Guest post: For teen girls with autistic traits — a plea for watchful waiting

This guest post by 4thWaveNow community member neverfallingforit is second in a series exploring the increasingly well known connection between autism spectrum disorder (ASD) and gender dysphoria (or other gender-related issues).

 Many of us have shared observations that our kids show signs of ASD. Unfortunately, the current treatment paradigm tends to view ASD as no barrier to “transitioning” kids and young adults.

 A word about the title of this post. The current approach fostered by WPATH is generally referred to as “watchful waiting” with regard to diagnosing younger children as transgender. While this sounds like a hands-off approach, in reality “watchful waiting,” to trans activists and many gender specialists,  often includes the use of “preferred pronouns,” “social transition,” and (frequently) puberty blockers. Once these kids reach adolescence, “watchful waiting” ends and the path to full medical transition becomes available.

There is much that is still unexplored (and unstudied) about the impact of these supposedly benign interventions on actually helping to create a persistent transgender identity in children and young people. I’ll have more to say about this in a future post.


by neverfallingforit

When my daughter first started identifying as transgender, I quickly and easily found articles online which posed a link between autism and gender identity issues. I bought the books Aspergirls by Rudy Simone and I am Aspiengirl by Tania A Marshall. At the back of each book there is a checklist of traits for girls with Asperger Syndrome, many of which I learned were different from those which appear in the male Asperger profile.

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I also learned that formal research on the autistic female profile is relatively new, and as such, is years behind clinical and anecdotal observations. After reading the books, my daughter herself placed ticks next to a whole host of these traits, and I began to suspect that an autistic spectrum disorder (ASD) was in the mix here somewhere. Several traits particularly jumped out at me:

  • may have androgynous traits despite an outwardly feminine appearance. Thinks of herself as half-male/half-female (well balanced anima/animus)
  • may not have a strong sense of identity and can be very chameleon-like, especially before diagnosis
  •  will not have many girlfriends and will not do “girly” things like shopping with them or have get-togethers to “hang out”
  •  emotionally immature and emotionally sensitive
  •  strong sensory issues – sounds, sights, smells, touch and prone to overload
  •  will have obsessions but they are not as unusual as her male counterpart (less likely to be a “trainspotter”)

After finding 4thWaveNow, I read that gender identity clinics are seeing a higher number of natal girls in their referrals than they would expect from previous epidemiological knowledge, and also that it is very common to find that these girls had autism spectrum characteristics. Some of the studies alluded to the fact that cultural factors could also be at play in the increasing referral rates.

As I read the comments on many of 4thWaveNow’s posts, I could see a profile emerging of a subset of teenage girls who had come to believe that they were born in the wrong body. Most had never previously mentioned gender dysphoric feelings to their parents, although many had never been “girly girls.” They often seem to share the same personality traits; traits which fitted right into the female Asperger profile. 4thWaves’s comprehensive article on autism discusses how autistic spectrum traits could lead to a transgender presentation and I could clearly see how this applied to my daughter.

What really caught my attention was how these girls also seemed to share the same cultural traits. My parental antennae kicked in.

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Then, I found an article on GenderTrender, and some more pennies began to drop. Way back in 2010, that blog was insightfully covering the transgender trend in ‘tween and teenage girls

 who believe that rejection of increasingly constrictive female norms means they must be male. These girls don’t want to act out a ‘female’ role in relationships with boys.

Here was an apt description of my daughter, who kept telling me that she must be a boy because she was a “rubbish girl,” that she wanted “to be the boy in the relationship, saying the lines and making the moves.”

She and her friends had recently been watching porn videos on their phones at school, and a letter had been sent home to parents. I wondered if the images she had seen had frightened her. Girls with ASD often have sensory issues which can mean they don’t like to be touched much, or hugged; a few in my daughter’s online social group describe themselves as asexual. Maybe she felt that taking on a male presentation would ensure that she wasn’t pressured into situations which she was uncomfortable with? She refuses to discuss it with me.

As the same article also observed,

 they don’t want to be marginalized as the gender non-conforming women that they are. Femininity rejecting females simply DO NOT EXIST in the media reflection that is so important to children and teens in western culture. These kids want to fit into social norms, wear the right brands, get the right haircuts, and look like the people in magazines. “Transgender” has a certain cachet, a certain alterna-cool about it for those in middle school and high school years. Declaring one’s trans status is like getting the ultimate cool tattoo or piercing body mod and provides girls with special status and treatment amongst their peers as well as school officials, employers, parents and other authorities.

This, too, has been my experience. My daughter’s social popularity rose on her transgender announcement, and what teenager wouldn’t rejoice in that–especially one who had previously had trouble maintaining friends? She attracted much encouragement and support.

I read all the statistics about suicide rates, the suffering of those with crippling dysphoria, about the bravery of coming out as trans in a hostile world — and yet my daughter displayed no such angst. She declared herself the happiest ever and demanded that we catch up with the rest of the world. Her anger and distress were only directed at us, her parents, when we questioned her transgender narrative.

One of the most heartbreaking parts of my story is the way my daughter has been encouraged to believe that we, her parents, don’t love and respect her because “we don’t want her to be happy.” Outside of our family, her friends, college teachers and the media are cheering and validating her male presentation. She is genuinely bewildered, disappointed and hurt by our inability to sign up to her self-diagnosis, without question, without due diligence. Not long ago, she reblogged a popular post on her Tumblr account. It is an illustration of a parent cutting the multicolored wings on the back of a “transgender” child.

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It’s common knowledge that teenagers always run with their peer group. They try out identities and refute parental opposition. There’s nothing new in that. That’s healthy. But it’s the untested lifelong medical treatments and surgery involved here which frighten us, and make us cautious parents – not “transphobes.” And, if my daughter does have Asperger Syndrome, does she have the ‘theory of mind’ to understand the long-term implications of what she is proposing?

Back to GenderTrender:

 The trans tweener trenders bond and encourage online via YouTube groups and web forums which function much like pro-ana, pro mia and trans-abled communities, encouraging dysphoria and censoring questioning and dissent.

The online spaces my daughter visits have become saturated with transgenderism. Many 4thWaveNow parents mention that their girls spend a great deal of time on Tumblr in particular. During Trans Awareness Week recently Tumblr was described glowingly:

 Tumblr seems like a natural fit for young transgender people to gather online, with a thriving social justice community and fandom devotees advocating LGBTQ rights, Tumblr fosters a culture of reaching out for advice from caring, experienced strangers… Tumblr’s also important because through finding one person who is similar to you, you’ll find 10 more, because they’ll be following people like themselves. When I was first working out I was trans, I didn’t follow that many other girls, but now I follow loads… the most important thing Tumblr’s trans community can give its members may be a sense of affirmation.

How intoxicating must that be? A legion of like-minded girls, with similar interests – after so many years of feeling like you don’t fit in. And how normalizing!

In my daughter’s case, I would also add into the mix the androgyny, cosplay and cross-play associated with anime and manga, and the androgyny, parental estrangement, disassociation, and angst messages that she absorbed during her previous obsession with the “emo” scene too.

Not feeling either stereotypically male or female is fine. Androgyny is fine. Trying on many identities is fine. But how did these feelings become conflated with a transgender diagnosis, when they all fit firmly into the Asperger girls’ profile too?

Here are a few quotes from parents of girls with Asperger Syndrome, which feature in the  I am Aspiengirl  book:

 “She went from princess, to tomboy, to punk, to emo to goth. She is having trouble finding out just who she is and has gotten involved with the wrong types of people. She is not interested in dating and finds flirting very confusing. She also does not seem to have a solid gender identity.”


“She has recently given up trying to fit in. She is going through very challenging teenage years, feeling even more outcast. We are now watching her embrace opposite conventions, despise femininity, social and gender rules. She is now a tomboy and a bit confused about her gender.”


“We all thought she had gone to the “dark side”. She just didn’t fit in anywhere and had no idea who she was. She seemed to despise femininity and defined social and gender rules. When she has friends, she tends to naively and blindly follow wherever they go, their rules, taking on their traits, from the way they dress to the way they talk and act.” 


“Just a few months ago, she was wearing frilly dresses and looked like a princess. Now she’s Goth and won’t let anyone call her by her new name. She has depression and panic attacks that sneak up on her from out of nowhere.”


She really struggles with sensory sensitivities, social anxiety, panic attacks and depression. She must have gone through at least three or four different lifestyle changes.


Do any of these anecdotes sound familiar to other parents in my position?

So what now? I strongly suspect that my daughter is on the autistic spectrum. I feel that she has Asperger-related issues which are impacting on her self-diagnosis of being trans. I feel transgenderism has become a special interest/ obsession that gives her relief from anxiety. All I want is to be reassured that clinicians will take care, be cautious, give her time to experience more life, to mature.

But will they?

Until I believe they will exercise proper caution, I am too scared to lead her into a therapist’s waiting room. Because I fear that, in some medical quarters, as soon as the word “transgender” is uttered, Asperger syndrome becomes downgraded to a mere co-existing condition.

In a recent small retrospective study of children presenting to a gender clinic in Boston, it was found that 23% of the patients potentially could be given an Asperger diagnosis but instead of urging caution, the researcher Daniel Shumer seemed to imply that it merely meant these kids may need to have the transition process explained more clearly.

 Given the growth of gender programs and general awareness of gender dysphoria in the U.S., Shumer said it helps to know that there’s a link between it and Asperger syndrome. He said he hopes his work will help persuade doctors to screen transgender patients for ASD and know that they may need to take more care to explain hormonal interventions to their patients on the autism spectrum.

Aron Janssen, MD, a child psychiatrist at NYU Langone Medical Center, who was not involved in the study had this to say,

It’s really about assessing what gender means to a population that may think of gender in a different way than the way most of us do,” Janssen said, explaining that thinking differently about gender shouldn’t limit treatment options for patients with ASD. In a way, people with ASD may express their gender more authentically because they’re not as swayed by social stereotypes, Janssen said.

Aron Janssen has recently taken part in an interview with The Ackerman Institute for the Family, which he has posted to the WPATH Facebook page. In it, he gives his view that gender dysphoria is a completely separate entity from autism spectrum disorder. He states that recent research has found an overlap between individuals who have gender dysphoria and individuals who have an autism spectrum disorder but we don’t really know why that is.

One of the implications for treatment, he says, can be that patients with autism who may have a “theory of mind” impairment could have difficulty in understanding how to communicate their internal gender identity to the outside world; in other words, they may not understand that how you speak, dress, act and appear are important to how people view your gender presentation. They may need help with that.

A Reddit commentator with Asperger’s would agree with that impairment, but reaches a different conclusion on the help needed:

 I can’t speak for all people with autism (I have Asperger’s), but I think a lot of people with autism spectrum disorder are confused by the messages that society puts out about how to act and how to perform gender. I always felt like I didn’t fit in with women when I was growing up. Had I been born later, I have to wonder if I’d be picking up this trans narrative and taking it to heart. This is not the kind of help that young people with autism need. They need appropriate services, help finding their way into jobs and meaningful social connections, not hormones.

Dr Janssen, however, appears to take a different perspective.

 For too long individuals with autism who have had gender dysphoria have had that gender dysphoria dismissed as filling category 2 of autism- that restricted or repetitive interests or behaviors – and their gender identity was thought of as a symptom of autism, as opposed to something that is genuine for each individual.

As such, he believes he needs to help patients express their own autonomy and give them access to the care they say they need.

Which all sounds great, if we weren’t talking about letting children with cognitive vulnerabilities make decisions about irreversible treatments before their brains reach full maturation!

My last point is this:  So much of the research available cites case studies of patients who have experienced gender dysphoria from a very young age. Information about the clinical management of SUDDEN, LATE ONSET gender dysphoria in YOUNG TEENAGE GIRLS has been impossible for me to find on the internet. 4thwave’s blog is the only place I have found where this particular path to transgender presentation is being discussed.

More importantly, parents are also beginning to come here to tell about desistance in their daughters. These stories are important. (These stories give me hope.) If you have a similar one to tell, please share it here. My plea to clinicians is that they read these accounts and adopt a WATCHFUL WAITING approach for this group of teens and young adults.

 

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If you care for “trans” kids, fight for freedom from gender, not the scalpel & syringe

I received this comment a few days ago. The theme is a common one among trans activists and gender specialists nowadays: They not only think they know how to diagnose “true trans” children. They are confident that social transition, puberty blocking, and cross sex hormones (with concomitant permanent sterilization) will lead to happy trans adults.

I’ve reproduced the comment here. (Boldface emphasis is my own.) My response is below.


LisaM says:

People are always mixing up Gender Non Conforming Only children, GNC Only, (usually first defined by their parents) and transgender children (those who show strong cross gender desires and associated Gender Dysphoria, GD, if thwarted).

Now GNC Only (little or no transgender desires and the associated GD) will fairly often, but not always by any means, end up bi-sexual, gay or lesbian as adolescents and adults and be happy with their gender (maybe after some exploration).

GNC with strong GD will nearly always retain that into adolescence and adulthood and at some stage transition or die.

So it is important to separate them out, which to be fair for a very young child can take a few years to work out, hence the WPATH ’support and wait and see’ approach.

The longer a child expresses transgender desires and has GD then the more likely they are really transgender. But, an important but, a child with strong GD may not be a ‘typical’* ‘sissy boy’ or ‘tomboy’. though they will almost certainly show GNC behaviour of some kind and strongly express transgender wishes.

A lot of that depends on how introverted or extroverted they are. The quiet, shy, sensitive and introverted child suffering terrible GD may not express themselves much in public as very GNC even though they may want to. Everyone forgets this point…… not every kid is a blazing extrovert and public performer. This explains the common issue of the child only expressing their transgender feelings at early adolescence, before that they were simply too shy and sensitive and hid it carefully.

The other issue is the treatment of some GNC Only kids, who if you do the ‘drop the Barbie’ stuff to them means you are making them act ‘straight’, which is cruel and if not actual SOCE** it is pretty close.

GNC Only behaviour by itself will not ‘make’ someone transgender, which seems to be the fear by some.
GD plus GNC means they are almost certainly transgender and almost never will change and if you try then you are playing Russian roulette with their lives. There is only one treatment for GD that works, transition***.

So the issue is selection and it is not that hard, although it will never be perfect. A 2012 study on CAMH children showed the only statistically significant factor (logistic regression) in their ‘persistence’ was the strength of their combined GNC/GD scores. So their own tests showed good measures to predict outcomes, which were a lot higher that the commonly stated ‘80% desist’ (based on lumping the two groups together).

A rough ‘back of the envelope’ calculation shows that maybe only 5% of GNC Only diagnosed kids are really transgender (diagnosis is never perfect). BUT, maybe as much as 80% to 90% of GNC + strong GD ones are (based on CAMH published numbers).

The majority, by far, are of course GNC Only with transgender children being a minority. CAMH’s own numbers (awhile back) stated that 70% of the kids they saw were GNC Only.

*And what is a typical ‘sissy boy’ or ‘tomboy’ anyway? This is usually just parent paranoia and absurd social ‘norms’.

**Sexual Orientation Change Efforts = sexuality reparative therapy.

***transition can mean socially or fully medically to the opposite gender, it can also mean becoming ‘gender queer’ or similar.

LisaM, first let me acknowledge that you are not arguing in your comment for full medical transition for all “transgender children.” In fact, you say that some kids may just want to “transition” to be “genderqueer.” But really, that is simply a matter of personality. We don’t need to label it with anything to do with “gender,” unless you believe in gender stereotypes. So it’s nonsensical to say such kids would be “transitioning” to anything–they’re just expressing their unique personalities, as well they should.

But apart from that statement on your part, I’ve done enough homework to know that medical transition is indeed the goal and outcome in an increasing number of pediatric cases. Much of my response will be addressing that outcome.

You don’t disagree, in the main, with the decades of peer-reviewed data that show most GNC kids will desist. What you and the other WPATHers are arguing about is the small core of kids who persist in their dysphoria as preadolescents.

WPATH activists and gender specialists are pretty confident that they’ve come up with a way to separate the “truly transgender child” from the merely “gender nonconforming” (GNC).  GD + GNC = transgender for life and in need of transition. To hear them tell it, it’s a slam-dunk. They eschew the older research because they say the net was cast too widely; that the “truly trans” kids were lumped in with merely gender nonconforming.

Here’s what I’m willing to grant:

  • There are a minority of kids who appear to be more persistent in their desire or claim to be the opposite sex.
  • Some of those kids might continue to want to “transition” as adults.
  • Some of the older studies may have been less specific in weeding out the more dysphoric from the merely GNC children.
  • Responsible, ethical clinicians don’t want to create “false positives” i.e., kids being trans’ed who would have grown out of it. They aren’t ogres.

Beyond that? What do you and other trans activists have to support medical transition of children?

That’s pretty much it.

You claim “there is only one treatment that works for gender dysphoria, transition.” But there is zero proof that the medical transition of children will produce happy adults decades later. There simply isn’t.

History and science don’t support the “transition early or suicide” narrative:

  • Show me the data proving that gender dysphoric children in earlier times didn’t end up living happy lives; that they committed suicide in the days before hormonal and surgical interventions were widely available.
  • Show me the data that dysphoric kids who are medically transitioned will be happier at 40 than kids who weren’t transitioned.
  • Show me proof that the very act of transitioning kids doesn’t create persistence. Especially because “social transition” is now being started earlier and earlier, when children are at their most impressionable and the brain is most plastic.  Do you know anything about normal child development?
  • Show me the data that the “two spirit” and GNC people in other non-technological cultures (that trans activists often co-opt) spend their days wanting to kill themselves because they can’t have surgery and hormones.
  • Show me proof that there is any such thing as innate gender identity.
  • Show me the data that these children won’t feel suicidal later on in life, after the “honeymoon phase” of transition has long passed. (In point of fact, way too many young people who are gender nonconforming, gay, or trans-identified have suicidal thoughts, and transition hasn’t prevented self harm in many.)

What is the big rush to transition kids, to prevent them from experiencing the “wrong puberty”?  I believe it is driven by adult trans activists obsessing about the fact that they didn’t–or still don’t–“pass” well enough. It’s about how realistic a facsimile of the opposite sex the endocrinologists and surgeons can manufacture.

The engine that drives this pediatric transition juggernaut is the memories and yearnings activists carry about their own childhoods. That’s what this whole medical-legal-media child transition craze is based upon: The anecdotal accounts of adult trans.

Anecdotes are fine, as far as they go. But why don’t trans activists give as much weight to anecdotes by formerly dysphoric people who are glad they were born before transition was a thing for kids? 

Based on their own retroactive wishes, trans activists are betting that all these kids who are being socially transitioned, puberty blocked, and sterilized are going to be happy adults — at 30, 40, 50 years old.

LisaM, in the name of helping these kids “pass” better as adults, it goes without saying that you and other activists also think it’s worth sacrificing a few false positives. As you said, “it will never be perfect.” Tell me: How many false positives do you think will be acceptable in the future? Regretful adults who were puberty blocked, sterilized, and operated upon, only to discover that they changed their minds later?

We’re talking about clinical guesswork with extremely high stakes. And it’s coupled with an activist strategy that is making it illegal to have a control group of kids who didn’t receive such “treatment.” The only “control group” will be future regretters (like you said, no diagnosis is perfect) who will haunt courthouses and psychotherapists’ offices long after the damage is done.

In the name of preventing the “wrong puberty,” you want to interrupt the natural course of development by blocking puberty and preventing these kids from discovering who they are without medical interference. You ignore the fact that a puberty-blocked kid also has blocked brain development because puberty isn’t just about secondary sex characteristics. It’s also about brain maturation. And by preventing natural puberty, you deny them the right to a first sexual experience in an unaltered body.  You give these kids what they say they want, thinking you are doing the right thing, contradicting decades of clinical practice, neuroscience, and child developmental psychology in thrall to a non-evidence-based belief in innate gender identity.

You think it’s all worth it—the sterilization, the false positives, the denial of puberty–because you have convinced yourselves that these kids will be happy adults.

But you don’t know that. Even the top doctors in the field admit it. The Dutch pioneers in the field of pediatric transition are uncertain.

You and your compatriots spend a prodigious amount of time and energy fighting for  children to be permanently sterilized and irretrievably altered. What would happen if, instead, you and the other trans activists formed lobbying groups to fight for full acceptance and understanding of gender nonconformity? Make the idea of having to “pass” a thing of the past, so that a little boy or girl would see adults and children who dressed and behaved and did anything they wanted, without the need and the encouragement to think there is something wrong with their bodies. Do you really think most of these “true trans” kids would still want to “transition?” Or that, at a minimum, they couldn’t just wait until adulthood to make the decision?

Trans activists believe strongly that transgender should be depathologized and seen as a normal variation in human experience. But there’s an inherent contradiction here. Setting aside the question of whether insurance and the medical system should pay for any and all interventions for something that is a “normal variation,” if it’s normal to feel “trans” or “genderqueer,” why don’t you fight for normalization of gender nonconformity?  What’s wrong with a 6’2 man in a dress? A normal variation shouldn’t require modern Western medical intervention, should it? Not everyone, everywhere in the world can afford that, can they?

Think of what you could do with your time and money, fighting for acceptance of children to be who they are, without thinking there’s something so wrong with their bodies that they have to be cut and drugged to feel whole. Think of the good you could do instead of agreeing with preschoolers that they might “really” not be a boy or girl.

“Girls can be anything!  Just because you like/play/feel [fill in the blank], you’re still a girl. A really cool girl!”

How on earth can anyone think that making it easier for an impressionable young child to want to undergo permanent medical changes is the most compassionate path? Wouldn’t it be kinder to fight against the need to conform to stereotypes in the first place?

 

 

The surgical suite: Modern-day closet for today’s teen lesbian

Despite the fact that trans activists are diligently trying to lower the age of consent for cross sex hormones and surgeries, as a general rule children under 18 in the US cannot access these “treatments” without parental consent (Oregon being a notable exception). I have argued that even 18 is too young to make such permanent decisions, given that executive function skills are not well developed until the early 20s.

But there is another, equally important reason to question medical transition for adolescent girls. According to several peer-reviewed studies (which I will be discussing in detail in this post),

  • 95-100% of girls who “persist” in gender dysphoria at adolescence are same-sex attracted; these girls are typically offered cross-sex hormones by age 16, and  surgeries as young as 18.
  • The typical age that a young lesbian has her first sexual experience and/or claims her sexual orientation is between the ages of 19 and the early 20s.

Let those two statements sink in for a moment.


Here’s the reality of what’s going on in gender clinics around the world right now. An increasing number of adolescent girls diagnosed with “gender dysphoria” are asking for, and receiving, cross-sex hormones and surgeries. The World Professional Organization for Transgender Health (WPATH) officially recommends cross-sex hormone treatment to begin as early as age 16, with SRS surgeries to be offered at age 18.

The vast majority of these girls presenting to clinics admit to being same-sex attracted. Yet data from studies of LGB (lesbian, gay, and bisexual) people shows that most young women don’t fully crystallize a lesbian orientation until 19 or older.

To take one of several examples, this 1997 study of 147 lesbians and gay men by Gregory Herek et al, “Correlates of Internalized Homophobia in a Community Sample of Lesbians and Gay Men,” found that

 The mean age for first attraction to a member of the same sex was 11.5 for females and 10.3 for males. Mean age for first orgasm with a person of the same sex was 20.2 for females and 17.7 for males. On average, females first identified themselves as lesbian or bisexual at age 20.2, whereas men did so at age 18.7. Mean age for first disclosure of one’s sexual orientation was 20.5 for females and 21.2 for males.

A 2014 study of 396 LGB people, “Variations in Sexual Identity Milestones Among Lesbians, Gay Men, and Bisexuals” [full article behind paywall] by Alexander Martos and colleagues reported a similar finding for age of first sexual experience:

Women self-identified as nonheterosexual when they were almost 3 years older than the men (age 17.6 vs. 14.8) and reported their first same-sex relationship when they were 1.4 years older than men (19.1 vs.17.7).

And not only do young lesbians take longer to realize and accept their sexual orientation than their gay male counterparts. Coming out to oneself, and to loved ones and the world, takes time. It’s a developmental process that evolves over a number of years, from the first signs of puberty into early adulthood, with several stages, as Martos et al say in their 2014 study:

Coming out is not a single event but a series of realizations and disclosures. The age at which sexual minorities first recognize their identity, tell others about their identity, and have same-sex relationships varies, and people may take different amounts of time between one milestone and the next. Scholars have proposed and tested models of sexual identity development for over 30 years. Cass (1979) developed an influential model, which outlined a six-stage linear psychological path of sexual identity development. Troiden (1989) built upon Cass’s model and reframed it within four stages: (a) sensitization, which may include a person’s first same-sex attraction and their first questioning of their heterosexual socialization, (b) identity confusion, a period during early to mid-adolescence that is marked by inner turmoil and often the initiation of same-sex sexual activity, (c) identity assumption, when a youth self-identifies as LGB and begins to reveal their “true self” to select people and seeks community among other LGBs, and (d) commitment, which is marked by the initiation of a same-sex romantic relationship and disclosure to a wide variety of heterosexual people (Floyd and Stein 2002). These models suggest that healthy and stable sexual identity development necessitates the full permeation of sexual identity into all aspects of a person’s life.

So the process of integration–“full permeation”–of one’s sexual orientation is a process that takes place over a period of years.  It involves “identity confusion” and “inner turmoil” in adolescence. And not to put too fine a point on it, but most lesbians don’t even begin to express and realize their orientation until 19 or 20 years old.

Yet same-sex attracted girls who present to gender clinics–many of them still with the concrete, either-or thinking of a child (e.g., if I like girls, I must be a guy), internalized homophobia, and overall lack of maturity and self reflection typical of their age, have been “socially transitioned” for years; have had their puberty “blocked” (such that they don’t have the opportunity or desire, in most cases, to actually experience a physical relationship with a love interest); and then move on to “transitioning” to….a straight male.

Here they are, girls without sexual experience, conditioned to reject their bodies and begin irreversible medical “treatments” before they’ve had a chance to embark on the years-long process of discovering their own bodies as sexual beings.

In a 2011 Dutch study “Desisting and persisting dysphoria after childhood, Steensma et al note that 100% of the girls who “persisted” in gender dysphoria by age 16 were same-sex attracted. As they indicate, this finding corroborates that of other researchers over many decades. A 2013 study,  also by Steensma et al, revealed the same information, but added more granularity: between 95.7 -100% of the 16-year-old (average age) girls reported exclusively same-sex attraction, fantasy, and behavior (defined as “kissing” because, as the authors note, that was the extent of their sexual experience). Age 16–well before the average age of coming out as lesbian noted in the studies I highlighted earlier.

With regard to sexual attraction, all persisters reported feeling exclusively attracted to persons of the same natal sex, which confirmed their gender identity as they viewed this attraction as a hetero­sexual attraction. They did not consider themselves homosexual or lesbian.

…the majority of adolescents kept their sexual attractions to themselves. Both boys and girls indicated that, as a result of fear of rejection, they did not speak about their sexual feelings to others, and did not try to date someone. Furthermore, most adolescents felt uncomfortable responding to romantic gestures from others.

In summarizing their findings, Steensma et al note that

…. The third factor that seemed to be associated with the persistence or desistence of childhood gender dysphoria was the experience of falling in love and sexual attraction. The persisters, all attracted to same- (natal) sex partners, indicated that the awareness of their sexual attractions func­tioned as a confirmation of their cross-gender identification as they viewed this as typically hetero­sexual.

These adolescents at age 16 regarded their same sex attractions as “typically heterosexual.” It’s fascinating that the study authors make this statement without any examination of exactly why the 100%-same-sex-attracted persisters viewed themselves this way, and whether this might give pause to the practice of medical transition—especially since in the very next paragraph, Steensma et al refer to earlier research findings that LGB people are late to claim their sexual orientations:

 All persisters reported feeling exclusively, and as long as they could remember, sexually attracted to individuals of the same natal sex, although none of the persisters considered themselves ‘homosexual’ or ‘lesbian,’ but (because of their cross-gender identity) ‘heterosexual.’

As for the desisters, about half of them were sexually attracted in fantasy to individuals of the same natal sex. Yet, all girls and most of the boys identified as heterosexual. The difference between the reported sexual attractions and identities may be related to the timing of the ‘coming-out’. The literature shows that the average age of the first feel­ings of same-sex attraction is generally during puberty and before the age of 18 (e.g., Barber, 2000; Herek, Cogan, Gillis & Glunt, 1998; Rust, 1996). However, the moment at which men and women identify and come out as gay, lesbian, or bisexual generally lies above the age of 18, at the end of adolescence or in their early twenties (e.g., Barber, 2000; Herek, Cogan, Gillis & Glunt, 1998; Rust, 1996).

Steensma et al give us what we need to know, but they don’t connect the dots: these same-sex attracted young adolescent girls undergo “transition” before they have the opportunity to experience themselves as sexual beings in their healthy, original bodies.

Why are we robbing our kids of the right—the basic human right—to discover their sexuality without preemptive tampering by the medical and psychiatric profession?  “Transition” prevents them from learning whether they might be gay/lesbian, freezing them at an immature stage of development when the only possibility they see is that they are heterosexuals trapped in the wrong body.

Trans activists like to say that gender identity and sexual orientation are completely unrelated. But obviously, it just ain’t so. Study after study, anecdote after anecdote, media story after media story, tells us that most “trans men” start off as same-sex attracted adolescents. But no one outside the blogosphere—no one –is pointing out the obvious: that girls who would naturally mature into lesbian adults are having the process of realizing their sexual orientation short-circuited by medical transition.

Who will step forward to stop this? Who with power in our society—the Congress, the President, the publisher of the New York Times¸ the child and adolescent psychologists–will raise their voices? Where are the lesbian doctors, lawyers, heads of LGBT organizations? Which of you will name this preemptive conversion therapy for what it is?

Guest post: Why do WPATH & the APA scorn desistance?

This post is written by overwhelmed, a 4thWaveNow community member and mother who recently wrote about her own daughter’s desistance from trans identification. Her personal experience inspired her to submit this piece about the current effort by some activists and gender specialists to discredit decades of peer-reviewed evidence that most children with gender dysphoria do indeed change their minds.

Stay tuned for an upcoming post by 4thWaveNow that will take a closer look at the anti-desistance meme being propagated by proponents of  pediatric “transition.”


 by overwhelmed

There should be regulations in place to protect our children from harmful medical interventions. I think most people would consider this statement a matter of plain common sense. But unfortunately, common sense seems to fly out the window when “trans kids” are involved. More and more gender dysphoric children are being treated with puberty blockers, cross-sex hormones and even surgeries at young ages.

Trans activism has been busily exerting political influence on the medical field.  Being closely tied to LGB has given the T legitimacy (even if the aims of T conflict with those of the LGB). Trans activists have helped convince the public that gender identity is comparable to sexual orientation. They insist that helping children become comfortable with their birth sex is as abominable as conversion therapy is to homosexuals; that it is bigoted to want a child to avoid being transgender, just as it is bigoted to not accept a person as gay. But, the thing is, unlike the T, the LGB doesn’t require all of these medical treatments. And, unlike the T, the LGB just want people to accept their sexual orientation. Besides political gain, there really is no good reason to conflate gender identity and sexual orientation.

Recently, trans activism forced the closure of the CAMH Gender Identity Clinic in Toronto. In response to this closure, sexology researcher Dr. James Cantor  posted a compilation of childhood gender dysphoria research going back many decades on his site Sexology Today:

Following the closure of the CAMH Gender Identity Clinic for children, I have been receiving requests for what the science says.  Do kids grow out of wanting to change sex, or does it continue when they are adults?

 In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 60–90% of trans- kids turn out no longer to be trans by adulthood.

Cantor shared his post on the the World Professional Association for Transgender Health (WPATH) Facebook page. Although WPATH supposedly promotes evidence-based care and research, the vast majority of WPATH Facebook commenters appear to have strongly held opinions that contradict WPATH’s professed mission. Many state that once someone identifies as transgender, they will be transgender for life (regardless of the age of realization). Some commenters say it is a right for anyone (gender dysphoric or not) who wants to have these medical interventions.

When confronted with Dr. Cantor’s research compilation, there were many attempts to discredit the information. Some commented that the studies were old, flawed, invalid, and called them “junk science.” But others were more confrontational:

kills people

fuel to fire

Another commenter, Colt Keo-Meier, trans activist academic and recent (2013) psychology graduate from the University of Houston, is currently the co-chair of the Committee for Transgender People and Gender Diversity, Division 44 of the American Psychological Association (APA). This committee issued guidelines a few months ago that effectively put a damper on the clinical judgment psychologists and social workers can use when treating their gender nonconforming and trans-identified clients (more on these APA guidelines shortly).  Keo-Meier apparently believes that a child’s persistence in a transgender identity is to be desired.

colt comment

The last commenter on Cantor’s thread I will mention is Jenn Burleton (of “In a Bind” fame), who here discounts the research compiled by Dr. Cantor (referred to by Burleton as “Mr. Candor”) as flawed, while bragging about the 0% desistance rate of the over 200 kids seen at Burleton’s TransActive Gender Center.

burleton.png

Jenn Burleton seems to celebrate the 0% desistance rate, but the fact that it contradicts decades of prior desistance research should raise alarms. What approach do they use at the TransActive Gender Center to obtain these “impressive” results?

Here are TransActive Gender Center’s “Best Practices” :

transactive best practices

So gender-confused children seen at TransActive are affirmed as the opposite sex, socially transitioned, and treated to the “empowerment” of pubertal suppression, cross-sex hormones and surgeries. Is it any wonder these kids don’t desist? They are literally being conditioned to keep believing something is wrong with their bodies. Additionally, these socially transitioned children, even if they did start to have doubts, will likely feel tremendous pressure not to go back to their birth sex. Adolescence is already challenging enough without these complications. Just imagine how difficult it would be for a child in public school to start out as Jennifer, but later change to John.

As it turns out, the American Psychological Association (APA) recommends the affirming and accepting approach that Jenn Burleton has put into action. (As an aside, it should be noted that five of the ten members of the Task Force responsible for the guidelines were transgender themselves.) The APA Guidelines mention two different approaches for working with gender dysphoric children, but only one of them is deemed ethical. As you read, please keep in mind that “TGNC” has been defined as Transgender and Gender Non-Conforming people, in effect, conflating these two groups of children:

 One approach encourages an affirmation and acceptance of children’s expressed gender identity. This may include assisting children to socially transition and to begin medical transition when their bodies have physically developed, or allowing a child’s gender identity to unfold without expectation of a specific outcome (A. L. de Vries & Cohen-Kettenis, 2012; Edwards-Leeper & Spack, 2012; Ehrensaft, 2012; Hidalgo et al., 2013; Tishelman et al., 2015). Clinicians using this approach believe that an open exploration and affirmation will assist children to develop coping strategies and emotional tools to integrate a positive TGNC identity should gender questioning persist (Edwards-Leeper & Spack, 2012).

Notice how there isn’t any warning about possible negative consequences of the affirming and accepting approach? Just keep validating these kids and telling them it is possible to become the opposite sex. There seems to be no concern from the APA that all of this affirming will condition the child into believing they are transgender (when they may have desisted).

The APA guidelines do mention a second approach, though:

 In the second approach, children are encouraged to embrace their given bodies and to align with their assigned gender roles. This includes endorsing and supporting behaviors and attitudes that align with the child’s sex assigned at birth prior to the onset of puberty (Zucker, 2008a; Zucker, Wood, Singh, & Bradley, 2012). Clinicians using this approach believe that undergoing multiple medical interventions and living as a TGNC person in a world that stigmatizes gender nonconformity is a less desirable outcome than one in which children may be assisted to happily align with their sex assigned at birth (Zucker et al., 2012). Consensus does not exist regarding whether this approach may provide benefit (Zucker, 2008a; Zucker et al., 2012) or may cause harm or lead to psychosocial adversities (Hill et al., 2010; Pyne, 2014; Travers et al., 2012; Wallace & Russell, 2013). When addressing psychological interventions for children and adolescents, the World Professional Association for Transgender Health Standards of Care identify interventions “aimed at trying to change gender identity and expression to become more congruent with sex assigned at birth” as unethical (Coleman et al., 2012, p. 175). It is hoped that future research will offer improved guidance in this area of practice (Adelson & AACAP CQI, 2012; Malpas, 2011).

The APA felt the need to add on some warnings to the “embrace their given bodies” approach–just as WPATH members scolded Cantor that encouraging a child to align with their natal body is UNETHICAL. Seemingly defying common sense, we have literally come to the point that it is considered immoral (and in some areas illegal) to help a child feel comfortable with their body.

Yes, I said illegal. In more and more places, legislators are making the “embrace their given bodies” approach unlawful. Since 2012, the United States has banned gender identity “conversion therapy” in California, New Jersey, Illinois, Oregon, the District of Columbia and the city of Cincinnati, Ohio. And, in Canada, the practice has been banned in Ontario.

As parents who haven’t bought into the truth of our children’s sudden trans self-diagnosis, we have found ourselves in the position of going against the advice of WPATH and the APA. We want our children to realign with their bodies, to once again be whole, to be healthy. Desistance is our goal. We are not being transphobic, we sincerely care about the health of our children. We don’t want to “affirm” them as the opposite sex and validate that there is something so wrong with them that it leads to cross-sex hormones, surgeries and becoming lifelong medical patients. Transitioning should be a last-ditch effort, something to be used only when all other options have been thoroughly exhausted.

These guidelines and legislation, however, have made it difficult, and in some areas impossible, for parents to find mental health professionals willing to help their children (many of them with pre-existing mental health issues) feel comfortable in their bodies. Trans activists are using their influence to change medical guidelines and legislation to align with their strongly held beliefs, despite the scientific research that contradicts them. Instead of having desistance as a goal, they are working hard to make it a myth.

Teen decides she’s not trans, after all, but struggles with peer pressure

The guest post below, by pj white, is the personal account of a mother whose teen daughter temporarily identified as “trans,” but at 16, desisted.

While “gender specialists” and researchers often discuss younger children who persist in their gender dysphoria as they reach puberty, next to nothing is said about a phenomenon that more and more of us parents have personally experienced: the teenage daughter who, never having had a problem with being female as a child, suddenly insists she is trans at puberty–after a heaping helping of social media propaganda. And often these girls, like pj’s daughter, have other mental health issues that, once explored and addressed, help alleviate the desire to “transition.”

Every parent will respond to this situation in a different way; I’m grateful to pj for sharing her own parenting journey with us in such detail. And I’m particularly glad to hear directly from a parent about how difficult it can be for an adolescent to desist from trans-identification once they’ve started down the road. The glib insistence by trans activists and some “gender specialists” that social transition and puberty blockers won’t accidentally ensnare kids who really don’t want to persist is clearly unfounded. Peer acceptance and pressure is a real thing—yet another truism about adolescent developmental psychology that is ignored by the media, as well as too many providers entrusted with the care of young people. Luckily, a few researchers and clinicians, notably those in the Netherlands who pioneered the use of “puberty blockers,” are beginning to recognize the impact of media and “social transition” on those who might want to desist.

pj white notes that her daughter could have pursued her desire for “top surgery” had she been 18. But as I wrote a couple of days ago, the trend (supported by WPATH itself) is to allow such irreversible surgery at younger and younger ages. Can a move to permit total hysterectomy for 15-year-olds be far behind?

Pj white is available to respond to any remarks or questions you may have in the comments section of this post.


by pj white

My daughter has always been a dynamo. She hit the ground running as a toddler and didn’t stop until puberty hit her and knocked her flat. She never had the slightest interest in traditional girly gender roles. When she started middle school, I expressed fear that she’d be negatively influenced by other kids and want to start acting like a “Barbie Girl.” She put her hands on her hips, rolled her eyes, and said, “yeah, right, mom – I can’t wait to get in touch with my inner plastic doll.”

But when she started to develop breasts at a young age (11), and men started hooting at her from their cars, her sense of strength and power evaporated. She stopped washing and brushing her hair. She wore baggy dirty clothes, and her hair hung over her face in greasy knots. The other kids made fun of her, and eventually, she became more depressed and started skipping school.

Right after turning 13, she told me she was really a boy. This shocked me, because she had always expressed such pride in being a girl. She was proud when her period started at age 10 (we called it “the good blood”) and I taught her from a young age to be proud of her vulva, too. Girl Pride had been a big part of her life. Now she told me she wanted to have her breasts cut off and to inject testosterone.

I was devastated, but I tried to hide it from her. I didn’t want her to be damaged by my “transphobia.” I had been a single mom for most of her life. It had always been the two of us – mother and daughter – two strong females taking on the world. But my daughter was telling me she didn’t want to be a girl anymore. And I was afraid I would damage her by challenging those feelings.

At her request, I took her to a barber to get a “boy’s” haircut (she looked adorable). I also took her shopping in the “boy’s” section of Target to get her a new “boy’s” wardrobe (which was silly, because her clothing choices had always been androgynous). She also asked me to order her a breast binder, which I did.

Perhaps luckily, I couldn’t afford a psychologist, so I took her to the Castro Mission Health Center in San Francisco where we live. The staff there is absolutely lovely, and did not pressure my daughter to transition. They just accepted her where she was. (This is actually a great resource for kids who are LGBTQ). But the staff could not protect kids from the peer pressure they felt to follow through on transitioning once the decision had been made. And to my knowledge, the topic of having room to change one’s mind was not addressed.

The pressure I felt came more from the pop psychology I’d read on the Internet than from professionals (I couldn’t afford private appointments with professionals). According to social media, I was supposed to wholeheartedly celebrate my daughter’s sudden desire to transition, and was forbidden to question or feel sad about it. I felt as if I had only two choices: to be evil and transphobic like the Duggars, or to be a great mom who loved having a transgender son. There was no room for doubt or fear or grief about losing the daughter I thought I had.

I sent my daughter to a free support group where she met truly wonderful kids. I would gladly have adopted the two young trans men I met through my daughter’s participation in that group. I’d have been proud to have them as my “sons”. But I couldn’t help noticing that they came from very traditional families (one’s family was devoutly Muslim and the other’s had come from rural China). I feared I was being transphobic for thinking they might not have felt compelled to transition had they come from backgrounds more accepting of gender non-conformity/lesbianism.

My daughter stood out like a sore thumb in this group for trans boys, because she suddenly decided, for the first time in her life, to start performing femininity. Her femme performance was so over the top she put Ru Paul to shame. Somehow, identifying as a boy gave her permission to perform femininity as an experiment and a game.

My head was spinning. My daughter was now claiming to be a gay male drag queen in a girl’s body. She also insisted, to my relief, that she did not have to cut her breasts off or take testosterone to be a man (I did an internal happy dance). But when I tried to explain to her that gay men would probably not be attracted to her (she looked like Drew Barrymore after an assault by a drunken makeup artist), she got very upset with me. She said only transphobic gay men would refuse to date her. I tried, as gently as I could, to explain that gay men are not usually attracted to people with female bodies. She angrily reminded me that she did not have a female body. When I persisted in explaining that gay men might disagree, she burst into tears.

That was checkmate. She had won. I assured her that any gay man would be thrilled to be with her. Ugh.

During this time, while she was doing female drag and looking more girly than she ever had in her life, she decided to assert her maleness by using men’s public restrooms. I was with her at a park, and when she went off to use the restroom, I assumed she’d use the women’s room. Nope. She walked right into the men’s restroom. And I walked right in after her and dragged her out (The LOOKS we got!). I angrily lectured her on the dangers of men’s public restrooms, especially when, to all appearances, you are a 14-year-old girl. She accused me of not affirming her identity. I said I didn’t give a damn about her identity when her safety was at risk.

Slowly, the hyper-femme drag phase passed, and at 16, my daughter has regained some of the self she lost at puberty. She once again identifies as female, but wears the same type of gender-neutral clothing she wore as a child. She currently identifies as a lesbian, but has not yet had a serious dating relationship.

When I was finally able to take my daughter to a psychiatrist, she was diagnosed with ADD and depression. The doctor explained that many kids with ADD miss out on developing social skills, and when puberty hits, they become very self-conscious – feel inferior – and become depressed. This is compounded in girls who also feel an acute loss of social status when puberty hits. They go from being cute little human beings to pieces of meat subject to adult male harassment and assault. I believe this is what happened to my daughter. She didn’t fit in socially “as a girl” and she loathed the degradation that came with being an adolescent female. She saw transitioning to male as a way out of her pain (sounds crazy, I know, but these are adolescents we’re talking about).

In our case, it was the trendy trans-ideology promoted on Tumblr that caused us the most difficulty. We both bought into the trivialization of a very profound and rare condition: sex dysphoria. I believe we all should be very suspicious of the sudden desire to change sex at puberty. People are so irrational and malleable at that age. Kids need room to experiment and grow without committing to permanent life-altering medical treatments and labels.

It can also be mortifying for an adolescent to change his or her mind about transitioning. My daughter is too embarrassed to face the sweet kids in her former support group. An adolescent’s need for acceptance by peers, and the pressure to follow through on transition when that’s what your peers expect of you, should not be underestimated. This is particularly true when a kid is celebrated as “brave” and “heroic” for coming out as trans. How do you change your mind about transitioning under that kind of pressure? And what if “the courage to be trans” is what people celebrate most about you? My daughter was too ashamed to tell her friends she’d changed her mind – she just withdrew/disappeared from the group. She was homeschooled at the time, which was likely a key factor in allowing her to pull back. If her peer group had been unavoidable (i.e, in school), I don’t know if she’d have been able to desist.

I worked extremely hard not to pressure her during the whole process, because I didn’t want her to defiantly assert her “right” to transition. It’s one of the hardest things I’ve ever done: having to cry alone in another room over her desire to have her breasts cut off. I was terrified and horrified. And although I would never have let her do that under my watch, I knew she could if she were over 18. It was so hard to let her come to her own decision not to transition. In our case it worked, but I know every situation is different. In some other families, more assertive parenting might be necessary.

I am incredibly grateful that my child passed through her desire to transition. I think her depression, ADD, social awkwardness, and “gender nonconforming” personality all contributed to her falsely believing her gender was the problem.

My heart goes out to other parents struggling with this – it’s horrible to be accused of transphobia/bad parenting for not wanting your child to do permanent medical harm to herself. And while I’m very glad my daughter found her way back to herself,  it saddens and frightens me that current trans ideology made her journey back so guilt-ridden and difficult.

Mom forces insurance company to cover double mastectomy for her 15-year-old, with support of WPATH & Dan Karasic, MD

A 15-year-old cannot vote, sign a contract, drink, or get a tattoo. You can’t rent a car until you’re 25 years old. And in the US, the FDA has just proposed regulations to prevent minors from even using tanning beds.

Why all the restrictions? Well, last I checked, developmental psychologists, cognitive scientists, and informed members of the general public were aware that adolescents don’t have the cognitive wherewithal—the judgment, foresight, or awareness of future consequences–to make major, life-changing decisions, let alone suffer a bad sunburn. There has been so much replicated behavioral and neuroscientific research done on the subject of executive function in young people that it’s now considered settled science.

So the changes that happen between 18 and 25 are a continuation of the process that starts around puberty, and 18 year olds are about halfway through that process. Their prefrontal cortex is not yet fully developed. That’s the part of the brain that helps you to inhibit impulses and to plan and organize your behavior to reach a goal.

And the other part of the brain that is different in adolescence is that the brain’s reward system becomes highly active right around the time of puberty and then gradually goes back to an adult level, which it reaches around age 25 and that makes adolescents and young adults more interested in entering uncertain situations to seek out and try to find whether there might be a possibility of gaining something from those situations…one of the side effects of these changes in the reward system is that adolescents and young adults become much more sensitive to peer pressure than they they were earlier or will be as adults.

Another very readable (and amusing) article, “Dude, where’s my frontal cortex?,” sums it up thusly:

The frontal cortex is the most recently evolved part of the human brain. It’s where the sensible mature stuff happens: long-term planning, executive function, impulse control, and emotional regulation. It’s what makes you do the right thing when it’s the harder thing to do. But its neurons are not fully wired up until your mid-20s.

But the gender specialists at the helm of the World Professional Association for Transgender Health (WPATH) apparently never received the decades-old bulletin on adolescent brain development (or lack thereof), or so it seems. In the Brave New World of transgender “health care,” a 15-year-old can ask for and receive a double mastectomy, with mom’s blessing and collaboration. (In Oregon, a kid can decide to have her breasts removed whether mom approves or not, thanks to trans activists like Jenn Burleton and TransActive).

Last July, a mom posted to the WPATH public Facebook page, looking for advice on how to get “chest reconstruction” for her 15-year-old (i.e.,  double mastectomy. Why can’t these people use actual medical terminology, even amongst themselves? Do the providers and parents also get “triggered” by seeing a reference to female anatomy?)

[Note: For privacy reasons, I have chosen not to directly link to the (nevertheless) publicly viewable thread on the WPATH Facebook page.]

Seems mom’s insurance company balked at  covering elective removal of breast tissue in people under 18.

WPATH mom of 15 yr old

Psychiatrist Dan Karasic, one of the key contributors to the WPATH Standards of Care (SOC), and provider at the San Francisco Center for Excellence in Transgender Health, is happy to help, citing the SOC chapter and verse (page 21 to be exact) that WPATH fully supports “chest surgery” for minors, although it’s apparently still “too limiting” for his taste:

WPATH mom 2

Mom has already picked out the surgeon for her child, and another commenter, former Transgender Law Center employee Jason Tescher, recommends she try to “force” her insurance company to cover the cost (per the doctor’s website, $8500):

tescher

The WPATH thread went dark until today (more on that in a minute). But who is Dr. Mangubat?

mangubat

In addition to being a popular presenter at Gender Odyssey, the yearly shindig for all things transgender, Dr. Mangubat is apparently well known as a surgeon who’s an easy touch for those looking for double mastectomies. As recently as six days ago,  underage top surgery seekers on Reddit were recommending him:

Also, the surgeon I went to (Dr. Mangubat) did not require any kind of letter and I don’t think he requires patients to be on T either, but I could be wrong on that. It was as easy as emailing his office to set up a consultation and then I was immediately able to schedule the surgery.

As to the mom’s efforts to get insurance to cover the removal of her child’s breasts,  an update appeared moments ago on the WPATH thread. Mom shares her good news: the insurance company has agreed to reimburse her for the double mastectomy that they “couldn’t wait for” and had done in August.

insurance appeal

Dr. Karasic couldn’t be happier.

karasic happy

It’s likely only a matter of time before insurance coverage for teen surgery will be the norm. The Obama administration recently proposed new rules that will require all insurance companies to pay for “transition” services. One wonders just how many “identities” the transgender umbrella will cover when it comes to federally mandated health care services?

The entire Reddit thread that references Dr. Mangubat  (as well as two other surgeons I’ve previously written about–Dr. Curtis Crane in San Francisco, and Dr. McLean in Ontario) is worth reading in this regard, because it’s primarily about “nonbinary” people who don’t identify as FTM getting access to “top surgery” on demand–exactly what providers like Dan Karasic promote and what is already happening, apparently, in San Francisco at taxpayer expense, as I detailed in a recent post.

As I also discussed in that post, Karasic is a major WPATH player pushing for the elimination of “gender dysphoria” as a requirement for “transition” services; he wants to  replace GD with a new diagnostic code, “gender incongruence,” which would do away with the need for any distress, dysphoria, or disorder but still allow for billing for what amounts to a lifestyle choice–for anyone who claims “gender incongruence,” on demand.

So we know Karasic and WPATH are OK with 15-year-olds who ID as FTM undergoing irreversible surgeries. Does he also believe, as he does for adult patients, that a 15-year-old (or 13-year old?) who identifies as genderqueer, gender fluid, or non-binary should ALSO get insurance-funded double mastectomies?

 

Groundbreaking study: Kids mean what they say

The clinic advised that Rudy should start to make his own choices and, specifically, recommended that he was allowed to pick an item of clothing. ‘He chose a Disney princess nightie and skipped around the house in it, laughing,’ recalls Kathryn. Towards the end of Year 1 at school, Rudy started wearing girls’ clothes at home. ‘Of course, he chose to dress as a girl. I watched him at the disco, chatting to girls, wearing a pink glittery dress. That was a turning point.’ Back home, Rudy chose a girl’s school uniform for the new term and asked to be called Ruby.

–Parenting a transgender child: The day my four-year-old son told me he was a girl

 


When Ana was five years old, her mother Cathy organised a birthday party with one rather unusual condition: No girly presents, please. ‘I felt awful doing it, but I knew Ana would be devastated if anything pink or fluffy turned up.’

‘I knew when I was growing up,’ says Alfie now, ‘that I didn’t want to do the things that girls did. I was the sort of kid who ran around and got dirty. … People thought me being a tomboy was a phase, but I knew I wouldn’t change. I didn’t want to wear girl clothes. I hated the way they fitted to me. … I was told I would change and get interested in make-up, but I could never see it happening.’ The paediatrician then brought up the topic of gender transition. So in the car on the way home, I said to mum: ‘I think I’m transgender.’

–My child had a boy’s brain in a girl’s body


Trans activists and gender specialists don’t have much in the way of well controlled, peer-reviewed research to support their core assumption that “gender identity” is innate and immutable. The latest brain science shows very little difference between male and female brains. If this is the case, what is the scientific basis for believing there is an innate “gender identity,” baked in at birth, that would be worth turning young people into sterilized, permanent medical patients as adults?

Recently,  in the activist blogosphere, the transgender press, and on the WPATH Facebook page, there have been excited proclamations that data to prove “true identity” has emerged in the form of a paper published a few months ago in the journal Psychological Science. The study of 32 “transgender” children and the same number of non-trans controls, entitled “Gender Cognition in Transgender Children,” [abstract; full study here] was conducted by University of Washington assistant professor of psychology and director of its TransYouth Project  Kristina Olson (not to be confused with LA Children’s Hospital gender specialist Johanna Olson), along with transgender activist Aidan Key and Stony Brook University assistant professor of psychology Nicholas Eaton.

I’m going to start with the punch line and work backwards from there: The study demonstrates only that 32 socially transitioned children (that is, kids who are being “supported” by their families and “gender specialists” in being referred to by an opposite sex name, pronouns, and assumedly, though the authors don’t tell us, sporting opposite-sex-stereotyped clothing and hairstyles), really, truly do prefer the playmates, hairstyles, and clothing more typical of the opposite sex. Further, these “transgender” children really and truly do prefer and “identify with” the same playmates and physical attributes as the control group of “cisgender” children (yes, the study authors use that term) of the opposite sex.

Who were the “transgender children” recruited for the study?

To be included in the current study, children had to be 5 to 12 years old and live in all contexts as the gender expression “opposite” of their natal sex. These requirements resulted in the exclusion of 4 additional gender-nonconforming participants

And the control group?

Thirty-two control participants (20 female, 12 male; mean age = 9 years) … matched to the transgender participants were recruited through the first author’s research lab from a database of families interested in participating in developmental psychology research studies. They were required to have no significant history of gender nonconformity.

[Note: A group of “cisgender” siblings of the “transgender” children were also part of the study, but time and space in this blog do not allow a full analysis of their responses, which were similar to but not the same as the non-familial “cisgender” control group.]

What do the authors mean by “gender nonconforming” or “no significant history of gender nonconformity”? This is never defined, although we can guess that the “transgender” children dress, play, and appear differently from generally recognized gender stereotypes. But the control group? Do the authors mean these children entirely conformed to stereotypes—i.e., the girls all wore dresses, played with dolls, and had long hair, while the boys played with trucks, had short hair and wore rough-and-tumble   trousers?

Olson et al don’t tell us. And what about the four excluded “gender nonconforming” subjects, who apparently did not “live in all contexts” as “opposite” to their natal sex? Did these children occasionally indulge in sex-stereotyped play and behaviors, so they weren’t “trans” enough?

The study stimuli consisted of questions coupled with pictures of boys and girls, “matched for approximate age and attractiveness.” (And what does “attractiveness” mean? There is an even bigger question vis-à-vis these pictures, which I will get to in a few moments).

Olson and colleagues tested the children in 3 areas:

  • Gender preference (for play/friendship)
  • Object preference (associating a nonsense word with a picture of a boy or girl,  saying this was the name of a toy or food that the pictured child was using)
  • Gender identity (whether the child feels they are a boy or girl)

Each of these three variables were addressed via explicit (i.e., responses to direct questions)  and implicit measures.

What’s the difference between explicit and implicit measures? In psychology research, it has been posited that “implicit” measures

 may resist self-presentational forces that can mask personally or socially undesirable evaluative associations

In other words, “implicit” measures are meant to get at how someone really thinks and feels, whereas a reliance strictly on explicit “self reporting” might be tainted by what a subject thinks someone wants to hear (or other motives).

So, for the “gender preference” part of the Olson et al study, the explicit measure was to ask the child, “who would you rather be friends with?” when shown a pair of pictures of a boy and girl. The implicit measure was to show the children pictures of a boy and girl and ask to label them “good” or “bad.”  (The underlying premise here is that most pre-pubescent kids prefer their own “gender” as playmates).

For gender identity, the implicit measure consisted of asking the research subjects to label pictures of boys and girls as “me” or “not me.” The explicit corollary was

telling them that people have outsides (their physical body) and insides (their feelings, thoughts, and mind). They were told that some people feel like they are boys on the outside, and some feel like they are girls  on the outside, and that those people might feel the same way or different on the inside. They were told some people feel, for example, like a boy on the outside and inside, and that others feel like a boy on the outside but a girl on the inside. Further, they were told that some people feel like both or neither, or that their feelings change over time.

Children were asked whether, on the inside, they felt like a boy, a girl, neither, or both; whether their gender identity changed over time; or whether they did not know.

For “object preferences” the authors didn’t assess preference for actual objects, but only whether the research subjects chose the same preferences as pictured  boys or girls. They were

shown pairs of photographs of children and told that each one had a preferred toy or food. The names of these items were in fact novel words (e.g., “This is Amanda and she likes to play flerp. This is Andrew and he likes to play babber.”). Our interest here was whether children would use the gender of the person endorsing the item to inform their own preferences.

It’s difficult to see how this adds any more information than asking kids what sex playmates they prefer. If a child who “identifies” as a boy sees a picture of a boy playing “babber,” that child would likely prefer to do what the pictured boy is doing.

Be that as it may, what exactly did Olson et al set out to prove with these probes?

… if these children are not confused, delayed, or pretending, and in fact their expressed gender represents their true identity, we would expect them to respond   similarly to gender-matched control participants not only on self-report measures, but also on implicit ones.

We reasoned that if children are confused by the particular questions posed to them….[or] if they are merely self-reporting the “wrong” gender identity… or even if they are just oppositionally reacting to the question of their gender identity— …these children should show one of two patterns of confusion. First, they could be truly confused, as indicated by random responding and no systematic  response across measures and participants. Alternatively, they could implicitly identify as their natal sex (because they actually understand gender and are merely self reporting this “incorrect” gender).

And the results of the study? Surprise—the socially transitioned “transgender” children did indeed respond similarly to the “cisgender” control group.

But what does this actually demonstrate?

First, let’s consider the stimuli, consisting of pictures of age-matched boys and girls. What would distinguish a picture of a prepubescent boy from a picture of a prepubescent girl,  apart from clothing and hair styles? Not much.

Prior to puberty and the influence of estrogen or testosterone, school-aged kids look much the same. So unless the pictured boys and girls had identical haircuts and clothing, the 32 “transgender” children labeling a boy or girl picture as “me” or “not me” would have been identifying with a boy or girl based on stereotyped dress and appearance—haircuts, clothing, and the like. How could it be otherwise?

Put another way, if the pictures of the boys and girls did all have the same haircut and clothes, irrespective of biological sex, would the research subjects have been able to identify the sex of the child they identified with? Likely not.

Now, to the question of whether these kids were confused, delayed, or pretending, the authors did show that these kids are not likely to be knowingly pretending to be the opposite sex, nor are they “confused” i.e., they just don’t know what they think or feel. But why is this of much significance?  What would be the motivation for these children to “merely” self report the “incorrect” gender, or to “oppositionally react”? The fact that these kids are sincere in their convictions is reported by Olson et al as an important finding, but does anyone, including critics of pediatric transition like me, doubt that dysphoric or trans-identified kids really mean their gender nonconformity?

Further,  deliberately “pretending” in order to deceive is not the same as conflating fantasy or desire with objective reality–an aspect of normal childhood development which activists, gender specialists, and researchers like these seem never to have heard of. Just because a child  sincerely sees him or herself as the opposite sex does not make it true.  Child psychologists have known for decades that children’s firmly held beliefs do not always comport with reality.

 Research indicates that children begin to learn the difference between fantasy and reality between the ages of 3 and 5 (University of Texas, 2006).  However, in various contexts, situations, or individual circumstances, children may still have difficulty discerning the difference between fantasy and reality as old as age 8 or 9, and even through age 11 or 12. For some children this tendency may be stronger than with others.

The authors seem not to have thought of the most obvious conclusion: That these kids DO believe they are the opposite sex but that doesn’t make it so—especially since even the implicit measures the authors seem to think are so meaningful are nothing more than identification with gender-stereotyped activities and appearances which they happen to prefer.

By demonstrating that the “transgender” children aren’t just being obstinate or dishonest, Olson et al seem to believe that their study indicates (in their words) “true identity” in the children they have labeled “transgender.”

But what is “true identity?” Is it the elusive Holy Grail of inborn, unchangeable gender, something no one has come remotely close to proving, yet is the unquestioned assumption from which all the current medical and psychological and legal decisions about “transgender children” have flowed in the last few years?

That the authors even use the term “true identity,” which they themselves admit is unproven, is all we need to show the study is fatally tainted by confirmation bias.

 Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand.

–Confirmation Bias: A Ubiquitous Phenomenon in Many Guises, by Raymond S. Nickerson,  Tufts University

It’s quite clear that the authors’ “hypothesis in hand” is that there is such a thing as “true identity.” Further, they interpret the evidence that “transgender” children feel as strongly about their identity and gender nonconformity as “cisgender” children do as somehow confirming this hypothesis. Even though they themselves in their Notes section  of the study assert:

  1. We avoid using common colloquial phrases such as “born as a boy” because they suggest that transgender identities are not innate (an unresolved scientific question) and are thus offensive to some individuals.

 On the one hand, because they don’t want to be “offensive” to “some individuals” (and I think we can guess who they are), Olson et al don’t want to “suggest” that gender isn’t innate (and in fact present their study as evidence that their “transgender” research subjects have a “true identity,”). But at the same time, the authors explicitly acknowledge that the question of “innate” gender identity is an “unresolved scientific question.”

But while being careful not to offend “some” people, they don’t have any trouble splattering the term “cisgender” throughout this article,  despite the fact that some other individuals find “cis,” well—offensive. Certainly Olson et al aren’t living in such a bubble that they are unaware that the label “cisgender” is repugnant to many of us who the transgender community apply it to.

And in point 2 in the Notes, we have a further indication that the authors’ work is riddled with confirmation bias:

2. We use the term “opposite” for clarity but acknowledge that gender is not binary.

They “acknowledge” that gender is not binary. But as with “innate  gender identity,” who has proven that “gender is not binary?”  No one. This jargon comes straight from the trans activist lexicon.

In peer-reviewed research, investigators always indicate the limitations and possible flaws in their study.  The weaknesses I’ve pointed out in this post are not even marginally addressed by the authors. What limitations do Olson et al concede?

 All of the participants tested here identified and lived life as one gender at the time of assessment, choosing names consistent with that gender and preferring those pronouns as well. Future studies along the spectrum of childhood transgender experiences will be needed to clarify how generalizable these findings are to children who have different degrees of identified gender expression or to those with different life experiences.

Apparently what’s next is seeing whether their study measures can also be used to prove the “true” identities of “gender fluid,” “genderqueer,” and “nonbinary” children. I wonder what exclusion criteria they’ll have in future studies? Hopefully they will be more precise in their definitions of what constitutes  gender (non)conformity in their next paper.

In their summary, Olson et al reiterate their key finding that these kids really mean it when they say they prefer the lifestyle of the opposite sex:

In summary, our findings refute the assumption that transgender children are simply confused by the questions at hand, delayed, pretending, or being oppositional. Instead, transgender children show responses that look largely indistinguishable from those of cisgender children, who match transgender children’s gender expression on both more- and less-controllable measures. Further, and addressing the broader concern about transgender individuals’ mere existence raised at the outset of this article,the data reported here should serve as evidence that transgender children do indeed exist and that their identity is a deeply held one.

“Do indeed exist.” Of course children who believe they are, or want to be, the opposite sex “exist.” And of course such children are going to exhibit preferences for the appearances and activities of the opposite sex, in a “deeply held” way. But it doesn’t follow that those children are somehow innately the opposite sex.

All Olson and colleagues have demonstrated is that some children really, really, really want to be the opposite sex; even to the point of saying they are the opposite sex. They want to look and dress like the opposite sex—a girl, for instance, might want a short haircut and to wear comfortable boys’ clothes. They like playing with children of the opposite sex. And they like doing things that the opposite sex likes to do. In other words, these kids are don’t conform to the stereotypes of their birth gender. But does it then follow that they should be groomed and conditioned to believe they are the opposite sex, leading them in the near future to puberty blockers and on to sterilization and surgeries?

If the stakes were not so incredibly high, a study like this could simply be filed away under “strongly held beliefs and desires of gender nonconforming children.” But given the fact that so many activists and gender specialists are in the business of promoting medical transition, this study should instead be filed under “confirmation bias rationalizes non-evidence-based medical experimentation on vulnerable children.” What Olson et al have not proven is innate gender identity. All they have shown is that these kids really mean it when they say they are or want to be the opposite sex.

This study, instead of being promoted as a rationale for pediatric transition, should carry no more weight than any of the thousands of media articles trumpeting the unsubstantiated yet continuously promoted idea that children who refuse to conform to gender stereotypes—yes, who really mean it when they say they want to look and play and dress like the opposite sex—are “transgender.” Like the ones quoted at the beginning of this article. Or the thousands of others that have been published in the last few years. Like this one:

Tom charges about in a Batman costume, brandishing a sword. …Tom loves dressing up. “Normally as a superhero,” Cassie [his mom] says.

“Batman and Superman,” Tom adds. “And Wolverine!” He also likes to play cowboys or policemen with his best friend, Charlie. “Sometimes we arrest people. Remember when we did it yesterday to the dog?” He grins. “He wasn’t putting the ball down.” He shows me his bedroom. There’s his treasured Playmobil pirate ship, his Marvel poster featuring Ironman, Captain America and the Hulk, and his pencil case shaped like a football boot.

When Cassie took three-year-old Tom to the barber for the first time, she wept. “That was the final thing. If I let him get his hair cut short, that was me accepting he is a boy.” The hairdresser was bemused. “I was crying and I had this little boy with me who had hair down to his arse. She asked him: ‘Has your mummy never let you get your hair cut?’ And he loved it, because she thought he was a boy with long hair.” After that, Tom never got mistaken for a girl, and became much happier.

Transgender children: ‘This is who he is – I have to respect that’