Dr. Stephen Levine is an American psychiatrist, he is renowned for his five decades of work in human sexuality and gender dysphoria. This lengthy video is from his testimony in front of the PA Health Committee in March of 2020. His expertise is of great relevance and worth the time.
Video Transcript AI Summary
In this video, the speaker discusses gender dysphoria and the different perspectives on its treatment. They argue that the aspiration to become a complete man or woman is not biologically attainable, even in the trans person's subjective self. They explain that gender dysphoria is a psychiatric illness, not a medical disease, and there is no physical abnormality associated with it. The speaker presents two ways of looking at gender dysphoria: a developmental model and a watchful waiting approach. They emphasize the importance of considering the long-term consequences of affirming a transgender identity in children and highlight the potential risks and harms associated with transitioning. The speaker questions the lack of scientific evidence supporting immediate affirmation and raises concerns about the ethical implications of intervening when children would naturally desist from their gender dysphoria.
Speaker 0: I first encountered a patient suffering from what we now call gender dysphoria in July 1973. In 1974, I founded the Case Western Reserve University Gender Identity Clinic. I was an early member of the Harry Benjamin International Gender Dysphoria Association, which today is known as WPATH. I served as the Chairman of the Standards of Care Committee for WPATH. Contrary to hopes that medicine and society can fulfill the aspiration of the trans individual to become a complete man or a complete woman.
This is not biologically attainable. Indeed, the aspiration to become a complete Man or woman is not even attainable in the trans person's private subjective self. First perspective, some speak of gender dysphoria as though it were a curable physical mental illness that causes endless suffering. It should be noted, however, that gender dysphoria is not a medical disease, It's a psychiatric illness. There is no physical or biologic or specific abnormality of the sex organs or the brain at this point in our knowledge among these individuals.
And since doctors gave up performing lobotomies to treat psychiatric disorders many decades ago, gender dysphoria is the only psychiatric diagnosis which doctors are attempting to treat by surgery. The second way of looking at gender dysphoria is in developmental terms. We could call that a developmental model. In a young child, we would view attraction to a transgender identity as likely as an adaptation to a psychological problem that was first manifested as a failure to establish a comfortable conventional sense of self in early childhood. In an adolescent, clinicians would look for fear or sense of failure associated with the roles that the individual associates with his or her biologic sex.
In other words, we're very thoughtful about the things that a child may misunderstand, May not have lived long enough to grasp yet. Many young children, trans identified boys, Think that males can only exist in this range of behavior whereas when they're older They will understand you can be a man in any one of these ways and similarly for girls. This is a child's thinking not a grown up's thinking. Some strident advocates oppose the developmental view asserting that trans identity is biologically caused and it's unchangeable. But this is not supported by Science.
Recent sudden changes in the numbers and makeup of those experiencing gender dysphoria Strongly suggest a cultural or a sociologic rather than a biologic cause because the genetic makeup of our species Does not change over a 20 year period. A recent study has documented a clustering of new presentations in specific schools among specific friends group. All these observations point to a social influences on the construction of gender identity or transgender identity. The first approach we would call watch for waiting. We have a 6 year old, a 8 year old who is cross gender identified and gender non conforming.
This model is particularly relevant to those before puberty. The scientific basis of this approach is the fact documented by 11 of 11 prospective follow-up studies Performed by different research groups at different times in different countries, 11 of 11 studies have demonstrated that the large majority of young children who present with gender dysphoria if left untreated, Uninvolved with will evolve to a gender identity consonant with their biologic sex by the end of adolescence. There have been 11 studies of children following young children for 10 years up to 10 years into adolescence. All 11 of those studies have found that the majority of the children outgrow it, the majority. The highest one is like close to 90% but there's some have been in the 60% range, You see?
So that's very important for us to understand because it feels to me like there may be an ethical question here about intervening when children would desist. It seems to me that why aren't we talking about the ethics of that? I, myself and other clinicians have witnessed reinvestment in patients' biologic sex in some individual patients who are undergoing psychotherapy. I have published a paper recently on one patient who sought my therapeutic assistant to reclaim his male gender identity 30 years after living as a woman and who is in fact today living as a man. I have seen children desist even before puberty in response Thoughts to thoughtful parental interactions and just a few meetings with a therapist.
In my opinion, in the case of children, Prompt and thorough affirmation of a claimed transgender identity disregards the principles of child development and family dynamics and is not supported by science. Many trans care facilities are staffed by mental health professionals who have very limited experience with recognizing and treating psychiatric problems that often accompany gender dysphoria. As a result of the downgrading of the role of psychiatric assessment and treatment of patients, new gender affirming clinics have arisen in many urban settings and recommend transition with remarkable indeed distressing Really remarkable speed. Sometimes after a single 1 hour session, in my opinion this cannot be reconciled with responsible mental health care. These clinics are often called gender affirming clinics.
The name of the clinic tells you That there is not a careful psychiatric extended evaluation of this stuff. What is happening in the United States is affirmation, affirmation, affirmation. And no consequence, No thought given to the long term consequences based upon 50 years of cross gender cross sectional studies Showing that this is a marginalized, vulnerable, psychiatric and drug impaired Groups of people. We have a phenomenon where a high number of people, a high percentage of people have significant ongoing psychiatric needs. It Seems to me that all of us should have some pause about what we do and I don't think that the concept of we have a 6 year old who's non gender conforming and that we ought to affirm that child and let that leave that child to believe that She can be a boy or she can be a girl.
I don't think that's helping with what psychiatrists call the reality testing of the child. A comparison of recent and older studies suggest that when affirming methodology is used with children, A substantial proportion of those children who would otherwise have desisted if left alone persist in their gender identity. In other words, gender affirming of children leads to a very high incidence of trans identity at puberty and the failure to desist. Whereas if you leave the children alone many of them will desist. If you treat them young and intervene and support They're going to have a transgender identity in adolescence so we have to ask ourselves the question, what does that mean for the long run of the child.
The increasingly widespread use of social transition for children is locking a large number of children into with trans identity and life who would otherwise become comfortable with their gender of their biologic sex before reaching adult We should all seriously consider that the drive to block puberty derives from the experience of trans identified adults who recall personal discomfort about their subjective gender discomfort in childhood and adolescence. It does not consider All those children and teenagers who outgrew their discomfort. In other words, the idea of giving puberty blockers is based upon adults who are not doing well recalling that they were uncomfortable with their body. And so that suffering, say among 40 year olds, have led some researchers to think we could prevent this suffering If we only block their puberty but that does not consider those people who outgrew it and are not talking at age 40 about their discomfort. Certain advocates and advocacy organizations make statements that would give the impression that science has already established that prompt affirmation is the best for all patients including children who present the indicators of trans identity.
This belief is not based on good science, it ignores both what is known and what It is unknown about health outcomes for transgender people. Advocates of immediate and unquestioning affirmation of social transition Sometimes assert that any other course will result in a higher risk of suicide in affected children and young teenagers. Leaving aside young children who very rarely commit suicide for any reason. It is certainly true that individuals with gender dysphoria are well known to commit suicide at elevated rates, But this is true both before and after social transition and before and after gender con Forming surgery which used to be called sex reassignment surgery. No studies show that affirmation of children or adolescents reduces completed suicide rates, prevents suicidal ideation or improves long term outcomes as compared to either watchful waiting or psychotherapeutic model of approach to these children.
Claims that affirmation will reduce the risk of suicide for children and adolescents is not based on firmly established science. A Swedish follow-up study tracked almost all individuals in that country who underwent sex reassignment surgery over a 30 year period and found the suicide rate. I am not exaggerating ladies and gentlemen. The suicide rate in Sweden among people who are operated on for this Problem was 19 times the general population. We do not know that kids who do not transition have a higher risk of suicide.
We do not know that. That is not an established fact. But what many people Believe that unless I transition my kid they're going to be dead. And what happens often times is the trusted mental health, the trusted pediatrician or the mental health counselor or the psychiatric evaluator or the nurse dealing with them has said to their parents. That's a manipulative, coercive, terrifying thing.
You see, now we in the medical profession want our patients to trust us. That we know the size of things and if we summarize that your kid is going to Dead unless you transition them, they either trust that and oh my God we better do this And let me put aside all my intuitive worries about the wisdom of this, you see, or they get another opinion. There are no studies that show the affirmation of a trans identity in pre pubescent children leads to more positive outcomes say by age 25 or 30, than does watchful waiting or ordinary psychotherapeutic approaches. On the other hand, what is known is that there are numerous known likely and possible long term downside risks associated with living life as a transgender individual. Let me detail several classes of predictable, likely, or possible harms to patients associated with transitioning to live as a transgender individual.
The first one I want to mention is sterilization. Obviously, sex reassignment surgeries that remove penis, testes, ovaries, vagina, and uterus are inevitably sterilizing. But medical professions also believe that we should assume that cross sex hormones which are increasingly administered to older minors may also be permanently sterilizing. Does any 11 year old, even one who has parental consent, Have the capacity to consider the implications of personal sterility that may show up in his or her life 20 years later. 2nd, the loss of sexual response.
Puberty blocking prevent maturation of the sexual organs and sexual physiologic responses. Some and perhaps many transgender individuals who transitioned as children and thus do not go through puberty consistent with their sex Face significantly diminished sexual response as they enter into young adult life and are unable to ever experience orgasm. Children of course cannot imagine what this will mean for their future lives and psyches. In terms of mental health In my opinion, individuals in whom puberty is delayed multiple years are likely to suffer negative psychosocial and self confident effects As they stand on the sidelines while their peers undergo pubertal changes and get involved in social interactions that caused them anxiety but helped them to learn how to manage their sexual feelings and to conduct interpersonal relationships. Thus, if you block a kid's puberty for 3, 4 years he remains looking like a child and feeling like a child while his peers are into a whole different phase.
I've worked with multiple individuals who've abandoned trans female identity after inhabiting that identity for years who expressed regret. A surgical group prominently active in sex reassignment surgery has published a report on a Series of 7 male to female patients requesting surgery to transform their surgically constructed female genitalia back to their original male form. They cannot surgically be returned to their previous normal genital anatomy. The trans person of either sex who requests having their body returned to the original sex appearance should worry all professionals.
