There's No Standard for Care When it Comes to Trans Medicine | Opinion

Even before my story aired on "60 Minutes," activists were pressing for the episode to be censored or cancelled.

The story I wanted to tell was my own: In my early 20s, I became depressed and gender dysphoric after years of obsessing over identity issues. Finally, I thought I saw my route forward: the total transformation of medical transition, to live as a man.

I had the most supportive possible environment for transitioning: easy access to hormones, an affirming community and insurance coverage. What I didn't have was a therapist who could help me scrutinize the underlying issues I had before I undertook serious medical decisions. Instead, I was diagnosed with gender dysphoria and given the green light to start transition by my doctor on the first visit.

I started my transformation with cross-sex hormones injections. Four months later, I had my breasts removed in the masculinizing surgical procedure known as "top surgery." The day I got my first testosterone shot, I wept with joy. I thought I had discovered my path to self-actualization as a transgender man.

One year later, I would be curled in my bed, clutching my double-mastectomy scars and sobbing with regret.

detransitioning
The author four months after surgery

I wondered desperately how I could have been so wrong about something so important. I knew people who were very happy with their changes. But it all went wrong for me.

My gender dysphoria, which I had taken as proof that I was truly meant to live as male, turned out to stem from other mental health issues. My change had been a brutal mistake, and I would have to live with the consequences—numb scars, no breasts, a deepened voice—for the rest of my life.

I joined the ranks of the "detransitioners": people who had undertaken physical gender transition to live as the opposite sex, which could include puberty blockers, hormones, and facial, chest, or genital surgery, and then reverted back to living as their birth sex.

I went on "60 Minutes" because I wanted people to understand that trans medicine is not always being administered responsibly and safely. I knew I had been badly hurt by my transition, and I wasn't the only one. But going on TV to talk about regretting my permanent bodily changes was scary. Transgender issues are incredibly fraught right now; Chimamanda Adichie recently published an essay about the brutal backlash she got for daring to speak of trans issues with nuance.

She was not the first person to reap the social media whirlwind on the topic. J.K. Rowling incurred the same social media wrath for a mild-mannered essay where, among other things, she worried about young women being hurt by hasty transgender medicalization.

But even before the "60 Minutes" episode aired, the backlash to it had begun. After news of the upcoming segment was leaked on Twitter, activists threw a fit. Some said it would be irresponsible to even speak of our stories on TV, that it would hurt transgender people. In the "overtime report" about the episode, interviewer Lesley Stahl said "she cannot remember another story she has worked on at '60 Minutes' where comments and criticisms began surfacing from advocates before the piece aired."

detransitioning
iStock

I found it strange. For all the worry about how interviewing detrans people would negatively affect the trans community, it seemed a piece was missing: concern for the people who had been hurt by transgender medical treatment, which is increasingly being administered to patients in their teens.

Activists may not want to admit it, but I am not alone in my regret. During my quest to understand everything about my transition and what went wrong, I wrote online, on Twitter and on a blog. I connected with many other detransitioners and found that many of their stories were similar to mine.

Some stopped quickly, others were on cross-sex hormones for years and had multiple surgeries before deciding the path wasn't right for them. Many had complicating factors when they chose to transition that they later identified as root causes to their unhappiness. Often, I saw people speak of untreated mental health issues, a huge life crisis before transition, a past with sexual abuse, a struggle to accept oneself as gay or bisexual, or undiagnosed autism.

For many, the regret and pain was intense, as it was for me. In a lot of ways, there is no "going back." Many of us are left wondering, "Why didn't my therapist help me figure out my underlying problems beforehand?"

As Scott Newgent, a trans man himself, wrote in Newsweek earlier this year, "There is no structured, tested, or widely accepted baseline for transgender health care." Trans health care is a newer field, and while there are some generally accepted standards of care made by WPATH, there is no requirement that they be followed. While WPATH has recommendations for identity exploration and mental health guidance, in many informed consent clinics, you can access cross-sex hormones with no assessment at all.

In my own medical odyssey, I did not receive most of the therapeutic exploration recommended by the WPATH standards of care. As such, I was left to my own self-diagnosis.

Worldwide, trans medicine, especially for children and adolescents, is under new scrutiny. There was the Kiera Bell case in Britain, where the high court ruled that people under 16 were unlikely to be able to consent to puberty blockers. And a Swedish hospital recently stopped puberty blockers for under-16s out of precaution.

With serious questions being raised about trans medicine around the world, I would think that a nuanced public conversation about how we can improve medical transition is just what we need. And yet, instead of having this conversation, GLAAD denounced me, inaccurately saying I sought to limit affirming trans health care when in fact, I'm part of an organization that actively opposes legislation against trans health care. Laverne Cox released a video denouncing the whole segment as "dehumanizing."

So why the resistance to hearing complicated, and even negative, stories about transgender healthcare? I understand why the media is afraid to cover stories like mine; there's a long history of stigma around transgender people, and shedding light on problems with trans medicine is seen as leading to more stigma.

And yet, when activists push stories like mine under the rug and try to shut down stories of medical negligence, they are only protecting doctors, not patients.

Real lives are at stake.

All people deserve to feel safe enough to tell their stories, even if those stories are complicated and politically inconvenient. Without that truth-telling, more people—especially young people—will be sold one-size-fits-all trans care that may cause them lifelong scars and regret.

Grace Lidinsky-Smith is President of GCCAN and writes about her experiences on her blog. Twitter: @HormoneHangover.

The views in this article are the writer's own.