We believe that there are many routes that may lead to the development of distress over an individual’s gender. Equally, there are just as many routes out of such distress.
That’s why we would like to see a wider range of treatment options and more evidence-based approaches to gender-questioning children and young people.
What is gender dysphoria?
“Gender Dysphoria” (also known as “Gender Incongruence”) is the official term for a condition diagnosed by a professional clinician (e.g., a psychiatrist or clinical psychologist) to describe when an individual experiences psychological distress due to feelings of a mismatch between their sex and their gender identity. Most people today self-diagnose themselves with gender dysphoria, even though it is a psychological condition listed in the DSM-5. The word dysphoria refers to a state of unease or dissatisfaction and is the opposite of euphoria. Although gender dysphoria has historically almost always begins in childhood, in current times it typically manifests in puberty or later in life.
What is gender identity?
“Gender identity” is an individual’s personal sense of their gender. This is a concept that was initially developed by two clinicians in the 1950s and 1960s, John Money and Robert Stoller, who put forward the idea that every one of us has an unidentifiable, unfalsifiable, invisible element inside us that motivates us to behave in certain ways and that subscribes to certain gender norms and expectations. There is ongoing debate about how many gender identities there are – some say there are only two, others say 112, while still others say there are as many gender identities as there are people in the world. Many people say they do not have a gender identity and so they do not subscribe to this belief.
What does trans mean?
In the 1990s the terms “transvestite” and “transsexual” were melded together in the one term “transgender”. Since then, the word “transgender” has been further broadened, and now “trans” is an umbrella term for anyone who identifies with it. Some but not all people who identify as trans have gender dysphoria, and not everyone who has gender dysphoria identifies as trans. Some people who identify as trans undergo medical interventions including cross-sex hormones and/or surgery to align their body more closely to their inner gender identity; this is known as “medical transition”. Some people who identify as trans do not undergo any medical transition.
What is conversion therapy?
Conversion therapy is a damaging pseudo-scientific practice that was until very recently commonly understood to refer to “gay conversion therapy”. This so-called “therapy” was harmful, anti-therapeutic, and involved coercive practices which sought to change a person’s sexual orientation from homosexual to heterosexual. There is an extensive body of evidence showing that not only were these practices morally wrong, they did not change sexual orientation and in fact caused harm. Today, no ethical therapist engages in “conversion therapy,” and it is generally only religious zealots who will try to engage in this barbaric practice. Ethical therapy should never have an agenda nor a planned outcome; they should instead be exploratory and willing to engage in a gentle and compassionate therapeutic process. There is consensus among therapists about approaches to sexual orientation however there are two differing approaches to gender dysphoria.
Gender exploratory therapists differentiate between sexual orientation and gender identity and believe that bans on Conversion Therapy should recognise the differing needs of people who struggle with their sexual orientation and people who experience gender-related distress. Gender exploratory therapists believe that self-acceptance can often be an integral part of the therapeutic process and so individuals who have difficulty with their sexual orientation might need help to come to terms with being gay, lesbian or bisexual while individuals who are experiencing gender-related distress may benefit from learning to accept and even the love their bodies.
Gender affirmative therapists do not distinguish between sexual orientation and gender identity and believe that the same definition of Conversion Therapy should be used for sexual orientation and gender identity. This approach does not recognise the unique needs of people with gender dysphoria and instead treats this cohort in the very same manner as they treat people who are gay, lesbian or bisexual. Gender affirmative therapists believe that all gender-questioning individuals should be facilitated towards social transition, puberty blockers, cross-sex hormones, and surgery without any psychological or exploratory process. This is a thorny and complex subject that requires thought before quick judgements are made.
For further information see: https://sex-matters.org/posts/updates/types-of-therapy/
What is Gender Exploratory Therapy?
Gender Exploratory Therapy is based upon well-established, conventional, therapeutic approaches that distinguishes between sexual orientation (which requires no therapeutic intervention) and gender dysphoria (which is a distressing condition that can benefit from a therapeutic process). Gender Exploratory Therapy recognises that it is beneficial for the individual to have reflected upon their inner motivations before making any big decisions such as medical transition. The central aim of Gender Exploratory Therapy is to bring about a deeper understanding of the person’s sense of self. This approach builds self-awareness and insight and is non-invasive.
What is the Gender Affirmative Model of Care?
Gender affirmation is very different from Gender Exploratory Therapy as it is an aggressive treatment model with a one-size-fits-all approach that fast-tracks medical interventions that alters the person’s physical expression. Although the World Professional Association for Transgender Healthcare (WPATH) currently recommend the Gender Affirmative Model, there is no quality research to support this model of care and the Gender Affirmative Model of Care has recently been discredited by the Cass Review.
How are concerns about gender identity different from concerns some people had about gay people years ago?
Some people believe that their gender identity is somewhere inside them; that their gender identity is similar to their sexual orientation – it’s just a part of you and nobody can really understand it but you. Consequently, many people view being trans as the same as being gay or lesbian or bisexual. This is compounded by the decision in the 1990s to add “Transgender” to the “lesbian, gay, bisexual LGB” moniker to become LGBT. However, there are fundamental differences:
- Being gay is how you feel about other people, while being trans is how you feel about yourself.
- Being gay is empirical, which means there are objective scientific tests that can show that a person is gay, lesbian, or bisexual through their heart rate, sweat glands, tumescence etc. There are no objective scientific tests that can show a person is trans; being trans relies solely on the person’s belief.
- Gay, lesbian, and bisexual animals have been observed, but there are no trans animals.
- Being gay does not require any medical intervention, while being trans can require a lifetime of medicalisation.
- The gay rights movement had no equivalent to the current controversies over medicalisation of children with gender dysphoria and transgender males accessing women’s only spaces e.g., in prisons.
This article provides a more detailed analysis about the difference between being gay and being trans.
What is gender critical theory?
Gender critical theory asserts that there are only two sexes, sex cannot be changed, and our bodies are part of what makes us who we are. Gender critical theorists believe that society’s expectations and emphasis on stereotypical gender roles is regressive and damaging. For example, people who believe in gender critical theory do not believe a boy must “act like a boy” and instead believe that a young boy who wants to dress up as a princess or play with dolls should be allowed to do that.
What is gender identity theory?
Gender identity theory takes an opposing view to gender identity theory and posits that we all have an invisible gender identity within us which can be misaligned with the sex of our body. Gender identity theory hypothesises that everybody, no matter what age, should have access to medical interventions to attempt to align their body more closely to their gender identity to alleviate any distress they might feel about their sense of gender. Subscribers to gender identity theory believe that gender identity overrides biological sex and hence a female child who claims to be a boy may in fact be a boy and a person born male who claims to identify as a woman is in fact a woman.
Why is there such controversy about trans issues?
There is such controversy about trans issues because of the conflict between the two main theories – gender identity theory and gender critical theory – and how these theories are being put into practice in society. For example, both sides of the debate tend to become incredibly engaged in questions such as: “Should children diagnosed with gender dysphoria be provided with medication to interrupt puberty?” and “Should transwomen be allowed to play women’s sport?” because these issues have a significant impact on wider society. Currently, disagreement seems to become very heightened very quickly, especially in Western culture. The gender wars are mainly found on social media, which acts as a vector for heightened debate, and so rather than civilised discussion of these complex issues, this controversy has become deeply divisive.
Is there such a thing as the “transgender brain”?
Although much is made of brain imaging, and many people like to declare that people are transgender because of hormone exposure in the brain, there is no credible scientific evidence to support this theory. Scientists have not been able to locate a “gender area” of the brain that is innate and fixed: when controlled for sexual orientation and exposure to hormonal interventions, the brains of trans-identified individuals cannot be reliably distinguished from the brains of people of the same sex who do not identify as transgender.
There is no test to identify if an individual is truly transgender; clinicians rely on self-reports to diagnose. Although this is not the only condition that’s diagnosed from a subjective state (like depression and anxiety), it’s arguably the only condition where a self-reported feeling leads to a cascade of irreversible, risky, and highly experimental medical interventions for young people.
There is also plenty of evidence that gender identity can change and evolve, especially in young people. This is entirely consistent with what we know about brain function: the brain is plastic, open to influence and suggestion, and responsive to nurture, environment, and experience.
Do intersex conditions prove that sex is a spectrum?
There are 2 sexes: male and female. Biological sex is not a spectrum and the existence of intersex conditions do not alter this fact. In a rare 0.018% of cases, people can have a Disorder (Difference) in Sexual Development, or DSD (formerly known as “intersex”). In most cases of DSD, the individual is still clearly of male or female sex. Although additional investigation may be required in some cases to clarify the sex, instances when sex cannot be determined at birth are exceedingly rare and comprise of a fraction of the <01.% who have DSDs. Yet the fact remains that every human is still either male or female as we are a sexually dymorphic species.
The issue of “diagnosis creep”, where expert panels get together and decide to expand the definition of any given disease, has impacted many people’s understanding of DSDs. An example of diagnosis creep happened in 2008, when a new definition of osteoporosis increased the number of elderly women with the condition from 21% to 72%; it also happened with diabetes, where a large percentage of the population is now deemed to be “pre-diabetic”. This has arguably happened with DSD’s as some people expand the definition of DSDs to include anyone who has a difference in their sex characteristics. This has led some people to argue that as many as 2% of people have DSDs and the professor of philosophy, Kathleen Stock has commented in her book Material Girls: Why Reality Matters for Feminism that under Fausto-Sterling’s expanded definition she could be incorrectly described as “intersex” as she lost an ovary in early adulthood.
As with all subjects that are even tenuously related to the subject of sex and gender, these issues are subject to intense scrutiny these days and the debate continues to bring about argument and controversy.