Gender Expression: Authentic, Ambiguous, or Delusory?

Much about the Harley Street Gender Clinic in London’s west end is ambiguous, not to say confused, just like the idea of gender expression itself. The Clinic is run by a Dr Vickie Pasterski, who according to a TEDx talk she gave, believes ‘there are as many gender presentations as there are stars in the sky.’

After viewing the Clinic’s website I took the liberty of sending the following email to Dr Pasterski (she’s a PhD-type doctor) and asking for her comments:

You talk about ‘individuals diagnosed with gender dysphoria’. But what is gender dysphoria? No objective criteria exist. Therefore you are making a diagnosis out of someone’s fantasy or delusion that they were born in the ‘wrong’ body. Also, a diagnosis implies an illness or abnormality of some sort. Or do you consider so-called gender dysphoria is a normal state for some people? Do you make it clear to your clients that it is impossible to change their sex and that hormonal manipulation (and surgery if undertaken) are cosmetic treatments? Should not people in this situation, especially if aged under 18, rather be helped to accept or come to terms with their biological reality?

I received a prompt acknowledgement from the practice manager, one Marcela Noble, informing me that ‘Dr Pasterski is on leave from until [sic] Monday 12th December 2022.’ See what I mean about ambiguity? But Ms Noble is nothing if not friendly – she’s positively gushing:

We are ever so thankful for your kindness, patience and understanding. Please know that we have your best interest in mind and your request(s) have been logged. With warmest regards…

On the other hand, she can’t refrain from a repetitive touch of the school mistress, kindly though she does it:

Please be advised we receive on average 100 emails per day. We endeavour to respond within 10 working days however this is not always possible…We would kindly ask you to refrain from sending duplicate emails unless urgent…We kindly ask that you refrain from contacting us regarding outstanding reports as this decreases our staff capacity to attend to the writing of the reports.

Now let’s return to the website. The first words are:

Welcome to the Harley Street Gender Clinic

But if we go to their ‘Register Now’ form we find:

We would like to extend our warmest welcome to the Harley Street Gender Clinic

At first glance it looks as if ‘we’ and ‘our’, whoever they may be, are welcoming the Harley Street Gender Clinic to something rather than the Harley Street Gender Clinic welcoming prospective fee-paying clients. Presumably, they mean to say: The Harley Street Gender Clinic extends you a warm welcome.

They continue:

If you would like to book in for consultation with one of our gender specialists, please fill in the below Registration Form. Once submitted, one of our staff will be in contact to discuss your needs and to make appropriate arrangements.

The writing would better if it finished after ‘contact’ because the rest is obvious. Then we find this (emphasis in original):

NB: When completing the form, please provide the name you prefer that we use in our clinic – Write your name exactly as you wish it to appear in our system. Otherwise, we may not be able to match further correspondence with your registration. 

Again, all this is obvious and doesn’t need saying, let alone repeating, or at most the first sentence up to the underlined bit would suffice.

Returning to the website’s opening page, it sports a quotation:

Authenticity is the soul made visible

Not being clear what that means I looked it up and found it’s attributed to an American writer of ‘inspirational’ books called Sarah Ban Breathnach. So, if you’re authentic does this mean your soul is on display? Or are they implying that transgenderism is authentic for some people? It may be, but it wouldn’t serve the Clinic’s interests to leave it at that.

After the quotation from Ms Breathnach we have what appears to be their mission statement:

Providing guidance, support and treatment toward authentic gender expression

Guidance and support (what’s the difference?) may be helpful for people confused about their gender – confused in the sense that they can’t decide whether to think of themselves as male, female, neither, both, or as a something in between. But for people who are convinced, that is to say, deluded, that they are of the opposite sex, when the Harley Street Gender Clinic mentions treatment this means hormonal manipulation and even surgery. For example, in the case of a girl who believes she’s a boy, when entering puberty she may be offered a so-called puberty blocker likely followed by male hormone (testosterone) injections and even removal of her breasts! And this is called being authentic? It’s the very opposite of authentic – better to call it artificial, imitation, or bogus gender expression.

One thing that is clear, however, is the Clinic’s ‘affirmative’ approach:

The goals of your assessment are essentially to diagnose Gender Dysphoria and to establish a plan going forward according to your needs and preferences (e.g., start with hormone therapy, undertake surgery, etc.)

Let’s take out the unnecessary words:

The goals of assessment are to diagnose gender dysphoria and plan for hormone treatment or surgery according to your needs.

So the diagnosis has already been decided. After paying a mere £500, in someone who thinks they have gender dysphoria, this so-called diagnosis will be confirmed and if they wish to ‘transition’ – as presumably all the clients potentially do otherwise there would be no point in the consultation – a report will be written to act as a referral to one or more associated specialists depending on the treatment being sought.

​In the case of adults over 18 who are presumed to be capable of making an informed choice and who wish to have their body altered by hormonal treatment or surgery or both, then good luck to them. But for people under 18 it’s an entirely different matter. Such a person, after passing through the hands of this Clinic and having been treated by one or more of their specialists, is likely to end up infertile and incapable of experiencing normal sexuality, to say nothing of the risk of suffering long-term side effects from disrupting normal puberty hormonal changes.

The Clinic boasts of nineteen Top Surgery Surgeons (surgeons who are prepared to remove a woman’s healthy breasts) including one each in Greece, Poland, and America; ten Hormone Replacement Therapy Specialists; eight Genitoplasty Surgeons; the Harley Street Fertility Clinic ‘who have experience working with transgender patients’; and others.

For the initial fee (with follow-up consultations at £250 a pop) the Clinic offers the following:

Support and Guidance: While there is no right way to go about gender transition or to take the decision not to transition, specialist support can help with finding the right path for a given individual.

It’s true that ‘there is no right way to go about gender transition,’ but then they contradict this by saying ‘specialist support can help with finding the right path.’ Presumably they intended the first part of the sentence to read: ‘While there is no one right way…’

We are also informed:

Puberty itself marks a period of rapid physiological change and development of secondary sex characteristics. When the inner sense of self is incongruent with biological sex, further development of unwanted sex characteristics can be exceptionally difficult.

This may indeed be the problem for some adolescents but the Clinic hardly seems a neutral resource – the assumptions that gender dysphoria is a diagnosis and that there is such a process as transitioning amount to their default positions. But I wonder how many of their clients take the decision not to transition and for how many of them do they provide support and guidance to accept their biological reality.

[Note added 9 January 2023. It is now a month after Dr Pasterski should have returned from leave. Her reply to my email? Silence.]

Text © Gabriel Symonds

Photo credit: Alexander Grey on Unsplash

Gabriel Symonds

Dr Gabriel Symonds is a British doctor living in Japan who is interested in helping smokers quit. He has developed a unique simple method without nicotine, drugs, hypnosis or gimmicks that he has used successfully with hundreds of smokers. Further information can be found at www.nicotinemonkey.com

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