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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

Thanks to all who commented on [my original post](https://ovarit.com/o/WomensHealthLounge/42057/my-dietitian-is-a-tra-and-how-i-handled-it-poorly). 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](https://medium.com/@rebeccarc/j-k-rowling-and-the-trans-activists-a-story-in-screenshots-78e01dca68d)) 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](https://destroyyourbinder.tumblr.com/post/620860243262488576/unriddling-the-sphinx-autism-the-magnetism-of), but please let me know if you have any questions. Best, salty-tomorrow

34 comments

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

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.

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.

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.

[–] Yemaya 24 points Edited

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.

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.

[–] Yemaya 9 points Edited

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!

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

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.

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.

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.

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.

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

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

" 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.

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.

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.

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!!!

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 🤞

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.

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