Four Signs Your Trans Healthcare Opinion is Cissexist Claptrap

At some point during my career of fact-checking the trans-antagonistic self indulgent wankery that passes for journalism these days, things started to blur together. I could play a game called “Who Said It: Transphobic Radical ‘Feminist’ or Catholic Priest?” when examining the statements and sometimes mix them up, their tangled logic and moralistic aggression seemingly borrowing from one another to the point of being difficult to tell apart. In this morass I began to notice a number of repeated rhetorical tricks frequently present in these anti-trans hit pieces, tricks which I’ve documented below. These rhetorical devices often obfuscate the increasingly-clear evidence to their hypothetical questions, which are themselves posed to give the impression of being unanswerable–so just go with your gut. You know, the gut that’s more willing to accept a conspiracy theory than some statistics.

And so, here we are, four red flags common in cissexist healthcare op-eds.

1. It positions “trans” and “healthy” as mutually exclusive.

By now us insidious “trans activists” have largely succeeded at disseminating the statistics on the abuses trans people, as a demographic, are subject to. While a lot more folks are aware that trans people experience catastrophic rates of depression, PTSD, anxiety, and other symptoms common to violent victimization (including the suicidal ideation derived from it), a select few like to talk about it with an ass-backwards causation.

When you actually compare suicide rates within the trans community, we can actually isolate the risk factors. A 2015 study of transgender Ontarians by G.R. Bauer et. al.  demonstrated that suicide risk decreased dramatically when said trans folk retained the support of their parental connections (and to be clear, that support did not look like trying to change their mind about transitioning). Positive mental health outcomes also correlated with the retention of careers, the support of peers and school environments, and having no history of experiencing violence or sexual violence.

It also demonstrated that the farther along a trans person is in their transition, the less likely they are to attempt suicide. Transitioning actively lowers suicide risk in the long term. In fact, most of the suicide ideation observed in the Ontarian study is clustered around coming out and the planning thereof, tapering off as time progresses, and coming to a rest at a rate comparable to the general population. Given that coming out (or being outed involuntarily) are the impetuses for discrimination, the evidence very strongly suggests that the actual cause of high suicidal ideation in trans folk is the way cisgender people respond to us. For those of us lucky to be met with more support than resistance, it usually reflects in our reduced rates of trauma-related effects.

Contrast all that, with right-wing darling Paul McHugh, one of three doctors (we’ll get to that later) repeatedly quoted to position gender variance (“transgenderism,” as they insist on calling it) as a mental illness itself. (emphasis mine)

“This intensely felt sense of being transgendered [sic] constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken – it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes.”

Here Paul McHugh and the many, many, many, many cheerleaders he possesses directly links gender variance with illness itself. But this position is only tenuously maintained by sheer denial of further evidence. For instance, in addition to identifying the factors contributing to positive mental health outcomes (which were again, parental & social support, job security, not a victim of violence), we’ve also identified the causes of the negative outcomes.

Because you know who else has an absurdly high rate of suicide?

Victims of violence. People who’ve lost their livelihood. People whose misery was blamed on themselves by their religion.

What did all the previous statistics on trans people say? Oh yeah–we were at much higher risk for violence, work instability, and social rejection.

It’s discrimination by cis people that correlates with a gender variant identity, and that discrimination causing our poor mental health outcomes. Those insisting this is not the case are nothing less than evidence denialists who have to pretend that “healthy, happy, resilient” and “transgender” are necessarily mutually exclusive outcomes, despite all the data showing that we can (and will be) as every bit well-adjusted as the general population when y’all stop shitting on us.

Novel idea, that.

2. It equates “transgender” with “surgery.”


And thus equates “transgender youth” with “children having surgery.”

For starters, most adult trans folk have a lot more on their plate than their embodied dysphoria, and it’s hardly a unified concern #1. But while it is important for many of us, I want to clarify that when it comes to gender questioning children, no endosex child qualifies for surgery under the prevailing standards of the Worldwide Professional Association for Transgender Health. The default assumption that most minors even have the option of surgery is an unsubstantiated fiction maintained by pundits like Jesse Singal, yet this assumption is positively endemic in any conversation where the subject is transgender and gender questioning children.

I repeat this claim a lot in my work because of the sheer audacity behind the faux concern for surgery. I can’t find a single fracking peep from these same people over Intersex Genital Mutilationactual surgeries being imposed on actual children without their consent with actual negative effects, unlike the purely invented spectre of trans youth surgery. To quote myself from elsewhere: “If the pearls of castration anxiety must be clutched, kindly take them where they’re actually needed.”

All the data on positive health outcomes (physical and mental) of trans youth are, by definition, outcomes achieved without the use of surgery. Dr. Kristina Olson found that in prepubescent children, being given the chance to take up different pronouns and clothing styles produced children whose mental health was no different from their peers. Adolescents given appropriate access to pubertal suppression and later hormone replacement entered adulthood no more likely than the general population to exhibit depression (though they did still exhibit higher rates of anxiety–which went down after they were able to consent to and receive surgery as adults).

Surgery hasn’t even entered the picture yet for transgender minors who are endosex, and isn’t going to for anyone following the WPATH standards. There is much more to a transition than surgery, and indeed the lion’s share of effort happens long before surgery. To reduce transition to that is to ignore all the legal hurdles, all the effort that has to go into changing grooming habits, all the preparation and planning to publicly profess an identity still so poorly understood the default knee-jerk response is castration anxiety. Which is fucked up, because that’s the sort thing on the distant end of a horizon. Long before that, there’s the fighting over hair. Clothes. Names. Pronouns. The tiniest, least consequential shit is still something most gender questioning and trans youth have to fight tooth and nail for. Surgery? Fugeddaboutit. Even with optimal access as in the Dutch Model most people don’t even start surgeries until they’re 20, and at that point the ball is in their court despite your best efforts to convince them into thinking otherwise.

Now compare all that with the American College of Pediatricians–a tiny but noisy hate group that is trying to convince you it is the American Academy of Pediatricianswho compare children consenting to “sex changes” to children crossing a busy street.

While the AAP does not dispute any of this research, it appears to heed it only selectively. Apparently, cognitive immaturity is an obstacle to crossing the street but not for giving consent to a sex change. Looks like “correctness” outranks science when science gets in the way of agenda.

You know, those sex changes they aren’t qualified to receive. Wait, who’s pushing an agenda again?


3. It positions the health of cisgender people against the health of transgender people.


Norman Spack is credited with bringing the highly successful Dutch Model to North America. He describes in his practice a model us trans health nerds call “gender affirmation”–simply put, a methodology that neither persuades nor dissuades its subjects to make any particular declaration of gender identity and simply provides a non-judgemental space for the clinician to make observations about the way the child expresses themselves freely. All the children in the program learn the distinction between gender expression and embodied gender dysphoria, and many consolidate their understanding of their gendered experience in a way that does not require them to profess a trans identity or transition. Only those children who routinely exhibit that embodied gender dysphoria–not mere dissatisfaction with gender roles–are eligible for hormone blockers as they enter puberty. Only those teenagers who remain consistent, insistent, and persistent in their distress over their embodied dysphoria can even be considered for hormone replacements. At any point the patients can turn back and change their minds (though the WPATH notes [p. 18] this is possibly a result of parental/societal transphobia applying pressure to “re-closet” themselves as it is of coming to terms with ones sexed attributes). Only after they’re adults will ethical clinicians even consider their consent for surgery.

Again, I stress the results: This produces adults who are no more likely than the general population to exhibit depression and other negative psychiatric effects we discussed earlier that are consequences of discrimination–regardless of their actual gender identity. Any claims that the needs of cis kids and trans kids are mutually exclusive are specifically denying the results of the Dutch Model, as it demonstrates that it need not be so.

What sets the Dutch Model apart from previous trans healthcare provisions is that there is no “one track” for the patient, specifically rejecting template treatment plans. As it turns out, patient-centred care where the health and happiness of the patient is the objective (rather than the comfort of the parents, schools, or society) produces patients that are… wait for it… healthy and happy!

Novel idea, that. I know it seems like I’m saying really obvious shit, but there are a lot of cis people who want either the only healthcare provisions available to trans people to be a sort of Orwellian gender police who shock us until we’re in so much pain we say whatever they want to hear to make it stop, or for no healthcare provisions to exist at all while pretending this is some kind of compromise. I’m at a loss as to what it is about trans topics that so readily short-circuits people’s critical thinking.

Now that we’ve established that the health and happiness of all subjects, regardless of their gender identity, is indeed attainable and not some kind of ephemeral butterfly, let’s contrast the decades-old research repeatedly brought up by anti-trans pundits to obscure the actual scientific consensus.

At the risk of repeating myself too much, I’ll just briefly remind that the results of the Dutch Model of gender healthcare show extremely high rates of satisfaction for its patients regardless of their gender identity. That means all patients, trans, cis, whatever the case may be, came out of it satisfied. This method, also called gender affirmation, specifically rejects one-size-fits-all approaches and tailor-fits treatment to each individual patient.

Kenneth Zucker in summarizing his research states that roughly 70% of the children admitted to his clinic were “sub-threshold for gender dysphoria,” meaning they weren’t experiencing the embodied anxiety that motivates people to transition. Despite this, Zucker and his squadron of various proteges had, by inserting themselves into the gender identity work group for the DSM-4, successfully changed the definition of the then-called “gender identity disorder” to… not actually need gender dysphoria. Suddenly, Zucker could claim that all his patients were “transgender”–despite the fact that this was plainly not the case by his own admission elsewhere in his research–and then follow this up by saying that the same proportion of patients “ceased to be transgender” by the time they were adolescents.

Which, you know, is a bit like saying you’ve fixed the patient’s broken leg, even though they originally were admitted to the hospital for a fever?

I’ll be honest, I don’t know how people still clinging to the 80% desistance myth have overlooked this rather critical detail from their own source material (I suspect they haven’t actually read Zucker’s work), but here: Enjoy an entire conspiracy website run by a virulently transphobic cis lesbian predicated on the desistance misconception trying to convince you that transition healthcare is a eugenics conspiracy to eradicate cis gays.

(I mean, trans people can be gay too, but never mind that.)

It’s a stubborn myth despite its transparently obvious origin in methodological manipulation, yet there are no shortage of arguments setting up a false dichotomy of “healthy cis kids” OR “healthy trans kids,” citing the desistance myth as to why gender related healthcare provisions shouldn’t exist at all for trans youth since you can’t have one with the other, according to these pundits.

As we said earlier, the Dutch Model proved that it needn’t be an either/or situation.

4. A-cherry pickin’ we go!


Norman Spack. Diane Ehrensaft. Annelou de Vries. Peggy Cohen-Kettenis. Jamie Veale. This is just a short sampling of the researchers who, since the 1990s, began to examine the otherwise unchallenged healthcare ontologies for trans folk that dominated the 70s, 80s, and 90s.

De Vries, for example, is a name that frequently comes up in the context of the Dutch Model in papers that examine the well being of their trans patients. As I said, their papers contribute to the growing body of evidence that trans people can be healthy and happy, and that this occurs most often when they have a combination of access to affirming healthcare and experience no, or less, discrimination and violence. Most importantly, they’ve all described in the process of formulating the gender affirmative model of healthcare those patients who profess identities other than a transgender one. Diane Ehrensaft, in particular, has presented her findings on distinguishing between children who are frustrated by gender roles, and children who are embodying anxiety specifically because of their sexed attributes. For the former, she says: (emphasis added)

Yes.  To be what we refer to as gender diverse, which includes having a gender identity (who I know myself to be as male, female, or other)  that does not match the sex assigned at birth or having gender expressions (how I do my gender—clothes, activities, etc.), or both, may come with stress or distress about being in that position, but it may not.  When it does, we recognize dysphoria, when it does not, we perceive it as gender expansiveness that is integrated and accompanied by a feeling of satisfaction and well-being.

In other words, practitioners of gender affirmation are well aware that children are likely to be admitted to their practices on the basis of gender nonconforming behaviour, rather than (or in addition to) a gender dysphoric identity. They are well aware that the two groups of patients have different needs.

Small wonder then that if one’s intention is to scaremonger, scapegoat, and obfuscate, to convince you of some evil surgery-and-drug pushing cabal, that the above named researchers are seldom (if ever) mentioned. Instead, the anti-trans writers want you to believe that no research has progressed since the 1990s, when Kenneth Zucker, Ray Blanchard, and Paul McHugh–our three horsemen of the transphobic apocalypse, as it were–enjoyed an era of their findings, the Pathology Model, being seldom challenged.

[Aside: There are a number of other academics who jumped on the anti-trans bandwagon, such as J. Michael Bailey and Alice Dreger–however, they did not perform original research on gender variance and simply batted for Ray Blanchard. As such, assume that if either of them are quoted, that the criticisms of Blanchard’s work likely transfers to their opinions as well. This is also true of Kenneth Zucker’s supporters, such as Jesse Singal and Sarah Ditum. But the actual source material we’re criticizing comes from these three aforementioned researchers, even if there are a number of gnattering journalists pumping their egos.]

For example, let’s compare Dr. Ehrensaft words, an actual practitioner of gender affirmation–with all its “whens” and “ifs” and “may or may nots”–to Sarah Ditum’s characterization of gender affirmation: (emphasis added)

Even so, these claims continue to recycled by those who endorse a “gender affirmative” approach to trans children – where the child’s assertion of their identity is accepted immediately and uncritically – and reject Zucker’s more critical practice.

Perhaps this is why I often find myself asking whether these anti-trans pundits have ever even bothered to consult the research and healthcare provisions they claim to be criticizing. “When” and “if” and “may or may not” are conditional qualifiers that contradict Ditum’s plainly false assertion that patients under gender affirmation have their assertions accepted “uncritically.” This lie was particularly egregious in BBC’s “Transgender Kids: Who Knows Best?” when it went on to characterize gender affirmation as “railroading” patients–which made me laugh, because it came from Ray Blanchard, who railroads his patients into compulsory heterosexuality.

Really, they must tell me the brand of their psychological projector.

After blatantly lying about what gender affirmation is, Ditum goes on to defend Dr. Zucker’s practice on the basis that it doesn’t push drugs and surgery on kids. You know, the surgeries that the kids don’t fucking qualify for, as we discussed.

I’m getting a bit thin with the manipulation here.

As for the problems with Dr. Zucker’s practice:

This is just a short sample of the report. In the above quoted text there are two accusations regarding the inadequacies of the methodology of the clinic: 1) No distinction between gender variant behaviour and gender dysphoric identity, a distinction which was sought out in the DSM-3 but sidelined by the same CAMH Sexologists whose work has been discredited; and 2) That the clinic had not adapted to current scientific findings. The other allegation is with respects to medical ethics. That’s without going into the other sixteen points of contention found in the report.

So I say again: Kenneth Zucker was not fired “by transgender activists” as both the documentary and Jesse Singal claim; nor was he “fired for challenging the gender affirmative approach” as both the documentary and Sarah Ditum claim. The clinic was reviewed by Dr. Zucker’s peers in psychiatry, and Zucker relieved for a practice considered questionable on its scientific basis. I will remind my readers that academics, not just “trans activists,” had been criticizing his work long before his firing. Ditum, Singal, and Conroy are all trying to smear trans activists as being anti-scientific. In reality, the scientific consensus was what unseated Zucker’s work and vindicated our complaints about his clinic.

You can read the rest of that here if you so desire–for the purposes of this piece, the important takeaway was that there were legitimate, scientific critiques of Dr. Zucker’s practice and the Pathology Model more generally. Critiques often buried by his supporters who insist he’s the victim of the ebul trans cabal. Unfortunately for them, the scientific consensus didn’t simply stop in the 1990s. Attempts to frame trans healthcare as risky to cis folk (see #3) have to focus on Dr. Zucker to the exclusion of the researchers who have resolved this dilemma.

So what should you do if you identify these attempts to manipulate you in the next trendy trans healthcare op-ed? Honestly, stop reading it. It’s unlikely you’ll ever get through to the author, because those pulling these rhetorical tricks are seeing what they want to see and nothing else. My hope is that by comparing their statements to the actual evidence, that the rest of us will start to see what they are denying.



  1. anat says

    FYI I am aware of quite a few transgender boys who had chest reconstruction surgery at ages 15 -17. AFAIK all of them had used binders for quite a while pre-surgery.

  2. Siobhan says


    FYI I am aware of quite a few transgender boys who had chest reconstruction surgery at ages 15 -17. AFAIK all of them had used binders for quite a while pre-surgery.

    I don’t doubt that, but:
    1. They would have to be Gillick competent, in which case legally and morally it is their decision to make and their consequences to handle.
    2. I’m not sure how often that is offered in the first place and am not aware of any statistics that measure the frequency. As I understand it, it’s an option for extreme cases.

  3. anat says

    How often it is offered? The boys demand it. Parents try to get coverage from insurance, some insurers are better than others in this regard. The process often involves getting denied and appealing (some say at least 3 times, in order to satisfy some bureaucratic stuff), in the end they get some percentage covered, depending on insurer.

  4. says

    All the children in the program learn the distinction between gender expression and embodied gender dysphoria, and many consolidate their understanding of their gendered experience in a way that does not require them to profess a trans identity or transition.

    Wait, are you saying that in this model all the cis girls who like cars and the cis boys who like pink dolls get actually told “that’s ok” and then can go home and be a happy pink dolls loving boy? But that would mean that the TERFS who constantly claim that gender non conforming cis kids are pressured into being trans are lying?

  5. Siobhan says


    But that would mean that the TERFS who constantly claim that gender non conforming cis kids are pressured into being trans are lying?

    In all seriousness, it depends. Some TERFs take a more concern-troll approach and might legitimately believe these concerns are valid, whereas some TERFs are outright genocidal and are willfully obscuring the facts in a bid to run interference on our healthcare. I think writers like Sarah Ditum are in the former category.

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