The Real Life Test: to be or not to be?

I am not a medical or other form of psych clinician. but a legal advisor. However, I have 35 years experience of the trans community, as a member & as a phone support worker. I have also run a national FTM support organization for 19 years, as well as co-running what has been the world’s most successful lobby and legal campaign for trans people; Press for Change. I am now Chair of Transgender Europe, President of the World Professional Association for Transgender Health, and Professor of Equalities Law, at the School of Law , in Manchester Metropolitan University.

Personally, I have now provided legal advice to around 3-400 trans people, from all over the world, over the last 20 years and probably know on a personal level around 1500 transsexual people, as well as knowing in a more general sense at least twice that. And of course I teach extensively about the right to bodily autonomy for the patient.

I am often asked whether I think the Real Life Test (RLT) is a valid exercise of the doctor's power over the patient. The RLT is considered to be that period of time when Trans people must socially transition from one gender to another, during which they must wait for psych letters saying they are suitable for gender reassignment surgeries. In WPATH's Harry Benjamin Standards of Care v6 this period is known as the Real Life Experience (RLE) though it seems that here in the UK, and worldwide most doctors and their patients still refer to it as the RLT. IT is advised to be one year long before any letters are provided for surgery. However, many clinicians choose for it to be 2 years, and some clinicians seem to make some patient's wait indefinately for these magical letters. This causes many patients great distress.

So what do I think about the RLT?

Well, for a start I truly believe that fully informed patients who are able to, and will take full responsibility for the decisions they make, can have what surgery they want, so long as a surgeon is happy to do it.

However, of my experience of the 15 - 20 cases of 'trans' people who regret their treatment including genital surgery so much as to seek to change back, I would estimate that three quarters of them expedited their genital surgery, paying privately and not completing a RLT of longer than a few months at most. Eight or nine of these people did not undertake any RLT at all before their surgery.

I am not saying that in some cases where a RLT has not taken place, there has not been a very successful result – but other than trans men, who were living as men for some time already, I know very few of these.

However, I believe the RLT, or as I (and the WPATH SoC) would prefer it was called, the RLE (experience), is still fundamentally flawed in many clinical practices. It's practice is often set out in such a way it focus's the patient's mind on PASSING the test, whether by; 'passing' , or, more likely, by persuading themselves that they are passing, or by pretending they are passing —- or as the French psychoanalyst Collete Chiland might say for the majority ; by deluding themselves or by an illusion of themselves.

The use of the symbolic test forces patients to race for the goal, to cross the winning tape. I prefer the RLE to be thought of as a period of time for patients to deal with the very difficult and traumatic time of transition, and to ensure they are certain that this is the right route for them including the route to surgery, but by being held up to be goal orientated it adds on a significant and often debilitating further stress at this time.

Consequently, the RLT, as it is currently understood and often practiced, prevents the patient from a whole range of possibilities, because they are driven towards the goal and 'passing' the test. Patients do not understand that nobody need fail the test of 'passing' well enough for surgery, but they are terrified that they will be the one.

Furthermore along with clinicians, our social, employment and legal systems frequently support this arcane and falsely conceptualized pathway e.g. no legal change of sex without surgery and therefore no successful, social, change of gender. A simple question, how many doctors write to their patient's employers saying that the period of living in role before surgery provides an opportunity for the patient to work out what path is best for them, but that it does not necessarily mean that they are less than the wo/man they claim to be? Do they ask that the patients work records are changed, but also say that of course the patient might want to change them back, or not, at a later date? Do they explain that a failure to deal with discrimination is not only unlawful, but will ensure that this period is a terrible experience for the patient, and this would not help the patient successfully undergo this medically led experience in order to discover what is the best way for them?

A properly conceived RLE would include all these things, 'permission' for surgery would not even be part of the package. That would be an ongoing discussion in regular therapy sessions throughout the period of the RLE (not currently funded on the National Health Services here in the UK - and the NHS is by no means free, we pay a lot for it through our salaries). It would be focused on the patient’s understanding and their evaluations of their transitioning experiences. It would not be time bound, but rather be bound by the joint decisions of the patient and the practitioner. Some surgeries, those available without any sort of psych evaluation, such as those surgeries which are cosmetic, such as mastectomy and mammoplasty would not be part of the RLE, except as background to the regular discussions. The patient with their clinician's guidance could choose when they felt ready for any of these and whether sooner or later they would proceed to them.

As for genital surgery, discussions would not be about whether a patient could have it, but rather would be about whether the patient was able to give fully informed consent for it; what that means, providing the full information the patient needs, including reasons for not having surgery, and information about people without surgery who have succeeded (give them a copy of Rikki Anne Wilchins’ book: 'Read my Lips'),

Finally it would involve discussing whether the patient felt fully informed, whether genital surgery was appropriate for them at this stage, and of course such time as when the patient thought it was appropriate for them. It would not be about whether the practitioner, nor when the practitioner, thought it was appropriate for the patient.

I know several practitioners who already use this sort of programme, and patients appear to have nothing but praise. But even then, it seems a failure of the clinician’s duty in that very few advertise their wares which provide a valuable RLE. Patients are left to find that out later when they commence the procedure. Unfortunately, though, most practitioners still maintain an RLT that has little or no benefit to the patient, rather it maintains their constant sense of failure and put the fear of god (the clinician ) in them.

So, overall, my view of the RLT is that it is mostly done in a way which is not good medicine and certainly not best practice, even if it is (apparently) according to the current HBIGDA Standards of Care.

I believe that during that period of transition when most trans people are having to fire-fight major crises of day to day, a time for reflection and therapy to seriously consider the meaning of what they wish to do - never mind discover what it is that they wish to do, can only be a very good thing. It would ensure that patients are able to make fully informed decisions. That way, fewer of the few who would otherwise find it was a mistake will conclude they have made that mistake. Clinician’s must have discretion in by passing the wait - we all know of people who really do not need a time of reflection or therapy, so it must not be compulsory for all - but undoubtedly those people are few and far between. Nor must it cover cosmetic surgeries which are not genital - a mastectomy or a . It should be a process of full information disclosure intended to ensure valid consent, if genital surgery is the chosen pathway. It must, also, fully support the patient in the process of managing the social change; in the family, at work, and in law. Finally it must not be a goal orientated programme, rather a collaborative fact finding programme.

I believe that this would be the only RLE that could ever be considered best practice, and I am of the view that most patients would discover that it was of significant benefit in their decision making process.

Stephen

OII's response to being told the truth, kindly

see part 1 of this blog here

Trying to make sense of it all.

20th July 2008: Curtis HInkle has now taken down Sophia Siedlberg's defamatory commentary - I thank him for that. However, he says that in challenging this defamatory post, I have humiliated him in front of OII's board. I am sorry he feels humiliated, but wonder why? After all, would he take such lies about him, lying down. I hope not. And it isn't that hard to speak the truth. On the website they continue to maintain it as if I have not responded!


3rd August 2008: As this is now a little bit of history, I can comment further.
OII activists have removed the offensive and defamatory attack on myself, which was written by Sophie Seidlberg. However after I wrote this blog, in which I gave them truthful and honest answers, they have now put in its' place the following:

"OII did eventually receive an email from Stephen Whittle which appeared initially to answer some of the questions raised by members of OII. And it also appeared that Stephen Whittle was being polite and reasonable. However, later on Stephen Whittle said in his blog that he was both angry and felt the discussion with OII was very hostile. For us the problem appears to be the inconsistency with which Stephen conducted himself in this debate, being civil with us at first, but later taking a very unpleasant stance in his blog and in emails to various individuals who challenged him on some points. We are concerned because OII and intersex activists feel they are being attacked by Stephen Whittle for asking these questions about Zucker. The president of OII has decided not to communicate any further with Stephen Whittle."

Clearly they do not get the message - I have absolutely no problems with any person questioning whether Ken Zicker should be chairing the APA's DSM V committee. I think it has to be questioned and the answer should probably be no, he should not, not least because he is not an MD & psychiatrist, merely a psychologist. However I do want an apology from Seidleburg, and from Hinkle for publishing her gross and defamatory remarks about myself and what I supposedly 'think'. They may well have been read by hundreds of people, and many of them, in turn, might think they were truthful if they did not know me well. Have they ever thought of the possibilities of this and they impact it has had , not just on myself but also on my partner and wife, Sarah, and the rest of the family.

OII clearly think that requesting an apology and asking for the removal of defamatory remarks was taking an 'unpleasant stance' and that to ask for these to eb done is to 'attack' them. I chose to respond sensibly and very carefully, with a great deal of consideration both in the letter to them and, later when they still had not removed it, in this, my blog , but unfortunately nothing happened until I made it quite clear that, if they did not remove the offensive material, I would sue them .


They also clearly think it was acceptable to continue publishing these lies long after I had written to them with a very considered and reasonable answer (in their own words) was acceptable. Why do they think I took to blogging. The answer is that they were my inspiration. I wasn't going to continue after I had written my first blog about Alice Dreger's article on the 'apparent' saintliness of Ken Zucker. Rather, it became clear to me that if I was being attacked on the web as an irresponsible liar, trampling on other people's lives etc. then, at the very least, such perpetrators should expect is a public web response. This is my reputation they are trying to ruin.

To be honest I am now glad they have decided to vanish from my life – I could do with the extra time. However, I wish them and OII well, and I hope that the battles they are fighting to better the lives of intersex kids and adults go well for them. But if they are this paranoid about their friends, I doubt they are going to manage to speak to their enemies. An apology is still waited, though I am not holding my breath. I suppose I should now ask them to remove this latest comment which has taken the line that I took an 'unpleasant stance', because I took the time to be as pleasant as possible ... well not quite, I didn't (in the end) in the case of one individual who was exceptionally rude. But I am not apologising to her until she decides to apologise to me.

OII and the demon 'Whittle'

Intersex Activists go mad for no reason at all


Stephen Whittle, 14 June 2006: I received a disturbing email and commentary on the 8th July 2008, from the "Organisation Internationale des Intersexes Founder, Organisation Intersex International" www.intersexualite.org/
The original email can be found, along with their commentary on me, at www.intersexualite.org/WPATH.html -- 28th July - the commentary has now been removed, but despite several considered & lengthy responses from myself, they still say they have received no response from me.
The protagonists ; Curtis Hinkle and Sophia Siedlberg from OII-UK, start by saying they are writing this because

"It would seem that Dr. Whittle is not entirely happy about this state of affairs, that is, he does not like people saying "We do not want Dr. Kenneth Zucker anywhere near our health care "."

Nothing could be further from the truth, in fact in 2000 I wrote the first serious piece about how these paediatric gender consultants should be legally liable for the dreadful and often unlawful decision making they practiced on behalf of their patients. I am certainly not a fan of Dr Zucker. A year after my article was published a physician, from one such leading clinic wrote an almost identical paper and won a research prize for it from GIRES (but more about them later).
Curtis Hinkle and Sophia Siedlberg from OII-UK then go on to say:

"Stephen Whittle's reputation, well his unending desire to interfere with the lives of intersex people is nothing new. There are two reasons why we say this. Firstly in 2000 Whittle interfered with intersex organizations and affairs by claiming that Press for Change was mandated to deal with intersex people."

There is no evidence for this claim. It is not true, because Press for Change (PFC) and myself especially have always maintained we are an organisation lobbying on behalf of trans people, and never on intersex issues.

In fact in the mid 1990s, PFC deliberately withdrew its links with GIRES, a charity originally set up by PFC, after GIRES started to claim it was speaking on behalf of intersex issues. We have maintained that distance, especially as GIRES has continued to maintain trans people are intersex, basing that idea upon the 'brain sex' experiments of Zhou et al,  

PFC is an organisation run by trans people , for trans people, about trans people's issues, and I have never said or claimed anything other than that.There are some intersex people who also claim a trans identity. They sometimes work with PFC, and some see us as their mandated voice, but we can only ever talk about their trans issues as we are not experts on the rest of their lives. 

Curtis and Sophia, go on to sayi that when

"Whittle was trying to get the "Gender recognition bill" through parliament, he made sure that previous legal rulings dealing with intersex people (Specifically the Halliday case) were no longer valid and replaced it with a universal "Gender Recognition Act" where people who did not agree with the sex they were assigned as children (In the case of intersex people) had to go on a "Gender register" and obtain a "Gender recognition certificate".

This is just stuff and nonsense,as well as defamatory, as you will see from my reply (see below), which I publish in full at the end of this blog (they haven't bothered to publish it on the page www.intersexualite.org/WPATH.html , which contained the defamatory remarks). The Gender Recognition Certificate is only available to Trans people. 

Intersex people in the UK can continue to use the ages old method of having their birth certificate amended (those intersex people who also identify as trans can use either method).For those who want to read a history of how intersex people have been classified in law, I suggest you read: Stephen Whittle and Lewis Turner (2007), '''Sex Changes'? Paradigm Shifts in 'Sex' and 'Gender' Following the Gender Recognition Act?'', in Sociological Review Online.

Curtis and Sophia go on to say that I apparently use:

"Aggressive damage limitation, clandestine policy making and a total disregard for those affected by all this"

and that this is "nothing new for Whittle".. Apparently, they will not "accept being made to "shut up" by Whittle"

I cannot imagine a moment where I have asked anyone (other than GIRES) to shut up about this matter. But they proceed to say I do not "have a mandate to deal with intersex people", as if I ever did. 

I have never claimed, nor will I ever claim to have any sort of mandate for intersex people -- the reason why is simple, I am trans, not intersex.

Hinkle and Seidlburg then asked why I had

"not responded to OII's Enquiries being asked by Curtis Hinkle, the founder of OII. and Whittle, in classic Whittle Fashion, simply ignored it."

Well for a start I did not ignore it. I had responded several times, but OIL's email contained so much complex material that I did not as yet know how to answer it in full. It felt that whatever I said I would end up getting 'shot in the back', metaphorically, by someone. 

I get between 20 and 50 emails a day requiring considered answers (the rest get yes or no), most from students or colleagues at my day job, the rest from trans people seeking legal advice, or my PFC/TGEU/WPATH colleagues.

As I had been travelling extensively recently, at no point did I feel I had the time to give considered thought to an answer. It seemed clear that OIL. Hinkle et al had decided (for whatever reason) to hate and crucify me. In this world of instant email they expect answers tomorrow, something that is rarely possible for me or anyone else.

Email needs to be treated as if ordinary postal mail. I believe it is too instant, and leads to serious communication problems. I do not like the tit for tat nature of emails, and will not be drawn into those forms of communication.

 I start answering my email sometime in the late afternoon, otherwise I would never get the rest of my job done. Emails are done in the following order: Students first, work colleague’s second, PFC work third, followed by TGEU, and then ignominiously at the end, WPATH. 

The rest comes later if there ever is a later, which often times there isn't as I fall asleep from exhaustion. But more to the point, after I replied to OII they took three weeks to reply to me, and only did so when I insisted on a reply. Clearly one rule for one, another for the rest.

The conclusion to their commentary is a fine piece of fantasy writing. Seidlberg says:

"Stephen Whittle, in his now well known arrogance (is it well known? I’m not sure I am  arrogant, just a tiny bit bossy) “has some agenda that he seeks to impose on intersex people. ...  we suspect Whittle has a point of view that underpins all this. Basically we sense he regards female to male transsexualism as a "Legitimate intersex condition" or "DSD" (To use the contentious terminology he espouses) while he regards male to female transsexualism as a "Fetish"."

Seidlburg's says this is

"evidenced by comments like "Male to female transsexuals have their brains removed when getting SRS."

Clearly she cannot get a trans community joke when it is thrown at them – that is probably because they are intersex and not trans. I am a funny (ha ha) bloke at times, and sometimes even make light hearted humorous jokes about the effects of oestrogen & testosterone, but now jokes at our own expense are apparently a sin. 

Sophia needs laughter classes - surely she can see that the joke is all about the patriarchal values that I have spent my life undermining, and the need for a feminist perspective in our trans lives. If I thought such a thing was true, I would not be saying it; I would have left the trans women dominated organisations Press for Change and TGEU years ago. Sophia goes on and say: 

"Given that this misogynist attitude fits hand in glove with the past antics of ISNA (Who regarded those intersex people who rejected being assigned male as children by surgeons as "liars") I am not surprised he feels so confident about his probable agenda."

My ‘probable’ agenda - what bollocks. IF I had an agenda, I would have kept it 'hidden' at the very least, but the agenda they imagine I have does not exist. That they have to imagine what I might be thinking demonstrates how little they know me. 

There are no hidden secrets; I was born female bodied. The person I am what came out of a life long project for change: a person in a female body, which I have adapted because I was driven by deep unhappiness to reach a point where I could live a life where others knew me as a man, even if only (but what a glorious only) a trans man. 

Let me make this really clear:

• I am not intersex
• I do not consider myself to be intersex.
• I am a trans(sexual) man, and very, very proud to be so.
• I am not interested in the ideas about brainsex of the Zhou et al. sort.
• I am not, and don't do, intersex
• I am not into chromosomes - I have no idea what mine are
• I am into hormone replacement therapy, but I have no idea whether I am killing myself with each dose of testosterone - but it makes me feel good.
• I have an identity which includes the following aspects of identity English / British / Manchester transgender / transsexual / poly /pan / bisexual, sexual /ex-working class / now middle class (yuk) / disabled / quite fit / academic / teacher/ leader / lobbyist / political / husband / partner / and father to 4 children.
• I am a member of the transgender community 
• I am interested in the politics of gender.
• I am into being an excellent human rights and equalities lawyer.
• I care about people, whether trans, intersex, or cis, and take particular care if they seek my legal advice.
• I care about every person's entitlement to their human rights and their right, in law, to be treated equally, respectfully, and without fear or prejudice, regardless of our differences.

I eventually did fully respond to Curtis and Sophia’s letter and commentary -- you see names are much kinder, I don't do Whittle, I tell my students that Stephen will do nicely - we are all adults now.

Unfortunately, a month later, Curtis and Sophia had not put my response on their website. Rather they have maintained their complaints about myself and my failure to apparently reply, as if I have never responded, and that I am unwilling to explain myself - hence my reason for this blog.

So Curtis and Sophia, I need you to take down the webpage discussing me and my apparent beliefs. It is defamatory and therefore unlawful. (This is NOT a threat: but interestingly, in the UK, I can sue for defamation on the web, regardless of where in the world a defamatory piece was written or published. Those who defame have to provide hard evidence that the allegations they make are true).

Secondly, I would like an apology, but I am not holding my breath, do you hear me Curtis and Sophia of OIL?
_______________________________________________________
My Letter of RESPONSE, sent by email to OII Dear Curtis & Sophie:
Dear OII,

Unfortunately I am a  busy man, and often do not immediately have the time to answer emails which raise very complex issues in the manner which I would like to.

However I will try to answer some key issues that I feel I am able to address, within my limited time: 

Let's start with WPATH. I think it best that WPATH's board develops a consensus position on its relationship to intersex people and their concerns. Work is currently taking place on this matter, but I cannot give a date, as yet, as to when some conclusion might be reached. However I would repeat WPATH's mission statement to explain what WPATH are endeavouring to achieve. WPATH is an international multidisciplinary professional Association. The mission of WPATH is

to promote evidence based care, education, research, advocacy, public policy and respect in transgender health. The vision of WPATH is to expand its worldwide authority by promoting education, advocacy, training, research, quality health care and best practice standards for service providers and policy makers regarding gender variant individuals.

I can assure the members of OII that I have written to the chair of WPATH's Committee on 'Disorders of Sex Development" and asked that consideration is given to ensure that the content of the committee's work reflects more publicly, their support of the position of many people with intersex differences. They have a difficult remit, as you know, in that many intersex groups are run by parents and though many WPATH committee members may wish to influence them and the physicians they use, they do not wish to lead them to disengage, as then the committee's educational purpose will not be able to be met.

I have also asked the committee chair that they work with the committee to consider changing the name to better reflect the work that they do, which is to educate medical professionals about best practice when there are, for example, 'Differences in Sex Development". I am still waiting to hear their response. Now to answer your specific points:

PRESS FOR CHANGW & THE GENDER RECOGNITION ACT 2005:
You say that Press for Change damaged the rights of intersex people in the UK, through our role as stakeholders in the development of the Gender Recognition Act 2004 (GRA). Clearly there has been a misunderstanding of the law in this area. 

In English law, there has been *NO* change of the position of intersex people with the coming into force of the Gender Recognition Act. Since time immemorial, intersex people in the UK have been able to apply to have their birth certificates amended to better reflect the sex they are. This system is still in existence for those who wish to use it.
There may be a few intersex people , who also identify as trans, who can chose instead to use the Gender Recognition process in order to obtain a completely new birth certificate - that is their choice.

AS UK LAW STILL STANDS:
Intersex people who have their initial birth certificate amended, have complete and full rights from the time of their birth, in their real.chosen or preferred sex. - Trans people who obtain a new birth certificate, are recognised for all legal purposes in their preferred gender from the date of their application to the Gender Recognition Panel. To read a history of the legal claisifcation on Intersex people go to Stephen Whittle and Lewis Turner (2007), '"Sex Changes'? Paradigm Shifts in 'Sex' and 'Gender' Following the Gender Recognition Act?", Sociological Review Online.

THE JOELE HALLIDAY CASE:
This did not change the law as it relates to people with an intersex body. Rather it was a case as to whether government would allow a child who was intersexed to have a 'new' birth certificate reflecting her own definition of her sex, and for that birth certificate to be as if she was originally recognised as that sex when the birth certificate was being prepared. The decision of government to allow Joele a concession to have a completely new birth certificate was a reflection of government's concern public opinion. What was exactly decided was that in a case of severe cloacal exstrophy, which is a rare and complicated defect that occurs during the prenatal development of the lower abdominal wall structures, a child who was 'Gillick competent' i.e. was able to give informed consent, or if not via their parents competence, could ask that their birth certificate, rather than be altered, reflect the child's preferred sex which may be at odds with what the apparent chromosonal structure might appear to say. Government agreed to this request on a 'one by one ' basis.

PFC's ROLE IN THE HALLIDAY CASE:
As you can imagine, all of this was part and parcel of the 1990s liberalisation of UK attitudes and a retreat from the Corbett v Corbett model of sex determination. At the time of Joele Halliday's application, Press for Change provided some limited help, as requested, by discovering a 'secret' 1960s Scottish case (Fforbes-Semphill v Fforbes-Semphill, now available in the Scottish library) in which the court had decided a person's sex on the basis of a multi-factoral approach, not just the gonads, genitals and chromosome approach of Corbett. This had some influence on government personnel who were making the decisions. That took place long before the GRA was even conceived of in its current form. The GRA does not alter that position, nor does it alter the basic practice of allowing intersex people to apply for an amended birth certificate. We do not have figures for how many, if any, intersex people insead choose the gender recognition process. However, I can assure any UK intersex person that if they are told they cannot amend their birth certificate, but must use the GRA process, they can seek legal advice from myself.

PFC's & STEPHEN WHITTLE'S POLICY ON INTERSEX People and Concerns:
My private position is well known; trans organisations have no place in voicing intersex issues, unless they relate to intersex people who are members who are also trans. For this very reason, Press for Change seperated many years ago from the charity it created , GIRES when GIRES claimed to be speaking on behalf of intersex people. PFC has expertise on trans issues not intersex issues. This separation has cost us considerable financial benefits over the last 10 years, but Press for Change is still quite clear on this policy matter. Press for Change does not intervene or speak on behalf of intersex people. Nor do I, as a trans man. The best, and what is after all most appropriate, that I can offer is to pass on the messages from the intersex community to those that can make a difference.

I hope this satisfies some of your enquiries.

Stephen-----------------------------------

Informed dissent - DSM, Zucker and Aice Dreger

DRE(D)GERING

Read Alice Dreger's "informed Dissent" here

Stephen Whittle, 27th May 2008: Activist,

Blanchard, CAMH, DSM IV, DSM V, FTM, ICD 10, Lawrence, MTF, T, Trans, WPATH, Zucker, ..... I currently wake up in in an alphabet soup sweat from a regurring nightmare, firmly embedded in the current Trans Activists vs Psychotherapeutic Professions debate around the writing of version V (5) of the Diagnostic Manual of the Amercian Psychiatric Association.

This week, Alice Dreger, published a polemic blog against the trans activists campaigning against the appointment of Dr's Ken Zucker and Ray Blanchard to the committee responsible for writing the new diagnostic statements of childhood and adult 'gender identity disorders' for DSM V , Alice Dreger says
"For dissent to be effective, for it to be sustainable, for it to be ethical, it has to be factually right". (See Informed Dissent)

I totally agree with her ... but as she steams through her vicious, if not quite transphobic, something quite close to it blog, the arguments she uses are very clever, but not true when considered through the realities of trans and trans / or not trans kids' lives, and are consequently disingenuous and therefore unethical. I quote, in full:
"Zucker also said that, if he could make a child feel comfortable with the genitals she or he was born with, without causing harm, then that would be best. As someone who has been a long-time advocate of keeping children’s genitals intact and using psychologists to help parents to accept their “different” children, I admit I was sympathetic to these arguments. In fact, as I thought about it more, I realized that pushing gender-atypical kids towards eventual transition (as some “progressive” therapists seem to do) could be another case of ultimately changing the child surgically to satisfy parental discomfort with the child’s atypicality. ."
(See Informed Dissent)

Let us get the facts straight. No one, including, and especially trans activists is advocating doing anything but keeping children's genitals intact. There is nothing on the table from either party to this heated discussion suggesting that gender atypical children should have their genitals surgically operated on to change them to look more like the genitals of children of the opposite birth sex . So why does Alice Dreger raise this point?

Firstly, she is making it quite clear to us that she is an expert on this matter - which of course she is not. She is an academic who has specialised and gained some expert perspectives on the history of intersex lives and the surgical interventions used on intersex children, and according to a recent interview helped lead the Intersex Society of North America for ten years. But she is not an expert of any sort on gender identity issues, she simply knows very little about trans lives.

Secondly, she is saying that Dr's Zucker and Blanchard are not wrong in not advocating such surgery - and that anybody who is advocating it is wicked. As I have said, however, she speaks falsely by failing to tell the whole truth and nothing but the truth; she fails to point out that in all the Internet activity from trans folk expressing anger at Dr's Zucker's and Blanchard's appointments that the trans activists also think such surgery would be wicked. Instead she leaves the question hanging so that all right minded people will thank that is not the case.

Thirdly, she refers to the pushing of gender atypical children to eventual transition as wicked. Of course, as anyone who has been working with the trans community for as long as myself (33 years) or even as long as Dr's Zucker and Blanchard, knows it is not possible to push a non-transperson to transition. The only exceptions are the easily diagnosed schizophrenic disorders which might just make a person that. But they are not trans people, and their diagnosis has nothing to do with diagnosing trans people.

I did stop and wonder whether this last statement was accurate. Could non-trans children be pushed to transition? I feel it is important here to consider the small but whole set of medical literature and case law reflecting 'mistakes'.1 There are:

• some people who are trans feel that transitioning and surgery cost them too much, in terms of health, family, work, and other social networks, but they do not to 'change back'.


• other trans people who have felt that the social stigma surrounding trans identities led their transition and later life being a nightmare, but only a very few of them want to change back.


• an even smaller number trans people (I have known 12 out of the thousands of trans people I have met) who feel that their doctor pushed them through the process too quickly when they were not quite ready to decide whether it was yet right for them, and so took a wrong route, but most choose not to 'change back'.


• a tiny number of cases (I know 4 out of the thousands of the trans community) of non-trans people who feel they were pushed to transition and surgery at a time when they were just mixed up about their identity, feeling wrongly that they were trans, most of these want to 'change back'.

Overall, the long term studies show that between 5 and 14% of (mtf) trans women are not happy with the consequences of their transition; however almost all of these relate it to social stigma or poor surgical results. Between 0 and 6% of (ftm) trans men are not happy with the consequences of their transition; however almost of these relate it to poor surgical results. VERY, VERY few of both groups feel they were not trans, should not have transitioned, and if they did surgically transition - now want to transition back.

However, in relation to young people, the most telling evidence comes from the follow up studies from the team of another member of the DSM V committee, Dr Peggy Cohen-Kettenis, whose role it will be to lead the sub-working group who are responsible for writing (or choosing not to write) the specific diagnostic statements on gender identity disorders. Her co-written paper "Psychiatric Comorbidity Among Children With Gender Identity Disorder"2 states that that:
"children with GID are at risk for developing co-occurring problems. Because 69% of the children do not have an anxiety disorder, a full-blown anxiety disorder does not seem to be a necessary condition for the development of GID. Clinicians working with children with GID should be aware of the risk for co-occurring psychiatric problems and must realize that externalizing comorbidity, if present, can make a child with GID more vulnerable to social ostracism." (p. 1307, abstract)
as such physicians seeing children with GID should be very careful to diagnose and treat co-morbid illnesses, before or alongside interventionist treatments for GID so as to ensure that transition is not seen by the child as the cure for anxiety and unhappiness, when in fact it rarely is.
But, another paper "Sex Reassignment of Adolescent Transsexuals: A Follow-up Study"3 co-authored by Dr Cohen-Kettenis concludes in the abstract that:
"Starting the sex reassignment procedure before adulthood results in favorable postoperative functioning" but the team also say that this success is only possible:
"provided that careful diagnosis takes place in a specialized gender team and that the criteria for starting the procedure early are stringent."

Alice Dreger has chosen to villify and mock the trans communty - both in her blog, but more importantly in her paper recently published in the Archive's of Sexual Behaviour, in which she condemns the trans people involved in the Michael J. Bailey (him of "The Man who would be Queen") Crisis as liars and frauds without taking the time to speak to them properly. She behaved as if a cub reporter on the National Enquirer or the Daily Star, calling the trans people without introduction, and demanding they answer here questions. If she had rung me I would have politely told her not to be so rude and to get off my line, with as many 4 letter words as it took. There are certain standards when academics write - it is the ethics of doing research, and everytime we must remember those people we seek answers from are research subjects to be treated with respect and not to be hounded into giving information until they had given fully informed consent. I could not credit that it was ultimately publihsed by the archives of sexual behavior - though written to look like an academic paper, it was not formed from the basis normally required - that of ethical academic research. ..... Oh, but wait, guess who is the editor - why no other than Mr. Zucker himself.

So, Alice Dreger considers herself above the normal ethics of research as we saw then and as we see now in this particular blog. In it, she condemns trans activists for not wanting a guy who is not an MD or other medical professional, and who would rather make gender variant children 'normal' than allow them to grow up as trans in the future, chair a committee which will decide the basis on which trans youth and adults will be treated by the medical professions in the future. I tell you something , I don't want him deciding my life, or treatment, either.

Clearly the APA process is flawed, surely and only sensibly, they would ask a medical professional, at least a psychiatrist in the field of trans treatment, to lead a group whihc is going to decide on treatment routeways in the future. Instead we have to settle for this guy (who is so short he looks like a [ftm] trans man, but is so arrogant he couldn't possibly be), who works at a clinic which is notorious amongst trans people for the disastrous, rude and arrogant way they are treated there. I accept that might not be the full picture of the Clarke Institute. But it is a persistant picture (in the past I have received many letters asking for help from it's desperate patients.) Nevertheless, I do acknowledge that there may well be satisfied trans patients from the clinic, but I do wonder whether they knew they were entitled to get better respect from clinical staff.

Anyhow , what is done is done and we will now have to await the outcome, but I, for one, will not be wasting breath waiting for it. As for Ms Dreger, I think she should go back the her university's research gudies, manuals etc and look up ethics.

1 I'm not going to cite all of these, this is a blog not an academic paper.
2 Wallien,Madeleine.; Swaab, Hanna.; Cohen-Kettenis, Peggy.: Psychiatric Comorbidity Among Children With Gender Identity Disorder J Am Acad Child Adolesc Psychiatry. 2007 Oct ;46 (10):1307-1314
3 Cohen-Kettenis, Peggy T. Ph.D.; Van Goozen, Stephanie H.M. Ph.D.: Sex Reassignment of Adolescent Transsexuals: A Follow-up Study