Sunday, 23 April 2017

People Get to Do Things They Might Regret

The Guardian is apparently a font of anti-trans articles and articles that can be used that way, between the mom insisting that her kid is a tomboy and is not trans (despite a previous article where the kid states that he’s a boy), the really harsh letter to a trans ex, and this article detailing the experience of a woman who started a transition to male and regretted it. The article in and of itself wasn’t anti-trans, but it was thrown at me as a supposed example of “children being sterilized because they’re confused about their gender.” (It’s not—she was 18 when she had surgery and while testosterone can affect fertility, she still has a chance to get pregnant.)

Before sharing my take on this article, I want to give some background from actual trans organizations on the subject of detransition and amplify the voices of trans people who have been there*:
http://ift.tt/2oAHfEk – An explanation from Trans Advocate about reasons people detransition, as well as statistics
http://ift.tt/2ojIfAP – The author of Transgender Explained for Those Who Are Not, a trans woman, writes about why people regret sex-reassignment surgery
http://ift.tt/2inaM5B – An interview with two trans women who were widely reported as detransitioning. (One had only paused; the other had decided to detransition due to social pressures but changed her mind again.)

As far as the author’s experience itself, she was dealt a really crappy hand, and I have an awful lot of sympathy. She transitioned very quickly after being suicidal as a teenager. She had no counseling at all and started hormones and had chest surgery at the age of 18. Her chest surgery was botched, leaving her with major scarring. So, that’s two huge instances of extremely poor medical treatment. The usual standard of care involves not only counseling, but a whole year of Real-Life Experience (RLE) living openly as their gender prior to any surgery. (Some doctors even require it before hormones.)

She’s also completely right that oppressive sexism makes women and girls feel broken when it’s society, not us, that has something wrong with it. And it’s much easier to try to change yourself than to fight against the forces of society that try to force you into compliance.

I think hers is a story that’s worth telling, because it underscores the importance of good counselling before making a life-altering medical decision, as well as the damaging effects of misogyny. Also, it’s a true story, and everybody deserves to have their experience heard and respected.

But. (There’s always a but.) The way I’ve seen it used is really harmful. This author’s experience is *not* the norm for trans people who undergo surgical transition. There’s usually tons of counseling and a requirement that the person live as their gender prior to surgery. If you want to use this article to say, “Some counseling should exist,” great, most trans people would agree with you. But if you want to use it to expand gatekeeping that already makes trans people’s life more difficult, or to argue that we shouldn’t acknowledge people’s gender when they tell us they’re trans, then not so much.

The idea that adult people need to be protected, at all costs, from doing anything they might regret is pretty infantilizing. People particularly freak out about sterilization, whether directly through surgery or indirectly in the cases where hormones make someone infertile. (They also tend to assume that the second is an automatic guarantee, which it is not.) And yet, a lot of those people, certainly the ones who consider themselves feminists, wouldn’t question a cis woman’s right to have her tubes tied if she doesn’t want children or doesn’t want more children. To expect a trans person to undergo more strenuous gatekeeping than a cis woman for a similar choice indicates that you don’t view them as adults who can make their own decisions. (That’s not to diminish the amount of gatekeeping women who want permanent sterilization *do* face, especially if they haven’t had kids at all.)

Everyone will make dozens of choices in their lives that they might regret. Medical ones tend to have the most gatekeeping, with consent forms and counseling, but everything from your choice of a college major to your choice of a spouse can change your life. And that’s just the decisions that you know are life-altering at the time. It’s pretty obvious when you’re standing up in church or the courthouse to say “I do” that this is a life-altering moment, but asking that person for their number or sitting down next to them in chem lab probably didn’t seem like a turning point. It’s hard to imagine a life where you can never make a choice you regret. Your choices would have to be so constrained by other people as to be completely meaningless.

There’s no way to stop people from making decisions they may later regret, nor should we try. The best we can do is make sure they have good options available to them and have the time and information to make the choice that’s right for them. It may turn out that what they thought was right for them at the time wasn’t, but they’re still the only person who can make that choice.

With kids, of course the ideal is that they never have to face major decisions they aren’t ready for, because they have loving parents and a network of school and community to shield them from that. Reality, of course, is not that simple. A pregnant fourteen-year-old can either give birth or have an abortion. If she gives birth, she can raise the baby herself or put them up for adoption. All of those are life-altering choices, and there’s no neutral option.

I don’t want to equate being a trans teen with being a pregnant teen because they’re very different life experiences (and some teens experience both), but in both cases, there are no neutral options. There’s a cost for a kid to live as their assigned at birth gender, and a cost for them to transition. Current medical best practices include puberty blockers, giving the kid time to think about the decision and keep all their options open. Then, if they decide to transition, there’s more counseling at each step. The intent is already to protect kids from having to make life-altering decisions before they’re ready, and to make sure that they and their parents have the necessary information and fully consider all medical decisions.

The one place where I truly disagree with the author of the Guardian piece is where she says transitioning “should be seen as the last resort.” I think the idea of transition as a last resort is harmful because it adds onto the standard of informed consent. It’s not enough that the patient be aware of all their options and have thoroughly considered their choice. Instead, they have to somehow prove that they’ve suffered “enough” or are at “enough” risk to be allowed to transition. Considering that the author herself was suicidal when she transitioned, the bar for “last resort” would have to be extraordinarily high to have prevented the transition that she came to regret. So how many suicidal trans people would be denied care and would die as a result? Obviously, she didn’t get appropriate medical care. She had no counseling, and her surgery was botched. So of course she wants stricter standards. But “last resort” swings too far in the other direction, and it doesn’t treat trans people as adults who get to make their own life decisions.

*Referring to gender gets a little messy when people detransition, but the basic principle is to respect how someone refers to themselves. The author of the Guardian piece is “she” because she states that she’s a woman, not a trans man. Likewise, the two women interviewed in the Vice article paused their transitions but identify themselves as women. (This would be the case regardless of what surgeries they have or don’t have, or what meds they take or don’t take.)




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