What a great interview! Your ongoing willingness to engage with him and challenge him sparked a very important facet of the transition- the detransitioners! What a positive outcome; your work and his work are important milestones in moving the needle from “transition surgery is a human right” to caution and evidence based care. Many are paying attention.

Excellent interview. I'm so glad you introduced him to some detransitioners, and that he was a man of honor who saw a need and stepped forward.

So many doctors are practicing "fruit basket medicine," where they just focus on the happy families that sing their praises and bring them gifts. Detransitioners rarely confront the doctors who harmed them.

I remember a gender doctor getting very red in the face and blustering that he'd worked with over 400 families and had not ONE detransitioner (when I asked about detransition in a large group session at the national AAP meeting in 2022).

"That you know of," I muttered to myself.

Congratulations Lisa on influencing this surgeon to open his eyes and step up to right some wrongs.

The humans rights dimension begs for more exploration. If this is where the trans rights proponents make their stand, then what really is the claim to medical insurance? By which I mean: since when does having extensive and expensive medical procedures on a healthy body constitute "necessary medical care" subject to insurance reimbursements? The good surgeon -- we should remember his name-- mentions the Freudian assertion that paying for therapy is essential or the therapy does not work. This is a very wide reference to all the spiritual reasons "medical care" works: a person needs to pay for healing, that's a general truism; the placebo effect is major major major.; there's also regression toward the mean. That is, given time most unwellness gets better. The body "regresses toward the mean", that is, becomes more regular, more ordinary, and less sick. Trans "gender affirming care" merely takes another place in the hocus pocus of fallible medicine. Anyway, there is no medical necessity for anyone to access such care if their body is healthy. They claim it is not a mental illness. Ok, then sure everyone has the right to life, but there's no right to medicalize a healthy body.

The human rights argument slides right into trans and gender identity as spiritual beliefs or a Neo-religion. I read a book recently totally earnestly explaining the deep spirituality of transness. ... so, this is a religion that requires extensive medicalization of the converts.

Maybe that's true like this trans author claims, that trans is fundamentally spiritual. That vaporizes the grounds to be taught to kids in schools as "science". Spiritual trans also dissolves grounds to obtain free medicalization. The government does not sponsor religions. First Amendment, right?

We can happily defeat this movement on human rights grounds. If they're forced to argue human rights, they'll lose medical insurance funding. That's a prediction. They also should be kicked out of our schools.

It's great that you LSD planted a seed, and despite your article not being published, the surgeon was thoughtful and questioning. And now working pro bono for young people who've been harmed. Plus a big shift in one important organisation that will hopefully lead to more changes. Great to see good journalism in action, even when censorship had been applied.

Well done, Lisa, raising the awareness of detransitioners. That is HUGE! A big thank you to Dr. Glasberg for being open to listening, taking your comments to heart and for making the effort to understand the facts. Now, the one bit left is how to become fully aware of how many of these kids are on the autism spectrum. Also, ‘informed consent’ in this area of practice is far from where it should be.

This was a great conversation. I really appreciate Dr Glasberg pointing out the mismatch between what mental health outcomes are promised w gender surgeries vs cosmetic surgeries being explicitly about form. Is this cosmetic or “treatment”? The two are quite different

Important conversation. Thank you both.

As Dr. Glasberg said, patient autonomy means freedom of the patient to deny care, not freedom of the physician to dictate it (although "care" in this case should really be in quotation marks for obvious reasons).

It's quite telling that both Dr. Glasberg and Lisa Selin Davis have had experiences with physicians wherein the latter were "stone-faced and hostile." Clearly, the Hippocratic Oath means far less to such people than their pockets or their egos.

Someday, when there is a reckoning (sadly, only many years from now, I believe), these people will crawl quietly back into the woodwork, pretending they never did anything wrong, and hoping the rest of us will forget about it. I, for one, won't.

Many thanks for this great conversation.

Brilliant

Great to see you to in conversation!

It's good to see the sea change in thinking about 'gender dysphoria' in the last year. It wouldn't have happened under a Harris administration. Has anyone asked the ASPS why they suddenly came out with this the week *after* the Fox Varian judgement, rather than, say, a year or two before?

This is one of the most important talks I have ever heard on this topic. I have listened to some excellent podcast series (Wider Lens is at the top) that inform, enrage, offer hope, and create an emotional connection. For the first time I see solutions focus, non-political, and a genuine way out. The statement the ASPS produced covers a lot. WPATH should learn from the ethical issues and all people working in this area should get lessons on “human rights” and “autonomy” in healthcare. Clearly thats a mess. Having listened i can now say the bar should be 21. This means no state facilitated services (marker change, ID, GSA Clubs in schools, etc) until the adolescent is an adult.

Sounds good but neglected to mention that the change to age 19 only occured after a law suit successfully fined a plastic surgeon.

Also whilst there was recognition of the need to show surgical benefit, the costs of surgery (especially genital) was not even mentioned ('do not harm' disappears with the prescription of blockers, hormones, and surgery).

Thank you both so much for this and for all you have done!!

Three questions/points...

1. Your conversation spoke of surgery changing form.

But do any of the evidence-based plastic surgeries discussed here as comparisons destroy or seriously harm function?

I thought not? E.g., reproductive capacity, breastfeeding, normal urinary tract function...?

The breast reduction people get does not usually destroy breastfeeding ability, does it? Unlike "top surgery" which usually does --I gather the nipples are even sometimes removed and placed elsewhere?

Rhinoplasty does not interfere with breathing and smell?

2. Also, within plastic surgery practice, is it true that if a patient wants a mental health benefit from surgery that there is always a concern regarding body dysmorphic disorder, that the field tries to screen for? And that those with BDD should not have surgery, as surgery does not usually seem to help them and often leads to either requests for further surgeries or to mental health decline (anyhow or perhaps as a result)?

3. ROGD/gender dysphoria often arises as part of the transition to adulthood. Puberty and separation from parents, e.g., going to college, are both key stages in this developmental path. As age 19 unfortunately catches the latter ROGD kids, I would argue 19 is too young. The big recent spike in new cases occurs through college age. Colleges are also encouraging medical transition (probably not realizing they can contribute to the wish for it).

Thank you both again and again and again!

Thank You!

Wow--thank you both. Dr Glasberg's willingness to consider evidence and to consider how to help detransitioners is so important. Thank you Lisa for bringing it to his attention.

Irreversibility was mentioned but was functionality? Rhinoplasty doesn't prevent breathing through the nose. Butt lifts don't prevent one from sitting. Breast reductions may (or may not?) allow for future breastfeeding, and I hope they do not end the sensations so important for sexual function. But the gender affirming mastectomies are often done to prevent any future breastfeeding, any future sensation, and any possibility of reconstruction. They end function that already exists.

Is it mostly the case that cosmetic surgeries do not intentionally end functionality but gender surgeries do?

Excellent interview.

Really interesting conversation. Thanks for all you do Lisa.

Okay, I stand corrected. Though I'd still say '24 is rather late to the party, but then some haven't got there yet at all....