On her website, Berkeley-based clinical psychologist Erica Anderson describes her mission as helping those “who have embarked upon a gender journey.” She also seeks to advance the “shared goals of social justice and transgender well-being,” and offers assistance to anyone seeking to “understand, educate, and level up as a transgender ally.” Quillette readers may interpret these phrases as a coded indication that Dr. Anderson is a doctrinaire proponent of what some have termed “gender ideology.” But in fact, her views are more nuanced. Indeed, she has recently begun to speak out against efforts to protect the prevailing orthodoxy in her field from critique.
Last year, Dr. Anderson read Abigail Shrier’s 2020 book Irreversible Damage: The Transgender Craze Seducing Our Daughters, which many transgender activists have denounced as transphobic. But Dr. Anderson was open to Shrier’s concerns about girls being swept up by trans identification—often resulting in medicalization—for social and ideological reasons, and she agreed to be interviewed by Shrier about the poor care that some children who identify as transgender have been receiving. Dr. Anderson—who transitioned to living as a woman after growing up as a boy scout and church group leader in suburban Minnesota—said she was “not a fan” of summarily putting trans-identified children on puberty blockers. She also told Shrier that she’d submitted a co-authored op-ed to the New York Times “warning that many transgender healthcare providers were treating kids recklessly.”
“That is going to earn me a lot of criticism from some colleagues, but given what I see [in regard to teenage girls transitioning without proper safeguards], my experience as a psychologist treating gender-variant youth makes me worried that decisions will be made that will later be regretted by those making them,” Dr. Anderson added. The better approach was one that “evaluate[d] the mental health of someone historically … and to prepare them for making such a life-changing decision.”
The Times passed on the submission. But Dr. Anderson’s op-ed, written with clinical psychologist Laura Edwards-Leeper, was subsequently published in the Washington Post in November under the headline “The mental health establishment is failing trans kids.” And while many writers who make this kind of argument are routinely dismissed as transphobic “TERFs,” Dr. Anderson should not be dismissed in this ad hominem manner. As the credit line of the article noted, she is not only a clinical psychologist, but also a member of the American Psychological Association committee writing the guidelines for working with transgender individuals, a former president of the US Professional Association for Transgender Health (USPATH), and a former board member of the influential World Professional Association for Transgender Health (WPATH), which self-describes as a “non-profit, interdisciplinary professional and educational organization devoted to transgender health.”
A month earlier, following Shrier’s interview, WPATH and USPATH had put out an odd joint letter in regard to the use of pubertal blockers and hormone therapy for transgender youth, stating that the two organizations “oppose the use of the lay press, either impartial or of any political slant or viewpoint, as a forum for the scientific debate of these issues, or the politicization of these issues in any way.” Obviously, there is an important distinction to be made between peer-reviewed scientific journals and the lay press. But even so, specialist organizations of this type denouncing any form of discussion that isn’t conducted by “experts and stakeholders” is concerning. It is especially concerning for gender dysphoric youth, as well as their parents and guardians, who are seeking to explore the varied and complicated stories about medical interventions and emerging research—stories the press should, in fact, report.
As it happens, Dr. Anderson had not only been president of USPATH for two years, but also had been its first transgender president. In 2021, she quit the organization’s board, and the position of Past-President, after voicing (by her account) solitary dissent against a proposed six-month moratorium on speaking to the press while USPATH awaited public comments on the eighth iteration of its Standards of Care.
In conjunction with the joint letter issued in October, WPATH and USPATH were making a clear statement that no one involved with them could comment in the press on issues that Dr. Anderson had dedicated her career to studying. Last month, she spoke to me about her opposition to this stance; her fears about the form that the gender “affirming” care model has taken in recent years; and the need to keep parents involved in the health-care process.
Lisa Selin Davis: Can you tell me what happened at USPATH?
Erica Anderson: I got to a point in my concern that I felt I could no longer continue in good conscience to support the direction of USPATH, which I had led for the last two years. I resigned from the USPATH board of directors at the end of our last meeting. I have some concerns—serious concerns.
LD: What are those concerns?
EA: There was going to be a 30-day moratorium on speaking to any press about any subject. And after that [was discussed], I read a statement: “I’ve made the case for a more open posture to the press and the public. We need to engage them in supporting our work and the standards of care. I cannot abide the tactics of muzzling leaders in the USPATH/WPATH. I will not give up on my First Amendment rights. I’m done. I’m out of here.”
LD: Why do you think they instituted what is essentially a ban on talking to the press?
EA: I don’t think there’s unanimity about it. One group of leaders is just wary of talking to [the] press at all. Some of them have had experiences that they regard as negative, maybe being misquoted or misunderstood. We’re all professional people and scientists, and we’re used to talking in nuance … We have to take into account the fact that the potential for misunderstanding is huge. So some of these folks just say, “Let’s not talk to them at all.” Others are of the view that an open dialog with the press is to our advantage, in that we want to disseminate accurate information about what WPATH is and what our standards of care are, and we want to educate the public.
After the [Abigail Shrier] article, there was a WPATH board meeting especially called to discuss a set of media issues. And we had, I thought, a fairly nuanced and fleshed out conversation. The main criticism of me is that many in the trans community regard Abigail Shrier as anathema, as a critic of appropriate trans care. I think that’s an inaccurate reading of what she’s written. And I think that it’s a distortion.
We need to ask: What do we do with trans youth, and what are the implications of deploying puberty blockers and cross-sex hormones early in adolescence, which is a more aggressive posture than has been used historically by those who have treated transgender youth for a long time, for decades, including [experts] in the Netherlands and in Sweden?
Several WPATH board members spoke up, and said, “the points that Erica was making in that interview are correct. There are problems. And she’s right about those problems.”
LD: Can you explain what those problems are?
EA: There are a lot of issues that [Shrier] brings up in the book that are worthy of deeper attention, including what’s happening to our adolescent girls. The data are very clear that adolescent girls are coming to gender clinics in greater proportion than adolescent boys. And this is a change in the last couple of years. And it’s an open question: What do we make of that? We don’t really know what’s going on. And we should be concerned about it.
[At the USPATH meeting], there was also a proposal by the president to evaluate the issue of “fluid gender journeys,” which was kind of code for the issue of detransitioners. And on both issues, [the president] acknowledged that there’s a there there—that there’s something there that is important and needs attention.
LD: Why do you feel so passionately about maintaining an open relationship with the press?
EA: I adopted, years ago, the position that public education and education through the media is a tool to broaden understanding, but maybe, more importantly, broaden acceptance of transgender people.
Five years ago, in October 2016, I came out to two-million Swedes on a Sunday night, on a very popular TV show in Sweden … I was invited to a lot of things that I would never have been invited to had I not been on the show, including discussions with the Parliament and cabinet members about transgender issues in regard to the health system. And I realized the power of the media. I realized there’s an amazing power to educate.
I had a number of people write me who said, “You know, my uncle, my father, whoever it was, thought that all transgender people were crazy. And then they saw you on TV.” I humanized the idea that a transgender person could be understood easily by other people who had never met a transgender person. I didn’t aspire to be an activist. But that experience changed me. I realized that there’s a power in speaking out. These are things that have resonated deeply with me as someone who years ago was a closeted trans person. I was afraid that I wouldn’t ever find acceptance, and that I would never feel I could live my truth and live fully. And after those experiences, I really felt I could.
I can tell you personal examples of trying to get affirming care 25 years ago, when I was 45. There was none to be had. I went to an endocrinologist and I said, “I’m transgender and I’d like you to help me with my gender transition hormones.” She looked at me like I was an alien. She wouldn’t establish eye contact. She said, “Oh, I don’t do that.” This is not in a backwater place; this is in Philadelphia.
In the past, we were told that people who were transgender had a deep-seated psychiatric disorder, which no longer is the prevailing view, but for many years it was, which was why so many trans people feel traumatized, especially adult trans people, who were basically told they were crazy.
LD: I’m surprised that, as a trans person who found the courage to come out and found acceptance, you don’t think that all children identifying as trans should be allowed to transition without assessment.
EA: When you’ve seen one transgender person, you’ve seen one. In the popular view, there’s a meme, there’s a story, there’s a narrative, and if you fit that narrative, then you’re trans, and if you don’t, you may not be trans. But I don’t have a narrative that I think everybody fits.
I’m worried that gender minority identities have become a bit trendy, and that with the weird circumstances of the last two years of pandemic, adolescents who are notoriously susceptible to peer influence have found it necessary to have their communication and their social relationships online. They’ve gotten more information, and more social support online than ever before, and they’re reliant on it.
I’m worried there’s a new group of adolescents who have pre-existing mental-health problems, and they’re looking for solutions, and they’re looking for an explanation for who they are … And there’s a bit of, I would say, fantasy about seizing upon an identity that to them may explain their distress. They may believe and verbalize that: “Okay, the solution to my problem is to transition. And then I won’t have these other issues—eating disorders, depression, anxiety, social problems.” That is misguided. As far as I know, gender transition doesn’t cure depression, doesn’t cure anxiety disorders, doesn’t cure autism-spectrum disorder, it doesn’t cure ADHD. [But] it can [provide] help for the right person.
What I want always is individualized evaluation and a comprehensive bio-psychosocial evaluation. That’s the language in the Standards of Care. For professional people, whether they’re medical or mental-health [specialists], to say, “Just accept what the kid says and then make your decisions accordingly” ignores the long history we have of issues in child and adolescent development, and it is a disservice to the patient.
How many patients present for diabetes and just go to their doctor and say, “I’m diabetic, so give me insulin.” And the doctor says, “Oh, okay, you say so. It’s true.” No, they do some testing. They want to confirm that that’s actually true. That’s actually what the patient needs. And that’s all I’m asking for. I’m just asking for a reasonable evaluation of what every kid needs.
I couldn’t be more gender affirming. But I will tell you, having had many, many hundreds of interviews with kids and families, I don’t give a 13- or 14-year-old carte blanche just because they say magic words. To just say that if a kid says they’re trans, they’re trans, and so treat them as such, and expedite gender-affirming medical support? No.
LD: With diabetes, there’s a clear test. How can you ever know for sure what a kid with gender dysphoria needs?
EA: That’s the challenge of the evaluation, which is to understand the relationship, if there is one, among all the things going on with the young person. If you look at the diagnosis of gender dysphoria, the key phrase that I always point to is reflected in a marked incongruence between one’s [experienced/expressed] gender and one’s sex assigned at birth. Now ask yourself: How do you measure a “marked incongruence”? … Who decides, and does it have to be an enduring incongruence? In the diagnostic criteria, it says such a marked incongruence has to be present for a minimum of six months.
I’ve interviewed kids who have come to this conclusion since the pandemic [began]. At some point, they told their parents, and they come to me and say, “Our child told us last month that they were trans.” Okay. Then the investigation work begins. Were the issues about identity brewing before, and to what extent? How far back do they go? If a child is insistent … and their presentation is persistent, then that’s a good indication that they may be trans, but persistence is not three weeks. A kid trying on the idea that maybe their gender is different than the sex assigned at birth—that’s part of their gender journey and exploration. But it may not endure.
Earlier today, I talked to some parents who brought their child to a health [professional]. The child was seen three times by a therapist and then recommended for hormones. The therapist never talked to the parents … I keep hearing these stories, and I believe them. And they’re plentiful. I hear from people who say, “We took our child to a therapist who said, ‘Your child is trans. I recommend hormones.’” And this is happening all over.
We don’t have a lab test. We don’t have a psychological test. I get asked this time and time again: Is this kid truly trans? And I don’t think that’s a helpful question to ask. I think the question to ask is: “Is the gender presented by the child enduring? And do we … have a consensus on the likelihood that it’s going to endure?”
[One] irony is that the people who say every trans kids should be affirmed want to invoke the research that says trans kids who are affirmed do well. But that research is typically based on the methodical, careful approach taken in the Netherlands, Sweden, and other places where they use the same approach I’m advocating for, which is the comprehensive, bio-psychosocial evaluation of issues, and the inclusion of parental advice.
LD: What happens if you feel the child is a good candidate for the medical path and the parents don’t agree?
EA: Kids who are gender variant, who are gender creative, who don’t have support from families are at a disadvantage. Some of the work involves engaging everyone in the family, particularly the parents. Sometimes, parents say, “This came out of the blue when our kid was basically on a computer all day. I don’t understand this.” Many, many parents are confused and, in some cases, terrified by all the issues that are swirling, and they’re looking for a guide. They’re looking for reasonable, sane guidance.
LD: So if the parents are confused or skeptical or unsupportive, is cutting them out—or encouraging the development of a secret trans identity—better for the child?
EA: These are misguided efforts, at best. Unethical and irresponsible, probably. I’m a parent. I have two grown children. I empathize significantly with parents who are struggling to do the right thing for their children. I hear from these parents all the time. They’re not right-wing transphobic, bigoted parents. They’re well-meaning parents trying to do the best thing that they can for their children.
Those who say, “Just ignore the parents or work around them”—I am furious about that. They’re undermining the life of this child who desperately needs support. I routinely am talking about the importance of arriving at a consensus about what’s true about a child. We need to talk with each other. You don’t want to rush ahead with a kid, giving them encouragement that they’re going to get hormones, until we bring their parents along … Battling the parents is a no-win proposition.
LD: What happens now that you’ve left the leadership of these organizations? Who replaces you? Will there be any nuanced voices left?
EA: Well, that’s a good question. I don’t know the answer.
This is a companion discussion topic for the original entry at https://quillette.com/2022/01/06/a-transgender-pioneer-explains-why-she-stepped-down-from-uspath-and-wpath/