I know what you’re thinking, these three things have got nothing to do with each other. Let’s let an adult man explain why it is essential children have access to these brain/body-modifying chemicals. Are you sitting comfortably?
About this event
In this talk, Florence Ashley discusses adolescent medical transition and why it is effective and ethical.
It is sometimes argued that adolescent medical transition is ineffective and unethical because its mental health benefits are unproven. Drawing an analogy to reproductive healthcare, Florence Ashley (they/them) argues that this misrepresents how we justify definitional medical interventions — that is, interventions that are sought for their own sake as an instrument of self-definition and autonomy over fundamental aspects of personal identity. Understood as definitional medical care, adolescent medical transition is effective if it brings about the desired physiological changes and is ethical unless proven overwhelmingly harmful.
ABOUT FLORENCE ASHLEY
Florence Ashley, BCL/JD, LLM (Bioeth) is a transfeminine jurist and bioethicist based in Toronto, where they are a doctoral student at the University of Toronto Faculty of Law and Joint Centre for Bioethics. Their doctoral project examines how science is deployed and used within the legal system to simultaneously bolster and undermine trans youth’s autonomy. Their research is supported by a SSHRC Joseph-Armand Bombardier Doctoral Scholarship. Prior to their doctoral studies, they served as clerk to Justice Sheilah Martin of the Supreme Court of Canada (2019-2020), being the first openly transfeminine person to clerk at the highest court. Prior to clerking, they completed degrees in civil law and common law followed by a master’s in law and bioethics at McGill University. Florence’s book, Banning Transgender Conversion Practices: A Legal and Policy Analysis, is forthcoming with UBC Press.
ABOUT THIS EVENT: The Centre for Gender & Sexual Health Equity Speaker Series brings cutting-edge research in the field of gender and sexual health equity to researchers, practitioners, students and interested members of the public, creating a unique opportunity for education and dialogue.From the blurb on Eventbrite
Summary of argument
Women are allowed to use birth control to prevent pregnancy or have abortions to prevent childbirth, therefore children should have unrestricted access to puberty blockers. That one point, repeated again and again over the course of 45 minutes.
Whine, whine, whine, whine, whine.
Things he forgot to mention
This obviously isn’t an exhaustive list, but it is worth pointing out that Ashley failed to describe what puberty blockers actually are (i.e. GnRH agonists, Lupron being one such brand name), how they work, method of delivery (implants, injection, etc) or any of the documented side effects that we know about so far (infertility, bone density loss, stunted genital development, arrested mental development).
He also failed to mention that whilst puberty blockers necessarily have to be prescribed to children under 16 if they are to stop puberty, the same is not true for birth control, since the age of consent is generally 16 years old and we would expect most girls to be of age before they sought the oral contraceptive pill. Abortions for the under 16s is a rare scenario. Therefore the two issues are not really analogous.
The host from the Centre for Gender & Sexual Health, based in British Columbia, Canada, was Travis Salway, who described himself as a ‘research scientist’. Like Florence Ashley he is supposedly interested in ending ‘conversion therapy’ – see his article here.
Salway told us that he and Ashley had been working together for the last two years on the issue of conversion therapy and that Ashley was an expert in it. He read out the bio about Ashley as above – the man has three law degrees. I had to double check the meaning of the word ‘bioethics’, just to make sure I wasn’t going mad.
Predictably Ashley’s appearance on camera was a lot less impressive than his headshot shown in the promotion for the event, wearing a very low cut top meant we were confronted with an aggressive-looking triangle of white flesh throughout. Thankfully his ‘titties’ were out of view. He is about to publish a book about so-called ‘trans conversion therapy’ (a snip at £59). Yet here he was with his very own explanation of exactly why children should be allowed to be sterilised with GnRH agonists (commonly known as ‘puberty blockers’). You really couldn’t make it up.
Ashley’s book is called Banning Transgender Conversion Practices: A Legal and Policy Analysis and the blurb goes:
Survivors of conversion practices – interventions meant to stop gender transition – have likened the process to torture. Florence Ashley rethinks and pushes forward the banning of these practices by surveying these bans in different jurisdictions, and addressing key issues around their legal regulation. Ashley also investigates the advantages and disadvantages of legislative approaches to regulating conversion therapies, and provides guidance for how prohibitions can be improved. Finally, Ashley offers a carefully annotated model law that provides detailed guidance for legislatures and policymakers. Most importantly, this book centres the experiences of trans people themselves in its analysis and recommendations.Taken from Foyles website
The whining starts
Ashley started by childishly rubbishing the names of US states (‘they all sound the same to me’) which had started to be more cautious about allowing children access to puberty blockade drugs. Critics described the therapy as ‘experimental’ and because the mental health benefits were ‘insufficiently proven’ it was therefore a justification to restrict children accessing the drugs. That would sound sensible to any bioethics student.
Ashley explained that he would be presenting the argument against. We would be the first audience to hear Ashley’s argument in full.
Looking for evidence that puberty blockers would improve mental health was ‘wrong’. Of course, Ashley told us, no one, including him, wanted to have a medical treatment which wasn’t effective. Ashley argued that we don’t know the outcomes of birth control in terms of mental health and therefore puberty blockers should be treated in the same way.
In reproductive health that’s how we’re framing it, we’re saying autonomy first and then we look at whether it is so harmful that it would justify taking away rights, and we conclude no it’s not.Florence Ashley, 7.30 minutes
Trans healthcare is like reproductive healthcare and the same standards should apply otherwise there is a double standard, and double standards are discriminatory.
Gender dysphoria should not be regarded as a mental illness – also, we don’t regard women seeking birth control or abortions as mentally ill, do we? Being trans was really to do with ‘incompatibility’ between desire and reality.
If we force women to have babies that would cause them mental distress, just like when a ‘trans’ child is denied puberty blockade.
When women seek out birth control, they aren’t exposed to diagnostic criteria, Ashley argued, and therefore nor should trans people seeking care.
(He didn’t use the word ‘women’ by the way, but that’s who he really meant, not men seeking free condoms.)
When I go for conventional medical care, I care a lot if there is any proven evidence that it actually helps. When I go to get to trans care, I don’t give a f- flying damn, because I want the care itself. I want the intervention itself.Florence Ashley, 15 mins
In an obvious affectation, Ashley spent a lot of time twirling his hair decorously, in an attempt to create the impression that he was uncertain of himself, you know, in the way that ladies are when we’re giving a big impressive presentation.
Ashley told us the reason why abortions must be allowed was because it impacts on gender and racial equality, including not being able to complete education and spending time out of the workplace. Similarly if trans people can’t get their hands on hormone treatment they experience psychological harm and might not be able to continue school. More people will realise that they are trans and thus more likely to experience literal violence. They also won’t be able to participate in society.
Counter arguments – reversibility
This is where you might need to say some bad swears out loud.
Yes, Ashley gaily admitted, you can’t unbake a cake, time is irreversible and if a child takes puberty blockers they definitely lose a bit of pubertal growth that cannot be recovered.
Guess what else is regrettable though? Abortion. Women also regret abortions. (He used the word women in this case since anti-abortionists weren’t ‘exactly trans inclusive’.)
Gender dysphoria is defined as a mental illness and is still in the DSM (Diagnostic and Statistical Manual of Mental Disorders). Yet, wanting an abortion isn’t described that way. Not fair!
Ashley asked us to imagine waking up one morning in the body of another person – how dysphoric would that make you feel?
I don’t mean that for the trans people in the audience, I’m going to focus on the cis people in the audience. If you’re a cis man imagine you wake up in the body of a cis woman and vice versa. Um, quite naturally, you’d be like, yo this sucks, and after that, when you’re past the novelty aspect of it, you’d probably start being very distressed, because you’d be that’s not me, that’s not my body. […]
Yet we would hardly say that it is some form of mental illness on your part, there’s something going on, that leads to distress […] that was caused by Freaky Friday (magic) and in the case of trans people, sort of bio cognitive happenstance.Florence Ashley, explaining Freaky Friday to us, 27 mins
Ashley said it was also worth noting that the gender dysphoria diagnosis in the DSM was kept ‘primarily because there were fears that it would impact access to insurance coverage’. No shit.
Know what else has been pathologised previously? Abortion. Freud described it as infanticide and past psychoanalytic literature as ‘hysteria’ and ‘divestment from oedipal guilt’. These sound like diagnoses they might level at a trans person, Ashley said.
We just want the hormones, not the diagnosis
Ashley just wants the treatment itself, he isn’t bothered about how the diagnosis and condition is defined. Or more eloquently:
… in the case of trans health, I don’t give a damn, I want – you know – I want titties! Just give me titties! I don’t give a damn if you think I have whatever is the mental illness associated with being trans.Florence Ashley, around 35 minutes
Ashley then went on to suggest that he has depression and anxiety and wanted doctors to diagnose and treat this properly.
Ashley promised us that he had done research from the ‘medical royal colleges’ looking at mental health outcomes for women who had had abortions, although the reports were ‘poor quality’ (an aesthetic he’s familiar with) there had been no evidence whatsoever of any psychological detriment. So there.
The logical conclusion therefore was that trans care should also be allowed without restriction.
Randomised drug control trials
Evidence-based medicine has never been well adapted to the realities of psychological research, said Ashley.
Although randomised control trials are great for drug safety, they aren’t so great when the outcome you are looking at are psychological benefits. Imagine you would have to randomly assign people to have an abortion or not. Not only that the trial couldn’t be double blind.
‘Cis people have them’
Ashley rehashed the well worn trope that ‘cis’ people benefit from hormone treatment, therefore why shouldn’t ‘trans’ people? Ashley claimed the risk of taking hormones was about the same as the oral contraceptive pill (which isn’t true as the oestrogen dose in the OCP is a tiny fraction of the arbitrary hormone doses meted out for gender dysphoria).
Also, why was it okay for children to have puberty blockers for precocious puberty but not for children who were ‘trans’, -huh, huh?
This is where Ashley got really wobbly, uttering even less meaningful sentences.
Who gets to decide whether an assessment is necessary? It could be seen as a natural result of my argument that we don’t want to assess people on whether they are truly trans. That’s something I genuinely believe in.
It requires a second argument to the effect that assessments don’t work and regrets are really low rate, which I do in another paper.
Another thing I don’t say is who should ultimately decide when I’m talking about gender affirming care, especially for youth, and so there’s a question who gets to decide. Who gets to legally consent to the care when you have, let’s say, a 12 year old who want puberty blockers.Ashley deliberately avoiding the obvious, 44 mins
Thus completed his bonkers argument. Even a schoolchild of average intelligence could deliver a more nuanced and legalistic argument that the one he has come up with. Ashley really is as dumb as a rock.
What is going on in Quebec?
Short answer: Really bad shit. Long answer: A Family Law Reform would allow birth certificates to record both the sex marker and the gender marker, and the sex marker would only be changeable based on genitals, so only those who have genital surgery will be able to change it. You can then add on top of that your gender identity, for example non-binary. Ashley found this very gross because a female non-binary person would be outed by such a certificate (‘your genitals are outed essentially’). ‘This is pretty horrendous,’ he opined.
Ashley retweeted this article on his Twitter feed – the main complaint from trans activists appears to be that it would ‘force’ people into having surgery. I really can’t remember the last time I showed someone my birth certificate.
What is your best estimate of regret amongst those who transition?
What counts as regret though? posited Ashley, and what regrets matter? Some people only have passing regrets, others have outcome regrets, whilst for some there were decision regrets, but which may only be partial. Also, were overall regrets tied to a ‘re-transition’. Ashley claims to have looked at the data on transition regrets.
Lisa Littman’s most recent study was ‘extremely biased’ but Ashley was forced to admit that the report had shown that only about a quarter of the participants had reported back to the gender identity clinic that they had regrets. You can read that study here, it’s called Individuals Treated for Gender Dysphoria with Medical and/or Surgical Transition Who Subsequently Detransitioned: A Survey of 100 Detransitioners‘.
Ashley claims that the study participants joined the ‘anti-trans movements afterward’ and had been radicalised and therefore the study could not be relied upon. There was also societal rejection of trans people which had played into their outcomes. (In fact the study found that the most common reason for detransition was the person becoming more comfortable with their natal sex (60%) and health concerns (49%.)
Ashley concluded that possibly the regret rate could be as high as 4 percent but around 2 percent was more likely and emphasised that this was a tiny number in comparison with regret rates for other surgeries/treatments.
Ashley will be doing further work on these issues, and I believe may have said he was doing a project with someone called Mackinnon. That’s something to look forward to.
The Centre for Gender & Sexual Health Equity posted an edited version of Ashley’s talk.
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