A psychiatrist with decades of experience working with transgender people has outlined what he believes to be 13 scientifically false assumptions which serve as the foundation of affirmation-only therapy for children and adolescents suffering from gender dysphoria.
Dr Stephen Levine was testifying before a Florida House Health & Human Services Committee on Feb 21 in favour of a ban on medical sex changes for minors. Levine was part of a panel of experts invited by Rep. Randy Fine who afterwards announced plans to pursue legislation to ban medical interventions such as puberty blockers, cross-sex hormones and sex change surgeries for under 18s in the state, according to Florida Politics.
Levine listed 13 ideas he had found in scientific literature written by those who support affirmation and medical interventions for young people who believe themselves to be transgender, stating he believes that all are scientifically untrue.
Before commencing with the list, Levine asked those assembled to consider the possibility that child sex changes is yet another medical blunder.
"We have a history of 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," said Levine.
Levine told the committee it is untrue to say that a trans identity once established is immutable, unchangeable and unchanging. Also untrue is the claim that prenatal, biologic forces cause a trans identity, as well as the idea that sexual orientation is entirely separate from gender identity. This he says is false due to the strong correlation between gender dysphoria in childhood and homosexuality in adulthood.
Levine then called the suggestion that gender identity is not a symptomatic reflection of some other problem "not a psychologically tenable concept."
He went on to point out the incoherency of the idea that gender dysphoria is a serious medical condition that requires medical intervention but only if the person wants it.
"There is some inherent paradox in that idea," said Levine. "It’s a serious medical condition that implies we should treat it but we should only treat it if the patient wants."
Levine does not believe that the "associated emotional problems" experienced by gender dysphoric children and adolescents come from living in a discriminatory world, noting that many of the children diagnosed with gender dysphoria have prior mental health diagnoses. Nor does he believe that medical sex changes are the only available treatment for gender dysphoria in young people.
He disagreed with the claim that psychotherapy is the equivalent of conversion therapy, and likewise disregarded the suggestion that affirmation and medical interventions improve mental health and social function, stating that there are no long term studies to support such a claim.
Rather, Levine told the committee that there are many studies that indicate elevated death rates for adults who have undergone sex changes, "so the idea that this improves mental health is uncertain at best."
Next, Levine took aim at the transition-or-suicide narrative, calling it the "most powerful coercive untruth that parents of teenagers are told."
He cited a long-term Swedish study that showed females who had undergone sex change surgeries had "40 times the suicide rate," and that the average rate was 19 times higher than the general population.
"So we realise that we are exposing people to the great risk of suicide in the long run," said Levine.
He also stated it was not true that young teenagers know best what will make them happy in the future, nor that meeting the diagnostic criteria for gender dysphoria predicts a good outcome for sex change interventions.
Lastly Levine told the panel that it is not true to say that detransition and regret are rare, suggesting that researchers who report a low regret rate are defining regret in the narrowest sense.
"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 changed back to their original form, which is a very limited concept of what regret is."
To conclude, Levine asks how an intervention can be trusted when the ideas that underpin it are not true or not correct.
In the past, Levine has spoken about the chain of trust that exists within the medical world and how he believes that chain is broken in the field of gender medicine.
In a 2022 interview on the Wider Lens podcast, Levine explained that doctors and medical students have to be able to trust that the policies being made at high levels are based upon rigorous science because no one has time to look at the origins of each policy.
Doctors and mental health professionals have to be able to trust what they are taught, and Levine believes when it comes to transgender treatments, the chain of trust is "untrustworthy," calling the scientific basis for the recommendations made by the World Professional Association for Transgender Health “lacking.”
Levine described medical students of today graduating with "the zeal of the newly converted," holding the belief that being trans is normal and that a trans person can have highly successful lives just like anybody else, and how they consider him an "old fuddy duddy" for giving them the facts about shortened life expectancy and suicide rates among those who have transitioned.
Levine said he has been accused of being "very conservative" on the issue of gender medicine and he pleads guilty to that accusation. He has spoken about his introduction to the field through a male patient who medically transitioned only to commit suicide nine years later, an event that had a profound impact on Levine’s career. He says he has seen many patients who think that their troubles will disappear if they undergo a sex change who later discover that "life is not as easy as they imagined."
"They didn’t escape much, so I plead guilty to being biased," said Levine.
Levine also told the committee that he believes that the psychiatric profession has been brainwashed by the World Professional Association of Transgender Health (WPATH) into believing that the best way to treat transgender patients is to affirm them and give them what they want.
“We have to take our hats off to WPATH because they have convinced the American mental health professionals, including their organisations, that science has already delivered the verdict that this is the best treatment and young mental health professionals are coming out of graduate schools being taught that the only thing to do for these kids is to transition them and to affirm,” said Levine.
“I think they don't understand the 13 points that I made…They just don't understand our psychiatric professions have been brainwashed.”
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