This article is so balanced and well-written. And extremely well-researched. Thank you, Bernard! I am the Danish psychotherapist quoted in the article. If anyone wants to read my blog "Transgender - The Fine Print" ("Transkøn - Det med småt"), it can be found here: https://www.transkoen.dk/
Contra some Democrats resistant to the "right wing issue" they perceive in pediatric transition, the decline and fall of the 'trans kids' project will be seen by historians as a vindication of single payer healthcare systems.
Why is that? Is it that these systems have the data, knowledge of the financial costs & the administrative power to make changes at the national level?
Aug 14, 2023·edited Aug 14, 2023Liked by Bernard Lane
The US does not have a centralized health or record-keeping system. All these countries with what I will call 'public insurers' are slamming the brakes because they have a single system to capture and apply data. In the US, private insurers do most of that work. There are a few very large ones and some small ones. As seen in Australia, insurers are the entities where the most crucial changes ultimately happen. Insurance companies are highly regulated in America. It would be anticompetitive for them to talk to each other too much, for example. Present regulations under the Affordable Care Act require them to cover 'gender affirmation' etc. So you can think of Denmark as having a central nervous system that responds to change more efficiently than the American healthcare system, which is more distributed and regulated by captured policies in government and organizations. They can, and will, come around, but only well after the states with national care plans.
We have Medicaid, which is more of a poverty program that does not act as a single payer system. Because of its role in transing foster kids and funding the Planned Parenthood hormones-on-demand program, I predict lots of scandals to emerge from it.
The gender clinic issue has certainly been poorly served by accountability shifting within Australia’s federal system. Yet New Zealand is a unitary system & so far has not course corrected on gender medicine.
Single payer systems are also easier to capture. One reason we are dealing with this right now is the messy process of passing the Affordable Care Act under Obama in the first place!
Great news re Denmark. Something irks me a little. There seems to be a tendency to build in loopholes or backdoors. For example, maybe somewhere the surgery is banned for under 18 year-olds, but *except* for mature minors. What a mature minor is, is wide open to interpretation. Maybe puberty blockers are banned *except* for clinical trials. I don't quite get this. Given minors cannot legally consent, how can they be put on blockers for a trial?
It’s strangely pleasant to read in others writing of several points I’ve maintained for years on the subject, particularly the idea “opting out of the feminine rather than into the masculine”. Since the early 80’s in discussions on the subject I maintained that it’s impossible for someone to “feel like” they are the opposite sex, because their own baseline experience of feeling a sex is feeling their own body. That is all anyone can ever know, the experience they are born with.
You can, however be uncomfortable with that experience. For a male, transsexualism can only be the negation of being masculine, never the confirmation of “being” a woman, and vice-versa. Under that view transsexualism falls into a broad category of dysphorias where the mind creates discomfort in a mismatch between expectation and perception. My mind says I don’t have a leg (body integrity disorder) or I shouldn’t be able to see, or
I should not have a penis... it becomes reasonable.
It's an interesting question because I can imagine that negation of masculinity, for example, may reflect social influences as much as a male's bodily experience.
I think there’s “intrinsic” rejection and “extrinsic”, similar to constitutional or facultative homosexual sex.
In men who are strongly homosexual (like me) our hypothalamus is activated strongly, measurably to the presence of Androstenedione, heterosexual men, not activated, bisexual men, activated. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1129091/ for an example.) My gayness is an intrinsic, unalterable part of my neural and cognitive setup, “constitutional.” There is also “facultative” or situational homosexual behaviors say, in an all male prison (or perhaps a pirate ship! I tend to think whimsically) where having sex with a man is perhaps the least bad opportunity for intimacy.
I view most transsexuals I have known as intrinsic. They seem to have had a visceral, panic reaction to their self perception of having the “wrong plumbing”, and the language they use to describe it is incredibly similar to that of Body Integrity Dysphoria people, where amputation made them feel “whole”. Their mind refuses to accept the presence of sexual organs, and it has nothing to do with male or female sex per se. It’s the presence of a bodily organ they cannot stop refusing to accept - a strange double-negative but that occurs more often than you think in biological systems.
Extrinsic which is what I hear more recently has to do with the refusal to accept existing as a sex they dislike, not organ focused. Again it’s the negative - not that a man “is” a woman; it’s that they cannot not dislike being a man, which make them unhappy, which seems much more have to do with roles and socialization, acquired if you like. I would compare it to visceral learned dislike of a given race, religion, or a phobia. There’s no organic reason for a person to irrationally fear spiders, and perhaps no organic reason for someone to irrationally hate their sex.
If you read about surgery for dysmporhia--my understanding is that the dysmorphia either moves to another part of the body or the person just becomes more and more unhappy--which is why, I understand, maybe I'm wrong, MD's are not supposed to operate on people if they have body dysmorphia. Sounds similar at least from way out here (to my nonexpert ears) to what a lot of those with GD report.
That’s the problem with an intrinsic mismatch, it seems to be a relative problem also. For instance if you have anorexia no matter how much you diet, your perception never changes. Here’s how I became interested in this subject...
I have been a heavy bodybuilder for decades. One of the first trainers I had, 2000, asked me my goals. I wanted among other things “arms near his size”. He was a competitive bodybuilder. Surprised, he asked me how big I thought my arms were. Then, measuring my right arm, it was 21”, left arm around 20.5” - I was 1/2” larger than he was. I was in shock, I felt like my arms were “pipecleaners”. He also told me to stop doing so much to my shoulders, because they were “freaky”. I finally had to acknowledge to myself that I was gigantic, there was a reason all my casual clothes were XXXL, custom shirts and jackets... but when I saw myself in a gym mirror, I looked small, a feeling I had from childhood - and I was not a “small” child.
This perception had a single exception: when I was standing beside a pro-sized bodybuilder, I actually saw my muscles expand as long as I didn’t look myself in the eye in the mirror. If I did, pop! The muscles shrank, I could go back and forth at will - it was a bizarre hallucinatory experience, and it was repeatable. That’s when I grasped that no matter how big I got, “freaky”, my mind would always, and forever, tell me visually that I was small. So; I never trust “how I look” in a mirror, I rely on tape measures, and gradually dialed the gym back. My arms now are “only” 17” or 18”, ginormous, and in the mirror they look tiny, but I accept it’s a completely false perception. My mild discomfort at being “small” never goes away, and it started roughly at puberty.
So roughly 23 years ago I started looking for similar cognitive phenomena, and found it in many areas. It was a consistent explanation for a huge variety of human perceptual problems, and applied to transsexualism easily. Gender, not actually an existing cognitive “thing”, cannot be a problem of this nature. The language of “gender dysphoria” is quite different from transsexualism. The fairly silly”Being in the wrong body” is completely different from being unhappy with one’s own body.
As they say in poker, that’s the tell. And as you point out, surgery, makeup and similar adjustment won’t eliminate the intolerable problem. You must learn to accomodate the problem, as people with other disabilities do. And make no mistake, it's a disability, as anything which distorts perception is.
This article is so balanced and well-written. And extremely well-researched. Thank you, Bernard! I am the Danish psychotherapist quoted in the article. If anyone wants to read my blog "Transgender - The Fine Print" ("Transkøn - Det med småt"), it can be found here: https://www.transkoen.dk/
Thanks, Lotte!
Thank you both for what you have written about this!!!!
Thank you. That is sweet of you to say! This craziness must be stopped, so there is no other way. :-)
Wonderful article.....it's why I am a paid subscriber.
Contra some Democrats resistant to the "right wing issue" they perceive in pediatric transition, the decline and fall of the 'trans kids' project will be seen by historians as a vindication of single payer healthcare systems.
Why is that? Is it that these systems have the data, knowledge of the financial costs & the administrative power to make changes at the national level?
The US does not have a centralized health or record-keeping system. All these countries with what I will call 'public insurers' are slamming the brakes because they have a single system to capture and apply data. In the US, private insurers do most of that work. There are a few very large ones and some small ones. As seen in Australia, insurers are the entities where the most crucial changes ultimately happen. Insurance companies are highly regulated in America. It would be anticompetitive for them to talk to each other too much, for example. Present regulations under the Affordable Care Act require them to cover 'gender affirmation' etc. So you can think of Denmark as having a central nervous system that responds to change more efficiently than the American healthcare system, which is more distributed and regulated by captured policies in government and organizations. They can, and will, come around, but only well after the states with national care plans.
We have Medicaid, which is more of a poverty program that does not act as a single payer system. Because of its role in transing foster kids and funding the Planned Parenthood hormones-on-demand program, I predict lots of scandals to emerge from it.
The gender clinic issue has certainly been poorly served by accountability shifting within Australia’s federal system. Yet New Zealand is a unitary system & so far has not course corrected on gender medicine.
Single payer systems are also easier to capture. One reason we are dealing with this right now is the messy process of passing the Affordable Care Act under Obama in the first place!
ah ok, you answered my Canada question, thanks!
Canada's system belongs to the provinces, not the federal state BTW.
but Canada :(.
Canada is a counterexample :(.
[this is discussed above...]
Great news re Denmark. Something irks me a little. There seems to be a tendency to build in loopholes or backdoors. For example, maybe somewhere the surgery is banned for under 18 year-olds, but *except* for mature minors. What a mature minor is, is wide open to interpretation. Maybe puberty blockers are banned *except* for clinical trials. I don't quite get this. Given minors cannot legally consent, how can they be put on blockers for a trial?
It’s strangely pleasant to read in others writing of several points I’ve maintained for years on the subject, particularly the idea “opting out of the feminine rather than into the masculine”. Since the early 80’s in discussions on the subject I maintained that it’s impossible for someone to “feel like” they are the opposite sex, because their own baseline experience of feeling a sex is feeling their own body. That is all anyone can ever know, the experience they are born with.
You can, however be uncomfortable with that experience. For a male, transsexualism can only be the negation of being masculine, never the confirmation of “being” a woman, and vice-versa. Under that view transsexualism falls into a broad category of dysphorias where the mind creates discomfort in a mismatch between expectation and perception. My mind says I don’t have a leg (body integrity disorder) or I shouldn’t be able to see, or
I should not have a penis... it becomes reasonable.
It's an interesting question because I can imagine that negation of masculinity, for example, may reflect social influences as much as a male's bodily experience.
I think there’s “intrinsic” rejection and “extrinsic”, similar to constitutional or facultative homosexual sex.
In men who are strongly homosexual (like me) our hypothalamus is activated strongly, measurably to the presence of Androstenedione, heterosexual men, not activated, bisexual men, activated. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1129091/ for an example.) My gayness is an intrinsic, unalterable part of my neural and cognitive setup, “constitutional.” There is also “facultative” or situational homosexual behaviors say, in an all male prison (or perhaps a pirate ship! I tend to think whimsically) where having sex with a man is perhaps the least bad opportunity for intimacy.
I view most transsexuals I have known as intrinsic. They seem to have had a visceral, panic reaction to their self perception of having the “wrong plumbing”, and the language they use to describe it is incredibly similar to that of Body Integrity Dysphoria people, where amputation made them feel “whole”. Their mind refuses to accept the presence of sexual organs, and it has nothing to do with male or female sex per se. It’s the presence of a bodily organ they cannot stop refusing to accept - a strange double-negative but that occurs more often than you think in biological systems.
Extrinsic which is what I hear more recently has to do with the refusal to accept existing as a sex they dislike, not organ focused. Again it’s the negative - not that a man “is” a woman; it’s that they cannot not dislike being a man, which make them unhappy, which seems much more have to do with roles and socialization, acquired if you like. I would compare it to visceral learned dislike of a given race, religion, or a phobia. There’s no organic reason for a person to irrationally fear spiders, and perhaps no organic reason for someone to irrationally hate their sex.
If you read about surgery for dysmporhia--my understanding is that the dysmorphia either moves to another part of the body or the person just becomes more and more unhappy--which is why, I understand, maybe I'm wrong, MD's are not supposed to operate on people if they have body dysmorphia. Sounds similar at least from way out here (to my nonexpert ears) to what a lot of those with GD report.
That’s the problem with an intrinsic mismatch, it seems to be a relative problem also. For instance if you have anorexia no matter how much you diet, your perception never changes. Here’s how I became interested in this subject...
I have been a heavy bodybuilder for decades. One of the first trainers I had, 2000, asked me my goals. I wanted among other things “arms near his size”. He was a competitive bodybuilder. Surprised, he asked me how big I thought my arms were. Then, measuring my right arm, it was 21”, left arm around 20.5” - I was 1/2” larger than he was. I was in shock, I felt like my arms were “pipecleaners”. He also told me to stop doing so much to my shoulders, because they were “freaky”. I finally had to acknowledge to myself that I was gigantic, there was a reason all my casual clothes were XXXL, custom shirts and jackets... but when I saw myself in a gym mirror, I looked small, a feeling I had from childhood - and I was not a “small” child.
This perception had a single exception: when I was standing beside a pro-sized bodybuilder, I actually saw my muscles expand as long as I didn’t look myself in the eye in the mirror. If I did, pop! The muscles shrank, I could go back and forth at will - it was a bizarre hallucinatory experience, and it was repeatable. That’s when I grasped that no matter how big I got, “freaky”, my mind would always, and forever, tell me visually that I was small. So; I never trust “how I look” in a mirror, I rely on tape measures, and gradually dialed the gym back. My arms now are “only” 17” or 18”, ginormous, and in the mirror they look tiny, but I accept it’s a completely false perception. My mild discomfort at being “small” never goes away, and it started roughly at puberty.
So roughly 23 years ago I started looking for similar cognitive phenomena, and found it in many areas. It was a consistent explanation for a huge variety of human perceptual problems, and applied to transsexualism easily. Gender, not actually an existing cognitive “thing”, cannot be a problem of this nature. The language of “gender dysphoria” is quite different from transsexualism. The fairly silly”Being in the wrong body” is completely different from being unhappy with one’s own body.
As they say in poker, that’s the tell. And as you point out, surgery, makeup and similar adjustment won’t eliminate the intolerable problem. You must learn to accomodate the problem, as people with other disabilities do. And make no mistake, it's a disability, as anything which distorts perception is.