Gender: A Wider Lens

This is the last episode in our pioneers series and the second interview with Dr. Paul Vasey. If you haven’t heard our conversation with Paul in episode 57, I recommend you go back and listen to that one first, as we build upon many of the ideas we introduced there. Today we continue reflecting on the way Western activism interacts with research and the interpretation of the fa’afafine, the muxe, and other third-gender individuals from different countries. We talk about the implications of the fact that the fa’afafine, for example, don’t try to identify as women and whether there are conflicting rights issues in Samoa. Paul also explains how Western funding organizations can end up imposing foreign concepts onto other cultures. We even touch on the implications for things like puberty blockers and early medical intervention.

It was a real pleasure to wrap up our series with Paul and we hope you’ll enjoy this interview and stick around next week for the post-series analysis with me and Stella.

Links:

“What can the Samoan ‘Fa’afafine’ teach us about the Western concept of gender identity disorder in childhood?” by Paul Vasey and Nancy Bartlett (2007).Pubmed.ncbi.nlm.nih.gov/17951883/

Extended Notes

• Stella and Sasha reflect on the last episode they had with Paul, having now the time to digest what they’ve learned so far in this series.
• What is the implication of the fa’afafine to have their own gender category?
• Fa’afafines having their own gender role consequently makes gender dysphoria uncommon in these cultural settings.
• Paul talks about sports teams and how the fa’afafine participate in them as an example.
• What is the Samoan’s opinion about today’s phenomenon of trans women competing in international sports?
• Paul shares the impact the western culture has with the fa’afafine and the common questions he gets from them.
• What is the most important thing we can learn from the Samoan culture?
• Paul is skeptical about the imposition of ideas from other cultures to work when they don’t develop organically.
• Gender-diverse individuals in non-Western cultures are commonly depicted in idealized terms but there is no such thing as a gender utopia. Paul talks about how he thinks that’s not the reality of their everyday lives.
• What are the points of difference between fa’afafine and muxe? Paul shares what they are.
• The similarities between fa’afafine and muxe mean there is a biological structure to same-sex attraction that can be culturally universal.
• Sasha asks Paul how he addresses cultural relativism between different cultures.
• Paul does not suggest that either conceptual framework for understanding male femininity and same-sex attraction is better or worse than the other. Each has its own benefits and costs.
• In Samoa, male same-sex attraction doesn’t really mean anything. Paul explains this further.
• Paul also talks about the statistics between Western gay people vs fa’afafine vs. muxe and their implications.
• How do cultural influences contribute to ROGD? Paul shares his insights.
• Talking about cross-cultural context, Paul highlights the importance of historical change through time in terms of what boyhood femininity means.
• Paul uses the term female gynephilia as exclusive and explains why.
• Paul mentions Paul Bailey and what he said about having less flexibility in men and what that implicates.
• It’s natural for cultures to interact with each other and it’s natural to exchange ideas and concepts in order to evolve. But what happens when one culture imposes on another?
• Paul often finds a lot of people who are outsiders of
  
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Dr. Anne Lawrence is a physician, sex researcher, and academic writer. She is also a postoperative male-to-female transsexual who underwent gender transition in 1996. Since early childhood, she had experienced an intense desire to have a female body, but she had been unable to find any scientific or popular descriptions of transsexualism that spoke to her experience. This changed in the early 1990s when she discovered Dr. Ray Blanchard’s writings about the concept of autogynephilia, which he defined as “a male's propensity to be sexually aroused by the thought or image of himself as a female.” Blanchard’s revolutionary concept gave Dr. Lawrence an essential insight into the meaning of her desire for sex reassignment, and it helped her find the courage to undergo gender transition.

Dr. Lawrence subsequently began to research and write extensively about transsexualism and associated issues, both in academic journals and on her website, “Transsexual Women’s Resources.” She is best known for her controversial book, Men Trapped in Men’s Bodies: Narratives of Autogynephilic Transsexualism, published in 2013. The book provides a detailed summary and analysis of existing research about autogynephilia and related phenomena. It also contains excerpts from narratives submitted by over 200 male informants, describing their personal experiences of autogynephilic transsexualism and gender dysphoria.

Anne tells us about her early experiences with AGP in childhood, how she tried various ways to sometimes navigate, alleviate or avoid this propensity. She ultimately transitioned in her 40s. Anne is now 71 and reflects on the long game. We spend time talking about her finding Dr. Blanchard’s work and her own research, her book, and her academic interest in understanding this AGP experience.

The end of the conversation took an unexpected turn when she described mindset, the intensity, and the desperate measures that seem so reasonable when you’re tortured with severe autogynephilia. For the record, Anne has not been involved in the field for many years and her reflections do not encompass the ROGD phenomenon. Stella and I feel it’s important to listen to people’s experiences so we can understand all the manifestations of GD. However, we believe in the power of therapeutic intervention and we don’t think a nihilistic approach is helpful to deeply distressed individuals.

Links:

2008 Paper: Shame and Narcissistic Rage in Autogynephilic Transsexualism 

Pfox.org/Shame-Rage.pdf

2013 Book: Men Trapped in Men’s Bodies 

Springer.com/book/10.1007/978-1-4614-5182-2

Extended Notes

• Anne opens the discussion by breaking down what autogynephilia is.
• She also talks about studies that describe children having autogynephilia.
• Anne shares her personal history with autogynephilia starting when she was just a child.
• When Anne told her parents she wanted to be a girl, she was sent for psychotherapy and thought it wasn’t going to be helpful.
• What did Anne’s therapist do to break empathy and connection?
• Anne experimented with estrogens at age eighteen.
• She shares her realizations after her attempt at self-castration.
• How did she come to the idea of how she used estrogens back then? Where did she get it from?
• Anne made several attempts to not express her autogynephilic feelings. She shares what those attempts were.
• How did Ray Blanchard’s work shift Anne’s thinking or experience of her propensities?
• Anne graphically describes how she despaired really liking her male...
  
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The reason this interview is so important is bc the concept of puberty blockers originated with these two researchers (along w/ cohen kettenis.) We talk about patient zero and the 22 year follow up w/ this person. We get into the nitty gritty details about the 2 studies on which all puberty blocker treatment is based: we ask why they selected certain methods, talked about eligibility criteria, and the 15 participants who didn’t make it into the final study. We even touch on Jazz Jennings, social media, ROGD and detransition. This conversation felt, to us at least, like we barely scratched the surface: we were frankly left with more questions than answers, which we are so eager to talk about in our post series analysis. You’ll probably notice the vast differences between the perspectives of these researchers and of myself and Stella, but nonetheless it was a productive and fascinating conversation. 

Bio: Steensma 

Thomas D. Steensma, Ph.D., is a health psychologist, principal investigator and part of the outpatient management team at the Center of Expertise on Gender Dysphoria at Amsterdam UMC, The Netherlands. 

Trained as a child and adolescent psychologist, his clinical work is focused on the counseling and treatment of people of all ages with gender incongruence and Differences in Sex Development (DSD). 

As principal investigator, his research lines are focused on psychosexual development, gender identity development and treatment evaluation of youth with gender incongruence. Over the years, he has published over 50 peer reviewed articles in international journals and several book chapters in close collaboration with prominent scientists in the field of gender and sexology. He has co-supervised several Ph.D. and master students. 

His recent scientific work is focused on understanding the developments in our field focusing on the change in observed sex ratios and the influence of media attention on gender referrals and understanding the processes and factors involved in non-binary gender identity formation. 

He is currently part of the working group for the text revision of the DSM-5 chapter on Gender Dysphoria. In the development of the 8th version of the Standards of Care of the World Professional Association of Transgender Health (WPATH), he is part of two working groups: Assessment and Therapeutic Approaches of Non-Binary People and Assessment, Support and Therapeutic Approaches of Children. 

Bio: de Vries 

Annelou de Vries is a child and adolescent psychiatrist and full staff member in the dept of child and adolescent psychiatry working at the Amsterdam UMC. 

Annelou de Vries is leading the Child Psychiatry Department of the Center of Expertise on Gender Dysphoria of the Amsterdam UMC. She is president elect of the European Professional Association of Transgender Health (EPATH) . She is co-chair of the adolescent chapter of the Standards of Care revision of the World Professional Association of Transgender Health (WPATH).  

At present, her lines of research focus on 1) the co-occurrence of autism and gender dysphoria, 2) capacity for informed consent of transgender adolescents, 3) long term follow up of transgender adolescence into middle adulthood, 4) sexual development of transgender adolescents,  5) shared decision making in transgender care, and 6) pathways in gender identity exploration and affirmation. 

Links:

Young adult psychological outcome after puberty suppression and gender reassignment 

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com

Susan Bradley is Professor Emerita at the University of Toronto. She graduated with her medical degree in 1966 and completed her residency in Psychiatry U of Toronto from 1968 to 1972. In 1975 she became the Founder of Gender Identity Clinic for Children and Adolescents at Clarke Institute of Psychiatry. In 1985 dr bradley handed over the head position to Dr Kenneth Zucker (who we interviewed in ep 59). She is the author or co-author of over 50 articles on various forms of psychopathology including gender identity disorders in children and adolescents. After stepping down as Psychiatrist-in-Chief at HSC spent almost 20 years consulting to Children’s Mental Health Agencies around the Greater Toronto Area with a special interest in children with Autism Spectrum Disorder who are high functioning. Dr Bradley retired in 2010. 

This conversation was an incredible opportunity to hear Susan give her extremely informed long-term perspective on gender nonconforming children and their treatment. She describes what she calls the ‘naivety’ of the early clinicians who put too much trust in the endocrinologists’ eager and scientifically weak recommendations. Looking back, she worries that puberty blockers were just facilitating transition and wonders if many of the dysphoric children the clinic saw actually had undiagnosed high-functioning autism. We discuss the cognitive rigidity associated with autism as well as the laser-like focus some young people have when seeking medical transition. She also shares her thoughts on the new population of ROGD kids and the cult-like aspects of social media trans activism. Dr Bradley was honest, incredibly knowledgeable, and this conversation gives us all much food for thought.  

Links:  

Singh paper - desistance:  

https://www.frontiersin.org/articles/10.3389/fpsyt.2021.632784/full 

Dr. Az Hakeem was born and brought up in North Wales and has lived and worked in London since studying medicine. He is a Consultant Psychiatrist who previously trained in forensic Psychotherapy, Mentalization-Based Therapy and is a Group Analyst. He previously worked within the NHS in Forensic Psychotherapy specializing in Analytic Psychotherapy for conditions relating to sex, gender, sexual perversion, and violence at The Portman Clinic, part of The Tavistock & Portman Clinics.

Dr. Az Hakeem is unique in that he is the only consultant psychiatrist in psychotherapy who specializes in the specialist application of exploratory psychotherapy to persons suffering from gender dysphoria. He set up and ran the only specialist psychotherapy service for adults with gender dysphoria in the UK in the NHS and is the author of TRANS: Exploring Gender Identity and Gender Dysphoria.

After over 15 years working in the NHS, Dr. Hakeem now works exclusively in private practice.

In addition to his clinical work, Dr. Az Hakeem has worked as a consultant to the media, on-screen specialist, and TV Co-presenter on a number of TV programs in both the UK and Australia. 

Dr. Az Hakeem considers himself a “Gender Critical Psychiatrist.” Today we get to hear about Dr. Hakeem’s facilitated group therapy for gender-distressed adults. He ran these groups for twelve years from 2000 to 2012. Containing a mix of pre-medical-transition individuals who were often gender-euphoric and post-medical-transition individuals who experienced regret, these groups created a fascinating opportunity to give gender-dysphoric individuals more insight into the long-term experience of transition. In this episode. we discuss Dr. Az’s understanding of gender distress and how he contextualizes ROGD kids into this framework.

Links:

TRANS: Exploring Gender Identity and Gender Dysphoria: 

Amzn.to/3rckYzw

The Curious Incident of the Dog in the Night, by Mark Haddon: 

Amzn.to/3IKVbEA

“Development and validation of a measure for assessing gender dysphoria in adults: The Gender Preoccupation and Stability Questionnaire” Hakeem, A., Črnčec, R., Asghari-Fard, M., Harte, F., Eapen V. International Journal of Transgenderism (26th August, 2016) Tandfonline.com/doi/abs/10.1080/15532739.2016.1217812?journalCode=wijt20

“Psychotherapy for Gender Identity Disorders” Hakeem, A. Advances in Psychiatric Treatment (2012), vol.18, 17-24 Cambridge.org/core/journals/advances-in-psychiatric-treatment/article/psychotherapy-for-gender-identity-disorders/D10025B4A7EBBC2250E71EA6A12465F0

“Study Protocol for a randomized controlled trial of mentalization based therapy against specialist supportive clinical management in patients with both eating disorders and symptoms of borderline personality disorder” Robinson, P., Barrett, B., Bateman, A., Hakeem, A., Hellier, J., Lemonsky, F., Rutterford, C., Schmidt, U., Fonagy, P. BMC Psychiatry 14(1): 51. 2014

Pubmed.ncbi.nlm.nih.gov/24555511

“Deconstructing Gender in Trans-Gender Identities” Hakeem, A. Group Analysis. The International Journal of Group Analysis Volume 43 Issue 2, June 2010

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