Revisiting Episode 6: Gender Interventions—Treatments or Experiments?
A review of Episode 6, first published January 15th, 2021.
This episode entitled "Gender Interventions: Treatments or Experiments?", delved into the complexities surrounding medical interventions in gender care, particularly for youth. We take listeners on a whistle-stop tour through the history of psychological and medical approaches to sex and gender throughout the 20th century. We also offer important context for the emergence of WPATH (the World Professional Association for Transgender Health) and the development of today’s “affirmative model” of gender care.
A Critical Examination of Medical Interventions
Sasha and I explore the rapidly evolving landscape of gender medicine and explore the evidence base for interventions such as puberty blockers and cross-sex hormones. We discuss our concerns about the long-term effects of these treatments and the ethical implications of administering them, especially to minors.
Some of the conversation centered on the concept of informed consent. We pondered whether individuals, particularly adolescents, are provided with comprehensive information to make truly informed decisions about their bodies and identities. We also highlighted the necessity for thorough psychological assessments and the potential risks of bypassing such evaluations in favor of expedited medical pathways.
These are some of the key themes we explored:
Historical Foundations: We traced the evolving history of gender transitions, starting with the earliest experimental cases and moving through to the present-day landscape.
Controversial Origins: The psychological and medical theories underpinning gender transition have always been controversial, raising ethical questions from the very beginning.
A Famous Case Gone Wrong: Sasha shares the story of a set of twin boys from 1965—one of whom was transitioned to female as a child following a medical accident. The case had tragic consequences and serves as a cautionary tale about experimental interventions.
Medical Attitudes Shifted Rapidly: In 1965, only 3% of surgeons took requests for sex-change operations seriously. But by the 1970s, such surgeries were becoming increasingly routine—despite the lack of long-term data.
“Can We?” vs. “Should We?”: Much of early gender medicine was driven by a desire to see what was possible, rather than by careful ethical deliberation.
Understanding Gender Dysphoria: Despite decades of inquiry, we still don’t fully understand why some individuals experience gender dysphoria. Psychologists once took a more investigative, exploratory approach to understand this deeply personal phenomenon.
The Rise in Diagnoses: The 2010s saw a dramatic uptick in gender dysphoria cases—particularly among adolescents. We discuss what might have changed.
Dr. Kenneth Zucker’s Work: Both Sasha and Stella highlight their appreciation for the nuanced research by Dr. Zucker, especially his focus on child development and gender distress.
Complex Causes: The desire to transition often stems from a complex web of factors—social, psychological, and biological. There’s no single explanation, and every case is different.
The Medical Burden of Transition: Transitioning can involve lifelong medical intervention. Even some trans people themselves acknowledge that, if it can be avoided, it often should be.
Puberty Blockers & Psychological Impact: Sasha shares findings from studies on children given hormone blockers for two years. What are the long-term effects on mental health and development?
Outdated Diagnostic Criteria: The DSM criteria for diagnosing gender dysphoria often rely on rigid and stereotypical gender roles—such as a boy preferring “girl” toys—which many now question.
The Placebo Effect in Gender Medicine: Could some perceived successes in gender intervention be explained by placebo effects rather than real clinical efficacy?
Disturbing Mortality Data: Sasha cites a study where 4.5% of males who underwent gender interventions later died. Shockingly, this study was still considered a “success” in some circles.
Comparing LGB and Trans Treatments: There’s a stark contrast between the treatment pathways for gay and lesbian individuals versus those identifying as trans. One group is encouraged to live freely; the other often faces a lifetime of medicalisation.
Early Intervention – Where’s the Evidence?: Despite the push to transition younger and younger children, there’s little evidence to support that early intervention leads to better long-term outcomes.
Development Matters: Puberty is a critical developmental period. Halting it isn’t a neutral act—it has serious implications, both physically and psychologically.
Looking Beneath the Surface: Body distress doesn’t always mean someone is trans. There may be deeper issues at play—ones that deserve careful, compassionate exploration.
Reflecting on the Episode's Impact
Looking back, this episode sparked meaningful dialogue among listeners and also underscored the importance of scrutinizing medical practices that have profound and lasting effects on individuals' lives.
For those who have been with us from the beginning, revisiting this episode offers a chance to reflect on how the discourse around gender interventions has evolved. For new listeners, it provides foundational insights into the critical questions that continue to shape conversations in this field.
Listen to Episode 6 here: Gender Interventions: Treatments or Experiments?
Links About John Money & David Reimer
● http://www.hawaii.edu/PCSS/biblio/art...
● https://embryo.asu.edu/pages/david-re...
Books
Harry Benjamin: The Transsexual Phenomenon, Human Outreach & Achievement Institute, (1966)
Robert Stoller: Sex and Gender: On the Development of Masculinity and Femininity, Science House, (1968)
Juno Dawson: The Gender Games, p.5, Hachette (2017)
Diane Ehrensaft: Gender Creative Child, The: Pathways for Nurturing and Supporting Children Who Live Outside Gender Boxes (2016)
Donald Winnicott: "Ego Distortion in Terms of True and false self ', in The Maturational Process and the Facilitating Environment (London 1965) p. 121
Criteria for Gender Dysphoria in the DSM 5: https://www.psychiatry.org/patients-f...
Standards of Care WPATH Standards of Care (Version 7), 2012: https://www.wpath.org/publications/soc
Harry Benjamin Standards of Care (Version 6), 2001: http://www.genderpsychology.org/trans...
Norman Spack Ted talk: https://www.ted.com/talks/norman_spac...
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