Is there much data for treatment/approach to these patients? Didn’t have much exposure in residency if anyone has some resources I would appreciate it
Gender dysphoria
- Thread starter robellis
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Depends on many factors. Adolescent-onset gender dysphoria is usually something very different than pre-adolescent onset.
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I can't view the attachment
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Do these work? I'm on my phone and limited in what I can link/attach at the moment
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I can see the original attachments on a PC as PDFs. Interesting if there's that big of a difference in the disorders with relatively minimal difference with age of onset. Will definitely be reading these later, thanks @LadyHalcyon
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I edited my original attachment post so hopefully those are now available. Sorry I'm not more tech savvy but definitely worth reading imo. I work some with this population and it can be difficult to find research that doesn't fit with the current PC narrative. Also, there aren't many longitudinal studies and, per usual, tons of confounding variables.
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Gender dysphoria is not one thing
by J. Michael Bailey, Ph.D and Ray Blanchard, Ph.D This is the second in a series of articles authored by Drs. Bailey and Blanchard; see here for their first piece. Many parents who are part of th…
4thwavenow.com
Just came across this. Not a peer reviewed article but links to them. Discusses autogynephilia. Interesting stuff.
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Blanchard is a hack, his beliefs are basically nonsenseGender dysphoria is not one thing
by J. Michael Bailey, Ph.D and Ray Blanchard, Ph.D This is the second in a series of articles authored by Drs. Bailey and Blanchard; see here for their first piece. Many parents who are part of th…4thwavenow.com
Just came across this. Not a peer reviewed article but links to them. Discusses autogynephilia. Interesting stuff.
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Gender Dissenter Gets Fired | National Review
‘Within a few short weeks I was removed from my leadership position and then, within the next year, subjected to fairly hostile work-environment situations.’
www.nationalreview.com
An interesting interview.
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He was the head of Clinical Sexology Services in the Law and Mental Health Program at the Centre for Addiction and Mental Health in Toronto, Ontario from 1995 to 2010. His beliefs are not politically correct. I have found some of the best forensic research comes from Canada.
Also, ATSA doesn't think he is a hack. They gave him a Significant Achievement Award in 2010.
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I think he's doing his best with the information he has, but much like Freud he fabricates many conclusions based on his preconceived notions of individuals and their behavior with poor evidence aside from observational case studies and small research experiments that wouldn't meet the mark for significance in any other field. His research also fails to explain female-to-male transgender behavior to any degree. The only valid conclusion that can be gleaned is that there probably are different types of transgender presentations, but everything else is conjecture and theory without any real degree of concrete evidence.
I think its helpful to separate out two commons concerns around pediatric gender identity:
1) Can gender identity be psychosocially mediated?
There are some who place importance of the question of whether gender identity and sexual orientation are strictly biological phenomena, determined at birth, and immutable. There are good reasons to believe that this is not the case, and that psychosocial factors may play a prominent role - this is certainly not a new idea. One response to this is - so what? Unless you have the position at the outset that one particular gender identity is inherently worse than another, it shouldn't matter whether it is purely biological or not. On the other hand, if you believe that having a particular gender identity represents a negative outcome, you would be more concerned about this, and try to address these psychosocial factors. I think that much of the reason this is important to folks relates to the same bias that would make them consider non-heterosexual orientations to be less positive outcomes. But there are also people who in good faith believe that the challenges associated with affirming a non-cisgender identity justify efforts to reduce psychosocial factors which could increase the prevalence of such an identity. However, as providers there is basically no way to do that, and we have no data-driven advice to give parents about this either (although I don't think we should shame parents who use gender-stereotyped clothing and environments for babies and young children. I think we need to teach people the typical connotations of their assigned gender the way we would insist that they do whole range of things until they have sufficient experience to form their own perspective). I also think it is wrong to 'cancel' people who bring up this question.
2) Is it wrong to affirm people?
The reasons people give for not wanting to affirm patients would be reasonable prior to us now having ample data to say that an affirming approach is associated with a reduced risk of suicide and improved mental health outcomes. Concerns regarding desistence and detransition should be informed by the data which shows that most individuals do not desist, and those that do frequently cite external reasons (Stimga, financial, family) for doing so. There is no process for identifying people who are likely to desist and there is no good alternative to being affirming. It is unclear what a more 'thorough' evaluation will yield and there is a grandiose assumption that we can make better predictions if we do a 3 or 6 month evaluation period. The only clinical experiences I've had that have gone well for patients who have desisted is when I affirmed them to begin with and they trusted me enough to explore their gender identity and then made a range of decisions. I have treated over 200 young adults who transitioned as teenagers, and although many have stopped hormones, some have desisted altogether, some have more complex narratives, not one has described disappointment or anger at their provider for accepting them where they were at.
It is wrong that people are losing their jobs for expressing concern. It is also not helpful that people are freaking out as much as they are.
1) Can gender identity be psychosocially mediated?
There are some who place importance of the question of whether gender identity and sexual orientation are strictly biological phenomena, determined at birth, and immutable. There are good reasons to believe that this is not the case, and that psychosocial factors may play a prominent role - this is certainly not a new idea. One response to this is - so what? Unless you have the position at the outset that one particular gender identity is inherently worse than another, it shouldn't matter whether it is purely biological or not. On the other hand, if you believe that having a particular gender identity represents a negative outcome, you would be more concerned about this, and try to address these psychosocial factors. I think that much of the reason this is important to folks relates to the same bias that would make them consider non-heterosexual orientations to be less positive outcomes. But there are also people who in good faith believe that the challenges associated with affirming a non-cisgender identity justify efforts to reduce psychosocial factors which could increase the prevalence of such an identity. However, as providers there is basically no way to do that, and we have no data-driven advice to give parents about this either (although I don't think we should shame parents who use gender-stereotyped clothing and environments for babies and young children. I think we need to teach people the typical connotations of their assigned gender the way we would insist that they do whole range of things until they have sufficient experience to form their own perspective). I also think it is wrong to 'cancel' people who bring up this question.
2) Is it wrong to affirm people?
The reasons people give for not wanting to affirm patients would be reasonable prior to us now having ample data to say that an affirming approach is associated with a reduced risk of suicide and improved mental health outcomes. Concerns regarding desistence and detransition should be informed by the data which shows that most individuals do not desist, and those that do frequently cite external reasons (Stimga, financial, family) for doing so. There is no process for identifying people who are likely to desist and there is no good alternative to being affirming. It is unclear what a more 'thorough' evaluation will yield and there is a grandiose assumption that we can make better predictions if we do a 3 or 6 month evaluation period. The only clinical experiences I've had that have gone well for patients who have desisted is when I affirmed them to begin with and they trusted me enough to explore their gender identity and then made a range of decisions. I have treated over 200 young adults who transitioned as teenagers, and although many have stopped hormones, some have desisted altogether, some have more complex narratives, not one has described disappointment or anger at their provider for accepting them where they were at.
It is wrong that people are losing their jobs for expressing concern. It is also not helpful that people are freaking out as much as they are.
I think there is superficial appeal to his idea that if you 'firmly and Kindly' insist that an 11 year old NOT socially transition that this will increase the odds of desistance. And to some extent I agree - I think its important to help a child understand the gender they were assigned, get to live in that gender, and work through challenges that arise related to being that gender. But if an 11 year old is indicating a strong preference for wanting to engage in non-gender-stereotyped behaviors and appearance, there are many problems with his suggested approach, including:
1) I am not aware of an evidence-based, or even well described clinical approach that does this successfully. I have however treated young folks who have required hospitalization when there parents pursue this approach
2) There is not evidence that allowing an 11 year old to pursue social transition will increase the odds of them persisting or progressing towards a non-cisgender identity. On the contrary, its possible that this freedom to explore might provide the necessary information to allow them to more comfortably occupy the identity which matches their gender assigned at birth. I've had clinical experiences where the resistance to allowing a patient to explore gender in any way has led to them digging in their heels and expressing an even stronger commitment to fully affirm a transgender identity; I've had contrasting experiences where allowing a social transition has led to a decision to live outside the confines of certain gendered stereotypes, but without an urgent need to change their physical body
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I never said anything about any of that. I just said that Blanchard's underlying theories are glorified garbage. I'm not a specialist in gender transition treatment, however, so with regard to the treatment aspects I defer elsewhere, not my bag. I can diagnose, but treatment depends on your underlying understanding of etiology. Since I don't believe we do not fully understand the etiology of the condition with any certainty, I don't feel comfortable personally making treatment recommendations. Blamchard's etiologies seem like nonsense on the level of Freud's theories, hence why I don't buy them. If I did I might feel comfortable treating this population, but alas, having given them a through read I find them very lacking in any real substance from which one could draw scientifically-based conclusions
I know, I'm responding to the entirety of what is on his website. Just my contribution 🙂
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Ah, fair.
Personally I think there's a lot of nuance to it. I think there's probably a good portion of people who certainly are trans and know from a young age and nothing will ever change it. I've also met those that detransitioned because they realized it was a terrible mistake. To those that will never change and truly feel transition is the only way forward, delaying care could lead to worsening dysphoria and consequences up to and including suicide. To those that transition and realize it was a mistake, the same consequences could result. I don't feel comfortable being the one to make that call, personally. I strongly considered going into this area of psychiatry but came to the conclusion that I would have trouble living with myself if I made even one mistake due to the severity of the error and the great violation to the ethical prinicipal of doing no harm I would have committed
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