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Update: My dietitian is a TRA and I spoke up against her
Posted September 18, 2021 by salty-tomorrow in WomensHealthLounge

Thanks to all who commented on my original post. You provided me perspective and encouragement. I was especially reassured simply by how fast you all responded! I am grateful for this supportive community.

I've been following up on the matter, so I thought I would share my latest writing. For context, I have complained to the supervisor (without using the word trans, oops), stopped going to IOP, discussed the entire issue with my therapist, and written this email. Let me know what you think!


Hi [supervisor], thank you for taking the time to speak with me earlier this week, and for your help as I sorted out my treatment options going forward. Now that I have had some space to process, I realize I didn't make it fully clear what was said and why I found it objectionable.

In a discussion about healthy at any size, an idea I largely agree with, [dietitian] mentioned how this is an important activism topic for her, and shared that she had recently read a post by another activist that said that it is transphobic to assume that people who take cross-sex hormones are unhealthy. I have many problems with this statement, as well as its timing.

First, this statement is medically inaccurate. It might not be kind to make assumptions about other people's health, but it is true that increased levels of testosterone in females, and estrogen in males, do lead to health issues. There is decades of research, data and anecdote, demonstrating that high testosterone in women can cause PCOS, uterine and vaginal atrophy, painful periods and orgasms, hirsutism, acne, and more. Long-term use of exogenous testosterone also leads to infertility, by way of medically recommended hysterectomy, which has its own list of health implications. The list of side effects from long-term estrogen use in males is just as long.

Second, this statement was triggering. I have been accused of transphobia, as well as cursed at and called names, for arguing that defending women and their rights is not inherently an attack on people who identify as trans. I simply believe that it is not possible for humans to change sex, and that distinctions between men and women, males and females, are necessary for achieving liberation for women and girls and equality between the sexes.

This was not the first time that [dietitian] has made comments that suggest that she does not hold these beliefs. ("Menstruating people" is female-erasure, and "men and women and people who identify as non-binary" undermines sexual dimorphism.) Because of this, my history of abuse, and the abuse directed at me and women like me who oppose this language (J. K. Rowling and the trans activists: a story in screenshots) I did not feel comfortable speaking up in the moment and have struggled to articulate what set me off.

Finally, it was inappropriate for such a statement to be made in the middle of an eating disorder nutrition therapy group centered around overcoming diet culture and promoting body acceptance. On the surface, it is inappropriate because it takes what is supposed to be a therapeutic conversation into a political subject fraught with controversy. Further, it is inappropriate to imply that I am hateful or afraid because I have different beliefs about this issue.

More deeply, and most concerningly, the comment promotes an ideology that normalizes body dysmorphia. "Trans" is the idea that there exists a certain set of people who are "born in the wrong body" and that these people must undergo dangerous medical procedures in order to make their bodies resemble to opposite sex. That is, it is the idea that there is something wrong with your body, that obsessing about your feelings of discomfort in your body is valid, and that you should do what you can to alter your appearance. This is not, as [dietitian] presented it, a healing, body-neutral narrative; this is body dysmorphia.

I hope that this has clarified my position. It is my hope that [treatment center] and [dietitian] will understand why it is concerning to me that this is a permissible subject in your facility. I didn't even get into how this relates to my autism--that is a discussion for another time, but please let me know if you have any questions.

Best, salty-tomorrow

34 comments

IrishTheFrenchieSeptember 18, 2021

Perfect reply. Well thought, to the point, and without a hint of shame. Bravo.

salty-tomorrow [OP]September 18, 2021

Thank you! Your comment about the lack of shame was helpful to me as I agonized over hitting send haha I am not ashamed about my beliefs, and I should not be ashamed about sharing them.

HollyhockSeptember 18, 2021

Respectfully, I do not see your statements as beliefs. I see your statements as observed material facts. You may trust or believe in those facts, but they are not based on faith, rather on data.

salty-tomorrow [OP]September 19, 2021(Edited September 19, 2021)

I agree, but I also think it’s a useful framing in this context. If the dietitian is going to proclaim her religious beliefs in the middle of group, my beliefs ought to be respected as well. I also don’t feel that I need her to change her mind—if she wants to be a TRA, so be it, I just don’t think it’s appropriate during ED treatment.

YemayaSeptember 18, 2021(Edited September 18, 2021)

good for you!

I have noticed that HAES dietitians tend to also be TRAs.

I’m not sure how a dietitian could tell clients to be accepting of their body at any current size that it is and then turn around and support someone removing body parts in then name of gender.

chromodorisrexSeptember 18, 2021

HAES evangelists were my gateway to seeing the bad-faith arguments later made by TRAs. They both demand ideology and inner feelings be placed above outer material realities.

It’s funny that so many HAES proponents are TRAs, when body positivity & loving the body you are in are completely at odds with trans ideology of a “wrong” body that requires drugs & surgical intervention.

YemayaSeptember 18, 2021(Edited September 18, 2021)

Right! It’s completely hypocritical. Some HAES people are so extreme they think any weight loss is “diet culture”and bad, doesn’t matter if weight is interfering with someone’s life and makes them uncomfortable. But if trans people are uncomfortable in their bodies? Completely fine and acceptable! Get surgery! Take drugs!

[Deleted]September 19, 2021

The biggest WTF I have witnessed by HAES was Lizzo supporting HAES so much and saying how happy/confident she is as a "big" woman but also saying on many occasions she hates her body...and also losing some weight because it is apparently something that happens when you dont binge all the time and exercise

HAES also intensely hate people losing weight, because there is nothing positive for them to look (idgaf if people are offended, i will say it) - healthy

chromodorisrexSeptember 19, 2021

You’re not kidding, they do loathe people losing weight for any reason, legitimate or not. Witness “body positive” Tess Holliday being rude to her fans and saying their weight loss triggered her. Someone inspired by you to love themselves loses weight and you lash out on them?? That’s not a good look and it shows that self-improvement is not the goal. I know it has good intentions but it doesn’t have great outcomes or spokespeople.

The author who pushes HAES the most, Linda Bacon, is now a they/them called Lindo. Believes one form of quackery, primed to join another.

[Deleted]September 19, 2021

A famous HAED libfem woman compared diets to rape.. HAES is absolute bullshit

I hate how on one side there are people who ignore EDs, self hate, and all psychological aspects of losing weights and being healthy and just screech CICO, and on the other side you have magical (annoying af) creatures that think they are fat because the mean faes made them go against the law of physics.

I cannot believe anyone in HAES, esp the "professionals", still dont understand that when doctors talk about "diet" they are using the word referring to the entirety of what one eats normally, thus the idea is lifestyle change. Yet, they play obtuse and think that a doctor suggesting a diet is asking them to follow the ABC diet (the "pro ana" diet) or some shake cleanse crap.

[Deleted]September 19, 2021

Also, I will always find it amusing how these empowered, happy, confident fat-activists have body issues.

If you are triggered by somebody weight loss, you have an issue with your body. Tess even said she has anorexia (which ofc she hasnt, but she might have BED or at least some seriously maladaptive thoughts/behaviours about food and her body), but apparently she should be a role model of how one should relate to food and their own body? I would rather listen to people who recovered from their ED and are happy, thank you very much

salty-tomorrow [OP]September 18, 2021(Edited September 18, 2021)

It was clear to me she gets her propaganda for both from the same people. It’s bizarre no one sees the contradiction….

[Deleted]September 19, 2021

I mean, they are the same anti-science type of bs. No, you cannot be healthy at Tess's size the same way you are not healthy at Eugenia's - yet people (even on this site) will agree with the latter example but not the former. You can be relatively healthi-ER at any size, because well, technically there is always something worse.

Obesity is the second biggest behavioural cause of cancer (following smoking), any type of doctor-related professional who peddles HAES is an idiot. Replace "eating excessively" and "be obese" with references to smoking and it will be very clear how different people's approach are towards obesity.

I don't find it weird at all that someone who believes HAES is also supporting non-necessary hormones and surgical procedures, as HAES is also based on hating your body (but pretending you dont - see Lizzo) and demanding everyone else validates you because you are emotionally dependent on what other people say.

HAES and TRA are basically the same thing, with the difference that HAES is killing thousands already.

salty-tomorrow [OP]September 19, 2021(Edited September 19, 2021)

Obesity is not a behavior. Also, there have been no studies so far able to demonstrate a causal relationship between excess weight and poor health outcomes. Things like poor diet and sedentary life style are linked to health issues, but this is not the same as being above a random weight standard developed for men and set by insurance companies to make more money.

I am not saying that being the size of Tess Holiday is good for you, and I’m right there with you on the hypocrisy of media figures when it comes to promoting conflicting narratives, but taken at face value, I believe “healthy at any size” is a useful concept to teach in an eating disorder treatment context. Whether a woman restricts or binges or both, she needs to know that the size of her body is unrelated to her value.

After the dietitian made her transphobia comment, and I was already checked out and not participating, she asked “what’s one thing that has helped you the most in your relationship with your body?”

“Radical feminism,” I wanted to say, and I really wish I had.

Thanks for commenting.

[Deleted]September 19, 2021

Disagree, and think it doesn't make sense.

The idea of HAES would also mean that Eugene Cooney is healthy, which she is ofc not. The idea of ameliorating risk is instead much better. You can be morbidly obese, but if you walk as much as you can, it will be better than not doing anything.

The idea that body size is unrelated to value/worth is not HAES, HAES = HEALTH at every size. Health is not reflecting of personal value. A disabled person's worth is based on being a person, not on their health. HAES community is also greatly against losing weight, and promotes extreme bodies.

I believe that becoming an healthi-ER weight (which might still be obese for someone who is like 400 lb) is an act of love towards yourself. The point is that you should NOT HATE your body or yourself at any size - but saying you are healthy at any size is pure science denialism. If the H stood for "happy" I would support it - be happy at any size, but dont deny you are unealthy

[Deleted]September 19, 2021

Body size doesn't determine your human worth. But let's not pretend that being overweight won't have a negative impact on your health.

Don't try to guilt-trip us. Radical feminism isn't therapy. It is just a lens of analyzing the world in relation to women.

If you need help with your body issues, you need to go to actual expert.

[Deleted]September 19, 2021

There are no direct experiments of smoking in humans*, so you cannot prove causal link between smoking and lung cancer.

Joints love carrying extra mass, your heart likes the fat blanket that tries to strangle it, also the other organs really love that visceral fat keeping them warm and tight <3 Let's not forget to support cholesterol happily flowing through your veins. And ofc, let's not forget CANCER (and in general obesity being a confounding factor for so much stuff, ahem...dying because of covid?)

*idk, I am assuming the ethics would be tricky and basically the same as overfeeding people

Also, there have been no studies so far able to demonstrate a causal relationship between excess weight and poor health outcomes.

I cannot with the bullshit. Idgaf if i sound like an asshole. This is killing thousand of people - and for me is not any different than listening to TRA bs.

"Large prospective studies show a significant association with obesity for several cancers, and the International Agency for Research on Cancer has classified the evidence of a causal link as ‘sufficient’ for cancers of the colon, female breast (postmenopausal), endometrium, kidney (renal cell), and esophagus (adenocarcinoma)"

"Historical data from the past 25 years point to obesity as a cause of approximately 14% of cancer deaths in men and up to 20% of cancer deaths in women [1]. These may be conservative estimates because the population has gained substantial weight over this time period and the prevalence of overweight and obesity has increased from 15% in 1980 to 35% in 2005 [2] (Fig. 1). Some now estimate that the total health burden of overweight and obesity may exceed that for cigarette smoking [3]."

And because this if a forum that is women-focused:

"Elevated serum estrogen levels as well as enhanced local production of estrogen have been considered primary mediators of how increased body weight promotes breast cancer development in postmenopausal women."

[Deleted]September 19, 2021

You are responding to the wrong person.

bellatrixbellsSeptember 18, 2021

" On the surface, it is inappropriate because it takes what is supposed to be a therapeutic conversation into a political subject fraught with controversy."

Yes, and it automatically alienates non-cultists because we know what happens when we speak up about this religion. When someone in a group, especially in a position of authority, pledges their allegiance to it, it's usually a warning that they will weed out dissenters, and possibly also dox them. Personally I always feel uneasy because I know most of the people around are clueless and will spontaneously join the "be kind and tolerant" brigade, and TRAs know this.

salty-tomorrow [OP]September 18, 2021(Edited September 18, 2021)

Exactly, it was presented as if we all agree “transphobia” is something worth combating, which makes it impossible to contradict her argument from a neutral position, even if I had been able to speak up in the moment.

[Deleted]September 19, 2021

it automatically alienates non-cultists because we know what happens when we speak up about this religion. When someone in a group, especially in a position of authority, pledges their allegiance to it, it's usually a warning that they will weed out dissenters, and possibly also dox them

Before I "terfed out," I was in the process of recovering from long-term and severe abuse by narcissistic relationship partners and family members. Even then, the overwhelming creepiness of the cult behaviours made me so deeply uncomfortable that, even though I considered myself an active trans ally, I couldn't stand to be around people who exhibited traits I'd already learned to associate with intense psychological, leading to physical, abuse.

bellatrixbellsSeptember 19, 2021

Totally feeling you !!

PenthesileaSeptember 18, 2021

Fantastic.

SrfthrowawaySeptember 18, 2021

Well done.

GoodForHerSeptember 18, 2021(Edited September 18, 2021)

I love this email. Very clear, calm, and rational.

WatcherattheGatesSeptember 18, 2021

Brava!

SamuraiGhostCatSeptember 18, 2021

Damn, what a perfect, well-worded, articulate response. You touched on every point perfectly... wow... I’m just very impressed. I think your letter will have a huge impact hopefully. You should be really proud of yourself for it!!!

salty-tomorrow [OP]September 18, 2021

What a lovely comment, thank you so much! I’m the type that even after I’ve sent it I’m thinking about what I could have said better, so I appreciate your praise and reassurance. Fingers crossed I peak at least one person 🤞

[Deleted]September 18, 2021

Use of exogenous testosterone in men increases risk of serious heart problems by 50%. So im sure it's not doing anything helpful for women.

Rfem584September 18, 2021

Wonderful!!

HollyhockSeptember 18, 2021

You rock! Well written!!!

SaladSparklzSeptember 19, 2021

Yes!!!! Beautifully stated!!! My only wish is to have watched their faces as they read it! Bravo sister!!!

[Deleted]September 19, 2021

Perfectly put, I would be interested to see what the response is

GrimeldaSSeptember 19, 2021

Great letter. Calm, rational and to the point. Well done.