SA situation has not demonstrated openness to critical discussion

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Thank you to the Professional Association for Transgender Health, South Africa (Pathsa), for the letter, to which I respond. You claim that what I wrote is “not an accurate reflection of gender-affirming health care”, but everything in my article of August 25 has factual backing from numerous sources, which I suggest require very careful consideration by Pathsa.

It appears that in your haste to refute my claims you have given too little attention to what I wrote — thus assuming things I did not say, nor acknowledging recognition of the evidence I used.

Namely, the very movingly honest accounts written by both Keira Ball and Katherine Burnham (see more below); Lisa Marchiano’s Journal article “Outbreak: On Transgender Teens and Psychic Epidemics”; an Open Letter to Epath [European Professional Association for Transgender Health] — numerous other articles, and much else I have read on transitioning over many years. As well as much talking to those who have close experience of the current South African situation with regard to gender reassignment, and to therapists who are worried about these current attitudes.

Reading various interviews with Torrey Peters (a trans woman) about the motivation for her book, Detransition, Baby, she says: “A lot of people I know detransition because it was really hard to live as a trans woman or trans man. And they detransition not because they don’t have those feelings, but because it’s just so difficult. But that reality doesn’t get talked about, because if you talk about that reality, then it ends up getting weaponised against other trans people.”

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Further, it seems disingenuous to claim, as you do, that regret is very rare. In the light of the writings of the two women I quote (and they represent many more), this appears to require challenging. They claim that many attempts to discuss and consider detransitioning, and the reasons for taking this drastic step, are being silenced. Which is what Keira Bell, Torrey Peters, and many others, have experienced.

And the South African situation has not demonstrated its openness to critical discussion.

I wish immediately to refute your claim that I appear “not to be tolerant of either health professionals providing gender-affirming healthcare or transgender and gender diverse individuals …” This, despite my closing paragraph where I state: “disrupting gender stereotypes … has created a more receptive attitude to the complex issue of human sexuality, presenting a range of possibilities across a broad spectrum … extending the creative potency of ‘female’ and ‘male’ energies.”

iming the L-Word — Sappho’s Daughters Out in Afric
iming the L-Word Sappho’s Daughters Out in Africa
Detransition, Baby, by Torrey Peters
Detransition, Baby, by Torrey Peters

I also compiled and edited the book Reclaiming the L-Word — Sappho’s Daughters Out in Africa, published by Modjaji Books in 2011 — an anthology of lesbian writing and stories, where I wrote an introduction on understanding and accepting lesbian lifestyles.

And I also took part in submissions to those compiling the new SA Constitution in the early 1990s urging the inclusion of LGBTI rights.

The main gist of my concern is not the actual possibility of enabling those who wish to undergo transition, but the huge growth in the number of girls demanding transition as a “cure” for being unhappy with their pubescent bodies; the apparent ill-considered haste with which they are urged by therapists to embark on this uncertain, risky journey, and the refusal to acknowledge that there are possible alternatives to dealing with these feeling, before resorting to more radical hormone and surgical procedures, which might not be the long-term solution.

You do not address the crucial issue of why, in approximately the last two years, there has been an extraordinary increase in the numbers of young girls, both pre-teen and late adolescent, who are apparently self-diagnosing gender dysphoria and rushing to embark on hormone treatment and even surgical procedures.

It should be of great concern that so many therapists are willing to encourage this without taking cognisance of the previous requirement that one should live as the opposite gender for at least two years before taking the decision to make radical changes to one’s body that will result in long-term medication with uncertain effects.

There appears to be alarming haste to medicalise and pathologise what are normal puberty changes, which cause distress in many young people, but are part of the maturing process which therapists can assist with — talking-therapy assisting with accepting these as part of the process of becoming an adult. Examining what it means to them to “pass” as male or female, what they truly want from life, and why. Discussing the possibility of exploring a non-binary androgynous persona. But, after just a few sessions, young girls are put on hormones or puberty blockers, to disrupt this normal process.

"Her article should be compulsory reading for all gender therapists in order to ensure a responsible and careful concern for best practice."
Alleyn Diesel

Lisa Marchiano, a certified Jungian analyst in private practice in Philadelphia, America, addresses the startling growth in young girls demanding transition, suggesting viewing this in terms of a social contagion — “On Transgender Teens and Psychic Epidemics” — manifesting as increasing numbers of youngsters claim to be transgender with little, if any, prior history of gender unhappiness. Some demanding drastic measures to change their bodies.

Her fear is “that adopting a transgender identity has become the newest way for teen girls to express feelings of discomfort with their bodies — typically experienced by adolescent girls. The problem here is that many young people are seeking transition … And this can have extreme consequences.”

She also fears that certain therapists inadvertently validate these self-diagnoses without careful exploration of existing trauma and sexual orientation.

She calls for more critical talking-therapy before encouraging young people to alter their bodies permanently, when there might be less invasive, safer, methods of dealing with such distress.

Her article should be compulsory reading for all gender therapists in order to ensure a responsible and careful concern for best practice.

Likewise, are you prepared to brush aside — ignore — the British high court findings against the London Tavistock Clinic in the Keira Bell case? Where they stated clearly that the effects of hormone treatment are in many instances irreversible. The judges in the Tavistock case expressed their concerns about the lack of follow-up data, in the light of “the experimental nature of the treatment and the profound impact that it has”.

You also ignore the legal challenge to British GP Dr Helen Webberley this year, who ran an unlicensed gender-clinic offering sex-change treatment to children as young as 13 years, and has been banned from practicing, charged with 29 counts of failure to provide good, ongoing clinical care to child patients who received hormone treatment.

And, the fact that, despite these challenges, certain SA therapists and medical practitioners are still assuring their patients that the effects of hormone treatment are easily reversible? What you claim as an internationally accepted option. Can you claim that this is “best practice”?

Your criticism of what you refer to as my “distasteful language” seems to me justified in the light of Keira Bell’s anguish over “puberty and testosterone caused me to have to deal with vaginal atrophy, a thinning and fragility of the vaginal walls that normally occurs after menopause” — in a 23 year old! And, “as a result of the surgery, there’s nerve damage to my chest, and I don’t have sensation the way I used to. If I am ever able to have children, I will never breastfeed them.” She also says, “I hated the appearance of my breasts.”

If this cannot be viewed as unnecessary mutilation of healthy body parts and producing a Frankenstein-like body, then we differ in what we perceive as comfortable and acceptable.

To reiterate my profound disquiet: my article to which you object asked, in the light of ample evidence for extreme caution, for more careful use of gender reassignment treatment — to be resorted to only after all other options have been considered over a period of time.

Otherwise it could lead to yet more pain, distress and regret — the supposed “cure” in fact proving to be more damaging than the original symptoms. As shown by the tragic experiences of Keira Bell, Katherine Burnham and many others whose stories may not just be swept under the carpet and dismissed as unproven claims that “regret is very rare”.

• Alleyn Diesel PhD. previously taught religious and gender studies at the University of Natal.

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