“Degrading military readiness”: Trans servicemembers speak out on Trump’s ban

Zinnia JonesPresident Trump’s July 26 tweets stating his intention to exclude all transgender people from the U.S. armed forces, citing “tremendous medical costs and disruption”, were met with surprise and alarm from many quarters. Most immediately, in the nine minutes between Trump’s first ambiguous tweet citing “consultation with my Generals and military experts” and his next tweet referring to trans troops, some at the Pentagon feared he was about to announce a military strike against North Korea. That day, spokeswoman Sarah Huckabee Sanders stated that Trump believes trans servicemembers erode “military readiness and unit cohesion”, but found herself at a loss to explain how this policy would be implemented and threatened to end the press briefing rather than take any more questions on this topic.

Trump’s impulsive announcement was later revealed as a hamhanded and overbroad attempt, encouraged by Steve Bannon, to satisfy several House Republicans who objected to a bill funding a border wall with Mexico because it also contained provisions funding medical transition care for trans troops. The following day, the Joint Chiefs of Staff announced “no modifications” to existing policy – providing an easy out for Trump to let the matter drop if he should choose to reconsider his snap decision. Continue reading

Posted in Health care, Military, Politics and law, Transphobia and prejudice | Tagged , , , | 1 Comment

Four low-cost alternatives to puberty blockers for transgender adolescents

Related: How to find doctors for HRT, Myths about youth transition, Ethics of treatment for trans youth

Zinnia JonesDisclaimer: I am not a doctor, and this is not medical advice. Do not take any medication without appropriate medical supervision.

Puberty suppression for transgender youth, developed in the 1990s, is one of the most important advances in the history of transition treatment. With the use of fully reversible GnRH analogue medications to halt natural puberty in appropriately diagnosed adolescents, and the later addition of cross-sex hormones, these youth are largely spared the development of gender-inappropriate sex characteristics: facial and body hair growth, voice deepening, and masculine facial structure and body shape in trans girls; and breast growth and hip widening in trans boys. As a result, many will not have to undergo costly and invasive procedures in adulthood to reverse the unwanted effects of original puberty, such as facial feminization surgery and chest reconstruction.

Treatment with puberty blockers is known to lead to measurably better outcomes for trans youth compared to transitioning in adulthood. Following use of puberty blockers and later treatment with cross-sex hormones and surgery, this population no longer experiences gender dysphoria, with overall psychological functioning comparable to their cisgender peers, and good quality of life (de Vries et al., 2014). Conversely, withholding puberty blockers from gender-dysphoric adolescents can result in worsening of dysphoria, depression, self-harm, and suicidality (Radix & Silva, 2014).

Because of the clear benefits of puberty blockers for trans youth, this treatment protocol is supported by the American Academy of Pediatrics, American Psychological Association, American Psychiatric Association, American Academy of Child and Adolescent Psychiatry, American College of Obstetricians and Gynecologists, and many more professional medical organizations. Blockers for trans kids are now offered by dozens of major hospitals and gender clinics across the United States.

However, many trans youth and their families still struggle to access these medically necessary treatments, often due to the expense of GnRH analogues and uneven insurance coverage of these medications for kids with gender dysphoria. But biology does not wait – these youth are in a critical developmental period, and foregoing puberty blockers can have lifelong consequences (Giordano, 2008). In light of these challenges, trans kids deserve more accessible and affordable options for blocking puberty. A number of recent studies have provided clinical evidence that inexpensive generic medications can be used in place of GnRH analogues for effective puberty suppression in trans youth, offering a potential alternative to more costly treatment. Continue reading

Posted in Endocrinology, Health care, Outcomes of transition, Trans youth, Transgender medicine | Tagged , , , , , | Leave a comment

Fresh trans myths of 2017: “rapid onset gender dysphoria”

Zinnia JonesIf, like me, you make a habit of trawling through the darker side of opinion pieces on trans issues, you might have come across a peculiar new term: “rapid onset gender dysphoria”. This supposedly recent occurrence is described by the National Review, the right-wing Alliance Defending Freedom, Robert Stacy McCain, and others as a phenomenon of teenagers “suddenly” coming out, sometimes “in groups”, after “total immersion” in social media related to transitioning. Even a recent article in The Stranger made reference to this alleged trend:

Increased visibility and societal acceptance are also logical explanations for the perceived growth in the trans population: More people are aware it’s an option now. But, as a study published this year in the Journal of Adolescent Health notes, parents have begun reporting “a rapid onset of gender dysphoria” in adolescents and teens who are “part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same time frame.”

If researchers have potentially discovered a previously unknown type of gender dysphoria, this would certainly be a fascinating development. There’s just one problem: there is no evidence to suggest that this is any kind of distinct clinical entity. The various features of this purported phenomenon can already be explained within existing models and currently available evidence. And more than that, it appears that the very concept could have originated with a specific group of transphobic activists. Continue reading

Posted in Gender dysphoria, Hoaxes, Media, Trans youth, Transphobia and prejudice | Tagged , , , | 11 Comments

Anatomy of disinformation: Blaire White lies about puberty blockers and vaginoplasty

Previously: Debunking myths about youth transition

Zinnia JonesI hate covering anything related to Blaire White. It’s absolutely crushing to watch her recklessly inflict falsehoods on the public’s understanding of trans issues and I genuinely wish she would stop so that I never have to write about her again. Sadly, here we are once more.

Not content with disregarding the established medical consensus and evidence on youth transition, or telling impossible lies about a 9-year-old trans girl and her family, Blaire White has now turned her attention to Jazz Jennings, a teenage trans girl and star of TLC’s I Am Jazz. On June 26, Blaire White tweeted about “why children should NOT be allowed to transition”, claiming that Jennings is unable to have vaginoplasty (surgical construction of a vagina and vulva from penile and scrotal tissue) due to genital underdevelopment as a result of using puberty blockers:

Pictured: the cake

Continue reading

Posted in Hoaxes, Replies, Surgery, Trans youth, Transgender medicine | Tagged , , , , | 6 Comments

Depersonalization in gender dysphoria: widespread and widely unrecognized

Zinnia JonesI’m going to list some descriptions of certain feelings, and I’d like for any trans or gender-questioning readers to think about whether they’ve felt anything similar to this over the course of their lives.

  • A sense of detachment or estrangement from your own thoughts, feelings, or body: “I know I have feelings but I don’t feel them”
  • Feeling split into two parts, with one going through the motions of participating in the world and one observing quietly: “There is this body that walks around and somebody else just watches”
  • Feeling as if you have an “unreal” or absent self: “I have no self”
  • Experiencing the world as distant, dreamlike, foggy, lifeless, colorless, artificial, like a picture with no depth, or less than real
  • Being absorbed in yourself and experiencing a compulsive self-scrutiny or extreme rumination
  • Having an ongoing and coherent dialogue with yourself
  • Feeling like a veil or glass wall separates you from the world
  • Emotional or physical numbness, such as a feeling of having a head filled with cotton
  • Lacking a sense of agency – feeling flat, robotic, dead, or like a “zombie”
  • Inability to imagine things
  • Being able to think clearly, but feeling as if some essential quality is lacking from your thoughts or experience of the world
  • A sense of disconnectedness from life, impeding you from creative and open involvement with the world

These are taken directly from clinical descriptions of depersonalization and derealization, symptoms which are generally characterized as “feelings of unreality” (American Psychiatric Association, 2013; Sierra, 2009; Steinberg, Cicchetti, Buchanan, Hall, & Rounsaville, 1993; Medford, 2012). This is not a matter of “delusion” – while these are considered dissociative symptoms, individuals who experience them without other dissociative conditions typically have an intact grasp of reality. They’re able to recognize and understand the real world in a normal way, but their experience of life and of their own existence takes on an “unreal” sensation.

Despite the reduced emotionality of those with depersonalization, they often find these feelings to be deeply unpleasant and distressing, and can suffer “extreme emotional pain” as a result (Medford, 2012; American Psychiatric Association, 2013). An additional challenge is that the subjective experience of depersonalization can be “particularly difficult for patients to describe, and can sometimes go unnoticed or can be experienced by patients habituated to it as ‘normal’” (Steinberg et al., 1993).

Depersonalization symptoms can also occur in the context of untreated gender dysphoria, yet this is not widely recognized among the public or in most literature on transness and transitioning. Descriptions of depersonalization-like experiences feature prominently in many trans people’s recountings of their lives prior to transition, and these symptoms can heavily impact their general quality of life. But with very little attention given to depersonalization as a discrete symptom experienced by many with gender dysphoria, some trans people may struggle to recognize that this could be an indicator of dysphoria, and may not be aware that they could find relief via transitioning. Continue reading

Posted in Awareness building, Depersonalization, Gender dysphoria, Outcomes of transition, Psychology and psychiatry | Tagged , , , , | 20 Comments