What happens when a psychiatrist who spent 50 years treating gender dysphoria refuses to abandon science for ideology? Stephen Levine's journey from co-founding a gender clinic in 1974 to being labeled a "hateful guy" reveals how a field once seeking answers became allergic to questions. As WPATH transformed from clinical inquiry to advocacy, Levine witnessed the moment when booing replaced peer review at professional conferences. From paraphilias as barriers to love to the myth of the 2% regret rate, this conversation exposes why the medical treatment of trans-identified people makes everyone miserable—patients, families, and the doctors who dare to say "we don't know."
About Stephen Levine
Dr. Stephen B. Levine is a Distinguished Life Fellow of the American Psychiatric Association and Clinical Professor of Psychiatry at Case Western Reserve University School of Medicine. Since 1974, he has co-directed one of the first gender identity clinics in the United States, treating "the full range of human beings" from 18-year-old exhibitionists to 94-year-old couples. Former chair of the 5th Standards of Care committee for what became WPATH, he left the organization in 2002 when advocacy replaced science. Author of numerous books on sexuality and love, including "Barriers to Loving", he earned the moniker "voice of reason" for asking uncomfortable questions like: "How many people have to be harmed by a treatment intervention before we stop?" A practicing psychiatrist for over 50 years, he remains "a student" who recognizes that "all behavior is multifactorial."
The Boxing Gloves That Cured a Paraphilia
Levine shares the unforgettable case of a newlywed who needed his wife to wear Everlast boxing shorts and gloves before intimacy. When Levine connected this to childhood trauma—a father who called him a coward for not fighting—the understanding killed the compulsion. "God damn you, Doctor Levine, I can't do this anymore. You ruined it for me." The wife thought Levine was "the greatest" when ordinary intimacy returned. This story illuminates Levine's core insight: paraphilias are "intrapsychic barriers to bonding," preventing the genuine connection humans crave. Understanding can sometimes dissolve what seems immutable.
When Scientists Started Getting Booed
The breaking point came at the 2002 HIBIGDA conference in Galveston. For the first time, "a large percentage of cross-dressed men" filled the audience, booing presentations they disliked. Levine cut a paragraph from his talk to avoid more booing—and realized "this is not how clinical science operates." When no one said "you can't boo, this is not appropriate," he saw the future: ideology had won. Earlier, Richard Green had told him to "go study bipolar disorder" and leave the field, revealing how even leaders wanted questioners gone. The transformation from inquiry to advocacy was complete.
The Myth of the 2% Regret Rate
"We hear all the time... there is only a 2% regret rate. It's ridiculous. See, we see people throughout the life cycle." Levine demolishes this statistic with simple logic: "The most common thing we regret in life is who we married"—hence divorce rates. When treating a 42-year-old "pool shark" who rides motorcycles but cries when called "sir," Levine sees the complexity: she's "genuinely happy" living as a woman but needs four psychiatric medications, can't sleep, battles depression, and faces "constant fear of being read." The binary of regret/no-regret obscures the messy reality of lives lived in permanent tension.
Masochism and the Trans Connection
In a revelation spanning 120 years, Levine explains how "transvestism... was recognized as closely related to masochism" at the turn of the 20th century. Under patriarchy, men who cross-dressed were seen as embracing their own defectiveness—"I want to be a woman. I'm not an adequate man." Today's narrative flips this ("I love my femininity"), but Levine suspects it's often "disguised self-hatred." Even his own college terror about not liking beer ("What is wrong with me?") illustrates how masculine anxiety drives behavior. Stella's observation about trans men displaying scars "pornographically" suggests masochism persists in new forms.
The Authority Crisis
Parents have "internalized their own inadequacy," constantly "second-guessing ourselves." The distinction between authoritative and authoritarian has been lost. "Sometimes you just need to say you're going to bed now... And the kid says why? And you said because I said so." Without authority, "children need their parents to have authority over them. They need to understand that their parents will protect them." Modern parenting's fear of saying no extends to medical decisions with permanent consequences.
The Beer, the Mother, and the Psychiatrist
In a moment of stunning vulnerability, Levine shares how he denied being like his mother in college—only to have roommates "explode in laughter" at the obvious lie. His mother "liked to have people talk to her and they would spill the beans"—and here he is, a psychiatrist. This self-recognition shapes his approach: even "profoundly impaired human beings" have "more intensity" of traits we all possess. We're all curious about our orifices, none naturally faithful, all struggling with impulses. The question is how some "balance those same impulses" while others are consumed by them.
The Science That Never Happened
Levine's prescription for "getting out of this mess" is elegantly simple: do actual science. Compare transitioned people with matched controls—siblings or those "born the same week, same year, same community." Study "7 or 8 parameters of their lives." For youth, create three randomized groups: current affirmative care, psychotherapy only, and watchful waiting. Follow them for five years. But "in America, we don't believe in science anymore." When half of state legislatures ban youth transition, "they believe you can't trust the doctors"—a catastrophic loss of medical credibility. "I want to be trustworthy," Levine says, but trustworthiness requires admitting what we don't know.
The Expert Who Knows Nothing
"People call me an expert. I just love this." Levine's definition: "A person who knows what is known and what is not known about a very narrow subject." By this measure, "I seem to know what is not known in the field. And so I'm an expert. I am a genuine expert." This Socratic wisdom—knowing the limits of knowledge—once defined medical humility. Now it makes you a "hateful guy." When a child psychiatrist testified that transition enables youth to have "a full successful, satisfying adult life," Levine responded: "I'm glad he thinks that, but we don't know that." In a field drowning in certainty, uncertainty is heresy.
View Dr. Levine's full publication list
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