Secret #41: Gender Affirming Care with Steve Graybar
In this episode we are joined by Dr. Steve Graybar, a clinical psychologist from the University of Arizona.
They delve into the complex and sensitive topic of gender affirming care for minors. Dr. Graybar provides a nuanced analysis, advocating for a more comprehensive and research-based approach to gender affirming care. He emphasizes the need to reimagine the current model to include thorough psychological evaluation and family therapy while cautioning against the politically charged atmosphere surrounding the issue.
The discussion also explores the risks of medical transitioning and the importance of empirical support and informed consent in making these significant decisions.
Highlights:
Evolution of gender reassignment and need for long-term follow-up studies
Social pressures and vulnerabilities during adolescence
Emphasis on family therapy to prevent parental alienation
Societal Approach and Policy Recommendations
TIMESTAMPS
[00:00] Introduction and Disclaimer
[01:50] Reimagining Gender Affirming Care
[05:49] Concerns and Controversies
[08:20] The Role of Research and Evidence
[12:18] Mental Health and Gender Dysphoria
[21:09] Social Transitioning and Puberty Blockers
[27:51] The Impact of Puberty Blockers
[28:32] Medical Interventions vs. Psychosocial Interventions
[29:29] Surgery and Its Consequences
[30:38] Detransitioning and Regret
[32:24] Bone Density and Neuropsychological Concerns
[35:01] The Role of Parents and Clinicians
[38:46] Social Contagion and Peer Influence
[42:10] Reimagining Affirming Care
[47:40] Final Thoughts and Reflections
Follow us on Facebook @lifesdirtylittlesecretspodcast and on Instagram @lifesdirtylittlesecrets
Reach out and let us know you are listening and what you would like to hear on the show - email:lifesdirtylittlesecretspodcast@gmail.com
-
Secret #41: Gender Affirming Care with Steve Graybar LDLS Episode
Introduction and Disclaimer
[00:00:00]
Emma Waddington: Welcome to Life's Sturdy Little Secrets. I'm Emma Waddington.
And I'm Chris McCurry. Our guest today has been a dear friend of mine for almost 40 years. Dr. Steve Graybar received his PhD from the University of Nevada, Reno, where he was a year ahead of me in the program, but light years ahead of me in wisdom and dedication to the field. It was a great pleasure to know him as we endured graduate school together and then watched our professional and family lives blossom over the years.
After graduation, Steve spent some years affiliated with the Department of Psychiatry at the UNR School of Medicine. He currently splits his time between Reno and Tucson, where he has a private practice.
Chris McCurry: I'm going to take the unusual step of
giving
a little disclaimer, as it were, at the beginning, because we're going to talk about gender affirming care [00:01:00] for minors.
This is obviously a very hot topic, and in doing a podcast on this important topic, we are in no way, and I mean, No way. Meaning to give to support, aid, or comfort to the bigots out there who are using this complex Nuanced and sensitive topic as a political cudgel, and you know who you are, you know, the politicians and others who would demean and dehumanize young people whose lives are difficult enough as it is.
And so we want people who are struggling with gender and identity issues to get the compassionate support they need.
And
as we've done for a long time on this podcast, we want any person seeking help.
To be supported by good science. And I think that pretty much sums things up. So thanks for joining us, Steve.
It's been a pleasure. That's been our podcast for the day. Just kidding. We're actually going to talk about this, but this is a hot topic. So Steve, [00:02:00] thank you for joining us.
Reimagining Gender Affirming Care
Chris McCurry: You talk about re imagining gender affirming care. Why do we need to re imagine gender affirming care?
Steve Graybar: You know, it's gender who can argue with gender affirming care That's like arguing, you know against hot lunches for orphans But that's only in the title and my concern has been as I read about it And learned about it and actually tried to learn more about it And it was it actually became more and more diffuse And less clear to me what gender affirming care meant Other than in this is probably going to be a very controversial thing to say other than it seemed to start functioning as a funnel toward medical transitioning.
Which, is not the same as gender affirming care in my mind, at least the way I would have thought. Understood it. And so gender affirming care has as its, fundamental [00:03:00] tenants, even in, I believe it was the APA monitor here in the States, American Psychological Association publication, and it really, it's fundamental or its foundation is taking kids claims that face value, believing what kids are saying and assuming that kids know exactly what they want and what they're talking about and are, even intellectually as well as emotionally capable.
Of articulating other thoughts and feelings in ways that I know adults struggle to do and I struggle to do around conflictual or complex or difficult topics. And it seems, I know it sounds stereotypic that, you know, But I am worried that gender affirming care, has functioned of late. And there's been a lot of discussion in some articles and some whistle blowing and now lawsuits about how it has [00:04:00] functioned to bypass mental health care, mental health providers, and really is sort of streamlining many young people into the process of medical transitioning.
So re imagining gender affirming care, I don't want to re imagine affirming. Also, I would like it. I'd like, I would like gender affirming care to fall under the auspices. Of psychotherapy as an empirically supported treatment that is grounded in informed consent. So if you're making a recommendation to someone, what, is the basis of that recommendation?
And if you're sitting across from someone, a child and or their family or parents, what are your responsibilities? To inform consent to sharing where this pathway lead and trans identification doesn't necessarily have to lead anywhere. And I think in [00:05:00] a psychotherapeutic relationship, that's exactly what can happen a potential for that to happen.
Seems greater to me, and there might be greater confidence. If they do choose to medically transition. But right now I think that medical mental health people are being viewed by many in, the trans community and community as gatekeepers. That's letting some people in and keeping a lot of people out.
And and that's an affront to the patient's autonomy. I think in some ways it's a recognition of children's vulnerability and family's vulnerability to and around this issue. Does that help? Does that make sense? Or is that
Chris McCurry: Absolutely.
Steve Graybar: confusing?
Chris McCurry: No, it's it's a good statement, of, the position that, you know, you've ta you're taking in this paper that you've written that I do hope gets published. Did you say it was [00:06:00] accepted somewhere?
Concerns and Controversies
Steve Graybar: It was accepted and then upon being accepted, it was. Unaccepted and, and that's really, it's striking because there's a little section in this paper about how the controversy surrounding this topic is. Influencing clinicians as well as researchers. As well as what people are willing to publish, what other people are willing to research.
Or to even talk about so your preamble to our meeting today is, necessary, and, is important to sort of clarify where, you stand. And hopefully, I'll be able to convey to people where I stand, which is not against medical transitioning. Where I stand is for empirical support. Research based support for these most powerful and at times irreversible interventions.
And that's really where I stand on all of this is I'm willing to if, the research supports [00:07:00] it, I'm in, if the research shows that gender dysphoria. Is, addressed? Who would argue with that? If the research shows that social and emotional functioning of these people who are going through medical transitioning is effective?
I don't, I'm sure there are some people who would stand in the way of that. I'm not one of them. Does that
Chris McCurry: So you, yes, and you, mentioned the Dutch protocols, which it seems when you're reading, from my reading of your paper, It kind of got everybody started down this path. Is that an accurate description?
Steve Graybar: I don't know that they got everyone started, but they, I don't, you know, Chris, you and I are old enough to remember. Remember, this used to be about transsexuals.
Chris McCurry: Right.
Steve Graybar: surgeries. And that was, you know, way back Christine Jorgensen, I think was the
patient that comes to mind in the fifties and sixties and it, was happening in the sixties and Johns Hopkins was a big part of it.
And even in the [00:08:00] seventies and then it stopped and it, sort of, or it certainly quieted down, but Johns Hopkins. As I recall, just pulled out of it and said, we're done, we're out. And. My recollection is because of the dubious nature of their outcomes. There's one study that's just disastrous. It basically was a 20 year follow up of those patients who, whose,
whose attempted suicide rate was 19 times higher than that of the general public, which is catastrophic.
The Role of Research and Evidence
Steve Graybar: So it, very long term and you know, one of the calls that I'm a part of is we need long-term follow ups. Not six months, certainly not six weeks. But five and 10 and 15 years when you're intervening with someone who's 15, how they're feeling it about it at 17, I don't find as compelling as at 27 and you can't push time and I'm hoping these [00:09:00] studies are underway, but we are acting as if they're already underway and they've provided us with answers.
Chris McCurry: So then, there was pass in Great Britain.
Steve Graybar: Yes. Yeah. Hillary Cass is a very well known pediatrician. And was asked by the NHS in, in Great Britain to look into this. And so she, cobbled together a research team to, to gather all the studies internationally that they could get their hands on. And then from that, they tried to pull out those studies that were not so methodologically flawed.
And this is a difficult issue because they are, they have small sample sizes. Very low follow ups at the attrition rates. All kinds of no control groups, confounding interventions. There's a lot of people in psychotherapy who had the, trans the medical transitioning done, what role did that play, et cetera, et cetera.[00:10:00]
So the, and so they pulled out the best studies they could find. That would not be methodologically dismissed by your average master's thesis committee, if that makes sense to your viewers. And, from those studies, she came out with an incredibly powerful, not at all edgy, I mean, talk about compassionate and kind, in a very kind and compassionate way, she stepped on a lot of toes.
And it wasn't with a gleam in her eye, not when I saw her interviewed, not when I read this, it's about a 400 page report. She, said with a gravity and a, I'm very sorry, but we don't have the evidence that we need to support these dramatic interventions. We just don't, it's not there worldwide.
It's we have no long term solutions for gender dysphoria, no, gains, significant [00:11:00] gains that we can document in social and emotional well being and functioning for these patients. I mean it's, really quite incredible what she, and she's also talking, she talks about while a great deal of research has been published in this area, it's been of poor quality, and that's true.
I basically did the cast. Study on my own and then she trumps me and publishes 1st. How rude is that? So anyway aside from her bad manners, but I was really impressed with myself because I came up with many of the same things like this is not so good. How did we get here? But she talks about there's no solid evidence for transgender patients, their families or clinicians to draw from.
In their personal and professional decision making. That's pretty powerful stuff. And she has other conclusions about how research has been misrepresented as being more effective than it actually has been. That [00:12:00] political, social and political controversy has affected clinical decision making.
I think it's intimidated mental health professionals right out of the arena. Would you want to be a therapist? Who gets in the way of this train? Well, many therapists aren't. Many have just sort of abdicated. Many deeply and, there is, I, you know, we were talking briefly before we got on about good and evil.
I don't think this is about good and evil. I don't think it's that simple.
Mental Health and Gender Dysphoria
Steve Graybar: I think people deeply, want to help and want to intervene with young people's suffering. And if I may, unconsciously, want to somehow reverse what mental health has done to the gay community by diagnosing them as having a mental illness in the fifties, sixties and seventies and doing all the damage we did through conversion therapy.
And so I'm not going to be on the wrong side of that. I'm not going to be on the wrong side of history [00:13:00] again. I think that has pushed a lot of mental health folks. That my reflex was to accept this and, I think it was grounded in, that again, I'm old enough to remember when it was pulled out of the DSM for homosexuality.
So the
cast part, I can't say enough about it, but it's powerful. I believe that she was impartial. I really do. I know she's being just savaged in great Britain and you have to, I'd recommend anyone watch a YouTube video of her if there's like the least, most savageable person on the planet, it looks like this lady.
I mean, she's, kind, she's thoughtful, she's caring, and she's almost apologetic for our lack of data. So I, just, I find her very compelling.
Chris McCurry: well, I think, you know, this has become so politicized, And I would make a gross overgeneralization and say that a lot of [00:14:00] people who are In the mental health field are probably leaning a bit more toward liberal views. And so they feel they need to take a stand against, you know, again, black and white, good and evil.
They need to take a stand against all the stuff that we're seeing that
Is going on. And, you know, particularly here in the United States, it's become so politicized and you have, you know, certain states that.
Are
passing, you know, really draconian laws, you know, not just in this area, but for, you know, reproductive rights and everything else.
And so everything gets lumped together. there is no more discussion at that point. It's you're either for or against
Steve Graybar: Well, yes, that's sort of the black and white thinking in psycho hellenic parlance. It's, splitted, which is a very primitive defense against reality. And as, far as, you know, the [00:15:00] politicalization of this I don't know the governor of Texas, but I'm certain that he and I have, this is the first time we may have agreed on anything.
And, I don't think we agree on this either, because I think I'm willing to wait for the data. And to support the data, whichever way it falls. And of course, I think he's unburdened by science as are many, of the folks. I don't want to paint too broadly with this brushstroke, but you know, if this is in your heart, this just feels wrong to you.
There's no amount of data that's going to convince you.
Chris McCurry: On either side, then
Steve Graybar: well, right now that's how I'm feeling when I am. Attacked by, you know, I'm pretty
liberal.
Chris McCurry: this podcast drops,
[00:16:00] Okay.
Emma Waddington: I guess before, before we started this conversation or before we decided to have you on, I wasn't very well read in this area. Obviously it's all come about since I graduated, so it's, all relatively new, but to reading your paper and doing my own research I came to realize that the, data isn't there.
And that was a surprise given,
Steve Graybar: yes.
Emma Waddington: the force with which, the argument has been made. In certain communities and certain countries around what gender affirming care should look like. It's quite striking. I'm curious as to how that happened. How did, we come to be having this conversation?
[00:17:00] In as much as the,
Chris McCurry: Silence.
Emma Waddington: said in your, paper, how is it that
Chris McCurry: Silence. Silence.
Steve Graybar: that really got me rolling was that somehow treatments and interventions have preceded data. And that hap, that, I think that's very common in, in psychology and in medicine. People in the field, people on the front lines see some things and try some things and make some connections that aren't available to people purely in a laboratory setting.
And so they get out in front of it. And then they start, well, I wonder if this is a real thing. And there's only and, many people say, well, it feels right. And we stopped there. But that's, not our charge, not as professionals. It's to take it back to a research setting, and to weed out, you know, that's what the scientific method [00:18:00] is.
It's, the weed out our biases. It's the control, literally control for our biases and our blind spots and our wishes, you know, The biggest defense against that is the null hypothesis. And so let's, go back and do what we were trained to do. And I'm, really speaking to mental health types we've abdicated.
I mean, come on now you, can't be a student of human psychology or understand or grasp childhood development, cognitive development, emotional development. And really believe some of the things that are being said and or done. One of the things in the paper, I really talked about things that I didn't talk about.
One of them was, can children ever give informed consent? Can people who are profoundly emotionally disturbed? I think, your listeners, your viewers, I'm not sure which they are, or if they're both, would be shocked at the mental health diagnoses. Of young people who [00:19:00] are going through medical transitioning, including thought disorder.
I mean, I hope and pray that's rare, but I'll tell you what isn't, especially in the UK, autism and autism spectrum disordered kids are being medically transitioned. And then for the rest of the folks out there, kids with We have to be very, careful with personality disorder diagnoses in general, but in particular with children.
But there is a place for almost a prodromal borderline personality process for minors. And none of these things are going to shock you kids who are cutting kids who have chronic suicidal ideation, impulsivity, other types of self injury yada, yada, suicide attempts. You name it, impulsivity, whatever, anxiety, panic, mood disorders.
Oh, then they have, and they also have gender dysphoria. How does gender [00:20:00] dysphoria trump those multiple diagnoses? How, do we, presume that those preexisting. Emotional difficulties are caused by gender dysphoria or being a minority person, a person with gender dysphoria who's been discriminated against when they have preceded, in many instances, the gender dysphoria.
And then people will say, well, those are the causes of gender dysphoria. And it's, that's also frequently not the case for what, there's another classification out there for rapid onset gender dysphoria, which is sort of interesting. But it's, just, yes I'm, assuming that having gender dysphoria can lead to great emotional upset and distress.
But it doesn't lead to trauma, necessarily. I mean, the trauma has preceded many of these kids [00:21:00] experience of gender dysphoria. So we're looking at that gender dysphoria may be a cause of emotional disturbance, but it may also be in effect. And that has not been teased out. That has not been answered yet.
Does that, did I remotely answer your question, Emma? Can we talk baseball?
Social Transitioning and Puberty Blockers
Steve Graybar: I'm, much better.
Emma Waddington: think that's really interesting
and
Chris McCurry: with the way the Mariners have been doing.
don't know what I've
Emma Waddington: think
I think what's, interesting with what in my reading preparing for this, I think I was of the assumption that. My understanding was that gender dysphoria because of the stigma, the discrimination, the bullying,
Leads to many mental health issues and therefore there's the argument, right? The issue is the gender dysphoria because of the context that it creates and that the mental health issues that come, come about afterwards. But reading the Cass work and reading your work, [00:22:00] I came to realize that actually it's much more contextual. The gender dysphoria doesn't happen in and of its own. It happens in the context often of many other mental health issues, that sometimes proceed.
Steve Graybar: gender dysphoria is actually I think in some cases, I fear that I might be right, but I'm certainly willing to be wrong is a problem solving approach to kids with some profound emotional disturbances.
It's a way to try and explain. We, there's a lot of discussion and, research that many of these children, if not socially transitioned, and that's another topic that. Should get the three of us tar and feathered. It is, if they're not socially transitioned, if they're loved and supported and allowed to be who they are, we'll naturally accept their natal sex, their birth sex.
By the time puberty, which is so dreaded and [00:23:00] feared, like so many things that we dread and fear, that once we start to move through it, It's actually strengthening. It's cohering. It helps us make sense of so many things. Going into it, it's I don't know, I don't know what kind of car washes they have around the world, but if, you know, those multi purpose car washes.
Well, I'm always a little anxious right at the beginning, right at the mouth of that thing. I'm a little tight and but all of a sudden I'm feeling pretty good about myself when I'm three quarters of the way through and I can see that there's light at the end of the tunnel. I can still escape my car if it gets stuck in there.
Well, that's how it is for so many things that are anchored in anxiety. Is exposure, and I hate to sound so banal, but exposure based living is the way to live. It involves healthy risk taking. It involves approaching those things that we fear. And what we are doing with puberty blocking [00:24:00] is probably one of the most high tech avoidance strategies one can imagine.
For kids who, in many research, the range is, well, there's a number of studies that say it's 80%. Will desist with their trans identification. That's, a brutal number. If we are transitioning a significant number of those, I talk about social transitioning, that kid social transitioning is very, effective.
If kids are socially transitioned between the ages of six and seven by age 12,
Chris McCurry: You need to find that quickly.
Steve Graybar: it's using a different name, using a different pronoun. Different dress and sort of being, allowed to move in the world. As if I were allowed when I was a boy to move in the world as a girl, and this is at school and at home and other places. And, [00:25:00] so, it is very much, very reinforcing, very positive and very powerful experience.
And in this one study, I read 60 percent of those kids by the time they turn 12, And already had remained trans identified and had begun puberty blockers. So you can see how the numbers don't fit up. They don't match that. And one of the most important findings in the CAS report is that we cannot distinguish.
transitory from enduring trans identification. And the more I read that gender discontentedness is almost developmental, and especially so for girls. And it's striking to me that girls in the study of detransitioners by Littman, were most likely to report feeling forced or pushed [00:26:00] Into transitioning.
You, I don't want to say forced, but, pressured is, was the word was the actual word, I'm sorry.
Chris McCurry: By whom?
Steve Graybar: Well, by therapists, they were in there, parents, and health care practitioners, and different types, well, also friends.
Chris McCurry: Social media, no doubt.
Yeah. Silence.
Steve Graybar: Et cetera, et cetera. But I still don't know what Tumblr is, but it even sounds evil to me. I'm trying to destroy anyone's livelihood here.
I'm just saying it, it just seems to be implicated as offering this kind of information and, peer groups, huge.
Emma Waddington: [00:27:00] I'm
Steve Graybar: It's, sources,
Emma Waddington: I'm
struck by, you know, if we have a young person who's got, you know, significant gender dysphoria and, you know, is reporting a lot of anxiety. Suicidality is very high in the community. Suicide attempts are very high too. And my understanding was that puberty blockers We're a way, like you said, to sort of slow the process down, to help them make a decision, to buy time exactly, to help them make a decision as to what they want to do. But Listening to you and having read your work. It does. It seems to do more than that.
It
doesn't just buy them time. It actually seems to make a decision for them.
Steve Graybar: Well, that's what social transitioning does, in my opinion,
Emma Waddington: yeah. Yes. down on that. And then, Chris, I'm sure you can wax eloquently about cognitive dissonance. You know, in for a penny, in [00:28:00] for a pound, you've come this far.
The Impact of Puberty Blockers
Steve Graybar: You've advertised your entire life that I'm not really a boy, I'm a girl.
And the whole school worked with you on that. And now you started Puberty Blockers. And Puberty Blockers bring with it all kinds of different feelings and experiences. And all of a sudden you are now being passed by. You're not growing. There's growth hormone in there. and and so the world has moved on from you, or if I were the case in point, has moved on for me as a boy, my friends are now becoming young men.
So it's, not as passive. It's a propellant just like the social transitioning. And I have to make something clear because someone pointed this out to me and it feels like a fair criticism, and then it also seems bizarre. They said, you seem to be saying that it's, it's, preferable or it's a superior outcome for [00:29:00] someone to be non trans over trans.
Do you understand what I'm saying?
Chris McCurry: Yep. Go
Steve Graybar: good to be non trans, and I think you have to work to hear me say that, but if that's what anyone's hearing, that's not my issue.
Risks and Benefits of Medical Interventions
Steve Graybar: My issue is what are the risks and benefits of medical interventions versus psychosocial intervention?
And what is the data supporting each? And it's and, one carries with it tremendous implications, including aspects of irreversible interventions. So if I have a bias, the bias in my life I have the best orthopedic surgeon in the world because he's mostly an orthopedic consultant because he said to me, and this is, you know, I immediately threw myself at his feet and.
Worshipped at the altar when he said, there's nothing that surgery [00:30:00] can't make worse. And we're talking about this old man's potential knee replacement. Well, he knows that I have a bias towards I'll do anything not to have surgery. I've had many surgeries. They're hard and, they're never, it's never quite the same and, I respect surgeries because I think my life has been saved by a couple, but there's always been consequences.
Surgery and Its Consequences
Steve Graybar: And so when he says, well, you can do this or you can do six weeks in physical therapy. I have a deep and meaningful and ongoing relationship with my physical therapist. Because I'll do anything to avoid surgery. And I'm not being cavalier about this. I'm just saying, surgery is a big damn deal. And so we better really be able to identify, can you imagine having a huge surgery that you, and here's more of some of the semantical concerns I have.
Detransitioning and Regret
Steve Graybar: They're calling detransitioning regret. Regret? Having your reproductive organs removed and then thinking you made a mistake? Regret [00:31:00] doesn't quite capture it. I regret backing up into the light pole in my parking lot. I don't regret initiating a revolution upon my body. That I'm going to have to live with the rest of my life.
And if I decide to detransition, even detransitioning in many cases a misnomer, you're not going to get your breasts back. If you've had a mastectomy, you're not going to get your ovaries back. If you've had a hysterectomy or your genitals or all kinds of things. And so regret doesn't capture what happens, at least from the kids that been exposed to in almost, exclusively online.
What they're dealing with is not regret. It's horror. They're haunted by this decision. And they're asking all of us as adults and as clinicians, where were you? And that's a damn reasonable question. In my opinion, where, are we on this? Especially if we knew the
data as [00:32:00] Emma, as you pointed out, you've read the data.
It's not there. Not yet. That's all I'm saying. Not yet.
Emma Waddington: it is. It is.
Concerns About Puberty Blockers
Emma Waddington: It seems like reading your work and it's like it, 'cause my understanding was puberty bookers, like you said, by his time, but it actually initiates a process, doesn't it? creates a cascade
Steve Graybar: Yeah. So much of what
we do.
Emma Waddington: quite scary.
Steve Graybar: It's not targeting. We don't, you know, when you, we're not just blocking aspects of certain hormones and what they're doing. We're blocking what hormones do during puberty. Which is why one of the big issues right now is about bone density concerns and young women having stress f fractures in their twenties because their bones are not calcifying, because that's a part of what puberty does for young women also.
And, Chris, I know you could speak to this in ways that I can't, puberty is involved in neuropsychological [00:33:00] development until our mid twenties. And that is stopped. That's stopped there. The research is not clear how much is lost, but there's some suggestions about what is missing neuropsychologically or cognitively, when we initiate this.
It's not solid yet, but it's a significant concern, which I think is reasonable that we would want answered. The same is true with cross sex hormones. There are some serious concerns by some serious researchers about cardiovascular risks. And then the surgeries certainly are going to bring sterility if you have the entire surgery, and sexual dysfunction, two very common outcomes of the full process.
And how do you talk about, will you miss orgasm to a a child when you're about to put them on puberty blockers? How can we, even those, I don't know if you've heard of the WPATH files.[00:34:00]
Emma Waddington: Yes I've, read them
Yeah,
Steve Graybar: when someone's joking about talking to a little girl about having children and, alludes to, it's like talking to a rock, well, then God damn it, don't do it.
what you are talking about. What are you doing? And I, and this isn't, they're not coming in. This is elective. I know children don't understand when they're going through chemo. But it is for their parents to understand. So why would someone
pretend to explain something that is outside the grasp of a child? Is it for their conscience? Is it for the child's benefit? What, exactly, what were they doing? And I know that may have been an isolated example and I could possibly, certainly be taking it out of context, but what I saw, and it may have been presented to me out of context, but what I saw was pretty terrible.
And I don't think that's modal. I, get me started. I, don't think this is about good and evil, but that was a damn rotten thing to [00:35:00] joke about. And the person was joking about it. And again, out of context, not knowing that they're being taped. We all say crazy stuff. I get it. damn, that sort of stung.
Sorry, I don't mean to.
The Role of Parents and Clinicians
Emma Waddington: no and, that's the, like reading through that piece of work. I think it's the SOC 8 is the latest version of their work is informing a lot of the care in the U. S. from what I was reading. And. countries too, I think not in Europe so much. I think what's, yeah, what's just striking me is thinking that we all want to do the best for these young people and these children.
I mean, nobody's denying that, you know, we want to take care of them. And, it's really scary because some of them are really, distressed and very unwell. And yet it feels like we've been pushed into a direction. Because [00:36:00] of some of the severity of their presentation, I mean, some, you know, very high rates of suicidality and attempts has pushed us into the urgency of doing something about it and concerns are there.
And this conversation that what we're doing is moving quicker than the research and, potentially, I'm struck, I keep going back to these puberty blockers, but I found it very difficult to find the research, but I had read it where. If children and you've alluded to it, you know, with young people are allowed to go through puberty, the majority of the gender dysphoria gets resolved. I found that unbelievable. Yeah, that's what the data says, but it's not easy to find. As in you have to do the work to find the data. I think the that's where Cass comes in. She's, you know, helped us with this, but you need to do your research. [00:37:00] Because that's quite reassuring as a parent.
your child, like you said, you know, your child is going through this, and you know we'll, work, we'll support them as they go through this period, but the process of puberty is paramount helping them potentially resolve, or come to a Clearer understanding as to what they want to do moving forward.
Chris McCurry: That's kind of the flip side of informed consent, because in the same way that you can't, it's hard to talk to an eight year old about, you know, having orgasms, you know, for the rest of their life. It's also hard to say, this will get better in 10 years. That's, you know, kids are so much in the moment and they're suffering now and they're going to let their parents know that they're suffering and the parents are going to suffer for their kids suffering.
And so they're in a bind.
Steve Graybar: Parents are in hell on every side of this issue. But one of the things I want to, I don't know if clarify is the word, but comment on is that [00:38:00] the, trans kids the data is that they are no more likely to commit suicide than any other mental health patient, kid in mental health treatment.
So, there used to be this big threat, which was your kid will kill themselves if you don't do this. That was a part of the informed consent process, by the way, that's been reported wildly by whistleblowers.
So, so that, that, sort of urban legend by now, but I believe it has happened, but the, Chris, you've also just described, you know, the paradox of parenting.
Social and Psychological Pressures
Steve Graybar: I mean, kids want a lot of things now, and it's our job to endure alongside them those things that are and are not possible. And the issue is they live in a milieu in which they're being told we can transform a Ken doll into a Barbie doll and you'll live happily ever after. Who doesn't want a piece of that action when you're 13.
We're taking the most vulnerable, emotionally vulnerable phase of human [00:39:00] development, I hesitate to say this, but we're preying upon it. And as opposed to helping people wade through these multiple life changes and emotional waves,
we're medicating it. We're intervening with it chemically. By blocking and natural processes of the body and then we're surgically getting involved and as it just doesn't make sense to me to do that without an abundance of solid high quality research saying, yes, this is the right path. And I think that's what's happening.
My one thought and it's, this is, not going to help any of the three of us, if you don't cut this out, my one thought is I, am old enough to remember the nineties and the false memory syndrome and the implanting of false memories by therapists and the spike in reports of child sexual abuse.
By women, young women, middle aged women, older women, by their[00:40:00]
Chris McCurry: Satanic abuse.
Steve Graybar: Satanic abuse, paternal abuse. And then the corollary to all that was the proliferation of multiple personality disorder. This is a true story. I, have people who identified themselves as therapists and saying, yeah, boy I, I, This is a hard week. You know, I've got 17 multiples on my caseload.
. So it's just, I actually and, you know, the hockey stick, the data, you know, we're cruising along like this and all of a sudden, 2008, 2010, it's skyrocketing and. Just, that's a phenomenon. And it looks a
Chris McCurry: Well,
Steve Graybar: a social contagion.
Chris McCurry: yeah, well, I mean people, argue that, you know, left handedness skyrocketed when we stopped making kids use, their right hands, you know, in school. So, you know, people say, well, it's just, we're no longer, you know, suppressing or repressing [00:41:00] this stuff, but, you know I, do think there is a great deal of social pressure and in the same way that there are websites for, you anorexia, pro anorexia websites. And I was hearing recently about, websites encouraging kids to be estranged from their parents if they feel, you know victimized or
Traumatized. And
Steve Graybar: websites and many platforms. Parents are being vilified as the enemy to your freedom, into your transitioning, into your happiness, into your true self. And to that extent I, hate to sound too crazy, but that's how cults work. They sever those ties in which there's going to be a semblance of reality and truth.
And there's also a sense of historicity that can wade through this with kids. And yet parents are, they're being [00:42:00] vilified. That's where most of my clinical experiences is, really in this area is with parents. How, what do I do not to lose my kid? And what they're doing is they're exchanging surgeries and.
And medical interventions for holding on and having a relationship with a kid. I mean they're, hostages.
Reimagining Affirming Care
Chris McCurry: so if we do reimagine affirming care, would that look like?
Steve Graybar: Of course, I have my bias. I, think that family therapy is crucial to make sure that this parental alienation doesn't occur. That, that psychotherapy and empirically supported psychotherapy and empirically supported interventions start being developed. That this needs to beginning of the be the beginning.
Some we've allowed ourselves, I think, out of fear and intimidation. And also heartfelt beliefs, perhaps. To be pushed [00:43:00] aside in theorizing, in researching, and in intervening with these patients. And so gender affirming care affirms the gender dysphoric experience and how difficult that is. But it generates additional solutions, possibilities, and develops a level of relatedness where one can challenge the all and all or nothing thinking the black and white thinking the splitting that goes on and the intensity of, these experiences.
It's not, it's, holding the line for reality and, it's not just stepping back and sort of saying, you know, believing kids, they have this feeling. None of us, none of the three of us believe our feelings. are totally and completely accurate representations of reality all the time. We have to step back from our feelings.
Most good therapy helps us [00:44:00] accept our feelings, observe, and be curious in order to understand our feelings, not to be slaves to them. It's a very different process than, this is what you're feeling, this must be true. Or, people who have similar feelings, Are trans, you know, that's the, sort of helpful advice that kids are giving other kids and denying the social contagion to this when there's five girls in the same friend group presenting that's not the lifting of a prohibition.
Against a oppressed minority. That's a social psychological process that is affecting oftentimes vulnerable kids kids who want to belong. And at the same time, there's a part of me, this is where I began, I, believe there are truly trans kids. But I think it's a fraction of what we're seeing.
my fear is that we're, we are way off in those [00:45:00] numbers.
Emma Waddington: So I guess in a way, what, I mean, it sounds like a compassionate stance in that it's a journey with your, with the parents, with the young person. With the therapist to make sense of what's happening before making a decision whether to transition or not. And I guess this idea of buying time is, it's not about buying time, it's actually about let's do some interventions socially and emotionally to see what's happening, they can function to the best of their ability, given.
The different complexities, like it's much more nuanced and complicated
Steve Graybar: Right. I don't want to meet with meet oversimplification with oversimplification. I think that I think this is very complex. I think it's very difficult work. I think it will be very challenging. And one of the things [00:46:00] that we could do. In my opinion, as a culture or as in our society is what they've done in Europe, which is no medical transitioning before the age of 18,
Emma Waddington: Yeah.
Steve Graybar: takes it out of the parents hands
Emma Waddington: Yes,
Steve Graybar: And it takes the pressure off parents that this is the way it is.
This is the law. We're going to support you through this, with all the love, understanding and acceptance that we can muster. And we're going to get help doing that. And the last thing I would like to throw out is also I would like to see whatever medical transitioning is occurring and social transitioning that is occurring in the states be under the auspices of research.
Because if this does not have empirical support, a scientific base, then it's experimental. So then it should be truly occurring in an experimental and a research context.
Chris McCurry: Well, again, you know, you've got, they pass laws and certain states in the United States [00:47:00] prohibiting, you know, these treatments for minors, it's, it's
an incredible political, you know, pushback. And I think that's, where all the things that you're describing get drowned out.
Well,
Steve Graybar: This is our failing. We haven't done the research. The research has to catch up to and surpass the interventions. Which is why we should be preventing this outside of a research context, not because we want to stick it to some liberals, or we want to gain political advantage.
That, that's just terrible. It's the bottom of cynicism of, behaving in that way.
Final Thoughts and Reflections
Chris McCurry: Well, any final thoughts? I mean,, I just I do hope you get the paper published. I hope somebody has the courage to do that. And, I hope [00:48:00] people will come away from this, being a little more curious about the science. And feeling empowered to, not be swept along by, you know, emotion or political agendas, you know, people can look at this in the best interest of these vulnerable young people.
Emma Waddington: think that, you know, as clinicians, many, steer away because they don't believe they know enough. And I think that is wise. But perhaps when we think about what do we know and what don't we know, need to. Do better research ourselves and
Chris McCurry: LLC.
Emma Waddington: of doing, there is fear of doing harm and, understandably not being able to support young people the way they deserve. And maybe what, you know, one takeaway from [00:49:00] me is that as a clinician, as a psychologist, I can support the family and the young person. In many ways that I can really create these, this environment where we can explore and support, the process of understanding of connection, the relational piece with the families is incredibly important.
And we see it all the time with young people that they get alienated and incredibly painful for everybody that's involved. not to underestimate really the impact clinicians can have, because I think potentially that's been one of the dangerous messages.
Steve Graybar: Well, if you'll not meet a more tortured group of people than the parents,
Emma Waddington: Yeah,
Steve Graybar: they are just suffering, because they don't want to lose their child. And there, there is a pull that parents are in some ways the enemy, [00:50:00] and so they're supporting. And doing everything they can, even things they just do not believe in, to maintain a relationship with their I, can't talk to my son.
I can't talk to my daughter. I feel I'm losing them. I don't recognize them. Something's wrong, if you can imagine. And then there are other adults in their lives, medical professionals, who are pulling them in at a pace that is unnecessary, in my opinion. I know their hair is on fire. children, these young people, I know this, been promised something and they're convinced that the sooner I get this done, the better.
nobody wants to, I mean, you know, if you've got cancer and someone's got an experimental drug who's, not going to get in line. This feels terrible to an adolescent. Again, the most vulnerable time in their lives. And the key to my suffering is over there and you're preventing me from doing it.
[00:51:00] Huff.
Chris McCurry: Yeah.
Steve Graybar: Well, thank you both very much for
having me.
Chris McCurry: Graybar. Wow. I'm sure we'll get, some feedback on this one. But it was it was a great conversation and I really appreciate you willing to
Steve Graybar: I have this terrible sense that the three of us are all depressed. I
Emma Waddington: well I found,
Chris McCurry: right.
Steve Graybar: people are consumed with being nice and kind to, to people who are in difficult situations. What's not to love about that and this generation, you know We, pummel them with our judgments, but more than anything, they're the least judgmental generation that I've been exposed to, and I've [00:52:00] been on college campuses for about three generations now, and they're good, young people.
They really are. And they want to, if they're going to make a mistake, they want to make it. They want to err on the side of kindness. I have no argument with that. I really don't. So I, just agree with you, Emma, so much.
Chris McCurry: right.
Steve Graybar: All right.
Thanks so much for tuning into the life's dirty little secrets podcast. If you have any feedback for us or secrets for future episodes, you can email us at life's dirty little secrets podcast at gmail. com. Be sure to follow us on Instagram at life's dirty little secrets or on Facebook at life's dirty little secrets podcast.
We invite you to follow rate and review us on wherever you listen to this podcast. It is the best way to get our podcast out in front of new listeners. We'll be back. See you then.
