Medical Perspectives on Dysphoria and Detransition: Make More Noise

On the last day of November, a meeting was held in Manchester to discuss the elephant in the room of medical transition: the detransitioners. It was organised by feminist collective Make More Noise to mark the foundation of the Detransition Advocacy Network. The importance of the issues raised cannot be understated, and so the two panels of the event will each have their own article. This is not a word-for-word recap: an audio version will be available at the end of the article. Instead I have sought to present the main themes raised in the course of the discussion.

The Medical Professionals 

The first panel was composed of professionals with various areas of expertise. 

Stella O’Malley is a psychotherapist, best selling author and public speaker. Her documentary ‘Trans Kids – it’s time to talk’ was one of the first films to investigate the treatment of transgender children.

Dr David Bell is a past president of the British Psychoanalytic Society and consultant psychiatrist at Tavistock, the country’s only NHS gender identity service for children. He published a damning report on the failings of the service to analyse the psychological and social factors which might lead children to decide they should transition. 

Dr Anna Hutchinson is a chartered Clinical Psychologist and has held senior positions at a number of internationally renowned London hospitals, including Great Ormond Street Hospital and The Tavistock Centre. In July 2019 she signed a letter in support of greater research into   Rapid Onset Gender Dysphoria (ROGD.)

Dr Hannah Ryan has been working as a doctor in the NHS for 10 years. She has worked for the Cochrane Infectious Disease Group where she performed systematic reviews, working in evidence synthesis for health policy. Her interest in the ways that evidence is used in formulating guidelines and informing clinical practice is the reason why she takes an interest in trans health.

Where is the evidence? 

Though randomised control trials have not been conducted upon the efficacy of transitioning, these standards are rarely achieved in the area of mental health. However, even lower standards of evidence have not been met. It is extraordinary that no centre has properly followed up patients across decades. Thousands of people are being treated on the basis of very small studies. 

The evidence which does exist is largely drawn from the original cohort – of males who desire to transition into women. In recent years we have seen a total reversal of the statistics – where it used to be 75% male, now it has become 75% female, and yet organisations are still proceeding on the assumption that the original studies still apply. 

Furthermore, the characteristics of gender dysphoria being treated have changed. It used to be that dysphoria was presented as lifelong, and people came in to see how it could be treated. Now people are entering into the medical sphere having already socially transitioned, or identifying as nonbinary or gender fluid. 

Remember our History

The treatment of gender dysphoria is on the cutting edge of medical science. We need to proceed with caution if we wish to avoid repeating the mistakes of the past. Lobotomies and electroshock therapies were widely used historically to treat people who struggled to conform with society. Now we recognise that they were incredibly damaging practices. When new medical treatments are discovered, people look for problems to solve with them. The discourse arises to justify the use of the technology. 

This is especially true where medicine is commercialised. In the US, doctors have begun to amputate people with healthy limbs, simply because the patient wishes them to be removed. From a market perspective, this makes sense, but doctors have a duty of care to their patients which goes beyond that. The customer is always right, but doctors should know that what people want is not always what they need. 

Puberty Blockers 

The drugs which we call ‘puberty blockers’ are similar to anti-depressants in that they are named after a desired outcome. The suppression of puberty hormones most likely has a wide ranging variety of effects, which need to be examined closely. 

The blockers are supposed to give young people a time to reflect on their options before puberty takes its natural course. However, you can’t just put puberty on pause – it is both socially and biologically expected to happen at a certain time. Furthermore, it used to be that 80% of children with gender dysphoria would grow out of it. When put on puberty blockers, there is almost no desistance whatsoever – and no studies have been done to examine why. Given that transition requires a long physical and social struggle, we should be looking for ways to help people deal with gender dysphoria without transitioning. Anything which puts people on the opposite path should be looked at with alarm, not celebration. 

Social Factors 

Counselling must be the first port of call for people with gender dysphoria. Medical intervention should always be a last resort, but thousands of children are coming in with scripts informing them exactly what to say to get put on the path to medicalisation. Doctors are used to pressure from patients, but this pressure is coming from outside organisations and internal medical guidelines. The Memorandum of Understanding prohibits conversion therapy for gay and transgender patients. But what constitutes ‘conversion therapy’ for trans people? Accepting homosexuality does not require a lifetime of drugs and surgery. 

In fact, aversion to homosexuality, and sexist expectations of conformity to gender roles, do appear to play a part in causing a desire to transition. Many detransitioners turn out to be gay or lesbian. To read what some of those detransitioners have to say, stay tuned for the second half of our coverage of this event.