by Marie Verite and Brie J
Dr. Kenneth Zucker, recognized as one of the world’s top experts in childhood gender dysphoria, penned the following paper (released today).
Zucker, K. J. (2018). The myth of persistence: Response to “A Critical Commentary on Follow-Up Studies and “Desistance” Theories about Transgender and Gender Non-Conforming Children” by Temple Newhook et al. (2018). International Journal of Transgenderism. https://doi.org/10.1080/15532739.2018.1468293
Dr. Zucker has offered to provide a PDF of the full-text article if readers contact him via email.
Multiple trans-activist journalists and “affirmative” gender clinicians have (rather successfully) propagated the meme that desistance from a trans identity is a “myth”; that Zucker (former director of the Toronto clinic), Thomas Steensma, Peggy Cohen-Kettenis (of the Amsterdam team which pioneered the use of puberty blockers for gender-dysphoric children), and others have wrongly conflated merely gender nonconforming children with “true trans” kids. Therefore, their entire body of research is essentially worthless. These critics have gone further, accusing some clinicians (like Zucker) of forcing harmful reparative therapy on “trans kids.”
Dr. Zucker’s detailed rebuttal to the Temple-Newhook et al article is well worth reading in its entirety. Be forewarned: The paper is densely argued and referenced, such that understanding it requires a decent working knowledge of the clinical literature on childhood gender dysphoria, the nuances/changes in the DSM diagnostic classifications (e.g., DSM-IV “gender identity disorder” vs. DSM-V “gender dysphoria”), as well as the trans-activist reactions to all of the above.
In a series of tweets today, Dr. Zucker emphasized one of the key points in his paper.
“…that pre-pubertal gender social transition is itself a psychosocial treatment, which Temple-Newhook et al ignore.”
The context for this tweet can be found on page 7 of Dr. Zucker’s article:
Thus, I would hypothesize that when more follow-up data of children who socially transition prior to puberty become available, the persistence rate will be extremely high. This is not a value judgment – it is simply an empirical prediction. Just like Temple Newhook et al. (2018) argue that some of the children in the four follow-up studies included those who may have received treatment “to lower the odds” of persistence, I would argue that parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.
And later, on page 10:
Temple Newhook et al. (2018) go on to state that “It is important to acknowledge that discouraging social transition [with reference to the Dutch team’s putative therapeutic approach] is itself an intervention with the potential to impact research findings…” Fair enough. But Temple Newhook et al. (2018) curiously suppress the inverse: encouraging social transition is itself an intervention with the potential to impact findings. I find this omission astonishing.
An astonishing omission, indeed.
As regular readers of this website will know, most parents in the 4thWaveNow community are particularly concerned about the recent increase in teens (particularly females) presenting to gender clinics, with a sudden onset of gender dysphoria around the age of puberty.
Although the characteristics and clinical course of early-onset gender dysphoria (the primary population discussed in Zucker’s paper) are different from that of adolescent-onset, an underlying question pertains to both: Does “affirmative” treatment increase the likelihood that a cross-sex identification will persist?
We must point out here that trans activists consider it “transphobic” for anyone to believe that a child’s desistance from trans-identification would be preferable to persistence. (In fact, this accusation is leveled by Temple Newhook et al in their paper, in so many words. This helps to explain why so many trans activists object to the very idea of studying persistence vs. desistance in the first place.) Yet, we find it mystifying that a preference for desistance is even controversial. Surely, if a child can find peace in his or her unaltered body–and happily avoid becoming a sterilized medical patient dependent for life on drugs and surgeries–that is a positive outcome. To leverage an analogy popular with trans activists, many say that “gender affirming” medical treatment is analogous to treatment for children with life-threatening cancers. Yet who would not feel happy for the cancer patient who goes into remission, thus avoiding the ravages of chemo and radiation?
Furthermore, is it not possible to support young people in their gender atypicality, while at the same time encouraging bodily acceptance?
Central to this discussion is the trans-activist conflation of psychotherapeutic methods with conversion therapy. Zucker addresses this problem head-on on page 9:
Now, of course, it would not come as a surprise if Temple Newhook et al. (2018) took umbrage at the mere idea of a treatment arm designed to reduce a child’s gender dysphoria via psychotherapeutic methods. They might, for example, offer up the following from the seventh edition of the Standards of Care:
Treatment aimed at trying to change a person’s gender identity…to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964)….Such treatment is no longer considered ethical.” (Coleman et al., 2011, p. 175)
Yet, on the very same page of the Standards, one finds the following: “Psychotherapy should focus on reducing a child’s…distress related to the gender dysphoria…” (p. 175) or “Mental health professionals…. should give ample room for clients to explore different options for gender expression” (p. 175). The lack of internal consistency between the first statement and the second and third statements is rather astonishing.
“Reducing a child’s…distress related to the gender dysphoria” should be the primary goal of all treatment methods. Quite a few 4thWaveNow parents have observed that upon social transition, their children’s dysphoria actually increased. This is another aspect related to the different populations (early-onset vs. adolescent rapid-onset) that needs to be clarified but still remains unknown. Dr. Zucker explains that he “prefers the following summary statements about therapeutics with regard to children with gender dysphoria”:
Different clinical approaches have been advocated for childhood gender discordance….There have been no randomized controlled trials of any treatment….the proposed benefits of treatment to eliminate gender discordance…must be carefully weighed against… possible deleterious effects. (American Academy of Child and Adolescent Psychiatry, 2012, pp. 968–969)
Very few studies have systematically researched any given mode of intervention with respect to an outcome variable in GID and no studies have systematically com- pared results of different interventions….In light of the limited empirical evidence and disagreements…among experts in the field…recommendations supported by the available literature are largely limited to the areas [reviewed] and would be in the form of general suggestions and cautions… (Byne et al., 2012, p. 772)
…because no approach to working with [transgender and gender nonconforming] children has been adequately, empirically validated, consensus does not exist regarding best practice with pre-pubertal children. Lack of consensus about the preferred approach to treatment may be due, in part, to divergent ideas regarding what constitutes optimal treatment outcomes… (American Psychological Association, 2015, p. 842)
Here at 4thWaveNow, we have repeatedly stated that we seek to support—not “eliminate”–our children’s “gender discordance” although we resist the idea that gender atypicality is a sign of bodily incongruence. More than anything, 4thWaveNow parents seek to help our children minimize the discomfort that accompanies their nonconformity to gender norms. Since many of our children only experienced dysphoria upon reaching puberty, we call for (much) more evidence that social and medical transition are better at alleviating dysphoria than psychotherapeutic methods.
And as Dr. Zucker has made clear via his life’s work (and in this paper), the jury is still very much out on that question–despite the many attempts by trans activists to deplatform those who study the matter of persistence and desistance.
“Furthermore, is it not possible to support young people in their gender atypicality, while at the same time encouraging bodily acceptance?” indeed.
Nature vs Nurture? (and I say nurture…but perhaps coersion is a better word? is it even neglect?)
I understand that many parents are motivated by love and support, but the above question does not seem to get asked. Are they afraid of being labelled bigots? Is there general pressure from medical teams? or religious groups? Is this a reflection of a pharma-phillic society, looking for quick fixes and external blame/fault?
“Parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.”
I hope many clinicians, teachers, and parents will read this article.
Why would anyone want this for their child?
A lifestyle that involves a lifetime of cross-sex hormones? Surgeries? Why?
Sure, support gender non-conformity–whatever that is (there are many ways to be a man or a woman).
Parents are coerced to go along with a social transition, to go against all common sense and history, to lie. Parents are coerced by the gender docs to adopt new pronouns and names for their child. If they don’t jump through these social transition hoops, they are warned of increased distress and possible suicide attempts by the child. The child/teen/young adults are encouraged in this same belief. Everyone must go along with their notions–or disaster will strike.
We all know that social transitions lead quickly to medical transitions.
Don’t drink the Kool-Aid from the gender clinics.
“Parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.”
I agree, missingdaughter. The above sentence cannot be emphasized enough. Not only is this a common-sense statement which just about anyone should be able to determine on their own after a bit of thought, but research also bears this statement out.
Why is the transgender label put on children so casually and with such celebration? Why are parents called bigots when they want their children to avoid a lifetime of experimental drug use and surgeries with outcomes that leave much to be desired? Sexual reassignment surgeries are not comparable to surgeries to remove a cancerous tumor or fix a broken bone. As talented as some surgeons might be, and as advanced as some surgery techniques have become, sexual reassignment surgery patients start out with healthy bodies but end up with functional limitations and require a lifetime of upkeep, fending off infections and other complications.
To want our children to avoid finding themselves in this situation is not bigotry. Clinicians should be on our side, and the few clinicians who already are on our side should not be vilified for it. The clinicians pushing social and medical transition on children by telling them they’ll be driven to suicide if they don’t transition have much to answer for.
Thank you, Dr. Zucker. And thank you for this distillation of Zucker’s article! I, too, was struck by this statement:
“Parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.”
Wholeheartedly agree! To make a further point, I expand on its meaning towards Gender Identity Laws and schools:
“Current Gender Identity Laws that require schools to support, implement, and/or encourage a gender social transition are implementing a psychosocial treatment that will increase the odds of long-term persistence.”
Should schools be in the business of running psychosocial treatments on teens without parental consent? Are school officials highly trained experts in this field and qualified to weigh the pros and cons of this psychosocial treatment’s impact? Do they have an intimate knowledge of a student’s current mental health? Are they carefully monitoring and keeping track of outcomes? No, no, no and no!
Like others here on this website, my teenage daughter self-identified at her high school and within minutes her name and biological sex were changed in the system without our consent.
I’m trying to educate the school and protect my daughter from what I view as a law built around an ideology that has great impact on how I can help her. The school is trying to follow the law and avoid being legally libel for “gender identity” discrimination. I sense they are sympathetic towards our situation, but they can’t say a word.
In many ways it’s surreal and like living through a plague others choose not to see. My hands are tied at school on this topic, so I focus on the things I can influence. My money goes to therapy for my child. I can’t afford to lawyer up to fight this State Law, nor do I want to be in the headlines or compromise the privacy of my child. Nor do I want any spotlight on us to then have trans activists reaching out to her to “support” her, give her GoFund money or what have you, and to turn her against us. Beyond infuriating.
I’m 100% for supporting my kid in whatever gender conformance or non-conformance they want. Explore away
What I find problematic is how much worse my kid’s mental health got while they were identifying as transgender. Transitioning wouldn’t have fixed it, even though she was certain it would. Sometimes kids, being kids, don’t always know what’s best.
Thank you for continuing to speak out and for making your work available.
I had a somewhat in-depth conversation with my daughter yesterday, (some times it’s hard to do this as we walk on egg shells most of the time to avoid the outbursts that occur), and I asked her the question, ‘Have you ever even asked yourself WHY you think you feel this way?’. She never wants to explore that with me, her therapist or anyone for that matter. It’s just the way she feels and that’s all there is to it. She is so focused on following that agenda and nothing needs to get in the way of that. I am just baffled that these young girls would not even want to explore why this is going on and that they don’t ever want to try to fix it. And she acts like the horror stories that happen to these young men and women with these hormones and so forth are just made up! Praying always for all of us going through this.
My 20 year old is the same way. Sometimes I think she actually WANTS to be dysphoric and trans. My family walks on eggshells as well. I understand that my daughter is an adult but then I expect her to act accordingly. Why the outbursts?? I feel like she doesn’t want to question this too deeply because then it would all fall apart for her. I really appreciate the brace few who are questioning the affirm only approach. I cannot express enough that therapists and specialists who blindly follow this approach are very much “bullying” parents into following this approach. At least in my case. I actually had a paid therapists pretty much tell me how and what I should feel or my child would commit suicide! My daughters mental status completely deteriorated after social transition . I do use the pronouns and name out of respect for her. I support and will always love her BUT if she ever asks my opinion I will always be truthful. I physically cannot lie to my children. I do not believe my kid has looked at this carefully and weighed all the options. I do not believe my kid completely understands the health risks she may experience. I do not pay for any treatments because I feel that if she is adult enough to make this decision so quickly than she needs to be financially responsible as well. I feel like this is the only thing that has slowed the process somewhat. I do hold these professionals responsible for not helping my vulnerable and depressed child really weigh the pros and the cons of transitioning. I will never trust the mental health profession ever again. That may sound extreme to some but my family has been through hell and from our experience these therapists have actually facilitated damaging what was once a close and loving relationship with my child. I am working very very hard to build that relationship back up but that means (at least for now) that we walk on eggshells around the medical decision to transition. I have no control over this but I pray every day for all these young people and their families. I pray that our society will allow critical thought and true scientific data to be considered. I do feel so much for the parents of underage children going through this because they know that it is ultimately their decision. I do believe some are motivated by homophobia or just being swept up in the whole craziness. I think for most of these parents though they are being told by trusted doctors and therapists that this is the right thing to do. My heart breaks for those families! I pray all their children will be ok.
https://bellabirth.wordpress.com/2018/04/14/star-dust-and-fairy-wings/ I wrote this poem, which I thought seemed appropriate. ..it is simple but not.
I also wrote this “Our patriarchal society likes to infantalise us, and this obsession with identity is the perfect ruse. It is superficial and even childish to be focused on ‘identity’ in this way.” In this post https://bellabirth.wordpress.com/2018/02/24/polite-ticks/ which comes to mind by the comments above.
This is such an important discussion.
“Parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.”
Of course I totally agree. But my question is how. HOW can we stop the social transition from happening, when EVERYONE (Doctors, Therapists, Schools) is against us!
When my daughter first started this about 1.5 years ago – The first thing I tried to do was have her medically checked out because she was sooo extremely different – her personality -her compassion, her religious belief–EVERYTHING. But her biggest thing was her anger, acne etc. After researching I felt she had many. signs of PCOS (which can cause depression, anxiety,self esteem issues and yes gender confusion). So I dragged her to my OBGYN (the one who delivered her who I had trusted.) Well… after a brief talk to both of us together, and after he heard the “transgender”word, he decided NOT to do his job.He never listened to me, her mom! the one who knows her best! … He gave her ovaries a scan, found no cysts (I did NOT know then that most women w/ PCOS do NOT have cysts)…He patronized me and then said to us both “well when your 15– ya know!” WHAT?! KNOW WHAT?! he tested her hormones after i insisted. They came back with HI testosterone levels —- but he told me that it had nothing to do with her GID.Total affirmation -we left with her smiling, me in tears.This affirmation, pushed her soo much further in. What an injustice done to us.
We continued to struggle through this, then came the name change -we said No, but then she declared herself trans in school and they tell me they have to call her what she wants to be called -pronouns and all…You cannot change your name legally till 18 but yet schools can change it.To top it off, we go to pick her up early, and they cant find/locate her under her LEGAL name…. so we have to spit out her boy name so they know who we are talking about. so, they are forcing us (her parents) who are trying to keep her from mutilating her healthy body, to contribute to it -Insanity. 2nd total affirmation! We did force her to change it back.But not without everyone seeing it first, and start using it.
After school affirmation, her body dysphoria got worse. I tried to bring her to a therapist who specialized in eating disorders and body image. After 3 sessions she affirmed my daughter and said I should too. Third affirmation. My daughter wouldn’t even look at me then.
Fast forward to 5 months ago– our wonderful home is total hell. Her anger got worse, her Acne was bad even on antibiotics, and her body was changing practically in front of our eyes. Her shoulders got broad.. we thought she must have gotten “T” somehow?somewhere? behind our back. So I got her to an endocrinologist. Another horrible office visit. Dr. first thing, asked if she had another preferred name. 4th Affirmation. WHAT? I wanted to scream- “Its in her chart.” but I didn’t want to give more ammunition to the “my parents don’t support me” story, so I held my tongue and just insisted she do a full workup- which she did. She changed her tune(a bit) when she diagnosed my daughter with PCOS and HYPERANDROGENISM (overload of male hormones). Something she could have been getting treatment for if the first doctor did his job. So heart wrenching.
Everywhere you turn -your parental rights are being stripped from you. I am trying desperately to help her. But no one wants to listen to the parent, the one who knows and loves her the most -the one who would die for her, No-instead they choose to listen to a self-diagnosing teenager. So HOW do we manage to keep our kids from social transition? I cannot even get my daughter correct help for fear of another affirmation. I also do not trust anyone anymore… I pray constantly -its about all i have left.
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