The battle for gender therapy

And just like that, after four years of hard work, Leibowitz, de Vries and the rest of their group were called traitors by the peers and communities they tried to take care of. “We knew from the beginning the magnitude of the need for these standards,” Leibowitz told me. “I don’t know if I’ve recognized the magnitude of the controversy. It’s the result of the fact that our world, the world of gender care, has exploded.”

In the 1950s And in the 1960s, small groups of European and American doctors began talking about how to evaluate adults who want to make a medical transition. Endocrinologist Harry Benjamin, first named after WPATH, accepted the idea that those who agreed to treat him (mainly transgender women) were “born in the wrong body.” Fearing a lawsuit from a dissatisfied patient, doctors quickly eliminated the patient for mental stability. And, arbitrarily, as the University of Pennsylvania historian Beans Velocci wrote in a TSQ: Transgender Studies Quarterly article last year, they included only those who believed they would pass as the identified gender. Some doctors have promised transgender adults to live as heterosexuals after the transition.

The small group of clinicians who wrote the first standard of care were all cisgender. After the WPATH was created in 1979, transgender advocates became more and more influential within the organization, but many transgender people were paternal and sneaky to the treatment of subsequent versions of the standard. It was considered to impose a barrier. For some genital surgery, the criteria required that adults survive for one year of the specified gender and be referred by two mental health professionals. SOC8 is the first version to omit these requirements and employs a model of “shared decision” between adult patients and surgeons.

The leap in the transition of youth to health care took place in the Netherlands in the 1980s. Peggy Cohen-Kettenis, a Dutch clinical psychologist specializing in children, has begun to be referred to a teenager who is experiencing gender identity disorder (then called gender identity disorder). But treatment wasn’t the main answer, retired Cohen Ketennis told me on the phone this spring. “We can sit and talk forever, but they really needed treatment.” As their bodies developed in ways they didn’t want, “they just got worse because of it.” did”. She decided to help some of her patients start hormone therapy at the age of 16 instead of waiting until the age of 18. She monitored them weekly and then monthly. “Surprisingly, the first couple was doing much better than when they first came,” she said. “It encouraged me to continue.”

Cohen-Kettenis helped establish an innovative treatment protocol. Patient Zero, known as FG, was introduced to Henriette A. Delemarre-van de Waal around 1987. The pediatric physician set up a gender clinic in Amsterdam with Cohen-Kettenis. At the age of 13, FG was desperate to experience a woman’s puberty, Demarare-van de Waal put him in an adolescent suppressant, and Cohen-Kettenis later monitored him. The drug suspends the development of secondary sexual characteristics, and if FG decides to take testosterone, avoid the experience that his body feels betraying him, gain time, and later in male puberty. Makes it easier to experience. Transgender adults who also treated Cohen-Kettenis sometimes wished they could make the transition early in their lives when they were able to achieve the masculine or feminine ideals they envisioned. “Of course, I wanted it,” FG said in an interview with historian Alex Backer in the 2020 book “The Dutch Approach” about the Amsterdam clinic. “Later, I realized I was the first guinea pig, but I didn’t care.”

In the next decade, Cohen-Kettenis and Delemare-van de Waal designed an assessment for young people who appear to be candidates for treatment. In family surveys and sessions, Cohen-Kettenis investigated the reasons for gender identity in adolescents and considered whether treatment and / or medication should be addressed. The policy was to delay treatment for people with problems such as attention deficit and eating disorders, or for those who lack a stable and supportive family, in order to eliminate factors that could interfere with treatment. .. “We did a lot of other work before they started, which caused them a lot of frustration,” Cohen-Ke Tennis said. “Maybe we were too selective in the early stages,” she says, looking back and eliminating young people who might have benefited.

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