Excerpts: Gender Odyssey Conference, Seattle 8/23-8/27, 2017 attended by USPATH/WPATH & Kaiser Permanente members
https://archive.is/K6BVm
Here we provide audio from the 2017 to examine the policies and worldviews of health professionals who practice the affirmative care model for childhood and adult gender dysphoria. They often do not follow the standards of evidence-based medicine. These cases are similar in their extremism to cases reviewed in the WPATH Files released by Mia Hughes on Micheal Shellenberger’s project Environmental Progress.
*Dates retained in audio file names
Access audio files below. Audio involving talks given to parents is not posted here, rather relevant quotes from the health professionals are transcribed.
https://drive.google.com/drive/folders/1dewBuW4bzx0ECoypHpNGJpGM3TmqOhcN?usp=share_link
Talks By Johanna Olson-Kennedy
Violating Reporting Suicide Guidelines / Misrepresenting It
20170823_oslon_blockers1 (3:30-4:05)
Shows a slide of people who have killed themselves and says that the list is growing.
“This is one reason why I do this work, so young people are not added to this slide. It is really still happening and that’s all very real. And as a lot of people go on their nonsensical rages how being trans is trendy people are dying and that’s real.”
Destruction of sexual function appearing an afterthought
Audio File: 20170823_olson_blockers2, (7:00-9:15)
“Now how many people here saw the episode of Jazz where she went to the surgeon and the surgeon was like, “You can’t have a vagina, ugg. For folks who didn’t see it, for people with testicles who are blocked in tanner stage 2, they do not have a lot of penile tissue, and when you do a procedure that you use the tissue of the penis to make a neovagina, um usually you would just do an inversion and use that tissue but if you don’t have a lot you need to do graft from another part of the body, usually scrotal tissue. There are other ways that people do this, does not preclude you from having a vaginoplasty but I want people to think about this…
We have to think about these things. Right? Blocking is one tool that’s an awesome tool for a lot of people. And what does that mean? Does that mean that trans feminine, trans girls who get blocked in tanner 2, we are we are making the assumption that all of them are going to have genital surgery? Are we doing that? Because we might be doing that. [Laughs nervously] I’m just saying we might be doing that. And so that actually is worthy of a conversation. Because many trans women do not have genital surgery. Love their genitals, enjoy their genitals, like to use them. That’s fantastic. We love people who love their bodies and use them and enjoy them. That’s a great human place to be. But we have to ask ourselves if you have tanner 2 male genitals are you going to be able to use them? Are you going to want to use them? Or we are we, just assuming that everybody is now going to have to say, ‘Well I either need to go through puberty to get adult sized genitals or I’m going to have these genitals that I have or I’m getting surgery.’
Does that make sense? If we are judging the success of vaginoplasty by post-surgical orgasm how do we know people are having orgasms prior to surgery if we are blocking them at tanner 2?”
*Short clip publicly available here:
https://drive.google.com/file/d/1M_Gva6JSsAk3-6AKksLc-m5OaMZulTKF/view
*Context 4thwave ICYI:
https://4thwavenow.com/2018/07/08/does-prepubertal-medical-transition-impact-adult-sexual-function/
20170825_olson_blockers_parents_same_as_8_23_talk (54:40-54:45)
*Repeats Jazz story when told “she couldn’t have a vagina” in parents’ talk.
"Wasn’t that terrifying? I thought it was really unfortunate.”
Acknowledgement this is experimentation on minors
20170826_olson_parent_q&a_over12 (23:42-24:11)
“We don’t have enough data to know what happens with growth spurts for people when they go on T. It’s just all over the place right now. And so, I think once we have a better idea of that or we collect all of this data together, we are going to say ‘Hey, it turns out if you’re within a certain amount of time of menarche you can induce a male growth spurt,’ then we will probably make different decisions around testosterone and blockers.”
20170826_olson_parent_q&a_over12 (18:21-19:00) (audio not made public due to parents)
Response to a parent question. Question is hard to hear but something about a female youth on Lupron and “going into severe depression.” (17:16)
“I think it’s, that’s like hashtag this whole field. Right? It’s super difficult because there isn’t enough data. And that you know, we rely on clinical experience of people doing this work. So I mean, so many of these things I learned after putting hundreds of- So I think, I think we’ve blocked about 160 kids in our practice. Um and so I do think that the other piece isn’t necessarily blaming it all on menopausal symptoms, but also remembering that there is a psychosocial impact of being in puberty purgatory.”
20170825_olson_blockers_parents_same_as_8_23_talk (1:10:45-1:11:38)
“If you now block, you go back to that prepubertal bone density accrual. And at the time that you add on cross-sex hormones your bone density is going to be relatively lower compared to your peer group. Right? Which makes sense because they’ve been going along with the pubertal bone density rate. So, this is an important thing, this is why we keep track of bone density, both at baseline, and as people are on blockers. We have shown in some preliminary studies that bone density starts up again, when, accrual starts back up again when cross-sex hormones are added on. We still need a lot of information is the reality. We don’t have all the information, but what has preliminarily been shown is that bone density starts to accrue again at a pubertal rate when you add on hormones. But what that also means is, is it’s probably not a good idea to block somebody at nine and wait until sixteen to give them hormones…”
20170825_olson_blockers_parents_same_as_8_23_talk (51:20-51:24)
“There is no test to show somebody’s gender.”
Extreme hormonal effects
20170823_olson_blockers2 (29:00-30:03)
“Emotional lability. This is really common with blockers. Um, I wouldn’t say that it’s like, I would say it’s not uncommon. I’ve had a handful of people who um when they go on blockers they have a period of time where they are really emotionally labile they can have mood swings they can have behavioral changes. Part of it, and it’s important to realize the mechanism related to this because if you go back to this diagram when you give someone an analog of something, you’re going to flood them with the message to make more of their endogenous hormones.
If their endogenous hormones feel really yucky and wrong for them they’re probably going to feel bad in that first 4 to 6 weeks so always saying if your kid is experiencing suicidality or depression you want to have do you want to have an eagle eye on that kid for that first time period. So emotional lability weight gain some kids gain weight.
If their endogenous hormones feel really yucky and wrong for them they’re probably going to feel bad in that first 4 to 6 weeks so always saying if your kid if your kid is experiencing suicidality or depression you want to have do you want to have an eagle eye on that kid for that first time period. So emotional lability.
Weight gain- Some kids gain weight. It’s usually the kids who start out a little bit heavier. It’s very similar to the like the Ortho Evra patch or Depo-Provera, if you start out. I mean my peanut kids like rarely will gain weight. Just, just unfortunate.”
20170823_olson_blockers2 (30:17-31:02)
“OK, here’s another thing. If you practice a model where you don’t start hormones until sixteen and you put a 14-year-old trans boy on blockers you are putting them in menopause which you just have to understand that that is going to potentially be a train wreck. Right? So, I mean menopause is bad enough when you’re menopause age but when you are fourteen and you are having hot flashes and memory problems and insomnia and you just feel like crap, like and you’re 14, that’s a terrible combination. This is really common. There’s this expectation of like, “Oh I have this kid and he’s a total train wreck and I put them on blockers and why is he doing so bad?” Well because he’s in [giggles] menopause.”
Short clip publicly available here: https://drive.google.com/file/d/1isyuejQO_mT_LqUkXsiNdzmCG2UOpCht/view
Context 4thwave ICYI:
https://4thwavenow.com/2018/07/08/does-prepubertal-medical-transition-impact-adult-sexual-function/
Diagnostic criteria is unclear/ medicalized non-binary identities for minors
20170823_olson_blockers2 (33:30-37:25)
“Let me tell you a story about a young person, assigned female at birth. 18 months old. Assigned female at birth, 18 months old, “I a boy.” This kid was insistent, persistent, consistent to the T. Right? And not that that is the only way you can be trans. But this kid was. This was this kids story. I’m a boy, I’m a boy. I go into my dad’s closet. I get his ties. I get his shorts. I put on his blah blah blah, want to scream, kicking screaming 3 years old. No dresses no dresses. Um so, the mom came into our program and said, “Ok fix my kid.” And the therapist was like “Oh no we are just going to see you and your husband.” [audience laughs]. And so, they are going to help their kid do a social transition, lived as a boy from three onward, uh nobody, was nondisclosed at school. And at about 8, just before this kid 9th birthday, this kid was what I call dropping gender bombs. Right, this kid had struggled because this kid loved, like American girl doll, pink sparkly UGG boots. Right? And so, I’m thinking like, "Oh this is going to be like among my myriad of gay trans boys. Right?" And so I’m just, but it’s starting for this kid, really difficult for this kid to get um, not with the girls, not with the boys. Right? This kid never had a place. Right? [mumbled] affirmed. And so I said, um, and this kid by the way had told me, ok first of all this kid said, “If I’m a trans boy and I want to wear girl’s cloths, am I a cross dresser?” [audience laughs]. “Yeah, I don’t know, are you, like?” [audience laughter] [she mumbles].
Then this kid said I think what I’m going to do is be a boy in elementary school and girl in middle school and by high school I will have a better idea of what works best for me. Sounds pretty profound, um. So, I said to this kid, “It sounds like you are ready to try on girl.” And this kid said, “Yes, I am.” And so I said, “OK let’s do the work we need to do, we went to the school. We said, “This kid’s going by birth name, female pronouns.” So, everyone thought this kid was a trans girl. Right? [audience laughs]. And the mom, but before that the mom was like “What should I do.” And I said, “Well what would we do with any kid who was going to do a gender, a physical gender transition. And she said, “Are you suggesting I take my assign female at birth, who has been living as a boy, out for a weekend as a girl and see how it goes? And I said “Yeah.” And that’s what we did. And it was great, and the kid loved it. And so, and then in the school, everyone thought it was a trans girl. Right? People would be like, “I know your secret, you have a penis”. And this kid was like. “Really, where.” [audience laughs]. So, two weeks after social transition, living as a girl calls me up, “I got a second breast bud, I need a blocker.” “Ok, why?” Tells the therapist, “I feel like a little girl dangling a little boy over the cliff and if I don’t get a blocker he will die. That’s what this nine year old said, [repeats for someone who didn’t hear]. And so, I brought the kid in and the kid in and said “Tell me about this, tell me about blockers. “Well, I just don’t know. I just don’t know!” And so, I said “Well, why do we put blockers in.” “So, I don’t get boobs” Yes, ok. So, we put a blocker in. Two years later the kid says, “I want the blocker out. I want to go through girl puberty.” “All right come in, let’s talk about it. Do you remember why we put the blocker in?” “Yes.” Why’d we put the blocker in? “So, I didn’t get boobs?” “So, what’s going on with your gender.” “I don’t know? But I want to go through girl puberty.” Ok well what if your gender lands more on boy. This is word for word. “It’s 2015 Jo who said boys can’t have boobs?” [audience laughs out loud]. Touche’, small child.”
Goes on to say the kid said they “might not be here” if the parents hadn’t let them live as a boy.
20170823_olson_blockers2 1:23:33-1:24:49
“There are a variety of medical interventions available for non-binary folks. Creative thinking, thinking out of the box. Trying to figure out what people want and what people don’t want. It can be challenging but it also can be really really exciting and fun in really addressing like, what are some of the things you want? How can we get them for you? What can’t we do...There’s sort of like, a lot of different things people want. I really encourage people if they are going to get hysterectomies to think about leaving an ovary or two, just because you get injection fatigue. Right? “I really like testosterone, I don’t want to keep injecting myself.” You still want hormone protection. Right? And your ovaries are still going to make estrogen. So I think that’s important. Maybe T for a year. Maybe a central blocker plus low dose T. These are all possibilities. Maybe no medical intervention at all. Non-binary assigned males maybe Spyro only. Maybe feminizing hormones for just a short amount of time. Maybe selective estrogen receptor modulators. Like I had a young person who could not, had, had um autism and couldn’t stand the kinesthetic feel of breasts but really liked the how they looked. So, I was like, ‘What are we going to do here.’ But loved the way that estrogen made their brain feel. Right?”
20170826_olson_parent_q&a_over12 (3:53-6:10)
Response to a parent question about a 12-year-old (female) about hormone options for an “agender” youth (2:40). JOK talks about hormone options for a while until start of this quote.
“I know testostrogen um [audience laughs]. So, there, there are some options. I think it’s challenging because you do need a certain, you you need to have sex steroids for bone protection and probably a lot of other things that we are not nearly as clued in about as we need to be. But uh, so certainly there’s going to come a time and for the young people in my practice I get, I, I hesitate to have people on just blockers in that age range for more than two years. Although I think you still can do that and I mean certainly we use blockers in adult populations for longer than two years. But I do worry about their bone density.
There are things that people can do, and it will largely depend on how your child wants to wear their gender. So, a lot of times um, my non-binary kids, who don’t mostly, my assigned females at birth who don’t identify as in the binary, they preferred to be misgendered as male than female. Um, and some people have chosen to do testosterone for a year and then stop. Some people have chosen to do very low dose to see how it makes them feel and make a decision if they want to continue on it or not. Some kids they just simply have to come off of blockers and go through some more of their endogenous puberty to say ‘oh no, I don’t want this, this is bad.’ And then some kids are like, ‘Aaahh, it’s ok,’ you know. At some point your kid is going to have to make a choice which is really hard. I I I imagine that must be really really difficult. But I also imagine this is not going to be um. It’s probably unlikely that your young person is going to want to be on perpetual blockers. That’s my guess.”
20170823_olson_blockers2 (45:30-45:57)
“The harder piece is when non-binary kids want to be on blockers forever. And you’re like you can’t do that ‘cause hormones actually are binary. And there’s no testostrogen [audience laughs]. Right? So, it’s more complicated. So, in the back, but I. So, I get nervous around two years. Ok, if someone’s on a blocker, that they are post-pubertal and they are on it two years or more, I start to get like [nervously] oouuuhhhhhhh. You gotta make a decision here.”
medicalizing Very young Kids / Downplaying Deistance
20170825_olson_blockers_parents_same_as_8_23_talk (55:42-55:49)
“So, on average most of the trans masculine kids I block are on average ten. And the girls are eleven or twelve.”
20170823_olson_blockers2 (47:51-48:21)
“Identity formation is the major task of adolescence and the urge for what is true about the self is the driving force behind many commitments behind identity. Gender is not part of that. I really want to be clear about this. We are born with our gender. When we come to know if it’s different than our assigned sex at birth is variable depending on the person to person. But it’s not a thing! That teenagers go, ‘I might be a different gender.’ That’s not a thing. That’s not a thing that all adolescents experience.”
20170826_olson_parent_q&a_under12 (13:30-16:38)
*Response to audience member asking how many kids with a DSM diagnosis would desist in the past.
“So, there hasn’t been in the past 30 or so years a study that has asked that exact question. But if you go back into the literature and you look at the older data it’s a little bit more difficult because the criteria were different and so, um, the question would be slightly different. I think it’s, in my practice and I’m certainly going to caveat this by saying for sure I have a skewed population. Right? Because I’m a medical provider and I don’t know that people, that I am people’s first stop. You know so this is why I think this is really important for people to understand is that, um we focus a lot of, and I’ve been talking about this the whole weekend like, or the whole week, that we focus a lot of our attention on sort of the landing spot. And not as much on meeting that kid where they are in the, in the space that they are at in the present. And so, I, I think while it-it might be interesting to ask the question how many kids who meet DSM diagnostic criteria go on to have trans identities, that might be an interesting or useful question but I think um, it sets up a false paradigm for a lot of reasons. The first is that you can’t have the diagnosis unless you have distress. So, that means that perhaps the first time you go into care with a professional at seven let’s say, and you have a lot of distress because you haven’t socially transitioned yet, you’re going to meet diagnostic criteria. Because uh, in order to have that you have to have that category B of functional impairment related to distress. But what happens if you socially transition and two years later you come back in and you don’t have functional distress. You don’t, you no longer have a diagnosis. So if you’re encountering somebody asking that research question, uh er, they’re not going to have the diagnosis. So, what used to happen when they looked at research was people were categorized as sub threshold and threshold. So, you had enough of the criteria to get a diagnosis or you were sub threshold you had some of the criteria but not all of them. Right? And so, I think it’s just a really really problematic question. I think the questions that Kristina Olson is asking in her project are probably the more useful questions. What is, what is the function and mental health of youth who are supported in a gender role that matches for them? So, it’s a very difficult question. And nobody has ever asked that pure question that you’re, that you’re asking right there. Now certainly in the data kids who reach threshold for that diagnosis are far more likely to carry-on with a trans identity. So, there is something about those diagnostic criteria, as silly as some of them are, that are predictive of people um, having a trans identity in adolescence.”
20170823_olson_blockers2 (32:42-33:29)
“I have had 2 kids in my practice who started blockers and chose not to continue blockers. Ok, and I want to talk about them because this is a common question. People will say, um, ‘Why is the data show, see the data shows that almost everybody who goes on blockers continues onto cross sex hormones. See we are making em trans.’ No no really. That’s real, not kidding! People say that. Someone said that at Amsterdam. We don’t know why all of the kids who went on blockers went on hormones. Because they’re trans [audience laughs]. Like there’s something really complex. You’re over thinking it. So I want to talk about, could people, is it possible, that people might make a different decision?”
*Proceeds to tell the story of a female child socially transitioned very young (3) as boy. Kid is all over the map, later liking very girly things. It is long but may be worth a listen as it highlights their willingness to indulge serious confusion in young people, and medicalize it if requested, and act like going back and forth with meds is no big deal. She gives the kid a blocker at one point, takes it out later. Last quote after describing much confusion in this child, the kid says, “It’s 2015, Jo, who says boys can’t have boobs.”
Placed this story in the “Diagnostic criteria is unclear” section as well.
20170824_olson_aydin_professional_q&a (2:28-5:46)
Audience member- “I would like to hear where is the data regarding detransition and regrets. I get asked these questions all the time. Where is the data? I saw your very good presentation this morning about chest surgery and the number of patients who regret that or don’t think that that was right thing to do. Is there any other data? Where are these people who are making so much noise.”
JOK-…“the language that you sometimes hear are like, persisters and desisters around childhood. So, there is a body of data that comes out of the seventies and eighties, primarily out of Toronto and Ken Zucker’s clinic that asks the question, and I’m just going to simplify it because it’s easier to distill it. It asked the question how many boys who are wanting to wear dresses in childhood go on to be trans-identified. That’s the real question. Right? So if you were assigned male at birth and you wanted to play with dolls and act effeminate and then you didn’t want to do that, sort of in adolescence you are considered a desister. And if you have a gender identity of something different than male you are considered to be a persister. It’s not my language. I hate it, I think it’s horrible. But uh, there’s, so that data that showed well you know most of the people that were assigned male, they were boys who wanted to wear girl’s cloths, actually were not anything but male.”
Audience member- “They were boys who wanted to wear girls’ cloths.”
JOK- “Boy’s wanting to wear girls’ cloths. Exactly!
But unfortunately, and so, it’s important to recognize that in that data, the, all of the people that were studied were prepubertal. They were children. They were not having medical intervention. And so nobody was suggesting medical intervention. Nobody was getting surgery. Nobody was, none of that was happening. Only talking about, pretty much, children, who boys wanted to look like girls, or act like girls, or play with girls’ things or wear clothes that girls would wear, blah blah blah.
So that data though is a meme for the noise about why young people should not go through any medical interventions, either puberty blocking or hormones. So, is it bad data? I mean you could argue all data has problems. Right?
But the issues around this particular body of data is that the question is, it’s not just one study. Like it’s a handful of studies. Right? And so the question is different, and how you measure gender dysphoria is different, and how/what the follow up time period is, is different. And the nature of the fact that the clinic kind of practiced a reparative model impacts the data. So, there is a lot of stuff that makes it not very useful in many, many ways. Except as a tool against the community.”
Desistance research studies contradict above:
Do children & teens with serious gender dysphoria ever desist from the dysphoria?
Pressuring parents To transition their kids
20170823_olson_blockers2 (48:30-49:52)
“Some present with a prolonged history of gender dysphoria but the absolute hardest are the twelve to fourteen year old trans boys coming out to their parents…they came out like two months ago, and what happens? At nine years old something doesn’t feel right. I’m starting puberty, I’m doing all this work, I’m going online, I found 750,000 YouTube videos “this is me one month on T;” I’m connected to my community; I know I’m trans; I’m now twelve years old and I absolutely have to tell my parents and now my parents are here and I’m here [points far away]
And because I’m thirteen you need to get on the ball and this needs to have happened yesterday and because I am here and my parents are here [far away]. And the parent desperately wants you as the professional to close that gap and by pushing their kid backwards. Right? But you as a professional know that you have to close that gap by pushing the parents forward. And keeping them. You have to keep them because they have to give consent and you want them to be supportive. That’s the best possible outcome. Right? So that is a sticky wicket. You have to work hard to learn how to do this. And the more you do it, the better you will get at it.”
Short clip publicly available here:
https://drive.google.com/file/d/1q_yGwZnVoMjFWxF1nYkoGuLdl7OrnXaG/view
No “gatekeeping”
20170823_olson_blockers2 (32:22-32:45)
“We do not practice a gatekeeper model, um, in my facility. We do all of the discussion ourselves. And we um, I am going to talk about our model in a minute. If you do practice a gatekeeper model, I strongly advise you to reconsider that. And why you’re doing it.”
Lack of concern for long-term consequences of quick fix
20170824_olson_aydin_professional_q&a (22:07-22:14)
“Let’s think about where you are and how we can help you function the best right now.”
Social influence on trans ID not possible for minors
20170823_olson_blockers2 (56:13-57:56)
“Trans is trendy, right everybody? Everyone’s trans at my kid’s school. [audience laughs]. People say that. All my kid’s friends are trans. That’s why they are saying they are trans. [Audience member “Because they are they cool ones.” Laughter]. And It’s so trendy and rewarding. Um, and so then people say like, ‘I don’t understand it? I mean like um my kid was best friends with this kid in elementary school and now they are both trans.’ We have a whole perpetual cart/horse conversation. So gender bending is trendy. Gender bending is trendy! It is awesome, that young people are participating in a movement to remove the nonsensical relationship with the binary. It is not useful for youth. And they are participating in it. And in solidarity with trans folks and their friends they are gender bending with expression and identity. And that is great and gender bending kids are not in distress. They are not talking about needing to go to the doctor. They are not talking about self-harm or experiencing it or practicing it. They are not talking about suicide. They are pushing the society to get rid of something that is no longer useful, and is painful and hurtful to a lot of folks. That’s a really important distinction. Your kid might have a lot of friends who might be gender bending and in solidarity your kid might have friends who are trans, who have gender dysphoria. But those are not always the same thing. Like, your kid, your kid is not going to be made accidentally trans by their friends.”
Denial Homosexual Transexuals are same-sex attracted
20170823_olson_blockers1 (23:50-24:00)
“I like how transgender people don’t see themselves as gay when they obviously are, as in like it, I mean I hate it. Because they are a group of liars.“
Queer Theory / Gender Ideology
20170823_oslon_blockers1 (7:03-7:10)
Johanna Olson-Kennedy Made the Gender Abacus- she made gender abacus not Bill Nye.
https://www.youtube.com/watch?v=TKjKZ5RzT9s
20170823_oslon_blockers1 (14:35:14:14:50)
Sexual Orientation and gender identity is conflated, mixing of gay and trans (she’s exasperated by this).
20170823_oslon_blockers1 (15:40-16:50)
Story about using the gender abacus to help inform decisions about how to medicalize youth. The abacus is a diagnostic tool.
20170823_oslon_blockers1 (17:35-18:00)
“I still review scientific papers that use language like natal female or biologic male or things like that. And that’s inappropriate language. And it negates the idea that biology is much more comprehensive than people see it as.”
Large numbers of trans identified youth at LA Children’s Hospital
20170823_oslon_blockers1 (4:30)
Her clinic (2017) had “We just have under 1000 active patients now, between 3 and 25.”
20170823_oslon_blockers1 (6:00-6:35)
An increase in trans masculine experience across all clinics (65% females at her clinic). Nonbinary going up.
20170826_olson_parent_q&a_over12 (18:20)
“There isn’t enough data, we rely on clinical data. We’ve blocked about 160 kids”
Dr. Michelle Angello (LCSW)
“Complicated Cases”- GendeR Dysphoria
20170824_angelo_complicated_cases1
20170824_angelo_complicated_cases2
Many of these conversations went back and forth or meandered. Therefore, notes are provided for subject matter rather than full transcription.
General comments
20170824_angelo_complicated_cases1 (0:59-1:55)
Penance for not being a better trans ally. Familiar DEI buzzwords about “doing better”.
20170824_angelo_complicated_cases1 (2:22-2:50)
Trans therapy becoming “marketable” recently.
20170824_angelo_complicated_cases1 (8:25-8:50)
She used to be an expert witness but finds it traumatic and triggering.
Transitioning people who are very mentally ill
20170824_angelo_complicated_cases1 (4:30-5:20)
Thinks talk should be called “This is what you will actually see” instead of “complicated cases”. Goes on to say complicated is representative.
“Do you usually get a relatively straight forward situation?” Several people giggle.
20170824_angelo_complicated_cases1 (7:00)
“What hasn’t been a complicated situation.”
20170824_angelo_complicated_cases1 (13:45-16:00)
Therapist who has worked with disassociation, MPD, “alters,” “parts of different genders.” Presenting personality may be trans but other personalities are not trans. He’s saying all the personalities might not be “signed on” for transition- (audio is bad- it’s the way the room was set up).
Angelo does not have experience with this and doesn’t recommend anything specific but has seen a case of an altar.
20170824_angelo_complicated_cases1 15:55-17:00
Therapist who has a psychotic patient experiencing “a lot of delusions.” Still considering medical treatment. Angelo doesn’t address ethics of having psychotic patients do this, seems a given they should be medicalized if they want to. She talks about how trauma is universal to trans experience “whether real or perceived.”
20170824_angelo_complicated_cases1 (17:15-18:38)
*Audio not good
Person works with “quite a few DID patients.” Talks about family systems model and applying it to DID (formally MPD).
“in getting the rest of the system to get some form of consent”
*I think she is saying she means people identify as a system and one or some parts want to trans and others may not. And if she works through the trauma, it can help make the decision easier if one “part” wants to transition but others don’t.
20170824_angelo_complicated_cases1 (18:39-9:15)
This woman is saying she applies internal family systems model of therapy to systems that exist in one person.
Here’s what the internal family systems model is. https://www.forbes.com/health/mind/what-is-internal-family-systems-therapy-ifs/#:~:text=Internal%20Family%20Systems%20(IFS)%20therapy%20isn%27t%20as%20well,psychotherapy%20that%20many%20find%20helpful.
20170824_angelo_complicated_cases2 (36:15-37:55)
(see also in regret)
Therapist talks about what to do with a psychotic patient. Therapist says she “hates to say no” but… Another therapist chimes in to say “we are holding the trans community to a higher standard.” Admits there’s no “magic” cure. She says regret happens. Makes on odd statement “all of mental health and medicine is kinda like that.” (It isn’t though).
20170824_angelo_complicated_cases2 (46:15-49:20)
Making note because another person is saying they see a lot of DID+trans. Therapist who works at an emergency psychiatric hospital says he sees “a lot” of people with psychosis and trans identities. He worries that some don’t take dissociative people’s trans identities seriously. Angelo, like most in her realm, indicates support for providing gender affirming care to psychotic and delusional people.
20170824_angelo_complicated_cases2 (48:44-49:08)
Angelo- “Many times, for them, that’s the thing. That’s the thing causing them the greatest distress”….“they haven’t necessarily had the validation that this other aspect of you is authentic as well.”
Many Patients Are Autistic
20170824_angelo_complicated_cases1 (8:55)
55-60% of kids feel too bullied at schools and do school at home.
20170824_angelo_complicated_cases1 (9:35-12:05)
She says autism spectrum common. 6 months ago she started Gender Alliance (for 18-25 autistics) (18 teens/young adults all didn’t have any friends in real life, all their friends were online only). Says she needs to do things like teach them to say thank you.
20170824_angelo_complicated_cases2 (36:15-37:55)
Therapist talks about what to do with a psychotic patient. Therapist says she “hates to say no” but… Another therapist chimes in to say “we are holding the trans community to a higher standard.” Admits there’s no “magic” cure. She says regret happens. Makes on odd statement “all of mental health and medicine is kinda like that.” (It isn’t though). No one really addresses what to do if client is severely mentally ill and the ethics of consent.
20170824_angelo_complicated_cases2 (38:10-42:48)
Therapist talks about autism and obsessiveness (she worries). She talks about the fact the patient has another therapist fast tracking transition. She wants things slowed down. Angelo notes strong insistence in this cohort. At 41:00 someone downplays autism black and white thinking concern.
20170824_angelo_complicated_cases2 (45:12-46-14)
More reasonable therapist talks about autism. She says she values slowing down with autistic clients. Highlights their different thought patterns are like a different language.
Surgeries on obese people with BMIs considered over the safety limit
20170824_angelo_complicated_cases1 (22:10-22:33)
The next section is a long bit about getting overweight people approved for surgery.
Someone who works within Kaiser wants “work arounds” and admin options for people deemed too obese for surgery.
20170824_angelo_complicated_cases1 (22:34-23:54)
Another chimes in. Recommends interviewing surgeons for top surgery. Her contact in San Diego does top surgery “regardless of BMI.” “If you go directly to a surgeon and ask them, they might have different criteria.” She states bottom surgery outcome for MtFs is always affected by BMI though.
20170824_angelo_complicated_cases1 (23:55-25-58)
This clip highlights a “healthy at any size” anti-“fatphobia” ideologue.
“How are we able to get you the service that you need whether or not you want to lose weight?”
She puts pressure on insurance companies and medical providers regardless of risk regarding surgery on overweight people.
She also states she sees “lots of people with disordered eating challenges.”
More about nudging surgeons to do surgeries regardless of BMI.
“Let’s make an actual outcome rather than here is an impossible outcome”
20170824_angelo_complicated_cases2 (0:09-2:25)
Person from a private clinic mentions they don’t have the same strict guidelines as hospitals. They don’t have a BMI cutoff. She admits higher rates of issues with overweight patients who undergo mastectomy. She just lets them know that.
20170824_angelo_complicated_cases2 (2:21)
“We kind of make our own rules.” (people giggle)
20170824_angelo_complicated_cases2 (2:29-3:17)
Now these people want gastric bypass for those too overweight for surgeries to be considered covered under transgender care, as medically necessary. No case of this happening was provided though.
20170824_angelo_complicated_cases2 (3:22-4:33)
Another woman says she encounters this “quite a lot.” Notes BMI standard has gone from 40 to 30 over the years, doesn’t say why. She says, “It’s really horrifying to me.”
“And I always try to ask you know, specific to the procedure, whether it’s about weight or something else, like nicotine, or marijuana, or whatever the concern is. What is the real medical concern? Because sometimes there is a real medical reason. And sometimes it’s just we expect trans people to, um, be skinny. And we hold them to higher standards than we do other people. Both physically and in terms of [garbled] mental health.”
Says this is the view because providers are looking through a “cosmetic lens”, so maybe there is truth to this, but seems irrelevant to the point that being overweight is linked to more risk.
20170824_angelo_complicated_cases2 (4:34)
Another “health at every size” person. Person is trans FtM and said it was “horrifying, absolutely horrifying” what she had to go through, “heartbreaking”. Discusses all the surgeons under her insurance had BMI cutoffs.
20170824_angelo_complicated_cases2 (6:18-7:08)
People discuss if this is an insurance issue, “I wonder if it’s a liability issue.”
Another woman says yes, higher BMI= more risk, and this is “universally true.” Notes a lot of “literature on this.” She still advocates it be done.
20170824_angelo_complicated_cases2 (8:10-8:56)
Woman asks if gender affirming care is treated differently than other care that is “medically necessary.”
20170824_angelo_complicated_cases2 (9:00-11:50)
A few narratives of the supposed transformational power of getting surgeries to motivate people to lose weight after they get the surgery. An MtF tells the story and a couple of professionals seem to support his narrative. Don’t know if there is evidence for this.
Coding Issues for coverage
20170824_angelo_complicated_cases2 (11:57)
Loss of fertility
20170824_angelo_complicated_cases2 (16:60-18:20)
Regret
20170824_angelo_complicated_cases2 (21:30-29:39)
Therapist talks about a young regretter. (hard to hear). Angelo admits regret will be more common.
Angelo talks about much of it being about post op blues (she calls the surgery medically necessary and celebratory, but the body experiences it as “trauma”).
20170824_angelo_complicated_cases2 (29:40-32:11)
Therapist worries about regret. Ask what to do as to not feel so invested if the patient is 100% sure or not.
20170824_angelo_complicated_cases2 (33:17-35:00)
Therapist talks about another young person seemingly with regrets and about how the surgery didn’t really fix their bad feelings. Angelo admits transition isn’t a panacea for everyone and says, “now we have an opportunity to work on this.” I just find it so odd these therapists don’t see any value in working on “this” to cope pre-transition.
20170824_angelo_complicated_cases2 (35:05-36:10)
Therapist talks about expectations as it seems her clients aren’t all happy post-op. She seems disappointed and having to approach this cohort with “a different framework.” Asks herself if she is “imposing” the expectation that they get better on them (the goal of this “treatment” is to help them get better though) She’s conflicted about pressure in the system to rush things.
20170824_angelo_complicated_cases2 (36:15-37:55)
Therapist talks about what to do with a psychotic patient. Therapist says she “hates to say no” but… Another therapist chimes in to say “we are holding the trans community to a higher standard.” Admits there’s no “magic” cure. She says regret happens. Makes on odd statement “all of mental health and medicine is kinda like that.” (It isn’t though). No one really addresses what to do if client is severely mentally ill and the ethics of consent.
Queer Theory Ideologues
20170824_angelo_complicated_cases2 (42:48-45:10)
This woman loves Serrano (a likely autogynephilic “MTF” trans activist) and quotes him. She thinks worrying about regret is transphobic.
“We live in a culture that values trans bodies less than cis bodies.”
20170824_angelo_complicated_cases249:20
Next up, therapist (?) into queer theory (totally regular, gender conforming, normal looking woman who is “trans”, a 30-year-old who loves Tumblr). She repeats every cliché about “gender journey.”
Dr. Kristina Olson, Psychologist & Lead Researcher for The Trans Youth Project
Talk on the Trans Youth Project Study of Socially Transitioned Children
20170824_kristina_transyouthproject
Participants want “nonbinary children” diagnosed in childhood
(17:36-17:50)
So lacking um for people who uh feel uh more, who are on the nonbinary and don’t feel comfortable on such a binary um, is there any talk about that? (audience question). Olson states more nonbinary acknowledgment happening.
Positive representation of Jazz Jennings, victim of genital stunting and a severely botched vaginoplasty
(26:15)
“I like to use jazz Jennings as an example because she’s too old to be in my study and she’s very public about being a transgender girl. So let’s say nine-year-old Jazz signed up for my study that she’s transgender.”
(55:25 56-09)
“Here’s Jazz Jennings when she was little. I wish she was in my study laughs. I like to think about her as, when I think about the conclusions of the study because I think uh for anyone who’s like seen her or seen her show, I think she kind of well, demonstrates a lot of the basic findings that we have that she seems by all accounts to be doing well, um happy kid. She has like a supportive family. And she also you know, does things, like if you didn’t know she was trans, nothing that she said would seem particularly striking to you. She would just seem like any other girl, and that is um what we are finding so far um, by and large.”
States puberty blockers are reversible (They are not In Some Cases For Sure)
(50:14-50-54)
“At Tanner stage two, which is the earliest signs of puberty with Dr. approval and parent approval a transgender kid could be put on blockers which basically pause puberty. The child goes off of them the reversible and the child will go back to having natal puberty and it’s usually administered via an implant or shot. So this is right around the onset of puberty if a child wants to kind of continue, then usually one to four years later, um the teen gets hormones, and those are not considered to be completely reversible because things like your voice changes . And then at 18 or in some cases, younger kids, kids or I guess they’re adults at 18 can have various surgeries.”
No acknowlegement of possibility of social contagion
(1:04:39-1:05:11)
“One of the kind of frustrating things I hear a lot is people saying, you know, “this is just trendy, isn’t it like you’ve been studying something that’s trendy, everybody’s gotten to be today or gender nonconforming or non-binary.” And I like to remind people that we for a very long time known that this is not a new thing, and in fact a thing that exists all over the world. There are many different cultures, who have recognition that there are groups other than just people assigned male at birth and people assigned female at birth.”
Cultural appropriation as justification for the affirmative model
(1:04:39-1:05:11)
“One of the kind of frustrating things I hear a lot is people saying, you know, ‘this is just trendy, isn’t it like you’ve been studying something that’s trendy, everybody’s gotten to be today or gender nonconforming or non-binary.’ And I like to remind people that we for a very long time known that this is not a new thing, and in fact a thing that exists all over the world. There are many different cultures, who have recognition that there are groups other than just people assigned male at birth and people assigned female at birth.”
(1:05:21-1:05:57)
“This is a representation of places that have fully recognized more than one or more than two um sexes or genders, depending on they cut it. Um And I think it’s really important to remember that, that that’s actually maybe new to many people in the United States, that uh there is gender diversity. They may not have thought of it. They may not have known that they knew someone , who is gender diverse in someway, but there are places that fully acknowledged that when you’re born, for example, you could be born a boy a girl or a fa’ fafini Samoa.”
Aydin Olson Kennedy
Talk on Gender Dysphoric Youth
20170823_aydin_youth_bpd2
This talk mostly highlights how affirmative model advocate dysphorics youths’ problem to lack of validation and that transition is not a cure all.
First 16.5 mins totally pointless rambling by a parent/activist
(16:35) Aydin starts
Dismissive of Comorbid Conditions
(16:50 -22:35)
Dismissive of therapists observing increase of BPD
“I’m frustrated…BPD is the new bipolar”
(28:20-28:35)
Dimisses other issues
(28:40-35:50)
Then relates this all to why it appears youth has BPD when the problem is really that they are trans. It’s worth listening to this whole section just to get where they are coming from. Heavy emphasis on validation.
TRansition not Effective for Solving all Problems
(37:05-38:00)
You can’t “fix” the youth’s problems (she spends “15 mins” a week? with the youths)
(3:40-6:50)
“Gender Dysphoria is a lifelong experience…you can’t change a feminine body”