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nothing-makes--sense · 2 months

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Fact Check: Fact Check: 216 Instances Of Factual Errors Found In Right-Wing "WPATH Files" Document

In response to the WPATH files being dropped, transgender activist Erin Reed made a response, fact checking the claims made in the editorial of the original document, written by Mia Hughes. Reed claims that there are 216 “instances of factual inaccuracies, erroneous citations, misinterpretations of what is “leaked,” and purposeful omissions contradicting the authors central editorialized claims.”

The introduction is spent discrediting the organizations involved as “right wing” and “anti trans.” Reed alleges that the quick rate at which the files were spread was a “coordinated and organized embargo campaign, leaving those in support of care with scant time to review the voluminous documents and respond.”

The first claim that Reed alleges to be false is the claim that the Beyond WPATH declaration was signed by many people who were not doctors, pointing out signatures with occupations such as “DJ” and “yoga instructor” as well as comments like “concerned parent.” The original document does not claim that all signatures were from doctors, with the exact quote stating that it was “now signed by over 2,000 concerned individuals, many of whom are clinicians working with gender diverse young people.” (bold text mine). Nowhere does it imply that only doctors were able to sign it, it simply acknowledges that many people who signed the petition were doctors. One important thing to note is that the creator of the petition, Dr. Joseph Burgo, alleges that the petition was hijacked by trans activists adding fake signatures. (timestamp: 16 min)

Here is a screenshot of the top signers of the petition. Highlighted are all medical professionals.

Note that one of the signers, Stephen B. Levine, was a former president of WPATH who left due to the organization becoming less evidence based and more focused on activists.

Next, Reed criticizes the quality of the citations, stating, "When addressing supposedly "scientific" citations, the report's performance is equally lacking." One example given is an article from The Guardian from 2004, and another being “a conservative site called "The New Atlantis, " Upon visiting the link to the New Atlantis’s “about” page, they explicitly state they are a nonpartisan organization. That being said, other sources do allege this particular publication is right wing. However, this attempt to frame any opposing source as "right wing" or "conservative" is a significant part of Reed's argument on why the information is unreliable.

Reed accuses many of the studies cited to be misrepresented. One study cited in the WPATH files is a Swedish study which is quoted as finding, “rates of completed suicide post-surgical transition to be greatly elevated over the general population.”

Reed links to an article from a site called Trans Advocate, which contains an interview with the author of the Swedish study on how her work has been misinterpreted. In this article, the study is quoted as saying, “no inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism. In other words, the results should not be interpreted such as sex reassignment per se increases morbidity and mortality.” The study does not conclude that sex reassignment surgery works, but there is also no reason to suggest it causes people to be more suicidal than they were pre-transition. Hughes does imply that suicide risk can increase after transition in cases where certain mental health conditions such as BPD are left untreated, and the patient comes to regret transition later, but this is not cited as scientific fact (42).

On the page before the Swedish study is referenced (42), Hughes discusses the mental health issues commonly found in trans-identified youth and how those issues may account for the higher rate of suicidality. Reed fails to acknowledge the Amsterdam study that concluded “the suicide risk in transgender people is higher than in the general population and seems to occur at every stage of transitioning.” While some parts of the Swedish study may have been misinterpreted, there are other studies with similar findings. The point is not that suicidality increases after transition, but rather that there is little evidence to suggest that transition has a long-term benefit on a person's other mental health issues.

Reed links to three studies disputing both the 2009 study and the Swedish study, implying that all of this “much newer research from peer-reviewed articles,” completely invalidates the findings of the other studies. The first study that Reed gives as a rebuttal does not actually come to the conclusion that there is a “substantial improvement in the quality of life for transgender individuals.” This 2017 study concludes that, “Our results show that transgender women generally have a lower QoL compared to the general population. GRS leads to an improvement in general well-being as a trend but over the long-term, QoL decreases slightly in line with that of the comparison group.” Basically, it claims that quality of life increases shortly after surgery, but later declines after about 5 years. They acknowledge that this is the case in the general population as well, and they state that there is still little consensus on trans identified people’s quality of life.

The second study Reed cites looks at the quality of life of patients who have received phalloplasties. Only 32 patients were part of this study, and they found that “88% of our patients were very satisfied with the aesthetic result, 75% have had sex after surgery, and 72% were very satisfied with sexual function after GAS. Eighty-one percent had a strong improvement of QOL, and 91% would undergo the same treatment again.” However, there is more evidence that phalloplasty is a dangerous procedure, and Reed fails to acknowledge any of those studies, such as this study of 1731 phalloplasty patients, finding that the "Overall complication rate was high at 76.5%"

The third study was a survey of 27,715 trans identified adults from 2015. The introduction of the study admits that “Mental health effects of gender-affirming surgery thus remain controversial.” In this survey, only 25% of participants had undergone surgery. This study was only a secondary analysis of these survey responses, comparing results of those who did not undergo surgery with those who had.

Reed implies that the 2% fatality rate of the vaginoplasty performed on males who had previously been on puberty blockers is irrelevant because the death “occurred from a wound infection, a potential complication for any surgery.” Hughes acknowledges that the patient died of necrotizing fasciitis, (19) and the case report that Reed links states that the patient, “developed septic shock and multiple organ failure on the basis of an extended-spectrum β-lactamase-producing Escherichia coli. A severe progression of the necrotizing fasciitis was lethal, despite repeated surgical debridement, intravenous antibiotic use, and supportive care at the intensive care unit.” The study that Reed then links to prove this treatment is successful contains extremely graphic images detailing the surgery without any warning. This does not discredit the study, but for that reason I cannot really look at it.

Reed attempts to debunk the accusation that those who took puberty blockers cannot orgasm, by alluding to there being two studies disproving this. However, it appears that Reed linked the same study twice within this quote, "To ensure factual accuracy, studies have shown that those who took puberty blockers are capable of orgasm" Only the abstract is available to me for this study. Because this study is behind a paywall, it is difficult for me to verify Reed’s claims about their results. The study is a survey of group of 31 primary total laparoscopic intestinal vaginoplasty patients, and is a survey about general quality of life one year after the surgery. It states that the group was “relatively young,” and states that the, “median age at time of surgery = 19.1 years, range = 18.3–45.0.” However, it gives no indication of when the patients began transition. It does imply that patients were on "Puberty-suppressing hormonal treatment”, but does not make any mention of when the patients started puberty blockers. Marci Bowers, head of WPATH, has explicitly stated that “I’m unaware of an individual claiming ability to orgasm when they were blocked at Tanner Stage 2.” Tanner Stage 2 is around the age of 11. It is possible these patients began blockers later on, but that evidence is not available to me either way. Another important thing to note is that the conclusion of the second study states, “This group of relatively young transgender women reported satisfactory functional and esthetic results of the neovagina and a good quality of life, despite low Female Sexual Function Index scores.” (bold text mine) “The mean Female Sexual Function Index total score of sexually active transgender women was 26.0 ± 6.8.”

This study is a survey relying on patients to self report their satisfaction, and Hughes does acknowledge the flaws of self reported studies on page 33, stating that measurable studies showed less positive results than surveys. Many of the studies Reed cites as rebuttals rely on self report.

Finally, Reed criticizes the idea that gender dysphoric youth would eventually desist post-puberty. One of the links provided as evidence against this claim leads to another article of Reed's. The criticism of Kenneth Zucker's research from the 90s appears to be that it classifies children with "gender identity disorder" as those who are simply gender non-conforming. The article uses this graphic to illustrate the difference between gender identity disorder and the current DSM-5 diagnosis of gender dysphoria, implying that the latter has stricter requirements.

Reed dismisses any correlation between social transition and desistance rates and accuses Hughes of implying that, “social transition prevents this “natural” desistance, a hypothesis that has not been validated.” While there may have been some flaws in Zunker's original study, this massive difference between then and now certainly raises questions on how the impact of social transition affects a child.

In the next section, Reed claims that the “leaked material” is frequently misrepresented, yet only provides three examples of this occurring. It does appear that Hughes left out the part about the orgasm in the first example, which would have been important context to include (28). In the second example, Reed accuses Hughes of leaving out the fact that it was a detransitioner who used the phrase “gender journey” and not a clinician. In reality, Hughes does not specify who said this, simply stating “There is talk about detransition being just another step in a patient’s “gender journey.” (31) However, we only have the clinicians word to go off to prove that the patient used that phrase, and there is evidence of another clinician pushing patients to identify with their language. This doctor decided to label a patient as “eunuch identified,” despite him not claiming that label himself (51). The third example of a misrepresentation consists of a patient developing a hepatic adenoma (liver mass) after taking testosterone. Reed is correct that hepatic adenomas are benign and that they are linked to both contraceptives and hormones. However, Reed accuses the document of leaving out the fact that the patient was on both oral contraceptives and testosterone. Hughes does in fact state that the patient was on norethindrone acetate, which is a contraceptive. In the WPATH document, the doctor specifically suspects that the hormones are the cause of the liver masses as opposed to the contraceptive.

Reed alleges that Stella O’Malley and Genspect “teased a young trans girl testifying in front of a school board.” The linked tweet reads: “US-UTAH: 11 yr old “Alison” came out as trans at 8 after having a vision of wearing a long white dress in a field. Dad says his “daughter” must be “validated in who she is” & allowed to use girls spaces bc many trans-identified people consider suicide.”

Overall, Reed’s fact checking only provides a few examples, nowhere near the 216 claimed. Many of the studies linked as rebuttals do not come to the same conclusions as Reed implies. In my opinion, it appears that Reed did not expect the audience of this article to go and read the WPATH files for themselves, or for that matter, even check the links thoroughly. The few good points that are made here do not discredit the entirety of the report, and Reed fails to address the main claims in the report; such as WPATH members admitting that children do not have the capacity to consent, their disregard of proper scientific protocol, the experimental approach to healthcare, disregard of patients' other mental health issues, and lack of ethics.

If anyone wants to add things to this or expand on anything, please feel free to do so. There were a couple sections where my understanding was a bit limited, such as the limitations of the trans youth desistance study, and the puberty blockers/vaginoplasty study.

Edit: Moving this disclaimer down here because a TRA quit reading immediately after they saw this. I would like to acknowledge that I am not a doctor or any type of medical professional (neither is Reed) and some scientific studies may be difficult for me to interpret.

Edit 2: Removed the part about the New Atlantis because I have seen mixed info on it's political leanings.

#wpath #wpath files #transgender #trans #gender critical #erin reed #terfblr #radfem #radical feminism #radical feminists do interact #trans activism

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marblecakemix · 2 months

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One crustal thing I see a lot of TRAs not getting is that most of the younger radfems (like me) were first subscribed to the gender ideology and were somewhat believers of the "woke" trans agenda.

Most radfems know from experience what your believes are. And this is the same reason why I'm no longer subscribed to that bullshit.

#talk tag #trans #transgender #nonbinary #gender ideology #trans activism #radical lesbian #radical feminist #radical feminism #radical feminist safe #gender critical #gender abolitionist #radblr #radfem #feminism #my post #my stuff

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museumofferedophelia · 8 months

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So TRAs believe that you are "terfy" if you aren't attracted to penises. Then consider that TRAs threaten, doxx, shame, harass, and physically attack women they declare terfs.

It's not too hard to see the implicit threat in that, right? That harassment, social exclusion, and violence hangs over homosexual women who refuse to have sex with penises?

"Oh, but it's not sexually coercive, we're not telling anyone to do anything."

No, you're just associating them with a group who you unabashedly threaten to silence, to expose, to attack, to socially ostracise, to kill, then you wait to see if they'll change their mind when met with these implicit threats.

If you shame women for "genital preferences" (ie. innate, immutable female homosexuality), then you are practicing sexual coercion. Any woman who has sex with you following this rhetoric was threatened into doing so, and you are a rapist.

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august-beee · 6 months

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If you wouldn’t call a black person with albinism a white person because of their skin color why would you call a biological man or woman with chromosomal differences, variation in their genitalia or even hormone disorders as “queer” or included in the gay community? The term intersex is an umbrella term that denotes differences in sex hormones, internal or external genitalia, or chromosomes. These are disorders of sex. Even in individuals with true gonadal intersex traits, they will have either male or female chromosomes. To my knowledge there has never been a human born with both a chromosomal variant as well as internal and external genital variants that cannot be determined to be male or female. Every person born is either male or female. Having these conditions does not make a person something other than male or female. A woman being born without a uterus/ovaries, clitoromegaly (an enlarged clitoris), or some chromosomal mutation doesn’t make her any less of a woman. It doesn’t surprise me that TRAs will use these conditions to justify someone with a completely male or female body saying that they are or transitioning to the other sex. Intersex people are valid men and women.

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sometimesraven · 11 months

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so i did a thing, feel free to slap it all over your local area and/or face

#trans rights #anti terf #anti gender critical #politics #transgender #trans genocide #trans community #anti radical feminism #rad inclus #intersectionality #activism #human rights #if anyone knows where all the redbubble kids are going these days i'll put this shit on stickers and stuff

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autistic-and-radical · 8 months

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I'm wondering, for what trans rights American TRAs are fighting for? I just don't get it. Transitioning children? Self-identification? Abolishing gendered spaces? I'm from Poland. Over here, trans people have it awfully hard, both medical and social transition are very troublesome and even dangerous. Gay people can't get married here, can't adopt kids. Conversion therapy is alive and well despite being illegal. Hell, a girl at the pride parade got SHOT for nothing a few weeks back. In 2020 a bunch of men went around after the pride parade beating people up just for having something rainbow on them. Those "anti-trans" bills y'all are talking about are bills that protect women and children. You have it really good in the US compared to Eastern Europe, the Middle East, Africa, South America, etc.

#gender critical #tra #trans rights activism #tras #radblr #women deserve better #gender ideology #anti gender ideology #radfems do interact #terf #terf safe #terfsafe #terfblr #usa #trans identified male

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pronoun-fucker · 2 years

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Perhaps it makes sense that women — those supposedly compliant and agreeable, self-sacrificing and everything-nice creatures — were the ones to finally bring our polarized country together.

Because the far right and the far left have found the one thing they can agree on: Women don’t count.

The right’s position here is the better known, the movement having aggressively dedicated itself to stripping women of fundamental rights for decades. Thanks in part to two Supreme Court justices who have been credibly accused of abusive behavior toward women, Roe v. Wade, nearly 50 years a target, has been ruthlessly overturned.

Far more bewildering has been the fringe left jumping in with its own perhaps unintentionally but effectively misogynist agenda. There was a time when campus groups and activist organizations advocated strenuously on behalf of women. Women’s rights were human rights and something to fight for. Though the Equal Rights Amendment was never ratified, legal scholars and advocacy groups spent years working to otherwise establish women as a protected class.

But today, a number of academics, uber-progressives, transgender activists, civil liberties organizations and medical organizations are working toward an opposite end: to deny women their humanity, reducing them to a mix of body parts and gender stereotypes.

As reported by my colleague Michael Powell, even the word “women” has become verboten. Previously a commonly understood term for half the world’s population, the word had a specific meaning tied to genetics, biology, history, politics and culture. No longer. In its place are unwieldy terms like “pregnant people,” “menstruators” and “bodies with vaginas.”

Planned Parenthood, once a stalwart defender of women’s rights, omits the word “women” from its home page. NARAL Pro-Choice America has used “birthing people” in lieu of “women.” The American Civil Liberties Union, a longtime defender of women’s rights, last month tweeted its outrage over the possible overturning of Roe v. Wade as a threat to several groups: “Black, Indigenous and other people of color, the L.G.B.T.Q. community, immigrants, young people.”

It left out those threatened most of all: women. Talk about a bitter way to mark the 50th anniversary of Title IX.

The noble intent behind omitting the word “women” is to make room for the relatively tiny number of transgender men and people identifying as nonbinary who retain aspects of female biological function and can conceive, give birth or breastfeed. But despite a spirit of inclusion, the result has been to shove women to the side.

Women, of course, have been accommodating. They’ve welcomed transgender women into their organizations. They’ve learned that to propose any space just for biological women in situations where the presence of males can be threatening or unfair — rape crisis centers, domestic abuse shelters, competitive sports — is currently viewed by some as exclusionary. If there are other marginalized people to fight for, it’s assumed women will be the ones to serve other people’s agendas rather than promote their own.

But, but, but. Can you blame the sisterhood for feeling a little nervous? For wincing at the presumption of acquiescence? For worrying about the broader implications? For wondering what kind of message we are sending to young girls about feeling good in their bodies, pride in their sex and the prospects of womanhood? For essentially ceding to another backlash?

Women didn’t fight this long and this hard only to be told we couldn’t call ourselves women anymore. This isn’t just a semantic issue; it’s also a question of moral harm, an affront to our very sense of ourselves.

It wasn’t so long ago — and in some places the belief persists — that women were considered a mere rib to Adam’s whole. Seeing women as their own complete entities, not just a collection of derivative parts, was an important part of the struggle for sexual equality.

But here we go again, parsing women into organs. Last year the British medical journal The Lancet patted itself on the back for a cover article on menstruation. Yet instead of mentioning the human beings who get to enjoy this monthly biological activity, the cover referred to “bodies with vaginas.” It’s almost as if the other bits and bobs — uteruses, ovaries or even something relatively gender-neutral like brains — were inconsequential. That such things tend to be wrapped together in a human package with two X sex chromosomes is apparently unmentionable.

“What are we, chopped liver?” a woman might be tempted to joke, but in this organ-centric and largely humorless atmosphere, perhaps she would be wiser not to.

Those women who do publicly express mixed emotions or opposing views are often brutally denounced for asserting themselves. (Google the word “transgender” combined with the name Martina Navratilova, J.K. Rowling or Kathleen Stock to get a withering sense.) They risk their jobs and their personal safety. They are maligned as somehow transphobic or labeled TERFs, a pejorative that may be unfamiliar to those who don’t step onto this particular Twitter battlefield. Ostensibly shorthand for “trans-exclusionary radical feminist,” which originally referred to a subgroup of the British feminist movement, “TERF” has come to denote any woman, feminist or not, who persists in believing that while transgender women should be free to live their lives with dignity and respect, they are not identical to those who were born female and who have lived their entire lives as such, with all the biological trappings, societal and cultural expectations, economic realities and safety issues that involves.

But in a world of chosen gender identities, women as a biological category don’t exist. Some might even call this kind of thing erasure.

When not defining women by body parts, misogynists on both ideological poles seem determined to reduce women to rigid gender stereotypes. The formula on the right we know well: Women are maternal and domestic — the feelers and the givers and the “Don’t mind mes.” The unanticipated newcomers to such retrograde typecasting are the supposed progressives on the fringe left. In accordance with a newly embraced gender theory, they now propose that girls — gay or straight — who do not self-identify as feminine are somehow not fully girls. Gender identity workbooks created by transgender advocacy groups for use in schools offer children helpful diagrams suggesting that certain styles or behaviors are “masculine” and others “feminine.”

Didn’t we ditch those straitened categories in the ’70s?

The women’s movement and the gay rights movement, after all, tried to free the sexes from the construct of gender, with its antiquated notions of masculinity and femininity, to accept all women for who they are, whether tomboy, girly girl or butch dyke. To undo all this is to lose hard-won ground for women — and for men, too.

Those on the right who are threatened by women’s equality have always fought fiercely to put women back in their place. What has been disheartening is that some on the fringe left have been equally dismissive, resorting to bullying, threats of violence, public shaming and other scare tactics when women try to reassert that right. The effect is to curtail discussion of women’s issues in the public sphere.

But women are not the enemy here. Consider that in the real world, most violence against trans men and women is committed by men but, in the online world and in the academy, most of the ire at those who balk at this new gender ideology seems to be directed at women.

It’s heartbreaking. And it’s counterproductive.

Tolerance for one group need not mean intolerance for another. We can respect transgender women without castigating females who point out that biological women still constitute a category of their own — with their own specific needs and prerogatives.

If only women’s voices were routinely welcomed and respected on these issues. But whether Trumpist or traditionalist, fringe left activist or academic ideologue, misogynists from both extremes of the political spectrum relish equally the power to shut women up.

Link | Archived link

#radical feminism #trans activism #gender critical #terf #misogyny #I would personally argue that trans activists are not the far left but still

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intersexbookclub · 3 months

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Summary: Chapter 4 of Critical Intersex

For many of us, Chapter 4 of Critical Intersex (2009) turned out to be a particularly rich source of information about intersex history. So I (Elizabeth) have decided to give a fairly detailed summary of the chapter because I think it’s important to get that info out there. I’m gonna give a little bit of commentary as I go, and then a summary of our book club discussion of the chapter.

The chapter is titled “(Un)Queering identity: the biosocial production of intersex/DSD” by Alyson K. Spurgas. It is a history of ISNA, the Intersex Society of North America, and how it went from being a force for intersex liberation to selling out the movement in favour of medicalization. (See here for summary of the other chapters we read of the book!)

Our high level reactions:

Elizabeth (@ipso-faculty): Until I read chapter 4, I didn't really realise how reactionary “DSD” was. It hadn't been clear to me how much it was a response to the beginning of an organized intersex advocacy movement in the United States.

Michelle (@scifimagpie): I could feel the fury in the writer's tone. It was a real barn burner.

Also Michelle: the fuckin' respectability politics of DSD really got under my skin, as a term! I know the importance, as a queer person, of not forcing people to ID as queer, but this was a lot.

Introducing the chapter

The introduction sets the tone by talking about how in the Victorian era there was a historical shift from intersex being a religious/juridical issue to a pathology, and how this was intensified in the 1950s with John Money’s invention of the optimal gender rearing model.

Spurgas briefly discusses how the OGR model is harmful to intersex people, and how it iatrogenically produces sexual dysfunction and gender dysphoria. “Iatrogenic” means caused by medicine; iatrogenesis is the production of disease or other side-effects as a result of medical intervention.

This sets scene for why in the early 1990s, Cheryl Chase and other intersex activists founded the Intersex Society of North America (ISNA). It had started as a support group, and morphed significantly over its lifetime. ISNA closed up shop in 2008.

Initially, ISNA was what we’d now call interliberationist. They were anti-pathologization. Their stance was that intersexuality is not itself pathological and the wellbeing of intersex people is endangered by medical intervention. They organized around the abolition of surgical intervention. They also created fora like Hermaphrodites With Attitude for the deconstruction of bodies/sexes/genders and development of an intersex identity that was inherently queer.

The early ISNA activists explicitly aligned intersexuality in solidarity with LGB and transgender organizing. There was a belief that similar to LGBT organizing, once intersex people got enough visibility and consciousness-raising, people would “come out” in greater numbers (p100).

By the end of the 90s, however, many intersex people were actively rejecting being seen as queer and as political subjects/actors. The organization had become instead aligned with surgeons and clinicians, had replaced “intersex” with “DSD” in their language.

By the time ISNA disbanded in 2008 they had leaned in hard on a so-called “pragmatic” / “harm reduction” model / “children’s rights perspective”. The view was that since infants in Western countries are “born medical subjects as it is” (p100)

Where did DSD come from?

In 2005, the term “disorders of sexual differentiation” had been recently coined in an article by Alice Dreger, Cheryl Chase, “and three other clinicians associated with the ISNA… [so as] to ‘label the condition rather than the person’” (p101). Dreger et al thought that intersex was “not medically accurate” (p101) and that the goal should be effective nomenclature to “sort patients into diagnostically meaningful groups” (p101).

Dreger et al argued that the term intersex “attracts the interest of a large number of people whose interest is based on a sexual fetish and people who suffer from delusions about their own medical histories” (Dreger et al quoted on p101)

Per Spurgas, Dreger et al had an explicit agenda of “distancing intersex activism from queer and transgressive sex/gender politics and instead in supporting Western medical productions of intersexuality” (p102). In other words: they were intermedicalists.

According to Dreger et al, an alignment with medicine is strategically important because intersex people often require medical attention, and hence need to be legible to clinicians. “For those in favor of the transition to DSD, intersex is first and foremost a disorder requiring medical treatment” (p102)

Later in 2005 there was a “Intersex Consensus Meeting” organized by a society of paediatricians and endocrinologists. Fifty “experts” were assembled from ten countries (p101)... with a grand total of two actually intersex people in attendance (Cheryl Chase and Barbara Thomas, from XY-Frauen).

At the meeting, they agreed to adopt the term DSD along with a “‘patient-centred’ and ‘evidence-based’ treatment protocol” to replace the OGR treatment model (p101)

In 2006, a consortium of American clinicians and bioethicists was formed and created clinical guidelines for treating DSDs. They defined DSD quite narrowly: if your gonads or genitals don’t match your gender, or you have a sex chromosome anomaly. So no hormonal variations like hyperandrogenism allowed.

The pro-DSD movement: it was mostly doctors

Spurgas quotes the consortium: “note that the term ‘intersex’ is avoided here because of its imprecision” (p102) - our highlight. There’s a lot of doctors hating on intersex for being a category of political organizing that gets encoded as the category is “imprecise” 👀

Spurgas gets into how the doctors dressed up their re-pathologization of intersex as “patient centred” (p103) - remember this is being led by doctors, not patients, and any intersex inclusion was tokenistic. (Elizabeth: it was amazing how much bs this was.)

As Spurgas puts it, the pro-DSD movement “represents an abandonment of the desire for a pan-intersexual/queer identity and an embrace of the complete medicalization of intersex… the intersex individual is now to be understood fundamentally as a patient” (p103)

Around the same time some paediatricians almost came close to publicly advocating against infant genital mutilation by denouoncing some infant surgeries. Spurgas notes they recommended “that intersex individuals be subjected (or self-subject) to extensive psychological/psychiatric, hormonal, steroidal and other medical” interventions for the rest of their lives (p103).

This call to instead focus on non-surgical medical interventions then got amplified by other clinicians and intermedicalist intersex advocacy organizations.

The push for non-surgical pathologization hence wound up as a sort of “compromise” path - it satisfied the intermedicalists and anti-queer intersex activists, and had the allure of collaborating with doctors to end infant surgeries. (Note: It is 2024 and infant surgeries are still a thing 😡.)

The pro-DSD camp within the intersex community

Spurgas then goes on to get into the discursive politics of DSD. There’s some definite transphobia in the push for “people with DSDs are simply men and women who happen to have congenital birth conditions” (p104). (Summarizer’s note: this language is still employed by anti-trans activists.)

The pro-DSD camp claimed that it was “a logical step in the ‘evolution in thinking’” 💩 and that it would be a more “humane” treatment model (p105) 💩

Also that “parents and doctors are not going to want to give a child a label with a politicized meaning” (p104) which really gives the game away doesn’t it? Intersex people have started raising consciousness, demanding their rights, and asserting they are not broken, so now the poor doctors can’t use the label as a diagnosis. 🤮

Spurgas quotes Emi Koyama, an intermedicalist who emphasized how “most intersex people identify as ‘perfectly ordinary, heterosexual, non-trans men and women’” (p104) along with a whole bunch of other quotes that are obviously queerphobic. Note from Elizabeth: I’m not gonna repeat it all because it’s gross. In my kindest reading of this section, it reads like gender dysphoria for being mistaken as genderqueer, but instead of that being a source of solidarity with genderqueers it is used as a form of dual closure (when a minority group goes out of its way to oppress a more marginalized group in order to try and get acceptance with the majority group).

Koyama and Dreger were explicitly anti-trans, and viewed intergender type stuff as “a ‘trans co-optation’ of intersex identity” (p105) 🤮

Most intersex people resisted “DSD” from its creation

On page 106, Spurgas shifts to talking about how a lot intersex people were resistant to the DSD shift. Organization Intersex International (OII) and Bodies Like Ours (BLO) were highly critical of the shift! 💛 BLO in particular noted that 80-90% of their website users were against the DSD term. Note from Elizabeth: indeed, every survey I’ve seen on the subject has been overwhelmingly against DSD - a 2015 IHRA survey found only 3% of intersex Australians favoured the DSD term.

Proponents of “intersex” over “DSD” testified to it being depathologizing. They called out the medicalization as such: that it serves to reinforce that “intersex people don’t exist” (David Cameron, p107), that it is damaging to be “told they have a disorder” (Esther Leidolf, p107), that there is “a purposeful conflation of treatment for ‘health reasons’ and ‘cosmetic reasons’ (Curtis Hinkle, p107), and that it’s being pushed mainly by perisex people as a reactionary, assimilationist endeavour (ibid).

Interliberationism never went away - intersex people kept pushing for 🌈 queer solidarity 🌈 and depathologization - even though ISNA, the largest intersex advocacy organization, had abandoned this position.

Spurgas describes how a lot of criticism of DSD came from non-Anglophone intersex groups, that the term is even worse in a lot of languages - it connotes “disturbed” in German and has an ambiguity with pedophilia and fetishism in French (p111).

The DSD push was basically entirely USA-based, with little international consultation (p111). Spurgas briefly addresses the imperialism inherent in the “DSD” term on pages 118/119.

Other noteworthy positions in the DSD debate

Spurgas gives a well-deserved shout out to the doctors who opposed the push to DSD, who mostly came from psychiatry and opposed it on the grounds that the pathologization would be psychologically damaging and that intersex patients “have taken comfort (and in many cases, pride) in their (pan-)intersex identity” (p108) 🌈 - Elizabeth: yay, psychiatrists doing their job!

Interestingly, both sides of the DSD issue apparently have invoked disability studies/rights for their side: Koyama claimed DSD would herald the beginning of a disability rights based era of intersex activism (p109) while anti-DSDers noted the importance in disability rights in moving away from pathologization (p109).

Those who didn’t like DSD but who saw a strategic purpose for it argued it would “preser[ve] the psychic comfort of parents”, that there is basically a necessity to coddle the parents of intersex children in order to protect the children from their parents. (p110)

Some proposed less pathologizing alternatives like “variations of sex development” and “divergence of sex development” (p110)

The DSD treatment model and the intersex treadmill

Remember all intersex groups were united that sex assignment surgery on infants needs to be abolished. The DSD framework that was sold as a shift away from surgical intervention, but it never actually eradicated it as an option (p112). Indeed, it keeps ambiguous the difference between medically necessary surgical intervention and culturally desired cosmetic surgery (p112). (Note from Elizabeth: funny how *this* ambiguity is acceptable to doctors.)

What DSD really changed was a shift from “fixing” the child with surgery to instead providing “lifelong ‘management’ to continue passing” (p112), resulting in more medical intervention, such as through hormonal and behavioural therapies to “[keep] it in remission” (p113).

Cheryl Chase coined the “intersex treadmill’: the never-ending drive to fit within a normative sex category (p113), which Spurgas deploys to talk about the proliferation of “lifelong treatments” and how it creates the need for constant surveillance of intersex bodies (p114). Medical specialization adds to the proliferation, as one needs increasingly more specialists who have increasingly narrow specialties.

There’s a cruel irony in how the DSD model pushes for lifelong psychiatric and psychological care of intersex patients so as to attend to the PTSD that is caused by medical intervention. (p115) It pushes a capitalistic model where as much money can be milked as possible out of intersex patients (p116).

The DSD treatment model, if it encourages patients to find community at all, hence pushes condition-specific medical support groups rather than pan-intersex advocacy groups (p115)

Other stuff in the chapter

Spurgas does more Foucault-ing at the end of the chapter. Highlight: “The intersex/DSD body is a site of biosocial contestation over which ways of knowing not only truth of sex, but the truth of the self, are fought. Both intelligibility and tangible resources are the prizes accorded to the winner(s) of the battle over truth of sex” (p117)

There’s some stuff on the patient-as-consumer that didn’t really land with anybody at the book club meeting - we’re mostly Canadians and the idea of patient-as-consumer isn’t relatable. Ei noted it isn’t even that relatable from their position as an American.

***

Having now summarized the chapter, here's a summary of our discussion at book club...

Opening reactions

Michelle (M): the way the main lady involved became medicalized really made my heart sink, reading that.

Elizabeth (E): I do remember some discussion of intersex people in the 90s, and it never really grew in the way that other queer identities did! This has kind of helped for me to understand what the fuck happened here.

E: It was definitely a very insightful reading on that part, while being absolutely outraging. I didn't know, but I guess I wasn't surprised at how pivotal US-centrism was. The author was talking about "North American centric" though but always meant the United States!!! Canada was just not part of this! They even make mention of Quebec as separate and one of the opposing regions. I was like, What are you doing here, America? You are not the entirety of our continent!!!

E: The feedback from non-Anglophone intersex advocates that DSD does not translate was something that I was like, "Yes!" For me, when I read the French term - that sounded like something that would include vaginismus, erectile dysfunction - it sounds far more general and negative.

M: the fuckin' respectability politics of DSD really got under my skin, as a term! I know the importance, as a queer person, of not forcing people to ID as queer, but this was a lot.

E: it was very assimilationist in a way that was very upsetting. I knew intellectually that this was going on. There was such a distinct advocacy push for that. The coddling of parents and doctors at the expense of intersex people was such a theme of this chapter, in a way that was very upsetting. They started out with this goal of intersex liberation, and instead, wound up coddling parents and doctors.

Solidarities

M: I feel like there's a real ableist parallel to the autism movement here… It dovetails with how the autism movement was like, "Aww, we're sorry about your emotionless monster baby! This must be so hard for you [parents]!" And it felt like "aw, it's okay, we'll fix your baby so they can interface with heterosexuality!" [Note: both of us are neurodivergent]

E: A lot of intersexism is a fear that you're going to have a queer child, both in terms of orientation and gender.

E: You cannot have intersex liberation without putting an end to homophobia and transphobia.

M: We're such natural allies there!

E: I understand that there are these very dysphoric ipsogender or cisgender people, who don't want to be mistaken as trans, but like it or not, their rights are linked to trans people! When I encounter these people, I don't know how to convey, "whether you like it or not, you're not going to get more rights by doing everything you can to be as distant as possible."

M: it reminds me of the movements by some younger queers to adhere to respectability politics.

E: Oh no. There are younger queers who want respectability politics????

M: well, some younger queers are very reactionary about neopronouns and kink at pride. they don't always know the difference between representation and "imposing" kinks on others. In a way, it reminds me of the more intentional rejection of queer weirdos, or queerdos, if you will, by republican gays.

E: I feel like a lot of anti-queerdom that comes out of the ipso and cisgender intersex community reads as very dysphoric to me. That needs to be acknowledged as gender dysphoria.

M: That resonates to me. When I heard about my own androgen imbalance, I was like, "does that mean I'm not a real woman?" And now I would happily say "fuck that question," but we do need an empathy and sensitivity for that experience. Though not tolerance for people who invalidate others, to be honest.

E: The term "iatrogensis" was new to me. The term refers to a disease caused or aggravated by medical intervention.

M: So like a surgical complication, or gender dysphoria caused by improper medical counselling!

The DSD debate

ei: i think the "disorder" discussion is really interesting. in my opinion, if someone feels their intersex condition is a disorder they have every right to label it that way, but if someone does not feel the same they have every right to reject the disorder label. personally i use the label "condition". i don't agree with forcing labels on anyone or stripping them away from anyone either.

M: for me, it felt like a cautionary tale about which labels to accept.

ei: i'm all around very tired of people label policing others and making blanket statements such as "all people who are this have to use this label”... i also use variation sometimes, i tend to go back and forth between variation and condition. I think it's a delicate balance between being sensitive to people's label preferences vs making space for other definitions/communities.

We then spoke about language for a bunch of communities (Black people, non-binary people) for a while

E: one thing that was very harrowing for me about this chapter is that while there was this push to end coercive infant surgery, they basically ceded all of the ground on "interventions" happening from puberty onward. And as someone who has had to fight off coercive medical interventions in puberty, I have a lot of trauma about violent enforcement of femininity and the medical establishment.

ei: i completely agree that it's psychologically harmful tbh…. i was assigned male at birth and my doctors want me to start testosterone to make me more like a perisex male. which is extremely counterproductive because i'm literally transfem and have expressed this many times

Doctors Doing Harm

M: for me, the validation of how doctors can be harmful in this chapter meant a lot.

E: something that surprised me and made me happy was that there were some psychiatrists who spoke out against the DSD label. As someone who routinely hears a lot of anti-psychiatry stuff - because there's a lot of good reason to be skeptical of psychiatry, as a discipline - it was just nice to see some psychiatrists on the right side of things, doing right by their patients. Psychiatrists were making the argument that DSD would be psychologically harmful to a lot of intersex people.

ei: like. being told that something so inherently you, so inherently linked to your identity and sense of self, is a disorder of sexual development, something to be fixed and corrected. that has to be so harmful

ei: like i won't lie i do have a lot of severe trauma surrounding the way i've been treated due to being intersex. but so much of my negative experiences are repetitive smaller things. Like the way people treat me like my only purpose is to teach them about intersex people …. either that or they get really creepy and gross. I’m lucky in that i'm not visibly intersex, so i do have the privilege of choosing who knows. but there's a reason why i usually don't tell people irl.

M: intersex and autism have overlap again about how like, minor presentation can be? As opposed to the sort of monstrous presentation [Carnival barker impression] "Come see the sensational half-man, half-woman! Behold the h-------dite!" And like - the way nonverbal people are also treated feels relevant to that, because that's how autism is often treated, like a freakshow and a pity party for the parents? And it's so dehumanizing. And as someone who might potentially have a nonverbal child, because my wife is expecting and my husband and she both have ADHD - I'm just very fed up with ableism and the perception of monstrosity.

Overall, this was a chapter that had a lot to talk about! See here for our discussion of Chapters 5-7 from the same volume.

#intersex #intersex studies #queer theory #gender studies #actually intersex #intersex rights #intersex activism #intersex books #book reviews #book summaries #paper summaries #lit review #critical intersex #intersex history

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