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Biden’s cowardly war on conversion therapy It's not the job of a doctor to affirm your identity

Make peace with the body you have (TIMOTHY A. CLARY/AFP via Getty Images)

Make peace with the body you have (TIMOTHY A. CLARY/AFP via Getty Images)


June 23, 2022   6 mins

Body horror dwells in the fear of damage that cannot be undone. It involves stories of skin, and limbs, and teeth, and eyes — precious and irreplaceable, now scarred or severed or irrevocably changed. In some versions, the Icarus stories, the damage is self-inflicted: fevered experimentation becomes joyful discovery becomes tragic hubris, the enterprising scientist watching with fascination as his body falls to pieces, a disintegrating structure with his consciousness trapped inside.

But in others, it’s the result of medical madness, a doctor so drunk on the possibility of a breakthrough — or so convinced he’s already made one — that he presses forward in violation of scientific principle, of basic decency, of his own humanity. These latter stories are more frightening. It’s the betrayal of it: the violation of that sacred oath to do no harm, and of the trust we place in the physicians who care for us at our most vulnerable.

That fear — of medical mutilation, of waking up from surgical sleep to find your body altered in ways you never wanted — has roots not just in horror but in history, where doctors who fancied themselves as cutting-edge would infect their patients with deadly diseases, or lobotomise them, or surgically extract their teeth and organs (this last item was part of an early 20th century vogue for “surgical bacteriology”; the doctor who disfigured his patients was hailed at the time as a pioneer). Today, we can find the same fear lurking just beneath the surface of the debate over transgender medicine.

Eight years after Time magazine declared that we are living through a transgender tipping point, there’s a growing sense of unease in the US, that we might have tipped too far, too fast. The momentum of the movement has given way to unanswered questions and nagging doubts: about the long-term side effects of using puberty blockers off-label, about the revelation that patients who begin to transition as children are likely to experience infertility or sexual dysfunction, about the testimony of regretful transitioners who say they were rushed by a gung-ho medical establishment into lives, and bodies, that they didn’t really want.

Some of the detransition stories are heartbreaking, or haunting. Some are
 more than that. “No one told me that the base area of your penis is left, it can’t be removed — meaning you’re left with a literal stump inside that twitches. When you take Testosterone and your libido returns, you wake up with morning wood, without the tree,” reads one representative account. “I dream often, that I have both sets of genitals, in the dream I’m distressed I have both. Why both I think? I tell myself to wake up because I know it’s just a dream. And I awaken into a living nightmare.”

Unlike in Britain, stories like this, horrifying to the average person, do not appear to have breached the consciousness of the American government. The Biden White House has enthusiastically taken up the cause of not just ensuring access to medical transition for children who identify as trans, but taking other treatment options off the table. Last week, the White House announced that Biden will sign an executive order which takes specific aim at “so-called ‘conversion therapy’ — a discredited and dangerous practice that seeks to suppress or change the sexual orientation or gender identity of LGBTQI+ people”.

Critics have already noted the error in lumping in conversion therapy practices in relation to sexual orientation — which were ineffective at best and barbaric at worst — with the type of therapy that aims to help patients find a measure of peace with the bodies they have; such concerns have already led to the exclusion of transgender people from a government ban on conversion therapy in England and Wales. In the US, it is not yet clear whether a doctor with a patient who presented with gender dysphoria and an eating disorder, for instance, would be guilty of practising “conversion therapy” if he tried to address the patient’s mental health issues before opening the door to puberty blockers, hormones, and gender reassignment surgery.

But what this debate also illuminates is a growing tension over what it means, in one’s capacity as a medical doctor, to do no harm — when a growing contingent insists, passionately, that the worst harm one can do to a trans person is to fail to affirm their identity.

Two different ideas have emerged; two answers to the question about what medicine is for. Once, we agreed that the point was to be healed and made whole. The endpoint of the patient’s journey is that he stops being one; the doctor’s triumph is in seeing him walk out the door with high hopes that they’ll never meet again. Also in most cases, the process of healing was governed by a certain conservatism: a desire that the cure not be worse than the disease, a reluctance to adopt extreme measures when more moderate ones might suffice. And so your doctor would likely prescribe physical therapy before surgery, or try to restore healthy function to the organs you have before removing them from your body and replacing them with transplants. The most invasive, disruptive, and destructive treatments — amputation, chemotherapy — were understood as last resorts, to be held back until and unless they would make the difference between life and death.

The progressive wisdom surrounding trans medical care is a near-complete inversion of these norms, save that last one: here, gender dysphoria is seen as no less serious than cancer or gangrene in its necessity for urgent treatment. In place of the ominous shadow on an X-ray, we have the spectre of suicide among trans teens: without immediate and aggressive medical intervention, we are told, the patient will die.

The urgency makes sense, especially as a rhetorical strategy aimed at the parents of gender dysphoric teens. The question “Would you rather have a living daughter or a dead son?” is thrown around a lot these days (obviously, nobody ever wants the latter). And if you accept the premise, if you imagine a dozen bodies piling up for every second spent on debating best practices, then of course the conservative approach of a do-no-harm doctor would seem like the most harmful thing imaginable. But it’s worth noting how this understanding reverses the nature of the patient’s trajectory: now, one enters the system and does not leave. Now, there’s no end point, no cure, only treatment. The patient will spend the rest of his life undergoing procedures, taking hormones, being monitored by doctors. The journey never ends.

This, of course, is the best-case scenario. The worst-case scenario, the one beginning to make itself known in Substack posts and Twitter threads, is either downplayed or ignored by activists who imagine — not incorrectly — that to acknowledge it would be a giant wrench in the works of what they hope to achieve. The narratives of regretted transition are too ghastly: how can your guts not twist at the image of that phantom appendage, long since severed, still twitching with desire at the root? How can you not share the outrage when he writes: “I cannot believe they were allowed to do this to me.”

Would psychological treatment aimed at persuading this patient not to undergo a penectomy fall under the auspices of conversion therapy? Maybe: but if so, you will have trouble convincing most people that conversion therapy is a bad thing. Most people would prefer that he had the chance, every chance, to avoid such terrible regret. To make peace with the body he had — a body that is now altered, forever — before a surgeon began removing pieces of it.

There is a powerful push at the moment to make the above sentiment unspeakable, and I understand why. As rare as stories of detransition are, they are viscerally horrifying in their evocation of the undoable. They fester and wriggle in the same dark part of the imagination as Jeff Goldblum in Cronenberg’s The Fly, saving his body parts in his medicine cabinet as they fall off one by one — or Ronald Reagan in King’s Row, waking up to find his legs amputated, screaming “Where’s the rest of me?” — or that recurring nightmare, ubiquitous around the world, that all your teeth have fallen out. You can’t fight horror like that with pleas for sympathy. Your best hope is to make it taboo.

Whether it should be remains to be seen. Certainly, none of this is to say that no young person can benefit from medical transition. Perhaps many of them would, and perhaps the urge to tap the brakes in this moment will prove to have been a mistake. Some predict that we’ll soon be hit by a tidal wave of lawsuits from former patients who were rushed into medical transition too quickly; others are no less certain that countless trans youth will suffer terribly, if not die, due to state laws that challenge their access to cross-sex hormones and surgery.

But the quest to redefine “harm” in a medical context, to enshrine identity rather than health as the North Star which physicians should follow, and to make it taboo even to consider therapeutic alternatives to medical transition, will be a particularly uphill battle for reasons that go beyond politics. For all our sympathy, all our care, all of the passionate and persuasive arguments that it is the job of medicine not just to heal a patient’s ailments but affirm his sense of self, most people will never overcome the conviction — a visceral sense as much as an intellectual one — that doctors should not cut into us first and ask questions later.


Kat Rosenfield is an UnHerd columnist and co-host of the Feminine Chaos podcast. Her latest novel is You Must Remember This.

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Brian Villanueva
Brian Villanueva
2 years ago

So much ink and so much angst over a backwater mental illness that affects a single digit decimal of 1% of all people.

This charade will only end when the lawyers start winning judgements against doctors who mutilated and sterilized these teenagers. Here in the US, that’s how we decide things. We don’t engage in political debate about policy, we just sue each other until the insurance companies tire of paying out judgements and force the industry they insure to change their practices. The trans craze has been a bonanza for the medical-industrial complex including pharma. And when it dies, it will be bonanza for the lawyers.

Then all our progressive virtue signalers (including the by-then-ex-President) will quietly delete their tweets and re-Tweet their “longstanding concern about teenagers being abused by unproven gender therapies.” Our press will pat themselves on the back for their reporting for a few weeks and then move on to the next shiny object. And the entire sordid tale will be memory holed, only to be regurgitated in our conscious minds when we encounter one of those unfortunately maimed asexual creatures (by then in their 30’s and 40’s) who we will briefly pity while trying to ignore.

And that’s the real tragedy. Most of us will move on from this lunacy. But those whose bodies have been altered permanently, who can never have children, whose real mental illnesses have gone untreated, who have torn asunder their family relationships… those people are the real victims.

Jeremy Bray
Jeremy Bray
2 years ago

Sadly those who have supported the drive to mutilate rather than try to treat for ideological reasons will remain untouched by the tsunami of litigation.
Politics should have no business intervening in areas of clinical choice to rule out a legitimate non-surgical intervention.

Is there any evidence that suicide is more likely among those denied trans surgery than among those with mental problems desiring other extreme self-mutilation. Perhaps we have entered a place where the desires of the mentally afflicted must always be respected and a surgeon should never try to persuade a patient that some desired surgery is not in their best interests however physically and psychologically dangerous they may be.

Ian Stewart
Ian Stewart
2 years ago
Reply to  Jeremy Bray

I recall there was a medical study but can’t recall the source which concluded the suicide risk is virtually zero. It’s fake science based on an emotive fallacy.

Derek Smith
Derek Smith
2 years ago

For one account by a ‘detransitioner’ of the permanent damage – both physical and mental – done to a male body, google ‘Rod Dreher Twitchy Stump’. A stiff drink will be required.

Nikki Hayes
Nikki Hayes
2 years ago
Reply to  Derek Smith

Christ that is awful – and you were right about the stiff drink. That doctors can do this to people is completely abhorrent – they should be struck off!

Cathy Carron
Cathy Carron
2 years ago

…not even 1% – transgenders are said to represent just 0.04% of the population. About 20 years ago, John Hopkins University stopped doing these surgeries after their research showed that these amputations and reassignments did not ‘cure’ the malady, and that most trans continued to have psychological issues regardless. So it’s baffling, as to why these medieval practices are still be carried out. Have we gone backwards?
As for Biden – he’s not fully there. It just appears various aides put papers in front of him and he signs. For all intensive purposes he has no clue as to the depth and breathe of this or many other issues. Based on his age and mental slowness, he should have never been elected.

Last edited 2 years ago by Cathy Carron
Jane Watson
Jane Watson
2 years ago

I hope you’re right about the insurance companies coming to the rescue. As I understand it, this is what happened in the States with Multiple Personality Disorder. So many people (women) were diagnosed in a short period of time that special facilities were opened for residential ‘treatment’. Parents were accused of abuse (recalled under hypnosis) and people were imprisoned. It quickly became a lucrative industry, but imploded when patients were seen to get worse, not better, and diagnosis and treatment were delegitimised.

There’s an excellent book ‘Creating Hysteria’ by Joan Acocella recounting this story. The similarities with the trans industry are stark – professionals beginning to diagnose a previously rare condition at a vastly increased rate, creating life long patients and ever increasing demands on their services and ‘expertise’.

There’s no evidence that the professionals concerned were anything other than sincere, which I suspect is true of those involved in trans ‘medicine’, although it is well known that GIDS units in the UK have extremely high staff turnover. Those who leave seem to hold their tongues until they are due to retire unfortunately.

We can at least be grateful for the limiting effect of the NHS on the availability of medication and surgery for children in the UK. We thankfully don’t see 13 yr old girls receiving double mastectomies, as per the US.

eddie shank
eddie shank
2 years ago

I don’t think I could have ever said it better. As a parent I could never allow my minor child to due the conversion. When they are an adult, they can make the decision for there self. To me it’s like having your six year old have sex,smoke,drink alcohol,drive a car,carry a gun,etc …

susan bellush
susan bellush
2 years ago

I know more people with transitioning children (myself included) than I know that died from Covid. This has become a hysteria in this country. This may have affected less than 1% of my generation but it is consuming 10+% of teens today. The fallout is going to be massive. In the meantime I will pray for my son.

Nunya Bizness
Nunya Bizness
2 years ago

1%? Try 5% (https://www.washingtonpost.com/nation/2022/06/08/pew-research-trans-nonbinary-young-adults/). That’s what we’re up to now that transgenderism has become a social pathogen. Research Rapid Onset Gender Dysphoria: being trans has become young girls’ way of coping with the horrors of modern femalehood (the ubiquitous porn, the anomie, the havoc wreaked by social media and dating apps, etc.).

Jim Jam
Jim Jam
2 years ago

It’s odd isn’t it – for a ‘progressive’ movement so utterly obsessed with being on the ‘right side of history’, it should be their modern flagship cause – that of trans butchery and other irreversable damages meted out to intentionally confused children and young adults – that seems to be the most obvious candidate for being unambiguously on the wrong side of it.

Lindsay S
Lindsay S
2 years ago
Reply to  Jim Jam

The complete and utter denial of these children being groomed into this is what I find the most disturbing aspect. This entire field is covered in safeguarding red flags!

Martin Johnson
Martin Johnson
2 years ago
Reply to  Jim Jam

Not really, in the US at least. Left causes long ago decided to advance their power by defining false coalitions and claiming big numbers in support of their positions. Combining Blacks and Latinos was the start—2 “groups” ravh of which was very heterogeneous to begin with, and were often quite antagonistic to each other, somehow transformed into a single voting bloc. Followed by LGBT, with the T having nothing to do with L, G, or B, each of which already had differences with each other.

But magically trans was redefined into the successor of the civil rights movement on the mid-20th century, even the abolitionists of the 19th.

It is all bullshit but it worked.

Last edited 2 years ago by Martin Johnson
Martin Johnson
Martin Johnson
2 years ago
Reply to  Martin Johnson

Add to that the financial incentive to exploit vulnerable people with decades of drugs, surgeries, other medical interventions, and psychotherapy. Esp when you can even create the vulnerability via social contagion. And convince yourself that you are the good guy.

It is enough to make you think Satan is real and walking among us.

R Wright
R Wright
2 years ago

Given that the data shows that puberty blockers and surgery actually increase suicidality among the trans the idea that doctors are weighing any of this up falls flat. They dont care. It isnt about do no harm. They want the cash.
If they wanted to lower the famous 41% suicide attempt rate among this lot they would start with fixing their gender dysphoria first through mental health provision. That would deprive the health system of the chance to make hundreds of thousands from the patient (victim) through the sale of drugs and surgeries. They cannot allow that. Until the monetary incentives end, this carnival of lobbying and astro turf activism will roll on, leaving behind thousands of eunuchs and flat chested girls in its wake.

Last edited 2 years ago by robertdkwright
Richard Craven
Richard Craven
2 years ago

Doctors who castrate healthy children are sadistic paedophiles.

Martin Johnson
Martin Johnson
2 years ago
Reply to  Richard Craven

Some of them think they are doing holy work. Not sure which is the more dangerous attitude.

Saul D
Saul D
2 years ago

If someone is going to take the pain and struggle to transition then they need the emotional maturity to understand all the implications of induced deformity, many of which will only apply after sexual maturity. It’s impossible to think of a child as having enough awareness of the implications. We don’t even let children have tattoos until they’re 18.
But it also hints at something else. The keenness of the medical profession to medicalise in order to sell medical procedures and drug interventions. Don’t think you’re pretty enough? Buy some of our plastic surgery. Trouble at work? Take these anti-depressants. We have become our own disease. There is constantly something wrong with us that is caused by who we are and how we feel we ought to be.

David Yetter
David Yetter
2 years ago
Reply to  Saul D

A short motto: if you’re too young to consent to have sex, you’re too young to consent to change sex.
Of course, if it catches on, watch the Left, which was always the force pushing for age of consent to be raised to 18, to reverse field and start arguing that age of consent should be 10 (as it was in the early 19th century in most states in the US).

Lillian Fry
Lillian Fry
2 years ago

I read once that your body forever treats a reconstructed “vagina” as a wound and attempts to close it, much like pierced ears require the forever use of earrings. I believe the article was in The Atlantic, years before this issue became front and center. I couldn’t find it but I believe they were trying to portray the consequences of such surgery honestly.

Derek Smith
Derek Smith
2 years ago
Reply to  Lillian Fry

That’s correct.

Linda Hutchinson
Linda Hutchinson
2 years ago
Reply to  Lillian Fry

If true, this is just another ghastly consequence of this horror show.

john meyers
john meyers
2 years ago

I’m a psychiatrist. Several years ago, around the time of Time magazine’s “tipping point” the psychiatric definition of transsexual changed: where once we recognized “primary transsexualism” (the 1% incidence noted in another comment) and “secondary transsexualism” (typically, persons who were psychotic who came to think they were of a different gender—though there were persons with severe personality disorders, abuse, etc. in this group too), those distinctions were dropped. Now, there is only “gender dysphoria”. you don’t need a psychiatrist to diagnose that. If I were to explore whether that dysphoria might be related to psychosis, or drug use, or sexual abuse, i’m skating very, very close to “conversion therapy.”
in the hospital where I work, over 50% of adolescents admitted to our residential program declare themselves “transgender.” The rate is perhaps 15% in the adult programs. I have a few who are obviously psychotic, but I don’t dare to point this out as I walk hallways festooned with posters declaring “this is a trans friendly place.”
I’m 56 years old and will retire at the end of the year. None of this squares with the Oath I took. i’m morally wounded and am leaving before my soul rots and falls off like some unwanted member.

Nic Cowper
Nic Cowper
2 years ago

I love unherd simply for writing fearlessly on difficult subjects.

Chris Hume
Chris Hume
2 years ago

It’s astonishing to me that a doctor could be presented with a patient who has suicidal ideation and body dysmorphia to the extent that they believe only radical surgery and pharmacological intervention could alleviate their suffering, and not consider it most likely that this desire to alter one’s body to such an extent is a function of a mental injury rather than the cause.

Helen E
Helen E
2 years ago

One of the best pieces I’ve ever read, anywhere, on trans “affirming” surgical intervention. And on the twisted policy imperatives coming out of the Biden administration on gender ideology

Last edited 2 years ago by Helen E
Steve Jolly
Steve Jolly
2 years ago

What fascinates me is where this comes from exactly. New conditions of humanity shouldn’t just appear out of thin air. After millions of years of evolution, where was transsexuality as a condition for the first 99.9%. Homosexuality, and even pedophilia, are present throughout human history, famously in Ancient Greece and Rome. It has always existed, but rarely been acceptable. It has been observed in other species as well. We have no such history or scientific foundation for transsexuality that I am aware of, unless you count the said history of homosexuality, but we’re told transsexuality is not the same. To me the question is simple. Can a doctor do a brain scan and say whether the brain is male or female? If the answer is yes, why is that not the sole determining factor for a medical doctor? If the answer is no, how do we conclude transsexuality even exists beyond an individual’s say so? The causes of even well accepted mental illnesses are not well understood and the diagnoses are imprecise and prone to error. It’s one thing, however, to tell someone to take a pill, the effects of which can be studied and determined to the point where a doctor’s creed to ‘do no harm’ can be easily met, and another to perform surgery that will have permanent irreversible effects on the body. Gender reassignment surgery would, in any other period of human history, be condemned as butchery by any ethical medical professional, and that should give us pause. The current generation, however, has shown a particular tendency to dismiss, disdain, or completely rewrite history according to their own values, so why should this be any different.

Cathy Carron
Cathy Carron
2 years ago
Reply to  Steve Jolly

Yes, sireee, this current period does speak to a unique form of ‘societal decadency’.

h w
h w
2 years ago

The current approach is too narrow, discriminatory. Why the obessesion with sex-characterisitics in efforts to satisfy a very few people’s identity-appearance desires with legislative fuss and tax funding? Plenty – maybe even most – of us have appearances that do not reflect our very diverse inner identities. Let government provide free hair colour, accent-training, wrinkle cream, puberty-accelerating drugs, high heels, breast-implants (for women), botox, girdles, hair colour, liposuction, diet pills, face lifts, make-up, tanning/bleaching, steroids, body building aparatus, eye-lid surgery…

Nikki Hayes
Nikki Hayes
2 years ago

Gender dysphoria is a mental illness – so why on earth do we not treat it like a mental illness? Its considered transphobic to even mention that maybe therapy is a better idea than serious life changing drugs and surgery. These trans rights activists and the doctors who enable these disgusting practices have a lot to answer for – and, make no mistake, one day they will have to answer for all the damage they have done. I worry about the susceptible teenagers who are sucked into this nonsense – they are ruining their lives and bodies permanently, people talk about “de-transitioning” but its not really possible to do that in any meaningful way.

Tony Sandy
Tony Sandy
2 years ago

What do I think of all this? These kids are not turned into the opposite sex as they want but travesties of what it means to be males or females. Surgery is not a perfect remedy for this situation of wanting to be more masculine than the body you were born with or more feminine. Doctors cannot be blamed totally for this demand anymore than an abortionist can be blamed for something you could do to abort a baby yourself (or emasculate yourself if it came down to it). Society is an accomplice in all this, not the instigator.

Julian Farrows
Julian Farrows
2 years ago

I think this article hits the mark about transgenderism and where it is leading us to: https://www.thinkinghousewife.com/2016/12/the-manufactured-insanity-of-transgenderism/#

Richard Courtemanche
Richard Courtemanche
2 years ago

One with so much power with a certain ‘affinity’ for children, apparently. A dangerous enclave.

James Bell
James Bell
2 years ago

HSV-1 and HSV-2. Both virus types can cause sores around the mouth (herpes labialis) and on the genitals (genital herpes). It’s also crucial to learn as much as you can about your diagnosis. Seek options, Find out about what’s out there that could help, ( worldrehabilitateclinic com 

Jacob Mason
Jacob Mason
2 years ago

We need to separate the discussion of the Morality of conversion therapy and the Effectiveness of conversion therapy.

The American Psychological Association vaguely combines the two (as does the author of this article).
Perhaps conversion therapy should not be practiced because it does not work, perhaps it should not be practiced because it is immoral. I am uninterested in hearing anyone’s opinion who is not interested in this distinction.