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.
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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

 

 

Brown University and PLOS ONE: Defend academic freedom and scientific inquiry

We are urging Brown University and the editors of the peer-reviewed journal PLOS ONE to continue to support the research of Dr. Lisa Littman. Her recently published paper, “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” explores the possibility that social contagion may cause some teens and young adults to incorrectly conclude they are transgender, and thereby undertake irreversible medical interventions that they may eventually regret.

Since its publication, there has been a concerted effort to suppress Dr. Littman’s groundbreaking study. Complete details can be found below. Readers who share our concern about this activist-driven attack on scientific inquiry and academic freedom are strongly encouraged to sign the petition at this link.

In addition,  please consider telephoning and/or writing a personal letter to the following individuals at Brown University and PLOS ONE. What’s at stake: The future of research into the unexplained increase in young people, particularly girls, presenting to gender clinics.

Bess Marcus, Dean of School of Public Health, bess_marcus@brown.edu, 401-863-9858

Christopher Kahler, Chair of Behavioral and Social Sciences, christopher_kahler@brown.edu, 401-863-6651

Brian Clark, Director of News and Editorial Development, brian_clark@brown.edu, 401-863-1638

Joerg Heber, PLOS ONE Editor-in-Chief, jheber@plos.org, 415-624-1200


Petition text

We, the undersigned, are writing in support of Dr. Lisa Littman of Brown University and her study on the topic of rapid onset gender dysphoria (ROGD).

Many of us are parents of teens and young adults who, having never expressed discomfort with their sex during childhood, experienced a sudden onset of gender dysphoria after exposure to the concept through peers and/or websites promoting transition. Some of the signatories to this petition are parents who completed Dr. Littman’s survey. The results of the study support the possibility that social contagion, rather than an innate, immutable sense of incongruence between body and mind, may be at work in some of these cases.

We are grateful that Dr. Littman’s research has been published and that this issue is finally beginning to get the attention it deserves. Although an abrupt adolescent onset of dysphoria has been mentioned previously in the scientific literature[1] , Dr. Littman’s study is the first to explore and document the phenomenon in detail. It describes what appears to be happening to many young people today.

We must be very clear: the parental reports in this study offer important and much-needed preliminary information about a cohort of adolescents, mostly girls, who with no prior history of dysphoria, are requesting irreversible medical interventions, including the potential to impair fertility and future sexual function. In any other group of children, these grave consequences would be seen as human rights violations unless there was significant and overwhelming evidence these procedures would be beneficial long-term.

Across the world in the last few years, researchers and clinicians have noted a sharp uptick in the number of young people, primarily females, who are requesting medical transition services. For example, in the United Kingdom gender clinic referrals have quadruped in the last five years. This constitutes an epidemic. As a leader in public health research, it is incumbent upon Brown University to investigate the causes and conditions leading to this sharp increase, as well as the long term outcomes.

Tavistock-referrals-of-boys-vs-girls-

Referral data from Tavistock GIDS: http://gids.nhs.uk/number-referrals

We are disheartened to see that Brown University has already removed a news release announcing the study from its website and replaced it with a letter to their community that states: “There is an added obligation for vigilance in research design and analysis any time there are implications for the health of the communities at the center of research and study.”

We, the undersigned, many of whom are parents who participated in Littman’s survey, agree wholeheartedly that the “scientific community holds an obligation for vigilance in research design and methodology.” There has yet to be a study that includes a cohort of youth offered mental health care in place of affirmation therapy. The glaring absence of a control group of youth who are supported by their families in their gender exploration but who are not affirmed in “wrong body” beliefs is a failure of the scientific community. As the number of girls and young women who desist from their trans identification grows, we must demand recognition for this cohort as members of the “communities at the center of research and study.”

The university has effectively caved to pressure from activists who claim that Dr. Littman recruited participants from “anti-trans” or “far right” hate sites. Similarly, the moderator of the PLOS One Twitter site promised to “investigate” the published study after trans activists mobbed their account. Trans activists  claim the parents who completed the survey were too transphobic to accept that their children were trans and too disconnected to have noticed that they had been suffering from dysphoria since childhood.

These claims are false in every respect. The three websites referenced are available for all to view, but the vast majority of contributors are secular, engaged, open-minded, mostly liberal-leaning parents.

These sites point to the probability that many kids who are today identifying as trans are in fact experiencing internalized homophobia. In other words, the contributors to these sites are concerned about the wellbeing of gay and lesbian kids, and they want to ensure that their children are not transitioning simply because they are ashamed of their sexual orientation.

Consider the study results:

  • 85.9% support same-sex marriage.
  • 88.2% believe trans people deserve the same rights and protections as everyone else.

Clearly, those who claim the respondents are from the far right are either misinformed or disingenuous.

And what of the claim that the parents were “unsupportive” or too disconnected from their children to recognize they had felt dysphoric during childhood? Dr. Littman acknowledges this possibility in her paper. However, she also notes that “the 200 plus responses appear to have been prepared carefully and were rich in detail, suggesting they were written in good faith and that parents were attentive observers of their children’s lives.”

Littman’s study offers, for the first time, a glimpse into families who hold space for their dysphoric children while also seeking out mental health care that focuses on underlying conditions. Consider some of her findings:

  • 204 out of 256 youth reported on in the study claimed alternative sexualities to their parents prior to coming out as transgender
  • Over 200 youth were supported in changing their presentation in terms of hairstyle and dress
  • 188 had changed their names
  • 175 had changed their pronouns
  • 111 youth told their parents they wanted to see a gender therapist; 92 were taken to see one

Moreover, of Dr. Littman’s respondents, there were only eight cases of estrangement: six by the youths themselves and two “where the estrangement was initiated by the parent because the AYA’s outbursts were affecting younger siblings or there was a threat of violence made by the AYA to the parent.” [AYA = “adolescent or young adult.”]

These are clearly parents who supported their children in their distress and through exploration of identity. Littman’s study also found that 119 youth requested medical interventions at the same time they announced their new gender identity or within the first month of their announcement. Remember, 100% of the youth discussed in her survey did not qualify for a diagnosis of gender dysphoria at any point in their childhood or  prior to coming out. Yet, 17 youth were offered an Rx on their first visit with a clinician. Perhaps even more concerning, “For parents who knew the content of their child’s evaluation, 71.6% reported that the clinician did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria before proceeding and 70.0% report that the clinician did not request any medical records before proceeding.” This is in a cohort of young people of whom 62.5% had been diagnosed with at least one mental health or neurodevelopmental disability prior to the onset of gender dysphoria, which mirrors data from other affirmation-focused clinics.[2]

Another notable criticism of the study is that Dr. Littman sought input only from parents, not from their children. Here again she acknowledges the limitation: “Although this research adds the necessary component of parent observation to our understanding of gender dysphoric adolescents and young adults, future study in this area should include both parent and child input.” We understand that Dr. Littman plans future surveys specifically for dysphoric youth and we cannot emphasize enough how important this research will be for this particular group of young people and their families.

We, the signatories to this letter, overwhelmingly support the rights of transgender people, but we want better diagnostic and mental health care for youth who suddenly demand serious medical interventions, particularly in the absence of a history of dysphoria.  We believe that medical interventions that may benefit some individuals may not help, and may even harm, others, as already evidenced by the growing number of desisters and detransitioners, many of whom have already suffered from irreversible side effects of their earlier medical transition . We support more research to help distinguish between the two groups, and Dr. Littman’s study is an important first step.

We strongly urge Brown University and PLOS ONE to resist ideologically-based attempts to squelch controversial research evidence. Please stand firm for academic freedom and scientific inquiry.  We urge you to support Dr. Littman in this important line of research.


[1] See, for example, Bonfatto, M. & Crasnow, E. (2018) Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service, Journal of Child Psychotherapy, 44:1, 29-46, DOI: 10.1080/0075417X.2018.1443150. Also see Byne, W., Bradley, S. J., Coleman, E., Eyler, A. E., Green, R., Menvielle, E. J., . . . Tompkins, D. A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4), 759-796. doi:10.1007/s10508-012-9975-x.

[2] “In all diagnostic [mental health] categories, prevalence was severalfold higher among TGNC youth than in matched reference groups.” http://pediatrics.aappublications.org/content/early/2018/04/12/peds.2017-3845

 

 

First peer-reviewed study of rapid onset gender dysphoria released today

The research, conducted by Dr. Lisa Littman, examines parent reports of the heretofore little-studied phenomenon of rapid onset of gender dysphoria in adolescence, also called ROGD.

The full paper can be accessed here (open access):

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330

Stay tuned for an interview with Dr. Littman here on 4thWaveNow within the next few days.

Research evidence: Gender-atypical tots likely to become gay or lesbian

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.


Transgender activists insist that children who behave in ways more typical of the opposite sex—a boy who likes dressing up as a fairy princess, a girl who enjoys rough-and-tumble play—are ‘transgender’. Such kids, they argue, must be subjected to medical interventions to make them superficially resemble the opposite sex, and these interventions must take place as soon as possible. The British National Health Service gives puberty-blocking hormones to children as young as 10, while in the United States some surgeons will amputate the breasts of 13-year-old girls.

Many of the kids labelled ‘transgender’ would—if left alone—grow up to be lesbian or gay. This observation has been made by many parents, and sometimes their children who desisted or detransitioned, whose stories are gathered on this website. It is also supported by a growing body of scientific research. Developmental Psychology published an important article last year (Li, Kung, and Hines 2017), which 4thWaveNow has previously highlighted. Thanks to the generosity of Gu Li in sharing some of the data, I will try to explicate the results for the general reader.

The article exploits a survey of exceptional quality, from a well-defined population: mothers giving birth in a county in southwestern England in 1991–2. Therefore it avoids the problem of haphazard sampling which undermines so many surveys of sexuality. The survey is large, so the article analyzes 4,597 children. Because they are tracked over time, we can see how the children behaved just before starting school (at 4 years and 9 months), and then how they turned out by the age of 15.

Gendered behavior

The survey asked mothers (or other caregivers) about their children’s behavior. We are interested in the questions on gender which comprise the Preschool Activities Inventory (Golombok and Rust 1993). This is a standard list of two dozen questions covering toys, activities, and characteristics. For example, the interviewer asks how often the child played with toy guns in the last month, from “never” to “very often.” All these questions are condensed into a single scale, so that the child can be placed somewhere on a spectrum from most ‘feminine’ to most ‘masculine’.

The Preschool Activities Inventory predates the emergence of transgenderism as a phenomenon. Yet the questions bear a striking resemblance to the reasons given by parents for diagnosing their kids as transgender, as catalogued by Lily Maynard. Thus, femininity is elicited by questions about playing with dolls, dressing in girls’ clothes, and pretending to be a female character like a princess; masculinity by playing with cars, or joining ball games. Today’s trans kids, in other words, would be drawn from those on the extremes of the Inventory.

Biggs image 1

The first graph plots gendered activities of the children in the survey. The horizontal axis is derived from the Preschool Activities Inventory, ranging from most ‘masculine’ to most ‘feminine’. Clearly there is a large difference, on average, between boys and girls. But there is also a wide variation within each sex. Indeed, the two distributions overlap at the edges. The mid point between the typical (median) girl and the typical boy is indicated by a vertical line. About 6% of girls behaved in ways more typical of boys than of girls, and vice versa for 3% of boys. A few of these kids were extremely atypical for their sex: girls, for example, who preferred even more ‘masculine’ activities than those chosen by the typical boy.

These atypical kids, incidentally, demonstrate the limits of socialization as the sole explanation for gendered behavior. Parents were not encouraging them to deviate from gender norms, and yet this subset of children were becoming more gender-divergent as they grew up (activities were also measured earlier, at the ages of 2½ and 3½) while most of their peers were gravitating towards behavior more typical for their sex. In fact, analysis of this same population shows that the mothers with higher levels of testosterone gave birth to girls who chose more ‘masculine’ activities, though there was no effect on boys (Hines et al. 2002). As the authors note in the abstract, “nonheterosexual individuals appear to diverge from gender norms regardless of social encouragement to conform to gender roles.”

Sexual orientation

Now fast forward ten years to the children at 15 (in 2006–07). They were asked about their sexual orientation, recording their answer confidentially on a computer. For simplicity we will divide orientation into two groups: on one hand, heterosexuals (“100%” or “mainly”) and on the other, homosexuals (“100%” or “mainly” gay or lesbian). A small number of teens identified as bisexual or asexual; they are excluded from the total.

Only 1.1% of boys identified as gay rather than heterosexual, and 0.7% of girls identified as lesbian. These proportions roughly match the total British population, but younger cohorts—like the millennials in this survey—are more likely to call themselves gay or lesbian than older generations. Therefore one suspects that some of those who called themselves heterosexual at 15 would subsequently come out as gay or lesbian in their late teens or early twenties.

Biggs image 2

The second graph uses gendered behavior to predict subsequent sexual orientation for girls. The horizontal axis is the same as in the first graph. The curve shows how girls who had preferred more ‘masculine’ activities were far more likely to identify as lesbians. As the curve extends further to the right, it is based on fewer individuals (shown as points), and so estimation becomes less certain. We can, however, be confident in the following comparison. A girl who was average in gendered activities has a 0.5% chance of becoming lesbian. For a girl who was midway between average girl and average boy, the probability triples to 1.7%.

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The third graph is the equivalent for boys. A boy who was at the average in gendered activities has a 0.6% chance of becoming gay. For a boy who was halfway between the average boy and the average girl, the probability multiplies eight-fold to 4.9%. Again, we cannot give too much credence to the extreme left of the curve, as it derives from only a few individuals. One final point needs emphasis. While kids who behaved in ways more typical of the opposite sex were far more likely to identify as homosexual than those who conformed, nevertheless the majority of them were heterosexual. As noted already, some of them would come out as gay or lesbian later on. Nevertheless, the majority of gender-nonconforming kids are heterosexual.

In sum, then, girls and boys growing up in England in the early 1990s preferred different toys and activities. To what extent this reflected socialization from parents and television, as feminists emphasize, and to what extent innate sexual differences, remains an open question.

It’s crucial is to appreciate variation and overlap as well as differences. Just as some women are naturally taller than some men, so some girls prefer more ‘masculine’ activities than some boys do. Such girls were far more likely to turn out as lesbian. That was the case, at least, in this survey of children coming of age in a society that was relatively tolerant of homosexuality—and before transgender identities were ascendant in social media and schools. We can only speculate how the cohort born ten years later would identify. But we must realize that the characteristics that now diagnose a ‘transgender child’ are the same characteristics that increase the chances of a teenager becoming gay or lesbian.

Note

Predicted probabilities are estimated from logistic regression. Adding a quadratic term or log transforming the Preschool Activities Inventory does not improve the model’s fit. N = 2,382 boys and 2,141 girls. Data kindly supplied by Gu Li.


References

Golombok, Susan, and John Rust. 1993. “The Pre-School Activities Inventory: A Standardized Assessment of Gender Role in Children.” Psychological Assessment, vol. 5, pp. 131–136.

Hines Melissa, Susan Golombok, John Rust, Katie J. Johnston, Jean Golding, and Avon Longitudinal Study of Parents and Children Study Team. 2002. “Testosterone During Pregnancy and Gender Role Behavior of Preschool Children: A Longitudinal, Population Study.” Child Development, vol. 73, pp. 1678–87.

Li, Gu, Karson T. F. Kung, and Melissa Hines. 2017. “Childhood Gender-Typed Behavior and Adolescent Sexual Orientation: A Longitudinal Population-Based Study.” Developmental Psychology, vol. 53, pp. 764–77.

Does prepubertal medical transition impact adult sexual function?

by Brie Jontry

Brie is a public spokesperson for 4thWaveNow. She can be found on Twitter @bjontry. To learn more about her, read her interview, “Born in the Right Body.” 

All audio clips (click to listen) are from the Gender Odyssey conference in Seattle, Washington, August 2017.


A few months ago, I watched a YouTube video made by a young non-binary person who couldn’t orgasm. Born female, their natal sex hormones were suppressed in late puberty and testosterone followed. While I knew “puberty blockers” (a gonadotropin-releasing hormone agonist) followed by cross-sex hormones stops future sexual development in males–and sterilize both sexes–I realized I didn’t know anything about how this process affects females and their future ability to experience sexual pleasure.

GnRH agonists suppress 95% of all sex hormone production. For a “vagina-haver,” low levels of estrogen, LH, and FSH can mean vaginal atrophy, or life with a potentially very dry, possibly itchy, thin-walled vagina that is more prone to bacterial infections, bleeding during sexual activity, and urinary incontinence, among other annoying-to-serious health issues. Estrogen keeps mucous membranes healthy and pelvic floor muscles strong.

I read a number of studies that found  “sexual desire, sexual interest and sexual intercourse were totally annulled” during GnRH use in male cancer patients and repeat sex offenders, and that females, sent into “chemical menopause” after being treated with Lupron for endometriosis, experienced even greater decreases in libido, sexual function, and ability to achieve sexual pleasure than women in natural menopause. This could be because during natural menopause, LH and FSH hormones, which are important to emotional well being and sexual desire, surge, but they are also suppressed by GnRH agonists.

I turned to the Facebook group frequented by members of WPATH, hoping to find more information. Surely members of the World Professional Association for Transgender HEALTH would be concerned with protecting young people’s’ abilities to function sexually as mature adults, right?

My search for “orgasm + blockers” turned up six posts. None about what happens to female bodies. The first and most pertinent post is this one (click to read the whole conversation), written by a therapist who has helped “100s of kids transition” and who is also an aunt to two trans teens. In reading her posts, I usually find this therapist to be thoughtful, with sincere concern for teens’ well being, and I was glad she was the one asking (even though it is concerning she’s helped so many kids down this path yet required a “sophisticated” parent to jolt her into thinking about this question):

sexual function piece arlene 1

None of Arlene’s very, very, smart friends were able to give her much of an answer.

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Bummer, even the Dutch don’t know. That’s when Arlene is reminded by her fellow WPATH members that dead people can’t have orgasms.

sexual function piece kelley winters

While Arlene defends the value of difficult questions, one of the busiest pediatric gender docs in the country, Johanna Olson-Kennedy who oversees the care of some 900 plus patients at The Center for Transyouth Health and Development at Children’s Hospital Los Angeles, stops by to share a report about infant and toddler masturbation.

She tells readers that she’d “love it” if everyone could “enjoy” an “amazing article” that talks about how “of these 13 orgasming and masturbating infants and children, 5 were misdiagnosed with seizure, and on anti epileptic meds.”

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She doesn’t bother to post a link to the full text report published online in Annals of Saudi Medicine (but I will), she just uploads a sideways picture of the first page.

sexual function piece olson saudi 2

It’s a sad read about the sex hormone levels in a sample of thirteen babies and toddlers diagnosed with “gratification disorder” (they masturbate. Often) who were seen at pediatric neurology clinics in Jordan. It wouldn’t be worth mentioning here except that Olson-Kennedy references this study again a year later when she talks about the population of natal males who will be forever stuck with “Tanner II genitals” during her presentation for parents: “Puberty Suppression: What, When, and How,” at the 2017 Seattle Gender Odyssey Conference. Audio of the presentation, which is excerpted below into small clips, is available in full here.

It is unclear what this study has to do with protecting sexual function in males denied natal puberty. At the conference, Olson-Kennedy explains that she “went on a journey to find out if prepubertal kids have orgasms.” But how does the study support her own practice of administering blockers and hormones to prepubescent youth? First and foremost, orgasm is never mentioned in this short report focused on masturbation. The subjects were thirteen children between the ages of 4 and 36 months, not “18 months and nine” years old, as she claims. Moreover, only three of the thirteen young ones studied were male, the group of people Arlene is concerned with in her FB post. “What if “we” get it wrong?” Olson-Kennedy asks towards the end of the anecdote, and laughs.  The “Cis Trajectory” is the problem; conceiving un-medicalized bodies as preferable, according to Olson-Kennedy, is the problem (Olson-Kennedy, Gender Odyssey, 8/25/17 8:41-9:50).

Most of us have known or heard of babies and toddlers who like to fiddle with their bits. No one should deny that even the youngest of infants is capable of pleasurable feelings when they touch sensitive parts of their bodies. Even people with immature genitals and lower levels of sex hormones can experience sexual pleasure but are these early childhood experiences comparable to adult ones? Are they ‘good enough’ for a lifetime? Do you think you’d be bitter, as an adult, if as a minor, doctors took away your potential to ever experience full adult sexual pleasure? I would be, yet it appears Olson-Kennedy is suggesting that since very young children masturbate, parents shouldn’t worry about the potential loss of sexual function that results from GnRH agonists used in early puberty and followed by cross-sex hormones.

We need to talk about this more, even if it is uncomfortable. Our children have a right to grow into bodies capable of experiencing full sexual pleasure. The organs responsible for fertility are also those responsible for sexual function. Locking people into an adulthood with prepubescent sex organs–or a need for genital surgery–should be a focal point in all conversations about the consequences of denying children natal puberty.

These issues are rarely discussed anywhere, unless you’re lucky enough to catch Olson-Kennedy at a gender conference. Olson-Kennedy “gives prescriptions to people to masturbate” because (as she explains at Gender Odyssey conference in Seattle in August 2017),

Blocking is one tool that’s an awesome tool for a lot of people. And what does that mean? Does that mean that trans feminine, trans girls who get blocked in tanner 2 we are we are making the assumption that all of them are going to have genital surgery. Are we doing that? Because we might be doing that. (Laughs) I’m just saying we might be doing that. And so that actually is worthy of a conversation. Because many trans women do not have genital surgery. Love their genitals, enjoy their genitals, like to use them.

That’s fantastic. We love people who love their bodies and use them and enjoy them. That’s a great human place to be. But we have to ask ourselves if you have Tanner II male genitals are you going to be able to use them, are you going to want to be able to use them? Or we are we just assuming that everybody is now going to have to say “Well I either need to go through puberty to get adult sized genitals or I’m going to have these genitals that I have or I’m getting surgery.” Does that make sense?…If we are judging the success of vaginoplasty by post-surgical orgasm how do we know people are having orgasms prior to surgery if we are blocking them at Tanner II? (Olson-Kennedy, Gender Odyssey, 8/25/17, 8:41-9:50)

In another Facebook post, Olson-Kennedy asks:

sexual function post olson 3

Procuring approval for vaginoplasties at younger ages is important because, only guessing here, her patients aren’t happy to “have NON FUNCTIONING genitals because they had the extraordinary opportunity to avoid “male pubertal maturation.”

sexual function post olson 4

Let’s talk about that. Drugs that are successfully used to chemically castrate sex offenders, which have been shown to lower IQ as much as ten points in children taking them for precocious puberty, are now being prescribed off-label to kids in Tanner II who don’t want to suffer what Winters describes as “irreversible disfiguration from incongruent puberty.” How can adolescents or their parents make an informed decision or a balanced cost-benefit analysis about the potential for permanent sexual dysfunction when the language used to describe the natural process of development equates a body capable of ejaculation and orgasm with one that is disfigured?

We’d be reckless not to think that at least some of the bodies acted on with cross-sex hormones before they have a chance to fully develop will, at some point, seem “disfigured” to the adults who live in them and to those who might want to have sex with them. In a recent study, 958 adults aged 18-81, 87.5% said they wouldn’t consider dating a trans person.

However, even among those willing to date trans persons, a pattern of masculine privileging and transfeminine exclusion appeared, such that participants were disproportionately willing to date trans men, but not trans women, even if doing so was counter to their self-identified sexual and gender identity (e.g., a lesbian dating a trans man but not a trans woman).

How much more difficult will it be for some to find partners and sexual pleasure in their altered bodies? Does Olson-Kennedy talk about these challenges with her patients? In her talk at Seattle Gender Odyssey last year, she says she checks in with some about where they’re looking for dates. Online, she says, it’s easier to disclose and find people interested but “you may be someone’s fetish” (Olson-Kennedy, Gender Odyssey, 8/25/17 1:15:23).

I’m stuck once again, wondering how knowing all this, she still claims that her role is to “Do everything in your human power to get them what they need and deserve” (:29 – 1:14)) when they’re eleven years old and what they want may not be in their long-term best interest?

Oh, and natal females, the group that set me off on this research in the first place? According to Olson-Kennedy, suppressing puberty isn’t all that wonderful for them, either. She explains to parents at Gender Odyssey that not only are emotional lability and significant behavioral changes frequent and serious side effects of blockers (29:15) but another reason these kids are “doing so bad” is because blockers put them in menopause. I appreciate her candor,  “Menopause is bad enough when you’re menopause-age, but when you’re fourteen and you’re having hot flashes, memory problems, insomnia, and you feel like crap, it is really terrible. This is really common” she says, of the current treatment protocol. “What happens when you put a fourteen year old in menopause?” she asks the audience. “You’re shutting down their ovaries,” she answers herself (Olson-Kennedy, Gender Odyssey, 8/25/17, 30:25)

Towards the end of her talk, Olson-Kennedy briefly mentions that pelvic pain is common after 18+ months on testosterone, and that she thinks it comes from “the pelvic floor” not an atrophic uterus. She says genital dysphoria usually sets in two-three years after starting on testosterone, which also negatively impacts the health of female sexual organs, causing vaginal, cervical, and uterine atrophy. I can’t help but wonder how GnRH agonists followed by testosterone, a treatment plan that may produce a double whammy of vaginal and pelvic area discomfort, impacts an already dysphoric teen’s feelings about her body, about her sexuality? The potential for vaginal, cervical, and uterine atrophy needs to become a focus in discussions surrounding youth medical transition, and what that means for the sexual becoming of a vagina-cervix-uterus-haver (perhaps still with the shallow vaginal cavity and thinner vaginal walls of a prepubescent child).

So, why? Why, given all the negatives associated with puberty suppression and early medical transition, aren’t mental health tools like dialectical behavioral therapy, which is successful at helping even suicidal people learn to manage distress and discomfort, offered first?

Instead, Olson-Kennedy focuses on getting parents to stifle every protective urge they possess so they’ll sign off on unnecessary and harmful medical interventions for a group of children, at least some of whom sound remarkably like those categorized by Lisa Littman, Susan Bradley, Riittakerttu Kaltiala-Heino, Ray Blanchard, Michael Bailey, Tania Marshall, and 4thWaveNow parents as experiencing ‘rapid onset’ gender dysphoria:

Some present with a prolonged history of gender dysphoria but the absolute hardest are the twelve to fourteen year old trans boys coming out to their parents…they came out like two months ago, and what happens? At nine years old something doesn’t feel right. I’m starting puberty, I’m doing all this work, I’m going online, I found 750,000 YouTube videos “this is me one month on T;” I’m connected to my community; I know I’m trans; I’m twelve years old and I absolutely have to tell my parents and now my parents are here and I’m here [points far away]

And because I’m thirteen you need to get on the ball and this needs to have happened yesterday and because I am here and my parents are here [far away] and the parent desperately wants you, the provider, to close that gap by pushing their kid backwards. But you as a professional know you have to close that gap by pushing them forward and keeping them. You want to keep them because you want them to give consent and be supportive. (Olson-Kennedy, Gender Odyssey, 8/25/17, 48:30-49:50)

I didn’t find all the answers I was looking for because no one has them. There is no medical diagnosis of “wrong” or “incongruent” puberty. Denying a body any stage of sexual development as a first-line of treatment for a non-lethal condition should never be encouraged let alone celebrated. Let’s refocus the discussion on ways to help young people manage their distress that prioritizes their physical and sexual health.