This is a correction to my letter of October 1, written in response to your review of my exhibition "Reframed Positions" published on September 1, 2023. Given the length of my previous letter, it is not my intent to needlessly dwell on things. However, after much confusion, I have identified the quote causing your reviewer's discontent. I now realize it did not happen during my talk at the Volksbühne as previously thought, but was taken from an exhibition-related interview published in 2020. Although this does not invalidate the overall analysis of censorship in my previous letter, it does nullify certain specific things I said based on that misunderstanding of venue. I am also now able to directly address the quote in question.

Your reviewer's concerns about the content of my "talk" with chief curator Lawrence English ("Gerade deshalb hinterlässt ihre Äußerung zur Transitionsmedizin im Talk mit English einen bitteren Beigeschmack. [Fn. 9: Thaemlitz/Englisch [sic], S. 6.] Die Kurator*innen verpassten hier ihre Verantwortung, zu intervenieren, als die eingeladene Künstlerin unwidersprochen Argumente trans*feindlicher Desinformation zur angeblichen Gefahr pubertätsblockender Medikamente echote.") refers to a passage from English's privately held interview with me that was published in 2020 as part of the first installation of "Reframed Positions" at The SubStation, in Melbourne. ["Reframed Positions: Terre Thaemlitz in Conversation with Lawrence English," http://comatonse.com/reviews/substation200424.pdf] Although I had previously seen your reviewer's footnote "Thaemlitz/Englisch [sic], S. 6," I could not place it at the time because page six of the printed interview only speaks about my days in art school. This, combined with the public talk at Volksbühne being mentioned earlier in your review, led me to conclude the "talk with English" referred to the one at Volksbühne. In my limited German, I therefore dismissed "S. 6" as some kind of internal editorial marker of your publication. However, a German colleague who was also initially confused by this section of your review managed to trace the quote in question to page eleven of the interview. (In the pdf version, both pages eleven and twelve of the physical publication occupy the sixth page of the digital file, hence your reviewer's mistaken footnote.)

The quote is as follows, with the sentence referencing hormone blockers italicized here for clarity:

Today we shudder at the outdated notion of medical institutions attempting to "cure homosexuals," and yet today’s gender transitioning therapies are literally a financial redirection of those very research funds away from sexuality to gender. It is increasingly commonplace to give children experiencing gender crises damaging hormone blockers, rather than feminist tools for coping, organizing and living within an unsatisfactory and limiting gender binary. We are still being duped, still being experimented on, cut, physically and chemically deprived of sexual function, deprived of the ability to orgasm.

And despite how many of us may embrace these limitations, and attempt to reinscribe them with Pride^TM-ful notions of self-fulfillment, it is undeniable that on the culturally macro level these limitations are continuing a long tradition of dominant culture medically debilitating - not manifesting - our sexualities.

I suspect your reviewer's description of my statement as "echoing unchallenged arguments of anti-trans* disinformation" hinges around my use of the word "damaging." In retrospect, the sentence would have held its primary intent even if "damaging" had been omitted altogether. For simplicity's sake, that is likely how I would choose say it today if given the chance. (Although, perhaps your reviewer would still have their same objections.) In my view, the problem with my quote is not so much the term "damaging" in and of itself, but the fact it was not better framed so as to explain what kind of damage I was referring to (social? medical? physiological? psychological? economic?).

Thinking back to the time of that interview, I suppose the assertiveness of my word choice was in part an adverse response to an ever-escalating climate of cancel culture in which I was aware that directly expressing any concerns about the risks of hormone blockers - even as a trans person - were likely to illicit backlash from mainstream LGBT institutions and pundits. Like many people, I do have a history of words coming out a bit too bluntly when struggling to find words in the midst of feelings of repression, even though such circumstances demand more care. My two letters to you are also framed by this same climate of repression, the ongoing reality of which is materially substantiated by your call for "intervention" itself.

I do not say these things in an attempt to eschew personal responsibility for my original word choices, nor do I apologize for those choices since: 1) your reviewer's response to my quote has already overwritten any personal intent I held with a politic of us-versus-them in which I feel no representation; thus 2) any such apology would only give power to that politic's ability to divide and conquer, in which the only voices that culturally retain a semblance of stability are those of radically anti-trans advocates on the one side, and on the other side those advocating for blind faith in the safety and efficacy of transitional therapies. For example, consider the Swedish politician and YouTuber Mia Mulder, whose stance can be paraphrased as, "I'm not a physician, and yes there are known risks, but get over it." ["Puberty Blockers Are Safe, As Far As We Know. Get Over It," https://youtu.be/C7XYfffLMEQ?si=ToFktlPcBcaEq9CO] What is between is missing.

My statement in the interview was part of a longer rebuttal to a comment by English about audiences - and societies in general - becoming more open with the passage of time. My response touched upon a lot of topics, but this specific quote was speaking to the overlap of transgendered medical interventions and sexuality. As I wrote in my previous letter, I do place the sacrifices of sexual function typically associated with many gender therapies within a larger history of the clinical sexual suppression of homosexuality and other sexual variance. My response to English included a passing reference to hormone blockers because puberty is obviously an important phase in sexual development, and popular transitional therapies for youth such as hormone blocking GnRH analogues do have the common side effect of inhibiting the physiological capacity for arousal and orgasm. As a result, it seems sensible to have concerns about the possibility for negative physical and psychological effects on sexual development.

These drugs were originally developed to delay precocious puberty in children, and have been widely used in that manner since the 1980's. It is my understanding that hormone blockers were first given to transgendered teens in 1991, but this alternate usage did not really become commonplace until the 2000's. Notably, the control of precocious puberty - which rarely presents physical health risks - is entwined with social sexual mores. A chief concern is how untreated children - particularly girls - become negatively stereotyped and socialized by both peers and adults as hypersexual, promiscuous, deviant, etc. So we once again quickly find the material history of these drugs - their development and deployment - is inextricably linked to the medical control of sexuality.

Whereas the effect of sexual suppression in children with precocious puberty is deliberate and understood as a benefit, in transgendered teenagers and young adults it can complicate the course of development for sexual expression and identity. While it offers the child with precocious puberty a greater chance to socially and sexually fall in sync with peers, among transgendered teenagers and young adults it knowingly places them out of sync by design. While medical professionals encourage us to place our faith in their guidance when evaluating benefits versus risks, the impact of hormone blockers on sexual development in transgendered people remains overwhelmingly unstudied. In my experience, attempts to research this topic have only turned up statements acknowledging this historic lack of study rather than any useful information on the topic itself - and even those acknowledgments remain few and far between.

If I may interject some dark humor, I can also honestly say that in my experience as a teen who never turned to alcohol or drugs to help manage the miseries of daily verbal and physical harassment from family, peers and adults, there were definitely days when masturbatory release saved my life. Developmental complications resulting from hormone blockers can also present psychological and physiological challenges to those who choose not to transition after stopping hormone blockers (referred to by clinicians as "desistance"). Socially and psychologically, it is a very different thing to go through puberty as a young adult rather than as a teenager. Furthermore, despite medical industry claims that the effects of hormone blockers are fully reversible, adults undergoing delayed puberty are often left with signs of reduced physical growth.

There are radically varying statistics regarding the number of people who discontinue puberty blockers and do not go on to further transitional therapies. When I say radically varying, I mean radically varying - from 2% to 94%. I personally consider both extremes questionable. The lowest rates usually refer to individual, hyper-specialized clinics whose success rates do not reflect the industry as a whole - despite their data being picked up and misquoted by major online news sources that make it appear to be a global average. Conversely, the highest extremes tend to appear in articles with obvious anti-trans bias, and thus seem plainly exaggerated. Over the years, the rates I have seen mentioned most often within articles that I felt did not demonstrate extreme bias in either direction tended to fall between 60% and 70%, which is also in line with accounts of the experiences of children from parents I personally know. Make of that what you will, but amidst all of the contradictory data, that is why I tend to consider those numbers the most likely to be credible on a wide scale.

Researchers who reference lower rates of desistance tend to argue that studies showing higher rates are typically flawed because older diagnostic practices have a tendency to statistically incorporate people such as "proto-gay boys" who were never transgendered to begin with, but were simply brought to clinics by parents upset over their children not conforming to gender norms. That sounds like a reasonable explanation for the wide statistical divide. It implies that statistics showing low rates of desistance can be trusted because diagnostic practices across the medical industry are becoming more honed, and treatments are increasingly only being given to the appropriate people. Following this logic, which also relies on an assumption that the actual base median need for such treatments within a given population is typically stable regardless of misdiagnosis, one would assume that the total number of teens receiving hormone blockers should currently be in notable decline as a result of better contemporary diagnostics ensuring fewer are getting them needlessly. This should hold true regardless of today's exponential annual increase in diagnoses of gender dysphoria among minors.

Such a decline in the prescription of hormone blockers should be easily provable by looking at annual insurance claim data for a drop in the number of youth with diagnoses of gender dysphoria who go on to initiate hormone blocking treatments. Potential data bias would likely fall in favor of generating artificially low rates of desistance based on a possible undercounting of hormone blocker treatments not covered by insurance, or practitioners prescribing blockers without logging a gender dysphoria diagnosis. In other words, any error in data should make those claiming low rates of desistance look all the better, and alleviate my skepticism. However, using statistics from a report in Reuters pulling US data for the years 2017 to 2021 from Komodo Health Inc. as a typical example, the percentile relationship between diagnoses of gender dysphoria and hormone blocker usage among youth between the ages of 6-17 over those five years shows no significant drop, steadily fluctuating between 3% and 5%, or one in every twenty-to-thirty subjects. ["Putting Numbers on the Rise in Children Seeking Gender Care," https://www.reuters.com/investigates/special-report/usa-transyouth-data/] Even if one were to optimistically argue that the rate of hormone blocker usage might naturally increase as public information improves and treatments become more accessible, a corresponding increase in associative diagnoses of gender dysphoria should offset any artificial percentile inflation of base median need. Thus we should still see a drop in the percentage of trans youth given hormone blockers.

While this exercise does not help us verify a current overall percentage rate for hormone blocker desistance, it does seem to disprove a decline in their prescription that is fundamental to the logic of those defending the veracity of lower rates. I consider this a critical observation because, although most queers and trans people have enough lived experience to quickly recognize the bias of a religious fanatic or political conservative citing high rates of desistance, it is far more difficult to demonstrate to that same audience how advocates for medical transitioning therapies come with their own biases. These difficulties are only exacerbated by calls for censoring intervention such as the one in your review, which uses a one-dimensional claim of transphobia to virtue signal which topics are and are not permitted among liberal good company.

It is a misery that, all things considered, I continue to see no reason to relax my skepticism or be less cautious about medical practices that are aimed at altering bodies exhibiting and enacting gender and/or sexual variances. This misery compels me to defend the rights of people to speak openly on such topics, regardless of how they may support or contradict my own views. Seeing how strongly your reviewer reacted to my mere passing mention of hormone blockers indicates the cultural hostility faced by trans allies who are far more committed than I to researching their risks. Your reviewer seems to fear the act of listening will inherently lead to the act of agreeing. I assure you, that is a flawed premise. Your reviewer did not propose that the curators ask me to elaborate on my point so that they and others could better understand and judge it for themselves. Rather, they called for curatorial "intervention (intervenieren)," which remains nothing more than a politely phrased call for censorship by asserting that authority figures (i.e., curators) had a "responsibility (Verantwortung)" to interrupt me (or others in my position) and unequivocally reject my position in front of, and on behalf of, the public. The result can only be an undeniable silencing of the weaker voice in that context - i.e., the artist's status as the curator's employee.

It is not fear mongering to state factually and without hyperbole that there are many known short- and long-term health risks associated with hormone blockers. Most are clearly listed on the pharmaceutical companies' own informational websites. As with any drug, it is not conspiracy theory to admit there is a high possibility that other known side effects are being hidden by pharmaceutical companies, their public discussion being relegated to user testimonials that are often discredited on the basis of their information not coming from a clinical source. And still other risks can only be revealed over time with more extended usage. I think most people understand these circumstances are not in any way unique to hormone blockers, and apply to most any drug available in today's pharmaceutical market. So much so that I find it odd for anyone to attempt to stifle discussions and analyses around medical treatments of any kind. To foster the ability to question a treatment's risks and efficacy is not to invalidate the treatment itself. To the contrary, it is necessary to furthering research and reducing medical injury.

Any personal anger I may hold regarding the abuses of medical industries that came across in the curtness of my statement to English should in no way be construed as anger towards people undergoing transitional therapies of any kind. They all have my solidarity, compassion and best wishes for favorable outcomes. Like your reviewer, I am sure, my concerns over these issues are informed by struggles I have personally witnessed, heard about through friends and comrades, and found in documents I have stumbled upon over the years. I will share one story with you from this latter category, which reflects cultural dynamics found in Japan and several other Asian societies.

About ten years ago I was watching television here in Japan. It was Pride^TM month, and the Japanese national broadcaster NHK had a roundtable program featuring queer and trans youth. To be specific, there were several queers plus one FTM trans youth. His trans experience - which was intended as a feel-good success story - began when entering middle school (junior high), which is the age when most Japanese schools require students to start wearing uniforms. This means skirts for girls, and pant suits for boys. At that time still identified as a girl, she adamantly refused to wear a skirt. When her parents insisted, she refused to go to school altogether. School administrators advised the parents to put her into counseling. By the student's own account, based on his stubborn refusal to wear a dress he was ultimately diagnosed with gender dysphoria, placed on hormone blockers, and as of the show's taping was preparing to begin taking testosterone. When asked by the program's cheerful host if he had always felt like a male - fishing for an obligatory essentialist "born this way" moment - the student good-naturedly smiled and said he liked sports. For sure, one of the reasons that teen left such a deep impression on me was because in that moment they did not reflexively parrot an essentialist narrative, despite not having the opportunity or perhaps not even the language to express a non-essentialist take on their experience.

Compared to how similar programs might play out in Germany, I am sure this all sounds cartoonishly superficial. I assure you I am conveying the entire program segment as it happened. I would like to think that the reality of his experiences leading to diagnosis and treatments within this land of hyper-conformity was far more nuanced than what was shared with us viewers. Perhaps. Although, having lived here for almost a quarter of a century now, I can also say with solemn sincerity, most likely not. We can never know the reality of his experience, but ultimately we are not meant to know. You see, the real point of this story is not the teenager, but the social document generated about them by the national broadcaster of Japan. Representing the cultural interests of Japanese society, NHK sold its audience the notion that transitional therapies are a completely logical response to children who refuse to wear gender-coded uniforms. In a classic demonstration of ideological inversion, what was purportedly a program celebrating Japan's liberalism and cultural openness was, at its core, a document of its conservatism and desperation to preserve rigid gender divides.

Like the teenager himself, we were not pointed to alternative solutions such as schools making exceptions to dress codes, or encouraging parents to place such children in schools without uniforms, or doing away with dress codes altogether, or a hundred other possible solutions that would not involve medical intervention. The teenager was not offered any history lessons about indigenous Japanese struggles for gender equality. They were not told about global struggles for women to wear trousers, or how in many European countries women used to be required to obtain special trouser permits from the police, or how women were not allowed to wear trousers on the US Senate floor until 1993, or countless other such facts capable of instilling a sense of solidarity while revealing the absurdity of the moment they were caught up in. All of these omissions were literally by design, as the early 2000s saw Prime Minister Junichiro Koizumi order then Education Minister and future Prime Minsiter Shinzo Abe to put an end to Japan's burgeoning "gender free" movement in public schools. Abe went so far as physically removing books by Japanese feminist authors from public libraries. We still live in the conservative aftermath of that cultural campaign, under which a full generation has now grown up.

Writing from within this cultural context, I will leave you with a rare bit of local good news that happened just this past October 25. After years of failed legal battles by trans advocates, the Japanese Supreme Court has finally ruled that the government requiring people to eliminate their reproductive functions if they wish to officially change gender constitutes a human rights violation and is unconstitutional. This is a major step toward Japan allowing legal gender change for people who are living socialized as a different gender, but who wish to avoid the risks and suffering associated with procedures such as phalloplasty and vaginoplasty. Currently, gender documentation is required for everything from housing to full-time employment. Without matching documents, people are relegated a life of struggle with inadequate housing and part-time income. The court's ruling is particularly important since the Japanese medical system does not offer good support for transsexuals. People are currently required to commit to an extremely regimented ten-year course of therapy and resocialization before possibly gaining access to genital surgeries. Out of desperation to socially stabilize their lives sooner, many Japanese end up getting operations done quicker and cheaper in nearby countries like Thailand and Singapore. While they are able to legally change gender upon their return, they are typically sent to the back of the line by Japanese physicians when seeking required ongoing medical maintenance. The court case has in no small part been won by the repeated willingness of people who underwent transitional therapies to testify openly about the physiological and psychological difficulties they face, and how contemporary Japanese law fosters unnecessarily high rates of post-transitional regret. I wonder if your reviewer might also be inclined to describe this scenario, which I consider an incredibly compassionate undertaking, as "echoing unchallenged arguments of anti-trans* disinformation?" Needless to say, this country is still far from revising the requirements for legally changing gender, but it is an unexpected and important legal victory.

All of these topics are pieces of the broader contextual puzzle that led me to say to English, "It is increasingly commonplace to give children experiencing gender crises damaging hormone blockers, rather than feminist tools for coping, organizing and living within an unsatisfactory and limiting gender binary." Admittedly, that brief statement within a larger interview on a wide range of topics did not reflect my intentions or motivating thoughts well. It could not. That requires elaboration such as I have attempted here, in opposition to your call for silencing "intervention." You and your staff are welcome to disagree with my views. After all, my opposition to censorship is ultimately a defense of the ability to disagree.

- Terre Thaemlitz, November 16, 2023

 
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