In 1973, the same year that the American Psychiatric Association stopped calling homosexuality a mental illness, Dr. Stephen Levine finished his residency in psychiatry. Within a month, an unforgettable patient crossed his path.
In 1974, a year after the crisis intervention, Levine continued helping the formerly suicidal patient. He also founded a gender identity clinic at Ohio’s widely respected Case Western Reserve University, where Levine had earned his medical degree before completing his residency at University Hospitals of Cleveland. The clinic later separated from the university and has been renamed a couple times.
Court Showdown LoomsIn that 113-page declaration supporting the Stop Adolescents from Experimentation (SAFE) Act, Levine says: “Science, not politics, needs to drive trans care. ...There has been a rush to treat, and a remarkable absence of ethical concern based on obvious scientific limitations.”
Levine may take the witness stand when the law goes on trial starting Oct. 17 in U.S. District Court for the Eastern District of Arkansas. State Attorney General Leslie Rutledge did not respond to an email seeking confirmation.
Based on Levine’s understanding of the literature, no solid studies have adequately investigated the so-called “gender-affirming” treatments’ long-term effects on a person’s overall well-being, he said in court records. The general state of research about gender-dysphoric children has been called "low quality" in professional literature, he said.
That’s why Levine recommends that other states consider following Arkansas’ lead in putting a halt to hormones and surgeries for such youths.
The Arkansas law has been on hold since shortly after its passage in April 2021. A month later, the American Civil Liberties Union (ACLU) filed a lawsuit seeking to invalidate the SAFE Act. Representing four gender-dysphoric youths and two doctors, the ACLU wants Judge James Moody Jr. to declare the law unconstitutional.
Lightning Rod For ControversyTo detractors, the author of Exhibit 1 might as well be Public Enemy No. 1.
Levine's defenders, however, publicly praise him for a careful, measured, compassionate approach to caring for transgender people. And, on his website, Levine says he has dedicated his work to helping people navigate one of life’s strongest desires: “the ambition to love and be loved.”
Although The Epoch Times was unable to secure an interview with Levine, online sources and court records provide insights into Levine’s research, his understanding of the science, and his opinions about the issues facing clinicians, their young patients and their families.
Multiple sources document a tragic end for Levine’s 1973 suicidal patient. The patient went through feminizing surgery, as desired. Nevertheless, the patient ended up committing suicide about a decade after Levine first intervened.
Dueling PerspectivesIn the Arkansas court declaration, Levine retraces his history as a clinical psychologist. He explains how professionals’ responses to transgender care dramatically shifted. He also criticizes the currently touted “gender-affirming care” model, which calls for automatic acceptance when a child declares, “I am trans.”
That can begin a progression toward changing into the opposite gender, at least in appearance. A person's sex, programmed into DNA, cannot be changed.
“Social transition,” includes encouraging children to start using a new name to match perceived gender identity, along with pronouns, clothes, hairstyles and other adjustments. The next steps can be pubertal-blocking hormones, cross-sex hormones and ultimately surgery—alteration of body parts associated with the other sex.
Jack Turban, a fellow in adolescent and child psychiatry at Stanford University, is among the experts backing the ACLU who dispute Levine’s conclusions. Turban, who also holds degrees from Yale and Harvard universities, is a relative newcomer to researching care for transgender-identifying youths. His first such study was in 2015, records show.
But Turban says Levine and other experts for Arkansas harbor outmoded, “outlier” views. “Their views are not supported by any of the leading medical organizations,” Turban said.
Turban says “all existing evidence indicates that gender-affirming medical treatments improve mental health outcomes” for gender-identifying youths. Another absolute: “There is no evidence that gender affirmation makes persistence in a transgender identity more likely.”
Further, Turban states: “It would be dangerous and unethical” to prohibit those medical interventions.
Experts on both sides accuse each other of omitting important, relevant research findings from the treatises they filed in court. And they disagree over the recent implications of some European companies discontinuing or curtailing some of the medical interventions for gender-dysphoric youths.
'Politics and Ideology' DominateAs Levine sees it, the “core issue” in the Arkansas court case is: Hormonal and surgical treatments spread internationally well before “the objective-reliable-scientific appraisal” of the consequences to gender-dysphoric children.
For nearly three decades, Levine belonged to the precursor of the often-cited World Professional Association for Transgender Health (WPATH). He even chaired a committee that sets the group’s international standards of care.
But in 2002, Levine parted ways with the organization. He had concluded that “politics and ideology” had overtaken “proper, reliable scientific methodologies.”
The group began opening its biennial meetings to “trans individuals who are not licensed professionals,” Levine said. The intent, apparently, was to allow those people to contribute opinions about the care they think they should receive.
As a result, WPATH began taking “a very narrow and ideologically driven view” of controversial issues, Levine opined.
The group says its mission is “To promote evidence-based care, education, research, public policy, and respect in transgender health.”
But, in Levin’s view, WPATH has donned a mantle of advocacy. And that is incompatible with the pursuit of valid scientific findings.
Does The Fix Work?Many proponents of gender-affirming care now seem focused on fixing the patients’ dysphoria with medical intervention without first attempting to understand the factors that may have helped to form it, Levine said. Nor is there much of an effort to identify and address other pathologies affecting the patient, and to consider the person as a whole.
He noted that a number of studies, including one from 2021, have shown that the vast majority of grade-school-aged children will “desist” by adolescence, or revert to the gender identity corresponding with their sex. However, Levine acknowledged that some people who strongly believe in “prompt affirmation and social transition” insist that transgender children very rarely desist—a significant, unexplained change from years past, he said.
If children are immediately “affirmed” in the questioning of their own gender, then fast-tracked to hormones, there’s no way to know how many of those children would have been helped with a “watchful waiting” approach, Levine said.
Some gender-affirmers dismiss the possibility of “social contagion,” spreading among peers and across the internet. But there are multiple reports of children "coming out" as transgender in groups; Levine said that theory offers a plausible explanation for recent surges in numbers of young people self-identifying as transgender.
More Than a 'Time-Out'Meanwhile, Levine worries about the possible unintended effects of puberty blockers, calling them “a major hormonal disruption” of basic human development. These drugs are usually given to early-stage adolescents.
Freezing these children’s stage of development while their peers are changing “cannot be considered a mere 'time-out,' or pause,” he wrote, because it has psycho-sexual-social implications. Yet proponents of these drugs minimize the potential harm “by declaring their effects as reversible,” without good studies of the long-term effects, he said.
Therapy for young children that encourages transition cannot be considered to be neutral because it alters the child’s life path, Levine said, “with highly unpredictable effects on mental and physical health, suicidality and life expectancy.”
“Claims that a civil right is at stake do not change the fact that what is proposed is a social and medical experiment on vulnerable patients."