A Tale of Two Conferences, Part 2

Can we talk? I don't know. I hope so. Or maybe: LISTEN TO US, DAMMIT!

from Stephanie Davies-Arai’s presentation

I’d love you to read Part 1 if you haven’t yet. But here’s a quick summary in the meantime:

The EPATH conference of some 500-professionals was laced with an air of paranoia, with words like genocide and attack thrown around. But it also professed to be a gathering of serious scientists sharing serious science, not [just] ideology. A source told me that they had actively sought presentations on detransition, for instance, and there were people openly talking about the low-quality of research and the shift in demographics—aka ROGD. That is a lot of movement from “no debate.”

Still, they dismissed the “attacks” (otherwise known as criticisms) as ideologically-driven pseudo-science, comparing objectors to flat earthers and climate change deniers. That’s, of course, what many criticizing the science of youth gender medicine say about them.

Very few people asked questions. That lack of curiosity and concern, well, concerned me, and some of it seemed overtly political. Annelou deVries, author of the study most widely touted to show the positive effects of gender medical interventions for youth, at one point suggested a presenter emphasize how careful she and her colleagues are in diagnosis and medicating. They were communicating to their critics through the conference.

What would their critics say in return?

***

I left EPATH on the afternoon of the second day to see the opening of the Genspect conference, called “The Bigger Picture.” Set in a hotel in downtown Killarney, the conference was smaller, more intimate, and more intellectually diverse. There were presentations on medical evidence and on how to work with gender dysphoric kids and health workshops for detransitioners, among many other topics.

I was feeling uncharacteristically optimistic for several reasons.

1. EPATH had actually acknowledged that there were problems, instead of hiding beneath the cloak of “no debate.”

2. I had met several reasonable clinicians at EPATH, who were concerned about the shifting demographics and the increase in detransitioners.

3. Some EPATH people, including trans people, had taken Genspect up on its invitation to attend. Maybe some of them just came to spy, but others were legitimately curious, or at least trying to be.

Corinna Cohn described my optimism as Pollyannaish. But for me, it’s both informed and necessary. I don’t want to be locked in a forever culture war around this issue, and I am certain that if some of the stalwart defenders of gender-affirmative care really listened to those who’d been hurt by it, they’d push for reform. By the time I got to The Bigger Picture, I had the feeling for the first time that such a denouement might be more possible, and successful, than Middle East peace talks.

So, admittedly, I squirmed a little in my seat when Genspect Vice Director Alisdair Gunn—author of some brilliant work under the name Angus Fox—convened the conference with this joke: “For those who don't know, my pronouns are your bank account number, your mother's maiden name, and the name of your first pet—this is a respectful space, so you can just jot those down and leave them at the door.” Watching that back on a video just now, I was chuckling (it’s a legit good joke), but at the time I thought about the believers visiting from planet EPATH, who might not feel called in, as it were, when the crowd cheered at pronoun jokes or the lack of unisex bathrooms. I thought perhaps we were living up to their fears about the people in attendance, that we mock and belittle them.

But Gunn immediately transitioned to the real spirit of the conference, and of those in the resistance to gender identity ideology. “We welcome robust debate,” he said. “We believe in lots of different points of view.” Respectful disagreement was the goal and the expectation—something, he said, a roomful of adults should be able to manage.

Gunn finished with his wishes for the conference, which came out almost as a prayer: He hoped it would be fruitful, useful, powerful and edifying, “particularly for those people who are here for circumstances that they would rather not be here for.” And, he said, he hoped “that the connections that we make will spur us on to do better work, and continue to be active in this area and make positive change.”

Stella O’Malley, Genspect’s director, spoke next, about how she became drawn into the gender debates when speaking to parents as the pandemic started. Their families had been “ripped up.” They’d been lied to by doctors. Most had “quirky, vulnerable, slightly awkward, cerebral, artistic children,” who were filled with such self-loathing that they fell for what she called “the most bewitching line in the world”: that they could take a pill and become somebody else—somebody better. Then she found another horribly mistreated group: detransitioners, once folded into the LGBTQ community (or at least the TQ) and the gender clinics, and then cast out.

The World Professional Association for Transgender Health—EPATH’s parent, essentially—had spent years crafting new guidelines with 120 authors. But, she said, “after all that work with all those authors, they chose to write a chapter on eunuchs. They chose to write a chapter on non-binary identified people. They chose not to write a chapter on detransitioners. So they have discredited themselves.” Indeed, in a later session, several people called out “Fuck WPATH!”

I squirmed again, thinking that delegates from EPATH hadn’t shown up to be admonished. Which isn’t to say that they shouldn’t be, but rather that if the goal was dialogue, that seemed like a deterrent.

But that wasn’t the only point of Genspect’s conference, I began to realize. This was a gathering of the angry, the bereft, the ostracized, the unheard, the traumatized—and also, the determined, the hopeful, the nuanced. This was a conference about forcing people to listen to the truth, no matter how it discomfited them; they should be discomfited.

That was clear during the first evening’s panel. After rousing speeches by Helen Joyce and Maya Forstater of Sex Matters—England’s TERFs extraordinaire—the podcaster Benjamin Boyce led a panel discussion with detransitioners—those who’d partaken of gender-affirming care and went on to regret it. He called them, “the most amazing, resilient souls.”

Their stories were different, but similar. There was Jet, a Dutch woman who was always gender nonconforming, and found trans on the internet at 14, went to the gender clinic at 15, went on blockers and hormones at 16, and had a mastectomy at 18. At 22, she quit testosterone, realizing she was a lesbian. She had trusted the doctors, she said—the experts who diagnosed her with gender dysphoria, but didn’t probe for the source of it.

There was Michelle, who took T at 22. Two years later, she had a mastectomy, then a hysterectomy six years later. When she first began to detransition, she identified as nonbinary for another four years. It took her until age 32 to fully disentangle herself from the concept of gender identity.

Laura was 15 when she began to question gender identity, and 18 when she identified as trans. The next year she took T, and had a double mastectomy at 20. At 22, she was diagnosed with PTSD, which helped her realize gender wasn’t the issue, and she detransitioned. She was simply a gender nonconforming woman, not someone who needed medicating.

Camille had been presenting more masculinely since a traumatic event in her tweens, but at age 20, she found gender ideology. At 26, she believed she was non-binary and at 30 had a double mastectomy. Two years later, she detransitioned. She’s now suing her doctors.

Helena started identifying as trans at 15, and went on testosterone after her 18th birthday. By 19, she’d detransitioned, and became one of the first to speak out.

Ritchie started transitioning “because I was a little bit mental when I was in my early 20s,” he said, when he was both dealing with a lot of trauma and finding things about gender online. He went on T blockers and estrogens, then had a penile inversion, which he described as: “I don't have testicles anymore and they've created a nice little pocket.” When he realized he was not trans, and accepted himself as gay, he detransitioned.

He wasn’t sure that detransition was a useful term anymore. “I think I’m in recovery, is what I am,” he said. That declaration changed the atmosphere in the room. These were people who’d been equally failed by therapists, doctors, journalists, politicians. They’d been victimized, but didn’t want to be painted as victims, didn’t want to detransitioner to be their only identity. Transition itself was already an incorrect word—no one had actually changed sex. So perhaps, Camille said, they should focus less on language and more on what her doctors had actually done: removed her healthy breasts because she was experiencing mental distress.

I thought about the panel I’d seen down the street, that showed a spike in mental health directly after puberty blockers or hormones, followed by a serious plummet. How could those researchers continue crunching numbers without pausing to listen to the actual experience of the plummeting? Yes, they had a poster presentation on detransition at EPATH, but they didn’t have a panel of detransitioners telling them what they’d done wrong, what they’d missed, what they should have done instead, and the impact of the enormous mistake. The people in this room had been so hurt. Not “harmed” by misgendering or deadnaming—not made to experience emotional discomfort. Some of them had lost body parts, years of their lives, their relationships with their children, drawn in by the promise of better mental health, enlisted into an army where normies are the bad guys, and they were special and fragile.

from Stephanie Davies-Arai’s presentation

I came back to this feeling over and over during Genspect’s conference, that practitioners of gender medicine, and politicians supporting, defending, and increasing access to it, must listen to these stories. Both Eliza Mondegreen and Stephanie Davies-Arai of Transgender Trend offered astounding presentations on cultural and online influences. No one should administer hormones or cut off body parts before asking: Where did you get the idea that this will improve your life? How many books with popular kids with mastectomy scars have you read? How many times have you scoured Reddit threads that teach you that doubting your trans identity proves that you’re transgender?

From Eliza Mondegreen’s presentation

Many times, there were overlaps between content at both conferences, interpreted in massively different ways. I heard “moral panic” at both. I heard the importance of people of different disciplines connecting to get their message out. The importance of questioning. The fear of shitty journalism.

Both conferences acknowledged the low quality of evidence at EPATH, but Dr. Julia Mason showed us just what that meant:

The anonymous retrospective survey of adults who still identify as transgender (used erroneously to assert a low detransition rate) showed adults who wanted and got puberty blockers had better mental health than those who wanted them and didn’t get them. But many said they were over 18 when they took them, which means they probably didn’t understand what puberty blockers were. And many were denied medical interventions if their mental health was already bad; it doesn’t mean not getting the drugs made them worse, but that they weren’t well enough to take them.

At EPATH, there was a session on “Childhood gender nonconformity in relation to gender dysphoria and psychiatric outcomes,” which noted the established connection between childhood gender nonconformity and gender dysphoria. “However,” the abstract noted, “the majority of children with gender nonconforming behavior are not diagnosed with gender dysphoria in adolescence or adulthood, and more evidence on the link between gender nonconformity and gender dysphoria is required.”

I have no evidence at my fingertips for this, but I don’t believe that most GNC kids are dysphoric. In fact, in some cultures where there are categories for such people—like the fa’afafine of Samoa—there seems to be almost no gender dysphoria at all. But this study found that adults with GD recalled more gender nonconforming childhood behavior than controls, asserting an “association between childhood gender nonconformity and gender dysphoria.”

From Stephanie Davies-Arai’s presentation

If I were them, I’d investigate why there are cultures with gender nonconforming kids and no dysphoria, rather than assuming that most GNC kids will grow up to be gender dysphoric—it was almost as if they were fishing for clients.

From Michael Biggs’ presentation

If only those who took in this research had attended Michael Biggs’ presentation at Genspect, which established the difference between age old cross-gendered behavior in children and the very new concept of the transgender child. If only they’d seen Ken Zucker’s presentation on the desistance literature, the 11 high-quality prospective studies that show a very high rate of desistance when gender dysphoric children are not socially transitioned, and that the majority of those kids grow up to be same-sex attracted. The association is between gender nonconformity and homosexuality, more than gender dysphoria. How can people at EPATH ignore this?

Genspect’s conference was indeed full of respectful disagreement, and there were often too many questions to get to (if you listened in, you may have noticed that I am a question hog). It was emotional. It was informative. And it was a brilliant marketing idea. I thought over and over of Hannah Barnes’ TIME TO THINK, of how many times whistleblowers expressed the need to pause and find out what was going on, in order to chart the best way forward. That’ll never happen until more believers in gender medicine listen to the testimonies of those who’ve been hurt by it.

I had intended my write-ups to be detached and reporterly, but by the end of my time in Ireland, after attending both conferences, I found myself profoundly changed. My optimism had drained. Pollyanna became Debbie Downer. It’s not that I learned anything new necessarily. It’s that there’s a very big difference between what I do normally and what was happening in Killarney. Normally, I’m interviewing, by Zoom or phone, academics and clinicians touting the life-saving nature of their work (or I used to do that, when they would talk to me), and then talking to those whose lives were severely negatively impacted by that work, and trying to tell the whole story. I can see the disconnect, but I can’t always feel it. This time, I wandered among hundreds of those academics and clinicians and then went down the street to sit with those hurt by them—the angry, the traumatized, the gaslit, the silenced.

I returned home, exhausted and angry, feeling that nothing I’m doing to get the truth out is working, annoyed at the slow pace of progress. Maybe my constant call for peace is because I don’t think the opposing team can win. Maybe it’s a manifestation of low self-esteem, more than a reasonable stance. Perhaps my expectations are so low that I’m mistaking these tiny breadcrumbs EPATH tossed me for some kind of meal.

Last night, Nina Paley, Corinna Cohn, Alisdair Gunn and I hopped on a livestream podcast to parse what had happened, and I told Alisdair about my initial reaction—that the tenor of the conference wasn’t inviting to those on the ground, offering these interventions—but maybe that wasn’t the point.

It wasn’t, Alisdair said. The point is to stop pediatric and adolescent gender medical transition, and to make sure every adult is properly informed. My point has always been to make sure that anyone supporting these interventions is properly informed, to get the press to report honestly. I think, in the end, this event will help both of us with our goals.

The videos are online. I hope EPATH—and Democrats and journalists and members of medical associations—will watch. I want everyone making policy around youth gender medicine to acknowledge the cost in the cost-benefit analysis. That cost, that loss, has real human manifestation, real grief, real trauma, real pain. Those practicing gender-affirming care cannot call themselves ethical if they continue to ignore that.