Transcript for Dr Stephen Levine: 13 Untruths Behind Gender Affirmative Therapies for Kids
On Feb 21, 2023 the Florida House of Health & Human Services Committee heard testimony from licensed psychiatrist Stephen Levine MD. He outlined 13 scientifically false assumptions which serve as the foundation of affirmation-only therapy for gender dysphoria in kids.
‘I plan to emphasise 13 ideas that I have found in the literature, written by those who affirm care for children and adolescents and adults for trans gender phenomenon. Each one of these 13 points, I believe is scientifically untrue. Nonetheless, they are firmly believed and when they are countered in meetings, when they are confronted in meetings, it produces a passionate outcry that it isn’t true.
But as far as I can see, these 13 ideas are not scientifically verifiable and are clinically apparently incorrect. Nonetheless, affirmative care doctors assert them in their writings and in their speeches repeatedly. And having eavesdropped on this literature for all these years, I feel very strongly that none of them are correct.
And before I give you these 13, I want to raise that one way of considering this big question of trans care for youth is whether this is an example of therapeutic advance to help afflicted human beings, or whether this is yet another medical misadventure. In medicine we have a history of many medical misadventures. Most recently, and most damaging is the opioid epidemic where we began prescribing opioids liberally without scientific demonstration as to its use and its utility and its harms. And now every state in the United States and elsewhere is suffering from premature death due to opioid abuse.
So here are the 13 things that are not true in my view.
“A trans identity once established is immutable, unchangeable, unchanging.”
This is clearly not true.
Second, “Trans identities are primarily caused by prenatal biologic forces.”
That is the justification of the treatment is, “we’re just correcting some biologic embryologic mistake.”
Third, “Sexual orientation is entirely independent of gender identity.”
Sexual orientation is a bias that all of us have for romantic and sexual purposes for members of a class of males or females. And in the standards of care from WPATH it’s been asserted that they’re entirely separate. But when you watch the child develop from a childhood to puberty to middle adolescence, you often see that the first manifestation of gender dysphoria, before gender dysphoria shows up, is that, “I’m attracted to members of the same sex.” And you watch the evolution of orientation throughout adolescence and you quickly see that they are not entirely separate phenomenon like the advocates say they are.
And the fourth idea that is not true is that: “No form of gender identity is an abnormality and no form of gender identity is symptomatic reflection of some other problem.”
This is not a psychologically tenable concept, but it is asserted all the time, and you can read it in the standards of care.
Fifth, “Gender dysphoria is a serious medical condition and it requires medical intervention – only if the patient wants it.”
So there is some inherent paradox in that idea, right? It’s a serious medical condition that implies that we should treat it, but we should only treat it if the patient wants it.
Six: “The associated emotional problems are primarily due to living in a discriminatory world.”
Even though many of the children who are diagnosed with gender dysphoria eventually, previously have been diagnosed with other problems.
Seven: “No effective alternative approaches to affirmative care exist. This is the only thing that will save your child,” we tell parents. And many of the practitioners actually believe there are no alternate approaches. But Dr Laidlaw just told us about an alternate psychiatric approach.
Eight: “Attempts to provide psychotherapy are unethical versions of conversion therapy and should be outlawed.”
You see, any attempt to help the child in the family is called conversion therapy, and people are urging that to be outlawed in various jurisdictions.
Nine: “Affirmative care, lastingly improves mental health and social function.”
This is the justification for the treatment, even though we don’t have studies that demonstrate that. We don’t have long-term studies at all that demonstrate that. And we have many studies that indicate, and you’ve seen slides of the death rates, and a recent study has reaffirmed the elevated death rates of transsexual adults. So the idea that this improves mental health is uncertain at best.
Ten: “Affirmative care reduces the rates of suicidal ideation and prevents suicide.”
This is the most powerful, coercive untruth that parents of teenagers are told. “Would you rather visit your child in the cemetery or have a trans child?” And many people, including one of our panelists today, have demonstrated the lack of veracity of that assumption.
When we look at the Swedish studies, the females who underwent sex reassignment surgery had, I think, 40 times the suicide rate. The average suicide rate that was quoted was 19 times because the males’ suicide rate was a little less than 19. So we realized that we are exposing people to the great risk of suicide in the long run. And when we don’t have follow up studies of the youth, we need to be informing parents about what we do know about the long-term outcomes, which is not happening at all.
The eleventh idea is that, “Teens, young teens, know best what will make them happy in the future.”
I hear that all the time, because this is their, “genuine, true self.” Not true. They don’t know what’s best for them, necessarily.
Twelve: “Meeting diagnostic criteria for gender dysphoria predicts a good outcome to affirmative care.”
That’s not true either.
And finally: “Regret and detransition are rare among these patients.”
As the last two years have begun to show, detransition is increasingly recognized. When people assert that regret is rare, it’s because they’re defining regret as telling their original therapist that they wish they didn’t undergo this. Or asking to have their body rechanged back to their original form, which is a very limited concept of what regret represents.
So these 13 ideas stand as a monument to the assertions that affirmative care, the science of affirmative care, has already established its superiority and its benefit. If ideas that underpin an intervention are not true, are not correct, how can we trust the intervention itself?
I think that’s all I wanted to say to you today, and I’m happy to answer any questions in the future.’
