“We’re sterilizing a generation who will not be able to have their own kids. And we’re altering their sexual functioning in a way that’s going to make it more difficult for them to have loving relationships.”
Stephanie Winn is a licensed marriage and family therapist who is currently treating detransitioners and parents with gender-questioning youth.
She says that gender-affirming care is costly to one’s physical health and antithetical to the therapeutic process, reducing the role of the therapist from a curious explorer to someone who is not allowed to probe, question, or act with discernment.
“We’re essentially agreeing with the lie that these vulnerable, young people who are in a moment of great distress, really truly have no other ways of coping than to make life-altering decisions with a lot of negative ramifications for their health. And that’s not true,” says Winn. “Puberty blockers are not FDA-approved for the treatment of a mental health condition. They’re being prescribed off label for very young children. And we know for a fact that puberty blockers damage, among other things, brain development, also bone development.”
Winn and I discuss “Affirmation Generation,” a new documentary she is featured in, which critically explores the gender-affirming model, society’s suppression of detransitioners, the for-profit trans-industry and the many myths associated with being transgender.
“So many of the vulnerable, young people who are presenting with gender dysphoria are autistic. Many of them have trauma histories. They’ve been bullied. They’ve been abandoned,” says Winn.
Stephanie Winn, such a pleasure to have you on American Thought Leaders.
Thanks for having me. It’s great to be here.
Stephanie, congratulations on this amazing, amazing film and we’re going to talk about that today. Before we go there, you’re a psychotherapist yourself, and you say something in the film that I thought would be a perfect launch point for us. You say, “Clinicians, we’ve been sold a bill of lies.” What are the lies?
For one, we’ve been lied to that so-called gender-affirming care is an actual model of psychotherapy like other models. We have many models of psychotherapy, DVT, ACT, CVD, EMDR, these are just some acronyms. Models of psychotherapy generally include ways of conceptualizing and formulating our clients’ distress and understanding their presenting problems, and then ways to proceed with helping treat their distress.
Gender-affirming care is actually antithetical to the therapeutic process, which always necessarily includes really getting to know our clients and exploring their life circumstances. I mentioned this in the film as well. We do a psychosocial assessment. We assess what’s happening for them physiologically, environmentally, socially, internally, and in terms of their phases of life.
Normally, we have to have room to explore all of these things in order to do our jobs well. But with the so-called gender-affirming model, what we’re told is not to ask questions, just to affirm, and just to agree. It’s a reduction of our role from a curious explorer who uses mirroring and reflection as one of many tools, to somebody who is relegated to the role of only mirroring and reflecting, without probing, questioning, or discernment.
When I say that we’ve been lied to, I’m talking about how our generally agreeable and conscientious natures have been exploited by being asked to do something that is actually antithetical to the goals of our profession. Because therapy is mental health and mental health is part of healthcare, part of helping the individual be well.
What is it to be healthy? It is to have a sense of vitality, capability, being able to do things, being able to have healthy relationships, and being able to be physically active and pursue meaningful work. These are some of the foundational cornerstones of health, along with eating well and sleeping well and things like that.
What therapists are doing who are practicing so-called gender-affirming care, in other words, just agreeing with their clients on this question of gender, is not actually in the service of health. Because this social affirmation is the first step in a process that leads to hormones and surgeries that are experimental and that are very costly to physical health.
This is one reason that I’m passionate about this issue. I’m sure we’re going to talk about this more, but the threat of suicide is often used to push concerned citizens, especially parents into a so-called affirmation. But we know that in the long-term, things that increase suicide risk include not having the health and vitality to be physically active, to feel good in your body, and to have meaningful relationships.
I’m sure we’ll talk about all of that more, but basically, we’re undermining people’s long-term health and wellbeing when we practice gender-affirming care. We’re essentially agreeing with the lie that these vulnerable young people who are in a moment of great distress really truly have no other ways of coping than to make life altering decisions with a lot of negative ramifications for their health.
That’s not true. That’s how we’ve been lied to. In the process, we’ve been lied to about our own capabilities as therapists to support our clients’ resilience and our duty to challenge them when their thought process is not completely sound.
In the film, it’s mentioned that lobotomies were once one of these physiological interventions in very rare situations to try to deal with a mental condition. There was an analogy drawn that this gender-affirming care model leads to these very profound physiological interventions and was comparable. Please tell me about that.
It’s pretty wild, isn’t it? This is part of our history as Americans, the lobotomy craze of the 1940s. That was its peak, but it was actually longer than that. If you think about lobotomies from today’s standpoint, it’s like how could we have ever done that? How could we have ever thought that you should mess with person’s brain by putting an ice pick through their nose to fix something psychological?
And yet, that does bear resemblance to what’s happening today, because it was always experimental. It was always nothing but experimental, and yet it was being proposed like it was a legitimate form of treatment and it damaged people permanently.
One parallel I see is that puberty blockers are not FDA approved for the treatment of a mental health condition. They’re being prescribed off-label for very young children. We know for a fact that puberty blockers damage, among other things, brain development, bone development, and every system of the body. This is a so-called treatment that is interfering with a young person’s development in a profound way. It’s not FDA approved, and yet it’s being prescribed outside of clinical trials. And we’re not even tracking what’s happening to these kids.
I want to discuss some of the potential harms associated with these interventions for sure. They’re typically billed as not being particularly harmful. You sent me this report about puberty blockers, which I found shocking.
Before we go there, there is this question that’s hanging in the air. In many cases, these are children or teens who are just discovering themselves and they’re making these profound life decisions that will affect them permanently, without being able to remotely grasp the consequences. You could ask them, “Do you want to have children one day?” They may reply, “I don’t know.” There’s a million questions I could add to that. How is this even being considered?
That’s a great question, and in our documentary, Lisa Marchiano makes that comment. She says that it strikes her as extremely naive of any responsible adults to go along with this child’s understanding of who they are and what they’re going to want in the future. Anyone watching this can think of someone you know that swore up and down they did not want children when they were in their teens or 20s. And then, a switch flipped at some point, maybe at even 35, where suddenly they wanted children desperately, and now they’re so grateful that they have them.
If there are healthy people who pass through normal phases of life thinking they didn’t want children, and then that changed for them at some point in life, how are we assuming that young, vulnerable, mentally unwell, impulsive, angsty teenagers and prepubescent teens could possibly know what they’re going to want in the future?
I don’t understand how so many people are going along with this and how we’re assuming that the better life outcome is to live in accordance with this magical gender identity, and that we know kids are going to be happy with that, rather than leaving open the possibility of having a family.
Almost ubiquitously, gender dysphoria is associated with some other issues, and often those issues just get swept off to the side. There’s a term that’s mentioned in the film that actually describes that.
The term you’re looking for is diagnostic overshadowing. It is the idea that when you have various comorbidities or potential comorbidities that maybe haven’t even been diagnosed or ruled out properly, gender dysphoria trumps all of them. It overshadows all of them.
There’s a dangerous and unfounded presupposition in this gender-affirming model that if you just treat gender dysphoria by permanently changing the young person’s body, all the other issues will go away. What I see is actually the opposite.
What I see is that youth who have been exposed to this culture and these narratives around gender identity, that culture, much of it online, gives them a language, a framework, a way of thinking about their psychological distress.
You’ll hear these youth refer to things as “My dysphoria.” When they say my dysphoria, they could actually be talking about anything. They could be talking about PMS or social anxiety or ADHD. We know that about 48 per cent of the children referred to the Tavistock Gender Identity Clinic, which has now been ordered to shut down, were autistic.
There’s any number of things it could be referring to, but the language that they have for it is the term dysphoria. It’s always my dysphoria this, my dysphoria that. Something I’ve learned from working with the parents of these youth is that almost any upsetting life situation can serve as a trigger for so-called dysphoria.
It could be that they got a bad grade on a test, or their girlfriend dumped them, or they found out that their friends were hanging out behind their back without them. It could have nothing to do with gender or even sex. Yet the language that they have for it is dysphoria. And then, they go down this sometimes obsessive compulsive route where that leads to thinking, “Now I have to cut my tits off,” pardon my language.
But there’s this urgency of I have this distress, I don’t know what to do about it, so I’m going to interpret that it’s about my gender. Because that gives me something to control, and that gives me something to plan for and to look forward to. So, they are going to take that next step, whatever that next step is, depending on where the child or that young vulnerable person is in their so-called gender journey.
It’s always, “Here’s something I can do about it. I can pursue that next step in passing, or in being affirmed, or in medicalizing my transition, and that will alleviate my distress.” These kids and young people aren’t being given a proper emotional vocabulary, a way of conceptualizing normal or abnormal psychological difficulties.
What would you do in this situation where a child or a young person comes in and says, “I think I’m a different gender than my birth gender?”
A therapist who ascribes to this belief system basically just has to agree with that and maybe even praise it. Let’s be honest. The attitude that you’re taught to have toward these young, vulnerable, confused people is, “I’m so glad that you told me. Thank you for trusting me with this wonderful news about your gender identity.”
I’m exaggerating a little bit, but you’re supposed to be so warm and welcoming and praise this magical truth that they’ve just come out with. And then, you ask about who else knows about this and how do you want me to talk about you when your parents are around? Which then comes down to the issue of how we’re triangulating parents and children.
Now, we are just focusing on how you’ve discovered this wonderful thing about yourself and found the courage to tell me and trust me with this important fact. How can I support you in your gender journey? Do you need help coming out to your parents or educating them? Do you need help socially transitioning at school? That’s the next step that therapists are expected to do with that approach.
A number of young people in the film mentioned that by the first visit or second visit, they were already being prescribed drugs of some sort, which is very difficult to fathom.
Right. The role of the therapist here is interesting, if you look at how mental health clinicians intersect with the medical system. I am an LMFT, a licensed marriage and family therapist. I’m a master’s level clinician, which means I have a master’s degree in counseling psychology. I have internship hours that I accrued under supervision after that to gain licensure and I passed an exam.
There are other master’s level clinicians like an LPC, for example, a licensed professional counselor. That’s another type of master’s level clinician. You have clinicians who are at the master’s level rather than doctors. When it comes to doctors, you have clinical psychologists, but then you also have psychiatrists who can prescribe.
When you look at master’s level clinicians, we have to stay within our bounds in regards to medical advice. We learn how to recognize signs that a person might need to work with a doctor on certain issues. For example, there are certain nutrient deficiencies that can cause depression and anxiety.
As therapists, we can’t say, “I think you must have low vitamin D levels,” But within my scope of practice I could say, “We’re living here in the Pacific Northwest and it’s the winter and many people are low in vitamin D. You’re presenting with signs of fatigue, loss of interest, and loss of pleasure. When was the last time you saw your doctor and had some routine lab tests? Maybe there could be a vitamin D or other deficiency. We just want to make sure we’re ruling that out.”
Another thing that I could say within my scope of practice would be that if someone is presenting for depression, but there’s a sign that they have sleep apnea, we know that untreated sleep apnea can make all kinds of mental health conditions worse because your brain is not replenishing at night. So, I would suggest that they work with their doctor on treatment.
Normally, we stay within our limits. If a client comes to us saying, “I want to take medication for depression or anxiety or ADHD,” well, we can help them process their thoughts and feelings on the pros and cons about that. We can provide a certain amount of psychoeducation, but mostly we refer out to other professionals. Now, contrast this with the role of the therapists in the medical system with this gender-affirming care, therapists who are practicing, “writing letters recommending surgery.”
Now, under the so-called informed consent model, a therapist’s letter is not even required. The letters are pretty useless anyway, because anyone who’s writing those letters has already been indoctrinated. I don’t think that there’s a proper process of assessing and ruling out who is and isn’t a fit for any of these interventions. But we’ve been asked to go outside of our limits and recommend that people take these medical steps. It’s confusing, and it’s a boundary violation.
The assumption is that the mental state is the correct state and the body is what’s wrong. I’ve also seen this slogan, “Nobody is born in the wrong body,” and I guess this is a response to that. It would seem to suggest that gender dysphoria isn’t actually a condition. Can you help me untangle this?
Right. There are two questions there. The second one being whether gender dysphoria is a diagnosable mental health condition. But the way you put this initially is really important to explore, this idea that it’s the body that’s wrong and the mind is fine. That seems like an interesting way of defending against shame.
You can look at the fact that so many of the vulnerable young people who are presenting with gender dysphoria are autistic, and many of them have trauma histories. They’ve been bullied, and they’ve been abandoned. We know these kids are overrepresented in foster care and adoption. Oftentimes there’s deep attachment wounds, and deep issues with having a loving, stable connection with one’s family. The natural response to that is shame and inadequacy.
That shame can be so painful and so overwhelming. It really takes a lot of maturity to learn how to integrate our shame and tolerate it. So, there is this idea that there’s nothing wrong with me, my identity, my mind, my psyche; it’s my body that’s wrong. That’s why I’m different.
It’s a really convenient explanation for defending against the shame of these kids, especially the ones who’ve been bullied because they’re autistic. Autistic kids are socially awkward. They’re often bullied, and they don’t understand how to process that. They don’t know why they’ve been mocked and made fun of, but they sure feel badly about themselves. So, there’s already enough shame there.
It’s very tempting to have something that says, “Oh, this is why I’m different. This is why I’ve been made fun of and then, I don’t have to feel that shame.” The idea of therapy though, proper exploratory therapy or watchful waiting feels intrusive, because if you’re walking around with this intolerable level of unprocessed shame that there’s something fundamentally wrong with me. There’s something corrupt about me that people just don’t like, and I don’t know what it is and I don’t know how to control it.
The idea that a therapist could see that thing about you is really alarming. It takes the right sort of situation and the right sort of clinical relationship to help someone who’s walking around with that much shame and anxiety to understand what therapy could be for them.
A lot of these young people are very guarded against the possibility that anything could be “wrong” with them. They also are resisting the hard and abstract work of self-improvement that comes with the healing process.
There is often trauma that is associated with gender dysphoria. Is that 100 per cent of the time? I think it almost always is, from what I’ve been reading.
I don’t know the comorbidity rate with a PTSD diagnosis. Like I said, with the Tavistock GIDS program referrals, 48 per cent of those young people had autism. I do know that with adoption, foster care, sexual trauma history, as well as homosexuality, we’re seeing high rates of those in youth presenting with gender distress.
Clearly, you’re not a gender-affirming therapist today, but you were at one point.
I came of age at an interesting moment. I went to grad school from 2010 to 2013, right as this stuff was starting to take hold, but kind of marginally. Our class had one social justice warrior, but I’m imagining that grad schools now have 90 per cent of the people in those classes having the same attitude as that one social justice warrior did back then. I don’t honestly remember learning about gender dysphoria or the idea of trans in grad school, except we had a psychopathology course where we study the DSM.
I came of age in an interesting time because when I was in grad school, we were still operating under the DSM-IV Diagnostic and Statistical Manual of Mental Disorders. We were studying the fourth edition, knowing the fifth edition was about to come out. I believe 2013, the year I graduated, is the same year that the DSM-V came out.
So. I didn’t get a lot of exposure to this in grad school. Then, between when I started practicing in 2013 to now, 10 years later, there has been an exponential rise. It wasn’t until 2017 that I went to a training for so-called gender-affirming care. In retrospect, it was quite shocking. Every time I talk about this training, I just think about how therapists have this polite, deferential, agreeable nature and we all sit quietly and do as we’re told. I think about the company culture and how that can affect how we relate to training. I also think that training was, in retrospect, a departure from how training normally goes.
It was really led by an activist in disguise telling us, “This is the model now and you must comply.” I have a vague recollection of one or two people raising issues and being kind of shut down. After that, we were expected to comply, and there was a lot of pressure. At the time, I was a younger therapist working for group practice, as opposed to an older, more experienced therapist, or a more independent therapist in private practice, which I am now.
In a company or agency culture, there’s a lot of pressure to be kind, agreeable, and conscientious. You don’t want to create problems for anyone, and you don’t want to look like you don’t know what you’re talking about. Even though we were being sold this really radical and frankly absurd idea, I don’t think anybody wanted to look like they were the bad guy.
You go in with this deferential attitude like, “What I’m being told seems counterintuitive, but they must know something I don’t know.” It took me years of going along with this thinking—they must know something I don’t know—until I finally reached the point where I realized I actually know something that is important, and now I have something to say.
Was there some defining moment where you thought to yourself, “I am going to change how I treat this?”
I wish that I could identify one. It was such a gradual process for me, working with these trans-identified young people and not seeing them get better and feeling like we couldn’t talk about the elephant in the room. I was feeling deeply conflicted about what I was supposed to be doing.
Because on the one hand, when I worked for that company, there was a slight bit of pressure that if you were a good therapist, you would go to the next level of training where they taught you how to write these letters, basically rubber-stamping people for surgery.
I always felt like, “I should do that,” but a part of me didn’t want to. I was just seeing these young people not getting better, and having that question in the back of my mind of, “Is this really necessary for the ones who were pursuing surgeries and hormones, is this really it?”
Especially when I was seeing other issues; autism, trauma, eating disorders, and homosexuality, you name it. As much as I had my doubts, I was being sold this story that this is what’s going to help these people get better. If you’re not seeing what’s on the other side of that, then you just have to believe it.
But then I found out about detransitioners. My first exposure to detransitioners was finding out that their stories were being suppressed. That was the first time I heard about them. I heard about how trans-rights activists were trying to stop 60 Minutes from going through with their story on detransitioners. I thought, “Wait a minute, I need to hear this side of the story.”
That’s when I started listening to detransitioners and phasing out accepting trans-identified people into my practice as new patients. I was wrapping up the work that I was doing with my existing patients, and really just keeping the focus on the things that they were there to talk about. I didn’t question or push back because I thought that that would be too risky to our therapeutic relationships. I researched the issue for about a year or two before I said anything publicly to anybody.
Was one of the reasons why you were afraid to do that because you often hear this told to parents, “If you don’t affirm, your child is going to commit suicide or there’s a higher likelihood they will commit suicide. “ Presumably, therapists learn the same thing?
Yes, and it’s such a dangerous myth. We do see higher rates of suicidal ideation in trans-identified young people, but we really can’t separate that out from their comorbidities. You can look at all the comorbidities; depression, anxiety, OCD, body dysmorphia, and eating disorders, which is a major one that I hadn’t mentioned yet.