Health

The battle over sex therapy


And rightly so, after four years of hard work, Leibowitz, de Vries, and the rest of their team were called traitors by their peers and the community they sought to care for. “We understood the need for these standards from the very beginning,” Leibowitz told me. “I’m not sure we realize the magnitude of the controversy. It is a result of the fact that our world, the world that cares about gender, has exploded. “

In the 1950s and in the 1960s, a small group of doctors in Europe and the United States started talking about how to evaluate adults who wanted to make a medical transition. Harry Benjamin, an endocrinologist, who was originally named WPATH, accepts the idea that the people he agrees to treat (mostly transgender women) are “born in the wrong body”. “. Fearing lawsuits from dissatisfied patients, doctors quickly excluded the patient for mental stability reasons. And, arbitrarily, they only include people they believe will go on to transcend the gender they identified, as Beans Velocci, a historian at the University of Pennsylvania, wrote in an article last year on TSQ: Transgender Research Quarterly. Some doctors have asked transgender adults to promise to live like heterosexuals after they transition.

The small group of clinicians who wrote the first Standard of Care were all transgender. After the creation of WPATH in 1979, transgender advocates became increasingly influential within the organization, but many transgender people see subsequent versions of the standard as barriers to fathers. and demeaning treatment. For some genital surgeries, the standards require adults to live for one year as their gender identified and to provide referrals from two mental health professionals. SOC8 is the first version to meet these requirements, adopting a “joint decision-making” model between the adult patient and the surgeon.

The leap towards youth medical transformation occurred in the Netherlands in the 1980s. Peggy Cohen-Kettenis, a Dutch clinical psychologist specializing in children, began receiving referrals from Dr. teenagers who were experiencing gender dysphoria (then called gender identity disorder). But therapy isn’t the answer, Cohen-Kettenis, who is retired, told me by phone this spring. “We could sit and talk forever, but they really need medical treatment.” When their bodies grow in ways they don’t want to, “they just make it worse because of it.” She decided to help some of her patients start hormone therapy at the age of 16 rather than waiting until the age of 18, a practice practiced in the Netherlands and elsewhere at the time. She monitored them weekly, then monthly. “To my surprise, the first couple did so much better than the first time they came,” she said. “That encouraged me to keep going.”

Cohen-Kettenis helped establish a treatment regimen that has proven to be revolutionary. Patient Zero, known as FG, was introduced around 1987 to Henriette A. Delemarre-van de Waal, a pediatric endocrinologist with whom Cohen-Kettenis founded the sex clinic in Amsterdam. At the age of 13, FG was desperate about going through female puberty, and Delemarre-van de Waal put him on a puberty inhibitor, after which Cohen-Kettenis followed him. The drug will halt the development of secondary sex characteristics, make FG not feel like his body is betraying him, buy time, and make it easier for him to go through male puberty, if he then I decided to take testosterone. Transgender adults, whom Cohen-Kettenis also treated, sometimes say they wish they could transition earlier in life, when they could achieve their ideal of masculinity or femininity. visualization. “Of course, I want that,” FG said of puberty-suppressing drugs, in an interview in “The Dutch Approach,” historian Alex Bakker’s 2020 book on the Amsterdam clinic. . “Then I realized that I was the first, the guinea pig. But I didn’t care. ”

Over the next decade, Cohen-Kettenis and Delemarre-van de Waal designed a review for young people who appeared to be candidates for medical treatment. In questionnaires and family sessions, Cohen-Kettenis explored the reasons for a young person’s gender dysphoria, looking at whether it could be better addressed with therapy or medication. both. The policy is to delay treatment for people with problems such as attention deficits and eating disorders or who do not have stable, supportive families, in order to eliminate factors that may interfere with the treatment. “We did a lot of other work before letting them start, which created a lot of frustration for them,” says Cohen-Kettenis. “Perhaps we were too selective in the early stages.” Looking back, she says, she thinks young people who may have benefited have been excluded.



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