Excellent article from British psychiatrists about the current state of "affirmation only" transgender care. How do we help GNC patients but "first, do no harm"? https://twitter.com/robertod2010/status/1290759442863013890

How psychiatrists can help with a state "that is no longer a disorder nor a mental condition and yet for which medical interventions are frequently sought and in which mental health comorbidities are common."

Re: DSM-5: "Definitions are inadequate in explaining how anyone experiences the gender of the opposite sex. Without further explanation of ‘toys, games or activities’ that are typical of each sex, this is left to parents, teachers and doctors to determine."

"Questions remain . . regarding whether gender dysphoria is a normal variation of gender expression, a social construct, a medical disease or a mental illness. If merely a natural variation, it becomes difficult to identify the purpose of or justification for medical intervention

"Within current debates, if gender identity becomes uncoupled from both biological sex & gendered socialisation, it develops an intangible soul-like quality or ‘essence’. As a pure subjective experience, it may be overwhelming & powerful but is also unverifiable & unfalsifiable."

"How should doctors consider the body? We are born as, and die as, a body; we are our bodies. How can someone be born in the wrong body? Many patients bring a ‘wrong’ or ‘wronged’ body to their doctor; these may be traumatised, wounded, diseased or disliked bodies."

"Although mental illness is overrepresented in the trans population it is important to note that gender non-conformity itself is not a mental illness or disorder. As there is evidence that many psychiatric disorders persist despite positive affirmation and medical transition,

it is puzzling why transition would come to be seen as a key goal rather than other outcomes, such as improved quality of life and reduced morbidity."

"Those seeking transition are a vulnerable population who suffer from high levels of suicidality, psychiatric morbidity and associated difficulties. Medical and surgical transition is sought to relieve these psychiatric symptoms."

"Plausibly, there is an initial reduction in distress following transition, although no controlled trials exist. Therefore, the long-term outcome of medical and surgical transition in terms of mortality and quality of life remains unknown."

"No long-term comparative studies exist that satisfactorily demonstrate that hormonal and surgical interventions are superior to a biopsychosocial formulation with evidence-based therapy in reducing psychological distress, body dysphoria and underlying mental illness."