Stephen B. Levine

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Stephen Barrett Levine (born 1942) is an American psychiatrist known for his thesis that gender dysphoria and being transgender are often caused by psychological issues that should be treated psycho-analytically as opposed to with gender-affirming care. He co-founded Case Western Reserve University School of Medicine's Gender Identity Clinic in 1974, served as the chair of the World Professional Association for Transgender Health (WPATH) drafting committee for the 5th edition of their Standards of Care (SOC-5) published 1998, and served on the American Psychiatric Association (APA) DSM-IV (1994) Subcommittee on Gender Identity Disorders.

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He has since distanced himself from these organizations, arguing they are more concerned with civil rights than evidence and too receptive to the transgender community. Since 2006 he has worked with U.S. state prisons to deny transgender inmates medical and social transitions. In recent years, he has worked with the Alliance Defending Freedom to support anti-trans legislation as an expert witness. He has supported banning gender-affirming care for minors, overturning bans on conversion therapy, preventing transgender students from participating in sports matching their identity, and forcing schools to out them to their parents. He is now a member of Genspect and the Society for Evidence-Based Gender Medicine.

Education and career

Levine earned his M.D. from Case Western Reserve University School of Medicine in 1967 and serves as a Clinical Professor of Psychiatry there. His clinical practice began in the mid-1970s as the University Hospitals of Cleveland Sexual Dysfunction Clinic. In 1993 the Clinic separated from University Hospitals, and is presently called The Center for Marital and Sexual Health in Beachwood, Ohio.[ citation needed ]

His early work focused on premature ejaculation and erectile dysfunction, and he has written on a number of treatment options, including vacuum pumps, [1] injections into the corpus cavernosum of the penis, [2] and Viagra. [3] The most potent aphrodisiacs, according to Levine, are psychological intimacy [4] and voyeurism: "looking at pictures or movies of people engaged in genital or romantic interplay." [5] [ non-primary sources needed ]

Levine has written on sex offenders, including professionals who offend. [6] He cites Kurt Freund as an important influence because Freund wanted to define the subtypes of child molesters to help devise a means of prevention. [7] Levine has written about adultery and infidelity and believes pejorative terms like "cheating" and "infidelity" prevent addressing the issue in realistic terms. [8] [ non-primary sources needed ]

He was section co-editor with R. Taylor Segraves for the section on sexual and gender identity disorders in Treatments of Psychiatric Disorders by Glen Gabbard. Notable contributors included Martin Kafka (paraphilias) and Kenneth Zucker (gender identity disorder in children and adolescents). [9] [ non-primary sources needed ]

Although much of his work is written for other clinicians, Levine has written books for a lay audience, including Solving Common Sexual Problems (1997) and Sexuality in Mid-Life (2004).[ non-primary sources needed ]

Work on transgender healthcare

In 1974 he created the Case Western Gender Identity Clinic to treat transgender people which recommended surgery for only 10% patients and he became an influential figure in trans healthcare in the 70s and 80s. [10] Levine's approach emphasized psychoanalytic treatment for transgender people as opposed to medical interventions, arguing that people transition to "avoid painful intrapsychic problems" caused by factors such as "an overly long, excessively symbiotic" relationship with the patients mother. [10] He has argued that transgender people are commonly pathologically narcissistic. [11] In the 1990's, scientific consensus on transgender healthcare began to diverge from psychoanalytic theories as gender-affirming medical care was seen as more effective than therapy for treating gender dysphoria. [10]

Levine was named Chair of the fifth edition of the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) in 1998, [12] the last iteration to include "autogynephilia." [13] He cut ties with WPATH in 2001 due to his view that they had become too responsive to transgender activists and patients. [14] [10] He argued that WPATH's biennial meetings being open to transgender people who weren't medical professionals limited "the ability for honest and scientific debate". [15] He has criticized later editions of the SOC for no longer considering transgender identity a mental disorder, arguing that it's not true that "no form of gender identity is an abnormality", and stated their are "effective alternative approaches" to gender-affirming care such as "gender exploratory therapy" which he argues are not a form of conversion therapy. [13] [16]

Levine served on the American Psychiatric Association (APA) DSM-IV (1994) Subcommittee on Gender Identity Disorders. [17] He serves on the editorial board for the Archives of Sexual Behavior alongside Kenneth Zucker, Ray Blanchard, and J. Michael Bailey. [18]

He is a member of Genspect and the Society for Evidence-Based Gender Medicine, scientifically fringe organizations formed in reaction to gender-affirming care. [11] He has argued the mainstream medical establishment has moved to the fringe on transgender healthcare and that groups such as the APA were endorsing WPATH's updated SOC "on the basis of civil rights" instead of scientific evidence. [10]

Lobbying

Since 2006, Levine has been frequently hired as an expert witness by American state prisons to testify against access to medical or social transition for trans prisoners, and been used by many prisons in a clinical context to deny said measures to individual prisoners. [10] [14] He works as the Gender Dysphoria Consultant for the Massachusetts Department of Corrections and denied all applications for surgery he received, arguing the patients wanted to transition due to sexual deviance, unresolved trauma, or to escape the moral opprobrium of their crimes. [10] [19]

Since then, he has served as an expert witness on nearly every transgender rights case in the United States for the parties opposing transgender rights. [16] Levine has stated he is opposed to unilateral bans on gender affirming care, but has supported them as an expert witness for the Alliance Defending Freedom. [20] [14] He also presented evidence during Bell v Tavistock to support the United Kingdom NHS banning the prescription of puberty blockers to those under 16. [15]

He has supported legislation that would forcibly out transgender youth to their parents [20] and ban them playing on sports teams that match their identity, [10] He also testified in favor of overturning Washington state's ban on conversion therapy. [10]

Selected publications

Related Research Articles

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder. The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.

Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, though many such treatments are also pursued by cisgender and non-intersex persons. It is also known as sex reassignment surgery (SRS), gender confirmation surgery (GCS), and several other names.

The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria, and creating standardized treatment for transgender and gender variant people. WPATH was founded in 1979 and named HBIGDA in honor of Harry Benjamin during a period where there was no clinical consensus on how and when to provide gender-affirming care.

The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist – especially outside the United States – the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.

Hypoactive sexual desire disorder (HSDD), hyposexuality or inhibited sexual desire (ISD) is sometimes considered a sexual dysfunction, and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician. For this to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug, or some other medical condition. A person with ISD will not start, or respond to their partner's desire for, sexual activity. HSDD affects approximately 10% of all pre-menopausal women in the United States, or about 6 million women, 1.5% of men and an unstudied amount of gender non-conforming people.

The following outline is provided as an overview of and topical guide to transgender topics.

<span class="mw-page-title-main">Ray Blanchard</span> American-Canadian sexologist (born 1945)

Ray Milton Blanchard III is an American-Canadian sexologist who researches pedophilia, sexual orientation and gender identity. He has found that men with more older brothers are more likely to be gay than men with fewer older brothers, a phenomenon he attributes to the reaction of the mother's immune system to male fetuses. Blanchard has also published research studies on phallometry and several paraphilias, including autoerotic asphyxia. Blanchard also proposed a typology of transsexualism.

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.

The American-Canadian sexologist Ray Blanchard proposed a psychological typology of gender dysphoria, transsexualism, and fetishistic transvestism in a series of academic papers through the 1980s and 1990s. Building on the work of earlier researchers, including his colleague Kurt Freund, Blanchard categorized trans women into two groups: homosexual transsexuals who are attracted exclusively to men and are feminine in both behavior and appearance; and autogynephilic transsexuals who experience sexual arousal at the idea of having a female body. Blanchard and his supporters argue that the typology explains differences between the two groups in childhood gender nonconformity, sexual orientation, history of sexual fetishism, and age of transition.

<span class="mw-page-title-main">Transgender sexuality</span> Sexuality of transgender people

Sexuality in transgender individuals encompasses all the issues of sexuality of other groups, including establishing a sexual identity, learning to deal with one's sexual needs, and finding a partner, but may be complicated by issues of gender dysphoria, side effects of surgery, physiological and emotional effects of hormone replacement therapy, psychological aspects of expressing sexuality after medical transition, or social aspects of expressing their gender.

<span class="mw-page-title-main">Eli Coleman</span>

Eli Coleman is an American psychologist and sexologist. He is professor emeritus and former director of the Eli Coleman Institute for Sexual and Gender Health in the Department of Family Medicine and Community Health at the University of Minnesota. In 2007, he was appointed the first endowed Chair in Sexual Health at the University of Minnesota Medical School. He has published research on sexual orientation, sexual dysfunction and compulsivity, gender dysphoria, and sex offenders.

Kenneth J. Zucker is an American-Canadian psychologist and sexologist known for the living in your own skin model, a form of conversion therapy aimed at preventing pre-pubertal chidren from growing up transgender by modifying their gender identity and expression.

Robert Taylor Segraves is an American psychiatrist who works on sexual dysfunction and its pharmacologic causes and treatments.

<span class="mw-page-title-main">Transsexual</span> People experiencing a gender identity inconsistent with their assigned sex

A transsexual person is someone who experiences a gender identity that is inconsistent with their assigned sex, and desires to permanently transition to the sex or gender with which they identify, usually seeking medical assistance to help them align their body with their identified sex or gender.

<span class="mw-page-title-main">LGBTQ rights in Florida</span>

Lesbian, gay, bisexual, and transgender (LGBTQ) people in the U.S. state of Florida have federal protections, but many face legal difficulties on the state level that are not experienced by non-LGBT residents. Same-sex sexual activity became legal in the state after the U.S. Supreme Court's decision in Lawrence v. Texas on June 26, 2003, although the state legislature has not repealed its sodomy law. Same-sex marriage has been legal in the state since January 6, 2015. Discrimination on account of sexual orientation and gender identity in employment, housing and public accommodations is outlawed following the U.S. Supreme Court's ruling in Bostock v. Clayton County. In addition, several cities and counties, comprising about 55 percent of Florida's population, have enacted anti-discrimination ordinances. These include Jacksonville, Miami, Tampa, Orlando, St. Petersburg, Tallahassee and West Palm Beach, among others. Conversion therapy is also banned in a number of cities in the state, mainly in the Miami metropolitan area, but has been struck down by the 11th Circuit Court of Appeals. In September 2023, Lake Worth Beach, Florida became an official "LGBT sanctuary city" to protect and defend LGBT rights.

Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. They are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

The real-life experience (RLE), sometimes called the real-life test (RLT), is a period of time or process in which transgender individuals live full-time in their identified gender role in order to be eligible to receive gender-affirming treatment. The purpose of the RLE has been to confirm that a given transgender person could function successfully as a member of said gender in society, as well as to confirm that they are sure they want to live as said gender for the rest of their life. A documented RLE was previously a requirement of many physicians before prescribing gender-affirming hormone therapy, and a requirement of most surgeons before performing gender-affirming surgery.

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world. Gender affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender affirming care is to help a transgender individual conform to their desired gender identity.

<span class="mw-page-title-main">Autism and LGBTQ identities</span>

Current research indicates that autistic people have higher rates of LGBTQ identities and feelings than the general population. A variety of explanations for this have been proposed, such as prenatal hormonal exposure, which has been linked with sexual orientation, gender dysphoria and autism. Alternatively, autistic people may be less reliant on social norms and thus are more open about their orientation or gender identity. A narrative review published in 2016 stated that while various hypotheses have been proposed for an association between autism and gender dysphoria, they lack strong evidence.

References

  1. ↑ Turner LA, Althof SE, Levine SB, et al. (1991). External Vacuum Devices in the Treatment of Erectile Dysfunction: A One-Year Study of Sexual and … Journal of Sex & Marital Therapy
  2. ↑ Althof SE, Turner LA, Levine SB, Risen C, Kursh ED (1987). Intracavernosal injection in the treatment of impotence: A prospective study of sexual... Journal of Sex & Marital Therapy
  3. ↑ Pallas J, Levine SB, Althof SE, Risen CB (2000). A Study Using Viagra in a Mental Health Practice. Journal of Sex & Marital Therapy
  4. ↑ Levine SB (1991). Psychological intimacy. Journal of Sex & Marital Therapy
  5. ↑ Brody JE (August 4, 1993). Personal health. New York Times
  6. ↑ Levine SB, Risen CB, Althof SE (1994). Professionals who sexually offend: Evaluation procedure; and preliminary findings. Journal of Sex & Marital Therapy
  7. ↑ Freeman, Karen (October 27, 1996). Kurt Freund Dies at 82; Studied Deviant Sexual Arousal. New York Times
  8. ↑ Alexander, Brian (April 17, 2007). To stay or stray? Crimes of opportunity [ dead link ]. NBC News
  9. ↑ Segraves RT, Levine SB (section editors) Sexual and Gender Identity Disorders. In Gabbard GO, ed. (2001). Treatments of Psychiatric Disorders.
  10. 1 2 3 4 5 6 7 8 9 Stahl, Aviva (July 8, 2021). "Prisoners, Doctors, and the Battle Over Trans Medical Care". Wired Magazine.
  11. 1 2 Wuest, Joanna; Last, Briana S. (2024-03-01). "Agents of scientific uncertainty: Conflicts over evidence and expertise in gender-affirming care bans for minors". Social Science & Medicine. 344: 116533. doi:10.1016/j.socscimed.2023.116533. ISSN   0277-9536. PMID   38401237.
  12. ↑ Levine SB, Brown G, Coleman E, Cohen-Kettenis P Hage JJ, Van Maasdam J, Petersen M, Pfaefflin F, Schaefer LC (1999). The Standards of Care for Gender Identity Disorders. Journal of Psychology & Human Sexuality
  13. 1 2 "Foundations of the Contemporary Anti-LGBTQ+ Pseudoscience Network". Southern Poverty Law Center. Retrieved 2024-10-08.
  14. 1 2 3 "These Paid 'Experts' Are Crisscrossing The Country To Defend Anti-Trans Laws". HuffPost. 2023-09-15. Retrieved 2023-12-17.
  15. 1 2 Keena, Colm. "Gender distress treatment in young people: a highly charged debate". Irish Times.
  16. 1 2 Caraballo, Alejandra (2022). "The Anti-Transgender Medical Expert Industry". Journal of Law, Medicine & Ethics. 50 (4): 687–692. doi:10.1017/jme.2023.9. ISSN   1073-1105. PMID   36883410.
  17. ↑ Bradley SJ, Blanchard R, Coates SW, Green R, Levine SB, Meyer-Bahlburg HFL, Pauly IB, Zucker KJ (1991). Interim report of the DSM-IV Subcommittee on Gender Identity Disorders. Archives of Sexual Behavior Volume 20, Number 4 / August, 1991
  18. ↑ "Group dynamics and division of labor within the anti-LGBTQ+ pseudoscience network". Southern Poverty Law Center. December 12, 2023. Retrieved 2024-10-09.
  19. ↑ Lazine, Mira (2024-09-18). "Trans inmate wins right to gender-affirming surgery despite state law banning it". LGBTQ Nation. Retrieved 2024-10-08.
  20. 1 2 "Manufacturing the doubt that fuels the network". Southern Poverty Law Center. December 12, 2023. Retrieved 2024-10-09.
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