Should Mermaids be permitted to influence UK public policy on ‘trans kids’?

by Artemisia

Mermaids is a UK charity. Its aims are ‘to relieve the mental and emotional stress of all persons aged 19 years and under who are in any manner affected by gender identity issues, and their families, and to advance public education in the same’.

The organisation began a number of years ago as a support group for parents, and it still maintains an online forum. It also undertakes casework, training, advocacy and political campaigning.

In interviews with the press, its Chief Executive Officer, Susie Green, has described her experiences as the perplexed mother of a small boy who was drawn to ‘girly dresses and dolls’ rather than ‘’trucks and football’. When Jackie was nine, permission was obtained for him to wear girls’ clothes to school.

At twelve, his mother took him to the United States for a consultation with Dr Norman Spack, an endocrinologist at Boston Children’s Hospital. Dr Spack prescribed a puberty-blocking hormone, a treatment that at that time was banned in Britain for any child younger than sixteen.

Later, when Jackie was thirteen, Spack put him on estrogen: again, a highly controversial approach. Current policy in the NHS prohibits the prescription of cross-sex hormones to children younger than about 16.

In recent years, under Susie Green’s leadership, Mermaids has pressed insistently, disregarding the concerns of clinicians, for cross-sex hormones to be prescribed to younger children.

For Jackie’s sixteenth birthday, he was flown to Thailand where he underwent a seven-hour operation to fashion a pseudo-vagina. This would not be legal nowadays; soon after Jackie’s operation new regulations were imposed by the Thai Medical Council, restricting ‘sex change operations’ to patients over the age of eighteen. Furthermore, since 2009, young adults aged 18-20 must now obtain parental permission to undergo sex change procedures in Thailand. As can also be seen in this excerpt from a 2009 Telegraph article discussing tightened restrictions, a Thai gay rights activist drew attention to the phenomenon of post-SRS regret experienced by some patients.

In England under the NHS, irreversible gender-related surgery is only available to patients eighteen and older. This is in accordance with international standards of care.

Mrs Green has promoted Mermaids energetically. As CEO, and before that, Chair, she has been regularly quoted and interviewed in the media. In recent years she has been an invited speaker at various forums and conferences. Convenors have included the Westminster Social Policy Forum and the Royal College of Paediatrics and Child Health.

In 2015, Mrs Green was selected to give evidence in person to the inquiry into Transgender Equality conducted by the Women and Equalities Committee of the House of Commons. Mermaids also submitted a written statement. Later in this post I shall have more to say about that.

In a previous post I discussed an episode in which local authority social workers handed over to Mermaids the effective management of a child welfare case. This did not end well. Ultimately the High Court ordered that the child be removed from his mother. The charity was excluded from further contact.

Mermaids also offers training to professionals:

With this in view, it is reasonable to enquire into Mrs Green’s qualifications for the kinds of activity she and her organisation undertake. Under ‘Education’ on her LinkedIn page there is only one institution listed: ‘prince2 academy’.

PRINCE2 is an acronym for PRojects IN Controlled Environment and as its name suggests, it is a project management system. The PRINCE2 Academy appears to be a set of courses delivering online training in the PRINCE2 method. It is not clear if Mrs Green is a registered PRINCE2 practitioner or whether she has simply taken the foundation course. But that is not particularly important.

Project delivery is about process. Training, advocacy, an advisory role with respect to public policy: these are primarily about content. Delivery of accurate information is key, accompanied with well-informed insight, perceptive analysis.

Let’s look at how Mermaids measures up.

Mermaids submitted erroneous evidence to the Women and Equalities Committee

 The following passage is taken from the written evidence submitted by Mermaids to the Transgender Equality Inquiry conducted by the Women and Equalities Committee in 2015.

Mermaids frequently quote the Equality Act, primarily to schools unwilling to accommodate trans children. Antithetically, a young person of 16 wanted their name changing at school but their parents did not consent to this. Although the Equality and Human Rights Committee found the schools refusal to comply was discriminatory, they could not proceed with action against the school as the young person was under 18.

[Recommendation]: Lower or remove the age the Commission could pursue a young person’s complaint without parental consent.

This passage was quoted in the Committee’s report, which duly recommended:

The Equality and Human Rights Commission must be able to investigate complaints of discrimination raised by children and adolescents without the requirement to have their parents’ consent. [See pp. 27, 74, 81]

Following which the Government Equalities Office looked into the matter. Here is the Government response:

No such restriction exists on the Equality and Human Rights Commission’s (EHRC’s) power to investigate complaints of discrimination, and we are not aware of any legal basis for the statement in Mermaids’ written evidence to the Committee that “a young person of 16 wanted their name changing at school but their parents did not consent to this. Although the Equality and Human Rights Committee [sic] found the schools [sic] refusal to comply was discriminatory, they could not proceed with action against the school as the young person was under 18.” The Committee may wish to note that, in order to comply with the Data Protection Act 1998, the Equality Advisory and Support Service may pass an individual’s details to the EHRC only with the explicit consent of the individual. The case referred to in Mermaids’ written evidence was not referred to the EHRC. EHRC staff have met with Mermaids recently to clarify how the referrals process operates. [p. 13]

Rather snarky, it seems to me, but civil servants don’t like having their time wasted.

So: for whatever reason, Mermaids included a claim without foundation in its submission to the Transgender Equality Inquiry. The Committee trusted the organisation to know what it was talking about — and found itself with egg on its face.

Does Mermaids understand how much this matters?

It matters because public policy should be founded on sound evidence — on facts. No one who peddles made-up claims should be advising government committees.  Nor should they be involved in training professional people with direct responsibility for children, sick people or families in crisis.

Susie Green refused to acknowledge on the BBC that cross-sex hormones cause sterility

susie green bbc newsnight

Susie Green

 The evidence is there on YouTube for everyone to see. On 1 November 2016 there was a short debate on BBC Newsnight between Susie Green of Mermaids and Stephanie Davies-Arai of Transgender Trend.

Here is a transcript of the key exchange, which begins at around 4:20. Important passages bolded:

 Stephanie Davies-Arai: The treatment pathway is the same as transsexual, it’s cross-sex hormones (not cross-gender hormones). It leads to children being sterilised and on medication for life in order to be ‘their authentic selves’.

Evan Davis (interviewer) to Susie Green: Is that correct or …

Susie Green: Well no. I think that in terms of the way that these young people are assessed, they go through very careful assessments before any medical intervention is offered, that’s never before puberty has at least begun and got through to a certain stage …

Susie Green’s denial—’Well no’—and avoidance of the key issues raised by Ms Davies-Arai–are remarkable. Note the following points:

  1. ‘The treatment pathway is … cross-sex hormones’

At the Tavistock and Portman Gender Identity Development Service (GIDS) the treatment pathway is cross-sex hormones from the age of 16.

Less than four months before she appeared on Newsnight Susie Green gave a statement to the Guardian in which she called for the age limit for prescribing cross-sex hormones to be lowered.

  1. ‘It leads to children being sterilised’

This is a well-recognised effect of administering cross-sex hormones. Here is a concise and comprehensive statement from a medical authority, which also covers the effects of so-called ‘puberty blockers’ and gonadectomy:

Medical treatments—effects on fertility

Pubertal suppression with gonadotropin releasing agonists (GnRH-a) not only prevents development of potentially distressing secondary sex characteristics but also suspends germ cell maturation. Puberty appears to progress normally after discontinuation. However, many transgender individuals initiate gender-affirming hormone therapy concurrently with pubertal suppression, and thus, germ cells never fully mature. …

Gender-affirming hormones produce impairments in gonadal histology that can cause infertility. Estrogen use by transgender women results in impaired spermatogenesis and an absence of Leydig cells in the testis. Testosterone use by transgender men causes ovarian stromal hyperplasia and follicular atresia.

Gonadal effects of gender-affirming hormones are thought to be at least partially reversible. For example, pregnancy has been reported in transgender men who have previously used testosterone. Thresholds have not been established for the amount and duration of exogenous testosterone or estrogen exposure necessary to have a permanent negative effect on fertility.

For patients who elect surgical transition, gonadectomy will render them permanently sterile.

Source: Johnson EK, Finlayson C (2016) ‘Preservation of fertility potential for gender and sex diverse individuals’, Transgender Health 1:1, 41–44

  1. ‘It leads to children being … on medication for life’

Here are a couple of relevant statements by medical authorities:

  1. a) ‘Cross-sex hormone treatment has an important role in acquiring the secondary sex characteristics of the desired sex. Transsexuals often start taking sex hormones at young to middle age and in higher than recommended dosages. Fearing loss of secondary characteristics of the reassigned sex, transsexual subjects usually continue hormones lifelong.’

Source: Asscheman, Henk, Giltay, Erik J et al, ‘A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones’, Eur J Endocrinol April 1, 2011 164, 635-642

  1. b) ‘After reassignment surgery, which includes gonadectomy, hormone therapy must be continued.’

Source: Gooren, Louis J., Giltay, Erik J, Bunck, Mathijs C. ‘Long-Term Treatment of Transsexuals with Cross-Sex Hormones: Extensive Personal Experience’ The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 1, 1 January 2008, Pages 19–25


Considering her position as the CEO of an organisation that claims to speak with authority on the transition of children and young people, it is shocking that Susie Green should go on television and mislead the public on these crucial matters.

To say the very least: this is not professional behaviour.

Immediately after saying ‘Well no’, Mrs Green changed the subject with very noticeable promptness. Let’s look at what she said next: ‘in terms of the way that these young people are assessed, they go through very careful assessments before any medical intervention is offered’.

We might find this just a little bit glib, coming as it does from a woman who ignored the settled opinion of experienced clinicians and arranged for her son to have a gonadectomy when he had barely turned sixteen–in a country (Thailand) which now bans such surgeries to people under the age of 18.

Mermaids has falsely stated the survey population when purporting to cite statistics for suicidality among ‘trans youth’

In presentations aimed at concerned professionals, Mermaids has exhibited a PowerPoint slide with the heading ‘Statistics’. It displays a set of figures designed to chill. But let me quickly say: these are not what they seem. They have been fiddled to support an agenda. They are, in fact, completely worthless.

Mermaids-suicide-stats-compressor

Here are the phony statistics in question:

  • ‘59% trans youth considered suicide
  • 48% attempted suicide
  • 57% actively self-harm’

A subheading claims that the figures come from a survey of ‘more than 2000 trans people in the UK’. The survey, cited at the foot, was conducted by academics from three universities in collaboration with PACE, a now-defunct LGBT+ mental health charity. The report was published in 2014.

There is no mention of the report’s title: LGB&T Mental Health — Risk and Resilience Explored. The foreword records that ‘Over 2000 people completed our survey…’

Spot the obvious mistake. The trans participants in the survey were only a subset of the total number of people who took part. The statement that ‘more than 2000 trans people’ were surveyed is not true.

And this matters enormously, because unless the survey population is of adequate size, the results of the survey have very little meaning. It is not possible to use those results to make useful generalisations about the target population, the group about which the survey is intended to provide information.

In the case of the survey into ‘LGBT&T Mental Health’, the overwhelming majority of respondents were lesbian, gay or bisexual. Only a minority, just over 17%, identified themselves as trans.

And here’s the clincher: Only 27 of the trans respondents were under 26. This is the total size of the survey population on which the claim is based that 48% of ‘trans youth’ have attempted suicide.

There is absolutely no way that the results of such a tiny survey can be mapped onto the whole population of trans-identifying young people in the UK.

That twelve of the 27 reported such an attempt is very sad for them and their families. However, it tells us nothing about the prevalence of suicide attempts among ‘trans youth’ in general. This micro-survey is of no value whatsoever as a basis for determining social policy.

This is not an abstruse matter: it should be obvious to anyone with common sense.

Mermaids has used the supposedly high risk of suicide attempts by trans-identified young people to support its campaign to lower the age at which the NHS prescribes cross-sex hormones to children. It claims that medical transition reduces the likelihood that a gender dysphoric child will commit suicide. In reality, there is no persuasive evidence that this is true.

When Susie Green gave oral evidence to the Transgender Equality Inquiry she argued that the treatment protocols followed by the Gender Identity Development Service are too restrictive and should be relaxed. She claimed that children waiting to be put on cross-sex hormones become ‘self-harming and suicidal’ and referred to ‘a 48% suicide attempt risk’.

This claim was picked up and repeated in the report from the Committee: ‘Mermaids said there was a significant risk of self-harm or suicide where hormone treatment is not yet being given; they drew attention to evidence that the attempted suicide rate among young trans people is 48 per cent.’ [p. 52]

For the 48% figure a footnote refers to an article in the Guardian published in November 2014. The Guardian in turn cites ‘findings released by Pace’. Evidently the journalist had had an advance view of a press release from PACE dated 20 November. This press release predated the publication of the full report of the survey.

The press release gives an overall figure of 485 for ‘survey participants under the age of 26’. Rather strangely, however, it omits to give an overall number for the ‘young trans* participants’ while stating that ‘48.1% … have attempted suicide’. The use of percentages at this point conceals the very small number of respondents. The other figures in the Guardian post also come from PACE: the Guardian has simply rounded them down, so that 48.1% becomes a snappier 48% and the figure of ‘59.3%’ for suicidal thoughts becomes 59%.

It is, perhaps, not coincidental that these misleading and alarmist figures were initially presented by a charity that was forced to shut its doors for lack of funding just over one year later.

Meanwhile, the Guardian confused matters further by implying that all of the ‘more than 2,000 people’ surveyed were ‘trans’. Presumably this was due to a careless misreading of the statement from PACE.

Given that the Mermaids PowerPoint slide refers to a ‘survey of more than 2000 trans people’ it seems likely that the figures on the slide came by way of the Guardian report. Even assuming that this is the case, it does not let Mermaids off the hook.

It is simply not professional to quote statistics from a newspaper report without attempting to check them at source. In this case the survey report is easily found on the web. Although PACE has closed down, the report has been archived on several sites by interested parties.

Regardless of what it was intending to do, Mermaids deceived the audiences to whom it presented that PowerPoint slide. Even more important and worrying, it gave misleading information to the Women and Equalities Committee.

There is more. The problems with the figures on the PowerPoint slide have been pointed out in detail in at least two important blog posts:

So far as I am aware Mermaids has never acknowledged either of these critiques, nor has it qualified Susie Green’s statement to the Women and Equalities Committee.

The organisation does not seem to have cited the 48% figure recently. But last month Mrs Green was back beating the same old drum, this time in an article on Huffington Post UK. This time she kept things vague, asserting that there are ‘shockingly high statistics for suicide attempts by transgender young people’ without citing any source at all.

These serious misstatements of fact are not acceptable

Mermaids presents itself as a repository of wisdom on the subject of transgender children and youth and in many quarters it is accepted as such. The inaccurate statements detailed above are not minor matters. The UK, as a society, cannot afford such lapses in an organisation that trains professionals and advises on public policy.

Moreover, none of this is helpful to children who show symptoms of gender dysphoria or gender identity disorder (as currently defined), or their anxious and more or less bewildered parents. They deserve a more professional service than Mermaids is currently providing.

Meanwhile, it should, unfortunately, be recognised that it is never safe to take on trust any statement that comes from Mermaids.

 

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‘Bridging hormones’: Increasing number of UK GPs leery of prescribing treatment

by SunMum

SunMum is a UK parent with kids who have been affected by gender ideology. She can be found on Twitter @Mum3Sun


 If you are a medical care provider and you have concerns about the safety and appropriateness of prescribing hormones and surgery to young people who are uncomfortable with their bodies, you are not alone. Trans activists frequently cite the non-existent ‘consensus of the medical community’ to argue that the only effective way of treating gender dysphoria is social and medical transition. However, in this carefully researched piece, SunMum reveals that a growing number of general practitioners (GPs) in the UK appear to feel uncomfortable providing transgender health services.

 Special note to UK readers: If you are concerned about proposed changes regarding transgender health services in this country, please complete the NHS survey by October 16. A helpful guide can be found here.


The recent sudden increase in young people identifying as trans presents a quandary for the UK’s National Health Service. Trans activists demand access to ‘life saving’ health care but there are simply not enough gender specialists to deal with all the new patients. Currently NHS England is holding a twelveweek public consultation on specialised gender identity services for adults who, worryingly, they define as ‘17 and above’. But it seems that not all GPs are happy with the role they are being asked to play. The current arrangement is that the patient’s own GP is responsible for ‘prescribing, on the recommendation of the specialist team’. But according to the Guide to Consultation ‘a small but significant and increasing proportion of GPs do not feel able to accept responsibility for prescribing’.

Why are GPs increasingly unhappy to prescribe gender medicine? Surely the profile of transgender has never been higher as trans charities work to ‘Embrace. Empower. Educate’?

Zara Aziz, a GP partner in Bristol writing in the Guardian newspaper in August 2017 in response to the consultation, is concerned about the demands placed on GPs by what she describes as ‘a niche field’ of medicine. GPs are asked to monitor gender treatment through blood and hormone levels. And since 2016, new British Medical Association guidelines ask them in some circumstances – where patients are self-medicating with hormones or where there is self-harm or risk of suicide – to provide “bridging prescriptions” for emergency hormones. This new demand has met with resistance from the General Practitioners Committee which states that GPs ‘should not be obliged to prescribe “bridging prescriptions’’’. So the BMA and the GPs own organisation are in conflict. According to the GPC, the British Medical Association’s report ‘fails to address the resulting significant medicolegal implications for GPs, and neglects the non-pharmacological needs of [gender dysphoric] patients.’ It almost sounds as if GPs would prefer psychotherapy to medication for these patients. As Dr Aziz put it, GPs are worried about ‘the risk of complaints and litigation against family doctors’.

GPs have clearly noticed the sudden increase in demand for gender medicine. Zara Aziz reports that ‘this year I have seen three gender dysphoria patients (although I have not prescribed any treatment for them yet), but before that it was that many in nine years.’ Like many of us, these reluctant GPs seem to be waking up to the realisation that something strange is going on. Just 10 years ago the number of adolescents who wanted to transition to the opposite gender was vanishingly small; today they seem to be in every school.

If a GP does go ahead and offer a ‘bridging prescription’ for hormones, she will be doing so off-label; these drugs are tested and licensed for other uses. As the NHS consultation document points out: ‘This arrangement differs from prescribing practice in many other secondary and tertiary care services, particularly when prescribing for ‘off label’ indications.’

Gender medicine asks GPs to behave in ways for which they have not been trained.  Perhaps the protocols of gender specialists are increasingly diverging from those of other medical specialties, and this gives the doctors pause?

2015 miller enquiry sunmum

From left: Susie Green, CEO Mermaids, and Anna Lee, first “queer trans disabled lesbian woman” to run for women’s officer at the National Union of Students, listen to Bernadette Wren (on right), consultant clinical psychologist at Tavistock clinic.

Or perhaps these GPs are concerned about the influence that activist groups like Mermaids and Action for Trans Health are having on transgender health care. After all, these groups are pushing for earlier and swifter intervention. In evidence to the UK Parliament Transgender Equality Inquiry in 2015, Susie Green of Mermaids spoke of the frustration of parents with NHS treatment pathways and explained that her organisation helped them to access early intervention abroad:

 ‘We have current conversations going on; I have at least six families who have children who are pubertal who are looking at that option now and are actively contacting the Hamburg centres and America to access that treatment, because they know that they are not going to get it here within the NHS.’ (Q58)

Many activist groups believe the role of the clinician is only to supply the drugs and medication requested by the transgender  patient. Perhaps GPs are concerned that activists are driving treatment decisions that rightfully belong in the hands of medical professionals.

In 2009, one of the leading British gender specialists, Dr Stuart Lorimer, a psychiatric consultant at Charing Cross Gender Identity Clinic and founder of GenderCare, a London private gender clinic, was asked what he saw as his biggest impediment in the development of gender identity services. The answer was ‘medical colleagues, GPs, other psychiatrists’. Lorimer mentioned a survey of 1,000 doctors of which 84 percent felt that gender services are ‘not legitimate, not deserved, should not be in the NHS’.

It is clear that a consensus on the protocols of transgender medicine does not exist outside the small group of specialists. A much-cited Swedish study from 2011 describes the standard treatment for gender dysphoria as ‘a unique intervention not only in psychiatry but in all of medicine’. Searching for parallels, one contributor to 4thwavenow had to go as far back as lobotomy. No other contemporary psychiatric therapy, after all, includes ‘the surgical removal of [healthy] body parts.’

Transgender medicine is not just a specialized field but something of a club. A 2003 Dutch study asked 382 Dutch psychiatrists about their experience of ‘diagnosing and treating patients with gender identity disorder’ and found that ‘[a] small number of psychiatrists’ were responsible for a large proportion of the referrals to ‘specialized sex reassignment therapy centres’. The study concludes that ‘the therapy options proposed to patients with gender identity disorder depend heavily on the personal preferences of psychiatrists’. (Am J Psychiatry 2003; 160:1332–1336) Personal preference is not a reassuring basis for medical treatment.

In the UK it seems that nothing much has changed in the 14 years since the Dutch study. Transgender medicine continues to be in the hands of a small group of clinicians and the NHS consultation guide cited above notes that ‘there is limited collaboration and sharing of best practice across the current providers’. A small number of treatment centres operate on the basis of limited evidence about outcomes.

It’s both welcome – and worrying – that the NHS is only now bidding for research into gender medicine. The commissioning brief acknowledges ‘the lack of a UK evidence base for the NHS to inform decisions about gender identity health services’. And the research bid notes that ‘the long-term iatrogenic impacts of hormonal treatments and surgeries on young people and adults are largely unknown, but some studies show some treatments increase risks of several long-term conditions including cardiovascular and renal diseases, and fracture risk, while research on user satisfaction and psychological outcomes in the UK is of small scale and duration.’ These treatment protocols, in other words, could be causing long term damage – we don’t know enough to rule this out.

When evidence is lacking, we might expect doctors to be cautious. But instead of trying to understand the reluctance of so many GPs, trans activists demand swifter interventions and ascribe medical caution to bigotry. Zara Aziz explains that ‘any reticence on our part to prescribe can be challenged and can sometimes be misinterpreted for prejudice.’ Specialists and activists work to bypass the caution of mainstream doctors. Lorimer’s private GenderCare clinic is designed specifically to get round the reservations of GPs. He explains that:

 In my GenderCare clinic, I saw those people who’d yet to reach a GIC, whose GPs had stalled, dismissed or, in one memorable case, informed them that no such service had ever existed in the UK.

Guidance for NHS clinicians who also offer private treatment issued in May 2009 recommended that ‘specialists should as a general rule make it clear to members of the public that they usually do not accept patients without a referral from a GP or other practitioner.’lorimer summer reading

GPs may not subscribe to the conventions of gender clinicians, but they do tend to know their patients and their family situations. And that, more than anything else, may explain the increasing reluctance of many GPs to provide transgender health services. Just as parents know their children, GPs know their patients. Perhaps more and more of them are seeing young patients who never expressed discomfort with their bodies as children suddenly demanding transgender health services. That would certainly be enough to make a good GP think hard before writing a prescription for cross-sex hormones.

Transgender Children PREDATOR ALERT: Riley Byerly

Warning: This is a highly disturbing, important piece of investigative journalism by GenderTrender. All parents of trans-identified youth need to read it.

Many parents turn to adult trans activists for advice on how to parent their kids. While no one would suggest every such “advisor” is a dangerous predator, is it really a wise idea to seek counsel from such individuals? Particularly since some better-known trans activists, and organizations run by such activists, encourage young people to abandon parents if they won’t endorse their transgender identity–and seek solace in “glitter families” of strangers on the Internet.

GenderTrender

Brynner Rennecke / Riley Byerly

WARNING for all parents of transgender children, all transgender teens and tweens, and all parents of children who interact with adults on the internet.

Riley Byerly is a transwoman who authors the website ‘My Transgender Life: Sharing My Life One Moment At A Time’.

He also goes by the name Riley Lilian Grace Byerly. He is 27. His legal name is Brynner Phoenix Rennecke. He currently resides in Minot, North Dakota, but has also lived in Tucson, Arizona within the last year.

From his bog: Arizona resident

Before his arrest at the age of 15, this transwoman had raped or sexually assaulted at least five children. From ages 18 to 26 he was confined under civil commitment in the state hospital in Jamestown, North Dakota as a sexual offender at high risk to re-offend. He was released last year.

Released from Civil Commitment…

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Nevertheless, she persisted… as a role model for girls in STEM

Yesterday, the Washington Post published the account of a girl who heretofore—since the age of 8–had been a role model for other girls interested in science and math. She was a popular YouTube star, garnering up to a million views for her robotics videos. She was even invited to the White House in 2013.

But at 16, Super Awesome Sylvia, after (by her own report) spending some time on the Internet considering trans stuff, announced she’s now a boy.

wapo sylviaAs is typical for journalists covering trans-kids at the once-venerable Post, not even the mildest skeptical question was asked about why a strong, somewhat gender-atypical girl would morph from a positive example for other girls, into a “trans boy.”

And not only are there no questions: The author of the puff-piece even used male pronouns to refer to the little girl before she “identified” as a boy, thereby neatly erasing her past as a spunky 8-year-old girl with a penchant for invention.

We used this story as a springboard to create an alternate story: about a different girl named Spectacular Sarah who resists the gender-saturated, society-wide encouragement to proclaim she’s a boy because she likes short hair and geeky pursuits (in Sarah’s case, renewable energy).

For full effect, we recommend you read the entire Washington Post story prior to ours.

Note: This piece is a work of fiction and a fair-use parody. Characters and details in this story should not be construed to represent any actual person or situation.


Anywhere, USA. — This is the story of Spectacular Sarah, an ingenious little girl who made portable backyard windmills.

At age 8, Sarah Smith put on a lab coat and started a web show. A gap-toothed little kid with a pony tail and soldering iron, a rare sight in the boy’s club of amateur inventors.

Before long, Sarah had tens of thousands of viewers. And tons of windmills, of course.

The most famous was the windmill that powered her family’s kitchen appliances. On days it turned, it generated enough power to keep a small fridge running and to cook three meals a day on the electric range.

But that windmill did other things, too.

It got Sarah invited to her state’s Science Fair in 2015, when the governor tried it out to run the microwave in the governor’s mansion. He told its shaky-legged, 10-year-old inventor that it was great to see girls in tech who could serve as inspiration to other girls.

By middle school, Sarah was giving speeches all over the world, from the United Nations to elite girls’ schools in South America. This was a big deal for a kid from a small, windy town in Anywhere, USA, whose parents often worried about paying the next bill.

That’s how — year after year, show after show, speech after speech — Spectacular Sarah’s windmills turned a little kid into a role model for girls everywhere.

And that’s how “they”—some adult activists and confused kids on Tumblr– tried to trap her.

Because these days, when a girl breaks the stereotypical mold, people start asking if she’s “really” a boy. Especially people who’ve spent a lot of time on the Internet, or reporters who didn’t take the time to get the backstory. Sarah didn’t feel like a genius, or a celebrity—but she knew darn well she was a girl—though she had her doubts for a while.Wapo SarahThis is the story of Sarah Smith, a 16-year-old girl who actually prefers art to science, and knows a lot more about herself than her Tumblr pals and clueless reporters seem to think.  Now when people ask about her pronouns and assume she is a boy, she tells them, “Just because I’m a girl who got famous for doing geeky stuff, that doesn’t mean I’m going to take the easy way out and tell everyone I’m going to ‘transition.’”

Instead, Sarah broke free.

  1. My name is Sarah

In the beginning there was simply Sarah. No one asking if she was a boy (this was before that sort of nonsense got started), no spectacular anything. Just Sarah and her mom and dad (and later a sister and two brothers) growing up in windy Anywhere, USA. A regular little girl, by all appearances.

“When I was a kid, I was just a kid,” Sarah said. “Making cool stuff.”

Sarah had always wanted to know how things worked.

She liked to pull apart old TV sets and put together miniature solar panel kits with her dad, Bill, an industrial engineer.

One day in 2011, Sarah decided to make a Vimeo show about making things. Her mom, Jane, sewed a lab coat fit for a 7-year-old. Dad helped write the scripts and held the camera. (Mom and Dad were pretty “gender conforming”). Then Sarah just did her thing—and her thing was renewable energy projects on a kid-sized scale.

“Hi! My name is Sarah and this is our spectacular science show!” Sarah said in the first episode, pumping her arms in the air. “Let’s get out there and show the world we can do better than fossil fuels!”

Spectacular Sarah showed kids how to make a miniature solar panel that could power a table lamp, a small radio fueled by the energy from a super-hot compost pile, and a boom box wired to the mini windmill that would serve as prototype for the bigger windmills she engineered later on.

And kids watched. And Sarah watched, amazed, as hundreds of viewers became thousands. “Renewable Energy for All” magazine started hosting the show on its Vimeo channel, and altogether more than a million people clicked on Sarah’s videos.

Sarah got into the character. She wore the lab coat to alternative energy fairs, selling Sarah bling at her booths, or posing with cardboard-cutout idols like “Hermione Granger” from Harry Potter.

In time, Sarah would get emails from parents who told her she was an idol herself especially to their daughters, but also their sons.

One day last summer, when it was all over and Spectacular Sarah was just Sarah, dad Bill sat on a patio eating chips and salsa, watching his daughter splash in a pool, wondering if the fun had been worth all the trouble it caused.

“Before any of this happened I used to tell Sarah, ‘Fame happens to the unlucky; it’s not a healthy thing.”’ Bill said. “As a kid, it’s a trap.”

Bill was thinking about something else, too: He’d seen “I am Jazz,” and he knew that a new fad was starting to take hold: A fascination with kids who were “gender nonconforming” who are now being promoted as “born in the wrong body.” He knew Sarah had already been asked more than once about her “preferred pronouns”–including by some adults who ought to know better.

 2.  Sarah meets the governor

When she was 10, with a few years of making miniature renewable energy devices behind her, Sarah decided to enter the international “Alternatives to Fossil Fuel” games. The competition was fierce: teams from around the world competed to see whose toy-sized windmills and solar panels could keep a test radio running the longest.

wapo windmill 2Sarah dreamed up something more in her artistic style:  windmill arms that painted abstract designs as they rotated around. Her windmill had a paintbrush on two of the spinning arms, with a bright wood frame and five little trays of paint. As the arms spun, paint spewed onto a canvas. A local tech company partnered with the Smiths to build it, Sarah’s fans helped crowdfund it, and Sarah’s dad made a computer app to send windmill artwork through a Galaxy Note.

It won the gold medal in the Most Creative Renewable category — and caught the eye of people in the Anywhere State legislature and the governor’s mansion.

“They were just freaking out that there’s a girl making stuff,” Sarah said.

Right then and there, Sarah knew she wanted to be a role model for other girls. She was starting to learn, even at 10, that some of the other techy girls in her school—some of whom liked short hair and rough play—were wondering if all that meant they weren’t “really” girls.

Sarah remembers shaking nervously as she walked through the governor’s mansion that spring. The other kids’ projects all seemed so elaborate. A huge solar panel; an artificial waterfall to demonstrate the power of rushing water; even a ski parka heated by a small solar panel on the back, invented by three 9-year-old boys.

“Why am I here?” Sarah thought. “I have this weird windmill that I made.”

“It’s really neat!” Spectacular Sarah told a solar engineer who’d come to see the show.

And she smiled in her lab-coat with the governor, and held up a model of a windmill that might someday power the state legislature building.

She came back to Anywhere, USA with photos that still get passed around her family — the highlight of her career as a girl genius.

At the end of that school year she got an F in math.

The truth was, Sarah says, she’s never been a natural at science. She liked the fairs, and she liked messing around with her family on the show, and she knew how to say the right things.

The last big trip was to South America, where Sarah would make speeches at elite private girls’ schools — and finally begin to confront those who claimed a girl like her just had to be a boy.

3.  Just the beginning for Spectacular Sarah

Even before South America, there had been signs that all was not as it seemed with the person called Sarah Smith.  Sarah remembers asking a friend in seventh grade, “Is it weird that people keep wondering if I’m a boy? It’s starting to make me wonder, too!?” In her private sketchbook, she started to draw herself with shorter hair and hairy legs. Her friend, who’d just gotten a Tumblr account said, “Yeah, I’ve noticed lots of girls who hate long hair and never want to shave their legs ‘coming out’ as boys. What do you think?”

Sarah spent a lot of time thinking about this stuff. But they were still passing thoughts. In South America, in 2014, girls in uniform skirts crowded around the windmill and listened to Spectacular Sarah’s tips on invention.

The tour went so well that after Sarah returned home, the Smiths said, she got an offer to come back and study free at one of the schools — “a place where girls make their visions come true.”

“It’s an amazing school,” Sarah said. “An entire wing is dedicated to women inventors.”

But as she waited for the start of the South American school year, those questions she’d discussed with her friend began to pass through her mind more and more often.

The character Spectacular Sarah began to fade from her life—and for a brief time, so did the person called Sarah.

Sarah became reluctant to make new Vimeo shows, and eventually stopped altogether. Her parents weren’t sure why at first. They didn’t know that Sarah could no longer stand to look at her long curls, or listen to “how squeaky my voice was.”

And the thought of that school in South America, with its laboratories and uniforms, loomed in Sarah’s mind like a deadline.

Finally, she decided, “I can’t live with myself wearing a skirt every day.”

She wrote a letter to the school, asking why a girl couldn’t wear pants instead of a skirt to school. To her surprise, the school principal wrote back right away. She said, “You know, you’re right. We support girls being and becoming who they are, no matter what they wear, how they cut their hair, or what they like to do. If you want to wear pants, you’re still very welcome. In fact, you can be the first to challenge our outdated dress code. Hope to see you soon!”

4.  Shape-shifting goddess of the sea and prophecy

Sarah was spending more and more time alone in her pink-painted bedroom, not making things anymore, not talking much, sometimes crying for unexplained reasons. The Vimeo show was all but abandoned.

Sarah’s mom, Jane, went into the room one day to talk it out, mother and daughter.

“Mom,” said Sarah. “Why is everything pink in this room? You know, I’ve never liked that color. And you know what else? I hate dresses, and I want to cut my hair—I hate the curls and they just get in my way!”

Jane looked surprised for a moment, then answered,” Of course, we can change that. It’s just a color, after all. And you can do what you like with your hair. I’ll make an appointment for the haircut this afternoon.”

Sarah hesitated. “Mom? You don’t think I’m really a boy because I want to have short hair and I hate pink—do you?”

“Of course not!” Jane answered. “I know there’s a lot of those kind of messages on TV and the Internet now. It’s pretty much everywhere, wherever you look. But you just be the best person you can be.”

In secret, Sarah was already working on that. She was drawing herself in her sketchbook all the time, prototyping new haircuts. She was looking up words on the Internet: Lesbian; gay; gender fluid; pansexual; asexual; bisexual; tri-gender; demi-girl.

“So many labels,” Sarah thought. None seemed to fit.

She sat down at the dinner table one evening, and told her parents and siblings: “I have something to say. Everyone on social media, and even some of my friends keep saying a girl like me must be transgender. But the more I think about it, the more I realize I’m fine the way I am. But sometimes I do get confused by the stuff I see online, and what my friends are saying.”

Luckily, Sarah’s parents weren’t born yesterday. They said, “You know, Sarah, trends come and go. We know it’s tempting to believe you might be “born in the wrong body” because you’ve done stuff more typical of boys your age. But you shouldn’t feel any pressure at all to agree with what other teenagers are saying or doing.  No matter what, just think for yourself!”

It took some time for Sarah to get used to the idea that the older teens on Instagram and Tumblr might be wrong.  She started reading and watching worrisome accounts and videos by young people who’d been injecting themselves with testosterone and having their breasts removed. A lot of them seemed happy for awhile, but the obsession with “passing,” and the side effects from the drugs and surgeries, weighed on her.  With her parents’ support, she came to realize she’d been swayed, as teenagers always have been, by the opinions of her peers. She’d always been a tough, independent thinker, and it didn’t take long for her to realize she was fine just as she was—especially since her parents fully supported her getting a super-short haircut and taking all her “girl clothes” to the thrift store, swapping them for the more comfortable pants and T-shirts in the boys’ section.

As fall turned to winter, Sarah fell silent less often, and her confidence grew. She painted her room blue over the pink, covering one wall with a “women in tech” mural, and another with Post-it notes to herself. “Wow, that was a close call. Girl, you are loved.”

The family came to realize that Sarah Smith’s greatest project had been to figure out that she had always been Sarah Smith, after all.

But she still wanted a change, something to honor the journey she’d been on—from wondering if she was a boy to returning home to herself again. So, the family sat down and brainstormed a new name. They settled on Thetis, a Greek goddess known for shape-shifting and prophecy. Sarah liked that Thetis was a sea goddess, given her own strong interest in protecting the planet by working with renewable energy.

Sarah’s journey home to herself may seem pretty simple, in hindsight. It was anything but at the time.

“About the best thing we can do when we’re young is give ourselves time to grow and mature into the unique adults we all become someday,” her mom told Sarah one day.

“There’s no need for a strong girl to say she’s trans, just because she’s different,” her dad remarked. “Strong, independent girl” probably covers 90 percent of what you are. The rest is something else that’s uniquely you.”

5. Spectacular STEM girls

“Do you want to just shut it down?” her dad asked Sarah one day, when she was still in the throes of trying to figure out if she was “really” a boy or not. He meant the show, and Spectacular Sarah. To erase and move past that whole chunk of a life.

But Sarah didn’t want that.

“I’ve thought about it, and I’m still that girl role model I’ve always been,” she said. “I don’t want it to end. Yeah, I’m not crazy about my squeaky voice, but I’ve noticed most women’s voices change and get a richer tone as they get older. Besides, I also did research on the testosterone that some girls are taking to lower their voices. That’s a permanent change. What if I regret it later? I can’t go back—my Adam’s apple will stay the same. And that’s not even considering the hair I’d grow on my face and chest, and maybe later going bald!”

So, she decided to keep Spectacular Sarah on Vimeo–but also added a drawing of the Greek goddess Thetis whose name she’d chosen: a powerful woman who could shape-shift when she wanted to. Thetis/Sarah could wear what she wanted, cut her hair or grow it long, choose a career as a social worker some day or as an industrial engineer. That brainy girl character was here to stay.

Sarah drew a comic strip, explaining how shape-shifter Thetis represented the wide-open choices every girl had, if she had supportive parents and teachers who believed in her potential.  And because Thetis was also a goddess of prophecy, Sarah added a caption predicting that one day soon, girls who didn’t fit the typical “feminine” mold would  no longer be asked “preferred pronouns.” They’d just be left alone to become  shining examples of the many unique ways girls can live their lives.

6. Mini windmills

Life now . . . well, it’s never perfect. Sarah met another girl who had also considered whether she was trans for a while last year. They bonded over a shared hatred of gym and started dating. Sarah is coming to terms with the idea that she might be a lesbian, and feeling glad that she didn’t start down the road to hormones and surgery like some of the girls she’s seen on Tumblr. She’s learning to do sculpture and working on her drawings of Thetis.

She gets a few glares in the hallways of high school, people insisting on misgendering her as male, others asking her if she’s sure she doesn’t want to be referred to as he/him. But all in all, she’s glad not to be worried about which locker room to use; glad to be done with the chest binder a friend let her borrow to try out a couple of times. That binder hurt, and made it nearly impossible to run faster than a walk,  without having to take a time out to catch her breath. And while wearing it, she sometimes thought that the only way to get away from that constricting device would be to get rid of her breasts entirely. What was the point of all this, really? Who wanted a life spent in doctors’ offices and hospitals?

A few months ago, Sarah went with her family on her first science trip since fully resolving her feelings about being a girl—and a lesbian.

Sarah and her girlfriend and Sarah’s dad sat at the next table, trying to sell mini windmill models to pass the time.

To advertise, they put up the same photo of Spectacular Sarah and the governor, which had always drawn customers. That day, it drew a huge crowd.

“Oh, who’s this person?” someone would ask, looking at the ponytailed kid in the photo.

“Well . . . it’s this person, right here,” Bill would say, and point to his daughter.

“But that’s a guy.”

Bill tried the direct explanation: “That’s no boy—it’s my daughter. She just likes her hair short now and wears more comfortable clothes.”

To Sarah’s surprise that day, a lot of girls her age walked up to talk to her. So many had the same story: They preferred the hobbies, clothes, and hairstyles more typical of boys, had briefly considered they might be trans—then realized they could do everything they wanted as the awesome, strong girls they’d always been

The next time someone looked at the photo and asked for the girl — “Oh, is she here today?” Sarah was the one who answered. Pointing to herself, she said:

“She hasn’t gone anywhere. She’s right here.”

wapo windmill 4

New support forum for parents of gender-dysphoric kids & young adults

Note to all: We at 4thWaveNow are very happy to see the launch of this new forum for parents. But please also keep participating in the comments sections of posts on 4thWaveNow. We want to continue to be an open forum for all (parents and others) who question the contemporary rush to transition kids, teens, and young adults. Also, your continued participation here is vital for the many near-drowning parents who shipwreck by accident upon 4thWaveNow–one of the few places on the open Internet that openly questions the wisdom of turning gender-questioning kids into lifelong medical patients.


by Niniane, Kellogmom, Gender Critical Dad, Marge Bouvier Simpson, Mary, & Cat

There is a new forum for parents of gender dysphoric kids, teens, and young adults. We’re here to provide peer support for parents who would like a thoughtful and cautious approach to intervention for their gender-dysphoric daughter or son.

https://gendercriticalresources.com/Support/

Please note: Anyone may register for the forum, but you will be unable to contribute or see posts until approved by a moderator.

Most of the parents on the forum have teens or tweens who appear to be presenting with rapid-onset adolescent gender dysphoria, which some experts believe may be significantly influenced by such social factors as peer pressure, social media, and the Internet. Social contagion is a real thing for young people. Parents with rapid-onset teens desperately need support for a cautious approach, since the prevailing “affirmative” treatment model has been influenced more by ideology than evidence. Indeed, many parents joining the forum have had difficulty finding professionals who would support them in following a more careful route when addressing their child’s dysphoria.People help join solve bridge puzzle

In general, the parents who find their way to this forum value tolerance — tolerance of diverse viewpoints, political affiliations, and sexual orientations. We are not interested in pushing forward any ideology. We simply care about our children and want to support each other in discovering what is best for them.

If you have a child who has desisted from a trans identification, your presence is especially welcome on the forum, and we hope you will join us. You can help other parents learn how to help their child resolve his or her distress without resorting to life-long medical intervention.

We hope all parents who need support will join the forum. There is strength in numbers. If parents find each other, we can offer each other support and know we are not alone. We can have a louder voice when speaking to schools, professionals, and policy makers. Please come find us. We look forward to seeing you there.

A note of caution: Please understand that the moderators have no way of verifying anyone’s identity. Therefore, we cannot guarantee that everyone on the board will be there in good faith. It is probably wise to operate under the assumption that the forum is being watched by those who would not wish us well. So, when you join, choose an anonymous user name, don’t reveal identifying details about yourself, and use appropriate caution when interacting with others on the forum.

https://gendercriticalresources.com/Support/

 

Suicide or transition: The only options for gender dysphoric kids?

by J. Michael Bailey, Ph.D  and Ray Blanchard, Ph.D

This is the first in a series of articles authored by Drs. Bailey and Blanchard. As their time permits, they will be available to interact in the comments section of this post. Please note: As always on 4thWaveNow, if you disagree with the content of this article, your comments will be more likely to be published if they are delivered respectfully. Hateful or trollish comments will be deleted.


Michael Bailey is Professor of Psychology at Northwestern University. His book The Man Who Would Be Queen provides a readable scientific account of two kinds of gender dysphoria among natal males, and is available as a free download here.

Ray Blanchard received his A.B. in psychology from the University of Pennsylvania in 1967 and his Ph.D. from the University of Illinois in 1973. He was the psychologist in the Adult Gender Identity Clinic of Toronto’s Centre for Addiction and Mental Health (CAMH) from 1980–1995 and the Head of CAMH’s Clinical Sexology Services from 1995–2010.


It is increasingly common for gender dysphoric adolescents and mental health professionals to claim that transition is necessary to prevent suicide. The tragic case of Leelah Alcorn is often cited as the rallying cry: “transition or else!” Leelah (originally Joshua) was a gender dysphoric natal male who committed suicide at age 17, blaming her parents for failing to support her gender transition and forcing her into Christian reparative therapy. Subsequently, various “Leelah’s Laws” banning “conversion therapy” for gender dysphoria (among other things) have been passed or are being considered across the United States.

The suicide of one’s child is every parent’s nightmare. Given the choice for our child between gender transition and suicide, we would certainly choose transition. But the best scientific evidence suggests that gender transition is not necessary to prevent suicide.

We provide a more detailed essay below, but here’s the bottom line:

  1. Children (most commonly, adolescents) who threaten to commit suicide rarely do so, although they are more likely to kill themselves than children who do not threaten suicide.
  2. Mental health problems, including suicide, are associated with some forms of gender dysphoria. But suicide is rare even among gender dysphoric persons.
  3. There is no persuasive evidence that gender transition reduces gender dysphoric children’s likelihood of killing themselves.
  4. The idea that mental health problems–including suicidality–are caused by gender dysphoria rather than the other way around (i.e., mental health and personality issues cause a vulnerability to experience gender dysphoria) is currently popular and politically correct. It is, however, unproven and as likely to be false as true.

Suicide vs Suicidality vs Non-suicidal Self-injury

Suicide is a rare event. In the United States in 2014, about 13 out of every 100,000 persons committed suicide. Suicide was most common among middle aged white males, who accounted for about 7 out of 10 known suicides.

It is helpful to distinguish at least four different things: Completed suicide means death by suicide. Suicidality means either thinking about committing suicide or attempting suicide. Non-suicidal self-injury means injuring oneself (most often by cutting one’s skin) without intending to die. Finally, mental illness includes a variety of conditions, from depression to conduct disorder to personality disorders (such as borderline personality disorder) to schizophrenia–some of which are especially strongly associated with completed suicide and suicidality, others of which are more strongly associated with non-suicidal self-injury.

Obviously, completed suicide is what we are most worried about. Because it is so rare, however, and because it is often difficult to know about the dead person’s motivations for suicide, it has been especially difficult to study. There are fewer studies focusing on gender dysphoria and completed suicide than on gender dysphoria and either suicidality or non-suicidal self-injury. Studies of suicidality must rely on self-report (for example, someone must report that they are, or have been, thinking about committing suicide), and this complicates interpretations of results. (Maybe some people, some times, are especially likely to say they have been suicidal, even if they haven’t been.) Also there is more than one kind of gender dysphoria–we think there are three (this is a topic for another day)–and we should not expect risks to be identical for all types.

The Scientific Literature

Our aim here is not to review every available study, but to focus on the best evidence. Larger, more representative studies–and most importantly, studies of completed suicide–are most informative.

Studies of Completed Suicides

 Two large systematic studies of completed suicide and gender dysphoria have been published, one from the Netherlands, the other from Sweden. Notably, both countries are socially liberal, and both studies were conducted fairly recently (1997 and 2011). Both studies focused on patients who had been treated medically at national gender clinics. These patients all either began or completed medical gender transition, and we refer to them as “transsexuals.” (We don’t know how many of the patients there were from each of the three types we believe exist.)

The Dutch study’s suicide data were of male-to-female transsexuals (natal males transitioned to females) treated with cross-sex hormones (and many also with surgery). Of 816 male-to-female transsexuals, 13 (1.6%) completed suicide. This was 9 times higher than expected. Still, suicide was rare in the sample. The Swedish study found an even larger increase in the rate of suicide, 19 times higher among the transsexuals than among a non-transsexual control group. Still, only 10 out of 324 transsexuals (i.e., 3.1% of the group) committed suicide. Again, still rare. Note that both studies were of gender dysphoric persons who transitioned. As such, their results hardly support the curative effects of transition.

The Dutch and Swedish studies were of adults whose gender dysphoria may or may not have begun in childhood. No published study has focused only on childhood onset cases. However, psychologist Kenneth Zucker has tracked the outcome of more than 150 childhood onset cases treated at the Centre for Addiction and Mental Health into adolescence and young adulthood. He has generously shared with us (in a personal communication) his outcome data for suicide. Out of those more than 150 cases followed, only one had committed suicide. Furthermore, Dr. Zucker’s understanding (based on parent report) is that this suicide was not due to gender dysphoria, but rather to an unrelated psychiatric illness. On the one hand, one suicide out of 150 cases is more than we’d expect by chance. On the other hand, it is a rare outcome among gender dysphoric children and adults.

Studies of Suicidality and Non-suicidal Self-injury

People who commit suicide were suicidal before they did so. But most people who are suicidal do not commit suicide. “Suicidal” is necessarily a vague word, encompassing “intends to commit suicide” and “thinks about suicide,” both in a wide range of intensity. Furthermore, most studies would include as “suicidal” someone who falsely reports a past or present intention to commit suicide.

Why would anyone falsely report being suicidal? One reason is to influence the behavior of others. Saying that one is suicidal usually gets attention–sympathy, for example. It can be a way of impressing others with the seriousness of one’s feelings or needs. Although this possibility has not been directly studied, reporting suicidality may sometimes be a strategy for advancing a social cause.

According to data from the Centers for Disease Control (CDC), the rates of intentional but non-fatal self-injury peak during adolescence at about 450 per 100,000 girls and a bit fewer than 250 per 100,000 boys. These rates are much higher than the 13 per 100,000 American completed suicides per year (and remember that suicide is more common among adults than adolescents). So it is reasonable to assume that most adolescent self-injury is not intended to end one’s life. We are not suggesting that parents ignore children’s self-injury. We simply mean that self-injury often has motives besides genuinely suicidal intent.

 Not surprisingly, given the increased rates of suicide among gender dysphoric adults, suicidality (i.e., self-reported suicidal thoughts and past “suicide attempts”) is also higher among the transgendered. One recent survey statistically analyzed by the Williams Institute reported that 41% of transgender adults had ever made a suicide attempt, compared with a rate of 4.6% for controls. This survey recruited respondents using convenience sampling, however, and this may have inflated the rate of suicidal reports. Additionally, the authors of the survey included the following (admirable) disclaimer):

Data from the U.S. population at large, however, show clear demographic differences between suicide attempters and those who die by suicide. While almost 80 percent of all suicide deaths occur among males, about 75 percent of suicide attempts are made by females. Adolescents, who overall have a relatively low suicide rate of about 7 per 100,000 people, account for a substantial proportion of suicide attempts, making perhaps 100 or more attempts for every suicide death. By contrast, the elderly have a much higher suicide rate of about 15 per 100,000, but make only four attempts for every completed suicide. Although making a suicide attempt generally increases the risk of subsequent suicidal behavior, six separate studies that have followed suicide attempters for periods of five to 37 years found death by suicide to occur in 7 to 13 percent of the samples (Tidemalm et al., 2008). We do not know whether these general population patterns hold true for transgender people but in the absence of supporting data, we should be especially careful not to extrapolate findings about suicide attempts among transgender adults to imply conclusions about completed suicide in this population.

That is, importantly, the authors realize that suicidality and completed suicide are very different things, and it is suicidality that they have studied. Completed suicides in their group will be much, much lower.

Increased suicidality for gender dysphoric children was also reported by parents in a recent study by Kenneth Zucker’s research group.

A systematic review of non-suicidal self-injurious behavior in “trans people” found a higher rate, especially for trans men (i.e., natal females who have transitioned to males). The most common method mentioned was self-cutting. (Self-cutting is a common symptom of borderline personality disorder, which is also far more common among non-transgender natal females than among natal males.)

Is Transition the Answer, After All?

In a very recent study psychologist Kristina Olson reported that parents who supported their gender dysphoric children’s social transition rated them just as mentally healthy as their non-gender-dysphoric siblings. Furthermore, parents’ reports suggested that the socially transitioned gender dysphoric children were not less mentally healthy than a random sample would be expected to be.

This research falls far short of negating or explaining the findings we have reviewed above. First, it was relatively small, including only 73 gender dysphoric children. Second, families were recruited via convenience sampling, increasing the likelihood of various selection biases. For example, it is possible that especially mentally healthy families volunteer for this kind of research. Third, the assessment was a brief snapshot; we would expect socially transitioned gender dysphoric children to be faring better at that snapshot compared with children struggling with their gender dysphoria. (There is little doubt that at first, gender dysphoric children are happier if allowed to socially transition.) Young gender dysphoric children do not show that many psychological or behavior problems, aside from their gender issues. The aforementioned study by Kenneth Zucker’s research group showed that mental health problems, including suicidality, increased with age. Perhaps this won’t happen with Olson’s participants, but it’s too soon to know.

Why Is Gender Dysphoria Associated with Mental Problems, Including Suicidality?

 We don’t know.

The current conventional wisdom is that gender dysphoria creates a need for gender transition that, if frustrated, causes all the problems. That is a convenient position for pro-transition clinicians and activists. But they simply don’t know that this is true. Furthermore, both our past experience studying mental illness scientifically and specific findings related to gender dysphoria suggests the conventional wisdom is unlikely to be correct.

As an example, Leelah Alcorn’s suicide (like most suicides) was tragic, but she appears to have had problems that were not obviously caused by her gender dysphoria. She posted as Joshua (her male identity) on Tumblr:

“I’m literally such a bitch. shit happens in my life that isn’t even really that bad and all I do is complain about it to everyone around me and threaten to commit suicide and make them feel sorry for me, then they view me as sub-human and someone they have to take care of like a child. then when they don’t meet my each and every single expectation I lash out at them and make them feel like shit and like they weren’t good enough to take care of me. since I can only find imperfections in myself I try my hardest to find imperfections in everyone around me and use them as a way to one up myself and make others feel bad to make myself look better.”

Sophisticated causal analysis of mental illness and life experiences has invariably shown that things are more complex than previously assumed. For example, although depression is certainly caused by adverse life experiences, those vulnerable to depression have a tendency to generate their own stressful life experiences. So it’s not as simple as depression being caused by life experiences alone. Also, depression has a considerable genetic influence. Similarly, women with borderline personality disorder (BPD) report that they have experienced disproportionate childhood sexual abuse (CSA), and many clinicians and researchers have assumed that CSA causes BPD. But one just can’t assume the causal direction goes that way–one must eliminate alternative possibilities. Recent sophisticated studies suggest that, in fact, CSA does not cause BPD.

Research to understand the link between gender dysphoria, various mental problems (including suicidality), and completed suicides will take time. There is already plenty of reason, however, to doubt the conventional wisdom that all the trouble is caused by delaying gender transition of gender dysphoric persons. We have already mentioned the fact that transitioned adults who had been gender dysphoric (i.e., “transsexuals”) have increased rates of completed suicide. Their transition did not prevent this, evidently. Suicide (and threats to commit suicide) can be socially contagious. Thus, social contagion may play an important role in both suicidality and gender dysphoria itself. Autism is a risk factor for both gender dysphoria and suicidality. No one, to our knowledge, believes that gender dysphoria causes autism.

Conclusions

Parents with gender dysphoric children almost always want the best for them, but many of these parents do not immediately conclude that instant gender transition is the best solution. It serves these parents poorly to exaggerate the likelihood of their children’s suicide, or to assert that suicide or suicidality would be the parents’ fault.


References

Aitken, M., VanderLaan, D. P., Wasserman, L., Stojanovski, S., & Zucker, K. J. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry55(6), 513-520.

Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one6(2), e16885.

Marshall, E., Claes, L., Bouman, W. P., Witcomb, G. L., & Arcelus, J. (2016). Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. International review of psychiatry28(1), 58-69.

Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic reviews30(1), 133-154.

Van Kesteren, P. J., Asscheman, H., Megens, J. A., & Gooren, L. J. (1997). Mortality and morbidity in transsexual subjects treated with cross‐sex hormones. Clinical endocrinology47(3), 337-343.

Are you sending or losing your teen to college?

The following piece is a collaborative effort by a group of parents whose offspring began “gender transition” at university. They will be responding in the comments section under the username “POSTS”: Parents Of Sudden Transgender Students.


What if you sent your kid off to the Ivory Tower and you never saw her or him again–at least, you never saw a recognizable facsimile of the person you knew and loved for 18 years?

College is a time to “find oneself,” to try on different hats. How about transgender, genderqueer, non-binary? Some teens start to explore a transgender identity in high school, often via the Internet. Others may not have previously considered or even imagined a transgender identity before stepping onto a college campus.

If it were all just identity exploration, it would be one thing; but many college students are quickly advancing into medical treatments–often with the financial support of the university. Diagnostic testing or even basic counseling are no longer necessary, and college-bound teens have quickly figured this out. “Coming out” as transgender is now treated pretty much the same as a gay or lesbian coming out, not as the gender identity disorder it was considered to be only a short time ago.

And colleges compete to show how inclusive they can be of a myriad of transgender identities. The college end game is to be and stay highly ranked.

chronicle of higher ed


For a high school student questioning their identity, there is much advice available to help them select a trans-friendly campus. Your soon-to-be-away-from-home child may click away on the new wealth of information that could feed into their choice of college, as in campus pride, more pride, a pride guide to transforming your body.

There are even scholarship opportunities available for those considering a transgender identity. If one can commit to a new identity (and possibly a new body), the money is waiting. The Internet is full of transgender opportunities that institutions of higher learning offer before and during those formative college years. If we provided an inclusive list, it would all run together into a confusing (to parents) alphabet soup of acronyms. These acronyms and micro-identities are an easy sell to today’s gender-questioning students.

Campus pride student health clinic

Some students never question their gender identity until after being immersed in college life. Perhaps they take an elective course in Queer Theory in the Gender Studies Department, opening their eyes to viewpoints they didn’t know existed. Ok, isn’t that what an education is all about? But the medicalization of a newfound queer or trans identity can happen astonishingly quickly now.

Many young-adults-in-formation who suddenly announce a trans identity have a history of anxiety; are brilliant misfits with few friends; are gay or lesbian (and thus in no need of medical intervention); are a tad nerdy with possible autism spectrum traits–or perhaps all the above. Your daughter or son may lack a strong identity–in fact, the list gets so long that we could shorten it to “your child, any child.” Any kid who feels a great need to belong somewhere.

Once a transgender identity decision is made, instructions for what to do next are only a click away, such as at Carleton College in Minnesota:

carleton

In the National Geographic special, Gender Revolution, Katie Couric interviewed Tamar Szabo Gendler, Dean of Arts and Sciences at Yale. Dean Gendler is pleased that Yale is at the forefront of the gender revolution:

Universities are places that thrive on new discovery and I think that universities find it thrilling to feel like in the face of new knowledge we are able to figure out how to transform society as a consequence.

Some colleges cover trans medical treatments under the student health insurance plan.  According to Campus Pride, a whopping 86 US institutions cover hormones and surgeries, while another 22 will pay for hormones only. In a story in the New York Times on February 12, 2013, the author notes that no university covered such treatment as recently as 2007, but now exclusive universities like Stanford are onboard.

ny times

“No one knows how many” indeed–though we know that number has grown since the article was written four years ago.  Where once universities provided birth control and routine care on their health plans, now many (like the University of Massachusetts, Amherst) offer the full gamut of major, irreversible sex-reassignment procedures–including phalloplasty and vaginoplasty.

umass amherst

And while it may be hard to imagine how a student could take time out of their busy schedule to have sex reassignment surgery, the coverage of cross-sex hormones on so many student health plans might catch the eye of a gender-defying high school student; especially now that they’re away from the prying eyes of their parents.

Washington State University, in rural Pullman, scores a solid five stars from the CampusPride Index. Why? Trans health care, including (starting fall semester 2017) cross-sex hormones, is available via the student clinic. And as WSU explains, they are continually making changes to meet the needs demanded by their students:

WSU hormone treatment

At the University of California, Santa Cruz, the Queer Center provides a page chock-full of resources, including lists of sex reassignment surgeons, affirmative therapists, and how to get legal name changes on campus and state ID documents.

ucsc

Many colleges embrace the WPATH (World Professional Association for Transgender Health) guidelines:

A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy – although highly recommended – is not a requirement.

But informed consent gender clinics do not require mental health screenings by licensed therapists, and access to these clinics has been growing in recent years. Under this model, cross-sex hormones can be available even for a “non-binary” presentation; it is the individual’s choice what their goal and treatment protocol is.

Yale has provided gender surgeries on the student health plan since 2013; more recently, gender fluid and nonbinary Yale students have begun agitating for their right to treatment on demand.yale enbies

 

“The medical establishment is prejudiced against nonbinary people, ignoring the fact that gender fluidity exists,” Amend said. “Doctors can propagate a notion of ‘not being trans enough,’ which is toxic to the mental health of patients.”

Amend added that there is a community of nonbinary or gender fluid students at Yale, and that he knows of students who have had to tell psychiatrists that they are “more trans” than they feel, out of a fear that the doctors will withhold treatment if they appear more gender fluid.


Affirmative Care in the Student Counseling and Health Centers

How does this all happen so fast….a teen learning about transgender in high school, and starting cross-sex hormone injections in college?

Every day, young fresh faces, some not looking so fresh anymore, crowd the waiting rooms of student counseling centers all over Campus Country. Being a counselor in a college setting makes for job security: the 18-25-year-old cohort has the highest rate of mental health issues and the waiting list can be long.

Students have many stressors: a new environment, roommates, academic pressures, sexual shenanigans/hook-up culture, social pressures of every kind. Some of these students arrive burned-out by an intense college prep course in high school. Some have pre-existing mental health woes. They are strongly encouraged to use their student mental health center if any issues arise. That’s generally a good thing; we all want our kids to thrive and be healthy. But it can also be a less-positive thing, when the clinic is known as Affirmative Care.

What is Affirmative Care? In the mental health world pertaining to LGBTQetc it means that whatever narrative you bring to the table, you will receive an amen, a yes, a suspension of disbelief from the therapist. A student can make a transgender proclamation, whether this  is sudden, whether it makes any sense in the ongoing narrative of his or her life, and it will be accepted without question by the affirmative therapist. If one brings a tangible mental health diagnosis to the affirming counselor, whether it is mild depression, anxiety, bipolar, psychosis, no problem. Because if you have a mental health concern, it must be because you have not been affirmed and celebrated for identifying differently from your “assigned birth sex”. A life out of line with your gender identity explains all other mental health issues….or so the argument goes.


 Safe Places

Concerned about what your student is doing on campus, suddenly transitioning socially and via hormone use? If over 18 (as most are), they are considered to be adults now, and they can be safe on campus, even from parents, in “Safe Places.” Recently, the proliferation of “Safe Places” on college campuses have received a lot of attention, mirth, and critiques. Some argue that Safe Places magnify victimhood narratives and curtail freedom of speech and thought on college campuses. But the organized Safe Place coalitions do serve a valuable function. There are many people who need shelter and protection: domestic abuse victims, sexual assault/sex trafficked victims, run-away teens, individuals in groups that are marginalized, including LGBTQ people. None of us should tolerate violence or bullying.

If your child claims to be transgender, on most campuses they will be treated as a protected class against anyone who might question this new identity. A young adult caught up in the transgender warp will often say or do anything to have their way, to claim victimhood status. Doubting parents could even be hit by a  Do-notContact Order if they express dismay that their child is using cross-sex hormones via the student (or off-campus) health clinic—after all, the benign and kindly college administrators serve as in loci parentis. So the college clinic that injects students with cross-sex hormones, which cause permanent harm and morphed bodies, is just another “safe place.”

The subject of gender identity and safe spaces is a moving target, with the defining happening on college campuses. From the Los Angeles Times:

The meaning of a “safe space” has shifted dramatically on college campuses. Until about two years ago, a safe space referred to a room where people — often gay and transgender students — could discuss problems they shared in a forum where they were sheltered from epithets and other attacks.

Then temporary meeting spaces morphed into permanent ones. More recently, some advocates have turned their attention to student housing, which they want to turn into safe spaces by segregating student living quarters. Who would have imagined that the original safe space motive — to explore issues in an inclusive environment — would so quickly give way to the impulse to quarantine oneself and create de facto cultural segregation?

Safe space activism stems primarily from the separatist impulses associated with the politics of identity, already rampant on campus. For some individuals, the attraction of a safe space is that it insulates them from not just hostility, but the views of people who are not like them. Students’ frequent demand for protection from uncomfortable ideas on campus — such as so-called trigger warnings — is now paralleled by calls to be physically separated too. Groups contend that their well-being depends on living with their own kind.


In preparing this piece, we talked to several parents whose young adult offspring transitioned while at university. Here are a few of their comments:

 She did have some troubles in high school with anxiety, cutting and anorexia

From three mothers of sons who suddenly decided at university they were trans: all are very bright, nerdy and on the ASD spectrum

She asked us not to come to the Family Weekend at the end of October, she told us she was invited elsewhere for Thanksgiving

He had a romantic rejection, he attended a talk about trans at his university, he spent a lot of time online and developed dissociative disorder, then said he believed if he transitioned he would be more present in his body

We were met at the airport by a stranger: her skin was coarsened with acne, she had noticeable facial hair, her hair was chopped into a severe cut

The trans woman announcement came when my son was depressed and struggling with the complexity of social and romantic life at the university

She said she was lesbian in high school, but next spring in her first year in college there was a shock: a health insurance claim for testosterone

Several months later, it became apparent by both her appearance and mysterious medical bills, that our daughter was receiving testosterone in the college health clinic

His personality changed and he appeared terrified by everything; he told me that his friends thought the university failed to recognize mental illness

It was all hidden from us.

It was all hidden from us.  Until the body morphing started.