Theology in the Raw - 825: The Ethics of Medical Interventions for Trans* Identified Kids: Jane Wheeler

Episode Date: October 26, 2020

Jane Wheeler is the founder and President of Rethink Medical Identity Ethics (https://rethinkime.org), which is a a non-profit research and education organization dedicated to improving and optimizing ethical long term care and treatment for gender variant children, adolescents and youth. Jane practiced law for many years as a corporate regulatory healthcare attorney in licensing, standards of care and informed consent. She was a board member of Lawyers for Human Rights (now the Los Angeles LGBT Bar Association) and served on GLAAD/LA Women’s Committee. She received her J.D. from UCLA Law School and has a B.A. from University of Arizona in Anthropology. She currently works as a consultant for non-profits in the area of funding for health and education related programs and projects, and mom to two teenagers. In this episode, we talk about her work at ReIME, the facts about puberty blockers and cross sex hormones, current problems with how trans* identified kids are being treated, and how we can best care for trans* and gender non-conforming kids. Connect with Preston Twitter | @PrestonSprinkle Instagram | @preston.sprinkle Youtube | Preston Sprinkle Check out his website prestonsprinkle.com If you enjoy the podcast, be sure to leave a review.

Hello, friends. Welcome back to another episode of Theology in the Raw. I have on the show today, Jane Wheeler. Jane Wheeler is the founder and president of Rethink Identity Medical Ethics. If you go to rethinkime.org, you can check out the work that she is involved in. And it's just, it's a fantastic organization that she has started. And the main thing that it addresses is some of the ethical questions surrounding medical interventions with teenagers who are gender nonconforming or identify as transgender or nonbinary. It's a huge conversation happening in a in certain spheres of the medical field. And Jane is navigating that extremely well, I think. She's very sharp, very wise. She has a, well, I talk about her credentials in the podcast, but yeah, she got her JD from UCLA law school. Super smart, super awesome. And actually the topic that we're going to discuss, I get into a lot of the same stuff we talk about here in my forthcoming book, Embodied Transgender Identities, the church and what the Bible has to say.

Now, Jane is not, she doesn't confess. She's not a religious person, doesn't have like a Christian faith commitment. In fact, she's a lesbian with two teenage sons. And so she's coming at this strictly from kind of a scientific point of view. Now, my book, I do come at it from a Christian point of view, but I do deal a lot with a lot of the scientific research, the data, and actually a lot of the stuff we talk about in this podcast, I do have a couple chapters that does get into some of the questions surrounding medical interventions with trans-identified teenagers. So this is very relevant to my forthcoming book, which you can check out where books are sold, probably Amazon,

maybe Barnes & Noble, if that's still around. It's available for pre-order. Again, the book is embodied. You can check it out at Amazon. It comes out February 1st. So let's dive into our topic with the one and only Jane Wheeler. Okay, hey, welcome back to another episode of Theology in the Raw. I am here with Jane Wheeler. Jane is the president of Rethink Identity Medicine Ethics. She has a Juris Doctorate from UCLA Law School, a BA from University of Arizona in Anthropology, law school, a BA from University of Arizona in anthropology, and has served, has been a board member for human rights and serve, wait, I'm getting a board member of lawyers for human rights. Now the Los Angeles LGBT Bar Association and has served on GLAAD's LA Women's Committee. Jane, thanks so much for being on the podcast. I've

been looking forward to this for a really long time. We've been kind of emailing back and forth for a while, and I've benefited from your work so much. So I've got a bunch of questions for you to unpack for us. But thanks so much for being on. No problem. Glad to be here. So talk to me about Rethink Identity Medicine Ethics. And what is it? What led you to start this? And what's some of the work that you guys are doing through this organization? Well, we put it together about a year and a half ago, and we just began to really delve into certain initiatives. And I'll describe them in a minute.

But it was put together by myself, Lisa Marciano, and Jenny Cyphers. And we came together after contacting one another through social media. We're all over the country with different emphasis and different backgrounds with interacting with this area, identity medicine. And we began to talk about how we would like to have an organization that is an educational and research organization that promotes ethical identity medicine for children and youth. And at that time, when we were looking into it, there was really nothing happening other than blogs on the subject, Fourth Wave now being the most prominent one. In the U.K., there are also blogs.

And now we are a part of a growing group of people that are interested in pursuing research and also helping people to be more educated about what's going on and how to improve the care that's being provided. My background is, as you can tell, I have been a lawyer. I was a health care regulatory attorney practicing in Los Angeles, primarily in the 90s during the AIDS crisis, and was very much involved with licensure clinics, AIDS clinics, and also informed consent and other issues. So when I became aware of what was going on with the medicalization of gender medicine, of gender medicine, and it was moving towards increasingly younger medicalization.

So what was happening with the demographics around children and youth who were seeking to transition, I became very much interested in how this had developed and the degree to which there was regulatory oversight and what kind of care was actually being provided to this population. And we just, you know, it has taken a while for us to pull it all together, but we just finished our frontline survey, which was a needs assessment. It's still in the analytics aspect of it, but we had an open online survey for detransitioners and desisters. Anyone who transitioned and stopped for whatever reason was invited to partake in this survey as a needs assessment. What care do you feel that you need now and perhaps did not get earlier? And so these are sort of two prongs.

But it is to approach how to provide better care to this population, regardless of whether they actually transition or don't transition or detransition. And we're doing the analytics and data gathering is being done by the Northern Colorado University Sociology Department. So we're working on that and we're also working on a parent guide with other organizations. parent guide with organizations, Society for Evidence-Based Gender Medicine and Gender Health Query. And we're putting that together as well. So those are our two most prominent initiatives that have come. OK, we've been able to pull off for someone who doesn't really maybe have any idea of what's going on, what this

conversation is about, when you say, you use the phrase like this population, can you unpack specifically the kinds of people that you're talking about? I think, you know, there is a population of young people that are going through a process of reflecting on questioning and pursuing their gender identity what has come to be known as their gender identity and these young people have may have an actual different identity or a different gender expression or they may be gender non-conforming in some way and they they're also exploring because they're young people, their sexualities. So it's a part of the package, particularly for those that are post-pubescent or going through adolescence. The two intersect quite deeply.

And so we want to have ethical care for this population. And do you find, are you seeing, and I know the answer to this, I'm just going to help my audience here. I mean, do you find that the care for this population, gender nonconforming, people wrestling with their gender identity, do you find that there are some ethical problems in how they're being cared for in, say, mainstream medicine right now? Well, yes, I think there are definitely ethical problems because people are not completely aware of the harms. are primarily, medical ethics are primarily triggered by harms and is guided by the motive to avoid unnecessary harms. And so it has sort of a process of analyzing whether these harms are

indeed being ethically managed and whether they are being offered and managed in an ethical manner. And obviously, when you're dealing with children, there's a question of whether they are competent or have the capacity to even appreciate the harms. And when the harms are long term, meaning they may not be impacting you immediately, then you have a question of whether they have the competency and capacity to appreciate long-term harms or the potential for long-term harms. And it's sort of an unraveling of an onion because then you begin to ask, well, what do we know about the harms? And there are definitely harms that are involved. And that's the whole other aspect of this, is that these are irreversible interventions that impact children and youth, and obviously adults as well, but in a different way to children and youth,

because the interventions that start earlier earlier with puberty blockers, with cross-sex hormones, with top surgeries, and obviously sexual reassignment surgeries that are bottom surgeries. All of these are irreversible. And there's some aspects of the hormones that are irreversible. And there's some aspects of the hormones that are irreversible, and there's some aspects of taking puberty blockers that are not neutral, and we don't have a lot of research on the impact of these interventions, and so because they are very dramatic, increasingly large population. And that's the other aspect of it, is that the demographics have changed dramatically

over the last 10 years. Not only the gross numbers of children that are going to gender clinics and experiencing of children that are going to gender clinics and experiencing medical interventions has grown, but the actual demographics of girls versus boys and ages has changed dramatically over the last 10 years. I want to get into why that's changed, because that's something that's becoming very well known, is that gender dysphoria in children is typically something that affected, you know, a small percentage of the population, but primarily males, where now it's a much higher population. But the inversion of the sex ratio has dramatically switched, which raises questions. I want to get back to that, but just to go back.

So you're saying, can you maybe explain when, you know, you were talking about puberty blockers and some of the negative side effects that those can have? Now, if somebody Googles around a little bit, they'll hear lots of people with credentials to say these are perfectly safe, they're irreversible. They just allow somebody who's wrestling with their gender identity to buy them some time to not go through puberty without really understanding who they are. So there's a popular narrative that says these are perfectly safe. And yet I've been reading studies that show that we don't know that. There's no long-term studies done on these. And the ones we do know are showing some negative side effects.

Well, I think – Yeah. Well, excuse me. I think that the thing to grasp, which is really hard to take in, is how little this has been studied, that there are no real long-term studies. There are short-term studies of, let's say, five years as to whether the degree to which bone density has been impacted. But not on this population and not on a population that has been followed with cross-sex hormones. So, and not in the long term. So, we really are in a very weak research, and it's just beginning. And I don't

think people fully appreciate how little is known as to what is the impact. But we do know anecdotally what some of this is. And we do know where puberty blockers have been used on children who have precocious puberty, meaning to prevent them from growing too much. But the use of puberty blockers for that population is very different. It's for a shorter period of time, and there are no cross-sex hormones that are followed. So they then resume puberty. And that's the long and the short of it is how little is actually known and how much we are increasingly knowing that that there are impacts and we cannot represent that it's fully reversible. And, you know, the Tavistock kids clinic in the UK had to remove their representations on their website to that effect because this is a changing science.

Yeah. We have a lengthy article coming out. My organization, we've been following the Tavistock controversy really closely. We have a really long article. In fact, by the time this releases, it'll probably already be out as a very long blog on our website. I'll send you the link. And it's that the Tavistock. So it's the main gender clinic in the UK. And it has become almost like a microcosm of some of the issues surrounding everything we're talking about the ethics of how to treat kids with either gender dysphoria or gender non-conforming identities or behaviors. What would you say to the argument that says, look, okay, yes, there's a health risk. Everything has a health risk. Eating bacon, driving a car is a health risk. But these kids, the suicide rate is off the chart. And so wouldn't you rather have somebody with some possible physical health side effects versus somebody who ends up taking their life?

Well, first of all, have you seen somebody raise that argument? Is that a popular argument? And how would you respond to that? It is a very popular argument. I don't think we, you know, I think the question is twofold. One is you're treating a population as if it's all suicidal. And we don't treat populations as if they're suicidal. We treat individuals as if they may or may not be suicidal. And they still are entitled to a full assessment and a full appreciation of

what may be going on that is creating their dysphoria. And that should not, you know, whether they're suicidal or not suicidal, or, you know, what the actual suicidal statistics are, you don't withhold care based upon that. And that the the primary issue is that um is simple affirming actually the best care is there another way to represent to them to this population that they need to explore and they need to be open to cognitive therapies. And there are ways of being supportive of them without setting them on a track to medically transition when we don't really know all the facts of their individual cases. That's the first thing.

The second thing is that the statistics around this are now coming up to question, because most of these statistics were based upon adults. And I don't want to get into a full discussion of the statistics around suicides. Children are, you know, this is a vulnerable population. Their needs should be addressed. But whether or not you withhold cognitive and other therapies should not be preempted because, in general, adults who have this condition have had higher rates of suicidal ideation. We don't think that's a great medical model. You raise a good point. It's a controversial one from what I can tell that if a child comes in with gender dysphoria, gender nonconforming identities, expressions, interests, whatever, you know,

you're saying that they should be like other possible causes for that dysphoria should be explored. But that's a popular thing to do. I mean, Ken Zucker, who he was the world renowned expert on gender dysphoria in kids. And he, you know, he's developed this bio social model of caring for kids. Like, let's explore what's going on. Has there been past trauma? Is there are they on the autism spectrum um do they have internalized misogyny or homophobia or the there's he's a big fan of exploring lots of psychosocial things that the child might be

wrestling with and oftentimes are but he got fired for that. Well, he was fired and then he sued and won his case. So, you know. Okay. Yeah. Oh, that, okay. I actually didn't know the out, so he sued. I didn't hear that part. Okay.

What do the critics of that model say? Because it seems like to me, if somebody is wrestling, it just seems obvious on the outside, like, of course we should explore other things going on. Why has that become very politically incorrect even due? Well, this is a question of what you think is going on and what kind of care a child is entitled to. a child is entitled to. I think that the affirmative model is set out to reduce stigma and to encourage kids to self-accept and to encourage others to accept that their gender dysphoria is the result of a variant of gender identity,

and that we have that. That's the thesis. I mean, the gender identities are variant, and that we belong on a spectrum. This is a theory about this, as to why children have gender dysphoria, what the nature of the gender dysphoria is. I just want to go back to the representation is that there are reasons that there may, there's no reason that someone has gender dysphoria.

Gender dysphoria is a distress, a distress with dealing with stereotypes, because that's what the DSM is. The DSM has, you know, you have to have six of eight possible, you know, items in order to qualify to have gender dysphoria. Basically, five of those have to do with stereotypes. And the sixth is whether or not your relationship to these stereotypes or who you play with or how you like to dress causes you distress about who you might be. Well, that's a pretty broad way of defining who has gender dysphoria or what gender dysphoria is. And I think that the question in someone's mind is,

to what degree are children self-diagnosing their problems with their bodies or how they feel about themselves or how they feel about stereotypes really are set to meet this criteria. And therefore, we're too quick to give them this diagnosis. And it's too facile a diagnosis. And we should be analyzing what else could be contributing to this and afford them the full spectrum of care because the harms are irreversible. And therefore, the scrutiny should be heightened. And I think that what we feel is happening is that they're not getting the full breadth of what psychoanalysts or psycho psychology has developmental psychology has to offer. And it'd be more nuanced and it should be a more exploratory walk than a fixed walk of, well,

you feel this way because, and therefore it's a given that you will transition. That's sort of what it's come down to. Why isn't it? It is kind of, again, as somebody who's not in the medical field, looking on and seeing how somebody like a Ken Zucker or others who have this more exploratory model can be really ostracized. Are medical professionals oblivious to some of these harms? I mean, it's eerie to think, wait a minute, all these endocrinologists who specialize in this aren't aware of these studies that show, you know, or is there political pressure? I mean, can you help us understand why is this not discussed more often? Yeah, I think that there obviously is political pressure. But, you know, and there's a question as to how we've come to this point of feeling this way about this particular population.

And it obviously has a lot to do with how homosexuals and homosexuality was treated early on. It's been folded in to that model. And therefore, it's easy for people to understand the homosexual treatments and conversion therapies in that model and how stigma played a role in depression. And that has all been transposed onto the gender identity issues. And I don't think that they're the same at all. And as a result, I don't think the same model should be transposed from one to the other. So, yeah, most people are familiar with, you know, sexual orientation change efforts. In Christian circles, we call it, you know, ex-gay ministries that try to change somebody from being gay to straight, meaning stop being attracted to the same sex and start being

attracted to the opposite sex. And there's an ongoing debate, right? Both, I mean, within the church and outside the church. There's no real debate outside the church, I don't think, but even within the church, there's some debates. But the church. I don't think, but we, even within the church, there's some debates, but I think the majority of people I talked to say, yeah, I don't think be doing that anymore. That doesn't seem very helpful or even ethical. Um,

but what you're saying is, um, there's widespread agreement that we shouldn't try to change somebody's sexual orientation, especially a youth. Um, but people have taken that truism and mapped it upon gender identity saying we also shouldn't try to change somebody's gender identity if they

identify as say the opposite sex or non-binary then that is what they are and if anything needs to change it would be the body needs to change And yet that's not seen as conversion therapy. Conversion therapy is being viewed as changing somebody's internal sense of who they are. Is that. Yes. So it's it does. It doesn't map quite accurately. And that's why we think it's inappropriate, because, you know, under homosexuality, the idea was that your body, that you're male, that you're female, and to have an integration without your mind. And I think the gender identity is basically saying the problem is your mind. Excuse me.

The problem is your body, and you need to change your body. And that's why you feel the way you feel. And so to me, it's just completely different. I think also, and we can talk a little bit about this, but there were actual studies that homosexuality was, you know, conversion therapies for homosexuality were not successful. That is not true with gender identity. You know, you mentioned Ken Zucker, but there are also, you know, the Dutch model that people talk about now, all, you know, had great success, if you want to call it success, meaning avoiding

unneccessary intervention. That's a success. Determining what is necessary and what is not necessary is a different issue. But they had, you know, 65, 80, 90 percent desistance, meaning the child did not need to have a medical intervention. That is not the same as, and they experienced to some, therapies, being left alone, being given room to explore on their own, holding spaces for them, also exploring whether or not there was trauma, a whole list of things. different model than the problems that homosexuals had when somebody tried to intervene with cognitive therapies. They were harmful. They were not successful. So these things are apples and oranges because they're developmentally different. The risks of unnecessary harms are different. I mean, what I like to say is the normalization of homosexuality was to depathologize it so that you didn't have any medical interventions. You didn't have chemical castration. You didn't have to go on meds to deal with depression over the fact that you were attracted.

You didn't have lobotomies. You didn't have all of these things that were used to medicalize your condition. Well, the reverse is true here. We are actually medicalizing a condition and saying, well, we're going to introduce interventions in order for you to cope with this condition. introduce interventions in order for you to cope with this condition that is completely inverse to what we wanted and to happen with regard to homosexuality and so you cannot use the same models at all and yet it's it is i mean you're a lawyer so you tell me. As I've danced around, it does seem that I keep seeing sexual orientation and gender identity conversion efforts. They're just conflated together. Is that written into law in certain states?

Or is it not quite there yet? Well, this is – yeah. Okay. Yeah. I have thoughts about the conversion therapy bans are overbroad and vague. I'm really looking forward, and not with regard to homosexuality per se, but certainly with regard to gender identity, because what does it mean? They prohibit trying to change someone's identity. And that's the key element, is an intention to change.

Where does conversion therapy leave off and everything else that we feel is necessary to provide for the whole person, all of the developmental knowledge that we have around identity development and trauma and depression or whatever else, isolation and even minority stress. All of these things. Where does it, you know, how do you calibrate when you are exploring, when you are asking questions, and when you are, quote, unquote, gatekeeping? When does it become evidence of an intention? The bands do not make that clear, what the differentiation is. And like most things that are broadly written or vaguely written,

the proof is in the pudding. The proof is when somebody's licensure is pulled. But nobody wants their license to be the test case. So what you have is very vague prohibitions that include gender identity that have not been tested in the courts to see if they are valid bans, because if a ban is too valid, I mean too vague, you can't enforce it. And therefore, somebody will, I was not put on notice that this was illegal, because it was so vague, I had no way of interpreting it. And so the court can say, I can't apply this legislation.

But the point is, is that the result of that, of these vague, broad bans in certain know, is this not applying to you? And that's what the actual impact has been. The impact has not been to keep people from doing conversion therapy on identity. The impact has been that only people who do affirmative clear-cut affirmative therapy practicing on this population because they know that they are safe wow what oh man so um that that makes sense i mean i put myself in the shoes of a therapist a medical professional whatever and if i know if i just affirm the affirm the identity affirm dysphoria give them what they want whatever then i'm clear there's no risk and yet you could be irreversibly

significantly harming this adolescent um yeah that's eerie a little bit i mean how widespread is it i mean it's enough of an issue that you started this whole organization i don't think you make a lot of money from the organization what's your motivation is this is this a serious enough issue that um people should really wake up to well i think it's a serious serious issue that children in this population are not being provided all of the care that is available. I mean, all that we know developmentally, all that we could assist them in. They're not given appropriate assessments as to what may be contributing to their feelings. And I think that that is true. I think from what we hear from clinicians and now from detransitioners and people who transitioned and stopped for whatever reason, that the level of care that is being offered is not adequate to prevent unnecessary harm. You mentioned, we've mentioned detransitioners a few times, and we have some friends in common

that have transitioned in their teenage years and now are detransitioning. Now, some people say, yeah, of course, one or two percent might regret their transition i mean people regret stuff all the time but the overwhelming um population that does transitions are that do transition are very happy with their transition it has helped their dysphoria their other mental health um things are wrestling with is is what some people will say and yet mental health things are wrestling with is what some people will say. And yet, anecdotally, at least, it just seems like there's a growing number of detransitioners who keep saying the same thing. They're in their early 20s. They're typically female. And they're saying exactly what you're saying, that they don't feel like looking back, they were cared for holistically or

appropriately. They were just people went along with whatever they kind of said and demanded. And now they're paying the price for that. Is that am I wrong to say that this again? No, we don't know the numbers. And I don't think that we're going to know the numbers for a while. And and so I don't want to represent, you know, what the numbers are. I think that, you know, our position is that they are part and parcel of this same population.

And therefore, their needs are legitimate and valid, and that we should be using what they are telling us to not only provide them with better care, but to avoid some of the pitfalls that we, you know, may be coming up around this. We are still in a very early stage of this, you know, of this exponential growth. exponential growth. And we don't really know what is creating it or what the impact of it is and whether this population will have a different trajectory as far as whether more of them desist or detransition. I think that common sense, to some degree, tells you that the less preparation you have, because transitioning is not a small item, not for you physically, not for you mentally, and not for you socially. And this was why there was a great deal of gatekeeping that went in, because it was not a small deal. But we have minimized all of that. We have made it into something we absolutely self-diagnose. And we absolutely provide hormones with one or two meetings.

And we can get them pretty much on demand. And there's no way that in our culture that's not going to affect the level of regret. Have there been lawsuits from, again, detransitioners in their early 20s that say, I feel like it was medical malpractice from my caretakers? Are there any lawsuits? Is that happening? Or do you foresee that in the future? Carabelle in the UK is the most prominent lawsuit and she's suing Tavistock. And I think it's, you know, no coincidence that once she sued them, they took a lot of stuff down from their website

as being perhaps misrepresenting the risks of the intervention and being misleading about it. What's her name again? It's Cara Bell, is that? Yeah, Cara Bell. Yeah. And so she has a suit that's proceeding through the courts. It's going to take a while.

I mean, this is ostensibly how the West, in particular the U.S., practices medicine. It goes whole hog, OxyContin, I could name you a million, you know, until the thing about OxyContin was that the negative effects were so quick. So it was like everybody has it and then everybody, you know, in a bad way. So it's very quick to show cause and effect. You did this, you did that. So we're not going to have that.

But at the same time, that's how we manage medicine is through adverse events and people suing. These drugs that are being provided, puberty blockers, are off-label. The cross-sex hormones is an off-label. This means that there are no long-term studies as to the impact, This means that there are no long-term studies as to the impact, and therefore the FDA has not approved them for this use. But what we allow for that, because we want the biggest flexibility between a doctor and a patient, for them to come to what is the best protocols and usage for them. And unless it has been banned or unless there have been enough adverse effects that the FDA has put a warning on it,

then we proceed until people begin to complain and sue. That's how it works. Until that happens, we go whole hog and pretend that it's safe. Every time. Not some of the time. Not the time. Every time. So you're saying it's just a matter of time until there is some big lawsuit or lawsuits that shake people up to kind of reconsider their method of intervention? I think it's a matter of time. I think that there have been, I think, in Canada, informed consent lawsuits in which the informed consent forms and the time representing what the risks were

were not adequate. I think that in this country we're going to have problems around the fact that because we designate uh 18 year olds to be fully competent and so you just have to give them a litany of risk and not really assess how are they competent are they are they do they have capacity what is influencing them this is it's being treated sort of like plastic surgery. You know, this is something you wanted for you. Right. You know, you did a GoFundMe and you got the money, or you're on Medicaid, or your parents' insurance, or your university's insurance.

Cover it. and should cover it. And if it's a covered service, then it's between you and yourself as to whether or not this is appropriate and you take the full risk. Obviously for minors, and there's a whole quasi area in here of what we call the mature minor, but is that children by definition do not have the capacity or competency to fully evaluate the risks. And so therefore, it is actually adults that are making this decision for them. And that's a whole different area of analysis.

And that's why, to me, the scrutiny has to be much higher because you are deciding for somebody else a child and the i know at least in oregon the informed consent the age is something like i think it's 15 right a 15 year old can go in without any parent knowledge and get a double mastectomy and cross-sex hormones without their parents knowing. Is that true? Yes. I think it's the youngest. I think it's the youngest.

And now, you know, there's a lot happening in that area as to if the parents don't want to consent and they're younger, how you manipulate or traverse separating the child out so that the child can get the services regardless of what the parents consent to or not consent to. Yeah, I had a parent of a 14-year-old in California that told me – they came to me in tears. I mean I don't know what to say. They said my fort is demanding cross-sex hormones. I want to say no, but if I say no, she'll go report me saying it's a harmful toxic environment my mother's not affirming my identity she's not giving me the medical treatment i need um and so she'll lose custody she's like what do i do and i i don't i'm like i don't as a parent of four kids you're a parent with two i mean I mean, I don't, that's so eerie that people are in that situation.

Right. It's a very, very, very difficult situation. But I think from our point of view, a lot of this has developed in this way because the public is not fully aware of the nature of the harms. the harms and not fully aware of how little deep assessment is going on with regard to whether an individual child should be going through a medical transition. And that's generally what we find is that this has not been fully platformed. It's not part of a public debate. fully platformed. And it's not part of a public debate. And there's a great deal of effort to smother it in its crib for better this kind of discussion as being transphobic. And that's what happened with regard to certain legislation that came up last year, and I think probably will come up once we get around this political season. And again, with regard to legislation, with regard to particularly puberty blockers, because they begin so young. And pretty much once you start the puberty blockers, pretty much once you start the puberty blockers,

there's a 99% to 100% will go on to cross-sex hormones. So it's not a pause. It is part of a pathway. And understanding it for what it is and how it is actually used and the role that it plays in the life, in the physical life of a child and when it can be introduced, can be introduced as young as eight, depending on when the child is in stage 10 or stage two. But I think, you know, so some of that legislation, regardless of what I think of whether or not you should make something criminal or just a civil penalty or what the penalty should be for proceeding, was really, I felt, promoted a

discussion and a higher awareness of what the level of care is that's actually being provided and what the actual medical risks are. And I don't think that we as a society can really evaluate what the best practice is unless we have this information available to us. And so is that kind of the driving goal in your organization to just spread awareness of specifically these medical issues that aren't being addressed? Well, I think that we have a twofold, is that we cannot arrive at what is ethical care unless we are discussing what the harms are and have a full appreciation for the nature and the extent of the harms. That's the thing. And the second thing is to begin to explore how to provide a better model of care for this population that isn't tantamount to receiving the care that they're being provided, but opens up the care again in light of these harms, in light of the population that is being impacted,

in light of the influences that may be causing some of this to happen to girls in particular, but to the extent that it's happening. And, you know, I'm hoping that even those that support affirmative care will begin to reassess the level of care that they're beginning by and sort of back up a bit and say, well, we need – this population is different. This is being impacted by outside influences that we did not anticipate and we need to adjust for and not be too quick in what we assess as being appropriate interventions. Yeah. So I'm curious. So this has your talk. J.K. Rowling has been very public voicing a lot of the same concerns you voiced with specifically adolescents, underage kids receiving medical intervention too quickly. And she's been labeled a homophobe, transphobe, anti-LGBT. Do you get those kind of accusations and how do you respond to that?

Well, I think everyone does. I mean, you know, there is a particular dogma and line that makes people feel safe within, you know, the trans community. And anyone that doesn't hold that line is questionable and we are questioned. it is being provided and really maintain that that is really what we're focused on. And asking the trans community itself and asking clinicians to really pause in their affirmation, not that you can't affirm someone, but you need to fully assess and explore with that individual all the things that might be going into causing that distress. It is sad because, I mean, at least the motivation for people across the kind of spectrum of how to care for kids, the motivation is what is the best care for these individual children i don't i don't hear anybody at least in the broader conversation um not care about the

kids so the you know the say the trans activists you know they're like man if these kids can transition before they go through adolescence they can pass a lot more easily and their their distress will be reduced and so i mean I mean, agree or disagree, their motivation is I want what's best for these kids, I think, at least verbally. And same thing, people that are a little more critical of gender affirming care are saying, no, I think this is actually doing more harm than good. Why can't we come together and have a discussion when the motivation at least is publicly the same? other and have a discussion when the motivation at least is publicly the same we want to look at all the evidence look at all the facts get our arms around this so that we can best care for these these kids uh do you foresee that conversation happening or is it just going to keep being a big outrage session well given i i do see it happening and i don do see it happening. And I don't see it happening immediately, but I do feel it will happen over time.

Because, again, that's how we practice medicine. We take in new information. We see that things are not working out. We see that people are getting addicted to OxyContin, whatever it is. We see the results, and then we reassess, and that's how it works. So I think that some of this will resolve itself eventually, because the information, there will be long-term studies, there will be suits of people who feel that they didn't get the full breadth of care they could have gotten, or they weren't fully informed of what the risks were and there will have to be in a reassessment

there was reassessment of intersex surgeries right it took 25 years wow that's true yeah and and and as a result of the patients themselves uh coming to the floor and talking about what their experience was or wasn't and we don't we're not going to come to a perfect resolution but i do feel that you know medicine will change and i i do feel that this population will begin to become vocal for itself. And right now, I think that a lot of people, older people, are speaking for this population. Because the numbers of kids that are going through this process has never been seen before. Right. process has never been seen before right and you know and as a result of that there's we're going to learn a great deal i just want us to be open to what we're going to find hey would you so in my

again in my anecdotal experience it seems like a lot of older self-identified transsexuals who prefer the term transsexual not transgender transgender, they're very concerned about kids transitioning too quickly. And they obviously would be very much in support of some people transitioning. You know, they're very much for that, that I have no moral problems with that. But they're more and more I'm seeing people, again, older, let's say older than 50, you know, transsexuals who are the most concerned. Are you seeing that as well? Or is my anecdotal? I certainly know of them. You know, I certainly know that there is an actual population, you know, the population of people who will talk about their experience, who will come out and actually want to get in front of,

you know, an audience and vocalize is a different group than those that just want to go on with their lives. Right. And are quite happy with the choices that they have made. But I would say that in general, the older population that did refer to themselves or think of themselves more in the terminology of a transsexual appreciate the assessment that they went through and are concerned because there is a way of making it seem easy and not. Yeah, yeah. I'm going to say something really politically incorrect,

but most people on my audience I don't think will catch it. And I would love your thoughts on it. If you want to plead the fifth, I totally get it. But it seems like some of the most aggressive and let me just make a distinction between trans activists, a small minority of trans people versus the average person

who would be under the trans umbrella. Most trans people versus the average person who would be on the under the trans umbrella most trans people i every trans person i personally know is not an activist they don't even resonate with that they're just as you said they're just trying to live they're trying to figure themselves out um so i don't like it when people conflate the two they hear a trans activist and then they think oh that represents trans people And that's just not true. However, in my experience, some of the loudest trans activists would fit the profile of being autogynephiliac, which is a certain type of experience. It seems like a very specific kind of trans person that is the most vocal, especially in this area. Does that, I don't know, is that, again, my anecdotal observation? Well, let me say, you're not, you know, that is not exclusive to trans activists.

I think all activists are pretty vocal. It's part of being an activist is that you want to be out in front of something and something and you have a passion about it and you want to put forth a position and a perspective. That's what makes an activist an activist. I think, you know, I don't like to talk too much about the politics of it, but I think that you can say that there are activists who are creating a situation where there is a downward pressure to have medical transition of children younger and capacity to consent younger. capacity to consent younger, and that is the result of an ideology around what is causing the distress, meaning that you're born this way and that there's no sense in any other way of that.

And the sooner you get on with it, the earlier the child will be. And the sooner you get on with it, the earlier the child will be. And that's a perspective. And it is a perspective of coming from an ideology around what is causing the gender distress. And I can appreciate that the motivation, again, is I think they want the best for other people. I would disagree with that just from an anthropological or philosophical point of view. But the motivation I can appreciate and I could affirm that in somebody that it seems like they truly do want what's best for the kids. How do people respond though?

And I won't keep you much longer, Jane, and I'm sure you have other things to do. That's good in theory. That's good in theory. That's good in theory. But we have to return to what the science can actually provide. Well, that's where I was going. I mean, according to all the studies, 61% to 88%, and I have an 80-page document combing through these studies, so I'm not just reciting some tweet.

It seems legit to me that 61% to 88%, depending on the study, of kids pre-adolescence with gender dysphoria, it goes away after adolescence. How do the people who think that, no, if a five-year-old says they're trans, that's what they'll always be like, how do they respond to those studies? Because there isn't, I mean, it just seems like pretty clear. You know, what I would say is that the short-term benefit, because this is the language that is used, is that if you affirm, regardless of the age, the child will thrive. And the child thrives under being affirmed and so it's it's it's it's sort of saying well uh under you mean the what the way the the affirm model is set out is it's it's stages you socially transition and we can you know which is to uh allow the child to express the opposite gender and confirm through name changes and also to confirm through pronoun use.

That's sort of socially transition. And then as the child grows up, you block their puberties. You block puberty, and then you give cross-sex hormones and then you do surgeries. That's sort of the overview. Each one is more invasive. The problem with that is that social transition and puberty balkers until recently were viewed as a neutral intervention. And therefore, the child could still desist.

What's to prevent the child from desisting? You know, you could just, you know, you haven't harmed the child. The child can say, I've changed my mind. What's the deal? You know, it's perfectly free to do that. I think our position is that socially transitioning is not neutral. It is actually a way of conditioning the child to think of themselves in a social setting as a particular gender.

It begins to read itself confirming. as a particular gender. It begins to read itself confirming. And it then also places a burden on the child that if the child begins to go through puberty and begins to ask questions about whether or not becomes more mindful of their experiences, the child has to backtrack. And that is a different burden being placed on the child than allowing the child to have the space to actually freely explore. And so we don't feel that social transitioning is actually neutral. Well, I don't know how anybody could say it is neutral. Anybody with any kind of awareness of basic science or sociology, even things like brain plasticity, we know that habits and the whole nature nurture thing has been, it's so complex. I mean, even habits in life rewires

in different ways, like to think that what we do socially doesn't have some kind of effect on our self perception our psychology. That just seems so naive to me. I don't know. It's fascinating that somebody would say it's a neutral thing. You could say it's a good thing or whatever, but to say it won't have any real lasting effect, that seems insane to me. Well, also, and I think, you know,

but I think because in this sort of vacuum of no long-term studies where we can't say, well, socially transitioning will lead to puberty blockers, which will lead to, and then we have these harms. So you have, in effect, sort of saddled a young child with a certain set of harms. And that's what I mean, until we have a full grasp of what the harms are, we really cannot fully assess what is ethical. And my position is, and our position is at Rhyme, is that we have enough information that this should be treated at least as experimental and not be treated as neutral or irreversible or not harmful and that you are taking substantial risks by entering this. It's not a glitter walk. It's not fun this child will experience a great deal of psychological and social repercussions

from going through this process and adults are determining that the child is not and we haven't even gone here we could leave this maybe for another time but he said it's not a glitter walk and yet there are some youtubers with literally millions of followers who portray it as just that a glitter walk and i think that um and we're now starting to understand i think the the impact of social media especially youtube or tumblr and others that um yeah that's uh everything you're saying is not the dominant voice they're hearing. Yes. Yeah, which is eerie again. Jane, thanks so much for being on the podcast. I've taken you over an hour and eight seconds.

Oh, it flew by. Yeah, it flew. I could talk to you for hours. And again, for those of you who are interested, I mean, you've probably Googled it already and listened to Jane, but Rethink IME. Rethinkime.org. That's Rethink Identity Medicine Ethics. Loads of great, great resources here. What I love about your ministry or your organization, Jane, is that the research is so thorough and thoughtful.

Like you're not citing, you know, some tabloid or whatever. You have like citations of actual peer-reviewed research. You have on your board, I mean, some high-powered professionals here on your board of advisors and stuff. I mean, it's the quality. As an academic myself, I just appreciate when something is just done with academic, um, thoroughness. And I, so you're, yeah, your organization's fantastic. I hope a lot of people check it out after this.

Well, thanks so much. Yeah. All right. Take care. Take care. Thank you.