This is another in a series of posts examining statements made by top gender specialists at the inaugural USPATH conference in Los Angeles in February 2017. (See here and here for more.)
Not so long ago, unremitting distress about one’s gender was the one and only reason for medical transition. Those days are over. With activists clamoring for a change from “gender dysphoria” to “gender incongruence” in the next revision to the international register of diagnosis codes, the ICD-11, the push is on for insurance-paid hormones and surgeries for anyone who believes their body is in any way “incongruent” with their “gender identity.” And this effort includes medical intervention for children and adolescents.
In this clip, excerpted from a USPATH symposium entitled “OUTSIDE OF THE BINARY – CARE FOR NON-BINARY ADOLESCENTS AND YOUNG ADULTS,” pediatric gender specialist Johanna Olson-Kennedy MD, discusses her views on medical interventions for “nonbinary” youth.
As always, we recommend that you listen to the recorded excerpt yourself, as well as reading the transcript included in this post. Time stamps are indicated by square brackets. 
According to Dr. Olson-Kennedy,
There are still people who want to embark on phenotypic gender transition—hormones and surgeries—who don’t meet this criterion [for gender dysphoria]. Well, what are we to do?
…And it’s great. I love this. I don’t like the word “pass” at all. Passing as a member of the other sex is not a criterion for treatment, whereas achievement of personal comfort and well being are. And that is really the crux of what should guide our care, as medical providers, as professionals in the mental health role.
How is this any different from elective cosmetic surgery? Trans activists will say it’s “medically necessary” because it is a guaranteed suicide preventative, a dubious claim at best. But how about a teen girl who hates herself and is self-harming because her breasts are (to her) too large or too small? What about her “comfort and well being”?
[:52] So, there are a lot of medical intervention possibilities for folks who have nonbinary identities. And again, this is really not for me to determine. It’s really for me to work with a person to determine what it is they’re interested in.
As we all know by now, the idea that a medical or psych provider should use diagnostic skills to determine whether a young person ought to undergo permanent drug or surgical treatments is so 20th century.
[1:06] Some people are like, oh! no menses, no mustache. You know, assigned female at birth, “I really don’t want facial hair, I don’t want [inaudible], I’m super dysphoric about bleeding.”
So, there’s lots of options, certainly for menstrual suppression. I love—I was so excited to be in one of the first sessions that I went to, which was gynecologic care for trans-masculine folks, this “leave a gonad” thing.
So, it was this idea of, you know, maybe you don’t wanna have bleeding but you still want estrogen, and you want that support from a medical perspective. Or you just don’t want to go on testosterone.
It’s 2017, and designer endocrine systems are all the rage. Human beings should tinker and tamper with their delicate hormonal balance, because it’s what they want right here, right now. Mix and match–why not?
[1:48] There’s lots of these different things. Maybe a central blocker and low dose testosterone. I had a young person who went on testosterone for a year, and it was like, that’s enough, I’m fine with it. I’m masculinized enough, and that’s good for me. Or no medical intervention at all. That’s absolutely possible.
The slide below, from a different talk at the same USPATH conference, pretty well encapsulates this “treatment” approach:
So we see the mindset of “affirm-only gender doctors here; why so many of them don’t acknowledge there might be permanent harm done to young people who eventually detransition. There are no mistakes. It’s all part of the gender journey.
[2:06] So, for nonbinary assigned males, maybe just Spironolactone [an androgen blocker] or using a peripheral blocker only. That might be something that people opt for. I had a young person who really [inaudible] nonbinary identity, but kind of, very very huge fear of a large nipple areola complex. Like, “I just can’t even deal with that.”
All you women with large nipple areolas that you just can’t even deal with, maybe you can get Medicaid to cover that in your state? Worth a try.
It would be one thing if these people were arguing for elective, cosmetic treatments on demand, for adults. But activists and gender specialists not only want to retain a medical diagnosis, gender incongruence in the next version of the ICD-11; they want insurance to cover all trans-related treatments, for nonbinaries and anyone else who wants them. In fact, some public and private insurance policies (such as that of the San Francisco Department of Public Health) already provide such coverage.
Back to Olson-Kennedy and her areola-avoidant patient:
[2:33] So, we put them on Spironolactone for a while, and then eventually she came back and said I wanna go on estrogen. So there’s selective estrogen receptor modulators for people who do not want breast development. That could be a possibility. Maybe hormones, no surgery. No medical intervention, another possibility.
No medical intervention: Just one of many dishes in the smorgasbord of options for nonbinary, gender fluid youth. Who’s to say (certainly not a medical doctor), which is the least harmful of those possibilities in the long run?
[2:51] My observations: Sometimes nonbinary identities are strategic…to protect themselves, to protect their parents. What I can tell you for certain about trans kids, youth, is they do a lot of taking care of the people around them.
Here we see a theme we’ve heard from other affirm-only genderists: Trans youth are more mature than “cis” kids. They are extraordinarily prescient about their future; they know for certain what they will want at age 20, 30, 40.
Prominent gender therapist Diane Ehrensaft lauds her tween clients for having the wisdom and foresight to opt for adoption in the future—unlike their balking parents, whose only reason for objecting to sterilizing a 12-year-old is a selfish desire for grandchildren.
But there’s something else crucial to note about Olson-Kennedy’s comments: After initially lauding her young enbies for pursuing smaller nipple areolas, or choosing to halt their menstrual periods without sprouting a beard, she is now implying to her audience that nonbinary is only a stopover for many of these kids. They are only claiming this identity to “take care of” their parents, when what they really want is to go whole hog to a binary transition.
[3:18] “I will sacrifice my own comfort for the comfort of the people around me, who I know I’m making very uncomfortable with my gender.”
What an extraordinary assertion. Trans kids aren’t just mature beyond their years when it comes to making irreversible decisions about their bodily integrity and fertility. They also emanate Buddha-like concern for the feelings of others, especially their woefully ignorant parents. How long before we have religious sects led by trans kid gurus, like Tibetan child lamas on steroids?
And how does the claim that trans kids are precociously mature square with the accumulating evidence of a strong correlation between gender dysphoria and autism? Young people with autism are not exactly known for their self-sacrificing nature or their ability to reflect upon the feelings of others.
[3:33] And so, marking that out is really important. Because again, because expressing that [they are nonbinary] is often used as evidence that they are not trans. “No, well they don’t want to do this. Clearly, they’re not trans.” And having that conversation, and making sure that someone isn’t taking care of someone else at their own sacrifice.
Are they “taking care of someone else” or perhaps listening to a family member who just might have the best interests of the child at heart, more than a gender doctor who hasn’t known the kid their entire lives?
So, on the one hand, we hear that nonbinaries need treatments “to feel more comfortable,” and at the same time, we’re told that a significant number of martyr-like trans kids are “sacrificing” themselves by feigning a nonbinary identity for the comfort of their parents. Which is it?
The Guardian recently produced a mini-documentary on nonbinary milennials and their quest for comfort. Meghan Murphy dissected this bit of puffery, and took on the living nightmare of feeling uncomfortable in this article.
Well worth a look.