One aspect of the trans toxic debate has been raging for years: trans rights versus women’s rights.
Another of the many areas of huge contention is how people with gender dysphoria (GD) are treated.
In the treatment of trans people, the norms of mental health professionalism, the ethics applied elsewhere, seem to be, at best, problematic, and at worst, decidedly, self-servingly and dangerously absent.
Those absences present serious risks to GD sufferers, and raise worrying questions about the integrity of people working in the field. Here are just some.
Where does “affirmative only” care end and false hope begin?
Has the trans epidemic become a trans “scamdemic”?
Is the “therapeutic” validation of all claimed trans feelings driven by delusional thinking, political ideology, or personal/professional gain, or all three?
Have feelings become more important than facts in the minds of some mental health “professionals”?
If you are trans, or care for someone who is, are you or they at risk of being subjected to the dangers and consequences of what amounts to conversion therapy by “affirmative only” ‘therapists’?
Where does “affirmative only” care end and false hope begin?
The “affirmative only” approach, is widely used to describe gender-affirming care. It places the highest priority on validating and affirming a person’s self-claimed, self-identified gender feelings, whatever the biological or factual reality.
The affirmative only approach puts GD sufferers on the fast-track to access social, hormonal, or surgical interventions.
Advocates claim that such an approach is “scientific” and “evidence-based.” Yet those same advocates, after the Tavistock scandal, refused to hand over the evidence that would have enabled independent scientific analysis.
Of the studies that advocate the “affirmative only” approach, I am unaware of any that have been conducted by those authors who have no overt or covert interest in the outcome of the studies. Neither am I aware of any that were not funded by those who had an interest in choosing which piper to pay to ensure their desired tune was played.
That is, there appear to be no properly conducted, scientific studies which have not been contaminated by either political ideology, toxic wokery or financial motives. Such “studies” are little more than propaganda masquerading as science.
There can be little doubt when a person’s GD is so severe that they are at serious risk of suicide, that giving them some hope is better than the person ending their lives.
However, it may be that the affirmative only approach crosses multiple ethical lines into “false hope.”
Persuading a person to embark on a course of gender reassignment holds out the false hope that they can resolve their deeply ingrained psychological issues by medicalising them.
There is no known medical cause of GD. That means medicalising the problem cannot cure it. There are dozens of highly plausible psychological causes, and around 80% of people solve their presented GD challenge by changing their psychological position.
Multiple independent studies have found that many people who have gone through “transitioning,” expecting to fix their social or mental health problems, actually experience persistent distress and ongoing mental health problems post “treatment.”
Even partial transitioning, (hormonal “treatment” only), does not reliably reduce psychiatric symptoms.
It seems many people who have been persuaded to have sex “reassignment,” as a cure-all for their GD, end up with severe nerve damage, and/or urinary tract infections, and/or incontinence, and/or are rendered anorgasmic for life. Almost all are sterilised.
In some cases, all four new afflictions are ongoing, for life, and are added to the burden of their existing mental health morbidities.
One of the most alarming aspects of the “treatment” of GD, is that around 80% of people who present with that challenge, go on to live a gay or non-binary lifestyle. That is, 100% of people are given the “affirmative only” approach, leading down the path of full transition, when in fact, four in every five seem to be merely conflating or confusing sexuality with gender identity; they misattribute their sexuality differences as gender incongruence.
The 80% who are, therefore, being inappropriately subjected to the “affirmative only” approach may be caused further harm by such mistreatment.
What would be safer, ethically acceptable, and more effective?
The approach I have taken to help GD presenters, I call “Conflation Exploration.” It seems more ethical and responsible. In this approach, all forms of confusion over sexuality, gender, masculinity or femininity are explored.
Conflation Exploration involves those people presenting with GD learning about the wide range of gender identities, gender roles, sexualities (and more) which exist across the human spectrum.
We explore, drawing on the perspective of their own observations, that there are extremely feminine men and exceptionally masculine women who are completely heterosexual, and uber masculine men and ultra feminine women who are exclusively homosexual. We note that some androgynous people whose biological gender is hard to determine at first sight, can be heterosexual, homosexual, bi-sexual, or asexual, and that some people move fluidly through various forms of sexuality and gender identity over the course of their lives.
Since education is almost always part of any responsible, ethical and effective psychotherapy, it seems reasonable that all people who present with GD can benefit from learning about the variety of gender and sexuality identities, and how flexible and fluid are those self-perceptions. Doing so helps GD presenters understand their current self-reported internal experience.
Under the “affirmative only” regime, imposed on therapists, what seems to happen is that in at least 80% of cases, GD presenters find that their “therapist” colludes with them about their gender misattribution, and ignores their sexuality conflation and confusion.
In most professions, such unethical, harming behaviour would lead to such “therapists” being struck off.
In medicine, giving people false hope, a ‘cure-all narrative,’ is a career ending ethical breach. Why is that behaviour thought to be even remotely acceptable in the treatment of people presenting with GD?
Has the trans epidemic become a trans “scamdemic”?
The trans epidemic is taking place on a massive scale. Around 5% of young adults in several Western countries are now presenting as gender dysphoric.
Transgender ideologues claim that the massive and increasing numbers are to be expected as a result of greater awareness.
Concerned parent cite those same figures as evidence of social contagion and ideological capture; some are so alarmed that they describe the rise in presented cases of GD as the “woke mind virus.”
There is no doubt that therapists, physicians, drug companies and social ideologues stand to benefit substantially from the promotion of “affirmative only treatment.”
Many “therapists” have their entire livelihoods dependent on the affirmative only industry. Once committed to the gender reassignment path, the ongoing lifetime financial costs to GD sufferers, and society, are enormous.
The incentives for dodgy behaviour are substantial. There have been multiple exposures of clinics behaving in the most self-serving and despicable ways, in full knowledge of the short, medium and long-term harm being done to the GD clients who (unwisely) trusted them.
Alone, the financial self-interest motive cannot explain the affirmative only approach. While clearly ethically conflicted and potentially dangerous to the 80%, it does bring benefit to some; the 20%.
Of the 20% of GD presenters who go down the transition pathway, there is no doubt that around half of them have their levels of depression reduced after they have been prescribed hormones. That is, around 10% of the total number of GD presenters seem to benefit from the affirmation only approach imposed on the 100%.
Of the 10% who psychologically benefit from physical hormonal treatment, it is probable that around half are responding to the placebo effect. That is, only around 5% of people presenting with GD have improvements in their mental health because of the hormones, yet, alarmingly, 100% seem to be encouraged down the transition pathway.
In no other field of health care would a “treatment” approach that is effective in 5% of cases be considered ethical or safe to impose on 100% of cases.
It is highly likely that the earnings and profit motive are major factors driving the massive increases in the diagnosis of GD. Many people who are now “transitioned,” are likely to be that way, living with lifetime health problems, because their “therapy” was provided more to treat their therapist’s wallet that any presenting symptoms.
Does the heavy financial motive to steer people down the transition pathway mean there is a conspiracy, an organised scam, a scamdemic?
If there is, it would be almost impossible to uncover; such covert conspirators rarely do anything other than cover-up their crimes and destroy those who try to expose them.
Much more likely is a “conflation of interests”. That is, the parties who have their own interests in the “affirmative only” approach (with all its benefits to them personally), each, independently act in the same direction: to push gender dysphorics down the transition pathway. If there is a scamdemic, it can thrive without the need for any orchestration or coordination.
For balance, I should say this, there are some great therapists out there, who acknowledge that if someone presents with GD, it is that person’s claimed or perceived experience. But competent therapists do not cross the line into affirming that experience, any more than they would affirm to a paranoid person that “yes, they are out to get you.”
Acknowledging the perceptions of a person’s reported experience is very, very different from affirming the experience as reality, and every competent therapist follows that principle. At least, in all areas other than GD.
Those blinded by ideology take a different view. By prioritising claimed or self-reported subjective experience over objective reality, in 100% of cases, they cross an ethical and professionalism line, and perform all sorts of reasoning gymnastics to justify doing so.
Alas, there seem to be far too many “therapists” who do cross that line. Why?
The motives behind gender affirmation
In all probability, there is a combination of all three drivers, and the precise weighting of each depends on the individual motives of those benefiting from the transgender industry.
Some therapists may genuinely believe that the “affirmation only” approach is appropriate from the perspective of patient autonomy and well-being; they believe in a psychological framework that prioritises self-perception and self-identification over fact or reality.
Expressed crudely, if a person self-identifies as a boiling kettle, in the mind of trans ideologues, that ought to be affirmed because it is the person’s actual experience, and it is not appropriate to challenge their perceived, claimed or even delusional emotional reality.
Such an approach is clearly not evidence-based, and cannot be; no-one but the person making the claim to be a boiling kettle can know whether or not they are actually steaming hot.
In the vast majority of cases of GD there are mental health comorbidities such as autism or trauma. The “affirmative only” approach not only fails to disentangle the complex interplay of comorbidities before validating the self-reported internal experience, it refuses to do so, with serious harm to many.
When a high-status “therapeutic” professional affirms a GD sufferer’s perceived experience, that may reinforce and consolidate the problematic claimed identity rather than get to the bottom of its causes and drivers.
There may also be an element of groupthink driving the massive increase in the numbers claiming to experience GD. Ideologically captured therapists who will validate anyone’s claimed internal experience, could be encouraging the dysfunctional and life-changing gender ideas of people who are confused about their role in society. Therapist and GD sufferer could, thus, be reinforcing each other’s delusions. That is a primary hallmark of groupthink.
Another hallmark of groupthink is the ferocity of attack that is launched against anyone who dares to challenge the shared groupthink beliefs.
If groupthink were widely present among gender ideologues that is what we would expect to witness.
Indeed, we have seen that, repeatedly, each time someone speaks out about the actions and claims of the trans extremists. For instance, the way JK Rowling has been treated for expressing genuine and well-founded concerns for women’s public safety.
Many therapists seem to be coerced in to falsely claiming to support the “affirmative only” approach for fear of being vilified as “transphobic.” Still others refuse to help GD cases for the same reasons. There have been multiple reports of teachers being frightened to challenge children who have chosen to self-identify as cats or other animals; teachers, it seems, are now expected to ignore fact in favour of claimed feelings.
Have facts lost ground to feelings?
“My feelings are reality.”
The “affirmative only” approach draws on the ideological stance that prioritises subjective experience over objective reality or scrutiny. This ethos, “my feelings are reality” holds that an individual’s internal sense of gender is inherently valid, overpowering and negating any and every biological fact or reality.
Identity politics and the therapeutic culture of self-actualisation, has created a bizarre situation where questioning someone’s claimed self-perception, however delusional, is seen as invalidating their autonomy.
People have lost their jobs and been prosecuted for not using the preferred pronouns of GD sufferers. Fear seems drive a false narrative.
The dangers of a passing phase of exploration.
In huge numbers of cases, young people suddenly adopt transgender identities, without a scintilla of prior GD indication. Therapists, by diktat of their “professional” organisations, are expected to affirm that leap. Therapists are advised that if a client claims to feel they are in the wrong body, then they are, in fact, in the wrong body.
In so affirming, therapists are reinforcing, as permanent, a socially constructed identity that may be no more than one of the many passing exploratory phases experienced by most young people. When temporary feelings are elevated above permanent facts, life changing harm inevitably follows.
If immediate trans affirmation is the default approach, it seems likely that proper exploration of underlying issues is side-lined or even completely abandoned.
It seems impossible for any proper diagnosis to be conducted if the default setting is “affirmative only.”
Over and over again we learn from cases of de-transitioners, about their so-called “therapists” ignoring what were no more than teenage confusions or experimentations.
Perhaps after the upcoming batch of legal actions against such “therapists” has come to court, the trans “therapeutic” approach will abandon its dangerous “self-chosen identity first” ideology and adopt genuinely evidence-based practice.
In science, if a researcher claims to be objective after having affirmed a particular outcome, no-one in their right mind would trust whatever conclusions that “researcher” came to. Their biases shape, control and self-fulfil the design and outcome of their so called “research.”
There have been many studies that demonstrated exactly that. People who have been persuaded to “transition,” seem to have had their complex feelings, (based on trauma, or other challenges), misinterpreted as GD by their “therapist.”
‘Misinterpreted’ is probably the wrong word: when delusional people look at the world, they see precisely what they want to see; they interpret the facts to suit their pre-conceived ideas. That may be the most dangerous aspect of the “affirmative only” approach: the therapists’ delusional, ideologically driven, self-fulfilling thoughts, influence their clients in damaging ways.
One of the many ironies of this toxic scenario, is that almost all therapists are, or ought to be, aware of the landmark studies, which demonstrate how the expectations of an authority figure determine the outcomes of those over whom they have authority, (Milgram, Rosenthal and many more).
Yet, ideologues still advocate the “affirmative only” approach. Even worse, in all professional organisations, in ALL other contexts, any therapist engaging in such refusal to address their own delusions would deemed dangerous and unethical.
IF a person is one of the 20% of presenting GD cases that could have better outcomes by transitioning, either in full or in part, it is known that the affirmative only approach is perceived by them as helpful.
On first viewing that seems, for the 20%, a reasonable and wise way to conduct therapy.
However, there is NO assessment of whether someone is in the 80% group, or the 20% group before the affirmative only approach is applied.
That is akin to providing people with a medical treatment that could kill some people and cure others, before determining whether the treatment will be lethal or curative for any given patient. No responsible person would take such an approach. Yet, that is the reality of toxic trans treatment.
Rapport formation and fact gathering are the first stages in any therapy. Both empathy and exploration are essential. If empathy displaces exploration, as is the case with the affirmative only policy, damage can be done, as many de-transitioners will confirm. Many are in the process of taking legal action, and it seems for good reason.
A dangerous extension of toxic wokery?
“Anyone who questions my feelings is a bad person.”
“Toxic wokery” describes the hostile, aggressive and abusive enforcement of claimed social sensitivity. Those who ask reasonable questions, who raise well-founded legitimate concerns, are vilified in public by the toxic wokerati. Anyone who does anything other than affirm is not just wrong but morally reprehensible.
The toxic woke “reasoning” is: if a person claiming to have trans feelings has those claims questioned, the questioner is obviously invalidating the trans person’s existence, and that makes such vile people a legitimate target for censure, cancellation, or abuse. For invalidating the existence of a trans person, the “bigot’s” existence ought to be invalidated in return. That is, the trans ideologues actually treat others in the same way that they claim trans people are treated.
Many therapists feel that they cannot challenge the “affirmative only” policy without fear of professional ruination, or public doxing by the toxic wokerati. Unless therapists support “affirmative only” they become villains, and in several reported cases, unemployable villains.
That does not sound like evidence-based practice. It does not sound like science. It does sound like authoritarian extremism. It looks even more extreme and more ideological when we remember that the “therapists” have refused to hand over the data that would reveal the truth.
How much contribution is made by each of the three factors, (personal gain, ideology, and toxic wokery), seeming to drive toxic trans treatment?
Profit might be the strongest driver in privatised contexts (for example, in the US). Perhaps greed drives 40% of the adoption of the“affirmative only” approach in privatised contexts. The contribution may be less than 40% possibly where salary and career protection are the main financial motives.
The affirmative only ideology is pervasive across all Western care cultures. Ideology may account for 50%, of the drivers, given that several organisations have been ideologically captured and they control the training and guidelines.
Toxic wokery, as an enforcer, might contribute 20–30%. Toxic wokery seems to have the greatest enforcement capability where cancel culture thrives, that is, in the anglophone countries.
Together, the three drivers form a feedback loop: profit funds the system, ideology steers it, and toxic wokery guards it, and shields it from scrutiny.
Is affirmation a form of conversion therapy?
Conversion therapy uses coercion or persuasion to steer people to a gender identity or sexual orientation that aligns with societal norms.
The “affirmative only” approach claims to do the opposite of conversion therapy. It claims to steer toward transgender identity validation.
Does it?
Does the “affirmative only” approach use coercion or persuasion to steer people to validate and confirm whatever gender identity or sexual orientation aligns with woke society norms?
Let’s explore the “affirmative only” reasoning. If a teenager expressed homosexual ideation, and their therapist affirmed that they were indeed homosexual, automatically, without any exploration, would that therapist be accused of trying to convert the teenager to homosexuality. Almost certainly.
If questioning a person’s gender identity is actively banned, as it is by several “professional” organisations, those who are merely gender uncertain could feel persuaded or coerced by an authority figure (their therapist) into accepting that they are trans.
Does that fit the criteria for describing what is going on as conversion therapy? It seems so. At very least, the affirmative only approach stifles doubt and proper exploration of gender identity.
Were transitioners warned about sterility?
Gender-affirming surgery (hysterectomy, orchiectomy) almost always result in sterility. Alas, because the affirmative only trans lobby has captured many professional organisations, and they have refused to release the data or case notes, we just don’t know how many people presenting with GD have been persuaded and how many were self-driven.
What we do know is that the therapists concerned are worried that if the data is released it will open up many of them to legal action. Why? Many de-transitioners report that they felt rushed into taking irreversible steps without full or informed consent.
There seems to be an elephant in the trans treatment room. Trans therapists all claim to be making evidence-based decisions, while at the same time refusing to make the evidence available for independent scrutiny, or the proper scientific analysis that could create the evidence necessary to make evidence-based decisions. Under such circumstances it is impossible to make evidence-based decisions.
How many were left in the dark?
A quick search of social media will uncover many de-transitioner testimonies stating that the risks such as sterility, infection, incontinence and sexual dysfunction, and anorgasmia were all downplayed or not mentioned.
The same seems to apply to mental health outcomes being oversold by “therapists.” Many de-transitioners report that they were never offered non-surgery pathways to address their GD. If that is not gross clinical negligence, worthy of legal action, what is?
As mentioned before, when the trans therapists and their institutions are withholding the evidence, perhaps out of well-founded fear of being sued, we just don’t know how many people were in a position to give fully informed consent, or how many were properly told that they were likely to end up with severe health problems.
Is trans treatment toxic?
The “affirmative only” approach owes it spread to three less that noble motives: profit fuels its growth, ideology shapes its ethos, and toxic wokery shields it from scrutiny.
The extent to which each of the toxic drivers applies varies between cultures. Profit motives are more dominant in market-driven systems, identity ideology in progressive circles, and toxic wokery in socially volatile ones. Together, they drive a model that, while helping a small percentage, overreaches and converts doubters into transitioners under motives less pure than advertised. Without evidence, transparency and open debate, the truth of how much harm is being done remains deliberately obscured. The incentives to conceal and cover-up evidence are too clear to dismiss.
Here is the acid test question. Now that you know the motives, the groupthink, the bizarre reasoning, the delusions, the fear of speaking truth, the toxicity, would you want yourself or one of your relatives to be caught up in the trans “treatment” industry?
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.
