Sebastian M. Barr, Ph.D.
@DrSebastianBarr
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Psychologist hoping to advance understanding of gender diversity, trauma recovery, and psychotherapy. He/him 🏳️⚧️
Western Mass (Pioneer Valley)
Joined June 2019
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Pinned Tweet
I was feeling really heavy working on a lesson about the stressors & trauma trans youth face. I put on Glenn Copeland to soothe me & help me tap into my hopefulness. And then I thought wait this should be a part of my course! So I made a whole playlist.
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This is such a good example of junk science being used against trans people. This will be cited in anti-trans spaces forever now. The original paper found that 3.47% of ppl who had gender affirming surgery attempted suicide vs. 0.29% of ppl who didn't have surgery.
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The ppl who didn't have surgery were general population healthcare users. So majority cisgender. This isn't a study of gender affirming surgery and its impacts on suicidality; it's a study of trans people's increased risk of suicidality which countless studies have linked to
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I'm a psychologist w/actual expertise in this area. There is NO evidence that gender dysphoria commonly develops secondary to mental health conditions. There IS evidence that dysphoria, non-affirmation, & bias CONTRIBUTE to the development of mental health conditions. Infuriating
The New York Times is claiming as fact that "many patients" have mental health conditions that can make it difficult to find the "root cause" of someone's dysphoria. Absolutely no citation whatsoever for this claim.
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This is such a good example of junk science being used against trans people. This will be cited in anti-trans spaces forever now. Researchers at U of Texas found that 3.47% of ppl who had gender affirming surgery attempted suicide vs. 0.29% of ppl who didn't have surgery.
New study, based on 1,501 adults aged 18-60 who had gender-affirming surgery & an emergency-room visit:
“Individuals who underwent gender-affirming surgery had a 12.12-fold higher suicide attempt risk than those who did not (3.47% vs. 0.29%)”
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Some misinformation about the shooting has inadvertently spread. Two clarifications:
1. The performer at Club Q has said the woman who subdued the shooter w/her heels was NOT a drag queen
2. The NYT cover with the flag & bullet holes is from an artist, not the actual front page
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experiences of non-affirmation, bias, and related trauma (e.g., this review in American Psychologist - ). If anything, a suicide attempt rate of less than 4% suggests gender affirming surgery is having a positive impact bc we typically see much
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The "control groups" of ppl who didn't have surgery were general population healthcare users. So overwhelmingly cisgender. This isn't a study of the impacts of gender affirming surgery on suicidality; it's a study of trans ppl's increased risk of suicide which countless studies
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higher rates of attempts in the trans community at large. Of course without a comparison group of trans people who didn't have gender affirming surgery, we can't know what the relationship between surgery and suicide risk is in this sample.
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But this won't stop people from citing this study and falsely claiming that gender affirming surgery is a risk factor for suicide. Smh.
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I wish I could express the cruelty of NYT & Reuters choosing THIS WEEK to push longreads sowing skepticism re: trans identity & gender affirming healthcare. This week, leading up to Trans Day of Remembrance, when we mourn our trans friends lost to anti-trans violence & suicide.
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Nothing quite like a room of punks (et al) scream singing "god bless your transsexual heart" to remind you that the Abigail Shriers & Chaya Whatevers of the world aren't winning their fight against us.
Thank you
@LauraJaneGrace
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As a part of the Cass Review, researchers at York University did a series of systematic reviews which have now been published in The Archives of Childhood Disease. These are very good examples of the unfortunate reality that peer review doesn't guarantee good science esp when (1/
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Florida's
#HB1421
misrepresents the peer-reviewed scholarship of my colleagues and me to support the incredibly inaccurate claim that psychosis is "commonly comorbid with gender dysphoria." We have issued the attached statement.
(Text is in image description.)
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ATTN: Researchers interested in studying trans health/wellbeing (or anything trans). Did you know that a lot of awesome folks (many of them trans and researchers themselves) have put together a bunch of tools and guidelines to help you do this better?
Links in the thread below!
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Hi. Can't believe I need to say this on record in 2024. But please don't prescribe a child antidepressants or anxiety medication because they say they're trans and express distress related to gender dysphoria.
1) it won't work and is unnecessary medication
2) this is GICE
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Again, this is junk science that highlights the increased suicide risk that trans ppl face compared to c*s ppl.
Fun fact: researchers out of Sweden ran a study that actually looked at the question of the relationship between gender-affirming surgery & suicide risk.
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have linked to experiences of non-affirmation, bias, & related trauma (e.g., this review in American Psychologist - ). If anything, a suicide attempt rate of less than 4% suggests gender affirming surgery is having a positive impact bc we typically see much
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higher rates of attempts in the trans community at large. Of course without a comparison group of trans people who didn't have gender affirming surgery, we can't know what the relationship between surgery and suicide risk is in this sample.
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I've spent my career contributing to and following the evidence on trans care. The Cass Report does not do this.
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But this won't stop people from citing this study and falsely claiming that gender affirming surgery is a risk factor for suicide. Smh.
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Attention people gathering demographic information, if you ask me my gender, I'm going to say male. If you ask me separately if I'm transgender, I will say yes. But neither transgender nor the horribly outdated term "female-to-male" are my gender.
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Again, this is junk science that highlights the increased suicide risk that trans ppl face compared to c*s ppl.
Fun fact: researchers out of Sweden ran a study that actually looked at the question of the relationship between gender-affirming surgery & suicide risk.
New study, based on 1,501 adults aged 18-60 who had gender-affirming surgery & an emergency-room visit:
“Individuals who underwent gender-affirming surgery had a 12.12-fold higher suicide attempt risk than those who did not (3.47% vs. 0.29%)”
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bias is present. First of all, believing that the most appropriate outlet for publishing about approaches to trans youth is a journal titled Archives of Childhood Disease is already telling. Viewing gender diversity or even gender dysphoria as disease starts researchers out (2/
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from a biased foundation. It communicates that non-cisgender kids are sick and it suggests that gender diversity is an affliction to be eradicated. I struggle to fathom how any work done from this starting point could be considered sound. (3/
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When people ask how I'm doing I tend to say I'm ok but I'm not.
I think I will start saying "Well I'm a trans person witnessing an immense wave of hate & state-sanctioned restrictions on things that help trans ppl survive this hellscape, while few else recognize this crisis.."
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To be clear, affirmation for kids means acknowledging their gender identity. Using the name and pronouns they want to use, not forcing them to dress or cut their hair or socialize in ways that they don't want to. (6/
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Again, this is junk science that highlights the increased suicide risk that trans ppl face compared to c*s ppl.
Fun fact: researchers out of Sweden ran a study that actually looked at the question of the relationship between gender-affirming surgery & suicide risk.
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BIG NEWS:
@APA
adopts Policy Statement on Affirming Evidence-Based Inclusive Care for Transgender, Gender Diverse, and Nonbinary Individuals, Addressing Misinformation, and the Role of Psychological Practice and Science.
Read the full policy:
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@transscribe
Meanwhile I'm hearing that trans health experts are having a very hard time getting NYTimes & other major papers to publish op-eds re' the importance and evidence base for gender affirmation w/ youth, or direct responses to the sensationalist opeds they've published on the topic.
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Ah hell I had the wrong link earlier in this thread. THIS is the review on suicide risk factors among trans folks, published in American Psychologist.
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The authors of this "systematic review" on social affirmation seem to demand that we conduct longitudinal studies where some youth are affirmed in their gender and others aren't & then compare those groups over time before they will accept the positive impacts of affirmation (5/
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The studies the authors dismiss as not showing clear benefits found that socially affirmed trans children had comparable mental health to cis siblings and peers. Decontextualized as they present it, this may seem like not having an impact. But the context of course is that (7/
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trans children and older youth have alarming psychological distress, and a group of young people growing up not displaying that disparity strongly suggests the benefit of affirmation. Especially taken in addtl context like studies that show negative impacts of misgendering (8/
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I STRONGLY object to randomized control trials in which gender affirming care is withheld/delayed for ppl seeking it based solely on random assignment to a treatment group. This is not ethical given what is already well established about care, dysphoria, & mental health.
Gender-Affirming Care Access Improves Mental Health: Study
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Something I've said repeatedly is that a major factor in my relative emotional stability is that when I came out as trans at 21/22, I was able to access healthcare providers that believed that I knew who I was.
Informed consent to T changed my life for the better.
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I haven't read the whole set of articles and I'm not sure it's the best use of my time. I did start the article that claims to be a systematic review of the evidence on social affirmation for trans and nonbinary youth. It is.... Bad. (4/
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Trans & nonbinary folks, I'm a trans psychologist and doing this free training for mental health providers on how to support their clients increasingly hostile sociopolitical climates. I'd love to include your voices.
What would you like therapists to understand or do?
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seriously because it is so monstrously harmful and frankly an absurd assertion that that's what is needed to understand the benefits/impacts of affirmation enough to endorse such a path. (11/
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Again the authors' expectation is that there's a meaningful control - iow instead of comparing that group to cis peers, they should have been compared to kids who expressed a different gender but WEREN'T affirmed in that gender. I can't quite bring myself to engage with this (10/
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and qualitative analyses of life improvement when trans people are perceived and treated in alignment with our genders. (9/
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You can see this collection of hogwash at Archives of Childhood Disease. First you should read Cal Horton's excellent piece on how cissexism makes the Cass Review and the so-called empirical inquiry associated with it a distorted mess. (12/
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Cis people not defining transness based on their own incomplete impressions challenge.
Transness is not about gender expression or even gender roles. We've been saying this for decades.
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Source for
#1
-
The one who saved my life and stomped the shooter’s face in was not a drag queen, she is a trans woman. Let’s not call trans women drag queens during this time of grieving over a transphobic attack.
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I was recently reminded of something a mentor once told me: "If a client retells you a story, assume you didn't hear before what they need you to hear now." 1/4
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It's hard for me to interpret this as anything but people who are opposed to gender diversity and alarmed by the existence of trans youth engaging in a review protocol specifically with the intention of finding ways to dismiss any support for affirmation. It's alarming (14/
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I'm thinking of making a 20-30 minute webinar consolidating the many worthy critiques of the Cass Report. I'm deeply concerned by people outside of this field believing the review is thorough, unbiased, and making reasonable conclusions.
I've spent my career contributing to and following the evidence on trans care. The Cass Report does not do this.
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GICE = gender identity change efforts and these are demonstrably harmful, which is why the
@APA
has strongly condemned them and many jurisdictions ban such practices.
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to see medical research journals used for this purpose in 2024. Though it certainly fits with our society's robust history of letting biases and adherence to status quo social power structures shape research that is uplifted by some (somehow) as neutral & informed despite (15/
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This meme (from lesbianpulp on Instagram) captures one of the main reasons I believe in the value of long-term psychotherapy: It is a lot of work to let yourself be known by a therapist, to survive the "mortifying ordeal of being known" - and that work takes time.
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I often interact with therapists who consciously or unconsciously believe that certain emotions or thoughts of their clients are dangerous, and it's their jobs to soothe those emotions or challenge and banish those thoughts.
Our job in therapy is the opposite. 1/3
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We don't see horror story news reports about people regretting mother/parenthood. There aren't widespread campaigns to make sure ppl are really sure before they go through with pregnancy & family building.
This to me speaks volumes about how we view trans people and transition.
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Glad this is finally getting some attention but y'all. We've been saying this. Where was this reporting when there still was a chance at defeating the legislation?
With more than a dozen states enacting laws limiting gender-affirming care for transgender minors, an AP analysis found that many of those bills stemmed not from a grassroots movement but from a handful of conservative interest groups’ model legislation.
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Who's gonna tell them I co-authored the review on psychosis incidence among trans & nonbinary people?
To be clear it is NOT highly associated. We found some suggestion of increased risk which we hypothesize may be due to diagnostic bias & inc stressors.
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On mother's day 2022, Alabama moms (& all parents) of trans youth lost the right to consent to affirming care for their children.
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@jonkay
Jon & friends: This is not a study on the relationship between gender-affirming care & suicidality bc they didn't have a comparison group of ppl w/gender incongruence. A study ) did actually look at this though and here were their results:
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Maybe I'm just looking for someone to blame, but I feel seething rage bubbling up for the so-called allies whose ~just asking questions~ approaches helped launch this bs into the mainstream & gave the right wing baseless but easy quotations/citations. Y'all are complicit.
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@Twitter
the two tweets I reported this morning were calling me a groomer and saying I should be shot. Within a few minutes I was told they didn't violate rules.
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Took my
@sweatermuppet
tee to the ballet yesterday afternoon.
On the walk back, someone shouted "that is a great shirt, sir!" and flashed me a peace sign.
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I need to say something about the way I see (mostly cis) folks using assigned sex at birth, which you will often see written as AMAB (assigned male at birth) or AFAB (assigned female at birth). (1/x)
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My Twitter app is glitching and won't let me post the link to the Archives of Childhood Disease in my last tweet. Here it is 🤢 (13/
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With all the misinformation flying around about trans youth, I'm so glad this book (put together by
@BrynnTannehill
) exists! I'm proud to have contributed alongside other experts in psychosocial well-being, medical providers, & parents. Pre-order:
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Are youth with gender dysphoria more likely to have experienced sexual abuse than non-trans youth?
This is commonly stated as fact, often w/the suggestion that said sexual abuse is a contributing factor in the dysphoria & leads youth to ID as trans.
Let’s look at the evidence
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As I note in my reply to that added context, I still find it worth noting that the association to disease is powerful and should have been considered.
@ValoisDuBins
That's helpful background on the journal and I think a worthy critique of my take on this aspect. I think there's still a powerful association here that someone concerned with a not-inherently-pathologizing effort would have avoided. But I will add yr point to the thread!
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Adding this context that the journal is the BMJ official journal for the Royal College of Pediatrics and Child Health, and that likely informed its role as the place to publish these reviews so my critique of the journal title should be tempered.
@DrSebastianBarr
While I agree Cass is problematic, I think this particular criticism of a journal title is very weak sauce. The title is old fashioned (btw it’s Archives of Disease in Childhood) but it’s the official journal of the RCPCH and respected.
Stick to critiquing the review methods.
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Can you imagine looking at the social, political, and medical landscape for trans people and concluding that the biggest and most urgent crisis is that people are *too* accepting of gender diversity and trans youth?!
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Branstrom and Pachankis used Sweden's National Patient Register to examine hospitalizations after serious suicide attempts among people with diagnoses of gender incongruence (or earlier iterations of that diagnosis) between 2005 and 2015.
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Having an article about ~both sides~ of the questions of whether/when/how parents should be told about their youth's trans identity or gender exploration without once mentioning the mountains of evidence of the harm of parent rejection and non-affirmation... is bad journalism.
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@ButNotTheCity
The emotional abuse trans women have suffered in relationships with cis women who subscribe to the idea of "trans widowhood"... The scars of this are some of the more painful things I bear witness to in my psychotherapy practice.
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Thrilled that
@drthema
is now the American Psychological Association president-elect!!! I first learned of Dr. Bryant-Davis' contributions to our field during my diss work. I was trying to use feminist models of trauma to conceptualize aspects of the trans experience
@thema4apa
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2.8% of ppl with gender incongruence who had not had surgery were hospitalized for a suicide attempt between 2005-2015. Less than .01% of trans people who had had surgery 4+ years ago were hospitalized for a suicide attempt.
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Only 22 individuals with gender incongruence had made but survived a serious enough suicide attempt to be hospitalized, which limited statistical analyses and findings. But I'll discuss the results descriptively with the consideration that differences were not statistically sig:
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For months a group of psychologists who are by all definitions experts in trans health have been working on a thoroughly researched evidence-based response to the misinformation & poor framing that has been haunting pop press discourse on trans youth.
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On tdor we gather and read the names of trans people murdered for living their lives. Many of us also mark the lives lost to anti-trans stigma by suicide. In the days leading up to it this year, we are having to defend our community against distortion & misrepresentation.
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On mother's day 2022, Alabama moms (& all parents) of trans youth are terrified for the well-being of their kids. Some who are able to are figuring out how to upend their lives to move in order protect their children.
On mother's day 2022, Alabama moms (& all parents) of trans youth lost the right to consent to affirming care for their children.
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@GBBranstetter
I've had multiple clients express a dream of teaching that they believe is no longer attainable or at least not worth the pain bc of shit like this.
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I am aware of leading psychologists who have been trying to get op-ed published in support of gender affirming care for years & are rejected. A reminder that the APA nearly unanimously supported a statement on gender affirming care.
16 anon psychologists shouldn't fool anyone.
What monsters they must think we are
As usual these cowards refuse to have their names published;
Letters: the Observer:
We are ashamed of the role psychology played in gender care.
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@IncognitoNewt
This is a good follow up question and I'm assuming you're asking in good faith. This is part of how we can be confident conceptualizing distress as coming from dysphoria rather than causing it - because we have robust empirical data & community stories about just this.
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This week, Trans Week of Awareness - culminating in tdor, is already a very emotionally heavy time as we grieve and take care of each other while continuing to try to educate & advocate.
The added injury of having all this going on. I can't even tell you. I'm tired.
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"...their abortion was personally a form of gender-affirming care in the sense that being pregnant would've caused intense gender dysphoria for them."
Lots of important stuff in this article:
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I'm the kinda guy who can publish a peer reviewed article on why anti-trans bias & non-affirmation could be conceptualized as potentially traumatic (w/empirical support) while failing to recognize how I'm being traumatized by it all.
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Yesterday, I reported a comment that denied transness was real, called me sick for being trans, & baselessly accused me of a hateful trope (victimizing children & making them trans).
@X
found this didn't violate any rules.
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By tolerating the feelings and thoughts or beliefs that clients are most terrified of or defended against, we demonstrate our belief that such experiences are survivable for the client. And when they face them they can drop the defenses that have been causing distress. 2/3
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Exactly. I will sadly and somewhat wearily point to this slide I made in 2020 but wasn't even new back then.
If anti-trans activists succeed in stigmatising the trans community to the point of exclusion, Dr Cass can come along in ten years time with her clipboard and say you never leave the house, you have no job, no stable relationships therefore transition is a BAD THING
#Catch22
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and I SUSPECT the suicide attempt rate for people who WANT surgery but haven't had it is higher than the rate for overall trans folks who haven't had surgery, if we are moving off of a safe assumption that dysphoria is part of what is driving the suicide risk.
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Some important limitations in addition to the lack of power for determining statistical significance of this difference: 1) We don't know how many of the people who hadn't had surgery wanted it. I suspect there are plenty of non-op trans folks without dysphoria in that group
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Also my god to suggest the report is courageous feels like a real slap in the face to trans ppl existing in hostile environments & those of us who have been trying to meaningfully do good research & clinical work in cissexist spaces. Yes, Cass is the courageous hero here /sarcasm
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Those memes about therapists being like "and what do we say when....?" are so bizarre to me. As though psychotherapy is about training ppl to react to certain situations/internal stimuli with specific scripts.
I know they're jokes but I also do think some ppl practice this way.
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The hill I will die on: When talking about mental health, psychology, oppression, community, healthcare needs, etc, broad LGBTQ+ focuses (foci?) will not do justice to trans people.
Research, policy, and interventions need to consider uniqueness of non-cis experience.
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@ErinInTheMorn
Do we know how much bathroom laws (I'm thinking NC) have actually been enforced? I understand them to be a terror and oppression tactic more than a vehicle for arresting trans people.
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Psychologist popping on here to say that despite Erica Anderson's uncited claims, there is no empirical support for the idea that social forms of gender affirmation are dangerous for or harmful to youth.
There is however lots of evidence that non-affirmation is harmful.
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But anyway, this is still a much much much better designed and analyzed study than the junk Straub et al just published. And it suggests at worst a null relationship between gender-affirming surgery and serious suicide attempts, and possibly a beneficial relationship.
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Woof. Psychologist here. If a young person is ready & is struggling w/impact of puberty, a 'straightforward' case like this should not involve mandated weekly therapy before supporting care. I think it's important to name that's probably $10k+ worth of required sessions.
Erica Anderson takes a year of weekly meeting before prescribing puberty blockers for a ‘straightforward’ case, letting the kid’s body continue to go through a distressing endogenous puberty while she rakes in the money. This is cruel, and borders on extortion.
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