Shawn is a first-generation college grad working at the New York Times and just penned a popular op-ed on his own experience growing up in a culture of opioids in suburban Philly. A more detailed version of his story was published last summer in Liberties. It’s a moving account of a Millennial tragedy.

You can listen to the episode right away in the audio player embedded above, or right below it you can click “Listen in podcast app” — which will connect you to the Dishcast feed. For two clips of my conversation with Shawn — on how teen parties became a boring den of zombies; and on how the good intentions of Big Pharma took a reckless deadly turn — head over to our YouTube page.

Meanwhile, many readers are responding to last week’s trans/detrans episode with Buck Angel and Helena Kerschner:

I thought it was terrific! Buck is a character and Helena is warm and precocious. I had not heard of either of them beforehand, so I nearly skipped the episode. But after I began listening, I quickly appreciated their personalities; they are both open, non-dogmatic, friendly and cheerful. By the end of your discussion, I found myself really rooting for Helena and Buck. It is wonderful that they appear to be thriving despite the difficulties they’ve faced.

Another reader was drawn to Buck in particular:

Thanks for a particularly good Dishcast! I’m pretty damn close to a Kinsey six or whatever; I may admire women as beautiful and impressive humans, but they do NOTHING for me sexually. I like GUYS: the hairiness, the attitude, the pheromones, the works. Someone like Buck Angel DOES just resonate as a “guy” — the secondary characteristics and attitude matter a lot more than external genitalia. So I guess that’s where I differ from you: the dick, per se, does not make the man — attitude and presentation are far more important.

The problem I’ve run into has been that some super-cute trans otter-or-bear men who appeal immensely on visual/“GUY” terms, will then, almost immediately, if not preemptively, throw up a VERY hostile separatist-lesbian wall of critical theory about “I’m not interested if you’re just objectifying me/I’m not your experiment.” If objectification is oppression, then gay men are all dirty pigs! As a 34-years-out gay man, if someone is purporting to BE a gay man, well, isn’t objectification the whole bloody point?! All my 40-50-60ish cis-male gay pals are ALL about the friendly/brotherly gropey-fun objectification. It makes us all feel seen and appreciated in a low key kind of way.

Needless to say, I’ve had little luck with the FTM community, at least the young ‘uns. But it’s the antithesis of truth to say that’s because I’m Transphobic.

On the other hand, I do get it: That kind of gropey-fun attitude for either straight/cis women or, apparently, for anyone whose youngest formative years were as equipped with female organs and hormones, is problematic, to say the least. And I’m glad you kinda pointed that out: There is a BIG biological divergence here.

All of this just makes me REALLY appreciate a guy like Buck, who’s clearly a guy we would all just like to hang out with, and fool around with, as one of the guys. He did it utterly by himself so long ago, not in any Boomer-parent-coddled cocoon or with any internet echo chambers of satirically Orwellian social theory. He’s just … a GUY.

Next up, a cis woman brings to bear her experience with hormone therapy:

I had stage III ovarian cancer at age 33 and now don’t have ovaries and have been on hormone replacement for the past seven years. If a trans person told me they had gotten surgery or taken hormones, I would support them because I don’t think it’s my place to tell another adult what to do. However, if they asked my opinion on whether to get surgery or take hormones, my answer would be absolutely not.

I know that some people might benefit from hormone treatment, as I do. But I know better than anyone the complexity of dealing with hormone changes. And when it comes to elective surgery, that’s just about the dumbest thing a person could ever do. Celebrating the fact that children are doing this is insanity.

Over the years, I’ve found myself wandering into conversations where people get very angry at me for sharing my opinions. For example, my brother flipped out on me for saying that I think many of these young people would benefit from not having medical interventions and working toward accepting themselves as they are, however they happen to be, even if this isn’t their preferred gender. Yes, they might feel they “are” another gender, but isn’t it an even higher plane of being to just accept whatever you are and try to be healthy?

I still feel like a woman even though my female organs have been removed and I have no natural estrogen/progesterone and went into menopause as a young adult, then back out of menopause on hormone treatment. Losing those hormones didn’t change who I am. It did, however, make me appreciate being healthy and being sane. A hormone upheaval makes you feel neither of these things. I take hormone treatment now (as small of doses as possible) to try to reduce the physical symptoms of menopause. I look at parents championing their children’s needless surgeries and experimental hormone treatments in disbelief.

Another incident that gave me pause: A colleague had her husband suddenly tell her he was trans and that he was leaving her. Everyone in the community, including at their children’s school, was applauding him for his choice. I would see her at work walking around sadly, like a ghost, no one caring about her. I remarked to someone, “Why is he cheered for leaving his family, but a straight man would be criticized for this? Why is being trans in this special category where you can’t criticize any action a trans person takes?”

At the time, I had been married for six months. I said, “Would you applaud my husband if he’d announced today that actually he is trans and he’s leaving me?” They looked momentarily conflicted and then remembered to double-down on their stupid ideology and told me yes, and got still more agitated. Then I got the lecture on how he would be getting to be his “real self”, so I should be happy for him.

I fully support anyone doing what is best for them, but does being one gender or another need to define your very existence? Does it belong above every other priority and every other consideration? As someone who has faced cancer and infertility as a young woman, I would say not. I have always wanted to have children. Therefore, I guess you could say that the “real me” is someone who is fertile. But I’m not.

The funny thing is, accepting things as they are is a wonderful thing and can be very freeing. After my cancer, I found my husband and this year we had a son. Yes, my baby wasn’t created the natural way, but I wouldn’t change anything now and I accept the way my life has gone. My body is scarred; I have permanent nerve damage; I have no lymph nodes in my torso; my hormone treatments carry unknown risks; and I think I might be getting osteoporosis — and I’m just 41 years old.

The “real me” that I feel I am inside wouldn’t have any of these problems. I believe I can say I know what it’s like to feel your body should be different. But yet, cancer has taken that away and I am still completely me, if I’m willing to accept myself.

Thank you so much for the Dish. I recently discovered it and am so grateful to you for your work. As my husband says, “We expected the dogma to come from the right, but now it’s coming from the left.” It sometimes feels like everyone has gone crazy, and you have made me feel so much less alone!

Here’s a dissent from a “long-time reader since your blog was purple”:

I’m a middle-aged bisexual male married to a middle-aged trans woman. We’ve been together for 19 years and I was her boyfriend even before she transitioned (being bisexual comes in handy that way).

First I’d like to say that if you’re going to have these big league discussions about trans people, you really should be better informed about all trans adjacent topics. You owe it to your audience to read all the major trans studies and know them by name, talk with endocrinologists, talk to SRS surgeons, understand all about intersex conditions, the SRY gene, the sex organ homologies, the stages of body and mind sex differentiation, and know trans pharmacology and youth impact inside and out. You should know more about these things than a nerdy 17-year-old trans girl with a dozen browser tabs open every night, but the reality is that you don’t.

You’re going to tell me you’re trying, but you’re not trying hard enough. (I almost unsubbed forever after the American College of Pediatricians / American Academy of Pediatricians screwup.) Maybe your audience can’t tell that you’re phoning it in, but I can — which pains me to say about someone who’s often moved me to tears about the nuances of the gay experience. You also dug into ALL the messy specific details around abortion, as well as the Arab Spring, on your blog. Do it again for trans people if you’re going to keep doing this.

I won’t b******t you: youth trans healthcare is a zero-sum harm reduction/application game. Either you cause some harm to the gay-but-confused-not-trans kid by mistakenly delaying their puberty until 16 and then HRT, or you cause harm to the actually-trans-girl by forcing her to endure permanent masculinizing features (hands, feet, height, frame, hips...) that may cause her to be permanently clocked (and often discriminated against) as a trans woman for the rest of her life. This zero sum is undeniable. The healthcare industry and the WPATH SOC 7 generally has a high bar for determining fitness but obviously lax (and often low-income) clinics with good intentions can pave the road to hell. You go to war against the healthcare system you have, as Rumsfeld never said.

The vectors of harm are not the same for MTF vs FTM kids (and those clinically mistaken for them). It may even be the case that the solutions and risks and age determinations for MTF vs FTM should be different. Only the data and the analysis can tell you that.

I’ll bring up one point you haven’t touched on, that you should: You can’t keep young trans people from hormones. You act as if many corners of the internet like this one don’t exist: https://www.reddit.com/r/TransDIY. You don’t even need pre-paid debit cards anymore, since many sites that deliver meds will take crypto as payment.

The worst case: ubiquitous birth control pills. One trip to Planned Parenthood with a cis girl friend and you have them. This is the standard way that trans women with no resources in poorer parts of the world feminize themselves, in Thailand (katoey), India (hijra/kinnar), Indonesia (waria), Mexico (muxe), etc.

Does birth control (ethinylestradiol) have major blood clot health risks if you’re not suppressing T? Yes. Will the desperate-to-transition people give a f**k? Not really. Does it work? So/So, but when you’re a trans girl who hates that you look like a “brick”, it works wonders for taking the edge of dysphoria. Risks be damned.

My wife took birth control pills during puberty, because she was trans, poor and desperate, and it was a different time. She’s glad she did. I wish she didn’t have to.

As always, I’m grateful for my reader’s insights. I have to say, though, that his conditions for even entering a public debate on a tricky subject — you need to have read everything in the literature cold before you even dare to write a word — is unrealistic in a democracy. We all get to have a say. We can’t all be masters of every subject. And in my defense, I think we’ve covered a huge range of issues connected to the trans debate, both on Substack and the old Dish, before the topic was trendy — and I’m committed to doing more. And I’m always open to readers’ sharing their knowledge and opinions.

And one of the first things that reader suggests I do, “talk with endocrinologists”, is happening soon: Carole Hooven, who teaches behavioral endocrinology at Harvard, has agreed to join the Dishcast. And regarding “all about intersex conditions”, we have Alice Dreger on our short list. Julie Bindel is recording next week. Thanks for all the guest recommendations so far — including Natalie Wynn and Justin Vivian Bond — and please keep them coming: dish@andrewsullivan.com.

Lastly, a reader makes a semantic point:

When it comes to your “Trans Proposal In The Trans Wars,” I respectfully suggest you use “reasonable accommodation” rather than “compromise”? It sounds better.

When I referred to “the trans question” on Twitter, many people claimed I was comparing it to “the Jewish question” and thus the Final Solution. Oy. For the record, I constantly referred to “the gay question” in all the years I pushed for and debated marriage equality.

This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit andrewsullivan.substack.com/subscribe

Shawn McCreesh On Surviving The Opioid Crisis

The Dishcast with Andrew Sullivan