He’s championed transgender rights for years. But when this expert asked questions about whether young people changing sex might later regret it, he was plunged into a Kafkaesque nightmare
NO ONE could accuse psychotherapist James Caspian of being a bigot or prejudiced against transgender people. His LGBT — that’s lesbian, gay, bisexual and transgender — credentials are impeccable.
For this slight, measured, gay man is not only a trustee of the transgender charity The Beaumont Trust, but he has dedicated more than a decade of his life to counselling hundreds of patients who wish to change their gender.
He publishes academic papers on the subject, contributes to books and addresses some of the finest minds in the health professions at conferences around the world — and has done extensive work training fellow psychotherapists on transgender awareness.
If there was ever an expert in this field, James, 58, is it. But lately James has had a gutful of the increasingly frustrating politics surrounding the trans lobby, after a study he wanted to carry out into transgender people was blocked by Bath Spa University for being ‘politically incorrect’.
The nature of his research? To ask questions about the increasing numbers of people who were changing gender and subsequently regretting it. ‘I’m not antitrans. I’ve helped hundreds of people while they were transitioning, but when I started to do preliminary research I was taken aback by what I discovered,’ he says. ‘It wasn’t so much that there seemed to be increasing numbers of younger people, particularly females, transitioning, but that there were so many of them who seemed to be later reversing the transition.
‘Some of those young women were saying they felt they’d made a mistake, but had been influenced by a kind of social movement ramped up by the internet.
‘When I talked to colleagues about what I was finding, one said: “I didn’t think we were supposed to talk about that.”-Discussion is being suppressed by a small, but vocal, minority in the LGBT community who seem to have an agenda to push the boundaries of trans rights whatever the cost. It is why this research was important.
‘I think we’ve arrived at a point as a society where people are afraid to say what they think, and that’s not a good thing in my field.’
James is not alone in his concerns. Since going public with an interview on Radio 4 last month about the disturbing censorship of debate on gender identity, he says he has been inundated with messages of support.
One message from a trans woman reads: ‘ I know many people, including myself, who fully support your research and it was so heartening to hear you speak on such an important contemporary subject. Young people need to understand what a huge step this is to take. Let’s hope the university sees some sense. I send you very best wishes.’
Common sense, however, seems to have flown out of the window in this particular arena. James is keen to point out that he cares deeply about transgender people, but says he also worries about impressionable youngsters who could be rushing into decisions and regretting them later.
‘I want to be completely clear. I don’t think there’s anything wrong with people exploring gender identities,’ he says.
‘However, some people are having medical treatment and surgeries they are coming to regret. When people talk about young people transitioning, perhaps they don’t quite understand what a huge thing it is to do.
‘It involves treatments that can be impossible to reverse, such as hysterectomies, mastectomies and genital surgery.
‘You need hormones for life. You change everything — the pituitary gland, the brain, everything — and there is always a risk of side effects.
‘ For instance, the hormone testosterone can increase red blood cells so there’s a higher risk of heart attack and strokes.’
He chooses his words carefully. He fears he has to be cautious about what he says for fear of being ‘slaughtered’ by the vocal minority.
Fear seems to define the debate surrounding trans rights, he says. Challenge the extremists and you’ll be accused of being transphobic — prejudiced against transgender people.
It seems almost absurd James should find himself in this position, as he’s one of Britain’s foremost transgender experts.
After graduating from the University of Westminster with a degree in Chinese, he decided he wanted to be a psychotherapist and did a postgraduate advanced diploma at the National College of Hypnosis and Psychotherapy.
He’d developed an interest in transgender issues after basing his dissertation on Chinese transexuals, and was approached in 2001 to become a trustee of the transgender charity, The Beaumont Trust. He’s also a member of the World Professional Association for Transgender Health. Until the beginning of the year, he was a trustee of the official psychotherapy regulator, the UK Council for Psychotherapy.
He held the position for two years, during which time he acted as a consultant to a working group drawing up a ‘Memorandum of Understanding’ on transgender issues. This is an agreement between various health professional, religious and LGBT groups on how to handle patients.
The topic covered was the highly emotive subject of what’s called ‘conversion therapy’. This is the practice of seeking to alter an individual’s sexual orientation or their wish to change gender through counselling.
The practice dates back to the early 20th century, when homosexuality and transgenderism were deemed diseases which could be treated.
Everyone in the working group — including James — agreed conversion therapy should be banned.
James, however, wanted the memorandum to specifically accept that some people regret their transition and that there are patients who might have other underlying psychological issues.
Without spelling out these irrefutable facts, he feared health professionals could be prevented from exploring the potentially deeper reasons for a patient saying they wanted to change sex.
The committee, which included health professionals and representatives from the outspoken LGBTIQ (where ‘ I’ stands for intersex and ‘Q’ for queer) group
‘Discussion is being suppressed by a small but vocal minority’
‘People are afraid to say what they think’
Pink Therapy and the Association of Christian Counsellors, eventually decided not to include James’s recommendations.
The Memorandum of Understanding will take effect this month. Effectively, it could prevent a therapist, when presented with a person who wants to change sex, from exploring any possible ulterior reason behind their decision. This disturbs James greatly.
‘Any ethical therapist wouldn’t try to impose their view of how a client should be — but surely they should be able to explore if gender identity is truly the psychological issue,’ he says.
‘We need a framework that allows therapists to freely explore other underlying issues that may be present before they start gender reassignment treatment, without the fear of being accused of conversion therapy if they do so.
‘The Memorandum of Understanding is saying we must accept whatever gender identity a client says they are without question.
‘I was one of the few people involved who understood transition from a clinical perspective and was not a campaigner, so I had no axe to grind — just concern for the clients and the professionals,’ he says. ‘When I looked at the ban on conversion therapy, I said, “If you’re not careful, you’re going to make people think they can’t ever question what somebody coming to them is saying and that’s dangerous”.
‘Already counsellors have contacted me to say they’re worried that if a young client — say a 16year-old — comes to them with a number of mental health issues or a history of sexual abuse and says, “I want to transition”, that it won’t be safe for them to say, “Well, let’s look at this sexual abuse you had. Could that have anything to do with the way you feel about your body?”, because that could be construed as conversion therapy.
‘One psychotherapist who works with young people called me last night to say she is worried this memorandum could simplify things to a scary degree.
‘She said: “If all I did was affirm my patients were trans without exploring any mental health issues they might have, I don’t think I’d be able to help them properly.”
‘ Equally, people are afraid it might not be safe to work with someone who wants to detransition, i.e. reverse their sex change.
‘Let’s say a trans female, who is no longer happy in their gender, goes to a counsellor to say they want to go back to living as a man. Could that counsellor be accused of conversion therapy if they help them?
‘ I kept arguing for specific wording to say, “We do acknowledge some people do regret their transitions and reverse them, or change their minds.” But every time I tried to put that wording in it was rejected.
‘There are lots of activists within the LGBT community and I sensed that everyone was scared of them.
‘One of them said to me on the phone, “Are you going to block this memorandum?” Of course I didn’t want to block it, but I wanted to make it safe for everybody.
‘It was a long phone call and quite intimidating. I felt whatever I said was being interpreted as a threat. I felt this person wasn’t prepared to listen to anything I was saying. It literally made the hairs stand up on the back of my neck. That’s really powerful that sort of fear.
‘The problem is that the activists feel only they have any right to say anything and anyone who disagrees with them walks on eggshells for fear of being accused of being transphobic. I had sleepless nights over the memorandum. I would wake up at 3am worrying about it.
‘At that point, I honestly felt I was the only person in the world who was carrying the interests of people who had transitioned and regretted it. Nobody else involved knew what I knew about how these people were suffering, because I was researching them.’
James originally decided to embark upon his research after talking to the internationally respected Dr Miroslav Djordjevic, a professor of urology and surgery at the University of Belgrade School of Medicine in Serbia, when he was in London for a conference three years ago.
‘He does a lot of gender reassignment surgery with patients from all over the world. He said in the last year he’d done seven reverse gender reassignment operations on people who had transitioned from male to female and then decided it was wrong and wanted to go back.
‘That means they couldn’t get back the male genitalia so he was creating phalloplasties, cosmetic replacements developed in World War I for soldiers who’d suffered terrible injuries.’
‘He said his work seemed to suggest the percentage of people detransitioning was increasing and there needed to be some research.
‘I decided to do it, so went to Bath Spa University and signed up for an MA in Counselling and Psychotherapy, and started to do the preliminary research.
‘Traditionally, people had always thought the regret rate among those who transition is between 1 and 5 per cent, so the general attitude among people involved in the transgender world was it was so low that it wasn’t really important. But that was based upon old research from the Eighties and Nineties.
‘ My preliminary research suggested those percentages were out of date. You just need to look at the increasing numbers of those regretting and reversing their transition on the internet on websites and in blogs.
‘Last year, a group of young women in the U. S. who detransitioned had their first ever convention.’
There are many posts on the internet from those who regret changing gender. Each of them makes for desperately sad reading.
Take, for example, the anonymous 30-year-old who transitioned from a female to a male and is now detransitioning, who wrote on a blog recently: ‘ I don’t blame anyone else for my idiocy.
‘I just wish I would have learned to love myself before completely turning my life upside down with all of this.
‘I’ve been injecting testosterone for around three and a half years, have had top surgery [a double mastectomy] and a hysterectomy.
‘ I know I’ll be able to have reconstructive surgery on my breasts eventually. I mainly worry about how people will treat me until I can re-feminise my face, body and fix the thinning hair issue.’
James, a deeply feeling man who began his working life as an auxiliary psychiatric nurse, shakes his head. Many of the younger people who present at gender clinics have a history of mental health issues such as self-harming, social anxiety, eating disorders and so on. They see transitioning as their panacea.’
In addition, James says that the proportion of people attending gender clinics who are on the autistic spectrum is approximately six times higher than the general population.
‘The activist line is, “Oh that’s because they’re trans so if they weren’t discriminated against and could just be themselves and transition they wouldn’t have mental health issues.” That’s far too simplistic. I wanted to try to find the truth.’
In November 2015, James submitted his first proposed Masters Research title, ‘ An examination of the experiences of people who have undergone reverse gender reassignment surgery’, which was accepted.
‘I had some people contacting me who said, “Yes we’ve reversed our gender reassignment, but we’re so traumatised we don’t want to talk about it.” It made me realise how very important the research is.
‘Then a group of young women in the U.S. contacted me. They’d transitioned from female to male, had double mastectomies, then re-transitioned back to female.
‘They’d stopped the hormone treatment that had been suppressing their menstrual cycles, but didn’t want reconstructive surgery to rebuild their breasts.
‘I wanted to include them in my research, particularly as some of the women said they thought their original decision to transition to male had come from social and political pressure, not for psychological reasons.’
He submitted a revised title in October 2016: ‘An examination of the experience of people who have undergone Gender Reassignment Procedure and/or have reversed a gender transition.’
James accepted the research might not be ‘politically correct’, but felt it was important.
The next month the university rejected his proposal on the basis that ‘the posting of unpleasant material on blogs or social media may be detrimental to the reputation of the University’.
‘All I wanted to do with my research was listen to what people were saying and report it,’ James says.
‘Society is changing so rapidly that a lot of people feel uncertain of their place in it and they’re looking for something. The fact is, the idea of trans identities is now being brought into the classroom and is all over the internet.
‘I really think it’s good people who have transitioned have rights and they’re legally recognised in their gender. People fought for years for that and it’s very important.
‘Some people need to transition and benefit from it. It’s a complex field, which is why we need to be able to have a healthy discussion about it and not feel afraid to do so.
This has all become a kind of Kafkaesque weird tangle. Somebody needs to call it out.’
‘There’s a fear you’ll be called transphobic’
‘Transitioning is seen as their panacea’