“Being ‘affirmative’ is often misrepresented as meaning that a trans identity is encouraged, or treated as a preferred outcome, when an alternative understanding is that this practice is a stance whereby no particular path or identity is privileged over any other.”
I’m not sure that this is true, but even if it is, it is representative of the problem in hand, and the reason behind much criticism.
Of course the aim of all involved should be to work towards the least damaging pathway, which in (?almost) all cases is for the patient to become comfortable in their own skin without any damaging medical or surgical interference.
Pretending that is not a preferable outcome is a huge part of the problem and, it seems, a huge blind spot for all those working at the forefront of this service. Medical transition was previously a treatment of last resort, and if it does persist as a treatment (it may well yet be wholly discredited) it needs to return to that model, unless there is overwhelming evidence in the pipeline that affirmation is actually better in some way, which is looking less and less likely.
How they cannot see the harm they are doing is beyond me. It can only be, I think, that they are either way too close or way too invested. Thank goodness Hillary Cass can stand back a bit and see the bigger picture.