Talk it out

Conversion therapy is making a comeback in the new HHS report on treating gender dysphoria

There is a new press release and report from the Department of Health and Human Services (HHS) that suggests that “Medical Interventions for Children and Adolescents with Gender Dysphoria” offers “evidence pointing to significant risks” to offering medical gender-affirming care, “including irreversible harms such as infertility—while finding very weak evidence of benefit.”

The research provided goes on to explain how “psychotherapeutic approaches to managing gender dysphoria in children and adolescents” is an acceptable and perhaps preferred treatment to medical transition, despite having been “mischaracterized as ‘conversion therapy.’”

Until the authors of this report used the words “conversion therapy” I was not of the mind that talk therapy would be a bad idea for minors, or even adults like myself, going through gender-affirming care for the first time. I agree with the consensus of the report that minors are sensitive to their environment and prone to mood swings - I know I sure was.

Plus, being in the closet and experiencing gender dysphoria can lead to mental health problems that persist after gender-affirming care starts. Humans have other problems that have nothing to do with their gender identity, and these problems and maladaptive coping mechanisms can complicate and obfuscate their understanding of their gender as it blends with their other mental health diagnoses.

For example, I had a series of surgeries that were unrelated to my gender identity, before the age of 9 that left me with complex PTSD. But in addition to that, I was a closeted little queer, trans kid. My CPTSD was compounded by the fact that I was in hiding for most of my life, making these two disparate problems and their interlocking symptoms confusing and hard to parse out.

It took me decades of talk therapy, spiritual wellness training, and eventually 12-step programs to peel back the layers of dysfunction enough to see with clear eyes what was going on inside me.

So sure, why not require some talk therapy for kids, and everyone, considering gender-affirming care, and continue to offer it as an option throughout the treatment. I was surprised- nay, shocked- given the level of discourse around this subject, that when I started my gender-affirming care program with Kaiser Permanente, the only talk therapy included in my plan was a one-hour PowerPoint session. I sat with my therapist and watched them go through the slides about the effects of hormones, the different types of top and bottom surgery. One hour.

In order to get a therapist to talk to about this stuff at length, as I considered whether any of this made sense for me, I had to order one à la carte outside my network, incurring thousands of dollars in bills in a matter of months. And while this therapist was great, she had no special training in gender-affirming care or navigating LGBTQ+ identity.

So yes, bring on the talk therapy, covered as part of gender-affirming care, and start training therapists to deal specifically with the issues that may come up like dating as trans, navigating gender pronouns in conversation with family and the broader world, and undoing years of gendered-thinking and socialization.

However, it seems that that’s not what the HHS has in mind. By defensively bringing up the topic of “conversion therapy” in their report, apropos nothing, they are like a Shakespearian villain accidentally revealing their evil plot. Methinks the HHS doth protest too much.

If it’s not conversion therapy, then what is it? What is the aim of this therapy that would be offered instead of, not in conjunction with, medical gender transition care? Given that the first chapter of their full report is entitled “Exceptionalism,” they most likely just want us trans folks to go back to being normal already.

The subtext of all this, and perhaps the most troubling argument for this new gender dysphoria treatment manifesto, is that the “HHS believes that medical ethics should be central in this debate,” which is no longer a debate because the government is shutting down anyone who doesn’t agree with them. But that aside- medical ethics, a subjective term at best, is an unsteady place to place one’s core arguments without proper research-based evidence, especially given the wild pendulums of medical ethics throughout history. One example of outdated ethics include the long-standing practice of doctors masturbating female patients diagnosed with “hysteria,” because, among the many crazy assumptions, it was believed that the womb had moved to a different part of the body.

We may giggle or gasp at practices like this now, but the medical institutions of the time were deadly serious about them- at least as a way to uphold social norms. Pathologize these unhappy women and treat their ‘symptoms’, but don’t change anything about the context of their unhappiness. That’s the policy when the subtext is oppression.

It is no different in treating gender dysphoria as if it’s a problem and not a symptom of a problem. But the people at the HHS know that. They’re not interested in scientific studies or the historical precedence of non-binary gender expression in other cultures. They’re interested in rhetoric and brainwashing kids into thinking they are cis-gendered and straight.

Not surprisingly, conversion therapy, or talk therapy to wish away gender dysphoria and gayness, is not shown to work. Cornell University on their Public Policy Research Portal reported findings from 12 studies proving that CT actively causes harm to its participants with “links to depression, suicidality, anxiety, social isolation and decreased capacity for intimacy.” It is categorically ruled out by the APA as being harmful as a practice, not to mention again that it doesn’t work.

The problem with accurately studying the effects of gender dysphoria, as the HHS points out, is the same as studying the effects of CT: you can keep track of changes in behavior during treatment, but have no way of examining someone’s inner emotions.

Anecdotally, I can attest that trying to make yourself into something you are not, regardless of the methods, does not work to create a happy person. When I was a young person realizing I was different, I quickly tried to change myself to fit in and feel safe, hoping it would make my life and the lives of those around me easier. I spent decades wandering through various circles of hell because I wasn’t allowing myself to just be myself, all because at some point very early on I tried to talk myself out of it. To the HHS and anyone who needs to hear it, it didn’t work.

I’m writing this essay to appeal to those who need to hear that their identity is worth fighting for, and to those who may have doubts about how to treat children with gender dysphoria. I wasted so much time ignoring parts of myself that were desperately crying out to be seen and heard, all because I didn’t take myself seriously. I didn’t allow myself to grow into the person I was meant to be because it was scary and unprecedented in my family, in my neighborhood, in my school.

Times were different then, but they changed because people stood up for the vulnerable. And the vulnerable had the courage to stand up for themselves. With new reports like this coming out daily, we who believe in freedom are being called to stand up for a new wave of vulnerable people. Let’s not fall asleep on the job.