Lived expertise

Gender solipsism in Conferenceville

Photo by Norbu GYACHUNG on Unsplash

This is a report from a discreet delegate to the November 2-4 conference of the Australian Professional Association for Trans Health (AusPATH), which is a hybrid professional-trans activist organisation.

I don’t believe that people really are born with male or female souls that are different from their bodies, or that anyone should feel like their personality is unacceptable in the body they have, such that they need to change either of them. But I care about people who do. So, I went to the AusPATH conference—because these are the professionals in the area, and I wanted to know what best practice was, so I could understand how these issues were being thought of by the people who do the work every day.

Before the conference started, attendees were informed that a quiet room would be provided with bean bags and a soothing environment, in case anyone was triggered or overwhelmed. The conference app included a “Meet and greet” function. It was common for people to introduce themselves as shy or socially anxious, and to ask others to come seek them out and initiate discussion. A thread was also started for any “neurodiverse” participants to introduce themselves and a meet-up of all the “neurospicy” attendees was organised. These are not things I have encountered before at professional or academic conferences.

The conference was attended by medical professionals, but the majority of those present were people who considered themselves part of the trans community and identified as trans or gender diverse. The field is now dominated by workers with “lived experience”—workers with professional and research degrees focused on their lived experience and workers without professional qualifications relying on their “lived expertise”.

Note that lived experience is now being called lived expertise and many presenters included an “Acknowledgment of lived experience/expertise” on the same slide as their “Acknowledgement of country”. It is not unusual now for specialist gender clinics to employ more lived experience peer-support workers than professional staff, and staff who do not identify as trans have said that lived experience workers are privileged and given the floor to speak over others.

The quality of research presented at the AusPATH conference was surprisingly poor. There was a small number of professionals who demonstrated sound methodology, objectivity, critical thinking and deep knowledge of their fields. These papers focused on service provision models and data analysis, and tended not to concentrate on the feelings or identities of their subjects, or of the authors themselves.

Most papers, panels and workshops, however, focused on personal, emotional and subjective accounts of lived experience and/or superficial accounts of studies with poor research bases, methods and analysis.

Online surveys marketed through social media such as Instagram and TikTok formed the dominant method of data collection, with participants self-selecting and self-reporting. Many studies had fewer than 20 or even ten participants; in some cases only 1-3 members of a group had supplied answers. Virtually no controls were used and there was little analysis of results; results were used as raw data that confirmed pre-determined narratives. The first finding from one study conducted by a hospital’s child research institute was “that non-binary people exist”, and a common explanation of data showing a high level of mental health disturbances was that it “confirms lived experience”.

Instead of presenting research or work in the field, many speakers chose to present on their own feelings of fear and trauma. Most focused on mental and physical conditions suffered by people who identify as trans or gender diverse, but no explanation other than “the effects of transphobia” was offered for the high rate of co-morbidities. Eating disorders, autism, depression and anxiety were the most commonly identified co-morbidities. One study reported that 99.59 per cent of the 2,400 trans-identifying people surveyed had disordered eating behaviours in the three months before the survey. Yet there was no suggestion that any co-morbidity might be a confounding factor in trans identification; this would have suggested pathology at odds with the desired normalisation of gender identity.

Nor was there meaningful opportunity for discussion or questions. Attendees could register questions on an app and if there was time at the end of a session, the moderator sometimes chose to select a small number of questions to ask. Papers were limited to 12 mins each, including changeover between presenters, and panels ran from one to the other without any audience engagement.

No clear agreed set of data, policies or healthcare strategy was identified. To the extent that any coherent approach was taken, the key themes of trans healthcare emerged as—

Depathologisation: yet a medical model is being pursued to treat what is now framed as a “normal variation of human identity”. This inconsistency was never addressed.

Informed consent: medical interventions are framed as entitlements and informed consent is conceived of shallowly as “the ability to say what you want”. The idea is that acceptance equates to fully informed consent and that doctors play no legitimate role in approving or withholding medical interventions based on their professional judgment.

Access: any barrier to treatment access was disparaged. Medical interventions ought to be available on demand, free or as close to free as possible, online or local, rather than centralised in any specialist clinics, and not “gatekept” by any third party. Attendees did occasionally comment on this quietly between themselves. Some pro-affirmation professionals discussed the question of trans “entitlement” and the difficulty of knowing when a patient should be told “No”. Topics that came up in this context included trans-identified males artificially stimulating lactation to “chestfeed” babies or requesting uterus implants, as well as lobbying to serve prison sentences in women’s jails.

Emotional support: the primary role of the medical profession is seen as supporting the emotional needs of the trans and gender-diverse community. Medical and surgical intervention is framed as the main way of doing this. Therapy, recovery or coping skills were not addressed.

“Neurodiversity” is the most common axis of marginalisation being wielded as a marker of special identity, along with Aboriginality and physical disability. These markers are presented as sources of disadvantage and oppression, but are self-proclaimed and held out as something close to trophies. No role was discussed for medical professionals in formally diagnosing, treating or alleviating neurodiverse conditions. More traditional left-wing axes of oppression such as sexual orientation or class difference/poverty were not of major concern.

The toilets at the conference were made gender neutral. This news was delivered as an important announcement at the outset. One bathroom was labelled “toilets” and the other was “toilets and urinals”. The entrances were next to each other. Amusingly, at every break across the three days, there was a line for the “toilets” bathroom. Waiting in that line were women, men in dresses who identified as women, and women in suits who identified as men.

The only people I never saw in line were men wearing pants. And I never saw a single person go in or out of the bathroom labelled “toilets and urinals”. Even when a queue of us were standing for almost 10 minutes to enter the “toilets” bathroom and a few women glanced over to the empty next-door bathroom, no-one left the line and switched. I went downstairs to use the standard gendered bathrooms once, and found a few men who had come downstairs to use the male toilet there instead. Yet everyone cheered in public for the “gender-neutral toilets” provided.

At the conference, the phenomenon of detransitioners was minimised—they were fleetingly mentioned, but glossed over in a way that suggested that denying them acknowledgment would stop them from existing. Language was used in such a way to make it appear a temporary stage. The primary paper to discuss this suggested that detransition be called instead “re-identification with birth sex” and seen as merely one stage in the “journey of being trans”. The concept of detransition was dismissed as an idea weaponised by critics. So, no plan for support, prevention or treatment of detransitioners was presented.

Only 100 per cent-affirming voices were heard. A culture of “us versus them” was created and inflamed, opposing the attendees to any person outside the “community”. The community was spoken of as being under attack, erased and hated. The conference was less a gathering of medical professionals than an emotional appeal to fragility and pathological defensiveness. Some speakers were parents of trans-identifying children and talked about the “joy” of parenting a trans child in an encouraging, marketing kind of way.

The increasing number of adolescent females in gender clinics was acknowledged at the conference, but explained away. One argument was that “transmisogyny” prevents adolescent boys from seeking treatment because, as “girls”, they would be subject to misogyny. And as trans, they would suffer transphobia. Were it not for these forces, so the argument goes, just as many adolescent males as females would present for treatment—meaning that girls are not disproportionately vulnerable to gender ideology when going through puberty.

Rapid-Onset Gender Dysphoria was derided as disinformation spread by malicious forces against the trans community. This also had the effect of normalising the higher numbers of adult males claiming a female identity in the later stages of life, often after building a career and family. These men are celebrated for having become strong enough to withstand transmisogyny and to come out as their true selves. There is no room for the view that they are acting out fetish behaviours at a time in their life when they risk little.

Young people were presented as fully informed by gender-affirming healthcare workers of the risk to fertility—and as entirely unconcerned by it. Their reported reasons included viewing pregnancy as gross and painful; never wanting children (this was said at ages 13-19 roughly); regarding storage of eggs or sperm was too expensive; and feeling they could “just adopt later.” Infertility was mostly glossed over. Conference goers in casual conversation made remarks such as, “but none of us ever knows what we’ll want in the future”. Infertility from medical intervention was likened to getting piercings or failing to make time-sensitive decisions such as training for elite sports.

There were different opinions on when fertility would be affected. Some attendees insisted that fertility was not an issue until surgery and therefore did not require meaningful consent until then. Some made out that it was relatively easy to obtain a child through egg and sperm storage, or through adoption. Other attendees pushed back on the idea that adoption and/or fostering were easy—or even possible.

As for the ethical dimension of working with young people and families, the primary ethics seemed to be the priority of affirmation. For example, it was suggested that longitudinal studies should not be undertaken if they would require any delay in providing medical interventions to any cohort.

Neither funding sources for the conference, nor connections with government or industry were addressed at any point. Recent trans-supportive laws and proposals—targeting “conversion therapy” or “misinformation”, for example—were not mentioned at all.

Instead, governments were presented as entirely hostile to the trans community and much concern was expressed about “misinformation” and “disinformation” from members of the public, usually characterising it as malicious and organised—a campaign of attack against the trans and gender-diverse community. Papers were presented on strategies for trans organisations to counter negative information both in the public realm and with parents concerned about affirmative interventions for their trans-identifying children.

Advice for health professionals included the provision of diagrams such as the “Genderbread Person”, maps of European colonisation and inaccurate historical timelines showing what was claimed to be “gender diversity” in Indigenous populations across the globe. In truth, this was a conflation of modern gender theory with culturally specific and often homophobic labels used within traditional societies.

Parents from non-western backgrounds were to be told that they were wrong if they thought their countries of origin did not have a trans population and that views such as theirs simply drove trans people underground.

It was recommended that health professionals tell parents that 48 per cent of trans youth have attempted suicide—a statistic from a low-quality online survey—and that the single biggest risk to their child would be a lack of parental support in transition. This approach was described as “empowering” parents to effectively stop their child committing suicide, and not acknowledged as emotional blackmail.

We often speak of institutional capture, but it hits differently when you see it. AusPATH did not present as a healthcare professionals’ organisation using its expertise for advocacy; it presented as an advocacy organisation using its healthcare credentials for ideology.