, 22 tweets, 5 min read Read on Twitter
1. So, today in things that aren't broke but right wingers want to "fix" them are access to legal and medical policies as part of gender transitions. Exhibit A is Jamie Shupe, writing for the Heritage Foundation's propaganda arm, The Daily Signal.
2. Shupe transitioned after inadequate access to mental health care, then detransitioned prior to any surgeries. He cites Blanchard, Dreger, and Bailey to argue that no one should be allowed to transition, and instead should all receive some sort of undefined conversion therapy.
3. This is a perfect example of using a single anecdote, out of context, to argue for bad policy that would end up harming far more people than it helps. It's also zero surprise that what Shupe says matches perfectly with Ryan Anderson's religious dogma and talking points.
4. First, let's talk regret rates. Regret rates for gender confirmation surgery typically are between 1 and 4%. Regret rates for transitioning are also similarly low. Detransition is very rare (~1%)
5. When people do have regrets, the studies consistently show the reasons for weren't because the individual wasn't transgender, but because of lack of familial support, rejection, and mistreatment. huffingtonpost.com/brynn-tannehil…
6. At the same time, an overwhelming body of evidence supports the conclusion that transition benefits the large majority of transgender people.

whatweknow.inequality.cornell.edu/topics/lgbt-eq…
7. Next, let's address the idea that transitioning back is somehow impossible. Short version: it isn't. You can change your name, and gender marker back if you wish. The policy mechanism was right there on the application for gender marker change when I got my DL in Ohio.
8. It's basically the same level of hassle than changing it in the first place was. So, if the argument was that it's too easy in the first place, then it's not too hard in reverse either.
9. Then there's whether or not the process is too easy. For most transgender people with access to adequate health care, there's usually at least months with a therapist before a recommendation with a doctor. Then, after that, you can get HRT.
10. Then, if you live in your gender full time for a year and get a sign-off by two mental health professionals (one a PhD), plus a long interview with the surgeon, who will also likely want your doctor's notes. This gatekeeping results in a regret rate of approximately 1-2%
11. Compare this with gastric surgery for weight loss, which requires no psychological evaluation, staying on a diet for three months, requires permanent lifestyle changes, has a high complication rate, and has a serious regret rate of 30%. soard.org/article/S1550-…
12. You don't see the Daily Signal, or the Heritage Foundation publishing articles about how it awful it is that people can get gastric surgery too easily, despite numbers far worse than for GCS. Thus, this is not about concern for patients. It is about moral disapproval.
13. Finally, there is the individual case of Shupe. He readily admits he received inadequate mental health counseling, but ultimately ended up taking no surgical (permanent) steps towards transition.
14. The medical literature specifically states, for over a decade, that providers should take extra care with cases like Shupe's. Indeed, the year of real life experience convinced Shupe not to proceed.

ncbi.nlm.nih.gov/pubmed/15842032
15. In short, Shupe's story isn't a cautionary tale, but is instead anecdotal evidence that the system, as is, worked as intended by putting enough barriers in place that someone who shouldn't undergo GCS, didn't.
16. The bigger picture data and research tells a similar story. Gatekeeping is high, regret and detransition are VERY low, and when the latter two happen it is very rarely because the person wasn't trans. In short, a tiny fraction of a tiny fraction.
17. With the filters turned up so high, type one errors are low, but transgender people often have to jump through a lot of hoops other people do not. This is why some providers are going to an informed consent model: because in both the US and UK competent trans care is uncommon
18. The solution isn't no care, because that would harm FAR more people than it helps (by, like 99 to 1). It's not conversion therapy, because as hard as religious conservatives try to pretend it exists, no one has ever shown a therapy to make people "not trans".
19. (Note: they tried all the same things on trans people as they did to gays to make them not-trans or not-gay. It worked just as well on trans people as it did on gays, which is to say not at all)
20. Thus, if you want to reduce an already low regret rate (compared to other procedures), all the studies recommend better training and awareness for mental health care providers, not shutting off legal and medical access to transition.
21. Shupe, and the Heritage Foundation's, positions go against the empirical evidence that regret and false positives are already very rare, the research on the subject, and the considered positions of the AMA, APA, and other professional health orgs lambdalegal.org/sites/default/…
22. Their positions and recommendations are not based on science or data, but on anecdotes and moral opprobrium rather than any sort of comparative analysis.
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