Suicide or transition: The only options for gender dysphoric kids?

by J. Michael Bailey, Ph.D  and Ray Blanchard, Ph.D

This is the first in a series of articles authored by Drs. Bailey and Blanchard. As their time permits, they will be available to interact in the comments section of this post. Please note: As always on 4thWaveNow, if you disagree with the content of this article, your comments will be more likely to be published if they are delivered respectfully. Hateful or trollish comments will be deleted.

Michael Bailey is Professor of Psychology at Northwestern University. His book The Man Who Would Be Queen provides a readable scientific account of two kinds of gender dysphoria among natal males, and is available as a free download here.

Ray Blanchard received his A.B. in psychology from the University of Pennsylvania in 1967 and his Ph.D. from the University of Illinois in 1973. He was the psychologist in the Adult Gender Identity Clinic of Toronto’s Centre for Addiction and Mental Health (CAMH) from 1980–1995 and the Head of CAMH’s Clinical Sexology Services from 1995–2010.

It is increasingly common for gender dysphoric adolescents and mental health professionals to claim that transition is necessary to prevent suicide. The tragic case of Leelah Alcorn is often cited as the rallying cry: “transition or else!” Leelah (originally Joshua) was a gender dysphoric natal male who committed suicide at age 17, blaming her parents for failing to support her gender transition and forcing her into Christian reparative therapy. Subsequently, various “Leelah’s Laws” banning “conversion therapy” for gender dysphoria (among other things) have been passed or are being considered across the United States.

The suicide of one’s child is every parent’s nightmare. Given the choice for our child between gender transition and suicide, we would certainly choose transition. But the best scientific evidence suggests that gender transition is not necessary to prevent suicide.

We provide a more detailed essay below, but here’s the bottom line:

  1. Children (most commonly, adolescents) who threaten to commit suicide rarely do so, although they are more likely to kill themselves than children who do not threaten suicide.
  2. Mental health problems, including suicide, are associated with some forms of gender dysphoria. But suicide is rare even among gender dysphoric persons.
  3. There is no persuasive evidence that gender transition reduces gender dysphoric children’s likelihood of killing themselves.
  4. The idea that mental health problems–including suicidality–are caused by gender dysphoria rather than the other way around (i.e., mental health and personality issues cause a vulnerability to experience gender dysphoria) is currently popular and politically correct. It is, however, unproven and as likely to be false as true.

Suicide vs Suicidality vs Non-suicidal Self-injury

Suicide is a rare event. In the United States in 2014, about 13 out of every 100,000 persons committed suicide. Suicide was most common among middle aged white males, who accounted for about 7 out of 10 known suicides.

It is helpful to distinguish at least four different things: Completed suicide means death by suicide. Suicidality means either thinking about committing suicide or attempting suicide. Non-suicidal self-injury means injuring oneself (most often by cutting one’s skin) without intending to die. Finally, mental illness includes a variety of conditions, from depression to conduct disorder to personality disorders (such as borderline personality disorder) to schizophrenia–some of which are especially strongly associated with completed suicide and suicidality, others of which are more strongly associated with non-suicidal self-injury.

Obviously, completed suicide is what we are most worried about. Because it is so rare, however, and because it is often difficult to know about the dead person’s motivations for suicide, it has been especially difficult to study. There are fewer studies focusing on gender dysphoria and completed suicide than on gender dysphoria and either suicidality or non-suicidal self-injury. Studies of suicidality must rely on self-report (for example, someone must report that they are, or have been, thinking about committing suicide), and this complicates interpretations of results. (Maybe some people, some times, are especially likely to say they have been suicidal, even if they haven’t been.) Also there is more than one kind of gender dysphoria–we think there are three (this is a topic for another day)–and we should not expect risks to be identical for all types.

The Scientific Literature

Our aim here is not to review every available study, but to focus on the best evidence. Larger, more representative studies–and most importantly, studies of completed suicide–are most informative.

Studies of Completed Suicides

 Two large systematic studies of completed suicide and gender dysphoria have been published, one from the Netherlands, the other from Sweden. Notably, both countries are socially liberal, and both studies were conducted fairly recently (1997 and 2011). Both studies focused on patients who had been treated medically at national gender clinics. These patients all either began or completed medical gender transition, and we refer to them as “transsexuals.” (We don’t know how many of the patients there were from each of the three types we believe exist.)

The Dutch study’s suicide data were of male-to-female transsexuals (natal males transitioned to females) treated with cross-sex hormones (and many also with surgery). Of 816 male-to-female transsexuals, 13 (1.6%) completed suicide. This was 9 times higher than expected. Still, suicide was rare in the sample. The Swedish study found an even larger increase in the rate of suicide, 19 times higher among the transsexuals than among a non-transsexual control group. Still, only 10 out of 324 transsexuals (i.e., 3.1% of the group) committed suicide. Again, still rare. Note that both studies were of gender dysphoric persons who transitioned. As such, their results hardly support the curative effects of transition.

The Dutch and Swedish studies were of adults whose gender dysphoria may or may not have begun in childhood. No published study has focused only on childhood onset cases. However, psychologist Kenneth Zucker has tracked the outcome of more than 150 childhood onset cases treated at the Centre for Addiction and Mental Health into adolescence and young adulthood. He has generously shared with us (in a personal communication) his outcome data for suicide. Out of those more than 150 cases followed, only one had committed suicide. Furthermore, Dr. Zucker’s understanding (based on parent report) is that this suicide was not due to gender dysphoria, but rather to an unrelated psychiatric illness. On the one hand, one suicide out of 150 cases is more than we’d expect by chance. On the other hand, it is a rare outcome among gender dysphoric children and adults.

Studies of Suicidality and Non-suicidal Self-injury

People who commit suicide were suicidal before they did so. But most people who are suicidal do not commit suicide. “Suicidal” is necessarily a vague word, encompassing “intends to commit suicide” and “thinks about suicide,” both in a wide range of intensity. Furthermore, most studies would include as “suicidal” someone who falsely reports a past or present intention to commit suicide.

Why would anyone falsely report being suicidal? One reason is to influence the behavior of others. Saying that one is suicidal usually gets attention–sympathy, for example. It can be a way of impressing others with the seriousness of one’s feelings or needs. Although this possibility has not been directly studied, reporting suicidality may sometimes be a strategy for advancing a social cause.

According to data from the Centers for Disease Control (CDC), the rates of intentional but non-fatal self-injury peak during adolescence at about 450 per 100,000 girls and a bit fewer than 250 per 100,000 boys. These rates are much higher than the 13 per 100,000 American completed suicides per year (and remember that suicide is more common among adults than adolescents). So it is reasonable to assume that most adolescent self-injury is not intended to end one’s life. We are not suggesting that parents ignore children’s self-injury. We simply mean that self-injury often has motives besides genuinely suicidal intent.

 Not surprisingly, given the increased rates of suicide among gender dysphoric adults, suicidality (i.e., self-reported suicidal thoughts and past “suicide attempts”) is also higher among the transgendered. One recent survey statistically analyzed by the Williams Institute reported that 41% of transgender adults had ever made a suicide attempt, compared with a rate of 4.6% for controls. This survey recruited respondents using convenience sampling, however, and this may have inflated the rate of suicidal reports. Additionally, the authors of the survey included the following (admirable) disclaimer):

Data from the U.S. population at large, however, show clear demographic differences between suicide attempters and those who die by suicide. While almost 80 percent of all suicide deaths occur among males, about 75 percent of suicide attempts are made by females. Adolescents, who overall have a relatively low suicide rate of about 7 per 100,000 people, account for a substantial proportion of suicide attempts, making perhaps 100 or more attempts for every suicide death. By contrast, the elderly have a much higher suicide rate of about 15 per 100,000, but make only four attempts for every completed suicide. Although making a suicide attempt generally increases the risk of subsequent suicidal behavior, six separate studies that have followed suicide attempters for periods of five to 37 years found death by suicide to occur in 7 to 13 percent of the samples (Tidemalm et al., 2008). We do not know whether these general population patterns hold true for transgender people but in the absence of supporting data, we should be especially careful not to extrapolate findings about suicide attempts among transgender adults to imply conclusions about completed suicide in this population.

That is, importantly, the authors realize that suicidality and completed suicide are very different things, and it is suicidality that they have studied. Completed suicides in their group will be much, much lower.

Increased suicidality for gender dysphoric children was also reported by parents in a recent study by Kenneth Zucker’s research group.

A systematic review of non-suicidal self-injurious behavior in “trans people” found a higher rate, especially for trans men (i.e., natal females who have transitioned to males). The most common method mentioned was self-cutting. (Self-cutting is a common symptom of borderline personality disorder, which is also far more common among non-transgender natal females than among natal males.)

Is Transition the Answer, After All?

In a very recent study psychologist Kristina Olson reported that parents who supported their gender dysphoric children’s social transition rated them just as mentally healthy as their non-gender-dysphoric siblings. Furthermore, parents’ reports suggested that the socially transitioned gender dysphoric children were not less mentally healthy than a random sample would be expected to be.

This research falls far short of negating or explaining the findings we have reviewed above. First, it was relatively small, including only 73 gender dysphoric children. Second, families were recruited via convenience sampling, increasing the likelihood of various selection biases. For example, it is possible that especially mentally healthy families volunteer for this kind of research. Third, the assessment was a brief snapshot; we would expect socially transitioned gender dysphoric children to be faring better at that snapshot compared with children struggling with their gender dysphoria. (There is little doubt that at first, gender dysphoric children are happier if allowed to socially transition.) Young gender dysphoric children do not show that many psychological or behavior problems, aside from their gender issues. The aforementioned study by Kenneth Zucker’s research group showed that mental health problems, including suicidality, increased with age. Perhaps this won’t happen with Olson’s participants, but it’s too soon to know.

Why Is Gender Dysphoria Associated with Mental Problems, Including Suicidality?

 We don’t know.

The current conventional wisdom is that gender dysphoria creates a need for gender transition that, if frustrated, causes all the problems. That is a convenient position for pro-transition clinicians and activists. But they simply don’t know that this is true. Furthermore, both our past experience studying mental illness scientifically and specific findings related to gender dysphoria suggests the conventional wisdom is unlikely to be correct.

As an example, Leelah Alcorn’s suicide (like most suicides) was tragic, but she appears to have had problems that were not obviously caused by her gender dysphoria. She posted as Joshua (her male identity) on Tumblr:

“I’m literally such a bitch. shit happens in my life that isn’t even really that bad and all I do is complain about it to everyone around me and threaten to commit suicide and make them feel sorry for me, then they view me as sub-human and someone they have to take care of like a child. then when they don’t meet my each and every single expectation I lash out at them and make them feel like shit and like they weren’t good enough to take care of me. since I can only find imperfections in myself I try my hardest to find imperfections in everyone around me and use them as a way to one up myself and make others feel bad to make myself look better.”

Sophisticated causal analysis of mental illness and life experiences has invariably shown that things are more complex than previously assumed. For example, although depression is certainly caused by adverse life experiences, those vulnerable to depression have a tendency to generate their own stressful life experiences. So it’s not as simple as depression being caused by life experiences alone. Also, depression has a considerable genetic influence. Similarly, women with borderline personality disorder (BPD) report that they have experienced disproportionate childhood sexual abuse (CSA), and many clinicians and researchers have assumed that CSA causes BPD. But one just can’t assume the causal direction goes that way–one must eliminate alternative possibilities. Recent sophisticated studies suggest that, in fact, CSA does not cause BPD.

Research to understand the link between gender dysphoria, various mental problems (including suicidality), and completed suicides will take time. There is already plenty of reason, however, to doubt the conventional wisdom that all the trouble is caused by delaying gender transition of gender dysphoric persons. We have already mentioned the fact that transitioned adults who had been gender dysphoric (i.e., “transsexuals”) have increased rates of completed suicide. Their transition did not prevent this, evidently. Suicide (and threats to commit suicide) can be socially contagious. Thus, social contagion may play an important role in both suicidality and gender dysphoria itself. Autism is a risk factor for both gender dysphoria and suicidality. No one, to our knowledge, believes that gender dysphoria causes autism.


Parents with gender dysphoric children almost always want the best for them, but many of these parents do not immediately conclude that instant gender transition is the best solution. It serves these parents poorly to exaggerate the likelihood of their children’s suicide, or to assert that suicide or suicidality would be the parents’ fault.


Aitken, M., VanderLaan, D. P., Wasserman, L., Stojanovski, S., & Zucker, K. J. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry55(6), 513-520.

Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one6(2), e16885.

Marshall, E., Claes, L., Bouman, W. P., Witcomb, G. L., & Arcelus, J. (2016). Non-suicidal self-injury and suicidality in trans people: a systematic review of the literature. International review of psychiatry28(1), 58-69.

Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic reviews30(1), 133-154.

Van Kesteren, P. J., Asscheman, H., Megens, J. A., & Gooren, L. J. (1997). Mortality and morbidity in transsexual subjects treated with cross‐sex hormones. Clinical endocrinology47(3), 337-343.


213 thoughts on “Suicide or transition: The only options for gender dysphoric kids?

  1. So for me this is kind of like, if Paul Newman and Joanne Woodward showed up to star in your high school play… incredible and magnificent and thank you both so much, researchers and leaders in the profession, for visiting us in our community. Amazing piece, of course, and I hope everyone here realizes how lucky we are, that these two lions of the field have shared this with us. This is a tour de force.

    Liked by 11 people

    • Worriedmom, I definitely appreciate the information that they have given us. I am also so very grateful that it was written in such a way that I was able to clearly understand. Thank you Drs. Bailey and Blanchard.

      Liked by 6 people

    • worriedmom, I love your analogy! When I first saw the title and the byline, my immediate reaction was, “Wow, 4thWaveNow has been called up from the Little League to the Majors in one fell swoop!”

      Drs. Blanchard and Bailey, my heartfelt thanks for your (as always) excellent writing, and for sharing your expertise with us. You two have been in the trenches for far longer than the trans phenomenon has even been on our radar for most of us.

      In your article, you write “Also there is more than one kind of gender dysphoria–we think there are three (this is a topic for another day).” I fervently hope this is a “trailer” for an upcoming article.

      Liked by 7 people

  2. The doctors have composed a well-documented, sensible, educational piece here that is so important amid the misinformation and scare tactics currently circulating. It is “medical transition or die” for teens, according to most sources. Our family was literally told that their “child’s blood would be on there hands” and so there was no other option. BTW, whatever happened to Lisa Littman’s study on spontaneous teen onset of gender dysphoria, peer groups, social media, and social contagion? (It is mentioned above with a link.) Was it shut down? There are a number of discussion boards online where teens are specifically advised to threaten suicide as an effective strategy for getting hormones from reluctant parents. Finally, this is such a measured, non-sensational, reasoned and informed piece, but I wonder how many researchers would in today’s dicey climate risk saying anything that might challenge the “hormones/surgery or death” narrative that is pushed hard on parents by both teens and gender specialists. I hope you have a secure job! Final question: We have been told over and over that the transgender phenomenon is something that takes place in the womb, likely from exposure to hormone-disrupting chemicals that are responsible for biologically triggering this phenomenon. How much evidence is there for that? Is this actually similar to the gender issues with gulls and frogs? That information about the hormone-disrupting chemicals is presented in book after book as conventional wisdom, but has anyone actually studied that? Thank you.

    Liked by 8 people

    • This is the current state of affairs we are in. Affirmation only and informed consent gender clinics where one can obtain a prescription for cross-sex hormones on the first visit….that is what happened to my 18 year old daughter…who I am now supposed to call “he” with the flip of a switch, to a young adult who admitted being transgender for social reasons (not uncommon for distraught misfits now).

      I am reading a lot about ADHD and how females can last a long time under the radar before finally being diagnosed. There is so much I see that could fit my daughter. Yet she never had any diagnostics. Her university is one of the many that buy into the whole suicide risk, so they just went along with her sense-of-reality…in fact cheerleaded it….rather than encourage her to seek diagnostics off-campus. Very impulsively she went to the gender clinic, and they also only affirm. Who knows how she might have felt 2 years ago if she had been treated with appropriate medications. This is all started during the high stress time of 11th-12th grade in a demanding high school.

      And so parents and families are put in a very strange position. I plainly see mental health issues, but my daughter only hears “he is happy, what’s the problem?” The change to remove diagnostics and to allow for informed consent treatments was a huge mistake. To put all of the trust in someone’s brain who is actually suffering any number of other issues they could not possibly sort through on their own is medical malpractice, plain and simple.

      Dr. Bailey and Dr. Blanchard, thank you for your post. I hope you can help add back required diagnostics for young adults. The 18-25 year old age group is so vulnerable and desperately needs the lips of therapists to be unzipped. I know my daughter expected that she would have to go through some therapy, but it never happened.

      Liked by 11 people

      • I’m sorry Nervous Wreck. My daughter decided this at 17.5 and is now 18. She’s living in a dorm that is a radical lgbtq+ SJW living learning community. She didn’t ask to be put there but since they asked her gender and preferred pronouns they put her there. There is a winter group they can “apply to” and they announce that they won’t let your parents know. You know because we are so abusive paying for college.

        Liked by 3 people

      • Fighting for the girl that deserves to thrive,
        I hope parents of high school kids stay alert, because this all happened to my daughter SO FAST. I had no idea an 18 year old could walk into a clinic and come with a prescription for testosterone. I had absolutely no idea this was happening. My kid shows a whole lot more signs of other mental health issues than she ever did or does of gender dysphoria. I might have stepped in, but the whole thing gave me a nervous breakdown. It’s one thing for a teen daughter to say “I’m your son”, and another to actually be transitioning in a matter of months. This just is not right. She deserved to have her underlying issues explored and treated first.

        Liked by 2 people

    • Lisa Littman’s study will be published before long. She presented her data at the July meeting of the International Academy of Sex Research (the most prestigious meeting of sex researchers), and she was very well received.

      Regarding the causes of transgender phenomena, it is important to realize that there is not just one kind of gender dysphoria (or transgender). We think there are three (and perhaps we will blog about this at some point). Only one type, the childhood-onset type (essentially, the very feminine prepubescent boy who wants to be a girl or very masculine girl who wants to be a boy) are especially likely to reflect the influence of early androgens. My impression is that readers of 4thWaveNow disproportionately have gender dysphoric children of another type: Rapid Onset Adolescent onset. This type seems less likely to reflect the kind of influences assumed by the “transgender is the brain of one sex in the body of another” model.

      In general, scientific research has found evidence for virtually everything that there are inborn influences, although these influences are not necessarily completely determinative. I am pretty sure that gender dysphoria is one arena where social forces are also very powerful. A useful way to think about this is that each kind of transgender requires a certain seed, but the social soil is also very important. The current social milieu that is so prevalent that glorifies transition and stigmatizes parents who want to avoid their children’s transition is soil for transition.

      But regardless of the social soil, gender dysphoric children would likely be different than other children. Perhaps not gender dysphoric, but different.

      Liked by 5 people

      • Drs. Bailey and Blanchard, given the body of research which has shown that young children who are “gender nonconforming” often grow up to be lesbian or gay, isn’t there a bit of a “sticky wicket” when it comes to diagnosing them as transgender in the first place? Melissa Hines and colleagues, as you are likely aware, published a study of nearly 5000 people last year. They found a strong correlation between GNC behavior in very early childhood and self-defined homosexuality at age 15; and this finding was irrespective of whether their parents approved of such gender-atypical behavior. Hines et al have also done a lot of work on the effect of prenatal testosterone on childhood gender atypicality. Research from the Dutch team who pioneered the use of puberty blockers, and others, has indicated that nearly all childhood gender-dysphoric “persisters” are same-sex attracted. Research into the coming-out process for LGB people has also found that many non-heterosexual individuals recognize and accept their sexual orientation late–average age 19 or 20, long after the die has been cast for “trans” kids put on blockers and cross-sex hormones. Given all of this, is it any wonder that a movement is building amongst some in the LGB community to protest what they see as proactive (even if unintentional) anti-gay eugenics being visited on children who would likely grow up to be gay or lesbian if not tampered with medically? Certainly, several of us in the 4thWaveNow community are parents of now self-identified lesbian and gay teens who we feel we saved from hasty diagnosis by “affirmative” gender doctors when they were in the throes of pubertal angst–and just in time.

        Without the “suicide or transition” reason, why doesn’t it make most sense to delay medical transition to adulthood, to allow these young people the chance to come to terms with their sexuality and other aspects of who they are–with the benefit of more mature executive function and the ability to understand the magnitude of the choice to become a permanent medical patient as a transgendered individual?

        Liked by 10 people

      • Thank you, Dr. Bailey, for your comment. My daughter was “different” from an early age….but that can mean any number of things going on. She is a gifted kid….and the social isolation that gifted kids feel is well documented. She has never received any counseling about this possible explanation, and I was late to see the impact because she internalized all of this so much. I missed it because she did have friends….they just were not the kind of friend her genius brain was seeking.

        And the list of other possible explanations for being “different” is no doubt long, including ASD traits, ADHD, OCD, anxiety, etc (now all astonishingly blamed on gendered brain differences!). Now she is in her 20s and living “as a man” because she had friendship troubles with other girls going way back to childhood. She has yet to tell me how many close friendships she now has with men, and I’m not holding by breath. As always, she relies on her animal friends….and there has been quite a menagerie!

        That my daughter was able to start testosterone without having to go through any diagnostics and counseling process is truly horrifying.

        I recall reading somewhere…and now I can’t relocate it, unfortunately, there was concern by experts that the change to Gender Dysphoria and the move to affirmation only & informed consent would result in transitioning for purely social reasons, and that is exactly what has happened…in the very nutrient-rich social soil she found via internet “friends” and on her university campus.

        It seems once “gender” is mentioned, all other psychological knowledge is thrown out the window. Some of this is the effect of state laws regarding “conversion” therapy. My hope is that these laws can all be revisited with strong definitions of what exactly torturous “conversion” therapy really is, so that psychologists can once again truly counsel.

        Liked by 7 people

      • 4thwavenow:

        Hmm, I’ve never understood why there are no “reply” buttons to some posts, but then again, I’m not too familiar with this system, I mostly use Disqus.

        I was just wondering if you had read the accounts of pre-ww2 (and sometimes later) male homosexuals?

        It’s actually quite interesting history to read about the underground communities that existed, where effeminate men dressed up in womens clothing and sought out men and so on. There are many gay men on record from that period and later stating they would rather have been women. Quentin Crisp would be the most famous example. If there are different causes for homosexuality we should also accept different outcomes.

        And on that note there was your comment:

        “Without the “suicide or transition” reason, why doesn’t it make most sense to delay medical transition to adulthood, to allow these young people the chance to come to terms with their sexuality and other aspects of who they are”

        But the whole point of the thing is that for example in male to female HSTS boys they don’t want to go through male puberty? And look like a man in a dress not being able to attract women?

        On the mention of coming to terms with your sexuality:

        I’ve heard that children do have a sexuality, even if it’s pre-pubertal/undeveloped, I mean I’ve seen documentaries with transgender children where they talk about their future husbands?

        One example: (Specifically she is talking about it between 30:17 – 30:50, she even touches upon an identity as a gay man). (That child is 11).

        Children do seem to have some sort of undeveloped sexuality or at least interest, when I was a teenager the first day at working at a school (in Sweden we do a sort of work practice between 14-15 years of age) I was told to find some children missing from class, I did find them, they were all naked together in a hut doing show and tell, and a boy was masturbating in front of the girls. Take notice these kids were 7-9 years old, and I was doing “work practice” at this school helping these kids with math etc, so I was quite surprised lol. What happened after was that I just told the teacher and then I never tried to find out if they got punished or anything.

        It has been noticed that these effeminate boys prefer the role of wife and mother when doing family play, and personally from my own experience, I would say I knew I was heterosexual when I was 7 years old, I mean I had a “girlfriend”, but mostly only boys as friends, there was some kisses with this girlfriend and so on, obviously it was very basic, maybe monkey see, monkey do (children imitating adults). I would like to point out though at this point in time in my group at school (about 30 people in each group), we had an effeminate boy always trying to kiss the other boys (and flirting), he is today out as a gay man (strangely enough lol). When I was 11 I def. remember knowing I was heterosexual, since I remember (sorry for crudeness), masturbating at that point in time.

        Maybe it’s that a homosexual identity is harder to come to terms with?


      • @Nicholas
        “But the whole point of the thing is that for example in male to female HSTS boys they don’t want to go through male puberty? And look like a man in a dress not being able to attract women?”

        You might wanna stop and think about the second part of that statement a bit. Pic to help:×0

        If you meant ‘and not be able to attract men’ (rather than ‘women’), that should also not be a problem, as long as he’s trying to attract men who are actually attracted to men. Drag Queens don’t seem to have a problem, and no hormones or surgery are required. Regardless of what he looks like, women/men who aren’t into men are not going to be interested in him.

        The issue with referring to such historical examples is that homophobia was more than rife, male-attracted men were actually criminalised. It’s not so very surprising in such a hostile society if some gay/bisexual men might have wished to be women, which would allow their sexuality to be more socially accepted. Homophobia is still a major issue today, so being LGB can take more coming to terms with as a result. In this article:
        “Family members were flat-out asking me if this kid was gay. It made me nervous, and I was constantly worried about what people would think of me, of us and of my parenting.”
        This is not simply a perfectly fine ‘different outcome’, it’s the result of the parent’s homophobia.

        Liked by 1 person

      • Leo:

        You got it right there, I was typing in a hurry since I had to leave for a family event. I haven’t even had chance to respond to Bailey/Blanchard yet, but will do so later tonight, I did mean “man” and not “woman”.

        “The issue with referring to such historical examples is that homophobia was more than rife, male-attracted men were actually criminalised. It’s not so very surprising in such a hostile society if some gay/bisexual men might have wished to be women, which would allow their sexuality to be more socially accepted. Homophobia is still a major issue today, so being LGB can take more coming to terms with as a result.”

        Sure, but that would not explain the crossdressing and acting like women would it? And all the other gendered behaviour.

        Homophobia is one thing, but I am talking about people that lived secret lives as women, were exclusively homosexual and are on record saying they want/wanted (they are dead now) to be women.

        Quentin Crisp wore womens clothing openly, and stated he wanted to be a woman in several interviews.

        Let’s also remember that there were non-autogynephilic transgender people getting aid during the “height” of homophobia, and treating transgender children from what I read is not really new. The first transgender child was treated in 1948 by Harry Benjamin from what I’ve read.

        And sure, some parents of transgender children might be homophobic and prefer a “transgender daughter” to a “gay son”, but I don’t think this is a general rule. Also the only cases I’ve seen has been in the US, I’ve not seen such a thing here in Europe (at least not in Sweden where I live and the other countries I’ve visited in Europe).

        Let’s remember that a lot of the homosexual transsexuals were out as gay men and then transititoned in the middle 20s, Carmen Carrera is one example.

        To end this post, I mean if it is due to hormonal influences on the brain in utero, then it is something that should be apparent in childhood no? Which it seems also to be. And let’s also remember, different causes of homosexuality means different outcomes, and let’s also remember that many homosexual men that don’t at least state gender dysphoria have effeminate traits, and I’m almost wondering if it’s not homophobia that make a lot of gay men actively work to shed any obvious femininity.


      • @Nicholas
        “Sure, but that would not explain the crossdressing and acting like women would it? And all the other gendered behaviour.”

        I think it would. In our heteronormative society, women are expected to partner with men and femininity is meant to be what’s attractive to men. Historically, gay men were not permitted to be partnered with other men. Therefore they might well wish to be a woman in order to be with men, and take on gendered behaviours and a way of dressing as part of that.

        Are there some biological factors, maybe. I’d point out though that feminine gay men are WAY more feminine (if that’s even the word, it’s not always the same as the femininity expected of women) than the average woman, it’s actually NOT how women act, it’s more a performance, a caricatured version. A feminine gay man I met and got to know a bit once was wildly theatrical, none of the women around were acting that way, I’ve never met one who does, and tbh, that specific type of intentional attention-hogging? I associate it with the result of male socialisation, not with how women typically behave. It’s also hard to see how superficial, cultural aspects like clothing choice, when clothing differs over time and across cultures anyway, could be down to anything biological. Even if you’re thinking of children, not all girls do the dressy-up Princessy thing, and that used to be much less common, it’s fairly recent really. In my mum’s day no one she knew (including her three sisters) even did that stuff, they played in the fields with their go-cart, climbed trees and sheds, she fell off and broke her arm… That wasn’t considered ‘tomboyish’, it was just normal.

        “Let’s also remember that there were non-autogynephilic transgender people getting aid during the “height” of homophobia, and treating transgender children from what I read is not really new.”
        Well, yes, I’d say that’s not surprising and the homophobia is at least part of he reason (though not the whole story in all cases). Transition is accepted even in Iran, being same-sex attracted is not.


      • Leo:

        Well, when I said “gendered behaviour” (I know I’m not very good with these terms), I meant more stuff like, walking and so on.

        It has been observed that women and men walk differently, a huge part of the conversion therapy in the past was training effeminate boys to “walk like men”, “talk like men” and so on. You perhaps want to argue that the walk was socialized from an early age, though I find that a strange argument.

        Anyhow, I was referring to the more evotionary stuff. (They are actually doing some studies now on hormone markers and gendered play which will be interesting to see the results of).

        Let’s not forget though, whatever the hormonal influences on these mens brains, that doesn’t mean they are entirely “women” or “feminized”. So obviously we shouldn’t expect to see 100% womanlike behaviour.

        I don’t see how such behaviour (really young boys being so feminine, and not over the top feminine like the older gay men you are describing) could be socialized.

        Also I know the type you describe, in high school we had a guy that introduced himself to everyone with “I’m a homosexual, eh, thoughts!?”, he was really annoying. That’s not my experience of most gay men though, still most of them being feminine/having feminine traits, and it’s really not my experience of homosexual transsexuals, though there are some there too, but never seen any of the early age version behave like that. (As in those that never identified as gay men/boys before transitioning in their late teens/early 20s.)


  3. The trans identified teen in my life avoided doing work in therapy to address depression, anxiety, verbal abuse, etc for years, but was thrilled to talk to a gender therapist. All they wanted to talk about was gender. The idea that gender transition will solve other emotional problems doesn’t make any sense, but is extremely attractive to teens compared to having to put in years of work learning to manage mood problems, riding the psych med carousel, possibly for life. Another trans person i knew went through a year of therapy and srs without anyone noticing obvious bipolar disorder, this person was ridiculously manic like robin williams. I cannot imagine the despair that must come when you complete transition and discover that you have all the same problems. It seems to me that it would be sensible to have some kind of protocol about how much work must be done on a psych problem before addressing any medical transition. Some detransitioners I’ve talked to had their gender dysphoria resolve when adequately medicated for their other mental illnesses.

    Liked by 12 people

  4. Thank you for this article. I hope therapists and families will think deeply about this issue.

    I have two questions related to teen girls and transgender identities:

    1) Is there any data that shows a progression of self-harm behaviors in adolescent girls, as in cutting, anorexia, and transgender? I realize transgender is not considered a self-harm behavior. I cannot help but think of this presentation in teen girls as the ultimate disaffection.

    2) A chicken and egg question, is there any data that suggests that dissociative behavior and gender dysphoria occurs because of what is being viewed on a screen?

    Liked by 8 people

    • Your questions require me to speculate, but I have thought a lot about these issues.

      You are, I suspect, concerned with Rapid Onset Gender Dysphoria in adolescent girls. This kind of gender dysphoria is new, and I think it spreads via social contagion and iatrogenic therapy (i.e., gender therapists who help convince these kids that they are trans). Not all kids are equally susceptible to this type. The kind who are more susceptible to it include the kinds prone to self-harm (not generally suicide but things like cutting). Some of these individuals have borderline personality disorder (BPD), and self-harm is strongly associated with that diagnosis. So is tenuous identity and a tendency to embrace new identities. “Dissociation” is a nebulous concept, but it is also associated with BPD.

      The Rapid Onset Gender Dysphoria epidemic reminds me of the 1980s-90s epidemic of recovered memories of childhood sexual abuse. Many persons (most often women) came falsely to believe that they’d been horribly sexually abused by their fathers (usually). No reputable scientist I know believes these memories were accurate. But they were associated with “dissociative” phenomena such as “Multiple Personality Disorder” (scare quotes intended). Also BPD. (Not everyone who had recovered memories had these problems though. Listen to this:

      I don’t think I understand the part of your question about “what is being viewed on a screen,” but I do think that persons participating in internet groups which focus on “Am I trans?” are especially likely to come to believe they’re trans. If they never had signs of gender dysphoria in childhood (and if they don’t have autogynephilia), they’re probably Rapid Onset.

      Liked by 6 people

      • Yes, the Rapid Onset Gender Dysphoria describes our daughter. I thought she showed signs of BPD–though no official diagnosis.She managed to do a pretty good re-write of herself after getting drawn into certain sites on the internet. She denies things in her past that happened–even with much evidence to the contrary. Some of these teen girls will deny all history and then there is deadnaming. If you are a parent that refuses to erase history, you are seen as abusive.
        Thank you for your work and sharing your research.

        Liked by 5 people

  5. This was an excellent article and I recently saw Ray on Tucker Carlson and I thought you were excellent. Of course the trans-activist gets more time to spout nonsense.

    I would like to ask about your data on there being more suicides after transitioning (transvestites). If this is so then it would follow that there are higher numbers of people who are unhappy after transitioning than before. So why then is it even an option? It seems to me that it is a poor treatment.

    I have read that AGPs have been ‘triggered’ at some point early in life. I don’t know if that is true but I am wondering what you think of the Japanese Anime and it’s porno version as well. I feel strongly that a lot of young men have been gender confused by this? So many twitter accounts with anime all over by young transwomen. Any opinion?

    Thanks so much for all your work. Please invent a pill. 🙂

    Liked by 3 people

    • I’ve heard about Ray Blanchard being on Tucker Carlson, but googling to find the episode leaves me with nothing. Nothing on youtube either. What episode was this? When? Glad for some help here.


      • I have never been on Tucker Carlson’s show. It is possible that Carlson replayed a segment of a television news show or documentary in which I appeared (presumably with the permission of the copyright holders in the broadcasting industry).


    • If you’d like the opinion of an anime fan, I’d say that the explanation is that autistic people may gravitate to ‘geeky’ stuff like anime. The anime club I was a member of certainly included people on the spectrum. So, it’s their autism that’s connected to trans-identification, not the anime.

      While some anime may include themes around gender or cross-dressing, due in part to the history of this in Japanese theatre (that, and it’s a fetish thing), if you think about it, so does Shakespeare. I don’t think there’s any reason it should be especially confusing, and not all anime include this (and some that do, handle it more seriously – Shouwa Genroku Rakugo Shinjuu is a period drama where it’s handled appropriately, to show the limitations of gender, not to enforce conformity to it). I don’t even think that many ‘transwomen’ are confused, they know they’re men really. The anime community are also as inclined to mock the idea, and to joke about ‘traps’ (male characters who are drawn to look female, hence a potential ‘trap’ for straight men) as anything, rather than being 100% on board with and accepting of trans-identification. This joking behaviour is not simply a fetish thing, but a kind of macho performance – that they are so secure in their heterosexuality, that ‘traps’ aren’t a risk to it, they can safely declare that the trap is the ‘best girl’ in the show, or that finding such a character attractive is/isn’t gay, especially as the unreality of the medium is part of the performance (it’s safe to joke about because not real, and the characters, being drawn, can be basically indistinguishable from a female character anyway). So, while generally fairly live and let live as long as you’re not perceived as causing an issue, the community is not really overall such as to actively encourage trans-id. In the US currently, it does seem as though geeks are often treated as ‘failing’ at masculinity/femininity (another reason for geeks intentionally playing around with gender is defiance of this – if you can’t conform and are being punished for it, might as well make declarations of non-conformity), though, and that’s true for female geeks here in the UK, too (I certainly felt like I was no good at being a girl, growing up). So I don’t know if that potential insecurity might be an issue.

      Liked by 3 people

  6. Thank you for this article! We are living proof of your hypotheses and I want the whole world – especially gender therapists – to understant it and rethink their approach.
    August 2016: Our 12-year old daughter restricted her eating (lost weight over 2 months), was depressed and we took her to a therapist in September. Early January, in front of the therapist, she announced was transgender and wanted to discuss surgical options to remove her breasts. The therapist (nodding away in affirmation) swiftly recommended we see a gender therapist. We didn’t fall for that. We phoned other therapists who all said the same thing – see an expert and/or affirm her chosen identity. We didn’t fall for that either. We told her how much we loved her, that it’s best to take things slow, spent more time with her just doing things she liked and studied transgenderism like we never studied before (we both have advanced degrees). We celebrated her 13th birthday with non-gender gifts and lots of fun.
    May 2017: We found out (in a dramatic emotional scene) that she had been miserable for the past two school years and didn’t fit in with any kids her age, hated her looks, thought she was fat, was cutting a little bit, had suicidal thoughts and generally hated herself and wanted to be dead. We found out that at her lowest time last September is when she searched the internet to find out why she was so depressed and found encouragement in vlogs from trans you.tubers and began to think she must be trans and possibly gay. She watched for months (Sept to May) and became 100% convinced she was trans, started rewriting her memories, and was so optimistic when she told the therapist about her new plans to become a boy.
    May through July 2017: We focused on boosting her self-confidence, showed her the BBC documentary featuring Dr. Zucker, talked about how a girl can do anything she wants to do, and much more – all the time gently telling her to keep her mind open to many explanations for her depression. It took its toll on us though – extremely difficult to say the least.
    September 2017: She no longer thinks she’s transgender. She realized that when she thought she was transgender, that all she really wanted to do was erase herself and start over as a new person. She did this in a totally different and much more positive way. She began exercising, she used mindfullness apps when she felt anxious, she forced herself to talk with kids her age and got positive responses, she started dressing more feminine to see how she felt about it (and liked it!), she kept up communication with us when she felt unsure of herself, she became more active in her interests/hobbies. She now refers to the last year of her life when she thought she was trans as “the time I didn’t feel very good about myself.” She still fights anxiety and depression a little bit and we are ever mindful to help her with all of this, but the truth hath prevailed for us.
    I want others to understand that gender therapists are making a mistake with jumping to affirmation. I have no doubt that had we taken her to a gender therapist and affirmed this insanity, she’d be on the path of doctor-assisted self-destruction via hormones and surgery. Opening everyone’s minds and exploring root causes should be step #1 along with developing healthy habits (kids who want immediate action will appreciate active steps) and opening positive communication with their parents. I thank our lucky stars that this happened while she was young and had not yet pulled too far away from us as we expect in her older teen years.
    Please, I implore you to get this message out. I would love to, I’d even throw myself under the biggot bus for speaking out, but this would be against my family’s wishes for anonymity and I will not destroy what we have fought so hard to protect – our family.

    Liked by 15 people

    • Thank you for sharing. Yours is an inspirational story. I’m glad you had the sense to resist the strong social forces pressuring immediate transition for your daughter.

      Liked by 5 people

    • I admire (and envy) your ability to steer your daughter away from this. Congratulations! I hope other parents of younger children will read what you did and follow suit.

      Liked by 6 people

  7. Question for the authors:
    What are your thoughts on the potential for researchers to find neurochemical and/or neurophysiological abnormalities in “true transgenders”?
    More importantly at this time, if/when we find neurochemical and neurophysiological abnormalities and can use these as transgender markers for diagnosis, should we still treat this condition with hormones and surgery?
    My thoughts: There are lots of neurochemical and/or neurophysiological abnormalities associated with mental disorders. One curious example is a very strange condition where patients insist that one of their limbs must be amputated (apotemnophilia). Researchers are discovering neurophysiological reasons in the parietal lobe for this odd disorder. Here’s the problem: Would you amputate? I think the answer has been and always will be “no, we shouldn’t amputate.” So why would we surgically and chemically alter a transgender? Why not work with the neuroplastic mind to accept the body? (I know the APA 2015 guidelines for trans treatment dismiss this approach as ‘not the consensus’ for treatment.)

    Liked by 5 people

    • Actually, I favor amputation for persons with apotemnophilia. Here’s why: Their lives are enriched (for reasons we don’t understand well) by becoming amputees. And importantly, we have no idea how to make these very strong, very persistent desires desist. For analogous reasons, I favor sex reassignment surgery for natal males with autogynephilia, assuming they understand the costs and benefits and nature of their condition.

      Our position (confident I speak for Ray too here) is that we prefer to help someone avoid medical gender transition when possible. But sometimes medical gender transition is for the best. But not usually, and far less often than the current zeitgeist asserts.

      Liked by 4 people

      • I saw a documentary where the phantom limb specialist Vilayanur Ramachandran tried treating apotemnophilia with mirrors just like phantom limb. Instead of seeing their ‘bad’ leg they saw a reflection of their ‘good’ leg and their dysphoria decreased immediately. I don’t know if this could have any application to gender dysphoria though as it isn’t an asymmetric condition – there is no ‘good’ side to reflect.

        Liked by 8 people

      • I in no way want to sound overly critical, but this is something about which I’ve always been curious: when you consider the benefits of transitioning individual AGP males –their “enrichment” –do you also weigh the resulting harms visited upon the wives & children of these men or the (literally decades of) harassment many of them direct towards lesbians? Additionally, I wonder how you weigh the impact they’ve had/are having on women’s rights (and sex specific programs meant to create parity for females) regarding their push to legally redefine the sex-category “female” as being what amounts to sex stereotypes.

        Also, I wonder, given that it appears that the most vocal activists online promoting the transition of children (to both children & adults) seem to be primarily late-transitioning AGP type males, whether this has any impact on your beliefs regarding the appropriateness of such therapy.

        Liked by 6 people

      • I understand that you feel that for some autogynophiles who persist in their obsession medical transition may be the best option for their mental health. However, in recent years their claims about their condition and their mental health have come to take precedence in policy and law over the safety and boundaries of real females. For instance, they are increasingly successful at getting urinals put in formerly all female spaces and it is common to see comments from them on social media that confirm that they don’t “just want to pee”, but they want to show their “lady dicks” to young girls and other women. They want us women to “grow up” and realize that erections are normal female functions and that we must shut up and not complain when they masturbate in what used to be all female showers and changing rooms. Increasingly, violent child molesters and murderers of women transition and get put in female prisons or are identified in press and public records as women which disguises the fact that their crimes are typical of violent males (and very rare for actual females) and are directed against women and (mostly) girl children. So, even if this might be good for their mental health, it is having a negative effect on women and girls in the larger culture.

        Liked by 7 people

      • I wonder how you’d apply that to those of us with other mental illnesses/neurological conditions, though? Many of us are not helped by treatment, or do not get even the basic, standard treatment that guidelines state we should (eg. NICE). There’s little chance of us getting anything else even if we know it would help us, and we can forget about social adjustments for us of the sort transactivists demand (frankly, I’m not putting up with fetishistic men getting special treatment I as a mentally ill woman would never in a zillion years get or expect, enough is enough). We’re expected to live with it, and to be as resilient as we can. We don’t necessarily get any help at all even if we’re actually in crisis at that present moment, never mind on a hypothetical.

        From my own experience, mental illness can totally mess you up, but living with it can enrich life in other, unexpected ways. Acceptance, coping day to day, is not the worst possible thing – must mental illness always be something to be ‘fixed’ at any cost?

        With transition, there also remains the risk of regret, serious complications, even death (as one young patient in a study died during surgery). I don’t think that’s ever ethically justified, on healthy bodies. My nerve damage and the resulting excruciating pain, which is a risk with SRS too, is not any easier to live with than my mental illness. Can we really be sure someone prepared to do something that drastic understands the risks and their condition properly?

        Liked by 2 people

      • A lot of people really want things that are bad for them, like drug addicts. I don’t know why having a strong desire cease is a treatment goal. You can argue that their lives are subjectively enriched, but they are objectively harmed by amputation. It seems a lot like lobotomy, many people were helped by it compared to doing nothing, but compared to drugs that were layer developed it was more damaging than necessary. What if a therapy or medication can address these problems? You can’t unamputate a limb, so those people who were operated on will have more difficult lives than they otherwise could have.

        Liked by 3 people

    • There have been a small number of studies that examined the brain anatomy of transsexuals. These have produced some interesting preliminary findings, but they have been conducted on small numbers of subjects, and the interpretation of these studies is sometimes unclear.

      I think it would be a mistake for any of the “sides” in the various debates over transsexualism/transgender to base their arguments on the existing neuroanatomic research. For one thing, future research using larger numbers of subjects and more powerful technology might overturn the conclusions of the existing studies.

      For another thing, the clinical implications of any future knowledge about neuroanatomic findings are not obvious. Suppose, for example, it turns out that the brains of gender dysphoric or gender nonconforming women are somehow shifted in the direction of averaged men’s brains. That would not prove that these women would be happier adopting the male social role or undergoing masculinizing surgeries (e.g., construction of a male chest contour). That has to be researched separately in clinical outcome studies that look at psychological and social adjustment. Conversely, outcome studies showing that sex reassignment is the most effective treatment for female-to-male transsexuals would still be the best guidance for clinical decision-making, even if neuroanatomical masculinization in such patients is never established.

      I am not going to try to list all the relevant studies in my reply to this comment. Here is a selection of relevant articles:

      Liked by 3 people

    • It’s also important to remember one big difference here, there are very few documented cases of BIID (think it’s in the hundreds). While transsexuality is far more common.


  8. Thanks so much for this article. I realize that looking at news reports about trasngender youth suicide is not scientific, but the last 5 or 6 I have seen were suicides of young people who were all fully supported by family, schools, friends, and professionals. It does make me wonder…..

    Liked by 6 people

    • I worry that some of our young people are spying on this blog and thinking, I’ll show them how serious I am. Message to all of our struggling young adults: Your life is precious and worth living. Seek help if you are truly suicidal.

      Liked by 5 people

      • Missingdaughter: Yes! We do not mean to encourage dismissal of worry about suicide. We only mean to provide accurate information. Two first cousins in my family killed themselves in young adulthood. (Both were seriously mentally ill.) I know suicide happens and how devastating it is.

        Persons who decide at the last minute not to kill themselves, or those who are prevented in serious attempts, are nearly always glad they didn’t do it.

        Liked by 4 people

  9. If only this was on the front cover of Time or National Geographic had a special on this or It was is ANY non conservative newspaper! What a wonderful dream that would be. I want to thank you both and 4th Wave Now for trying to help save vulnerable young lives. It is so clear to literally so many people that a lot of this is social contagion yet the experts at gender clinics won’t admit it or label it as a positive that these kids are redefining gender. Those exact words were spoken to me by the gender therapist at a leading children’s hospital. I was told my kid had a lot of discomfort around her body. I had to remind THEM how common body discomfort is to a huge amount of girls, teens, and women. That really pisses me off that we, just regular old mom and dads, have more of a grasp on mental health issues and general psychology than these damn experts that want to pump hormones in my kids body!!! So I am very grateful to these doctors for speaking out and showing some common sense. I was truly beginning to seriously question if common sense is a dying concept in AMerica.

    Liked by 9 people

  10. The suicide narrative is very powerful. This suicide was reported last week in a similar fashion in several mainstream newspapers, e.g.
    This implies very strongly that the poor child committed suicide because she wasn’t allowed to change her name.
    I have a daughter who thinks she is male and I of course stopped in my tracks, petrified again that if I question anything to do with this I might ’cause’ her to take her own life.

    The facts are entirely different: This individual was fully supported by both school and father. The father and school have issued a complaint:

    I despair of the disgraceful standards of this sloppy journalism and the lack of critical thought. Immense damage is being caused by careless repetition of the ‘transition or die’ narrative.

    Liked by 9 people

  11. I’m reading the pdf of Dr. Bailey’s book provided in the link above. It’s not about suicide as this essay is. It’s about natal boys born with a medical condition that makes them have no penis or an impossibly problematic penis, so the standard practice has been to castrate them, give them a vagina, and have the parents raise them as girls (hormones later).

    It’s very interesting, but I’m only on page 50-something, so I “don’t know the ending”. But it strikes me that the girls who say they want to be a boy, don’t say “I don’t identify with having a vagina” or “I wish I had a penis”. Maybe they did but it’s not in the book, or at least not in what I’ve read so far. They like sports, and one even rejected the color pink. But pink doesn’t equal girl – it’s totally learned.

    I guess what I’m feeling is that so many natal girls love doing the things that these natal boys/raised as girls liked doing but associated with being a boy, that I can’t help but wonder if they could have handled remaining “girls” if everything around them reinforced the reality that plenty of natal girls are assertive, like sports, etc.

    I believe it said that of the ones that were old enough to recognize their own sexuality, they were all attracted to other females – so those ones at least may be lesbian if they remain female. But it’s not just lesbians that are assertive or like sports, especially nowadays.

    Anyway, it’s all very interesting. This blog definitely gives one the opportunity to exercise their brain!

    Liked by 3 people

    • Just to be clearer: you can’t ‘remain female’ if you’re not. A vagina is not something that can be surgically created, males with a medical condition are still males, boys, and cannot be lesbians.

      Liked by 3 people

    • Actually, your summary of my book applies to only one chapter. My book has 3 sections, all about natal males. The first is about little boys who want to be girls. (Childhood onset gender dysphoria) The second is about gay men, and the ways they’re feminine and the other ways they’re masculine. The third is about transsexuals, and is a good introduction to the two types of males who become female.

      Liked by 1 person

  12. I’m very interested in the idea that depression-prone people create more stress in their lives, but I found the literature review to be very heavy-going. Are there other sources that give a more straightforward narrative explanation of the theory?

    Liked by 2 people

      • Are there some academic articles you might recommend? Those with depression can hate themselves so much that they become irritable and lash out at others to transfer their bad feelings out onto others. And what is more appealing to a self-hater than the promise of reinvention via transition? seems like time to rule out depression and other mental health issues is time well spent.

        Liked by 1 person

    • This is INCREDIBLY interesting to me, as well. My trans-identifying daughter certainly fits this bill to a T. (Pardon the unintentional trans-related pun.) She is diagnosed with anxiety and depression and, most especially, when she socially transitioned while in high school (against our advice, but we didn’t punish her or stand in her way because we thought maybe it would backfire), she just seemed to draw stressors and stressful people into her orbit. As we’ve told many professionals — she was doing exactly what she had determined would make her successful and happier and then she refused to go to the place which saw her exactly he way she wanted to be seen and stayed home with us — the people she said made her feel the worst. And then, she watched documentaries about mentally ill people which made her incredibly sad and she said made her want to kill herself.

      Conversely, she would do nothing we suggested which might alleviate her stress and negative functioning. She wouldn’t eat regularly and in a more healthy fashion. (All carbs all the time.) She wouldn’t exercise at all — even a walk around the block. She refused to do any mindfulness/meditaion — I tried to include her in my 15-minute practice which I found to be very helpful. It doesn’t fix anything, but it changes my emotions and attachment to them, which is remarkable. She wouldn’t detach from her phone and do anything face-to-face and outside of herself. None of these things are fixes, but they promote a better baseline functionality and promote excellent sleep, which is the rising tide which lifts all boats. (Note that none of those suggestions are in any way related to an identity. We did try to remain as neutral as we felt comfortable with and tried not to focus on identity or play into her issues.)

      Thankfully, a therapist finally listened to us after she also spoke to our daughter’s sisters (and whose experiences mirrored ours) and she also watched our daughter melt down when she put up a little resistance to our kid. She directed us to an educational consultant because our school, with our daughter’s mental health issues, should have assessed her for an IEP and they didn’t. Our consultant said our district would likely have to agree to sending our kid to a therapeutic boarding school and the school would want to see that our child had done some serious therapeutic work beforehand. And that THAT would only be achievable by sending her to a wilderness program. This advice saved our daughter and our family. Finally, a staff and therapist could observe my kid 24/7 for several months. They saw her anxiety at play, they saw her resistance to authority. They got a great experience of how she misinterpreted social situations. Essentially, they lived with her and they saw everything that we had been telling professionals about for years — but they wouldn’t listen to us because we were the big, bad parents who wouldn’t agree to transition their child, so we were liars and evil.

      While I do not know exactly how my kid is identifying because I feel she’s doing real therapeutic work (even as she reached her 18th birthday, she agreed to continue in treatment) and I don’t want to get off that track, I know she goes by her birth name (and a gender-neutral family nickname related to that), she has no reaction to female pronouns attached to her. She is referred to in female relationship terms — daughter, sister — and has no negative reaction. She is at an all-girls school and is talked about as a girl, a young woman, female. She seems to not even notice.

      We continue to see her past insistence on trans-identifying as a control issue associated with her pervasive anxiety. She is beginning to acknowledge that trying to control other people is NOT a productive coping strategy and she’s learning healthier ones. We are incredibly hopeful for her adult life prospects. We are saddened that the reaction to a teen identifying as trans is not to treat that child as an individual, but rather to insist on a one-size-fits-all treatment. It took an enormous toll on our entire family and continues to be a source of negativity within our personal relationships with our daughter.

      Liked by 11 people

      • Adolescence is such a terrible time for so many. Additional psychological problems make it so much worse for a few. I’m glad things are looking up for your daughter. I hope this continues.

        Liked by 3 people

  13. Thank you for your excellent post – reasonable, measured, and layman-friendly.

    I’ve done some reading recently on Lupron, one of the popular puberty-blocking medications used for children experiencing gender dysphoria, to “buy them time”. According to studies linked by the website, Lupron can actually cause depression in 30% of patients.

    What are your feelings regarding the widespread use of Lupron for patients who, by their own admissions, are already depressed or suicidal? (Understood that this isn’t really your specialty)

    What you wrote above seems to fit in with something I noticed recently; a transgender person online reported being depressed and suicidal while going through early puberty, and then when they received puberty blockers they said they immediately lost their suicidal thoughts. From what you wrote above, it sounds like they got a boost of euphoria at being “on their way” toward a new identity.

    Liked by 4 people

    • To repeat, there is more than one kind of gender dysphoria, and answers may vary according to which. I am more receptive to the idea that a 14 year old whose gender dysphoria was evident to everyone by age 6 might go on lupron to delay puberty than I am to the idea that a 14 year old who last month decided she is trans do so.

      Liked by 2 people

  14. Thank you Drs. Bailey and Blanchard for this very sober, scientific response to the media’s (and gender therapists’) alarmist trope of “suicide or transition” which scares many parents into allowing for transition. Also, thank you Dr. Zucker for providing information from your study. You all have been working in this field for years and your words should be taken very seriously.

    A few questions for Dr. Blanchard (and Dr. Zucker if he would like to answer):

    1. What is your experience from working at CAMH in Toronto of adolescent females increasingly identifying as transgender?
    2. Does the increase in girls identifying as transgender correlate with a decrease the number of girls who are anorexic? In other words, is transitioning a new way for girls to deal with body issues?
    3. Do you really believe in “true transgender” and if so what do you believe that means? Should it be considered a mental illness?

    I’m the mother of a nineteen-year-old who fully believes she’s a gay man and I’m hoping that this society regains its common sense and listens to real science again.

    Liked by 8 people

  15. Replying to 4thWaveNow’s comment/questions:

    She writes: “Drs. Bailey and Blanchard, given the body of research which has shown that young children who are “gender nonconforming” often grow up to be lesbian or gay, isn’t there a bit of a “sticky wicket” when it comes to diagnosing them as transgender in the first place?”

    Remember “transgender” is not the diagnosis. It’s “gender dysphoria.” I do worry that some pro-transition therapists are incorrectly inferring gender dysphoria from gender nonconformity, based on what some parents have told me.

    Even diagnosing gender dysphoria strictly, the childhood onset cases–if they don’t transition–are disproportionately future gay/lesbian individuals. And research shows that into the recent past, most persons with childhood onset gender dysphoria have not needed to transition.

    Liked by 4 people

    • “I do worry that some pro-transition therapists are incorrectly inferring gender dysphoria from gender nonconformity, based on what some parents have told me.”

      THANK-YOU for worrying about this, because that is EXACTLY what is happening.

      At least some of this is now happening on college campuses….for instance:

      My daughter had some sessions with a college counselor. When I met with them together, the counselor told me that the college counseling office does not diagnose, yet she told me my daughter had gender dysphoria (based on my daughter claiming to be transgender).

      And that same office has brochures handy for the local informed consent gender clinic. Which obviously does no diagnostics or it wouldn’t be informed consent. And my daughter only needed a single session at that clinic to receive a prescription for testosterone.

      So who diagnosed her? she diagnosed herself as transgender based solely on sessions with the internet.

      Liked by 5 people

    • Even diagnosing gender dysphoria strictly, the childhood onset cases–if they don’t transition–are disproportionately future gay/lesbian individuals.

      I can’t speak for gay men (who I feel are very different than lesbians in the first place), but in my experience with lesbians, there was no gender dyspohoria in childhood. Wanting a wider gender role, yes, but not wanting to be male. We felt actually blessed to be female – of course, we weren’t growing up in the Victorian era having few rights, it was the height of the women’s movement.

      Are these childhood onset cases you speak of (who don’t transition) retaining their gender dysphoria as adult lesbians? If they are, I would suggest they are a different breed of lesbian.


      • Most lesbians were not gender dysphoric girls. But gender dysphoric girls have a much higher rate of becoming lesbian than other girls (roughly 20-30% versus 1%). I don’t think we know whether lesbians who were gender dysphoric girls are very different from other lesbians. (I do know that some lesbians transition to males during adulthood, and I suspect some/many of those were gender dysphoric girls.)

        Liked by 1 person

      • Though not wishing to *universalize* my individual experience, I was one of those “gender dysphoric” kids who desperately wanted to be a boy & turned out to be lesbian (lol).

        I think that restrictive gender roles/social disapproval for gender-non-conformity contributed to this desire, but due to religion & the way that women were (are!) represented in the media, etc., (and overtly expressed sexism along with various personal factors, I also came to believe that women were inferior & that I wasn’t like *them.* I associated almost exclusively with boys (who also were derisive of girls).

        Had I not been kicked out of the “boy’s club” when adolescence rolled around & friendships took on a different more sexualized connotation, I honestly don’t know what turn I would have taken. I’d like to think that the burgeoning women’s movement would have woken me from my misogyny, but honestly, this will always be an unanswered question. I had no idea that I was a lesbian, but I did know that I had no desire to become involved romantically with boys.

        The good news for me was that when I was at that in-between social space, the second wave *was* there along with other girls who had absorbed its lessons & were adamant about *sharing* (lol) and demonstrating by their own strength that I had been terribly wrong.

        Long story short, by eyes were opened to both my own misogyny and analysis of the context of my own self-hatred of my femaleness. Ultimately, I felt pretty stupid and even ashamed for ever questioning the value of being a girl regardless of having come to the understanding of how we, as women, are socialized to accept secondary status. We spend our entire lives trying to overcome that socialization, don’t we?

        As an adult, the only “gender dysphoria” that I have is the disappointment that *gender* itself has risen to such primacy in a culture that made such gains in the past & should know better by now. I’m glad I’m a woman and lucky to be a lesbian. That’s how I feel as an adult. I do not, however, think that those women that retain “GD” (I honestly hate that term) are of a “different breed.” I think they are women who have not confronted their own misogyny or internalized lesbophobia, and as a result, surround themselves with a “community” that reinforces it & continues to vilify lesbians and lesbianism.

        Liked by 1 person

  16. Dr. Bailey, Dr. Blanchard, or Dr. Zucker,

    Is anyone with professional credentials working on a survey study of detransitioners?
    here is a survey conducted by one:

    Detransitioners have stories to tell. Is anyone in a professional capacity even listening and factoring in their lessons?

    Also, I would love to write a letter about my family’s story to a professional or professional group that plays a part in clinical decision-making…to call attention to the dangers of informed consent gender clinics that allow an 18-year-old to self-identity and essentially self-medicate with permanent effects on their still-a-teenage-brain bodies…but who would that be?

    Liked by 8 people

  17. I believe that extreme gender dysphoria should be considered a mental disorder. It can be a circumscribed mental disorder; many transsexuals function competently, and some brilliantly, in areas of life unrelated to their gender preoccupations. I also believe that fully established transsexualism in adults can rarely or never be extirpated but that sex reassignment surgery is an effective palliative treatment in many adult cases. The decision to recommend sex reassignment should be made very cautiously, however, because some patients regret the decision to transition, even fully adult patients who had been appropriately screened for surgery.

    Liked by 6 people

  18. Thank you Drs Bailey and Blanchard for this very clear and persuasive account. I just want to say that my experience as a parent of two young people who have had gender dysphoria backs up your case. It is clear to me that suicidality can be treated and that gender transition does not cure existing mental health problems. My daughter progressed via a series of diagnoses in her teenage years (eating disorder, mood disorder, suicidality leading to a serious suicide attempt, emergent BPD diagnosis and gender dysphoria) to recovery aged 21 after dialectical behaviour therapy. Her treatment focused on self-acceptance and learning to understand her thoughts and feelings. She also had low dose anti-psychotic treatment for a short time. By contrast, my son developed sudden onset gender dysphoria aged 21 the year after his sister’s suicide attempt which he found traumatic. He showed no signs of gender dysphoria as a child. He told me that he knew he was trans by searching on the internet. The language he uses echoes internet trans activism and he has shown trans sites to me to explain how he knew he was trans. He has been given hormones and is receiving no help to understand his thoughts and feelings. He is now deeply depressed, isolated, living on benefits and sleeping during the day. He has become violent and angry though he still maintains that he is pleased with his bodily changes. Simply in terms of outcomes, the experience of these two kids suggests how unhelpful gender affirmation can be. What can we do to change the standard approach?

    Liked by 6 people

    • Ray Blanchard and I are doing what we can, namely, try to educate people with scientific facts rather than ideological wishes. We are planning a website for families with gender dysphoric children. Stay tuned.

      I’m very sorry about your son. I’m interested, however. Ray and I suspect that many cases of males with sudden onset GD have autogynephilia (AGP). AGP is a pattern of sexual interest in the idea of becoming a woman. AGP phenomena are usually hidden from parents (and virtually everyone) but include fetishistic cross dressing (wearing sexy clothes in private and masturbating while looking in a mirror, most often).

      But Lisa Littman’s work (and your son’s history) requires us to be open minded to the possibility that Rapid Onset GD can be contagious to males too. Please let us know (privately if you prefer) if you know more about your son’s motivations.

      Liked by 4 people

      • No mother can say that their son’s trans identification is NOT AGP. I suspect it is one reason why so few mothers of trans identified sons speak out. (I am in touch with three privately) But this is a question I have thought about quite a bit. Transition because you believe you really are, inside, the other sex makes no sense to me at all. AGP as a reason to take hormones, however, only makes sense up to a point because cross sex hormones reduce libido. James Barrett: ‘Males with autogynaephilia usually seek oestrogen treatment to eliminate this effect. Such treatment diminishes the libido that gives rise to the very desire itself, and autogynaephilia may wane over time, only to be replaced by another unusual sexual drive. For these reasons, autogynaephilia is not usually an indication for oestrogen treatment’ (Barrett 2007a). I think it is often assumed that trans identified girls suffer from body issues whereas for boys it is really about sex. The assumption that boys are sexual and girls are not is a cultural stereotype that’s been around for about 200 years (since the start of the nineteenth century). But it is also true that testosterone heightens libido in trans identified girls, whereas oestrogen dampens libido in trans identified men. So it would be equally logical to argue that it is TIFs (trans identified females) who are sexually motivated whereas TIMs (trans identified males) are trying to escape sexualization. (I realise that this argument will not find many takers on this site, but hold your horses, I have more to say). It also seems to me that gender clinicians work within sexist stereotypes when they attempt to make ‘women’: the women they make can act as passive sexual partners but are unlikely to experience much sexual pleasure due to the suppression of testosterone which is generally present in natal women. In other words, the ‘women’ these doctors create is a figment of the male imagination. More generally, I am suspicious of the assumption (an assumption which belongs to the twentieth century) that sex is (always) the underlying truth, the bedrock of identity, the thing which lies underneath the last cover. This is naturally the case for a sex researcher: your topic is sex, that is the answer you are looking for. But the belief that sex is the ultimate meaning has not been there for most of history. Up till the nineteenth century we would more likely have believed that the ‘self’ was the ‘soul’ which was made by God. Twentieth century people like me are amazed to find that twenty-first century people think ‘Gender’ is the thing inside, the thing that cannot be changed, the ultimate truth that cannot be questioned. What I think is that it is complicated: that sexuality is likely to be a factor for all transgender, but that fact is not the whole story. Sex is many things: a form of self-soothing, a practice formed according to cultural stories and images. It is part of the story. It is because transgender in the 21st century still uses the 20thc belief that sex is the ultimate truth that no one is willing to challenge transgender activism. (P.S. for clarification I am liberal about sex and gender expression).

        Liked by 2 people

      • To Dr Blanchard and Dr Bailey. I’m very grateful to hear that you are starting a science based website on this topic. I’m in the camp of LGB, and yes even T people, who worry these new policies with regards to youth will increase persistence. I attended a gender conference recently with the usual pro transition names you already know trying to keep an open mind. Zero % of these people expressed any concerns about over medicalization. In fact, the attitude was “you won’t know until you try it.” I heard 2 health professionals state that worrying about preventing desistance with these new protocols is inherently transphobic and we shouldn’t even bother asking the question. If you are LGB and think these people care if they disfigure a femme pre-gay boy’s genitals with blockers to cross sex hormones unnecessarily, I can’t say there is one single thing that comes out of their mouths to indicate they do DESPITE not being able to quote hard evidence. One of the clinicians in regards to the worry about why almost no kids put on hormone blockers desist was something to the effect of “because they are trans daaaahhhh” with no actual data to back up this statement nor any desire to acquire any.

        Liked by 5 people

      • This is directed to the homoarchy regarding your statement about a gender specialist, “One of the clinicians in regards to the worry about why almost no kids put on hormone blockers desist was something to the effect of “because they are trans daaaahhhh”…”

        This is the kind of circular thinking which makes me insane. EVERYONE is included under the trans umbrella when they need to show how pervasive this phenomena is, but when confronted with desistors or detranstitioners (especially women), the response is that those people were just gender-non-conforming and not really transgender. There is zero acknowledgement that almost every situation can generate false positives and that, especially with irreversible consequences and CHILDREN, most thinking, caring human beings want to see a more robust diagnostic situation and time to really make sure these kids are NOT traumatized or have comorbid mental illness which require treatment, or are non-neurotypical, or, frankly, are just young and susceptible to social contagion.

        It also boggles my mind that the current leaning is to run, headlong, into hormonal and surgical intervention instead of trying less-invasive methods for people with dysphoria to see if some of the discomfort and pain can be alleviated without causing massive damage physical damage to completely healthy tissue, if possible. This idea that a healthy body is not important and that massive physical interventions are no big deal is incredibly short-sighted and doing it with children/teen (especially with girls, who have almost zero research, especially with the sudden-onset cohort) seems irresponsible and unethical.

        Liked by 4 people

      • What I think is going on with the natal males is different but also the shift in culture is playing a large role in what is happening. Medical and social transition is only one possible outcome of AGP fantasies, and used to very rarely happen with young people. It is on a spectrum of severity, and also often co-exists with desires for women. There is also evidence that culture influences how people identify and express these fantasies but not the fantasies themselves.

        So, I do think what is different now is that the culture has shifted to the point where many more people of this category are transitioning than before, because that is the preferred outcome culturally. I think psychological and cultural factors both influence what happens with people with these fantasies, but once they exist they cannot be changed.

        This makes things much more complicated when working with natal males, because you cannot change these fantasies, additionally there is a strong age-component to the effectiveness of gender treatments for natal males, so if someone is going to undergo these treatments it is probably preferable for them to undergo them earlier than later. If someone is going to transition MTF it is probably better for them to do it at a young age than at midlife. Still, there are probably people that will undergo this process in this age and time, that might be happier without it. The costs and benefits should be examined carefully.

        No one really knows what the psychological factors are that influence people into one path or the other. I present my own ideas about this on my blog, but they are speculative (though informed by research, general psychological knowledge, time in the community and personal experience). We really need more research into this, but it would be challenging research without the politics, and with the politics even more difficult.

        The other thing that makes it difficult to talk about this, is it leads people to leap to the conclusion that people are transitioning because it turns them on, and that is not accurate. Sexuality plays a role but it is not a direct effect. People take drugs which greatly reduce their libido and their identities persist. Actually, relief from these fantasies is often cited as a positive effect of medical transition. Transgender identity of this type does have something to do with sexuality, but it is not reducible to sexuality. The same way that gay or heterosexual cultural identities have something to do with sexuality, but aren’t reducible to sexuality.

        Also I agree with James Cantor that shaming this type of sexuality actually contributes to more people adopting these kind of identities, which is something that gender critical people do sometimes. For many people I think the best outcome would be to accept their fantasies without shame, and then decide whether to keep them as fantasies, or enact them with consenting partners or not , undergo medical and social transition or not according what leads to the best possible lives for themselves, balanced with the impact on others of their decisions. This is something that easier said than done, as many people are in a lot of distress and trying to figure out how to relieve that distress. This is why I do not oppose gender transition absolutely despite my own negative experience.


      • I wanted to confirm what thirdwaytrans said, based on my own observations of MTF I have known. The first person I knew who transitioned, starting around 2010, had previously identified as a transvestite. When I met her, she seemed happy and comfortable with this label. We were college students at the time, and she became embroiled with her parents in a conflict over her cross-dressing after they discovered women’s clothing that she had left at their house. Her parents wanted to set rules for how she could dress and wear her hair in public and rebelling against this became an important part of how she asserted her independence as a young adult. When she looked to the internet for support, she found everyone seemed to be saying that if she felt the way she did, that meant she was a transwoman and needed to transition. She was convinced that if she didn’t transition in her early 20s, she would never be able to pass. This also gave her another chance to re-invent herself beyond her parent’s control.

        Our friend group supported her as a transvestite and as a transgender woman, but identifying as transgender brought more social support from the LGBT organizations on campus. I can understand why she wanted to rebel from her parents and assert herself as a new person, but as her friend, I wish I had asked more questions. It doesn’t seem like she has been very happy with her life in the 7 years she she has began her transition, but she is locked-in to her identity as a woman. She’s a bit of an SJW and often complains about how men are oppressors on social media. I think it would cause cognitive discord with her if she were to re-identify with what she sees as an oppressive group.

        A lot of MTF seemed to be involved with social justice circles before coming out, and sometimes I think these groups use dehumanizing language to talk about males and male sexuality. I wouldn’t be surprised if this was a tipping point for some males when trying to decide how to best address AGP feelings.

        Another person I knew used to identify as gender-fluid. This identification seemed to stem from some public cross-dressing, and realizing they liked being seen as a woman and getting compliments on their performance of femininity. But after talking with a transwomen realized they had the same sorts of feelings. This convinced the person that medical transition was the only correct was to express those feelings.

        Personally, I wish these would-be MTFs would ask us “cis” woman what it’s like to be a woman, instead of just asking each other. I think we’d give them a broader perspective.

        Liked by 3 people

  19. Drs. Blanchard and Bailey, thanks for speaking out in our community! It’s a relief to know that some experts in the field are taking parents like us seriously.

    Constantly hearing the drumbeat of “you can either have a live son, or a dead daughter” wears parents down. I think many of them succumb to the pressure and OK medical interventions. They’re desperate to save their child’s life. So I greatly appreciate you sharing research that reveals suicide is not as inevitable as trans activists (and most mainstream media) claim. Both of you have probably put a lot of parent’s minds at ease.

    My daughter no longer identifies as transgender, although she did for about a year. Her identity came on suddenly after a traumatic experience. She was also heavily influenced by trans social media. During this time period, she felt absolutely miserable and hated her body. I remember feeling a lot of pressure to capitulate to her demand for testosterone. And there were a couple of professionals I interacted with–one a nurse, one a therapist–that recommended I immediately affirm her as my son. According to them, my daughter’s trauma, social media influence, and lack of history of gender dysphoria were irrelevant.

    Anyway, I’m fortunate that with some effort, I was able to find another therapist for my daughter. Their sessions primarily focused on her underlying issues, not gender. After several months of therapy, she eventually discarded her trans identity and has since then (about two years now) consistently embraced being female. She is now much more comfortable in her body.

    I resisted the pressure to go down the path of medical transition with my daughter, but I really do understand why parents cave into it. There is so much “support” for parents who transition their kids. And barely any support (besides this website) for parents that want another option.

    I’m hoping your expertise and credentials will lend credence to the experiences of parents like us. There are many of us who are waiting for more professionals to wake up and realize that our concerns are valid. Sudden onset gender dysphoric young people need more options besides affirmation-only care.

    Liked by 11 people

  20. I have been thinking of e-mailing these two researchers in the past to ask some questions, but I figured they probably get that all the time, so I didn’t. And now when there is a chance it feels like all the questions I used to have, at least the good ones, have disappeared out of my mind.

    I do have some general things I’ve wondered about (hopefully it’s allowed to stray from the article). Would be grateful for some replies. Hopefully my English will be sufficient, it’s my third language.

    1. Is the concept of erotic target location error just a concept? What evidence is there? I’ve always wondered how something can function and not function at the same time (since most AGPs do seem to want relationships, mostly with women).

    2. Has there been any studies done on sex change regret? My observation has been that (almost entirely from newspaper/blog stories) the most common form of sex change regret seems to come from those with autism or some other disorder (not AGP/homosexual), then a close second are AGPs that realized the reality of being a woman isn’t as fun as the fantasy, and the least common would be homosexual transsexuals, that mostly seem to detransition due to family pressure/negative reactions. Would that observation be close to the truth?

    3. Could there be more than one “type” of homosexual transsexual? When reading about HSTS I’ve noticed there are many different narratives, another thing I noticed it that it seems HSTS seem less likely to want to lose their penis, probably due to some AGPs fetishization of having female genitalia. Anyhow, the two main narratives I’ve noticed among homosexuals is those wanting to be girls from a really early age (who seem more wanting of reassignment surgery), and those that identify as gay boys/men for a time until they transition in their late teens/early 20s, the later type are feminine as well, though do not have seemed to experienced the same kind of “dysphoria”. Are AGPs more likely to get the operation?

    Then there is the whole matter of self-identification, some HSTS seem to be entirely against being identified as anything other than women, while others say they realize they aren’t women, call themselves all kinds of things, even “proud tranny”. Not that the other type doesn’t realize their genotype also, it just seems they have a stronger need of being accepted as women. (I’m just referring to people actually having taken hormones and so on, and not drag queens/transvestites).

    Then ofc there is those with financial incentives and so on overall, which might fudge the numbers a bit.

    I’ve also wondered why there seems to be more HSTS in places like South America, Thailand and so on. Easier for men to be feminine is some cultures?

    4. I was wondering what you two think of the recent neuroimaging science by such as Rametti, Savic and others? It seems really interesting to me all the science coming now on hormonal effects, markers, neuroimaging etc. Thinking of studies like these ones specifically:

    Is there any other recent research (especially on homosexual transsexuality) that touches more on the biological side of things? Such as neuroimaging, hormonal studies etc. Even hormonal effects on gendered play.

    5. Three questions on the nature of homosexuality (specifically male)
    1. Could homophilia exist? I’ve read a lot about the switch from “philia” to “sexuality”, and myself I don’t question that homosexuality is inborn, but I also wonder if homophilia as a paraphilia could exist in addition to “inborn homosexuality”? I’ve noticed that there seem to be a lot of self-identifying “straight” men (in relationships with women), that enjoy gay sex while at the same time claiming not to be attracted to men, some might say these men are closeted, though I wonder. Could Blanchards autogynephilic “pseudo-bisexuality” also account for other forms of bisexuality? Some people do seem to fetishize body parts (not as in possessing them but enjoying them), simply said, if there is a foot fetish couldn’t there be a penis fetish lol? Personally I’ve never met a bisexual so far without a strong preference for either sex.

    2. Could there be a non-genetic influence on twins where one is homosexual and the other one isn’t? Some biological process that had an effect one just one of them?

    3. From what I understand studies on male homosexuals have shown that they generally are feminine in childhood (non-transsexual homosexuals). Even them that seem very “manly” have feminine traits, why do you think there is such a desistance in femininity? Ofc, women don’t seem to be as feminine as when they were children when older either, I’m just wondering if this suppression is entirely cultural, or what’s going on here? I do remember reading about conversion therapy in the past, and very often they tried working on mannerisms, such as helping boys to “walk and talk like men”. Neuroimaging studies seem to show them to be very similar, are these just different narratives/life choices? Shame seems to be a strong motivator to change behaviour.

    6. In Blanchards maternal immune hypothesis (
    I assume that miscarriages/abortions would also contribute to this effect? Take notice I haven’t read that much on biology yet, so I was wondering if even things like blood transfusions or transplants could also contribute to such an immunization. One day I am gonna have to read up so I can understand it better, I know what an “antigen” is, “histocompatibility” is entirely lost on me though.

    7. Disagreement between Bailey/Blanchard? I was wondering about this one, in Baileys book (The Man Who Would be Queen) you seem to state that homosexual transsexuals transition due to sexuality and you refer to Blanchard, but reading Blanchard he doesn’t seem to claim that it’s entirely due to sexuality. Was wondering about this discrepancy. (Thanks for making the book free btw).

    Sorry for all the questions, I’ll probably remember 100 more of them once I’ve pressed “post comment”. And once all this is over I will remember the “good ones” I had when reading certain research.

    Thank you for any responses!


      • I’m sorry for being such an annoyance =P

        Two of the things I have previously wondered about were kind of resolved by this article.

        “Why Is Gender Dysphoria Associated with Mental Problems, Including Suicidality?”

        For example, one thing I noticed with all the studies looking at mental health problems were that they didn’t seem to use typology, and rather put everyone in one big group, some studies even included anyone self-identifying as gender non-confirming or crossdressers etc. Based on narratives from those living with autogynephiles (such as former wives, who are ofc not entirely unbiased), and other such things you can glean from the personal stories of AGPs, it does seem that they are higher in certain disorders, then if grouped together with HSTS that seems to fudge the numbers for HSTS. I would be interesting to see separate studies (not just referring to suicidality).

        Many of the studies that report high rates of suicide attempt doesn’t seem to make this distinction either or even have very good methodology. This Williams Insitute study seems popular in the newspapers:

        But even the researchers themselves point out it’s weaknesses (and they hardly even mention different types).

        I think it will be hard to have any proper discussion on anything related to suicide or other mental health issues until the proper studies (as in methodology) are in.

        Do you doctors see it as a problem that there isn’t separation by type in studies like these?

        It is realistic to assume right that if one (AGP) is a developmental disorder, which I hear can be caused by a number of things, AGPs should be higher in other developmental disorders. While if homosexuality is caused by hormonal influences/genetics/etc, and not being a “developmental disorder” in the same way, we should see less of secondary disorders?

        “No published study has focused only on childhood onset cases” <—That's the big dynamite in your article in my opinion.

        Thanks again for being here!


    • Nicholas,

      I’ll try to respond to at least some of your questions.

      1. “Erotic Target Location Errors” and “Erotic Target Identity Inversions” are best considered theories, but they have some awfully surprising/fascinating (and I think compelling) support. Two articles that use the concept are Anne Lawrence’s, on BIID:

      and ours on autopedophilia:

      2. Ray Blanchard has conducted research on sex change regret. It is not common, although it happens. More common among probably autogynephilic cases. Someday I want to write an essay entitled “What is a mistake?” I think that “not actively regretting gender transition” is a pretty weak criterion for success, although regretting certainly signals failure.

      3. I have seen examples of both of the “types” of HSTS you mention, but I doubt they differ in a typological way. More likely intensity and life circumstances.

      (No number) “I’ve also wondered why there seems to be more HSTS in places like South America, Thailand and so on. Easier for men to be feminine is some cultures?” Culture seems to play a large role in what happens to very feminine androphilic males. (They are easily identifiable visually as not natal females.) In Samoa they have taken on female personas and kept their penises. In some parts of east Asia, they seem increasingly to transition and be difficult to distinguish from natal females. (I suspect it has been hard to be a very feminine male in Korea, Thailand, and Japan, although this is my speculation rather than knowledge.) The question you ask could be the source of a really fascinating dissertation.

      4. The neuroimaging studies you mention are largely exploratory (there is no clear a prior hypothesis) and have small samples. So I’m skeptical until they have been exactly replicated.

      5. Regarding “I also wonder if homophilia as a paraphilia could exist in addition to “inborn homosexuality”,” certain paraphilias increase the likelihood that a man will engage in bisexual behavior and identify bisexually. Autogynephilia is one (Blanchard has coined the term “pseudobisexuality” to denote the gratification that some autogynephilic males get in being desired by men.) Masochism (being forced to engage in homosexual acts) is another. Anne Lawrence wrote a paper on a man with autoandrophilia, and I have wondered if this man is at all like other androphilic men. I suspect not.

      6. For Ray

      7. I don’t think Ray has explicitly disagreed with me on this, but I do think the idea is mine that the decision to transition among androphilic natal males is influenced by social feedback about how they appear as women and how well they’d do on the mating market after transition. Some I’ve interviewed actually told me this was true of them. Others said it wasn’t.

      Liked by 1 person

      • @Micheal Baily
        “I suspect it has been hard to be a very feminine male in Korea, Thailand, and Japan, although this is my speculation rather than knowledge”
        In Asia? There are certainly pretty heavy restrictions as to role (salaryman etc), but Japan doesn’t really have quite the same ideas about masculinity to begin with, with pretty/beautiful males (bishounen/biseinen) having been praised and seen as attractive since at least the time of the Genji (which includes homosexual acts/homoeroticism, too). Playing with gender, even just as a fetish or prostitution/sex work thing, goes back a way in Japanese culture (eg. in shunga erotic prints, which some photobooks featuring crossdressed men might be seen as a tamer modern version of). While the Japanese press may sometimes like to fuss about the idea of ‘herbivore men’ who aren’t sufficiently masculine to go after women (something rather overstated in the Western press), the issue seems primarily the concern over falling birth rates (might be less of a problem if houses were affordable). Fashions among young men, including music artists (this goes for Korean pop, too), are often enough ‘feminine’ by current US standards. Here’s an example (yes, I believe one is wearing a skirt, which is a fashion):

        They might not exactly wear that to work, of course (that’s the same for women), and street fashion is only so representative. But there is at least a place to, in the big city at least. I wouldn’t want to overstate the prevalence of geek (otaku) culture because it’s not like you can get just away with being an otaku without being seen as weird any more than here, but cosplay culture provides this as well, and male cosplayers may dress as female characters (Example from China: Older Japanese people might not always approve of what the kids are up to, but then, they basically never do anyway.
        The cultural appreciation for cuteness can provide space for femininity, too.
        While Japanese TV is admittedly often amazingly terrible, crossdressing male models have been on variety shows, too. It doesn’t mean acceptance is anything like widespread, obviously, but progress seems to be being made, and there may have been niches for longer, though not always ideal ones.

        Really the US at present seem to take notions about masculinity to an unhinged extreme, from a British perspective as well.


    • I’m going to answer Nicholas’ questions – or at least some of them, there are a lot – without reading Mike’s responses.

      1. The relation between autogynephilia and gender dysphoria is complicated. There are many inherent contradictions, and individuals resolve those contradictions in different ways. I can give an example with quotes from Magnus Hirschfeld, whose description of heterosexual transvestism is the forerunner of my description of autogynephilia. In one place he wrote, “They feel attracted, not by the women outside them, but by the woman inside them.” In another place, however, he wrote, “They feel attracted, not only by the women outside them, but also by the woman inside them.” In other words, Hirschfeld must have recognized that the direction of sexual interest toward self-as-woman is a matter of degree.

      2. There have been a few studies of postoperative regret. The published studies are now rather old and might not apply at all to the current wave of transitions in adolescent or young adult females. I found evidence that nonhomosexual (i.e., autogynephilic) male-to-females were more likely to express regrets or second thoughts, but Anne Lawrence did not confirm that result in her study. I have the impression (not recorded in my published study) that nonhomosexual/AGP transsexuals sometimes experience regret when they become romantically involved with a new woman or become re-involved with a former wife or female partner.

      3. There may have been a shift, over the past 30-40 years, from the majority of male-to-female surgical reassignments being homosexual transsexuals to being autogynephilic transsexuals. It is hard to tell because the diagnoses of erotic preference in early studies may not be reliable or reported at all. There is certainly a cultural difference, as Anne Lawrence has shown: Autogynephilic transsexualism is common in Western countries but is rare in the East (where it might simply be more closeted or repressed by different cultural norms).

      4. In a previous Comment, I gave links to four articles on neuroanatomy, all of which are open access. I also stated my opinion on the interpretation of the existing imaging research.

      5.1 I’m not sure I understand these questions. As far as I am concerned, the phenomenon of “pseudobisexuality” in autogynephilic men is beyond doubt. I give a clinical vignette in this chapter: The more interesting question is the prevalence and qualitative nature of bisexuality in men with male gender identity and no significant paraphilias. I never studied those interesting individuals in my research career and I am ignorant but open-minded about them.

      5.2 Yes, there could be a biological explanation for discordant sexual orientations in monozygotic twins. For example, their intrauterine environments could be slightly different.

      5.3 I don’t think anybody has studied the actual mechanisms of desistance in feminine prehomosexual boys or masculine prehomosexual girls. The mechanisms could be anything from simple cognitive maturation to social disapproval of cross-gender behavior. Social class seems to be involved, but social class could be confounded with genetic differences in IQ or who knows what.

      6.0 Miscarriages or abortions could certainly contribute to the fraternal birth order effect, but such information about maternal history is hard to get from adult sons. In one recently published study, it was obtained directly from mothers:

      7. I don’t think I ever wrote that the goal of gender reorientation for homosexual MTFs was to pursue heterosexual men as romantic or sexual partners, although that position is often attributed to me on the internet. It is likely true that most homosexual MTFs find heterosexual men more sexually attractive than homosexual men. However, there exist many homosexual men with *normal* male gender identity who also find heterosexual men more sexually attractive, but they would never consider sex change surgery in order to pursue them. I have interviewed many homosexual MTFs who were so feminine that they could not hide this if they tried, and I think that their desire for gender reorientation has a lot to do with the hope of being more successful socially in the female role.


      • Thank you to both you Drs. for responding! I’m already reading up and learning new things. Some responses:

        Dr Bailey:

        1. I had actually never heard of autopedophilia before today, I knew people with one paraphilia (like autogynephilia) often have other paraphilias also, but that one was new to me. For example, the first time I saw Stefonknee Wolscht, I was thinking “autogynephilia”, and when I heard the claim of being a 6-yearold girl, I was thinking “paraphilic infantilism”. Is paraphilic infantilism something similar to autopedophilia? Though I’m hearing that Stefonknee has sex with his/her “parents” and taking on a childs role, so maybe that’s autopedophilia then. (Yeah, I know I am not qualified or able to diagnose people, I just start to ask questions when I see a grown man claiming to be a 6-year old girl, and I’m naturally curious =P). From what I can read the difference between the two seems to be that infantilism refers to an infant-like state, though in similar articles it says it refers to age play of “any age”. Then again, on this one I was looking at Wikipedia, and Wikipedia once told me the Battle of Camden was an American victory.

        I still have a problem with understanding paraphilias though, hormonal effects on the brain in utero is one thing to understand, though I do not understand a developmental disorder that can make someone sexually interested in the activities covered by these philias we are talking about. Maybe I need to start reading up more on the topic. Any tips on what to read to start forming a basic understanding of paraphilias? How they are formed etc? Has their been any neuroimaging studies done on pedophiles and those with BIID? How are they related?

        3. “The question you ask could be the source of a really fascinating dissertation.”
        Yes it really would. Overall I find sexuality research interesting, there seems to be so many unanswered questions.

        4. I often hear the small sample argument, though I wonder if it’s fair to demand larger samples? Since they were already divided by type, and then these recent studies had hormone controls unlike some previous studies by Zhou for example. I also wonder about this, because then there are other studies with not much larger sample groups that seem to be taken seriously, like Richard Greens study for example. I also thought the studies on non-transsexual homosexual males done in Sweden were showing similar results?

        7. It’s possible that I read an article about someone “refuting” you by saying you claimed Blanchard said things he didn’t say. It’s a while since I read the book, so couldn’t remember 100%. And yeah, those transactivists (no names need to be mentioned since most people know who they are already), behaved/behaves appallingly.

        Dr Blanchard:

        4. I’m actually quite surprised, since it seems to me Rametti and Savic confirmed your typology? But yeah, the results need to be reproduced, though I thought there were such studies on non-transsexual male homosexuals done in Sweden that showed similar results to Ramettis study? Can we really expect large sample groups with hormone controls and all that? Are these results not what you expected to see? I was quite excited to see studies with hormone controls existed, because I was a bit doubtful about the studies I read before them which lacked hormone controls. The study Rametti did on female to male transsexuals is a separate study right? That one showed results one would expect, just as the study on male to females.
        Not that science is based on confirming mine or anyone elses expectations.

        5.1. I actually read the article you linked to before, it was very interesting. And yeah, I did mean those men who don’t seem to have any paraphilias, yet claim bisexuality, since my observation has been a strong preference for either sex, but there are always things that makes you wonder. I hope someone will study the phenomenon someday. There are even those that have sex with men and do not claim bisexuality.

        5.2. I assume you mean studies like by Gringas and Chen:

        It’s interesting stuff, I just started reading up about it. (It would be lazy for me not trying to find something on my own before I asked you about it). Will read up more on this. Always fun to learn something new.

        5.3. It seems to me a very key issue in all of this. My understanding was that you and others have certain theories on why some desist? Like self-selection. I hoped you might have some on this one also, but yeah, pressure by society and maturation were my guesses as well, and they make sense.

        6.0. Interesting, will take a look at it.

        7. Yeah, it’s likely that I read something by someone, and then mixed things up. Some people have “refuted” Bailey by saying he based his findings on your research, and then saying that you never claimed/found such a thing to be true. It seems a lot of things are attributed to you on the internet. Some with very very loose basis as in taken out of context. It’s from all this controversy though that I’ve recently learnt to check who is behind studies and what their agenda is, in the past I mostly looked at the methodology. The scary part is that some of these distortions or lies work very well, I just remembered that Bailey stated his theory, that he referred to your research in his book, and that you didn’t claim such a thing in what I’ve read in your publications, and a few comments about it made me think that Bailey had actually used you as a reference for that theory, because why would they lie about something so easily disproven?

        Thanks again to both of you! I will look some more at all the studies once my brain is less tired. Need to power nap.


  21. Thank you for writing about this important topic. When my teen daughter suddenly announced she was transgender (with absolutely no “warning signs” throughout childhood), my common sense told me this was the result of her Aspergerish-thinking, not fitting in with peers, attending a school where trans identity was fairly common, and living in an increasingly trans-affirming culture.

    After one year (when what I assumed was a phase did not pass), I consulted with a gender therapist. His serious and authoritative citing of suicide statistics (“the biggest predictor of your child’s potential suicide is the lack of support by parents”) persuaded me to support her social transition. Consultations with other therapists — including those who specialize in autism — continued to use the threat of suicide to scare me into submission.

    Unfortunately, I listened to these “experts” and my daughter’s identity as a boy became more firmly entrenched. It wasn’t until last December that I discovered 4thwavenow, and realized I was not the only one who had doubts.

    Thank you again, Drs. Bailey,. Blanchard, and Zucker. Gender therapists’ affirmation-only approach is destroying lives, including mine and my daughter’s. Meanwhile, the mental health community is blinded by politics leaving parents like me nowhere to go for professional support.

    Liked by 8 people

  22. To Darkest Yorkshire: I am very skeptical of Vilayanur Ramachandran’s take on apotemnophilia. I think he is the proverbial person with the hammer who sees nails everywhere. I think his theory is wrong and suspect his therapy won’t work in the long term. I am open to being persuaded with data, however.


  23. To fightingunreality: You raise some real issues. I think it’s hard on wives and children when husbands/fathers become women! And in today’s climate, no one sympathizes with anyone but the transitioning men (to transwomen). A terrific book exemplifying all this is “Sex Changes: A Memoir” by Christine Benvenuto. Although she does not name or recognize autogynephilia in her husband, it is there. What she does see is his selfishness and the unfairness of others’ applauding his decision and treating her as an embarrassment to their progressive worldview that she is unhappy with it.

    I think a family man’s decision to transition is very like a decision to divorce a wife and leave the family. (I stand by this even if the man wants to stay married after transitioning, assuming the wife didn’t agree to the plan before marriage.) When as often happens, this is at mid-life, it’s very much like a mid-life crisis. I do not think we should forbid such decisions, and I also don’t think we should shun those who make them. But I also don’t think the decisions are especially admirable. Nor do I think the families should be left in the cold.

    Liked by 3 people

  24. To GILAW: I think the knee-jerk defense of bathroom rights for the transgender is a form of unthoughtful virtue signaling. The transgender have more pressing issues than universal bathroom access, and there are reasonable objections to it. My mind is not entirely made up on the issue, but I have certainly been criticized for not taking the knee-jerk virtue signaling position.

    Liked by 7 people

  25. Responding to Leo: As stated your objections are too absolute. Sure there is a chance of regret, and in fact Ray and I are collaborating on a website aimed at reversing the pro-transition zeitgeist. But some gender dysphoric individuals suffer for years before transitioning and are happy and without regrets. Some even wish they’d done it earlier. I suppose my bias is toward letting adults make decisions, and slowing down non-adults. I’d encourage both to think about transition a long time before going there.

    Liked by 4 people

  26. Nervous Wreck: A book I liked about depression is “The Depths” by Jonathan Rottenberg, a psychologist who has struggled with depression himself. It has some new and sensible ideas.

    Liked by 2 people

  27. I believe there are some people have who completely organic sex dysphoria, unrelated to gender roles, autism, fetishism, or anything else, and that these people are best treated with hormones are surgery. But they’re an extremely rare and small group of people, and the vast majority of trans-identified people have something else going on causing their trans-identification.

    And I also think that a lot of the non-organic trans people would always have been on the fringes of society and more prone to suicide, regardless of time period or culture–if they weren’t, they wouldn’t be trans now.

    If you look at the paper about suicide, 69% of those surveyed have experienced homelessness, and the trans people who are most likely to commit suicide are non-white, not well educated, and impoverished. Even if they decided to live as a gay man/lesbian, a lot of them would still have really awful lives. The middle class, white, suburban trans boy that I think constitutes the majority of readers’ children does not fit the profile of the average suicide attempting trans person. Which is partly why I don’t buy the ‘suicide or transition’ argument.

    Liked by 3 people

    • >The middle class, white, suburban trans boy

      Would sink or swim depending on their situation. Many parents (especially religious ones) kick their children out for being trans. This is neither a middle class nor white issue. Mid-transition you’re extremely reliant on your parents, or whoever else, because you’re in a state where presenting yourself to other people is extremely difficult.


  28. This. “Although this possibility has not been directly studied, reporting suicidality may sometimes be a strategy for advancing a social cause.”

    Nothing demonstrates the validity of this statement about using suicide to advance a social cause more than the current political fight over transgender military service. For years, most Democrat or otherwise liberal leaning media outlets have been including trans suicide statistics in nearly every transgender related article they’ve published.

    But now that these same outlets suddenly find themselves having to make the case that trans people are fit to serve in the military, because of Trump’s ban. In doing so, however, they’ve suddenly reversed course and no longer include these statistics. Because of how discrediting and toxic they are in this context.

    The reason why these media outlets are now backtracking on the statistics is clearly obvious: they simply can’t make any serious case that a transgender population group with a 41% attempted or completed suicide rate is fit to serve. But as cited in this article, they previously were able to use this strategy to garner sympathy and sway political outcomes.

    As I’ve summarized it previously: be careful what you advocate, because it just might come back and bite you in the butt.

    Liked by 5 people

  29. Drs. Blanchard and Bailey,

    I am interested in how language fosters identities and fuels social movements.
    I am curious if you read this article in a recent Harper’s Magazine?

    This article, “Sons and Daughters–The village where girls turn into boys” is about the village of Saladillo in the Dominican Republic. This village has a high rate of the intersex condition, 5-alpha-reducatase deficiency. Children with this condition are genetically male but are most often raised as girls, as they have ambiguous genitalia. Not surprisingly, with the onset of puberty, these girls (no breasts or curves here) almost always reclaim their male identities.

    The author of this piece seems to intentionally equate this intersex condition to what is happening with many of our girls in the states (who are not intersex) and have a sudden onset of gender dysphoria in adolescence and wish to artificially appear male by injecting cross-sex hormones, and possibly progress to surgery. The author seems to confuse a biological spectrum (intersex) with a gender spectrum.
    The author, Ms. Topol, states the village is “laboratory of gender fluidity”.
    She concludes: “Indeed, my questions, primed by the conversation about intersex in the United States, often left people confused. Nobody cared who used which bathroom.”

    I was left flummoxed by this article.

    Liked by 1 person

    • Transsexuals have long attempted to understand or explain their conditions as a type or analog of intersexuality. The most recent version of this thinking is the idea of intersexuality at the neuroanatomic level. I wrote a comment (with links) about that earlier in this thread. It might be noted that intersexed people are not uniformly enthusiastic about being lumped with transsexuals. Many of them feel that their issues are quite different.

      It is now standard practice for journalists to take their cues about transsexualism from transsexual activists. That is about as sensible as asking cancer patients for their views on oncology. It results in journalists writing articles about “gender” that are mostly just hand-waving (often with a heavy dose of virtue-signalling). It is usually pointless to try to parse such articles, because there is no there there.

      Liked by 5 people

      • Please help me to understand how we got to the current state of affairs where a young adult 18-year-old needs absolutely no medical & mental health diagnostics and period of time for counseling and can go to an informed consent gender clinic and receive a prescription for cross-sex hormones in one visit. You are aware this is happening, right?

        This goes way beyond only journalists listening only to transsexuals.

        Today’s affirmation-only and informed consent model were approved with huge influence from the transsexual community, correct?

        Liked by 5 people

  30. In response to SunMum:

    “No mother can say that their son’s trans identification is NOT AGP.”

    If a boy has been pervasively, persistently, and conspicuously feminine from early childhood up to the time he explicitly announces that he is transsexual, then it’s a pretty safe bet that his orientation is homosexual and not autogynephilic.

    “Males with autogynaephilia usually seek estrogen treatment to eliminate this effect.”

    I don’t think the desire for, or response to, estrogen (or any other testosterone-lowering medication) is a very good diagnostic for autogynephilia. It is an old idea, going back to the 1970’s, that hormone administration produced very different effects in “transvestites” (i.e., heterosexual fetishistic cross-dressers) and in “true transsexuals.” This could supposedly be used as the basis for differential diagnosis. I don’t think it works.

    Liked by 2 people

  31. According to Drs Bailey and Blanchard then this (‘Up to 50% of trans people have actually attempted suicide at least once in their live’) is all a lie.

    From the ‘Australian LGBTI People Mental Health & Suicide’, 2013

    Suicide and Self-Harm:
    • LGBTI people have the highest rates of suicidality of any population in Australia.
    • 20% of trans Australians and 15.7% of lesbian, gay and bisexual Australians report current suicidal ideation (thoughts). A UK study reported 84% of trans participants having thought
    about ending their lives at some point.

    • Up to 50% of trans people have ~actually attempted~ suicide at least once in their lives.

    • Same-sex attracted Australians have up to 14x higher rates of suicide attempts than their heterosexual peers.Rates are 6x higher for same-sex attracted young people (20-42% cf.

    • The average age of a first suicide attempt is 16 years – often before ‘coming out’.

    • Rates of almost all types of violence are highest against trans people. Approximately 50% of adult trans Australians experience verbal abuse, social exclusion and having rumours spread about them. A third have been threatened with violence, with 19% having been physically attacked (and a similar number reporting discrimination by the police), 11% experience obscene mail and phone calls and damage to personal property. 64% modify their behaviour due to fear of stigmatization and discrimination.
    49% of trans respondents to a NSW study reported having been sexually assaulted.

    Nice to see them ‘helping’ with this issue:
    • LGBTI people can also internalize homophobia and transphobia: they are socialized in the same environment as their peers, thus receiving the same negative messages in relation to sexuality, sex and gender diversity. The vast majority have been told directly and/or via more diffuse ‘public opinion’ that they are not ‘normal’.
    The lack of visible positive role models and difficulty accessing affirming peer support can hinder the development of positive self-concepts, self-esteem and resilience and cause significant mental distress.

    • ‘Coming Out’ refers to identifying ones self as LGBTI. Lesbian, gay, bisexual and trans people often go through a process of questioning their sexual orientation and/or gender identity

    ****which they may not disclose to others for some time, if at all. ****

    This is sometimes referred to as ‘coming out’ to yourself. For many people there is stress associated with coming to terms with one’s sexual orientation, gender identity or sex identity and the potential impact of associated life changes and (feared actual) experience of discrimination.

    Research shows that the majority of first suicide attempts by LGBT people are made prior to coming out to others.

    Suicide attempts by trans people are usually made before the person has engaged in any gender-related treatment, counselling or therapy.

    • Lesbian, gay and bisexual Australians are twice as likely as heterosexual Australians to have no contact with family or no family to rely on for serious problems (11.8% v. 5.9%).
    Figures are likely to be even higher for trans people. Many LGBTI people are more likely to seek or receive primary emotional support and health information and advice from friendship/peer support networks, in particular LGBTI friends, sometimes referred to as ‘families of choice’.

    But just keep stopping them and making them suffer ….because it makes YOU feel better, never mind about burying the bodies.
    • For some transsexual people, access to medical interventions to affirm their gender of identity (eg realignment surgery, hormones) represents, quite literally, a matter of life or death.

    Certainly, a 2012 UK study showed that those trans people who wanted “gender reassignment or transition” but were as yet unable to access it and those who were unsure whether or not they wanted to had the lowest rates of life satisfaction. Most trans people who had undergone such a process reported being more satisfied with their lives since then (70%), with improved mental health (74%) and lower rates of suicidal ideation (thoughts) and attempts (63%).

    The 2% who reported being less satisfied with their lives post-intervention explained this in terms of experiences of transphobia, including loss of family, friends and employment, and/or poor surgical outcomes.

    There are a range of barriers to accessing such medical interventions, including approval from psychiatrists and high financial costs (with simultaneously reduced economic opportunities).


    • LisaM, your comment went to the spam folder because of your history of hostile trolling of this site. Nevertheless, we will publish just this one, to allow Dr. Bailey or Blanchard to respond. However, we will not approve another comment of yours until further notice, so please don’t spend time composing another.

      Liked by 4 people

    • Lisa Mullin responds to our post with a list of survey findings of the kind we address in our essay. It is certainly inaccurate to assert, as she does, that we dismiss such findings as a “lie.” But it would require reading our essay, of which she appears incapable, to understand why those findings do not lead to her preferred conclusion that more and more children should gender transition earlier and earlier. Perhaps she can bear to read one sentence we quoted, from a researcher of the liberal Williams Institute:

      “….we should be especially careful not to extrapolate findings about suicide attempts among transgender adults to imply conclusions about completed suicide in this population.”

      Mullin’s contribution here is consistent with my interactions with her on the WPATH Facebook page, which I recommend to anyone wanting to evaluate the scientific quality of the pro-transition side (or for that matter, the idea that gender transition is good for mental health). Mullin et al. may think they’re saving lives of gender dysphoric children. I think it more likely that Mullin/WPATH are teaching the children to enact suicidality to get what they want now (and are likely to regret later).

      Liked by 10 people

  32. Trans lobby groups often argue that trans youth are disproportionately affected by depression or suicidal thoughts and must therefore be treated with gender affirmative care in order to improve such mental health issues.

    Have you any opinions on trans youth with depression/suicidal thoughts being prescribed GnRH analogues such as Lupron, of which – from what I’ve read (studies linked below) – depression and suicidal thoughts are noted side effects?

    Is it possible that the hormone blockers themselves are actually worsening (or even instigating) these issues?

    Liked by 3 people

  33. My mind is just overwhelmed with this information. As a volunteer for a suicide crisis line in the past I knew to take my daughters online threats seriously. However I am also aware that she could be suffering from PMDD as her self esteem plummets the week before she menstrates. I have noticed this trend in her moods for about 5 consecutive months. My question to the esteemed experts is: How much of a factor could a possible diagnosis of PMDD play in her sudden onset dysphoria? Her twin doesn’t appear to display any PMDD signs. Just curious as I am so very new to this epidemic(my words). Also how much of today’s ‘freeness with hormone therapy’ based on the questionable research of Alfred Kinsey?

    Liked by 1 person

    • I don’t think Alfred Kinsey’s work had much to do with the current trend of medical and mental health professionals supporting gender reorientation at younger and younger ages.

      I think that many factors in the Zeitgeist have contributed to this. I would not even know how to list them in order of importance.

      One factor is the reframing of transsexualism as a human rights problem rather than a clinical problem by trans activists. This was reinforced by the ensconcing of trans activism within the Social Justice faction in the ongoing culture wars. Another factor was the media fascination with transsexualism as a new version of the Cinderella story (which always owed much of its emotional appeal to Cinderella’s early victimization). It is possible that the widespread legalization of gay marriage left a vacuum for social justice warriors to fill. The pioneering work on Lupron therapy by the Amsterdam clinic (who are fairly conservative in their use of it) became a model for clinicians with less experience and less caution. In the new attention economy, being the supportive parent of a trans child acquired a lot of cachet. In contrast, parents of desisting children have been generally unwilling to go public because they want to protect the privacy of their children. The internet, of course, intensified everything.

      Liked by 8 people

    • I’m not a doctor, but my trans-identifying daughter definitely has terrible premenstrual mood swings and painful periods. She is on a mood stabilizer and it doesn’t help much when she’s premenstrual and the first day or two of her cycle. She is currently also on the Pill and it seems to be helping with her premenstrual and menstrual mood issues and physical issues.

      I didn’t find ANYONE who would take my observations or concerns about this seriously until I got her placed in a therapeutic boarding school for girls and her female psychiatrist was receptive to her experience of painful periods and my observation of her mood swings leading up to them.

      I would suggest you look for a woman psychiatrist to discuss this with. A mood stabilizer might be appropriate or the birth control pill. Good luck.

      Liked by 4 people

      • My daughter has been on the pill due to painful periods and migraines since 9th grade. Since starting the pill (progesterone) she has been nauseous and more and more depressed and then transgender. I really feel the pill has harmed her by making her more depressed and very possibly causing the nausea. I say this because I had extreme nausea on the pill and during pregnancies….. just I realized that was the reason. I’m curious why no doctors ever consider that hormones may be making these conditions worse. And imagine how impossible it is to convince someone who is petrified of periods that something that stops them could be causing more harm than good. What a complicated web teenage years are.

        Liked by 1 person

  34. A friend in my writing group knew a family with a 16-year-old boy who point-blank told his parents he’d kill himself if he didn’t start taking estrogen pills. His parents put him on cross-sex hormones after this. It’s so emotionally and psychologically manipulative to make that kind of threat. I can’t help but wonder if he truly were already feeling suicidal, or if he thought he’d kill himself without hormones because that’s what his friends and social media told him.

    Liked by 4 people

  35. i personally think a lot , if not most, of these kids just have general dysphoria and have latched onto gender dysphoria because it explains their unease with themselves and their bodies. Couple this with Americas obsession with turning absolutely everything into a disorder and treating it with drugs. My faith in both the medical and mental health fields have really been shattered. We need to stop thinking everything has a quick solution. Most adults know that everyday life is a struggle. We need as a society to empower our kids with the right messages like working on body acceptance and pushing through uncomfortable feelings. I am not denying the existence of true gender dysphoria or any other mental health issue but I have become very worried about our countries obsession with diagnosing everybody with something. I think teen girls fall especially prey to this.

    Liked by 10 people

      • Jeez louise, that is a page about depression/anxiety.

        I personally could tick the vast majority of those boxes, right now.

        Maybe I just need T to make my life better.

        Liked by 5 people

      • Just for the record, the “8 signs of gender dysphoria” article and others on the “Genderanalysis-dot-net” site, are written by Zinnia Jones, who is a high-school dropout. Most self-diagnosed teen transkids who hang on his every word don’t know this, however. Zinnia Jones also videos himself doing all sorts of lewd things, and sells the videos as a source of income. “Camwhore” is a term I have seen used for him. A high-school dropout and self-pornographer is portraying himself as some sort of scientific, medical expert and influencing our kids to think they are trans, because it helps him, in his own mind, not feel so ashamed if he can normalize his fetish.

        What a world.

        Liked by 7 people

      • Sun, not to go into too much more detail here, but I would VERY strongly encourage your child, and you, to avoid content coming from “Zinnia Jones.” To put it mildly and obliquely, Jones is not a “well individual.” The material and ideas that Jones promulgates are not coming from a trained scientist, or even a high school (much less a college) graduate. And, Jones’ other activities, many of which can be viewed on multiple sites on the internet, are unsavory to say the least.

        I think there are probably many more websites where a person can get information about transition, whether those are medical sites, or even the major “LGBT” organizations, which would be highly preferable to Jones’ and not lead your child into dark places.

        Liked by 4 people

      • Zinnia Jones submitted a reasonable comment here a few minutes ago. The admins were considering posting it, but when we checked Jones’ Twitter feed just now, we decided against.

        Zinnia didn’t come to 4thWaveNow for honest dialogue, but to troll, and then go back to snicker on Twitter about “TERF moms” like a middle school boy, along with the other paragons of maturity and parenting wisdom on there.

        Interestingly, Jones thinks merely knowing about Jones’ porn persona is the same as imbibing its output.

        Let’s see: Would you trust the parenting advice of someone who tweets things like this ?

        And trans activists wonder why they’ve created a backlash.

        Liked by 6 people

      • Jones is exactly the type of person I was referencing at the end of my previous comment: someone whose “transgenderism” appears to be related to paraphilia, yet who positions himself as someone, by virtue of having transitioned, as having expertise regarding childhood gender confusion which he never experienced.

        The fact that he (with no consideration of his background & online behavior) is welcomed by online media as having such expertise is ridiculous. The reality that he’s having contact with & influence over children is downright appalling.

        Liked by 4 people

      • Very interesting article. Indeed, those are signs of general anxiety and depression. I could tick off all those boxes, too, and I could suggest more compelling reasons for feeling that way than the idea that I was “born in the wrong body.” This is a cult that preys on depressed/anxious kids and gives them a “quick fix” and a ready-made support group for them to deal with problems that actually have no easy solution, and for which they should, in most cases, turn to their parents for help learning coping mechanisms.

        Liked by 1 person

    • No.

      This is not based on mind-reading but on science (and some experience–see below). Evidence does currently not support the existence of more than two types (androphilic/homosexual MTF and autogynephilic/nonhomosexual MTF). That could change, in principle, but in the meantime there is lots of reason to doubt autogynephilia denial of nonhomosexual MTFs.

      My book, which provided the first popular science account of the two types of MTFs, was viciously attacked by some trans women whose histories were more consistent with an AGP picture than a homosexual picture. These included four who tried to ruin my life. Of these, Anjelica Kieltyka (Cher in my book) had as a man fetishistically cross dressed, including wearing a fake vulva while filming herself having sex with a male faceless dummy. Deirdre McCloskey wrote in her autobiography of having hundreds (or was it thousands) of episodes of fetishistic cross dressing. (She named the activity differently, but that’s what I’d call it.) Andrea James had written an email to Anne Lawrence several years before my book was published admitting her autogynephilia and describing Ray Blanchard’s ideas as “brilliant.” Only previously married with children Lynn Conway, who adorns her university webpage with pictures of herself in bikinis and asserts that fetishistic cross dressing is common (but to my knowledge hasn’t admitted doing it herself) has not outed herself for all intents and purposes. So how persuasive is denial of autogynephilia among even the biggest haters?

      Liked by 5 people

      • Is it John Moneys gender theory they are espousing now? I thought it had “died”, mostly supported by fringe academics in gender science and so on, and a little people here and there. Now I hear transactivists talking about how gender identity is shaped in early childhood but sexual orientation comes later, or basically a rehash of Moneys gender theory. Is there some scientist today they are basing their theories on? Or is it all just coming from autogynephilic transactivists? It seems gender theory is having a second coming.

        This also seems to be the dominant narrative, which is surprising.


  36. Responding to thehomoarchy: Persons such as yourself are especially valuable in changing the world. Unfortunately for you, you are also probably subject to more attacks, since you associated with both sides of the issue. (I don’t think that my side “attacks” anyone, though.) Please hang in there, with your good judgment and values.

    Liked by 3 people

  37. I am an AGP man, who medically transition and now is pondering if continue or not. I always read about “something else” as an option to transition or suicide, what is it? I Want another option, which is it? What is the option to transition.


    • You would likely find the information you seek at a site like The idea that therapy and mindfulness and other non-invasive techniques can help people who transidentify to decrease their dysphoria, if you are having dysphoria.

      If you are transidentifying because you think it is a sexually-driven situation, I believe that thirdwaytrans, a biological man who transitioned and presented as a transwoman for two decades (I recall) and then decided to identify as a feminine man, addresses that as well.

      Best of luck to you.


      • There are a lot of possible outcomes of AGP fantasies, ranging from full medical and gender transition, to low-dose hormone therapy, to cross-dressing, to just accepting that you have fantasies.

        I found that once I worked through a lot of other issues I let go of that female identity and was able to be comfortable being a male in the world. I really wish I had done that first, as I am faced with a lot of challenges that I might not have otherwise.

        I don’t know what is right for you personally, but it does vary individually. Transition or suicide is certainly not true for everyone with AGP fantasies, that idea is pretty harmful and locks people into one path. For some people transition may be the best or only way.


    • The alternative to gender transition includes re-conceptualizing autogynephilic gender dysphoria as an intermittently painful, chronic condition; acknowledging that many people live with painful, chronic, medical and psychiatric conditions without giving up on the basic worth of life; and accepting that there are conditions for which the cure is worse than the disease.

      An autogynephilic gender dysphoric should do a cost–benefit analysis of gender transition: Is it likely that the benefits of gender transition would outweigh the costs, or vice versa? If the answer is not clear, then you should consider therapy with a competent mental health professional. This should be someone who can help you decide what is best for you; someone who can be completely impartial and objective. In general, I think it would be a good idea to avoid “gender specialists” and find someone with broader experience in counselling or psychotherapy.

      Liked by 5 people

  38. Even if we admit that there are some people who may benefit from a medical transition, it’s still very problematic for many reasons. For example, a “gay transman” is going to find out very quickly that gay men really don’t do well having sex with someone with a vagina or a rather horrendous looking fake penis that has to be pumped up. However, If you are over 25 and have explored all other treatment options and do not have the delusion you can actually change your sex, I can’t really criticize you. But I still would feel sad that this is your best or only option.

    Liked by 4 people

  39. I have many questions in regards to the exact nature of autogynephilic transsexualism for Drs. Bailey and Blanchard and how it manifests, particularly in younger generations.

    With many young people adopting trans identities (including many young males under the age of 25 who formerly identified as heterosexual), what behaviors would have to be evident to make a transsexual of such an age autogynpehilic? Are they at all different from those of late-transitioning autogynephiles?

    Have you ever encountered an outwardly effeminate autogynephile who was pre-transition? Or must all autogynephiles exhibit traditionally masculine traits and cross-dress privately?

    How do the behaviors of autogynephiles and androphilic transsexuals differ mid/post-transition? Have autogynephiles ever experienced a decrease in arousal from crossdressing post-transition and adopted less hyper-feminized styles of dress? (i.e. dressing in such a way that could be considered “butch” or “tomboyish”?)

    Finally, can bisexual natal males fall under the category of androphilic transsexual? Or can an individual possess both traits of an autogynephile and androphilic transsexual?

    I apologize for the onslaught of questions, it is really very exciting to hear from you two. I’m practically geeking out at the fact that you have created something of an open Q&A here! I find your studies to be quite fascinating and am hoping to someday read the entirety of The Man Who Would Be Queen.

    Liked by 1 person

    • “Have autogynephiles ever experienced a decrease in arousal from crossdressing post-transition and adopted less hyper-feminized styles of dress? (i.e. dressing in such a way that could be considered “butch” or “tomboyish”?)”

      This question interests me too.

      In her less-than-cogent book Whipping Girl, transactivist icon Julia Serano, after trashing Drs. Blanchard and Bailey, discusses her autogynephilic fantasies, then says they stopped after transition. (She attributes her fantasies to cultural messages that link feminine apparel and sex.)

      Serano also makes rather a big deal about the fact that she does not always dress in a feminine manner. (Of course, she thinks feminism should “empower” “femininity” and seems obsessed with the topic.)


      • Serrano is a misogynist and will never be an actual feminist. Also, I’m getting a little weary of how many people who simply have questions about biological men and how they feel during, before, and after transition have flocked here to question the doctors when this is one of the ONLY spaces for parents of sudden-onset teen and pediatric trans-identification.

        All the trans-identified and trans-supportive have the entire rest of the internet, it seems. Give ’em an inch, they shove their way right in and make it all about men. AGAIN.

        Liked by 1 person

      • katiesan, some of the people here are parents of trans-identified males. I think it might be helpful for parents to understand how their sons feel, how they came to their trans identity, and how AGP feelings can sometimes be resolved differently. That’s why I shared information about my friend in an above thread.

        I am sorry that you feel this comment section has been hijacked. Trans-identity does seem to present very differently in males and females, and I understand why you are only interested in information that pertains to your daughter.

        Liked by 1 person

      • Hey Katiesan,

        I guess I am one of the people you are talking about.

        I started reading this blog a while back when I realized the different types of transsexuals, and in addition when I started reading about sex change regret, all the people with different conditions such as autism etc that got misdiagnosed with gender dysphoria, when they really aren’t transgender/sexual at all, they just have certain issues/fixation etc. And I cared about these people, which I why I try to read everything available. (Men and women). The reason my questions is about male to female transgender people is because from what I know there isn’t any research on autoandrophilia that I have found at least, which means there is not much to ask about yet.

        That said, I don’t believe transition is wrong for every preteen/teen (it’s really only social before that). Those with fixations/body issues and so on, have just been caught up in something they shouldn’t be in (it seems to me).

        I’m sorry if you feel others are taking up space that shouldn’t.

        The “about” on this blog says it’s for the gender-critical, which I guess is technically what I am, and I did specify that my questions were unrelated to the article itself.

        Remember there are two narratives that are being taken apart here/right now, the one you and I care about (those misdiagnosed), and the whole “gender is separate from sex and sexuality” dogma, which mostly autogynephiles use to hide their paraphilia it seems to me.


      • I just feel as if this topic is about suicidality and I know there are parents here of boys. But the comments aren’t about suicide and sons, it’s turning into a “pick the brains of the doctors about trans-identifying males in general.” And I’m not going to apologize for thinking that that is not productive for parents of children of either sex. Which is what this website is mostly for, since we don’t have really any other space devoted to our issues, which are not the exact same for trans-identifying kids, adults, or simply interested people.


      • katiesan–

        “Serrano is a misogynist and will never be an actual feminist.”

        Yes. I know.

        “All the trans-identified and trans-supportive have the entire rest of the internet, it seems. Give ’em an inch, they shove their way right in and make it all about men. AGAIN”

        If you think I am trans-identified, or that my comment was trans-supportive, you really need to work on your reading comprehension.

        Somebody asked a question and I seconded the question. Understanding trans ideology is important for those of us who oppose it. B&B can answer or not, as they choose. This takes nothing from you or your concerns.


      • “Serrano is a misogynist and will never be an actual feminist.”

        Agreed. Sort of implied in my comment, I thought.

        “All the trans-identified and trans-supportive have the entire rest of the internet, it seems.”

        This seems to be directed at me, as I am the only one here who’s mentioned Serano.

        I am neither trans-identified nor trans-supportive. Nor am I a man.

        I appreciate Dr. Blanchard taking the time to answer the question.


    • > With many young people adopting trans identities (including many young males under the age of 25 who formerly identified as heterosexual), what behaviors would have to be evident to make a transsexual of such an age autogynephilic? Are they at all different from those of late-transitioning autogynephiles?

      If young gender dysphoric male has a negative history of conspicuous femininity as a child, a negative history of strong and exclusive sexual attraction to the male physique, and a positive history of sexual arousal in association with the thought or image of himself as a female, I would diagnose him as autogynephilic. The basis of diagnosis is more or less the same as for older gender dysphoric males, except that older males have had more time to build up a history of sexual relationships with women, marriage to women, and fatherhood—all of which increase confidence in the diagnosis.

      I expect that early-transitioning autogynephilic males would be much less likely to have married women or fathered children than late-transitioning autogynephilic males. Other than the guilt and conflict older patients feel because of having young, dependent children, and the fact that older patients were raised in a different social climate, I doubt that older and younger patients are essentially much different.

      > Have you ever encountered an outwardly effeminate autogynephile who was pre-transition? Or must all autogynephiles exhibit traditionally masculine traits and cross-dress privately?

      There are autogynephilic males who are unmasculine, as opposed to feminine. For example, as children or adolescents, they might be interested in computers rather than team sports.

      Not every autogynephile cross-dresses, privately or otherwise. I have written a fair amount about this, for example here:

      I have a briefer description of a non-cross-dressing autogynephile in here: Here is the brief description:

      “Philip was a 38-year-old professional man referred to the author’s clinic for assessment. His presenting complaint was chronic gender dysphoria, which had led, on occasion, to episodes of depression severe enough to disrupt his professional life. Philip began masturbating at puberty, which occurred at age 12 or 13. The earliest sexual fantasy he could recall was that of having a woman’s body. When he masturbated, he would imagine that he was a nude woman lying alone in her bed. His mental imagery would focus on his breasts, his vagina, the softness of his skin, and so on—all the characteristic features of the female physique. This remained his favorite sexual fantasy throughout life. Philip cross-dressed only once in his life, at the age of 6. This consisted of trying on a dress belonging to an older cousin. When questioned why he did not cross-dress at present—he lived alone and there was nothing to prevent him—he indicated that he simply did not feel strongly impelled to do so.”

      > How do the behaviors of autogynephiles and androphilic transsexuals differ mid/post-transition? Have autogynephiles ever experienced a decrease in arousal from crossdressing post-transition and adopted less hyper-feminized styles of dress? (i.e. dressing in such a way that could be considered “butch” or “tomboyish”?)

      Androphilic transsexuals are sexually attracted to men and men’s bodies both pre- and post-transition. How often they are really successful in acquiring “straight” male partners after sex reassignment is a matter of conjecture. For one thing, the neovagina is not always sufficiently capacious to accommodate a normal-sized penis, which some men would find sexually frustrating. (When the introitus is too narrow, the neovagina cannot be used for penovaginal intercourse at all.) Furthermore, some straight men are turned off by the simple idea that a postoperative transsexual had previously been a male, no matter how perfectly the transsexual simulates a female after surgery.

      Autogynephiles are less likely to get penile erections from women’s clothes after they start wearing them all the time. This does not mean that autogynephilic gender dysphoria is unrelated to eroticism. Both I and Anne A. Lawrence have written about this. I would recommend Lawrence’s book, Men Trapped in Men’s Bodies: Narratives of Autogynephilic Transsexualism, as an excellent resource completely devoted to the topic of autogynephilia: Dr. Lawrence is an outstanding scholar, and she is remarkably insightful, realistic, and objective. She is a postoperative autogynephilic MTF transsexual herself. Dr. Bailey’s book, The Man Who Would Be Queen, is equally perceptive:

      Some autogynephilic transsexuals dress in less stereotypically female clothing after surgery. This may be a combination of the postoperative “rush” being over and a realistic response to the fact that dressing up in stereotypically female clothing is a lot of work, especially for a biological male. Another reality is that many male-to-female transsexuals do not pass very well as women—although they may be close enough that other people are willing to treat them that way. For MTFs who don’t “pass” in the sense of actually being perceived as biological women, dressing “butch” is not changing things much anyway.
      > Finally, can bisexual natal males fall under the category of androphilic transsexual? Or can an individual possess both traits of an autogynephile and androphilic transsexual?

      During the 15 years when I regularly interviewed gender dysphoric patients, I saw exactly one male who seemed to be truly homosexual and truly autogynephilic. Much more common are autogynephilic males for whom male sexual partners are interesting purely because they symbolize the autogynephile’s own femininity. See, for example, the clinical vignette of “Franz” here:


  40. Have you heard of anyone trying dialectical behavioral therapy (DBT) as treatment for rapid onset gender dysphoria in teenage girls? My understanding of DBT is that patients learn mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills to cope with overwhelming emotions. It is so hard to find anything I can offer my daughter as an alternative to testosterone. One DBT provider I met with will not work with my daughter. She is afraid of being called on the carpet for not following the affirmative approach. I can’t blame her in the current environment.


    • My daughter is in DBT. It’s been our nightmare. It all has to do with the therapists. They have a lot of catch phrases. The patients are to be working toward a “life worth living”. For my daughter it is clearly working towards being a boy. The therapist told us in front of her that statistics say that if we don’t support her she will either kill herself of become estranged. Thus, that is what she is working on. Funny that they tell the patient not to use emotional blackmail but then they do it.

      Liked by 1 person

    • DBT/CBT are proven therapies which help people with anxiety/depression/personality disorders improve their life functioning. They can be absolutely fantastic treatments, if taught correctly and actually put into practice.

      When my daughter was trans-identifying, she was tested for ADHD (didn’t have it — her inability to attend was due to anxiety). The psychologist recommended CBT as being an excellent treatment for highly anxious people. We spoke to our daughter’s current therapist, at the time, who knew a therapist who specialized in CBT and we arranged for her to take on my daughter. I was initially hopeful — the woman spoke about how teenage brains are still developing and how the anxiety response works and if you do the homework/exercises, a person can change how they react and how they think and improve their situation. We did not speak about my daughter’s trans identification and I was hoping that working on just her anxiety would be something which might have a snowballing effect and lessen her need to identify so strongly as trans. I had not been very happy that my kid seemed to just have an undiscerning audience for her previous, almost-all talk therapy therapist. That situation seemed VERY performative.

      Anyway, within a couple of sessions, it became obvious that my kid was going to have to do more than talk about herself — she was going to have to engage WITH the therapist and practice some techniques and actually LEARN how to apply this theory. HA! Her superpower was avoidance. She walked into a session, declared she was trans, and then the CBT was unceremoniously dropped and it turned into a situation of trying to pressure us to agree to our daughter’s latest desire to socially transition. We ended up firing the therapist.

      By now we’d seen how therapists operate in an affirmative-only situation and I started vetting people on the phone and I also learned it was unlikely I was going to find anyone who would even be agnostic about trans issues. When my daughter was hospitalized multiple times, she went into an outpatient treatment program. Since she and almost all of the kids exhibited suicidality, they taught DBT. Again, the therapy is proven to help people who are suicidal and who THREATEN suicide, but only if it is taught and implemented. My kid essentially slept through that program. I, unfortunately, was abused by her every Wednesday, in a multi-family group session, in front of strangers, and the therapist did NOTHING to stop it. I was encouraged, as the therapy specifically calls for it, to be “radically honest” and then my kid used what I told her against me, over and over.

      When we sent our daughter to a wilderness program, they also taught CBT/DBT. My kid still resisted, but she at least actually LISTENED this time. I know they also use these therapies at her school. We don’t talk about it specifically, but I’m sure it’s kind of seamlessly woven into their days as is most of the therapy and treatment due to it being a boarding school where the kids live in homes with mom/dad teams (think a Boys Town/Girls Town situation).

      Broken down, DBT specifically encourages clients to work always toward being safe and staying alive. That is job one. Once a client has agreed to that, the idea is that most of these people have thinking patterns which are very black/white or extreme and they have great difficulty holding two conflicting ideas or emotions or actions, in their heads at the same time and instead of privileging one or the other, finding a “middle path” or “wise path” or COMPROMISE. I would hope that any parent, especiallly of a teen, would recognize the value of specifically teaching teens how to identify extreme thinking and encouraging compromise. As I kept telling everyone in this very long journey I’ve found myself on, I’m not trying to brag, but I’m a functioning adult. I have a long-lived, successful marriage, I am raising three kids, I am close with my family-of-origin — I, like most people like me, have most of these skills. I HAVE BEEN COMPROMISING WITH THIS DAUGHTER AS MY JOB. Of course, that is unrecognized mostly by the daughter in question because she was not getting exactly what she wanted.

      As our kid realized that her thinking patterns and anxiety were constricting her life and she was FORCED to participate and engage in therapy, she began to feel her situation improve. No one was talking about her identity — everyone was talking about her thinking and her listening and her behaviors. All of that, however, was because of programs which also listened to PARENTS. I would tell you that the two therapists we’ve worked with in wilderness and at boarding school are NOT agnostic about kids who identify as trans — one was a specialist in sex and gender issues with kids and the current one I could feel resisting my telling of the facts of my kid’s situation initially. However, both were OPEN and both took our viewpoints and feelings and experiences seriously. We weren’t immediately seen as enemies of our kid. Also, the most important thing was that my kid was away from us and she exhibited ALL the behaviors and thinking and manipulations she had at home, when she had no need to. She could have, theoretically, been super-functioning and proven that we were the ones who were obviously interpreting the situation incorrectly. However, that was just not the case. And, so, therapists who are open to also judging incorrectly and who work in programs which support FAMILIES have been lifesavers for our kid and us.

      TL; DR The therapy itself is proven to work. However, it relies completely on the therapist, the program, and whether your child will engage. Best of luck.


      • Katiesan, could you give some more information about the wilderness program? I’ve been trying to find something for my daughter. The problem now is that she is 18 and considered an adult.


      • There are a number of wilderness programs throughout the United States. I hesitate to name the exact one we used, for privacy reasons. It was specifically recommended to us by an educational placement expert after she had discussed our daughter’s situation with us and she has several decades experience (and keeps super-current, traveling about a third of the year observing treatment programs and schools) and often recommends situations based on a specific fit for a student and a therapist, which was what happened in our case.

        You can do some research online or you could research and look for educational consultants/educational placement experts who might be able to advise you. I do know that the program we used had an adult (young adult — 18-24, I think) program alongside the adolescent track. Of course, in that age range, the client has to agree to go to treatment, which is a consideration.

        The experience was beneficial for all of us. Our daughter could be “waited out.” She was also observed, 24/7 in a way that finally demonstrated her actual behaviors and not her recounting of her perception of reality. The manipulation/splitting she did, particularly, was on full display. The program talks about how, even though they use current and evidence-based therapies, nature does its work, as well. She started to feel better in general, because she was eating properly and hiking out every day and had to engage with the other girls and staff in order to have her baseline needs met. Our daughter now says the program saved her life and showed her her life could be worth living. She talks about how she’d like to go into forestry and maybe be a park ranger and also that she’d like to be a staff member in the program when she’s old enough.

        I hope that you can find a program and that your daughter would be receptive to trying it.


      • No, I’ve done a lot of searching and haven’t found anything concretely hopeful. When everyone is yelling affirmation it is hard to trust any program.


      • katiesan … a little off topic, but it is really wonderful to hear that your daughter is doing well and looking toward a productive and (I hope) much happier future.

        Knowing a bit of what you have been through with her? Which I’m sure was often much worse than you have let us know?

        I am so glad, for you and for her and for all the family.

        May you be able to breathe easier, going forward. (Maybe not ever “easy.” But … “easier.”)

        Liked by 1 person

      • puzzled, thanks so much. This place has been a lifeline for me in some of my darkest times and I definitely appreciate the good wishes.And I definitely feel them for all the struggling parents who post here.

        Here’s to 4thwave for finding a way to give us all some of the validation and community we needed.

        Liked by 2 people

      • I love the idea of a wilderness program or a gap year. I do realize that both of these ideas are more of an ideal and not feasible for all.
        A cheer to the power of nature and the wilderness to return a person to wholeness.


  41. Dear contributors,

    I have two questions:

    1. Have you observed any parallels between BPD induced identity disturbance and GID? Are you open to the idea that some types of gender confusion are symptoms of BPD?

    2. With regards to your recent tweets about gender signalling and why it’s done, what are your thoughts on NPD as an underlying cause of some trans people’s dysphoria? Gender identity as false self, internet trans activism and demands for affirmation as supply seeking, “misgendering” or perceived gender invalidation as a source of catastrophic narcissistic injury that usually causes the patient to lash out in utterly disproportionate and irrational ways. Surely I am not the only one who has noticed this?

    Thank you so much for writing this.

    Liked by 1 person

    • I believe that Axis II personality disorders likely figure in prominently in some kinds of gender dysphoria (especially rapid onset). Empirical research will be needed to verify this, however.


      • Professor Bailey, I came across TMWWBQ while reading Alice Dreger’s “Galileo’s Middle Finger Heretics, Activists and the Search for Justice in Science” Who wouldn’t want to read something with such an engaging title? I had no idea of the topics contained there in. I wish I was still in ignorance of them.
        While waiting for her book to arrive, my then 26 year old son came home for a visit. The two of us were headed down the freeway to get lunch when he announced, “I’m transgender.”
        While driving and trying to keep my eyes on the road, I asked “what does that mean to you?” (It’s been all downhill from there)
        He told me that several months before he had purchased a bra with built in breasts and when he tried the on it was “Awesome”. Which prompted him to call his maternal grandmother for advice on finding a therapist. He located one near where he was working out of state. To supplement their therapy she gave him WPATH as a resource.
        He has told me very little about there sessions. She told him to think back to times in his life that he felt he was a she and when me male felt wrong. He gave me a couple of examples of this that sounded suspicious at best.
        I could go on, he went back out of state for work. The book came. When I got to your section of it, I was near completely derailed. I immediately read your book, not hopeful to say the least. At the time I had hoped that if he read “Galileo’s” he might be able to see the manipulation from the activists and at the very least question his sudden feeling of being female. He wouldn’t read it. I sent him your book. No, he wouldn’t read it either. Neither were worth his time.
        He lost his job and moved back home before Christmas of 2015. He started estrogen in January of 2016. He won’t be bothered with any research that isn’t 100% trans affirmative.
        I made the mistake of telling him that I could not support his decision. He immediately stopped talking to me about it. He was unemployed for about a year and has now been working again for the past 9 months or so. Needless to say, things have been tense here for about 2 years now. I believe there are a plethora of reasons he has decided to do this, none of which are because he’s a woman trapped in a mans body. Which is what he asserts. If you’re interest, I’d be glad to elaborate further. Thank you for your work and replies here.


      • absurdysphoria, you are in such a difficult spot with an adult child who you obviously have little influence over. I know I can’t really be of any help, but I hope that acknowledgment that your story has been heard and that you are not alone is some comfort. I hope your son can find his way back.


      • To Absurdysphoria (below),

        I am sorry about your son. It sounds very likely that he is autogynephilic. We know little about the ways that autogynephilic natal males should live their lives to maximize their happiness. This is partly because it has been such a taboo topic that few have even thought about it, much less tried to collect any data.

        I do not know what is best for you to do, or for your son to do. AGP may be a condition in which sometimes–depending on its particular manifestations–a male may be happier transitioning. But not always. In my opinion, the best decisions will be made with truth in mind, rather than some fantasy, which is what your son is preferring (and those who attacked me prefer).

        We are writing in detail about this for 4thWaveNow and for our forthcoming website. But I can confidently tell you, we don’t know enough about how to help people like your son.


      • Thank you for your reply. AGP seems more likely than homosexual transsexualism. I personally think with him that it has more to do with his character and temperament. He has stated since this started that he thinks he might be asexual. Based on conversations years before any of this, I’m more inclined to think he just gave up due to his perception of what women want. He also immersed himself in World of Warcraft for over five years which I believe may have overrode his natural sex drive and undermined his reward system. He still spends most of his off time with Blizzard entertainment and YouTube and has said if that’s all his life will be then it won’t be that bad. My biggest difficulty with this is his wasted potential.


  42. Dr Bailey: Just to say I have emailed you a timeline of my son’s transition in case it sheds any light. And sorry if my last post was written in a bit of a huff. You can imagine this is all quite difficult, but we really are very grateful for your work.


  43. Hello Dr Bailey and/or Dr Blanchard. I have a male-identifying daughter aged 19. She told us at age 18. Before that she had a period of anxiety and depression. She has since had a diagnosis of Autism (high-functioning), and is responding well to CBT and anti-depressive medication. She had always been happily non-conforming but never showed any signs of difficulty before this – so I would say she is in the sudden onset group. The advice given by the autism psychiatrist was to wait until she has got her head around the autism diagnosis before proceeding with any irreversible changes to reduce the risk of a mistake, which seems like sound advice to me. In her head, however, she is definitely male and it is only long waiting lists for the gender clinic here in the UK which is holding her back from what she has been told is inevitable – hormones and surgery to find her authentic self. My question is whether some young people (autistic or otherwise) are in fact suffering from a very real identity /existential crisis which is manifesting itself as a gender identity problem, but that may well resolve itself over time and with maturity (which may be significantly delayed in young people on the autistic spectrum). And if so, is it not negligent for any medical professional to recommend to their client that they wait before embarking on irreversible changes?

    Liked by 2 people

    • Last sentence should have read “is it negligent for any medical professional not to recommend to their client that they wait before embarking on any irreversible changes?”


      • This is a very good question that we can’t answer confidently. Why are autistic traits associated with gender dysphoria? I can think of two general reasons. First, maybe as you suggest, autistic persons are especially likely to misinterpret issues as gender dysphoria. Second, maybe those who have some propensity for gender issues (e.g., they are very gender nonconforming) may be especially likely to become gender dysphoric if they have the obsessive autistic side. No one knows which (if either) is true.

        Liked by 1 person

  44. katiesan:

    I’d like to apologize as well. There appeared to be a pattern forming with users asking the doctors about their theories and research, and I followed suit. But you are right, this is not the place to be discussing the topic of late onset dysphoria in adults.

    Please forgive me for intruding.

    Future commenters, consider keeping questions directed toward the doctors on-topic (that is, questions relating to gender dysphoric youth, only). This is the parents’ space and we must respect that. They need the doctors’ insight more than we do.


    • Thank you, Alex. I was not trying to particularly go after individuals — it was more a trend that I was seeing play out in comments. I appreciate that you listen and hear what’s being said and not take it too personally or feel defensive. It shows a great deal of maturity on your part.

      Liked by 1 person

  45. I want to be very, very clear — I am, of course, supportive of parents of males asking questions in this space in general and in this topic particularly. But, I don’t think that’s what is going on in a subset of the posts. And, I don’t feel as if it’s PARENTS who are mostly asking these broad questions which are outside of the site parameters and definitely the topic at hand in this post.

    But, by all means, men who aren’t here as parents, educate me on why I feel the way I do and why I’m wrong. It’s not like that hasn’t been my entire experience as a parent with a trans-identifying teen for the past four years.

    Liked by 1 person

    • Katiesan:

      I have been reading the comments and it doesn’t seem anyone suggested to you that you are wrong? I personally think that you are probably right (probably since I know very little of your situation, and even if I did, I’m not a qualified medical professional). It does seem to me that a lot of those with sex change regret that come out in media have been former teenage women with certain issues and fixations. (with former I didn’t mean former women but former teenagers that transed in their teens and then regretted it when they started to come into their late teens/early 20s). (English is my third language, I’m Swedish). And yeah, the numbers of these young women seem to be increasing in ways it shouldn’t.

      I know what you mean though with AGPs, trying to control others narratives, I see that all the time, especially when HSTS try to identify as something other than “women”.

      I’m here as a interested student myself (actual student (uni), not a student of life). But yeah I will save my questions about general theories for later, if they ever do something like this again (I usually seem to miss such things though).

      I hope everything resolves itself with your daughter, and you find the help you need, or you both need rather.

      Liked by 1 person

  46. Out of curiosity… how would you suggest sudden onset gender dysphoria be treated? And how would a therapist even be able to differentiate sudden onset from other types of gender dysphoria. My daughter is 19 and falls under the sudden onset. I tried to get her to agree to family therapy but she would not have it. I’m sure her therapists is getting a very one sided story but there isn’t much I can do to keeep her from transitioning because she is an “adult”

    Liked by 3 people

  47. Some general comments: First, we raised some issues that were not central to this piece (like the 3 types of gender dysphoria) that we should address, but not here. We would like to blog here again, with permission, and that will be our next topic. Second, it is simultaneously true that autogynephilic individuals tend to be especially interested/inquisitive, and that usually there is no forum for honest AGPs to ask questions. We want to change that. But perhaps I will stop answering their questions on this particular blog. Third, there are real differences of opinion regarding how best to treat/react to gender dysphoric children. For example, some of you think that Dialectical Behavior Therapy is wonderful; others think it is harmful. I think that likely, its value depends on the approach of the person offering it. That’s not very reassuring, though. My impression is that the empirical literature for DBT’s effectiveness is weak. It is targeted on very hard to treat populations, however.

    SumMum, I will write you privately.

    Ray Blanchard and I are modest in our treatment suggestions because, simply, No One Knows! What we are most insistent about is that these decisions are better made with accurate knowledge, and there is knowledge about many aspects of gender dysphoria.

    Liked by 2 people

    • I just would like to point out that I’m not AGP =P.

      I’m just intensely interested (driven by the politicial issues and having friends that are HSTS, and encountering a lot of AGPs in the computer world), and still choosing my major, so have been considering going for something in the psychological field (here in Sweden). (Either that or economy).

      So would be great if the next one wasn’t just for AGPs ;), always nice to be able to ask questions on things you wonder about.

      Liked by 1 person

  48. I apologize if this sounds bitter but if therapists and researchers just “don’t know”…. wouldn’t the most ethical model be to do the least invasive first and proceed with extreme caution? As 4th Wave Now has tweeted.. the model in the U.S. is very akin to the Wild West . Sorry if I am extremely angry at a system that is basically scratching their heads while OUR kids are the experiment. This is not directed at these doctors (whom I appreciate for speaking out). Informed consent clinics are akin to pain clinics in my mind. Very little concern with healthy outcomes!!

    Liked by 6 people

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