The quick end of my career

as a trans health provider

A mental health nurse since 2008, I’ve worked in a number of different settings: an acute stabilization unit, a specialized eating disorders program, and community youth programs. About 2-3 years ago, when the youth clinic I helped launch started seeing a flood of trans identified young people seeking medical services, we started discussions about how to best support them. One of doctors was interested in learning about trans healthcare but she had limited sessional time available at the clinic. Since assessment is one of my strengths, we came up with a plan to utilize some of my time to coordinate services, do the bulk of the assessment and provide education.

I was the clinical supervisor at the time and excited to add this to my portfolio. Having been through the system myself, many years ago, I thought my experience would be an asset to the young people and their families, and I was keen to see behind the curtain and learn how to do the work well. I started designing a weekly drop in, staffed by volunteers in the community who wanted to donate their skills to support these young people. In the queue I had a lawyer to help with things like legal name changes, a trauma informed yoga instructor to promote wellness and bodily integrity, and counsellors to support mental health. As an interdisciplinary clinic, there was a lot we could offer, from housing services, financial support, life skills development, harm reduction supplies and primary care. It seemed like the ideal setting to do individualized care plans for the whole person, as we were doing with any of the youth who walked through our doors.

We reached out to the Provincial Health Authority’s specialist program, Trans Care BC (TCBC), to provide training. They came out to our small city twice. What they delivered, I’d describe as cultural sensitivity training – two days of personal narratives and the proper use of chosen names and pronouns, to make the patients feel good. There was no discussion about gender dysphoria, peer reviewed evidence or the nuts and bolts of assessment or clinical decision-making. We were given a one page checklist, in a primary care booklet they’d published, for things to cover in the hormone readiness assessment, and informed that the purpose of the assessment was only to determine capacity to consent to treatment. But, it was unclear what capacity to consent really meant for minors or people with various mental health or developmental disabilities. To that, I was told that people have a right to be both mentally ill and trans, just like someone can be both gay and have a mental illness. So, mental illness should not be a “barrier” to gender affirming services. Their website, under eligibility for hormone therapy, states that “You do not have be trans to be eligible for hormone therapy” and it’s difficult to find any mention of gender dysphoria anywhere on the site. Having an identity is one thing. Accessing medical interventions that permanently alter one’s body is quite a different matter.

In addition to the in-person trainings, I was also participating in weekly mentorship calls which is available to any clinician in the province, and I was invited onto a community of practice email listserv where people could ask questions of more experienced practitioners.

I found these resources added to my confusion more than clarifying things.

Photo by Nik Shuliahin 💛💙 on Unsplash

There was talk about whether or not Abigail Shrier was a “TERF” and how awful it was that the Gender Identity Service in the UK was under review.

One clinician from the surgery program wrote that they typically don’t tell patients about possible negative outcomes because they don’t want to appear as though they are discouraging people from accessing services.

There was mention of clinicians telling parents “would you rather have a dead son or an alive daughter?”

There was enthusiastic support for a psychologist who has been recorded telling an audience to fake being suicidal to get what they want, and has a contract with the Ministry of Child and Family Services to provide gender affirming care to youth in the foster care system.

This is where I got into hot water.

I started asking questions about Gender Dysphoria diagnosis and the different kinds of Gender Dysphoria.

I defended Abigail Shrier as someone who was raising concerns about the impact of an ideology, and that it’s not transphobic to debate ideology.

I suggested that if we base our healthcare system and security on a political ideology, we are a castle built on sand, because political seasons change.

I stated that I believe it’s ethical to do systematic reviews of evidence and services.

I shared a link to Benjamin Boyce’s interviews with multiple thinkers, including trans people, researchers and detransitioners about trans without the lens of queer theory.

I raised concerns about the ROGD phenomenon, which I believe I was seeing first hand in many of the highly vulnerable and complex youth coming to our clinic. Most of our clients were teen girls, many who never had a history of gender non-conformity as children. Most had autism, ADHD and/or childhood trauma histories.

I endorsed slowing down assessment, especially when there were comorbidities like autism.

I was told by the medical director of TCBC that the things I was raising were inappropriate and that they would not be participating in such a discussion.

I was told that ROGD doesn’t exist.

I was told I was “gatekeeping” because I provided a mom with resources to ponder rather than medical interventions for the 12 year old who wasn’t even expressing a desire to start hormones yet.

I received a direct email stating that they were “concerned” about the beliefs I hold.

They requested a meeting with my manager and head office, and said I was spreading “propaganda” that wasn’t evidence-based (keep in mind that their own training was based on personal narratives and community surveys, not peer reviewed evidence). I was told that “detransition” is very rare, and just a TERF narrative so I shouldn’t be discussing it with patients or parents. They threatened to pull the grant money they’d given us to create the weekly drop in.

(I didn’t mention that one of my close FTM friends regrets her transition and was a former patient at their clinic.)

One of the TCBC staff, a transwoman, joined forces with 2 other transwomen to smear my name on social media. They called my head office in an attempt to get me fired, stating that they were from a radio show with Vancouver Co-op Radio .

My employer conducted an audit of my work and found no fault. I was well within the boundaries of what the WPATH SOC 7 recommended. However, at that point, I declined to continue doing any trans specific work, within a framework I felt was unethical, incompetent and unsafe for such vulnerable youth. I was so disturbed by this experience, I decided to make my concerns public.

It was at this point that I reached out to Dr Lisa Littman, the Canadian Gender Report and the Society for Evidence Based Gender Medicine (SEGM) and launched the Gender Dysphoria Alliance Canada, with my FTM friend who regretted transition.

I was promptly removed from the TCBC mentorship email list, and they made a complaint to the owner of the listserv, requesting that I be removed because I was a spy.

Since this series of unfortunate events, the Cass Review of the GIDs in the UK has revealed a lack of supporting evidence and harms done to young people.

Several European countries including Finland (a nation known for being progressive and trans inclusionary) have done their own systematic reviews of the evidence and are pivoting to prioritize psychotherapy and comprehensive assessment for youth.

There is growing preliminary evidence and firsthand accounts of ROGD as a social phenomenon.

There is growing evidence that detransition rates are climbing at an alarming rate.

Clinic data throughout the western world demonstrates the same sex ratio flip and comorbidities I was seeing in our clinic.

Many of the US states have banned gender affirming care for minors, including the state of Florida after conducting its own systematic review of the evidence.

The accounts of Jamie Reed, now know to us as the Missouri Whistleblower, mirror my own observations. It’s quite common for healthcare providers working with youth to see several manifestations of social contagions like pseudo tics, eating disorders, OCD, multiple personalities and various “gender identities” like catgender, cakegender and frog gender.

Meanwhile, Canada passed into law a conversion therapy ban worded: any attempt to change a person’s gender identity to cisgender is an offense that can sentence a counsellor to 5 years in jail.

I can’t tell a client they’re not actually a cat.

I wanted to help these kids, not harm them.

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