Transgenderism and the "Medical Model"

"We generally trust what other people say about their own mental states. If someone says, 'My arm hurts', we typically grant credence to their claims. We have this trust in people's self-reports of their mental states to be within the purview of people's epistemic authority -- authority over knowledge."
"If I were to doubt that person's claim without serious reasons to believe otherwise, I would be committing an injustice because I would unjustly fail to recognize their authoritative knowledge of their own experience of the world."
"When I decided that I wanted to take  hormones to feminize my body, the last thing I wanted to do was to go in front of a psychologist to justify my decision."
"There are people who aren't fully transphobic but who have this kind of very visceral suspicion of trans people and are afraid to move away from the medical model. And the illness model is 'Well, we have to figure out what this illness is because there is this underlying 'disease' we have to cure'."
Florence Ashley, transfeminine bioethicist, masters of law candidate, McGill University

Forcing transgender teens to undergo psychiatric assessments before prescribing them hormone treatment is “dehumanizing” and unjustified, argues transfeminine bioethicist Florence Ashley, of McGill University. - Photo courtesy of Florence Ashley

"We take the use of puberty blockers and/or hormones seriously and all our patients go through rigorous assessments, including a mental-health check to ensure they understand the risks and to ensure gender transition is in their best interest."
"[Those guidelines -- by the World Professional Association for Transgender Health -- recommend assessments by a] trans-competent mental-health professional [to] independently evaluate the youth's gender identity and the youth's ability to consent or assent [to body-changing treatments]."
B.C. Children's Hospital gender clinic

According to Ms. Ashley's new paper, published in the Journal of Medical Ethics just recently, the psychiatric assessments that transgender teens must undergo before medical permission is granted for them to receive permanent gender-alterating treatment including drugs, this 'dehumanizes' the individual. Guidelines currently in effect recommend that adults and transteens intent on receiving potentially irreversible feminizing or masculinizing hormones must first undergo mental-health screening.

According to Ms. Ashley this is a practise that in her opinion devalues the lives and bodies of trans people -- reflecting a mistrust of trans voices, turning the transitioning process into medical treatment specifically meant to address a psychiatric illness. Doctors, she insists, should believe the individual involved, claiming to be trans. Which would ideally include minors with the measured maturity to enable them to determine the future of their own health care.

This paper has been published at the very time that gender clinic wait lists in Canada take up to a year or more before an individual can be seen and evaluated even as experts in the field struggle with the issue of how to determine the age at which a young person is deemed too young for "cross-sex" hormones to be prescribed. Hormones such as estrogens to begin the development process to alter a male at birth "assignment" to a trans girl; similarly testosterone prescribed  for a transboy; a female transitioning to male.

Closeup of two caucasian men holding hands with a rainbow-patterned wristban on their wrists. Forcing transgender teens to undergo psychiatric assessments before prescribing them hormone treatment is “dehumanizing” and unjustified, argues transfeminine bioethicist Florence Ashley, of McGill University. Getty Images

In the former instance, to initiate the process of a trans girl developing a feminized shape, and in the latter case, attaining a more angular jaw, deeper voice and masculine physique in the case of a trans boy. The assessments for "gender dysphoria", the term that psychiatry uses to describe the discordance people may experience if their body doesn't appear to align with their gender identity, left Ms. Ashley with the feeling of having been "exposed, naked and dehumanized", as she put it.

From the perspective of the responsible health provider who thinks first and foremost of the vast and irreversible physical changes that will be taking place with medical intervention, cross-sex hormones have the potential to be the cause of irreversible physical changes including breast development with estrogen, or with testosterone, a permanent deepening of the voice. Ms. Ashley rejects this concern, claiming the drugs represent no greater risk than other medical interventions which no psychological assessments are required to determine the preparedness of the individual to receive.

In most Canadian provinces the law allows for mature minors to reach decisions respecting their own medical care as long as it can be assured they are able to appreciate the "reasonably foreseeable consequences" of such a decision. According to the international medical organization, the Endocrine Society, cross-sex or "gender-affirming" hormones may be administered at age 16, even as young as 13-1/2 in particular circumstances, despite that some experts are concerned that lacking proper assessments teens could begin an irreversible hormone therapy that might later cause them great regret should their gender dysphoria fail to persist.

By requiring a mental health assessment instead of taking the transgender person’s word, doctors ‘deny the authority trans people have over their own mental health experiences.’