genspect.substack.com
2026-05-29
Gender-Affirming Care arrived like a bat out of hell as a novel approach for people who identified as transgender. It had no robust, reliable, or replicable evidence base to support it. It had no coherent or well-established therapeutic model underpinning it. There was no new scientific discovery that supported its arrival. There were no giants of psychology who put forward this remarkably unusual and antithetical approach to the therapeutic process. Instead, Gender-Affirming Care arose as a consequence of a political campaign from the World Professional Association for Transgender Health (WPATH) in a bid to build an understanding of trans identity as healthy, normal, and something to be celebrated in public life.
Prior to this, the word 'affirmation' emerged as a response to discrimination, particularly in the mid-20th century United States. To affirm someone was to recognise their equal dignity and legal standing in the face of exclusion, laws and customs that denied it. Movements for racial equality, women's rights, and later gay rights used the language of affirmation to insist that marginalised groups should not merely be tolerated but fully recognised as citizens with the same legal and social standing as others. It was a public, political act aimed at securing rights. Only in the late twentieth and early twenty-first century did it shift into therapy jargon, where it came to mean endorsing personal identity claims. As with many new fashionable words such as "lived experience" or "authentic self", it was happily accepted as a quick way to demonstrate that you were a therapist who was happy to keep up with contemporary times.