Stephanie Winn: The ‘Trans Industry’ Is Creating a Sterilized Generation and Medical Patients for Life
“We’re sterilizing a generation who will not be able to have their own kids. And we’re altering their sexual functioning in a way that’s going to make it more difficult for them to have loving relationships.” [FULL TRANSCRIPT of this interview below]
Stephanie Winn is a licensed marriage and family therapist who is currently treating detransitioners and parents with gender-questioning youth.
She says that gender-affirming care is costly to one’s physical health and antithetical to the therapeutic process, reducing the role of the therapist from a curious explorer to someone who is not allowed to probe, question, or act with discernment.
“We’re essentially agreeing with the lie that these vulnerable, young people who are in a moment of great distress, really truly have no other ways of coping than to make life-altering decisions with a lot of negative ramifications for their health. And that’s not true,” says Winn. “Puberty blockers are not FDA-approved for the treatment of a mental health condition. They’re being prescribed off label for very young children. And we know for a fact that puberty blockers damage, among other things, brain development, also bone development.”
Winn and I discuss “Affirmation Generation,” a new documentary she is featured in, which critically explores the gender-affirming model, society’s suppression of detransitioners, the for-profit trans-industry and the many myths associated with being transgender.
“So many of the vulnerable, young people who are presenting with gender dysphoria are autistic. Many of them have trauma histories. They’ve been bullied. They’ve been abandoned,” says Winn.
Stephanie Winn, such a pleasure to have you on American Thought Leaders.
Thanks for having me. It’s great to be here.
Stephanie, congratulations on this amazing, amazing film and we’re going to talk about that today. Before we go there, you’re a psychotherapist yourself, and you say something in the film that I thought would be a perfect launch point for us. You say, “Clinicians, we’ve been sold a bill of lies.” What are the lies?
For one, we’ve been lied to that so-called gender-affirming care is an actual model of psychotherapy like other models. We have many models of psychotherapy, DVT, ACT, CVD, EMDR, these are just some acronyms. Models of psychotherapy generally include ways of conceptualizing and formulating our clients’ distress and understanding their presenting problems, and then ways to proceed with helping treat their distress.
Gender-affirming care is actually antithetical to the therapeutic process, which always necessarily includes really getting to know our clients and exploring their life circumstances. I mentioned this in the film as well. We do a psychosocial assessment. We assess what’s happening for them physiologically, environmentally, socially, internally, and in terms of their phases of life.
Normally, we have to have room to explore all of these things in order to do our jobs well. But with the so-called gender-affirming model, what we’re told is not to ask questions, just to affirm, and just to agree. It’s a reduction of our role from a curious explorer who uses mirroring and reflection as one of many tools, to somebody who is relegated to the role of only mirroring and reflecting, without probing, questioning, or discernment.
When I say that we’ve been lied to, I’m talking about how our generally agreeable and conscientious natures have been exploited by being asked to do something that is actually antithetical to the goals of our profession. Because therapy is mental health and mental health is part of healthcare, part of helping the individual be well.
What is it to be healthy? It is to have a sense of vitality, capability, being able to do things, being able to have healthy relationships, and being able to be physically active and pursue meaningful work. These are some of the foundational cornerstones of health, along with eating well and sleeping well and things like that.
What therapists are doing who are practicing so-called gender-affirming care, in other words, just agreeing with their clients on this question of gender, is not actually in the service of health. Because this social affirmation is the first step in a process that leads to hormones and surgeries that are experimental and that are very costly to physical health.
This is one reason that I’m passionate about this issue. I’m sure we’re going to talk about this more, but the threat of suicide is often used to push concerned citizens, especially parents into a so-called affirmation. But we know that in the long-term, things that increase suicide risk include not having the health and vitality to be physically active, to feel good in your body, and to have meaningful relationships.
I’m sure we’ll talk about all of that more, but basically, we’re undermining people’s long-term health and wellbeing when we practice gender-affirming care. We’re essentially agreeing with the lie that these vulnerable young people who are in a moment of great distress really truly have no other ways of coping than to make life altering decisions with a lot of negative ramifications for their health.
That’s not true. That’s how we’ve been lied to. In the process, we’ve been lied to about our own capabilities as therapists to support our clients’ resilience and our duty to challenge them when their thought process is not completely sound.
In the film, it’s mentioned that lobotomies were once one of these physiological interventions in very rare situations to try to deal with a mental condition. There was an analogy drawn that this gender-affirming care model leads to these very profound physiological interventions and was comparable. Please tell me about that.
It’s pretty wild, isn’t it? This is part of our history as Americans, the lobotomy craze of the 1940s. That was its peak, but it was actually longer than that. If you think about lobotomies from today’s standpoint, it’s like how could we have ever done that? How could we have ever thought that you should mess with person’s brain by putting an ice pick through their nose to fix something psychological?
And yet, that does bear resemblance to what’s happening today, because it was always experimental. It was always nothing but experimental, and yet it was being proposed like it was a legitimate form of treatment and it damaged people permanently.
One parallel I see is that puberty blockers are not FDA approved for the treatment of a mental health condition. They’re being prescribed off-label for very young children. We know for a fact that puberty blockers damage, among other things, brain development, bone development, and every system of the body. This is a so-called treatment that is interfering with a young person’s development in a profound way. It’s not FDA approved, and yet it’s being prescribed outside of clinical trials. And we’re not even tracking what’s happening to these kids.
I want to discuss some of the potential harms associated with these interventions for sure. They’re typically billed as not being particularly harmful. You sent me this report about puberty blockers, which I found shocking.
Before we go there, there is this question that’s hanging in the air. In many cases, these are children or teens who are just discovering themselves and they’re making these profound life decisions that will affect them permanently, without being able to remotely grasp the consequences. You could ask them, “Do you want to have children one day?” They may reply, “I don’t know.” There’s a million questions I could add to that. How is this even being considered?
That’s a great question, and in our documentary, Lisa Marchiano makes that comment. She says that it strikes her as extremely naive of any responsible adults to go along with this child’s understanding of who they are and what they’re going to want in the future. Anyone watching this can think of someone you know that swore up and down they did not want children when they were in their teens or 20s. And then, a switch flipped at some point, maybe at even 35, where suddenly they wanted children desperately, and now they’re so grateful that they have them.
If there are healthy people who pass through normal phases of life thinking they didn’t want children, and then that changed for them at some point in life, how are we assuming that young, vulnerable, mentally unwell, impulsive, angsty teenagers and prepubescent teens could possibly know what they’re going to want in the future?
I don’t understand how so many people are going along with this and how we’re assuming that the better life outcome is to live in accordance with this magical gender identity, and that we know kids are going to be happy with that, rather than leaving open the possibility of having a family.
Almost ubiquitously, gender dysphoria is associated with some other issues, and often those issues just get swept off to the side. There’s a term that’s mentioned in the film that actually describes that.
The term you’re looking for is diagnostic overshadowing. It is the idea that when you have various comorbidities or potential comorbidities that maybe haven’t even been diagnosed or ruled out properly, gender dysphoria trumps all of them. It overshadows all of them.
There’s a dangerous and unfounded presupposition in this gender-affirming model that if you just treat gender dysphoria by permanently changing the young person’s body, all the other issues will go away. What I see is actually the opposite.
What I see is that youth who have been exposed to this culture and these narratives around gender identity, that culture, much of it online, gives them a language, a framework, a way of thinking about their psychological distress.
You’ll hear these youth refer to things as “My dysphoria.” When they say my dysphoria, they could actually be talking about anything. They could be talking about PMS or social anxiety or ADHD. We know that about 48 per cent of the children referred to the Tavistock Gender Identity Clinic, which has now been ordered to shut down, were autistic.
There’s any number of things it could be referring to, but the language that they have for it is the term dysphoria. It’s always my dysphoria this, my dysphoria that. Something I’ve learned from working with the parents of these youth is that almost any upsetting life situation can serve as a trigger for so-called dysphoria.
It could be that they got a bad grade on a test, or their girlfriend dumped them, or they found out that their friends were hanging out behind their back without them. It could have nothing to do with gender or even sex. Yet the language that they have for it is dysphoria. And then, they go down this sometimes obsessive compulsive route where that leads to thinking, “Now I have to cut my tits off,” pardon my language.
But there’s this urgency of I have this distress, I don’t know what to do about it, so I’m going to interpret that it’s about my gender. Because that gives me something to control, and that gives me something to plan for and to look forward to. So, they are going to take that next step, whatever that next step is, depending on where the child or that young vulnerable person is in their so-called gender journey.
It’s always, “Here’s something I can do about it. I can pursue that next step in passing, or in being affirmed, or in medicalizing my transition, and that will alleviate my distress.” These kids and young people aren’t being given a proper emotional vocabulary, a way of conceptualizing normal or abnormal psychological difficulties.
What would you do in this situation where a child or a young person comes in and says, “I think I’m a different gender than my birth gender?”
A therapist who ascribes to this belief system basically just has to agree with that and maybe even praise it. Let’s be honest. The attitude that you’re taught to have toward these young, vulnerable, confused people is, “I’m so glad that you told me. Thank you for trusting me with this wonderful news about your gender identity.”
I’m exaggerating a little bit, but you’re supposed to be so warm and welcoming and praise this magical truth that they’ve just come out with. And then, you ask about who else knows about this and how do you want me to talk about you when your parents are around? Which then comes down to the issue of how we’re triangulating parents and children.
Now, we are just focusing on how you’ve discovered this wonderful thing about yourself and found the courage to tell me and trust me with this important fact. How can I support you in your gender journey? Do you need help coming out to your parents or educating them? Do you need help socially transitioning at school? That’s the next step that therapists are expected to do with that approach.
A number of young people in the film mentioned that by the first visit or second visit, they were already being prescribed drugs of some sort, which is very difficult to fathom.
Right. The role of the therapist here is interesting, if you look at how mental health clinicians intersect with the medical system. I am an LMFT, a licensed marriage and family therapist. I’m a master’s level clinician, which means I have a master’s degree in counseling psychology. I have internship hours that I accrued under supervision after that to gain licensure and I passed an exam.
There are other master’s level clinicians like an LPC, for example, a licensed professional counselor. That’s another type of master’s level clinician. You have clinicians who are at the master’s level rather than doctors. When it comes to doctors, you have clinical psychologists, but then you also have psychiatrists who can prescribe.
When you look at master’s level clinicians, we have to stay within our bounds in regards to medical advice. We learn how to recognize signs that a person might need to work with a doctor on certain issues. For example, there are certain nutrient deficiencies that can cause depression and anxiety.
As therapists, we can’t say, “I think you must have low vitamin D levels,” But within my scope of practice I could say, “We’re living here in the Pacific Northwest and it’s the winter and many people are low in vitamin D. You’re presenting with signs of fatigue, loss of interest, and loss of pleasure. When was the last time you saw your doctor and had some routine lab tests? Maybe there could be a vitamin D or other deficiency. We just want to make sure we’re ruling that out.”
Another thing that I could say within my scope of practice would be that if someone is presenting for depression, but there’s a sign that they have sleep apnea, we know that untreated sleep apnea can make all kinds of mental health conditions worse because your brain is not replenishing at night. So, I would suggest that they work with their doctor on treatment.
Normally, we stay within our limits. If a client comes to us saying, “I want to take medication for depression or anxiety or ADHD,” well, we can help them process their thoughts and feelings on the pros and cons about that. We can provide a certain amount of psychoeducation, but mostly we refer out to other professionals. Now, contrast this with the role of the therapists in the medical system with this gender-affirming care, therapists who are practicing, “writing letters recommending surgery.”
Now, under the so-called informed consent model, a therapist’s letter is not even required. The letters are pretty useless anyway, because anyone who’s writing those letters has already been indoctrinated. I don’t think that there’s a proper process of assessing and ruling out who is and isn’t a fit for any of these interventions. But we’ve been asked to go outside of our limits and recommend that people take these medical steps. It’s confusing, and it’s a boundary violation.
The assumption is that the mental state is the correct state and the body is what’s wrong. I’ve also seen this slogan, “Nobody is born in the wrong body,” and I guess this is a response to that. It would seem to suggest that gender dysphoria isn’t actually a condition. Can you help me untangle this?
Right. There are two questions there. The second one being whether gender dysphoria is a diagnosable mental health condition. But the way you put this initially is really important to explore, this idea that it’s the body that’s wrong and the mind is fine. That seems like an interesting way of defending against shame.
You can look at the fact that so many of the vulnerable young people who are presenting with gender dysphoria are autistic, and many of them have trauma histories. They’ve been bullied, and they’ve been abandoned. We know these kids are overrepresented in foster care and adoption. Oftentimes there’s deep attachment wounds, and deep issues with having a loving, stable connection with one’s family. The natural response to that is shame and inadequacy.
That shame can be so painful and so overwhelming. It really takes a lot of maturity to learn how to integrate our shame and tolerate it. So, there is this idea that there’s nothing wrong with me, my identity, my mind, my psyche; it’s my body that’s wrong. That’s why I’m different.
It’s a really convenient explanation for defending against the shame of these kids, especially the ones who’ve been bullied because they’re autistic. Autistic kids are socially awkward. They’re often bullied, and they don’t understand how to process that. They don’t know why they’ve been mocked and made fun of, but they sure feel badly about themselves. So, there’s already enough shame there.
It’s very tempting to have something that says, “Oh, this is why I’m different. This is why I’ve been made fun of and then, I don’t have to feel that shame.” The idea of therapy though, proper exploratory therapy or watchful waiting feels intrusive, because if you’re walking around with this intolerable level of unprocessed shame that there’s something fundamentally wrong with me. There’s something corrupt about me that people just don’t like, and I don’t know what it is and I don’t know how to control it.
The idea that a therapist could see that thing about you is really alarming. It takes the right sort of situation and the right sort of clinical relationship to help someone who’s walking around with that much shame and anxiety to understand what therapy could be for them.
A lot of these young people are very guarded against the possibility that anything could be “wrong” with them. They also are resisting the hard and abstract work of self-improvement that comes with the healing process.
There is often trauma that is associated with gender dysphoria. Is that 100 per cent of the time? I think it almost always is, from what I’ve been reading.
I don’t know the comorbidity rate with a PTSD diagnosis. Like I said, with the Tavistock GIDS program referrals, 48 per cent of those young people had autism. I do know that with adoption, foster care, sexual trauma history, as well as homosexuality, we’re seeing high rates of those in youth presenting with gender distress.
Clearly, you’re not a gender-affirming therapist today, but you were at one point.
I came of age at an interesting moment. I went to grad school from 2010 to 2013, right as this stuff was starting to take hold, but kind of marginally. Our class had one social justice warrior, but I’m imagining that grad schools now have 90 per cent of the people in those classes having the same attitude as that one social justice warrior did back then. I don’t honestly remember learning about gender dysphoria or the idea of trans in grad school, except we had a psychopathology course where we study the DSM.
I came of age in an interesting time because when I was in grad school, we were still operating under the DSM-IV Diagnostic and Statistical Manual of Mental Disorders. We were studying the fourth edition, knowing the fifth edition was about to come out. I believe 2013, the year I graduated, is the same year that the DSM-V came out.
So. I didn’t get a lot of exposure to this in grad school. Then, between when I started practicing in 2013 to now, 10 years later, there has been an exponential rise. It wasn’t until 2017 that I went to a training for so-called gender-affirming care. In retrospect, it was quite shocking. Every time I talk about this training, I just think about how therapists have this polite, deferential, agreeable nature and we all sit quietly and do as we’re told. I think about the company culture and how that can affect how we relate to training. I also think that training was, in retrospect, a departure from how training normally goes.
It was really led by an activist in disguise telling us, “This is the model now and you must comply.” I have a vague recollection of one or two people raising issues and being kind of shut down. After that, we were expected to comply, and there was a lot of pressure. At the time, I was a younger therapist working for group practice, as opposed to an older, more experienced therapist, or a more independent therapist in private practice, which I am now.
In a company or agency culture, there’s a lot of pressure to be kind, agreeable, and conscientious. You don’t want to create problems for anyone, and you don’t want to look like you don’t know what you’re talking about. Even though we were being sold this really radical and frankly absurd idea, I don’t think anybody wanted to look like they were the bad guy.
You go in with this deferential attitude like, “What I’m being told seems counterintuitive, but they must know something I don’t know.” It took me years of going along with this thinking—they must know something I don’t know—until I finally reached the point where I realized I actually know something that is important, and now I have something to say.
Was there some defining moment where you thought to yourself, “I am going to change how I treat this?”
I wish that I could identify one. It was such a gradual process for me, working with these trans-identified young people and not seeing them get better and feeling like we couldn’t talk about the elephant in the room. I was feeling deeply conflicted about what I was supposed to be doing.
Because on the one hand, when I worked for that company, there was a slight bit of pressure that if you were a good therapist, you would go to the next level of training where they taught you how to write these letters, basically rubber-stamping people for surgery.
I always felt like, “I should do that,” but a part of me didn’t want to. I was just seeing these young people not getting better, and having that question in the back of my mind of, “Is this really necessary for the ones who were pursuing surgeries and hormones, is this really it?”
Especially when I was seeing other issues; autism, trauma, eating disorders, and homosexuality, you name it. As much as I had my doubts, I was being sold this story that this is what’s going to help these people get better. If you’re not seeing what’s on the other side of that, then you just have to believe it.
But then I found out about detransitioners. My first exposure to detransitioners was finding out that their stories were being suppressed. That was the first time I heard about them. I heard about how trans-rights activists were trying to stop 60 Minutes from going through with their story on detransitioners. I thought, “Wait a minute, I need to hear this side of the story.”
That’s when I started listening to detransitioners and phasing out accepting trans-identified people into my practice as new patients. I was wrapping up the work that I was doing with my existing patients, and really just keeping the focus on the things that they were there to talk about. I didn’t question or push back because I thought that that would be too risky to our therapeutic relationships. I researched the issue for about a year or two before I said anything publicly to anybody.
Was one of the reasons why you were afraid to do that because you often hear this told to parents, “If you don’t affirm, your child is going to commit suicide or there’s a higher likelihood they will commit suicide. “ Presumably, therapists learn the same thing?
Yes, and it’s such a dangerous myth. We do see higher rates of suicidal ideation in trans-identified young people, but we really can’t separate that out from their comorbidities. You can look at all the comorbidities; depression, anxiety, OCD, body dysmorphia, and eating disorders, which is a major one that I hadn’t mentioned yet.
If you look at all the psychiatric comorbidities, as far as I’m aware, the rate of suicidal ideation amongst trans-identified youth isn’t higher than non-trans identified young people who also have those same comorbidities. But we do have to consider that a lot of these young people are actually being told on the internet and by their peers that they should be threatening suicide to get what they want; that affirmation from their parents, or whether it’s a binder or puberty blockers or hormones. Therefore, we do see a higher rate of suicidal ideation in general.
However, ideation and behavior are two different things. Suicide attempts or self-injurious behavior and completed suicide are very different. For every one person that actually completes suicide, there are many who attempt and end up in a hospital or not even needing hospitalization depending on the degree of self-injury. The thing is with teenagers that they can be very impulsive.
To put it more casually, they can be dramatic, they’re kind of known for that. Teenagers are actually quite safe in their home environments with their parents, because the love that a parent has for their child is one of the most powerful forces that we know as humans.
If people say, “Your child will commit suicide,” First of all, “will” means might. “Commit” means attempt—not complete. When a child expresses any degree of suicidal ideation, appropriate therapy involves really exploring how far they’re going down that train of thought, and whether they actually have access to any type of weapon, sharps, pills, a vehicle that they could drive off a cliff, or whatever they’re thinking.
You need to know if they have a specific plan in mind and you need to assess their reasons for wanting to die, but also their reasons for wanting to live. Usually, there’s a fair amount of ambivalence and there’s almost always at least one thing that’s keeping them going.
Unfortunately, for a lot of these trans-identified youth, the thing that’s keeping them going is the fantasy, that dangling carrot of, “If my parents will just affirm me and if I can just transition,” but all of that is socially mediated. If we were to expand it and get them off of that kind of obsessive way of thinking, there’s usually something else to live for too.
It could be their cat, or it could be wanting to see their favorite band in concert. It could be wanting to go to the college that they’ve dreamed of. It could be having a crush on someone. My point is, just because a teenager expresses having thoughts of suicide or self-harm, it doesn’t mean that they have a plan. It means an intention, and it certainly doesn’t mean they’re unsafe at home.
As therapists, we’re all trained to guide parents through this process of how to inspect your child’s room and remove sharps, lock up sharps and weapons, lock up pills, and conduct checks every 15 minutes if you have to. Remove their door if you have to. There are things that parents can do to protect their children.
The threat of suicide has been grossly distorted and people have been backed into a corner and intimidated in a way that’s really quite sick, because that is truly every parent’s worst fear. I happen to know, not professionally, but personally, a parent who has lost a child to suicide. The fact that people are making light of that by using it in a manipulative way is just morally abhorrent.
My concern is for the long-term suicide risk. Adolescents are actually pretty safe as long as they have parents who are not neglectful. We have plenty of data on suicidality, and all therapists are trained to understand some of the basic risk factors and protective factors. One of the biggest protective factors is responsibility to children or loved ones. So, we’re talking about lifespan suicide risk.
If you’re a therapist like me and you’ve been in practice long enough, you’ve had that experience of actually sitting with someone who’s deep in depression and who’s actually had fantasies of driving their car off a cliff. We’ve actually had these conversations, and then you ask them, “What has kept you here so far?
“How come you didn’t do that on your way home from work last night?” If they have kids, it’s definitely the first thing out of their mouth. If they don’t have kids, but they have a husband or wife or somebody that they love, it’s like, “Well, I couldn’t do that to my loved ones.” That’s always the first thing out of their mouth.
Responsibility to loved ones is a huge protective factor, even for people who are in the worst part of depression. One of my concerns for why so-called gender-affirming care is so harmful is because it actually takes away that protective factor. We’re sterilizing a generation who will not be able to have their own kids, and we are altering their sexual functioning in a way that’s going to make it more difficult for them to have loving relationships.
You take away people’s ability to have families, to get married or have a long-term stable loving relationship. You just took away a huge lifelong protective factor. Engagement in hobbies is also a big protective factor, and also the ability to do things that make you feel good physically, like sports, dance, and exercise.
They are huge protective factors, as well as helping people exercise again if they’re in the depths of depression, and helping people remember things that they love doing and pick those interests up again. We’re potentially taking away those things as well, with so-called gender-affirming care.
Why? Because puberty blockers create problems with bone density. We’re inducing osteoporosis and osteopenia. In our documentary, David medically transitioned to living as a woman in his adulthood just using estrogen. He didn’t take puberty blockers as far as I’m aware.
He developed osteoporosis and osteopenia. He was walking with a hunch. We’re actually inducing disabilities, and that’s just the bone stuff. I’m not even talking about blood clots, heart attack, diabetes, and all of the other medical complications that result from these things. We’re inducing chronic pain. Chronic pain is a major risk factor for suicide. People who live with chronic pain disability or chronic illness are across the lifespan at a much higher risk of suicide.
Again, speaking from experience, I lost someone to suicide, and it is speculated that chronic pain and disability was one of the reasons that he felt so hopeless. I’ve also had that clinical experience, talking to people about what makes them feel so desperate that they’re thinking about ending it.
It is when you can’t get out of bed, not just because you’re depressed psychologically, but because you’re in pain physically and you live with that day in and day out. You can’t do the things you might have enjoyed, and you can’t go out with your friends and you can’t work.
We are also putting people in a situation where their ability to work is going to be impacted because of the increased risk of all these diseases and disabilities, combined with the problems that we’re creating for people cognitively. Because we also know that these drugs affect people cognitively. Puberty blockers impair brain development, specifically with regard to executive functioning and emotion regulation.
Taken to an extreme, you’re looking at the potential for crippling levels of attention deficit and emotion dysregulation. Borderline personality disorder is the behavioral manifestation of somebody who has extreme chronic issues with emotion regulation.
When someone can’t concentrate, can’t function, can’t take care of themselves, can’t stabilize their emotions, and can’t deal with life’s ups and downs because their brain has been chemically altered during a developmental period—yes, you’re setting people up for poverty and unemployment. These are huge risk factors for suicide. I could go on; so-called gender-affirming care is full of these risk factors.
The worst nightmare for any parent is their child committing suicide. I imagine one of the worst nightmares for a therapist is a patient in their care committing suicide. Given the strength of this ideology, I’m trying to imagine being the person that says, “I’m not going to affirm,” and then, what if that suicide actually does happen?” Suddenly, it’s clear that you’re the villain, or at least in this thought construct that I just described.
Yes, and you’re right. Therapists have, I would say, two main worst fears. One of them you just described, the fear that our patient will complete suicide. The other is more self-centered. It’s that we will suffer attacks against our license and potentially lose it, and I have faced those attacks.
One of the flaws in the typical personality profiles of a therapist is we’re a little too fear-based sometimes. We work so hard to get our licenses. We sometimes go into hundreds of thousands of dollars of debt for graduate school. And then, after getting a graduate degree, we have to complete thousands of supervised hours, and we work so hard to study for this exam. We work so hard to get our licenses.
We’re just so afraid of losing them. Between the fear that someone could make a complaint against your license, and the fear that one of your patients could end up hospitalized or dead, those two fears keep us acting from a place of fear rather than a place of courage, rather than trusting our intuition and acting honestly, and doing what love would compel us to do. Ultimately, we can never really control either of those.
Again, speaking from personal experience, while I personally have not lost a patient to suicide while they were under my care, while I worked in my first job in the mental health field, I worked at a facility where my coworker, who was quite young and vulnerable herself, was the primary counselor to a resident who died of suicide while we were there.
I’ve seen how this affects people, and he was not the one we were most worried about. We had a very high acuity population. We had people with psychosis, schizophrenia, schizoaffective disorder, complex trauma, personality disorders, people who had been in and out of the streets, in prostitution, and on drugs. We were working with a very high acuity population.
We had many people we were a lot more worried about than this young man, but he was the one who took his life during this time or actually shortly after leaving, and we found out about it. You can just never know. Like I said, I’ve also lost someone to suicide. He was a therapist. He was a brilliant therapist who saved people’s marriages and he died of suicide. Again, it’s speculated that chronic pain and disability was a reason for that.
You just never know. My message to therapists that I want to encourage to be bold on this issue is that, yes, it is scary living with the knowledge that you could face a threat against your license or that a patient of yours could complete suicide. Just like it’s scary having a child and knowing that something bad could happen to your child.
It’s a fear that you choose to take on living with every day as part of the package, part of the responsibility that you’ve taken on. But you do it because it’s meaningful, and ultimately, you can never know whether going this way or that way will make things better or worse. A lot of parents who are concerned about their trans-identified youth are in a very similar position.
They ask me questions like this, and it’s coming from a place of so much fear and worry for their kid. They ask me, “If I say this, if I do that, do you think that’s going to push my child further away? If I draw a harder boundary and tell them what I really think of all this gender stuff, is that going to push them away? Am I going to lose my kid?”
The answer is always, “Maybe so, maybe not.” So ultimately, given that we can never fully predict or control the impact of our actions, we have to choose some kind of guiding value, and I just don’t think fear is a very good guiding value. I think courage and love are better guiding values.
You did mention that this gender-affirming care doesn’t work as a therapy, whereas this watchful waiting, which you referenced briefly and I’m becoming more familiar with over the last months, is something that actually has been shown to work.
Yes. We don’t have evidence that the long-term outcomes for these kids are going to be any better, and gender-affirming care doesn’t actually propose any particular approach to therapy itself, other than just agreeing with the patient. Watchful waiting, which you described, it’s also not particularly an approach to therapy. It’s not a whole therapeutic toolkit.
It’s basically just the message that if a kid presents with distress or confusion about their gender or sexual identity as a young person, just don’t do anything about it. Just let them be a kid and give them time and chances are, they’ll grow out of it. Usually it will turn out that they are gay. At least that’s how it was before this became a social contagion, back when the rates of gender dysphoria were lower.
Most of the people who had gender dysphoria were males. Now, the gender ratios flipped, and mostly they would turn out to be homosexual, and puberty was actually the cure. Just going through the natural process of puberty, the gender dysphoria would desist, because the kid becomes a sexual being as they go through adolescence.
As they develop an identity in adulthood, hopefully if they’re in a supportive environment, they can come to terms with accepting themselves as potentially a gay or lesbian person, or simply a so-called gender-nonconforming, tomboyish girl, for instance.
Watchful waiting is basically just the idea that we don’t need to pathologize gender nonconformity, or gender atypicality, which is a more kind of neutral term that Leonard Sax uses. I like gender atypicality. We don’t need to pathologize that. Kids will be kids, they’ll play around with different identities. Kids will believe in all kinds of things. We as adults need to just watch and wait.
You watch and wait, but it sounds like you can also try to address some of these other comorbidities which are almost always there.
Exactly. If you look at gender dysphoria 20 or 30 years ago, before it was a social contagion, some of the reasons that a young person might present with feeling of distress over being a boy or being a girl, might have to do with their social environment. Let’s say they’re a gender atypical child in a household that adheres to gender norms.
It’s going to be more distressing if you’re a girl who wants to play in the mud, growing up with a mother who wants to dress you up in pink and tell you how a good girl should act. That mismatch with your environment is going to create more distress than that same girl with that tomboyish disposition who wants to play in the mud whose mom says, “Yeah, go for it. Dinner is at six.”
The social environment plays a role. But yes, in this day and age, we increasingly see that a variety of mental health conditions are all kind of getting subsumed under this gender dysphoria umbrella. We’re not looking at what’s really going on, and why they’re feeling so much distress in the first place.
You mentioned now there’s a lot more girls than boys. I’ve heard about this rapid onset of gender dysphoria and that it almost functions like a social contagion. There have been some papers written showing that this is a thing. How did this happen, exactly ?
The term rapid onset gender dysphoria was coined in 2018 by Dr. Lisa Littman, who’s also featured in our film. She’s a physician and a scientist who noticed the same pattern of one after the next group of adolescent girls all suddenly declaring that they’re boys, typically all together.
Dr. Littman has done some really great work looking at the pattern of these clusters of socially-influenced groups. In that study, she talked with parents about their observations about their children’s behavior. And then, she also did a study on detransitioners that was illuminating as well.
We talked very briefly about this as we were preparing, and it’s something that I’ve been interested in. There is some evidence of a connection between consumption of pornography and gender dysphoria.
Absolutely. I’ll divide that connection into two broad categories; male and female. With males, we’re looking at an older cohort, typically heterosexual, and autogynephilic, meaning attracted to the idea of themselves as a woman. That cohort tends to be influenced by certain, how shall I say it, deviant porn that they’ve gotten into after a process of becoming addicted and needing higher and higher levels of stimulation.
I am more interested, for the sake of our conversation today, in the experiences of these young women. Because it’s now increasingly prevalent that adolescent girls even, not just boys, are being exposed to pornography at very early ages. Even for the girls who aren’t exposed, they are around boys who were looking at that porn, and that porn is shaping the boys’ behavior, and their expectations of the girls.
Girls are either getting exposed directly to these horrifying images of being exploited as being associated with what it is to be female, or they’re being mistreated by boys. For example, I’ve heard many stories now of girls whose first sexual or romantic experiences were very pornographic in nature, because of how the boys that they’re interested in have been shaped by porn culture.
This combination of factors of how porn is directly and indirectly affecting girls is understandably making these girls quite frightened at the idea of being female, if this is what it means, if what they’re seeing in porn is what it means to be female. Who can blame them for wanting to opt out and say, “No, thanks, that’s not me.”
Then, they have this alternative idea of being a boy, and specifically for many of these girls, the idea of being a gay boy, which is fed into by, I believe, anime and other aspects of online culture that I’m not terribly familiar with. It’s like, they get this horrifying porn, this degrading, humiliating gross porn on the one hand that says, “This is what it is to be a female.”
Or you could be this sweet anime gay boy who has a love story. Those love stories, they’re being shown with the anime, and I’m sure there’s more words for it, and some listeners probably know more about this than me, but there is a whole online culture in which these young people fantasize about these kind of idealized gay boy relationships that are very affectionate and romantic and loving, which is what girls have always wanted. It seems that these girls like the path to having a safe, affectionate, loving, sweet, innocent relationship, which lies in being a boy rather than being a girl.
These days, what kind of patients do you work with?
I still see ordinary people who aren’t particularly concerned with gender over other issues, and I work with couples as well. But for the people concerned with gender, I work with detransitioners and parents who are worried about their children. I don’t work with gender questioning youth because I’ve already faced threats to my license. It’s very easy if I were to work with these youth for them to Google me, become outraged and submit another complaint to my licensing board. So I stay out of that, but I work with parents who are concerned about their youth.
You’re working with the parents, not their kids.
Right. Parents who come to me are typically extremely stressed out. This crisis takes a toll on the whole family, on their sleep and their wellbeing. Sometimes we have to talk about self-care. Also, I want to say that my background, my professional training is in understanding and working with family systems, and looking at how all the parts connect.
What we see in families with trans-identified youth is that the youth are sometimes what we would call in family systems theory, the identified patient, meaning there’s a problem in the whole system. The whole family is not well, but there’s one person who manifests that unwellness and typically becomes scapegoated for it. Sometimes you’ll see that the youth presenting with gender distress is the identified patient in the family.
It’s really just a symptom. My job is to look at what it is a symptom of. What is the symptom trying to diagnose the system with? Since I’m not working with the youth, I’m hearing the parent’s report, and I’m getting a picture in my mind. I do have some pretty good skills with regard to when someone tells me about someone else who’s not present.
I can usually make inferences and I’ll say, “It sounds like this person might react this way. Does that sound like them?” They’ll say, “Yes, that is how that person would react in that situation.” So, I’ve gotten good at consulting about someone who’s not present in the room. These parents tell me what’s going on with their children, and I help them identify what it could be a symptom of.
For example, in some families, by the time the youth is identifying as trans and the family is getting into conflict over that, it’s just the pinnacle of something that’s been developing for a long time. It’s sort of the image of the glacier where there’s only a little part that’s above the water. The part we can see is the trans identification.
But there’s so much that came before it that might have to do with problems in the marriage, difficulty figuring out how to parent together, maybe unprocessed trauma dating back generations, and even skewed roles in the family. There are times where these kids are trying to control or alter something in the family system by presenting with this distress.
That’s why I ask the question, “What is this diagnosing about the family system?” And then, I work with the parents on what they can do. If the parents typically haven’t had very good boundaries, then I work with them on boundaries. I work with them on staying emotionally grounded, but also understanding there’s a huge cognitive piece to our work together, because I help them understand the mentality of a teenager who’s been indoctrinated into a cult.
I provide a lot of psychoeducation on what these kids are being exposed to. That’s another thing. A lot of these parents, some are in their 30s, but a lot of them are in their 40s and 50s. They may not have grown up with the internet. They’re certainly not as immersed in it as their teenagers are.
I’ll get parents coming to me saying, “My kids said the craziest thing, can you believe this?” And then I say, “Yes, that’s what they all say. It’s a TikTok trend.” It sounds crazy, so I’m educating the parents on what their kids are being exposed to, helping them understand what their kids are going through, and I do that with a lot of compassion for the kids. But it doesn’t mean that we have to agree with the kids’ self-diagnosis or their preferred way of addressing the situation.
You referred to the term gender cult earlier in our conversation. How is it a cult?
Boy, how it is not a cult would be a shorter list. The one thing that cults typically have that the gender cult does not is a single charismatic leader, but you still do have several charismatic leaders. There are many of them, and they’re internet influencers; the Jeffrey Marsh’s and the Dylan Mulvaney’s of the world, and that Addison character. You have these public figures who get a lot of attention.
The splitting off of vulnerable, young, naive in many ways, but also very bright in other ways, young people from their families is a classic move of cults. If you can drive a wedge between parents and their children, then you have vulnerable people at your disposal who still need love and something to attach to, someone to idealize, and something to believe in. They’ll work very fervently for the cause that you reattach them to.
The family triangulation is a big one. Obviously, it’s a body modification cult, that is literally what it is. It has this bizarre kind of quasi or pseudo-religious way of thinking about the world. There’s a lot of magical thinking.
There’s a lot of nonsensical ideas that you have to buy into to believe in this stuff. For example, there’s an episode of my podcast called The Myth of the Magical Child with Matt Osborne, where we talk about how he was raised being told that he was an indigo child, and he sees the similarities between the idea of the indigo child and the idea of a trans child.
Again, there’s a departure from reality where the normal laws of human nature don’t apply, like the idea that a child knows who they are, and that what a teenager wants right now is what’s always going to be good for them. There is this suspension from disbelief.
If you look at the progression of cults, there’s a lot of similarities here as well. Where again, you start off with young, vulnerable people, many of them gifted, quirky, weird, and you start off with love bombing them, giving them this idea of belonging and that it’s all going to be so great when you join us, and it’s just literally rainbows and glitter. Those are the symbols that they use.
So first, there is this love bombing, “We are your family now. It’s all going to be better when you join us and when you take these steps.” But then you progressively have to give up more and more of yourself in order to please them. There’s always that dangling carrot of, “Well, if you’re really one of us, then you’re going to take these steps.”
Of course, that first step is social transition and social affirmation. It might be things like binding, taking puberty blockers, cross-sex hormones and surgeries one after another. It’s typically not just one surgery and these surgeries have a high rate of complication. There is always that next step that you are expected to take. “We love you so much, but also you’re not really one of us if you don’t take that next step, if you don’t fight for our cause, if you don’t proselytize our cause.”
I noticed this back when I was still working with these indoctrinated youth, they didn’t want to be around what they called cis people. They wanted to only be around their kind of people, and that is just a reflection that they’re being progressively cut off from the world, and told that the world is unsafe.
That’s something that this has in common with cults as well. The idea that the world is unsafe, and that normal people aren’t special. They don’t get it, and are out to get you. You have to at all times surround yourself with reminders of what we are about. Those are just a few of the characteristics that trans stuff has in common with cults.
One more that comes to mind, and maybe you can comment on this because you do work with detransitioners, there is often a high cost of leaving.
What is the situation?
Detransitioners, I admire the courage many of them have. I know some of them would push back against that saying, “I had no choice.” But they’ve really had to give up so much. Because when they finally realize that this is not what they thought it was, and that these people don’t really love them, and that altering their body didn’t make them feel better, and in many cases it made them feel worse psychologically and physically.
Whenever that all finally breaks down for them, they have to give up everything that they have built their identity and worldview and sense of self on for the past however many years. Sometimes it’s been their entire adulthood. Sometimes it was their entire adolescence and adulthood.
There’s a real shattering of the ego and of everything they thought they knew that had to take place. Then, to admit that to other people is to not only risk losing friends, but to risk having people turn against you, telling you that you are bigoted or that you are indoctrinated into a Right-wing cult now. That’s one of the things that they believe.
Another thing I’ve noticed with detransitioners is so much fear and guilt about letting people down, especially if they pushed their parents into it, or if they feel like their parents really thought they were doing the right thing, or whatever steps they took in whatever relationships to get people to go along with this. They have to walk it back and admit, “I was wrong, and I put you through all that for nothing,”
You can look at some of the worst case scenarios, and not to say that all of these have been things I’ve seen in my office, but things I’ve heard in different situations. There are people whose parents divorced over this. What is it like to feel like you are responsible for your parents divorcing, because you were so sure that you were trans and you were so adamant, that mom who was backing you up was right, and dad was the bad guy?
And when mom decided to divorce dad over this, you had mom’s back and you thought that was the right choice. Now, you realize that you were just in a cult the whole time, and you feel responsible for splitting your parents up. There are a lot of situations like that, and a lot of variations on that, but I think the guilt is about, “Wow, I did so much to get other people to go along with this.”
Then, there’s employment difficulties as well, because for people who have to detransition at work, that can be really embarrassing and in a number of different ways. In one of my podcast interviews with a detransitioner in Australia named Oliver Davies, he talks about how he had been using the women’s facilities at work. He was in the habit of biking to work, and he would shower when he got there.
Then, just as he was gradually realizing that this wasn’t really him, he just kind of walked it back like, “Oops.” But that’s relatively mild compared to what some detransitioners go through with their employment situations, because I’ve also heard stories for examples of female detransitioners who were in male-dominated professions.
When they were passing as a male, they were treated one way, and then when they reverted to living as their birth sex, they were treated a different way. Their experiences of discrimination are in some ways even more painful than the average woman’s experiences with discrimination, because they actually knew what it was like to be treated with the assumption that they were competent.
And then, years down the line with even more experience under their belt, they’re now being treated like they’re not competent because they’re presenting as their birth sex. So, that can be extremely painful and isolating.
One of the things that’s mentioned in the film is when some of these young people get these very extensive interventions, essentially that puts them on a track to basically be medicalized for life. There’s a kind of whole budding industry ramping up for this purpose. Please tell me about this.
Absolutely. It is a huge industry that is growing a lot, and it’s a big money maker for hospitals. Matt Walsh leaked a video from Vanderbilt talking about how much money is in this. There are some charts in our film that show the exponential rise of the profits in this industry, along with the exponential rise in the youth presenting with this distress.
It’s becoming increasingly difficult to believe that this is all happening organically. You’re right that these trans-identified young people are absolutely being set up to become medical patients for life, and that can happen in a number of ways. Once someone is on cross-sex hormones, they have to continue taking those hormones.
If they don’t, if they physically “detransition,” then they are going to encounter another host of medical problems. The detrans young people I’ve met are dealing with really complex and novel medical situations that a lot of doctors don’t know how to treat. If a trans-identified person has certain body parts removed, then they will always have to be on exogenous hormones.
So for females, with a hysterectomy, or for males being castrated, the body parts that produce hormones naturally are gone. They either have to remain on those cross-sex hormones, or if they wish to switch back to their natal sex hormones, they have to take those exogenously as well. So, there’s the dependency on hormones.
There’s also the continual pursuit of more and more surgeries in order to so-called pass for their new gender. Then, there’s the medical complications that these hormones and surgeries create, the increased risk of early Alzheimer’s and dementia, and even psychosis.
That’s with having the uterus removed?
Hysterectomies, yes. But also, cross-sex hormones have been known to create early dementia in males, bone loss or failure to develop bone density, osteoporosis, osteopenia and all kinds of musculoskeletal issues that can result from poor bone structure. There is an increased risk of all kinds of cardiovascular and metabolic diseases, and even certain types of cancers. People are going to become sick for life.
The young people making these decisions are starting off with young, healthy bodies. Most of us accept those who grew up with some kind of disability, most of us can remember how invincible we felt before we’d ever really gone through a major illness or injury.
By the time you get to be my age or your age, we’ve been humbled because we’ve been sick, we’ve been injured and we’re grateful for our health. We don’t take it for granted. I don’t think it’s a coincidence that this stuff is being marketed to young people who have no idea what it’s actually like to live day in and day out with chronic pain and disability.
This is obviously critical information that both parents and kids should know at the outset of having these discussions, and as we’ve been discussing, they don’t often get that information. I’m reminded of something that you posted in your Twitter handle. You have three purposes in life, or in your practice.
The third one is to promote justice and healing for those who have been harmed by gender-affirming care. You’ve converted your practice into doing this, and you also have this podcast called, “You must be some kind of therapist.” You have some really fascinating guests. Please tell me more about what you’re doing to facilitate that healing.
In our film, a therapist named Lisa Marchiano describes detransitioners as shadow people. She talks about how Jung said that the shadow is any part of us that we don’t really want to know about. She talked about her process of thinking about how detransitioners really hold the shadow for society, because society is turning a blind eye.
There are people who are still bought into the idea that trans kids are a good thing, that it’s about compassion and justice. They don’t want to face that shadow of having their faith shattered and realizing that people are actually being hurt by this. So currently, I would say detransitioners are in the shadow, as Lisa Marchiano has described, of our society and really ostracized and outcast, and they can’t get proper medical care.
One of my main concerns as a mental health professional is how badly my field has betrayed these vulnerable people. In many cases, therapists played a role in doing this. We actually pushed people down a path of transition, and it’s not pretty and a lot of people don’t want to talk about it.
But what I’ve learned from listening to detransitioners is that the people who have been medically harmed by this and regret it, in some cases have homicidal levels of rage toward the people who did this to them, including people in my very own profession. So, when I talk about promoting justice and healing for those who’ve been harmed, sunshine is the best disinfectant.
The first thing we need to do is stop putting them in the shadow and start bringing them out into the light and looking at what people are experiencing, being present with the pain and suffering that we have caused them, taking responsibility for that and seeking to earn and be worthy of their trust. Because right now, we’re not. Detransitioners have been medically and mentally harmed by the professionals who are supposed to help them, and now they don’t trust us and that’s our fault.
We need to earn back their trust, and that is not a process that can be rushed. One of the first things you learn when you’re studying to become a trauma therapist is how sacred trust is, how easily it’s disrupted, and what it takes to actually develop that in a healing relationship.
Frankly, detransitioners have no reason to trust therapists like me even, not to speak of therapists who created this mess. Somehow, we need a cultural shift to help society turn the light of day, and our compassion and our desire for justice and all of the liberal values that are caught up in this craze, we need to turn those values toward this new rapidly emerging population of people who are suffering in these profound ways.
We need to start talking about it, and we need to start educating a new generation of professionals to deal with the aftermath, as well as making some societal shifts. For instance, medical care for detransitioners is not properly funded. Can you believe that in some cases Medicaid will actually pay for a confused, distressed young woman to amputate her breasts, but they won’t pay for reconstruction?
Not that you can ever reconstruct breasts, you can’t restore the breast tissue if the mammary glands have been removed. But if she wants at least something cosmetic to help her feel like she’s restoring her dignity, they won’t provide that. The same thing with how insurance will pay for testosterone, but it won’t pay for laser hair removal for females who regret the impact of testosterone on their body.
We need them to get appropriate medical care. We need to train medical professionals in how to deal with the novel and complex medical situations that detransitioners find themselves in. We need to train therapists in a whole new degree of competent trauma therapy.
The film Affirmation Generation is one step in that direction. I really think it’s a film that has the ability to help anyone with an open mind accept its contents. It’s beautiful in that way. So, congratulations again. How can people see it?
Thank you. Affirmation Generation can be streamed online at affirmationgenerationmovie.com. We’re encouraging people to organize screenings for March 12th, which is Detrans Awareness Day. If you happen to be watching this before March 12th, we encourage you to have some friends or family over into your living room or rent a whole theater if you have access to that, or anything in between to share the message that we’re trying to spread.
Our producers really put a lot of thought into how we can share everything that we’ve learned in an hour-and-a-half film. If there’s one thing that you could ask someone who’s on the fence about this issue to do, what would that thing be? It’s to watch this film.
Stephanie Winn, it’s such a pleasure to have you on the show.
Thank you. It’s been great being here.
Thank you all for joining Stephanie Winn and me on this episode of American Thought Leaders. I’m your host, Jan Jekielek.
This transcript has been edited for clarity and brevity.