‘Gender transition’ regret deserves a voice, says former patient

Denver Newsroom, Jun 29, 2021 / 18:00 pm

New York woman Grace Lidinsky-Smith said she regrets going through “gender transition” surgery, in a June 25 essay.

Lidinsky-Smith wrote that she’s not the only person who feels wrongly prescribed hormone therapy and surgery by medical providers who operate under no commonly agreed standard of care. Her June 25 essay, “There's No Standard for Care When it Comes to Trans Medicine,” was published by Newsweek.

“Activists may not want to admit it, but I am not alone in my regret,” she said. Lidinsky-Smith said her self-examination led her to discover other “detransitioners” with similar stories.

Some people stopped a gender-transition procedure quickly, she said, while “others were on cross-sex hormones for years and had multiple surgeries before deciding the path wasn't right for them.” 

She emphasized the need to show more concern “for the people who had been hurt by transgender medical treatment, which is increasingly being administered to patients in their teens.”

Lidinsky-Smith also spoke about her life in a May 2021 television interview for CBS News’ 60 Minutes - an episode that proved controversial even before airing as transgender activists called for it to be censored or cancelled.

“I went on ‘60 Minutes’ because I wanted people to understand that trans medicine is not always being administered responsibly and safely,” Lidinsky-Smith said in her Newsweek essay. “I knew I had been badly hurt by my transition, and I wasn't the only one.”

In her early 20s, Lidinsky-Smith said, she became “depressed and gender dysphoric after years of obsessing over identity issues.”

“Finally, I thought I saw my route forward: the total transformation of medical transition, to live as a man,” she continued. “I started my transformation with cross-sex hormones injections. Four months later, I had my breasts removed in the masculinizing surgical procedure known as ‘top surgery’.”

“One year later, I would be curled in my bed, clutching my double-mastectomy scars and sobbing with regret,” Lidinsky-Smith said.

She believed other factors motivated her decision to seek a gender transition.

“I had the most supportive possible environment for transitioning: easy access to hormones, an affirming community and insurance coverage,” she said. “What I didn't have was a therapist who could help me scrutinize the underlying issues I had before I undertook serious medical decisions. Instead, I was diagnosed with gender dysphoria and given the green light to start transition by my doctor on the first visit.”

According to Lidinsky-Smith, “detransitioners” see various root causes that in retrospect contributed to their decision to “transition” genders: untreated mental health issues, a major life crisis, sexual abuse trauma, undiagnosed autism, or a struggle to accept a sexual orientation.

“For many, the regret and pain was intense, as it was for me,” she continued. “In a lot of ways, there is no ‘going back’. Many of us are left wondering, ‘Why didn't my therapist help me figure out my underlying problems beforehand?’”

She cited commentator Scott Newgent, who said “here is no structured, tested, or widely accepted baseline for transgender health care.”

Lidinsky-Smith is president of the Gender Care Consumer Advocacy Network. The organization lobbies against efforts to legally prohibit “trans care,” arguing instead for best practices and accountability for medical providers. It advocates for competent medical care, including the right to reparative treatment for surgeries or hormones that have caused “physical or emotional trauma.” It advocates for accurate medical information and for access to legal professionals to hold care providers accountable.  

She backs the standards of WPATH, the World Professional Association for Transgender Health. Though “trans care” is a newer field, she said, Lidinsky-Smith called the association’s standards “generally accepted,” but also lamented that there is no requirement that these standards be followed.

“In my own medical odyssey, I did not receive most of the therapeutic exploration recommended by the WPATH standards of care,” she said. “As such, I was left to my own self-diagnosis.”

However, Paul McHugh, psychiatry professor at the Johns Hopkins University School of Medicine, has himself challenged the WPATH standards. He provided testimony in an amicus brief for the U.S. Supreme Court Case of Harris Funeral Homes v. Equal Employment Opportunity Commission, decided in 2020.

“Without firm scientific evidence, the medical and psychiatric community should not follow the WPATH protocol to progress from social transition, to medical interventions, and ultimately to surgery,” he said in his amicus brief.

The pro-transgender association itself has said that “no controlled clinical trials of any feminizing/masculinizing hormone regimen have been conducted to evaluate safety or efficacy in producing physical transition,” McHugh wrote.

The fact that some patients undergoing medical and surgical sex reassignment may wish to return to a gender identity consistent with their biological sex suggests that this reassignment “carries considerable psychological and physical risk,” he said, and their beliefs about post-treatment life “may sometimes go unrealized.” Even in fully supportive environments, many who undergo such surgery “remain traumatized, often to the point of committing suicide.”

Though the American Medical Association is favorable to a pro-“gender reassignment” protocol, McHugh said that not following such protocol might show more positive results.

Given the harms of the WPATH protocol, he said, “social transition should not be encouraged.”

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“Not only does it not address the root issues causing clinical distress, it also makes it more likely for patients to forge ahead into hormone therapy and physical alteration of their body,” he said.

Hayes Inc., a company focused on assessing health technology and clinical programs, has given the quality of evidence for hormone therapy its lowest rating, according to McHugh. Further, the prevalence of suicide attempts among patients was not ameliorated by hormone therapy.

“Additionally, hormone therapy increased risk of cardiovascular disease, cerebrovascular and thromboembolic events, osteoporosis, and cancer,” he continued. “No proof of improved mortality, suicide rates, or death from illicit drug use was observed.”

“Scientific support for sex reassignment surgery is equally lacking,” said McHugh, who noted that Johns Hopkins Medical Center discontinued surgical intervention after a 1979 study on the efficacy of surgical transition. Other studies have shown negative consequences of surgical intervention, including a significant increase in suicide attempts and successful attempts.

As for children and teens, children encouraged to live as the opposite sex “may increasingly be unable to live as their own sex” because of how repetitive actions affect the brain. Some children who would otherwise overcome gender dysphoria may be unable to do so.

Puberty blockers have health risks including impaired bone growth, interference with brain development, and impaired fertility.

For her part, Lidinsky-Smith cited new scrutiny of the medical field prompted by the Kiera Bell case, a woman who said medical care staff wrongly encouraged her gender transition. In response, a U.K. high court ruled in 2020 that prospective patients under age 16 might lack the ability to consent to puberty blockers.

She called for “a nuanced public conversation about how we can improve medical transition,” but objected that GLAAD had denounced her and others who voiced regret.

She asked, “why the resistance to hearing complicated, and even negative, stories about transgender healthcare?”

“(W)hen activists push stories like mine under the rug and try to shut down stories of medical negligence, they are only protecting doctors, not patients,” Lidinsky-Smith said in Newsweek. Without seeking to tell the truth, she said, “more people—especially young people—will be sold one-size-fits-all trans care that may cause them lifelong scars and regret.”