Gender exploratory therapy

Is it conversion therapy?

Gender by Nick Youngson CC BY-SA 3.0 Alpha Stock Images

Recently Slate magazine published an article painting a picture of Gender Exploratory Therapy (GET) as a softer version of conversion therapy. As a member of the Gender Exporatory Therapy Association (GETA), a trans man, and a mental health counsellor, this was news to me. The article made strong assertions without evidence. I would like to try to offer a counter-perspective. I hope you will take the time to listen.

In 2004 I started my medical transition from female to male. I had spent years suffering from depression and anxiety, and had accessed therapy off and on for years. Nothing seemed to help. When I discovered the existence of individuals who skirted the gender norms - some of whom medically transitioned - I thought I had found the answer to my difficulties: of course I was unhappy, I was supposed to have been a man!  Desperate people take desperate measures. I had found a solution to what I thought was the problem. Turns out it wasn’t. 

By 2010, I had legally, socially and medically transitioned to male. For a time, I felt relief - euphoria even - at forging my own path. But as the years went by my doubts increased rather than decreased. My depression returned, as did my anxiety. Only now, I had more barriers to navigate, and a life-long dependence on hormone therapy. Was it worth it? I’m not so sure. Was it avoidable? I think so.

I am ambivalent on whether my decision to transition was a mistake or not, but what I can confidently say is that the medical system did nothing to help me untangle my reasons for transitioning or deepen my self-awareness. Healthcare is supposed to open up more possibilities, not further limit them. That didn’t happen. As soon as I announced to my psychiatrist that I wanted to live as a man, she immediately affirmed me and referred me to a psychologist specializing in assessing people for hormones and surgery treatments. I had a single appointment, 90 minutes long. That was enough for me to be diagnosed with gender identity disorder (now called gender dysphoria) and recommended for hormone therapy. Within three weeks of being assessed, and mere months after I first announced out loud my intentions to live as a man, I was started on testosterone injections. 

Some might say that I have no one to blame but myself, that I got what I wanted so what am I complaining about? In part these arguments are true. I had a particular idea in mind of what would help me, and my healthcare providers facilitated me actualizing that idea. But healthcare providers are not facilitators. Or, at least, that is not their primary role as I understand it. Healthcare providers are there to provide options and identify possibilities as well as risks. They are there to assess co-occurring conditions that might also be contributing to a client’s suffering. In my case I was offered only one possible treatment path. Medical transition.  

I was told by my endocrinologist that transsexualism was a neuroendocrinological condition, not a mental disorder. Later the surgeon who did my hysterectomy would inform me that my decision to transition wasn’t a choice but a medical necessity. I believed them, trusted them, because why wouldn’t I? They knew what they were talking about, didn’t they? They were the experts, after all. And they all seemed so confident.

As an ambivalent human desperate to be happy, I was a prime candidate for this kind of heavy-handed intervention. I had tried many previous mental health interventions to cure me of my depression and all had failed. Finally I took matters in my own hands and self-diagnosed myself as being a trans man. The doctors didn’t challenge this self-diagnosis and offered no possible alternative explanation for my symptoms (like that I had been sexually assaulted a few years earlier, had a toxic relationship with my mother, and was neurodivergent which contributed to social difficulties).

Testosterone levelled out my mood at least at first. And as a former 6ft1 female who was socially awkward, I found solace in blending in more easily as an introverted 6ft1 male-appearing person. Transition solved a lot of my social problems because it made me invisible in a way that felt safe. And previously I had rarely felt safe.

What transition didn’t do was teach me how to build strong relationships or manage my anxiety. It didn’t improve my fraught relationship with my body, and it didn’t prevent me from relapsing into depression. It also didn’t cure my gender dysphoria. If anything, my gender dysphoria worsened, as I was constantly striving for an impossibility — to be a literal man, something I would never be. I sent my DNA to 23andMe hoping to find a Y chromosome (I didn’t) and asked my doctor if I could be tested for an intersex condition (she wouldn’t). I was desperate for some tangible proof that I was really meant to be male, but there was none. There is none. And instead of helping me accept this fact, the healthcare providers encouraged me in pursuing an outcome that I would never fully achieve; not because I am defective, but because I am not a man. The story of the ugly duckling that is really a swan comes to mind.

My mental health only started to truly improve as I deepened my study into how our thought patterns can increase our suffering. As I grew into adulthood and threw myself into studying social work and psychology, I began to question what those doctors had told me at the start of my transition journey. I looked into the transgender-related research while doing my Master’s degree and found, to my surprise, that the science for medicalization was shaky. Much of the research was low quality, and in longer term studies the prognosis wasn’t great. 

For many years I kept quiet about my experience because I thought that my story was a rarity. Most people don’t detransition, after all, and the regret rates, as far as I was told, were low. But, as I started looking into the accounts of detransitioners, I started to hear stories very close to my own - experiences of lonely, awkward, sometimes neurodivergent young people, with a complex history of mental health issues who were being sold a narrative that gender medicalization would ‘cure’ them. That narrative was coming from doctors but also from the culture at large. 

I joined Gender Exploratory Therapy Association (GETA) last year in part because I was curious to see if psychotherapy could perhaps offer a viable alternative to lifelong medicalization. I encountered a thoughtful group of therapists who didn’t claim to have all the answers and who weren’t even necessarily against medical transition. What they offered were options, possibilities and a belief that clients deserved better than the treatment I (and so many others) had received and been failed by. Clients deserve more than false promises and easy answers to complex problems.

If anything GET is more respectful of client autonomy than the so-called gender affirmative care I received. I wasn’t given a choice other than transition. GET offers an alternative vision - choice informed by what we know and don’t know. Choice built on humility, not hubris.

I started transitioning almost 20 years ago. I do not blame my doctors and therapists for my transition (although I do feel some anger towards them for misleading me), because I recognize that clinicians are not researchers, and often they must make difficult healthcare decisions where data is lacking. Mistakes happen. But let’s not stick our heads in the sand and pretend that those mistakes aren’t happening. We know a lot more now and continue to learn more every day. Blindly affirming clients today is not the same as doing so 20 years ago — it takes a certain kind of wilful blindness to not listen to the experiences of detransitioners who are speaking out more and more. 

This is not a cis versus trans issue as it is so often framed. It is about providing ethical, evidence informed care to a vulnerable group of clients. It is about providing options and opening up possibilities. Not everyone transitions for the same reasons, and not everyone needs to medicalize to live healthy, productive lives. Gender affirming care harmed me and many others. GET offers a respectful alternative. It doesn’t claim to be the one and only solution.

I, for one, am glad it exists.