This Dr. Powers guy is incredible. The post reads like an apology.

I have many asexual transgender patients for whom their gender and HRT play zero role in anything to do with sexuality.

Yes, that's because for some AGP trans people, their entire sexuality is wrapped up in AGP, leaving no room for anything else. Asexual trans is more of a proof that it's something about human sexuality than a refutation.

There are people who get off on popping balloons. Human sexuality is wild and crazy, and people will fetishize anything.

This guy realizes human sexuality can be pretty diverse--gives popping balloons as an example, but then assumes that it must always somehow also express itself in a desire for intercourse. Popping balloons, he thinks, leads to sex. What if it's just popping balloons? What if it's sometimes just being a woman?

https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF Respondents were most likely to identify as queer (21%), and they also identified as pansexual (18%), gay, lesbian, or same-gender-loving (16%), straight (15%), bisexual (14%), and asexual (10%)

10% is wayyy higher than any estimation of asexuality in the general population, by an order of magnitude. Why? Never mind all the other orientation categories that are wildly over represented. Pretty sure it's got something to do with sexuality!

...when doctors encounter someone who clearly is not transition ready and who exhibits many signs demonstrating that they lack gender dysphoria and instead simply are pursuing a sexual fetish, they lack the ability to gatekeep these people.

That's reasonable. Except...

The purpose of the gates is not to keep transgender people out and away from HRT. Its to keep out these fetishists.

You're not doing a very good job there. Trans people on the internet are being encultured, and being specifically told what to say, and what not to say to their physician. He's on the internet. He has to know.

Autogynephilia is a real fetish. Its something that I see regularly.

Moment of reality.

If you presented to my clinic with this, and all you said was fetish and sexual things, I would send you to psychiatry to be evaluated. If then, in therapy, it was revealed that you had gender dysphoria you would get treatment. This is my whole point. I don't have to have a dubious psychological background. It's not my job to figure this out. It's just my job to sort these people to make sure they don't get hurt

So in the same breath, he uses psychologists and psychiatrists to inform him if a client really has gender dysphoria, and then he denigrates their professions as dubious.

Dr. Powers is not internally consistent with himself.