March 28, 2018

What Transphobic Norwegian Doctors can Teach Us about the Diversity of Transgender People

The major Norwegian clinic for transgender people is run by  doctors who are invalidating large sections of the transgender community. This  tells us a lot about how old stereotypes and prejudices among  gate keepers can ruin the lives of young trans people.


You'd better live up to the stereotypes if you want to get help from the transgender university clinic in Oslo. Photo: olgakr.
A progressive country...

As a Norwegian I am happy to say that we have some of the most liberal gender identity laws in the world. A trans person who wants to get legally recognized as their true gender, fills in an online form,  and that is all there is to it. There are no gate keepers in the legal sphere.

Morevoer, "transvestism" has been removed from the Norwegian version of the international medical manual, the ICD-10, and is no longer considered a mental illness. The same applies to being transgender in general.

...with a reactionary trans clinic

But getting your true gender legally recognized does not necessarily get you the medical assistance you need.  The National Treatment Unit for Transsexualism (Nasjonal behandlingstjeneste for transseksualisme, NBTS) at The University Hospital of Oslo has controls people's access to  surgery and does so in a very restrictive way.

I know of many trans people who have been denied any kind of help if they have admitted to erotic crossdreaming fantasies, for instance, or if they have not lived up to gender stereotypes as regards dress code, interests and mannerisms.

In the end it got so bad that Amnesty International got involved, arguing that the whole policy was in violation of trans peoples' human rights. (I have written more about this here.) 

A white paper has proposed a whole new regime, basically arguing that more clinics should provide services of this kind, in that way removing some of the power The National Treatment Unit for Transsexualism  has today.

Doctors show their true face

That has turned out to be a very wise recommendation, indeed. In a recent article in the major Oslo newspaper Aftenposten, leaders of the NBTS express opinions that are undeniably transphobic.
Among traditionalists Jazz Jennings is the perfect
transgender girl. God bless Jazz Jennings, but
the fact is that a large number of trans kids
are forced to hide who they are. 

The arguments they use to invalidate trans people are the  ones readers of this blog will know far too well:

Trans people who come out during puberty or later, and who do not visibly express their true gender through gender stereotypes throughout childhood, are not considered the right kind of transgender.

Anne Wæhre og Kim Alexander Tønseth from NBTS address the minister of health, Bent Høie, in their article, arguing that his liberal policy for transgender people has backfired.

The recent upsurge in young people approaching the clinic is, as they see it, the result of a "misguided and misplaced kindness mixed with minority activism and professional conflicts."


Calling trans boys girls

Wæhre and Tønseth present two "fictional" patients of the clinic in the article, using a lot of revealing quotation marks in the process:
"Erik" aged 16 came to the hospital last week, with strubble on his chin and dark, rough voice, even if he is born with ovaries and a uterus. The treatment was started by a low threshold service for youth in Oslo for those who feel that they are "born in the wrong body".
Remember that this is a clinic that provides hormones and surgery to transgender people, many of whom do feel that they were born in the wrong body.
Anne Wæhre is not willing to help
transgender people who repressed
their gender identity during childhood

What makes this new wave of female to male patients different from the kind of clients Wæhre and Tønseth like, is the fact that they come out post puberty:
"We are taking about teenage girls who several years after the start of puberty, suddenly experience that they are a boy. Two out of three are in addition to this suffering from serious depression, anxiety, self harming, trauma, autism-spectrum conditions, hallucination and suicidal thoughts."
This is an amazing paragraph. First they invalidate the patiens by calling them girls. Next they insinuate that their gender identity is somehow caused by the mental problems they may have.

Note also the use of the word "suddenly", which points in the direction that these feelings may be ephemeral and not real.

It should be obvious by now that suicidal thoughts among transgender people most often is caused by them being denied expressing their true gender, and the fact that they are harassed if they do so.

"Rapid onset gender dysphhoria"

Wæhre and Tønset continue:
"Internationally there are now appearing new discussions associated with this sudden appearance of bodily born girls who see help after puberty. These are discussions where one urges caution, something which so far has been absent in Norway."
Well, that is probably because "rapid onset dysphoria" is a term used by the transphobic fringes of our societies, like right wing religious fundamentalists and trans-exclusionary radical feminists (TERFs).

This phenomenon is not a puzzle, and the two of them provide the answer in their own text:
Could this be a reaction to increased openness in our society as regards gender?
Indeed, it can, and if the two of them had bothered to look into the teenage discourse found in social media like tumblr, they would know that this is so.

The Millennials and Generazion Z's do not share the restrictive binaries of their parents. They live in a world of continuums and diversity, both as regards sexuality and gender. That is liberating and it gives them hope – until they meet the "experts" at the university clinic, that is.

Early vs. late onset

It is clear that Wæhre and Tønseth have no idea what drives and motivates transgender people that are different from their traditional patients.

As Florence Ashley and Alexandre Baril have documented over at the Conversation, this way of thinking is just another variation of Ray Blanchard's transphobic "autogynephilia" theory, where transgender people are divided into two distinct groups:
Kim Alexander Tønseth is one of the leaders
of the university transgender clinic, but is
nevertheless calling trans boys girls.

1. "Proper" transgender people who shares the "proper "sexual orientation of their target gender and who live up to the "proper" gender stereotypes during childhood (like in an interest in Barbie dolls and pink princess dresses for those assigned male).

2. "Bad" or "false" transgender people, i.e. those who are "heterosexual" (which, in fact means that they are homosexual, that is attracted to people of the same gender as their own true gender) and who, for some reason, do not live up to the gender stereotypes of their target gender during childhood.

There is, as Ashley and Baril have documented, only one research study that seeks to document the existence of "rapid-onset gender dysphoria". It is riddled with flaws – hardly proof of this having become a serious social or medical problem.

Wæhre and Tønseth  ought to know the literature on "late onset" transgender people, given the positions they have. And if they don't, they should at least ask people outside their own academic silo for help, before attacking trans men in the way they are doing here.

Late onset is caused  by social oppression

There are perfectly sensible explanations for what has been called "late onset transgender people" may present different personality profiles from those who have been classified as "early onset". I am publishing a separate blog post in parallell with this one presenting the most common explanations.

Here are the highlights:

1. Late onset transgender people may have grown up in family settings that is more oppressive and transphobic, with parents and peers who punish gender variance severely.

2. Late onset transgender people may have a more introvert and people pleasing personalities, making it harder for them to insist on being their true gender.

3. Late onset transgender people often turn out to be gay or lesbian (or "heterosexual" as some researchers insist on calling them, referring to their assigned gender). They are more likely to try to stick to their assigned gender, as this may seem to be the only way they can find love and have a decent sex life. FTM trans people who love women and MTF people who love men can use the lesbian and gay communities to explore their sexuality and gender. This is much harder for the late onset cohort.

Being a man does not equal being masculine
The main problem in traditionalist transgender
health care is that the health personell
believe that masculinity or femininity
are limited to separate genders.
Photo:  Studio Grand Ouest 


I would also like to refer to Vetle Mikkelsen of, who in a response to their article presents the obvious argument, one that unfortunately has to be made over and over again:
There are feminine men. There are masculine women. This applies to both trans people and cis people. 
When the University Hospital and NBTS decide that only those who live up to old gender stereotypes will be given treatment, it should come as no surprise that many seek help from others.
Closing down the alternatives

Transgender people who do not live up to the stereotype have made use of alternative institutions to get help. These institutions have not been able to provide them with surgery, but they have been able to help them accept and understand themselves, and they have also – by various means – helped them gain access to hormones.

Wæhre and Tønseth are now trying to stop this.  They are using a kind of Trump logic to achieve their political goal. Instead of a "“total and complete shutdown of Muslims entering the United States until our country’s representatives can figure out what is going on,” they argue that all services for transgender people who do not live up to their standards should be shut down until science knows what is going on.

They want to strengthen their monopoly on  hormone replacement therapy and stop transgender and non-binary people who do not live up to their prejudices from getting help elsewhere. As they say:
"We are therefore very concerned about the growing group of sexologists and other therapists who, outside the national treatment unit, start providing low level treatment."
They provide no alternatives for this group, and since they do not want them at their clinic, I doubt very much that they will provide the research they think is needed.

How on earth can people who try to help trans people be transphobic?

I realize that it might seem unfair to call people who on a daily basis treat transgender patients transphobic, but there is no way around it. The behavior of Wæhre and Tønseth is invalidating, extremely harmful and based on ideas of what it means to be transgender that are old fashioned, heteronormative and imbued with stereotyping.

The implicit message trans people get when visiting the clinic is that transgender people should be more cisgender than cis people normally have to be.

Tor Folgerø and Tone Hellesund have put it this way:
The understanding of transsexuality that seems to dominate Norwegian culture – as well as the GID-clinic [the former name of the university clinic] and Harry Benjamin Ressursenter – is founded on a heteronormative basis. Heteronormativity is based on the idea that humanity can be divided into two distinctive and complementary categories: woman and man. Furthermore it is believed that the gender categories reflect specific and "natural" characteristica, and sexual desire is only to take place across these gender categories.
As Folgerø and Hellesund point out, this means that they try to exclude sexuality from the trans equation.  Because of this they also share the idea that transgender people are not to experience improper sexual feelings when dreaming of becoming their target sex.

FTM people asking the clinic for help is asked questions like:
"Did you have sex or did you masturbate when you were dressed up as a boy between the age of 12 and 18?" 
"Do you enjoy your feelings in/on your vagina when having sexual contact?"
They fail to see that it makes perfect sense for trans people to get aroused by the idea of being or becoming their target sex, as this is the only way they can have a sex life that is in harmony with their true gender. Instead the thinking at the clinic is dominated by old fashioned ideas of "transvestic fetishism" and "paraphilias".

These use to be arguments exclusively used against male to female trans people, but the great influx of FTM trans men has apparently led to some new and bizarre kind of gender equality.

Harry Benjamin Resource Centre

Note that the home pages of the clinic only provides links to the Harry Benjamin Ressurssenter, a conservative trans organization, which does its best to separate "real transsexuals" from the crossdressers and drag queens.  To them "transsexual" is a medical diagnosis, not an identity. Indeed, the organization changed name to Harry Benjamin Ressurssenter when the government started using the word "transkjønnet" (transgender) as an umbrella term for all gender variant people.

Both of the user representatives in the reference group of the clinic  comes from this resource center.  There are no links to – or group members from – the much broader Forbundet for transpersoner i Norge. This means that any direct feedback they get from transgender activists in Norway is from the separatist cohort.

The fact that they do not know the literature on late onset transgender people reinforces the impression that they are living in a  cultural "bubble", strengthened by professional arrogance and conservative prejudices.
"We live in a world where cats are understood to be
the opposite of dogs." Christine Marie Jentoft
commenting on Wæhre and Tønseth on Facebook

The Uncanny Valley

Note the reference to  "stubble on his chin and dark, rough voice" in someone they consider a woman.

This is a clear example of the discomfort transphobes feel when facing the "uncanny valley". In a trans context the uncanny valley refers to what happens when transphobes meet trans people who appear almost, but not exactly, like their target gender. Such meetings elicit "uncanny, or strangely familiar, feelings of eeriness and revulsion in the observer".

Pre-puberty trans kids do not, to the same degree, produced such feelings, as all children are expected to have feminine traits.

The "classical" transsexuals that people like Wæhre and Tønseth prefer, are – due to years of social training and treaments – normally more able to live up to the stereotypes and pass as cis.

The parallel to racism and the fear of those who look diffent is clear.

In other words: Wæhre and Tønseth  are part of what Norwegian transgender activist Christine Marie Jentoft has called the oppressive "cistem", which only accept trans people if they do not threaten the social and cultural status quo.

The Minister responds
Bent Høie, photo by Jarvin Jarle Vines


The minister of health, Bent Høie is a gay, married, man, and member of the Conservative Party.

He is definitely not the American kind of transphobic conservative, though, which is clearly  reflected in his carefully written response to Wæhre and Tønseth.

He distinguishes clearly between a legal change of gender and medical treatment.

The identity of a person is something only that person can decide, the minister argues, while "a bodily sex change is a larger and much more complex issue, which requires thorough professional review and specialized competences." (The minister is using the term "kjønn", which refers to both gender and biological sex in Norwegian).

Høie concludes (and yes, he is paraphrasing Wæhre and Tønseth here):
Young people who struggle and ponder on whether they are born in a wrong body, need – most of all – someone to talk to about difficult feelings and chaotic thoughts. 
The leaders of The National Treatment Unit for Transsexualism ask me to take responsibility for treatment-eager sexologists who give the daughters of the nation dark voices and lost fertility. I am more concerned about we can do together to give desperate young people quick and good treatment – whether they remain the daughters of the nation or become the sons of the nation.
Ouch!

UPDATE APRIL 20

At the beginning of April, the University Hospital Clinic, NBTS, announced that it will no longer accept patients who have been treated by other institutions. The main argument is  that "NTBS cannot make a safe diagnosis when this kind of treatment [hormone replacement therapy and/or surgery] has been started before one has finished the diagnostic process at the NTBS."

This is the first time I have heard of a hospital unit denying patients care, simply because they have seen other health personell first.

The real goal is clearly to exclude all transgender people who do not follow the hospital's strict and narrow ideas about the proper transgender journey from getting help. Given that the hospital has a monopoly on gender realignment surgery, that means that those labelled "unworthy" must go to private clinics.

The minister has announced that he will do his best to establish alternative services for trans people.

4 comments:

  1. I’m so surprised and disappointed to read this, Jack. I’m thankful, despite our current political environment, to be in the U.S.

    I can well imagine the frustration and hurt felt by trans Norwegians faced by such a group of people who’re supposed to be caring of them. It’s no surprise that trans people have such high rates of depression and suicide. I wonder if Norway’s statistics on this are even higher than in America.

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  2. good read as usual Jack and I am surprised that your country is to oppressive with regards to surgery. You can clearly see how the old stereoypes are still very much present in the early-onset vs late onset argumentation. As you rightly point out, coming out later doesn't mean you aren't trans but rather that you were more likely to suppress in order to conform which is what many of us who are older did.
    The entire system of gatekeeping is unfortunately run by people who understand little of this subject and I am wondering whether it would not be best served by qualified trans people who themselves recognize all the right signs.

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  3. The Norwegian weekly newspaper Morgenbladet, has a 7 page spread on the current conflict between traditionalist gate-keepers and open minded transgender activists.

    It is well written and brings in the various points of view in the current debate.

    One thing that is interesting with this particular article is that the author, Hanne Østli Jakobsen, seems to believe that the main dichotomy is between transsexual and non-binary people, and that the clinic at the University Hospital of Oslo (which is denying the majority of trans people treatment because they are not "real transsexuals") are mainly against giving "non-binary" people treatment.

    The life stories she present, however, are not necessarily stories about non-binary people, in the sense of them not identifying with one particular gender. They are instead stories about transgender people who know that gender is ambiguous, but who nevertheless wants to make use of surgery and hormones to get closer to a life where they present as their target gender – as men or women.

    In other words: Even if a transgender person has a solid gender core ("I am a woman!") that does not mean that he or she cannot express traits, interests or expressions that is more common in the other gender (as culture will have it). This applies to cis people too, obviously.

    When using the term "non-binary" as a catch all for people who present mixed gender traits and expressions, the journalist misses the point that what the doctors at the clinic really find troubling is not non-binary people per se, but transsexual people who are not living up to their standards of proper femininity or masculinity.

    To me non-binary means that your gender identity is not anchored in one of the two traditional genders, and this is why you, for instance, would like to use gender-neutral pronouns like "they" or "hen" (the Norwegian term).

    I realize that this is not the way many gender variant people use the term, and that the transgender journey will lead many trans people to test out terms and concepts over time. I am just saying that we have a didactic challenge here.

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  4. The Morgenbladet article can be found here: https://morgenbladet.no/aktuelt/2018/04/en-helt-normal-person

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