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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

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.

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."

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