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?

33 thoughts on “The surgical suite: Modern-day closet for today’s teen lesbian

      • The first time I read the Steensma paper, I had the same immediate reaction when I read the conclusion: those researchers *knew* that sexuality and experiencing love and relationships/sexual pleasure was one of the critical factors in desistence, yet NOWHERE in the conclusions did they consider the fact that the *option* of transitioning as children –which they themselves provided –was *itself* a factor in persistence.

        Not only does it prevent the kids from having the *time* or *maturity* necessary to resolve their sexual confusion or of the *experience* of sexuality in their own sexed bodies, the *existence* of the *possibility* of “opting out” eliminates the *need* of these gay and lesbian children to ever have to resolve that confusion and their own internalized homophobia.

        From Steensma:
        Male Persister #2 “At times I felt attracted to boys, but immediately tried to restrain the feeling. I always did so, I just don’t want to be in love or be confronted with others being in love with me right now.”

        Female Persister #9 “I always consciously suppressed romantic feelings; first I want to have my own feelings organized. Of course, it is impossible to suppress these feelings entirely but I do try; I just don’t want to date now.”

        Rather than going through the messy and often painful self-discovery that all gay and lesbian adolescents and young adults inevitably struggle through, they *avoid* it by attributing it to a *disorder* that just so happened to appear in the DSM as homosexuality, itself, was being removed.

        Again, from Steensma:
        Female Persister #3 “I always fell in love with girls, I never felt attracted to boys. A number of children concluded that I had to be a lesbian, I thought about this but I never experienced it this way. I was aware of having a female body but in my feelings I was a boy, so I was not a lesbian but a heterosexual, just like the other boys.”

        And, to further illustrate the point (and believe me, I could provide many more from the internet), an excerpt from the comment section of this blog by someone justifying “transition” by expressing similar sentiments: “What if the sexual preference for a natal female is for a female, but only if the natal female were male? That is, what if the natal female does not self-identify as lesbian, could not conceive of being a female having an intimate sexual relationship with a female, but desires an intimate sexual relationship with a female as a male.”

        The practice of transitioning children and adolescents *ensures* that the conflict between sexuality and sex becomes fixed –without challenge or experience –in the heteronormative and often homophobic understanding to which all children are encultured. To these kids, sexual attraction comes to define sex, the “cure” itself having created the disease. In so doing, it becomes the ultimate reparative therapy, but unlike the harsh and homophobic “gay conversion” therapies of the past, there is no chance to fully recover from the physical alterations incurred.

  1. I have seen this in my small Northwest town, and the degree of gross injustice to and exploitation of an 18-year-old girl who “transitioned” fully by age 21 was commensurate to the applause and admiration granted to her mother, a well-known political and social liberal here, for her “bravery” and “sensitivity” to her “trans child” — a peculiar kind of maternally wise devotion that resulted in her child undergoing a full mastectomy and hormonal treatments just as she was leaving her teens. How is the disgurement and poisoning of one’s daughter more lovingly progressive than the progressive and loving embrace of her as a young Lesbian?

  2. Thanks for writing this! It is so important to get the word out that the best treatment for children does not involve hormones and radical surgeries. Let the kids grow up. Let them have life experiences that are not controlled by their parents. Let them discover what they want for the rest of their lives.
    I know plenty of people who, when they were 18, got jobs that involved a lot of manual labor. They thought they could do it forever. They didn’t think about what it would be like to be 60 and still trying to do those jobs with arthritis and other ailments.

    Most teenagers cannot imagine BEING 40, let alone what their life might be like at 40 after 25 years of hormones and several major surgeries to remove/add body parts. When I was a teenager, I had no clue about the what I would want from my adult life.

    How many 18-year-olds go off to college thinking they want to study one thing and end up changing majors? When they do, most parents understand that it’s normal that 18-year-olds don’t always know what they want to do with their lives. It’s ok that they change their minds.

    Most 18-year-olds do not want to have kids right away. Some will say that they are never having children. They just can’t see themselves as parents, and they are not ready for that responsibility. That’s fine. It’s better to wait until they are ready. Many of those same people who don’t want kids at 18 DO want them at 30 or 35.

    If we say that kids are ready to make irreversible decisions about their physical health at 16 (or younger), why don’t we let them drink alcohol? Why do they have to be 21? They are supposed to be mature adults at 16 who know what is best for their bodies and understand the long-term effects of their decisions. Why don’t we let them smoke cigarettes? We will let 16-year-old girls poison themselves with testosterone, but we won’t let them poison themselves with cigarettes? If a teenager is using cocaine because that’s the only thing that makes them feel good, should the parents give them money to get more, or should the parents get them into treatment before they do permanent physical damage to their bodies?

    • Exactly. Treat kids for any underlying illness, physical or mental, and let them grow up. Wait and see. Stop acting as if personality and preferences are related to a person’s sex.

      I am completely flummoxed that in all other things, I am constantly reminded that my daughter is a teenager — she’s young, her brain isn’t finished yet, remember when you were that age, take it one day at a time — until it comes to the identity piece. When I bring that up, I get the head-tilt and the irritating “managing” voice, explaining that this area is decided and there is no question and no time and blah blah blah SUICIDE. Well, my kid has said she was suicidal several times now and it was always retroactively related to her identity stuff, but at the time, was always attributed to something very much mental heath-oriented. A contraindicated medication, a trigger not at all in the ballpark of identity, a hypomanic phase.

      Sad to say, but only the fact that my child is so demonstrably mentally ill and that her presenting as male hasn’t helped one bit is the only thing which seems to be raising questions with the professionals we’re currently dealing with.

      • The suicide card is played constantly. No one denies there is an unacceptably high rate of suicide in “gender nonconforming” and gay kids–not just trans-identified kids. I got a great response on Tumblr some months ago on this question. We need to make it OK for kids who don’t fit gender stereotypes to be themselves instead of encouraging kids to obsess over “passing” as the opposite sex. Here’s the advice someone sent me:

        The real way to reduce the rate of suicide among transgender teens:

        1. Stop telling people that they have to hurry up and transition or they’ll regret it for the rest of their life. They can transition later and have a happy life.

        2. Stop glamorizing transgender teens who commit suicide.

        3. Encourage them to get good therapy for their problems and think carefully about whether or not they should transition.

        4. Encourage them to stay connected to their family, even if their family is skeptical.

        Link to that comment is in this post here:
        http://4thwavenow.com/2015/12/24/self-harm-the-need-for-more-possibilities-for-gender-variant-kids/

      • One thing I’d like to add to 4th Wave’s list is STOP reinforcing the notion that gender-nonconforming and trans kids were “born in the wrong body.”

    • These are such good points, and I completely concur. I have been taking psychiatric medication since I was a teenager. I’m thirty now. I absolutely loathe having to go to regular doctor’s visits, and then to the pharmacy to get the prescriptions filled. I worry about what the people who work at CVS think of me. There is no way young people can comprehend all that is entailed in having to take prescription medication *for your life*. What happens when you want to stay out all night and don’t have the meds with you? Or when,despite your careful planning, you left the meds at home? These things happen.

      I was originally put on medication due to a serious eating disorder I suffered from in my teenage years. One thing the doctors consistently stressed to me was that they wanted me to have a *healthy* body, and that included having normal fertility. It didn’t matter that I said I never wanted to have children. They wisely knew that could change (though, in my case, it hasn’t). There are all sorts of health problems, including osteoperosis, that are associated with a lack of normal hormone production for females.

      I don’t understand why in the case of “trans” children, the advice given to patients with eating disorders, as well as every other mental health condition I am aware of, goes out the window. Suddenly, children and teenagers are mature enough to choose to forgo their fertility.

      Do these doctors and psychologists remember their own teenage years,and how much changed, including how their own minds and lives changed? It’s like they’ve forgotten everything they must know.

  3. Before I hit peak trans and began discovering all these things the gushing media refuses to report, I began following a number of young trans-identified people on YouTube to try to learn. Ordering their videos from oldest to youngest reveals just about all of the women started out as lesbians, often with a more butch look, and that the men started off as feminine gay guys. It’s so sad to see these healthy, attractive young people completely disrupting their bodies to try to erase their own biology and sexual orientation. Do these people who are all of 19, 21, 25 really expect to still be giving themselves hormone shots, taking pills, or dilating every week when they’re elderly? One of these FTMs I follow just posted a horrifying video about how a testosterone shot landed her in the ER with a hematoma after about a week of increasing pain. All because the power of media suggestion and social media binging told her she must be a boy because she liked stereotypically “boy” things instead of makeup and Disney princesses.

    I wonder how many of these self-identified trans young people would agree with the studies showing how long it takes to realize and accept a gay or lesbian identity, while at the same time arguing trans people immediately, unquestioningly know their own identity, even as young as 18 months. That would be painfully ironic.

  4. “They can transition later and have a happy life.”

    Can they? Happiness after transititoning is reported (studied, documented) as being transitory. There’s a lot of euphoria and celebrity and then that dies down and reality sets in. In the case of youth they find out you can’t remove teen angst. To put it bluntly, no one wants to “date” them: Straight men, gay men, will not date FtT, and neither do most lesbians.

    • I’ve heard some older trans people say they are happy that they transitioned and wish they had done it sooner. (This seems to be the impetus behind the rush to transition kids at younger and younger ages.) But there were different standards of care for those individuals who transitioned in previous decades. The doctors first ruled out mental illnesses and other conditions. The transition process was slower– it took years to complete all the required steps. People who transitioned back in the day were given ample time and space to figure out if this was what they really wanted to do. Nobody put 9-year-olds on blockers or 12-year-olds on cross-sex hormones.

      • It’s worth repeating (and repeating) that we have ZERO data about **long term** effects and regret rates of children and teens who have been “socially transitioned,” put on blockers, and then move on to hormones and surgeries. NONE. Because it’s new. The kids being “trans’ed” today are the research subjects of tomorrow (that is, the ones who are being enrolled in research studies today. Most AREN’T). They are the guinea pigs. The only thing we have (as Jen points out) is the fervent belief by adult trans activists that transitioning kids is what THEY would have wanted. In other words, anecdotes, memories, and other subjective claims. We know NOTHING about how these kids are going to feel at 30, 40, 50. Since most of them were reassured and conditioned that they actually ARE the opposite sex, that is also a factor that will affect persistence/desistance. And the fact of conditioning is never, ever discussed or acknowledged by trans activists. A huge flaw, and I can’t imagine they will study it. Because they have effectively destroyed the possibility of having a control group of kids who AREN’T socially transitioned/blocked. The only people who will be able to speak out are young people who are beginning to speak up now. Young people who avoided the whole thing because of actually having parents who didn’t go along with it. It’s going to take a very long time for this to all sort out, and the stakes are extremely high.

      • In my earlier comment, I mentioned trans adults who wished they had started the process earlier in life. But I have seen another side to this argument from adults who were gender-nonconforming kids/teens back in the 1950s through the 2000s– the ones who *didn’t* grow up to identify as trans. Many identify as LGB, others are straight. These adults are relieved that trans-ing kids wasn’t on anybody’s radar back in the day. They see today’s kids being shuttled to gender clinics and being pumped full of drugs and they think, “OMG! This could have been ME!!!”

        Unfortunately, these adults’ stories are not heard as often as those of trans adults. They only exist on blogs like this one, or in the comments section of articles about trans kids. But in the absence of a “control group” this is all there is.

    • Red, I don’t disagree with any of what you said. The thing about young people is, though, they live for today. Telling them that they will be miserable as trans adults and should never transition will just make most of them shut down and stop listening. I think the person who sent me this advice realized that. These teens are being pushed to think if they don’t trans as kids, they won’t “pass” as adults and they might as well kill themselves. That is so destructive. Just telling a teen to hold on, slow down, waiting is ok, you can make the choice to transition as an adult if that’s what you still want–that is probably a more effective message (that they can actually hear) than trying to convince them transition is wrong no matter what.

      • No of course you can’t tell a teen anything. Every parent knows that even if the kid is not lost in the trans cult. It’s the youth themselves, regretters or detransitioning teens who are saying it on various blogs and FB. Saying “I made a mistake”. I think they will be heard by their peers, but not the adult male sexual fetishists who try to shut them up with their threats of violence.

      • From 4thWave: “It’s worth repeating (and repeating) that we have ZERO data about **long term** effects and regret rates of children and teens who have been “socially transitioned,” put on blockers, and then move on to hormones and surgeries. NONE. Because it’s new.”

        Well, there’s this study, of course, which is from Steensma and Cohen-Kettinis again (who also have written on factors contributing to desisting, which have been discussed on this blog before): http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958.abstract

        Here’s the conclusion from the paper, in full:

        “Results of this study provide first evidence that, after CSH and GRS, a treatment protocol including puberty suppression leads to improved psychological functioning of transgender adolescents. While enabling them to make important age-appropriate developmental transitions, it contributes to a satisfactory objective and subjective well-being in young adulthood. Clinicians should realize that
        it is not only early medical intervention that determines this success, but also a comprehensive multidisciplinary approach that attends to the adolescent’s GD as well as their further well-being and a supportive environment.”

        There are always caveats, of course, but I find this promising. The subjects were 55 young transgender people, identified with persistent gender dysphoria. No desisters and all reporting subjective well-being.

    • Yes, I despair of the press. Jeremy Clarkson makes a few ill-advised comments in his Sunday Times column and it is immediately picked up by the press and creates a twitter storm which gives trans activists the chance to remind everyone of the ”Nearly half of young transgender people have attempted suicide” survey.

  5. I hear it said in the transgender community that gender expression has nothing to do with sexual orientation but why is it that all six of the “transmen” that I know lived first as lesbians? If gender questioning girls are using hormones and getting surgeries by the time they are 18, they have little chance of exploring their sexual orientation and natural inclinations without the influence of testosterone. The Testosterone often cause changes in sex drive and attraction. I have known several people who had formerly lived as lesbians who went on to participate in sexual encounters with men.

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