"Bound by law to offer gender affirming advice."

[BuckeyeLove]

Rogan recently had on JP again (for like what seems the millionth time) and JP at one point starts to discuss an anecdote about a young woman (minor) who was rushed to transitioning by providers. Gives examples of how occam's razor and base rates were essentially ignored (i.e., the girl was likely on the spectrum with a slew of other fairly typical mental syndromes for a teenage girl) and instead of addressing the likely simplest explanations for her problems, she was told "Maybe it's because you're really a man." Then ended up beginning the transitioning process and now has a whole bunch of resultant problems.

Not trying to get into a sociopolitical debate with this question, but here it is nonetheless: JP gives some quote that all medical providers are required to provide "gender affirming advice" or they could face penalty, and then cites that because of this the clinicians weren't able to act as clinical scientists and get to the actual problem at hand. I spent the some time this weekend scouring my state's relevant code and I have yet to see anything like this codified. Admittedly I have yet to do a deep dive into the APA ethics code to see how this would be addressed there or under which umbrella it might be relevant. Also, I'm not sure if this is a Canadian case (JP is licensed up there and currently at risk of losing it unless he goes through mandatory "re-education"), so maybe it's in their ethics code, but I'm wondering... what exactly does "gender affirming advice" really mean??? At least as it pertains to the practice of clinical psychology. Was Peterson just being melodramatic and/or hyperbolic (as he has a tendency to do)?

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[MiniLop]

Yeah, that seems like a really hyperbolic example designed to "energize the base" around the dangers of gender-affirming care. There's research out there to the effect that regrets around gender affirmation (whether medical or social) is extremely rare. But leave it to Rogan to only highlight the exceptions.

I would interpret the requirement for "gender affirming advice" to mean that providers should be open to and willing to provide guidance around gender issues. E.g., willing to talk these out with a client rather than dismissing them offhandedly, and to approach this with an open mind to gender (again, rather than an offhand opposition to the idea of gender variance).

 

[Sanman]

As far as laws, the U.S. is a mishmosh and most laws that protect gender-affirming care have to do with receiving parity with other folks (like having health insurance for their unique issues).

Having a background in pre-surgical evals, my question is how are we handling a referral on a minor patient sent for psych clearance to undergo transitioning?

 

[WisNeuro]

There are no laws mandating this in my state. I would suspect that he's grossly over-generalizing laws about discrimination against individuals. Though, this does partially touch at interesting debates in some areas, (e.g., gender norms for cognitive measures).

 

[Shiori]

Not to derail things, but I think he in trouble because of his tweets. Is he still seeing clients?

I know some states are creating guidelines related to social media presence for psychologists.

 

[PsyDr]

I think he is referring to the APA Guidelines on Trans care, which also adopts some other standards of care. Guidelines are different than standards of care. If you don't follow the standard of care, you are potentially open to malpractice liability.

He's an odd bird. I don't understand his habit of over reaching, or his habit of making everything about religion. Then again, he has "F You" money now.

 

[WisNeuro]

I think he is referring to the APA Guidelines on Trans care, which also adopts some other standards of care. Guidelines are different than standards of care. If you don't follow the standard of care, you are potentially open to malpractice liability.

He's an odd bird. I don't understand his habit of over reaching, or his habit of making everything about religion. Then again, he has "F You" money now.

Personally, I think his views skew that way naturally, but he saw the space for "intellectual thought leaders" in the far right/incel/gamer bro/etc space and the potential dollar signs attached to it. So, essentially he's a fairly intelligent grifter who just amplified his rhetoric to appeal to a certain niche that would adulate him.

 

[Sanman]

Personally, I think his views skew that way naturally, but he saw the space for "intellectual thought leaders" in the far right/incel/gamer bro/etc space and the potential dollar signs attached to it. So, essentially he's a fairly intelligent grifter who just amplified his rhetoric to appeal to a certain niche that would adulate him.

This. Plus, I am sure he could voluntarily give up his license and be fine on his social media money as an "entertainer" a la Dr. Phil.

 

[WisNeuro]

This. Plus, I am sure he could voluntarily give up his license and be fine on his social media money as an "entertainer" a la Dr. Phil.

Yeah, he's making plenty of money from book sales and speaking fees. If he's making any psych money at all, it's likely a minuscule portion of his revenue.

 

[PsyDr]

Personally, I think his views skew that way naturally, but he saw the space for "intellectual thought leaders" in the far right/incel/gamer bro/etc space and the potential dollar signs attached to it. So, essentially he's a fairly intelligent grifter who just amplified his rhetoric to appeal to a certain niche that would adulate him.

My view: I think he is motivated by religion, rather than money. It would explain why his son in law claims to be possessed by a demon named Igor.

I also find this funny. Get a religious guy all hopped up on benzos and cash, tell him not to say something, and watch him dig his heels in to hilarious degrees.

 

[WisNeuro]

My view: I think he is motivated by religion, rather than money. It would explain why his son in law claims to be possessed by a demon named Igor.

I also find this funny. Get a religious guy all hopped up on benzos and cash, tell him not to say something, and watch him dig his heels in to hilarious degrees.

Religious people are just weird. You can cognitive dissonance yourself out of anything with religion.

 

[R. Matey]

My view: I think he is motivated by religion, rather than money. It would explain why his son in law claims to be possessed by a demon named Igor.

Maybe, though his daughter is also pretty grifty with all her lion diet bs.

 

[BuckeyeLove]

He strikes me as an untreated bipolar II that's learned to cope/pass without meds. With a bit of charlatan on the side. Who only eats meat.

 

[PikminOC]

Personally, I think his views skew that way naturally, but he saw the space for "intellectual thought leaders" in the far right/incel/gamer bro/etc space and the potential dollar signs attached to it. So, essentially he's a fairly intelligent grifter who just amplified his rhetoric to appeal to a certain niche that would adulate him.

No different from the ones that skew left

 

[WisNeuro]

No different from the ones that skew left

In my comment, did I indicate otherwise? Do I need to comment on unrelated matters to avoid someone assuming my tacit agreement in anything that I have not explicitly stated?

 

[PikminOC]

In my comment, did I indicate otherwise? Do I need to comment on unrelated matters to avoid someone assuming my tacit agreement in anything that I have not explicitly stated?

Aocs little dance about Omar was quite hilarious

 

[WisNeuro]

Aocs little dance about Omar was quite hilarious

Tom Selleck had a mustache in Magnum PI.

 

[Therapist4Chnge]

I want to own a bengal tiger.

Wait…i thought we were posting random non sequiturs now?

As for JP….he’d be a snake oil salesman and/or a circus barker if this was 150yrs ago. He talks a mile wide & an inch deep, but his fan boys aren’t bright enough to realize it.

 

[WisNeuro]

South Korea is the largest exporter of Cadmium.

 

[Sanman]

I want to own a bengal tiger.

You sure about that? It did not go so well for Roy Horn or Joe Exotic.

 

[Sanman]

Tom Selleck had a mustache in Magnum PI.

So did John Hillerman (Higgins) and Roger Mosley (T.C.). Come to think of it, that was a mustache friendly show.

 

[WisNeuro]

So did John Hillerman (Higgins) and Roger Mosley (T.C.). Come to think of it, that was a mustache friendly show.

I am a strong advocate for mustache positivity. There is far too much mustache shaming that goes on in non-hipster circles.

 

[Therapist4Chnge]

You sure about that? It did not go so well for Roy Horn or Joe Exotic.

Oh, it would definitely kill me at some point. If I hand-raised it maybe i’d last longer.

 

[Therapist4Chnge]

So did John Hillerman (Higgins) and Roger Mosley (T.C.). Come to think of it, that was a mustache friendly show.

I would argue it was a mustache-forward show.

 

[borne_before]

Rogan recently had on JP again (for like what seems the millionth time) and JP at one point starts to discuss an anecdote about a young woman (minor) who was rushed to transitioning by providers. Gives examples of how occam's razor and base rates were essentially ignored (i.e., the girl was likely on the spectrum with a slew of other fairly typical mental syndromes for a teenage girl) and instead of addressing the likely simplest explanations for her problems, she was told "Maybe it's because you're really a man." Then ended up beginning the transitioning process and now has a whole bunch of resultant problems.

Not trying to get into a sociopolitical debate with this question, but here it is nonetheless: JP gives some quote that all medical providers are required to provide "gender affirming advice" or they could face penalty, and then cites that because of this the clinicians weren't able to act as clinical scientists and get to the actual problem at hand. I spent the some time this weekend scouring my state's relevant code and I have yet to see anything like this codified. Admittedly I have yet to do a deep dive into the APA ethics code to see how this would be addressed there or under which umbrella it might be relevant. Also, I'm not sure if this is a Canadian case (JP is licensed up there and currently at risk of losing it unless he goes through mandatory "re-education"), so maybe it's in their ethics code, but I'm wondering... what exactly does "gender affirming advice" really mean??? At least as it pertains to the practice of clinical psychology. Was Peterson just being melodramatic and/or hyperbolic (as he has a tendency to do)?

If the dude would have stopped there... That being said, I think there's probably something worth considering in the statement. Would this be an example of availability heuristic? Base rate are poorly understood.

 

[texanpsychdoc]

If the dude would have stopped there... That being said, I think there's probably something worth considering in the statement. Would this be an example of availability heuristic? Base rate are poorly understood.

Interesting face - folks on the autism spectrum tend to account for a statically significant portion of those who also identify as trans. I had a case at the VA where an LCSW had a bias towards surgery and basically immediately sided with the fact that the veteran was trans and needed gender-affirming care and request I do a pre-surgical evaluation. They basically insisted I do it just to get the formality out of the way. I pushed back pretty hard and ultimately declined to do the evaluation, one reason being that right there available literature on this topic is HIGHLY variable with shady theoretical underpinnings related to the construct of transgender identity. This tends to be an unpopular topic to discuss with folks that tend to jump on the "let's chop off the penis" bandwagon the moment certain key phrases or sentiments are expressed. This isn't to say that it surgeries be done in certain situations, but the prevalence that is being reported lately is highly confounded by biases within the mental health community and pop culture. For example, everybody who has attention problems seemingly thinks they have ADHD, then gets that diagnosis - lets Rx some Adderall stat.

 

[futureapppsy2]

So, "gender-affirming care" doesn't mean "tell everyone who's distressed that they're trans" and I can't think of a clinician (including a lot of trans ones) who would advocate for that. What it means is more "don't tell a trans person that they aren't really trans/are evil/etc when their gender identity is not the purpose of care (e.g., if a trans man comes to you with, say, a URI, don't tell them how they're "really a woman"]) and don't treat being trans as a "bad" outcome in care--people reporting tthat they are experiencing gender dysphoria may be trans, they may have something else going on that's causing distress, or both (they could, say, have PTSD *and* be trans, or be trans *and* autistic) but let them explore gender if they feel like it--try out different pronouns in affirming spaces or dress differently and see how that feels. Some people who question their gender may be cisgender but experiencing something else that's causing distress, some may be unambiguously trans, some may be non-binary (many of whom may not medically transition at all or transition partially; IME, if non-binary folks do medically transition, it tends to be quite delayed compared to binary trans folk), some may be in the gender non-conforming grey zone where they don't need to transition and don't identify as a gender differen from their birth sex but may need or want to do other things to feel comfortable in their gender expression (e.g., dress differently).

I think at least some of the push to medically transition quickly comes from the fact that, in a lot of situations, the only "good" trans person is seen as being one who passes entirely in a very stereotypically gender-conforming way and if you don't pass, you're just an embarrassment or a freak. So, the mission becomes to become a trans person who passes as a gender-conforming cisgender person ASAP, because society tends to be more comfortable with that. It's similar to how we've seen that "bathroom bills" often led to gender non-conforming cis people getting harrassed more than anything else and even some passing trans people getting harassed or attacked for actually following the law, because gender non-conformity makes a lot of people real uncomfortable.

Tbh, I've never gotten the argument that autistic people being more likely to be non-binary or trans somehow proves that those identities aren't "real"--it makes sense that the neurological and cognitive differences that we see in autism could also affect the neurological and cognitive underpinings of gender identity; co-morbid/co-occuring conditions are common in medicine and psychology and just because two conditions often exist together doesn't mean only one is "real."

 

[ClinicalABA]

Tbh, I've never gotten the argument that autistic people being more likely to be non-binary or trans somehow proves that those identities aren't "real"--it makes sense that the neurological and cognitive differences that we see in autism could also affect the neurological and cognitive underpinings of gender identity; co-morbid/co-occuring conditions are common in medicine and psychology and just because two conditions often exist together doesn't mean only one is "real."

Do you think there's anything about autistic individuals difficulties understanding some social rules makes them less likely to feel beholden to the ones that just don't feel right to them, and thus being more likely to express true feelings about non-binary or trans gender identity?

I probably should've prefaced that by asking if, in fact, there is evidence for higher rates of non-binary or trans gender identity associated with ASD?

 

[futureapppsy2]

Do you think there's anything about autistic individuals difficulties understanding some social rules makes them less likely to feel beholden to the ones that just don't feel right to them, and thus being more likely to express true feelings about non-binary or trans gender identity?

I probably should've prefaced that by asking if, in fact, there is evidence for higher rates of non-binary or trans gender identity associated with ASD?

There are some studies that have found higher rates of ttrans/non-binary identities in autistic populations; like with a lot of demographic prevalence differences, it's probably a mix of factors that explain it.

 

[texanpsychdoc]

So, "gender-affirming care" doesn't mean "tell everyone who's distressed that they're trans" and I can't think of a clinician (including a lot of trans ones) who would advocate for that. What it means is more "don't tell a trans person that they aren't really trans/are evil/etc when their gender identity is not the purpose of care (e.g., if a trans man comes to you with, say, a URI, don't tell them how they're "really a woman"]) and don't treat being trans as a "bad" outcome in care--people reporting tthat they are experiencing gender dysphoria may be trans, they may have something else going on that's causing distress, or both (they could, say, have PTSD *and* be trans, or be trans *and* autistic) but let them explore gender if they feel like it--try out different pronouns in affirming spaces or dress differently and see how that feels. Some people who question their gender may be cisgender but experiencing something else that's causing distress, some may be unambiguously trans, some may be non-binary (many of whom may not medically transition at all or transition partially; IME, if non-binary folks do medically transition, it tends to be quite delayed compared to binary trans folk), some may be in the gender non-conforming grey zone where they don't need to transition and don't identify as a gender differen from their birth sex but may need or want to do other things to feel comfortable in their gender expression (e.g., dress differently).

I think at least some of the push to medically transition quickly comes from the fact that, in a lot of situations, the only "good" trans person is seen as being one who passes entirely in a very stereotypically gender-conforming way and if you don't pass, you're just an embarrassment or a freak. So, the mission becomes to become a trans person who passes as a gender-conforming cisgender person ASAP, because society tends to be more comfortable with that. It's similar to how we've seen that "bathroom bills" often led to gender non-conforming cis people getting harrassed more than anything else and even some passing trans people getting harassed or attacked for actually following the law, because gender non-conformity makes a lot of people real uncomfortable.

Tbh, I've never gotten the argument that autistic people being more likely to be non-binary or trans somehow proves that those identities aren't "real"--it makes sense that the neurological and cognitive differences that we see in autism could also affect the neurological and cognitive underpinings of gender identity; co-morbid/co-occuring conditions are common in medicine and psychology and just because two conditions often exist together doesn't mean only one is "real."

This is really important in making a good differentiation to examine the moderating or mediating variable with what is presenting to us. It's not to say that what they are experiencing isn't real, but is undergoing a life-altering surgery that could be permanent the best first choice line of intervention? Would we not want to entertain less invasive or permanent procedures first? Maybe if we address some of the cognitive/intellectual elements in treatment we might see changes in how they view themselves, others, environment and how they interact in their major spheres of functioning. Maybe not, but pumping the brakes could at least give us some time to use process of elimination before we advocate for a procedure that could have equally distressing if not worse consequences for that patient in the long-run.

 

[texanpsychdoc]

There are some studies that have found higher rates of ttrans/non-binary identities in autistic populations; like with a lot of demographic prevalence differences, it's probably a mix of factors that explain it.

I think this goes to the point I was making, the available literature on transgender identity is highly variable, including for the reason you just mentioned. Before we start advocating for life-altering decisions to be made by an individual or their family, I think caution isn't necessarily a bad thing.

 

[Therapist4Chnge]

This is really important in making a good differentiation to examine the moderating or mediating variable with what is presenting to us. It's not to say that what they are experiencing isn't real, but is undergoing a life-altering surgery that could be permanent the best first choice line of intervention? Would we not want to entertain less invasive or permanent procedures first? Maybe if we address some of the cognitive/intellectual elements in treatment we might see changes in how they view themselves, others, environment and how they interact in their major spheres of functioning. Maybe not, but pumping the brakes could at least give us some time to use process of elimination before we advocate for a procedure that could have equally distressing if not worse consequences for that patient in the long-run.

It's not like there are clinics that are giving the hard sell to patients who are walking by on the street. There are psych evals and other requirements too. Unfortunately there is a lot of propaganda put out that makes it sound like doctors are recruiting elementary school kids to have invasive operations, which is patently false.

 

[Sanman]

It's not like there are clinics that are giving the hard sell to patients who are walking by on the street. There are psych evals and other requirements too. Unfortunately there is a lot of propaganda put out that makes it sound like doctors are recruiting elementary school kids to have invasive operations, which is patently false.

"Hey kid, want your tonsils out? We'll give you all the ice cream you can eat after you get them out. You know you want ice cream!"

 

[texanpsychdoc]

It's not like there are clinics that are giving the hard sell to patients who are walking by on the street. There are psych evals and other requirements too. Unfortunately there is a lot of propaganda put out that makes it sound like doctors are recruiting elementary school kids to have invasive operations, which is patently false.

Not saying it's propaganda, but I would also ask you how do you know that this isn't happening? I don't think that's the case either, but it sounds like there is also a bias for folks who tend to be in favor of gender-affirming care to immediately dismiss contradictory information and label them as "fringe" or "propaganda" when frankly, we do not have enough data to support either position.

Honestly, there have been plenty of stories out there where this has been the case. I realize there are surgical evaluations (remember, I was asked to do one at the VA!). I noticed a trend at my VA alone where we had people really wanting this procedure done. We had a lot of individuals on the spectrum who also identified as trans. I am speaking from personal experiences but also the literature I was reviewing before I was making the decision to decline their requests to evaluate. I had a colleague who also declined to do those evaluations.

 

[WisNeuro]

Not saying it's propaganda, but I would also ask you how do you know that this isn't happening? I don't think that's the case either, but it sounds like there is also a bias for folks who tend to be in favor of gender-affirming care to immediately dismiss contradictory information and label them as "fringe" or "propaganda" when frankly, we do not have enough data to support either position.

Honestly, there have been plenty of stories out there where this has been the case. I realize there are surgical evaluations (remember, I was asked to do one at the VA!). I noticed a trend at my VA alone where we had people really wanting this procedure done. We had a lot of individuals on the spectrum who also identified as trans. I am speaking from personal experiences but also the literature I was reviewing before I was making the decision to decline their requests to evaluate. I had a colleague who also declined to do those evaluations.

Just for clarification, what grounds are you specifically citing to refuse the evaluations? There are many reasons to not conduct an evaluation. What is the reason here?

 

[texanpsychdoc]

Just for clarification, what grounds are you specifically citing to refuse the evaluations? There are many reasons to not conduct an evaluation. What is the reason here?

For me, it was because the person was seeking a pre-surgical evaluation for surgery but did not want to first do a more broad diagnostic clarification assessment to see what there factors might be explaining their new-found preference for surgery. Their previous therapy records indicated the treating provider suspected ASD and talked with the veteran about examining that further for which they declined. I did not feel comfortable doing that type of evaluation because I believed there were too many confounding issues at hand that would otherwise prevent me from coming to a sound conclusion, and I would be serving in a gate-keeping role I did not want to be in.

 

[borne_before]

So, "gender-affirming care" doesn't mean "tell everyone who's distressed that they're trans" and I can't think of a clinician (including a lot of trans ones) who would advocate for that. What it means is more "don't tell a trans person that they aren't really trans/are evil/etc when their gender identity is not the purpose of care (e.g., if a trans man comes to you with, say, a URI, don't tell them how they're "really a woman"]) and don't treat being trans as a "bad" outcome in care--people reporting tthat they are experiencing gender dysphoria may be trans, they may have something else going on that's causing distress, or both (they could, say, have PTSD *and* be trans, or be trans *and* autistic) but let them explore gender if they feel like it--try out different pronouns in affirming spaces or dress differently and see how that feels. Some people who question their gender may be cisgender but experiencing something else that's causing distress, some may be unambiguously trans, some may be non-binary (many of whom may not medically transition at all or transition partially; IME, if non-binary folks do medically transition, it tends to be quite delayed compared to binary trans folk), some may be in the gender non-conforming grey zone where they don't need to transition and don't identify as a gender differen from their birth sex but may need or want to do other things to feel comfortable in their gender expression (e.g., dress differently).

I think at least some of the push to medically transition quickly comes from the fact that, in a lot of situations, the only "good" trans person is seen as being one who passes entirely in a very stereotypically gender-conforming way and if you don't pass, you're just an embarrassment or a freak. So, the mission becomes to become a trans person who passes as a gender-conforming cisgender person ASAP, because society tends to be more comfortable with that. It's similar to how we've seen that "bathroom bills" often led to gender non-conforming cis people getting harrassed more than anything else and even some passing trans people getting harassed or attacked for actually following the law, because gender non-conformity makes a lot of people real uncomfortable.

Tbh, I've never gotten the argument that autistic people being more likely to be non-binary or trans somehow proves that those identities aren't "real"--it makes sense that the neurological and cognitive differences that we see in autism could also affect the neurological and cognitive underpinings of gender identity; co-morbid/co-occuring conditions are common in medicine and psychology and just because two conditions often exist together doesn't mean only one is "real."

I just don't think there can be a meaningful conversation about transition without fleshing out various subtypes of people seeking to transition for it appears a very heterogenous group.

In males, Blanchard (when originally writing about the in 1990's uses very non pc term transexual) makes a distinction between:

• homosexual transitioners (e.g., the boy with gender dysphoria, loved doing girly things before/after puberty, will grow up and date males, regardless of if they transition)
• heterosexual transitioners (e.g., those who transition later in life, usually into masculine things before/after puberty, did not have gender dysphoria until later in life, often have autogynephilia, will adopt a lesbian identity post transition, often to not get bottom surgery)

In females, who are comparatively rare when compared to male transitioners:

• Females with gender dysphoria
• Females with late/rapid onset gender dysphoria (edit: this may not be a true phenom).

The final cluster includes the biological rare cases, endocrine disorders, congenital malformations, etc.

 

[borne_before]

There are some studies that have found higher rates of ttrans/non-binary identities in autistic populations; like with a lot of demographic prevalence differences, it's probably a mix of factors that explain it.

In those people with autism who are verbally capable of providing a response? There's probably a selection bias, and I'd be concerned about if the responders actually have autism or did some self-diagnosis.

 

[borne_before]

It's not like there are clinics that are giving the hard sell to patients who are walking by on the street. There are psych evals and other requirements too. Unfortunately there is a lot of propaganda put out that makes it sound like doctors are recruiting elementary school kids to have invasive operations, which is patently false.

But these clinics are HIGHLY incentivized financially to provide medical services. Transition, when hormones and surgery is involved, is really a chronic health condition and transition is palliative care - treatment that will conceivably last for the individuals life. These clinics are highly rewarded for generating a return stream of billable, procedures, etc. Not saying that transition is wrong in all cases, but it certain is right in all cases. There does appear to be a cluster of adolescent teens transitioning who share a remarkable similarity with the girls who would be cutting in prior cohorts.

My skepticism popped up when a hormone clinic, with an affirming name, opened up a storefront in a high dollar mid town shopping complex, right next to a famous steak and milkshake place, and catty corner to a luxury grocery outlet. The rent must be astronomical and it's their third location in my major metro.

While the doctors are not out recruiting, there is a financial incentive. I do think a lot of well meaning online spaces do tend to have a recruiting effect, for better or worse. Furthermore, there does appear to be a trend for an assumed informed consent in certain clinics.

Sorry, but the corporatism of the movement has my a bit cynical. It's probably a lot like the gluten free craze. It was great for celiacs, because of more options and greater aweareness. But a ton of people started going gluten free - whether they needed to or not. In those cases going GF probably didnt do any harm or any good. There's probably a group of transitioning people who fall into that category. There are a group of people who transitioned and highly regret it. Not sure which way is correct or if there is a correct way to identify them before hand. But, I truly don't think we've got it figured out yet as a field. Let's not pretend we do because it gives a moral virtue.

But I'm also reminded of a story from one of the blogs I posted about earlier:

The Hair Dryer Incident was probably the biggest dispute I’ve seen in the mental hospital where I work. Most of the time all the psychiatrists get along and have pretty much the same opinion about important things, but people were at each other’s throats about the Hair Dryer Incident.​

​

Basically, this one obsessive compulsive woman would drive to work every morning and worry she had left the hair dryer on and it was going to burn down her house. So she’d drive back home to check that the hair dryer was off, then drive back to work, then worry that maybe she hadn’t really checked well enough, then drive back, and so on ten or twenty times a day.​

​

It’s a pretty typical case of obsessive-compulsive disorder, but it was really interfering with her life. She worked some high-powered job – I think a lawyer – and she was constantly late to everything because of this driving back and forth, to the point where her career was in a downspin and she thought she would have to quit and go on disability. She wasn’t able to go out with friends, she wasn’t even able to go to restaurants because she would keep fretting she left the hair dryer on at home and have to rush back. She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped.​

​

So she came to my hospital and was seen by a colleague of mine, who told her “Hey, have you thought about just bringing the hair dryer with you?”​

​

And it worked.​

 

[Shiori]

WPATH is good place to have a better understanding of standards of care across disciplines if anyone is interested.

 

[Therapist4Chnge]

Not saying it's propaganda, but I would also ask you how do you know that this isn't happening? I don't think that's the case either, but it sounds like there is also a bias for folks who tend to be in favor of gender-affirming care to immediately dismiss contradictory information and label them as "fringe" or "propaganda" when frankly, we do not have enough data to support either position.

Honestly, there have been plenty of stories out there where this has been the case. I realize there are surgical evaluations (remember, I was asked to do one at the VA!). I noticed a trend at my VA alone where we had people really wanting this procedure done. We had a lot of individuals on the spectrum who also identified as trans. I am speaking from personal experiences but also the literature I was reviewing before I was making the decision to decline their requests to evaluate. I had a colleague who also declined to do those evaluations.

Your argument is that clinics *are* aggressively recruiting children and have pushed them to transition? Where is the proof? I'd think that if clinics were actually doing this there were be a plethora of cases, dozens...hundreds...thousands? Instead, arguing that it "could" be happening isn't helpful. This is a similar if not same argument against psychologists prescribing. Some people try to argue that it will maim and kill patients, but after years and years of psychologists prescribers....where is the proof? It's a boogieman argument, but without proof of the claim.

 

[texanpsychdoc]

Your argument is that clinics *are* aggressively recruiting children and have pushed them to transition? Where is the proof? I'd think that if clinics were actually doing this there were be a plethora of cases, dozens...hundreds...thousands? Instead, arguing that it "could" be happening isn't helpful. This is a similar if not same argument against psychologists prescribing. Some people try to argue that it will maim and kill patients, but after years and years of psychologists prescribers....where is the proof? It's a boogieman argument, but without proof of the claim.

So, currently serving on multiple RxP committees (both on a state and national level), I can tell you my views on the matter have evolved. In large part because I am listening to the opposition's points of views. They have merit. The absence of evidence does not equate to there being no evidence of the absence of something. To this end, what I am advocating for is, until we can get more solid and concrete information that is CONSISTENT with a minimum of moderate effect sizes across most areas of interest for operationalizing the construct of transgenderism, then we should be cautious in what treatments we as psychologists start signing our names to for "approval."

Our field has a nasty history of jumping to pre-mature and hasty conclusions because there were tentative evidence to support the feasibility for something without consistent nor large enough effect sizes to do so. Moreover, the fact that people push back on the idea of pumping the brakes and being cautious also is another concern as it seems the people who are screaming the loudest about the "opposition" being a bunch of conspiracy theorists who listen to propaganda and are averse to hearing alternative views are becoming the very thing they purport to dislike.

You can call it the "boogeyman argument" but I would call it being cautious. Psychology deals with shades of gray and lots of ambiguities - we are trying to define constructs, which by definition tend to lack physical or concrete features compared to things in our physical environment that can be directly observed. With this in mind, transgender identity represents one of the more ambiguous constructs we have faced in our professional lifetimes. Forgive me for wanting to "wait 10 minutes" before we sign off on a surgical evaluation endorsing the feasibility that engaging in an irreversible procedure will provide the patient the necessary identity elements they desire without also entertaining other confounding factors that could be influencing their present struggles.

And I should also add...I do not view RxP legislation/rights as being the same for pre-surgical procedures involving highly variable operationalization of constructs. Some times we are not always discussing apples vs. apples, but apples vs. coconuts.

 

[PikminOC]

WPATH is good place to have a better understanding of standards of care across disciplines if anyone is interested.

They keep changing them. I don't do these types of things as detransitioners occur and they sue everyone who they saw in the past.

 

[futureapppsy2]

It should be noted here that the
vast majority of care for trans children is non-medical social transition and psychosocial support, and that should also be the first step in adolescents and adults (and usually is). Again, I think a reason that people are prioritizing medical treatments more quickly is that it can be extremely hard and even dangerous to socially transition when you don’t “pass,” so the focus becomes on passing, which, let’s be real here, is greatly helped by medical treatments in a lot of people. So, there’s a balance between waiting for medical treatments until someone has socially transitioned for a sufficient period of time to make sure that they really do want to transition/are trans and setting people up for a lengthy pre-medical social transition period that can easily get very messy and even dangerous. With pre-pubscent children, this question isn’t there so much, as it’s much easier for them to purely socially transition and pass. With adolescents, it gets trickier, and with adults, even moreso, because non-medically-assisted passing becomes much harder with age. I think that’s one reason why non-binary folk tend to medically transition later, because there’s really no goal of passing as NB in the same way there is for binary trans folk (that, and the available medical treatments for nonbinary transition are fewer and much less clear).

 

[borne_before]

It should be noted here that the
vast majority of care for trans children is non-medical social transition and psychosocial support, and that should also be the first step in adolescents and adults (and usually is). Again, I think a reason that people are prioritizing medical treatments more quickly is that it can be extremely hard and even dangerous to socially transition when you don’t “pass,” so the focus becomes on passing, which, let’s be real here, is greatly helped by medical treatments in a lot of people. So, there’s a balance between waiting for medical treatments until someone has socially transitioned for a sufficient period of time to make sure that they really do want to transition/are trans and setting people up for a lengthy pre-medical social transition period that can easily get very messy and even dangerous. With pre-pubscent children, this question isn’t there so much, as it’s much easier for them to purely socially transition and pass. With adolescents, it gets trickier, and with adults, even moreso, because non-medically-assisted passing becomes much harder with age. I think that’s one reason why non-binary folk tend to medically transition later, because there’s really no goal of passing as NB in the same way there is for binary trans folk (that, and the available medical treatments for nonbinary transition are fewer and much less clear).

In children I do worry about munchie and personality disordered parents imposing a trans identity on a three year old. Those are probably edge cases but there are a select group of highly publicized early transitioning kids whose parents sure as hell are getting a lot of media attention and the kids transition launch was as savvy as any marketing campaign. My boy is currently working for a “rainbow dinosaur dress” - maybe I could be publishing this on social media and show how I’m the kind of parent who supports their kiddo.

And if anyone has any leads on cool rainbow dinosaur dresses please help me.

 

[Mad Jack]

But these clinics are HIGHLY incentivized financially to provide medical services. Transition, when hormones and surgery is involved, is really a chronic health condition and transition is palliative care - treatment that will conceivably last for the individuals life. These clinics are highly rewarded for generating a return stream of billable, procedures, etc. Not saying that transition is wrong in all cases, but it certain is right in all cases. There does appear to be a cluster of adolescent teens transitioning who share a remarkable similarity with the girls who would be cutting in prior cohorts.

My skepticism popped up when a hormone clinic, with an affirming name, opened up a storefront in a high dollar mid town shopping complex, right next to a famous steak and milkshake place, and catty corner to a luxury grocery outlet. The rent must be astronomical and it's their third location in my major metro.

While the doctors are not out recruiting, there is a financial incentive. I do think a lot of well meaning online spaces do tend to have a recruiting effect, for better or worse. Furthermore, there does appear to be a trend for an assumed informed consent in certain clinics.

Sorry, but the corporatism of the movement has my a bit cynical. It's probably a lot like the gluten free craze. It was great for celiacs, because of more options and greater aweareness. But a ton of people started going gluten free - whether they needed to or not. In those cases going GF probably didnt do any harm or any good. There's probably a group of transitioning people who fall into that category. There are a group of people who transitioned and highly regret it. Not sure which way is correct or if there is a correct way to identify them before hand. But, I truly don't think we've got it figured out yet as a field. Let's not pretend we do because it gives a moral virtue.

But I'm also reminded of a story from one of the blogs I posted about earlier:

The Hair Dryer Incident was probably the biggest dispute I’ve seen in the mental hospital where I work. Most of the time all the psychiatrists get along and have pretty much the same opinion about important things, but people were at each other’s throats about the Hair Dryer Incident.​

​

Basically, this one obsessive compulsive woman would drive to work every morning and worry she had left the hair dryer on and it was going to burn down her house. So she’d drive back home to check that the hair dryer was off, then drive back to work, then worry that maybe she hadn’t really checked well enough, then drive back, and so on ten or twenty times a day.​

​

It’s a pretty typical case of obsessive-compulsive disorder, but it was really interfering with her life. She worked some high-powered job – I think a lawyer – and she was constantly late to everything because of this driving back and forth, to the point where her career was in a downspin and she thought she would have to quit and go on disability. She wasn’t able to go out with friends, she wasn’t even able to go to restaurants because she would keep fretting she left the hair dryer on at home and have to rush back. She’d seen countless psychiatrists, psychologists, and counselors, she’d done all sorts of therapy, she’d taken every medication in the book, and none of them had helped.​

​

So she came to my hospital and was seen by a colleague of mine, who told her “Hey, have you thought about just bringing the hair dryer with you?”​

​

And it worked.​

I don't know what is going on where you are, but there certainly aren't clinics popping up left and right around here. There's one, and it's part of a public hospital network and swamped at all times. They would probably love to have less patients, if anything, because they've been around since before this became an issue and weren't eqipped to handle such an influx. I think there's a trend in certain youth populations right now to associate with mental illness, worsened by social media and particularly TikTok, which has led to certain groups of friends, typically groups of individuals that previously identified as female, all deciding they have various conditions. Clusters of friends insisting they have autism, tics, DID, gender dysphoria, ADHD, or any combination of the above. This is just my anecdotal experience combined with what some of my peers have expressed, but it seems there is this tendency to want to not just be different, but to be clinically different in a way that both feels validating and provides an explanation for their faults, and even better if they can get bonus accommodationslike headphones etc in class. Oh I'm not awkward, I have autism. Oh I'm not bored by math, I have ADHD.

I evaluate every patient objectively and fairly, and sometimes there's a diagnosis in there. Often it's depression or anxiety, which were enough back in my day (you don't have to be autistic, you can just be emo or goth, my god). But sometimes they do have autism or ADHD or what have you, though about 90% of the time they seem to be off the mark. When in doubt, I'll refer out for more formal testing, but I've yet to get an opinion that differed from my clinical opinion when I've done so.

Gender dysphoria, that's where it gets tricky, given that it's a very internal experience. I figure most of them will sort that one out with time, and leave that as their person journey to have. 85%, as noted above, will later identify as their birth gender. I'll provide the family the information for the gender clinic, who does very extensive workups for this sort of thing. Myself, though? I think it is up to each individual to reach what rings true for them. The ones that come to me that have been insistent on being transgender for the last 10 years, since as early as they could play? My bet is they'll stick with it, and transition is probably their answer. But I do worry for a lot of individuals that have fallen into groups where trans is the identity, and if you don't have it you feel like that's stripping you of your place in the group. I've seen many change their mind about gender expression, opting for either their birth gender or a nonbinary approach, just in my short time working with younger populations. To go all-in on treatment before that journey is complete feels foolish and at high risk of doing harm, which is the first thing we should not be doing in medicine.

 

[Shiori]

If anyone is doing this work in the VA, there are a lot of great TMS trainings related to individuals who identify as trans and/or genderfluid. They go into detail about our role as providers as well as risks and benefits of different treatments.

 

[ClinicalABA]

The take away message here seems to be that we really need to be careful about believing what we hear on Joe Rogan's show (or Joe Scarbarough's either, for that matter), as those show's and their guests may have an agenda (primarily related to enhancing the financial portfolio's of those involved) other than accurately presenting the common methods of the professionals in our field who are charged with actually working with and ethically and objectively promoting the well-being of individuals with serious mental and physical health concerns. The truth is often less effective at generating ad revenues and sponsorships than extreme or inflammatory presentations of the truth.

Seriously, people really believe that a child is encouraged to pursue gender reassignment medical interventions (including largely irreversible surgery) after an initial expression of gender-related concerns without additional discussion?

 

[WisNeuro]

The take away message here seems to be that we really need to be careful about believing what we hear on Joe Rogan's show (or Joe Scarbarough's either, for that matter), as those show's and their guests may have an agenda (primarily related to enhancing the financial portfolio's of those involved) other than accurately presenting the common methods of the professionals in our field who are charged with actually working with and ethically and objectively promoting the well-being of individuals with serious mental and physical health concerns. The truth is often less effective at generating ad revenues and sponsorships than extreme or inflammatory presentations of the truth.

Seriously, people really believe that a child is encouraged to pursue gender reassignment medical interventions (including largely irreversible surgery) after an initial expression of gender-related concerns without additional discussion?

Yes, many unserious people do indeed believe such garbage. And for those in our field, it's quite obvious that they've never talked or had any experience with providers or clinics who do this type of work. Willful ignorance.

 

[Shiori]

Honestly, most of my work in this area has been helping people who can't afford the care they would like to pursue. Many don't have thousands of dollars to spend on the surgical procedures and medications. That or the surgery wait times are long. We figure out alternatives that reduce the dysphoria. Then there are my clients who wouldn't survive surgery due to other health issues. It's complicated. That's why we have teams of people who are involved in the process. My role in psychology has mostly been for improving outcomes and appeasing insurance companies who still feel the letter is necessary even though the research is weak on their utility.