Thread by @DadTrans

In 1981 Stephen, a 14 yr old Trans boy in Pittsburg found a psychiatrist who would listen & asked for a 'sex change'. The psychiatrist spent 5 months analysing Stephen, & decided rather than provide hormone treatment he would prescribe anti depressents.. CW next tweet suicide 1/

Therapy' & antidepressents made things worse. Stephen had a number of suicide attempts immediately before or during menstruation. The psych to his credit, realised his treatment wasn't working & contacted an endocrinologist with experience working with 'Transsexuals' 2/

The Paediatric Endocrinologist, Dr Peter A Lee, prescribed medroxyprogesterone acetate, as a puberty blocker (now not used as less effective than GNrH agonists with a lot of side effects). Stephen had another period & took an overdose of amphetemines requiring intensive care 3/

Recovered & pleased to be alive Stephen returned to school. Over time Stephen's mental health improved & when the medroxyprogesterone stopped working, he was given Danazol, another drug used to block puberty, alongside mild masculanisation & later testosterone 4/

His psychologist made him wait until after he'd finished high school to publicly transition, which he did, in some style, at a family wedding "Steven attended, dressed in suit and tie, looking like a quite ordinary mid-adolescent boy" 5/

Stephen, his mum, sister and Grandma, met ahead of time to plan out how to best tell the wider family. Everything went well "Extended family members, although shocked when told, responded in a positive and supportive way." The year was 1982. 6/

Whilst he was happy with his deepening voice & increase in body and facial hair, Stephen had dysphoria around his chest, which he bound, & ovaries & uterus which he didn't want. On his 18th birthday, Stephen had successful bilateral mastectomy, hysterectomy, & oophorectomy 7/

Stephen was able to think about the rest of his life. He was looking at potential universities, at jobs, he was engaging with Trans media (2 early TV talkshow representations) & was writing to other Trans people via a newsletter - until then he had known no other Trans people 8/

Stephen's story is written up by his Psychologist & Endocrinologist in a 'Case Report'. The language is stigmatising & the early 'treatment' Stephen sufferred before trans healthcare, was conversion therapy in an attempt to create a "stable heterosexual or homosexual outcome" 9/

Despite obvious flaws Stephen's Case Report is a more authentic to Trans lived experience than the entire 'Cass Report'. Stephen endured conversion therapy, sedation, psychological examination, suicidality, & hospitalisation but never shifted from his conviction he was Trans 10/

As the Case Report states: "At no time did Stephen waver in his belief that he was a transsexual or in his desire for gender reassignment" and ..."By the end of this period, neither Susan's mother nor his psychiatrist (M.D.) had any doubt of his gender identity as a male". 11/

Stephen's doctor tried Psychotherapy, to 'cure' him, & it didn't work :"although helpful in many ways, has been unable to elicit or produce even the slightest ambivalence in Steven's expressed gender identity." 12/

Stephen's doctor tried anti depressents which didn't work . [anti depressents] "led to an improvement in sleep, concentration, & depressive affect, but the discordant gender identity and precipitous paramenstrual suicidality remained". 13/

Like today's Trans youth, 42 years ago, Stephen told anyone who would list he just wanted to "get on with my life", & when his Doctor finally listened, got an Endocrinologist involved, prescribed medication to block puberty & then testosterone. He was able to do just that. 14/

There's another lesson for Cass. Stephen's Case Report concludes "Since the majority of transsexuals refuse to participate in controlled treatment protocols, the best strategy may be early identification & systematic follow-up of children & adolescents with gender dysphoria" 15/

Even in 1981, desperate for healthcare, Stephen flat out refused to be enrolled in an controlled treatment programme. They tried to secure him in a psychiatric hospital but over the age of 14 in Pittsburg, he could legally check himself out, which he promptly did. 16/

Now, 42 years later, Cass & @NHSEngland want to make enrollment on a (as yet unknown) research protocol a requirement for healthcare. It was deeply unethical in 1981 & it is deeply unethical now. 17/

@NHSEngland Stephen wasn't the first adolescent to receive Trans healthcare, there are examples throughout the 20th century & the gender affirming healthcare he received or something very like it, soon became defined in the 'Dutch Protocol's' 1st phase in place by 1988 18/

@NHSEngland 'Puberty blockers' have been used for adolescent Trans health for 40 years. In spite of her rhetoric Cass found no strong evidence of any harm. There is plenty of evidence that Gender affirming healthcare - blockers, followed by hormones, when wanted, has really good outcomes 19/

@NHSEngland Stephen would be in his early 60s now. After desperately hard beginnings he was able to live his life because he had Doctors who were willing to learn & who did their best even lacking specialist knowledge. That's what today's youth deserve. Accessible healthcare. Not Cass 20/

We have learnt so much in the last 42 years, yet Cass seems to have gone back to the worst of the 1970s in her approach. It didn't work then, it won't work now. Trans healthcare helps Trans youth get on with their lives. It is that simple. In 1982 & 42 years later in 2024. END/

ps. Stephen's Case Report (Duncan & Lee 1984) can be read via link below Note I've used Stephen's correct pronouns in the thread (the authors make a conscious change half way through) & avoided the most stigmatising language. CW abuse / suicidality jaacap.org/article/S0002-…

I didn't include the anecdote included in the case report that after an overdose of speed, released from intensive care, Stephen "caught up on 2 weeks of missed work in 2 days at home".

#CassFlaws

If you have learned something from this Thread, please consider donating to @Genderintell who do incredible work, including running camps for Trans children & young people, so they benefit from a community growing up that Stephen never had. localgiving.org/donation/gende…