Pour lire l’integralite de l’interview en francais, rendez-vous ici.
In addition to Dr. Erica Anderson’s important opinion piece in the San Francisco Examiner earlier this week, the former WPATH board member and transwoman spoke to journalist Lisa Selin Davis for Quillette about her decision to quit as President of USPATH due to their media muzzle and her worries over how gender-questioning youth are no longer being properly assessed before medicalization. Below are highlights from that interview.
On why Dr. Anderson recently quit as USPATH President:
I got to a point in my concern that I felt I could no longer continue in good conscience to support the direction of USPATH, which I had led for the last two years…. I have some concerns—serious concerns…. There was going to be a 30-day moratorium on speaking to any press about any subject…. I read a statement: “I’ve made the case for a more open posture to the press and the public. We need to engage them in supporting our work and the standards of care. I cannot abide the tactics of muzzling leaders in the USPATH/WPATH. I will not give up on my First Amendment rights. I’m done. I’m out of here.”
On Abigail Shrier and her book Irreversible Damage:
The main criticism of me is that many in the trans community regard Abigail Shrier as anathema, as a critic of appropriate trans care. I think that’s an inaccurate reading of what she’s written. And I think that it’s a distortion….
There are a lot of issues that [Shrier] brings up in the book that are worthy of deeper attention, including what’s happening to our adolescent girls. The data are very clear that adolescent girls are coming to gender clinics in greater proportion than adolescent boys. And this is a change in the last couple of years. And it’s an open question: What do we make of that? We don’t really know what’s going on. And we should be concerned about it.
On the aggressive use of puberty blockers and cross-sex hormones:
We need to ask: What do we do with trans youth, and what are the implications of deploying puberty blockers and cross-sex hormones early in adolescence, which is a more aggressive posture than has been used historically by those who have treated transgender youth for a long time, for decades, including [experts] in the Netherlands and in Sweden?
On whether a one-size-fits-all medicalization approach is right for all gender-questioning youth:
When you’ve seen one transgender person, you’ve seen one….
What I want always is individualized evaluation and a comprehensive bio-psychosocial evaluation. That’s the language in the Standards of Care. For professional people, whether they’re medical or mental-health [specialists], to say, “Just accept what the kid says and then make your decisions accordingly” ignores the long history we have of issues in child and adolescent development, and it is a disservice to the patient….
We don’t have a lab test. We don’t have a psychological test. I get asked this time and time again: Is this kid truly trans? And I don’t think that’s a helpful question to ask. I think the question to ask is: “Is the gender presented by the child enduring? And do we … have a consensus on the likelihood that it’s going to endure?”
On social influence:
I’m worried that gender minority identities have become a bit trendy, and that with the weird circumstances of the last two years of pandemic, adolescents who are notoriously susceptible to peer influence have found it necessary to have their communication and their social relationships online.
I’m worried there’s a new group of adolescents who have pre-existing mental-health problems, and they’re looking for solutions, and they’re looking for an explanation for who they are … And there’s a bit of, I would say, fantasy about seizing upon an identity that to them may explain their distress. They may believe and verbalize that: “Okay, the solution to my problem is to transition. And then I won’t have these other issues—eating disorders, depression, anxiety, social problems.” That is misguided. As far as I know, gender transition doesn’t cure depression, doesn’t cure anxiety disorders, doesn’t cure autism-spectrum disorder, it doesn’t cure ADHD. [But] it can [provide] help for the right person….
On whether to just unquestioningly affirm a young person who says they are trans:
I couldn’t be more gender affirming. But I will tell you, having had many, many hundreds of interviews with kids and families, I don’t give a 13- or 14-year-old carte blanche just because they say magic words. To just say that if a kid says they’re trans, they’re trans, and so treat them as such, and expedite gender-affirming medical support? No….
[One] irony is that the people who say every trans kids should be affirmed want to invoke the research that says trans kids who are affirmed do well. But that research is typically based on the methodical, careful approach taken in the Netherlands, Sweden, and other places where they use the same approach I’m advocating for, which is the comprehensive, bio-psychosocial evaluation of issues, and the inclusion of parental advice.
On clinicians omitting parents from the decision-making process:
These are misguided efforts, at best. Unethical and irresponsible, probably. I’m a parent. I have two grown children. I empathize significantly with parents who are struggling to do the right thing for their children. I hear from these parents all the time. They’re not right-wing transphobic, bigoted parents. They’re well-meaning parents trying to do the best thing that they can for their children….
Those who say, “Just ignore the parents or work around them”—I am furious about that. They’re undermining the life of this child who desperately needs support. I routinely am talking about the importance of arriving at a consensus about what’s true about a child.… Battling the parents is a no-win proposition.