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Notes -
The WPATH To Hell Is Paved With Good Intentions
Things are starting to move fast in Genderland, or at least faster than I can cover them with while giving any sort of justice to the topic. I haven't even gone through the entire WPATH Files, when the Daily Caller (...News Foundation - an important distinction if you're searching for the source materials) released the WPATH Tapes. By spamming FOIAs they were able to get a hold of over 30 hours of video from the 2022 WPATH summit in Montreal. A lot of it is the same old same old that I brought while covering the Files (you can see the short clip playlist here) - there's a public face of gender specialists where the science is settled, you can either have a happy daughter or a dead son, puberty blockers are reversible, etc., etc... and a private face, where they discuss amongst each other the very same concerns they dismissed, when they were brought up by skeptics of Gender Affirming Care. What's new is that the raw amount of footage allowed me to confidently reach a conclusion about a question that's been bugging for a while - what is these people's deal? Are doctors trying to do what's best for their patients, or are they a bunch of ideologically captured fanatics, blind to the harm they are doing? The answer seems to simply be: yes.
I already remarked how a lot of these clinicians come off as quite sympathetic back when I covered the Files. When you listen to their talks you hear them openly expressing uncertainty about many aspects of Gender Affirming care, discussing the limits of their patients' (and their parents') understanding of some of the interventions, and the importance of bringing them up to speed, or you hear them bringing up known and potential side effects, and ways of mitigating them. With things like this, they almost come off as urging caution... the problem is that if you keep listening you get the distinct impression you're on a train with no breaks.
The Introduction to Trans Health talk is a good example of the good and the bad of that WPATH conference. It opens with a pull-at-your-heart-strings story, of Dr. Ren Massey's FTM transition and the struggle to find acceptance in society and from his parents. I ended up being quite moved by the story myself, and yet, in the fastest "Oh god, oh no, baby, what is you doing?" I have experienced to date, he drops this slide, where he proclaims everything from non-binaries to eunuchs is hecking valid.
I try to be honest about these things - I am biased, I pretty much already reached my conclusion on the subject, and it's going to be a hell of process to change my mind again, but no matter how certain I am of something there's always the possibility of being wrong. The thing is, "being wrong" to me means it turning out that people like Jack Turban were right, that gender dysphoria is a valid diagnosis, that doctors can reliably tell people who have it from people who don't, and they have treatments that are proven to alleviate their suffering.
Well, fuck me then, I guess. It turns out that the "medicalized narrative" may have been used in the past, but it's outdated now. Not all trans people have dysphoria, and not everyone wants to transition from one side of the binary to the other. The doctor's empashis needs to be on removing barriers, and on patient autonomy. Between several name drops of "intersectionality", "power and privilege", or "minority stress", as best as I can gather these folks are certified Queer Theorists, tirelessly working to deconstruct the idea that (cis)heterosexuality is normal. Sure, they'll take into account the consequences of gender treatments, and they'll try to make sure that patient's "transition goals" are within the realm of physical possibility, but there should be no other limits placed otherwise. It feels like they flipped the table. What I thought was a conversation about the state of medical science turns out to be a fight over who's worldview should prevail.
This seems to be the only explanation that can make sense out of the whole thing, and tie up the loose ends of the WPATH clinicians genuine concern for their patients, with wild off-the-wall stuff like the Eunuch Archive, or why they pull the knives out for Lisa Littman and the ROGD hypothesis or Blanchard's categorization of trans people, while remaining unbothered by Dianne Ehrensaft's gender angels and gender Tootsie Roll Pops.
Back when I covered the Eunuch Archive it was declared that I am a bad, bad boy, because in a forum with explicit rules about not booing the outgroup, I limited myself to providing evidence that child castration fetishists have an influential role in setting standards for transgender care, and are using it to promote their fetish, but refused to speculate on their motivation, and wouldn't declare them evil or insane. Other than it not mattering, and me not knowing, there was something unsatisfying about the two explanations that were offered. They were a too lucid to plead insanity, and haven't expressed a callous disregard for the well being of others, or a singular obsession with their own self-gratification, that people straight-forwardly associate with evil. What they do appear to be is completely ideologically captured. They view everything through the lens of Queer Theory and intersectionality, and are simply doing what is considered good in the light of that ideology, that this might involve affirming eunuchs, or transitioning schizophrenics doesn't phase them in the slightest.
All this seems to show the limits of analyzing motivations, and has implications on what it means to "boo the outgroup". That the road to hell is paved with good intentions is not a new lesson, but it seems that it's rarely understood as something more than "sometimes people get carried away trying to do good, and go too far", when some cases are probably better understood as "sometimes ideologies can make you commit obviously grievous harm, with a smile on your face". Perhaps the evil/insane dichotomy was the real Boo Outgroup all along?
I think the steelman also includes a number of concerns about a patient's long-term interests and what they'll desire afterward, but yes, for the most part the Blue Tribe medical community position has been much closer to the tumblr/Ozy gender anarchy than to the medical necessity framework for about a decade now.
(and, correspondingly, they've not really struggled with the extent that the mental health component and especially suicide risk was no small part of what permitted under traditional analysis that they're, if unintentionally, rejecting)
That said, while I think you're directionally correct, I will push back on:
I think there's another plausible explanation: they think, with reason, that Blanchard's autogynophilia theories seems factually wrong, in their common form and any form but their weakest, and that Blanchard (advocates, such as Bailey) seem unwilling to engage seriously with counterexamples.
((Yes, I absolutely see and agree with the irony, here. There's reason you aren't very happy with WPATH sticking fingers in ears about detransitioners, right?))
As a metaphor that I do have deeper insight in, I'll point to other examples of what Bailey et all call Erotic Target Identity Inversion: treatment of fursuiting or feral-focused furries as 'autoanthrozoophilia' and 'autozoophilia', respectively. In this model, furries who fursuit do so solely because they're aroused by being seen as anthros/animals, and that this ties into the feelings of species dysphoria.
That's not just something I made up to strawman the Blanchard/Bailey perspective, but one that Bailey highlighted himself. While the terms are (almost certainly intentionally) a little weird and loaded, there actually are people who fit into the categories that they're trying to describe, and I can even give number of online psuedonyms for people who do things like transformation kink or where otherwise 'being their character' is a good part of the erotic purpose. And I'll admit that while the community isn't always adult-oriented, a lot of it is.
So these theories must be true?
Well, no, because there's more to the actual theory than just its name: each of these theories include some level of predictive analysis, such that the presence of an autogyne or autoanthrophile says something broader about most of all of the remaining community. In Bailey's take, the presence of some number of (bisexual or gynophilic) transwomen who hide arousal from dressing as a woman meant that almost all (bisexual or gynophilic) transwoman claiming a lack of such arousal were just not willing to disclose it. Many advocates for 'autozoophilia' as a theory take this even further, to mean every person, categorically, achieving certain therian practices must also have such a sexual interest first.
Which doesn't seem to be the case in the furry and therian world, and it's not particularly hard to find (common!) exceptions. There's a lot of overlap between therians and furries, but there's definitely non-furry therians, and not all furry therians are in it for the sex. Where there is a sexual component to the fandom interest, some people often just want to get railed by a Space!Roman chubby wolf, rather than imagine themselves as 'being' or becoming one. By contrast, a lot of the various fursuit and therian practices aren't arousing; "fursuit_bowling" unsurprisingly turns up zero examples on e621, therian meditation had a buuunch of weird results and 'get a boner' basically never shows up, and in the modern day mirror-dwellers don't get that sort of response.
((The first counterargument is that they're all lying, but all I can say there is that I'm not, and for a universal position a single counterexample is fatal. The second counterargument is that some rare outliers exist, but most people are lying, and I'm skeptical: there's none of the medical pragmatic arguments that, and when it comes to embarrassment... I'll avoid some of the more bizarre or detailed points, but for a relatively tame example, I don't think the fursuiter with a nickname of 'pool toy' would be worried about that.))
There's pragmatic reasons these theories are concerning -- non-autogynophile and non-autoanthrophile fursuiters or non-autozoophile therians want neither sexual practices permitted in public nor their non-sexual practices from being restricted -- but even before you get that far there's a certain Someone Is Wrong On The Internet about things. It'd be like some sexologist making weird Pepe Silvia diagrams from people who find motorcyles empowering to talking about how people who change their own oil get off on it: I'm sure it happens somewhere, but no. Just no.
Crap like Keo-Meier/Ehrensaft (in addition to just being creepy) speak badly about the intellectual honesty or commitment to actual outreach to the unconverted: even as someone who's thrown together a list I recognize couldn't be all-inclusive, they're got a muddled mess of ingroup terms without any real inclusive or exclusive meaning.
That's all there is, though. It's not even predictive enough to be wrong.
I have no issue with people rejecting Blanchard. To the extent I think there's something to it, it's probably fair to describe it as it's weakest form. It's the "knives out" attitude that bothers me, in my experience most opponents don't reallly respond to it.
Consider the ROGD example, there was valid criticism of Littman's study when it came out, but most responses seemed to encourage dismissing the hypothesis outright, rather than verifying it with a higher quality study.
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