Abandoning the Ship of Woman: Guest post

On my Tumblr blog recently, I put out a call for stories from women who had lived for a time in the Abode of Childhood and Adolescent Gender Dysphoria–and who have returned to us, body and mind intact, to tell the tale. While I myself have always been “gender nonconforming,” I never seriously considered myself male, nor did I want to banish my female body. Which means I’m not the person to write an intelligent post on the subject.

I’ve now read dozens of accounts from formerly dysphoric women, but only on Tumblr and WordPress blogs. The trans-entranced mainstream journalists seem to have zero interest in reporting about the “ones who got away” and survived, reconciling with their female-ness to claim their place in the sisterhood of women.

I realize every day how incredibly fortunate I and my fellow baby boomers were to come of age when the Second Wave of feminism was cresting. One fundamental and deeply powerful message of that movement was that “woman” is a big, welcoming tent that all females can shelter under, no matter their physical or mental attributes. If you’re a double x, you’re in. The concept of  “gender nonconformity” would have been seen as pure nonsense by me and my companions when I was 20. And of course, it is still an absurdity, an invention of post-modernist Gender & Queer Studies academics (who, sadly, replaced the in-touch-with-reality Women’s Studies professors who raised the consciousness of and liberated so many women in the mid-20th century).

Women who once rejected themselves as female but returned to our fold are the guides our young “gender nonconforming” girls need today. I am very grateful to my online sisters who have shared their stories.  I consider them my teachers. If you are one of them, please consider submitting your own story to guest post here. I’d like this to be the start of a series. [To let me know you’d like to guest post, submit a comment to this article, and I will respond to you privately, without publishing your comment.]

Every woman who has experienced dissociation-from-female has a unique story to tell. While you may not relate to every aspect of Dot’s experiences in the guest post below, her repeated–and finally resolved–attempts to be other-than-woman is the universal crux of what too many of our young women are going through today.

Dot writes to us–young women and their parents alike–about her journey, from toddlerhood to adult woman, with this comment:

I tried to write these vignettes with the child and teenager I was in mind, but also as a means to speak to parents of these teens,  to provide some insight into these compulsions.

She entitled her piece “Stories from the 80%,” to acknowledge the well-researched fact that the vast majority of young females who have gender dysphoria eventually outgrow it–or at least learn to cope.

Stories from the 80%

by dot

Part 1: Tomboy

I’m 3. I’m screaming in a changing room because the dress I’m being made to wear is uncomfortable. Being girly means physical discomfort.
I’m 4. I’m popping the heads off all of my Barbies. Being girly means having pretty long hair, and I can’t relate to a toy that looks nothing like myself or any woman I know.
I’m 5. My mother disdains my love of bug-hunting and rough-and-tumble play with my mostly-male playmates. My carefree play-style requires her to painfully tame my long hair’s knots. I don’t understand why looking a certain way is supposed to be worth this pain. I cannot be decorative and adventurous at the same time. Being girly is antithetical to the exploration, curiosity, and physical play I love so much.
I’m 6. I’m refusing to use anything pink. Being girly means liking “feminine” colors. I don’t actually hate pink; I can barely see the color for what it is. I just know it is girly, and I am distinctly not girly.
I’m 7. I only enjoy the boy cartoon characters. They have fun and are funny. They get to move around more than the stiff princesses who I barely understand to be characters. They are elegantly moving statues used to dress up the set while the fun male characters have adventures and tell jokes. I am not girly. I’m like the male characters. I am physical, I am funny, and I have no interest in being beautiful. Maybe I am not a girl at all.
I’m 8. I am throwing a tantrum on the playground because my playmate wants to be Simba (the Lion King) this time. I always get to be Simba, so I relent and agree to play as Nala (the lioness)–this once. I feel profoundly awkward in the role. I tell her I refuse to play if I ever have to be Nala again. When I play as Simba, I scold my playmate for daring to sing “I just can’t wait to be queen” when I sing my number. That is not how the words go. Nala only becomes royalty by marriage. Ugh, girls are so stupid.
I’m 9, and my cousins are making me watch some obnoxious dance routine. I hate to watch them perform and don’t understand why they would do such a thing. I want to play video games, which they make fun of me for. My male playmates have largely abandoned me, pressured by each other into rejecting me. I’d never make my male playmates sit through stuff like this… so why am I lumped in with these cheerleading nitwits? Girliness appears to be a fundamental and natural part of girls. So I hate girls.

I’m 10. It’s already sunk in that my body is not for me to move around in without being harshly evaluated. I stop moving around and seek to shrink. My weight problems worsen, which only makes my shame greater. I further retreat into consuming and creating fantasy worlds that don’t require me to think about my body. I fail to see what this has to do with being a girl, mostly because I am not a girl.

Part 2: Dissociation

I’m 11. My female classmates begin to show an interest in boys. They ask me which celebrities I find attractive, which I can’t answer. I do not care about celebrities. To me, they look like aliens. I like some classmates, but I mostly just want to play video games with them. I miss my male companions. I cannot articulate any of these feelings, and so I’m bullied as a presumed lesbian. Joke’s on them, though! I don’t even like girls as friends. 
I’m 12. The family member who has been beating and molesting me for some years now tells me that I have a nice pussy. It was this pussy that allowed me to be his target. I don’t draw a connection between this and my nightly practice of lying in bed and dreaming of transformation. I want to be something with a penis and physical strength. I am fascinated with the Animorphs, which can turn into any animal they want. Surely I will grow up to become a shapeshifter, a cartoon character, an animal.
I’m 13. The fantasies are intensifying. They now include becoming a normal boy; attractive and assertive, gloriously my default self. Real boys are more interesting to me now. I want their attention, but not as object. I want to be engaged with as an equal. I reason that might not happen unless I am more like them. My fat, pubescent body is less compliant with that wish than it’s ever been, though, so I know I will look ridiculous even trying. I fantasize about slicing away chunks of my thighs and removing my breasts. Since I cannot be physically like the boys, I study them and pick up things I might have in common with them. I shift my tastes in video games, music, TV, and movies to be more violent. I mark myself proudly with shirts that advertise my male-friendly interests. I am one of the boys.
I’m 14, and at the peak of a period that I will later describe as dissociative. I am removed from my abuser, and basically without friends. The abuse has ended, but the coping mechanisms remain for years after. I am routinely suicidally depressed for years to come. I fail to see what any of this has to do with being a girl. Besides, I’m not really a girl.

I’m 15, and running into the arms of my first boyfriend. This is the first significant male attention in my life that is healthy. I try to be just like him. I am lucky, because this relationship is very nurturing. His home is the most stable I’ve ever witnessed up until this point. I might be a girl after all, but I’m a very unique and different type of girl.

Part 3: Not like the other girls

I’m 16. I finally begin to make friends again. Mostly male ones, since they seem to have come around to the idea again finally. They are just easier to get along with, you know? We have more in common, and I love the lack of drama. The drama that does happen is totally incidental. It has nothing to do with their maleness. They say I’m cool, because I’m not like the other girls.
I’m 17.  Much to my surprise, I’ve begun to figure out that I can, in fact, be attractive to people after all. It’s a rare combination to be both a girl cute enough to be objectified, yet to be fluent enough in male culture to be one of the guys as well. I’m different, so I get to be both. You can tell how different and cool I am since I actively and joyfully participate in the constant cruel commentary, jokes, and sexual ranking of women. I impress them by being the cruelest and most foul-mouthed among them. We’re talking about women, not me, so who cares? I’m drunk on the perception of being powerful for the first time in my life. I’m the one girl among the boys.
I’m 18. I’m beginning to understand that my position as a girl among boys is very conditional. If I object when they joke about making them sandwiches, their teasing only intensifies. It occurs to me that if I can be made the butt of these particular sexist jokes, maybe I am subject to all of those words that “weren’t about me” after all. I look at myself in a mirror. I am not the cartoon character or a genderless blob that I see myself as. Regardless of how I see myself, others look at me and see a girl.
I’m 19. I now suspect that sexism does, indeed, include me as an intended target. I stop complying with sexist jokes. In asserting this basic boundary, I immediately lose the majority of my male friends. I find myself very lonely and suicidally depressed. Even as I meet a lot of perfectly nice acquaintances at college, I fail to make female friends. I understand, now, though, that if my interior reality can be so easy to miss to an onlooker, I too must be failing to see people trapped in the bodies of girls and women. I consciously begin a years-long mission to begin seeing women as people.
I’m 20. I’m beginning to binge on liberal feminism. It allows me to unpack my fear of feminine clothes and accessories. I learn the origins of high heels and pink and blue as gender markers, and their scariness melts away. I’m so grateful for this first foray into feminism. I am a girl, and people hate me specifically for it.

I’m 21. I’m learning how to dress and carry my body in ways that allow me to achieve the desired effect I want to have on strangers. I marvel at the way wearing a dress changes interactions. I finally understand femininity as a costume, and one that doesn’t necessarily have to be physically uncomfortable. This discovery allows me to humanize women in a way I couldn’t before. I now have some female friends, but my relationships with them are somewhat awkward. It is hard when I look into them and see the ways that they are damaged, because they reflect the ways I am damaged. I am a girl, and embracing it doesn’t automatically improve this condition.

Part 4: Liberal feminism and its natural conclusions

I’m 22. I’m entering the workforce. Before, feminism was somewhat abstract. I am now beginning to acutely feel power dynamics and understand what they mean. My dress becomes more consistently feminine (why even bother with a day where I’m treated less well?) A boyfriend I love deeply pulls the rug out from under me by being very distant during a pregnancy scare. I begin to realize that even boyfriends who are very good to me can do this at any time I need them, at little risk to them. I stop having penetrative sex, never having enjoyed it in the first place. The guilt and shame over this failure as a woman follows me for years to come. Even though I’ve been a feminist for a while, I am just now beginning to understand how deeply patriarchy infiltrates my condition. It is a heavy weight. I am a woman, a person who is expected to take on bodily and emotional risk that others are not.
I’m 23. I’m diving further into liberal feminism. Through its language, I bond with other women for the first time. I begin to see that all of my adult female friends have stories similar to mine; nearly all of them were abused as children, have suffered dissociative tendencies, have been mistreated at work and in relationships. We have a lot to talk about. It is through these conversations that it occurs to me to call the abuse and molestation I endured abuse and molestation. Before now, I have not even integrated it. When I did think about it before, I utterly minimized it and made it out to myself like it was no big deal. Talk about dissociation! After years of effort, it is now much more natural to see the people living inside of women (even ones that do not seem relatable at first). I am a woman, so I have something in common with all bodies prone to our type of sexed trauma.
I’m 24. Through liberal feminism, I have been reading the works of anti-racist activists and writers for some years now. I have a firm grip on the social justice vocabulary, and have been actively trying to undo my racism as actively as I have been my internalized misogyny. And I’m now seeing a major upswell in a new topic that I am told must be central to my feminism: transgender issues. I instantly accept it, since it uses the same vocabulary and ideas presented to me by black feminists and womanists. My feminism will be intersectional or it will be bullshit, lest minority women be oppressed all over again. I am a woman, and I commit serious time and energy fighting for justice for my fellow women.
I am 25, and I wake up anxious sometimes. Nonbinary and transgender people that I love and respect tell stories about their childhoods that sound suspiciously like mine. I hear the word “cisgender” defined as “identifying with the sex assigned to you at birth.” Having never felt at home in my female body, having never felt an internal experience of femininity in my life, I begin to worry. I utterly fail the “if you woke up one day the opposite sex, how would you feel?” test. Even with my hard-won love of women, I would still happily transform into a man if it were painless, riskless, and complete. The idea of being a man with a deep voice, no expectation of being penetrated, and power narratives on my side is obviously appealing. But I do not desire to imperfectly and riskily change my body. I do not want to wear clothes that fit me poorly. I tell myself I am agender inside. I have always felt genderless and default, after all. I have never felt comfortable in my body for a variety of reasons, but the shift in feminist culture causes me to chafe and I fall back into familiar old feelings that could be called “gender dysphoria.” Should I be claiming this discomfort? Should I be addressing it with my clothing choices? I’m just pretending to be a woman, for the best outcomes I can hope for with this body.

I’m 26, and I am the breadwinner of my family. This success is exactly what I have wanted my whole life, but I’m feeling like a failed woman. I did not inspire my partner to take care of me financially (although it is his gentleness and kindness that I admire most in him). I know this is bullshit, but every day I still feel hideous and ashamed of this arrangement. I fail to see that my success is a form of gender nonconformity. I fail to see that my directness, my agency, my assertion in the humanity and dignity of women are all forms of gender nonconformity. I fail to see it because mainstream feminist discourse on gender is very alienating to people who do not care as much about fashion or presentation. Women are oppressed because they are feminine, and I am not truly feminine “inside”. I don’t even know what a woman is.

Part 5: Relief

I’m 27, I’m 28, I’m 29, I’m 30. I am an adult. After years of occasionally and fruitlessly googling “what is a woman?” and permutations thereof, I accidentally stumble upon gender-critical discourse. I find the radical feminism that has been so ubiquitously deemed irrelevant and hateful by mainstream liberal feminism.

It’s hard to overestimate how much radical feminism is considered taboo. All I knew about Dworkin and Steinem was that I hate them. Because they are bad.  I don’t want to poison myself with hatred! It’s to the point where I had never even read a single thing by any person aligned with radical feminism before. After years of calling myself a feminist. I was trying to have a feminism without history, without context, and most bizarrely without an understanding of the root of women’s oppression.

Now I am beginning to see things differently, and recognize my body as the site of my oppression. Mainstream feminism has totally abandoned this concept, and it’s left countless young women like me without any tools to integrate their experiences as theirs. This leaves them totally vulnerable to the tidy explanation that “you aren’t actually a girl.”

But there is a moral imperative to resist this.

When females who do not fit the mold abandon the ship of woman, we also abandon young people who need to see themselves in others. Peers and adults who are able to integrate their non-conforming experiences as appropriate to their own body, and as a vital part of the experience of women, are crucial role models for girls and adolescents.

If woman is a category only occupied and defined by those who appear to embrace the gender stereotypes of women, we are doomed. It is non-compliance within the category of woman that reminds us that women are fully human, not just natural targets for subjugation.

Femininity as we inherited it (prettiness, submission, sacrifice, vulnerability, and a million arbitrary culture-specific colors/fashions/toys) was made up by people with penises specifically to subjugate people with vaginas. Specifically to render us compliant, decorative, and groomed for exploitation.

 

Of course you didn’t comply with it. Even if it has some fun stuff, it is completely natural to associate even the fun, harmless girl-stuff with the painful. It’s no wonder many of us reject it categorically.

However, if we flip the script and decide that femininity is defined by things by, for, and related to people with vaginas, femininity simply means human. There is nothing a person with a vagina can do that is outside of a true definition of femininity/womanhood.

The only reason it wouldn’t be that way is if we assume women are truly and naturally restricted and incapable of the full range of human traits, behaviors, feelings.

No amount of liberal feminism came close to providing the relief I felt by coming to understand this. By knowing that I do not have to occupy the male-created narrative of femininity even a little to be 100% justified in my body, no matter what shit I wear. By realizing that discomfort in the female body is the design of patriarchy, not my individual unique nature. By learning that not every language even has gendered pronouns, and to imagine that reality. By appreciating how truly neutral all fashions and colors are. To come to grips with the fact that gender is just a story to explain the shitty position of women, not some essence to be found deep within myself to justify some part of me that demands an explanation.

This sounds obvious, even trite. But if you do not see the profundity in it nonetheless, you have probably not appreciated the depths of the oppression of women as a sex class.

Part 6: Epilogue

The parts of me that do not comply with the gender stereotypes assigned to me (which were defined by dead men specifically to subjugate me, regardless of the fact that other women are often strict enforcers of them) are not “masculine”.

I am not a “tired husband” because I come home from work late and just want to relax on the couch.

I am not in “boymode” when I opt to wear pants and practical shoes.

I do not need to express every aspect of my gender non-conformity in the forms of fashion, pronouns, or hairstyles in order to be meaningfully dismantling sex roles.

I do not need to justify the gender-compliant fashion choices I do make by deciding that dresses and makeup are the very height of agency and rebellion. Trying to make my own daily life easier does not need to be justified or explained away by the idea of doing it “for myself.”

I do not need to pick apart every aspect of who I am, what I like, or what I do and decide where it lies on a spectrum from masculine to feminine.

I am all of these things, and so all of them are appropriate for women. All of these things are within the realm of suitable behavior, thoughts, and feelings for a person with a vagina to have. They are all a part of a complicated and complete single self, not a fragmented collage of things that do not belong together. No aspect of myself needs to be explained away. It all makes perfect sense, and none of it contradicts my nature as a person with my body.

Let’s stop trying to patch a broken system we all intuitively rebelled against with a million convoluted chutes and ladders. Let’s consider scrapping it altogether. Let’s start by rejecting the notion of a feminine/masculine spectrum altogether, rather than attempting to do away with the biological reality that made us targets to begin with.

Let’s start by integrating ALL of our experiences, behaviors, and personalities into our own self-images, rather than seeking to embody an image that “fits” better. We’ve all been tricked into believing “woman” is a far more narrow category than it is. We can all fit into it. We can dictate its shape. It’s ours.

  
Dissociative tendencies: Young women and “otherkin”

One of the roots of so much of “I’m not a girl” issues, I think, is dissociation. At least for me.

Not long ago I was curious about the therian/otherkin phenomenon. I sought out some reading material and videos with an open heart. My heart, once open, proceeded to break. I saw video after video of kids that looked almost exactly like I did at 15.

I recognized within them a loneliness, a perceived otherness, that they sought an explanation for. I saw the very same lack of understanding of their physical body that I exhibited at that age. I heard them speak of their animal counterparts within coming out to protect them. I saw teenagers who were probably abused.

As a child, I also pretended to be a dog or cat, even when alone. I often bit other children, well past normal biting age. When playing “house,” I would always disappoint my younger playmates by abdicating my presumed role as mommy and refusing to play unless I could be a pet of some kind. I identified exclusively with male characters, yes, but all of them were also animals. Since male animal characters were allowed to look more animal-like, I believe that my concepts of gender neutrality/maleness/animalness were all very intertwined.

My tendencies evolved as I aged and were very much exacerbated by the abuse I would face as an adolescent. When alone, I would bark, meow, growl, and exhibit other inappropriate behaviors well into my teenage years. I knew not to behave like this around people but I longed to meet others like me. In the videos of otherkin and therians, I saw kids who were just like me who did happen to have had their quirks externally validated (by each other). This is not a cruel or purposeful thing, but in validating our behavior in others, we validate ourselves. Once a small community is formed, feedback loops are formed. These behaviors go beyond validation and into identity cultivation.

I think that there is a certain type of young person with more difficulty, than average, seeing themselves in a meaningful sense. And this is a form of dissociation. Of course, they see people in the real world, and do not see them as cartoons. They know that cartoons and movies are not real. But when it comes to understanding themselves, they have greater difficulty imagining the self that others see. This is very common among “nerdy” types. There are even memes about this phenomenon:

bogart meme
​​

I think this is the result of minds which tend to think very symbolically. I remember very specifically imagining how cool I was wearing a backwards hat as a kid, or later imagining myself as looking like a sexy catgirl when I wore a head-band with cat-ears. The reality of the matter was that I looked like a dumpy teenager with dirty cat-ears, not a lithe anime character I wanted to embody in those moments.

I have no explanation as to why some people think this symbolically when it comes to themselves. I have suspicions (trauma mixed with some sort of personality subset is my best guess). What I do know is that this type of person, in most circumstances, does not benefit from having their self-projections cultivated. Nor from having at their fingertips an infinite supply of validation for anything they could desire validation for. It leaves this type of person very vulnerable.

Their vulnerability is made even worse by the fact that they are generally quite intelligent and therefore able to rationalize anything to themselves. They, like most people, imagine themselves fairly immune from influence. I can promise you that at least one teenager with this sort of personality will show these words to their friends and laugh at the “condescending” suggestion that they are vulnerable to influence. Maybe it is condescending, but there is no non-condescending way to express such a reality. I can’t say that I, as a young person, would have read this essay or taken it seriously, either, though.

Invalidation will only bolster their fixation, giving it the aura of credibility manifesting in defiance.  Above all, they need time to work these things out without too much outside interference, and perhaps gentle but firm guidance to the reality that their self-perception and will is not something that others can or should be beholden to.

They do not lack empathy (and in fact can be quite concerned with justice and the feelings of others), but they lack some perspective-taking.

still have my sex-dysphoric and otherkin-type tendencies and feelings, but they have abated considerably. They no longer bother me at all now that I understand them as coping mechanisms largely developed in response to serious abuse in my young life. They were tools I built for myself out of self-preservation, which is its own sort of beautiful. Just like the therian kid has a wolf-self to protect him, I made these constructs to protect me. Free from toxic validation, I was able to have the time and space  to integrate them as part of my complex and whole self, rather than as my truest inner identity.

As an adult, I’m very grateful I was able to develop healthy, constructive creative outlets for them (not to mention a self-awareness that prevents me from ruining my life with inappropriate behavior). My adulthood would certainly not be as good as it is had my fantasy been indulged to the point where I could insist others (outside of the internet) see me as I would have preferred to be seen.

No other animal desires to be another animal. That experience is uniquely human. Coming to this was similar to my understanding that the ability to wish to be male when one is not male is an experience unique to those of us who are female.

I know that a lot of trans folk will find this comparison offensive, but it’s hard for me to overstate how much I related to animals and cartoons over people for huge chunks of my life. As an adolescent, these feelings about being not-human were very similar to my deep and serious feelings of being not-female. When otherkin-type kids say that they feel body-map dissonances similar to those described by trans folks, I believe them. I continue to feel both as well (fortunately, at greatly reduced rates and with no accompanying distress).

Internalized misogyny and the trap of the white feminist demon

A lot of very smart young female people get into liberal feminism, and think within a very brief amount of time that they have unpacked their internalized misogyny, but they still feel bad so obviously their pain requires more of an explanation than mere sexism.

In leftist circles nowadays, sexism is seen as one of the more frivolous oppressions, paling in comparison to race, class, and sexual minority struggles. I suspect this image of white feminists as privileged, perhaps even above white men, is popular because it is specifically the white man’s stereotypical view of white women. I urge you to question it, to fight it. White women of course have white privilege, which should always be scrutinized and unlearned. But none of this makes sexed trauma less real and serious.

“White feminism” is a useful description for a bundle of behaviors, values, and assumptions that have historically harmed women of color… when feminists of color use it. It has more recently been co-opted as a scapegoat by white liberal feminists, trans activists, and men. The White Feminist in popular discourse has basically become a silencing tactic, and a means to diminish the perspectives of anyone who doesn’t agree with a specific brand of liberal feminism. It’s important to be able to, as a white woman, accept the criticisms from women of color without caving to the temptation to dissociate.

Many young white women know they cannot un-white themselves, so they often proceed to un-woman themselves to avoid being the most privileged person at the feminist table. This is unfortunate, because they usually came to the table because they needed to in the face of their oppression. Since they are young and often traumatized, they are even more ill-equipped to integrate privilege into their self-concept than the average white person. Their legitimate problems along with their typical white fragility combine to make them want to dissociate. I theorize this is behind some of the uptick in non-binary and trans identities among young females (along with people claiming mental illnesses as part of their identities).

I honestly do not think young white women would be reaching so hard to claim other oppression-based identities if they understood and appreciated the gravity of the sex oppression they face. I suspect they suffer from the white man’s narrative that white women, particularly white feminists, are frivolous and just making too big a deal out of this whole patriarchy thing. This is just another facet of internalized misogyny, and it serves not only to de-center feminism from understanding itself as a movement concerned with sex-based oppression, but also to allow the would-be young white feminist to defer taking responsibility for understanding themselves as a person capable of racial oppression.

Many of their self-descriptions basically provide a laundry list of identifiers to make up for their bad one. It’s as if they say “I may be white and forming an understanding of feminism, but I’m not one of those nasty ever-so-privileged White Feminists. I’m just a poor little mentally ill, pansexual, non-binary, demiboy. Please accept the unthreatening posture these identifiers represent as a means to soften any racial privilege I might exude.”

It wasn’t until after years of exploring feminism that I was able to identify my sexual abuse as sexual abuse. And it was only after years of exploring feminism that I was able to make female friends. I believe you cannot understand a great deal of misogyny’s depths until you spend a good deal of time working outside of the home, or see yourself in the context of romantic relationships. These things take serious time and a lot of experiences to even begin unpacking. If you are thinking about transitioning or are calling yourself some other opt-out identity, do not rule out internalized misogyny. Do not rule out your own limited perspective on what a woman can or should be. Do not rule out your own oppression as less valid.

 
Ruling out internalized misogyny is a mistake for any person. To rule out internalized misogyny is to underestimate patriarchy. And trying to modify your own identity into a position of less privilege is just about the lamest and least responsible thing you can do.

 
And for crying out loud, do not “identify” as something other than yourself as a way to dodge your own racial, class, or other privilege. It’s a serious bummer to have to say that, and I know it will be met with indignation and fervent denial, but I’ve personally witnessed this happening among peers. It’s only human to be motivated by a desire for approval and belonging (especially among female-socialized people), so don’t be hard on yourself if you find this inside of you. Make peace with it. Own it. And heal.

Brainwashed parents of “trans” kids tell us outliers to get some “counceling”

I started this blog because I could find nothing–not a single website or blog post–written by a mother like me. There seemed to be no other parents who were, at a minimum, skeptical or uncomfortable with the “Yay your child is trans! Get onboard the hormone train!” narrative that saturates progressive communities and online media.

Now that I’ve been at this awhile, it’s evident that there are plenty of us. Katisan, who wrote the comment below, is one example. I’m so glad she found her way here. Too many other parents look for advice and guidance from the numerous pro-transition sites (which I’ll have much more to say about shortly).

I am in the thick of this with an extremely strong-willed, difficult teen (aside from the trans stuff) who is also diagnosed with anxiety and depression. We’ve been through two therapists already because my kid brings out the trans stuff and then that becomes the focus of her therapy. I feel like no on listens to ME, as the parent, about what could be going on. Or “honors” us, in trying to actually help instead of sending my kid on a path of chemical and surgical mutilation.

We’re not religious and we don’t care if she’s gay. But she’s a she. She’s not an it or a them or a he. We’ve never cared how she wears her hair or her clothing choices or policed her friends. But she has mood issues and she’s using this trans stuff as a way to amplify normal teenage issues — I hate my body; I’m exploring becoming a sexual person; my brain isn’t fully-finished, but I think I’m always right.

We feel that the anxiety and depression and strong-willed/ODD stuff is causing her to seek out things to obsess over to relieve her anxiety and to control everyone around her. The professionals all seem to think that we have it backwards — that the anxiety and depression and need for control stem from the fact that she’s trans. Do we just have to forego any therapy or support because the therapeutic community is so at odds with sane parents? She’s on medication which has helped with acting out destructively and controls the depression and anxiety enough that she’s happier. But the trans stuff is destroying our relationship with her and breaking up our family.

And, we’re terrified to talk about it since everyone else seems to be on the trans-is-terrific train. The last thing I need is a bunch of judgmental people screaming for my head in social media because I won’t kowtow to this fad.

It’s all here: the underlying mental health issues, the lack of support from psychologists, the profound doubts that her child is actually “transgender,” the impact on the family, and above all, the fear of talking about it. To anyone. Think of it: a mother in 2015, worried sick over her child’s welfare, with no one to openly discuss her concerns with. Seemingly everyone is against her. These are strange and terrible times we live in.

Where are the other worried parents? They’re either patting themselves on the back for getting with the program (despite their grief and confusion), or being told to get on board–ASAP. Here’s a typical site called Transgender Child, run by one “Jody C., the parent of a trans child with support from two gender therapists.” It bills itself thus:

This site offers information, support,  and more to help the issue of transgenderism become more visible and more accepted and to help you understand and support your trans child. 

Parents, you want to make transgenderism “more visible and accepted.” Your only task is to “understand” and “support” your “trans child.” (The site owner already knows your kid is “trans.”) Critical thinking? Prior knowledge of child? An intuition that this trans thing is just one more identity your teen is trying on? Nah, that formerly time-honored parenting wisdom is useless now. Who needs a brain to parent anymore? Seems our role could be performed by a well-programmed robot, reduced to saying “Sure, dear, whatever you say you are, you are!” and opening our wallets to the endocrinologists and gender therapists.

I’ve said it before, and I’ll say it again (and again and again): “Supporting” one’s gender nonconforming child does not have to mean simply going along like a mindless android with everything that child says or does. Loving a child can mean saying “no” (duh–hello? Didn’t we know this in like 1940?), though to listen to the trans activists and their enablers in the media and medical professions, saying “no” to hormones and/or surgery is the equivalent of handing that child a bottle of cyanide. Katisan is a supportive parent. She loves her daughter. She’s fine with her being a lesbian, with being “gender nonconforming.” She just hasn’t drunk the trans KoolAid herself.

ANYwho, let’s take a stroll through the Question and Answer section of the Transgender Child site to get a few tastes of what the moderators and indoctrinated parents have to say to the newbies who’ve come there for help.

S says

My 18 yr old child just came out as female to male transgender. I have always known something was different but now I realize that my daughter always felt like a male. I realize now that when she told us that she was gay, that was her confusion about who he is. My husband and I are fully supportive and just want the best for our child. I wish I could take the pain away that my child feels every day when he looks at his body. This is the hardest situation to deal with because we don’t know what is next. There are no support groups near our home. We have sought out help for him, we need help!

“That was her confusion about who he is.” Who’s confused, again?

M. says

My story is so familiar except my daughter is 17. I have known now less than a year she came out at 15 as lesbian first. She has not come out to all her friends and family, We live in an area where there is no help or support and actually travel 2 hrs to get to a transgender doctor and 2 hrs back again. Feel free to contact me if you wish I don’t have a vast knowledge although I am strong for my daughter I do my grieving in private. She is my only daughter with 3 brothers so that is really hard on me.

Ksays:

Hi M, I just wanted to check in with you and see how you were doing. I also have a FTM son. My house is now filled with testosterone!! URRGHH! (it’s a good UURGGHH!!) My house is now filled with Males. I’ve already told my sons that now this means I have 2 sons to take care of me instead of only one. Of course they both grin! LOL! Anyway, I just wanted to reach out and see how you were holding up. I do understand the crying behind closed doors.I do really well for awhile and then my wall starts to fall. But having support is really helpful. I hope you’ve been able to find something since your last post. Take care and God bless you and your family

says:

Our daughter came out as Lesbian at 15 after spending 10 days in the hospital after cutting. She has recently told us that she is transgender. I’m not sure how to handle this other with understanding (on the outside but confusion on the inside) and the unconditional love the we have for our kids. But she wants us to address her in the male pronouns and this is so hard for us. We have no friends or know of anyone else who has ever gone thru this or is currently in the process of having their child go thru this. We accept our child for who she is, unconditionally, but we don’t know how to handle the current issues. We’re looking for support to ask questions and understand what she’s going thru. And help understanding our feelings as well.

Predictable themes emerge. “He” thought he was a lesbian. Cutting. Parental suffering–behind closed doors.

R says

Please I am in need of help! My daughter continues to tell me she is pan sexual and she keeps trying to dress like a boy. She is my only daughter and I love her deeply. I was a tomboy growing up but she takes it further then that. On the outside I am trying to be supportive but on the inside I am so upset and don’t know how to help show her that it’s just a phase teens can go through.

“Pansexual”–often the first identity stop on the trans railroad (Tumblr and YouTube told me so!). Mom was a tomboy too, but hey, this girl is doing more than that–even though mom wants to tell her daughter it’s a phase! Predictably, she gets no support for exploring this potential phase more.

H says

About four years ago, my ‘lesbian daughter’ explained to me that she was really a straight man. It definitely took time for me to process that statement. Lots of time. Parents go through a transition, too.

Right. “Lesbian daughter.” Because you see, that “lesbian” stage of life was not real.  There are no quotation marks around the words straight man. Because that’s what “he” really is, and was. And parents? Just “process it.” Go through your own transition. Yours is not to question why.

And lest you think only moms and dads of teens are learning how to correctly parent their “transgender child” on this site:

S. says:

Hi there i think my 4 year old daughter is transgender, she wants to be a boy will only wear boy clothing and refuses to use the girls bathroom, I asked her what she wanted to be when she grew up and she said she wants to be a dad, I have two other daughters and she is defiantly different, I think this goes way beyond being a “tom boy”, her dad and I except her for who she is and will love her no matter what I was just looking for some advise or other peoples options on this.Thanks

As we might expect, none of the online experts step in to say, um, she’s only four years old. Maybe, um, she’s just exploring? How about you just leave her alone?

Hi, I am having the same issue as you with my daughter. This past Christmas she wanted cowgirl boots and girl stuff. All of a sudden she wants to be a boy. She hangs out with other kids who are troubled, all in their own ways. One of her friends goes back and forth on being a girl and straight, then she’s gay, then she’s trans. I am confused. My daughter still shows interest in boys as well. But I to add conflicted. Don’t know if I should support her or what to do? I keep feeling she is being influenced but she seems to feel very strong about being a boy, the thing is, she doesn’t seem all that boyish. But she is wearing “boy” clothes and shoes and it seems she is trying so hard? She is 13, can anyone help me out?!!

No one “helps out.” Confused kid, confused peers, confused parent…

It’s kind of a relief to know that someone else is going through the same thing as we are. My daughter is also 13 and, although she’s never been completely girly, she’s never showed signs of wanting to be a boy. She has been seeing a therapist for over a year for various reasons (divorce, cutting, father not really in the picture, etc) and has never mentioned it. Out of nowhere she tells me she is transgender. This happened about six weeks ago and I’m having a very hard time accepting this, only because we went from wanting dresses and makeup and having long hair to wearing no makeup, short hair, jeans and t-shirts all the time…I almost feel like she has never fit in and she’s trying to find a place to fit in. I will love her always but I don’t want her to rush into this when she’s never expressed feeling like this before. She hasn’t asked us to using any male pronouns but she has picked a name she likes…it’s the name of a Ninja Turtle character. That just doesn’t seem like a decision that was made by someone who has struggled with this her whole life like the other stories I’ve read and researched and seen.

says:

We are going thru the same thing! Total girly girl our daughter was but has changed to a gender neutral name, binds her chest and wears men’s clothes. Just started two years ago and we don’t get it! She won’t talk to us either and usually lies to us (but we usually find out the lie very fast).

Cutting. Divorce. Abrupt shift from “girly girl” to “trans.” Lying. What about these underlying issues? These parents have doubts, serious doubts. But no one–NO ONE–steps in to say this child may not be “trans.” The best advice one peer parent (of an MTF) can do is suggest–wait for it–PUBERTY BLOCKERS:

If your daughter (at birth) is agreeable, perhaps she can talk with a counselor at her school or with a mental health person who has expertise so your DAB can figure out what she wants ….. as she is still young, and her “road” would probably be easier if her own hormones were blocked. Using blocking meds can be discontinued, and she would continue to develop as a female, but, just saying, as my son is 23 yo, and his facial features would need a lot of help to transition to be a female ….. laser treatment of the beard, “shaving” down of the adam’s apple, and other surgeries to “look” more feminine. I know, I know, this is all hard. I am having a hard time with it, mostly because I am concerned for my son’s safety, employment, housing, social issues …. though the younger generations seem more ready to accept these changes. I am open to listen and support, but I don’t have an extra $100,000 lying around to have the beard lasered.

Notice how this parent has the PC language down–daughter “at birth.” Having a hard time, but resigned to it–except for the wallet part. The skeptical parent responds:

J, She has been seeing a psychologist for a while now. I just don’t get the sudden change. It doesn’t make sense to me. We really think she is just following what her friend is doing. Guess we will see where this all goes.

Wait and see. That’s the ticket. Wait and see.

S, That’s about all we can do, isn’t it? I live in a metropolitan area that, I guess, is a major center for gender re-assignment, and I am baffled that I see very very few resources for the PARENTS of transgender children. And the web sites that are out there for local resources seem to be mainly interested in gathering financial support, when as a parent I am just trying to get my head around this, as well as be supportive. But my daughter is older, and doesn’t contact me much anyway.

Wow. What few resources this parent can find are websites that are “mainly interested in gathering financial support.” These parents are trying to “get their heads around” this whole thing, and they aren’t getting much besides “buck up and be supportive.”

I want to cry out and wave to these parents–over here, over here! One commenter does try to inject some critical thinking into the conversation, using actual research and a mention of this blog:

I urge parents to move cautiously. get your kid in counseling stat, but have the counselor thoroughly explore any underlying mental health issues as well as some of the many reasons why your daughter might feel the way she does about her gender. Studies show 70-80% of kids outgrow their transgender feelings. Again, I am not in the medical field, but just a parent who thinks it is sensible to proceed with caution, rather than put girls on the fast track to transition. Even though these girls are too young to vote, smoke cigarettes, sign contracts or legally change their name — it is easy to find medical personnel who will put them on a fast track to permanent body changes with hormones and surgeries to remove healthy tissue.

Google “gender critical feminism.” Femaleness is being re-defined as sexy, sparkly, pink, pretty, and subservient. Just because a girl doesn’t fit this stereotype doesn’t mean she is “really” a male. A girl shouldn’t need to have disfiguring surgeries and be pumped full of dangerous male hormones to be allowed to wear cargo shorts, hiking boots and a short hair cut. Let your girl wear what she wants and go by whatever name she wants — she is still female no matter what she wears or what interests she pursues.

Allow these kids to mature before allowing them to make such huge, permanent decisions. Explore underlying mental issues and read on 4thwavenow about the problems with the accuracy of the 41% suicide ideation statistic.

This is an important message that is not popular in the trans community. I hope my comment will not be deleted. I am not trying to cause trouble, but just want parents and doctors to be cautious and sensible before allowing a teen to make these decisions. For some girls, transition may be the lesser of two evils, but for others who hit the “regret stage” at about 6-10 years after transition, it is a devastating mistake. Make sure your daughter is not part of the 70-80% who are simply trying to escape the dismal propsects of being a female in today’s society.

And…the fact-based, reasonable commenter is slapped down forthwith:

L says:

In response to the parent that posted about girls not wanting to be females in todays society. I urge you to inform yourself a little better and perhaps seek counceling yourself. Being transgender is not a choice it is how a person is made. I felt offended by your post and lack of truth in the information you wrote. Research is the only way you will learn to come to terms with your childs situation and accept it.

Don’t question! Get “counceling” for yourself, you transphobic parent. You are just uninformed. Stop offending the brave parents with your “lack of truth.” Do your research (but don’t dare produce any actual research evidence yourself). Come to terms! ACCEPT your child.

So Katisan (whose story I featured at the start of this post), that’s all you need to ease your pain: A little “counceling” to do away with that old-fashioned, critical thinking problem you seem to have.

There is more, much more, at this link.

The 41% trans suicide attempt rate: A tale of flawed data and lazy journalists

If there is one constant in reports about transgender people, it’s the prevalence of suicidal intent.  Nearly all media accounts cite an average 41% suicide attempt rate. A Google keyword search for “transgender 41% suicide” results in over 43,000 hits.

Often, the attempted suicide rate is presented in the context of a story about a young person desperately needing to medically “transition” to the opposite sex. Caitlyn Jenner mentioned the 41% when accepting the ESPY courage award last month, and gender specialists like Johanna Olson routinely bring up suicide as a rationale for hormone and surgical treatments.

In every one of the stories I’ve read, the unspoken or explicit assumption is that transition cures suicidality.

A parent reading one of these stories will be terrified. The very notion that a child might attempt suicide is the worst possible nightmare a mother or father could imagine. The message being hammered  over and over again is that we can only save our young people by supporting their transition to the opposite sex, no questions asked, if that’s what they say they want.  Period. End of discussion. (I have personally been accused of contributing to the risk of youth suicide, simply by raising the questions I do in my blogs.)

So where does this 41% figure come from?

Many media accounts don’t cite the source of the 41% number, but this one does: an analysis released in January 2014 by The Williams Institute, in collaboration with the American Foundation for Suicide Prevention. The report, Suicide Attempts Among Transgender and Gender Non-Conforming Adults, drew its data from a 2008 U.S. National Transgender Discrimination Survey of 6456 self-identified transgender and gender non-conforming adults (ages 18+). Of these, 2566 (40%) were biological females at birth. (As always, natal females will be the main focus of my post.)

A suicide attempt rate of 41% is an emergency. Surely the Williams Institute analysis is conclusive enough to warrant the burgeoning number of gender clinics hurrying to diagnose and start “transitioning” young people who identify as transgender? Does the data convincingly show that gender dysphoria is alleviated by “passing” as the opposite gender, and that medical transition lowers suicide rates?

It does no such thing.

The authors of the study were well aware of its limitations, as I’ll show in this post. But you don’t have to take my word for it: read the AFSP/Williams Institute analysis yourself. It’s written in accessible language and is only 18 pages long, much of which is summarized in easy-to-understand tables. This material could be absorbed by even an average journalist, who presumably is paid to be at least marginally interested in the actual findings of the survey. Even a part-time, unpaid, obscure blogger like me can digest it in under an hour.

But it seems the actual “reporters”—even the ones who cite the source of the 41% figure–don’t analyze the report beyond such generalities as: The results are staggering..disturbing…alarming…

Yes, they are. A 41% lifetime suicide attempt rate is horrific, especially when compared to a 4.7% suicide rate for the US population as a whole, and a 10-20% rate for lesbian, gay, bisexual people (these numbers are according to the authors of the survey). What, exactly, does the survey tell us about attempted suicide in the gender nonconforming (GNC) and trans community?  What is causing this high rate of suicidality?  As with most things, the devil is in the details.

I will not attempt to cover all aspects of the Williams Institute analysis in this post, but will highlight a few of the more interesting nuggets of information I gleaned;  in particular, weaknesses and findings that have not been addressed in other accounts I’ve read.

  • The authors note that the survey was flawed because only one binary, Yes/No question was asked: “Have you ever attempted suicide?” More careful and rigorous studies always follow up with in-person interviews, and when self-harming behaviors (not intended to end life) are controlled for, the actual suicide attempt rate is typically halved—meaning the suicide attempt rate could be as low as 20%.
  • The highest suicide attempt rate of all–60+%–was GNC and trans people who self-report a mental disability. No big surprise there; it’s well known that having certain mental conditions is a risk factor for suicidality. But by the authors’ own admission, the survey made no effort to ask for further details about these mental health issues. The status of having a mental condition was self reported, with no corroboration from medical records or a provider. Nor was there any attempt to discover whether the actual rate of mental illness was objectively higher (via diagnosis by a mental health provider) than reported by the subjects.
  • People who had either sought or received transition-related services had a higher suicide attempt rate than people who have not. And the survey did not ask whether suicide attempts occurred before or after services were sought or received.
  • The data suggest that natal females seem not to be helped at all, in terms of self harm, by being either “stealth” trans or passing as male.  (This is the opposite finding from that of natal males.)

Right from the get-go on page 3, under Methods and Limitations, the authors acknowledge the fundamental flaws in the survey. They urge caution in interpreting their findings:

First, the…questionnaire included only a single item about suicidal behavior that asked, “Have you ever attempted suicide?” with dichotomized responses of Yes/No. Researchers have found that using this question alone in surveys can inflate the percentage of affirmative responses, since some respondents may use it to communicate self-harm behavior that is not a “suicide attempt,” such as seriously considering suicide, planning for suicide, or engaging in self-harm behavior without the intent to die …The National Comorbity Survey, a nationally representative survey, found that probing for intent to die through in-person interviews reduced the prevalence of lifetime suicide attempts from 4.6 percent to 2.7 percent of the adult sample … Without such probes, we were unable to determine the extent to which the 41 percent of NTDS participants who reported ever attempting suicide may overestimate the actual prevalence of attempts … In addition, the analysis was limited due to a lack of follow-up questions asked of respondents who reported having attempted suicide about such things as age and transgender/gender non-conforming status at the time of the attempt.

We could stop right here and say the survey’s main data point–the 41%–is worthless. If, in general population studies, it has been shown that, without followup questions, the rate of actual suicide attempts could be artificially inflated to nearly double, the real rate for GNC/trans people could be closer to 20%. In addition, the authors point out that, without some sense of when the self harm took place, there is no way to determine whether identifying as gender nonconforming or transgender was the key factor in the self-harming behavior.

But let’s not stop there. Even if the rate is closer to 20%, that is still unacceptably high. And self harm is a huge problem, whether the actual intent to end one’s life is present or not.

Second, the survey did not directly explore mental health status and history, which have been identified as important risk factors for both attempted and completed suicide in the general population. Further, research has shown that the impact of adverse life events, such as being attacked or raped, is most severe among people with co-existing mood, anxiety and other mental disordersThe lack of systematic mental health information in the NTDS data significantly limited our ability to identify the pathways to suicidal behavior among the respondents.

In other words, the survey is seriously flawed because there is no reliable information about the actual mental health status of the participants; and, since mental health problems are a known self-harm risk, there is no way to accurately figure out whether the suicide attempt rate is as high as it is due to co-occurring mental illness–not necessarily because of  “gender dysphoria.” Further, another high risk factor for suicidality is being physically or sexually assaulted, especially for people with mental health disorders.

So the authors tell us two things: the 41% figure should be interpreted with great caution; and the causes of the elevated self harm/suicide attempt rate (whatever that rate actually is)–the “pathways”–cannot be reliably determined.

Williams Table 12

What about people who have contemplated or received medical transition services? The survey tabulated everything from transition-related counseling to bottom surgery:

Respondents who said they had received transition related health care or wanted to have it someday were more likely to report having attempted suicide than those who said they did not want it. This pattern was observed across all transition-related services and procedures that were explored in the NTDS.

Williams Inst suicide table 5

People who said they “did not want” these services had a lower self-harm rate. Does medical transition, or seeking transition services, decrease or increase suicide attempt rates? We don’t know, because the survey didn’t ask respondents if the self harm occurred before or after such services were soughtas the authors note:

The survey did not provide information about the timing of reported suicide attempts in relation to receiving transition-related health care, which precluded investigation of transition-related explanations for these patterns.

This is very important: I have most often seen the 41% rate mentioned, with no caveats or analysis, to justify young people receiving medical transition services. It’s clear from the authors’ own words that this survey cannot be responsibly used as a basis for the presumption that medical transition reduces self harming behaviors over the lifespan.

And now to one of the more interesting findings in the Williams Institute report:  natal females (in contrast to natal males) who say other people generally don’t recognize them as trans or GNC have the same or higher suicide attempt rate as females who are more often recognized by others.

Williams Table 7

Trans men (FTM) were found to have the same prevalence of lifetime suicide attempts (46%) regardless of whether they thought others can tell they are transgender. … for respondents in the last two gender identity categories – female-assigned cross-dressers and gender non-conforming/genderqueer people assigned female at birth – the prevalence of lifetime suicide attempts was found to be higher among those who said other people “occasionally” or “never” can tell they are transgender or gender non-conforming, compared to those who said that other people “always,” “most of the time,” or “sometimes” can tell. 

And later–buried  in the Executive Summary, we find this:

Importantly, our analyses suggest that the protective effect of non-recognition is especially significant for those on the trans feminine spectrum. For people on the trans masculine spectrum, however, our data suggest that this protective effect may not exist or, in some cases, may work in the opposite direction.

What does it mean to “not be recognized” as transgender or gender nonconforming? It could be one of two things: these natal females “pass” as male, or they are secretly gender nonconforming, perhaps cross dressing at home, in private. But in either case, being stealth or passing doesn’t seem to alleviate the urge to self harm.

I am going to guess that, for at least some of the natal females who answered this survey question, they did interpret  “people can’t tell”  to mean that they usually “pass” as male.  So for at least some of these females,  being perceived as male didn’t help them.  And FTMs, by all accounts, “pass” better than MTFs. Why wouldn’t passing relieve the distress for these female-born people? What is causing the misery in girls and women who are GNC or trans-identified?

If self harm risk remains elevated for many young women, whether they “pass” or not, wouldn’t a more compassionate and prudent approach be to help them–and their families–accept themselves as females who simply don’t fit societal gender norms? Many of these girls, prior to transition, live a lesbian lifestyle (even if they reject the label “lesbian”). How much kinder would it be to help them embrace the only bodies they will ever have, with the sexual preference they have, instead of endorsing extreme interventions that may never resolve their dysphoria?

Elsewhere in the survey, we learn that lack or loss of family support is a big factor in self-harm risk. This seems like a no-brainer. But support for what? Accepting a loved one’s gender expression or identity is not the same as getting on board with hormones and surgery. In fact, by encouraging the idea that they must medically transition (which entails lifelong and sometimes painful interventions) to be happy, might family and gender specialists even be increasing the risk of self harm?

It’s obvious that teens who are gender nonconforming are bullied and rejected because they don’t fit into the stereotypical boy or girl box–however they subjectively identify.  And like all kids, they just want to be accepted. Listen to Ash Haffner, the 16-year-old from Charlotte, North Carolina who died (as Joshua/Leelah Alcorn did) by bolting in front of a moving vehicle in February 2015, writing this days before her death:

if I die…I don’t want to be remembered as the faggot gay girl with all the scars on her arm. unfortunately thats who I am to alot of people. if those people would have just stayed silent and kept their ignorant thoughts in their heads then maybe i wouldn’t have those scars on my arm. maybe. it wasn’t always about what they had in their heads, it was what was inside of mine to. i just didn’t understand why i felt the way i did when i had a decent life. i may have come from a broken family but i always had a roof over my head and a loving mother who fully accepted me for who i was and never stopped trying. she was the only person who never gave up hope on me. but anyway, i don’t want to be remembered as the girl with problems, just remember me as someone who understood and stayed strong for as long as i could.”

Ash’s mother, who, according to media accounts, accepted her child as whatever gender Ash preferred, said:

“She was trying to figure out her identity,” Quick said. “She felt like a boy trapped in a girl’s body. She was caught somewhat in between. People weren’t really giving her the time to figure herself out. … All she wanted was for people to just accept her. Ash started enduring the most bullying when she cut her hair short.”

Ash’s “gender nonconformity”–her short hair, for crying out loud–is what caused the increase in bullying. Isn’t our challenge, as parents, as therapists, as a society, to  support our young people when they step outside stereotyped gender norms? To allow a girl to have a crew cut or wear boxer shorts? For a boy to wear a dress if he wants?


The Williams Institute analysis raises many more questions than it answers. It seems clear that being–or, more precisely, identifying as–some flavor of gender nonconforming or trans is correlated with a high rate of self harming behaviors. Mental health problems, coupled with a history of physical and/or sexual abuse or trauma, are associated with the highest risk of self harm. But judging by the evidence, gender specialists don’t seem to be taking those key risk factors into account when prescribing “transition” as an answer.

Whether the majority of these individuals who have self-harmed will ultimately benefit from medical transition is unknown (and for young people, this will not be known for years, if not decades), but there is absolutely nothing in the Williams survey analysis to indicate that medical transition will decrease suicidal intent or self harm.

In the words of the survey authors themselves:

Well-designed studies that specifically engage the transgender community will continue to be needed to identify and illuminate the health and mental health needs of transgender people, including access to appropriate health care services.

How about including the following things in “appropriate health services” for gender dysphoric young women?

  • family therapy aimed at helping parents and young women come to terms with being “gender nonconforming” women
  • evaluation and therapy for underlying mental health issues apart from gender dysphoria
  • strong female role models for girls and young women that don’t entail conforming to porn star chic
  • support for and acceptance of lesbian identity– especially for girls who don’t look like the gender-conforming, makeup-wearing “lesbians” on the “L” Word

Given the flawed data available to us, the leap in logic to assume the only viable choice is to medically transition or die ought to shame any provider, researcher, or journalist worth their salt. The Williams Institute data, if looked at honestly, should instead spur providers to offer effective psychological health evaluation and treatment for both young people and their families, and the least invasive intervention possible.

 

 

One psychologist who gets it: “Trans” kids and their parents deserve better

What of the gender variant child whose social environment both accepts and encourages an early transition but may be unaware that the child, unwilling to disappoint, has had a change of heart ?Jack Drescher, MD, quoting Cohen-Kettenis, personal communication, in the introduction to this special issue

The Journal of Homosexuality published a 300-page special issue on childhood gender dysphoria in March 2012. It contains articles by several well known “gender specialists,” including Norman Spack, Kenneth Zucker, Jack Drescher, Diane Ehrensaft and others. These providers discuss their own clinical practice and experiences, informed by their viewpoints–and biases–about “trans” kids.

But of most interest to me is a piece by clinical psychologist David Schwartz, PhD., who is not a gender specialist himself, but knowledgeable about child psychology and the dynamics of family therapy. In his aptly named “Listening to Children Imagining Gender: Observing the Inflation of an Idea,” Schwartz critically and compassionately analyzes three of the other articles in the issue, focusing particularly on one written by Laura Edwards-Leeper, PhD., and Norman Spack, MD. Dr. Spack is a leading proponent of childhood medical transition, and heads up the Disorders of Sexual Development (DSD) and Gender Management Service (GeMs) at Boston Children’s Hospital, the first of its kind in the US.

Schwartz has two main points: First, he skillfully clarifies how most of the other clinicians writing in the issue operate from an idea–an inflated idea, unsupported by evidence–that gender is innate from birth. Schwartz terms this “gender essentialism.” And the concerned parents who bring their kids to these specialists imbibe the same biased idea.

Schwartz’s second key point is that the literal acceptance of a “trans” child’s demands and assertions, while completely ignoring underlying motivations typical of all kids, is something new under the clinical sun when it comes to treating children. It’s as if the insights of decades of child psychology are being thrown out in favor of automatically endorsing a narrative—a narrative driven by children, with their necessarily immature understandings and desires.  And Schwartz makes it clear that this clinical approach is doing no favors to dysphoric children–nor their parents.

We desperately need more outspoken therapists like Dr. Schwartz, clinicians who have deep clinical insight into developmental psychology and parent-child dynamics–not just “gender dysphoria.”

Because for most readers, the full article (and the rest of the journal issue) will be behind a paywall,  I am extensively quoting several of Dr. Schwartz’s key passages. The abstract is here. [Update:  “Awesome Cat,” in the comments section below, has a link to the full Schwartz article.]

The writing and language is that of a peer-reviewed journal article–formal and perhaps less accessible to some. But I am allowing Dr. Schwartz’s words to stand on their own merits. It is unusual to see this kind of gender criticism in a recent journal on the subject of gender dysphoria. Please note: The subheadings and boldface emphasis are mine, not Dr. Schwartz’s.


“Liberal psychiatric treatment”: the avoidance of ambiguity, p. 461

I am disquieted and stimulated by my mediated encounter with the children, parents, and clinicians represented in these clinical articles.

The children have a deeply felt complaint, expressed  explicitly or indirectly through the disruptions they inevitably provoke. They say they are unhappy with being named, classified, and treated in accord with the match between their visible genitalia and the prevalent set of conventions regarding those genitalia. For them, gender has become preoccupying …

…The parents seem to be trying to catch up with terribly surprising news, with varying degrees of success. They are frightened, frustrated, freaked out, and, finally, defeated, as they are forced to relinquish a cherished perception. Their particular defensive configurations vary (guilt, despair, anger, embrace), but all face extreme intrapsychic disruption and pain. The clinicians try to make this child/parent/symptom matrix fit into a model of liberal psychiatric treatment. As is common in the medical sciences, most push against ambiguity, preferring to emphasize speculative generalizations (“genetics is likely a factor”) instead of highlighting the lack of data from controlled studies.

Desistance: Most kids with gender dysphoria will change their minds, pp. 467, 470

With respect to the advocacy of intervention, Edwards-Leeper and Spack … say that they “have learned that delaying proper diagnosis can lead to significant psychological consequences”.  This warning implies that the reliability of diagnosis and associated prognosis in this area has been established, which is the case only for diagnosis, that is, we cannot say reliably what the course will be for a given child with GID or gender dysphoria. In particular, we cannot reliably say whether he or she will persist with an expressed need to be affirmed in his/her non-natal gender, or not. In fact, the majority do not sustain the diagnosis, that is, they desist.

[This] fact (supported by five research articles going back to 1987)…every clinician and parent of a child who is gender dysphoric needs to keep firmly in mind. …

Given this uncertainty of prognosis, it is significant that Edwards-Leeper and Spack’s presentation of the pros and cons of pubertal suppression, a primary intervention in their protocol and their frequent recommendation following diagnosis, is imbalanced.  They offer seven physiological benefits to pubertal suppression (for the most part just a list of the physical effects) and no disadvantages. Likewise they tout the psychological advantages, but note no potential disadvantages. Their conclusion is: “Therefore,
it is our clinical impression that preventing these unwanted secondary sex characteristics with puberty blocking medical intervention allows for better long-term quality of life for transgender youth than what they would experience without this intervention.”

Better quality of life? p. 467

The claim of offering “better long-term  quality of life” based on clinical impression only, and absent significant longitudinal experience or controlled data collection, is questionable. Considering that Edwards-Leeper and Spack are advocating a pharmacological intervention aimed at prepubertal children and adolescents, a number of whom are likely to desist, it is surprising and of interest that they so minimize the importance and value of alternative interventions, ones that might have fewer unknown consequences, both physiological and psychological. An alternative sort of intervention would of course be some variety of psychological therapy. Most typically this might include support, reality testing, empathic interpretation and psychoeducation offered to both parents and children.

On the psychology of “trans” kids, p. 468

The intransigent style (cognitive and behavioral) of trans children may deter some clinicians from considering that some of their suffering might be helped without rhetorically opposing their desires or trying to persuade them to relinquish their assertions.

… The goal of psychotherapy in this situation would be to help the child feel better and offer reality-based guidance for social situations, as well as the prevention of self-harm, in the rare cases where that is an issue. In general, psychotherapy should entail increasing (parents’ and children’s) self-understanding, not coaxing or pressuring them to change their minds. The disturbing demands and claims of trans children, as well as reports of self-harm (untabulated, to my knowledge) may shock and scare both parents and clinicians into expecting less frustration tolerance from them than is realistic. Such an underestimate of the trans family’s resilience may be abetted by the availability of puberty suppressing drugs. Frightened of the onset of puberty, and intimidated by the at times ominous articulations of the children, parents and clinicians are relieved to imagine even a temporary solution.

Anecdotes from adolescents are not data, p. 468

…Edwards-Leeper and Spack’s  usage of anecdotal data concerns me. To counter what they describe as the leeriness of parents with respect to the taking on of transgender identities on the part of adolescents with no prior history of gender dysphoria, they say: “However, many of these adolescents report that their friends are not surprised by their declaration of their affirmed gender, often responding that they had suspected it for some time.” We must assume that Edwards-Leeper and Spack are aware that an adolescent’s report of other adolescents’ validation of a gender identity claim is not credible evidence of more than the first adolescent’s desire to persuade. How then are we to understand their inclusion of this anecdotal information? It would seem that natural skepticism has been suspended in favor of literality. Are they trying to highlight the alleged power of essential gender by pointing to its observability by others even before the subject himself or herself has self-awareness? If so, the weakness of an anecdote such as this gives the appearance of a lack of appropriate scientific and psychological skepticism, and inattention to methodology.

Kids aren’t little adults, p. 470

With essential gender in mind [clinicians] are likely to be less psychologically minded and less thorough in their consideration of the cost–benefit ratio of invasive interventions and of research that might militate against their impulses to intervene. To be sure, they are trying to be respectful of and responsive to children’s stated wishes. But it seems that beyond that, when child patients talk about their gender, their belief in its reality seems to distract the clinician from the fact that we cannot listen to children in the same way that we listen to adults. Patients’ communications always need some degree of interpretation; that is especially true for children, who, necessitated by their cognitive limitations, speak more symbolically.

Is a 5-year-old boy “really” a girl–or trying to be like Mommy? p. 473

Ehrensaft tells us that throughout a session to which Brady/Sophie arrived fully dressed as a girl, “[she] kept sucking in her tummy, in an attempt to make herself more girl on top” (p. 351). This child is less than 5 years old. Sucking in her tummy will not make her more girl on top, since little boys and girls are the same on top, which Brady/Sophie surely knows: It will make her more woman, a very different thing. One possible interpretive direction in light of this slip would be that this child is more interested in a ticket to adulthood than a gender change, but for some reason sees being female as a necessary first step…

.  …At the conclusion of this patient’s treatment, parents and therapist decide that it is best to permit Brady/Sophie to present as a girl at all times.  Sophie (still not 5 years old) proclaims: “I’m the happiest I’ve ever felt in my life.” Ehrensaft furnishes a putative expert statement to the parents, which says in part: “To promote her wellbeing and emotional health, it is imperative that Sophie be seen and treated as a female by her parents, her educational settings, and the community surrounding her.” …Such certainty in matters so fraught with unforeseeable possibilities including the welfare of a child surprises me. The certainty of the child about her gender is matched by the clinician’s certainty about the outcome, both of whom, I suggest, are encouraged by the notion of a true gender found at last. Moreover, I wonder if Ehrensaft has not imagined the inner life of this child, who is rather adult-like in her speech (do 4 year olds commonly speak of “in my life?”), as more adult than it is. This could be for many reasons including, of course, the personality of the child. However, I believe it is easier to be distracted from the childishness of a patient’s claims when the terms they use conceptually match the clinician’s ideas. 

Gender is power, p. 474

 It seems to me that trans children, in response to great psychic pain (and adaptively or not) have engaged the rhetoric of gender and, thus, stumbled upon a communication of such potency that their parents and therapists are detoured from listening to them as children, instead crediting them with adult-like cognition. When we infer that the trans child has a disturbance in an unobservable gender system, based on a claim of gender transformation, we are granting the truth of a child’s self-analysis and proposed self-construction. I doubt that the receipt of such a gratifying abundance … of respect from the clinician is consciously intended by the child. It is more likely that the child longs inchoately for an emotional experience like respect and rapidly gains unconscious awareness of the power of gender complaints to bring such gratification. When the longing is unwittingly satisfied by the parent or clinician who, thinking they understand the child’s problem, validates the terms of the discussion as the child has set them, the child is likely to reiterate the complaint in those terms.

  For that child, a psychological structure, more or less transient, begins to develop. For the adult, the illusion of understanding begins to perpetuate itself. The most immediate lesson that the trans child has learned, and then enacts, encouraged by these interactions, is that the idea of gender is very powerful, and if you want to get a rise out of people, play with it daringly. The lesson for the parent or clinician should be: Stop talking about gender. 

Schwartz goes there: the child who threatens self harm, p. 475

The specter of harm to children—any harm to any children—is surely a powerful influence in all discussions about children, and no doubt it is playing a role, spoken or not, in this one…. I am aware of no controlled data to indicate that the incidence of self harm among trans children is any greater than somewhere between very infrequent and rare. I am aware of no data to suggest that pubertal suppression, cross-sex hormone administration, or genital surgery diminishes the probability of self-harm in trans children. Moreover, there is no reason to believe that the three above-mentioned physical interventions are any better for the welfare of trans children than supportive psychotherapy and psychoeducation for parents. There are anecdotal reports of threats by children and of children dramatizing the possibility of self-mutilation. There are psychiatric protocols for addressing the patient who seems to pose a risk of self-harm that are minimally intrusive and unquestionably reversible. The long-term psychological and physiological consequences of chemogenic pubertal suppression, cross-sex hormone administration, and genital surgery are unknown, and, as is the case with all self-selected populations, very difficult to assess owing to problems of control and limited sample numbers. The palpable misery of an articulate child may distract the empathic clinician or parent from the venerable admonition: First, do no harm.

Conflation of gender skepticism with historical homophobia, p. 470

 Edwards-Leeper and Spack take pride in what they see as their avoidance of the mistakes prior generations of mental health professionals made, in particular when the latter refused to accept gay and lesbian people at their word, sans diagnosis. Indeed, the analogy is tempting, but I would argue, deeply flawed, itself an aspect of the conflation of gender and sexual orientation. …

“An artificially vitalized concept”,  p. 476

I believe the disquiet and stimulation I initially experienced after reading these articles and watching some videos, was a reaction to my perception of children and adults struggling in the thrall of an artificially vitalized concept that subjugates and empowers each in complementary ways, a phenomenon both intriguing and worrisome. Most of these adults—parents and clinicians—have been persuaded that gender is biologically real, with specific rules for healthy functioning. The children, having unconsciously learned of the adults’ imbuing of gender with particular potencies, that is, with reification, medicalization, and transgressive possibility, try to put it to use in the course of their own self-development. It proves to be a high-risk and high-gain tool. It has the power to command adult attention, to affect adult emotions and thus to alter the position in the family of the child who chooses to deploy it. As well, in the unconsciously operating hands of the child it can also bring enormous pain, which in its compelling resemblance to physical pain further misleads the adults toward the reification of gender.  It is disquieting to observe clinicians unconsciously colluding with troubled parents in the inflation of concepts that are inherently psychologically constricting.

Teaching children to be homophobic? p. 476

… Just as racism requires belief in natural races, sexism and homophobia require belief in natural genders. If we organize our responses to children who play or become preoccupied with gendered behavior around the idea that there are natural genders from which they are deviating or toward which they can aspire with medical help (transitioning), then, however indirectly, we are buttressing the very structures upon which the hatred of gay men and lesbians stands. Or put differently: As clinicians responding to trans children, we are responding to a subjectivity, not to the results of a biopsy or blood test. We and parents must choose whether we respond to that subjectivity as the upshot of a hypothesized psychophysiological gender system, on the one hand, or choose to go no further than regarding it as a mutable psychological situation on the other. Choosing the former, the more elaborately and speculatively theorized framework of essential gender, accepts a theoretical structure that has been used to rationalize sexism and homophobia and, therefore, tends to promote them despite good intentions.

We owe more to kids than to take them literally, p. 478

There is much more to children than what they say. We owe to them a deeper listening than a literal one. We will then likely find that their engagement with gender, especially when it is transgressive or countercultural, may reveal a creativity and even a politics that can contribute to the erosion (if not destabilization) of the gender system as it presently operates. If we listen to them literally, interpret their communications and performances through the categories we adults have grown up with, and of course have ourselves failed to transcend, we will miss whatever new story they are telling or protest they are making. If we listen and respond to what they are saying in the mirror of the old system, they will seem to buy it, because it comes with the feeling, although not the reality, of being understood, which they no doubt crave. Thus, stasis is guaranteed for the child and for our culture. I am not naïve enough to imagine an intellectual transcendence of essential gender. But, in the name of equality—of gender and of sexuality—we must avoid promoting its continued entrenchment.

Two recent survey studies by Dr. Johanna Olson: Biases, assumptions, and the medical transitioning of young people

“Confirmation bias, as the term is typically used in the psychological literature, connotes the seeking or interpreting of evidence in ways that are partial to existing beliefs, expectations, or a hypothesis in hand.”

Confirmation Bias: A Ubiquitous Phenomenon in Many Guises, by Raymond S. Nickerson,  Tufts University

In this post, I will look at two recent survey studies (i.e., patient questionnaires and demographic data culled from medical records) conducted by Dr. Johanna Olson and colleagues at the The Center for Transyouth Health and Development at Children’s Hospital, Los Angeles. These studies do not look at the medical effects or potential harms of hormone treatments and/or sterilization of prepubescent children and adolescents. Rather, they consist of self-reported characteristics and demographic data, with no questioning of the key “hypothesis in hand”: that medical transition is the treatment of choice for self-identified “transgender youth.”

A hypothesis in hand also can bias the interpretation of subsequently acquired data, either because one selectively looks for data that are supportive of the hypothesis and neglects to look for disconfirmatory data or because one interprets data to be confirmatory that really are not.

In looking at the work and public statements of Dr. Olson, there are a number of biases and assumptions that can be easily seen:

  • Children and adolescents who label themselves as “transgender,” or who claim to be the opposite sex, are a priori “transgender,” even though there is no hard scientific data that a “transgender child” actually exists.
  • The reason for depression and suicidal ideation in youth who identify as transgender is lack of access to medical transition (i.e., hormones and/or surgery) and/or lack of parental support for such treatments.
  • Comorbid mental health issues are not explored as possible causes for gender dysphoria or suicidal ideation.
  • Parental, clinician, internalized, or societal homophobia is not mentioned as a possible contributing factor in the diagnosis of “transgender youth.”
  • It is a foregone conclusion that the psychological stress experienced by a young person believing they are “actually” a member of the opposite sex cannot be addressed via supportive psychotherapy to help resolve such feelings.
  • Permanent adult sterility, the usual consequence of puberty blockers followed directly by cross-sex hormones, is an acceptable and tolerable outcome for prepubescent “transgender children.”
  • Further, despite overwhelming scientific consensus that judgment, decision-making, and awareness of future risks and rewards does not reach maturity in the human brain until the early 20s, prepubescent children facing irreversible sterility are capable of understanding and choosing this consequence.
  • The possibility of future patient regret (a completely unknown factor at this time) is insignificant in comparison with the urgent need to treat children NOW with hormones and (possibly) plastic surgeries.

Now to the two survey studies. First, let’s look at “Parental Support and Mental Health Among Transgender Adolescents” by Simons et al, examining the impact of parental support on the mental health of 66 self-identifying “transgender” youth ages 12-24. What’s the main conclusion?

 Parental support is associated with higher quality of life and is protective against depression in transgender adolescents.

What is meant by “parental support” in the context of the 66 youths included in the survey? The “limitations” section of the study tells us it wasn’t well defined:

The parental support measure did not delineate whether the subject was referring to one or more parents, differentiate between parents and other guardians or caregivers, or explore the impact of other sources of support on mental health. Also, it did not distinguish between general parental support versus support specifically for gender identity, or assess particular parental qualities or actions constituting support.

Readers who have been with me for awhile know that my idea of “support” for my erstwhile trans-identifying  teenager did not include agreeing to hormone or surgical treatments. Judging by the vague criteria in the survey, my daughter and I might have presented to Olson’s clinic, with my teen rating me as “supportive” even if, in the end, we left without a prescription for testosterone or a recommendation for “top surgery” (two interventions my teen, at the time, insisted she wanted).

Here is how the study defined parental “support.” The 66 patients

completed a survey assessing parental support (defined as help, advice, and confidante support)

Help, advice, and confidante support? You better believe I provided that to my kid.

Regarding the young people who were surveyed in the study:

Before meeting with medical staff, participants underwent mental health assessment by a provider with knowledge of gender nonconformity in youth to identify major mental health concerns and provide a recommendation that hormone therapy would benefit the participant in their transition process.

But the paper doesn’t provide any hint whether “identify[ing] major mental health concerns” might have included psychotherapy or some other exploration of how these concerns might contribute to the young person identifying as transgender. Nor do we know specifics of what these concerns might be.  All we know is that “hormone therapy” was recommended, and it is assumed that a “transition process” was a desirable outcome. In my own personal family case, finding a supportive therapist who was willing to explore other thorny psychological concerns was extremely important and led to a reduction in my child’s desire to medically transition.

Moving on, another limitation noted by the authors is

Findings were based on self-report and may be open to self-presentational biases.

In other words: Like the diagnosis of “transgender” itself, the survey data is based on subjective thoughts and emotions. While the researchers acknowledge this as a “limitation” of their study, why don’t they acknowledge that the “self report” of being the opposite sex (in contravention to objective biological reality) is itself a “limitation” of the entire enterprise of the medical transition of minors? The diagnosis of “transgender children”  as opposed to just letting kids be kids, however they “identify,” is the mother of all confirmation biases.

Dr. Olson is listed as the first author of the 2nd study, still in press: Baseline Physiologic and Psychosocial Characteristics of Transgender Youth Seeking Care for Gender Dysphoria. The subjects were 101 youth (approximately 50/50 male and female), ages 12-24, who had indicated the “desire to undergo puberty suppression or phenotypic gender transition” at Olson’s clinic from 2011-2013.

What were some key psychological findings these young people self-reported? (Of note, physiological characteristics did not differ from other similar-aged youth.)

  • suicidal ideation: 50%
  • suicide attempt: “nearly 1/3”
  • depression: mild-moderate 35%, severe 11%
  • drug use: alcohol (75.5%), tobacco (58%), cannabis (61.5%,), other drugs (43%)
  • gender dysphoria experienced since approximately age 8
  • revealed their transgender identification to family at a mean age of 17.1 years [Remember this one]

What do Olson et al conclude from their survey?

…transgender youth are aware of the incongruence between their internal gender identity and their assigned sex at early ages. Prevalence of depression and suicidality demonstrates that youth may benefit from timely and appropriate intervention. All participants expressed a desire to begin hormonal intervention to assist in bringing their physical bodies into better alignment with their internal gender identity.

Seems to me there are several assumptions and confirmation biases in operation here:

  • “Timely and appropriate intervention” apparently does not include anything other than “bringing their physical bodies into alignment” with internal identity. No suggestion is made that psychological treatement aimed at helping youth feel comfortable in their bodies should even by considered.
  • The assumption appears to be that depression and suicidality are caused by gender dysphoria–or at the very least, the correlation of  suicidal ideation with gender dysphoria–can only be solved through medical transition.
  • Suicidality rates for other psychological problems (apart from gender dysphoria)  are not mentioned or compared in this study, only those of “normal” adolescents  (6.7% for ages 12-17, 10.9% ages 18-24), even though there is research (see here, and here for examples) indicating that some disorders may occur at higher rates in people with gender dysphoria. Nothing in the survey or study design indicates any knowledge of these comorbidities, whether there was an attempt to control for them, or the fact that increased suicidality is associated with some of them.
  • And again, the key assumption: “Identifying” as transgender is a priori a reliable diagnosis, as opposed to a psychological problem that could possibly be exacerbated by some combination of peer pressure, societal trends,  or online social media.


But enough of my criticisms. What limitations do the authors of this study see?

…these data describe those who are able to access care related to gender dysphoria and desire medical intervention for gender transition. These results may not be generalizable to transgender youth who are not receiving care or to those who do not desire a phenotypic transition with cross-sex hormones…

…Lastly, data collected about early childhood gender nonconforming feelings or behaviors are subject to potential recall bias. Ideally, this information could be collected in a cohort of younger children currently experiencing gender nonconformity.

“Recall bias” means the adolescent or young adult may not be remembering his or her childhood experiences accurately. Also, and even more to the point: if most of the youth in this study “knew” they were trans at 8-years old, but didn’t “come out to family” until about age 17, how are they “truly transgender?”  The phenomenon of young kids insisting they are the opposite sex is often touted as proof of some innate brain-based gender. And as anyone who has raised a child knows, 8-year-old children don’t generally hide their true feelings from their parents. If these young people profess to have “known” they were the opposite sex as 8-year-olds, why didn’t they voice this realization earlier? Why did they wait until they were 17?

I have to wonder: given that the patients who completed the survey for this study had managed to secure hormone treatments at Olson’s clinic; and given the ready availability on the Internet of the list of requirements to qualify for hormone therapy, it’s not much of a stretch to think that many likely knew that reporting a long history of identifying as transgender would be helpful in actually qualifying for treatment.

And here comes the final caveat:

Although there are guidelines and recommendations for the treatment of transgender-identified youth with puberty suppression in early adolescence followed by appropriate hormone therapy, there remain fundamental questions about when to start puberty suppression with gonadotropin-releasing hormone analogues, when to add cross-sex hormones, and how young is too young for gender confirmation surgery.

Dr. Olson has repeatedly  gone on record as promoting early cross-sex hormones, stating in a recent NPR interview that it is “ridiculous” to make an adolescent wait until age 16, as the current WPATH standards prescribe. (Some might counter that it’s more absurd to permanently destroy a child’s fertility.) Interestingly, Olson et al seem to almost concede that point in their last-but-not least limitation to the current study:

Finally, the trajectory of gender nonconformity among peripubertal youth is still difficult to predict, creating serious concerns for providers and families about the possibility of future regret in response to more permanent aspects of hormone therapy, such as breast development and voice deepening. The data we have begun to collect are an attempt to understand the transgender youth population and follow them over time, tracking the safety and efficacy of medical intervention as well as the impact of intervention on quality of life, high-risk behaviors, suicidality, depression indices, gender dysphoria, and potential regret in response to early medical intervention. We will continue to publish our follow-up data as they are collected,

So once again, as I chronicled in an earlier post, providers of medical transition tell us, “We just don’t know.” The implications of this cannot be overstated.  These providers are, by their own admission, essentially experimenting on children and adolescents with treatments that have permanent consequences, and they have no idea what the rate of future regret will be. Let’s listen again:

“… the trajectory of gender nonconformity among peripubertal youth is still difficult to predict, creating serious concerns… about …future regret…in response to early medical intervention.”

There it is, folks, in black and white, in a peer reviewed journal. We don’t know, but we’re going to find out–after it’s too late to take any of it back.

It is not my intention to demonize Dr. Olson. In fact, to give Dr. Olson a heaping helping of Benefit of the Doubt, it’s quite possible she is operating from compassion for the suffering of the youth and families who visit her clinic. (I realize more cynical observers might say she and her fellow “gender specialists” are only in this field for profit, but I am not prepared to assign sociopathic greed at this juncture).

Might Dr. Olson be suffering from pathological altruism—a particular brand of confirmation bias?

A working definition of a pathological altruist then might be a person who sincerely engages in what he or she intends to be altruistic acts but who (in a fashion that can be reasonably anticipated) harms the very person or group he or she is trying to help

…such as the substantial percentage of her young patients who, without her intervention, would have been allowed to grow up to be gay, lesbian, or simply “gender nonconforming” adults, their fertility fully intact, without the need for an expensive lifelong medical condition treated by endocrinologists and surgeons.

or a person who, in the course of helping one person or group, inflicts reasonably foreseeable harm to others beyond the person or group being helped

That might be, in the case of the steadily increasing numbers of young women being transitioned, the harm to the lesbian community, particularly the “butch” and “gender nonconforming” lesbian community. And then there is the damage to families–parents, siblings, other relatives–whose doubts and concerns are dismissed as “transphobic.” Their prior knowledge of their loved one; their possibly correct hunch that the young person is not actually in need of such extreme intervention. Their opinions are never considered or legitimized in any research or media story I’ve seen, but brushed aside,  as they watch their loved one step on the conveyer belt of puberty blockers-cross-sex hormones-surgery, to be changed forever.

Dr. Olson and the other purveyors of pediatric medical transition are certainly reasonably intelligent human beings; obtaining an MD or PhD is no mean feat. But (again from the above linked article, Concepts and implications of altruism bias and pathological altruism by Barbara A. Oakley)

 Intelligence is no safeguard regarding these confirmation bias-related issues. Highly intelligent people, for example, do not reason more even-handedly and thoroughly; they simply are able to present more arguments supporting their own beliefs.

A hunt through ClinicalTrials.gov: Who is recruiting puberty-blocked kids for research studies?

When gender critics and gender advocates spar, the more thoughtful opponents at some point usually attack and parry with links to published research. There is sparse conclusive evidence regarding transsexual or transgender adults, but at least you can link to what little there is when making your points.

When it comes to systematic studies of the growing number of children and adolescents undergoing medical “transition” via hormones and surgeries? Not so much. In fact, pretty much nothing. Zilch. Nada.

As I discussed in this post, pediatric gender specialists—endocrinologists, pediatricians, psychiatrists— openly acknowledge that there is essentially no research about the effects and outcomes of childhood medical transition.

So what generally happens when more data is needed about an accelerating and urgent medical problem, one for which experimental treatments are being prescribed? Teams of doctors and/or academic researchers write grants to fund rigorous studies. In the US, important medical research is often funded through the National Institutes of Health or other government-funded agencies. Given the increase in gender dysphoric kids popping up for treatment*, it seems likely the NIH would be quite amenable to funding well-designed studies. Particularly since the medical treatments for childhood gender dysphoria are so extreme that they can result in the permanent sterilization of minors.

There are plenty of potential research subjects being seen in gender clinics right now. While the practice is relatively new, hormone treatment for gender dysphoric kids has been ongoing in the US since 2007 (first cases at Boston’s Children’s hospital) and for over 20 years in the Netherlands. There has been ample time for researchers to apply for and receive funding.

What could be studied in these children who are having natural puberty arrested? I can think of a few interesting lines of research:

  • The physiological and psychological effects of GnRH agonists (“puberty blockers”) on gender dysphoric children and adolescents
  • The physiological and psychological effects on adolescents who have gone directly from GnRH agonists to cross-sex hormones
  • Brain activity and neurological effects on adolescents who have delayed puberty; such studies could include noninvasive MRI and fMRI brain scans, coupled with behavioral observations
  • Attitudes and opinions of gender dysphoric children and adolescents vis-à-vis permanent loss of fertility and how these attitudes and opinions change (or don’t change) over time
  • Executive function development in prepubescent children who are under treatment vs. a control group of children who are not treated
  • Long term outcome studies comparing gender dysphoric children who undergo hormone and surgical treatments vs. those who do not

There are many other avenues research could take. And these studies, to be meaningful, ought to be longitudinal (over the longest time span possible), and start as soon as possible after the child begins treatment.

So given the desperate need for research being called for by all the experts in the field, surely some studies have been funded and are actively recruiting subjects?

The place to find current research studies is ClinicalTrials.gov. (The database also lists recently closed studies that are no longer recruiting). ClinicalTrials.gov indexes all studies in the world—not just the US—which are seeking subjects.

Here’s a sample of what I found—more to the point, what I didn’t find. I tried many permutations of keyword searches and came up essentially empty. I encourage readers to do their own searches and tell us your results in the comments section.

  • Puberty blocker: 0
  • GnRH agonist: Hundreds—but all for either cancer patients or for precocious puberty
  • GnRH agonist gender dysphoria: 0
  • GnRH agonist child gender: 0
  • GnRH agonist fertility: 99, all about adult cancer patients
  • MRI gender dysphoria: 0
  • Child (or adolescent) transgender: 4, all about HIV prevention
  • Gender dysphoria: 3, all about HIV risk
  • Adolescent transgender: 2, both about HIV prevention
  • Leuprolide [generic name for Lupron, a puberty  blocker]: Hundreds—but all for either cancer patients or for precocious puberty
  • Leuprolide transgender: 0

When it comes to medicine, if there are no current studies recruiting new subjects, it typically indicates that the research questions have been more or less settled. A clinical problem or hypothesis has been thoroughly explored, studies have been conducted, the results have been replicated, and evidence-based clinical practice follows from there.

But the use of off-label GnRH agonists followed by cross-sex hormones on prepubescent children is new. We don’t have the data.  And unless someone collects that data in a systematic way, we will never know the outcome of this grand experiment on young people.

What we have now are anecdotes, personal testimonies, and shrill voices demanding medical transition for children NOW.  The usual reason given is suicide prevention. But if innate gender is real, this means there have been “transgender” children and adolescents since the dawn of human history. Yet there is no prior record of nor claim of suicidal children claiming to be “in the wrong body” before the modern age, when pharmaceutical and surgical solutions have become de rigeur.

Surely we can all agree that any treatment meant to prevent suicide; any treatment resulting in possible sterilization of minors deserves serious and wide-ranging study. Someone needs to get moving.

But the evidence suggests—no one is.

As one detransitioned woman has said, “We aren’t even lab rats.”


*A cursory Internet search reveals many stories about the steady increase in kids referred to gender clinics throughout the Western world

False positives: How many 12-year-olds is it acceptable to mistakenly sterilize?

As anyone who has spent time reading this blog well knows, I am highly skeptical of the existing research which purports to show a static male or female “gender identity” in the brain. Even if there are fundamental differences between typical male and female brains, there are going to be bell-curve outliers; and those outliers are still biologically male or female. Further, to my knowledge, there is no research proving that there is an immutable “gender identity” that is persistent throughout the lifespan, regardless of lived experience and separate/apart from biological sex) . ** (see note, bottom of post)

But for the purposes of this post, let’s just assume that the strident proponents of childhood transition are correct: there is an immutable gender identity, set in stone and impervious to change via life experience. Further, we will assume that, for a small percentage of people who experience gender dysphoria in childhood (no more than  about 20%, the number generally agreed upon even by the most zealous transgender advocates), this gender identity is mistakenly lodged in the skull of the “wrong” body. It follows that there is such a thing as a truly transgender child. These kids really do have a mismatch between brain and body, and the most humane and medically responsible thing that can be done for them is to let them “transition” to the opposite sex, post haste. As young as possible.

Case closed? Not quite.

First, let’s be very clear what we are talking about here, in terms of pediatric medical treatment. The current protocol for children identified as transgender is puberty blockers  (GnRH agonists) administered at the onset of puberty (Tanner Stage 2). The child is then monitored for several years, and if they continue to believe they are the opposite sex, cross-sex hormones are started, so as to prevent natural puberty occurring in the “wrong” gender (i.e., the biological sex of the child). In the case of a natal girl with two x chromosomes and a biologically female body, she will not go through maturation of the ovaries, menstruation, breast development, nor other primary and secondary sexual characteristics. Cross-sex hormones (testosterone for a girl) will cause her to develop more in line with the sexual characteristics of a male: a slightly enlarged clitoris, increased body and facial hair, and an enlarged larynx resulting in a deepened voice. She will thus avoid the assumed trauma of going through the “wrong” puberty, with shrinkage and no maturation of her internal reproductive organs. She will appear more or less as the gender (male) she (now he) identifies with. These changes are permanent. They cannot be undone.

And one of these permanent changes is of special import: In nearly every case, this treatment protocol will result in irreversible sterility. This child will never be able to produce their own biological children. However, the gender experts believe this outcome is worth it and justified for “truly transgender” children. The puberty-blocked girl (who still has the brain of a prepubescent child, not that of a maturing adolescent) agrees that transitioning is far more important than future fertility, and the adults in charge make the monumental decision to destroy the child’s future reproductive capacity.

Fair enough? Maybe, if we continue to assume that there is such a thing as a “truly transgender” person with an immutable, innate gender identity; if we treat this condition as a sort of birth defect that will never change, even later in life; and that the young person in question will be forever miserable to the point of suicide if they do not chemically and surgically alter and thereby sterilize their hated and mistaken body.

The problem is, these gender experts—from the most certain to the most cautious—agree that they don’t reliably know which of these children really will be transgender for life. And what that means is there are going to be some false positives: kids who will mistakenly go through extreme medical and pharmaceutical treatments—not just in childhood and adolescence, but for life, since hormones must constantly be administered to suppress the “wrong” body from reverting to the characteristics normal for the genetic makeup of the person. Some number of these kids will have been misdiagnosed. It’s inevitable. Even the most careful clinician, who believes they have narrowed their treatment cohort to only those children who are most “persistent, consistent, and insistent” cannot prevent this, because the research simply isn’t there to tell clinicians who will or won’t grow up to be truly transgendered.

Let’s agree, for the sake of discussion, that these gender clinicians—and the parents who are authorizing the treatments—truly believe they are doing the right thing. They believe that these puberty-blocked children who continue to insist they are the opposite sex are correct. It’s worth repeating that these children’s brains, and thus their critical thinking, reasoning, judgment, and other aspects of executive function, have also not been allowed to mature; because puberty is about brain development, not just secondary sex characteristics. No matter how careful these clinicians and parents are, they are still going to catch a few wrong fish in the transition net they are casting.

Does this matter? How many misdiagnosed kids are acceptable? How many sterilized children (many of whom might otherwise have grown up to be gay or lesbian adults with a desire for their own biological children) are ok? 100? 50? 20? 2? 1?

Put it this way: If there were any other treatment, for any other disorder, which resulted in sterilizing prepubescent children, and which caused irreversible, permanent changes with as-yet-unknown side effects, you’d better believe that treatment would be limited to only the most extreme cases—and even then, only after extensive clinical trials. These clinical trials would span years of rigorous peer review, with successful completion of many replicated and corroborating studies, involving thousands of subjects. These studies would have to include untreated control groups, and these human trials would have to look at physical and psychological side effects and risks of this extreme and lifelong treatment.

Rigorous study, with several phases of clinical trials, is the norm for modern evidence-based medicine, even for life-threatening medical conditions. To take but one contemporary example, there has recently been a successful drug treatment protocol released for the treatment of chronic hepatitis C, which with prior treatments, had a rather dismal cure rate. Despite the promise of the ongoing clinical trials for the new hepatitis C drugs (over 90% cure rate), which took place over many years, the general public was not allowed access to these life-saving drugs. Many people died waiting for the drugs to be approved. If the side effects of these drugs had included sterility—for adult patients—it is highly unlikely the treatments would have been approved by the FDA. Even though the drugs might have saved many lives.

We don’t remove organs and body parts, we don’t give children powerful drugs for any other disorder based on what currently amounts to clinical guesswork. We don’t remove organs or administer chemotherapy because someone might go on to develop cancer later. We don’t prescribe poorly studied, off-label drugs or perform surgery on children to relieve them from psychological distress in any other case apart from “gender dysphoria.” Surgeries and lifelong drug treatment are rightly seen as last resorts, not the first line of treatment for a problem that might turn out to be transient.

The media and trans activists are constantly telling us how important it is to transition children—as young as possible. But what about the kids who might be wrongly diagnosed? Why does no one talk about them? Why is their future happiness not a subject for media exploration? What about the suicide rates of adults who realize with horror later in life that they actually don’t want hormones and surgeries?  That it was all a big mistake? That they don’t want to have to routinely stretch or pump up their artificially constructed sexual organs to keep them in some sort of working order? What about the adults who will mourn the children they were never allowed to bear because of decisions made by parents and doctors decades earlier?

If we care about all children, including the 80-95% of kids who in fact are only “gender nonconforming”;  if only a small number of “truly transgender” children exist, why not allow those few to transition as adults, when they have the cognitive wherewithal to decide for themselves? Why not simply help them cope with their feelings of dysphoria in childhood, instead of stunting their intellectual, emotional, and physical development, and risking the huge mistake of proactively sterilizing even one non-transgender child for life?

Would it really be so terrible for parents to simply let their kids wear what they want, pursue activities they want, heck, “identify” as they want, without the medical piece?

It only takes one person to file a malpractice lawsuit. There is no minimum number for a class action suit, but given the increasing numbers of children undergoing these early transition protocols, the typical 20-50 plaintiffs is not an unlikely number for future adults willing to litigate; a fraction of the people who will wish their parents and doctors had simply allowed them to dress and behave as they wished as children, without making permanent decisions that could not be undone.

So I ask the gender specialists, the parents, the activists, the journalists celebrating the medical transition of children: Granting you for the moment that your fervent belief in immutable, innate gender corresponds to reality, what concern do you have for the children who will be wrongly sterilized, drugged, and surgically altered? Do those children matter to you at all?

Is it acceptable to wrongly sterilize even ONE child?


** Such studies would be difficult to conduct. To come close to proving an innate “gender identity” separate from biological sex, that results in intractable transgenderism, researchers would necessarily have to scan large numbers of identical twins at birth. These twins would then have to be separated and raised in different environments, then be followed into adulthood. (Genetically identical twins are necessary to prove innate brain physiology, and the twins must be raised separately to control for the effects of life experience and influence, which would need to differ to prove that nature trumps nurture). A statistically significant number of those pairs of twins would then have to both be transgender-identified to prove that transgenderism is an essential and innate trait of the human brain.

The Advocate publishes hit piece aimed at gender critics

Today, Dawn Ennis of The Advocate posted a long piece attempting to take down critics of pediatric medical transition. My blog is linked on page 2, with an excerpt from an email thread that took place between Ennis and me:

“Yes, I DO support Mark’s efforts to shine a light on the current trend to transition kids. Please read my blog, because I’ve written extensively about it. I don’t particularly agree with his approach sometimes, which too often ends up in vicious Facebook wars. But his heart is in the right place — and you can quote me on that.

You really have no idea how much people who question the dominant trans paradigm are vilified and harassed. … We have to protect our CHILDREN’s anonymity. We can’t afford to have their identities exposed — unlike the parents who are making tons of money parading the children they are sterilizing before the fawning media. Jazz Jennings comes to mind.”

For any Advocate reader who might be reading this right now because of that referring link, I have this question for you:

Are you aware that The Advocate, initially a strong voice for gay and lesbian people, has in recent years been mostly trumpeting a one-sided meme about the positive effects of transition? More importantly: Do you know that there is a body of research going back decades indicating that 80-96% of “gender nonconforming” children grow up to be gay or lesbian if left alone and not interfered with by “gender specialists?” 

Please read these posts for an introduction.

Into the Heart of the Homophobic Beast

Parental Homophobia is Never Examined in Triumphant Transition Stories

Research evidence: Most Gender Dysphoric Children Grow Up to be Gay or Lesbian

Update: And before you write to me screaming about suicide, see my August 3 post on the often-cited 41% suicide attempt rate.

“Transition or die” is promoted to young people on Reddit and Tumblr. For more, see the excellent blog Transgender Reality for this: When Suicide is Presented as the Logical Alternative

I wrote earlier this year on suicide as well. “Transition or Die” should never be promoted by any responsible medical provider or media figure. Yet it is used constantly as a way to end reasoned discussion and force frightened parents into submission:

Teen Suicide and the Chilling Effect on Dialogue

And finally: Do you think it is rational to conflate anti-gay conversion therapy with psychotherapy that might allow a “gender nonconforming” child to become comfortable in their own body? Do you really think it is “transphobic” to attempt to help a possibly gay or lesbian young person avoid lifelong hormone treatments, plastic surgeries, and (in the case of puberty blockers followed immediately by cross-sex hormones) permanent sterility?

Anyone who truly supports gay and lesbian people owes it to themselves to read widely and understand the arguments of gender critics like me. Simply dismissing us as “transphobes” and TERFs is not worthy of any thoughtful progressive who cares about human rights and dignity.


For the record: Contrary to Dawn Ennis’ attempt to paint all gender critics as mindless followers, I began blogging well before Mark and Lynna Cummings posted their video criticizing puberty blockers and childhood transition. The blog GenderTrender, also mentioned by Ennis, has been extant for years.

Far from “parroting,” parents like me are finding their own voices by exploring the research base going back decades–and even by scrutinizing the words of “gender specialists” themselves:

Kingpins of pediatric transition confess: We have no idea what we’re doing

 

Some FTM peer counseling on breast binding injuries

This is Part 3 in a series about breast binding. Part 1 here, Part 2 here. The purpose of this series is to educate parents and caregivers about breast binders: their easy availability to girls and young women, and their potential dangers. 


Truth-about-transition has a new reblog up with peer advice for girls and women who have sustained an injury from breast binding. Like most of what truth-about-transition ferrets out, the post pretty much speaks for itself: breast binding can be dangerous–in rare cases, life-threatening.

As I noted in a prior post,  adolescents seek advice primarily from others their own age, with Tumblr, YouTube, and Instagram serving as peer counseling hubs for kids discussing dysphoria, surgeries, binding, hormones and everything else trans.

To their credit, the original poster offers advice to stay safe and avoid further injury. Which is a good thing. Adolescents aren’t exactly known for good judgment, foresight, or awareness of danger. Most teens seem to think they’re immortal, preferring to follow their own impulses and desires. They also tend to think adults (particularly their parents) are clueless morons.

The post (excerpted below) is interesting not so much for its pragmatic advice, but for the underlying and very typical messaging. It begins with commonsense advice for those with injuries:

1. Take the binder off. I don’t care how dysphoric you are, I don’t care how bad you feel, I don’t care who is around. DO NOT PUT IT BACK ON.

2. Go to the doctor. Or to a nurse. When I broke my ribs, I went to the nurse at my school because that was free and that worked fine.

Clearly, we are talking about kids here. The fact that the original poster went to the school nurse indicates that they handled this likely without parental knowledge or support. We are talking about broken bones here.

3. Accept that there isn’t anything you can do to heal faster. The most likely thing that doc is going to tell you is that you have some bruised ribs, and you need to let them heal. Sometimes broken ribs can break lungs, which is potentially fatal, so no matter what, you still need to do step two, but that’s probably not going to be the case.

Yes, a broken rib could puncture a lung. At least the original poster mentions the possibility, hopefully scaring the bejesus out of some of their readers. Some of these girls might actually talk to a caring parent (vs. a stranger on the Internet) the next time they have a chest injury, given the potential danger.

Later in the post, we receive the pièce de résistance:

6. Don’t reflect too hard on it. The first thing you are going to think is not “oh I have an injury so I better take care of myself” it’s going to be “this is the physical manifestation of my dysphoria and why does being trans always ruin my life”. Try to refrain from that particular thought. You have an injury. Treat it like any other injury or illness you could get.

Don’t even let the thought enter your mind that doing this to your body is maybe a bad idea. If your ribs are bruised or broken, if being trans ruins your life, is there any possibility you could see this another way? Maybe try to find a way to accept your healthy body, the only one you will ever have?

No. The original poster instructs you to “refrain from that particular thought.” It’s just an injury like any other. Nothing to see here. Move along. (Or maybe it’s time to contemplate a double mastectomy?)

The post finishes by reiterating the message to leave the binder off until the injury heals, with a mention of yet another danger–a warped ribcage:

What not to do.

1. Put that damn binder back on. Don’t. I see you tempted. Don’t.

2. I SAID DON’T.

3. You could end up with a warped ribcage if you don’t allow yourself to heal. Don’t put it back on.

4. Really. Don’t.


This post is but one of many in the Tumblr FTM blogosphere on the same subject. YouTube–the go-to place for FTM transition stories–has this video from 6 years ago which presents a similar cautionary tale.

Why are more girls than boys presenting to gender clinics?

For decades, more young men than young women presented to doctors and psychiatrists with gender dysphoria.  But that has all changed in recent years.

As reported in a 2015 article in the Journal of Sexual Medicineresearchers in Canada and the Netherlands examined data from 748 total clinic referrals in the two countries across several decades. The flip-flop in the boy-girl ratio is obvious, as seen in the  below graph from this quantitative study. As always, a picture is worth at least 1000 words.

Aitken sex ratio graph

The dramatic uptick in girls and women presenting to gender clinics from 2006-13 is abundantly clear–and there seems to be no end in sight.

Starting in 2006, we noted that the number of  referred female adolescents with GD was now  exceeding the number of referred male adolescents with GD in the Toronto clinic. Thus, there appears to be an emerging inversion in the sex ratio of adolescents with GD which, to our knowledge, has not been documented formally in the empirical literature.

The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006–2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a  clinic in Amsterdam.

Results. Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males.

This reversal of the boy-girl ratio seems to be the case in other Western countries as well. Two other studies, one from Germany, the other from Finland, corroborate the findings from the Toronto and Amsterdam clinics.

In the German study (2014)

Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts.

And in the Finnish study (2015), which looked at referrals from 2011-2013:

The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.

…The natal girl:boy ratio among the adolescent SR applicants was very high. In prepubertal children referred to gender identity services, boy:girl ratio is reportedly 3–6:1, with some variation across countries presumably due to cultural reasons [5,13]. Previously a more even boy:girl ratio has been suggested in adolescents seeking sex reassignment than among child samples [13]…

What could be causing this undeniable increase in referrals of girls with gender dysphoria?

The German and Finnish studies offer no explanation, other than to say “cultural factors” likely play a part. In the larger Toronto-Amsterdam paper, Aitken et al posit

It is well-known that cross-gender behavior in children is subject to more social stigma (e.g., peer rejection and peer teasing) in males than in females, in both clinic-referred adolescents with GD and in the general population [26–30]. Thus, it could be argued that it is easier for adolescent females to “come out” as transgendered than it is for adolescent males to come out as transgendered because masculine behavior is subject to less social sanction than feminine behavior. … Given that a transgendered identity as an “identity option” has become much more visible over the past decade, it is conceivable, therefore, that such an identity option is easier for females to declare than it is for males because it does not elicit as much of a negative
response. .. there are greater costs for a male to adopt a female gender identity in adolescence than it is for a female to adopt a male gender identity.

I find the authors’ explanation lacking for several reasons. One, this is nothing new. Girls who are “tomboys” are more socially acceptable than “sissy” or effeminate boys. This didn’t start in 2006. But more to the point, I think the authors’ reasoning is exactly backwards. If it is more acceptable for girls to be tomboys, why would those tomboys think they need to change their gender? It would seem that boys who are effeminate would feel a much greater sense of urgency about changing their sex, because they would face constant disapproval about their behavior from parents, schoolmates, and anyone else they encountered, especially in more conservative families and regions. Girls, on the other hand, would presumably feel more comfortable continuing to present as “gender nonconforming” or “tomboyish.”

I am not the first blogger to contemplate this question. GenderTrender, for one, has been blogging for years about the phenomenon of young, primarily lesbian young women “transitioning.”  Others have written in elegaic terms about the near eradication of less conventionally “feminine” lesbians, with so many now choosing “transition” instead of the fomerly proud and celebrated butch identity as in the bygone Second Wave era. The loss of womens’ bookstores, support groups, and other spaces, as well as role models (both in real life, and in movies, TV, and other media consumed so much by young people) is also key. Homophobia/lesbophobia is most certainly a factor. I have written several posts pointing out the influence of social media in glamorizing transition, with video logs and journals chronicling the FTM transition and the profound (and partially permanent) changes wrought by testosterone.

And what of the straight girls who transition to then become gay men? What motivates these young women to abandon the relatively easier path of heterosexuality? The current cultural expectation seems to be that girls look, act and dress like–to put it bluntly–porn stars, so a girl who eschews makeup and the other accoutrements  of “femininity” could be drawn to the relative freedom of a man’s life.

None of this fully explains the inversion in the ratio of girls to boys. But whatever the reason (and please share your own thoughts and theories in the comments), the increasing number of girls dis-idenitifying with their own bodies is an undeniable and growing trend–and to observers like me, an emergency.

I am haunted by the the words of a detransitioned woman, who recently wrote that when she was active in transgender circles, the only voices to be heard amongst both MTFs and FTMs were testosterone-deepened. Women’s voices were gone.

The voices of too many young women are being lost. Figuratively, as these young women no longer identify with their natal gender and join the chorus of male opinion. And literally: their female voices silenced and transformed by testosterone.