true they are or beneficial to the individual, contribute to the destructive myth of the trans/cis binary. I don’t want to generalize too much from my own experience, but I also strongly believe that transition does profound harm, even when it does help. People have the right to transition, but I also believe that the entire gender identity movement has become unfathomably destructive, especially to gender nonconforming young people who, for the most part, would almost certainly otherwise be homosexuals. There are areas of subtlety which I’m not sure how to explore in this regard, and they are beyond the scope of this essay.

Sense of Self

During the time I believed I was a woman, I enjoyed every step of transition, because it gave me an identity. I didn’t know who I was and a transgender narrative gave me a handle to understand myself. Rather than needing to take care of the wounded parts of my self, I created an entirely new persona, and I played that part every moment of every day.

This worked as a great solution for a time; I did a good job playing that part, rather than living as my authentic self, and was thus shielded from the vicissitudes of the world. This is of course textbook narcissism, which makes me wonder if trans is as much a cult of narcissism as a cult of gender.

With time however, my authentic self was nonetheless nurtured by my experiences and I began to become more genuine. This transformation had three parts:

1) Leaving the Trans Cult

After a nasty breakup, I left a queer land project and LGBT community where postmodern Marxist ideology was very dominant. I constantly self-censored to fit in with the group. My own political leanings tend towards Burkean conservatism, so I was more or less lying to myself and others. I attended mandatory sensitivity training which had the feel of a political indoctrination meeting. Almost every day, I ritualistically confessed my guilt as a white person in conversation with my peers, and they did the same with me. Over time I began to feel an actual intense guilt. And with that, I began to wake up to the fact that this sort of politic was bad for my mental health.

So after my nasty breakup, I left this queer community and got a live-in job at a farm. My coworkers there were much more free thinking, and I began to find it easier to think for myself. That year I worked 55-hour weeks and read about 60 books (including Spengler, Odum’s Ecology textbook, Marcus Aurelius, Homer, and more). This study, and the new milieu with new friends, allowed me the opportunity to learn that I’m strong and capable living on my own, and my worldview was massively expanded.

2) Going off Hormones

About 9 months after leaving the trans cult, I stopped taking hormones, and began taking herbs, and studying them, to maintain my health instead. I could pursue a passion that connects me to my inner self while showing me that I’m not dependent on maintaining a trans identity to meet my own health needs.

medicinal herbs

I’ve also developed skills which have helped many other people. In turn, I saw people valuing me for something deeper than my identity. I am very passionate about plants and have been my entire life. I am also open and spiritual in my psychological orientation. This makes the study and practice of herbalism deeply rewarding to my authentic self, and helped me become strong enough to escape from living mostly out of my trans identity.

3) Detransition

After leaving the queer land projects, I fell into several other social milieus where thoughts were heavily policed. By this point I had already stopped believing in the idea of transition, but kept up appearances for social benefit–and that social benefit was huge. Certain people would hire me because I was perceived as trans. I could find places to live with queer folks largely on account of my identity. Living in these environments, which were well stocked with self-appointed thought police, was bad for me, and I began contemplating leaving. Near the end of this time I developed debilitating chemical sensitivities, and decided my best bet was to live with my parents for a time. At that point, the entire trans narrative dissolved, and just as quickly, my chemical sensitivities became very easily manageable.

Some Closing Thoughts

Over the years, I’ve known dozens of trans people. Most had reasons that were less convincing than my own for transition, and as we’ve seen, my own justifications were rather feeble. This leads me to believe that, by and large, trans is a disingenuous ideology that is a current mass hysteria. It is also clearly something of an unintentional eugenics program against gender nonconforming folk. The entire enterprise makes me feel sick. It has become trendy to commit oneself to lifelong hormone therapy and surgical mutilation. I was not able to correctly appraise the situation at the time I became trans and deeply regret the decision now.

Going a little deeper, trans is profoundly sexist and actually creates less diversity in expression. I went from an authentic, studious, awkward, somewhat feminine man to performing full time as a trans woman. Eventually my authentic self reasserted itself, and now I’m slowly moving towards more integration. The trans narrative does much more than merely normalize mental illness; it creates mental illness. I would have never transitioned if I hadn’t been wounded by postmodernism and then given an escape hatch in trans. The narrative made me crazy just as much as my own predisposition made me vulnerable to it.

My sense is that no one wants to hear the voices of detransitioners until it is too late. My sincere hope is that some people who are considering transition, as well as parents with “trans” children, might read my essay and choose a brighter path than that of transition. Please learn from my mistakes and consider other options. Most dysmorphia goes away with time. The entire trans narrative is a sinister mental trap which is profoundly harmful. There are infinitely better ways to deal with the universal experiences of dissatisfaction and desire to be someone else.

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Dental dysphoria: Transgender medical procedures trump essential dental care across the US

by Worriedmom

Tax time rolls around again, all too soon, and as I tally up the itemized deductions for my 2016 return, I realize, to my sadness but not my shock, that once again this year, our dental expenses are close to $13,000. Between four adult children needing a variety of dental services, and the fact that my husband and I are beset with age-related dental woes, some months I think I pay our dentist’s office rent all by myself. Although my husband has a generous medical plan through his employer, it does not cover dental expenses, other than those incurred in an accident, and this is typical of many employer-provided benefits packages. So, we pay.

And when I pay, I take a moment to think about the people who can’t pay – but they still have teeth. What do they do? What happens to them?

First, if you’ve ever had an untreated cavity or, worse, an infection or abscessed tooth, you know that the pain involved can be incredibly intense: you can’t think, focus, or do virtually anything, until the situation is addressed. The drugstore has shelves filled with ointments and gels for treating dental pain, not all of which are for teething babies! Second, poor dental health affects nutrition. Ability to eat and appetite are adversely affected by painful or missing teeth.

According to the Kaiser Family Foundation’s “Access to Dental Care in Medicaid” report, “Research has also identified associations between chronic oral infections and diabetes, heart and lung disease, stroke, and poor birth outcomes.”

A serious side effect of poor dental health in adults is its adverse impact on employment. People whose teeth are unsightly or missing are often deterred from seeking employment, or better jobs, and can suffer discrimination in hiring. Poor dental health is not a “protected class” for the purposes of anti-discrimination law, so employers are free to decline to hire a candidate on that basis.

cletusAs a final but not at all minimal side effect, consider the psychic distress and embarrassment experienced by people with unattractive teeth. In the United States in particular, missing, crooked, or discolored teeth are associated by many people with ignorance, lower class status, poverty and other negative social qualities.

At 4thWaveNow, we do understand that the plural of anecdote isn’t evidence, but two quick stories might shed some light on the magnitude of the problem:

  • A 28 year old man from my church, who lacks dental insurance, is living with persistent tooth pain. One week it becomes acute. He leaves work and seeks care in the emergency room, where it is found that an infection has spread to his entire jaw, and he will now (after spending four days in the hospital), lose all of the teeth on one side of his mouth. He has also lost his job. Eighteen months later, he is unable to afford to replace his missing teeth and is still unemployed.
  • Another friend has a failed root canal which wakes her up with screaming pain in the wee hours of the morning. By the time she receives emergency care from an endodontist at 3 AM, the infection is already so aggressive it is invading her soft palate. The endodontist tells her if she’d waited until the next day to seek care, the infection could have potentially gone septic, and/or reached her brain.

Yet, we all treat dental care as if teeth and gums are not even connected to the rest of the body…

How widespread is lack of access to dental care in the United States? According to the Centers for Disease Control, in the period 2011-12, 17.5% of children between the ages of 5 and 17 and 27.4% of adults between the ages of 20 and 44 had untreated cavities. In 2014, 62% of adults between the ages of 18 and 64 had a single dental visit within the previous year; more than one-third of adults had not. Put another way, a 2012 Kellogg Foundation report estimated that some 83 million Americans faced barriers to dental care.

Medicaid, as our non-United States readers may not be aware, is the US health insurance program that provides health care for low-income people from birth until approximately age 65; it also pays for nursing home care for destitute adults of any age. Medicaid is the primary way for low-income or disabled people to access health care (and access to Medicaid was expanded in states which opted in via the implementation of the Affordable Care Act in 2010). Medicaid is administered through the states, and although there are some things that the federal government says that states must cover, dental care is not one of them, except for people under the age of 21. While some states have decided to provide dental care as part of Medicaid, fewer than half provide comprehensive dental care for adults and some do not even cover dental care that is required due to an accident.

The map below of dental coverage availability under Medicaid shows that 15 states provide “extensive” dental benefits (defined as benefits that can be chosen from a list of over 100 dental procedures); 19 states provide “limited” dental benefits (fewer than 100 covered procedures); and as to both of these classes, the annual benefit “cap” is $1,000. Several high-population states, including Florida and Texas, are among the 13 that cover only emergency dental care, and 4 states provide no dental coverage at all.

medicaid dental coverage map.jpg

Access to dental care is also inconsistent: in 2009, due to severe budget strain, the state of California eliminated adult dental care as a Medicaid benefit and did not restore it until 2014. Similarly, Illinois removed this Medicaid benefit in 2012 and restored it only in 2014.

How much does dental care cost in the United States? As might be expected in a country with such a large population and highly disparate financial circumstances, the answer is, it depends. In Connecticut, a high-income state, the average cost of a cleaning ranges from a high of $85 to a low of $66. In Mississippi, a low-income state, the same cleaning cost range is $60 (high end) to $45. For full mouth X-rays, the Connecticut range is $132-$87 – and the Mississippi range is $102-$63. For a filling, the Connecticut range is $139-$84 (for a non-front tooth that hasn’t been filled before) and in Mississippi the range is $105-$65. Finally, in Connecticut the range for a root canal (ouch) is $1,258-$1,046, and in Mississippi, it’s $918-$738. (All prices sourced via Dental Optimizer, an online dental cost calculation tool.)

With prices like these (notice that the cost of a root canal would likely exhaust an entire year’s dental benefit even in a state that provided comprehensive dental benefits through Medicaid), it’s probably no wonder that so many adults in the United States go without adequate dental care. In fact, kind-hearted and generous dentists actually provide “Missions of Mercy” to underserved populations in the United States, similar to medical missions that visit places like Rwanda and Zaire. A free dental clinic recently offered in Hartford, the capitol of Connecticut, attracted over 2,000 people, including one man who waited in line for over 15 hours to see a dentist (and recall that Connecticut is a state that provides “extensive” dental benefits under Medicaid).  For another recent example, a free dental clinic held in South Carolina attracted people who waited in line for over two days for dental care.

Dental charity clinic.jpg

Well, that’s enough of those unsexy teeth. Although there have been several articles and studies decrying the lack of dental care provided to adults, and detailing the negative overall health impact of that deficit, it is safe to say that this subject does not begin to arouse the passion and outcry comparable to that surrounding the demands that transgender people’s transition-related expenses ought to be paid for (by somebody else). There are no groups that have formed to advocate for access to dental care. Research has not disclosed a single demonstration or protest or letter-writing campaign or organized action on behalf of adults who lack access to dental care.

By contrast, there has been tremendous activism in the United States centered on compelling private insurance companies and the Medicaid program to provide transition-related health care. Similar activist pressure for guaranteed nationwide coverage of transition services was also placed on the Medicare program, which serves seniors and disabled people, but an extensive review by CMS resulted in no national change in policy, because

Overall, the quality and strength of evidence were low due to mostly observational study designs with no comparison groups, subjective endpoints, potential confounding (a situation where the association between the intervention and outcome is influenced by another factor such as a co-intervention), small sample sizes, lack of validated assessment tools, and considerable lost to follow-up.

But putting Medicare aside, between court rulings and legislation, access to payment for transition-related medical expenses has greatly expanded in recent years. And, of even greater significance, many states have passed “non-discrimination” laws, which typically provide that public and private health insurers may not refuse to cover (“exclude”) coverage for transition-related health expenses.

trans healthcarenow

The map below shows that as of 2016, 14 states had determined to provide transition-related health care as a covered benefit under Medicaid, and had also mandated that all private insurers cover transition-related health care. An additional 5 states either provide Medicaid coverage for transition-related health care or a private insurance mandate, but not both. The remaining 31 states did not, as of 2016, have legislation or rules covering transition-related care and Medicaid and/or private health insurance. By contrast, it does not appear that there is a single state that requires private health insurers to provide dental coverage.

trans healthcare map.jpg

Let us consider the case of California in more detail. Due to “intensive advocacy,” in 2012 and 2013, the state of California issued directives requiring private health insurance companies to provide transgender services. In addition, since it was ordered to do so by a court in 2001, the state’s Medicaid program has covered transition-related health care. Regular readers of 4thWave Now will not be surprised to find that the standards set by WPATH govern the criteria for “medical necessity” regarding the provision of transition services.

Recall, as noted above, that in the 6-year period from 2009 to 2014, when California was in the midst of a persistent budget crisis, the state eliminated all dental care for adults from its Medicaid program. And now, let’s run the numbers:

Going back to Dental Optimizer, the mid-range cost of a checkup in California is almost exactly $200 ($89 for the cleaning and $108 for the x-rays). Mid-range for a filling is $130 and mid-range for a root canal is $1,030.

Looking at some typical transition-related health care costs, the first case of sticker shock pops up with Lupron:

How Much Do They Cost and Are They Covered by Insurance?

These agents (medicines) are expensive. Typically, Depot-Lupron costs range from around $700 (online) to $800 (Portland area) to $1,500 dollars a month elsewhere for the monthly preparation. The 3 month preparation is equivalent in price. The histrelin implant is approximately $15,000 total for the device and the cost of surgically implanting it.

A histrelin implant would typically be used to provide the GnRH agonist medication in place of monthly Lupron shots. Estimating the cost of monthly Lupron shots at $1,000, which seems reasonable if not conservative based on the article, it appears that a year’s supply of Lupron, used to suppress puberty in a potentially transgender child, would cost $12,000, exclusive of the cost of monthly lab tests. In dental terms, 60 people could have a dental checkup, or almost 100 cavities could be filled, or almost 12 root canals could be performed. It is difficult to estimate the “average” amount of time that a child might spend taking Lupron; some providers argue that starting Lupron at age 9 or 10 is appropriate, while others wait until age 12 or 13. Assuming five years of Lupron shots, this translates into 300 dental checkups, almost 500 cavities filled, and nearly 60 root canals.

Moving on to hormones, as pretty much all puberty-suppressed children do, the price tag drops. The cost of hormone treatment is estimated at approximately $100 per month, or dental checkups for 6 lucky people, about 9 cavities, and a bit more than one root canal.

It’s when the “re-assignment surgeries” enter the picture that things really escalate.

According to multiple sources, the price of basic genital reassignment surgery or genital reconstruction surgery) for a man transitioning to a woman ranges from $7,000 for a simple orchiectomy and vaginoplasty to $25,000 for orchiectomy and the more complicated colovaginoplasty. This is often, but not always, followed up by breast augmentation, which can run anywhere from $5,000 to $10,000. That’s a total average high of $35,000, but estimates for the two procedures combined have ranged from $10,000 to upwards of $50,000. [Source.]

Taking the $35,000 number as our benchmark, and recalling that this does not include any other procedures also frequently deemed medically necessary, the dental cost of surgical transition for one male to female patient equates to 175 checkups, or about 270 cavities, or almost exactly 34 root canals. Note also that many transitioning men do not plan to “settle” for these $35,000 “half-measures:”

Some of Grey’s medical expenses are covered by her insurance, Kaiser Permanente, including her hormone therapy, a portion of her gender reassignment surgery and preparatory genital electrolysis that has to be done before the surgery. The insurance does not cover facial electrolysis (beard removal), laser body hair reduction, breast augmentation or facial feminization surgery, all of which Grey considers vital to her survival as a transgender woman.

No one sees me as physically female, just obviously transgender. This makes me an outcast and puts me at an extremely elevated risk for discrimination and harassment,” Grey said. ‘Just covering hormones and gender reassignment surgery is a half measure that still leaves us exposed to great risks and complications in our everyday lives.

The sky’s the limit, apparently.

How about women transitioning to male?

For women transitioning to men, the initial costs can be higher, and the choices more complicated. Some estimates lower-end cost of a metoidioplasty—a procedure that “frees” a hormone therapy-enlarged clitoris from the body for use as a phallus—at $2,000. That said, there are estimates of more complex metoidioplasties, as well as procedures that add testicles and involve full phalloplasties that top $100,000. Often double mastectomies, ranging in cost from $15,000 to $25,000, and sometimes hysterectomies, which run from $7,500 to $11,500, are performed. [Source.]

Although it’s clear that most women who hope to transition to male do not currently opt for the full-on phalloplasty procedure (see this recent 4thWave article for some great reasons why), the fact remains that, as a matter of California law, should a woman wish to pursue this option, private and public insurance must cover the $100,000+ cost. The dental equivalent of one phalloplasty is checkups for 500 people, or 769 cavities filled, or 97 root canals.

To further extend the analysis, prompt and competent dental care, as illustrated by the story at the beginning of the article, can often ward off much more serious and expensive dental problems. Simple cavities turn into abscessed, infected emergencies that often lead to the loss of the tooth and even body-wide illness and disability.

ignore your teeth they go away

By contrast, we see that “reassignment” surgeries themselves can lead to serious complications and the need for multiple follow-up or repair surgeries. To take one example that has been extensively documented online, one person has to date undergone more than 20 major surgeries to attempt to repair the effects of a failed phalloplasty.

Another, unexplored, aspect of providing transition-related medical care is the long-term effects of these interventions on healthy human bodies. Will the administration of puberty-blocking drugs and massive hormonal tampering lead to long-term medical consequences (and expenses)? This is unknown at present, but some early indicators aren’t looking particularly good.

Of course, we could evaluate any medical cost trade-off relative to transgender care, not just dental care. For one poignant example, fertility treatment generally is not covered under Medicaid. The dental analysis is striking because millions of people are profoundly affected, but it is only one of many choices made in the hotly contested world of health care spending.

Every society, outside of college economics classrooms, has limited resources, and must make tough decisions about how to allocate them. In a world of scarce resources, constituencies compete for their share, and more powerful, vocal and well-financed groups, in a system such as ours, will be better competitors. This is why lobbying, according to one source, was a $3.12 billion industry in the United States last year. It must be acknowledged, however, that distributing healthcare resources in one direction automatically preferences that group at the expense of others that do not receive those resources.

I would submit that the decision to direct health care spending towards transgender people, who by all accounts comprise a tiny fraction of the population (albeit one with potentially astronomical medical costs), and not towards dental care for adults, proves the extraordinary advocacy power and reach of the transgender movement. It also demonstrates that, contrary to activists’ efforts to characterize transgendered individuals as marginalized and under-privileged, as a whole this group is remarkably privileged. When the numbers show us that phalloplasty for one person is the equivalent of dental checkups for 500 people, and we choose the phalloplasty, we cannot conclude anything other than that we have decided the needs and concerns of one person take priority over those of the 500 people who go without dental care. Are the pain and suffering experienced by the natal woman who desires an artificial penis, more important than the pain and suffering of 500 people going without dental care? It seems that the answer to this question, at least in many places in the United States, is yes. We should ask ourselves why, and we should also ask ourselves whether that is fair.

Insurance requirements are a “ridiculous” speed bump on children’s gender journeys

Yesterday, Johanna Olson-Kennedy, MD, one of the better known US pediatric gender doctors, railed against insurance companies who stand in her way. It seems they have the temerity to demand written evidence that her prepubescent clients are mentally prepared for the chemical blockade of their natural puberty.

The insurance companies also, inexplicably, want to see evidence that the children and their parents have actually agreed to this off-label (not FDA approved) and very expensive drug treatment.

johanna olson april 12 2017 eradicate gatekeepers

Olson-Kennedy wants WPATH, in its next Standards of Care (SOC 8), to “eradicate” the requirement that minors have some sort of psychological evaluation before embarking down the Lupron road (which leads in nearly every case to cross-sex hormones, as Olson-Kennedy well knows):

So, what a lot of people want to understand is, “If I give my child this blocker, can I take it away, if at the end of a certain amount of time they no longer have a trans-gender identity, or they don’t want to continue on to pursue a transition with cross-sex hormones.” The answer to that is, “Yes.” They are reversible. You can take them off without any problems or major medical problems. But it’s very rare that that happens. In my practice, I have never had anyone who was put on blockers, that did not want to pursue cross-sex hormone transition at a later point.

Olson-Kennedy is also no doubt aware of the growing controversy about Lupron and other puberty blockers, but that doesn’t seem to be a concern when it comes to insurance reimbursements.

This isn’t the first time Olson-Kennedy has publicly complained about the foot-dragging of insurance companies. Last September, she posted “unfounded” denial letters from insurance companies on the WPATH Facebook page–mostly having to do with the fact that puberty blockers have never been approved by the US FDA for use in chemically halting the puberty of healthy “trans” kids.

Johanna Olson complaining about blue shield sept 21 2016 cropped

Should insurance companies be in the business of paying for experimental treatments on children–some who (on Olson’s caseload) were actively suicidal? Take a look at these denial letters. Do gender doctors like Olson-Kennedy deserve this level of oversight?

Is my use of “experimental” warranted as an adjective–apart from the fact that, a full ten years after Norman Spack, MD first began to use GnRh agonists in his practice, these drugs are still not approved for this use by US regulatory agencies?

Take a look at these remarks by Rob Garafolo, MD, another top pediatric gender doctor, made in a PBS interview two years ago:

garafolo admits experimenting

Garafolo is referring here to the multimillion dollar NIH grant he, Olson-Kennedy, Spack, and others have received to study “trans kids.” He hopes to have more answers after, as Garafolo admits, the kids have been experimented upon for 5 years–and beyond. As he says, it’s an “imperfect field” and how these children will fare through a lifetime is “entirely unknown.”

 

“The money is flowing” to “suck people in:” Vaginoplasty & the case of Jazz Jennings

Social media has been abuzz the last few days with the release of a trailer advertising the upcoming third season of “I Am Jazz.” It’s only a two-minute clip, but it packs a wallop. We see Jazz crying while saying “I just really hate myself” which is intense enough (given Jazz’s admission in the prior season of being suicidally depressed). But the big news is Jazz’s desire to seek bottom surgery. In the trailer, we see Jazz in three different doctors’ offices. The news isn’t good.

Doctor #1: You’re about to turn 16 so…I think it’s feasible that you could have bottom surgery.

Doctor #2 : We’re just now getting children who have been on puberty blocking hormones. When it comes to the surgery, we don’t have the raw materials we need.

Doctor #3: Testosterone suppression did you two big favors here (gestures at his chest, pantomiming breasts) but it didn’t do you any favors “down there.”

Doc two big favors

The benefits & drawbacks of blocking testosterone

The “raw materials” down there are, of course, the child-like male genitals Jazz would have, having been on puberty blockers (since age 10) and estrogen (since at least age 12), according to the first episode of “I Am Jazz” in Season 1. The most commonly performed procedure in the United States to create a facsimile of female genitalia, called “one-stage penile inversion” is more complicated and requires more steps when the male genitalia are the size of a prepubescent child.

A prior 4thWaveNow post, “Age is Just a Number,” touched on a few points from an April 2017 article in the Journal of Sexual Medicine co-authored by gender therapist Christine Milrod and USPATH head and UCSF gender psychiatrist Dan Karasic, which discussed exactly Jazz’s situation: “bottom surgery” for minor boys. The prior post emphasized some surgeons’ belief that minors should have the procedure done while still in high school so that their parents can ensure compliance; even be “active” in the dilation routine required to keep the neovagina open to “maintain the vaginal depth involved” before the teen becomes distracted by college.

But there is much more to say about not only the surgeons who operate on minors, but also those who recommend SRS for puberty-blocked preadolescents.

Of the 20 (anonymous) surgeons surveyed in the Milrod-Karasic article, 11 admitted to operating on boys under the age of 18. Unless Jazz seeks the procedure overseas, it’s highly likely it will be one of these surgeons who will do Jazz’s “bottom surgery,” should it take place before age 18.

From the get-go, co-authors Christine Milrod and Dan Karasic make clear that the growing trend of operating on minors is out of compliance with the current WPATH Standards of Care (SOC 7). But it’s evident from this and other writings that Milrod and Karasic –both proponents of “affirmative gender care” for minors—are interested in changing those standards for the next version (SOC 8). And they are not alone; lowering the age for genital surgery is a very popular topic among top gender clinicians like Johanna Olson-Kennedy and others.

Who are these 11 surgeons? Not even one has ever published on the issue:

The surgeons who perform the procedure on transgender minors have, without exception, refrained from publishing any peer-reviewed outcome data or technical articles on this small but increasingly important population….

…When asked about the lack of published data on surgery in minors, most participants asserted that GCS in all age groups had been a very small part of surgical medicine until very recently and that data on large volumes of procedures were not yet available. Some also cited the perceived “taboo” or outright stigma in performing the surgery and therefore a certain reluctance to share results or specific techniques.

But there are a few surgeons (whether they are part of the group surveyed for this article, we don’t know) who have been featured in news articles about genital surgeries on males under the age of 18. One of them, cited by Milrod and Karasic in a footnote, is Dr. Gary Alter, who in 2014 performed vaginoplasty on a 16-year-old.

Alter surgery

Dr. Gary Alter first removed the testicles and inserted a tissue expander (similar to an internal balloon) in the scrotum several months prior to the final sex change. The expander was progressively filled with fluid through a port during several follow-up visits in order to stretch the scrotal skin and yield enough skin as a graft to line the neovagina. The expander thus enabled the patient to avoid taking skin harvested from the flanks with the resulting unsightly scars. After 2.5 months, the expander was removed during the vaginoplasty and clitoral creation.

Just as Jazz’s doctors said: without the necessary “raw material” of a mature penis and scrotum, surgical fashioning of an approximation of female genitalia requires some rejiggering.

Interestingly, the article about Dr. Alter tells us that the 16-year-old’s psychotherapist was none other than Christine Milrod. who penned a piece “How Young is Too Young” in the Journal of Sexual Medicine in 2014. In it, Milrod argues for new guidelines that would allow underage surgeries on a “case-by-case basis.

milrod jsm 2

Professionals across disciplines treating female-affirmed adolescents can utilize the proposed ethical guidelines to facilitate decision making on a case-by-case basis to protect both patients and practitioners. These guidelines may also be used in support of more open discussions and disclosures of surgical results that could further the advancement of treatment in this emerging population.

“This emerging population”—male minors seeking genital surgeries.

Gary Alter is not the only one who has performed vaginoplasty on underage males. This 2015 New York Times piece features another surgeon, Dr. Christine McGinn (a late transitioning, former military MD):

Several doctors said they had performed surgery on minors. Kat’s surgeon, Dr. Christine McGinn, estimated that she had done more than 30 operations on children under 18, about half of them vaginoplasties for biological boys becoming girls, and the other half double mastectomies for girls becoming boys.

.. Kat’s parents trusted her not only as a specialist, but also as a role model: She had been a dashing male doctor in the Navy, before becoming a beautiful female doctor in civilian life.

When questioning the ethics involved in performing risky, irreversible, sterilizing surgeries on people too young to give informed consent, it’s easy to point the finger only at the surgeons. But as is made abundantly clear in the Milrod-Karasic article, it is psychotherapists like Christine Milrod who are heavily relied upon by the surgeons to make the correct referrals. No minor simply walks into a surgeon’s office to ask for SRS without first being referred by a gender therapist.

Nearly all participants reported an overwhelming reliance on mental health practitioners to assess the minor’s psychological readiness for surgery. Statements including “completely” (Surgeon 9) or “extremely” (Surgeon 10) were used to emphasize trust in the diagnostic expertise of mental health providers.

Surgeon 3 concurred: “I rely on them entirely. I need to make sure that the patients have realistic expectations, that they are not. I need to judge their maturity level and that they can handle pretty significant stress of any surgical procedure. But I don’t pretend to be a psychologist or have any expertise in the diagnosis of gender dysphoria, that’s a decision that needs experts.

Surgeons operate; psychologists assess maturity and readiness. But even with the blessing and recommendations of a gender therapist, some of the surveyed surgeons clearly have some understanding of the immaturity of a 15-year-old brain. Here’s what Surgeon 18 had to say:

In addition, a few participants urged caution, suggesting that some adolescents engage in gender exploration as part of a developmental phase and as part of the current zeitgeist: “I think it goes along the lines of a young person’s mind still being in the developmental stage. Things may happen and they may reorient their thinking, not just whether they are trans or not, but they may reorient their thinking about which surgery will serve their transgender needs. It is not a binary or tertiary model where they are just gay, straight, bisexual, or trans; there are a whole host of colors in-between. Many trans patients do not want GCS—it could be that at 15 they do, and at 25 they do not.”

Surgeon 19 even alludes to social contagion and the fact that kids are being taught indoctrinated about trans issues in school as a factor in some of them thinking they’re trans:

Depending on how old they are, there are a lot of classes that adolescents, even preadolescents in elementary schools, are getting these days. And they are trying to figure out if they are doing it because it is a new norm, versus what they really want. I have seen some … children go through phases of in and out, of thinking transgender. So that would be my concern—is it because it is popular now?

Karasic and Milrod note that a third of the surveyed surgeons believe the current WPATH recommendation for no surgeries under 18 should stand (only a third?) But the main thrust of this article seems to be that minors should be allowed genital surgery on a “case by case” basis; as if some 15 year olds can be 100% sure they are doing the right thing, while others might not. (How to tell?)  Milrod and Karasic say the surveyed surgeons are not worried about a potentially misdiagnosed client who might regret what they’ve done later on:

Despite the legal impossibility to obtain informed consent from the underage patient, the vast majority of participants were not concerned with malpractice lawsuits from parents or even from the patients as adults in the future. Engaging in best practices, maintaining open communication with the patient and her parents, and above all providing good results were seen as protective measures against any legal action.

Do Milrod, Karasic, and the confident surgeons quoted in the article believe some younger adolescents develop their frontal lobes faster than others? Do they think that just because a 15-year-old says “I’m 100% sure this is what I want” (what adolescent doesn’t say such a thing?), they can be trusted to know how they’ll feel in perpetuity? No one in the “gender care” field seems to be calling for MRI screening of frontal lobe density, weight, or size as a possible screening tool to differentiate the “true trans” teens (who really ought to have their testicles removed and their penises inverted) from the others who might change their minds.

Despite a lack of concern about misdiagnosis, many of the surgeons voiced concern about a severe lack of expertise in the field. Here’s Surgeon 14:

I believe that anyone who is performing vulvoplasty should have a fellowship training that is at least one year. It is going to be a rough period figuring that out, but I think we will get there eventually. I have seen horrific unethical practices by surgeons who lie about their experience and horrific results surgically as a result of that. We are using transgender people as guinea pigs and the medical profession allows this to happen. WPATH has the ability to have some teeth and regulate this more. But we don’t.

Then there’s the heady opportunity to ride the bucking bronco of this new medical trend:

The term Wild West also was used by a few highly experienced surgeons who were alarmed at the absence of surgical standards and the ease of entering the subspecialty without any documented training. To remedy the potential influx of “a bunch of solo practitioners, basically cowboys or cowgirls who kind of build their little house, advertise, and suck people in” (surgeon 13), several participants called on the WPATH to assume a larger role in demanding more stringent professional requirements and contribute toward sponsoring fellowships and surgical trainings across the country.

It’s hard to argue with a call for more training and expertise if these surgeries are going to be performed. But the underlying ethical question remains unanswered: Should minors be operated on? Especially when (as Surgeon 14 goes on to say) a new crop of poorly trained entrepreneurial surgeons is keen to profit on the trans trend:

…And now all of a sudden because it’s in the media, and really, the biggest reason for why everyone is doing it now, is the money is flowing. Because now insurance is paying. And now all these institutions have to have a program yesterday. And they are not doing it correctly, in my opinion. Seeing a week’s worth of surgery—maybe for a mastectomy, or maybe for an orchiectomy, or some of these other surgeries that are closely related, but this surgery is very advanced. The complications have severe consequences on patients’ lives and you can’t learn it in a week. And that is what’s happening; someone is going to see someone with a reputable name; they learn for a week, and they start doing them. And that is completely unethical!

 So we’ve established that there is a dearth of skilled surgeons, and that the penile inversion procedure is problematic for males (like Jazz) who have stunted genitalia resulting from years on GnRh agonists (puberty blocking hormones). But there is an alternate procedure that can be done: crafting a neovagina out of intestinal tissue. It turns out that this procedure is done in Europe far more than in the USA (where, according to the Milrod-Karasic article, there is a strong bias toward “one-stage penile inversion”).

In particular, plastic surgeons were biased toward penile inversion augmented by scrotal grafts, sometimes adding flank grafts, tissue expanders, or donor matrix tissue,27e29 and decisively rejecting intestinal vaginoplasty that would require no such additional measures and eliminate the need for lifelong dilatation.

Indeed, several Dutch studies can be found in the literature that discuss advantages of intestinal vaginoplasty for patients who have been on puberty blockers for many years. Arresting puberty seems to have spawned a whole new specialty for Dutch surgeons. In this 2016 article, Primary Total Laparoscopic Sigmoid Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia,” the, authors report generally good outcomes, apart from the fact that 1 of 42 subjects died from septic shock and multiorgan failure, and 17.1 percent suffered “long-term complications that needed a secondary correction.”

Dutch 2016 intestinal abstract

No doubt, Dutch surgeons are benefiting from the fact that pubertal blockade for gender dysphoric youth was pioneered in the Netherlands–a breakthrough heralded by the first US doctor to use it, Norman Spack, whose infamous statement about his enthusiasm for the practice was captured in the aforementioned New York Times article:

Dr. Spack recalled being at a meeting in Europe about 15 years ago, when he learned that the Dutch were using puberty blockers in transgender early adolescents.

I was salivating,” he recalled. “I said we had to do this.”

So, what does all this mean for Jazz? Clearly, the chemical stunting of Jazz’s genitalia–aka “penoscrotal hypoplasia”—is what prompted one of his/her doctors to say in the “I Am Jazz” trailer that “you can’t have the surgery you want.” But the intestinal method is available, at least in Europe. Then again as recently as 2015, Jazz seemed sort of ok with his/her birth genitals:

Surgery is a very big deal as it can be dangerous and very painful. While speaking with her doctor about the possibility of getting surgery someday, Jazz admitted that she has gotten used to her body just the way it is. She said she doesn’t feel awkward when looking down and seeing and seeing what’s there, but says, “Hey, thingaminga, how are you?”

In the promo for the new season, Jazz says “I’ve always dreamed of getting this procedure.” But this is only the trailer, so we don’t know what happens next until the season premiere in June. Maybe Jazz’s surgeon will go ahead with the modified penile inversion, involving donor skin grafts from Jazz’s own body, scrotal expanders, and all the rest. For the “cowboy and cowgirl” entrepreneurs who have hung out their shingle to “suck people in,” Jazz’s immature genitalia may be just another surgical challenge to overcome in the exciting new frontier of medical experimentation on teens frozen—like ancient insects in amber– in prepubescence; teens who, more likely than not, would have grown up to be gay in the bygone days before Big Medicine and Big Pharma stepped in to medicalize adolescent identity crises–as even the DSM-5 attests:

DSM 5 gay

But let’s not forget what several surgeons in the Milrod-Karasic article said: That they trust “completely” or “extremely” that gender therapists like Diane Ehrensaft, Christine Milrod, and all the other “affirmative” therapists will recommend surgery only for the correctly diagnosed youth in their care. So anyone questioning the increase in medical transition of minors should, above all, scrutinize the practices of these gender therapists.  Just how careful are they not to make a mistake? As Christine Milrod herself describes in her own “How Young is Too Young” piece,

[there is] “a genuine expression of fear among clinicians in making the wrong diagnosis, based on the fact that young people often experiment with gender role behavior as a consequence of normative identity development, and perhaps more so when the adolescent is gender variant”

OK, but given that “informed consent” is the current trend in practice, whereby adolescents who say they are trans are taken at their word while “gatekeeping” is derided, how easy will it be for US gender therapists to avoid making a wrong diagnosis—or any diagnosis at all?

Instead of grappling with these vexing issues, our media, academia, entertainment industry, and politicians remain in thrall to a medical fad which has resulted in a child celebrity whose most private struggles have been leveraged into a marketing bonanza.