Return of the Grown-ups

SEGM's informative conference ushered in a new era: agreeable disagreeing

If there’s one sentence I hope every attendee of the Society for Evidence Based Gender Medicine’s conference last week took to heart, it’s this:

No treatment with such low-quality evidence can be described as evidence-based, life-saving, and/or medically necessary.

Photo by Jaime Lopes on Unsplash

An international group of clinicians and academics presented at a series of panels over four days in New York City at SEGM’s conference. The location, I believe, is important: it signaled to critics that those concerned about the treatment of youth with gender dysphoria are feeling more emboldened to speak up and less apt to hide. The presenters included gay, lesbian and one trans participant, and plenty of liberals. There was even a staff reporter from a major publication! That is, the event was entirely divorced from right-wing politics. In fact, it was divorced from politics at all. It was about science, evidence, and how best to care for distressed young people.

Many of these presenters—from Germany, Belgium, the UK, Finland, Canada and the US, among other places—have been described by mainstream media and Twitter (okay, “X”) critics as transphobes and bigots. SEGM itself has been called “a crypto-Catholic fringe group,” which means…actually, I have no idea what that means. But if any of those critics actually watched these presenters talking about the research, the history, the struggles—to help patients and their approaches to doing so—it would be impossible for them to continue to believe that they were anything but knowledgeable, empathetic and concerned. I can’t remember a time when I was surrounded by so many reasonable people talking about this issue. Maybe never. They often disagreed with one another. They listened. They debated—it even got slightly heated, with people agreeing to disagree, and disagreeing without being disagreeable. That kind of behavior is exactly what this toxic subject needs.

These discussions seemed both advanced and rudimentary at the same time: primers on how evidence-based medicine, social contagions, and systematic reviews work. Dissections of the original Dutch studies. Examinations of the evidence on social transition. In many ways, I think these sessions allow those who want to speak up but don’t have enough information to educate themselves, and fortify themselves to ask questions about the world’s most unquestionable topic.

As I was sitting in front of clinicians from around the European continent, discussing how and why they changed their guidelines—uniformly to promote psychological support as the first line intervention—someone sent me the Politico article about how the American right wing had misrepresented the reforms there. The article accurately described how the Right is using these reforms to justify bans, and that those countries aren’t outright banning treatment.

Those countries are, however, ratcheting up the assessment process to be tighter than the Dutch’s. And much of the push is coming from clinicians themselves. They don’t need to go the political route, because they’re admitting that the American affirmative model is hurting children and adolescents. While some people at the SEGM conference likely believed that all youth gender transition/adolescent “sex” change should stop, others would be content with guidelines like Finland’s or Sweden’s. Meanwhile, the article didn’t note that Anna Hutchinson, the main whistleblower at the Tavistock’s Gender Identity Development Service (GIDS), is helping design the training program for the new staff at the reinvented services under development.

A few key takeaways from the conference, and things most people there did agree on:

• Parents always need to be involved in their children’s treatment.

• There is no one approach to treating gender dysphoria.

• We need to see the whole person, not just gender.

• The chain of trust has been broken, between patients and clinicians, between clinicians and their membership organizations.

• A therapist can affirm a client without “affirming” a gender identity.

• We don’t need a new model of treatment; we already know how therapy and psychological support works.

• We definitely need new and better guidelines, and no one knows how to get that done quickly in this country.

My enduring question: are we treating gender dysphoria or affirming trans identities—and how does the way we answer that question inform the work?

One thing that struck me: a lot of these new, stricter guidelines require that the kids being treated are more like those in the original Dutch research, with lifelong dysphoria. Yet through the work of Stephen Levine, E Abbruzzese, Julia W Mason and Michael Biggs, we now understand the Dutch studies to be deeply flawed, and to have transitioned kids who were very likely to grow up to be gay.

Why, I wondered, weren’t we more concerned about those kids? Clearly the rapid-onset gender dysphoric kids aren’t the intended cohort for gender medicine—but shouldn’t we be seriously reconsidering the meaning we make out of childhood-onset gender dysphoria, too? After all, clinicians who’ve been in this world for a long time once admitted the association between homosexuality and what was once called Gender Identity Disorder. Why don’t return to that folk knowledge and clinical know-how?

The answer, I believe, was politics. We gotta do what we can.