Parents petition American Academy of Pediatrics in response to policy statement on trans-identified youth

The letter from the parents’ Gender Critical forum (discussed and reproduced below) is also an online petition. To tell the American Academy of Pediatrics that kids deserve more careful assessment and cautious treatment than the affirmation approach recommended by the AAP, you can sign the petition here.


A group of parents from the 1000+-member Gender Critical Support forum (gendercriticalresources.com) launched a communications campaign this week in response to the recent policy statement about medical treatment for trans-identified children issued by the American Academy of Pediatricians (AAP). Members of the Gender Critical parents’ forum assert that affirmation therapy is a potentially harmful approach, and detail their perspective in the letter they are sending to the AAP Executive Committee, Board Members, Ethics Committee, and to doctors who will speak at the organization’s annual conference in Florida, November 2-6, 2018.

In an email, representatives of the Gender Critical parent forum told 4thWaveNow:

We parents know first-hand the results of the affirmation approach because many of our teens have been subject to it. Many of our children were offered prescriptions after one or two doctor visits, or they were given a referral to a gender clinic to consult about transition after no attempt was made to explore other reasons for the sudden transgender claim.

In many areas of the United States, it’s no longer considered a matter of commonsense to question a sudden announcement of being “born in the wrong body” in adolescence (with no previous signs), especially when preceded by or concurrent with anxiety, depression, autism, and/or questioning of sexual orientation. This affirm-only approach is outside the mainstream of international practice. We’ve outlined five problems with the fundamentals of the AAP’s policy statement in our letter to them.

The letter from the parents’ Gender Critical forum is also an online petition, reproduced in its entirety below. To tell the AAP that kids deserve more careful assessment and cautious treatment than the affirmation approach recommended by the AAP, you can sign the petition here.

4thWaveNow responded briefly to the AAP policy statement in this earlier post. Readers may also be interested in a critique of the AAP’s policy statement written by James Cantor, PhD., available at this link.


Dear American Academy of Pediatrics (AAP):

We need you and our children need you. There is a great and growing disservice that needs your attention, scientific curiosity, critical thinking, clinical experience, and compassion.

We have serious concerns about the AAP’s Policy Statement “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents” (Rafferty et al., 2018). While we believe that AAP’s intention behind this position statement is to protect the health of today’s gender-diverse youth (children through young adults), we are deeply concerned that the clinicians using affirmation therapy are inadvertently inflicting physical and psychological harm.

We are members of a rapidly growing online community of over 1,100 parents of transgender-identifying youth who need your help. We have no unifying political affiliation. We empathize with mature transgender-identifying people who deserve respect. We need to stop the harm to our children.

It is our concern that the AAP’s Policy Statement will continue, and possibly worsen, the harm brought to many children by the recent radical changes to treatment guidelines for transgender-identifying youth. Over the past decade, there has been an exponential rise of predominantly adolescent girls who are suddenly declaring themselves trans after the onset of puberty and who have no previous history of gender dysphoria (GD). Historically, GD showed at a much earlier age and has been exceedingly more common in boys. A recent groundbreaking study of an emergent late-onset, predominantly female trans-identifying patient population, finds significant parallels with the phenomenon of eating disorders, and includes social contagion as a key factor (Littman, 2018). The drastic increase in trans-identification and the switch to the predominant adolescent girl patient has prompted the United Kingdom (UK) Government to launch an investigation over concern that the 4400% increase in the last decade could be due to a social phenomenon (Rayner, 2018).

There is great harm being done to girls and some boys by medicalizing their gender non-conforming (GNC) behavior based on gender stereotypes, homosexuality, and/or underlying mental health issues that have led to trans-identification. The medicalization with gonadotropin releasing hormone (GnRH) agonists is highly experimental and comes with serious long-term consequences for bone health, potentially for neurological health, and as sterilizes the child when followed by cross-sex hormones. The harms of sex-aligned hormones (e.g., testosterone given to natal males) are well-known, include significant cardiovascular disease, and are increasingly exposed in lawsuits for non-transgender adults. Astonishingly, cross-sex hormones are given to the opposite sex in trans-identifying adolescents who are expected to be treated for their full lives and have permanent effects. The harms of surgeries are self-evident and irreversible, which is problematic for youth who change their minds.

The justification for non-FDA–approved medicines and surgeries is that the youth will commit suicide if these drastic measures aren’t taken (although this is not acknowledged in the AAP’s statement). There is no clinical data that supports that medical transition prevents suicide. Contrarily, long-term studies (>10 years) demonstrate increases in suicide rate, psychiatric hospitalization, and lower quality of life after sex reassignment surgery in adults (Dhejne et al., 2011; Simonsen et al., 2016; Kuhn et al., 2009).

Most transgender youth in the US who were reported in the news as having completed suicide were affirmed by social transition; thus, disproving that affirmation prevents suicide completion. The Williams Institute California GNC study reported that the percentage of teens identifying as either highly GNC or as androgynous has increased to nearly 30% and that neither group statistically differ from non-GNC teens in rates of lifetime suicide thoughts and attempts (Wilson, 2017). Furthermore, the risk of suicide in transgender-identifying youth is comparable or even less than that of youth who are non-heterosexual but who are not trans (CDC 2018, page 24, col 2, para 5), who have eating disorders (Smith, 2018), or who are referred to youth mental health services in the UK (GIDS, 2018) and yet, the “transition or die” mantra pervades as if transition is the only option.

We ask that you (1) consider our knowledge-based concerns presented as a scientific rebuttal to five main points made in the AAP position statement, (2) query AAP and other pediatricians anonymously to understand broader views, (3) conduct a more inclusive scientific debate with GD experts critical of affirmation therapy (e.g., gdworkinggroup.org) and (4) retract the AAP statement pending your inquiry. Please consider this letter a call to lead the way in exploring alternative non-invasive, non-harmful treatments. Your AAP oversight over the smaller subcommittee of “trans experts” is urgently needed.

  1. THE PROBLEM OF DIAGNOSIS

Rafferty et al. state “transgender identities and diverse gender expressions do not constitute a mental disorder.” (p 4) and “Some youth who identify as TGD also experience gender dysphoria, …” (p 3)

If transgender-identification is not a mental disorder, what is it? Is it a medical condition? If so, how is it diagnosed? How can the TGD “condition” be both a mental health disorder for “some youth” and not for others but both are treated the same way?

These questions are never answered directly by Rafferty et al. or other “trans experts,” as well as the American Psychological Association (APA) and the World Professional Association for Transgender Health (WPATH) because the answer is simply that the youth just needs to proclaim that they are transgender – it is purely self-diagnosed.

If “being transgender or gender diverse” isn’t a mental disorder or a medical condition, why are youth treated with the life-altering, non-FDA-approved drugs (experimental GnRH agonists are used for years and hormone therapies are used for a lifetime) and irreversible, serial cosmetic surgeries in an attempt to achieve a scientifically impossible goal?

We have experienced doctors giving prescriptions without adequate mental health consideration and after only 1-2 visits.

Summary: Diagnosis is the youth’s self-diagnosis. The life-altering medical treatments offered do not match the diagnostic process or the clinical evaluation standards of medicinal or surgical safety and efficacy.

2. THE PROBLEM OF MENTAL HEALTH & TRANS-IDENTIFICATION: “CHICKEN & THE EGG”

Rafferty et al. acknowledge that trans-identifying youth have “high rates of depression, anxiety, eating disorders, self-harm, and suicide” (p 3) and that “If a mental health issue exists, it most often stems from stigma and negative experiences rather than being intrinsic to the child” (p 4)

The view that trans-IDing youth have mental health problems because of their incongruity with their natal sex is a widespread assumption among “trans experts.” Another valid hypothesis is that mental health issues cause the person to trans-identify. Normal adolescent challenges coupled with the recent unfortunate declines in adolescent mental health (e.g., increases in anxiety, depression, self-harm, and suicide), the social media and iPhone explosion (Twenge et al., 2017), and the plethora of platforms targeting youth with transgender promotion are a recipe for adolescent trans-identification.

The role that mental health plays in a sudden proclamation of transgender status is discussed in a peer-reviewed scientific study that only begins to investigate the social influences on trans-identifying youth and reveals the emergence of rapidnset gender dysphoria (ROGD; Littman, 2018).

Physicians, GD experts and clinicians have been critical of the rush to affirm an adolescent’s trans-identification, especially where no history of GD exists. Some of these professionals are part of the Pediatric and Adolescent Gender Dysphoria Working Group (gdworkinggroup.org), but many, including several AAP pediatricians are not voicing their concern in public for fear of career reprisal (Kearns, 2018).

Trans-identification offers a way out of the misery of poor mental health, misogyny, loneliness, and hatred of oneself. It offers a completely new identity (i.e., it’s identity suicide with the advantage of being reborn). Trans-identification provides body alteration, commands authority figures to alter their language and behavior, comes with a fight for social justice, and provides a sense of belonging. Can you see this ultimate recipe for disaster? We see it playing out in our homes every day and it is torture that this is therapist- and pediatrician-sanctioned and encouraged.

Summary: We have experienced that providers (pediatricians, psychologists, etc.) do not explore, or only superficially inquire about, on-going or historical mental health, trauma experiences, or any potential causes of trans-identification before affirming the child’s self-diagnosis and proceeding with medical treatment, which is consistent with Dr. Littman’s study. We have also experienced that our children are using transgender-identification as a maladaptive coping mechanism as discussed in Dr. Littmans’s study. This idea is also supported in the context of anorexia nervosa and demonstrates similar adolescent clinical presentation profiles and social contagion aspects with the modern additional factor of pervasive social media exposure to transgender promotion.

3. THE PROBLEM OF IGNORING DESISTANCE & DETRANSITION

Rafferty et al. state “…children who are prepubertal and assert an identity of TGD know their gender as clearly and as consistently as their developmentally equivalent peers who identify as cisgender…” (p 4)

Eleven scientific studies indicate that transgender-identification is transient in most youth as demonstrated by desistance from transition and/or ceasing trans-identification after puberty (Cantor 2017). The dismissal of all 11 of these studies by Rafferty et al. is not scientifically validated by two citations consisting of opinion statements written by pro-affirmation extremists (Ehrensaft, 2018; Olson, 2016) who decide to throw out all the data that was astonishingly reproducible. All 11 studies demonstrate 60-90% of prepubertal children desist and further detailed scientific discussion has refuted criticisms of this unanimity of research findings (Zucker, 2018). In fact, two of the three references cited by Rafferty et al. that are used erroneously to cite support for affirmation therapy (see below under “the problem of not applying clinical science”), state that fewer than 20% of children persist in their transgender identity following puberty. In addition to the clinical data, desistance and detransition occur regularly as evidenced by verified published anecdotal accounts in several publications, all in 2018 alone (Anderson, 2018; Brunskell-Evans, 2018; Hope, 2018; Singal, 2018; Sullivan, 2018).

Several GC forum members are parents of desisters. Some of our children recognize that their trans-identification was part of a maladaptive coping mechanism. One girl desister says she was “ridiculously shy and incredibly awkward” and states that “I became depressed and I hated myself. I hated everything about me: my body, the way my voice sounded, my awkward personality, my face. Everything. I began questioning why I felt so awkward in my body and why I hated myself. I started questioning my gender. Not before long, I was 100% sure that I was actually a boy.” Many of our children have comorbid mental health issues and many watched some of the top 100 YouTube transgender celebrity vloggers in admiration just prior to their trans-identification.

Our families have experienced tremendous and unnecessary suffering brought on by irresponsible transgender promotion and iatrogenic therapy and there are thousands more who are trans-identifying for the same wrong reasons and yet they are 100% convinced of their self-diagnosis as well as their therapists, teachers, doctors, and some parents who accept their self-diagnosis as recommended by APA, WPATH, and now, AAP.

Summary: Desistance is the most common outcome among children. Persistence of the exponentially increased population of predominantly natal female, late-onset GD adolescents (including those newly identified as having ROGD) has not been studied. Today, youth are affirmed and either receive treatment or wait until they can get treatment, thus ensuring that they will be more likely to persist. Mistaken medical affirmation leading to detransition occurs regularly.

4. THE PROBLEM OF TRANSGENDER-IDENTIFICATION ETIOLOGY

Rafferty et al. state “gender identity evolves as an interplay of biology, development, socialization, and culture…” (p 4)

Three of these factors in determining if a youth will trans-identify can be summarized as the effect of the environment on the youth’s cognitive processes during development. This is exactly as we have experienced; these social factors are the dominant factors, and not biology. Evidence for social contagion is emerging in the literature (Littman, 2018) and is consistent with our experiences. By immersing themselves in trendy transgender-indoctrinating videos recommended when they open YouTube or when their friend groups decide they are transgender together in clusters, they become myopically fixated on transition.

When the natural developmental pubertal processes are artificially ceased by treatment with GnRH agonists, this negates the adolescent’s natural ability to desist from gender confusion. The majority of gender dysphoric youth desist after puberty, thus, stopping these profoundly important integrated developmental processes of neurochemistry and physiology can prolong persistence of GD. This is demonstrated by gender clinics admission that approximately 100% of children on GnRH agonists continue onto cross-sex hormones (Olson, 2018). It is also demonstrated in a study conducted at the Gender Identity Development Service (GIDS) where “persistence was strongly correlated with the commencement of physical interventions such as the hypothalamic blocker (t=.395, p=.007) and no patient within the sample desisted after having started on the hypothalamic blocker. [In contrast,] 90.3% of young people who did not commence the blocker desisted. For the children who commenced the blocker, feeling happier and more confident with their gender identity was a dominant theme that emerged during the semi-structured interviews at 6 months. However, the quantitative outcomes for these children at 1 years’ time suggest that they also continue to report an increase in internalising problems and body dissatisfaction, especially natal girls. [emphasis added]” as presented at a WPATH symposium (Carmichael, 2016).

As for the biological underpinnings of transgenderism, we know that it is not purely genetic as demonstrated by only 28% concordance in monozygotic twins and we know little else. Neuroimaging studies provide no unifying observations. The few MRI studies that show a minor difference in neuroanatomical substructures, gray matter volume, or cortical thickness are overtly flawed by the use of subjects who have been living daily life as a transgender individual (years of neuroplasticity at play), many have been using cross-sex hormones resulting in a myriad of neuroendocrine and potential neuroplastic changes, and most egregiously, cannot possibly rule out the probability that these small differences are due to personality differences such as the tendency to engage in behavior that is stereotypically associated with the opposite sex (gender non-conforming [GNC]) or such as homosexuality.

Most kids who desist grow up to be gay (Wallien et al., 2008). Are we converting “gays” to “straights”? Perhaps extremes on both sides of the political spectrum have motivations to accept or even encourage their child to trans-identify. Far-right parents may be embarrassed by GNC behavior and homosexuality and far-left parents may be eager to embrace the latest civil rights movement.

We are accepting of our kids’ GNC behavior and/or homosexuality. We don’t accept that their bodies are wrong and need to match gender stereotypes or become heterosexual.

Summary: There are several factors and individual trajectories leading a youth to trans-identify with the most dominant factors being environmental. The “trans experts” have ignored all environmental factors, attempted to over-emphasize any biological components, failed to tease-apart GNC behaviors or homosexuality from any minor biological basis of transgender identification, and focused solely on the false position that the youth is infallible in their self-diagnosis despite conclusive clinical evidence that children diagnose themselves incorrectly 60-90% of the time.

5. THE PROBLEM OF NOT APPLYING CLINICAL SCIENCE

Rafferty et al. states “There is a limited but growing body of evidence that suggests that using an integrated affirmative model results in young people having fewer mental health concerns whether they ultimately identify as transgender.” (p 4)

Two of the three references provided to support this statement contain no data and do not reference clinical data supporting this claim (Edwards-Leeper, 2012; Menvielle, 2012). One reference is a parent survey with inclusion criteria of parents who were seeking affirmation therapy and therefore biased in their ratings of affirmation therapy (Hill et al., 2010). Numerous other flaws include that some surveys were completed at baseline before affirmative care was administered and that the sample was unrepresentative of the study populations used for comparison in terms of social class and an unusually high adoption rate (52%). All these flaws and more have been eloquently discussed in Singh et al., 2011.

Rafferty et al.’s “growing body of evidence” turns out to be an erroneous, unsupported claim. The use of citations to support affirmation therapy were fact-checked by Clinical Psychologist James Cantor (Cantor, 2018). His critical commentary reveals how the citations actually demonstrate that the most common outcome of GD is desistance, the watchful waiting approach (not affirmation) is the approach recommended by most experts and institutions, and the citations used to claim that therapists opposed to affirmation therapy are engaged in conversion therapy have nothing to do with GD because they are studies on homosexuality (not GD). There are no comparative clinical studies between (1) affirmation therapy, which includes consideration or engagement in affirmative pharmaceutical therapies and serial cosmetic surgeries and (2) other non-affirmation therapies that exclude medicalization (but it can be reserved it as a last resort for the distant future).

This grave scientific error is repeated in the on-going National Institute of Health (NIH) study where there is no comparative or control group and only affirmation therapy is tested in clinic-registered youth (Olson, 2015). An example of an appropriate comparative therapy group would include one that was holistically treated for underlying mental health issues, engaged in regular physical activity that is enjoyable to the youth, assisted with building strong social connections, and supported by loving families who do not affirm that the youth is in the wrong body and instead only ask the youth to be open to all the possible reasons why they feel that way. “Watchful waiting” approach could be enhanced by exploring and resolving the youth’s underlying mental health issues and improving psychosocial skills, mind-body connection (i.e., engaging in physical activity), and family dynamics.

There is no mention of evaluating efficacy of affirmation therapy by Rafferty et al. Even the cited scientific publications do not evaluate efficacy of affirmative medical treatments and only offer speculation. Where is the data? Data need to show unequivocally that youth will benefit over the course of their lives from the experimental therapies.

The serious safety risks of GnRH agonists and cross-sex hormones (used alone or in combination) include cardiovascular events (venous thromboembolic disease, myocardial infarction and death), bone growth inhibition, psychological (e.g., aggression), sterilization, sexual dysfunction and potential neurological risks; all of which are scarcely mentioned in the position statement. No studies exist on the effects of these pharmaceuticals on children treated over five years and cross-sex hormones are intended for lifelong use. Long-term (>10 years) studies have demonstrated that medical transition leads to worsening of mental health and worsening of physical outcomes (Dhejne et al., 2011; Simonsen et al., 2016; Kuhn et al., 2009).

Herein lies another error in the ongoing NIH study (Olson, 2015) in that outcomes for efficacy and safety need to span past 10 years to justify the lifelong intention to medicate these youth; however, the study duration is only listed for 5 years. The idea of a honeymoon period post transition followed by a period of a return to worse mental health is supported by experienced psychiatrist, Dr. Roberto D’Angelo, who works with teen and adult trans-identifying people and their families. He has seen “that difficulties can resurface many years later and often these are the original difficulties that the person hoped transitioning would address”(gdworkinggroup.org). In contrast, Dr. Johanna Olson, one of the NIH authors, belittles the tragedy of regret by saying, “And here’s the other thing about chest surgery: If you want breasts at a later point in your life, you can go and get them” (Robbins, J, 2018).

We have used several supportive but non-affirming strategies and some of us have seen our children desist. Many of the strategies we’ve tried are reflected in the caring guidance offered by two clinical professionals, Lisa Marchiano and Sasha Ayad, who consider the full context of the youth’s experience, history, and parental input (Marchiano, 2017; Toward a more nuanced exploration, 2018).

Summary: With no clinical data and a flawed ongoing NIH study, how can the medical transition of youth who would normally desist be justified? Modern non-affirming strategies need to be evaluated.

CONCLUSION

After you consider our concerns and engage in critical evaluation, can you stand by this position statement? How about other AAP pediatricians (those outside the committee who authored this statement) – do they stand by it? We request that you investigate their attitudes and observations by surveying them – anonymously so they aren’t targeted for non-compliance with the forces of transactivism. We request that you stand by the AAP’s commitment to be “Dedicated to the health of all children” and retract this position statement while you conduct an inquiry.

If you have any doubt as to why we are anonymous, you need to look no further than Rafferty et al.’s recommendation to consider legal “support” in cases where parents do not comply with subjecting their children to experimental therapies (p 8).

Similarly, pediatricians and therapists remain silent or anonymous after witnessing the slander of those using non-affirmation approaches as demonstrated by world-renowned GD expert, Dr. Kenneth Zucker (Singal, 2016), and his long-awaited vindication (CAMH, 2018; The Canadian Press, 2018).

Please read our enclosed GC forum letter (also available at https://gendercriticalresources.com) with our four proposals and more support for our position (including further discussion on transgender suicide) with many more references that couldn’t be included here.

Copies of this letter and the enclosed have been sent to the media.

We sincerely thank you for your consideration,

Parents of trans-identifying youth


REFERENCES (note: all links were accessed October 2018)

CAMH Apology. (n.d.). Retrieved from https://www.camh.ca/en/camh-news-and-stories/camh-apology

Cantor, J (2017) How many transgender kids grow up to stay trans? PsyPost https://www.psypost.org/2017/12/many-transgender-kids-grow-stay-trans-50499.

Cantor, J (2018) American Academy of Pediatrics policy and trans- kids:Fact-checking. (n.d.). Retrieved from http://www.sexologytoday.org/2018/10/american-academy-of-pediatrics-policy.html

Carmichael, P et al. (2016) Gender Dysphoria in Younger Children: Support and Care in an Evolving Context (n.d.). WPATH Symposium. Retrieved from http://wpath2016.conferencespot.org/62620-wpathv2-1.3138789/t001-1.3140111/f009a-1.3140266/0706-000523-1.3140268

Center for Disease Control (CDC) (2018) MMWR Surveill Summ 2018;67(No. 8) Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2017/ss6708.pdf

Dhejne, C. et al. (2011) Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one, 6(2), e16885.

Edwards-Leeper, L & Spack N (2012) Psychological Evaluation and Medical Treatment of Transgender Youth in an Interdisciplinary “Gender Management Service” (GeMS) in a Major Pediatric Center, Journal of Homosexuality, 59:3, 321-336.

Ehrensaft, D et al. (2018) Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens. International Journal of Transgenderism, 1-18.

Gender Identity Service (GIDS) (2018) Our response in full to the ITV series Butterfly Retrieved from http://gids.nhs.uk/news-events/2018-10-15/our-response-full-itv-series-butterfly

Hill, D et al. (2010) An affirmative intervention for families with gender variant children: Parental ratings of child mental health and gender. Journal of sex & marital therapy36(1), 6-23.

Hope, L (2018) Is changing gender the new anorexia? We investigate if transgenderism has become a coping mechanism for teens. The Sun. Retrieved from https://www.thesun.co.uk/fabulous/7362652/changing-gender-new-anorexia/amp/?__twitter_impression=true

Kearns, M (2018) Don’t Let Transgender Activists Politicize Child Health Care. National Review. Retrieved from https://www.nationalreview.com/2018/10/dont-let-transgender-activists-politicize-child-health-care/

Kuhn, A et al. (2009) Quality of life 15 years after sex reassignment surgery for transsexualism. Fertil Steril. 92:1685–9.

Littman, L (2018) Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports. PloS one 13(8): e0202330. https://doi.org/10.1371/journal.pone.0202330.

Marchiano, L (2017) Guidance for Parents of Teens with Rapid Onset Gender Dysphoria. Retrieved from https://inspiredteentherapy.com/guidance-parents-teens-rapid-onset-gender-dysphoria/.

Menvielle, E (2012) A comprehensive program for children with gender variant behaviors and gender identity disorders. Journal of Homosexuality59(3), 357-368.

Olson, J et al. (2015) The Impact of Early Medical Treatment in Transgender Youth. Retrieved from http://grantome.com/grant/NIH/R01-HD082554-01A1 Accessed October 2018.

Olson, J (2017) Deciding when to treat a youth for gender re-assignment. https://www.kidsinthehouse.com/teenager/sexuality/transgender/deciding-when-to-treat-a-youth-for-gender-re-assignment

Olson, K (2016) Prepubescent transgender children: What we do and do not know. Journal of the American Academy of Child & Adolescent Psychiatry55(3), 155-156.

Rafferty, J & Committee on psychosocial aspects of child and family health (2018) Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics, e20182162.

Rayner, G (2018) Minister orders inquiry into 4,000 per cent rise in children wanting to change sex. Retrieved from https://www.telegraph.co.uk/politics/2018/09/16/minister-orders-inquiry-4000-per-cent-rise-children-wanting/

Robbins, J (2018) U.S. Doctors Are Performing Mastectomies On Healthy 13-Year-Old Girls. Retrieved from https://thefederalist.com/2018/09/12/u-s-doctors-performing-double-mastectomies-healthy-13-year-old-girls/

Singal, J (2016) How the Fight Over Transgender Kids Got a Leading Sex Researcher Fired. New York Magazine. https://www.thecut.com/2016/02/fight-over-trans-kids-got-a-researcher-fired.html

Singh, D et al. (2011) Commentary on “An Affirmative Intervention for Families with Gender Variant Children: Parental Ratings of Child Mental Health and Gender” by Hill, Menvielle, Sica, and Johnson (2010). Journal of Sex & Marital Therapy,37(2), 151-157. doi:10.1080/0092623x.2011.547362

Simonsen, R et al. (2016) Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality. Nordic journal of psychiatry, 70(4), 241-247.

Smith, A et al. (2018) Eating disorders and suicidality: what we know, what we don’t know, and suggestions for future research. Current opinion in psychology22, 63-67.

The Canadian Press (2018) CAMH reaches settlement with former head of gender identity clinic. CBC News Retrieved from https://www.cbc.ca/news/canada/toronto/camh-settlement-former-head-gender-identity-clinic-1.4854015

Toward a more nuanced exploration: An interview with Sasha Ayad. (2018) Retrieved from https://4thwavenow.com/2018/09/20/toward-a-more-nuanced-exploration-an-interview-with-sasha-ayad/

Twenge, J (2017) Are Smartphones Ruining a Generation? The Atlantic https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/

Wallien, M. & Cohen-Kettenis, P (2008) Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child & Adolescent Psychiatry47(12), 1413-1423.

Wilson, B et al. (2017) Characteristics and Mental Health of Gender Nonconforming Adolescents in California: Findings from the 2015–2016 California Health Interview Survey. The Williams Institute and UCLA Health Center for Health Policy Research

Zucker, K (2018) The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018), International Journal of Transgenderism, 19:2, 231-245.

AAP petition

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Attempted suicide by American LGBT adolescents

by Michael Biggs

Michael Biggs is Associate Professor of Sociology at the University of Oxford and Fellow of St Cross College. He researches social movements and collective protest.


Pediatrics just published an article showing that trans-identified children are substantially more likely to report attempted suicide than the general adolescent population. When the results are examined closely, however, we find that the risk extends to kids who identify as lesbian, gay, or bisexual. Emphasis on the exceptional fragility of trans adolescents overlooks the importance of sexual orientation. Indeed, my analysis suggests that gender-nonconforming girls are the most vulnerable, whether they consider themselves to be transgender, bisexual, or lesbian.

Previous evidence on suicide attempts among trans-identified youth has been methodologically flawed, even ignoring the most egregious examples. First, surveys have recruited respondents haphazardly—rather than sampling from a population. Second, respondents have not been asked for their sex, but only for their gender identity. In the United Kingdom, Stonewall’s School Report was marred on both counts.

Toomey, Syvertsen, and Shramko (2018)’s article in Pediatrics provides the first rigorous study of self-reported suicide attempts. They use data on 121,000 adolescents aged from 11 to 19, who were surveyed at schools across the United States. The findings, as reported by LGBTQ magazine The Advocate, are dramatic:

attemptedsuicide_advocate

Bear in mind that asking respondents whether they have ever attempted suicide will elicit an overestimate of the actual rate; we know from other studies that more probing questions are needed to distinguish genuine attempts to end life. Therefore we should interpret ‘attempted suicide’ broadly, to include all self-harming behaviors, including those not intended to result in death.

When the original article is examined closely, the results are more complicated than the headline suggests. The authors statistically analyze all the risk factors for attempted suicide, including sex and gender identity, sexual orientation, age, race, and parental education. Surprisingly, perhaps, the biggest single risk factor is actually sexual orientation.

The authors are publishing a companion article on sexual orientation. Until that becomes available, it is possible to estimate (from their Table 2) how the risk of attempted suicide varied according to different combinations of gender identity and sexual orientation—after adjusting for other characteristics like age and race.

The calculation is straightforward for heterosexual, lesbian, gay, and bisexual teens who were not trans-identified. (For simplicity the intermediate categories of ‘mostly heterosexual’ and ‘mostly lesbian or gay’ are omitted.) For each transgender category, I calculate the risk averaged across the observed distribution (from Table 1) of sexual orientations within the category. A caveat is that the these estimates have considerable margin of error because they derive from small numbers: 202 identified as male-to-female, 175 as female-to-male, and 344 as not exclusively male or female (‘nonbinary’ for short). A further 1,052 adolescents were not sure of their gender.

attemptedsuicide_odds.jpg

The graph above shows the estimated odds of a student reporting attempted suicide, compared to heterosexual boys. As the Advocate emphasized, teens who identified as female-to-male transgender had the highest risk of attempted suicide; the odds were four times higher than for heterosexual boys. What went unnoticed is that the risk was just as high for bisexual girls.

The next highest rates (triple the odds compared to heterosexual boys) were for bisexual boys, lesbian girls and for kids who identified as nonbinary. The latter’s sex was not recorded, but the majority are likely to be female; other survey evidence suggests that two-thirds of trans-identified adolescents are female (Eisenberg et al. 2017).

The next highest rates (roughly double the odds for heterosexual boys) were for gay boys, for male-to-female transgender kids, and for kids who were unsure of their gender identity (whose sex was not recorded). Finally, heterosexual girls had a significantly higher risk than heterosexual boys.

Stephanie Davies-Arai and Nic Williams’ critique of Stonewall’s School Report suggested that “[t]he ‘transgender’ category may just serve to cover up the scale of suicide attempts and self-harm rates of girls and young women.” Their conjecture is vindicated by this survey evidence from the United States. Over two thirds of the girls who identified as boys were sexually attracted to females (inferred from the proportion calling themselves heterosexual or bisexual), and so arguably are most similar to lesbian and bisexual girls. In sum, then, gender-nonconforming females were the group most likely to report attempted suicide, regardless of whether they identified as male or nonbinary—or as bisexual or lesbian.

James Cantor shreds American Academy of Peds gender-affirmative policy statement

Anyone who is paying attention knows the US holds the dubious distinction of being the world’s incubator for the “gender affirmative” approach. This treatment pathway–increasingly, the only pathway available in the United States–frequently consists of:

  • full social transition for children, starting as young as toddlerhood;
  • cross-sex hormones and even “top” and “bottom” surgeries for young teens, some of whom showed no childhood gender discomfort and only announced a trans identity in adolescence; and
  • affirmation of a child’s trans identity at any age, regardless of other possible causative/related factors (such as autism, social contagion, or same-sex attraction). Some of the more fervent US clinicians eschew careful psychological assessment before they prescribe full social and/or medical transition, asserting that such thorough evaluation is unnecessarily onerous or “triggering” to the young patient.

The American Academy of Pediatrics recently released a policy statement  which essentially rubber-stamps the affirmative approach. (While the Academy itself has tens of thousands of members, a recent article pointed out that the policy document was the work of a very small, activist-inspired subgroup). The AAP document creates the impression that affirmative treatment is a matter of settled clinical consensus.

Nothing could be further from the truth.

The AAP policy has a number of glaring flaws. To take just one example, it omits a significant body of research evidence that is inconvenient to the AAP’s affirmation-only doctrine. Worse: the research the AAP document does cite ironically substantiates the very “watchful waiting” approach dismissed by the AAP. The truth is, this more cautious approach is the most commonly used and evidence-based treatment for childhood gender dysphoria recognized by clinicians around the world.

There’s a lot more to pick apart in the AAP’s policy statement, and James Cantor, PhD., a Toronto-based sexologist, researcher, and clinical psychologist, did just that today. His long (but worth it) fact-checking article is required reading for anyone interested in the topic of pediatric transition.

Please read and share Dr. Cantor’s piece widely. You can read the whole thing here.

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There’s a sudden surge of trans students coming out at my college … and I’m scared to talk about it

by Emily Williams

Emily is a 20-year old college junior at a selective liberal arts university in the US. She is using a pseudonym for obvious reasons. All respectful commenters welcome, as always, but if you’re also a college/university student, we’d especially like to hear from you.


I have always been empathetic and sensitive to suffering. From a young age, I remember worrying about families who lost their health insurance, the exploitation of women, and the huge discrepancies of wealth in the world. So when I first heard stories about transgender teens, I was very troubled.

emily college silencedI got my Instagram account when I started high school six years ago. That’s when I started learning about the transgender community. I stumbled across their images without even trying. Most were young, 14 or 15, and laid a tragic narrative of being sickeningly confined to breasts and intolerant parents. Many of these internet strangers used the Instagram platform to connect with other trans youth, share their progress and unhealthy coping mechanisms, and discuss their comorbid mental health issues, such as anxiety, depression, and the fallout from sexual abuse. I did not interact with their posts, but read them out of curiosity and an attempt to understand.

That same year, I met my first real-life transgender person — the first of many. When I started high school, she went by her given name, Ingrid. She had buzzed hair, long winged eyeliner, combat boots, and lots of mini skirts. Clearly aiming to be different and cool. She was a senior, and spent most of her time painting in the art studio. Her look did not change throughout the year, but her name and pronouns did — at some point I began to hear people referring to someone named Diego. Before Diego/Ingrid graduated, s/he gave a presentation on “the transgender experience,” at which s/he defined what it feels like to have gender dysphoria, cited the suicide rate of trans people, and, most memorably, taught us trans etiquette: how to refer to trans people, use pronouns, and to never assume another person’s gender.

Throughout the rest of high school I came across this phenomenon several more times. Many more people I knew by association came out as trans. I heard more and more about trans people in the media (including celebrities like Laverne Cox and Caitlin Jenner), and began to hear LGBT or LGBTQ thrown around a bit more in a political context. I remained empathetic towards those who came out as trans, and tried to remember the politically correct language as best I could, often at the cost of what I had learned to be grammatically correct in my AP English Language class. While I still did not really understand how being or feeling transgender could work, I did not hear anyone else questioning it and felt I could not without offending or being insensitive.

emily college pullquote
But I was not ready for the culture shock of university, a small, selective liberal arts college. On the first day of orientation after moving into my new dorm, we had a floor meeting in which we introduced ourselves by name, location, fun fact, and preferred pronouns. “Remember, you cannot assume ANYONE’S gender identity!”  I felt silly having to tell a room of 40+ people that I prefer she/her pronouns, yet many people, at least five or six, who looked obviously male or female announced that they preferred the opposite pronouns. No one flinched or stuttered or acted like this activity was superfluous–though one international student asked me later, privately, why we had to do that. One person even announced that “some days” she would prefer to be called she, but other days would be going by he. Everyone nodded along, as if, of course, this makes sense.

By one month into my freshman year, the number of trans people I knew personally or by association was growing steadily. The school is small enough that even if you don’t know someone by name, you’ve probably seen them around. There were many boys wearing eyeliner but those were boys. There were girls wearing eyeliner that were also boys. Boys with small beards that were actually girls. And everything in between. One of my roommates started dating a “cis-passing” trans boy. Someone I met at the beginning of the year whose name was Tim would now like me to relearn that name as Rebecca. Someone else who started school with hair to her waist cut it all off and became Andrew. If you can’t determine gender by someone’s appearance, why have gender at all? Why not just call each other by our biology, whether we are happy with it or not, if only for consistency and clarity’s sake? I was trying to be empathetic but it was not easy, and confusing at best. No one said anything skeptical, and neither did I.

Two months into my freshman year, the signs on the bathrooms in an academic building were changed. Rather than being marked for men/women, both bathrooms were now “multi-stall.” The only indication that one was for men was the small print “with urinals,” vs “without urinals.” …

emily college pullquote 2It seemed that most of the students who were suddenly transitioning were biological females who were smart but socially awkward. They revealed their identities as trans men, usually through a haircut and new wardrobe, followed by a Facebook post alerting associates to a name and pronoun change. They would soon take to social media, student forums, and classroom discussions to rant about “cis privilege,” how oppressed they are because they get stared at by strangers, how they want to assault people who misgender them, and how in love with their “queer” identities they are.

A few weeks ago, a research paper was published suggesting that the recent increase in transgender identification among young people is the result of social contagion. This seems obvious to me. Yet officials at Brown University censored this paper. I shouldn’t be surprised. This is a topic that we can’t discuss on my college campus, either.

There is no doubt in my mind that there is a social contagion among college students. At my school, it is trendy to be transgender, and to people who feel like they don’t fit in, particularly with other people of their biological sex, choosing to transition to the opposite sex, and become a member of the opposite sex, may certainly seem like a more viable option than continuing to feel rejected while trying to fit in. But a lot of this culture surrounding trans teens and college students is aggressively narcissistic and cutesy — selfies captioned “i love being nonbinary,” “you’re gay no matter who you date,” and “baby’s first binder!” At best these random, new identities are invented to fit an aesthetic. At worst they are aggressively anti “straight white men,” apparently the worst species on earth and the ones responsible for all hardship, as they threaten professors and other students who dare to hint at an observation that doesn’t sound affirmative of transgender identities.

urinal dressWithin the past year, my second year at this college, I have had girlfriends who had to share a room with a biological male who decided, within the year, to change his name to Valerie. My two friends felt bad for Val, who was clearly socially awkward, had very low self confidence, and was always asking for their approval, (“do you think I look pretty?”). When they said yes of course, to validate Val, Val would reply with “I don’t think so.”

The odd part is that when we apply for housing we are able to select sex segregated or non-gender-based housing. If you select sex segregated as a female, you are paired with females, but if you select non-gender-based housing, you are paired with other people who selected non-gender-based housing, regardless of gender. These two girl friends of mine signed up for sex segregated housing, expecting to be roommates with only other females. Val signed up for non-gendered housing, yet it seems they did not have anyone to pair Val with, and thus decided it would be better to pair a biological male with two girls than two boys.

This is concerning for me, as a feminist. There is a reason why sex-segregated housing exists, and it is not for sexist reasons. Many, even most, women and college-aged girls are not comfortable sharing a room with a man they have never met. While sexual assault can happen in a number of circumstances, forcing women to room with men seems an easy way to increase the possibility. It has been important, historically, that women have spaces that are not open to men, for their own safety.

college piece flagSimilarly, this past year, on the “trans day of visibility,” all of the bathroom signs throughout school were replaced with paper signs that made all of the bathrooms gender neutral. This was done by the campus LGBT club, in order to make straight people get “what it feels like to decide which bathroom to use as a trans person.” I doubt this was accurate though, because I was still caught trying to decide which bathroom would not have men in it. I opted for the bathroom I remembered had been the women’s room, as did most women. One of my directionally challenged girl friends forgot which one it was and picked the men’s. She was immediately embarrassed and confused and went to hunt for the single stall a couple floors up. If our bathrooms were more European-style bathrooms, with floor to ceiling private doors, I would probably mind very little. However, these are cheap stalls that come up to your knees, and in the men’s room of course the urinals are open to all to see. One girl shared with me that she walked into the “women’s” gender neutral bathroom to find one of our younger male professors. She was overwhelmed and went to a different bathroom. She admitted to feeling bad, as she gets the point of gender neutral bathrooms and believes that trans people should be able to use any bathroom, but she just couldn’t bring herself to pee in front of our professor. Understandably.

What has been even more upsetting is to see is how quickly these new identities are accompanied by medical changes. I know several young women who were able to easily access testosterone soon after deciding they were trans. I know four who have had mastectomies. One is currently raising funds for her breast removal as part of  a GoFundMe campaign.

While I have tried my best, and initially succeeded, in believing the narratives of the transgender experience, it struck me at college that this phenomenon is so widespread, so political, and so trendy, that I am now completely dubious. I am not allowed to speak honestly and openly on this subject without being defamed as a conservative, a transphobe, intolerant, and anti-feminist. As someone who is not trans, I am not allowed to think or talk about trans issues unless I am agreeing with a trans person. Because I can’t know what it’s like to feel born in the wrong body.

At the present time, I now know about 30 trans people personally, and another 20 by name. Given that I attend such a small school, this is a very high percentage. Even the RA of my freshman year floor, who introduced herself two years ago with she/her pronouns, now goes by he/him and identifies as a boy.

This issue became personal when my childhood friend announced she is transgender, We played with Barbies and dressed as Disney princesses when we were young. We talked about our crushes on boys, and experimented with makeup and fashion when we were teens. I can’t believe that she really thinks she is a man. She plans to medically transition. I am scared for her.  But I am afraid to say anything.

I find it biologically and statistically improbable that all of these people, born at around the same time, were actually “born in the wrong body.” I find it strange that they think they need hormones and surgery that will sterilize them permanently. What seems obvious to me is that they are uncomfortable with their bodies, suffer from other issues like anxiety and depression,  and see the attention and attractiveness of transition as a way out.

What I don’t understand is why all of my friends act like this is normal. Am I really the only one who has concerns? Or is everyone as scared as I am to say something?

Toward a more nuanced exploration: An interview with Sasha Ayad

Sasha Ayad, M. Ed., LPC, is a Licensed Professional Counselor who works in private practice with teens and young adults who struggle with gender issues. We interviewed Sasha via email for this post.

She uses an exploration-based approach to seek out underlying issues and help her teen clients move towards self-awareness, resilience, and long-term well being. She also conducts occasional consultations for parents whose teens present with rapid onset gender dysphoria (ROGD).

In a monthly newsletter, Sasha’s reflects on interesting psychological material, and relates it back to the phenomenon of a sudden presentation of gender dysphoria in adolescence. She also offers advice for parents as they guide and support their gender-questioning teen. Readers can sign up here to receive the newsletter and Sasha’s PDF on how to search for gender-critical therapists in unlikely places.

Sasha has a full caseload and long waiting list, so is unable to take on new clients. However, Sasha offers a subscription-based Patreon account with videos designed to help parents engage in trusting and productive dialogue with their rapid-onset teen.

As her time permits, Sasha is available to interact in the comments section of this interview post.


Tell us something about your background, training, and work as a therapist.

In undergraduate school, I studied psychology and history. My graduate program was focused in counseling psychology, or the clinical practice of therapy. I’ve worked in the field of behavioral therapy and mental health in Houston, Texas since 2005, and in a counseling capacity since 2008. I spent many years working with young children on the autism spectrum through applied behavioral therapy. In the field of domestic and sexual violence, I worked as an individual and group therapist with women and children. I also developed and ran the first counseling program at a state-supported residential facility for adults with intellectual disabilities and concurrent mental illness. In recent years, I worked as a school counselor for underserved populations at a top-ranking charter school.

I am now working in my private practice full-time, based here in Houston. Most of my work is conducted online, and I see teen and young adult clients from all over the country and internationally. I specialize in working with adolescents who are struggling with gender and most of my clients are female. I also conduct occasional consults for families who have children presenting with Rapid Onset Gender Dysphoria, and create content for my monthly newsletter and video series.

I am a Licensed Professional Counselor (LPC) in Texas, and I hold a master’s degree in Education.

What specifically sparked your interest in working with adolescents and adults who have gender identity issues?

My interest in this population developed and grew organically out of my own desire to better understand the growing phenomenon. When I was a young graduate student, my understanding of this issue was limited and I was only marginally familiar with the conventional, textbook examples of childhood gender dysphoria: a person, who from a very young age, is completely convinced their body is the “wrong sex.” In these cases, the wrong body self-concept develops, seemingly, independent of societal norms and environmental influences. I used to think, “what a strange and troubling experience: to really believe you have the wrong sexed body.”

Even back then, I did hold skepticism about this narrative, with its heavy reliance on gender-atypical preferences and behaviors supplying the “evidence” that the child is actually in the “wrong body,” and therefore needs to socially and medically transition. Around 2012 I began more deeply investigating this idea of gender identity purely out of personal interest and professional curiosity. Keep in mind, this was before the huge boom of trans-identified kids in the years to come. I started to wonder how socialization and gender-norms may play a role in the idea of the “wrong body.” I also questioned the underlying suppositions of “gender identity”: that one’s “correct” biological sex or “authentic self” is always correlated with feelings of congruence between mind, spirit, and body (i.e. innate gender identity).

As time went on, I eventually discovered the work and writings of detransitioned people. I read about how quickly they were “affirmed” and shuttled towards a path of medical intervention, circumventing any opportunity for deep psychological exploration or self-knowledge. I became very disturbed by what seemed to be a failure of mental health practitioners, who were responsible for their care, to look at these young people as whole and complex individuals. Were many in our field simply blind to the myriad factors, both social and subconscious, that might interact and build up the idea of being “trapped in the wrong sexed body?” I grew quite baffled that therapists were treating gender identity without any of the thoughtfulness, intuition, or even clinical curiosity typically afforded to other presenting problems – not to mention the care historically mandated by our psychological ethical standards. And looking at the sheer number of young girls suddenly adopting a trans identity around puberty, it became obvious that something tremendously important and peculiar was happening.

I eventually stumbled upon this brilliant podcast interview with Lisa Marchiano, and my jaw dropped to hear another professional bravely speaking her mind and echoing some of the same fears I held. I reached out to her immediately and soon got connected with your work at 4thWaveNow, Transgender Trend, and many other fantastic resources.

Sasha photoThen in 2015, as a school counselor, I was required to take part in a training on “Supporting Trans and Gender-Diverse Youth.” To my disappointment (but not my surprise) the presenter completely failed to put forth a nuanced, thoughtful analysis, and even skirted issues when I brought them up during the training. I arranged several meetings with my manager at the time, the head of the counseling program – my goal was to educate her about the wider phenomenon and some of the less obvious problems with the training we were receiving. She graciously and thoughtfully listened to my concerns but admitted that there was so much she didn’t understand about the changes in the LGBTQAI movement, and she felt it was important to continue developing our counseling program according to the gender ideology advocates. I believe gender ideology proponents deliberately use “newspeak” and made-up language to confuse professionals into a state of self-doubt and subsequent willingness to dismiss their own intuition and clinical knowledge. And that’s exactly what I think happened to my manager, who is an incredibly brilliant, experienced, and competent social worker.

At that point I decided I would no longer take part in organizations that are committed to this belief system, with no real openness to other ways of looking at gender dysphoria. Further, some of these organizations promote this one-sided view unquestioningly to their mental health staff and the children they claim to serve. I also realized there is a scarcity of therapists working with these children in a manner that is not unconditionally affirmative. Other therapists seemed to avoid or block any type of gender and sexuality exploration, which is also harmful to the client. So, I decided to build the kind of therapy practice I thought was lacking for trans-identified youth. I started my practice part-time in 2016 and have been working independently in private practice full-time since July 2017.

Do you have a personal interest in this issue? Do you have relatives or friends who are affected by the current wave of transgender identifying children and adolescents?

Not until recently. A few years ago, when I worked as a middle school counselor, there was one child who was especially memorable; I spent much time with her, both as my counseling client and during extracurricular activities during my three years at the school.

She stood out from her peers in multiple ways. Despite having many brilliant and creative peers, she excelled in so many disparate domains, being a fantastic sketch artist, dancer, writer, and academic learner. She had impeccable grades in every subject and treated her peers with kindness and fairness. She created logos and t-shirt designs for clubs and school events, and played leadership roles in many campus groups: anime, drama, orchestra, art, and more. I have several beautiful pieces of art that she’s created for me over the years, mostly portraits of female characters, reminiscent of Japanese-style manga. Her appearance was also creatively inspired: she cycled through various hair-cuts, styles, and colors, and expressed her own personal fashion sense (and progressive political leanings) through graphic jewelry and buttons on her messenger bag. I always praised her for carving out her own sense of style and individuality.

She identified as bisexual at the time, and she was a great student-leader in my GSA club, showing initiative and often taking responsibility for large portions of our meetings. I was always careful in how we navigated conversations about gender and gender identity and she seemed to be well-grounded in her own unique expression of female identity. She was never particularly feminine, especially as a seventh grader, when there is immense social pressure to look a certain way. She always had lot of friends, was overall quite happy, and she was just one of those kids I never thought I’d have to worry about. I imagined her starting a graphic design company one day, or maybe being a video game software engineer. Really, her options are limitless.

I found out recently that she has come out as trans, and that she wants to transfer to a different school so she can start her new life as a “trans boy.” In my hours and hours of being with her, she never expressed thoughts of gender dysphoria, though I do remember that once she drew a picture of a pensive “non-binary” character and “their” girlfriend.

It feels like our best and brightest, our most creative and unique girls, are being sucked up into this vortex of confusion. The kids I meet in private practice are first introduced to me in the midst of their gender struggle, but it’s quite profound to have known someone before the identity-change, when they were happy and full of life. To think that she’s now disconnecting from her female self is very unsettling. It seems that her parents have fully accepted the wrong-body explanation and claim to have “always known she was a boy.”

How would you describe your therapeutic approach?

I’m pretty explicit with my teen clients regarding what to expect in therapy, because I believe truth, honesty, and trust are foundational aspects of any successful relationship, counseling included. I tell them something like this: “I’m different from ‘gender therapists’ you might have read about online because I won’t just meet with you one or two times then write you a letter for endocrinology. I believe my job is to help you explore who you are on a much deeper level. First I’ll spend a lot of time just asking questions and listening so I can try to understand what’s going on in your mind, heart, and body. Then we will work together to figure out what your problems are and how to solve them. That will require me to be really honest about what I see and for you to be really honest too, and sometimes counseling can be hard for those reasons. We also work together to really face your pain and see if it has something important to teach you about yourself. We can also look for ways to loosen the grip that pain has over your life so that you can find more confidence and purpose.”

As for the specifics, my approach is highly tailored to the constitution, mindset, resilience, age, and maturity of each client. I always start with trust and initial bonding, which can be hard with some clients who understand gender affirmation as a prerequisite to feelings of trust and safety. With more open clients, who are less defensive and more conversationally or intellectually predisposed, we might discuss the philosophy of gender identity and I give them space to sort through any doubts they might bring to the table. With other clients, who are in a more sensitive or fragile place, I may approach their identity indirectly, focusing instead on the underlying pain that is somehow finding relief in this new self-concept. I also like to pragmatically examine how taking on a trans identity will play out regarding a client’s self-confidence, their ability to exist in the world, how they relate to family, friends, and so on. Sometimes I have to start somewhere very basic, like assessing if the teen even understands what the words “male” and “female” mean, if they know anything about sexuality (age-appropriate understanding), or what they know about their own bodies.

The ideas that influenced my perspective at this point are quite eclectic and not restricted to the field of psychology. I draw from Acceptance and Commitment Therapy, behaviorism, social psychology, anthropology, history, and Taoism. More recently, I’m returning to a deeper exploration of psychoanalysis and Jungian analysis, which I find to be tremendously useful in making both micro- and macro- interpretations of what’s happening with my clients.

I also work closely with parents while respecting the confidentiality of the teen client. Having calls with my caseload parents every six weeks or so has proven to be incredibly important to the therapeutic progress of the teen client. Speaking with teens often gives me insights into ways that parents can deepen their relationship with their teen and to engage in more effective communication with them.

I’ve had very good feedback from my teen clients regarding their feelings of safety in session and ability to express themselves. I often hear that teens feel a great amount of pressure from others to “pick a label” and that our sessions are nice because they can explore gender without it needing to be so concrete.

Are you able to work across state lines, or must your clients be in the state of Texas?

Unlike clinical psychologists, LPCs can see clients in other states and outside the country, though I practice based on the regulations in the state of Texas. I make this clear in my initial consent conversations and documentation with new clients.

How has your your practice been going so far? Have you received any hateful or angry pushback? If so, how have you handled that?

Interestingly, I have not received too much negative pushback, but I don’t believe it will stay that way for long. I’ve seen a few people on Twitter make false claims about me, and some trolls have left unsavory comments on my blog posts. But these instances have not impacted my practice or my clients, as far as I can tell. When I speak with people about my practice face-to-face, I am typically met with far more inquiry and curiosity than hateful responses. Online though, people seem to respond with a great deal of assumptions, accelerated vitriol, and regurgitated one-liners from the trans advocacy playbook. There’s a huge difference between how my work is viewed online by trolls and in person by real people.

That being said, I have been blocked on social media by a few real-life acquaintances, which was eye opening for me. These people know nothing about the “trans kids” phenomenon, but they are the types who automatically adopt what they perceive as the correct liberal position and jump on the bandwagon without really thinking deeply about the issue at hand. Being treated this way by others on the left of the political spectrum has helped me to question many of my own long-held beliefs. I’ve wondered, “if people like me could be so blindly wrong about this, what have I been blindly wrong about?” It’s been one of the most intellectually stimulating and freeing experiences of my life to actually question my own deeply-held ideas with this much curiosity and openness.

Do you believe there is such a thing as a “truly transgender” child or adolescent? Why or why not?

It’s hard to answer a question when the terms of each word haven’t even been defined well. There’s no definition for “transgender” that isn’t completely circular in logic. Perhaps a better question is, “are there some children for whom the benefit of social and medical transition outweighs the risks”? Or maybe, “are there some children who, in order to live vital meaningful lives, must live in the gender role of the opposite sex”? To cover all my bases, let me include a question the gender therapist might ask too: “if a child is threatening to kill themselves, isn’t it better to support their transition?”

My answers for adults would look very different, but let me rephrase these questions a bit and answer them for kids.

1. “Are there some children for whom the benefits of social and medical transition outweigh the risks”?

If by “risk” we mean body discomfort or feelings of incongruence, then trying to prevent that risk is the wrong aim to strive for. Discomfort and biological limitations are ubiquitous and necessary teaching tools that have been a part of human existence throughout history, and felt particularly acutely in adolescence. The struggle between budding aspects of femininity and masculinity, independence and safety, social cohesion and isolation, assertiveness and passivity, and every other fundamental human developmental endeavor requires us to grapple with our own pain and limitations. Without that struggle we don’t develop resilience, we don’t learn about ourselves, and we don’t learn anything about living in the real world as it is, materially or socially.

That being said, it may be that classic cases of absolute insistence on being the opposite sex from the age a child could walk and talk are a different story. Of the hundreds of families I’ve talked to, only a few of them have kids whose gender dysphoria started in early childhood. Perhaps those families are more comfortable with transitioning their children, so they don’t contact me as much. Since I’ve not really worked with those kids, I don’t feel I’m qualified to prescribe their best treatment.

2. “Are there some children who, in order to live vital meaningful lives, must live in the gender role of the opposite sex?”

A “good life” doesn’t come from never experiencing discomfort, or conversely from always being perfectly comfortable, which I addressed in the previous question. But perhaps someone assumes that a girl who prefers or expresses strong masculinity would do better living “as a boy”? Are certain traits or behaviors literally incompatible with being a girl in society, or a man in society? Well, what does this say about our capacity to broaden independence and make room for personal preferences? And if someone does take on non-conformist roles, should they not also develop the personal resilience and emotional fortitude to stand firm in their own presentation with strength and individuality? I think there’s something inherently flawed about expecting all of society to completely abandon every aspect of our historically stable gender roles and it’s also flawed to say there’s no room for individuals to choose how to express themselves on the spectrum of femininity and masculinity.

3. “If a child is threatening to kill themselves, isn’t it better to support their transition?”
If a child is threatening to kill themselves, we should take a huge pause and think of the big picture. Since when do emotionally unstable, demanding children get to use threats to dictate decisions as important as fertility and surgery? Furthermore, if a child is that disturbed or troubled, then they are clearly in no position to make good choices about their long-term well being. The use of this threat by transgender-affirmation advocates is incredibly manipulative and has no precedent whatsoever in the field of psychology. I’ve worked with dozens of young people who are actively struggling with self harm and making suicidal statements (whether related to gender identity or not). These behaviors can serve many functions, not the least of which are expressing psychic pain, gaining attention and care from adults, or trying to manipulate people in power into making a concession of some sort. Children who haven’t developed the emotional or relational tools for self-soothing will use any means necessary to express pain and gain what they are seeking. I don’t mean to deride a child’s methods; she’s doing the best with what she has at the time. But these are reflections we must take very seriously as clinicians. So giving into these types of threats does far more harm than good for the child. We need to instead, conduct thorough risk assessments, create conscientious collaborative plans with the child and their family, and work through underlying issues if we really care about their safety and well-being (as therapists have always done with suicidal ideation).

In the current atmosphere, professionals who question the current “affirmative” approach to therapy for trans-identified kids may be risking their careers. Do you think the concern is overblown?

This is a touchy area so I want to start by saying that I can understand the pressures therapists feel from their institutions to make politically favorable choices and statements. Many clinicians also have their own family to be responsible for and feel financial pressures to not “rock the boat.” However, we have all taken vows of high ethical standards and going along with the affirmative approach undermines our professional moral duties.

Personally, as I’ve considered this question, I find myself asking: what’s the point of having a career based on helping others if you have to lie every day about harm that’s being done? And what does the collective and cumulative impact of lying and silence about this issue amount to in the long run?

Honestly, I don’t know what is going to happen in the next five, ten, or twenty years. In recent times whenever skeptical, intelligent, and nuanced articles about transitioning children appear, there’s often a dangerously aggressive and thoughtless effort to dismiss and diminish such arguments. The way things are going, I would not be surprised if things “get worse before they get better.” That being said, I am not worried about the work I’m doing because I believe it to be the right thing to do. Standing up for good always involves a risk and personal responsibility, a burden which I feel deeply committed to shoulder.

I strongly encourage other clinicians to speak the truth and be honest about what they are seeing, because complicit silence only makes more room for absurdity and confusion.

What will it take for more therapists to come out publicly in offering alternatives to the transgender-affirming approach to therapy?

Individuals listening to their gut, questioning actively, educating themselves, and finally, acting with honesty and courage. Because when I talk with people one-on-one, there’s a deep intrinsic knowing that we have spiraled out of control when it comes to transitioning kids, but people are afraid to even think deeply about it, question anything, seek out knowledge, or speak up.

The APA has issued “guidelines” for the treatment of what they term TGNC clients (transgender gender nonconforming). Though not binding, these guidelines are nevertheless considered “best practice.” Do you agree with them? If not, how does an APA member go about recommending changes to them?

I am not an APA member, since I am an LPC (Licensed Professional Counselor), and not a clinical psychologist. However, the APA is a powerful organization and their guidelines are looked to as aspirational principles which have significant impact on how therapy is informed and practiced. I disagree with the guidelines and believe they violate some of the most basic ethical standards, including beneficence, avoidance of maleficence, fidelity and responsibility. I believe the infiltration of political ideology into non-political organizations is the main confounding element in the organization’s ability to adhere to these professional values.

Regarding TGNC, some trans activists have essentially co-opted gender nonconformity under the “trans umbrella.” Who does that leave? No one is 100% “conforming” when it comes typical gender expression. As you know we at 4thWaveNow support such gender atypicality in our kids, but we strongly resist the notion that this means they are somehow “transgender.”

I agree – even trying to amalgamate “gender non-conforming” people into some semblance of a group is an impossible task since, like you said, no one is 100% “conforming.” We all exhibit traits of masculinity and femininity, and it’s absurd to try and find some line that constitutes “cis” and “trans” – according to some of the definitions of those terms floating around.

What are your views on the possible influences of parenting dynamics on children identifying as transgender?

It’s becoming harder and harder for parents to keep their children safe from questionable ideologies, since they have infiltrated our medical and educational institutions. But I do recommend some possible means by which parents can safeguard their kids:

  1. Due diligence in being aware of the types of ideas being taught at your child’s school: from early elementary all the way up to university. I know that’s a daunting task!
  2. Do what you can to monitor your child’s internet use and actively talk with them about some of the ideas they come across. Engage your child and really listen: let them share their thoughts, use that time to gather information and establish safety around certain touchy topics. Then engage them in thoughtful, critical, and deep analysis (in an age-appropriate and thoughtful manner). As a side note, I never imagined myself to be someone recommending an invasion of your child’s privacy; I’ve always been quite open-minded. But spending too much time online has proven to have very dangerous potential, so the long-respected parental role of boundary-setting and limit creation is crucial here. Monitor their internet use to get a sense of what material they are viewing frequently. This will help you gauge what you need to attend to. In general, the more you can keep them offline, engaged in real-life 3D activities, the better. Go outside together, leave your phones at home, go for hikes, take them fishing, and just generally reestablish a connection to the natural world.
  3. Help them regulate their eating and sleeping cycles, which play a crucial role in mood and depression. Sometimes kids stay awake, staring at a screen all night, filling their mind with anxiety-producing garbage. Set their bed-times, take their phones away overnight, and make sure they eat regularly and get plenty of physical exercise and real-life play and social interaction.
  4. Have a clear sense of your own family’s values and moral direction. What do you believe in? What ultimately guides your decisions, behaviors, beliefs, etc? Give them a strong foundation based on your own belief system. Model what you want them to learn. Don’t be dogmatic, but help them make connections to what is true and supports their long term well-being. Even if they explore other ideas in their teenage years, having a loving stable foundation gives them something to come back to or build upon.
  5. Don’t obsess over gender, but also don’t try to pretend it’s completely irrelevant. Set boundaries around any kind of physical manipulation or medical intervention. Binding breasts is a physical manipulation which can be harmful in the long run. Hormones and surgery should be off the table. But don’t get hung up on haircuts or clothing.
  6. Don’t argue with your child about whether or not they are “actually trans.” Don’t bother thinking back about their childhood, wracking your brain for “signs” of being different or non-conforming. A more pragmatic framing is to think about the real discomfort they are having, and ways to deal with it that don’t require completely transforming into a new person; this is why reducing the time your kids are on the Internet is so important. In my clinical experience, most rapid-onset dysphoric kids didn’t feel any gender incongruence until they learned what it was from social media sites. That being said, take the time to really listen to the gripes they have with the “girl role.” They likely have some very poignant observations and ideas to share.
  7. Don’t be afraid of emotions (your own or your child’s) in conversations with your teen. I’m not sure if this is a cultural thing, but I’m sometimes surprised by how afraid parents are that they might upset their child. I come from a family and culture in which open expression of emotions is ubiquitous and I have found it can be very healing when done carefully. Being honest about what you think is incredibly important, and deep emotional talks with your child are going to get turbulent – and that’s ok. It’s necessary to tell your children the truth, disagree, and show your own vulnerability. Go ahead and lovingly explain why you don’t agree with their thinking. They need to hear the truth, because they aren’t going to hear it from friends or the internet.

Queering the Student Body

by Missingdaughter

Missingdaughter is the mother of a young woman who went missing in college. The author is available to interact in the comments section of her article.


How many college students identify as genderqueer, as transgender, as something other than male or female? Short answer: we don’t know.

The Williams Institute of the UCLA School of Law tracks transgender demographics. In 2011, the Williams Institute found that 0.3% of adults identified as transgender. Another analysis from 2016, which utilized data from the CDC’s 2014 Behavioral Risk Factor Surveillance System (BRFSS), showed the number of adults identifying as transgender had risen to 0.6% of the population. What about teenagers? Yet another Williams Institute estimate in January of 2017 suggests that 0.7 percent of youth ages 13 to 17 identify as transgender. Teenagers are a difficult population to survey. Dr. Emily A. Greytek, director of research at G.L.S.E.N. thinks the numbers for teens identifying as transgender could range from 0.5% to 1.5%. Transgender is an umbrella term—this could also account for the fuzzy numbers.

For many reasons, the aforementioned data requires closer examination. For one thing, any statistic based on a generalization across a large population does not capture local variances. There is anecdotal evidence of localized clusters of transgender-identifying young people in much higher proportions than these US-wide statistics would indicate. Escalating evidence suggests an expanding social epidemic, a phenomenon being described as Rapid Onset Gender Dysphoria (ROGD).

Malcolm Gladwell argues in his book, The Tipping Point, that social epidemics germinate, emerge, and grow by specific mechanisms and for specific reasons, ultimately reaching a tipping point, the pivotal threshold at which ideas and behaviors spread uncontrollably throughout larger society. The surveys we have do not record the germination of alternative gender identities on college campuses.

The colleges themselves report only a vague sense of the numbers. In the Spring 2017 Association of American Colleges and Universities journal, a report titled “The Experiences of Incoming Transgender College Students: New Data on Gender Identity” uses data gathered from the 2015 CIRP Freshman Survey. The report follows 678 transgender students from 209 colleges and universities.

On financial matters, the report states, “transgender students receive financial aid at a higher rate than the national sample. More transgender students reported receiving Pell grants (32.8 percent versus 26.6 percent), need-based grants or scholarships (47.8 percent versus 36.6 percent), and work-study funding (35.4 percent versus 20.9 percent). More transgender students also received merit-based aid (60.7 percent versus 51.6 percent), which is especially encouraging given that the average high school academic performance of transgender students was slightly outpaced by the national average.…”

The trans-identified students have self-reported emotional health concerns: “52.1 percent of incoming transgender college students reported their emotional health as either below average or in the lowest 10 percent relative to their peers.” However, “nearly three-quarters of transgender students reported a good chance they would seek counseling (74.6 percent). One reason for this difference is that evaluation and referral by a mental health professional is typically recommended to those seeking or undergoing hormone therapy or gender confirmation procedures.”

campus queer college guide.jpgTransgender students are a politically and socially engaged group: “Nearly half of the transgender student sample reported having engaged in some type of activism within the year prior to college entry (47.4 percent), which is more than double the percentage of students in the national sample who reported having done so (20.8 percent). Other authors have noted the tendency of transgender students to view their identity through an activist lens, describing the intersection between their gender and activist identities, and the role other identities play at the intersection.” Further, more than two-thirds of incoming transgender college students indicated they were likely to participate in protests on campus (68.7 percent), as compared to about one-third of the national sample (33.1 percent).

Nowhere in this report did it state how many students pursue a medical transition while in college. It is understandable that colleges may not be able to track shifting gender and sexual micro-identities on their campuses. Some of these identities may be a passing whim. But we don’t know anything about how many students arrive at college with a transgender identity, or who adopt a transgender identity while in college, and—more importantly—how many of these students access campus health services for cross-sex hormones or are referred to a nearby off-campus provider for life-changing hormone treatments and/or surgery referrals. Because the students are over 18, FERPA restrictions may prevent a parent from ever learning that his or her young adult child has undergone life-changing medical interventions—even if the child is still covered under the parent’s insurance plan. (True: the student is legally an adult, though not fully in brain function.) Considering the heady atmosphere of trans cheerleading on a college campus and the easy access to medical clinics, a young adult could be more likely to pursue medical transition while away at college.

As noted in the article “Are you sending or losing your teen to college?” published last year on 4thWaveNow, “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.”

Some students arriving at college without a previous transgender identity will adopt this label in college. How does a coming-of-age journey turn into a coming-of-transgender journey? Why would a young person without previous gender dysphoria adopt this identity? Some would term these new identities as “late harvest apples,” a term used by Diane Ehrensaft to explain unlikely transgender proclamations from older teens and young adults. There are several reasons this identity might bloom in college. One is that gender ideology on most college campuses is an entrenched dogma that manages to unite marginalized and protected identities, tribalism, theory masquerading as science, the queering of curriculum—all these ideas combined form a nebulous all-encompassing groupthink. No one dare question this gender ideology, as this theory involves a protected class of people who are highly triggered by reality.

This new identity could form during O week, which is the week for welcoming new students to a college campus. There are also welcoming queer weeks and Q week. Further, it has become the norm to announce a preferred pronoun to other students and professors, and to be instructed on pronoun etiquette so one does not make a blunder.

From O week introduction icebreakers to the classroom, it is increasingly common to make a preferred pronoun declaration and to be asked to use assorted preferred pronouns for others. The following excerpts on preferred pronoun usage are from a guide created for faculty at Central Connecticut State University:

There are also lots of gender neutral pronouns in use. Here are a few you might hear:

They, them, theirs (Xena ate their food because they were hungry.) This is is a pretty common gender-neutral pronoun…. And yes, it can in fact be used in the singular.

Ze, hir (Xena ate hir food because ze was hungry.) Ze is pronounced like “zee” can also be spelled zie or xe, and replaces she/he/they. Hir is pronounced like “here” and replaces her/hers/him/his/they/theirs.

Just my name please! (Xena ate Xena’s food because Xena was hungry) Some people prefer not to use pronouns at all, using their name as a pronoun instead.

Never, ever refer to a person as “it” or “he-she” (unless they specifically ask you to.) These are offensive slurs used against trans and gender non-conforming individuals.

Why is it important to respect people’s PGPs? You can’t always know what someone’s PGP is by looking at them.

Asking and correctly using someone’s preferred pronoun is one of the most basic ways to show your respect for their gender identity.

When someone is referred to with the wrong pronoun, it can make them feel disrespected, invalidated, dismissed, alienated, or dysphoric (or, often, all of the above.)

It is a privilege to not have to worry about which pronoun someone is going to use for you based on how they perceive your gender. If you have this privilege, yet fail to respect someone else’s gender identity, it is not only disrespectful and hurtful, but also oppressive.

You will be setting an example for your class. If you are consistent about using someone’s preferred pronouns, they will follow your example.

Many of your students will be learning about PGPs for the first time, so this will be a learning opportunity for them that they will keep forever.

Discussing and correctly using PGPs sets a tone of respect and allyship that trans and gender nonconforming students do not take for granted. It can truly make all of the difference, especially for incoming first-year students that may feel particularly vulnerable, friendless, and scared.


Do take care, faculty. It is oppressive to oppressed classes to screw up their pronouns. But it is not oppressive to you to have to learn and use preferred pronouns. Can professors be dismissive of this silliness? No, not if they wish to not be dismissed from their positions. To take one example, a recent article stated that at the University of Minnesota a new draft proposal discloses that not correctly recognizing preferred pronouns could result in “disciplinary action up to and including termination from employment and academic sanctions up to and including academic expulsion.”

pronoun-buttons.jpgProfessors at many colleges are compelled to use the student’s “chosen” names, the preferred pronouns–and of course, since we are talking about legal adults, the families may have no idea this is happening with their student: “If you are made aware of a student’s LGBTQ or transgender status do not assume other professors, friends, or family are also aware of the student’s status.” CCSU recommends that faculty read Author Dean Spade’s journal article on working with transgender students. Dean Spade is a professor at the University of Seattle School of Law.

The idea that someone is defined by a gender identity will be promoted, the idea enforced, as soon as the student arrives on campus. If a student has not given gender identity much thought, she or he will now be fully immersed in declaring a gender. What is the effect on one’s identity when forced to declare a gender identity in a classroom or with the weekly RA meeting? Champlain College decided that it would be a good idea to have everyone wear a preferred pronoun button. Imagine declaring other identities on introductions, name tags, etc.: My political party is X, my sexual identity is X, though occasionally Y, my religion is X, my mixed-ethnicity includes V,W,X,Y,Z.

Sexual identities are whirred together with gender identities. It is no wonder that with so many options available that identities often do shift. Resident Advisors often receive LGBTQ training. RAs at UC San Diego are provided with a 74 page training manual on LGBTQ identities. This publication dates from 2007. If there is a more recent update, one would assume it focuses heavily on gender identities and creative sexuality labels.

Here is one item from this 2007 guide under ‘B’:

BDSM: (Bondage, Discipline/Domination, Submission/Sadism, and Masochism ) The terms ‘submission/sadism’ and ‘masochism’ refer to deriving pleasure from inflicting or receiving pain, often in a sexual context. The terms ‘bondage’ and ‘domination’ refer to playing with various power roles, in both sexual and social context. These practices are often misunderstood as abusive, but when practiced in a safe, sane, and consensual manner can be a part of healthy sex life. (Sometimes referred to as ‘leather.’)

Professors are expected to not only practice compelled pronoun speech, but also to queer the curriculum. From Vanderbilt University, we have a comprehensive guide, “Teaching Beyond the Gender Binary in the University Classroom”:

In this guide we learn the reasons some students may question the non-binary, “Clark, Rand,and Vogt (2003) observe that students may sometimes hold onto their current understanding of gender roles ‘like lifelines in class discussion’ when confronted with information that challenges their existing views.”

Instructors are encouraged to: “integrate non-conforming gender topics into courses that are seemingly unrelated to gender…Instructors might also “discuss medical diagnoses that have emerged in light of intersex patients.” Another recommendation is to “incorporate a class debate about the impact of gender labeling on the development of criteria for diagnosis, drug development and medical treatment.” Lastly, the authors suggest that “instructors might incorporate debates around the research on gender non-conforming brain structures, such as that of the female limbic nucleus neuron counts for male-to-female transsexuals. For some, the latter recommendation may seem problematic given the history of biological sexism and racism in the United States…In engineering classrooms, encouraging students to think about how existing technologies might require modification if one were to consider the needs of gender non-conforming individuals…In biology classrooms, incorporating readings about the variation of gender identity and expression when presenting about sex chromosomes.”

campus flag.jpgSo we can see that gender-related ideologies and pedagogy are no longer confined to the departments of Queer Studies, Women’s Studies, Gender Studies, and the Humanities.  The college experience is queered in likely and unlikely places by professors and students alike. Some other examples include:

A professor at Northern Illinois State is concerned that masculine lesbians are viewed as women and not transgender. ‘Zir’ says that “compulsory heterogenderism, participants’ gender identities often went unrecognized, rendering their trans* identities invisible.”

“Queer Ecologies” is a course taught at Eugene Lang College. A partial course description: “Drawing from traditions as diverse as evolutionary biology, LGBTQ+ movements, feminist science studies, and environmental justice…”

If one is stumped for ideas on queering the curriculum, QuERI is a site for courses such as, “Goodgirls, Sluts and Dykes: Heteronormative Policing in Adolescent Girlhood.”

To a young ideological student, it makes sense to insert queer into the Israeli–Palestinian conflict. This honors thesis is from the department of Gender & Sexuality at Davidson College:

The Gender and Sexuality Studies Department provides you with a solid grounding in the interconnected, interdisciplinary fields of gender, sexuality, and queer studies, and engage these fields from a variety of perspectives – religious, economic, political, social, biological, psychological, historical, anthropological, artistic, and literary.

New Mexico Tech promotes non-binary awareness in STEM fields.

It is no surprise that a full immersion into gender ideology on a college campus (that is consistently reinforced) could lead a young person to embrace this identity. Yes, some students arrive to college with a genderqueer or transgender identity. Some do not. If a student adopts this identity, there is no barrier to this identity going medical. A transgender identity, a non-binary identity–both of these stated identities can receive hormones and surgeries. There is a social contagion to this identity; if many other peers are headed to the student clinic for a testosterone shot, why not?

campus injectionIn last year’s college piece, we documented that medical transition services were easily available on college campuses, often with just a single visit to a counselor. The 2017 Campus Pride guide listed 86 colleges that cover medical transition surgeries. Students are often covered under their parent’s insurer, and these young adults can gain access to transgender medical services. We can only assume that insurer coverage will continue to increase. If the campus student health clinic does not provide these services, the student will be sent to a nearby off-campus “informed consent” clinic. Planned Parenthood now plays a large role in transgender health services. As in, young women come to Planned Parenthood for testosterone shots. Ironic, isn’t it? Most people think of Planned Parenthood as a place to obtain birth control–not as a place to obtain an off-label drug that may render these young women sterile, not to mention the many serious and permanent side effects of this drug.

Brown University has a generous student health care plan that provides a full range of sex reassignment surgery (SRS). As stated on Brown’s counseling website: “We partner with Brown Counseling and Psychological Services (CAPS) and University Health Services to collectively provide access, without undue barriers, to medical resources on and off-campus. Brown University health insurance provides trans-inclusive coverage for therapy, hormones, and gender affirmation surgeries for students, staff, and faculty.”

campus student healthRecently, Brown University has been in the news–no, not for the reason of ranking 14 in U.S. News Best National Universities. Professor Lisa Littman of Brown University recently published a study on ROGD, or Rapid Onset Gender Dysphoria. Her study was posted on the university’s news feed and then quickly taken down when students and other activists protested. A petition was created to support academic freedom and scientific inquiry. Dr. Littman’s study created a wake beyond the research community.

Does this university have conflicts of interest between supporting faculty research, scientific integrity, appeasing activist students and outside political groups–possibly conflicts with competing interests of faculty? Dr. Michelle Forcier is a professor at The Warren Alpert Medical School at Brown University. Dr. Forcier is passionate about transgender medical care: “Should we let them die when we have medicine for diabetes?” she said. “And we’re really talking about the same level of intervention. When gender non-conforming, transgender kids and adults are not supported (and) are stigmatized, then they can’t be healthy.”

Many colleges provide cross-sex hormones for their students. Here is some budgeting advice from Tufts University Health Care:

We recommend that Testosterone be obtained from pharmacies that have special expertise—Health Service commonly works with New Era Pharmacy in Portland Oregon which ships directly to you. At New Era, a 10 ml bottle of Testosterone lasts for 9 months or more depending on your dose, and costs $65 out of pocket, which is much cheaper than using your insurance. Prescriptions for needles and syringes will also be needed. Our nurses will work with you to help you learn to administer your injections. We will also provide you with a small sharps container for safe needle disposal.

Whether through the student health plan, the parent’s medical insurance (unbeknownst to the parents), or with some creative patch funding (as in one of the thousands of accounts on Go Fund Me by young women seeking “top surgery”), college students are a vulnerable population to the social contagion and permanent medical harm of a phenomenon being termed, ROGD or Rapid Onset Gender Dysphoria.

campus u of iowa clinic.jpgIn fall 2018, “The number of students projected to attend American colleges and universities is 19.9 million...Females are expected to account for the majority of college and university students in fall 2018: about 11.2 million females will attend in fall 2018. We don’t know the exact number of college students who are identifying as genderqueer or transgender. Colleges aren’t tracking these students. Let’s choose 1% as a number in the middle, approximating from various surveys.

What could this mean for these young women? This could translate into potentially 100K young women put on a pathway to receiving a mastectomy. No one is tracking these numbers.

Colleges must reveal how many students they refer to transgender medical health services on-campus or off-campus. Colleges and universities have an ethical responsibility to state how many students are receiving cross-sex hormones and even mastectomies due to the colleges affirming and encouraging these interventions, and sending these students to providers that are more than willing to chop off their breasts.

What will become of these young students, their futures? Many, with encouragement from peers and counselors, will estrange themselves from their families.

We will hear from some families, like this one, in a future article:

“the phone call from my daughter in the deepening voice, the phone call to the college dean of students who told me ‘sometimes children do not have the same moral compass as their parents,’ the visit to the same office where they threatened to call security on me, the generic text my husband and I received from our daughter cutting us out of her life”…

Controversy intensifies over Littman ROGD study; petition now signed by 3700, no word from Brown University or PLoS ONE

by Marie Verite

Update: 7 Sept 2018: Petition has now reached 4200 signatures. In addition to the articles linked below, new media coverage includes:  NBCNews, which covers the controversy as well as the petition, as does this San Diego Union/New York Daily News story; Ken Miller, biology prof and Brown alum in the Brown Daily Herald ; and Cathy Young in Newsday.


In the six days since the launch of the petition urging Brown University and PLoS One to continue supporting research into the sharp increase in youth—particularly females—who seek medical intervention for gender dysphoria, over 3700 have signed and over 1060 have written comments. The initial signature goal was 1000, which was quickly surpassed in less than 12 hours; the goal has since been continuously raised. As of this writing it stands at 4000.

The signatories include many families affected by rapid onset gender dysphoria (ROGD), medical professionals, therapists, doctors, and academics. You can read them all—and sign the petition, if you have not yet—here.  A small sampler of the 1000+ comments:


— Lee Jussim – Chair Psychology Department, Rutgers University “If it’s wrong, let someone produce evidence that it is wrong. Until that time, if the research pisses some people off, who cares? Galileo and Darwin pissed people off too. Brown U should be ashamed of itself for caving to sociopolitical pressure. Science denial, anyone?”

— Richard B. Krueger – Columbia University College of Physicians and Surgeons “Brown University’s actions in its failure to support Dr. Littman’s peer reviewed research are abhorrent.” 

— Nicholas H. Wolfinger – Professor, Department of Family and Consumer Studies, University of Utah “It’s extraordinary for a dean to withdraw support for a study, especially one by an untenured researcher. This is inimical to the spirit of open inquiry. The well-being of trans youth & other sexual minorities is best served by more research, not less.”


The petition was emailed to officials at Brown and PLoS ONE editors several days ago when it reached 2000 signatures, along with a personal letter requesting a response. As of this date, no reply email or even an acknowledgement of receipt has been received.

This week, parents who launched the petition will be mailing the hard-copy petition, with its over 3700 signatories and over 1000 comments, to the Brown University and PLoS officials named at the bottom of the petition, as well as to two WPATH officials located in the United States. A response from all recipients is being requested.

In addition to petition signatories, there have been many others who’ve stepped forward to express their concerns about this assault on academic freedom and the attempted muzzling of free and open discussion regarding the surge in new cases of gender dysphoria in youth and young adults. Press coverage of the exploding controversy is increasing.

This week, the US edition of The Economist ran a piece featuring a mother who completed Dr. Littman’s survey and her daughter, now a 21-year-old desister who identified temporarily as trans and demanded medical intervention at the age of 16. The piece also covers Littman’s study and the growing controversy around it. Entitled “Why are so many teen girls appearing in gender clinics?” the article appears online and in this week’s print edition.Economist cover

The Economist reports that the mother was fine with her daughter’s gender expression but drew the line at medical transition; Rachel and her mother Janette fought “for months.” In the end, Rachel desisted. The article concludes with this paragraph:

Squashing research risks injuring the health of an unknown number of troubled adolescent girls. Rachel, now 21, believes she latched on to a trans identity as a way of coping with on-off depression and being sexually abused as a child. After receiving therapy, her gender dysphoria disappeared. Had her mother affirmed her gender identity as a 16-year-old, as several gender therapists urged, Rachel would have embarked on a medical transition that she turned out not to want after all.

Despite the obvious caring and thoughtfulness demonstrated by the liberal mother and her daughter in the article, Dianne Ehrensaft, Director of Mental Health at the gender clinic associated with UC San Francisco’s Benioff Children’s Hospital and an internationally recognized gender therapist, told the Economist that Littman finding  research subjects on sites where skeptical parents like Janette congregate (such as 4thWaveNow)

“would be like recruiting from Klan or alt-right sites to demonstrate that blacks really are an inferior race.”

The Economist article is one of the first to center both the experience of a trans-identified teen who changed her mind and her mother. (Jesse Singal included such stories in his recent Atlantic story; Singal continues to undergo attacks by trans activists for what can only be described as a balanced piece on the matter of youth gender dysphoria).

There has been other prominent news coverage of the Littman controversy. Jeffrey Flier, Harvard University Higginson Professor of Physiology and Medicine at Harvard, and former Dean of Harvard Medical School, first reacted on Twitter to Brown’s removal of the press release of Littman’s’ study, and the university’s failure to support its own researcher:

flier sad day

A few days later, Flier penned a piece for Quillette (an online journal fast becoming one of the most respected outlets for nuanced and incisive writing), taking Brown University to task for its disgraceful treatment of Dr. Littman, an untenured professor, as well as its abdication of responsibility to defend academic freedom via its craven actions in the face of agenda-driven activists. In response, many prominent physicians have retweeted Flier’s piece, as well as Brown faculty members. In Quillette, Flier took no prisoners:

“In all my years in academia, I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published.”

Reactions to the Littman debacle were everywhere on Twitter (for better or worse, the cyber-public square, referred to by some as the “Agora of the 21st Century”), including  from other medical professionals, such as Nicholas Christakis, physician, writer, and researcher at Yale.

flier christakis tweets

An article on Medscape on August 28, “Caring for Transgender Kids: Is Clinical Practice Outpacing the Science?” attracted comments from several physicians, most expressing serious concerns about the epidemic of young people identifying as transgender in the last few years. [Note: Some of these physicians signed and commented on the petition calling on Brown and PLoS ONE to support Dr. Littman’s work.]

 

 

Many journalists have also weighed in on Twitter, overwhelmingly in support of Littman’s work and also the petition to Brown and PLoS ONE.

cathy young peteition tweet

Jon Kay, Canadian editor of Quillette opined on Twitter

 

Tonight, Kay tweeted a letter by a WPATH clinician condemning the ROGD research. Based on WPATH’s previous hostility to any and everything to do with ROGD, we should expect to be hearing more from them in the very near future.

Other coverage of the Littman controversy (recommended) includes Science magazine, Inside Higher Ed, attorney-blogger Jonathan Turley, and the Volokh Conspiracy in Reason magazine.

The intense, swift reaction to the Littman matter–and ROGD–is stunning. Ironically, the pile-on intended to suppress Littman’s work may have had the opposite effect of that desired by activists. As of this writing, Littman’s study has been viewed on the PLOS ONE website nearly 59,000 times (this count would not include, of course, additional views of the paper via email shares of PDFs, etc). Indeed, the Littman affair seems to have not only brought the question of rapid onset of gender dysphoria in adolescence, finally, into the public eye. It has also stimulated a broad group of thinkers, professionals, journalists, and clinicians to start talking about the issues, under the banner of academic freedom and the pursuit of truth over the ideological dictates of one group of activists.

It’s heartening to see that defense of these core values is not dead, after all, in the West.  We now have not just parents, but public intellectuals, physicians, and ethical clinicians speaking up who recognize what is occurring for what it is: An assault on scientific inquiry and an attempt to squelch open discussion of a phenomenon which is becoming more obvious by the day, despite every effort by the usual suspects to insist it doesn’t exist.

As of this writing, there has been no further public response from either Brown University or PLoS ONE. The last reaction we are aware of was an obsequious response by PLoS ONE on Twitter to a self-described BDSM trans sex worker who goes by the moniker “SadistHailey”/Hailey Heartless.

PLOS One hailey

As we observed on our Twitter account,

hailey little babs 4th tweet