What you can do for your kid: Series intro

by Carey Callahan

Carey Callahan is a family therapist, writer, and organizer advocating for responsible healthcare for gender dysphoria. You can find her writing at medium.com/mariacatt42 (where this piece was first published), and she tweets at @catt_bear.

This piece is an intro to a series Carey will be writing in the coming weeks.


One of the sadder parts of being detransitioned and public about it is that the parents find you. They’ve been told by a doctor or a social worker that the only route forward that protects against suicidality is to affirm their kid’s trans identity. That they need to be open to the possibility their kid may need their pubertal process disrupted, may need to begin what could within a couple of years turn into a life time commitment to cross sex hormones, and could need surgeries to socially function. They’ve been told asking questions about the impact of their kid’s peer group, internet use, drug use, co-morbid diagnoses, internalization of sexism, or family dynamics is transphobia. They’ve been told, no matter what their authentic emotions are, to celebrate their child’s transition.

I’m in the novel position of being both a detransitioned lady and a family therapist. I am not, and probably never will be, your family therapist. At this point in time I won’t work with families with a gender dysphoric young person because I’m scared of the risk to my license. In the past few months activists have filed complaints to the licensing boards of two therapists I’m connected with, both of whom have been public in their defense of the research into Rapid Onset Gender Dysphoria. To trans activists, promoting and enforcing “affirmative care” as the sole available clinical response to youth gender dysphoria (“GD” for the rest of this essay) is a battle so righteous that the ends justify the means. Those means include punishing mental health professionals by threatening their livelihoods, calling DHS on non-compliant parents, slandering youth GD researchers whose research documents majority youth desistance, harassing researchers whose research suggests the existence of a new cohort of youth GD diagnoses that may have vastly different outcomes than previous cohorts, or slandering and harassing even the reporters who acknowledge these events are happening. There is a group of activists within the trans community who truly believe that doubts about a child’s ability to understand and consent to the long term consequences of medical interventions whose long term consequences are a matter of intense controversy among adult patients can only be motivated by transphobia.

Pediatric transition has always been a troublesome topic for me. My efforts to advocate for resources and training for detransition mental healthcare have consistently put me in positions where I have to pick a side about pediatric transition. My choices have been: critique pediatric transition, be labeled a transphobe and be cut off from opportunities within the trans healthcare community to build an infrastructure for supporting detransitioners OR focus only on detransition care, and endorse pediatric transition.

Carey Callahan

At the end of the day, if I had a kid, they’d have to wait till they were 18 to get themselves on hormones and pursue surgeries, so I don’t feel right recommending parents do anything different. It’s not that I don’t believe I could have a kid who, in order to have a good life, truly did need to move through life in a gender role I didn’t expect. I know trans adults like that, and their medical transitions reduced their GD to such a level that they could function well, with loving partners and meaningful work. But my doubts about the ethics of pediatric transition are not based on assuming a trans kid’s identity isn’t going to be stable and long-lasting. (Although it’s worth remembering in 2009 hardly anyone had heard the word “nonbinary,” so I don’t think we can even can speculate about the gender schemas that will be popular in 2029.)

My insistence that any kid I raise be a legal adult before making these choices is based on knowing trans adults who have been surprised by the challenges of their long term healthcare. I am not going to create a situation where my kid is 25 and gets to blame their mom for pain when they orgasm, fusion of their uterus and cervix, reduced mitochondrial function, or straight up never having an orgasm. No way am I running the risk of allowing my kid to halt their puberty with Lupron shots and create a future spending big bucks at the dentist, rheumatologist, and endocrinologist. I didn’t have steady health insurance till my mid-thirties, so I don’t have faith that if my kid had chronic symptoms like the people in the Lupron Survivors Facebook group do that they’d be able to access specialists without sliding into inescapable medical debt.

Once I told a prominent psychiatrist and affirmative care researcher that there’s no way I would let a teen take testosterone because there’s a high likelihood they’d end up needing a hysterectomy in their twenties. After a hysterectomy you are dependent on HRT for your lifetime and need to prioritize having health insurance both for the HRT and the complications following the hysterectomy. It’s normal for Americans, especially in their twenties and thirties, to have long stretches of time where they can’t afford to see a doctor. The psychiatrist, appearing deeply perplexed, replied (this is a paraphrase), “But you can’t make decisions about your identity based on fears you won’t be able to access healthcare.”

The trans community is pretty clear you don’t need to take testosterone to identify as a trans man. Thus, testosterone isn’t actually a choice about your identity, it’s a choice about body modification, and yes you can absolutely choose to avoid body modifications that create risks to your health you fear you may not be able to manage. But if a Harvard educated psychiatrist can’t keep that distinction clear, can a teenager? Do the teenagers in your life know about co-pays, or how to get a referral to a specialist, or what COBRA is? I’ve had a fair amount of the letters of the LGBT alphabet soup confidently explained to me by teenagers, but I’ve never met a teen who knew how to apply for Medicaid benefits.

All this to say, if you are suspicious of the increased prevalence of youth GD referrals and the righteousness of activists who believe minors know what they’re getting into when they medically transition, I’m there with you. But if parenting teens were just about creating sane rules and explaining how the world works, teen boys could be trusted to shower regularly, teen girls could be trusted to use school bathrooms without putting fights on Snapchat, and Smirnoff Ice would have a significantly smaller market share.

The reality is that in many states on your teen’s 18th birthday they can walk into a Planned Parenthood and have the first of the two appointments it will take for them to get HRT. You have the power (although only if you and your coparent are on the same page) to keep your kid from initiating medical transition until that day. That day will roll around quicker than you think.

What this means is that cultivating a positive relationship in which you have credibility and influence with that person you made is paramount. From my work as a family therapist I can tell you being able to do that, when that person is in their teens and twenties, is a spiritual triumph. Young people’s psyches are built for separation, independence, and risk taking. But you, passionately loving parent, with the privilege of both your life experience, and fully formed pre-frontal cortex (boy howdy I’m hoping you can fully access all that emotion regulation) are gonna love that kid into some wise choices.

How do you do this?

The short answer is:

  1. An unconditionally loving relationship demonstrated by you giving them feedback that is intentionally overwhelmingly positive
  2. and lots of offering them your reflective listening skills;
  3. bounded by clear and explicit, age appropriate boundaries
  4. which are backed up by logical and consistent consequences.

Doesn’t strike you as that short of an answer, does it? But in actuality that answer above is the recipe for every successful relationship- kids, spouses, friends, coworkers. Having children hit puberty is a fantastic way to find out all your weird personal myths about how relationships should go and how exactly they do not work.

Here’s the basics of any human relationship: People love to be liked. People love to be understood and most people love to talk about themselves. People are most relaxed when rules, roles, and boundaries are clear, and people love to be relaxed. People absolutely don’t love logical consequences for their behavior. But the least painful way to learn about the process of considering logical consequences is from navigating logical and consistent consequences doled out by your parents.

Over the next two months I’ll dive into those 4 components of building a positive relationship with your kid, and how your kid’s gender dysphoria and trans identification interact with these components. I am NOT saying you can detrans your kid. I am absolutely saying that if you build a positive relationship with your kid, you can be both a valuable sounding board and a source of information for them. I know from my own experience the sources of information and the sounding boards (i.e. gender therapists and online community) available to gender dysphoric people who are discerning their medical choices tend to put forth a very rosy view of medical transition.

If you’re a parent, and you’re feeling desperate, the very best thing you can do before this series gets going is to get SERIOUS about your self-care. Having a child begin a clearly inappropriate medical transition is a specific level of hell, and I would never want to minimize how bad that situation sucks for parents. But in the midst of that hell you need to bring your parenting A game. You have to take up running, yoga, meditation, prayer, Xanax- whatever can chill out your emotional lizard brain so that you can access your logical, strategic, patient pre-frontal cortex. If you’re not giving an hour each day to chilling yourself out, you won’t be able to stay non-reactive when that baby you nursed tells you they’ve got a surgery date. An hour of self-care is the minimum, and I don’t want to get any emails from you if you wrote them before 2 hours.

Check back in about a week for Part 1, the deep dive into positive feedback for your endlessly confusing child.

 

 Finding middle ground: The importance of empathy

by Juliette

Juliette is a 19-year-old woman who identified as transgender for a brief period in her earlier teenage years. She wrote this piece particularly for parents who may be wondering how to best support and respond to their trans-identifying daughters, based on her positive experiences with her own parents during that time in her life. Juliette is originally from the Netherlands and now lives in the UK, where she is studying for a degree in linguistics.


Cases of young teenagers claiming to be transgender out of the blue seem to be on the rise. Though there are plenty of opinions and discussions on this to be found online, some voices are hard to hear: those of parents reluctant to give in to their children’s wishes to transition, and those of people who once identified with the transgender community and no longer do. I myself identified as transgender for a short time in my teens, but grew out of it. As I was looking for people with similar experiences, I came across 4thWaveNow. I recognise myself in many of the stories shared here, and I feel very sympathetic towards the parents sharing their struggles. I hope that sharing my experience with transgenderism and the ways in which my parents supported me in this will provide some insight to other people going through this.

When I was 16, I came out to my parents as genderqueer. This was following a coming-out as gay, which followed a coming-out as bisexual. At the time, I viewed this as a logical progression: I was breaking out of the heteronormative, cis-centric mold imposed on me by society. As a final step to complete this progression, I decided I would start hormone treatment when I turned 18, and start university ‘as a man’ — or at least, not as a gender-conforming woman. It never got that far, though: some six months later, I had started to grow out my hair, wear dresses and skirts again and didn’t think twice about ticking the ‘female’ box on my university application forms. Now, I have many other things to concern myself with outside of gender: I have recently finished an internship in linguistics in Singapore, and I look forward to earning my bachelor’s degree in linguistics at Cambridge University over the next three years. Rather than spending my free time obsessing over gender, I spend it on art, playing the violin, and going out with my friends.

Sometimes, though, I think back to when I identified as transgender. Mainly, I think about how it affected my parents, and my relationship with them. My parents never rejected me outright. However, when talking about this period later, I learnt how sceptical and worried they were. Now, I admire that they were able to keep most of this to themselves and trust me to figure myself out. Thankfully, I did manage to do just that, and I am now very glad I never made any permanent changes to my body. Looking back now, the reasons for my so-called gender dysphoria and wish to transition, followed by acceptance of my biological gender only about half a year later are painfully clear. They have little to do with gender beneath the surface.

As most teenagers do at some point or other, I started questioning my sexuality in high school. I was around 15 years old at this time and often turned towards the internet to share my thoughts and find like-minded people. The internet offers a wealth of stories and experiences from others on this topic and I spent a lot of time reading through these. In particular, I spent a lot of time on a blogging platform called Tumblr. On Tumblr, the LGBT community is particularly active. People share their personal experiences, as well as thoughts and opinions on sexuality as it relates to society, culture and politics. At the time I was discovering this content, I was young, impressionable and curious. Discussions about inequality, sexism and homophobia were a cause for me to be passionate about. Of course, in many places around the world people of non-traditional expression and sexual orientation aren’t considered equal, which ought to be discussed. However, rather than encouraging change and communication, many of the activist blogs I frequented on Tumblr encouraged a victim role. It was not unusual to see posts demonising people who identified as heterosexual or cisgender. In these communities on Tumblr, respect was earned not by showing strength, but rather by demonstrating the highest degree of victimhood. This means that the person with the most complex, unique and marginalised identity has the most authority — the unspoken rule was that someone who has not had the ‘lived experience’ could never understand, and could never have a useful word to say about an issue. Looking up to others in this community, I felt very tempted to immerse myself in these alternative identities. Besides, not identifying as heterosexual, I already felt like I fit in. It was a small effort to delve deeper.

As a teen, I struggled with identity and often found it hard to express myself. On Tumblr, the biggest discussions around self-expression usually centred around gender. This is how I became interested in dressing androgynously and rejecting traditional femininity. There were countless blogs of young people, mostly biological females, with boyish haircuts, wearing masculine clothes and asking to be addressed with gender neutral or masculine pronouns. Many spoke at length about their dislike of stereotypical femininity, their perception of heterosexual relationship and their discomfort with their female bodies. This struck a chord with me. As a young girl, at many points in my life, stereotypes and expectations felt forced upon me because of my being female: my family often asked me if I had a boyfriend yet, when I would finally grow out my hair beyond my shoulders, how many kids I wanted. These pressures made me insecure, partly because I didn’t want to fulfill some of these expectations, and partly because I was worried I wouldn’t be able to. I saw the experiences of non-binary, genderqueer and transgender-identified people on Tumblr as an escape from these pressures of traditional femininity.

However, none of this explains why I considered something so drastic as hormone treatment to change my feminine features. A much-used term on these gender-related blogs on Tumblr was gender dysphoria. Many people on the blogs I frequented described feeling trapped in their body and uncomfortable in their skin; they described being unhappy with their breasts and their hips, and feeling unattractive. On these blogs, these feelings were considered symptoms of gender dysphoria, and a sure sign that transitioning to the opposite sex with the help of hormone treatment and invasive surgery was the right course of action. At no point were negative side effects of these procedures discussed, nor was the possibility considered that these feelings might not be related to gender in the first place. At this age, there was much I disliked about my body, and combined with my need to reject traditional femininity, it seemed logical that gender dysphoria was the explanation for these feelings. I was convinced: I now had a way to experiment with self-expression and reject stereotypical femininity with masculine haircuts and clothing, and the term gender dysphoria to explain my bodily insecurities. After this, it wasn’t difficult for me to convince myself that transitioning was the key to happiness and security.

For me, the road to wanting to transition was a slow one. Initially, I simply enjoyed experimenting with more androgynous fashion and hairstyles. But over time, gender became an obsession. Relevant to my experience is the rest of my life at this time. My family had recently moved from the Netherlands to Scotland, where I started a new high school. At 15 years old, this was a very big shift for me and I struggled to make friends during my first year at school. On top of this, about a year after moving, my parents divorced. Perhaps as a cry for attention, an act of rebellion, or simply as a distraction, I became obsessed with all things gender identity. Everything around me reminded me of the biological and societal differences between the sexes. I became obsessed with hormone treatment and surgery, with disguising the feminine parts of my body and with ways to disassociate myself from femininity in all manners of expression. I was convinced that when I finally transitioned, and had the acceptance of my friends and family, I would be happy.

But every step I took — cutting my hair, wearing men’s clothes, adopting ‘masculine’ mannerisms — only made my insecurities worse. I felt like I didn’t fit in, I felt unattractive, and I felt like I would never be happy being in the body I was in, even more so than before I began presenting as male. I felt entirely dependent on outside validation that I came across as masculine —validation I didn’t often receive. For a while, I didn’t talk to my family about these feelings. But at some point, I felt so unhappy that I decided to talk to my mum about my wish to transition. I didn’t have to bring it up, but one day when I was in a particularly gloomy mood, my mum asked me directly if I wanted to be a boy. She’d noticed that I’d started wearing masculine clothes, cut my hair shorter and shorter, and had put the puzzle pieces together. That question allowed me to share the thoughts and feelings I had about gender and my body. During this conversation, my mum mostly allowed me to talk without interrupting, until I brought up the topic of transitioning.

I don’t believe I ever fully intended to transition; when I talked to my mum about hormone treatment, I had already decided I would start it only after finishing high school, so I would be able to start my ‘new life’ at university. I could tell my mum was hesitant: she expressed that she wasn’t convinced that hormone treatment was the right course, and she was very happy to hear that I wanted to wait a couple of years before starting treatment. Still, though, my mum was very understanding, and clearly wanted to fix my unhappiness as best she could. That reaction helped me step outside of my own head a little: it helped me realise the gravity of the decision I wanted to make. However, I was less receptive to my mum’s admission that it would be difficult for her to think of me as anything other than a daughter. I understand this now, and I am sure many parents here feel the same. At the time, though, this wasn’t something I wanted to hear: it made me feel pressured to fit an image my mum had of me.

We reached a compromise, though: my mum agreed to contact a gender therapist for me. We had one visit with this therapist — who didn’t push treatment, but simply wanted to look further into ways of self-expression without the constraint of labels — but when trying to book a follow-up appointment, we never heard back. My mum only received a response to her emails a few months later because of an issue with the therapist’s e-mail, and by this time I was no longer interested in transition. I wonder from time to time if I would have gone through with transition had I had more appointments with this gender therapist. It’s a scary thought, since I no longer have any desire to be male. However, I do feel like the appointment was helpful. It made me feel valid, but at the same time, it made the situation feel very real all of a sudden. It helped me to see how big of a change transitioning would be, and perhaps this was ultimately the first push for me to grow out of this phase.

Altogether, I identified as genderqueer and later as transgender for only about six months. I don’t remember exactly what led me to grow out of these feelings of gender dysphoria, but I think the most vital step was settling in at school. Making more friends and finding other ways to express myself, as well as feeling more at ease socially helped build my confidence. Around this time, I also started exercising, and this was a great way to relieve stress and learn to feel more at home in my body. By the time my fifth year of high school rolled around, I was too busy with friends, crushes and university applications to think much about gender.

Throughout all of this, my relationship with my parents was vital. My parents never rejected me — they expressed at times they didn’t agree with my self-diagnosis, but at no point did they make my insecurities feel invalid. My dad in particular was open to however I chose to express myself, and encouraged me to experiment. He complimented me on both my feminine and masculine clothes. He even took me to a male barber to get a haircut. I didn’t experience this affirmation as encouragement to transition; rather, it boosted my confidence and showed me my relationship with my dad wasn’t dependent on how I expressed myself. Both my parents made it clear that things like the way I dressed, the way I labeled myself, or who I loved would never make them reject me. Knowing I had their support and trust made it easier for me to return that trust, and kept me from feeling a need to rebel.

Now, I know how difficult the whole ordeal was for them, and I feel some guilt for worrying them as much as I did. The topic of gender doesn’t come up a lot in conversation: I feel too embarrassed to bring it up, even though I know my parents don’t think any less of me for it — though my family doesn’t shy back from making fun of my haircuts. At the time though, they took me seriously, for which I am very grateful. It allowed me to grow out of this phase of my life without need for intervention and before taking any drastic measures.

My view on these gender-related issues has changed gradually over the past few years. I see this sudden gender dysphoria that some teenagers express as symptomatic of other problems, rather than as a problem on its own. I interpreted my insecurity as gender dysphoria and my dislike of stereotypical femininity as a wish to be male. Frustrated with my situation — feeling alone at a new school, feeling insecure about my body, having to deal with my parents’ divorce — gender became an obsession. It functioned as an escape and as a problem to fix. I convinced myself that everything in my life would improve if I transitioned. I believe this might be the case for other young people claiming to experience gender dysphoria: obsession with gender serves as a way to avoid dealing with more complex, underlying issues with confidence, identity and security. These need to be dealt with first, before transition can even be considered. I also believe that the sudden increase in cases of gender-confused teens can be explained in part by the internet. I was introduced to these concepts of gender identity through the internet. It is also very easy to find people online that will affirm your feelings and encourage you to transition, even though these people are not nearly familiar enough with your real life to make these judgements. Validation is easily found online, which is why some teens might withdraw there to avoid confrontation instead of talking to family and friends in real life.

Despite my scepticism towards claims of gender dysphoria from teenagers, I would still urge parents of teens going through this to act with empathy before anything else. I don’t believe many teens would act this way on purpose, or to be manipulative: for me, it wasn’t in any way enjoyable to constantly deal with these obsessive thoughts and insecurities. For that reason, I would encourage parents not to view this as an act of rebellion from your child, but rather as a cry for help. What was by far the most helpful for me was knowing that my parents’ love for me was not lessened by how I chose to express myself, and that all their scepticism came from a place of concern. I also believe it is important not to reject your child outright, and to trust them to figure things out in their own time. Allow them to experiment with their fashion and hairstyle, and allow them to try out a different way to express their identity. Many children and young teens expressing gender dysphoria at some point in life later find they are gay, or that they simply feel more comfortable dressing like the opposite sex. If this turns out to be the case for your child, it is important that you support them — your acceptance will likely mean a lot to your child. Remember that for your child to share these thoughts and insecurities about their identity and body in the first place shows they trust you and are willing to talk, and this trust is something to be treasured.