Proposal for an Improved Gender Dysphoria Treatment Process

Proposal for an Improved Gender Dysphoria Treatment Process

Now that we're thinking about the consequences of the current state of gender affirmation culture and care, let's move past the negatives and look forward. What would a more ideal medical gender transition or simply treatment for gender dysphoria look like? Glad you asked. Below is my proposal for a more improved gender dysphoria treatment process. This is based on both the previous model and current model - informed by the most current science available. At the end is a self-analysis of the plan with acknowledgment of potential challenges.


For people in need of care:

If you are considering transitioning or dealing with gender dysphoria, you might be able to use this as a guide when medical support is lacking. Despite the expansion of care, there's so much variability in the quality of care and education, patients may need to have greater awareness than in cases of more standardized care.



  • 5-year term on average depending on the level of medical or surgical intervention needed.
  • Puberty Counseling available to start whenever needed. Gender and growth are rough for all children and we woefully underprepare them for the experience.
  • Medical interventions would start towards the latter half of the puberty process post-diagnosis. More research is needed on the most ideal time to start. Current guidlines in Denmark, Norway, & Sweden have changed the age limit for any medical interventions to 18.
  • Patients should be guided the entire time by a team of medical professionals and civilian counselors.
  • The goal should be to walk patients through the process of self-discovery and help them make dignified decisions about their life.



Because of the complexity of gender dysphoria and its sources, patients should start with a 1-year process of diagnosis and education. Critically, a self-harm assessment should be made early on to inform the rest of care. Depending on age, puberty counseling may be a valid avenue. Patients should be given guidance through identity cohesion practices such as hygiene, clothing, exercise, hobbies, familial routines, schooling/career, and behavioral affects. This time should involve learning about being gender non-conforming and authentically expressing themselves. We should also use this time to treat any underlying mental issues. There's evidence of a large overlap in people with gender dysphoria and conditions like OCD, ADHD, BPD, & Autism. These conditions should be well managed by the time social transition is reached.



If dysphoria diagnosis is supported, they should continue stage one and start 1 year of group counseling by elders who've both had successful and unsuccessful transitions. This would allow the patient to start envisioning their future life and the extent to which they would like to transition - as well as the level of risk they're willing to take. They can begin to find community and support from people who've struggled. This will also help them work through any emotional issues before taking on the journey of transition, which is difficult from start to finish. They will also have more support and resources once the transition starts. If the patient does present with comorbidities, these conditions should be well managed by the time social transition is reached.


Social Transition

Social transition should take roughly one year. This would include name & public clothing change, learning how to groom and socialize like the gender of choice. This time would build comfort and allow the patient to experience life closer to their ideal. This will help the patient see what they want even clearer. They may experiment with names, grooming, and styling to find what kind of person they want to be post-transition.


Hormone Replacement Therapy

2 years of hormones, if necessary. This would allow for a fuller understanding of their changes to the individual's body and if surgical intervention is necessary. This is also the time for education about potential risks and a more customized plan for surgical intervention. When fully informed, patients should feel more security and dignity in their choices long-term.


Presurgical Care

6 months - 1 year of surgical preparation. Patients would begin more cosmetic procedures like laser hair removal. This waiting period would avoid problems with grafts or other biological resources needed for successful surgical intervention.


Surgical Intervention

2-5 years of surgery and adjustment period. This would include continued counseling, physical therapy to maintain surgical results, any necessary revision surgeries, and hopefully allow for a smooth transition into life without constant medical intervention. Patients should be advised on every procedure they are to undertake by doctors and civilians for a well-rounded perspective.


Long Term Care

Designed per patient. Most likely 6-month follow-ups for 2-4 years and annually after that. Complications tracked and noted.


Cessation or Detransition Counseling

Patients may seek to stop or reverse their transition at any point for any number of reasons. Regardless, they will need as much if not more support during this time. Ideally, their support group would be strong and capable of guiding them. But professional therapy is highly advised. This is a new area of care and will require new guidelines.



Potential Impact

  • Improved Mental Health and Well-Being: Holistic support and early intervention can significantly enhance mental health outcomes.
  • Reduced Regret and Detransition Rates: Thorough assessment and gradual progression may lead to more satisfactory outcomes and lower detransition rates.
  • Increased Satisfaction and Quality of Life: Empowering patients through education and support can lead to higher satisfaction and improved quality of life post-transition.



  • Resource Intensive: The comprehensive approach may require significant resources, including specialized professionals and continuous support systems. This will also include new training and re-education for professionals.
  • Need for More Research: Some recommendations, like the timing of puberty interventions, require further research to establish best practices. B


Overall, the proposal aims to create a more structured, supportive, and informed process for individuals dealing with gender dysphoria, emphasizing the importance of mental health, education, and gradual progression through each stage of the transition.



Patient safety for children and adolescents with gender incongruence

Danish Health Authority (

 Norway’s guidance on paediatric gender treatment is unsafe, says review | The BMJ

Full Bibliography of modern gender affirming care research & guidelines

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2 commentaires

First off, thank you Hudson!
I wasn’t keeping up with these recent blog posts because I had a feeling they would leave me disappointed. Well, I finally have read them and ,suffice to say, boy was I right! I can’t in good conscience understand someone who would on one hand sell LE Pride month creams called “Hot Tranny Mess” and “Theirs” and in the other link these ill-informed posts. While I can’t articulate my feelings better than the other recent comments to your posts (seriously, read them), I can do my part in not supporting this company further.

Jul or yet another disappointed long timecustomer

Just trying to wrap my head around several recent posts that appear to have have culminated in this one. You spent 6 months with two colleagues preparing a series of newsletter/blog posts about “dangers” of gender affirming care, which laid the groundwork for releasing this “Proposal for an Improved Gender Dysphoria Treatment Process”? (A body products blog seems a strange place to offer such a proposal, but okay.) You state this work is based on an assembled bibliography (added ex post facto, 5 days after your initial writings received some criticism), as well as your personal experience counseling clients, and selected Youtube videos.

You also note that you have academic/university expertise around psychology and human sexuality, and you’ve been teaching for 14 years.

I know this isn’t a university setting, so maybe you feel you don’t need to apply academic rigor here, or offer context that would indicate deep knowledge or care about this issue. Yes, you belatedly posted a bibliography— but you made claims and statements that are not supported by it. To simply post a list of articles without any context or annotated connection to your content lends a false intellectual and ethical veneer to your project.

Given that this is a serious topic that impacts people’s real-life access to health care (not to mention their overall well-being), given that this issue has been highly politicized, given that the average person’s overall literacy on this topic is dismal, and given that many of the claims you’re making have previously been made in bad faith by bad actors using flawed data— given all that, your articles show a disturbing lack concern or care for the communities and people you are impacting. The lack of concern, reflected in the some of the language you chose in these posts, coupled with the casual way you intersperse unfounded claims next to evidence-informed information, is painful to witness.

You’re concerned about “danger” lurking within the medical-industrial complex, and in “gender-affirming” care models (which you attack yet don’t even bother to define), but you’re not concerned about any danger your own writing might pose by mixing medical facts with value judgements that you present as facts. That is not only dangerous, it is irresponsible. I doubt you’d get away with this kind of writing and argumentation in an academic setting. Just because you can get away with it on your blog doesn’t excuse your carelessness.

You’ve said that you want to give people “all the facts” so they can (presumably) make decisions that are right for their unique situation. You claim:

“My way of dealing with that is to simply break through the cloud of affirmation and provide you with all the information I’d give to someone who asks me in real life. This blog is the entirety of that information. If you get to the end of this and are still willing to risk it, that alone proves your commitment and authenticity.”

Being willing to “risk it” “proves your commitment and authenticity”? For someone who rails against nudging people toward medical treatment, you’ve just set up a false goalpost and a declaration about what that means about someone’s authenticity. But no pressure, right?

I’d hope that you’d want to offer people facts and a breadth of possible options so they can weigh them carefully, without feeling pressure in any specific direction. But you’re failing by that measure. You do a disservice when you offer vague statements of danger, or pieces of your subjective experience as fact. Then you burnish it all by acting like you’re making an informed contribution to the professional field of care.

Here are just a few things you offered in related posts that are vague, value-laden, and/or not clearly supported by the sources you offered:
“Current guidlines in Denmark, Norway, & Sweden have changed the age limit for any medical interventions to 18.”

But the documents you offered show they haven’t. Care teams continue to have discretion around medical treatment for those under 18 years old. There are (and were already) guidelines around what care for young people should look like, but there is no strict age limit. I’m not arguing pro or con here, just noting that you are misrepresenting the documents you offered in your bibliography.

“you have a high liklihood of health complications from hormones eventually.”
(Unsupported and vague, not to mention anyone prescribed hormones is informed of known risks, possible/expected changes, and how those changes might be potential pros/cons in the eyes of the patient.)

“The density of your body will not change very much, meaning you will physically feel like your natural sex to people who touch you.”
(Unsupported, subjective speculation.)

“You also will almost always still smell like the gender you were born even after decades… This will primarily be an issue with heterosexual and homosexual partners. Pan and bisexual partners are more likely to welcome the variety.”
(Unsupported, subjective speculation.)

“these procedures involve… permanently disfiguring your body”
(Emphasis mine. Value-loaded language implies that these particular procedures have a negative valence.)

“gender reassignment surgery and gender affirmation surgery on a perfectly healthy human body can be considered forms of mutilation
(Emphasis mine. Again, value-loaded language that denigrates anyone’s path that alters their body.)

“Gender transition is a decision that should never be made before fully experiencing and understanding the natural development of one’s physical adult body.”
(Opinion. You’re entitled to your feelings, but you’re supposedly presenting actual proposals for care in this section, which should be based on evidence and improving outcomes when appropriate.)

“Once they have taken hormones or undergone surgical procedures, they are left with permanent scars, damage, and disfigurement.
(Emphasis mine. Again, value-laden language. I’ve had a shoulder surgery that left scars, and involved shaving some bone to improve functionality. I don’t refer to that as “damage” or “disfigurement” because the outcome of the surgery, over decades, has proven a benefit to me. I would question the motives and compassion of my care practitioner if they referred to my shoulder using those words.)

You mentioned that you counsel people. Then you should know better than to allow your own value-judgements to influence a client’s decisions. If you can’t assist a client in sorting through their experiences, feelings, and needs without denigrating other people’s experiences and bodies, then maybe you need to find a new way to approach this topic.

You have (legitimate) concerns for any person for whom medical transition may not be a good choice. But do you fail to see how your words might impact a person for whom medical transition might allow them to thrive? How do you think some of the value statements quoted above might impact such a person if they sought your counsel? Or do you think it is your “job” to put clients through a gauntlet of negative statements about their own or other people’s bodies so they can prove their “authenticity”?

Care can’t be divorced from the reality of the inequities of the culture we live in. I don’t want to see any person feeling pressured to make choices— in any direction— that don’t feel right for them. I do not seek to silence or ignore the voices of those who feel the care they received didn’t serve them. The voices of the individual folks you linked to in your bibliography are important. Care around gender issues is obviously not one-size-fits-all, and can always be improved. Indeed, trans people have been advocating for improvements in care for decades.

Despite the concerns you’ve voiced, I think you’ve done far more harm than good with these posts. The discourse around gender-based care is already rife with misinformation, bad-faith actors, and people contributing their takes without knowing anything about the history, context, or reality of this topic. Your work here hasn’t shown any real effort to differentiate yourself from the noise.


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