In Whose Best Interest?

As much as I wish that we could move forward with scientifically backed measures like bans to conversion therapy, allowing trans or gender questioning youth to access hormone blockers and medically assisted transitional puberty, or implementation of SOGI 123 diversity and inclusion curriculum, we are unfortunately in a time where many people are really adamantly insistent to argue AGAINST science. There are all sorts of sociological and psychological explanations that can take account for why people are drawn to the skepticism of medical science, public health research and the advancement of human rights and as a lay person, I am not really the one to explain why other lay people are playing out their relationships to truth and skepticism in the ways they are. I will briefly make acknowledgement of the Dunning-Kruger Effect, as I see it playing out as an important factor in why people who are:

• Not Trans
• Not Scientists
• Not Doctors

are so strongly pushing an agenda that has actual harmful effects on people who are:

• trans or gender questioning
• scientists studying sex, gender, relationships, equity, justice, education, neuroscience, genetics, fertility etc
• doctors with an interest in fulfilling their responsibility to provide care and ‘do no harm’ as laid out under the hypocratic oath

The people most impacted by restrictions to access to transition are not as involved in resisting the calls to amend bill C-6 or standing up for SOGI, as the far right anti-trans agenda is, because:

• science backs the policies to end conversion therapy, medically delaying puberty for trans youth and the use of educational approaches that consider diversity of gender and sexuality
• human rights legislation backs the move to end conversion therapy, the rights of trans people to access appropriate care including hormone blockers and replacement treatments, and the importance of public systems like education to be representative to the population served.
• trans folks are living in a world riddled with systemic inequity and counter-protesting calls to derail legislation on it’s way to ratification is not a very worthy use of our already limited time and resources
• as the Dunning-Kruger effect explains, the more you know, the more you know you don’t know and therefor the “affected not-expert” may be more likely to trust the “experts” than the “unaffected non-expert”

But, that being said, I have grown tired of seeing the ongoing platforming of such “activism”, and given the news out of the UK, where these “gender critical” extremists have managed to pressure legislators to impose restrictions that bar access to hormone blockers and medical assistance through puberty to trans youth- I can’t hold my tongue any longer.

I am not a scientist. I am a blogger, a community radio host, a facilitator, an independent educator. By and large I can say whatever I want, my platform isn’t subject to the rigor of peer-review or ethics approvals, multiple readings or a the scrutiny of a second house. Instead, my positions are largely informed by the research conducted by those who HAVE been subject to such critiques, my own personal lived experience and the collection of anecdotal accounts I have gathered over 13 years of involvement within various trans communities. I consider it an honour and privilege to have had the opportunity to know personally or work with notable scholars and lawyers whose work is more subject to peer review, ethics approvals, and the need for an argument to stand up in court. When I read the accounts of people protesting Bill C-6, or SOGI, they often say things like “this ideology has appeared out of no where!” or “trans ideology has no basis in science/history/biology/genetics” – which to me is illustrative of the Dunning-Kroger Effect in action; those who do not know anything about this subject are the loudest in crying that they know the most about this subject while actively denying the existence of those who do ACTUALLY know about this topic. If by some twist, someone with that position has found themselves reading this, you will be happy to know I have included a list of links for you to “DO YOUR OWN RESEARCH”, and by that I mean, to dive into the legitimate research rather than take my rant or the ramblings of some ignorant gender critical as some sort of gospel truth.

Now with all of that established, I wish to get to what this is really about:

AUTONOMY

The way I explain this to young children is “You are the boss of your own body, I am the boss of my own body.” This simple enough concept, if broadly integrated into society, could theoretically have the ability to upend rape culture and end exploitation. Maybe that’s why this concept seems to rub certain folks (especially those inclined towards the maintenance of capitalism, the power of an increasingly fascist police state, and those served within “default” power dynamics that rely on exploitation.) the wrong way.

What does it mean to be the boss of one’s own body?

For me as a medically transitioning individual, this has meant the ability to access transition under the “Informed consent” model. This approach in regards to transition related care is relatively new (10+ years). When I first started taking hormones in 2007, the previous standards, Harry Benjamin Standards of Care, were still in common use (as they are in many places still). Looking at the HBSoC, you can see the emphasis placed on pathology and the role of the care provider as gate keeper. HBSoC approach to transition care recognizes that trans care, including non-medical interventions (social transition like a hair cut, wardrobe, names, pronouns etc), fully reversible interventions (like the use of hormone blockers for pre or mid- pubescent individuals), partially reversible interventions (like the use of hormones) and non-reverisble medical interventions (like surgery) can all have the potential to offer great relief to individuals experiencing the impacts of “Gender Identity Disorders”. The most recent update to these Standards of Care (2012) move away from the pathological “GID” and towards recognizing the treatment of “Gender Dysphoria” as the issue, but still place a great deal of the power in the care provider, rather than the individual accessing treatment. Alternately, Informed Consent models involve care providers working with patients to find the treatment options that fit best for the patient on the basis of patient education, understanding risks and benefits and the personal autonomy of the patient. As non-binary gender identities and decolonization of Indigenous traditions around genders continue to expand, shifts towards this model of care make more sense. Within Informed Consent care providers are not expected to maintain the degree of cultural competency across generational cohorts, sub-cultural groups or diverse ethnographic specifics that would be required to make declarative choices on the matter of “patient’s best interest”, as the patient them self are understood to carry those intricacies and weigh them out WITH the care provider, rather than having it done for them or to them. The HBSoC approach to medical transition is an old approach that comes from the same medical timeline as non-consensual hysterectomies of poor and racialized mothers (devastatingly still happening within the US immigration detention system) and the psychiatric/criminal institutionalization of gay and lesbian people on the sole basis of orientation (Canada ended this in 1969- meaning I personally know people who are survivors of this). The idea that a doctor, or legislator, is more suited to make decisions about one’s own person, is entrenched within a patriarchal world view; “Father knows best.”, “Follow the Doctors Orders”, “What do you know about your body, you haven’t been to medical school!?” This attitude may help doctors maintain an illusion of “patient compliance”, but will, like a ban on legal safe abortions, not actually keep people safer, but rather mean that the oversight of safety within care provision is impeded by preventing trust between patient and care provider. If people cannot access safe and appropriate care, it may prevent them from accessing care, but can also mean that patients access treatment without care, for example buying hormones on black or grey markets and undergoing HRT without tracking of levels through routine blood work. Additionally, as research has shown, suicidality amongst trans folks is extraordinarily high, but those rates go down significantly when trans folks are seen, supported, and able to access appropriate interventions of support. Reducing access to care doesn’t keep the people seeking access to that care safe- it does the opposite. How this very simple exercise in logic has gone over the heads of British law makers boggles me, but also demonstrates the devastating impacts of those squeaky Dunning-Kruger wheels. This is unfortunately not a harmless intellectual exercise, but one wherein the greasing of those wheels will likely result in lives lost, if not just significantly damaged. My perspectives on the new British legislation are that it forces the care of trans youth further back in time than the HBSoC, to an earlier, darker time, where care didn’t mean hoop jumping and gate keeping, it just didn’t exist at all.

A part of informed consent means accepting the consequences of things not turning out exactly how you thought they might. I had a concentric double mastectomy in July of this past year. It didn’t turn out. I have spent the last 5 months managing complications including failed drains, abnormal swelling, subdermal scarring, infections, and rejecting non-dissolving dissolving stitches. I will be returning to my surgeon this Friday to have the first of potentially a number of follow up, revisionary procedures. As much as I have had my own struggle to feel gratitude towards a procedure I had desperately looked forward to, which then made my dysphoria worse than it has ever been, I have struggled more with how to talk about this. After having a miscarriage I similarly struggled with discussing how emotionally devastating the experience was- because I knew that experiences like that are used to bandy the anti-choice lobby, the same has been true for me in regards to Gender Surgery. I have felt scared to talk about how I am unhappy, and in moments even regretful, about my surgery, because of the fear that the anti-trans/anti-body autonomy lobby would use a story like mine to push forward further gate keeping and restrictions to accessing gender affirming care. While I am not as happy as I had hoped for about the results of my top surgery, I would NEVER want that to be used as a reason that someone shouldn’t be able to make that choice for them self. I made a choice to have surgery, as with my choice to take hormones. In doing so, I accepted the risks, including but not limited to the potential of death under anesthesia, strange scarring, and an inability to breastfeed again. My Body, My Choice.

SOGI

The opposition to SOGI curriculum in schools seems to be a matter of the ignorant wanting to preserve ignorance on an intergenerational level. When opponents trash SOGI they call it “ideology” and say that it has been “snuck into schools”. The reality of course is that the development of SOGI curriculum is the result of many years of labour, first from LGBTQ parents and teachers, who have been for over 20 years doing all they can to see themselves, their families and the lived realities of their students reflected. For a long time that work involved replicated advocacy, as the same fights would need to be had in every grade, in every class room, every school and every district. SOGI takes that history and brings into a current moment where under the Canadian Charter of Rights and Freedoms, all people are supposed to be protected on the basis of sex, sexual orientation, gender identity and expression. This of course applies within the halls of public education, and teachers, support staff and administrators need tools and resources of how to ensure compliance of that when their training didn’t include LGBTQ cultural competencies and the systems they are working in pre-date these protections. SOGI offers the resources and tools to close this gap. There shouldn’t be anything controversial in the implementation of a toolkit aimed to help schools comply with current human rights protections.

Obviously I have a lot to say about all of this but will attempt to wrap up knowing that this length of read is a lot to expect of the attention span of the covid-fatigued, meme loving public. There is nothing “sneaky” or “trendy” or “malicious” about the movement towards trans liberation. We have always been here, we always will be. We challenge the nature of dysfunctional power dynamics in our very existence. Our existence isn’t a radical “ideology”, but the inverted efforts to suppress our voices, prevent our access to care, and demonize us while venerating those who call for hate and violence towards us are a dangerous ideology that needs to be challenged. We need allies to be in service to this work. Those leading the violent opposition demonstrate time and time again that we (trans folks) are sub-human within their perspectives, and their approaches are crafted in ways to specifically undermine our humanity at every turn, which on it’s own can have devastating effects on our well being.

Let us be the bosses of our own bodies.

You want to “DO YOUR OWN RESEARCH”?

I will recommend the works of these folks who are by their nature within law and academia well vetted and subject to a rigor you can rely on:

https://www.florenceashley.com/

https://www.ajlowik.com/

https://www.jwallaceskelton.com/

https://syrusmarcusware.com/about/

https://adriennesmithlaw.com/

Greta Bauer

Sari van Anders

Elizabeth Saewyc

https://zenasharman.com/

http://www.barbarafindlay.com/

And to close out this reference list, I am copying the text of a shared post written by my collaborator and friend, scholar A.J. Lowik in honour of intersex awareness day this year, as it also leads to some reputable refutations of simplistic sexual dimorphism and biological essentialism.