The creation of an international expert ...

The United Nations Human Rights Council has announced its "first ever independent expert focused on sexual orientation and gender identity (SOGI)."  The appointee is Vitit Muntarbhorn, a law professor from Thailand, and he will serve in this capacity for the next three years.  "Professor Muntarbhorn will be tasked with raising awareness about the violence and discrimination LGBT people face globally."

Reportedly, Mr Muntarbhorn has experience working in international human rights, but nowhere in the press release or in Google searches is it apparent how Mr Muntarbhorn is qualified as an expert on sexual orientation and gender identity, nor what criteria would define someone as an expert in these areas.  Mind you, the UNHRC statement about the resolution to create this position is telling:  "The positive vote responds to a joint campaign of a record 628 nongovernmental organizations from 151 countries calling on the Human Rights Council to adopt the resolution and create the independent expert."  The wording implies they created the person rather than the position.  Further:

"The expert will be tasked with assessing implementation of existing international human rights law, identifying best practices and gaps, raising awareness of violence and discrimination based on sexual orientation and gender identity, engaging in dialogue and consultation with states and other stakeholders, and facilitating provision of advisory services, technical assistance, capacity-building, and cooperation to help address violence and discrimination on these grounds."

Certainly, I endorse freedom from violence and discrimination for every person, but it remains to be seen how this language will be implemented.  More shared gender neutral bathrooms?

Sex or gender?

If you find yourself confused when trying to understand transgenderism, it may be because the proponents often conflate sex (biology) with gender (social role), and sexual orientation (biology of sexual partner in relation to your biology) with gender (social role).  Start with clarifying what exactly is being discussed.

"Gender is a profoundly political category based on a global system of power called patriarchy.  Patriarchy has to separate who counts as human and who counts as an appropriate target for violation.  That's what gender is, that political demarcation.  So gender is power that is disguised as biology.  There are biological explanations for everything from male spending patterns to rape, all based on the idea that men and women are biologically different, rather than being socially - and brutally - created." 

 Lierre Keith

If there is no such thing as being 'born in the wrong body', why does transgenderism exist?

In short, because of:

1. patriarchy

2. money

Minds more finely tuned to economics and politics than mine can draw the map (please!).  For example, how much money can pharmaceutical companies make from the life-long hormone treatment that transgender individuals are encouraged to purchase?  Is it a coincidence that as hormone replacement therapy for perimenopausal and menopausal women waned in popularity, the use of the same hormones for male to female transgender individuals rose?  And, interestingly, many insurance plans do not reimburse women for HRT, but do reimburse transgender male to female individuals for those same hormones, even though their use for transgenderism is off-label (ie not endorsed by the federal licencing bodies for that use in the market).

Transgenderism is an industry, analogous to harm reduction, which dispenses an abundance of sandwiches and clean needles but a paucity of detox beds, treatment programs, counseling, housing, and employment training.  Both transgenderism and harm reduction allow people and institutions to profit at the expense of entrenching patients in their disease.  These profiteers appropriate women's narratives and perpetuate their disenfranchisement.

If transgenderism, like harm reduction, is about patriarchy, why would men choose to be women?  It seems obvious why women might choose to be men - to avoid the demands of being female, to try to access the privilege of being male; however, no woman who attempts to be a man truly gains male privilege, she simply becomes even more marginalized, more invisible - a win for patriarchy.  As for men choosing to try to be women, well, one patriarchal success out of that maneuver is that men who identify as women then say that their identity grants them the right to say what it is to be a woman, thereby erasing the right of biologic women to claim that knowledge and experience - another win for patriarchy.  Regardless of the direction of changing gender, it is about sustaining male privilege and erasing women.

Patriarchy is about privilege, privilege is sustained by capitalism, and capitalism is comprised of industries, including the industry of health care and the industry of transgenderism.  Even well-intentioned health care providers are part, intentionally or as captives, of these industries:  for example, a nurse who works in a local clinic for pregnant street-involved women spends almost half her day in staff meetings and administrative tasks, and her clinical time in harm reduction, and although she predicts the day when male to female transgendered "clients" will be admitted to the clinic, she declines to speak up against this, even endorsing the employment of a trans man in the clinic, opting "to be careful," because she doesn't feel safe to express her opinions, though her position is unionized and she cannot be fired.  Yet, such is the coercive power of peer pressure.

Working from within the system necessarily means condoning and being complicit with the system.  It means being the system.

Whenever we make a health care decision which is premised to any degree on keeping our job, and at our job we profit more than do our patients, we fail in our ethical duty to put the patient's best interests first.  Health care providers must speak up, for the long-term best interests of their patients.

Cowardice may grant immediate access to personal privilege, but it is not rewarded by history.

As a society, it seems we care more about sorting our plastics for recycling than about the well-being of one another.

If there is no such thing as being 'born in the wrong body', what is transgenderism?

Anxiety.

The most common reason patients come to see me is because of consequences of lifestyle (such as diabetes and high blood pressure from being overweight and sedentary).  Most people intend to be healthier, they say they want to exercise regularly, they want to eat better, they don't want to be on medication, but they find themselves too busy with managing family and work and the chores of life, and feel too tired to go for a jog and have no time to prepare a meal from scratch.  In truth, every aspect in a day is a choice, everything we do or don't do is a decision, and these decisions demonstrate our priorities.  In our North American culture, we are encouraged to strive, to be over-worked, to be over-committed; many of us have to live like this for financial reasons, but our culture encourages this over-subscribed lifestyle to keep us consuming and to keep us distracted from paying attention to our best interests.

Not taking care of our basic needs for good health can cause or exacerbate anxiety.

Anxiety arises out of difference, out of comparing ourselves or being compared, from fearing or being judged 'less than.'  These differences are based on aspects such as class, race, ethnicity, biology - generally traits that we have no choice about, and thereby easy targets - and they are used to gate-keep us, to determine who has access to what sorts of education and employment and housing.  These differences determine your opportunities in your life.  These differences are used to determine who has access to 'the good life.'

In my experience, women are far more likely to see a doctor for help with anxiety, whether they recognize their struggles as such or not.  Often women present to a doctor because they are tired and can't keep up with the demands they feel, and rather than examine the demands (work, family and extended family, house maintenance, friends, exercise classes - and the right kind of exercise classes, appearance, etc), they believe there is something wrong with them.  They would rather have a vitamin deficiency or physical malady than question the cultural expectations and say it is too much.  When I asked one exhausted woman when she had last had a vacation, she burst into tears; still, she was determined that she was missing a nutrient rather than missing rest.

Men rarely come to a doctor because they are exhausted.  This is likely partly because they are less medicalized (women are trained from youth to go to doctors, for reproductive health primarily), but men also have fewer expectations placed upon them (they can gain a few pounds, they don't have to scrub the toilet before guests arrive, they don't have to be the one responsible for buying a birthday present for an in-law), and they also have more cultural permission to take a time-out (beer with the guys watching a game).  I am painting in broad strokes, but this is the illustration many individuals follow as though a map.

We try to manage anxiety in many ways, some with over-commitment, some with exercise, some with substances.  In our culture, not often are we endorsed for admitting we are anxious and are taking quiet time to regroup - unless that quiet time is of the right kind:  the right meditation class, the right holistic supplements, attendance at the right retreats - and, of course, having to do anything a proscribed 'right' way increases anxiety.  

Sometimes we manage anxiety not through over-functioning, as above, but by under-functioning, such as binge-watching shows.  This isn't relaxation; it is collapse and avoidance.

Anxiety manifests in many ways, from a unsettled, worrying mindset to fatigue to depression.  It is expressed culturally.  For example, eating disorders were rarely seen in Hong Kong, until Princess Diana's eating disorder was made public.

The language of gender and transgenderism is an expression of anxiety, specifically in response to biologic discrimination and oppression of women, no less than eating disorders are primarily a language about oppression of women.  When an anorexic woman who weighs ninety pounds says her best self weighs seventy pounds, the response ought not to be, "You are right, let me remove that second leg that is in the way of you being your best self."  The response ought to be, "Your body is not the problem; it is the messages about your body and who you are that are the problem.  Let's look at that."

And so how would wanting to change gender and attempting to do that by trying to change biology help anxiety?  Well, it wouldn't, it doesn't, but it keeps people busy, and distracted from their true discomfort.  As for why transgenderism exists, I will save that for a next post.

And then there were guidelines ...

I have drafted proposed clinical guidelines for detransitioning.  This is a work-in-progress, to be amended by the experiences of detransitioning individuals and their health care providers, for just as the knowledge of the consequences of transgender interventions is accumulating, so, too, and necessarily delayed, is the accumulation of knowledge about detransitioning.  Therefore, one will note these guidelines are, at present, short.

In writing these guidelines, I referred to the Standards of Care published by WPATH, and the clinical guidelines published by my local health authority.  It is worth noting a few things:  WPATH was originally the Harry Benjamin International Gender Dysphoria Association (and it is worth reading about Harry Benjamin's invention of clinical transgenderism), that WPATH and its Standards of Care are funded by the Tawani Foundation, which was created by Jennifer (James) Pritzker; and the original author of the WPATH Standards of Care is Dr Jamie Feldman, who was a family doctor, not even an endocrinologist.

As I wrote these guidelines, I quickly realized there wasn't much to state that could not be reduced to the Hippocratic Oath, which essentially exhorts physicians to first, do no harm.

In the beginning ...

I am starting this blog as a way to offer my support to anyone who is considering or reconsidering gender transition.  In the current climate, voices critiquing transgenderism are often intimidated into silence.  I want to create a safe forum for those who have journeyed down, any distance, the path of transgenderism and now have doubts.

I also want to welcome health care professionals who are questioning the current medical construct of transgenderism.

In 2015, I wrote an essay, My Disservice to My Transgender Patients, which received some attention, almost all positive.  Clearly, there is desire for conversation about transgenderism.

I am a medical doctor, but I will not offer advice beyond my general opinions.  A blog is not an adequate means to practice medicine. 

My opinion is that transgenderism is not a problem with being born in the wrong body; transgenderism is an expression of anxiety.  To treat it somatically, with hormones and surgery in an erroneous attempt to change one's physicality, is not only ineffective but wrong.  Transgenderism must be treated as an anxiety disorder, an expression of dis-ease with our society's entrenched and maladaptive gender roles.  As a culture, we will one day look back and see the current enthusiasm for transgenderism as dark days, when we willing misdirected people into wrong ideas and bad choices, sacrificing their health to serve the gender model.

While I advocate for the complete dismantlement of transgenderism, I am especially concerned about women who are opting for a male identity.  Transgenderism is about the erasure of women, both the movement of women towards a male identity, and the infiltration into women's space by men who adopt a female identity.  Transgenderism does not provide freedom from gender roles; it exaggerates women's inferior position in patriarchy.

There is a lot of useful information easily available, and I will not attempt to be a definitive resource.  My questioning of the medical construct started with Janice Raymond and Sheila Jeffreys and radical feminism and Women's Liberation Front.  The response to my essay introduced me to an online community of like-minded trans questioners, blogs such as GenderTrender, 4thWaveNow, and The Dirt, and a valued network of allies.

To treat transgenderism, the place to begin is to question the construct; what follows is to stop all the physical interventions and begin to analyze and manage the anxiety.  We may not be able to overturn patriarchy with one blog, but we can try to save individual lives, one at a time.