150 - The Consumerism of Gender-Affirming Care with Leor Sapir

"Doctors are not glorified shoe salesmen."

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In this episode, Sasha and Stella welcome Leor Sapir, a fellow at the Manhattan Institute (MI). He holds a Ph.D. in Political Science from Boston College and completed a postdoctoral fellowship at the Program on Constitutional Government at Harvard University. His work primarily focuses around pediatric gender medicine, education policy, and culture, and he has offered incisive analysis of the institutional capture of American medical groups on gender medicine, the lack of incentives for evidence-based practices in this area, and the growing divergence between the U.S. and other countries in medical policy.

This conversation covers some interesting ground. Leor offers his analysis of the recent New York Times piece by Pamela Paul on youth gender medicine and detransitioners. They explore the comparison between gender-affirming medicine and aesthetic consumer-based medicine (cosmetic surgery), specifically highlighting the ethical considerations involved, including the role of safeguarding. They touch on state-to-state bans on gender-affirming care in the United States. They question if affirming therapy fueling narcissism and inflating a sense of entitlement in trans-identitfied teens due to the reduction of the therapist's role to being a facilitator or coach rather than engaging in a reflective and exploratory therapeutic model of care. They even get into aligning social contagion and therapeutic practice patterns with the recovered memory craze of the 1990s.

Despite the challenges in media coverage of gender medicine impacting minors, this conversation celebrates the hope that finally, detransitioners stories are getting some attention, deeper questions are being explored, and evidence about rapid onset gender dysphoria and regret are being acknowledged. But Leor raises an interesting point about the “golden mean fallacy” when critiquing left-of-center reporting about pediatric gender medicine, so check out the episode to hear more about that.

Perhaps the biggest theme of the episode seems to revolve around the shift from patient-centered to patient-led care, questioning the role of doctors and the growing trend of patient autonomy, specifically in gender medicine. 

“We're seeing more examples of this, this trend of casting doctors as vendors and their patients as consumers. I think the opioid epidemic is actually a pretty good example of that, right? The adoption of pain as a fifth vital sign. There were some good reasons to do that, but at the same time, I think that the tendency there was clearly trying to make the subjective experience of the patient factor in a lot more heavily into the treatment decisions. And that paved the way to the deadliest iatrogenic epidemic we've ever seen, ongoing.”

Towards the end of the episode, the conversation shifts to drawing parallels between the current surge in the pursuit of gender-affirming care and the recovered memory craze of the 1990s. Highlighting the manifestation of unfalsifiable theories and the shift from symptoms-to-cause in therapy. They discuss the precarious nature of memory and the susceptibility to suggestibility, emphasizing the responsibility therapists have when working with distressed children questioning their identity. 

“Instead of therapy being a mirror to help patients become more reflective and ask themselves difficult questions and look a little deeper into their feelings and experiences, the role of the therapist is reduced to kind of a popular self-help guru who just helps the adolescent who has already figured everything out, figure out how to be his or her authentic self in different areas of life. That's not therapy. You can call that whatever you want, but that's not therapy. And it's definitely not a mental health assessment.”

Ultimately, this important conversation lends itself to some meaningful reflections on the ethical obligation of medical providers and clinicians to minimize harm and the importance of critically examining therapeutic and medical practices in the current cultural context around pediatric gender transition.

Resources & Links

Email info@genspect.org for information about Detrans Awareness Day 2024

Leor Sapir | Manhattan Institute Profile Page

@LeorSapir on X(Twitter)

As Kids, They Thought They Were Trans. They No Longer Do.

The U.S. Transgender Survey of 2015 Supports Rapid-Onset Gender Dysphoria: Revisiting the “Age of Realization and Disclosure of Gender Identity Among Transgender Adults”

Supporting Autonomy in Young People with Gender Dysphoria: Psychotherapy is Not Conversion Therapy

AAP reaffirms gender-affirming care policy, authorizes systematic review of evidence to guide update

The World Health Organization Clarifies its Plans to Issue Guidelines on Trans and Gender Diverse People—Significant Concerns Remain

The Memory Hole Podcast

Making Monsters: False Memories, Psychotherapy, and Sexual Hysteria

If you cannot access The New York Times piece with the link above, try this archive link.

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If you liked this episode, more episodes you might find interesting include:

Gender: A Wider Lens
Gender: A Wider Lens
Therapists Stella O’Malley and Sasha Ayad explore diverse perspectives through a psychological lens, fostering open dialogue on gender identity, transition, and the transgender umbrella. Their work with gender dysphoric clients and unique experiences yield an informed outlook delving into gender's psychological nuances. Interviews with clinicians, academics, transgender individuals, parents, detransitioners, and others touched by gender provide varied insights and intimate inquiry into the taboo yet relevant topic.