Further Thoughts on the Transgender Controversy

JudgmentTwoRather than responding to each of the many comments I received on my original post on transgender issues, I’ve decided to write a new, more generally responsive post.

Let’s go back to reader Lauren’s comment, the one that many people felt was fair and measured. I think this is largely because she takes care to fill it with “respectful” disclaimers so that it appears to be a balanced view, and I’m sure Lauren actually believed she was being fair. Some other readers therefore didn’t understand the strength of my response and found it defensive. Instead, I would describe it as angry. Political correctness gets under my skin, I admit it. It irks me that someone is willing to stop reading a blog she has valued, by an author whose book she has read many times, to show solidarity with friends, even though she acknowledges that my point of view has some validity. I’m not responding to a narcissistic injury; I’m reacting to a kind of thinking that is pervasive in our society and which I find frustrating, to put it mildly. But this isn’t the main problem.

Lauren then accuses me of being insensitive to the plight of transgenders in society. She implies I’m a hypocrite because I’ve written sympathetically about the ways that narcissists and psychopaths are scapegoated while supposedly ignoring the similar way that transgenders are shunned, persecuted, etc. Her argument seems to be that by viewing trans as a mental disorder (“even IF you’re completely right”), I am inviting or colluding with social ostracism. This makes no sense. When I empathize with the fate of narcissists and sociopaths, I don’t pretend they’re not mentally disturbed. Rather, I try to help readers understand the underlying pain and shame behind the behavior that makes them social pariahs. In my original post, I was trying to shed light on the unconscious psychodynamics of transgender people. In my view, these individuals are in enormous pain and deeply confused. I feel a great deal of sympathy for them, but I don’t pretend to support the view that they are “born that way,” any more than I pretend a psychopath is but a variation on “normal.” To view a person as having a mental illness is not the same thing as inviting other people to persecute them.

As Lauren points out, the transgender community has instead tried to “normalize” their condition. You can read about their lobbying efforts in this regard and the reasons for it here. Lauren states: “The idea that having a gender identity that doesn’t match your body is NOT a ‘brain sickness’ has, correct or not, helped to gain these people some serious traction in that regard [i.e., escaping from stigma and persecution].” In other words, I am insensitive to the plight of trans individuals because I don’t support a position that she admits may be wrong (“correct or not”), even if I don’t agree with it. To me, this is form of identity politics I find troubling and sometimes offensive. The truth does not matter. We must line up behind this particular interest group and support their position, even if we believe it to be wrong. If not, we risk being ostracized and shunned ourselves by those who are politically correct.

Lauren expresses her relief that she didn’t refer her trans friend to my site. Maybe that friend might have read something to her advantage, something that could have resonated with her experience on an unconscious level, even if (or especially because) it diverges from the consensus view. As I discussed in my article on this topic for The Atlantic,, in the current zeitgeist, people are told they have “nothing to feel ashamed about,” rather than being helped to explore the roots of their shame. Pretending that core shame does not exist promotes a defensive identity to ward off that shame, leading people to attack others who disagree in order to preserve and protect that identity.

Another reader, more measured in her response and trans herself, states that “there are many in our culture, who will take a post such as yours and hold it up as a rationale for denying someone like me equality, while claiming they [have] backing from experts (you). I realize that is not necessarily your intent.” Like Lauren, she seems to feel that I should suppress my opinion because other people might mis-use it. Like Lauren, she believes that being identified with a mental illness will lead to denial of equal rights. Again, the argument seems to be that, despite what I believe, I should support the transgender community in promoting a theory that conflicts with my own experience.

Some readers have faulted me for supposedly over-generalizing from one case anecdote. Over the years that I’ve been writing this blog, I’ve made generalizations about many other conditions based on my experience and no one has ever objected. If I had confined my original post to a discussion of Toby Sheldon, concluding with the opinion that people who repeatedly seek plastic surgery are trying to “fix” an internal problem by changing their external appearance, I doubt anyone would have criticized me for over-generalizing. Another reader tried to delegitimize me by pointing out that I used the old DSM-IV designation (Gender Identity Disorder) instead of the newer DSM5 label Gender Dysphoria, as if that proved I was professionally unqualified to have an opinion. Other readers have been more blatantly hostile. I believe that this particular subject is a political hot potato right now. To have an opinion that diverges from the politically correct one invites attack.

Psychologists, by virtue of the limited number of people they can see in a lifetime, base their opinions on a small population. But we also base our views on a general understanding of how human beings work, universal features of our psychology, what seems to be true across the board. While I may not have much experience with transgender individuals, I’ve listened for years as people have struggled with their gender identities — not people who wanted to change their bodies as a result, but men and women who felt insufficiently “masculine” or “feminine,” whatever those terms meant to them. They often felt deeply ashamed on some level, mistakenly (in my view) equating it with failure to conform to gender norms. It is from the fullness of my professional experience and my understanding of human nature that I have evolved my views.

To conclude: I have a great deal of sympathy for the suffering of trans people. Like ALL people with a mental illness (in my view), they deserve compassion and professional help rather than social opprobrium. But I also find it tragic that so many young people are feeling encouraged to make irreparable changes to their bodies. This debate has been incredibly stimulating and engaging, at least for me. The exchange I valued most was with a reader who brought to light just how much we DO NOT KNOW about the science in this area. I’m willing to acknowledge that my view is an opinion only, and that we can’t say with scientific certainty whether trans is a mental illness, a physiological condition, or a mixture of both. But if that’s the case, if we really don’t know, then we should stop encouraging people to surgically alter their bodies and take artifical hormones, as if we actually DO know both the cause and the remedy for their condition.

You are free to disagree with me, but don’t attack my integrity because I hold a view that differs from yours.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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When people enter psychotherapy, even if they’re desperate and deeply in need, they don’t fully reveal themselves in the early phases of treatment. As in any relationship, it takes time to develop enough trust so…


    I’m curious about what you think political correctness means, and what about it gets under your skin.

    A phrase like “at the risk of offending the politically correct LGBT crowd” is heavily loaded and inflammatory. That “LGBT crowd” is under constant attack simply for existing. Witness controversies surrounding Russian anti-gay laws, and the struggle to establish same-sex marriage rights.

    Overtly critical references to political correctness in this context usually constitute a dog-whistle for homophobic and transphobic views. Especially when coupled with the term “thought police”, as if oppressed social groups have the power to police the thoughts of oppressor groups.

    Arguably, using DSM to diagnose mental illness is itself transphobic in this instance in the same way that previous DSM classifications of homosexuality as mental illness were homophobic. Gender Identity Disorder would be better named Gender Mis-identity Disorder; what trans people experience is having a gender identity assigned to them that differs from their own experienced gender identity. It is society at large that has the illness; a morbid need for other people to conform to the restrictive gender identity assigned to them.

    Considering the lack of a scientific basis for anyone’s views that you refer to, what is the basis of your view that trans people are suffering the damaging effects of core shame? What is your fundamental objection to the alternative view that a trans woman is in fact a woman, and a trans man is in fact a man?

    I take your point about my “inflammatory” use of language and I will try to be more careful. It is a reflection of the irritation I feel with people who try to enforce conformity to their point of view. It’s their reactionary response to having been oppressed, I suppose, where the oppressed subsequently becomes the oppressor. I live in a very liberal community and find it oppressive to be attacked whenever I diverge from the acceptable views. (I’m a social liberal, by the way, and have never voted Republican, but that’s only because I despite Republicans for their position on abortion rights, etc. I feel largely out of sympathy with the Democratic party, as well.)

    I don’t advocate for a view of gender identity that is restrictive or “normal.” I’m in favor of more fluid gender roles where a trans person could just be who he or she is, non-conforming and sui generis. The use of hormones and surgical alteration endorses a binary view of gender I don’t support, as if it were an either/or proposition.

    Finally, my opinion (as I explained in this post) has evolved from personal experience and my understanding of human nature, based on my professional education and more than 30 years of experience as a psychotherapist.

    “I take your point about my “inflammatory” use of language and I will try to be more careful. It is a reflection of the irritation I feel with people who try to enforce conformity to their point of view.”

    I read your post exactly the way you meant it because I feel as you do about political correctness. I also knew from the moment I read the phrase “at the risk of offending the politically correct LGBT crowd” that someone would respond with how offended they were and then attack or criticize you for using inflammtory language, etc. I knew at that point that they would stop listening.

    However I will say that I was very well aware that the territory that you were venturing into was/is a political minefield. I used to participate on several blogs, including those that deal with feminism and no longer do given what I feel that they have devolved into–the ad hominem attacks, etc.

    “I live in a very liberal community and find it oppressive to be attacked whenever I diverge from the acceptable views. (I’m a social liberal, by the way, and have never voted Republican, but that’s only because I despite Republicans for their position on abortion rights, etc. I feel largely out of sympathy with the Democratic party, as well.)”

    I agree. I’ve always identified (by those people who insist upon backing me into a corner) as a moderate and more socially liberal. I usually didn’t vote Republican either for the same reasons and I don’t feel especially sympathetic towards the Democratic party as well. However this is starting to change given how annoyed I’ve become towards the extreme left.

    “It’s their reactionary response to having been oppressed, I suppose, where the oppressed subsequently becomes the oppressor.”

    I agree. Anyone who has a different opinion and they try any maneuver they can to either silence or suppress your voice. As for political correctness it gets under my skin as well. I believe I mentioned that elsewhere on a different article that you wrote. I find it extremely off-putting and frustrating for the same reasons. It stops a conversation and creates a massive roadblock.

    I’ve noticed that I now tend to write people off who indulge in this type of mindset and totally agree that it is far too pervasive in our society.

    I didn’t find your post offensive either. I appreciate you candor as usual and your willingness to tackle controversial subjects. I hope that they never silence you.

    I am glad I found this blog after several weeks of research into the transgender phenomenon. I am struggling with the issue because my 21 year old daughter has told me that she is going to undergo transition from female to male. She came out as lesbian in high school and for years before and after was a seemingly happy and functional person. Now she believes she is a man in a woman’s body.
    After weeks of reading websites and blogs on transgendered people I came to the conclusion that there is no consensus or conclusive research on the subject. There is in particular a dearth of information as to the long term consequences of infusing a female body with massive amounts of testosterone. The “informed consent” signed by patients is actually more along the lines of “we don’t have any information to give you and you are consenting to unknown risks.” Terminally ill patients are not given certain treatments because of unknown risks but perfectly healthy bodies are given potent drugs and healthy body parts are removed without question.
    Should people with family medical histories contraindicating use of hormones be going through this, they don’t know. My daughter was adopted so we do not know her biological family medical history. But that is apparently not important.
    There is no effort to explore therapeutic options other than hormones and surgery. Any attempt to discuss my concerns becomes an argument and then she doesn’t speak to me at all. I admit I become very emotional and so does she. I am now deciding whether to take her off my health insurance policy because it apparently covers the hormone part. The policy specifically exempts surgery for changing sex but there are “work arounds”. You say your back hurts and you get a mastectomy and if you have painful periods you must need a hysterectomy. The hormones can be obtained at Planned Parenthood. But taking her off my policy would guarantee my relationship with her would end.
    There are so many aspects of this that it is hard to cover briefly. Dr. Burgo is absolutely correct when he says that any critical analysis that disagrees with what is the “standard of care” is met with uproar that you are transphobic and wish to see transgendered people become the victims of prejudice and even violence. That could not be further from the truth. Most of us adore our gay and transgendered kids and prejudice and violence are something we constantly worry about. I believe there are many professionals who would explore other paths to navigate this struggle, but if you’re over 18 and want something, you do not want to be challenged. These young people are seeing psych professionals who rubber stamp their desires.
    Gender identity politics is rapidly eroding even the minimal standards of care that exists. When I read on my daughter’s Facebook page that she was getting her “T letter” I asked her how long she had been seeing her psychologist and she said since last Tuesday. I thought there was a year of counseling and “real life experience” and then hormones. She said the guidelines for getting the “T letter” had changed from one year then to six months and then to one day.
    The transgender political activists have succeeded in labeling this a medical condition that can only be treated with cross-sex hormones and surgery. Medicare has recently started paying for the surgery. This is all without the usually rigorous studies on safety and efficacy of treatment. Profoundly life altering, irreversible procedures are being conducted without long term studies into a condition that is solely based on a subjective feeling that one is occupying the wrong body. You get a more thorough work up if you say your big toe hurts than if you want to remove healthy body parts.
    I attended a psychologist appointment with my daughter where I was told that MRI studies showed that the brains of transgendered people show differences in certain areas. I asked if my daughter had an MRI because if these studies prove these differences shouldn’t this be part of the standard of care as it would be for any other observable condition. “It’s expensive.” I volunteered to pay for it but she just mumbled it’s not a part of the protocol. I was informed I was “cisgendered” and don’t know how it feels to be in the wrong body. How does this psychologist know what I feel in my body or how anybody else feels inside their body? I hate my body as much as the next person. It went downhill from there. Now we are back to the silent treatment. So my choice seems to be go along with this or be out of her life.
    Comments on other blogs usually degenerate into name-calling (“die you trans exclusionary radical feminist”) or arguing over proper use of pronouns. There is no questioning of whether the medical risks outweigh the benefits. There is no suggestion that there are alternatives to sex change. This does a tremendous disservice to those who are without health insurance or other means to finance what they are being told is the only way to resolve their identity crisis. They see no hope if drugs and surgery are the quickest, surest way to a “cure”.
    One of the most even-toned, kind and rational voices of a transgendered person’s point of view that I encountered was a blog by Matt Kailey, who transitioned from female to male. Sadly, he died in his sleep of heart failure at age 59 earlier this year after 13 years of being on testosterone. A question was raised as to whether this might have contributed to his early death was answered “no, he must have had a heart condition”.
    Dr. Burgo, please keep up your advocacy for a different therapeutic approach to transgender issues. While this population may be small there are a growing number of young lesbian women who now believe they are really heterosexual men in the wrong body. (It is curious that many male to female transgendered people are still sexually attracted to women.) But it is precisely because this population is so small that there are so few people who care about the issue. It is why a small number of activists have been able to hijack the politics of this issue and bullied the medical community into enabling a potentially dangerous and radical practice as acceptable without questioning the source of the problem.
    I wish I had seen your posts before l went to the psych appointment. Your comment that “I don’t advocate for a view of gender identity that is restrictive or “normal”. I’m in favor of more fluid gender roles where a trans person could just be who he or she is, non-conforming and sui-generis. The use of hormones and surgical alterations endorses a binary view of gender I don’t support” pretty much sums up everything I was trying to say.

    My heart goes out to you. I completely understand the dilemma you face regarding the insurance issue. I’m not going to advise you since either way seems fraught. I will hope for the best. In Andrew Solomon’s book, he states that about 75% of youth with gender dysphoria eventually outgrow it. Maybe she could just wait. What’s the hurry?

    In the same boat as Coco with my 16 year old natal female international adoptee. Love this kid so much. Her desire to transition is hanging since she brought it forward about a year ago, after watching way too many FTM youtubes IMO. I know it’s going to arise again though right now she (she still uses her fem name/pronouns) seems content to dress like a guy, wear short hair and a binder, and concentrate on school. Long run, who knows, but until/unless she appears more unhappy/upset/depressed than now, spouse & I are very inclined to counsel and model patience. When the frontal lobe development progresses so I have more faith in her ability to assess long-term risk/benefit, then … yeah. She will be an adult who gets to make adult choices. Making such choices for a kid who’s already had choices of adoption/relocation made for her — cannot be comfortable with this. The whole thing started emerging after her early menarche and … I do believe your shame-based theory is probably correct, at least in my kid’s case. It is very hard to know the right way to proceed so we just take it one day at a time and wait for her lead.

    Burgos will not post this, but notice, “he will be more careful.” It sounds like he won’t say it, but will think it anyway. I get pissed every time I read “Dr” Burgos comments. Yes, he is getting a crowd of supporters who are as sick as he is.

    I am a reader of this blog. I read it not because I am a follower of Joe but because I find his posts thought provoking and many times useful to advance my self knowledge.
    I am not sick in the insane sense of the word, but I do suffer from shame. Everyone I have ever known (a few transgenders included) suffers from shame too to some extent, but it’s how we react to that shame what matters.
    Being transgender means you feel shame about your natural gender and react to it by trying to change your gender instead of trying to figure out why you feel shame towards your natural gender. Many may feel that their nature is the other gender, but denial is a strong defense mechanism that has the capacity to fool us completely and we don’t know if its the culprit behind this belief that the other gender is our real gender. Maybe it’s not and some are just born with the wrong gender (maybe a cigar is a cigar), but I think it’s wise to at least investigate if it or any other defense mechanism is behind such belief, specially before we endanger our lives going under the knife to change things that cannot be easily undone.
    Personally I think believing you real gender is the other one is a false belief. To say that you were supposed to be born another gender is to assume that we are predisposed to a gender, and I don’t believe in destiny because accepting it means to not be responsible for your actions. Gender in humans is biological. The psychological differences are small and many (if not all) are the result of the different levels of certain hormones. Culture however has exaggerated these differences to differentiate us more easily. Thus any desire to be of another gender is most likely to be based mostly on how society sees this other gender and the ease with which they are able to achieve a certain goal. For the transgender this goal is in the unconscious. The bigger the need to achieve this goal, the bigger the desire to change gender because this is seen as the only viable option to achieve said goal. The desire to change gender is very unlikely to be physiological in nature because in order for the feeling of belonging to another gender to be physiological in nature it would require the person to have the hormonal balance of the other gender at some point in their lives for an unknown amount of time; unless there exist innate ideas specific to genders and the transgender person somehow got the wrong set of ideas at birth, but I doubt this because it goes against causality. Such hormonal imbalance would also cause physical features of the other gender to appear in the transgender whose desires to become the other gender are due to physiological reasons.
    Acceptance of others and yourself can only occur in the present.
    DISCLAIMER: This is just my unqualified subject-to-change opinion, but I would like to know if any of my claims or arguments are wrong or invalid.

    You make a lot of interesting points, most of which I agree with. Your point of view largely strikes me as “common sense,” but many people clearly don’t see it that way.

    I believe most therapists who work with trans people do their very best to explore the other reasons why a person might want to transition before recommending hormones and/or surgery. I suspect, though, that core shame of an unconscious nature, at least in the way I think about it, isn’t in their conceptual tool kit.

    Just a point about common sense….common sense is often flawed. Common sense makes sense to us because of various errors of thinking that we possess as humans, but what makes sense is not necessarily true, nor would it hold up under scrutiny. Common sense normally just means “ideas that are most commonly accepted” or “most palatable” and “agreed upon”.

    There isn’t a hormonal cause for us to be transgender. None of us believe we should have been born the other sex. We come to know ourselves and understand that we can no longer live, dress, love, or think as the sex we have been assigned is instructed by society to act. We identify to our core with living the life of the other sex. Those of us that are truly transgender are completely comfortable in our new lives, and go on to have successful careers, marriages, and family relations. The only single reason I’m happy it’s in the DSM is because it gives us the legal basis for medically necessary sex reassignment. Maybe the good doctor would be so kind as to sign off on my SRS recommendation?

    Veronica, I’m glad to hear that you’re happy in your life, but I disagree that not one transsexual believes he or she should have been born the other sex. I’ve read personal accounts that argue otherwise.

    I believe that people should be free to do what they like with their bodies, and that includes SRS. You don’t need my approval to pursue your happiness.

    I do need the referrals to be completed by a medical professional such as yourself, so in fact I do depend on you for my happiness. I wish to god I could make my own choices.

    Silver Cat–“Especially when coupled with the term “thought police”, as if oppressed social groups have the power to police the thoughts of oppressor groups.”

    I disagree. From a historical and political perspective your statement can be easily refuted. I wonder how familiar you are with the psychology behind cults. People often associate the word “cult” with religious groups, however cult behavior, and specifically unhealthy cult behavior, is not just found in religious groups. Such dysfunction is found within political parties, business corporations, professional societies (e.g., natural health practitioners, psychiatry, academia), and other social groups. One egregious example is Hitler’s Third Reich which entailed nightmarish cult behavior on political, social and quasi-religious levels.

    Thus, so called “oppressed” social groups which often band together to form larger “special interest” or political groups (many under the banner of oppression) are not immune to unhealthy dysfunction that plagues other social/political groups.

    Likewise, suppression of dissent, doubt, critical thinking, sincere questions, discussion or independent judgment all constitute unhealthy dysfunction. I’d add to that list over-reliance on the significance and doctrinal certainty of “uncertain science”, treating it as if it were some kind of sacred text and therefore infallible.

    There’s some pretty extensive and impressive work on the dynamics of cults which I’d encourage you to read up on given your statement.

    “Overtly critical references to political correctness in this context usually constitute a dog-whistle for homophobic and transphobic views.”

    Dr. Burgo merely articulated a professional opinion and expressing independent judgement, especially on HIS blog, neither makes him homophobic or trans-phobic. However I noticed that you used the disclaimer “usually” so that allows you some wriggle room and lets you off the hook for making such a comment if your intent was not to condescend to Dr. Burgo. I have no idea what you intent was however it sounded much like other reactive comments following these succession of articles and on that note–unfortunately offensive and downright hostile.

    I’ve been reading Dr. Burgo’s site for awhile now and I’ve never considered anything that I’ve read here to be offensive and that is why I gave him the benefit-of-the-doubt.

    It’s unfortunate that some commenters feel so discomfited by what he wrote that they make a choice to react with ad hominem attacks. Let’s put this in context–he was merely expressing an independent opinion.

    I so appreciate reading the words of someone who knows how to think clearly! Thanks so much for this, and thanks for standing up for me a bit.

    To me, the use of the transphobic criticism is an effort to invalidate my point-of-view by implying some unconscious psychological motivation, rather than addressing my opinion on its face. It’s a variation of the ad hominem attack.

    As a psychology professional, would you not open yourself to challenges and critiques from people, without saying or implying that their thinking abilities are flawed?

    Some people may call you transphobic, but they are expressing confusion and anger, just as you allow yourself to do on your blog. I think it should all be accepted and allowed.

    I’ve never considered anything I’ve read here to be offensive, though I think it’s all too easy for the internet to find offense in disagreement. I started reading your blog about two years ago when I was starting my own journey into the crazy world of psychotherapy. I don’t always agree with your posts, but I do find them interesting. Not sure why I’m only just deciding to post a comment after all this time, but here you have it.

    This topic in particular strikes a nerve with some people, I think, because it hits the very core of their identity. Those who have transitioned, or are considering transition, regardless of the underlying condition that may have lead them to that decision (shame, feeling like they’re in the wrong body, etc), have struggled to make that identity for themselves and it’s something they feel necessary to protect. Identity can be a fragile thing for a lot of people, particularly for those whose identity is still in flux.

    Does that mean I believe in self-censorship to save people from discomfort? No, in fact I would rather talk to someone who speaks frankly so that I can be absolutely sure that my own thoughts and decisions are sound: without a challenge, how can anyone be sure of the strength of their position?

    That said, while I didn’t read anything judgemental in your posts as it seems others have, I think it’s necessary to point out that the road to transition is not an easy one, and in my experience, there is not nearly as much encouragement for medical transition as you suggest here. (Note that I myself am not in this position.. I have many connections with people who are however.)

    You make a great point about irreparable changes. I do find something inherently wrong, however, with the fact that anyone wanting plastic surgery for cosmetic ‘attractiveness’ reasons can show up and schedule the proceedure so long as they have the cash to do so, but those looking for gender reassignment surgery have to jump through innumerable hoops regardless of their ability to pay.

    These are all excellent points and I’m in entire agreement. I don’t like the idea of gatekeepers to surgery any more than you do; why I object to is an environment that encourages the surgical/hormonal approach. I live in such an environment.

    For sure, and I agree with you. My point about surgery being harder to attain for transgender individuals than those seeking cosmetic perfection was more along the same lines actually: I think anyone electing to go under the knife for certain proceedures that are superficial in nature (meaning they medically unnecessary for anything other than to help with a psychological problem) should be absolutely 100% certain that the benefit far outweighs the risk. As much care should be taken in cases like Toby’s as they are for transgender individuals. The culture needs to change in favor of self acceptance and the acceptance of others.

    Food for thought – or at least it made me think – I had a young woman working for me one summer and she told me that her father had sexually abused her. She then said to me, and this is what gave me pause for thought “I think that’s why I’m gay.”
    I have another friend who is gay who was also sexually abused. Perhaps there are some who are born that way, but more who are looking for a safe place, an accepted place, in their lives.
    I have questioned my own sexuality because I work in a male dominated industry, grew up as a tom-boy, wear jeans all the time, don’t mind getting my hands dirty, cut my hair short and don’t find myself all that “girly”. My daughters tell me I’m more girly than I realize. I also asked my gay friend if I would know or if I would have to question and she said that I would just know.
    For me it’s a belief of to each his/her own. I am accepting but at the same time uncomfortable.

    Joe, I admire your courage taking a public stand on these complexly challenging, deeply distressing and scientifically uncertain issues. I know you well enough personally to know your views are not based on homophobia. I’ve treated only one trans person into mid- transition, so I haven’t the experience necessary to have an informed position. I’m also basically uncomfortable with the definitions of “mental Illness” and official “diagnostic” categories, which change so radically over time. As in so many other issues which seem to me to boil down to personal beliefs and preferences, I really don’t know what’s “right”.
    The controversy reminds me of the “false memory” debate over adults’ “repressed memories” of sexual and other extreme childhood abuse. The terrible consequences of a previous generation of therapists’ naive and unintended use of indirect and direct hypnotic suggestion, and their support of clients’ “retrieved” memories is now clear. Michael Yapko’s definitive book Memories of Abuse reports the strong scientific research and understanding of the hypnotic phenomena explaining most such “recovered memories”. Most well trained therapists now avoid the techniques which led to so many unsubstantiated imaginings of incest and ritual abuse, and the consequent family turmoil. I do believe memories of such things can be forgotten and retrieved, and using the highest standards of familiarity with hypnotic phenomena and required supporting evidence have greatly reduced the painful consequences of creation and/or support of such “retrieved memories”. Dr Bob

    Very interesting, Bob. As you say, these are “scientifically uncertain” issues and there’s a risk that current thinking may be entirely wrong. There are some interesting blogs out there, written by people who underwent surgery and transition, now finding that it did not ameliorate their distress. They can never get their body parts back again.

    This is well written. I thought what made us all unique individuals is that we have unique thoughts and opinions. Attacking someone because they have a different opinion than you do is just wrong (and ignorant, in my opinion). There are several issues that I and some of my best friends will never agree on and have had several heated (but respectful) debates about. We have agreed to disagree and can still embrace our friendships and respect that we think differently.

    I agree about those types of respectful conversation or even finding friends capable of it, but in reality I find it rare. I’ve only found one person in my life who is capable of it. We don’t allow our differences to impact the relationship negatively. Suffice to say I just don’t seem to meet people who tolerate someone expressing an opinion which is different from theirs and even more so if it surrounds or is about controversial topics.

    Most people it would seem don’t want lively intelligent debate or nuanced conversation and few seem capable of it. Most it would seem are mere showboats expecting others to hold up a mirror and make appreciative noises at them.

    Sorry to sound so cynical, but these past articles and the many comments, especially the ad hominem attacks and un-subscriptions only further validate my experiences of how rare it is to find people who can tolerate that kind of openness.

    I’m only sorry that you got a taste of this ugly mess and I hope that you are not on the receiving end of more extreme behaviors.

    I don’t know Lauren, but assume that she, like you, is both intelligent and well-meaning. Perhaps it is now time to let her comment rest, if for no other reason than you may deter future critics whose opinions you might find valuable, even if they were equally disagreeable to you.

    People find it hard to avoid ad hominem attacks when they feel strongly about an issue. And people often feel strongly about an issue because they have witnessed the pain is has caused to those they love. So, perhaps you, being very aware of your own mental processes, and the way the mind works in general, can send a little love her way.

    I think what is most important is this: You are both right. You are both wrong. You are both human. Let’s keep the dialogue going.

    “People find it hard to avoid ad hominem attacks when they feel strongly about an issue. And people often feel strongly about an issue because they have witnessed the pain is has caused to those they love. So, perhaps you, being very aware of your own mental processes, and the way the mind works in general, can send a little love her way.”

    In other words what you are saying is that it is very difficult for Lauren, and her supporters, to not take what Dr. Burgo wrote personally.

    I disagree with your comment for many reasons. First it may very well be that many people do have difficulty not taking things personally when they feel strongly about an issue. They may also have great difficulty “avoiding” ad hominen attacks, however difficult that may be a reason isn’t an excuse for making personal attacks towards others for merely stating or having a difference of opinion. It is possible to argue a position quite passionately without resorting to personal attacks and it may help one to be more persuasive, if changing or influencing another person’s opinion is your ultimate goal. I will add that people discussing differences without resorting to ugly personal attacks seems to be quite rare in this political climate, but it is not an impossible feat.

    I disagree with the premise about not being able to control one’s self or their emotional state and lashing out at others with personal attacks is evidence of someone demonstrating intolerance. It serves as a huge red flag to avoid them, because I don’t care to be subjected to their personal attacks if I don’t agree with them. The “my way or the highway” controlling intolerant mindset doesn’t bode well for any type of relationship.

    With that said I believe that it is necessary and wise for people to evaluate their own emotional states and re-activity. Failure to do so resorts in strained and compromised relationships and is that wise. You may find people who will tolerate poor behaviors but over the long haul those numbers will dwindle. People may feel empathy towards others and their plight and feeling hurt may be understandable, but it is NO excuse for behaving poorly towards others.

    I have been following Dr. Burgo’s blog for awhile now. I’ve never felt offended by anything that he has written. I appreciate his candor and feel that he is insightful, honest and articulate. I find that refreshing. I also felt that he was fair and appropriate with Lauren and others. The evidence is that he has allowed many hostile and inappropriate responses to stand. Therefore I find your suggestion basically telling him to let her comment rest both arrogant and offensive even if your intent was well meaning.

    It is his blog and he is fully capable of making that decision for himself. He also doesn’t need to be told to “show her a little love”, since I feel that he’s amply demonstrated not only awareness but tolerance, sensitivity and equanimity as well.

    I disagree with your comment about about deterring future critics. It flat out doesn’t work that way–if what you mean is silence them by suppressing your own opinion. One doesn’t deter critics by placating their egos simply to avoid conflict and if that is your strategy it isn’t an emotionally healthy one.

    On that note Dr. Burgo is not responsible for his critics feelings and reactions. I’d assert that it may behoove them to evaluate their own reactions and find other more effective ways to communicate. If you have a difference of opinion and you feel that it is valuable doesn’t it make sense to find more constructive means of communication than resorting to ugly, offensive and destructive ad hominem attacks.

    “I’d like to say a word for The Farmer”,
    Ah, sorry.. Cued wrong song.
    Yes. Jolanda. I am sick. I stayed with a man who was emotionally and sometimes physically abusive, for way too many yrs. as well, I had children with him. Sick, sick, sick.
    But sick because I follow this post? Sick because I enjoy Joes searching .?
    I don’t always agree with dr Burgo’s positions. And I certainly don’t consider myself one of his followers, yuk… Got my own mind.

    I find it a little strange that you are a supporter of abortion rights and yet to quail at affording the same rights of bodily autonomy to trans people.

    Adults today were raised and socialized in an environment where patriarchal gender and sex based binaries were all pervasive and heavily enforced. I think it only logical therefore that some trans people exhibit effects of that just like non trans people exhibit the same. (Note I did not use the word cis as I do not believe that cis and trans are a simple binary either.) When the our society stops teaching and enforcing sex and gender binaries, perhaps we will see a change in how Gender Dysphoria presents itself and the range of treatments will expand and evolve. I think we are starting to see the beginning of this process with the rise of the GenderQueer movement and the wonderful evolution of the way in which gender non conforming children are just starting to be treated. However until that day comes I think we are going to have to deal with the fallout of generations of trans people who were raised and stigmatized in a transphobic and cis centric society.

    I support the right of anyone to do what they like with their bodies, and that would include surgery to alter the physical appearance of their genitalia. What I object to is a professional environment that encourages this approach and ignores the psychological pain and emotional confusion that (in my view) lie behind it.

    I think that the average trans person encounters very little encouragement on their transition, either professionally or socially.

    In my opinion a trans person has to fight and struggle to get any treatment, even when the AMA and the APA have said that this treatment is deemed medically necessary. Any trans person who makes it through the process (whatever that process is for them) has in my view shown fortitude, strength of purpose and resilience beyond what any other patient is required to show.

    So while respecting your right to your view, if I were a trans person thinking about transition, I do not think I would come to you.

    There is much literature on the subject, including over a dozen studies showing brain differences in transsexual people. You would benefit greatly from doing some reading and reassessing your argument.

    Dr Jillian T Weiss
    Ramapo College

    I invite you to comment again with links to those studies along with your opinion as to what they do or do not prove. My view is that there is much interesting and suggestive “evidence” but nothing that would be considered “proof” by scientific standards, not by a long shot. And yet we act as if we know.

    In science, there is no “proof”, only theories that have yet to be shown as incorrect.

    Don’t you think, though, by refusing to admit you may be wrong as well, that you’re also “acting as if you know”?

    You do not know, you have a theory, and haven’t done anything to test it. Perhaps the reason people are responding vehemently is because you’re as unwilling as them to say you could be wrong?

    Your view is controversial, yes? Your view can be considered hurtful to some, yest? Your intentions don’t really matter. If I’m walking down the street and trip someone accidentally, my intention was not to trip them, but it’s not unreasonable to also apologize for the unintended consequences of my actions. Political correctness serves as a guideline so that even when “intentions” are good, hurt and anger and continued oppression does not continue.

    No one is “oppressing” you, Joe. No one is dictating what you can and cannot say, but there are consequences of you speaking your mind and offering your own theory. “Free speech” is not a freedom from consequences. I guess you’re lucky your “consequences” are just angry commenters who you’ve hurt, even if you didn’t intend to…

    In reply to your request for a citation of the studies, please see below. I apologize for the delay – the start of the semester is quite busy. Many scientific studies demonstrate that gender dysphoria often originates physically in the brain, and involves a physical and neurological origin. While we also know that some cases of gender dysphoria are related to psychological co-morbidities, such as schizophrenia and bi-polar disorder, these are not the majority of cases. Concerns about the effect of cross-sex hormonal treatment on the studies of brain differences in the basal ganglia of the stria terminals is generally ruled out because the density of nuclei that are the markers of difference are considered to be fixed at birth and not susceptible to change during maturation. At the same time, we do not well understand the function of this area of the brain, so the mechanism is obscure. Nonetheless, at this point in the science, I believe that there is enough evidence to show physical correlation in the brain. As to whether this is a causative factor or related to a third factor that causes both, I do not see enough evidence to support either. See Rametti et al., White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study, J Psychiatr Res. (2010) (Study showing inherent difference in the brain structure of transsexuals.); Tanaka et al., Regional cerebral blood flow changes in female to male gender identity disorder, Psychiatry Clin Neurosci. 64(2):157-61 (2010) (Study showing that subjects with Gender Identity Disorder had significant brain differences from those without the disorder.); Govier et al., Dichotic Listening, Handedness, Brain Organization and Transsexuality, International Journal of Transgenderism, 12:144–154 (2010) (Study showing brain differences in individuals with Gender Identity Disorder); Swaab & Garcia-Fulgaras, Sexual differentiation of the human brain in relation to gender identity and sexual orientation, Functional Neurology (2009) (Study showing brain differences in individual with Gender Identity Disorder.); Luders et al., Regional gray matter variation in male-to-female transsexualism, Neuroimage (2009) Jul 15;46(4):904-7 (Study showing brain differences in individuals with Gender Identity Disorder); Garcia-Falgueras et al., A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity, Brain 131(Pt 12):3132-46 (2008) (Study showing sex reversal of brain structures in individuals with Gender Identity Disorder); Berglund, et al., Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids, Cerebral Cortex, 18(8):1900-1908 (2008) (Study showing that individuals with Gender Identity Disorder associated with sex-atypical physiological responses in the brain); Besser et al., Atypical Gender Development: a review, International Journal of Transgenderism 9(1): 29-44. (2006) (Review study demonstrating that Gender Identity Disorder has a physical origin.); Swaab, Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation, Gynecol Endocrinol (2004) 19:301–312 (“In the human brain, structural differences have been described that seem to be related to gender identity and sexual orientation.”); Kruiver, et al., Male–to–female transsexuals have female neuron numbers in a limbic nucleus, J Clin Endocrinol Metab 85:2034–2041 (2000) (Study showing neuronal sex differences in brains of individuals with Gender Identity Disorder); Zhou et al., A sex difference in the human brain and its relation to transsexuality, Nature 378:68–70 (1995) (Study showing female brain structure in genetically male persons with Gender Identity Disorder).

    You obviously know quite a lot about the science here. Given that all mental/emotional/psychological processes are chemical/neurological in nature, it seems entirely expected to find brain differences in people with GID, and even to find similarities to people with the opposite gender by birth. But it doesn’t really answer the question of what is actually there at birth. Traumatic psychological events or disturbances in attachment that take place in the first two years of life will inevitably affect the development of the brain as it evolves (you probably know the work of Allan Schore), so unless these studies were done on infants who later demonstrated gender dysphoria (highly unlikely), we can’t decide what is nature and what is nurture. And as you say, there’s so little about many parts of the brain that we don’t understand, so much that may be caused by an “unidentified third factor,” that these kinds of studies aren’t terribly persuasive, at least not to me.

    If you are saying that there is a lot of scientific evidence to suggest that adult transgendered individuals have brains that differ in important ways from other people who were born with the same gender, I have no problem with that. If you are saying that there’s little we can do to alter their brains, I would likewise accept your point of view. But if you’re saying that these brain differences make them more or less equivalent to people with the opposite gender to theirs by birth, and that the solution is to try to alter the body and bring it into alignment with their brain, I would disagree.

    What all this science says to me is that for these unfortunate men and women, nature has gone seriously awry. Even if we accept the hypothesis that they are born as one psychological gender trapped in a body with the opposite gender, this suggests that nature has screwed up in a major way. If you’re familiar with my site, this describes the condition I refer to as “core shame” — the felt awareness that your development has gone awry, departing dramatically from the inbuilt “blueprint for normality” (Winnicott). I take up this issue in my most recent post.

    Dr Weiss, when were these brain scans done on trans gender people?
    Surely not at birth. I’m not a scientist, but as I understand it, the brain is malleable. Our experiences can change our brain structure.

    One of the defining characteristics of mental disorders is that if left untreated they interfere with an individual’s functioning: depression, anxiety, schizophrenia, OCD all make it difficult to hold a job, have friends, intimate relationships, the things people generally strive for in life.

    Now, how exactly does transgender identity make someone less capable of holding a job? How does it make them less capable of being a friend? Partner? Spouse? Parent? The only thing hindering them is discrimination. If society accepts them as they are and wish to be, they’re fully capable of contributing.

    Yes, difficulties with gender identity cause suffering. But it’s not suffering generated inside one’s head. It’s suffering caused by abuse and discrimination.

    Hi Dr. Burgos,
    It is so unfortunate that there is so much vitriol in our society and especially on the internet. From what I’ve read up until now, your blog has had a norm of sharing and civility which I’ve appreciated. I hope that norm can continue even if people disagree. I will continue to read your work because I find your honesty to be refreshing. Linda

    Dr Burgo,
    I can refer you to an excellent professional network for the purpose of becoming better informed about the best theory and practice in working with transgender patients. I can understand how you may consider that transgender people may be nonobjective about their condition, identity and situation. I’m sure you may believe that any professional who, despite greater study and exposure and experience has just “drunk the Kool Aid”. However I invite you to consider that your projection of pathology on transgender people may be based on lack of information and preconceptions and perhaps some uninspected antiquated notions. I have had the pleasure of working withing my community with literally thousands of people and observing transgender people’s lives over decades. Discrimination and bias in both the general public and on the part of professionals can make life very difficult indeed and is a source of direct stress and can exacerbate many conditions as you might expect. If you are not afraid to grown and learn even after this long in your career, I encourage you to invest more before expounding on this subject as an expert.

    Breanna Anderson

    In my experience, the professional network is geared toward helping people transition. I know a therapist who specializes in helping people in transition, and when I suggested to her that a trans identity might be formed in the earliest years of life as a defense against core shame, it had NEVER even occurred to her. Thus I’m not terribly interested in what my professional peer group believes because it is only consensus formed within a particular political climate. I’m interested in the science that does or does not support the trans identity theory.

    BTW, it doesn’t help your argument to ask whether I’m afraid to grow up.

    Well said Joe.

    I think this throws up lots of issues that are worth exploring. Rights and illness are very prevalent ways of thinking in our culture.

    I prefer to speak or interests (or even duties) than rights. And defining an illness gets tricky – the diagnosis “PTSD” has been a nice innovation in this regard I think; it acknowledges that uncommon behaviour can be an entirely sane reaction to an appalling situation. But this doesn’t the reaction doesn’t bring misery that needs to be alleviated if possible.

    As to trans stuff. It is hard to know. In our culture these people are bound to feel neurotic and have all sorts of issues because their self concept isn’t main stream. So I do think all can agree on eliminating discrimination.

    I had my little knowledge and big opinions about transgender issues before reading these last posts. I didn’t even know that there was more to it than “Transgender people – somehow born the wrong sex – need help fixing this (also, though: “We, the liberals are the good guys, and being accepting of transgender people is one way for us to be better than the intolerant people who think they should stay the way they are for religious reasons” – actually, I think, deep down, this stance was the reason I had an opinion about this at all, as I don’t know any transgender people, not even friends of friends). Thank you for helping me see that the issue is so much more complex. I don’t know if I agree with you, but I like having my prejudices challenged.

    “Another reader, more measured in her response and trans herself, states that “there are many in our culture, who will take a post such as yours and hold it up as a rationale for denying someone like me equality, while claiming they [have] backing from experts (you). I realize that is not necessarily your intent.” Like Lauren, she seems to feel that I should suppress my opinion because other people might mis-use it. ”

    I think that’s a valid point though, and I don’t think acknowledging it would be the same as suppressing your opinion, nor do I think was it suggested you should suppress your opinion. It merely pointed out a consequence of your actions for a fuller awareness and I don’t even think it sounded accusatory.

    With all due respect, when I read this one partial sentence,
    “While I may not have much experience with transgender individuals, ”
    I learned everything I needed to know about the controversy here about transgenders and the post that set off this controversy.
    Extrapolating an opinion from “not much experience,” is like saying I read something once about something so I can offer an opinion about something.
    I find this blog interesting, no I wont “unfollow,” but I will consider the opinions hereon in with a slight bit more skepticism.

    It almost never fails that no matter what the topic is and what the responses are that what we will see and experiences is a great variety of opinions on whatever the subject is. Those of us who make a living defining what is and what is not and the specifics of what those definitions are will feel a strong urge to approach the subject with what our emotional, educational and yes, spiritual investments are. To choose one or all of those preference to make a point of one kind of another has to in some way offend someone if for no other reason than the statement itself will be seem to be statement of fact rather than opinion.
    How quick we are to forget how fortunate we are to have freedom of expression. O.K. I know that those of us who have opinions which is every one of us, base those opinions on personal or professional experience. So far so good. It is o.k. whomever agrees or disagrees, but and in doing so it does not make the lesser of other opinions.
    Stepping back and away from what the subject matter happens to be we cannot help but wonder if there is a larger issue. I did not say a more “important” issue I simply suggest that there might be issues of greater magnitude. What we face in every statement of value or opinion is the issue of freedom to make those statements or have those opinions. Along with those opinions and statements is an indication of some measure of tolerance in our society for “whatever.”
    We live in a society where laws and regulation influence the distribution of power and abundance. And whether that power be individual or structured as a collective, it maters. Whether those law or regulations are socially imposed by attitudes or legislated into being by a legislative body, they exist as part of our agreement with one another. What we allow we agree to and like it or not change is subject to those allowances.
    The question is can we talk about what use to be called by some personal politics linking itself to individual behavior without precariously slipping into the larger body of politics?
    I think not. The line becomes more blurred as time moves on.
    Tolerance is the greater issue for those who live the life of any personal choice that can be made. No matter how someone chooses to live, how can we as fellow human beings assist in reducing their pain and suffering without feeling the need to define the rightness or wrongness of that choice. Remember, I’m not interested in who did or who did not accuse or offend the other . Another question is will our sympathy continue to be based individually on what “I” would do because this is how “I” feel because these are “My” experiences and my values. Life is Humanity. The sum is greater than the the individual parts. Or something like that.

    Thank you for speaking truth and being uninhibited in ecpressing your professional opinion. I look forward to your posts and appreciate the insight you bring. They have helped me in my recovery journey.

    Well said. It’s hard to speak out in the face of some of the hostile comments you have received. Some people just love being hostile!

    Dr. Burgo,
    I just wanted to note that I understood I was to filter all that you voiced starting with your 1/29/14 post, through your clear message that this is ALL from your PERSONAL point of view. Meaning to me that you are another one of us human beings voicing a view that feels like it is valuable and helpful to put out there but that I respectfully and thoughtfully keep in mind is also formulated from a vast repertoire of knowledge and experience. You voiced discomfort that sometimes folks may idealize your words of comfort and wisdom (ie-you) because of your position (maybe relying/leaning on your identity/sense of self rather than evaluating/processing your ideas through their own separate/strong identity?… A self-esteem issue in the mix here?) which then shocks and hurts when the illusion is busted as you voice something not comforting for them which consequentially sends them into a tail spend of attack/ backlash. To lighten up a bit, I add my short anecdote: When I took a college course in Abnormal Psychology last year I was approached differently for a good while… Many folks I knew would cautiously ask “are you psychoanalyzing me right now?” It took a while for them to to modulate back to the reality that I am still just imperfect me that simply took a psyche course to hopefully understand behaviors a bit better. I’d like to think that some of the folks in your blog just need processing time to think and modulate as well.
    Switching gears abit, I see the posting/blogging on the subject matter taking a good turn…. that many acknowledge the nature/nurture factor is blurry … with one hand checking and balancing, cautioning the other not to go off the deep end in either direction at this point…. some excellent firsthand experience and studies, but no concrete evidence yet. I ponder Ellen Degeneres. She seems genuine, smart, thoughtful, warm, empathetically witty, so open and real about life. She seems to be in a relatively healthy place, having chosen to/taking the direction to incorporate her homosexuality rather than challenge it. Maybe she missed out on being truer to herself had she attempted to challenge it psychologically? Maybe gender issues share the general premise applied to other behaviors/ character traits: if it causes distress and/or impaired functioning, then define and treat it as a disorder?

    The “distress” angle seems to be one shared by other readers. I’m not sure what you meant about EG when you said, “Maybe she missed out on being truer to herself had she attempted to challenge it psychologically?” She seems to be very much herself, at peace with her sexuality and her identity, which seems to me to be a blend of masculine and feminine aspects. I’m not sure what “truer” would look like. I think I’m just confused and don’t understand exactly what you meant.

    In my opinion people with mental illnesses should be given equal rights and addition help. It seems that this population of people are severely stigmatized and for the most part receive minimal help and compensation.
    As far as the transgender issue, I do not know, but life is short and people make choices—what’s important is that we treat all people equally and with compassion. This is off topic, but of great interest to me.
    I think people do not realize the devastating effects of abuse. Look at this recent example, Dylan Farrow. She says she was sexually abused by her father, Woody Allen–“I believe her”…You can read her letter and decide.
    She is writing now—partly, I think to help with her recovery—it’s part of the empowerment. But also to help other people that have been sexually abused. It is very brave of her. Obviously, as she notes, many people like Woody and thus would like Dylan to shut up.
    Mental Illnesses
    She has/had an eating disorder. Many people who have been sexually abused end up with a mental illness[es]. In order to get better [e.g., eating disorder treatment] it costs a lot of money!
    As she says, “Woody Allen is a living testament to the way our society fails the survivors of sexual assault and abuse.”

    Here is the link to the article:

    Why not accept what transgender people and their supporters say, that this is not a mental illness and that saying the kinds of things you say is harmful to them? Are you in a position to actually know better? Your opinion, which isn’t backed by the scientific evidence you require of the people talking about their own experience, can be harmful to others.

    Mr. Burgo:

    I have been reading your blog for a long time. I get a lot out of your posts, but I am saddened by what appears to me like an unfair response to some of your readers.

    I did not read an ad hominem attack in Kelli and/or Lauren’s posts, and Lauren’s post in particular did not read like a ‘long, angry tirade.’ From the vantage point of those of us who did not agree with you, you appear defensive.

    You do not need to agree with these posters, but they deserve the respect of a ‘thank you’ for sharing their opinions without accusing them of attacking you. Especially when many of us on the outside don’t feel that they are.

    We all have blind spots. Even psychotherapists. I just hope you can take the feedback given to you and sit with it for a while – without feeling the need to justify yourself – and see what happens.

    Though I appreciate your honesty about your feelings toward Lauren’s cancellation of her subscription to your blog, I’m concerned that you feel irked by her actions. Her problem was not with your opinion, it was with your response to her post that was unsettling – and she has every right to feel that way.


    I think the problem here is that some people just want everyone to agree with what they believe. Express a different opinion, and some people will absolutely HATE you for it!

    People need to be able to deal with others who have different views. Beleive me, there are a lot more serious issues in this world than trans-genderism. What percentage of the population is trans-gendered? Maybe 1/10th of 1/2 percent?

    To think that someone loved the blog before, and now is quitting because of this discussion shows me the INTOLERANCE people practice. I didn’t find the original piece offensive at all.

    Look – SOMETHING has got to be the cause of trans-genderism. I also suspect it’s got to do with some type of abuse very early in life. Who knows, but don’t hate Dr. Burgo for wondering why. That’s his profession, trying to help his patients figure things out!

    I read all the blogs here, but don’t respond often. I’m going to keep reading the blogs.

    Thank you.

    I feel like you’re continuing to try to defend yourself with this last post. I think this argument would be best served if everyone stopped trying to pass the ball over the fence. Just let it sit where it is and stop trying to be “right.”


    I’m not sure if you are aware that most transpeople do not have surgical interventions. Some do not because it is prohibitively expensive, but most because they are uninterested. Identifying as trans does not equate wanting a different body or believing everything would be better if only bodies were different. For people who choose to, there is a biased legal standard of mandatory psychotherapy (Benjamin criteria) that folks who undergo major surgeries do not have to engage in (preventative mastectomies, gastric bypass, cosmetic surgery, etc.). While I think this time could be invaluably used to discuss expectations of surgery on mental health (though I believe you don’t give transpeople enough credit in knowing that surgeries aren’t magic happy pills that fix everything about their life) I view this mostly as punitive and costly, letting psychiatrists or psychologists be the judge of whether someone is “man” or “woman” enough. Some psychiatrists/psychologisits won’t sign off on any body modification if someone doesn’t pick a gendered enough name or consistently wear dresses or do their nails or have long hair (for women). Some doctors don’t believe people can/should be trans and gay (trans folk who are attracted to be people of genders similar to their own ex. someone with a “male” body who identifies as a women who is attracted to women). Some doctors don’t think their “patients” are “trans enough” if they aren’t interested in full sex reassignment surgeries, let alone any at all. This I think is the opposite of supporting senses of selves as is that allow for fluidity and change, and continues to exacerbate our society’s assertion that there are two genders, that match up with two kinds of bodies, that are only attracted to ones that are different.

    I agree with you that it would be great if folks could live as is without gendered expectations or gender as a regulating force of power or value , and believe we should actively pursue social change that breaks notions of stability of gender, sexed bodies, and sexuality. But when you make essentialist claims like taking years of therapy to help someone connect with their femininity, I don’ think you actually agree with that agenda. It becomes transphobic when you are ok with cisgender people who having strong ideas of gender and gender identity but then assert transpeople should not and that they should both accept some notion of fluidity/genderlessness and a mental illness label. Unfortunately, gender is a powerful subjectivity, framing our senses selves, interactions with others, political and economic power, reified in our language, etc. that telling some people to stay out of our systems of gender while supporting indoctrinating of others into it (ex. connecting with femininity) seems systemically oppressive to me.

    Transpeople are one of you best allies if your goal is building a world that is not built on gendered oppression, but if you pathologize transpeople instead of actually listening to their perspectives and critique, not only are you participating in the systemic discrimination of transpeople, you will not get that world you seem to envision.

    I also believe that the mantra of “born into the wrong body” has been problematized within the trans community and I mostly only hear it from white cisgender liberals or people who live in the 90s. It is as much a rhetorical strategy as it is a belief, as our legal framework privileges protections against seemingly embodied discrimination (based on sex, color, physical disability, etc.) then on ones that lack claim of embodiedness. The mainstream LGBT rights organizations have pursued discrimination protections along the lines of civil rights for people of color by rhetorically using the language of embodied or “born this way” rhetoric because to them it seems it leads to legal expediency. As an aside, I don’t see it as a great strategy, but it does counter and try to protect against a lot of discrimination thickly layered on LGBT folks who before such mantras were attacked as immoral, criminal, and pathological, often internalizing such messaging. It seems you believe you should still pathologize transpeople, but don’t get that in doing so, you’re likely to evoke more such “born this way” rhetoric. If people stop moralizing, criminalizing, and pathologizing transpeople , gender nonconforming people , and queer people, I bet you’ll be exposed to much more interesting and meaningful conversations about sex, gender, and sexuality.

    This is very helpful, Martin. I have no problem with people (non-surgically) altering their appearance and adjusting conventional gender identities to more closely align with the ways they feel about themselves. I have a number of lesbian friends, for example, who dress and behave in quite “mannish” ways but are undoubtedly women and comfortable as such. They seem to stand somewhere between conventional notions of masculine and feminine. I actually prefer to be around people who don’t too rigidly conform to gender norms because I usually find them more interesting.

    Maybe I’m wrong, but it seems to me that it’s one thing to say: “I feel like I’m not really a woman in the conventional sense. Sometimes I feel like a man and I feel more authentic/comfortable when dressed and behaving like one, even though I know I’m still a woman.” To my point of view, it’s quite another to say, “As a matter of actual fact, I am a man living inside of a woman’s body,” whether or not the person has surgery. One seems to embrace a confused, messy, bi-gender identity I can relate to and the other to think in starkly binary terms. I’m with you on the need to stop moralizing and criminalizing, but if someone self-identifies as the opposite gender as a kind of denial, I think we’d do better to help them recognize it.

    I think you are correct that these two statements are somewhat different. I do think you are incorrect in labeling one healthy and one pathological.

    I don’t think the first one indicates a messy bi-gender identity, it seems that someone is expressing their gender in a way that is comfortable to them. Also, “Even though I know I’m still a woman” is the same thing as saying “In fact, I am a woman living in a woman’s body.”

    The second one seems too simplistic and not the whole story of someone who would say this to you, and implies nothing about the complicated expression of the gender they identify with. You flesh out the first statement with much more nuance that you do not seem to believe trans people (just like cispeople) have about how they do gender.

    I would also suspect that if you propose your hypotheses about some of your lesbian friends sense of gender and identity to them, they would likely disagree and be offended.

    Also try the “confused, messy, bi-gender identity” bit.

    Here is a script:

    Hi lesbian friend, I like that I can relate to you because of your embracing of a “confused, messy, bi-gender identity.” I know you must not “feel like a woman in a conventional sense,” and that sometimes you “feel more like a man and more authentic when [you] dress and behave like one.” Can I tell you more about how “mannish” you seem? Even though I present as a cisgender straight man who does believe I make choices about living as such or how such presentation affects my life, I like and relate to people who do not conform to rigid gender norms, so I like you.

    I don’t think (m)any of your friends would agree that their gender is messy, confused, or bi-gender. Women of all sexualities and gender expression may not feel like “women in a conventional sense” because there is no such thing, no matter how much they seem close or far from traditional gender norms. They also might point out that you rely on rigid understanding of gender/sex to describe their identities and sense of selves as if you know all about them, without first asking their understanding of themselves or questioning those rigid assumptions.

    Hi Dr. Burgo,

    I want to start out by saying that I found your blog recently and have been working my way through it as I search for information on BPD–my fiance’s singling likely has BPD and over the years has repeatedly hurt all members of the family. Your blog has been a source of insight for not only that topic, but for my own neuroses. Thank you very much. I will continue to keep reading, and I appreciate your insight and willingness to share your experiences.

    I just wanted to touch briefly on your dislike of a binary system of gender–the “either/or”– and a few other things. I too see no clout in a binary system, and see gender rather as a spectrum, or a web (I’ll call it spectrum for simplicity). I would like to present another opinion, however, that while many people fall somewhere in the middle of the spectrum, wanting to be at the extremes of the spectrum are not inherently wrong–whether it’s a person born anatomically female who wishes to be at the extreme feminine side of the spectrum, or a person born anatomically male who wishes to be at the extreme feminine side of the spectrum, or still yet someone born anatomically outside of the binary system who wishes to be at one extreme or another of the spectrum.

    Another interesting point to consider that doesn’t seem to have been touched on in either your blog posts or the comments, is the degree to which fetal brains are highly sensitive to hormone levels, and that there is frequently a clear biological distinction in male and female brains (with any degree between), regardless of the anatomical features the person is born with, determined by hormone levels in the brain at critical periods of development. Sometimes there really can be a biological basis for gender identity manifestations.

    I think you raise an interesting point, that to bring up an opinion or point of view that is contrary to recent advances in diction choices, or view points, can be increasingly difficult. Honestly, I (personally) think it is for good reasons most of the time, and that the underlying reason for changing terms, view points, etc, to be ‘politically correct’ is to acknowledge the judgement previously in place.

    I think the strong reactions you initially received (and this is my opinion–so clearly I may be wrong) are because you presented this view point as complete and somewhat absolute. In your follow up post you acknowledged that this is your opinion/view point, which I thought was really necessary. Thank you. I think, given the complexity of this topic, if you had begun your original post with this, you may not have gotten such a negative reaction. Maybe even by posing it as a possibility since it is an opinion, as in, ‘what do you readers think about this’, could have opened the discussion, but still have left room for the people who do not have a traumatic underlying issue.

    I do think that the basis for your post–the possibility that a person who is trans-gendered may have an underlying issue of shame, etc as you mentioned, should be considered. I don’t think anyone can really dispute that if this is the case–that if there is an early traumatic reason for their deep feeling on their gender–then understanding and exploring that experience is a really good idea before going through with surgeries, etc, and that if you work through those feelings you may end up feeling differently about your gender identity. However I think it’s necessary to also acknowledge that if this is not the case, if there is no underlying traumatic experience, that if their core shame is rooted in the fact that they feel intensely that their body should reflect x-y-or-z gender that they feel within themselves but instead their biological body is anatomically p-q-or-r, then surgeries/hrt may be a good course of action.


    I did find comments towards the very end of the other post on fetal brain development and gender. Your response to someone was that this is weakly supported.

    Funct Neurol. 2009 Jan-Mar;24(1):17-28. Sexual differentiation of the human brain in relation to gender identity and sexual orientation.

    From abstract: “However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in transsexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no proof that social environment after birth has an effect on gender identity or sexual orientation.”

    There are many others. I am not saying there are no cases where core shame is the root of gender identity, but I don’t think it’s possible to deny a biological link in at least some cases given what is known about fetal development.


    I definitely don’t argue with the science here. But I’d point out that having a brain that has been “masculinized” to some degree does not make a person with XX chromosomes into a man. And here’s a question based on my lack of knowledge: are their instances where the brains of people with XX chromosomes have been FULLY masculinized — that is, are indistinguishable from the “normal” brains of persons with XY chromosomes? The answer to that question might be an interesting place to continue the conversation.

    Very reasonable, and thank you. I also realized that another reason people reacted badly to my post is because of my sarcastic, disapproving stance toward Toby Sheldon. Even though I changed tones in the second half, I think the memory of my sarcasm “carried over” into my discussion of transgender issues and people felt that I was judging and disapproving of them.

    I think it might help to look at it less as being politically correct, and more as displaying contextual awareness — framing your opinion so as to make it clear where you locate yourself in the current social/cultural/political discussion surrounding transgender awareness and LGBT rights.

    At this particular moment, trans activists are reaching a tipping point in their efforts to bring trans awareness into the mainstream, and the gay rights movement, in general, is experiencing the vicious backlash that all rights movements experience when they come close to achieving their goals. In that climate, discussing this topic is kind of a minefield, and that doesn’t mean you can’t say anything, but it helps to be aware of the mines and finesse your approach a little bit to avoid stepping on them.

    For example, in this post, you clarified that, as a mental health professional, you don’t feel that it’s an insult to describe something as a “mental illness” or that having a mental illness means that a person should be treated disrespectfully. That would have been a good thing to clarify at the outset, given that a lot of people who are not mental health professionals call this a “mental illness” specifically for the purpose of dismissing and invalidating the experiences of trans people, and explaining why it’s okay to be mean to them (often in colourful language).

    My guess — and you can correct me if I’m wrong — is that, when you first posted, you weren’t aware of where all the mines were in this particular minefield, because you haven’t been as personally invested in following the social/cultural discussion around this issue. That’s fair, since we can’t all be personally invested in following everything, but I think it might explain why the comments went kaboom.

    Very wise and yes, I would have done better to pay attention to the particular political moment in which I was writing. I had some vague awareness of the minefield I was entering, but clearly not enough!

    As a published and well-referenced journal author, psychologist, and nurse with a focus on sex, gender, and identity issues, I would like to respond to Dr Bargo’s opinions.

    Once-upon-a-time the medical world thought hysteria, crying, and sadness were disordered female behaviours and signs of maladjustment that could be cured by hysterectomy. Once-upon-a-time therapists thought homosexuality could be cured through psychotherapy. Contemporary misgivings around sex and gender issues still remain in some circles. Feminists often label differences between the sexes as political while some in the medical world think of them in relation to psychological or psychiatric disorders. Whilst there is much more unknown than known about human biology, there is abundant scientific evidence that shows pre-natal and later pubescent exposure to sex hormones influence differences in anatomy, physiology, cognition, gender, and sexuality within and between the sexes.

    The belief that “on a factual basis, there is no scientific evidence to substantiate the theory that people are ‘born into’ bodies with genders that don’t match their emotional, psychological genders” is simply incorrect. Such evidence does exist and is mounting. Further, all good science starts with sound theory and there is a new theory that proposes all human variation is not categorical and comes as continua including bodily sex, brain sex, and sexuality. This theory suggests individuals are not simply categorically different as male or female, rather, any sense of bodily sex, brain sex (gender), and sexuality, comes normally distributed in all shades along separate yet interlinked continua. And significantly to this discussion, this new theory proposes these continua are not always in harmonious or ordered alignment.

    “Profound shame” sooner or later often results from the degree of failure to integrate into societies that consist of adaptive cisgendered individuals (being cisgendered is the norm). Such ‘shame’ was once the experience of the homosexual community. For many years, scientific understanding has not favoured psychoanalytic and psychological explanations of the origins of homosexuality. Importantly though, it is also too simplistic to maintain nature alone drives the human profile; innate and psycho-social elements act in establishing our human identity, one that remains flexible throughout the life-span, although this does not apply to bodily sex nor to brain sex (gender).

    Transsexualism (now more accurately referred to as the neurologically intersexed) is only as ‘disordered’ as the physically intersexed or homosexual population. All are clearly natural variation in the expression of the human condition. Transsexualism is arguably not of itself a disorder, unless you are predisposed to label much of natural human variety as ‘defensive identifications’ and ‘disordered’ thinking. People expressing an ancient transsexuality were once revered in their culture of origin only to be later denigrated in Western history under homophobic patrilineal cultures. Across Western civilization such denigration used to include homosexual populations and still does in many other cultures.

    Although medical supervision is appropriate for best outcomes for the neurologically intersexed, psychotherapy aimed at ‘trying to fix something wrong within them by [not] changing their exterior’ is unhelpful to say the least. Successful treatment of neurological intersex identities consists of measures designed to aid conformity to their gender and not to change their gender to match their anatomical sex. Research does suggest that those who seek pharmacological and surgical support do not harbor any more underlying psychopathological co-morbidities than does the general population, whereas, identity problems plague those who do not seek bodily re-alignment.

    The difficulty for medical practitioners is to filter the rare transsexual individuals out from other sex / gender variants including the body dysmorphic, and from fetishes including cross-dressing, transvestitism, and any other satire of the female sex. Psychotherapy is detrimental to and an ineffective ‘cure’ for the neurologically intersexed. It cannot be ‘cured’ by psychotherapy. Such a belief is as barbaric as was the whipping, canning, bashing, stoning, executing or otherwise attempting to exorcise homosexuality from individuals.

    That transsexualism results from an emotionally ‘catastrophic infancy and early childhood’ is atheoretical, vague, and as un-provable as is autogynephillia and repressed memories. More logically, the culturally unacceptable disrupted alignment of the biologically derived human continua, may result in some individuals finding difficulty fitting into their society.

    According to the American Psychiatric Association, it is valid to regard neurological intersexuality as a legitimate, though rare, form of human variability. Assisting in the rightful life choices of individuals who identify as such is no longer regarded by many as treatment for a disorder. Assistance with this life style choice is dispensed under widely accepted guidelines and explicitly aimed at transforming the body and not the mind.

    Your comment about your client’s vagina – “that smelly black festering wound in her body” was not worth sharing with anybody, it makes no point other than between you and her. Please never use such a statement again, it is unnecessary, adds nothing to you claims, and could well be taken as denigrating, smutty, degrading, and hugely offensive, and further, its use could definitely be interpreted as misogynistic.

    There is a whole lot more, but suffice to say, alignment of the continua in any way removed from culturally accepted norms may result in other than an ordered life. Bodily sex is not anatomically fluid and only partially medically / surgically alterable; brain sex is not anatomically fluid; however, there is evidence about biological flexibility that suggests sexuality, while biological in origin and not necessarily heterosexual, is also end-pleasure related and subject to psycho-social situations – i.e., reproductive sex is secondary to relational or bonding sex.

    There is the possibility that Dr Bargo is saying nothing about the origins of neurological intersex (transsexuality) and only giving his opinion as to where identity issues, such as those labeled Body Dysmorphia and Gender Identity Disorder, originate.


    I disagree with most of what you say, but everyone should have the right to his or her opinion. In particular, I disagree about the value of describing my client’s experience of her vagina. It exactly conveys the felt experience of core shame; it’s the language many people use to describe themselves when they get in touch with it.

    And no, I was not speaking about the rare cases of neurological intersex as I know virtually nothing about the science around it.

    Honest question – what are your thoughts on ex-gay or reparative therapy? You seem to think the APA is hostage to the “gay lobby” so do you think homosexuality should have been removed from the DSM? What if a distressed teen was being pressured by his religion to become straight? You seem to pride yourself on rejecting political correctness so do you think gay people can change to straight?

    Well… don’t ideas of gay and straight rely on binary understandings of genders and sex? And you believe these are fixed and should never allow for change as well? So it seems you still assert that people have two kinds of bodies (male and female), their gender should correspond with these bodies (man and woman) with allowance that some tertiary characteristics can be played with, and people can be attracted to only men, women, or both. This doesn’t seem very broad, fluid, or non-rigid to me.

    For all the talk on fluid understandings of gender, you still rely on two very rigid and over-determined anchors of masculine/man and feminine/woman to locate between, with very little flexibility of bodies. But these anchors you depend on for fluidity are falsehoods. When we write out words that we think of when we here “masculine” and when we think “feminine,” not only does everyone identify words on both lists, these lists will change over time and across culture. This means these anchor posts aren’t really real.

    When I say they are over determined, even young children can sense what words they SHOULD be masculine and feminine, and if we have certain kinds of bodies we should identify with these qualities. We learn this from family, media, school, etc., and often punished from staying from them and rewarded for adhering to them.

    Long story short, I don’t get how “As a matter of actual fact, I am a man living inside of a woman’s body” is pathological to you when if someone said “As a matter of actual fact, I am a man living inside a man’s body,” you would not have the same reaction to pathologize, even though they both are equally untrue statements. Similarly if someone said “For a fact , I’m gay: I am man who is attracted to men,” it would be equally as untrue as someone saying “for a fact, I’m straight: a man who is attracted to women.” It doesn’t seem you would question these people’s understanding of themselves despite the falseness of their statements.

    Maybe you are hung up on the “for a fact” bit. What if you replace it with, “this is my truth,” or “this is how I understand myself.” All people experience their identities differently and all have contradictions; what matter is that people experience themselves in the way they experience themselves. For some, that means close to the caricatures of masculinity and femininity no matter what sex we born, others have strong identities as men or women but express those genders in ways that others don’t think of as very manly or womanly. some people don’t want to have genders, some people have genders and want to make changes to their bodies for all sorts of reasons.

    Martin, I’m not sure this is your intent. But it sure reads like you are would advocate that sexual-identity-modification (the word reparative is a disgrace) therapy be something between the therapist and the client, and not something that ought be in the realm of public policy. No?

    TPG, what makes you think I support (I’ll use) conversion therapy?

    I certainly believe there is no evidence in support that any clinician has the skills or ability to change sexual orientations. I believe there is a lot of evidence to support that such therapies often lead to sustained and sometimes fatal harm. So I believe it is deeply unethical for clinicians to market that they can help change sexual orientations and engage clients in the process.

    As a matter of public policy, I would advocate insurance/medicaid reimbursements only be for treatments that have demonstrable intended efficacy (so not conversion therapies). This would keep the costs of such conversion therapies high (and hopefully limited). I also think that licencing boards and respected professional organizations should not accept practitioners of such therapy, limiting many of their privileges.

    I also believe that it should be law that minors cannot be forced into “conversion” therapy or programs (and I applaud California for making this law).

    That being said, even though I think it is ethically wrong and often a real tragedy, if an openly unlicensed professional can convince an adult with a large sustained income to pay them lots of money for a treatment that won’t have intended effects, I don’t know what could legally be done about that. I don’t want to offend Joe on his own site, but certainly some unscrupulous psychoanalysts get away with a similar racket legally (no licence/updated credentials, cash only practices, therapies that last for years without intended effects, limited evidence of intended effects and evidence of potential harm, etc.)

    That all being said, I do not like to disparage people for having an “ex-gay” identity. It is how some people identify and part of their lifecourse. While I don’t think sexual orientations change from any known therapy, I believe sexual identities are diverse and contextual and don’t have to stay the same forever, so I would respect someone’s subjective experience of themselves. I’m not sure Joe has that respect for the transpeople and their identities.

    My response to Joe was somewhat rhetorical. I say this as a gay man; I don’t see how Joe is so certain of fixedness of sexual orientation and “wellness” of gay people, but somehow claims transgender people are pathological for having a trans identity, does not believe them when they say what their gender is, and encourages treatment for their “condition” (sounds like “gender reparative therapy” to me).

    I read all of these lasts posts and comments. I am actually quite happy that you have brought up some interesting ideas about transgender people. At the clinic where I used to work, I came into contact with quite a lot of transgender people. I was happy to treat these patients. I could tell they made others feel uncomfortable, though. I don’t think it’s wrong to be transgender, and I would never want a transgender person to feel rejected or ostracized.

    And yet.

    I have often wondered if there is “something going on” with transgender people, besides the pain of being rejected by much of society. I have often wondered if their desire to alter their bodies/gender had anything to do with a deep shame inside (like the deep shame I feel in myself). I know my shame plays out in many ways, and I have become more aware of these types of things ever since reading your book, Dr. Burgo.

    I don’t think it was wrong of you to bring up the ideas you brought up. I think it’s good food for thought, and it would be wrong to let political correctness stop you from saying something that really has merit.

    Thanks, Emma. It’s nice to hear that these same ideas have occurred to someone else. I don’t think it’s “wrong” to be transgender, either. I don’t condemn or criticize; I just question the current modes of treatment to help them.

    I don’t want to take up much more blog space, but I have been thinking about these series of posts a lot.

    What I think triggered me the most that I couldn’t even respond to in my first response was the discussion between Miranda and Joe about “bad old days of discrimination” as if those days are over for transgender people. News flash: they aren’t! I would argue that whatever core shame issues Joe purports every transperson has and the suffering it might induce, it pales in comparison to suffering caused of the discrimination, ostracization, fear, and violence transpeople experience–particularly for transgender people of color–from every sector in our society from intimate partners and family through all sorts of grander institutions (jobs, healthcare, bathrooms, prison, school, military, etc.) that cisgender people rarely or never have to think about out. And if they do, it’s often because they are making claims about other people’s identities and concepts of self. Actually, these whole series of posts are triggering for me because Joe makes claims about the inner lives of transgender people admittedly without expertise in psychotherapy/psychology of transpeople (if there is such a thing), experience engaging with transgender people in his personal life or clinical practice, or identify as trans/variant/genderqueer himself, yet still claims a space to express strong and stigmatizing opinions about transpeople. Even further, when challenged, he gets angry and writes more about feeling “oppressed” from being challenged on these opinions (again, which admittedly are not informed) and stifled by political correctness. That’s the definition of unchecked privilege. Thinking you should be able to make claims about other people’s lives/identities without knowing about their lives/identities and then claiming the “oppressed have become oppressors” when you are challenged demonstrates a poor understanding of oppression and that challenges are likely valid.

    I suggest you read this timely blog post by Lambda Literary Award winner Mia McKenzie, called “4 Ways to Push Back Against Your Privilege” – http://www.blackgirldangerous.org/2014/02/4-ways-push-back-privilege/

    I’ll leave other thoughts about changing DSM diagnoses, health/health insurance, the cost of sex reassignment surgeries, out of this one…

    Thanks for the opportunity to continue the discussion.

    Looks like Piers Morgan has had a similar experience to you, Joe, this week:


    I think this second interview was a great opportunity to allow Janet Mock to explain why she criticized Piers over twitter and for him to really listen and be respectful. Instead, he was defensive (and gasp!) has been so distraught over his experience of “an infuriating 24 hours” of being “viciously abused,” as if transgender people do not fear and experience actual abuse everyday and he is the real oppressed victim. His “narcissistic”ego (to use language of this blog) was “villified” and responded from that perceived injury to his image.

    Notice how Piers get righteously upset that, as a self-identified liberal, that his language was called out as offensive, even when talking to the person whom was offended by his language. He doesn’t really try to elicit why his framing of Janet’s life was offensive, and disagrees with her to her face when she tries to explain trying to persuade her how not offensive he was.

    Notice he keeps trying to get the last word.

    Notice how he ignored Janet’s honest expression that she was afraid to call him out on air precisely because he has expressed allyship and she didn’t want to lose it, while at the same time insinuating she’ll never keep allies if she called out how people like him described her and other transpeople’s lives. If allies are really allies, then they take to heart when their language is called out and listen to and respect why they were called out, especially if coming from the mouth of the woman he purported to be an ally of. It doesn’t feel good, but it’s not the responsibility of people who experience marginalization everyday for their experience to hold the space for the feelings of allies when they do ignorant things. There are other ways to get support.

    Notice Janet making the point that the lived experience of transgender people are constantly invalided, questioned, and vilified, and it is not easy to overcome repeated invalidation of your expression of self that comes from all angles (including the mental health community) and a maintain a fierce identity and life. She spent a lot of time and energy writing a book elaborating her experience for her own perspective, that Piers refused to engage with it.

    Notice Piers’ confusion between gender, sex, and sexuality. While we often think of LBGT rights, that moniker historically arose due to alliances between diverse communities with multiple agendas. Even (especially) national and prominent “LGBT rights” organizations like the Human Rights campaign has been fairly and v0cally criticized by transgender activists for transphobic language and policy. Saying he prefaces his support for rights of transgender people with his support “of gay marriage and gay rights,” his links sexuality and gender as if they function the same way. He also doesn’t get that Janet was not “a boy until age 18” because she may or may not had any surgery, but that she is a woman and was a girl, regardless of the basis her parents/society used to label her body male when she was a baby.

    Thought I don’t want to speak for Janet, I think part of the “sensationalizing” she talks about in regards to being prefaced as “a boy until 18” is that it both reduces her identity to any physical alterations that she may or may not have made and in focusing on a specific “transition” or “reassignment” draws attention to her body and particular parts of her body. It objectifies transwoman especially in a really disrespectful manner by being more interested in body parts than the complexities of their life. Katie Couric did a similar thin in her interview with Carmen Carrera and LaVerne Cox. http://www.motherjones.com/mixed-media/2014/01/katie-couric-transgender-laverne-cox

    I know I’ve been writing a lot but it’s too timely and parallel to not include.

    Martin, intense and interesting . Not that I understood all of your position.
    If one could take all the ugly judging energy, coming from society- off people who experience themselves , as being born in the wrong body..
    So, if you take all that judging energy off.
    And the person, who wishes to have hormone treatment/ have radical changes to their sexual organs..
    In that moment, to me, it would seem a sorta wise thing, as a friend/ therapist/ concerned(loving)onlooker- to say. Hey, do you think maybe looking at why you want to radically change your body, could be beneficial? To offer therapeutic help, to a person- who wants to have hormones injected. Have bits of themselves cut off or added too..
    This whole, defensive argument from the Let’s support everything the trans community wants, though I can understand is well meaning, it is also quite barbaric.
    Rather than say, yes.. Let’s look at this felt experience( I am a man in a woman’s body), and maybe
    Really really work on that feeling/ rather than say. Hey yeah, can understand you feel this. Go get hormones/ go get bits of your body cut up..

    I can’t separate the “ugly judging energy” from society from the experience of self. Joe advocates for a less political and more psychological frame, but I don’t see these as separate. Our psyches arise as much from political environment than familiar or psychological. Even if they didn’t, they are enmeshed in political, economic, and social realities that make some more intelligible and healthy seeming at the expense of continued pathologization and misunderstanding of others. If we lived in a world that was not built on systemic oppression around gender, sex, sexuality, race, ability, etc. then we would see a lot of what we would call improvements in mental health and and reduction of shame. Let’s get there before we start challenging people’s sense of self in their lived environment.

    Now people start putting words in your mouth, even if they can just READ what you actually said. They assume your positions on other issues (I hate those kinda people), attack you personally and just can’t accept that its just your OPINION.

    English isn’t my first language, so please excuse any mistakes.

    After having read posts and comments, I felt as well like Lauren’s comment was being politically correct, which is indeed for me, the equivalent of right wing’s hypocrisy. I understand the fear of being put in a box, of being labeled something you sense you are not. I understand this fear, but I think this fear is getting the best of people like Lauren, they are so afraid of being judged ” oh my God what if my trans friend had read your blog, what would she had think of me and my recommendation? ” And this fear of being judged is exactly what allow them to cast harsh judgements upon others “you are being insensitive”, like the fear of missing is going to make you stingy.
    Personally this is a trait of character I prefer not to see in the politician I am going to vote for, for example.
    I think that you cannot prevent people from putting you in a box, and you cannot prevent people from misusing your words. This is a risk one has to take, and this is beyond one’s control. And that is why I feel like Lauren’s type of thinking is a way of trying to control the uncontrollable.

    I agreed with your assessment of Lauren’s comment. I never felt her comment was either measured or fair, although I could see how some people could interpret it that way given all of her “respectful disclaimers”. It struck me not only as being politically correct, but it also felt covertly manipulative, deceptive and controlling. I wondered how you would handle it as I was well aware that the territory that you were venturing into was/is a political minefield.

    One of the dead giveaways was using the term “solidarity” to show support. That made it political as that is usually an attempt to rally or enlist people to join forces to attack the targeted opposition. It may not be the main problem either, but it is frustrating because once that is on the table it usually spells doom for any kind of productive discussion (not that you have control over their reaction).

    Unfortunately, like another poster I think that you’ve been inadvertently sucked into a nasty political quagmire. It is a huge reason why I stopped participating on sites where I encountered these issues all of the time–people putting words into my mouth or getting pulled into semantics and then getting pulled into defending my opinion more and more by people who are not interested in insight, but want and demand AGREEMENT or people who want you to suppress your opinion because of their discomfort.

    Political correctness gets under my skin for a host of reasons. At times it infuriates me and like you it also feels like equivalent of the extreme right’s hypocrisy as well, although now I tend to associate those tactics more with the extreme left.

    I also agree with Lullylux’s comments above. Despite some of these personal attacks there has been some good discussion.

    Speaking of Ellen Degeneres, when I commented “Maybe she missed out on being truer to herself had she attempted to challenge [her homosexuality] psychologically?” I was thinking if she had opportunity (to explore it deeply, say, with someone skilled with your therapy orientation), desire, and stamina, to from birth on, psychologically dissect what oriented her towards homosexuality, could she have discovered aspects of herself that evolved along the way she was not aware of before, such as a sophisticated ego-syntonic system of coping/defense mechanisms that in processing might result in realizing a self that was not ,say, so homosexually oriented? I guess I am wondering if in the ideal world if such opportunity and motivation was mainstream would it help remove/eliminate prematurely locked-in identity conclusions and true up homo/trans sexual identities (any identities for that matter) such that a person might gather more information about themselves and conclude “truth is I no longer need to feel/ need to see myself as so masculine or feminine a woman or so feminine or masculine a man or trapped in a foreign body- I have gone deep inside, uncovered layers of coping maneuvers/mechanisms and see that beneath them I am something else” ……. That won’t require cutting my body, etc. to resolve, after all.

    This is very interesting. In my experience, what you describe is sometimes possible with deep psychotherapy; at others, some kind of early imprinting seems to take place and sexual object choice is immutable. But ideas of “masculine” and “feminine” can definitely change quite a lot.

    What are your thoughts on being gay? Do you think that’s also a sort of confusion? Is society too accepting of this?

    What are you thoughts on people who consider themselves to be asexual? I can’t see myself in a relationship with either gender and it has nothing to do with any bad experiences.

    These are topics best left for another post. But in brief — I do NOT think society is too accepting of homosexuals. I think society should be MORE tolerant and accepting of transgendered individuals. I do not advocate for intolerance; I advocate for a deeper, less politically-informed understanding.

    There is no contradiction between sympathizing with LGBT rights and being curious about the psychology behind, for example, transgender people. Needless to say, truth should be superordinate.

    It is that simple, yet people go totally ballistic.

    Are you going to write a post on the Biggest Loser Winner? Talking about obesity, delayed gratification, weightloss, why people gain lots of weight, perfectionism, overacheivers that feel worthless and the winner’s controversy over loosing too much weight and how she actually does look normal would be a pretty hot topic.


    I have been following your blog for some time now. You are insightful, honest and a great writer…and I have been lucky to be on the receiving end of it. I think however that your success has pulled you inadvertantly into the political arena. Though all of this is good; even your thoughts on how (first) to treat/address those people struggling with their gender identity. I just think you get pulled into the political arena…you get pulled into semantics…you get pulled into defending your opinion more and more. And this takes “you” and your insight away from where the world could most use you. Basic shame.

    In a way, what your thoughts are…that those who suffer from basic shame….will never be rid of it…100% of it at least. Their ‘basic shame’ that they are ‘defective’ in and of itself with forever indeed make them in a way, ironically, defective…not a 100% whole…not a 100% unaffected…and therefore…not 100% EVER the most suitable to pair up with. Your theory; though painfully and possibly true, confirms their fear that they are ‘not worthy’ to be someones partner; someone’s father; someone’s mother’ someone’s child.

    People who have the misfortune of carrying with them Basic shame (transgender and non transgender people)…COPE in life by trying to accept they are NOT defective. You managed to off balance this necessary and important way of thinking. Though I know your intentions were NOT to do that all. You were unfortunately and consequently attacked. Your job is to further explain…your thoughts…we trust you. So just keep explaining it until people understand more. I know, and I think most viewers know, that you were not intending to offend. And think carefully on your own with your brilliant mind … on how to best HEAL.

    Hi Anonomous.. I know I’m defective. To me, acknowledging the imperfections in my growth, liberates me to heal and grow and love and create/ without the added burden, of trying to ” present” myself- as other than what I am.

    Political correctness means an agreement not to notice. And it means that if a person does notice, there’s a social contract not to notice.

    It sucks hard.

    One can be a fervent support of transgender and GLBQT and other sexual minority rights and still explore the roots of how such alternate non-normative sexualities develop. That’s how I see Dr. Burgo, with whom I do not always agree. But I applaud him here.

    I drop in here from time to time and I see some unsubstantiated criticisms and attacks on the good doctor Burgo. I once read an article by Isamov entitled PRAISE EXCELLENCE written decades ago and his laments that excellence in many things was and is lacking. Dr. J is an unquestionable example of excellence for sure.

    I am sure the homosexual/trans gender/lesbian issue has in cases resulted in emotional turmoil for these people but that does not justify attacks on a man effective, decent and competent in his life work.

    I have a saying, “He who does something gets criticized” and so Dr. J gets criticized for his intelligent and valuable contributions to society. I would advise the individuals unfairly attacking him to take their politics and cast them over the precipice, and remember that throwing dirt only causes one to lose ground.

    The Dr is intelligent and his shoes are worn to tatters since he walks the walk and is right there where the rubber meets the road. Personally to Dr. B, if the crowd chooses Barabas and demands that he be crucified I will gladly carry his cross for him and give him all the water he needs to drink. The fact is that the USA is still a free nation where freedom of expression is existent in spite of the efforts of the current administration and the cabal of kooks within, (there is my two cents at politics) and Dr. Burgo is still entitled to his opinions, in spite of what anyone would say otherwise.

    Keep on doctor, damn but you are a good man. I quite admire you and am familiar with a very intelligent transgender individual who I know would applaud you and your efforts.

    Agree, Joe. The heart of the matter.

    You say:

    “I support the right of anyone to do what they like with their bodies, and that would include surgery to alter the physical appearance of their genitalia. What I object to is a professional environment that encourages this approach and ignores the psychological pain and emotional confusion that (in my view) lie behind it.”

    It sounds as though you are referring to the concept of “transsexual” as opposed to “transgender”, so I’m going to use the word “transsexual” in my comment.

    Firstly, I’m a Master’s student in psychology, and am not a fan of slapping on diagnoses in general, unless absolutely necessary (for insurance purposes, the purposes of an agency, medical intervention purposes, etc.). I am against viewing clients as mentally ill for the most part, and would rather focus on their abilities, competencies, and unique strengths. The DSM has been largely helpful, but largely unhelpful and even damaging as well, and I think we as a community need to remember this and be wary of slapping on diagnoses, especially on entire groups of individuals, who vary quite dramatically in their personalities and backgrounds.

    I have direct experience with several transsexual persons, and my experiences do not support the idea that being transsexual is a mental illness. I know these are merely “case studies”, but I would never in a million years call transsexuals mentally ill for being transsexual.

    For clarity, I will say that I agree with your general political stance, as it sounds here. I’m moderate, and don’t really side with any party, yet I am typically liberal on most topics. I also see the weakness in being overly politically correct. My reason — it often covers very real inequality and injustices. The language can sound perfectly equal, but the actions are anything but. Politically correct can often mean sweeping the truth under the rug, or being too afraid or unwilling to confront a seemingly impossible or difficult reality. But I really do not feel that NOT calling transsexuals mentally ill is merely a matter of being overly politically correct. And if I’ve interpreted your post incorrectly, please forgive me.

    I identify as a biologically bisexual woman and am in a long term relationship with a man. I have dated women as well, along with one female to male transsexual person. From my experience with this person, I knew he had unresolved issues from his past, though no more than the next person. From as far back as he can remember, he felt that he was male. I am not clear how that calls for labeling his desire to change from female to male as a mental illness. After receiving hormone therapy and having his breasts removed, he has progressed greatly in his education and career pursuits, and is more stable and genuinely happy than he has ever been. He has many supportive and loving people around him.

    My friend’s child was born male, but always felt like a female, so began to identify as female around the age of five. She is now a few years older, and would eventually like to start taking hormones. This child has supportive parents and a warm, loving, fun home environment. There is nothing mentally ill about this young girl, and to even imply it would be a travesty. She merely feels that she was born in the wrong body, and biologically we know that various “errors” can occur during the embryo and/or fetus stage.

    Unlike many mental illnesses that originate in late adolescence or early adulthood, those who are transsexual almost always KNOW from a very young age that something is not right with the sex of their bodies. Many transsexuals often wait to begin their transition only because they have been repeatedly confronted with resistance from others. We are now seeing the sexual reassignment process begin in much younger individuals because they have loving, supportive people in their lives who ACCEPT them unconditionally without viewing or labeling them as disordered.

    I have known several other transsexual individuals over the years. Some had traumatic lives, some had mildly traumatic lives, but you know what?….many actually had amazing parents and stable upbringings. I don’t think it’s correct to assume that every transsexual MUST as a rule have traumatic childhoods.

    Body dysmorphic disorder belongs in a separate conversation. That said, of course it is possible that a transsexual person could have body dysmorphic disorder. But again, that is a completely separate issue. To even imply that a transsexual individual is mentally ill is a failure of the profession of psychology, in my opinion. I completely and totally understand your aversion to certain attributes of many individuals belonging to the political far left, but I feel that this aversion may be getting in the way of clarity here.

    Historically, we know that the impulse for some people to want to change their sex is incredibly old, and can be traced back to ancient times. These people would live in misery because they consistently felt like they were strangers in their own bodies. I view this entirely as a biological issue, and not a mental one. Mental illness can develop (and is likely to develop) when the individual is continually misunderstood and rejected by others. Is it not a good thing that we now have the medical technology to give transsexuals the bodies they have wanted since childhood?

    Transsexuals seeking surgery VERY rarely have more than the absolute necessary surgeries to make them appear like the sex that they feel they are meant to be. The vast majority of female to males that I know will undergo “top surgery” (getting breasts removed), but they will not receive “bottom surgery” (sex reassignment surgery).

    Also, up until relatively recently, historically speaking, being anything other than straight was considered a mental disorder, yet most psychologists and therapists no longer believe this. Why is being transsexual different?

    I’d like to add something else: We readily admit that a person can be born with physical deformities in various parts of their bodies. Why then is it such a stretch to also recognize that mutations can occur in the “sexed” regions of the body?

    And one more thing: If we were not born into cultures that were so divided along the lines of male and female, perhaps those born in the wrong bodies would not feel the same kind of pressures to physically transform their bodies into the correct sex, as they perceive it. In that case, label society as mentally ill, but not the person.

    I think the feeling of being born in the wrong body could be either biological or coming from past pain. As for the past pain, I think there can be serious feelings of shame laid upon people for being gay, particularly in strict environments. So, to cope, some may unconsciously convince themselves that they were born in the wrong body. I think the solution is to delve into any feelings of shame one may have for being gay, and flesh them out before making a gender-reassignment decision. That should be in the toolkit. Once underlying shame feelings are gone, it should be clear if it’s biological or was coming from past pain.

    I knew one teen who was going to undergo a sex change because a close (enmeshed) friend was undergoing one. This teen was so glad to have realized, before it was too late, that it was not wanted. The “counseling” for it was a sham. It was all just support for doing it because the teen said this desire was felt since childhood, even though others had the nagging thought that it was because of the closeness with the friend going to the hormones/surgery. In my opinion, the teen that did undergo the sex change seemed to have gotten good counseling and will likely thrive in the new gender role.

    I’m so glad the teen you describe didn’t make that major mistake. What you say seems so reasonable. Given that the lasting consequences are so dire, doesn’t it make sense to explore all the possible psychological motivations for wanting a gender reassignment? As you say, the pre-surgery psychotherapy on offer is all too often a sham. What I’m trying to do is to add the concept of shame to the conceptual “toolkit,” as you called it. Thanks so much.

    There is a long history of seeing/viewing homosexuality as a disorder. This line of thinking, re: transgender identified people, is too close to such pathologizing for my taste. How is it helpful to frame a conversation “diagnosing” trans-identified people as having a disorder? Coming from a hetero-normative male who does not work intimately with trans folks, this feels very strange and discomforting. Not to mention dangerous. Politically correct thinking is important because politics matter when it comes to rights for non-gender-normative people. “Male” and “female,” while certainly linked to biology, are even more certainly defined by cultural norms – as evidenced by the vast differences of how “men” and “women” perform their identities in varying cultures throughout history and throughout the globe. Transgender identification is a rich source of unconventional empowerment with huge potential for much-needed wisdom in an all-too-heteronormative world that assumes gender constructs are somehow the dictates of nature, and that to fail to fall into clear and comfort-inducing roles is a pathological disorder.

    ““Male” and “female,” while certainly linked to biology, are even more certainly defined by cultural norms ”

    Doesnt that defeat the “male inside of a female body” argument?

    My reading of @Sarah’s post is that social expectations around gender normative behavior, comportment and roles are highly socially influenced. Human gender is a playable field.

    The assertion (mine) is that Gender Identity exists, is intrinsic and it does not invariably align with assigned gender just as sexual orientation (target of attraction) is not ivariable the inverse of ones assigned, binary gender. If it so happens that your identity sufficiently aligns with your assignment, you probably believe you don’t even *have* a gender identity. You are just you, a normal boy, girl, man, woman. We are more and more recognizing that gender identities may have an intermediate locus between the strictly female and male poles and, I suspect, a variable strength of attachment to that center.

    This is a very interesting discussion. I am a psychotherapist who has been trained psychodynamically and am glad I found this blog. As a therapist working with the LGBTQ population, I can understand the anger and resentment certain individuals may feel in regards to your post; however, I also think it is important to keep an open mind about such topics. While I affirm my patients’ gender identity, that does not mean I know WHY the person identifies as male or female. The science is not there and the healthcare of transgender individuals has by all means been politically influenced. I am quite disturbed when I meet someone who wants a letter of support for a transition or hormones but does not want to spend at least a year in therapy. It seems individuals are being “labeled” as gender dysphoric without much assessment. At the same time, we know that trans youth have a 50% chance of attempting suicide and it is imperative that, whatever we do, we lessen the stigma around such issues.

    I have to admit my first reaction to the blog post was anger – or at least I thought I would be angry, however, after reading through the comments I realize that it is incredibly arrogant and close-minded to ignore a plausible explanation to why someone is gender dysphoric when we really have very little truth to rely on. Is it nature or nurture? I can’t say I have the answer but what I will say is if we don’t continue to have the discussion, we will never know. And I say this as a trans affirming therapist. At the end of the day, though, I am not as sure it matters why someone identifies as male or female just as I don’t believe it matters why someone identifies as gay, straight, or someone in the middle. What does matter is that we support one’s right to find happiness, however that may manifest, and as long as no-one is being hurt in the process.

    Thanks, David. I agree that we need to keep the conversation going. Or rather, get the conversation started. There’s not much conversation going on in our profession, as far as I can tell. I’d also like to point out that there is major difference between supporting an individual who identifies as gay and someone who identifies as transgender. Gay people don’t typically take hormones and surgically alter their bodies, which is the standard treatment protocol these days.

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