I suppose it's a "gendered" concept that I was surprised it was the Dad behind me who had a package of Kleenex. All the women around me, and it was the Dad who handed me tissues at the Federal Trade Commission hearing on Pediatric Gender Transitions.
At dinner that night, as I tried to claim I rarely cry, he disabused me of this premise. "You cry a lot," he said. I suppose I should accept this statement.
I didn't when I worked in a pediatric gender center. When I started in 2018, I replaced the woman who held the position before me. We overlapped for about a week, and the thing I remember from our brief shared time together was her warning that she hoped I had thick skin. The endocrinologist yells a lot, she said; he made her cry often. I didn't worry at that time. I didn't think work was an appropriate place for crying.
In my tenure, I remember crying twice but being angry often. That same doctor did yell, often, but anyone who works in medicine understands the culture. Doctors believe they are above reproach. They are the final word and aren't used to being questioned about anything.
It was a Wednesday, and we were in the main St. Louis Children's Hospital clinic. The patient was older and new—a teen boy, maybe 19. I was seriously concerned after meeting with him. Some of my basic intake questions had disconcerting responses. I asked him about legal transition: did he have an ID, and if so, what name was on it, what gender marker? He didn't know. He didn't drive, didn't have a state ID. No identification. I started to discuss the steps for a legal name change and gender marker, and my basic instructions weren't landing. So, I tried to pivot my directions. I asked him, "Do you live in the city or the county?" He didn't know. I asked him, "Do you know if you have a library nearby?" He couldn't answer. I became more concerned and eventually got the nurse. I needed a second opinion on my increasing concerns regarding cognitive ability. I had worked in case management for decades; I know how to work with patients with limited literacy skills, how to try to meet people where they are. I know how to change my approach.
The nurse met with the patient and came away with the same concerns—this patient was clearly not comprehending what we were trying to communicate, so we told the doctor. This patient did say clearly when the nurse asked if they ever wanted to have kids that yes, they affirmed that they did.
The doctor went in and quickly returned, telling the nurse to send in the scripts for hormones. I asked the doctor if he'd discussed fertility, and the doctor was already mad. He had two student MDs following him, and he was in teaching mode—he was the one to ask questions, not us. But the nurse and I persisted. We asked, and he brushed us off, so I persisted.
I told the Dr. that this patient needed a referral to fertility preservation—that they had clearly stated they thought they would want biological children of their own, and yet no referral, no consideration. Dr. disagreed, and I didn't let it go. I said, "If we prescribe this without a fertility consult, we would run the real risk of leaving this patient rendered sterile," and he lost it.
He yelled and yelled and told me in so many words that I was an idiot, was not a doctor, and didn't understand that the evidence wasn't clear enough that we would ever sterilize anyone. He told me to shut up and that I was done. I couldn't let it go and said, "You have your job as the doctor, and I have mine, and my job is to stand up for the patient even right now when you think it's better that I just shut up." And he threw me out of the pod. He told me I was excused from the clinic and that I needed to pack up and leave and go back to my office.
I had embarrassed him, that was clear. I had challenged his authority and crossed the line—the not-invisible line where "support staff" aren't supposed to challenge clinicians. I went back to my office, and I cried.
That was the first time.
The second time was worse.
I was in my office, and I had sent an email. I had put in writing that which I was already being warned repeatedly could not have a paper trail. I asked the Drs if I could report as an adverse event the patient we sent to the Emergency Room that day because she was bleeding out.
We had prescribed her testosterone, and her vaginal canal had torn open. I was distraught and consulted with the nurse. We found the channel to report an adverse event, and we asked the doctors about filing the report.
Dr. did not respond in writing; he showed up at the office door. I should tell you what my office actually looked like—imagine a narrow closet, two desks on the wall, enough room for two chairs. There were no windows and one door; only doctors get windows.
He showed up and blocked the door, and he laid into me. I should not be writing any of this in emails. I was incorrect, this was not an adverse event, and again, I was dumb and not a doctor and couldn't understand. This was an expected result; this is just what testosterone can do. He was screaming again, and I was shaking and trapped. I was told clearly and that under no circumstances was I allowed to report anything ever through that channel.
I told him that his position, him blocking my doorway and screaming at me, had crossed a line. I told him I understood the direction but that he absolutely needed to leave.
He finally did, and I cried.
I was breaking my cardinal rules about working in medicine as a woman. I had set out to never cry at work, and here I was bawling my eyes out again in a medical setting.
At the FTC event, in a modern building with squeaky-clean marble floors, in leather, well-cushioned chairs in a large auditorium, I buried my face in my hands and allowed the tears to come again.
Simon is a smart, articulate, and good-natured young man. He is 21 and could be one of my sons; my oldest is 16. He dresses in colorful printed button-down shirts, often with matching bow ties. He spoke on the Federal Trade Commission's first panel with his father.
When many saw the pain that the gender industry had caused this pair, I saw something else. I saw the many parent-child relationships that I had destroyed. I witnessed these two—imperfect Dad with imperfect son—able to embrace, and I know that they still had each other.
Do you know how many parents had their relationships with their children ended by our gender center? How many times we sided with one parent and alienated the other? How much havoc we wreaked?
I should only hold the weight of my own failed marriages in my hands, but instead, I know I was complicit in many, because the affirming parent divorced the parent who rejected the ideology and then used the court to medicalize the child against the other parent's wishes.
I saw Simon's Dad say that he stood up to the clinician and told that doctor no, and I knew that I was often the one called in when the parents were like Simon's dad because I had exemplary de-escalation skills and could work my way into a parent feeling "heard" but yet ignored. I could “social work” (a fancy way to say manipulate) a parent into submitting into the affirming position. I sobbed because I knew that there were Dad’s like Gareth that I stood right back up to. I have no idea what would have happened if it was me that Gareth had met back then. He is a formidable parent, but I was pretty masterful in my skills.
So I sobbed, so we all sobbed in that room in the modern building with squeaky-clean floors and passed Kleenex around. Perhaps I should let go of the expectation that medical professionals should swallow back our tears. Perhaps it is just time to accept that I have a lot to cry about and accept the Kleenex and fight on.
You sound very brave to me in those confrontations you were willing to have to stand up for patients’ rights and well-being and you did try to hold accountability as best you could in that system however I do understand your regret about complicity with harm
I don’t know the mindset you were in and I never worked with youth, only adults, but I do recall conversations with parents of young adults whom I had evaluated for referral to medical providers and how I reassured them that regret was very unlikely if transition takes place in early adulthood, something I didn’t know was wrong at the time because the news hadn’t arrived yet about late onset gender dysphoria and detransitioners hadn’t yet emerged to tell their stories
So we thought that what we were dealing with was more fixed than mutable and if a younger person was pursuing this earlier than the older cohort we had seen before that, it seemed like this might help prevent some of those failed marriages and broken families due to later in life transitions
I couldn’t share with my clients or their families what I didn’t yet know or understand about the possibility of future regret so I forgive myself for that but I certainly would never practice again in the same manner
We thought we were helping, we thought we were informed, hindsight is 20/20 but nonetheless this serves as a painful lesson that will soon be essential history to be taught in educational settings for therapists and medical providers alike—we are still far from that but you have played a very important role in setting the stage for that future task and you will continue to be a great role model to speak to the importance of humility in admitting mistakes were made—and all we can do is learn from it and share that lesson with others
Thank you for writing this.