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When I worked at a Gender Identity Clinic (1980-1995), clinicians considered transition an option only for patients with severe gender dysphoria. Our clinicians believed that patients with mild or fluctuating degrees of gender dysphoria would probably maximize their overall quality of life by remaining in their original gender role and working to lessen their dysphoria rather than by transitioning.
Having been out of this area for a long time, I don’t know whether modern, “affirmation-only” gender clinicians ever give patients such advice, or whether they even acknowledge that gender dysphoria occurs with varying degrees of severity and constancy. I also don’t know whether any of them would candidly explain to patients that their realistic choice may be one of “least-worst” options. If this approach still occurs sometimes, one doesn’t see much evidence of it online. One is more likely to find stories, however accurate, of patients being prescribed hormones after a single visit.
Some of my Twitter/X followers seem to believe that gender identity clinics today are a simple continuation of clinics from the 1960’s, 70’s, and 80’s. That is not quite the case. The emergence of a trans right movement as a part of the progressive movement and the concomitant reframing of transsexualism as a political problem rather than a clinical problem have radically changed the way many people think about transsexualism.
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