Gender: A Wider Lens

Dr. Anne Lawrence is a physician, sex researcher, and academic writer. She is also a postoperative male-to-female transsexual who underwent gender transition in 1996. Since early childhood, she had experienced an intense desire to have a female body, but she had been unable to find any scientific or popular descriptions of transsexualism that spoke to her experience. This changed in the early 1990s when she discovered Dr. Ray Blanchard’s writings about the concept of autogynephilia, which he defined as “a male's propensity to be sexually aroused by the thought or image of himself as a female.” Blanchard’s revolutionary concept gave Dr. Lawrence an essential insight into the meaning of her desire for sex reassignment, and it helped her find the courage to undergo gender transition. Dr. Lawrence subsequently began to research and write extensively about transsexualism and associated issues, both in academic journals and on her website, “Transsexual Women’s Resources.” She is best known for her controversial book, Men Trapped in Men’s Bodies: Narratives of Autogynephilic Transsexualism, published in 2013. The book provides a detailed summary and analysis of existing research about autogynephilia and related phenomena. It also contains excerpts from narratives submitted by over 200 male informants, describing their personal experiences of autogynephilic transsexualism and gender dysphoria. Anne tells us about her early experiences with AGP in childhood, how she tried various ways to sometimes navigate, alleviate or avoid this propensity. She ultimately transitioned in her 40s. Anne is now 71 and reflects on the long game. We spend time talking about her finding Dr. Blanchard’s work and her own research, her book, and her academic interest in understanding this AGP experience. The end of the conversation took an unexpected turn when she described mindset, the intensity, and the desperate measures that seem so reasonable when you’re tortured with severe autogynephilia. For the record, Anne has not been involved in the field for many years and her reflections do not encompass the ROGD phenomenon. Stella and I feel it’s important to listen to people’s experiences so we can understand all the manifestations of GD. However, we believe in the power of therapeutic intervention and we don’t think a nihilistic approach is helpful to deeply distressed individuals. Links:2008 Paper: Shame and Narcissistic Rage in Autogynephilic Transsexualism Pfox.org/Shame-Rage.pdf 2013 Book: Men Trapped in Men’s Bodies Springer.com/book/10.1007/978-1-4614-5182-2  Extended NotesAnne opens the discussion by breaking down what autogynephilia is.She also talks about studies that describe children having autogynephilia.Anne shares her personal history with autogynephilia starting when she was just a child.When Anne told her parents she wanted to be a girl, she was sent for psychotherapy and thought it wasn’t going to be helpful.What did Anne’s therapist do to break empathy and connection?Anne experimented with estrogens at age eighteen.She shares her realizations after her attempt at self-castration.How did she come to the idea of how she used estrogens back then? Where did she get it from?Anne made several attempts to not express her autogynephilic feelings. She shares what those attempts were.How did Ray Blanchard’s work shift Anne’s thinking or experience of her propensities?Anne graphically describes how she despaired really liking her male... This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

The reason this interview is so important is bc the concept of puberty blockers originated with these two researchers (along w/ cohen kettenis.) We talk about patient zero and the 22 year follow up w/ this person. We get into the nitty gritty details about the 2 studies on which all puberty blocker treatment is based: we ask why they selected certain methods, talked about eligibility criteria, and the 15 participants who didn’t make it into the final study. We even touch on Jazz Jennings, social media, ROGD and detransition. This conversation felt, to us at least, like we barely scratched the surface: we were frankly left with more questions than answers, which we are so eager to talk about in our post series analysis. You’ll probably notice the vast differences between the perspectives of these researchers and of myself and Stella, but nonetheless it was a productive and fascinating conversation. Bio: Steensma Thomas D. Steensma, Ph.D., is a health psychologist, principal investigator and part of the outpatient management team at the Center of Expertise on Gender Dysphoria at Amsterdam UMC, The Netherlands. Trained as a child and adolescent psychologist, his clinical work is focused on the counseling and treatment of people of all ages with gender incongruence and Differences in Sex Development (DSD). As principal investigator, his research lines are focused on psychosexual development, gender identity development and treatment evaluation of youth with gender incongruence. Over the years, he has published over 50 peer reviewed articles in international journals and several book chapters in close collaboration with prominent scientists in the field of gender and sexology. He has co-supervised several Ph.D. and master students. His recent scientific work is focused on understanding the developments in our field focusing on the change in observed sex ratios and the influence of media attention on gender referrals and understanding the processes and factors involved in non-binary gender identity formation. He is currently part of the working group for the text revision of the DSM-5 chapter on Gender Dysphoria. In the development of the 8th version of the Standards of Care of the World Professional Association of Transgender Health (WPATH), he is part of two working groups: Assessment and Therapeutic Approaches of Non-Binary People and Assessment, Support and Therapeutic Approaches of Children.   Bio: de Vries Annelou de Vries is a child and adolescent psychiatrist and full staff member in the dept of child and adolescent psychiatry working at the Amsterdam UMC. Annelou de Vries is leading the Child Psychiatry Department of the Center of Expertise on Gender Dysphoria of the Amsterdam UMC. She is president elect of the European Professional Association of Transgender Health (EPATH) . She is co-chair of the adolescent chapter of the Standards of Care revision of the World Professional Association of Transgender Health (WPATH).  At present, her lines of research focus on 1) the co-occurrence of autism and gender dysphoria, 2) capacity for informed consent of transgender adolescents, 3) long term follow up of transgender adolescence into middle adulthood, 4) sexual development of transgender adolescents,  5) shared decision making in transgender care, and 6) pathways in gender identity exploration and affirmation.  Links:Young adult psychological outcome after puberty suppression and gender reassignment  This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Susan Bradley is Professor Emerita at the University of Toronto. She graduated with her medical degree in 1966 and completed her residency in Psychiatry U of Toronto from 1968 to 1972. In 1975 she became the Founder of Gender Identity Clinic for Children and Adolescents at Clarke Institute of Psychiatry. In 1985 dr bradley handed over the head position to Dr Kenneth Zucker (who we interviewed in ep 59). She is the author or co-author of over 50 articles on various forms of psychopathology including gender identity disorders in children and adolescents. After stepping down as Psychiatrist-in-Chief at HSC spent almost 20 years consulting to Children’s Mental Health Agencies around the Greater Toronto Area with a special interest in children with Autism Spectrum Disorder who are high functioning. Dr Bradley retired in 2010.  This conversation was an incredible opportunity to hear Susan give her extremely informed long-term perspective on gender nonconforming children and their treatment. She describes what she calls the ‘naivety’ of the early clinicians who put too much trust in the endocrinologists’ eager and scientifically weak recommendations. Looking back, she worries that puberty blockers were just facilitating transition and wonders if many of the dysphoric children the clinic saw actually had undiagnosed high-functioning autism. We discuss the cognitive rigidity associated with autism as well as the laser-like focus some young people have when seeking medical transition. She also shares her thoughts on the new population of ROGD kids and the cult-like aspects of social media trans activism. Dr Bradley was honest, incredibly knowledgeable, and this conversation gives us all much food for thought.   Links:  Singh paper - desistance:  https://www.frontiersin.org/articles/10.3389/fpsyt.2021.632784/full  This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Dr. Az Hakeem was born and brought up in North Wales and has lived and worked in London since studying medicine. He is a Consultant Psychiatrist who previously trained in forensic Psychotherapy, Mentalization-Based Therapy and is a Group Analyst. He previously worked within the NHS in Forensic Psychotherapy specializing in Analytic Psychotherapy for conditions relating to sex, gender, sexual perversion, and violence at The Portman Clinic, part of The Tavistock & Portman Clinics. Dr. Az Hakeem is unique in that he is the only consultant psychiatrist in psychotherapy who specializes in the specialist application of exploratory psychotherapy to persons suffering from gender dysphoria. He set up and ran the only specialist psychotherapy service for adults with gender dysphoria in the UK in the NHS and is the author of TRANS: Exploring Gender Identity and Gender Dysphoria. After over 15 years working in the NHS, Dr. Hakeem now works exclusively in private practice. In addition to his clinical work, Dr. Az Hakeem has worked as a consultant to the media, on-screen specialist, and TV Co-presenter on a number of TV programs in both the UK and Australia.  Dr. Az Hakeem considers himself a “Gender Critical Psychiatrist.” Today we get to hear about Dr. Hakeem’s facilitated group therapy for gender-distressed adults. He ran these groups for twelve years from 2000 to 2012. Containing a mix of pre-medical-transition individuals who were often gender-euphoric and post-medical-transition individuals who experienced regret, these groups created a fascinating opportunity to give gender-dysphoric individuals more insight into the long-term experience of transition. In this episode. we discuss Dr. Az’s understanding of gender distress and how he contextualizes ROGD kids into this framework. Links:TRANS: Exploring Gender Identity and Gender Dysphoria: Amzn.to/3rckYzw The Curious Incident of the Dog in the Night, by Mark Haddon: Amzn.to/3IKVbEA “Development and validation of a measure for assessing gender dysphoria in adults: The Gender Preoccupation and Stability Questionnaire” Hakeem, A., Črnčec, R., Asghari-Fard, M., Harte, F., Eapen V. International Journal of Transgenderism (26th August, 2016) Tandfonline.com/doi/abs/10.1080/15532739.2016.1217812?journalCode=wijt20 “Psychotherapy for Gender Identity Disorders” Hakeem, A. Advances in Psychiatric Treatment (2012), vol.18, 17-24 Cambridge.org/core/journals/advances-in-psychiatric-treatment/article/psychotherapy-for-gender-identity-disorders/D10025B4A7EBBC2250E71EA6A12465F0 “Study Protocol for a randomized controlled trial of mentalization based therapy against specialist supportive clinical management in patients with both eating disorders and symptoms of borderline personality disorder” Robinson, P., Barrett, B., Bateman, A., Hakeem, A., Hellier, J., Lemonsky, F., Rutterford, C., Schmidt, U., Fonagy, P. BMC Psychiatry 14(1): 51. 2014Pubmed.ncbi.nlm.nih.gov/24555511 “Deconstructing Gender in Trans-Gender Identities” Hakeem, A. Group Analysis. The International Journal of Group Analysis Volume 43 Issue 2, June 2010 This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Sasha and Stella sit down to discuss their thoughts and reflections on the Pioneer interviews they’ve conducted so far in the series. This analysis attempts to synthesize what they’ve learned, what differences in perspective they hold compared to their previous guests, and reiterate the importance of these discussions within the wider context of childhood transition, scientific inquiry, and deep exploration of all things gender. Links:Butch Identity DevelopmentExtended NotesSasha and Stella give a mid-series update on some of the thoughts they have had so far and talk about the range of guests they've had on.This series started with a bang with Dr. Paul Vasey and his research in Samoa.Is it more acceptable now for women to socially transition?Our society is obsessed with femininity. Sasha explores whether more masculine women get thrown to the wayside because of it.Is all of this genetic or not? Stella thinks there is a hereditary component to all of this.People who feel like they have a genetic mental health condition vs. an environmental mental health condition feel alienated. When it’s deemed “environmental,” it feels more human.Can we nurture ourselves into a different place from where we started? Stella says yes.Just because you are susceptible to something, doesn’t mean you will become it or that you are it.Where did the concept of puberty blockers come from? Why did it make sense as a form of “treatment”?Guest Michael Bailey had some thoughts on whether it made sense for trans men to marry or have a partner.Can you have a successful relationship when you have autogynephilia?Stella knows so many functioning alcoholics. You can always live what looks like a successful life, but underneath the surface, it’s in shambles.Stella is curious to see if anyone is doing research behind trans porn and who is watching that.The whole field around children with gender dysphoria has been badly handled.Guest Dr. Steve Levine talked about the chain of trust researchers have with one another and how there’s very little cross-checking the actual work.Stella is shocked that people want to silence researchers who have dedicated the last 20‒30 years of their lives within a particular field. Why silence them?Guest Carole Hooven experienced sexual assault and wanted to understand, through researching monkeys, why we were aggressive to one another.Sasha and Stella have some interesting guests lined up for you!This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org to learn more. For more about our show: Linktr.ee/WiderLensPod This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Riittakerttu Kaltiala, M.D., Ph.D., BSc, is a professor of adolescent psychiatry in Tampere University and chief psychiatrist in the Department of Adolescent Psychiatry at Tampere University Hospital. She is a specialist in psychiatry, adolescent psychiatry, and forensic psychiatry. She has been clinically involved in carrying out research on adolescent gender identity issues since 2011 when one of the two nationally centralized gender identity services for minors was opened in Finland, in Tampere University Hospital. She has been actively involved in service development, continuing education, and scientific writing and collaboration nationally and internationally, and in her home country she has been invited as a member of major national initiatives related to transgender treatment guidelines and legislation. She has published numerous scientific articles on adolescent mental health epidemiology, psychiatric health services research, and clinical adolescent psychiatry. Riitta tells us about the shift around 2010 in Finland in which health policymakers, politicians, activists, and human rights groups pushed for the inclusion of adolescent and child services for gender transition. The adolescent psychiatrists scrambled to accommodate these new demands but recognized that identity consolidation is known to take more time and they had concerns about such early interventions. Nevertheless, they began developing a program for childhood gender services based on the literature in other countries such as the UK and Netherlands. They were astonished and quite confused when the populations arriving at their services reflected a very different demographic in age, sex, and presentation of other comorbid psychiatric issues. They saw a shift again around 2015 which continued to confound the clinicians. Riitta tells us about reading the Littman ROGD research which accurately documented what she and colleagues were seeing. Dr. Kaltiala also tells us that predictions of improvement and symptom reduction reflected in the Dutch literature were not observed in their work, and describes how Finland has moved towards prioritizing psychological care and meeting all the needs of young patients who present with GD, rather than focusing only on the gender transition requests.Links:Dr Kaltiala’s Website:Riittakerttu.fi Adolescent GD Current Perspectives:Ncbi.nlm.nih.gov/pmc/articles/PMC5841333 Lisa Marchiano — Outbreak:Tandfonline.com/doi/full/10.1080/00332925.2017.1350804 GD and ASD: A Narrative ReviewPubmed.ncbi.nlm.nih.gov/26753812Extended NotesRiitta talks about how she got into psychiatry and got to work in this field.When did Riitta first come across gender identity? She shares the backstory.Riitta talks about how it was decided in Finland in 2009 that children and adolescents also needed gender medical intervention. What was the motivation behind this?It is during adolescence that young people seek and experiment with their identity. However, it is normal for them to change or evolve in 2‒3 years. It is part of the process of stabilizing their identity.It’s hard to expect in adolescent psychiatry during the early phases of adolescent development that the person would already be ready with any aspect of identity.In the beginning, most of society did not have an idea about gender identity issues so it was not discussed much, including in the medical This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Ray Blanchard was the psychologist in the Adult Gender Identity Clinic at the Clarke Institute of Psychiatry 1980–1995. Much of his research in those 15 years concerned transsexualism and milder forms of gender identity disorders. In 1995, he was appointed Head of the newly created Clinical Sexology Services at the CAMH. This unit comprised the Adult Gender Identity Clinic and the Kurt Freund Laboratory, the latter being the oldest laboratory in North America for the psychophysiological assessment of erotic interests in sexual offenders and other men with problematic sexual behavior. Blanchard retired from the CAMH in 2010. Since his retirement, he has continued to be active in research on human sexuality, often in collaboration with former students, colleagues, and their students. Today, Ray tells us how he got into the field, as he was primarily interested in conducting sex research. And then he found himself in a gender identity clinic. He got interested in boiling down the cumbersome and sprawling categorizations of gender dysphoria and deemphasizing women’s clothing. He wanted to uncover the wider framework that explains a variety of behaviors for dysphoric males. The term autogynephilia was born. Ray describes common misunderstandings about the term and addresses some myths about AGP, clusters of behavior, and what he calls “erotic mislearnings.”Links:Dr. Blanchard’s PublicationsMen Trapped in Men’s Bodies: Narratives of Autogynephilic Transsexualism, by Anne LawrenceThe Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism, by J. Michael BaileyExtended NotesA little bit about Ray and why he decided to work in sexology.What kind of classifications were there at the time for “transsexualism”?From 1980 to 1995, the females who wanted to transition in Ray’s clinic, all of them were attracted to other females.Ray talks about his observations with his patients that had autogynephilia and some common themes he saw within this group.Ray suggests listeners watch the difference in manners between Blaire White and Caitlyn Jenner.Ray shares his experiences in this field and how it’s changed throughout the years.Did Ray ever receive backlash for his work?Ray doesn’t believe there’s a connection between sexual abuse and gender dysphoria.Are male-to-female transexuals more likely to be pedophiles? Ray says no.Can autogynephilia be passed down to children? Is this genetic?Sasha wonders if it was easier to get the truth out of the patient back then vs. now; a time where people have an agenda to prove they’re trans.Having one erotic paraphilia tends to predispose you to other paraphilia. It’s not just an “autogynephilia” thing.Ray shares his thoughts on why pedophiles become pedophiles.What are some of the misconceptions of autogynephilia?Out of Ray’s clinical practice, only two women stood out as different from a gynophile.How come so many males transitioned in their late 40s?Ray shares his thoughts on trans widows and how they must be feeling when their partner comes out as trans.This podcast is sponsored by ReIME and Genspect. Visit Rethinkime.org and Genspect.org to learn more. For more... This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Dr. Steve Levine is Clinical Professor of Psychiatry at Case Western Reserve University School of Medicine.  He is the sole author of several books: Sex Is Not Simple in 1989 (translated to German in 1992 and reissued in English in 1997 as Solving Common Sexual Problems); Sexual Life: A clinician’s Guide in 1992; Sexuality in Mid-Life in 1998 and Demystifying Love: Plain Talk for the Mental Health Professional in 2006; Barriers to Loving: A Clinician’s Perspective in 2013; Psychotherapeutic Approaches to Sexual Problems: An Essential Guide for Mental Health Professionals in 2020. Dr. Levine is also the Senior Editor of the first (2003), second (2010), and third (2016) editions of the Handbook of Clinical Sexuality for Mental Health Professionals. He has been teaching, providing clinical care, and writing since 1973 and has generated original research, invited papers, commentaries, chapters, and book reviews. He has served as a journal manuscript and book prospectus reviewer for many years. He was co-director of the Center for Marital and Sexual Health/Levine, Risen & Associates, Inc. in Beachwood, Ohio from 1992-2017. He and two colleagues received a lifetime achievement Masters and Johnson’s Award from the Society for Sex Therapy and Research in March 2005.  He was given his Department of Psychiatry’s Hall of Fame  Award in 2021. In our conversation, Stephen is posed the question: Why are we so prone to reductionism in our thinking about transition and gender? He explains the “chain of trust” in medical school training and academia and how it can lead to a broken system and low-quality procedures being used on a massive scale. Additionally, Dr. Levine’s deep perspective on love, intimacy, and what makes us human reflects the great wisdom he has gained from over fifty years working as a psychiatrist.Links:Solving Common Sexual Problems (1997), by Stephen LevineSexual Life: A Clinician’s Guide (1992), by Stephen LevineSexuality in Mid-Life (1998), by Stephen LevineDemystifying Love: Plain Talk for the Mental Health Professional (2006), by Stephen LevineBarriers to Loving: A Clinician’s Perspective (2013), by Stephen LevinePsychotherapeutic Approaches to Sexual Problems: An Essential Guide for Mental Health Professionals (2020), by Stephen Levine Extended NotesStephen was first introduced into this field by a suicidal man who wanted to become a woman.Despite working with this person for a number of years, she later did commit suicide.Sixty-three percent of teenagers now identify as a non-binary person.It seems now that if you claim a trans identity, your childhood, your backstory, is totally... This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Dr. Zucker is a registered clinical psychologist in Ontario. He received his Ph.D. at the University of Toronto in Developmental Psychology in 1982. He is a Professor (Status Only) in the Department of Psychiatry, University of Toronto, and in private practice. He was the Chair of the 2013 DSM-5 Work Group on Sexual and Gender Identity Disorders. He is a past President of the International Academy of Sex Research and has been the Editor of Archives of Sexual Behavior since 2002. Since 1976, Dr. Zucker has worked clinically with children and adolescents with gender dysphoria and their families. His research spans a variety of areas, including epidemiology, diagnosis, and assessment, associated mental health challenges, causal mechanisms, and long-term follow-up. In our discussion, Ken describes the early years of working with childhood gender issues starting in the 1970s. We talk about the changes he’s seen in the kinds of kids, families, and therapists in the field. Politics has always been present in the world of gender identity treatment, but this came to a head for Ken when he was fired from his position at the CAMH hospital in Toronto 2015 after activists made some wild accusations and hospital administrators became fearful for their positions. After a three-year legal battle, he was finally vindicated and compensated. Even with his decades of leadership in the field, Zucker was not protected from this early cancel-culture manifestation. We talk about what his story means for individuals in practice and the field more broadly.Links:Dr. Zucker’s Website: Kenzuckerphd.com Sexual Identity Conflict in Children and Adults: Amazon.com/Sexual-Identity-Conflict-Children-Adults/dp/071560774XExtended NotesKen talks about how he accidentally got into the studies of gender identity disorders.He shares about when he met Sue Bradley and joined her gender identity clinic for children and adolescents at the Clark Institute of Psychiatry in Toronto that she just started in the early ’70s.What was it like working with this study, it being taboo at the time?Ken also talks about the parents that brought their children to their clinics. What led them to seek help?Anxiety about sexual orientation is still an issue that many parents struggle with.Ken shares the shift in focus of their research studies from the ’70s to the early 2000s between children and adolescents.How much impact do social media and the internet have with rapid onset gender dysphoria? Ken also shares his insights on this.Ken talks about his experience and the various views of the subcommittees within the DSM (Diagnostic and Statistical Manual of Mental Disorders) during his involvement with them.Ken gets into more details when their clinic got closed in 2015, being one of the early targets of cancel culture.With newer administrative heads in their child program, the criticisms they received in 2015 would have been taken differently if it was still managed with Sue Bradley and their former bosses.Ken shares what were his thoughts at this time. Did he think that his career would be ruined thereafter?Ken also talks more about the lawsuits he then filed against newspapers, the hospital, and one of the administrators of their program due to libelous comments and defamation, among other things.People being accused of things and these things going viral get them canceled as opposed to having an exchange of ideas has become a pervasive issue in the last years.Ken also shares his interactions with both new and old colleagues and how they fear for their... This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit www.widerlenspod.com/subscribe

Guest Michael J. Bailey discusses the origins of sexual orientation, his book 'The Man Who Would Be Queen,' and backlash faced. Topics include genetic influences on sexual orientation, encounters with trans individuals, societal challenges, controversies related to male femininity and autogynephilia, and the impact of relentless personal attacks on his life and work.