Monthly Archives: February 2018

WPATH & The Advocate aim to suppress new research on adolescent gender dysphoria

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by Brie Jontry

Brie is public spokesperson for 4thWaveNow. For more about her, see this interview. For more about Brie’s formerly trans-identified daughter, Noor, see here.

On February 20, The Advocate, one of the leading LGBT publications in the US, ran an article which attempted to invalidate data collected by physician and researcher Lisa Littman from parents whose children experienced Rapid Onset Gender Dysphoria (ROGD). The author, Brynn Tannehill, immediately posted the article to the WPATH Facebook page.

Tannehill ROGD WPATH post

In the thread,  Tannehill (along with Jo Hirst, author of the Gender Fairy), suggested The Journal of Adolescent Health should be asked to retract and/or apologize for publication of Littman’s preliminary findings. UCSF’s Dan Karasic, MD (moderator of the Facebook page and WPATH official) agreed.

Littman’s abstract had been accepted for poster presentation and the poster was presented at the March 2017 Annual Meeting. (The full paper has not been published yet, and we look forward to its availability).

karasic retract poster

Note: Interestingly, as of this writing, four days after they were written, the last three comments have been deleted from the original thread.

The dismissal of Littman’s work, and the move to suppress it, is unconscionable. For one thing, some young people (like my daughter)  who experienced ROGD have already desisted. Others, who were supported in procuring medical intervention, have already experienced regret. Many more desisters and detransitioners are sure to follow.

This trend has not gone unnoticed by at least some in WPATH. For example, veteran WPATH clinician Rachael St. Claire, in a Facebook post on January 5 of this year, made this comment (notice that commenting was turned off immediately after St.Claire posted):

WPATH jan 5 2018 detrans therapist

This concern is echoed by UCSF clinical psychologist Erica Anderson, herself a transgender woman, in a recent Washington Post article:

“I think a fair number of kids are getting into it because it’s trendy,” said Anderson, who was married for 30 years and fathered two children before transitioning seven years ago.

I’m often the naysayer at our meetings. I’m not sure it’s always really trans. I think in our haste to be supportive, we’re missing that element. Kids are all about being accepted by their peers. It’s trendy for professionals, too.”

In addition, clinics around the world have noted a sharp increase in the number of girls presenting for treatment in the last few years.

increase in girls

A once-rare condition is now increasingly common. It is surely in the interest of all people who care about gender dysphoric youth to investigate the reasons for the increase, and Littman’s work is an early contribution to this effort.

The ostensible reason given for Karasic et al’s desire to have Littman’s abstract retracted is that the data comes from a self-selected group of parents, culled from websites where such parents gather, in an anonymous survey format, and is thus deemed to be worthless. Yet advocates for pediatric transition constantly promote other survey studies, also culled from “self selected” groups (such as the Williams Institute suicidality survey), as well as research conducted by investigators who only recruit subjects from pro-early transition organizations (such as Kristina Olson’s two studies), with no attempt to broaden their samples to children who are not socially or medically transitioned.

In fact, Littman’s work is the first to study this new presentation of gender dysphoria, and she collected information from the people who know these children and teens better than any transgender advocate, endocrinologist, psychologist, or therapist ever could — their parents.

But you’re not listening to us.

Littman’s study, according to its critics, is contentious for a few reasons, but most notably for using the term “Rapid Onset Gender Dysphoria” as a descriptor for a new kind of trans-identifying youth, primarily natal females, who during or after puberty, begin to feel intense unhappiness about their sexed bodies and what it means to feel/be/present as a woman.

Let me emphasize: What is “rapid onset” in this population is the dysphoria, not the gender atypicality. What distinguishes these young people from the early-onset populations studied previously is that they may have been happily gender nonconforming throughout childhood (though some were more gender typical), but they were not unhappy (which is all “dysphoric” really means), nor did they claim or wish to be the opposite sex. The unhappiness set in suddenly, in nearly every case only after heavy peer influence, either on- or offline.

This phenomenon has only recently been noted by clinicians directly involved in treating gender dysphoric youth, as well as other mental health professionals. While there is no lack of evidence for adolescent emotional and behavioral social “contagions,” Littman’s research is the first to collect data on this phenomenon as it relates to identifying as transgender.

Even though rapid onset gender dysphoria has been noted by other researchers and clinicians who work with these populations, The Advocate and WPATH’s Dan Karasic consider the descriptor “junk science.” In a swift attempt at censorship, Karasic deleted all but one of my comments on the public WPATH Facebook page and then banned me from the group when I asked him to please consider the experiences of young people, like my daughter, for whom gender dysphoria set in hard and fast after being exposed to the idea that her gender nonconformity was in fact a sign of being transgender.

Interestingly, after I was purged, Karasic posted links to both my and my daughter’s stories on 4thWaveNow, and unfounded accusations were leveled against me and 4thWaveNow; since I was banned, I was not able to respond to them.

Interested readers may refer to these Twitter threads should you want more blow-by-blow details:

It is concerning, given Karasic’s reaction to Littman’s research, that he and others evidently leave no room for a teenager to be incorrect about how they are interpreting their feelings, no room for a clinician to be incorrect when recommending transition, and no room for a parent to understand what is going on with their own child. It is narrow minded and short-sighted, especially considering there is no long-term data supporting the benefits of early medical transition for gender dysphoria or consensus from the medical community about best treatment methods.

This lack of consensus, while well known and acknowledged by the international medical community, has been ignored by many transgender advocates, along with the “gender affirmative” recipients of a $5.7 million NIH grant, who, with the help of the mainstream media, have manipulated the public into believing early social transition, pubertal blockade, and early cross-hormone treatment constitute settled science.

To be clear, in “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study,” a 17-clinic international study published in The Journal of Adolescent Health, the authors explain that:

As still little is known about the etiology of GD and long-term treatment consequences in children and adolescents, there is great need for more systematic interdisciplinary and (world- wide) multicenter research and debate. As long as there are only limited long-term data in support of the guidelines, there will be no true consensus on treatment. To advance the ethical debate, we need to continue to discuss the diverse themes based on research data as an addition to merely opinions. Otherwise ideas, assumptions, and theories on GD treatment will diverge even more, which will lead to (even more) inconsistencies between the approaches recommended by health care professionals across different countries. (372)

I am sure some WPATH members, like the treatment teams in Lieke et al., “feel pressure from parents and adolescents to start with treatment at earlier ages.” I know there are others, besides those reported in Lieke et al. who:

[…] wondered in what way the increasing media attention affects the way gender-variant behavior is perceived by the child or adolescent with GD and by the society he or she lives in. They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior.

“They [adolescents] are living in their rooms, on the Internet during night-time, and thinking about this [gender dysphoria]. Then they come to the clinic and they are convinced that this [gender dysphoria] explains all their problems and now they have to be made a boy. I think these kinds of adolescents also take the idea from the media. But of course you cannot prevent this in the current area of free information spreading.” –Psychiatrist

It is unconscionable that transgender advocates, and the leading international body concerned with transgender medicine, would seek to quash data that address unsettled and mostly unexplored areas of concern. It is incredibly important that ROGD be included as a research point because the main studies used to justify the use of puberty blockers, cross-sex hormones and surgery in adolescents required “persistent gender dysphoria since childhood” and “no serious comorbid psychiatric disorders that may interfere with the diagnostic assessment” before the patients were eligible for medical intervention. In other words, none of the participants in these treatment studies had adolescent-onset of their gender dysphoria and none of the participants had serious psychiatric issues.

It is a huge leap to assume that an entirely different population of adolescents with a different presentation of symptoms will have the same results as the adolescents in the Amsterdam cohort.  An additional gap in the research is that because all the desistence and persistence studies are about adolescents who had childhood onset of gender dysphoria, the persistence and desistence rates for adolescent-onset gender dysphoria are unknown.

In all areas of medicine, best practices come from intense discussion and research into indications and contraindications, and into risks, benefits, and alternatives. Yet, WPATH’s Karasic, along with the trans advocates who have prominent roles in the organization, appear to believe it is in their community’s best interest to shut down all discussion about contraindications, risks and alternatives. This is inappropriate and undermines the very concept of informed consent.

Furthermore, The Advocate article suggests that Littman’s sample is biased because it gathered data from “unsupportive” parents. This framing is both fallacious and dangerous to gender nonconforming and dysphoric youth. It suggests that the only path for gender dysphoric youth, even those with a rapid onset, is full affirmation including fulfillment of requested medical interventions. It also implies that parents aren’t able to be both supportive and cautious.

I have spoken to some of the parents who participated in the study. Few could be described as “unsupportive.” In fact, almost overwhelmingly, these parents supported their children in thinking about their gender identity and helped facilitate their preferences for atypical gender presentation and interests (taking them for haircuts, new clothing, and so forth). Many sought professional mental health consultations and treatment for their children. But what many of these parents did not support for their underage teenagers were hormonal and surgical interventions. This is an important distinction: Littman’s sample were supportive parents who were unsupportive of a particular medical treatment option.

It is entirely possible to be supportive parents invested in our child’s well-being and not agree to unproven medical procedures for which there is no consensus from the medical community of long-term safety or benefit to the majority of dysphoric youth. However, the loudest voices in pediatric transgender medicine often cite Kristina Olson’s descriptive research about early social transition for children which relies on the methods that they decry as “junk” when used in Littman’s research (targeted recruitment and the collection of data from parents). Kristina Olson recruited her sample from support groups and conferences to find parents who have socially transitioned their children, which might consist only of parents who are supportive of early social and medical transition. So is it an acceptable method for both studies, junk for both studies, or are the WPATH activists simply going by whether they like or dislike the findings?

As all parents know, we can tell when our children are suffering. To remain credible, advocates for gender dysphoric youth and the international organization which claims to be concerned with generating best practices in the field of transgender medicine must acknowledge that ROGD exists and there are some trans-identifying youth who arrive at their identity from external social pressures, and at times, internalized homophobia.

Related to this last point, the WPATH Facebook page wasn’t the only place my respectful questions were deleted. In a comment on The Advocate article itself, I asked Tannehill and Advocate readers to consider the recent research into how homophobic name-calling influences (hint: greatly) children’s perceptions of their gender identity.

brie advocate comment

My comment was swiftly scrubbed from existence. For those interested in reading “The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity?” the full text is here.

Finally, the fact that ROGD is being discussed by the conservative media is not, no matter how many “incriminating” links Tannehill dropped in the Advocate piece, a legitimate reason to discredit the data. The irony is not lost on many 4thWaveNow parents that our stories are covered by media outlets we typically avoid. In this politically charged climate, it is important for researchers, clinicians, and parents to work together to “first do no harm” even when those we otherwise disagree with call for the same cautions.

Clearly, Brynn Tannehill and Dan Karasic do not speak for all members of WPATH. I know for certain that they do not speak for many professionals currently working with gender dysphoric youth who see in their own practices what can only be described as “rapid onset gender dysphoria” in an increasing number of adolescents, particularly girls. Clinicians are aware of the rapidly growing numbers of young people requesting services and the possibility of social contagion; there are those among you who are concerned by the potential for misdiagnosis and the subsequent harm that will come to some of your patients as a result.

It is time for those with concerns to speak out. Please do not allow your ethical and professional concerns to be held hostage by ideology.

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Part 2, Cincinnati trans-teen custody case: Legal analysis

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by worriedmom and worrieddad

4thWaveNow contributor Worriedmom has practiced civil litigation for many years in federal and state courts. She is joined in this Part 2 legal analysis of the Cincinnati custody case by Worrieddad, also a civil litigator and partner in his law firm. Part 1 (which includes text of the court decision itself) can be found here.

 In re JNS, the Cincinnati “transgender teenager” custody case, has occasioned a great deal of alternately gleeful and fearful reaction. As noted in our previous commentary, however, it is unlikely to uphold expectations on either side.

In view of the concern that some of our readers may have as to the potential application of this case to their personal situations, we thought it might be helpful to answer some of the questions raised by the case and to explore it in a bit more detail (usual caveat here that this is solely for informational purposes and not legal advice, for which you should always seek your own counsel).

Does this case cover my state?

There are three parts to the answer: first, custody and family law matters are classic examples of areas that are largely up to the individual states to decide. In other words, this case was governed by Ohio state law. Unless you live in Ohio, the case is not binding precedent for the courts in your state. Second, custody cases tend to be what we call “fact-specific.” Courts try to come up with the best way of handling the particular child and family’s circumstances: and as those will vary tremendously from family to family, even in Ohio the case may be of limited application. Third, although federal statutory and constitutional law protections and limitations are germane in certain transgender/custody cases, In re JNS did not decide any such issues.

How did the case get before the judge in the first place?

This is worth exploring in some detail, again because although it raises the specter of unbridled governmental interference in intimate family matters, it also appears that it treats an unusual situation (one unlikely to confront most of our readers).

The matter apparently began in November of 2016, when JNS emailed a crisis hotline, claiming that “one of his parents had told him to kill himself” and that his parents had refused to obtain counseling that was not “Christian-based.” (Note that some of these details are taken from news coverage of the case rather than the court papers themselves – a highly preferable source but one that is not currently available.) At some point prior to the November email, JNS had been hospitalized at the Cincinnati Children’s Hospital Medical Center (“Children’s Hospital”) for at least four weeks. (Id.) Clearly, then, JNS had been in great distress, in that a four-week psychiatric hospitalization is comparatively rare, especially for a teenager.

After the hotline email, in February of 2017, the Hamilton County Job & Family Services (“HCJFS”) stepped in and filed a petition to be granted temporary custody of JNS. Significantly, to avoid the necessity of a hearing (which would, of course, have been emotionally difficult for both JNS and JNS’ parents), the parents apparently agreed “to abide by a pre-existing ‘Safety Plan,’” in which JNS resided with JNS’ maternal grandparents as JNS had been doing prior to this hearing. At this February 2017 hearing, and as is customary in these types of contested matters, the court appointed a guardian ad litem (“GAL”) to represent JNS’ interests before the court.

Did the parents “lose custody” of JNS?

Yes (with qualifications). After the February 2017 hearing, the parties returned to court in April of 2017. At that time, the parents agreed JNS would be placed in the temporary custody of HCJFS and it was ordered that JNS would remain in the grandparents’ physical custody. All the parties agreed on the “permanency goal” that the grandparents would “guide [JNS] to adulthood.” The parents also declined “reunification services,” which would have prepared the parents and JNS for JNS to return and live at home.

Following that hearing, the Children’s Hospital filed “case plans” indicating its desire to initiate hormone therapy with JNS. However, in the court’s words, Children’s Hospital then “inexplicably” withdrew these case plans, and the matter proceeded to magistrate review for determination of the legal custody. In August of 2017, HCJFS filed a petition, seeking to terminate its own temporary custody of JNS, and to place legal custody with the maternal grandparents. In October of 2017, the magistrate conducted an “in camera” (confidential) interview with JNS; this was then followed in December of 2017 with petitions for legal custody filed on behalf of the maternal grandparents. Three days of trial ensued (in and of itself, an extraordinary expenditure of legal energy and judicial resources).

It is noteworthy that at every point during the proceeding, JNS’ parents apparently agreed that physical custody of JNS should remain with the grandparents (this was JNS’ wish as well). JNS’ GAL also agreed that the grandparents should have legal custody. This is significant because the recommendation of the GAL, as the “eyes and ears of the court,” typically carries great weight.

At the end of the proceedings, in the final decision entered on the matter, the court transferred legal custody to JNS’ grandparents. The grandparents are now empowered to consent to a name change for JNS and are obligated to provide medical insurance coverage.

The most significant issue, and the one that presumably concerns most parents, is the question of who will make medical decisions on JNS’ behalf. As noted, while the court ordered that the grandparents will be entitled to make medical decisions, the fact that it placed the condition of an independent evaluation on the grant, together with the fact that JNS will shortly turn 18 years of age, in practical terms means that the only person making medical decisions for JNS will be JNS. Moreover, the court’s decision primarily reflected the reality on the ground, that JNS had been living with the grandparents, by the consent of all concerned, and that JNS was never (while a minor, at any rate) going to return to the parents’ home. Practically speaking, during the short pendency before JNS turns 18, legal custody would either have stayed with HCJFS, or gone to the grandparents.

Did the court endorse medical transition for JNS and/or other young people?

Absolutely not. In fact, the court noted the “surprising lack of definitive clinical study” to support the advisability of any given course of treatment for gender dysphoria. The court also mentioned with “concern” that “100% of patients presenting to the Children’s Hospital are apparently considered appropriate candidates for gender treatment.” Interestingly, the court seemed to indicate some skepticism when it stated that after JNS was referred to the Children’s Hospital for treatment of anxiety and depression, the diagnosis “rather quickly” became one of gender dysphoria, and that the parents were “legitimately surprised and confused” at that sequence of events.

What about suicide?

This case is also significant for what it says about the “suicide issue.” The court did not appear pleased about the parties’ conflicting claims in this regard, stating that JNS’ medical records, as of the end of January 2017, indicated that suicide was not a factor. However, the “very next week,” when HCJFS first moved for custody of JNS on an emergency basis, it was claimed that JNS was, in fact, suicidal – and then more medical records, dated the week after that, stated that JNS was not. The court was understandably aggrieved by this apparent lack of consistency (if not transparency).

cincy court case part 2Interestingly, the court noted the potential future use of threats of suicidality in such proceedings, questioning whether minors might thereby be able to obtain desired medical procedures such as rhinoplasties or “similar cosmetic surgery.” The court also indicated that it should not permit such threats to govern the disposition of cases before it.

What is the likely lasting impact of In re: JNS?

We do not believe that the case has (or should have) any substantial effect for medical practitioners or parents. As discussed above, the court did not endorse or validate medical transition; in effect all it did was delay the process for a few months until JNS turns 18 and will be the sole arbiter of JNS’ decisions. It was not before the court to make any decisions about medical gender treatment that extend anywhere past the extreme facts and circumstances relating to JNS and JNS’ unfortunate family situation. Moreover, nothing in this case stands for the proposition that either obtaining, or refusing to obtain, “gender confirmation” treatment for a child is abuse, reportable or otherwise.

Although the court did not mention it, at present there is no “bright line” test for when a young person becomes legally competent to make his or her own medical decisions. Courts are gradually recognizing that children under the age of 18, who “demonstrate maturity and competence,” should have a voice in making their own medical decisions. It is, therefore, unsurprising, that the court weighted JNS’ wishes in determining JNS’ own “best interests.”

What’s the takeaway?

If we were to make any recommendations to parents based on this case, they would be:

  1. Seek competent, experienced counsel at the earliest possible stage of any proceedings that could potentially involve custody or child welfare issues.
  2. The press coverage of the case refers to allegations of religious animus, although it is noteworthy that the court made no reference to this subject – evidencing that those allegations played no part in the court’s reasoning.  We caution our readers that religion can play a tricky role in these types of cases (and of course we do not condone the making of any cruel comments, whether motivated by religion or otherwise).  While Wisconsin v. Yoder and its progeny stand for robust protection of parents’ religious values vis-à-vis government intervention in family matters, religious concerns, if present, often take a backseat in the eyes of the court as compared with scientific and medical evidence.
  3. Know what you’re getting into when you seek psychiatric care for your child or teen. In this case, a referral for anxiety and depression “quickly turned into” a diagnosis of gender dysphoria. Forewarned is forearmed.

Cincinnati trans-teen custody decision: More than meets the eye

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by worriedmom

4thWaveNow contributor Worriedmom has practiced civil litigation for many years in federal and state courts.

Note: Bolding in the court decision (reproduced at the bottom of this post) is by 4thWaveNow, to draw our readers’ attention to certain aspects of the case which have been ignored (so far) by the mainstream press.

Update 2/19/18: We have just posted a more detailed legal analysis of the case here.

So, we now have the decision in the soon-to-be-infamous “Cincinnati transgender custody case,” which we have reprinted below in its entirety as a service to our readers. Does the case strike an amazing and courageous blow for the freedom of transgender teens everywhere? No. Does the case give jack-booted government thugs the ability to batter down parents’ doors and drag kids off to the surgical suite? Again, no. Should this case strike fear into parents’ hearts and cause them to re-think their views on the advisability of transition for their children and teens? No.

A reading of the case – which we plan to review in much greater detail in the coming days – shows that it is, by and large, a temperate decision, the primary effect of which is merely to maintain the status quo until the person at issue, “JNS,” reaches the age of legal majority, which will happen shortly.

In fact, it is abundantly clear that JNS’ impending 18th birthday, which the decision characterized as occurring in a “few … months” is the over-riding factor driving this opinion. The Court has actually insured that nothing will take place in JNS’ medical care until JNS makes the decision, because the Court ruled that no treatment options can be pursued by the grandparents unless and until JNS has been evaluated by an independent medical authority. Practically and logistically, this will not happen until after JNS has turned 18, at which time JNS will be making the decision.

A few other points from the decision also raise interesting issues:

* The parents, while characterized as religious zealots and worse in the press, have supported JNS’ psychiatric treatment, both financially and otherwise.

* The Court noted that the parties’ claims about the likelihood or potential for suicide had constantly shifted throughout the history of the case; and

* The Court in fact expressed “concern” about the admission by Cincinnati Children’s Hospital Medical Center that “100%” of its patients are considered “appropriate” candidates for gender treatment.

cincy court case

Particularly in view of the sensational coverage attracted by this case, we feel it is even more important than usual for our readers to know and understand the relevant facts for themselves. In our view, this is a highly unusual case, likely to be of limited precedential value and confined to its particular facts and circumstances, that should not occasion undue concern, or elation, on either side.

Court decision is reproduced below for our readers’ convenience.

HAMILTON COUNTY JUVENILE COURT

In re: JNS                                                                           Case No. Fl7-334 X

JUDICIAL ENTRY

This case began on February 8, 2017, with the filing by the Hamilton County Department of Jobs and Family Services [hereinafter HCJFS].seeking an Interim Order of Custody of the child in question. Two days later an agreement was reached – specifically “to avoid a hearing on the motion”- whereby the parents agreed to abide by a pre-existing 11Safety plan,” thereby leaving the child in residence with the maternal grandparents. Parents further agreed to make the child available to participate in recommended therapy with Cincinnati Children’s Hospital Medical Center [hereinafter Children’s Hospital]. The agreement included the warning that “Any breach of these orders of interim protective supervision should alert HCJFS that an emergency situation exists and a risk assessment should be done to determine whether emergency court action is needed.11    A Guardian ad Litem for the child was also appointed at this hearing.

In April of 2017, the situation had deteriorated to the point that HCJFS proceeded on the complaint alleging dependency, neglect and abuse and sought temporary custody of the child.

By stipulation, the parties agreed to an adjudication of dependency, and the allegations of neglect and abuse were withdrawn. Based upon the agreement of the parties, the child was placed in the temporary custody of HCJFS and ordered to remain in continued residence with maternal grandparents. The parents declined reunification services and all parties expressed their agreement with the permanency goal of preparing the grandparents to guide the child to adulthood.

Following that adjudication and disposition by stipulation, several case plans were filed, all stating that Children’s Hospital “would like” to begin hormone therapy with the child pursuant to a treatment plan for the diagnosis of gender dysphoria.

Parents objected to the plan and several hearings were held. On August 23, 2017, the Magistrate declined to expedite the matter as he found that no emergency, as previously suggested in the petitions, existed. Inexplicably, the case plan seeking hormone treatment was withdrawn and the case took the posture of a relatively routine post-dispositional hearing on the issue of who should be the custodian of the child, weighing first and foremost the best interests of that child. HCJFS filed a Motion to Terminate Temporary Custody and Award Legal Custody to the maternal grandparents. An in-camera interview of the child was conducted on October 2, 2017, by the Magistrate and reviewed in preparation for the post-dispositional phase of the trial by this Court.

On December 6, 2017, maternal grandmother filed a Petition for Custody, and maternal grandfather filed a Petition for Custody on December 8, 2017. The matter was before this Court for final determination of custody.

If only it could be that simple.

On December 12,2017, January 23,2018 and January 26,2018, the Court conducted a trial on the post-dispositional motions.

The following attorneys and parties appeared: assistant prosecuting attorney Donald Clancy representing Kody Krebs and Diedre Gamer (HCJFS); attorney Karen Brinkman and attorney Amanda Pipik representing mother and father; attorney Ted Willis (civil attorney for mother and father); attorney Paul Hunt representing Brenda Gray-Johnson (Guardian ad Litem) and Mary Ramsay (Court Appointed Special Advocate); attorney Tom Mellott representing JNS (child); attorney Jeff Cutcher representing maternal grandparents; and attorney Jason Goldschmidt representing Children’s Hospital.

Despite the withdrawal of the case plan calling for hormone therapy to begin, the testimony presented by HCJFS centered on the medical condition of the child and the function of the Children’s Hospital Transgender Program. While the child was first presented BY HER PARENTS to Children’s Hospital for psychiatric treatment of anxiety and depression, that diagnosis rather quickly became one of gender dysphoria. Gender dysphoria is defined as: discomfort or stress that is caused by a discrepancy between a person’s gender identity and the gender assigned at birth, and the associated gender role….11   (World Professional Association for Transgender Health, Standards of Care for the Health of Transsexual, Transgender and Gender Nonconforming People, 7th Version). Treatment of that discomfort and stress can involve different degrees of intervention,and must be highly individualized and can range from psychotherapy, hormone therapy and ultimately surgical intervention to change sex characteristics. (It must be noted that the parents, while objecting to the administration of hormone therapy, have continued to financially support the ongoing therapy sessions for the child at the Children’s clinic.) The entire field of gender identity and non-conforming gender treatment is evolving rapidly and there is a surprising lack of definitive clinical study available to determine the success of different treatment modalities. One aspect, however, is constant in the testimony presented in court of all of the medical personnel, and in the sparse recognized professional journals available, and that is that the potential candidate for gender transition therapy must be consistent in the presentation of his or her gender identity. It is a concern for the Court that the statistic presented by Dr. Conard, the Director of the Transgender Program, in her testimony is that 100% of the patients seen by Children’s Hospital Clinic who present for care are considered to be appropriate candidates for continued gender treatment.

In this case, it is understandable that the parents were legitimately surprised and confused when the child’s anxiety and depression symptoms became the basis for the diagnosis of gender dysphoria. The child has lived until the summer of 2016 consistent with the assigned gender at birth. The parents sought appropriate mental health treatment when their child’s generalized anxiety and depression reached the point that hospitalization became necessary. The parents acknowledged that the child expressed suicidal intent if forced to return to their home. It is unfortunate that this case required resolution by the Court as the family would have been best served if this could have been settled within the family after all parties had ample exposure to the reality of the fact that the child truly may be gender non-conforming and has a legitimate right to pursue life with a different gender identity than the one assigned at birth.

It is not within this Court’s jurisdiction to intrude on the treatment of a child except in the very rare circumstance when the child’s life hangs in the balance of treatment versus non-treatment. The threat of suicide and the existence of suicidal ideation can never hold this Court hostage as it searches for proper outcome of litigation revolving around the best interests of that child. Despite the fact that the parents initially stipulated during the adjudicatory phase that the child had expressed suicidal ideation, the medical records in evidence indicate that at the time of the filing of the complaint, that ideation was not presenting as an imminent threat.

It is particularly troubling to the Court that the initial filings in this case indicate that suicide is a potential factor to be considered by the Court, when in the medical records admitted during trial it is clearly not. On January 31, 2017, the medical record clearly indicates “NO” to the question: Is the patient at risk for suicide? The complaint alleging the emergency nature of the facts was filed the very next week! The medical records admitted into evidence show that on February 10, 2017, the same response was entered to the same question. This was a mere three days after the filing of the complaint, and during the pendency of the 11emergency” posture of the complaint. The suggestion of imminent suicide alleges a fact pattern that requires this Court to act expeditiously in determining to what extent-if any-court intervention is appropriate. Should the Court take jurisdiction every time a minor threatens self-harm if he or she is unable to gain parents’ consent for some desired procedure, such as a rhinoplasty or similar cosmetic surgery? It is a sad commentary that the Juvenile Court system deals with the suicidal ideation of troubled adolescents on a regular basis but cannot let that threat govern the outcome or disposition of a case before it.

It now becomes the duty of this court to determine what is in the best interests of this child for the few remaining months of minority. Evidence was presented that the parents agree that the child should remain with the maternal grandparents and continue to attend the high school at which the child is excelling both academically and musically. The child wishes to remain in the care of the grandparents. The grandparents are suitable caregivers and have demonstrated an ability to meet the child’s needs. The Court Appointed Special Advocate and the Guardian ad Litem for the child recommended a grant of legal custody to the grandparents and advocated that the child’s best interest was served by the continued placement with the grandparents.

THEREFORE, it is the order of the Court that the Temporary Custody to HCJFS is terminated and Legal Custody of the child is awarded to the maternal grandparents, subject to the following conditions:

  1. Grandparents shall have the right to consent to the child’s petition to change name filed in the Probate Court.
  2. Grandparents, indicating in open court that they do not choose to pursue support for the

child, shall immediately cover the child with insurance for medical care.

  1. Grandparents shall have the right to determine what medical care shall be pursued at Children’s Hospital and its Transgender Program, but before hormone therapy begins, the child shall be evaluated by a psychologist NOT AFFILIATED with Cincinnati Children’s Hospital on the issue of consistency in the child’s gender presentation, and feelings of non-conformity.
  2. Parents are granted reasonable visitation and encouraged to work toward a reintegration of the child into the extended family.

In accordance with 42 U.S.C. Section 11431, the above-referenced child is entitled to immediate enrollment in school as defined by O.R.C. section 3313.64. The enrollment of a child in a school district under this division shall not be denied due to a delay in the school district’s receipt of any records required under section 3313.672 of the Ohio Revised Code or any other records required for enrollment. Northwest School District shall bear the costs of education, pursuant to O.R.C. sections 2151.35(8)(3) and 2151.362. Such determination is subject to re-determination by the department of education pursuant to O.R.C. 2151.362.

The Court would be remiss if it did not take this opportunity to encourage the Legislature to act in crafting legislation that would give the Juvenile Courts of this state a framework by which it could evaluate a minor petitioner’s right to consent to gender therapy. What is clear from the testimony presented in this case and the increasing worldwide interest in transgender care is that there is certainly a reasonable expectation that circumstances similar to the one at bar arc likely to repeat themselves. The Legislature should consider a set of standards by which the Court is able to judge and act upon that minor’s request based upon the child’s maturity. That type of legislation would give a voice and a pathway to youth similarly situated as JNS without attributing fault to the parents and involving them in protracted litigation which can and does destroy the family unit.

Judge Sylvia Sieve Hendon

February/16, 2018

 

The Tide Pod Challenge: How a teenage self-harm fad ought to be handled

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by Overwhelmed

If you haven’t heard, the Tide Pod Challenge is all the rage with teens and young adults. Unfortunately, many of them have bitten into, ingested, and accidentally inhaled the liquid laundry detergent packets, leading to serious medical consequences. Several young people have even died.

Tide bottleWhy has the challenge become so popular? Well, this age group is not known for risk aversion or for considering the consequences of their actions. And many of them have a social media presence and strive to accrue “likes” and gain new followers. So when #TidePodChallenge started trending, some of them just couldn’t resist. They recorded themselves biting into laundry pods and uploaded it to various social media platforms. This in turn inspired more to join in the dare.

I’m sure 4thWaveNow readers can appreciate the parallels between the Tide Pod Challenge and Rapid Onset Gender Dysphoria.  The same age group is involved. Both are spread by social contagion, which is greatly amplified by social media. And both cause medical harms.

Dr. Susan Bradley, longtime expert in childhood gender dysphoria, as well as autism, had this to say about Rapid Onset Gender Dysphoria (ROGD) in a recent article in the Canadian journal Post-Millennial:

In my own practice, I have seen a good many young women displaying the phenomenon known as “rapid onset gender dysphoria,” or ROGD, which overwhelmingly affects girls.

Typically, the ROGD teenage girls I see have, wittingly or not, begun to experience homoerotic feelings about which they are conflicted. They tend to be socially isolated, and somewhere “on the spectrum.” They may have histories of eating or self-harm disorders.

They have found companions with the same attributes on Internet sites, which diminishes such adolescents’ sadness over their social isolation, but which can also lead to foreclosure of reflective thinking about their own feelings and situation. Some of these girls are depressed, afflicted with suicidal ideation. Because of the initial euphoria they experience in finally “belonging” to a well-defined kinship group, they tend to embrace the idea of transitioning wholeheartedly as the solution to their other problems.

I’ve been impressed with the actions being taken to stem the Tide Pod Challenge (which I list below). It gives me hope that when the serious ramifications of Rapid Onset Gender Dysphoria are eventually acknowledged, steps will be taken to curb it as well.

So, how have responsible adults acted to reduce the number of young people being harmed by the Tide Pod Challenge?

  1. Many journalists are reporting about it. The public is being informed of this trend, including the serious medical implications—seizures, chemical burns to the eyes which can cause temporary blindness, fluid in the lungs, respiratory arrest, coma, death.
  1. YouTube (owned by Google) has removed videos that show people taking bites of laundry detergent packets. According to a spokesperson: “YouTube’s Community Guidelines prohibit content that’s intended to encourage dangerous activities that have an inherent risk of physical harm. We work to quickly remove flagged videos that violate our policies.”
  1. Facebook has followed suit, deleting content off its platforms (including Instagram), stating “we don’t allow the promotion of self-injury and will remove it when we’re made aware of it.”
  1. Procter and Gamble, which owns Tide, is trying to turn the tide (sorry, I couldn’t resist) of this social contagion. According to a company representative, “We are deeply concerned about conversations related to intentional and improper use of liquid laundry pacs and have been working with leading social media networks to remove harmful content that is not consistent with their policies.” Tide has even enlisted a celebrity, NFL star Rob Gronkowski, to appear in a Twitter video informing people that Tide Pods are for washing, not eating. It has already garnered millions of views.

tide podsThis is exactly how a socially contagious craze that is impacting young people SHOULD be handled. I dream of more journalists honestly covering Rapid Onset Gender Dysphoria and its associated often-irreversible medical consequences. I wish pharmaceutical companies would speak up and condemn the inappropriate, non-FDA approved, off-label use of their products. I hope social media platforms will restrict content that glorifies tweens, teens, and young adults altering their bodies via binding, cross-sex hormones, double mastectomies, and genital surgeries. It could easily be interpreted that cheering on medical transition already qualifies as a violation of YouTube’s policy of encouraging “dangerous activities that have an inherent risk of physical harm” and Facebook’s “promotion of self-injury.”

But unfortunately, the transgender rights movement is overshadowing this epidemic. I think the majority of the public is totally unaware that kids are being influenced, especially by social media, to believe that they are transgender. They become convinced their bodies are wrong and in need of drastic life-long medical interventions. The adults who are aware of this contagion are often afraid to raise concerns because they will be labeled transphobic (and potentially lose their jobs). Of course, this seriously dampens the opportunity for rational discussion on this topic. Mainstream journalists, particularly in the United States, have been extremely hesitant to cover it.

I have no doubt that Rapid Onset Gender Dysphoria will eventually become widely known as a disastrous medical fad. Steps will be taken to curtail the damages. It’s just a question of when. In the meantime, parents of ROGD kids and their allies will keep speaking out. They’re doing what they can to reduce the number of young people who may eventually regret how easy it was to medically transition.

Unlike the Tide Pod Challenge, the spread of Rapid Onset Gender Dysphoria has gone unchecked for several years now. Thousands of young people and their families have been impacted. It has gotten so out of control that serious efforts need to be undertaken to counteract the nearly insurmountable amounts of misinformation, and help control this social contagion. This effort needs to be more than parents speaking out. Medical organizations need to review the science (not rely on trans activist ideology), reevaluate their stance on pediatric medical transition, and rein in rogue practitioners. If we have any chance at stemming this, it will have to be done on a grand scale from multiple fronts.

Freed from the girl pen: Another mom and desister teen tell their stories

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This is another in our ongoing series of personal accounts by formerly trans-identified teens and their parents. Ash, age 16, identified as trans from ages 12-15 and has now desisted. We start with her mom Kelly’s account of her experiences, followed by Ash’s essay. Ash and Kelly are available to interact in the comments section of this article, as time permits.

4thWaveNow is always interested in hearing from desisters and their parents. Please let us know if you would like to guest post.

Mom’s perspective

By Kelly O’Connor

I didn’t take it too seriously when my daughter told me she was transgender. She had already told me she was gay, and she had ongoing anxiety and depression that I knew she was actively looking for relief from. She started puberty early, acquiring breasts which amplified her already frenetic mental state to the point that, like a wild horse, she could not tolerate most of the ropes society tried to hang her with. What young girl in her right mind wants to be culled from the herd and corralled into a ‘girl’ pen?

Prior to her identifying as trans, we had weathered a divorce, and I went back to being the single mom I had started out as (her biological father has never been in the picture). We began homeschooling soon after because there was bullying at her school. This brought the two of us much closer together, but she also began spending more time on social media looking for social outlets. That’s when the Trans Meme entered our lives in a big way. We were in a homeschooling group that had one kid who had trans’ed really young, but Ash’s biggest exposure was online on DeviantArt and Tumblr. Around the same time a close friend’s daughter, who was also on Tumblr, went on testosterone. Ash was now surrounded online and off by the idea that identifying as transgender was some sort of escape hatch.

gate 1Knowing that Ash was identifying as male online and wanted to do so IRL, I just kept up a non-committal, non-judgmental attitude about it. I never called her by a different pronoun, although she and her trans friend had made some attempts to get me to do so. I resisted because it felt like a slippery slope and reality was a pretty flexible concept for her at the time. She used to spin tales about people who didn’t exist or events that didn’t happen. She was into cutting and knives and horror films and intense, scary anime. Frankly, I didn’t have a big reaction to her coming out as trans because there were other, much scarier scenarios looming large in my mind. Her sexual/gender identity wasn’t a big concern for me. I was more focused on keeping her off of anti-psychotics. Looking back I think my non-reaction made it easier for her to change her mind. There was never a big line in the sand drawn by either of us and so nothing was ‘decided’ or set in motion. I’ve also always been very anti-interventionist. I don’t go to the doctor unless something is broken or the bleeding won’t stop. I once declined a D&C during a miscarriage – I didn’t want anyone scraping around in there – and the only drugs I take are ibuprofen, or antibiotics if necessary. Maybe that is why Ash never directly asked to be put on testosterone.

Having a child stand on the brink and stare into the maw of insanity was one of the most terrifying experiences of my life. It was a years-long scream into the dark and I felt I could tell no one. I knew drugs or institutionalization would put her in a place she would not return from but I wasn’t sure others would see it that way. The possibility that she was transgender complicated matters for us and she was very vulnerable to the idea, as I can imagine any teen struggling with mental illness would be.

But we got through it. I listened to her when she would talk to me, I told her about some of the things I had been through at that age, I found her a therapist she liked and I trusted, we took lots of walks, and we got a great big dog. I kept encouraging her and trying to connect her with friends and the outside world. I took an interest in her world which was mostly anime, and horror films at the time, so we went to anime conventions and did cosplay and watched movies. I just kept holding on to her and didn’t let go. Eventually, she emerged from the other side of her darkness and slowly came to re-inhabit the body she had abandoned. Now, at 16, she’s learning to be better friends with herself, and finding ways to deal with her mental lows like exercise and diet. And the ‘girl-pen’ is just a place she left in the dust.

Ash’s account:

 Ash is a 16 year old dual-enrolled college student who previously identified as transgender for 2+ years. She enjoys art/animation, games, and learning languages.

I am writing this essay because I want people to understand that mental illnesses aren’t being given the attention they deserve for many transgender-identifying teens and also that for females who are attracted to other females, we don’t usually get to see ourselves in popular culture.

From 12 to 15, I identified as transgender. I’m 16 now and I present as androgynous but I am a gender abolitionist in that I want people to be able to present however they choose, even though I also think gender roles are harmful.

trans bus

Cartoon by Kelly O’Connor

Starting in 2012, around the time when the rates of trans people were just starting to spike, I was very much involved in the LGBT community online and beginning to realize that I was attracted to females. All of my friends were female and there was a lot of drama. That was difficult, being attracted to people who were mean. It seemed like being a guy would make everything easier.

There’s also a lot of pressure on girls to be attractive. On guys too, but it takes ten times more effort for a girl to be seen as attractive than for a boy. As a young teen, the thought of having sex with my female body repulsed me. But thinking of myself as male, with a new life, without my past trauma, was a lot more comforting to me. I didn’t want to associate anything about myself with being female because my body felt like a canvas of memories I didn’t want to remember, didn’t want to see anymore. I was molested when I was younger by an older male teen. Everything about my female body felt wrong and dirty and dangerous to me.

When female teens I know started identifying as trans, they instantly became more sexual. There are a number of reasons why: repressed emotions, “daddy issues,” negative body images, previous trauma, and some are also disabled. It’s completely unacceptable to be a fat horny girl, but it is more than acceptable to be a fat horny boy.

It’s safer and more socially acceptable in general to be a sexual boy than a sexual girl, especially a girl who is attracted to other girls. The word “lesbian” makes a woman sound gross for liking another woman but the word “gay” sounds completely fine and happy. When I was 12, I told some friends who are boys that I was attracted to girls. They basically said that’s not real, meaning it’s not possible for two girls to have a relationship. However, they also said it was hot, which made me see the label “lesbian” as a fetish term, unlike the label “gay” which is a legitimate form for a relationship.

Anime was a very big interest of mine, just like it is for many other transgender teens. That led me to fan art for shows like Doctor Who and Sherlock Holmes as well. A good deal of the fan art focused on two male characters who were romantically involved, not in the show, or in canon, but in the fandom. Gay male relationships were glorified on all the art and social media websites I was using but it was very rare to ever see two women from the same show or two women from any show depicted as lesbians. Most of the females I knew were drawing gay male relationships, not female ones, because the desire was for what we thought that kind of relationship would be like (the gay male kind). My mom and I have talked about how different things were when she was a teen. She would have had a crush on the boys in the shows she liked but me and my friends wanted to be them.

I was drawing that kind of gay male relationship art when I started questioning my gender, and I received a lot of positive feedback for my art from people in the community. On social media, I set my gender to male and no one questioned it. As soon as I came out as trans, I started to receive a lot more attention. I felt happier and much more confident in myself than I ever had.

Things didn’t exactly change with my life, but I had much more confidence looking in the mirror. I used to completely break down because I hated myself so much. Once I had the word “transgender,” I had a better idea of what my identity was at the time and I was able to find information and resources to help with many of my issues: depression, anxiety, weight, etc. I truly believed I must be a boy because of how happy I felt coming out as one.

However, now I feel like the term “transgender” has become a coping mechanism for sufferers of abuse, trauma, emotional neglect, and mental illness. It’s not that big of a coincidence that many of the transgender people I’ve met have some kind of chronic physical or mental illness or come from a childhood where they were emotionally or sexually abused, or suffered neglect or abandonment. They need some way to cope and gain the attention and sense of control that they always craved and never received.

I used to feel incredibly dysphoric over certain parts of my body that a lot of transgender people also feel dysphoric over, such as my chest, my legs, my hips, etc. It is not exactly something I can explain but I have always felt very off about myself. I also struggle with quite a few mental illnesses that can make my mind not the most stable. I unfortunately mistook overall body dysphoria and the emotional results of trauma for gender dysphoria and came close to ruining/mutilating my body in an attempt to fix it.

I was the most dysphoric when I thought I was trans, I never wanted to leave the house. I was heavier and my boobs were larger and I was very obviously female. I had a binder for part of that time but it was uncomfortable and gave me breathing problems. My ribs were in severe pain from wearing it for hours a day. I almost fainted multiple times at an anime convention.

The dysphoria grew when I thought I may be a boy. I always wanted to come across as more masculine rather than feminine. I never wanted to be a tomboy, I wanted to be a real boy. When I thought I was trans, all I wanted was to have gender reassignment surgery but now, I’d never consider it, even though I prefer coming across androgynous. Part of the reason I would never consider surgery or hormones now is because I feel better about my body. I eat better now and exercise a lot. While you can’t control dysphoria, you can learn ways to get used to the feelings and those feelings get better over time as puberty ends. That’s how puberty works, it messes with you. When you first hit puberty, dysphoria spikes because there are all these changes you can’t control and in my case, didn’t like.

My boyfriend at the time, who was also identifying as transgender (I knew them as a girl for a few years beforehand), convinced me I should transition a few days after I mentioned I might be trans too. If I remember correctly, I told my mom a few months later, when we were sitting in the car at the drive through for Starbucks. We were pretty quiet until I turned away from her and said “Hey, I think I’m a boy. And I want to go by “Avery” (a name that I went by for awhile even after realising I wasn’t a boy). She turned to me and raised her eyebrow and said “Uh, alright. So you’re this now?” We got our coffee and it wasn’t spoken about again. I figured, since she didn’t freak out, that meant it would be OK to start some kind of process, but then the next day, she was talking to one of her friends on the phone, and she referred to me as “she” like usual.

During that time, I had no questions regarding the side effects of being on T; I just wanted it, none of the side effects mattered or seemed important. My mindset was just “if I do this, I will feel better about my body and I won’t feel suicidal anymore.” But, the thought that maybe I couldn’t get on T or blockers sent me into a much deeper depression than I was in before. No one was there to inform me about the side effects of hormone therapy and in the groups I was involved in, people only encouraged me to go ahead in my transition once I officially came out even though I was still a minor, still growing, and not yet receiving the mental health care I needed. They encouraged me to go ahead and do what I needed to do to be happy with myself.

Because I didn’t have much support in my life in other areas at that time, their support felt amazing. Up until that point, I had struggled with gaining friends for months, years even. The only person I really knew and talked to daily in my life was my mom and my ex boyfriend (who was severely mentally abusive towards me). All of a sudden, I had many new friends and I was getting a lot of attention for my new identity.

The next three years were me believing I was trans and my mom blowing me off. Thank goodness, because I would be close to getting my first surgery now at 16. I have a lot of transgender friends and the difference between me and them is their parents brought them to gender clinics or special gender therapists. Some of my friends self-harmed and threatened suicide so their parents would take them to gender therapists but I never did that. I did tell my mom I needed a therapist and she found one but her focus wasn’t on my gender identity. We never talked about that until this year.

While I realize now that I am not a boy and will never really be a boy, I’ve also come to discover the androgynous community. I still feel like there’s something missing and I may never find it but finding a nice balance between both genders has been better, healthier and safer for me. I’ve never supported gender roles and usually tend to ignore them and wear what I want, but the harsh reality is if gender roles weren’t so ingrained into today’s society then a lot of kids might not even be transitioning at all.

Over the past few years, I’ve worked hard to change my lifestyle. I recently registered at a community college, and I’ve been making more friends and getting involved in things outside of the house. I have a therapist who looks at my mental health issues instead of my identity. She helps me explore my feelings of dysphoria and repulsion over having a female body. I’ve come to understand that these feelings come from past trauma not because I’m really a boy.

Most of my friends are either transgender and/or gay. Some of my closest friends have struggled with their identities as long as me. I also have friends who I’ve watched go on testosterone, and while I may not agree with their decision, I support them no matter what.

For me personally, my identity doesn’t mean a lifetime of hormone therapy and it certainly doesn’t mean a series of surgeries. For me, I realized that if I had even one small doubt, it would lead to more and more doubt. That was a red flag for me and it should be a red flag in general. Once the process of HRT and surgeries starts, there’s no going back. I think it is very hard for teens who’ve made these choices to change their minds both because they’re afraid to lose the control they never had before and once they go back to being “cis,” they’ll be unimportant and nothing special in this world.