Sawbones: A Marital Tour of Misguided Medicine - Sawbones: An Incomplete History of Gender Confirmation

Episode Date: June 30, 2017

This week, special guest Laura Kate Dale joins Dr. Sydnee and Justin for a (very) incomplete history of gender confirmation. We hope you'll join us too! Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. We came across a pharmacy with a toy and that's lost it out. We pushed on through the broken glass and had ourselves a look around.

Some medicines, some medicines, the escalant macaque for the mouth. Hello everybody and welcome to Solbona's Emerald Tour of Miscite Admedicine. I'm your co-host Justin McElroy. And I'm Sydney McElroy. And Sydney, it's a very special episode today. I'm very excited. Me too. So do you want to talk about what we're talking about?

And then I will introduce our very special guest. Yes, sure. One topic that we have, we've wanted to cover for a while, and then specifically after our episodes earlier this month where we discussed conversion therapy, we had even more listeners than we'd already have kind of write us emails and say, you know, something that you've never covered, something that you never talked about, and that we had already wanted to talk about for a long time, was anything that had to do with transgender person's health issues, anything about surgeries or hormonal therapies or the history of that, we've never talked about any of it.

And so it's something we've wanted to talk about for a long time, and we're finally taking the opportunity to do so because we have a special guest. Our special guest this week has been writing for basically every video game outlet that I like. She is Laura Kate Dale and Laura, as you've almost certainly guessed from Sydney's introduction, we've brought you here to talk about you getting the scoop on Mario and Rabbids. Months before it was announced, we're all anxious to hear how you did it. I just wanted to bring you on to say nice. Well, here's the secret to how I did it. I'm good friends with Rabbit Peach and we spent one slightly sorted night together and I walked away with a lot

of very useful information. And aside from leaky video games, Laura is also a transgender woman who we thought could offer some really valuable perspective. We realized after we did our recent conversion therapy episode that there's a lot of topics that we would love to talk about that we don't necessarily have the context for, I guess, due to our life experience. Sure. I mean, I think as a doctor, I can sometimes decode like medical talk and the technical end of things.

I have that kind of expertise. And I've become, I guess, like an amateur historian or researcher anyway. I can do that stuff, but that's as far as I can take a topic. And that's where I turn up. Exactly. Yeah, we're going to be pretty focused in this episode. This is a very broad topic with a lot of facets to it. And we're going to be focusing for this episode just on the one surgical aspect. That's how broad this is the one surgical aspect of the two. Yeah. Okay. Well, you don't

even know. I don't even see this is why I don't know. I don't know. I hate having to pretend like I know what I'm doing. This is exhausting. I know. That's my whole day, honey. It's fun. Just keep saying words until it sounds like, you know what you're on about. That's usually my plan.

But obviously, this is not, um, surgery is not the be all end all of the transgender experience as I understand it from reading on the internet Right Go on go on no, please Laura, please Yeah, it's it's definitely one of those things that like when people talk about transition that's For many people outside of it. That's the like the finish line that people see where it's like oh If you've done this yet, you you a real trans person yet? But like a lot of people don't do surgical things for a lot of valid reasons and like, you know, a good simple one to throw out would be surgery is costly and difficult

and painful. And there's a lot of reasons where you might not want to go through very intensive surgery and things. So it's not the be all that end all, but it is a thing that a lot of people have questions about. And from a medical perspective, it's one of the aspects that is sort of the most in our in the saw bones wheelhouse, I guess you could say. Right, exactly. And thank you for saying that, Laura. That's exactly what I've learned through my research that I wanted to make sure we communicate it as well as that we're not. I know that that's a problem. I think, like you said, the media focuses on that a lot, and I don't want us to be one more voice saying that focusing on just the surgery. But from a medical standpoint,

it is a really interesting history, how some of these procedures came about, who first did them and where they were done. It's really interesting. And specifically, we're going to focus on patients who were assigned male at birth and have chosen to go the surgical route transitioning and kind of the history of vaginoplasty and gender confirming surgery on that side of things. And then also I wanted to talk just a little bit about, because you would express some interest in this Laura, in the history of uterine transplant, because that's kind of a whole

other surgery and topic unto itself, but it's very interesting and it's also very current and relevant because we're just kind of figuring that part of it out in the last couple of years. Okay, said we have blow-vaded enough, enough table setting. Please begin. Talk some history. Talk some history. Nerd.

I don't know why I said that. I'm sorry. I don't think you're a nerd. It just seems like a thing to say after you tell someone to talk some history. I think you're both a nerds from the outside of this. You have a podcast about medical history. God. I think that's fair. But I'm wearing a leather jacket every time we record. So I don't know. Yeah, maybe if you put sunglasses on, you can avoid nerds. Okay.

Usually for a lot of these topics, I'll try to take us all the way back to ancient times. And there's some mentions when we talk about gender confirming surgery. There are some mentions of this when you read like, like, hypocharties. I mean, even one of our show favorites, Pliny, the Elder, like, peripherally mentions that this is kind of something that is happening, but there's no real good descriptions. There's nothing for me to really pinpoint or point to of what was happening or what exactly it was being done.

And a lot of it kind of overlaps with like descriptions of just surgeries that were simply castration, which is a totally other thing and not exactly what we're talking about. So if you kind of go back to ancient times, you're not really going to get a whole lot of information. So I wanted to kind of focus on the more modern history of the actual like surgeries and procedures as we understand them today. And that really dates back to the early 1900s in Germany. That's where we kind of see the beginning of some of this. Some of this would be done in Denmark and then a lot of this was research was done in Germany with a doctor Steinach and a doctor Hirschfield. And there initial, there was an interest in patients that they were already seen and discussing

kind of transgender issues with and how to aid these patients in their transition process, not just the way that they were dressing and presenting to the world, but also medically where they're things that they could do to help with their dysphoria as we would probably call it now. So they began to study estrogen therapy first, and they actually created the world's first synthetic estrogen for this specific purpose. So that was the beginning of the treatments that they were offering. But then they kind of started moving on to an interest in surgical procedures.

Are there also surgeries that we could do and how would we do them and what would that look like? And they attempted some of these surgeries pretty early on in Berlin and in Dresden at the, what's called the Institute for Sexual Research. And this was some- It sounds, I mean, it sounds like a pretty chill place. I mean- I was going to say it sounds like a pretty big party over there like- Yeah, sexual research, yeah. Yeah, a whole institute just for that, excellent. They probably had to share a building though

Like they're having like below is probably like the Institute of studying Planner worth or something like that like I'm just picturing them renaming it like the institute a really good bang in I think it I think it probably actually would have been like you guys are joking about, kind of a cool place to hang out because these were really progressive thinkers who were looking at the world and looking at gender in a way that a lot of people weren't kind of up to date with yet. We're lagging behind. And so this was really like the forefront of this kind of thinking and progressive thought and research and philosophy and really interesting time. And I learned something I thought that out of this came the first surgical procedure would be done on Lily Elbe. That was I was a misconception on my part. But she was not the first patient to undergo this surgical procedure, which I didn't know.

Aren't you going to movie? Did you already know she had a movie? Yeah. I didn't see it. Yeah. It was a huge thing because was it Eddie Redmane, right? Yes. Yeah.

Yeah. Crumble, crumble about Eddie Redmane's costing that, but that's for another time. Yes. Yeah. Yeah. Yeah. Crumble about it. Great. Main's costing that that's for another time. Yes. Exactly. That I'm costing. Exactly. Because Lily Elb was a transgender woman and like you are both talking about the subject of the Danish girl, but she was not the first person to undergo surgery. She was very soon after the second person. But the first was actually someone named Dora Richter. I think Lilliel was already a performer and well-known, and I think that's part of why she's kind of remembered more. And then she also, whereas in Dora Richter's case,

they didn't go all the way with the surgical procedures to an attempt on a uterine transplant. They did with Lillielb. They attempted a uterine transplant as kind of the final, because there was a series of surgical procedures and they attempted that as the final procedure. And that was the stumbling block at the time. That was the procedure that actually her body rejected

the transplanted uterus, and unfortunately, three months later resulted in her passing away from infection and rejection, which was something that we just didn't understand well at the time that when it came to organ transplant, we have to worry about tissue matching and making sure that the body isn't going to reject the donor organ. And this is true for any organ, not just a uterus, and that there are drugs we can use to prevent rejection of a donor organ. This was just stuff we didn't understand yet. So, so I think that might be all that might be part of why we tend to

remember Lily Elbmore than we remember Dorire Richter. So all this took place in Germany. And this is happening up to the early 1930s. Now as you can imagine in the 1930s. I see where this is going. This is, things have been going so well till this point, but I see where we're handed. Yes, exactly. So because in the 1930s of the Nazis taking over Germany, specifically at the Institute for Sexual Research, there was a huge book burning, all of their research,

all of this literature and data that they've been accumulating to talk about how they're doing, what they're doing, and why it's so important and why it's moving forward. All of this was lost. I'm just going to make a wild guess here quickly. I've never actually heard anyone talk about the Nazis and trans people, but I'm guessing they weren't the biggest fans. I feel like that's a safe guess to make about the Nazis. Wild twist. They were huge in this one thing. They were just super, super aggressive. No, you're absolutely right. And I think that's something that probably doesn't get talked about because the fact that under the Nazi regime transgender persons

were persecuted gets kind of lumped in under the fact that everybody else in the lesbian bisexual gay community, everyone else got persecuted and it all just kinda gets put in together, but you're absolutely right. So all of this research was pretty much lost and they actually destroyed, well they didn't destroy it with bombings and whatnot that happened afterwards.

The Dresden Women's Clinic, where a lot of this was being done was destroyed. So unfortunately, this is probably a major setback. Yeah, no doubt about it. Because a lot of stuff was lost. But there was a young physician who had initially been studying at the Institute, Dr. Harry Benjamin, who had actually immigrated to the US much earlier in 1914, kind of accidentally. He had been visiting the the US and then he tried to go home But then world where one happened

Classic and he couldn't get home But you just hate it one world for one happens when you're trying to get your flight just the worst Yeah, I've had I've been in that exact same situation Except it was the crew needed to go sleep For the night because they were overworked. So it's like same thing basically. Like the same difference, yeah. Yeah, exactly. Exactly.

Be, you know, forced to immigrate to a brand new country because of a war. I don't remember if they did that to me or not. I don't remember being forced immigrated to another country, but it felt that way for me. So, so he got stuck here because of World War One and, you know, that was probably to our benefit

in the long run. He was working in New York and actually he would like summer and same Francisco, which at the time was quite a trek, you know. So it's like the early 1900s. Yeah, just getting it. Oh yeah, it's like half the summer's gone by the time you get there. Oh no, that's what I was kind of thinking. You're constantly wagging, and by the time you make it. The entire summer was just one really cool road trip back and forth. But I think that there's time to get back, but you enjoyed the ride. He just puts his feet in the ocean, he's like, ah, I did it anyway. He worked as many physicians back in the day.

He didn't have like one specific specialty. You could kind of just do whatever you felt like you were good at doing. And so he worked kind of as a psychiatrist sometimes, he did like general medical stuff, probably what you would think of as I'm a family doctor, what we would do. And then he also kind of tinkered with endocrinology and so hormonal research and that kind of stuff as well. And in his travels and studies and all the different things he was doing, he actually ran into Alfred Kinsey. Oh, right.

Liam Neeson. Liam Neeson. And of course, Kinsey was doing a lot of progressive research on sexuality. And Kinsey asked him, would you see one of my, not patients per se,

but somebody who I've been talking to, it's a young transgender girl whose mother is, it's sought me out to say, you know, every time I take my daughter to a doctor or psychiatrist or anyone for help with this, they all say the same thing. Well, we'll try to treat them so that they will, you know, feel like a boy. And that's not, I think it's wrong, and I don't want that. And I believe that I need help from a doctor to, you know, allow my daughter to live her gender identity. Laura, in your experience, but in your personal experience, and I'm going to be asking Laura's

experience, but in your personal experience, and I'm going to be asking Laura's, you know, personal questions, and I told her to just tell me to, to, to go jump off a pier if I, if I, ask about something she doesn't feel like talking about, but when you're taught, like, from your experience, when you started talking with doctors, was this, doctors was this? Was it more a more hopefully accepting environment than we find here in like 1914? It's better, but I wouldn't say it's good. There's still a lot of muddled around complicated stuff, even probably five or six years ago when I was first looking for hormone stuff. I think for me, I had to go through three different general practitioners before I found a doctor who knew enough about trans people to understand what I was asking of them and what the accepted like pathway to help was. A bunch, like the first two doctors I visited just

didn't know anything about trans people or what the procedure was for referring me on to anyone that could help. And beyond that, I think I had to be referred from a general practitioner to a mental health expert who did an hour long interview who sent me back to the general practitioner to wait a year to get a referral to a specialist and then six months between appointments with a special, it's a whole bouncing around waiting game within the medical establishment. Wow. Yeah. It's still like finding some a doctor that knows enough to be able to help is more the issue now than a refusal to help, I guess.

You mentioned a mental health interview. What is there a still an idea that I mean, did you get the sense that there was like an attempt that you had to be sort of vetted, like to really, really, really make sure that you felt this way or is that the idea? Yeah. So some of these stages, even since I went through in the UK, have already gone, like I don't believe you get referred to the mental health service anymore, but a lot of the gates that are put in place of access to things like hormones or surgery are gates

that are designed to make sure you're really definitely super, definitely 1,000% trans and there's no mistake. It's not enough to just rock up and be like, hey, I feel uncomfortable with my gender and with some help with that. They deliberately put in multiple checks and balances really spread out that it's difficult because I get the reasoning reasoning of things like oh we want to make sure you're interviewed by two separate doctors who then on a separate occasion will agree with each other and make sure they both agree that you're trans and that you've not said anything different to them. But I get I get that stuff but the problem is that like using myself as an example, is that like using myself as an example, I was still undergoing my first testosterone-based puberty when I was seeking help transitioning and every day that I was waiting for help with access for things like hormones and hormone blockers and things were days that my body

was changing in ways that I was unhappy with that we're going to make it more difficult when I did get hormones to undo the damage that had been done. And I spent like two years before like going through the medical system before I eventually got hormones. And that was two years of like changes to my body that you know could have been prevented had they just been like, oh, you're uncomfortable with with your gender, we can probably trust you on that. Sure. Right.

That's got to be incredibly frustrating. It really is like I know I'm going on a slight tangent here. No, please. A bunch of people end up buying, particularly for trans women. A lot of people will end up buying hormones online for trans women, a lot of people will end up buying hormones online without going through a doctor because of that frustration of, I don't want to have my body changing in ways I don't want it to while I'm waiting for medically approved access. And that's a real problem because obviously people aren't getting their blood work checked.

They're not making sure that this isn't that their levels and things are correct. It's, it's, and I should clarify, the reason why I specify this is more with trans women is because for trans men, testosterone in many countries is a controlled substance because of its uses in bodybuilding and things. And as such, you can't just buy it easily online. But estrogen is fairly easy to get a hold of. And a lot of people do so just because the waiting times to get a doctor to say yes, your trans will help you. Yeah, I think, you know, not to kind of continue the tangent. I think that's definitely something from having been through a medical school here in the US, not terribly long ago.

It's getting longer and longer ago, but not too long ago. These aren't issues that are discussed nearly enough in US medical schools. Doctors have not enough training at all. I mean, I'm a family doctor, but there should still be a baseline training for who to refer to and how to manage these issues and what kind of specialists and what kind of medications.

And I mean, we're just now, I know at the medical school that I'm affiliated with, we're just now beginning to develop this curriculum and make it part of routine education for all of our medical students just now. And so I can understand that being a huge problem. You mentioned that in the sort of medical database software that you all use, they're just like as in a few weeks or months ago,

was added the option for gender and preferred pronouns and more flexibility there, like just in the past few weeks. Oh, it's been, yeah, it's been within the last two months that they've just added this into our software so we can even, you know, indicate that in the medical record. And that's, yeah, and there was a lot of education that went with that with a lot of the physicians

as to how to use that and what does that mean? And I mean, and that's not because we, I mean, these are patients that exist in our community. I know we, we live in a tiny little town in West Virginia, but these patients are in our community as well. And you know, we need to know how to take care of them. And I think a lot of doctors don't. Uh, poor Harry Benjamin, we just brought him out of the annals of history and then we, we pivoted away from so let's let's

let's he's a wait this is my moment of spotlight so because we got off chat and so where were where were we with all Henry's Harry said see I'm I'm I'm misnamed him that's how bad it is I'm I'm he's slipping away from me I got his name wrong like three different times as I was trying to learn more information about him. So I mean, it's hard. He's not your fault. Okay. So he began this young girl that Kinsey introduced Dr. Benjamin to, he began treating with estrogen initially. And then after she had been undergoing those treatments for a while, began requesting, you know, are there surgical procedures? Well, because of his time spent at the sexual institute way back in the day, because we're right now we're moving into the 50s and 60s that he's doing this research. He knew that there

were surgeons that probably still knew how to do this procedure in places like Germany and Denmark that these surgeons were still there. He didn't know, are you still doing these surgeries? Is it, you know, is it secret? Is it under wraps or is it out? You know, what, what, what is the deal? So he began contacting some of these physicians he used to know. He found surgeons who were still able to do this procedure and he began referring patients back to Germany or sometimes Denmark, Denmark had very strict regulations on doing surgeries on anybody who wasn't a citizen of Denmark. So that was a very difficult place, but there were places that this was being done.

So he began kind of like as a hub to treat patients if they needed hormone therapy and then refer them to places if they desired surgery that they could have it done. So Germany, Denmark, Casablanca was actually a place they were doing a lot of surgeries. Romantic. Go figure. And then he kind of became an endocrinologist in regard to the hormonal end of treatment

as a result of all this. He became an expert on these hormonal therapies. Among his patients was another kind of famous person in history, Christine Jorgensen, who was an actress and a spokesperson for the transgender community, and it really raised awareness in the US at that point when she kind of told her story. So, and now what is the World Professional Association for Transgender Health was originally named after Harry Benjamin. Ah!

Okay. And they just re- I don't know, they forgot about, they renamed him. No one remembers, and these just lost a history. They tried, they were printing letterhead and they're like, what was that cat's name? Henry Harry? Oh well. Just see that. It's fine, whoever does the next bit of paperwork will Oh well. Just leave that off. It's fine.

Whoever does the next bit of paperwork will remember and they'll put it on. There we go. I'll just listen to this first. The beginning of the title of that group makes it seem like it's going to be about wrestling. World Professional Association sounds like the beginning of a wrestling organization. So I was interested to find out that was not the case. No, it's not. As far as I know.

Now, of course, Dr. Benjamin began reaching out to colleagues in the US to say, you know, you can do surgery. I mean, because this was still a time where not all doctors necessarily did surgery. We have moved far enough in history where just because you went to medical school didn't necessarily mean you could do surgery, which, of course, is where we are now.

I don't do surgery, I didn't learn how. But he began to reach out to some of his colleagues who could do surgeries and say, you know, this is probably something you could learn how to do. And if you did, this would be a huge advantage for my patients, because then they wouldn't have to go overseas. And I would be able to provide you with patients to see and do these procedures on. Do you think you could learn how to do them? So through these kind of contacts and his contacts abroad, he began to put together like a network

of people who were able to do these surgeries. And at the time, a lot of it was being done kind of in secret, not that there were any laws against it, but there was a fear if it was announced that the surgeon who did these other procedures within the community or whatever was also doing this. So a lot of it was kind of being done under wraps until John Hopkins stepped in. The Johns Hopkins? Not like in person. Like Johns Hopkins. Oh, not not like in person. Oh, like Johns Hopkins.

This is so excited. No, like that. We're going to find out what he's doing. The extra S in his name. That's all I was kind of curious. I was just excited. And it's like, oh, it's a name I recognize. What's he be up to?

I've never known who he actually was. I'm sorry. That's a disappointing. Now just like Johns Hopkins, the university stepped in. Oh, he was probably a guy at some point, right? Yeah, he was a guy. I don't remember what he did. What is he up to these days?

What is he into now, Sid? The medicines, the medicines that ask you let my God before the mouth. I'm Hell Lovelin. I'm Danielle Raffer. I am Michael Eagle. And we are the hosts of Tights and Fights, Maximum Fund's newest podcast dedicated to all things wrestling. We'll be talking about Sasha Banks, the Women's Revolution, Sasha Banks, the brand split,

and Sasha Banks' Wigs. And we'll also be talking about wrestler fashion. Some wrestlers wear too many clothes. Some wrestlers don't wear enough clothes at all. And I'll be doing impressions of all your favorite wrestlers. New episodes, Thursdays on Maximum Fun, wherever you get your podcasts. Oh yeah, dig it! I should buy podcasts, ties and buys. So several physicians at Johns Hopkins were kind of becoming aware.

They were younger physicians who were involved in research and they were becoming aware of these procedures, these surgeries being done. And wondering, hmm, is this something we should be, here we are, this renowned institute of medical research, is this something we should be doing? And they were already, and this is a whole other subject unto itself, but at Johns Hopkins, they were already doing procedures that were somewhat similar to some of these things on intersex patients, which on intersex patients, which exactly, which is a whole other topic because these were done against anybody's, if nobody was asked permission, these were forced on children. Yeah, this is, it is, it is a whole kind of worms, the intersects thing because that is like

at least within the US, that seems to be the, the root of a lot of surgeons expertise is, hey, these children have been born with ambiguous genitalia we're going to make a decision on their behalf of what to do with their genitals and they may grow up liking it or not. Exactly. We'll find out 50-50 chance. That's that you're exactly right and that's so unfortunately a lot of the kind of technical expertise that some of these surgeons already had was born of that. But their interest grew beyond that and so they opened what was called the gender identity clinic in 1966 and they began treating patients with hormones and as well, surgery.

They were kind of the beginning of this very strict criteria. I think some of what you've already started to talk about for hormone therapy or certainly for surgery. They had a, there was a psychiatric evaluation that was standard that everyone had to undergo. You had to start with a hormone therapy and you had to spend a year kind of with the hormone therapy presenting as that gender. And then after a year, if they decided you still really, really wanted it, then they might do the surgery for you.

Yeah. Can I, I do want to say something on the, the year weight that you mentioned there after like starting hormones weight this long? there, that you mentioned there after starting hormones wait this long. That is still a thing we have in the UK. It's often referred to as the real life experience test or something to that effect. And it's a really awkward thing to put trans people through because a lot of it basically comes down to,

hey, occasionally this is even used as a barrier to accessing hormones and it's this idea of you have to present as your target gender for a year or two years or however long the window is before will help you with medical transition in any way. And it puts trans people in this really weird position where they've not yet had any medical help offered to them but are having to try and present as their target gender regardless, which can be tricky because without having started hormones, for example, it's like, I don't want to have this facial hair going on and I don't want this and that and it's difficult. It's all stages that

are put in there, as you said, to be like, oh, we've got to make sure you're definitely sure. But again, it puts trans people in really awkward positions where they just have to kind of tough it out for a year where it's like, oh, there's every chance that people will know that you're trans, even if you don't want them to while you're waiting for hormones. Array! That's a really good point. And that was, you know, it's interesting as I was reading about, because I was reading about the, specifically, the gender identity clinic.

And from an interview that they've done about it recently with a patient who she went to the gender identity clinic, thought she was going to kind of work with them and then was not pleased with the way they were going about things and thought, you know what, I don't think this is for me. And her, as she was talking about the experience, she was saying, you know, the problem is that they kept talking about. And I saw this language a lot, like the intensity of, exactly, of a person's, you know, transgender self, basically, how intense are you as your gender identity? Yeah, it's, it's this idea of grading trans people on like how trans are you? And it's, it's weird because like, if you try to play that to anything else, it sounds ludicrous.

It's like, oh, can you, are you allowed to say that you're gay? Are you, are you gay enough on the gay scale? It's like, you know, it's weird to be like, yeah, you, you're dysphoric, but were you dysphoric early enough? Are you dysphoric enough now? How far are you on our scale? No one's ever questioned me on how straight I am. No one's ever asked me like, are you like monster truck rally straight ever asked me, like, are you, like, monster truck rally straight?

Or are you just... I will be the first to ask you, how straight are you, Justin? I'm like... A good amount of straight, I think, for my height and build. I feel like I have this the regular amount of straight. Just like, right in the mid... Like, if you did a chart of straight, I feel like... Like, I'm not at the top. I you did a chart of straight, I feel like,

like I'm not at the top, I'm not at the bottom, but I feel like I'm just about average. See, it's a ludicrous question. I don't know how it is. It is a ludicrous question. But like, that's what trans people basically get asked is like, it's a bunch of questions about like, did you feel this, like, can you remember feeling this when you were like three or four? And I'm like, is that relevant? I feel it now. That's exactly. And you know, when I was reading about that and I was thinking the only corollary I could really think of to that is if you, like in the

medical, when I'm talking about a medical condition, there are times where I will grade things as mild moderate or severe. And so then again, I think it's language that refers to it as a psychiatric or medical condition. And I think that's very, I have to imagine that's where these doctors' heads were. And then obviously that's wrong and problematic. And I could that's wrong and problematic. And I could see why many patients would go there, talk with these people and say, ooh, this is not. Can we use this as an opportunity to sort of circle back

on something that we talked about last episode, which we touched on in the last chunk of episodes about gender dysphoria? Yeah, I wanted to bring that up. Oh, well, I'm sorry I jumped ahead of you, Sidster. I didn't mean to. No, that's okay. Go ahead.

Go ahead. You're a physician. I'm literally just a doofus. This is kind of a question that has arisen to me. So as I was, when we were doing the conversion therapy episode, I very peripherally touched on gender dysphoria as a diagnosis that has been kind of abused or misused to as an excuse for, well, this person has gender dysphoria and the treatment for it is, let's send them

to conversion therapy to make them the gender we want them to be, that we feel for whatever terrible reason we want them to be that we feel for whatever terrible reason we want them to be. And that because it's been used that way that it's problematic, but as I've read that it's more complex than that because there's also necessary that you have a diagnosis to justify like to insurance companies. Yeah, it's so it is a really awkward it's a really awkward question like I, under the UK medical guidelines, I got diagnosed with gender dysphoria, and it's a thing that I get its function and why it's distinct and different from classifying gay people under the DSM in that being gay in order to be comfortable with being gay, you probably won't at any point require medication or surgery to be comfortable with being gay, which is a good reason to not

put it in the DSM. But because of the fact that some trans people will want access to medication and surgeries and associated things like voice training and things like that. I understand why a diagnosis is put there as a marker to say okay you've got this diagnosis therefore you are now eligible for x, y and z but it is it is awkward. I don't there's not a good solution really to the issue because it serves a functional purpose, even if it is a bit unfortunate that it is in the DSM in the same way that coma's actuality used to be. Sure.

Laura, I hate to sound like a doofus multiple times in one episode, but you mentioned something and passing there about voice training, and I'm just completely ignorant of that. What are you referring to? Okay. I can only speak for myself and for as a trans woman. Vocal training is the idea that as a trans woman estrogen doesn't undo changes to the voice done by testosterone. So, for me as an example, when I went through testosterone-based puberty, my voice dropped

and stopping, stopping taking testosterone and starting taking estrogen doesn't undo the fact that my voice physically dropped. And the vocal training is something that is offered in the UK to trans people under the NHS. And it's basically just like, imagine if you went to a singing teacher and they taught you how to sing at slightly higher registers and they taught you better vocal control, it's that same type of teaching but themed around improving, getting your vocal tone to where you want it to be, but also helping with mannerisms and vocal inflections, ways of speaking that might have been learnt over time before transition and working out how to get those

into more naturally female ranges. Interesting. I was sorry, I just didn't even know that was... That's all right. It's not a thing I ever did. I self taught myself changing my voice by doing a bunch of podcasts, but it's a thing that's on offer. Sid, were we, I'm sorry, we keep going out all these diversions? Well, that was... There's a lot of interesting stuff. That's what's making this episode, I think going out these diversions. Well, that was a lot of interesting stuff.

That's what's making this episode, I think, special and even better. So that's okay. So as I mentioned, they were doing this at Johns Hopkins. And again, this is kind of questionable because obviously they're providing a service that was not being routinely provided at the time, which is great. And they were attempting to do it in an evidence-based fashion. Let's see how we can do this so that it will work so that we know the best way to do this

next time, which is, of course, what we always try to do in medicine. But on the flip side, as I mentioned, there was also a lot of, I think, bias that went into the criteria that was developed in misunderstanding of what they were even talking about and dealing with and alienation of a lot of patients. But there was at least, we were kind of moving towards a better direction. And a lot of universities tried to follow suit. There were about 20 different universities across the US who developed their own program to train positions and students and do the same thing. And this would have continued to go, except for in 1979,

based on this evidence, a terribly flawed study was done by, yes, by bias researchers at Johns Hopkins, who were, their main interest was to shut this program down. It was a more conservative kind of administration that had moved in. They didn't like this and they wanted it shut down and so they commissioned the study and basically the results that they published

said, you know what, the patients that we are treating here are less happy than they were before we treated them and they regret doing this. And we shouldn't do this anymore. And that's the end of our episode folks. I never thought it would turn out this way. No, no, that's not actually. Yeah, it turns out I'm deeply unhappy

and I've got a reason to call. What a twist. Nobody thought it would shake out like this. What a twist. Yeah, this is the podcast where I announce I some detransitioning, you know, that's totally a thing. It was very unfortunate because this this one study and they were really like if you look at the way it went down, they were looking for a reason.

And this study was it was totally the handpicked certain people to ask the questions to, they didn't ask the appropriate questions, they were asked in very biased ways, that any degree of kind of dysphoria that may still exist was construed as a failure of treatment. Even if the patient maybe actually was happier than previously, if they were,

the least bit unhappy, it was considered a failure. And so as a result of this was shut down, and many other universities kind of said, well, if Johns Hopkins isn't going to do this anymore, we're not going to do it. Which is why you see this doesn't happen for the most part in universities in the US, which is a weird thing because typically medical advances research anything that's being done that's new and we're trying to improve on and that's cutting edge is done in a university setting. And for the most part these surgeries

now in the US are done at private offices, totally removed from universities stemming from this incident. And it's had really far-reaching consequences. Like, you still today will see studies that are skewed in the same way to make the same kind of conclusions. There's a lot of them that will do things like, okay, let's ask you about happiness at some point before you hit puberty. And let's ask you about happiness literally just after you've come out of surgery and everything is the worst thing in the world. It's like, oh, they're less happy at this point. Like a lot of studies like that still happen to varying degrees of existence. It's, it is not a good thing, but, existence, it's, it is not a good thing, but around. Right.

Luckily, at this point, this is kind of, I found this like, the story took this strange turn that I did not expect. So there was an office that kept doing these procedures even after a lot of universities had stopped and it was run by a country doctor named Dr. Stanley Bible who lived in this little mining town in Trinidad, called Trinidad, Colorado. So it was like population like 4500 or something. I mean, this tiny little town,

he was just this like general practitioner kind of trained, but Jack of all trades, doctor who would deliver babies and do minor surgical procedures and then also see you for like your colds or whatever. He had a local social worker who knew him, came to him and said, you know, I've heard about these surgeries. This was in 1969. I've heard about these surgeries that they're doing across the US.

I would like this done is can you do it? And he said, well, yeah, I could probably figure out that I could probably do that. America. That's how we do it over here. Well, we just, yeah, well, all right. It's like, oh, I lost the instruction book clip. I can probably still put this like a cabinet together. Exactly.

So he sent a letter to Hopkins and said, could you send me like some diagrams and some, like some instructions? And so I can do this. And they did. They sent him some descriptions and some books. And he read it all, studied it, and then started doing these surgeries in this tiny little mining town in Colorado. And it became kind of this like mecca for these surgeries. It just all these people all over the US started hearing that hey, I can refer my patients there.

There's a doctor there. And he started doing them and it's interesting. The hospital he worked at was actually a Catholic hospital. Mm. So at first he was hiding the charts from the nuns so they wouldn't know that he was doing this. Eventually they found out and they complained. So he wrote a letter to the Vatican pleading his case and basically saying, this is the right thing to do. What I'm doing is the right thing. These are

people who are coming to me as patients, they need my help. This is what helps them. I should do this. And he got a letter back from the Pope saying, okay, you know, well done, 1970s Pope. What a chill Pope. I know. Yeah, everyone's coming up about the current Pope being being like chill Pope, but this this previous Pope seems all right. This is a pretty pretty chill. I listen, if you know what Pope does this, he has probably done some other very unshill things. Oh, yeah, I'm not here about it. Most popes did some very young chill things, but this is one chill thing that you haven't had a good day. I know, I was I was raised Catholic, so I always have to be very careful. Like with this, I know my history, I would be very careful. But, so he continued to do these surgeries. He did about, in his career, he did about 5,000 surgeries.

And one of his biggest desires was that he would find a surgeon who was willing to move to this tiny little town in Colorado and continue his practice. It was one of the biggest things he wanted. He found a predecessor, Dr. Marcy Bowers, who moved to Trinidad and learned these procedures under him and began to do the same things and worked there after he retired. I would have still been working there, if it weren't for political forces at the hospital, that began to raise prices on these surgeries tremendously. And eventually she felt like she could not do her job there, you know, to any patient satisfaction. And

so she actually, even though her headquarters, like she saw as her official office there, her, like where she does her procedures during California now. But she's still doing these surgeries to the state. And as I was reading about this, Dr. Marci Bowers, I saw her called several times the rock star of the transgender surgery world, which I didn't know that, but. I've never heard that either,

but now I really like, the thought of her just like stopping the surgery to do a sick guitar solo. Lazy Chillin, please welcome to the OR! March 10th Bowers! She sounds really cool. I want to read more about her. I was kind of looking at her website. She was the first, as I understand it, the first transgender woman to be doing these procedures. And then she's also a worldwide spokesperson for stopping female genital mutilation worldwide.

So she does sound like a rock star, I will say. On a side note, we had mentioned the uterine transplant issue. And I know we wanted to talk about that a little more, because the question was why we tried this in the 30s, and then we really haven't tried it again until the last couple of years. And even then, we've not tried it. We've just skirted around the issue, at least as far as trans people are concerned. It's been just kind of that as a topic of discussion for a few years.

Exactly. After a big ol' gap. You're exactly right. Part of the issue was purely, we did not understand, like I mentioned before, we didn't understand anti-rejection drugs and that kind of thing. So it took us a while to understand how to safely transplant any organ, including the uterus. Specifically, the uterus took us a while to figure out, could we transplant a uterus

that would be functional in terms of carrying a child? And if we can do that, and we have to use anti-rejection drugs, are those going to be safe for the patient and the developing fetus? And I think that is part of why this research has taken so long. They did it in a lot of animal models before they felt comfortable attempting it at all in humans. I know that in 2014 was the most recent

that we've had any kind of success in this arena in Sweden. Mm. I believe this is the batch where of the people who were like potential candidates for this procedure, one of them was a trans woman. If I, is that the right one? Yes. Yes.

Yes. And I'll be honest, I tried to find the actual, like, why was this, was it random? Were they excluded specifically because of that? I don't know if you have the answer. I don't have the answer left. No, I've tried looking into it. And from what I can tell, it wasn't exclusion

on the basis of being trans because you would think that they wouldn't get to that stage of the of the selection process if them being trans was the ultimate problem, I guess. Like, you think they'd catch that earlier, but it is one of those things that like, regardless of why it didn't happen, it got a lot of people talking because a lot of a lot of the community of trans women had not really thought about you to enhance plants as a possibility because it was just never a discussed thing. And I think seeing a trans woman shortlisted for one got a lot of people very hopeful about this being something that might one day be a possible plausible option for trans women.

And I think a lot of that just comes down to, there's a lot of things that trans women get shouted at to tell us why we are not female enough to be women, whether, not having a uterus is one of them that's repeatedly shouted. And I think for a lot of trans women, if that was something that was possible and happened, even if didn't happen to that individual trans person, it would be a way to shout back slightly like, eh, you know, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh, eh dismissive of femininity anyway because there are women who are cisgender who are born without uteruses or who you know can't have children for whatever reason or don't produce estrogen etc.

Or there are lots. Lots of the things that are thrown at trans women to be insults are things that like there are cisgender women like that and you don't discredit their femininity for those reasons. But that's a whole other side thing. No, but I think that's a very relevant, especially in this conversation, from what I read, because they actually were successful with nine patients in Sweden, from those nine patients, and I think the ones that finally made it to the final kind of selection process to the end of it and actually had uterine transplants done. I think the majority of them were born without uteruses and then there was one uterine. Maybe, I don't know, that's a complete guess. Probably. Uterine. But and then there was one who had had her uterus removed after cervical cancer.

And I thought this was interesting. They only used donor uterine. They did not use cadaver uterine, which is what they've tried in the US. Because this has never successfully been done in the US. It was very highly publicized last year. They completed the surgery at Cleveland Clinic, but two weeks later they had to remove the uterus due to infection. So we've never done this in the US successfully, but they did with with online patients in

Sweden, they were successful. And so far, there have been five children born as a result of this. The donors of these uteruses, I also thought this was fascinating because they were looking for tissue matches. In several cases, it was the patient's mother who donated her uterus because they were a good tissue match. And there was something about that that I thought was kind of beautiful because they yeah, there was something really sweet to that. Yeah. You can think it's the uterus that carried you that now has carried your child. Yeah, that's beautiful He's the Uterus carries the baby, right? I yes, okay. I feel like we're getting into very

Do you like a uterus and your uterus territory of? You know maybe exhibit would be a great guess You know, maybe exhibit would be a great guess. But they found that this was also really helpful because one issue that when they had attempted these things before, they weren't necessarily looking to see if the donors of the uterus had ever carried a child before. Not the, and the only reason that matters is because then you know that the uterus is intrinsically capable of carrying a child. And you don't have to worry that maybe that uterus was never capable of carrying a child

the first place. So the rejection drugs we now know are safe and pregnancy. So. Yeah. That's the most obvious, like there are obviously some additional difficulties in doing this with trans women as opposed to cisgender women in that like you're pretty much going to be guaranteed to require a C-section for example, because how else is it, is it maybe ever going to get out of there, for example, or the questions of surgically are there ways to

connect a uterus to a vagina plastic vagina? There's a lot of questions about doing this with trans women, but like no one's tried, so we don't really know Sure, well, but I'll tell you we're closer than you think because currently we can't we don't know how to We cannot deliver the baby vaginally No matter who the patient is who receives the transplant uterus that we cannot deliver the baby vaginally, no matter who the patient is who receives the transplant uterus.

So all of these patients required C-sections. So that would not actually be an impediment. There we go, that's the thing I've learned. For ready-to-school bones, teaching me things, yeah. And they're not, currently, they are not actually, I hate to use these terms, hooking up sounds like you're plugging things. And they're not hooking up the uterus to the philopian tubes or ovaries if they're present. So all they're doing is taking if they want to, they can harvest their own eggs and create frozen embryos ahead of time,

where you could use just like we do with, you know, artificial insemination and vitro. Any of that, we could use a donor embryo to implant in the uterus anyway. So all of these things are not, you know, are not really barriers. I think the next step is just the only mention of it that I, as I was trying to read to see, is there some reason we haven't attempted it? Is there some, is it just that they just haven't selected a transgender woman yet randomly? Or is there some other reason? And the only discussion I saw was just this thought that we need to make sure that all of the

hormonal support for pregnancy is identical. And I think there was just some question, how do we make sure that all the hormonal mechanisms are exactly the same in every patient. Once we have successfully transplanted the uterus, implanted the embryo, and then, you know, because the hormonal changes that are involved with supporting a pregnancy from then on have to be there. But I think it's more of just a, we're not entirely certain yet, but not a, it isn't in place. I think it's just, that would be the next step. Well, if they, if they saw all that stuff out and they're looking for someone, I'll stick my hand up like, you know, it's all good with me. We know that, like, we're at the, is there anything else said?

Am I, I saw the history, I know that we're sort of at, this has been more of a survey, I think, than normally we would do of a topic. There's just so much to talk about. And we know that we did not get anywhere close to covering everything that sort of could be explored here because it's a really deep topic that and and I feel like In discovering that for me personally as like we saw just like how broad of a topic it was and how much there was a consider

I think it speaks to I If we circle back to the the difficulty in finding doctors who are the difficulty in finding doctors who are aware of the right things to do. I get the sense from and said, correct me if I'm wrong, but when you've talked about it, I get the sense that it's for some doctors, it's not necessary and malicious, but more a case of just not knowing where to start, not knowing how to begin educating themselves. I mean, I would ask both of you because you both have a lot more experience than me, Justin McAroy. In various aspects of this, like, does that, do you think that that's a fair characterization?

On my end, I'll just say, I think there is a lot of ignorance. I think that that's the primary thing is just people don't, you're right, people don't know. the primary thing is just people don't, you're right, people don't know. We, because we live in such a small town, such a small community in a rural kind of area, I think I would be lying if I didn't say that I have seen doctors that I know people who I do think that I know people who I do think have a mindset that this is something that we need to, you know, we shouldn't be participating in, that this is somehow morally wrong.

I hate to say that that exists, but I'd be lying if I said that it didn't. But I think largely speaking among my colleagues and the people that I personally work with, which is in a very, you know, we live in a very red state. I think it's just they don't know. They just don't understand.

I think from my perspective, there's two issues concurrently going. There's the lack of knowledge, which is a barrier at the start. And when you get up to specialists and you get to the top end, I think you have a separate issue, which mainly comes from that one study that implied, oh, you know, people aren't happy once they've transitioned. And this fear that specialists seem to have of, we need to make absolutely perfectly, definitely 1 million percent sure that you are trans, because we don't want you to come back later and say, why did you do this to me? This was the wrong thing to do. And that worry about treatment has sort of created a system

at least in the UK where like to give a fair example and most of this is because of fear based, all will just double check or will make you wait a bit longer to make sure you don't change your mind. I started talking to GPs about transition in 2011. If I had waited and kept using the NHS in the UK, I would still be at least a year away from having had a vagina plastic. It would have been a good seven years of waiting between first talking to a doctor and being able to have been a good seven years of waiting between first talking to a doctor and being able to have surgery for something that was causing me considerable discomfort.

As it was, I ended up a year ago going through private surgical options and I was very thankful that the internet was very, very giving and supporting and helped me to be able to do that. But it would have been a seven-year wait from talking to a doctor to having the option to have surgery for something that was causing me great discomfort. And so much of that is just fear that I will turn around a year later and say, why did you do this? That's, that's so unfortunate if a lot of that, like you've said, has stemmed from those studies since so many were like you've already mentioned wrong and flawed and poorly done. And doctors should know better. We know we're supposed to be trained in good research and bad research.

We're supposed to be able to look at studies and say, this is not well done, you know. We should be more critical of that than we are. Yeah, it's a real shame because honestly, like it's depressing that you can't just go to a doctor as a trans person and say, Hey, I feel really uncomfortable with my body. I want some help with that and just be believed because I think it's fair to say most people who are not trans at no

point feel so bad about their body that they decide to go talk to a doctor about it. Right, like, you know, if someone's come to tell you, hey, this is the thing I've been dealing with for a while, I'm, you know, I'm really uncomfortable with my body and I want to, you know, pursue options about that. It's a pretty good chance they're probably trans. Yeah, yeah, I think at that point, yeah, exactly. We take patients at their word for most complaints, you know, most things they come to the doctor for. Why? Why not? Usually, if you tell the doctor, your symptoms,

the doctor will trust that you've accurately reported them. They won't ask you to prove your symptoms. Over the course of seven years. For the next seven years, just make sure you still definitely have that to think. Actually, I'm going to need you to actually have a seizure for me. Yeah. I'm sorry. I know that you've been to the ER four times with them, but I'm not going to buy it until I see it.

Laura, thank you so much for talking with us about this. I think it's fascinating, and I really appreciate you much for talking with us about this. I think it's fascinating and I really appreciate you sharing your perspective with us. Where can people find your work? Because I know you're sort of right all over the place. Yeah, I do think sort of all over the place. The easiest place to keep track of me is at Laura K. Buzz, pretty much everywhere. Laura K. Buzz on buzz on Twitter YouTube anything like that. I also have a Patreon that's what pays my bills so patreon.com slash Laura K buzz you'll find all my stuff there as well. I also run a video game website called let's play video games so let's play video games.com

or just anywhere on the internet that will pay me to write. or just anywhere on the internet that will pay me to write. Well, Sydney, is there anything else you want to touch on before we always should thank the taxpayers for these? There's some medicines. Yes, and I just also want to, I know you already did, but like I wanted to for me to, like personally, say thank you, Laura, for coming on and talking about all this. This has been, and like, this has been fun, but it's also been so informative and interesting, and I have found it personally very fun to engage in.

And so I'm sure our listeners will too, but thank you so much. Thank you for having me. This has been really good. And I'm just sorry that I couldn't get through all of the things because as you said, there is too many things. There's a ton to talk about and it's definitely, I'm struggling with how to title this episode because I think anything that I call it will be insufficient but it's definitely something that we want to, on a lot of different topics, try to corral more people into walking us through stuff that there's a huge personal aspect to it. And I would say lack of awareness too,

which sort of complicates things. I'm glad that we've been able to talk about it. Do you mind if I say something before we finish up completely just something that I think is important to say after the, because we've been talking about it about this stuff very like historically sciencey focus. Like just from my perspective of someone who has been on hormone therapy for a long time and who has had lower surgery inside of a genoplasty, I just want to say to anyone that like isn't trans and is like a bit of a fee about trans people and about surgery and hormones and things.

I lived 20 years of my life uncomfortable in my own skin. And the moment I woke up from my vagina plastic it it wasn't as people sometimes imagine this grand moment of excitement. It was just a weight that was gone. And in the year or so since surgery, that weight has never come back. This just pressure and discomfort and general unhappiness that had sat on me for 20 years, disappeared overnight. And I just, I hope people will take that seriously because, you know, surgery and hormones have made me comfortable in my body. And that's I think that people, you know, not enough people take seriously still. Sorry, I know this a bit of a down a way to end, but I just felt it was the thing that was probably appropriate to say.

I think more than appropriate. Thank you. Thank you. Thank you Laura. Thank you Sidney. For both of you, I'm Justin McHory. It's weird. I've never outrode with three people before. I don't know grammatically what I'm doing anymore. But the fact remains that we will be here next week. This has been Saw Bones. And as as always don't drill a hole in your head. Alright! Maximumfund.org Comedy and Culture. Artistone. Listen or supported.