You Must Be Some Kind of Therapist

Swell AI Transcript: 107. Mia Hughes FINAL.mp3
Mia Hughes: But then they go and they show up at gender clinics and they've given themselves this diagnosis. And the madness is the fact that in gender clinics, nobody questions the diagnosis. Gender identity, ideology, this whole trans rights movement has created a culture-bound syndrome of gender dysphoria. And unhappy people are just applying that label to their lives, but it's not real in the sense that cancer is real or diabetes is real and yet we're treating it with this harsh brutal medical pathway that is as extreme as cancer treatment.
Stephanie Winn: You must be some kind of therapist. Today I have the pleasure of speaking with Mia Hughes. This is a long overdue interview, but it's also perfectly timed. Mia is an Ottawa-based British journalist and a researcher for Michael Schellenberger's nonprofit, Environmental Progress. She's the author of the WPATH Files report, which recently exposed the widespread medical mistreatment of children, adolescents, and vulnerable adults in the field of so-called gender-affirming care. I first met Mia over Twitter Spaces something like two years ago. I remember being in group conversations with you then and bookmarked all the way back then that someday I'd like to interview you. And I'm so glad that the time is finally here just in the wake of this sort of bombshell report that you've been working very hard on. So first, Mia, I just want to welcome you and also congratulate you for a job really well done.

Mia Hughes: Thank you. And thanks for having me. It has been a long time in coming.

Stephanie Winn: I'm happy to be here. So Mia, you have done a wonderful job. I'm just going to sort of briefly summarize for people who haven't heard about this yet, that there were these leaked files from, as it said in the report, a source or sources of internal communications at WPATH, and you wrote a report just summarizing them. in such a factual way. This feels long overdue and also perfectly timed. I think we should start at the beginning just for anybody who's not familiar with the basics. And we are going to go into some of the details, of course, of what's in the report and why everyone should read it. We're also going to talk about specific diagnoses and medical ethics. But first, just let's lay out the basics. What is WPATH, and why does this matter?

Mia Hughes: Right, so WPATH is the World Professional Association for Transgender Health. This, up until quite recently, I think it would have been accurate to say that this was the internationally respected organization setting the guidelines for healthcare for people who identify as transgender. It is not accurate to say that anymore because there are a large number of countries who have turned their back on WPATH completely. They are now rejecting the guidelines that this group puts out. So I would say it's no longer internationally respected. It's very much respected in North America. In the US and Canada, we follow WPATH mostly in gender clinics all over. So who are they? The group was started in 1978 and it was called at the time the Harry Benjamin International Gender Dysphoria Association, HBGDA is the acronym, terrible acronym. And they were a loose affiliation of people who had an interest in what at the time was called transsexualism. Now this was at the time a very obscure field of medicine, sexology, whatever. It was a very obscure field. And these people got together and I would like to think that in the beginning they really were trying to find the best way to help people who suffered from what at the time it would have been transsexualism I think was the diagnosis, gender identity disorder, now gender dysphoria, whatever you want to call it. And I'd like to think they were pursuing something like science in their own weird, obscure way. And then in about the late 1990s, this group took a very sharp, well, took a turn for the political, for the ideological. More and more people who identified as transgender started to join the group, which happens to be right at the same time that the modern trans rights movement was also getting off the ground, the late 1990s. So trans-identified people start joining the group and then the group's priority becomes political goals, not the pursuit of science. And we can actually, we can say that with some certainty because Dr. Stephen Levine was in the group And he left in 2002 and the reason that he left is that he said the group was no longer pursuing science and they were pursuing politics. So in the first decade of this century, they really do start to shift more towards the ideological In 2007, they go for the big rebrand. So they self-identify basically as the world-leading transgender healthcare group. They name themselves the World Professional Association for Transgender Health. And in 2007, that's when things really change. So they start to push at that point for They call it the de-psychopathologization of gender identities. So at this point they're pushing for being transgender is this perfectly natural, healthy state of being that we should all celebrate. There's no pathology whatsoever. The pathology is the distress that you feel because you are transgender. The distress that you feel when your mind and body are not aligned and the discrimination that you experience. because of that misalignment. And from that point on, they advocate for affirmation only. They advocate for the removal of guardrails around this very experimental treatment protocol. We've got no science to back this up. It's also life altering and rather brutal. And they advocate for the complete removal of all guardrails from this medical treatment pathway because guardrails become transphobic. In 2012, they produced Standards of Care 7. This is their guideline, Standards of Care 7. It's very pro-affirmation. It's very pro-medicalization. And mental health is sort of relegated to, viewed with suspicion, could actually be conversion therapy if it's not done right. It's got to be affirming psychotherapy and enabling medical transition. That's the point. And then between 2012 and 2022, they take a deep plunge into the bizarre, into the ideological. And that is, you can see that because in 2022 they came out with their Standards of Care 8. And this contained, well, most of your viewers probably know about the UNIC chapter. It contained an entire chapter on UNIC as a valid gender identity, even children can possess. So the chapter tells us a chapter on non-binary surgeries for creating these bodies that just don't exist in nature with two sets of genitals or no genitals at all. And they removed all the lower age limits for hormones and surgeries except for one, and that's plasty, which is a really horrific surgery that some women can undergo where they have their forearm turned into something that looks like a penis that's then sewn onto their groin. So this is a group that presents itself to the world as a medical group, presents itself to the world as a scientific group, and yet all it is is a fringe group of extreme trans activists advocating for a very experimental treatment medical treatment for some of the most vulnerable people in society, children, adolescents, and vulnerable adults.

Stephanie Winn: I just want to sort of contrast the facts that you presented and the history of what this organization is with how someone I don't actually remember hearing about WPATH in the training I went to on so-called gender-affirming care, that doesn't mean that WPATH was not discussed. It means I simply don't remember it. My first memory of reading the phrase WPATH was WPATH SOC 7, which I had to Google. WPATH Standards of Care 7. And I read that in the context of reading a letter that a colleague had written for one of my patients recommending surgery. So at the time, you know, I'd gone through the whole level one training of why it's so important to affirm gender identities and all that kind of stuff. and felt some reluctance about going on to the next level of training that I was encouraged to attend in which I would have learned how to write these letters. I never went to that training, but I was supposed to refer people to someone who did go to that training if they asked for a letter. And so in that context, I remember reading this letter. And the letters are less and less thorough. In many cases, they're operating on a so-called informed consent basis, which of course you clarify in the report. is a deeply flawed phrase to use in this situation. So sometimes letters aren't even required, but this is several years ago in situations where letters were ostensibly needed. And I remember reading that phrase and just thinking it sounded so official, and I felt so dumb for not knowing what it was. And I'm thinking, okay, well, this feels really radical. You know, hindsight being 20-20, I remember the parts of me that looking back didn't feel right about this. But it sounds so official. Here I am, someone with a master's degree and a professional license, thousands of hours of postgraduate training, and I have to Google WPATH standards of care. And so when an organization brands itself that way, it does carry this air of authority. Now, it's easy to see from the perspective that you're offering how it's all kind of a bunch of smoke and mirrors. If I was Machiavellian enough, I could find 1,000 people who agree with me about some insane theory and call ourselves the World Professional Association for people who subscribe to insane theory, and that would sound pretty official. And then we could publish something called the Standards of Care right and and then it sounds like you know but it's it's sort of like the i don't know the tail wagging the dog i want to mix my metaphors with like some wizard of oz stuff i'm just kidding That was just my little rant on how this has run away with itself and then how people with actual professional credentials end up encountering this organization and feeling like, oh, well, this must be really official. This must really mean something, but your report really exposes just how shoddy the science is, how politically motivated the group is, and how How far they've strayed from anything we would consider the standards of medical ethics. In fact, I've highlighted a section that I want to read in a little bit where I think you summed this up really well, just how far it's strayed from medical ethics. But please go ahead.

Mia Hughes: Yeah, on the standards of care and the medical world, the wider medical community being duped, that's a really, I find that endlessly fascinating to think about because I can understand how I was duped or somebody, a non-medical person, I can understand. You see the World Professional Association for Transgender Health. They've got these standards of care. Everything looks legit. Sure. I mean, if you have any faith in the medical world, you would not doubt this organization because you would think you can't possibly just self-identify as a medical group and set standards of care. There must be checks and balances in place to prevent that from happening. But what is incredible is that they pulled one over on the medical world. So it does look really legit. If you look at their standards of care eight, that is one hefty document. I honestly don't understand how anyone didn't look at the eunuch chapter and immediately have alarm bells going off like everywhere, but still let's overlook that for a moment. The fact that it's hundreds of pages long, there are hundreds of citations, it all just looks like it's got scientific weight to it, that it couldn't possibly be the empty shell that it really is. But if you take, I urge anyone, if they still don't believe what I'm saying here, take the time to just spend a day reading their citations. choose a chapter in the standards of care and then just click on the citations because they're there. There's hundreds of them and it's a mountain of junk science. It's truly some of the most remarkable science, so-called science, you could ever come across. There are no control groups. There's no follow-up. There's just self-report. There's Things that, you know, they'll have like a study and it's, you know, they're looking at access to gender affirming care. Is it better that these adolescents have access to hormones quickly or more slowly? And so they take two sets of, they look at the referrals to a gender clinic and they're like, okay, the ones who had to wait longer, reported that they were more depressed and they were more anxious and their mental health was worse. So the conclusion is we need to get these kids onto the drugs faster. It's a really bizarre It's just there's quantity, there's plenty, there's the hundreds and hundreds of studies, but all of them are junk. There's nothing that even remotely resembles something that you could call good quality science. And you've got to at some point wonder if this is deliberate. Are they deliberately pulling one over on us? Do they know how bad the science is, or are they living in some sort of delusional world where this really is good science and they really do think that they are an evidence-based group? It's very difficult to figure out the motives of what's going on in their minds.

Stephanie Winn: There are many instances throughout the report where you take direct quotes internally from WPATH members, including medical and psychiatric professionals, and they're admitting that they're winging it. They're admitting that their patients are mentally incapable of informed consent. And then you delve into informed consent, you delve into the suicide, the made up suicide statistics and the actual suicide statistics, and just about every major topic. I think we should sort of go through what the chapter headings are. I'll give you an opportunity to expand on any of these, but just to sort of open the floor, this is from midway through the report. This is from page 37 at the beginning of your section, WPATH has no respect for medical ethics. I just want to read this part. You wrote, traditional medical ethics is more than just first do no harm. The guiding principle of Hippocratic medicine is that illness places the afflicted into a compromised state against their will and preference. It is in this compromised state that the person enters into the doctor-patient relationship. Therefore, the patient must be able to trust that their doctor will use his or her knowledge and expertise only for the purpose of healing or ameliorating symptoms and easing suffering, always with the priority of minimizing harm. Throughout most of medical history, medicine did not involve intentionally destroying a healthy functioning bodily system. It is only in the 20th century, the new pseudo-medical approach has emerged that views the patient more as a consumer and the doctor of a supplier of pharmaceutical and surgical interventions tasked with fulfilling the patient's desires, which are quickly defined as needs. In the past, the emphasis on autonomy in medical ethics was meant to act as a shield. There were things a doctor could not do to you without your consent. Nowadays, and especially in gender medicine, autonomy acts as a sword. In its name, there is nothing a doctor may deny you.

Mia Hughes: Right. That's it. I mean, For me, when I think ethics, medical ethics, when I think medical ethics, I think the Hippocratic Oath. I think first do no harm. Doctors don't take healthy bodies and destroy them. Simply, that's just not ethical. That's not right. And yet in the files you really do see, and in WPATH's world of gender affirming medicine, It's all, it is entirely consumer-driven medicine. It is, it's first of all the patient self-diagnoses and the doctor, it is the clinician's job to accept that self-diagnosis, never question it. And then the patient just tells the doctor what they want and it is the doctor's job to provide it. In WPATH's world it's unethical to deny a person hormones and surgeries because the hormones and surgeries are a human right. This person is transgender and so access to hormones and surgeries is their human right. And so denying it is the violation of medical ethics. There is no sign of the Hippocratic Oath in this world. As far as I'm concerned, they have totally lost their moral and ethical compass, and they've got a very different guiding principle, and that guiding principle is access to hormones and surgeries. It's a human right. Denying it is a violation, therefore, of your oath to be a, I don't know, you're just providing body modification on demand. And the thing about it is it kind of tricks you because they're using the tools of medicine. They're using medical technology and the tools of medicine. but for a totally different purpose, not to alleviate suffering, although they think so, obviously, not to improve health, not to heal, not to alleviate suffering, but to actually destroy bodies in the service of an ideology that has no grounding whatsoever in truth. It's a very, it's a very different world to the world that most people imagine when they think ethical medicine.

Stephanie Winn: And there are quotes in there where it really gives you a sense of whiplash around the concept of medical necessity. Basically, professionals saying it's medically necessary if the patient If the patient says it's necessary for them, then that makes it medically necessary. Well, that's sort of the inverse of the definition of medical necessity, which must be defined by a medical professional. I think something is medically necessary if the doctor would say that whether or not the patient wants it, whether or not the patient believes it will work. It is their strong recommendation that the patient go through with the procedure or medication or whatever because the benefits outweigh the risks. It doesn't require the patient's belief in it, which is, you know, we know that there's a placebo function to that. It's about the risk-benefit analysis, but here it's like, well, the risk is if the patient doesn't get what the patient thinks they want, then they're going to be very unhappy. And they have no locus of control with regard to their choice to engage in self-harm. And we as the professionals have no obligation to ensure that they have a variety of resources for suicide prevention. If we're concerned about suicide risk, there's also no sort of the opposite of the sense that if you're in a suicidal state of mind, that you're in no place to be making life-altering decisions. We could go into the suicide part. I don't know if we want to go there just yet. I was kind of thinking it might be helpful for me to kind of read the chapter titles because the way that you have the table of contents organized and then the rest of the report is statements and then you back up each of those statements. Would that be helpful? Do you think, Tara?

Mia Hughes: Sure. I mean, on the medical necessity thing, it's a really crucial point to understand that WPATH standards of care that are guidelines, they're not actually standards of care. They don't meet the definition of what a standard of care is. They're guidelines. Their guidelines exist not, in my view, to improve the health and well-being of the patient cohort that they claim to serve. It's to get insurance coverage. That's the whole point of the standards of care. And in order for there to be insurance coverage, you need basically, it needs to be medically necessary and it also cannot be experimental. So you're right. It's quite simple. If the patient wants it, It's medically necessary. That's the definition. End of, end of. There's no, nothing else comes into it. And also, don't ever use the word experimental. If you look, if you read their standards of care eight, they don't use the word experimental. They use words that are synonymous with experimental. They'll say things like, oh, future research might indicate whether or not this is an appropriate approach to this, this treatment. Which means it's experimental. We don't have any research now, but they never use the word experimental because that's not covered on insurance and that's all the document exists for is insurance coverage.

Stephanie Winn: Well, and you've also laid out the case for why what they're doing does not constitute experimental medicine either, because with experiments there's a control group, there's tracking of outcomes, there's consenting to being a part of an experiment. All of those things are missing.

Mia Hughes: Yeah, it doesn't even meet the low bar of experimental. And yet they're pretending that the science is settled, this is medically necessary, life-saving care, we must come back to the life-saving part later, but it really is all lies. Everything that this group presents to the world is just, it is smoke and mirrors. And I cannot understand how that's legal. I can't understand how a group can so fraudulently represent itself and an entire treatment protocol. I don't understand how that can be legal. I think surely someone somewhere has got to legally challenge WPATH on the misinformation that they are spreading because people are making drastic life altering decisions based upon their trust that this is a real scientific and medical group who has done all the research and is presenting the best available treatment protocol that we have. People make very drastic life altering decisions about their own body or about their child's body based on their trust in WPATH. I don't understand how this group can be allowed to get away with lying to the public and misleading people into making very, very drastic decisions that will impact the rest of their life, have a dramatic impact on almost every aspect of their life.

Stephanie Winn: I love sleep. Sound sleep is a crucial foundation of good mental and physical health, from mood and concentration to metabolism and cellular repair. And I sleep very well thanks to my Eight Sleep Pod Pro Cover. My side of the bed is programmed to be warm when I get in and cool down to a neutral temperature in the middle of the night so I don't wake up overheated like I used to. How would you customize your bed temperature? Visit 8sleep.com and use promo code SUMTHERAPIST to take up to $200 off your purchase. Even if they're already running another sale, this code will get you an additional $50 off. 8sleep currently ships not only within the USA, but also to Canada, the UK, select countries in the European Union, and Australia. Thanks for considering purchases that support the show. That's actually a good question, is who should be accountable for holding WPATH accountable? You, as a journalist, have done your level best to hold them accountable with the investigative reporting that you've done. But given that they are a global organization and that there are these sort of subgroups, there's U.S., PATH, Europe, PATH, I don't know, all these subgroups. I mean, I have no idea who governs. Is this like an issue that needs to be brought to the United Nations? Is there a global health authority?

Mia Hughes: I mean, I honestly, I think it rests with the regional. So WPATH, again, World Professional Association, it's largely American, let's face it. Most of its members are American. It's based in the U.S. Canada where we're giving, you know, we put in our best. We've got a whole lot of WPATH members as well, but it's, I think it falls to, well, exactly who it falls, whose shoulders this responsibility falls to, I'm not entirely sure, but I think someone somewhere in the U.S. has got to look into the fraudulent activity of WPATH. They've got to investigate the lies that this group has been telling. Because of the harm that they're doing, they're doing terrible harm and somebody needs to investigate this. I would say it's someone in the U.S.

Stephanie Winn: They need to be held legally accountable. And we do already have some detransitioner lawsuits that are targeting medical and psychiatric organizations. It feels like it's just a matter of time and you've done everything necessary to put that information into the hands of whoever is ready to take it to that next step legally. Let's go over some of the chapter titles. So, WPATH has misled the public, and this has two subsections. WPATH knows children do not understand the effects of hormone therapy, and WPATH knows children cannot consent to iatrogenic fertility loss.

Mia Hughes: Right. I mean, this part is based on, there's a leaked panel discussion. The members, some very prominent WPATH members were in this panel discussion. It was an identity evolution workshop, I think was the title. And these panel members say the most remarkable things. The strange thing about watching it is they see everything that we see. They see all of the problems that we see, and yet they're the ones who are putting these kids on this treatment pathway. There's a Canadian endocrinologist, Dr. Daniel Metzger in there. Now, apparently Metzger has been transing kids in the BC Children's Hospital since 1998, if his bio on his website is to be believed. And so he's in there, he's basically talking about how difficult it is to talk to these kids about the treatment protocol. First thing he says is, you know, it's difficult because we're telling kids who haven't even had high school biology yet. So, they don't understand how the body works. They don't understand the endocrine system. They don't understand hormones. So, they'll come in and they want, one will want a deeper voice, but they don't want facial hair. Or they want to be feminized, but they don't want breasts. So, you know, they're just like pick and choose, a pick and mix for your hormone effects, basically, because they don't, they haven't had high school biology. And then he says something really chilling. He says, talking to a 13-year-old about fertility preservation is like talking to a blank wall. They'll be like, ooh, baby's gross. And it's like, I understand that completely because I was once a 13-year-old girl, and had you talked to me about fertility preservation at that point, I would have said the same. Ooh, baby's gross. Absolutely no way. The 13-year-old me would never ever have wanted to have children. And then that carried on all the way to my mid-twenties. When I hit 30, I baby fever hit. It was like someone flipped a switch inside me. I needed to have a baby right away. And then I had three children and then I became a stay at home mother. I was breastfeeding, co-sleeping, baby wearing. I was one of those mothers. Because people change and they grow and they mature and what you want when you're 13 is not necessarily, probably, likely not going to be what you want when you're 30. But he has this, so he sees that, he understands that it's like talking to a blank wall. But there's even another more chilling aspect to it in that he gets to, he says, he knows that there's fertility regret. And the reason he's talking about a Dutch study that has yet to be published, I think, but they talked about it in a conference and this had shown significant fertility regret in this young cohort that was sterilized as kids. And he says he understands that it doesn't surprise him because he sees it in his own patients. He follows up these adolescents and they get into their 20s and they show up and they tell him that they've met someone and they want to settle down. And he very carelessly responds to them, oh, the dog's not doing it for you anymore, is it? So it's like he sees exactly what we see. We've been saying for a long time you can't sterilize kids. They may say adamantly, strenuously that they do not want children. They will never want children. That's a normal teenage response. We all have been saying that all along. He's saying it. He sees the regret in his own patience. And yet still continues, as far as I can tell, as far as I can tell, he is still advocating for this treatment protocol for adolescents. And one of the reasons I know that is because he is all over the Canadian mainstream media. We've got the debate finally happened. It finally arrived on Canada's shores. People are realizing that something isn't quite right about this whole puberty suppression trans kid thing. And they keep interviewing, the mainstream media keeps interviewing this very same Canadian pediatric endocrinologist and he is in the mainstream media assuring Canadians that this is a fully, you know, it's an appropriate treatment protocol. Nobody's rushing kids into it. We do these thorough psychological assessments before any medical treatment. This is the very same man who says it's like talking to a blank wall, his private and his public. are completely in contrast, just like WPATH basically. They have their public persona, which is we're scientific and it's all evidence based, and then on the inside it's just trans activism and no science in sight. So It's misleading. That's why the heading of that chapter is WPATH has misled the public. What they say on the inside is in complete contrast to what they are presenting to the outside world.

Stephanie Winn: So there's this theme throughout of how two-faced WPATH is as an organization. And just relating recent experience, there's someone in my extended family now has a trans-identified child. And as soon as I found this out, I was like, talk to me. This is what I do. I help parents through this. And it's hard when it's someone in your own family because they know your personal issues. They remember when you were little and naive. And it's like, but I help people with this. And, you know, I remember this person, this parent, explaining the credentials of the therapist that they were taking their child to and why they felt confident. And I warned her. I was like, okay, I hear all the reasons that you think this therapist seems really credentialed and why you would expect a certain level of professionalism from someone with that type of background, and I'm trying to warn you Because this is what I've been doing for the last few years, talking to parents like you and hearing their stories, like, this person's not to be trusted. And sure enough, you know, a few months later, after the initial message of, oh yes, I'll explore what's really going on for your child, there's the, you need to go to a support group where you can learn to accept that your son is your daughter and blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, right? And it's like, yeah, the two-faced thing is really a theme throughout all of this. I have a couple more comments or questions on this section before we move on. I have to ask, I felt naive to lingo when I read this alarming phrase that you quoted, the dog's not doing it for you anymore. I have to ask, I'm probably not the only person left wondering, what the heck is the dog? Is that, what is that a euphemism for? Is that like for one's like fake sex organs or?

Mia Hughes: No, no, what that is, okay, the way I understand it, certainly I'm pretty sure I'm right on this, is When you're a teenager, like certainly it wasn't the case for me, I was simply the, I will never want kids. That's it. Just will never want kids. But there are some teenagers, young adults who think they'll always be happy just having a dog. I will never want kids. I don't want to commit to having kids. I've got my dogs. I'm perfectly happy. That's it. I can gladly sacrifice my fertility. Don't need it. Don't want it. I've got my dogs. And then sometime in the early 20s, mid 20s is when it often happens, they realize that they want more than just a dog. They want to have a child. They want to settle down with someone.

Stephanie Winn: I see. So it was literal. You're not satisfied just having pets anymore. You want actual children." Okay. God, I felt dumb. I was like, wow, that euphemism is something.

Mia Hughes: Well, because you never know with these people, right?

Stephanie Winn: Yeah, with their weird words. Speaking of which, the other strange phrase that I wanted to comment on, I don't think we're going in order here because I was going to go through the chapter titles. This phrase appears a lot later. But there is a phrase I saw several times in the WPATH files, embodiment goals. Again, this two-faced, pardon my language, this mindfuck that they're doing to people, the concept of embodiment through disembodiment, the concept that And there's a huge opportunity cost. That's something I talk about on this podcast, and I don't think we talk about enough as a society. It's just the opportunity cost of spending precious time, energy, resources, developmental phases of one's life building a false sense of identity. And as you had mentioned in the report, sort of related to the placebo effect, having this thing that you're looking forward to as a source of alleviation for your distress, imagining that that's what it'll bring you, but there's a huge opportunity cost to spending those years focused on that rather than focused on, as you've said, reconciling with your birth sex and moving on with all the other important developmental tasks like building friendships and relationships and competence and things like that. Anyway, this phrase embodiment though, right, like the part of the opportunity cost of going down the trans pathway at all is that you are resisting embodiment, you are resisting, as you have said, reconciling with your birth sex, and you're persisting During a time that the brain is extremely plastic, going through a lot of rewiring. I'm reading John Haidt's book, The Anxious Generation, right now. He talks about during puberty, the neural, the pruning, the rewiring, and the myelination, right? So during this incredibly plastic time, You are telling yourself over and over and over, I'm not really my body and I can't be in my body. I can't be comfortable in my body until I look a certain way. So you're building your neural pathways around disembodiment and dissociation and self-hatred. And then the expectation is that somehow when you reach this so-called embodiment goal, when you've had this or that surgery or whatever, that something will flip where now instead of the predominance of the neural pathways of disassociation, self-hatred, and emotional distress, now you're going to have the brain state of someone who'd been practicing self-acceptance and happiness all along. It just does not compute. To me, as someone who understands psychology, does not compute. I cringed every time I saw the word embodiment in that report.

Mia Hughes: And it's in the chapter that you're talking about, it's in the first chapter, because I know the child psychologist Diane Berg, who's one of the authors of the child chapter, she's in there saying that she uses the phrase embodiment goals with her. They always call them clients, I think, but this is children and adolescents that we're talking about, and you're talking about embodiment goals. I think it stems from the fact that they're very reluctant to diagnose because of this whole de-psychopathologization campaign that they went on. If it is a perfectly natural, healthy state of being to be transgender, it's not a mental illness, not a psychiatric disorder. Forget about what developmental pathway you took to come to the conclusion that you are transgender. None of that is important. All that is important is you are transgender. You have said you are transgender and anyone who says that they are trans, they are trans. And therefore we exist in WPATH, they all exist to help the transgender person achieve their embodiment goals. So it's taken away the pathology, it's taken away the diagnosis and almost the medical element of it and you're just really left with, it's not medicine again, it's this extreme consumer driven body modification embodiment goals But it's also, they're applying that to children and adolescents. I mean, I don't sit in the camp that adults can do whatever they want. I'm not even in that camp. That's why my report is about vulnerable adults just as much as it is about children. I don't think that adults should have complete, full access to any extreme body modification on their demand, regardless of what their mental health status is or whatever. I'm definitely nowhere near that camp. on what they're not working on exactly. They're not working on overcoming whatever problems in life that they had that led them to come to the wrong conclusion that they are a member of the opposite sex. And I think Jazz Jennings is not really the best example in one respect because Jazz didn't come to that conclusion. Jazz's mother came to that conclusion for Jazz and thrust that life upon him. But if you watch I Am Jazz, The very tragic, it's a tragedy filmed and aired for millions of people to watch, but the really tragic element is jazz as an adolescent is, you know, they've shut down his endocrine system so he's not having, you can tell he's not having the really passionate intense crushes that his friends are having or whatever, but he does have this, he wants to have a boyfriend and it feels almost as if it's because all of his friends, they have crushes and they have boyfriends and so he just wants to be a normal teenager, so he wants to have a boyfriend, but he can't have a boyfriend because he's the girl with a penis, and no boys at his high school are interested in the girl with the penis for obvious reasons. And so he fixates on whatever euphemism they use for his vaginoplasty, like he fixates on this surgery. This is going to solve all his problems. All he has to do is get the gender confirmation surgery, I think is what they call it, and then he'll be able to date because then he'll be a real girl and the boys will all be, he won't be the girl with the penis anymore. So then he has the surgery. Obviously, we all know it's botched. It doesn't go as planned at all. And he gets to the other side and he realizes he's still different. It hasn't solved any of the problems. Dating is still a nightmare because he's, you know, an inverted penis is not a vagina. And that's a reality that nobody ever told him. They sold him a fantasy that was never going to measure up to his expectations. So, of course, he's not thriving mentally because they lied to him all the way through his life and he set his sights on something that was an impossible fantasy that was never going to resolve anything.

Stephanie Winn: Oh, so many thoughts on that. For one, you talk about this idea of de-psychopathologizing. And that loops back to our earlier dialogue about how two-faced WPATH is. Because when it comes to getting insurance coverage, they will fight for the diagnosis. The diagnosis, which equates to a pathology of saying, yes, there is a psychopathology here. This is a treatment of a medical condition, without which we allege that the patient will further deteriorate. conveniently cover up other treatment options and real prevalence and desistance statistics. So when it comes to getting insurance coverage, when it comes to whenever it's strategically useful to them to frame it as a pathology, they will. But then they will turn around the moment it's expedient to them to depathologize it.

Mia Hughes: Yeah, it's true. Although I think, honestly, I think it was a stroke of genius. As much as I dislike the direction that they went in, if you look, so we've got DSM-IV was gender identity disorder. And then in the DSM-V, it became gender dysphoria. That is crucial, and that truly was a stroke of genius, and that was WPATH. There may have been other activist groups on the periphery, but that was WPATH who advocated for that shift. The brilliance of it is that gender identity disorder, your pathology was your identity, your gender identity, that was the disorder, the mismatched body and gender identity. So if that's the disorder, then the treatment should focus on reconciling the body with the mind, with the gender identity. What WPATH, that was pathologizing to transgender people. So what they did was they shifted to gender dysphoria. Now, then with this diagnosis, the identity is not the problem. The identity is perfectly fine, perfectly natural, healthy. It is totally normal to have an internal sense of self that does not match the reality of your body. That's totally normal in the new diagnosis. What is the pathology? is the distress that you feel because your body and mind are mismatched. And therefore the treatment for that, you can't do anything about the gender identity because that's perfectly natural and healthy. So the only treatment option you now have is medical transition, hormones and surgeries, to bring the body in line with the gender identity. So that's how they get around this. This is the de-psychopathologization. They de-psychopathologize the identity while making medical transition the only option. So it means they can have access to all of their hormones and surgery on demand and still be perfectly natural, healthy, well individuals. You see, it's a stroke of genius.

Stephanie Winn: I've been mentioning over the last several episodes this concept in psychology of egocentronic versus egodistonic. I don't know if you've heard me speak about this, but when we take a form of psychopathology, when we take a psychiatric diagnosis and we shift it from The problem, okay, well, how do I explain this? Okay. Identity is a core component of the psychological concept of egocentronic versus dystonic. And it's really important for those of us who are charged with treating psychiatric illnesses to understand how the patient thinks about their identity in relation to their distress. So typically when it's ego dystonic, that means the identity is separate from the distress. The distress is experienced as foreign to the identity. So this might be someone who's like, Normally, I'm a really capable, hardworking, fun-loving person and I've been in this depressive episode and it makes me feel like I'm totally not myself. I can't do the things I love. That's ego dystonic. This person is saying who I am as a person is not this thing that I'm going through and I want help getting past this. On the other hand, the classic example that I give of a condition that's eco-syntonic, where the disorder is fused with the sense of self, the most overt example is grandiose narcissism. Someone who's like, what do you mean? What's the problem? Why can't everybody just accept that I'm obviously the best, right? So no difference between the psychiatric problem and the sense of identity. So in general, in the field of psychology, we have this understanding that what used to be in DSM-IV, and this was another thing that was changed going from DSM-IV to DSM-V. In the DSM-IV, there were the axes. So there were axis one disorders and axis two disorders. And so this was a way that they separated ego dystonic from syntonic as one way of thinking about it. Conditions like anxiety and depression from personality disorders. Personality disorders were on a separate axis. And part of it is because, yeah, if someone's saying, I need help getting over this thing that's not me, that's a much different clinical pathway to treating it than someone saying, I'm not the problem, you're the problem. Your perception of me is the problem, right? So this shift was sort of out of step for the field of psychiatry because it's promoting an egocentronic framing of the issue. And that's what I think is so bizarre about this whole thing. Saying the problem isn't the identity, the problem is that my identity is a statement of fact that you cannot question. The problem is that I feel distressed because of this mismatch. Now I'm entitled to some so-called treatment to fix this so-called mismatch. And again, I've talked about neuroplasticity. We know, in fact, that the brain is much easier to change than the body. And it's much less harmful to do the things to naturally work with our capacity for neuroplasticity, to encourage resilience, to encourage self-acceptance, and as you've said, reconciling with the body. That takes inner work, right? And one of the features of an egocentronic condition or a personality disorder, an identity problem, is the expectation, I shouldn't have to do any work. I'm entitled to you doing the work for me. And that's exactly what we see here.

Mia Hughes: And I mean to bring up probably the most controversial of all, do you find though that it's got a lot to do with the fact that autogynophiles are leading the charge on this? Because I do think that's rather classic of the autogynophile that they're not, they are There's nothing wrong with, they are women, there's nothing wrong with the gender identity and everybody must accommodate their every desire, otherwise they'll ruin you, they'll destroy you. But as well, isn't auto-gynophilia It doesn't respond, because it's a paraphilia, it's not a psychiatric disorder, right? It doesn't typically respond very well or at all to psychotherapy or any sort of mental health intervention. Am I right in saying that?

Stephanie Winn: Well, so paraphilias, at least at one point, were classified in the DSM. I don't treat paraphilias. It's not something I have expertise in. I just talked about this with Joe Bergo, because he has expertise on narcissism and shame, which are highly related, as well as gender issues and autogynephilia. And he basically said, and I agree with this, that autogynephilia is basically the definition of narcissism. The classic, I mean, the falling in love with the image of yourself Right? That's the tale of Narcissus. We name narcissism after that. And here is someone saying, I am more in love with myself. than I could ever possibly be with another person. We have autogynephilic men making the argument that their love for themselves is as valid and as real and passionate as a man's love for a woman. So Joe Bergo and I talked about this. We know, I mean, there are studies that the rate of personality disorders, and I think a lot of people don't realize that this thing that is primarily affecting adolescent girls now, the social contagion, it's about 80% girls, 20% boys at this point in time, not to say we don't care about the boys because it's on the rise with them too. It's just not as bad in numbers. This thing that's affecting teenage girls is being driven by middle-aged men. And I don't know, whenever you see teenage girls and middle-aged men together, that's generally a problem. Like, how many of us as teenage girls were preyed upon by middle-aged men? It's a very common issue, and you, I believe, write about this in the report as well. Whether you're a longtime or first-time listener of the podcast, Odds are you're just as concerned as I am about the gender ideology crisis that's affecting today's youth. What you may not be as aware of is another insidious practice occurring in med school classrooms, practitioners' offices, and hospitals alike. The discriminatory practices that focus on race instead of qualifications of healthcare providers. These universities, associations, and sometimes even states are breaking federal laws in their racially discriminatory practices. And one group is holding them accountable. Do no harm. Do No Harm's membership-based organization is fighting so that patients get the best quality service and so that today's med students succeed as tomorrow's medical providers. If you're a medical provider, I encourage you to join Do No Harm today.

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Mia Hughes: That's exactly it. This is being led by autogynephilic men, typically middle-aged, and I'm not saying all of them have personality disorders or whatever else going on, but a disproportionate number, I think, do. And yeah, the exact same diagnosis is being applied to the teenage girl sucked into this social contagion, just interpreting puberty as a sign that she's transgender, or maybe she's suffered, a high number of them have suffered some sort of traumatic event and the They come to the conclusion that they're trans as a sort of coping mechanism. There's the girl with the eating disorder, there's the autistic girl, there's the girl who's just discovering her homosexual identity. All of these girls having a really difficult time are being given the exact same diagnosis as the autogynophilic man in his middle age. And the treatment is exactly the same too. Nobody is digging into what has led this person to give themselves the label trans. Nobody's digging into it. And these two groups absolutely must not be lumped together if we want to help both groups, to be honest, the autogynephilic men as well. And then there's the group of boys, which we mustn't forget about the boys. There's different things going on with the boys as well. A lot of them are homosexual and unable to… Society not being accepting of their femininity is certainly driving some boys to identify as girls. They're being taught, basically, that their femininity is a sign that they are transgender. And as well, we've got teenage autogynophiles. We have to grapple with that at some point. They also do not fit into the same diagnostic, should not fit into the same diagnostic category as the teenage girl or even the middle-aged man. We really need to separate the groups and look at what led these people to this conclusion that they are transgender if we want to help them. And that's where we go very wrong because inside WPATH, They have absolutely no interest in what led these people to this conclusion. They have absolutely no interest in what's going on in the young person's life that could have caused them to identify as transgender. None of that is important to them.

Stephanie Winn: One of many possible causes, as you noted, that has been discussed amongst gender critical therapists like myself is borderline personality disorder, of which one of the key features is identity instability. We also know that the frantic attempts to basically do anything to avoid real or perceived abandonment, there's just so many features, the self-harm, the impulsive behavior, all that kind of stuff. And you mentioned Prisha Mosley's case where her true diagnosis was actually borderline personality disorder. And you had quoted someone, I can't remember who, but it was put very well that considering how until recently the rates of transsexualism in the general population were very low. And then compare that to the rates of borderline personality disorder, especially amongst females, especially amongst young females. If even a portion of people with borderline personality disorder are getting their identity crisis confused with a gender identity crisis, then that's going to lead to a massive, massive overdiagnosis. of gender dysphoria.

Mia Hughes: Just so for the record, it's James Cantor who said that. He does express it really, really well. And the point there is as well, right, if you've got a misdiagnosis, if you've got somebody with borderline personality disorder, and you have misdiagnosed them as being transgender or having gender dysphoria, And then you immediately usher them onto this treatment pathway that is irreversible. It involves cross-sex hormones, surgeries, and the rest of it. They are going to get to the end and they're still going to have borderline personality disorder because you did nothing at all to address the issues going on there. And you've now made their life a whole lot more difficult because they're existing in an altered body. They likely have a lot of regret and a lot of anger that they were misdiagnosed and put down this inappropriate medical treatment pathway. And you've made their life basically a whole lot worse. And if they already had issues with self-harm and suicidality, you have created a very dangerous situation. The really crucial point that we're not grappling with at all is even the diagnosis of gender dysphoria itself, whatever you want to call it. We've got the World Health Organization calling it gender incongruence. We've got the DSM calling it gender dysphoria. In the past, it was gender identity disorder. You've really got to look at Is this even real? As far as I'm concerned, it is a culture bound syndrome that appeared at this time and in this place, and because it's in the symptom pool, I love Edward Shorter's concept of the symptom pool, which is the pool of legitimate mental health diagnoses that exist in any culture in any time. And so what you have is a bunch of unhappy people, people who are in a state of distress and mental fragility, and what they do, they select a diagnosis from the symptom pool of their time. Right now they can select gender dysphoria and then they apply that to their lives and it feels very real and it feels totally legitimate to them. But then they go and they show up at gender clinics and they've given themselves this diagnosis. And the madness is the fact that in gender clinics, nobody questions the diagnosis, even though it is as culture bound, in my opinion, as if we had the epidemic of multiple personality disorder. in the 1980s and 1990s, it spread like wildfire. It was an epidemic and then it disappeared because it was based entirely on something completely nonsensical that had no science and no evidence to it. The same thing is happening now, gender identity, ideology, this whole trans rights movement has created a culture bound syndrome of gender dysphoria and people, unhappy people are just applying that label to their lives but it's not necessarily, it's not real in the sense that cancer is real or diabetes is real and yet we're treating it with this harsh, brutal medical pathway that is as extreme as cancer treatment. And that's, we've really, I think a focus on what exactly the diagnosis is, is absolutely essential to avoid misdiagnosis, to avoid all of these kids, maybe they're autistic and they're interpreting their difficulties with autism as a sign that they're transgender, maybe their borderline personality. And then of course you could even debate Is borderline personality real? Is autism real? High functioning autism real? There's a really complex conversation to be had around all of these diagnoses and nobody inside WPATH is having it and very few people on the outside are having it either.

Stephanie Winn: Now you'd mentioned the epidemic in the past of the wave of excessive diagnoses of multiple personality disorder and there's two places I want to go with that. One is that what used to be called multiple personality disorder is now called dissociative identity disorder. It's making a comeback. It's been rebranded, it's making a comeback, it's becoming trendy in a new way, and you talk about this in the files. The other thing that you talk about in the files that's related to this is times that the field of medicine got things horribly wrong in the past.

Mia Hughes: Right, I mean, dissociative identity disorder, it's amazing to me that multiple personality disorder is back already. Okay, so we're talking that epidemic really was triggered by the book Sybil in 1973. didn't really, really pick up until the 1980s. But then we had this mad 15 year period where lives were ruined. Women's lives were ruined. Families were absolutely destroyed. People went to prison accused of the most horrific child abuse. None of it was true. It was all based on a totally pseudoscientific theory of recovered memory. This was the idea that these young, these women had been abused as children and they had repressed their memory. They had no memory of it. And then they just so happened to find themselves in the therapy session with somebody who was an expert in recovering these memories. And then they uncover all of these terrible, terrible memories of child abuse and with it, these altered personalities. Some of these women had hundreds of altered personalities by the time the epidemic basically collapsed under the weight of its own absurdity. And so the field of psychiatry, I think, just tried to sweep that under the carpet. Okay, that was really embarrassing. We got that totally wrong. Lawsuits, everything. It's like, let's just try and move on and forget about that. And here we are in 2024 and it's back and WPATH It's kind of surprising, but it's also not really surprising is the fact that people within WPATH are believers in multiple personality disorder. They've resurrected the scandal of the past and they fully embraced it as, you know, they call them now plural, plural identities. So you have to affirm the plural identities, you have to affirm the different head mates living inside a person. So in the files there is, there's this, it's a North Carolina therapist, and he, one of only two mentions of ethics in the files, might I add, And he's saying, if you have a patient with dissociative identity disorder, it's really important that you get consent from all of the alters, all of the patient's different personalities, before commencing hormones and surgeries. Because if you don't get consent from all of the alters, you could be open to lawsuits later, because you haven't ethically obtained informed consent. It's not really surprising that these people on the inside, they felt they believe in this ideological pseudo-scientific ideology. There's no science to the fact that everybody possesses a gender identity and people are born trans and hormones and surgeries is the right way to go. There's no science to that whatsoever, just as there was no science in the 1980s to say that people could repress memories and only would they be found in the hands of an expert in recovered memory. So, the fact that the two have collided is not that surprising, but it does show just how far off the rails these people are willing to go and have gone. Because, you know, in the report I talk about Dr. Dan Karasik. He's the lead author of the mental health chapter of WPATH Standards of Care 8. So we're not talking a fringe person here. We're talking a very prominent psychiatrist within WPATH. He's a believer. He believes you shouldn't be plural phobic. And he has, he's in a conference in 2017 talking about people with plural identities, multiple personalities and needing to get consent from all the alters and these very, very obviously mentally unwell people getting genital surgery and hormones and stuff. It's not that it's just a weird fringe within WPath, like a weird obscure group. It's the lead author of the mental health chapter for one. And you've got, I don't know, you've got, if you've got, if you believe you have multiple people living inside you. I don't know that affirmation is the way to go. I think, again, there's a danger to affirming. identities, and I believe they might be doing it with the best of intentions. I try and be as generous as I can, but they think somehow affirming the gender identities and affirming the plural identities, combining the two, and then, you know, someone in the conference in Montreal suggested to get all the alters to consent, you could have them use an app. Basically it's just a person talking to themselves on an app, all their different personalities, so they can reach an agreement on whether they can start hormones or have surgeries or whatever. I don't know that you're helping. I just think at some point the affirmation is going to be very detrimental.

Stephanie Winn: And I've spoken with a patient with personal experience of this, Leighton, a detransitioner who had dissociative identity disorder in reaction to trauma. Dissociation, I'm going to sort of distinguish that from the concept of multiple personalities, just to say that she was severely dissociated and needed help with integrating her parts. Went to a therapist who had this sort of plural affirming orientation, as well as gender affirming, and ended up going through with transitioning, not that you can ever really change your sex, right? But she went through with the hormones and said in retrospect that she needed help with integrating these split off parts of herself, not affirming having all these separate selves. There's so much to get through and I'm thinking, how do we prioritize it? So here's what I'm going to do next. I'm going to share a burning thought about dilation schedules, even if it's out of order. Then I'm going to just read through all the rest of the chapter titles, since I said I would. And then you can just pick any of those you want to comment on. And we'll make sure to leave time for some of the questions from locals, maybe a few questions from X as well. And we're going to try to do all that in half an hour. Sound good? Oh my. Sure. Okay. I just have to say, you commented in a few places in the report about these dilation schedules. So for those who are just hearing this for the first time, we're talking about males who get vaginoplasties, which are pretty horrifying procedures, and then have to stick to an intensive schedule of painful dilation to keep the surgically created wound open for long periods of time. So we're talking, what, like two and a half hours a day? of dilating for I don't actually know how long. And then it's weekly for life after that. And you've talked about how this is actually really difficult to do for a lot of people. And so after putting everything into having these surgeries, the surgeries are not, quote unquote, successful. And even if they did stick to the schedule, we're still talking about loss of sexual functioning, loss of fertility, painful urination, and a number of other problems. But you talked about situations where someone was homeless and severely mentally ill and needed to stick to one of these schedules. And just the audacity of the doctors to suggest that someone who's having such a hard time taking care of themselves on such a basic level is going to be able to do this. And I just wanted to chime in on that from personal experience as someone whose primary work these days is talking to parents of trans-identified youth, that a lot of these young men who are interested in hormones and surgeries are really bad at basic hygiene. I mean, I've had conversations with parents where the kid, especially when you add autism to the mix, which is usually a factor for these boys, you know, boys who were not open to hearing that wearing a dirty wrinkled shirt inside out is going to make it harder to make friends. And that maybe, OK, fine, grow your hair out if you want, but wash it and brush it. Because nobody likes your long, greasy hair that's tangled. I mean, boys who have not learned basic grooming, we're talking about people who are showering once a week, if that. These are people with major personal hygiene issues. And I can read the report and tell you these doctors are not having these real conversations with people about what is your self-care like. And so expecting someone to go from that level of self-care and personal hygiene to then following this intensive self-care regime. I mean, self-care regime. It's interesting that I put it that way. This intensive regime to maintain the cleanliness and openness of the surgically created wound. I mean, it's just tragic because imagine if these young people were actually dedicated to putting in that much time and energy to actual self-care. That's where the phrase self-care came from, right? If they were willing to put that in to hygiene, exercise, meditation, anything good for you, eating well, sleeping well. I just had to get that off my chest before we move on.

Mia Hughes: Yeah I mean the dilation thing again I think it is it's this it's this fixation so they they they latched on to the wrong idea they came to the wrong conclusion and They fixated on genital surgery as the solution. And once you become fixated, nothing can really sway them, take them off track. But then I think the reality, there's a fantasy, right? The fantasy is it's going to fix everything. It's going to be, it's going to solve all my problems. This is what I need to do. They wouldn't do it if they weren't sure that it's what they need to do. And then the reality hits in the post-op period. And that reality involves this insane dilation schedule that is going to be very painful. And just think about it in practical terms as well. You're recovering from major surgery. It's not easy to recover, even take out the genital surgery aspect of it. People often get depressed after major surgery because it is difficult to be an invalid. It is difficult to be. in pain and feeling terrible, these people likely have had mental health issues before they went into the surgery. That's not going to be improved by major surgery. And then add on to that the dilation schedule, which is very, very arduous and painful and difficult to stick to. But then there's one in there, there's a WPATH member in there, they're talking about, you know, whether or not patients, this very, very mentally unwell patient, we'll be able to deal with the difficult dilation schedule and this therapist in there is like well it would be great if everybody could be perfectly cleared for surgery but at the end of the day what can you do like and if they if they go into it If they go into it knowing that these complications can happen if they don't follow the dilation schedule and they consent to that, then you've done all you can. That's basically it. No concern whatsoever for this very mentally unwell person who very likely will not be able to deal with the dilation schedule. No concern for the lifelong impact that that will have on their physical and mental health. No concern ever, as far as I can see, for anyone's future. Just the here and now.

Stephanie Winn: I have to respond to this. I keep saying we're going to go on to more chapter titles, but there's so, so many things to say to this. Like, okay, the difficulty recovering from surgery. I just want to echo that because we do know from testimonies of detransitioners, there are people who get hooked on opioids as a result of these surgeries for one. Okay. We also know that distress tolerance is very low in this population. As I was mentioning earlier, borderline personality disorder is common. There's a family I've talked to whose child has borderline personality disorder and thinks she's trans who would, during a certain period of her life, threaten suicide every time she had a sinus infection because that's how low her distress tolerance was. So you're talking about putting people through pain, disability, inability to care for themselves, difficulty with personal hygiene as a result of all these surgeries and things, and just expecting that this so-called gender euphoria, this, oh, I've finally gotten what I want, is really going to get them through all of that. Which brings me to your other point that you made, this idea on the fixation, this will solve my problems. And again, here's where I just have to chime in with the psychology angle on things. And I think the simplest way to explain it is this, that knowing what will actually make you feel better and being able to predict that accurately stems from self-knowledge and lived experience. So for example, as we become older and wiser, we learn to recognize our bodily cues. We learn to recognize what I really need right now is a walk or a nap in the sun, a phone call with a friend, a shower, a healthy meal. to sleep on it or any number of other things that we might do for self-care. And how do we learn that? We learn that because the last time we felt this way and we did that thing, it helped us feel better. We have personal experience, right? These are tried and true coping strategies. In contrast, all of transgender medicalization, 100% of it, stems from wishful thinking, not from self-knowledge. Why? Because if you've never had this surgery before, then you've never had this surgery before. You cannot actually predict how you're going to feel afterwards, which is very different from knowing that you can predict how you'll feel after a nice hot bath, because you've done that hundreds of times. So that's the major distinction. It's this idea, I will feel better when this or that happens. is it based on experience or not? Because if it's not based on experience, then it's wishful thinking. It's a projection. And it says a lot about what you want. It says a lot about what stories you've been exposed to. But it doesn't actually say a lot about how you will truly feel after the thing happens that you project your hopes and dreams onto. And in your report, you talk about how there is this honeymoon phase and this placebo effect because people have been projecting all their hopes and dreams onto this. But you also say that based on people's experiences, that tends to last anywhere between two and seven years. And then you refer to the work of Dr. Az Hakim, who ran these support groups where he combined people, pre-operative people who had this fixation that this will solve my problems with post-operative people who were grieving and mourning and realizing it hadn't solved their problems. And when the two groups met, it was very effective. Most people ended up not going through the surgeries because they saw the reality. But unfortunately, most gender dysphoric people aren't going to support groups like that. They're going to social media and they're seeing a very curated image. And so it becomes this echo chamber.

Mia Hughes: Yeah, that's it. I really think as Dr. Az, Dr. Az Hakim. I think he hit on the solution before most of us even knew there was a problem. That was way back in the 2000s that he combined the regretters with the euphoric ones who were sure that this was the solution and yeah, like perfect. I mean it shouldn't really fall on people who regret to guide to help anyone, but those groups did seem to be really effective in just the fixation. They get them over the fixation. It's not the miracle solution that you think it's going to be. You've just reminded me, I read, I remember reading once that Harry Benjamin who triggered arguably an awful lot of this medical scandal. Harry Benjamin had this sort of diagnostic tool, I suppose, where he believed that if a man wanted vaginoplasty, that meant he was eligible, because no man would want it unless he were really transgender, and therefore he should be able to have it. Whereas I kind of flip it the other way, that if a man wants vaginoplasty, then he probably shouldn't be eligible to have it because he doesn't have a realistic idea of what it's actually going to do to his life. So I think it's the more cautious approach is the way to go, surely.

Stephanie Winn: I'm on the exact same page and I found myself saying really similar things. I mean, your report does an excellent job, and unfortunately we don't have time to get into all this, you do an excellent job at dispelling them, debunking the myth that actual informed consent is taking place. But when I've had conversations where someone plays devil's advocate and they say something like, If there was truly informed consent, like, why wouldn't you say that adults can do whatever they want? I'm on the same page as you about that one as well. And it's like, well, okay, for one, because it's not a doctor's job to just give a patient whatever they want. It's a doctor's job to do no harm and promote health. Anyway, besides that, though, if there were truly informed consent of all the facts, everything we know about this, then asking someone, do you still want to go through with this, would double as a test of their sanity and judgment. And so someone saying, well, yes, I do, would be like, OK, then we know that you're really not stable mentally right now. Right. So I just want people to understand what is in this report and why they should read it. I'm going to read through the rest of the chapter titles. You can feel free to jump in on any of them, but then we're also going to squeeze in some time for questions. So, WPATH is not a scientific group. The weak evidence base for puberty suppression, evidence in the files of WPATH's lack of respect for the scientific process. WPATH is not a medical group. WPATH has abandoned the Hippocratic Oath. Evidence showing the harmful effects of wrong sex hormones. Doctors improvising and experimenting. WPATH members causing surgical harm. Dismantling guardrails. WPATH members trivializing detransitioner stories of harm. Suspiciously low regret rates. Permanently medicalizing transient identities. WPATH has broken the chain of trust in medicine. Debbie Path has no respect for medical ethics. The ethics of informed consent. Minors cannot consent to sex trait modification procedures. Misinformed parents cannot give informed consent. The transition or suicide myth. Allowing severely mentally ill patients to consent to life-altering medical interventions. Minority stress. Do a great job on that one, by the way. Realistic expectations. Consumer-driven gender embodiment. Valuing patient autonomy over risk aversion. a brave new world. And then finally, before the conclusion, we have past cases of pseudoscientific hormonal and surgical experiments on children and vulnerable adults, including I don't know how to pronounce this.

Mia Hughes: Apotemnophilia. I don't even know if that's correct. Okay.

Stephanie Winn: And then engineering children's height with hormones. And then after the conclusion, you have the complete files lightly redacted of the original sources to back up every single claim that you make. So, I don't know if there are any burning thoughts on the contents of any of those chapters.

Mia Hughes: Well, I can say that, you know, the most, I'll give a brief rundown, the most, one of the most distressing parts for me to write was about the effect of hormones on the female body, the testosterone on the female body, what they are doing to these healthy young These teenage girls and young women who would be perfectly healthy, the vaginal atrophy, the liver tumors, the uterine atrophy, it's all just so distressing to read about and to write about. And the way they handle detransitioners as well just is absolutely, it makes my blood boil. This is the organization, bear in mind, that removed all the guardrails from this very experimental, brutal treatment protocol. They remove all the guardrails and then a whole bunch of innocent kids come stumbling along and come to terrible harm at the hands of WPATH members and gender affirming doctors. And then WPATH members, including Marcy Bowers, the president, has the nerve to say, well, you've got to own and take active responsibility for your medical decisions. totally passing the blame, blaming the victim when all of the blame lies on WPATH and every gender affirming clinician who follows WPATH and blaming the victim, trivializing first the pain that they go through and then saying, but it's your fault. That's like saying if you were misdiagnosed with cancer and you underwent chemotherapy and you had parts of your body chopped off and then at the end of it you realized You never had cancer in the first place, it was a misdiagnosis. That would be like blaming the victim. Was your fault for consenting to the chemotherapy? No, it's absolutely not. It's entirely the fault of the medical professionals. And then the weird world of non-binary surgeries is deeply disturbing. It's deeply disturbing to read people, surgeons, talking about creating body types that don't exist in nature. and everyone's in there policing each other's language about maybe they're non-standard now, but one day they'll be standard. There's no sign of the Hippocratic Oath in that section whatsoever. There's no sign of any concern for the patient's well-being or their future. There's just It's honestly, to me, it's like queer theory in the operating theater. And I find it deeply disturbing.

Stephanie Winn: When you described the victim blaming, it's yet another aspect of this two-faced nature of this organization. It feels almost diabolical. And it's sort of like the phrase that comes to mind is, look what you made me do. Right. The classic narcissistic abuse victim. It's like, Their vulnerability was exploited. They were told, if you think you might be trans, you're trans. There should be no alternative but affirmation. And then when the person says, hey, why wasn't there any alternative? Well, it's all your fault. Plus, liver tumors, I'm glad you brought that up. It was kind of earlier in the report, and I imagine maybe the way that that landed with you is part of why you put it kind of on the earlier side of the report, just these stories of these incredibly young women having these horrible adverse reactions. And it's like, what did you expect to happen that that's the part where like when I when I play out these imaginary conversations in my head with old friends I've lost touch with who I see on social media, they post something for like transgender day visibility and I And usually, I just unfollow or unfriend or whatever, because I'm not here to have that conversation right now. I just don't have the bandwidth for it. But when I imagine what it would be like to really sit down with that person and have a conversation, I would want to start with, what does trans mean to you? Is it a medical condition? Is it a psychiatric condition? Is it a demographic category? Because this is one of those smoke and mirrors things where they keep kind of shifting the story. And then at some point in the conversation, I want to get to, What do you think would happen if you put these chemicals into these types of bodies, if you give someone surgery to remove Can you just think for yourself for a moment? Because I just feel like there's been this widespread acceptance, including amongst people I knew who were pretty health conscious and pretty into holistic concepts. Anyway, I'm just ranting at this point. I do want to make sure to ask you some of these questions unless you had a thought on that. No, no, that's fine. Okay. First, I posted the opportunity to ask you questions in my Locals community, which as a friendly reminder to listeners, you can join at somekindoftherapist.locals.com for only $8 a month. You get early access to new episodes. You get to know who my guests will be and ask them questions, and you get exclusive content for supporters only. First, I posted in there, and we'll go through those questions first, and then if we have time after that, some questions from X. Osborne asks, You should ask Mia to explain the process of getting the WPATH files out and why it took months. Good journalism is often slow. Ask her why.

Mia Hughes: Right. It was months. So we got the files almost right after I started working for Michael, which was last April. Getting it right, it was essential to get it right. So when we were trying to first turn it into a series of articles for Michael's Substack Public, it just wasn't, it very quickly became apparent that we just couldn't do the files justice. So Michael came up with the idea to move me to his nonprofit to write this report. The report itself came together rather quickly once we hit the right note and we were off, but then yeah, there was so much more from, Michael announced it at Genspect in November and they were coming very soon. I think at the time we were planning to release them within weeks, but then More people joined the project and we had to, I won't go into too much detail, but we wanted the mainstream media to cover this story because I don't know if you've noticed that It can be ignored. It will never cease to amaze me that WPATH came out with a eunuch chapter in its standards of care in September 2022, and that didn't immediately collapse the organization, that the mainstream media were not all over that story. how on earth could this group possibly be trusted? But no, they ignored it. And so you need a little bit of prompting. We did some work behind the scenes to reach the mainstream media. And in order to do that, we had to have it packaged in a certain way, presented in a certain way. And so we took our time and we did all of the work behind the scenes to make it a story that would have as much impact as possible, simply because this is a medical scandal. People are coming to terrible harm. And WPATH sits at the very core of it. And so we really wanted to get the truth about WPATH out through as many channels as possible. And that really did take much more time than I imagined it would, but I think it was worth it.

Stephanie Winn: So following on that, Mr. Delgado asks, to the extent that she is aware, could Mia comment on the response so far, if any, of insurers or of medical and psychological associations to the revelations in her report? Has she heard anything from attorneys working on behalf of detransitioners as the potential evidentiary value, whether direct or indirect, of the WPATH files for their current or potential future cases? If you're looking for a simple way to take better care of yourself, check out Organifi. I start every day with a glass of their original green juice powder mixed with water. It contains moringa, ashwagandha, chlorella, spirulina, matcha, wheatgrass, beets, turmeric, mint, lemon, and coconut water. 100% organic with no added sugar. It's the best tasting superfood supplement I've ever tried. It's super easy to make and it makes me feel good. Organifi also makes several other delicious and nutritious superfood blends such as red juice, immune support, protein powders, a golden milk mix, and even superfood hot cocoa. Check out the collection at Organifi.com slash Sumtherapist. That's O-R-G-A-N-I-F-I dot com slash Sumtherapist. And use code SUMTHERAPIST to take 20% off your order.

Mia Hughes: Right, so I have been in touch with, I have heard from, there's a legal angle to it. Interestingly, for the detransition lawsuits, if you look at them, they're mostly about showing that the clinician did not follow WPATH. So I'm not sure that the files are going to be used. I think perhaps a little bit, I know that the report has already been cited in a brief on a gender medicine ban, because it does show that on the inside these people know that these kids cannot consent. It shows that. Also, people are using or they have taken the report and they are intending to use it in various ways that I'm not sure I can talk about, so I won't just in case I'm not supposed to. As for major medical organizations, these things take time. I think these are not organizations that are going to have a knee-jerk reaction. Goodness me, these people are a whole bunch of trans activists. We shouldn't be listening to them. Part of that I think is perhaps because WPATH members are on the inside of other medical associations as well. I do know that WPATH and the endocrine society can be sort of thought of as one. The whole gender aspect of the endocrine society is very much populated by WPATH members, so There is a plan to target the remaining medical associations and to pressure them into reading the report, acknowledging that the report exists, and then reassessing whether or not they want to be associated with this group. My point there is always that If you want the public to trust you as a medical association, as a medical institution, you cannot be seen to be associating with this group that has been so thoroughly discredited. It's going to have a wider impact well beyond the field of gender medicine into the wider general medical setting. You can't just follow the guidelines of these people and expect everyone to trust you on other decisions too.

Stephanie Winn: Okay, this next one is sort of a rant and a question mixed into one. But rather than trying to pull out the question, I'll just read the whole thing and you can respond to whatever part you want. It's actually in two parts. So Andrea says, ask how we make this mean anything. So this is going on to, you know, what you were just talking about the implications of this report. No one seems to care, and I just don't understand. It really is a religion to many. How do you tell someone transubstantiation by the power of the word from man to woman or woman to man is real? How are some of the best-hearted people I know falling deep into this extremely regressive lie? How great would it be if all this time were spent educating people that personality expressions are infinite? Sex is binary. I'm going to skip past this part because it has swear words in it. Thank you, Mia. Thank you, Michael. Thank you, Stephanie. Ask what we can do. Also, just listening to today's show, and I'm struck by the thinking we will unravel this lie. I am not sure we will. As I said, I think this is just heading towards bringing humanity into a digital cyborg techno sapiens where literally anything is possible. Then how will biology matter? Will biology be discarded, disregarded completely soon? You just pick whatever part of that you want to respond to, Ian.

Mia Hughes: Right. I mean, I'm not someone known for my optimism, actually, but I am optimistic that we will be rid of this one day, this whole absurdity. But how do we go about it? Everybody's got their own approach, and I'm not criticizing anyone's approach or saying one is better than the other. But I do think if your intention is to reach good, well-meaning, liberal, left-leaning people. You cannot go at it in a very harsh, you can't go on the attack and call them, you know, child abusers and call them butchers and liars and whatever. You just can't If what you are saying to your target is so far beyond the way they see themselves, they're not going to listen. They're going to shut down. They're just simply not going. They're going to think you've lost your mind. So the gentle approach is always the way if you're trying to get to the well-intentioned person who supports this basically because they think it's the next gay right. I would say that the best way to do that is therefore to show what's happening to children, to go into the part of the files that is Daniel Metzger saying, it's like talking to a blank wall. We're robbing these kids of their sexual development where there's regret and the dog's not doing it for you or anything. Go into that area of what they're doing to children and show that you You supported it because you thought it was the right thing to do, but actually very innocent, vulnerable teenagers are coming to terrible harm. Take the gentle approach. The angry approach is really not going to help. I understand the anger, I feel the anger and I'm guilty of it as well. I know I am on Twitter sometimes, but I just don't think it's the right way to reach these well-meaning people because they are good people and the very reason they support it is because they are good people and they want the best for these young so-called trans kids. They need to understand that kids are coming to harm because of their support of this medical scandal. I'm not sure if that even answered any.

Stephanie Winn: Well, actually, it not only answered that question, it also answered another one that I was going to pull from X. There are several questions for you there that we don't have time to get to, but there was one that I was going to pick and you started to answer it. And I do just want to say before I read it that when you talk about the gentle approach or I would say you do an excellent job of keeping your cool. I don't think I would ever have the patience to write something like this, because to me, I've already reached the conclusions that I have about this, and I don't need more information. I really don't need more evidence. I just know it's wrong. But your ability to stay calm and take a very factual approach and just present the evidence is really apparent in this report, and I think you've done a great job.

Mia Hughes: This is the time where I have to just step in and say a big thank you to my editor, Alex Gutentag, because believe me, the first versions of the report were less factual and there was a lot more anger on the page. So I feel the anger like everyone else. How can you possibly read about this medical crime and not have your blood boil? Yeah, you've got to tone it down if you want to reach people. It can't be too far from the reality that the version of themselves that they see, they think of themselves as good people. If you go in and you call them evil and child abusers, they're just not going to listen.

Stephanie Winn: So I'll finish with this. Like I said, I think you've already started to answer it, but just to give you an opportunity to add anything else to it, on X, Dilweed said, Mia, can you pick the three findings most likely to convince the average DEI-trained liberal there is more going on here than they realize?

Mia Hughes: Right, exactly. Okay, so the first part, we've got Daniel Metzger, what he is saying, contrasting what they say about child and adolescent transition to what they say on the inside, the truth. They know the truth as well as we do. They understand that this is totally inappropriate. The kids don't understand. They cannot consent and they are also regretting it. The second one I would say would be It depends. The left once cared about the disadvantaged. So if you are talking about someone who truly actually does still have left values and they care about disadvantaged people, I think I would personally go into the area where there's a woman, there's a therapist, a California therapist in there who says, In 15 years, we're talking about seriously mentally unwell people. And she's saying in 15 years, she's only turned down one patient for a surgical referral. And that's because the patient was in active psychosis in the assessment and was hallucinating. And she regrets that she had to turn that one down. But then she goes on to say, you know, everyone else got their surgical referral. We're talking Homeless people, people with major depressive disorders, schizophrenic, bipolar, everyone else got their surgical referral and is presumably living happily ever after. I think there's so much going on in that one statement. First and foremost, all of these people in various states of mental fragility. are being allowed to undergo very life altering, drastic surgeries. And then her use of the word presumably, she has no idea if these people are thriving or doing well in life and the surgical castration or the vaginoplasty solved all of their problems. She has no idea because she's not doing any follow up. and no one is doing any follow-up. Now, I would say that it is quite likely that the homeless person who got the orchiectomy, the surgical castration is not thriving and is not doing really well. And I think for a good person who cares about vulnerable, disadvantaged people in society, they should be horrified by this complete lack of interest in safeguarding these vulnerable people and the complete lack of curiosity about what became of them, their future health. Are they okay? Are they doing well? Nobody cares. That shows a certain callousness and a total disregard for the human life as far as I'm concerned. And then the third one, it's a tough call because I think if they're your average left-leaning, sort of woke type, they might be a bit put off if you start going on and on about non-binary surgeries, which would be, you know, it's the strongest evidence of the complete lack of ethics within this group. It's also the strongest evidence that this is a political activist group, not a medical group. If you think your audience can handle something like that, I would go there. If not, I personally think I would go with the harmful effect of testosterone on the female body and estrogen on the male body as well. It's also, there are some terrible side effects And you want your well-meaning, left-leaning friend to understand that this treatment pathway with such brutal effects is the first line of treatment, that the people inside WPATH make no attempt to avert the need for these hormones that are going to cause vaginal and uterine atrophy and make it almost impossible for the young person to have any sort of intimate relationship. These members are placing these healthy young women and teenage girls onto this treatment pathway without making any attempt to help them reconcile with their body. That should also horrify anyone who actually cares about the health and well-being of this vulnerable patient cohort.

Stephanie Winn: Well, thank you, Mia, for your incredible work and for this interview. I feel like we talked about so many things and yet we barely skimmed the surface. Go and read the WPATH files. It's free through Environmental Progress' website. Personally, I saved the PDF as a book on my iPad so I could highlight You could print it out, you could do whatever you want for ease of reading. I will include that link in the show notes. Mia, is there anything else you want people to know about where to find you?

Mia Hughes: Oh, well, you can find me on Twitter, of course. I'm sorry, X. I cannot, I just cannot call it X. So, at underscore cry me a river, that's where I'm most active. There's more to come from me at Environmental Progress, but I've yet to finalize what's in the works. Great.

Stephanie Winn: Thank you so much. It's been a pleasure. I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit sometherapist.com. or follow me on Twitter or Instagram at sometherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Pair, at nowaybackfilm.com. Special thanks to my producers, Eric and Amber Beals at Different Mix, and to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.