4thWaveNow contributor Overwhelmed is the mother of a daughter who previously identified as transgender. Her daughter is now comfortable being female even though she chooses to eschew conventionally feminine clothing and sports a short haircut.
Overwhelmed can be found on Twitter: @LavenderVerse
Why does the public seemingly trust that gender doctors know what they are doing? Well, one of the reasons is the frequent media portrayals of trans kids. Children who have recently undergone medical transition are being presented as success stories, even though no one knows the long term consequences of gender-affirming treatments.
I came across this article on the University of California San Francisco website. It covers the transition of three children—two who have puberty blocker implants and one, a natal female named Oliver, whose treatment has included puberty blockers, testosterone, a double mastectomy with chest contouring, a hysterectomy (at 16 years old!) and plans in the near future for the first in a series of phalloplasty surgeries. The article also highlights the involvement of three gender-affirming pioneers—Dr. Ehrensaft, Dr. Rosenthal and Joel Baum—whom I will discuss a little later in this post. But first I will focus on Oliver.
Oliver’s story (which I’ve pulled from three separate articles) starts off as expected—a young child uncomfortable in dresses who likes short hair and playing baseball. When puberty started, it caused a great deal of distress. Suicide was considered. And then:
A few months before his 15th birthday, …stumbled across the word “transgender” online. He read about people who had had medical treatment to align their bodies with their gender identity – their inner sense of who they are.
“Bam, my life changed,” he says. “It lifted a major weight to find out I could do something about all this pressure I had been feeling.”
At first Oliver’s parents, especially his father, didn’t accept that their daughter was really their son.
“It took me a bit to become a really supportive dad,” ….
For months they didn’t speak. But in the end, reading the suicide statistics for transgender teens brought him around.
“My kid’s not going to kill himself,” …. “I don’t care what he is, as long as he’s a productive person in society, and he needs all the support we can give him.”
Oliver was taken to UCSF’s Child and Adolescent Gender Center.
By age 15, Oliver… was on a dual regimen of testosterone, plus puberty blockers to keep his endogenous estrogen from competing with the male hormones.
While he had to endure a second puberty, and he’ll need to take testosterone for the rest of his life, he’s had no second thoughts about transitioning.
The summer after his sophomore year, he had “top” surgery – a double mastectomy and male chest contouring – in San Francisco. To pay for the procedure, which was not covered by insurance, he used earnings from years of showing and selling pigs at the Tuolumne County fair.
“It’s a lot of money for a 15-year-old,” he says of the $8,000 price tag. “But I appreciate it every day.”
His family’s insurance also wouldn’t cover a puberty blocker implant, so… at first chose cheaper but “gnarly” monthly shots. Later, concerned about unknown long-term effects of the blockers, and hating the painful shots, he opted for a hysterectomy at age 16 – performed by the same family doctor who had delivered him.
In June, he’ll undergo the first in a series of “bottom” surgeries to create male genitalia.
His only regret, he says, is not finding UCSF’s Gender Center sooner. “To not go through the wrong puberty, those kids are lucky,” he says. “That’s a team effort. You have to show [gender dysphoria], and parents have to catch it.”
Oliver’s story has been published in at least three media articles, likely reaching a large audience. The teen has also been influential in Oliver’s small town high school where at least four other transgender students have since come out.
An increasing number of children like Oliver are announcing they’re transgender, and families are looking to the experts in the field for guidance. Diane Ehrensaft, PhD, a clinical and developmental psychologist, is one of a number of pediatric gender-affirming pioneers in the San Francisco Bay area. She is Director of Mental Health and founding member of the UCSF Child and Adolescent Gender Center. She is a well-known proponent of the gender affirmative model and has authored two books on the subject. Ehrensaft has a private practice in Oakland and serves on the Board of Directors of Gender Spectrum.
Her credentials seem impressive, but there are concerns that her stance could unnecessarily pressure parents into eventually medically transitioning their children. She’s often quoted in news reports about trans kids. Here she is in the Duluth New Tribune article from above, rationalizing the dramatic increase in trans-identifying kids seeking treatment:
“We have lifted the lid culturally,” said developmental psychologist Diane Ehrensaft, whose Oakland, Calif. practice has seen a fourfold increase in the number of gender-questioning kids in recent years. “These kids have always existed, but they kept it underground.”
She is also quoted in the UCSF article:
“When a child says, ‘I’m not the gender you think I am,’ that can be a showstopper,” says Diane Ehrensaft, PhD, the Gender Center’s director of mental heath as well as a private-practice psychologist in Oakland. “Some parents say, ‘Not on my watch. No way am I signing off on a medical intervention. When they’re 18 they can do what they want.’ I say, ‘You’re absolutely right, you’re the ones minding the shop, but let me share with you the risk factors of holding back.’”
A parent swayed by Ehrensaft’s logic may believe that, contrary to historical records, there were always this many trans kids. This could lead parents to disregard the impacts of social contagion. And she tells parents that being cautious and holding back medical interventions until their child is 18 could lead to serious “risk factors.” Suicide seems to be implied.
Stephen Rosenthal, MD, is another pediatric gender-affirming pioneer in the San Francisco Bay area. He is a founder of the UCSF Child and Adolescent Gender Center and currently serves as its Medical Director. He is also the program director for Pediatric Endocrinology, director of the Endocrine Clinics, and co-director of the Disorders of Sexual Development (DSD) Clinic. Additionally, Rosenthal spends time as a professor of clinical pediatrics at UCSF and conducts research. Currently, he is participating in an NIH-funded study of pediatric medical transition.
He has stated that “these kids have a very high risk of depression, substance abuse, suicidal thoughts and suicide attempts. Not treating is not a neutral option.” He promotes early treatment—puberty blockers, cross-sex hormones and sometimes surgeries—to alleviate these symptoms without any proof of long term relief.
Under his direction, the UCSF Child and Adolescent Gender Center has grown substantially. It opened in 2010. By 2012 there were 75 patients and currently there are over 300 patients with about 10 new referrals a month. Business is booming. Clinics are being added in San Mateo and Oakland. The UCSF Gender Center network isn’t the only place in the San Francisco Bay area offering pediatric gender affirming treatment. Stanford and Kaiser Permanente provide similar services.
What could be driving all of these children to seek treatment? Well, the San Francisco Bay Area has been well-educated by Gender Spectrum, a “national advocacy group for gender expansive youth whose mission is to create a gender sensitive and inclusive environment for all children and teens.” Many schools in the area have hosted training sessions by Gender Spectrum. The goal of gender sensitivity training is to increase acceptance and decrease bullying, but it’s likely that some children get confused by the information, leading to a rise in referrals to gender clinics.
Joel Baum, MS, is an advocate for pediatric gender affirmation. He is the Senior Director of Professional Development and Family Services at Gender Spectrum and is the Director of Education and Advocacy for the UCSF Child and Adolescent Gender Center. He co-wrote Schools in Transition, A Guide for Supporting Transgender Students in K-12 Schools, which I discussed in this blog post. He has spoken in schools, at conferences (mentioned in this 4thWaveNow post) and, according to this article, promotes transgender awareness on radio shows.
Per the article, it was Baum who helped Emily and her husband realize that their son was really their daughter (Kelly).
One day Emily got a call from her husband, who was in his car listening on the radio to Joel Baum, MS, the Gender Center’s director of advocacy as well as the director of education and training for the Oakland-based nonprofit Gender Spectrum. “You’ve got to turn on the radio,” he told her. “I think this is our kid.’”
Emily was horrified to learn about the high rates of harassment, school failure, and suicide among transgender youth. “I couldn’t talk about it without weeping. I kept going to all these images in our culture for transgender people, that they’re on the edge, disenfranchised,” she says. “I was thinking, ‘I can’t lose my kid. I don’t care what her gender is. I’ve got to get on the other side of those statistics.’”
Her path forward, she says, was “unconditional acceptance of my child’s truth.”
The family started regular visits to Gender Center clinics and let Kelly be their guide. She grew her hair long. In third grade, she switched her masculine birth name to a gender-neutral nickname. At age nine, she transitioned socially, becoming “she” to relatives, friends, and classmates.
Intensely private, Kelly wanted no emails to parents, no classroom announcement. Just a quiet switch in pronouns. Her elementary school administrators and teachers – faced with their first transitioning student – were “incredibly supportive,” says Emily, who sought out staff training and put Kelly in a classroom with only one student who knew her from “before”: her best friend.
Now 13, Kelly has a matchstick-sized implant under the skin near her left bicep to suppress the male hormones her body produces. She’s blossomed into a “beautiful, smart, artistic, empathetic, fun kid,” Emily says. “I’m like, ‘Whoo! I hit the jackpot.’ But it was definitely a process and a journey for our family, and our daughter, to come to understand who she was.”
Ehrensaft, Rosenthal and Baum are promoting treatment for gender dysphoric children based on unproven theories, not solid evidence. There has been a dramatic rise in trans-identifying youth, but instead of questioning why, Ehrensaft says that the increase is due to hidden trans kids coming out. Rosenthal seems to believe that pre-emptive treatment (leading children to become permanent medical patients with unknown long term side effects) is worth it to potentially avoid future depression, substance abuse and suicide. Baum doesn’t appear to consider that transgender advocacy can lead some impressionable kids to mistakenly self-diagnose as trans. Or, that it can affect how parents interpret their children, potentially leading their gender defiant kids unnecessarily down the path of transition.
And each uses suicide statistics, flawed as they are, to justify early intervention. I’ve seen many parents in news articles state that the motivation to go along with transition was to avoid suicide. Parents are scared and feel pressured. They want to keep their children alive, no matter what. They don’t feel like they have a real choice. “I can either have a live son or a dead daughter” (or the reverse) is a common saying. When parents trust the advice of gender experts, they will accept puberty blockers, cross-sex hormones, mastectomies, and hysterectomies as necessary. Unfortunately, though, this approach does not guarantee a live child.
Tremendous pressure is being placed on parents to provide gender affirmative “support.” Media articles never quote these pioneers recommending what we do at 4thWaveNow—to support our children in defiance of gender. We allow our children to choose their haircuts, clothing and interests. We accept them as is, without pressuring them to conform to societal expectations. We urge caution and encourage reflection on what it means to be male or female. We consider the long term impacts of medical interventions. We don’t rush into gender affirmation via pronouns or treatments. We want to avoid suicide in our children, but realize that the underlying reasons are more complex than the trans kids media articles portray. And some of us have had success with this approach.
There is a great deal of trust being put in the experts in the field, but we need to remember that they are pioneers in the strictest sense. They are still developing new ways of thinking about and treating gender dysphoric patients. The process is not complete. Gender science is rapidly evolving and changes to treatment protocols are likely. Today’s success stories may not be tomorrow’s success stories. The trust in experts should be viewed from this perspective.