I found this unsent in my email archives. It's a response to my parents sending me a 2018 Stephen B. Levine paper scaremongering about transition, which I, for some reason, never sent.
This would have been written a few months after I'd started HRT (and very happy on it, already starting to be read as a woman in my masc work clothes by strangers), and most of a year into my relationship with my partner. Identifying information (like my doctor's names) has been stripped.
Good lord I was so charitable, here, conceded so much.
It's an interesting article and it brings up some good points, and the author isn't wrong to note the difficulties of transition and the effects it can have on those around the person transitioning. His desire for more realism and a bit less idealism in trans care seems wise. Certainly in many online trans communities there is very little space for things that aren't 100% affirming, which can lead to unrealistic expectations and a rather black-and-white view that paints anything but a highly positive response from friends or family as terribly transphobic. If that carries over into trans medical care (I don't think the medical professionals I've dealt with have that problem, [Gender doctor] noted that I at least had very realistic expectations for the results of HRT), that's something which needs to be reined in.
I've read a few of the studies it references, however, and I think the article misses the point of some of the data therein and fails to quote relevant statistics that challenge the point they want to make. For example, the author of the 2011 Swedish study on the outcomes of people who have undergone gender confirmation surgery has complained about her work being misrepresented as not supporting surgical interventions in trans patients. The study has no sample of trans people who did not undergo surgery, so it cannot show that surgery is or is not effective. To the author's credit, he specifically notes that limitation. It also leaves out somewhat more positive studies like Murad 2010. Trans people who have had access to hormones and/or surgery do have better outcomes than those who have not, based on a number of studies like that one. The data isn't great because of the small populations and other issues, but that is the trend which has been found most often. Furthermore, one thing that is fairly consistent in the literature I've read is that when a trans person is not accepted (acceptance here meaning using their chosen name and pronouns and not treating them like a mental case) by those closest to them their outcomes are significantly worse. In a Dutch study on transition regrets, the primary reason for regret was that family and/or society was unaccepting, not because the treatments were ineffective at reducing dysphoria. The challenge with these long-term studies of course is that attitudes toward trans people have changed pretty dramatically over the last few decades. I'm transitioning in a very different society than someone who transitioned in 1980. I also got lucky in that I'm not 6'2" with really broad shoulders and a strong jawline. And for surgery in particular, the options available today are much improved compared to decades past. It's also interesting to note that I don't cleanly fall into any of the 5 medical groups he lays out on page 31. I might be on female hormones (and happier that way) and okay with female pronouns but not male ones, but I'm not any more a woman than Janet from The Good Place is.
The list on page 32 seems like a pretty accurate summary of what [Old GP] and [Gender doctor] did in my case. Before I discussed my gender issues with [Old GP], we had already made good progress with my other mental health issues. We discussed what I wanted out of transition, what I expected, what I knew about the downsides, and [Old GP] recommended that I wait on the hormones and take time to explore my feelings as well as meet with some discussion groups like [local support group associated with a (liberal) church] to help provide more connections and grounding. When we met again a few months later, I asked about hormones and she was supportive of starting them. [Gender doctor] and I went over a lot of the same stuff again in our discussions. She also got my records from [Old GP], and agreed that I was ready to start HRT. I don't think this all was nearly as fly-by-night as you think it was. As an aside, I found Table 1 on page 33 an interesting assessment of the downsides. The vast majority of it is simply that society and the people in it may react poorly to a trans person. The suggestion that stigma may not be the sole explanation for poor outcomes of trans people is pure speculation.
