Letter to a gender clinic: A parent’s call to action

A version of the letter contained in this post was sent by the parents of a trans-identifying daughter to the gender clinic where she received transition services. PADad, who is the young woman’s father, would like this letter to serve as a template for other parents, and encourages readers to participate in the letter-writing campaign he describes below. PADad is available to interact in the comments section of this post.

Note to 4thWaveNow readers: The letter as written by PADad has undergone lawyer review. Please see the April 10, 2018 update posted beneath the letter.


 by PADad

Like many who congregate on 4thWaveNow, we are the parents of a young person (in our case, a 20-year-old daughter) who has recently and suddenly come out as transgender. And like most here, our daughter had never exhibited any gender dysphoria as a child.

We have been doing a lot of research and planning our steps carefully. We have decided that one thing we must do is to push back against the forces in our society that are encouraging young people to take potentially harmful medications and make irreversible changes to their bodies. We want to help ensure that, before they are given access to medical interventions, young people carefully explore why they believe these changes are needed and how the changes will affect their lives in the future.

The trans activists do not outnumber those of us who are concerned about this trend, and our inactivity is putting our children at risk. Right now, many clinicians prescribe hormones and surgeries for youth with little fear of repercussion. We can change the calculus for these clinicians. We must reveal to them how many parents have the same concerns, as well as our tenacity in calling them to account. We are not going away.

To that end, I have prepared a letter that I will be sending to all of the clinicians who are involved in my daughter’s care. Because she is on our health insurance plan, we have access to her actions and payments, so we know who these people are.

I have drafted a similar letter to send to our health insurance company, putting them on notice that they are complicit in this harmful trend and urging them to change their standards for the treatments and surgeries they will allow and cover. We are also pursuing legal representation to follow up on our letters.

If insurance companies see they may be exposing themselves to liability by covering interventions that may cause more harm than good, they can play an important role in limiting the number of young people who inappropriately undertake medical intervention.

This linked site contains a comprehensive list of gender clinics in the US., organized by state and easy to search. Please consider sending your own letters to no fewer than 10 clinicians on this list, if possible, by registered mail. You may choose to use/customize our letter (below) as a template. Choose the clinics who are closest to you and perhaps add in some at random. We need to get as many out there as we can.

If some of these clinicians and facilities change their ways, others will follow. The risk of lawsuits goes up for them if they allow themselves to be singled out. That can affect the cost of their malpractice insurance. If we act together, we can make a difference.


A Parent’s Letter to a Gender Clinic

You are receiving this letter because our child is a patient at your clinic or a clinic like yours. The purpose of the letter is to make you aware of a concern that many parents, including myself, and a large and growing number of medical professionals, share about the care you are providing for our children. Some of these young people are over the age of 18 and therefore do not have to include us in their health decisions. Regardless of their age, and regardless of whether or not we are involved in discussions between you and our children, you have an obligation to do what is best for their long-term health. We do not believe this is happening.

The increasing rate at which young people, aged 11-21, are coming out as transgender cannot be explained by the fact that the broader transgender movement in western societies is removing the social stigma around coming out. The evidence is very clear at this point, and becoming clearer by the day, that what is going on with at least some of these young people, particularly young women, has elements of a social contagion.

We are including links to multiple pieces of research at the end of this letter to support our statements and to elucidate our concerns. As medical professionals, you should be aware of this research, and you have an obligation to take it seriously. At a minimum, you should be raising the bar and making selection criteria considerably more stringent before prescribing “puberty blockers,” HRT and surgeries. Because these treatments have permanent effects on patients’ bodies and minds, you should be first requiring alternatives to these treatments which are more reversible. Unless social contagion and other underlying and preexisting factors (including other mental health issues) are ruled out, it is insufficient and negligent to place undue emphasis on self-reporting from the youths themselves.

We understand that you may be under the impression that existing law provides protection against future liability for prescribing these dangerous drugs and performing these surgical interventions. We disagree. Moreover, as human beings and responsible medical professionals, you can raise the bar for treatment, reduce future regret rates, and put pressure on your peers to be better informed and to act responsibly.

Be advised that through this letter, we are putting you on notice. So far as we know, the current course of medical transgender treatment for minors has never been tested in the context of medical malpractice liability, and we do not believe that these interventions will be found to meet the standard of care for the treatment of juvenile dysphoria.

If you do not act in the best interests of all of your patients, the day may well come that you will be held accountable. We are planning for that day. Clinics and doctors will be called out by name. We will call you out by name in legal proceedings, and in social and conventional media. You should assume that, particularly given the irreversible and (at least in some cases) unwanted changes that these young people will suffer, damages can reasonably be expected to be substantial.

In addition to the risk of legal action, you should think about your place in history and your reputation. This contagion will pass, as they all do. But due to its size and impact, you should expect this social contagion to be a topic for years to come. It is already large and catastrophic enough to garner significant interest and publication in medical, social and psychological journals. I urge you to think carefully about how your clinic and your name will be mentioned in the course of this crisis, and whether you protected or ultimately harmed young people; whether you acted out of concern for youth or for your profits. You can dismiss any single case or patient as justifiable, but history will be less kind when looking at the body of your work over time.

I would encourage you to read the referenced research and clinical opinion, including the multiple links to additional published research in these articles, and familiarize yourself with it. There is sufficient information there to warrant serious soul-searching in any practitioner involved in the medical transition of minors and young adults.


Update: April 10, 2018. A few trans activists have claimed that the letter as written amounts to issuing (possibly unlawful) threats. For clarity, here are remarks by two lawyers in the 4thWaveNow community. (Caveat: This statement should not to be construed as legal advice for anyone reading this.)

Any communication, such as the letter referenced above, that states “if you engage in X behavior, Y consequences may result” could be termed, in some sense, a “threat.” The issue is not whether “threat” is the correct appellation, the issue is whether that “threat” is actionable (i.e. potentially gives rise to civil or criminal liability). Here, the answer is no.

Start with the understanding that in the United States, there is extremely wide latitude for speech. We enjoy robust First Amendment protections that give us the ability to express our opinions quite freely and widely without government interference, compared to other countries. There are allowable restrictions for such things as defamation or criminal conspiracy, as one would expect, but generally speaking, such restrictions on speech tend to be very narrowly interpreted and difficult to fall within. In the U.S., there simply is no such tort or crime as “hate speech;” our Supreme Court so ruled last summer. Moreover, “hate crimes,” or crimes motivated by animus against a particular group based on group characteristics, are a sentencing enhancement, or an additional penalty that is added on to a pre-existing crime. Other than in a few very select instances that don’t apply here, there is no such thing as a “hate crime” standing alone (an underlying crime such as assault, battery, etc. has to have been committed to give rise to the “hate crime” add-on).​

​On the “threat” point, first, as to criminal liability. A “threat” only gives rise to criminal liability when it communicates or contains, for instance, the intention to use bodily harm against the recipient, to harm the person’s property (e.g. “terroristic threats”), or to obtain financial advantage by unlawful means specified in an applicable law. An example of the latter would be extortion (“pay me X or I’ll tell your husband you are having an affair”). The “clinic letter” does none of these things, and 4thWaveNow unequivocally and strongly condemns any revision to the letter that would threaten such actions.

Second, as to civil liability. It is generally permissible to threaten to take legal action against someone in order to assert or protect one’s legal rights. Lawyers send “demand letters” (letters that outline why a party should do, or not do, some action, and the legal consequences for refusing to comply) all the time.

Moreover, it is not 4thwavenow that is making any demand in the letter; and the letter, in the form contained on the site, does not identify any recipient.

Summing it up, at the very most the “clinic letter” could be viewed as containing a non-actionable “threat” by the individual at issue (a) that legal remedies may be sought, to the extent such remedies are now, or in the future become, available and appropriate, and (b) to advocate the subject positions with, and exert public pressure upon, medical providers and insurers.


Suggested References

 “Evidence for Altered Sex Ratio in Clinic-Referred Adolescents with Gender Dysphoria,” Aitken et al, The Journal of Sexual Medicine, 2015

https://www.ncbi.nlm.nih.gov/pubmed/25612159

Analysis of article here:

https://transresearch.info/2015/09/10/evidence-for-an-altered-sex-ratio-in-clinic-referred-adolescents-with-gender-dysphoria-review/

The Canadian clinic saw nearly nearly three times as many female teens in the past 8 years as they had seen in the previous thirty. The Dutch clinic saw nearly twice as many female teens in the past 8 years as they had seen in the previous seventeen.

Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: A Descriptive Study. Lisa L. Littman MPH., Journal of Adolescent Health, 2017.

http://www.jahonline.org/article/S1054-139X(16)30765-0/fulltext

Parents online are observed reporting their children experiencing a rapid onset of gender dysphoria appearing for the first time during or after puberty. They describe this development occurring in the context of being part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same time frame and/or an increase in social media/internet use. The purpose of this study is to document this observation and describe the resulting presentation of gender dysphoria inconsistent with existing research.

“Medicine must do better on gender,” Margaret McCartney, British Medical Journal, 2018

https://www.bmj.com/content/360/bmj.k1312

A clear rise in referrals of children to specialist gender identity services has been seen in recent years, particularly in teens. Yet the role assigned to medicine can’t be separated from societal attitudes and abilities. The debate on gender occurs in an environment where boys are seen as being boys, and girls as girls, because of how they behave rather than their biological sex…

…Therapists are right to be concerned about overdiagnosis and overtreatment. But this concern can be perceived by parents as a barrier rather than a caring, evidence based response.

Many children with gender dysphoria will grow up without reassignment surgery but will be gay or bisexual. One concern is that gender reassignment makes homosexuality “disappear”: in Iran being gay is illegal, but the rate of gender reassignment surgery is the highest in the world.

“CBC Self-Censorship Part of Frightening Gender Identity Trend,” Susan Bradley, The Post Millennial, 2018.

https://www.thepostmillennial.com/cbc-self-censorship-part-frightening-gender-identity-trend/

In my own practice, I have seen a good many young women displaying the phenomenon known as “rapid onset gender dysphoria,” or ROGD, which overwhelmingly affects girls. Typically, the ROGD teenage girls I see have, wittingly or not, begun to experience homoerotic feelings about which they are conflicted. They tend to be socially isolated, and somewhere “on the spectrum.” They may have histories of eating or self-harm disorders.

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

“Transgenderism and the Social Construction of Diagnosis,” Lisa Marchiano, Quillette, 2018.

http://quillette.com/2018/03/01/transgenderism-social-construction-diagnosis/

Activists and certain clinicians who are sympathetic to the activist movement appear to feel threatened by the idea of rapid onset gender dysphoria because the suggestion that dysphoria might be influenced by social or cultural factors undermines the notions of innateness. If dysphoria isn’t innate, justifying medical intervention becomes more complicated.

“Early Medical Treatment of Children and Adolescents with Gender Dysphoria: An Empirical Ethical Study.” Lieke et al, Journal of Adolescent Health, 2015 

https://www.ncbi.nlm.nih.gov/pubmed/26119518 

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits […]As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment.

“The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity” Delay et al,  Journal of Youth and Adolescence, 2017

https://link.springer.com/article/10.1007/s10964-017-0749-6

Homophobic name calling emerged as a form of peer influence that changed early adolescent gender identity, such that adolescents in this study appear to have internalized the messages they received from peers and incorporated these messages into their personal views of their own gender identity.

“The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?” Sahar Sadjadi,  Journal of Medical Humanities, 2013

https://pdfs.semanticscholar.org/46da/ae7559f1b49d4516b0eee5266ab24a6e739a.pdf

Currently, the health consequences of the treatment are relatively unexplored. The treatment is being implemented, however, under the pressure of the emergency of saving the child from the devastation assumed to follow the onset of puberty. It must be remembered that puberty suppression as the first step to medical transition, if followed by cross-sex hormones, which has been the case for almost all reported cases, leads to infertility due to the permanent immaturity of the gonads and the reproductive tract. The absence of the discussion of sterilization of children as a major ethical challenge in this bioethics article, and many other clinical debates on puberty suppression, is striking. For any other group of children, such an intervention would be discussed extensively with ethics review boards.

The annual number of referrals to the gender dysphoria specialist team at the Astrid Lindgren Children’s Hospital in Stockholm. Referenced article in Swedish:

http://lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2017/02/Kraftig-okning-av-konsdysfori-bland-barn-och-unga/

“A Different Stripe”, Renee Sullivan, Psychology Today, 2018

https://www.psychologytoday.com/articles/201803/different-stripe

It’s been four years since I reidentified as a woman. My gender dysphoria was real and often painful, but the way for me to resolve it wasn’t by becoming a man. It was by questioning and rejecting the stories society had told me about what it means to be a woman.

Some charts illustrating the steadily increasing number of natal females presenting to gender clinics, worldwide.

increase in girls Toronto amsterdam

Canada, Netherlands, UK, Finland

increase in girls sweden

Sweden

increase in girls tavistock

United Kingdom

New zealand increase in girls to gender clinic

New Zealand

increase in girls

Toronto and Amsterdam

 

 

 

Advertisements

Update: Top San Francisco phalloplasty surgeon now with 8 malpractice suits

by Worriedmom

Second in a series. Part 1 is here.

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


San Francisco phalloplasty surgeon, Curtis Crane, M.D., continues his odyssey through the San Francisco court system. Since our initial post about Dr. Crane and his legal troubles, one of the lawsuits that was then pending against him has apparently been settled, and two more have been filed. This brings to a total of eight the number of times that Dr. Crane has now been sued for medical malpractice in San Francisco Superior Court.

This post updates the reader on the various lawsuits now pending against Dr. Crane, and also documents the peculiar silence with which these allegations have been greeted in the transgender community. It is indeed strange that, for all their fears about violence and mistreatment, transgender activists do not appear concerned in the slightest about a member of the medical profession who is alleged to have botched multiple surgeries, behaved insensitively (some would say cruelly), and caused medical havoc for many. (Of course, the allegations contained in the complaints detailed herein, until either admitted, or tested and proven in a court of law, remain just that – allegations).

In fairness to Dr. Crane, let’s start with some general observations about medical malpractice. Although it’s difficult to find comprehensive statistics, a recent (2017) survey conducted by Medscape found that 55% of all practicing U.S. physicians have been sued at least once. According to the survey, surgeons, such as Dr. Crane, are particularly likely to be sued (85% of them have faced a malpractice suit at some point in their careers). However, a large-scale study using data from the National Practitioner Data Bank also found that a tiny fraction of doctors (1%) accounts for almost one-third (32%) of paid medical claims.

Claim-proneness results from a number of factors, including type of specialty, age and sex; however:

“Compared to physicians with only one previous claim, a physician who has had three previous claims is three times as likely to have another one,” said lead author David Studdert, a professor of medicine and law at Stanford. “A physician who has had four is four times more likely and so on.”

Dr. Crane thus appears to be among the fraction of physicians who are extremely frequent targets for medical malpractice lawsuits.

Before getting into the details, we wondered whether perhaps lawsuits are a common occurrence in practice areas such as this one that involve relatively experimental or new procedures, and a patient base that might tend to have unreasonably high expectations. But a San Francisco Superior Court record search for Doctors Thomas Satterwhite, Michael Safir, Richard Santucci, Ashley DeLeon, and Charles Lee, all surgical partners in Dr. Crane’s practice, does not reveal any pending medical malpractice lawsuits for any of these doctors. Curious indeed.

As is common to all United States courts, records of lawsuits and the underlying documents can be found by going to the court website for the appropriate jurisdiction, in this case the San Francisco Superior Court. It is helpful to have the case number (also called an “index” or “docket” number), although a search can also be performed using the person’s name, so those are provided below.

A review of the lawsuits pending against Dr. Crane reveals the following detail:

Lewis Raynor and Haven Herrin v. Crane, CGC-17-556713. The plaintiff in this case alleges negligence in connection with Dr. Crane’s implantation of an inflated pump device in a second-stage phalloplasty, and the subsequent infection and loss of 40% of the plaintiff’s penis. Trial is set for December 17, 2018.

Crane Part 2 Raynor

Doe v. Crane, CGC-17-557327. The plaintiff alleges negligence in connection with three “transformative urological surgical procedures,” including a “procedure similar to a metoidioplasty,” replacement of testicular implants, and the placement of a new 3-piece inflatable implant. A metoidioplasty is a surgical procedure that uses clitoral tissue that has been enlarged through testosterone use to form a “neophallus.” Trial is set for February 19, 2019.

Carter v. Crane, CGC-16-554254. This case involves the truly unfortunate case of Cayden Carter, a young trans man who has endured over 20 surgeries in a thus far fruitless quest to obtain, and then ameliorate the effects of, a male-appearing genital structure. Carter maintains a Tumblr blog and has written extensively about the many surgeries and lasting problems resulting from the original phalloplasty, including an ileostomy and the continued need for a colostomy bag.

Crane Part 2 Carter

According to Carter’s complaint, the first surgery performed by Dr. Crane resulted in a perforated colon, which Dr. Crane first ignored and then failed to repair. There is no trial date set for this matter.

Taylor Carson v. Crane, CGC-17-556743. This case involves a plaintiff who was operated on twice by Dr. Crane, first to create a penis (which became infected) and second to attempt to repair holes in the urethra in the new penis (which failed). The entire penis was later removed, and the plaintiff was informed by another doctor that he never should have been considered for this surgery. The case has been set down for trial on March 4, 2019.

Crane Part 2 Carson

Doe v. Crane, CGC-17-560690. This case involves a plaintiff who had already undergone several transgender surgeries who wished to replace an earlier phalloplasty with a new graft that would also include lengthened urethra. The plaintiff had already undergone a “vaginectomy” (surgery to remove all or part of the vagina) and a “scrotoplasty” (a plastic surgery designed to transform part of the female genital area into a scrotum). According to the plaintiff, he specifically advised Dr. Crane’s practice in advance of surgery that he did not require a vaginectomy or a scrotoplasty; however, during the phalloplasty both of these surgeries were indeed performed. Interestingly, possibly due to potential statute of limitations restrictions, the plaintiff brought his complaint seeking damages for “medical battery” and “promissory fraud,” rather than medical malpractice. On January 4, 2018, the court denied Dr. Crane’s motion to dismiss the complaint. Trial is set for June 24, 2019.

Oliver Davis v. Crane, CGC-17-557363. This case involves Dr. Crane’s performance of a stage 1 phalloplasty that subsequently acquired a large blood clot, which the plaintiff claims that Dr. Crane ignored.

Crane Part 2 Davis

Most recently, Dr. Crane moved to have the complaint dismissed on various grounds and on February 14 of this year he lost that motion. The case does not appear to be set for trial.

Andrew Shepherd v. Crane, CGC-17-559294. In this case, the plaintiff sought to have a phalloplasty and the construction of a “large, realistic-looking scrotum.” However, the scrotum that the plaintiff was allegedly given by Dr. Crane was too small to contain even the smallest testicular implants. Since this surgery, the plaintiff has had two more surgeries, with other doctors, to obtain a larger scrotum, but they have both been unsuccessful. The case is set for trial on April 15, 2019.

In addition to the above seven cases, an eighth case, Doe v. Crane, CGC-16-550630, has now been settled (as of June 2017). This case also involved urology/surgical services provided as part of a female-to-male transition. According to the plaintiff,

Crane Part 2 Doe

The court documents do not disclose what, if anything, the plaintiff received in settlement of the case.

One allegation common to virtually all of the above cases is that Dr. Crane “over-promised” and “under-delivered” in terms of the likely success, appearance, and functionality of the constructed genitals. Moreover, several of the plaintiffs also allege that Dr. Crane’s response, when confronted with complications or distressing symptoms following surgery, was inadequate, unconcerned, and even unfeeling.

As a final note, other than coverage by 4thWaveNow, there appears to be nothing on the internet about Dr. Curtis Crane that is not completely laudatory and admiring of his surgical skills and acumen. YouTube videos sing his praises (see “Dr. Crane is AHmazing” and “Do I Regret Lower Surgery?” for two recent examples) . The Brownstein-Crane Facebook page contains 22 5-star reviews and only 2 negative reviews (neither of which mention the eight malpractice lawsuits). Susan’s Place, a major resource page for transgender people to connect and share resources, has a thread on Dr. Crane which contains only praise and, again, no mention of the extensive legal history cited above. Transgender Pulse, another major transgender resource and support forum, also has none of the above information about Dr. Crane. TSSurgery.com, a site providing information for transgender people about surgeons and others, that also contains reviews, has a large section on Dr. Crane, but again, no mention of his legal troubles.

Poignantly if not somewhat hypocritically, the “ftm” (female to male) Reddit references our earlier post about Dr. Crane as the source for information about his practice, and goes on to allege that his practice has been dropped from the Kaiser Permanente California health plan due to “the amount of lawsuits” against him:

Crane Part 2 ftm reddit

We were not able to confirm whether Dr. Crane is still a listed physician with Kaiser Permanente from that insurer’s site, but at least one additional source seems to confirm that he is not. (The insurance section of Dr. Crane’s practice’s website also does not indicate that it is “in-network” with Kaiser Permanente.)

The types of injuries detailed above are truly sad. One can only imagine what life will be like for these patients in the years ahead, as they try to cope with malformed, misshapen, and certainly non-functional genitals. Moreover, many of these plaintiffs will have difficulty in maintaining proper excretory function, a complication that can have serious ramifications for health. The embarrassment, pain, expense, and disappointment must be profound. We ask, why are these actual injuries, suffered by actual transgender people, so much less important to the transgender community than such nebulous insults as “mis-gendering,” the inability to access a desired dressing room, or hurtful Tweets? The fact that Dr. Crane has been sued for medical malpractice in connection with transgender surgery no fewer than eight times in the last two years is a highly pertinent and relevant thing for transgender people to know. Why doesn’t the community want people to know it?

Has the UK become a police state? (And has Twitter become its informant?)

Inga Berenson is the mom of a teen girl who previously identified as transgender but has now desisted. She lives with her family in the United States.


By Inga Berenson

Freedom of speech took another big hit in the United Kingdom last month. In response to a complaint filed by Susie Green, CEO of Mermaids, the Yorkshire police interrogated Kellie-Jay Keen-Minshull because of some tweets she posted in 2016 and 2017. Known on Twitter as ThePosieParker, Ms. Keen-Minshull is a stay-at-home wife and mother of four.

Mermaids is a nonprofit organization based in the UK. According to its website, Mermaids “supports children and young people up to 20 years old who are gender diverse, and their families, and professionals involved in their care.”

The offending words

According to Ms. Keen-Minshull’s account, Ms. Green objected to a tweet stating that “the CEO of Mermaids took her 16-year-old to Thailand and got him castrated.”

For this tweet and others criticizing Mermaids for promoting pediatric transition, Ms. Keen-Minshull was “interviewed under caution” for 40 minutes on February 23, 2018. She now awaits the Crown Prosecution Service’s decision on whether she will be charged. According to Ms. Keen-Minshull, the potential charges against her are “nuisance, public order, malicious communications compounded with a potential hate crime.”

On the crowd-funder site she has set up to raise funds for her legal defense, Ms. Keen-Minshull writes, “This fight is not whether you agree with my views on [the] transgender issue as much as it is that you agree that I have a right to air my views, a right to voice an opinion, a right to free speech.”

Without question, Ms. Keen-Minshull’s tweets were strongly worded, but were they untrue?

Unmasking euphemisms

It is not disputed that eight years ago Ms. Green took her 16-year-old child to Thailand to receive gender reassignment surgery, which was and still is illegal for minors in the UK and is now illegal in Thailand. (In fact, the legal age for SRS was raised to 18 not long after the Greens went there for the surgery.)

In a 2012 BBC 3 documentary, Ms. Green confirmed that her child underwent full GRS in Thailand. The narrator [4:15] states that Ms. Green’s child was “the youngest person in the world to change gender through surgery.”

It must indeed have been painful for Ms. Green to see a tweet in which someone says she had her child castrated, but the statement is not untrue. In fact, this type of surgery involves far more than castration, which refers only to the removal of the testicles in natal males. But Ms. Keen-Minshull used the word “castrated” to make an important point: GRS is a euphemism that conceals the drastic nature of this medical intervention.

And if it seems unfair that Ms. Keen-Minshull singles out Ms. Green, we must remember that she is not merely a mother who did what she believed to be right for her child. As CEO of Mermaids, she is an advocate for the use of these interventions in other people’s children. Mermaids has provided training and education to various UK government agencies, including schools and (interestingly) the UK police force. Mermaids representatives regularly attend Pride parades and other events to reach out to gender-nonconforming children and teens to inform them about transition. Ms. Green cannot reasonably expect that others won’t point out the full reality of these interventions if she is promoting them for other children.

Ms. Keen-Minshull also came under fire for a tweet that said Mermaids “prey[s] on homosexual teens,” alluding to the organization’s efforts to reach out to gender nonconforming and gender dysphoric children, many of whom (many decades of research have shown) grow up to be gay or lesbian.

The 4thWaveNow website has previously featured articles about Mermaids and its influence on UK policymaking, as well as their efforts to circumvent parents and appeal directly to children and teens.

Although our website hosts authors from both North America and the UK,  4thWaveNow is based in the United States, which protects the freedom of speech via the 1st Amendment to the US Constitution. If that were not the case, we too might have been interrogated by the police, because Ms. Green’s complaint (which we have seen but are not at liberty to share at this time) also cited a tweet we issued in the summer of 2017:

mermaids candy and puppiesWe decided to raise this question in our tweet,  after seeing this one posted by Mermaids a few weeks earlier:

mermaids unsupportive parents

As parents of current or formerly trans-identified teens, we are concerned that Mermaids is trying to influence teens whose parents do not share the organization’s definition of “unsupportive.” (In fact, as parents who try to help our kids find ways to feel comfortable in their natural bodies – at least until they are adults, we are being supportive.) And the fact that Mermaids feels empowered to publicly state its intention to influence teens like ours is all the more troubling.

We and Ms. Keen-Minshull are far from alone in believing that Mermaids oversteps appropriate boundaries in advocating for transgender services for children. In October 2016, a court removed a seven-year-old child from his mother’s custody because she was found to have essentially groomed her child into a transgender identity. The mother had been receiving support from Mermaids. The court reportedly ordered the child should have no further contact with the charity. (See “The boy who ‘lived in stealth’: Judge challenges ‘emerging orthodoxy.’”)

Twitter’s role in the interrogation of Ms. Keen-Minshull

Although it’s troubling enough to think that a supposed democratic Western nation would interrogate someone for expressing her opinion, it’s even more troubling to hear that a US-based company revealed the person’s identity to the government. According to Ms. Keen-Minshull, the police informed her that they had obtained her contact information from Twitter.

This is not the first time that Twitter has shown its bias in the battle between adherents of gender ideology and those who see dangers in it. Gender-critical individuals have had their Twitter accounts suspended for merely stating that “transwomen are men” while adherents of gender ideology regularly direct misogynistic language like “cunt” or “Kill All TERFs” at people who disagree with them.

It turns out that individuals associated with Mermaids are also guilty of mud-slinging on Twitter. “Helen” (@Mimmymum), who has frequently stated she is a member of Mermaids, regularly brandishes the word “bigot” at those who don’t share her opinions. In a tweet referring to Dr. Ray Blanchard, an American-Canadian sexologist, best known for his research studies on transsexualism and sexual orientation, she writes:

mimmymum blanchardBoth sides of this debate are exercising their democratic right to express their opinions and their concerns about public policy, but it appears that both the UK police and Twitter have chosen to respect the rights of the one while disregarding the rights of the other.

Uncomfortable truths

Ms. Green and her organization suggest that those who oppose the transitioning of minors are motivated by bigotry and hate. They refuse to acknowledge that this opposition could stem from genuine concern for the welfare of children and outrage that organizations like hers promote transition so eagerly and misrepresent the realities of it.

In a segment on BBC Newsnight in November 2016, Stephanie Davies-Arai, founder of the organization Transgender Trend, said that “the treatment pathway [for treating trans-identified children is] … cross-sex hormones…. It leads to children being sterilized and on medication for life.” When the interviewer asked Ms. Green if this were correct, she answered, “Well, no,” then changed the subject. (See “Should Mermaids be permitted to influence UK public policy on ‘trans kids’?”)

Yet this statement is correct, and it’s acknowledged to be so by clinicians who promote and administer these treatments. While the word “castration” may be jarring, Ms. Keen-Minshull used it because it exposed the reality that activists like Ms. Green would evidently rather conceal.

Ms. Keen-Minshull believes strongly, as do we at 4thWaveNow, that drastic interventions like these deserve public scrutiny. To be able to express our concerns about these interventions, we must be able to name them. If people no longer have the right to speak uncomfortable truths because others may find them offensive, a democratic society is no longer possible.

An RN & mum of a trans-identified young adult on perils of off-label cross-hormones as first-line treatment for gender dysphoria

Mumtears is a registered nurse, a wife, and mum of two daughters, currently aged 23 and 20 years old. She lives with her husband of 27 years, the father of her two daughters. She says: “Because of my currently unpopular thoughts, and because of not wanting to cause harm to my family, I feel I need to remain anonymous. I also started a blog a while ago, but- frankly- I haven’t kept it up. I am not very technologically sophisticated. If you want to read what there is in my blog, you can find it at myheartandhope.wordpress.com.” She can be found on Twitter @Mumtears1 and is available to interact in the comments section of this post.


by Mumtears

I have been a registered nurse for 30 years. From childhood, I always wanted to be a nurse. I really feel like being in the nursing profession was a “calling” for me.

While going through my post-secondary studies, studying for my Bachelor of Nursing degree, I recall being taught that, in all conditions, medical and nursing treatments should always begin with the least invasive way to treat that condition. I was taught that this was best practice care for the human body.

I have had many years’ experience working in Acute Care Pediatrics at our local children’s hospital. It was there that I learned that children are not simply “little adults”. Pediatric patients require specific attention and care, due to their rapidly developing minds and bodies. Their bodies and minds function very differently from adults. Medications and treatments are all prescribed based on the child’s body weight. They also cross different developmental stages at different rates on their way to becoming adults.

For the past 7 years, I have been working at a very busy family practice, caring for all types of patients with all types of concerns, from birth to the very elderly. I work with a family physician who also specializes in transgender care and sexual health. I have seen, assessed and cared for countless adult transgender patients. They comprise a combination of male-to-transgender and female-to-transgender patients.

Almost 5 years ago, my youngest (then 16) daughter expressed to her dad and me that she “thought she should be a boy”. That was the day our family life changed in ways we never anticipated. Throughout childhood, our daughter never presented as stereotypically “masculine”. She never outwardly expressed to us any kind of discomfort. She appeared to be mostly happy. A bright spark. She loved to play outside: doodle with chalk on sidewalks, sandbox play, climb trees, ride bikes. She smiled often. She loved building with Lego, playing Polly Pockets and with tiny toy horses. She enjoyed making tiny crafts, including models of people and animals made of Sculpey clay.

She was also very academically smart, reading beginner short novels before entering Grade 1. She taught herself how to tie her shoes and how to ride a bike. With the help of her father, when she was about 8 years old, she built one amazing bicycle from two used bikes purchased at a garage sale. In Grade 4 she challenged a Math unit about fractions and passed the final exam with flying colours, even before the unit began. She was musically advanced, playing beautiful piano tunes at age six, wonderful tenor saxophone solos in junior high. We had her tested for giftedness by a school psychologist. He told us that she was “just below” the gifted category.

We parents did begin to notice some general, social discomfort in late junior high, but we assumed that this was normal teen awkwardness, which can happen during puberty, so we were not concerned about it. We were absolutely blindsided by her proclamation that she thought she would be a boy.

My older daughter never had a temper tantrum when she was a toddler. I thought it was down to good parenting. How wrong I was. When our younger daughter was born, she behaved quite differently from her sister. Different personalities, which was not surprising to us because my husband and I are also very different from each other. Our youngest daughter started having temper tantrums at 18 months of age, which lasted 4 long years. Then, it was like a light switch turned on. Suddenly she realized she could settle her emotions down by reading quietly, alone on her bed. After just over 4 years of a frequently chaotic time, our house and family seemed to be at peace again. It was lovely.

Thinking back to this time in early childhood, I thought my daughter’s gender discomfort might be a similar phase for her. I still think it might be. I pray that, with time and life experience, she will develop an acceptance and comfort about her female body, and a knowledge that being the female sex does not have to place limits on her happiness and what she can accomplish in life.

drawing-testosterone-injectionBefore daughter told us she thought she should be a boy, I had already seen and assessed countless adult transgender patients. They comprised a combination of male-to-transgender and female-to-transgender patients who ranged in age from late 20s to early 50s. I admit that I when I first started working in family practice, I was very naïve about what “transgender” means. I noticed that all of the adult transgender patients I met also had comorbid mental health issues, which had not been fully resolved and, in some cases were severe/debilitating. My professional duty was (and still is) to provide excellent, compassionate nursing care to these patients. My personality is compassionate, empathetic and caring. I learned some of the transgender lingo; for example, “top” and “bottom” surgery. I’ve administered countless testosterone injections. I’ve changed the dressing on the donor arm of a young 20-something female-to-transgender patient who had recently undergone phalloplasty surgery. And now, after I administer these injections, I’ve found myself in the staff washroom, trying to compose myself for my next patient. Watching female erasure (in particular) causes me much sadness, partly due to what is going on with my own daughter. But mostly due to the fact that I am an adult female-born woman.

As I already said—but it’s worth saying again–I was taught that, in all conditions, medical and nursing treatments should always begin with the least invasive way to treat that condition. I was also clearly taught that pediatric patients have smaller, ever changing and rapidly developing bodies and minds, and need to be treated differently from adult patients. I was taught that physical, mental, and emotional development in children is ongoing, well into the early to mid 20s. Because of my knowledge about child development, both body and mind, I don’t understand why the medication Lupron is being given to healthy-bodied children. This medication is approved for use to treat adults with advanced prostate cancer and endometriosis. In children it’s used to slow down precocious (early-onset) puberty. It’s only in the past few years that it’s being prescribed for children who have gender dysphoria. This is an off-label use for this drug and it’s being given to healthy-bodied children even though there has been no research done to determine its safety or efficacy regarding gender dysphoria.

And we know that puberty blockers lead in most cases to cross-sex hormones. Why is the current first-line treatment for gender dysphoria in young, healthy bodies off-label, unstudied cross-hormone prescriptions? Young adult females can go into a family doctor’s office, state “I’m transgender”, and be handed a Rx for Androgel. This is what happened with my daughter, over a year ago. She never filled that particular prescription. However, last week she notified her father and me that she plans to start taking testosterone. She’s in a lengthy queue to be seen by our city’s gender specialist/psychiatrist and is impatient. She gave us no concrete reasons for wanting to start taking testosterone. She demonstrates little outward discomfort when she is in our home or when interacting with extended family.

She had one visit with the same family doctor who gave her the previous Androgel Rx. She told us that he told her what side effects could occur (while reading from a computer screen). She told us that he did not discuss reproductive planning with her, and that he gave her no written information about any of the side effects. She told us that he gave her the prescription and some bloodwork requisitions. This family doctor did not take a multidisciplinary team approach; he acted on his own. He did not refer her to an endocrinologist to check her hormone levels. He did not send her to any mental health professional, who could have assessed her for the source of her discomfort and possibly provided her with other less-invasive treatment options, such as cognitive behavioural therapy. How is the way in which this family doctor gave my daughter this off-label cross-hormone prescription medically ethical? In my province, family physicians can be the primary prescriber of cross-hormones. While using a multidisciplinary approach might be a good practice, it is not mandated. I’m currently trying to find answers via our provincial and national medical associations. The answers I’m looking for aren’t forthcoming.

I know that in no other medical or other health-related case would something like this happen, with regard to the prescription of off-label medications. I’d like to give you another home-based, common-sense example: Young adult child says to parent: “I have a really bad headache.” Think about this. Would it make any sense for the parent’s first response to be, “Your dad has some leftover oxycodone from his recent surgery, which he no longer needs to take- here, have some!”? Of course not. What would make medical/practical sense would be to first check that the young adult isn’t dehydrated. It is known that dehydration can cause headaches. “Try drinking some water and see if you feel better”. That would be the least invasive thing to try at first. If drinking water didn’t help the headache and if the young adult child had no know allergies or health conditions, it would be appropriate to next offer them acetaminophen, dosed per the package instructions. It is known that acetaminophen is a very effective analgesic, with a low incidence of side effects. If the headache persisted, perhaps it would be appropriate to then try a non-steroidal anti-inflammatory, such as Advil. There might be some inflammation in the neck or jaw muscles, causing the headache, which, if reduced, could relieve the headache. It is known that Advil is a mostly safe anti-inflammatory medication, with low potential side effects.

Recently I attended a Medical Education Session, which was held at a recent clinic retreat. The session was about low testosterone levels in adult males and testosterone replacement therapy. What I learned is, that for male bodied patients, the recommendation is that if the testosterone bloodwork result is low, it is important to clearly understand the patients’ symptoms concerns and general health. If the patient’s symptoms are low and the patient is not concerned, then giving the patient a prescription for testosterone is not advised. This is because there are also many side effects that can happen from taking testosterone, which can cause negative symptoms/concerns for the patient–especially if these male-bodied patients also have other health concerns. I learned that this is appropriate safe medical care for male-bodied patients.

I’ve done my own learning about testosterone. The pharmacy companies’ printed drug information about testosterone products states that this medication should not be given to women. It has never been studied in female bodies. Also, there are no long-term studies which indicate safety or a positive result for females who take this medication. Physicians are prescribing it “off label”.

I have been trying to learn as much as I can about gender dysphoria and its treatment. I have read many studies, documents, medical association websites, etc., and continue to do so.

When I learned about the newly recognized “rapid onset gender dysphoria”, I realized that much of its description matched what we were/are witnessing in our youngest daughter. Currently there is little known regarding care or treatments for young people presenting with rapid onset gender dysphoria. And few physicians are even aware of this phenomenon. There has been a dramatic increase, over a short period of time, in the number of teens and young adults who are seeking care for being transgender. And the demographic for which sex is declaring transgender has also changed. There are now more natal females than males with this concern.

With all that I have learned about rapid onset gender dysphoria and current treatments for it, I have more questions: Why are these off-label testosterone prescriptions being given to young healthy-bodied female patients as a first-line treatment for gender dysphoria? Especially since it is known that testosterone causes permanent body changes in female bodies, making it an invasive and irreversible treatment. Why are physicians prescribing these off-label cross-hormones without doing further assessments to ensure that this is the best treatment for their patients? I believe these are reasonable questions to ask. I believe these are prudent questions to consider. It is not transphobic to ask these questions. Many parents are asking questions like these. If you’re a parent wanting to learn more and connect with other parents, you can check out: https://gendercriticalresources.com/Support/index.php


Afterword:

I have recently learned that my daughter has likely started her testosterone prescription already. I found the receipt for it in her room at home, for low dose Androgel, from a pharmacy our family never uses, so I know that she has purchased it. She is currently living away for university, in a city which is a 2-hour drive from our home, studying in an arts program there. She has never told any of our close extended family anything about her gender dysphoria. We all live in the same city and see each other fairly frequently. Our older daughter (a graduate with a degree in Cultural Anthropology) knows and supports her sister’s claims, but that is all.

androgelOur younger daughter had the opportunity over Christmas (two Christmas dinners actually), to tell anyone in her extended family about her plan to start testosterone. She hasn’t said anything to any of them. Nothing about her gender dysphoria. I’m sure that it will be upsetting to many of them. My daughter and I text back and forth. We text about her activities (theatre, parkour). About her classes (she studies hard and gets excellent grades). About her saxophone practice (she recently was accepted into the university’s wind orchestra). I am proud of the person she is. I see so much potential for her to become an amazing woman and I am sad that she wishes to erase her female body. Frankly, I believe that “gender” is a crap concept, which is why I don’t discuss this with her. Ever since she first told us her thoughts, we have been clear in telling her our concerns. It’s up to her to think about what we have told her. We hope that she will undergo some work to understand the source of her discomfort, but we know that the decision will be hers to make. She tells us that she loves us. We have clearly told her that we love her and always will. We financially help support her post-secondary education. We want her to have many good job opportunities. We want her to have a good life and be happy and healthy. I dread her voice changing. I dread seeing her beautiful face change. And I find myself wondering if she actually needs to go through all of this, in order for her to “find herself” and come out the other side. The birth name we gave our youngest daughter means “strong”. I thought this would serve her well. We continue to use her birth name because we have not given up hope. As parents, we were never prepared for any of this. And as a registered nurse, I am very disturbed by all of it.

Baptised in Fire: A relieved desister’s story

by Sam

Sam (not her real name), 22, identified as trans between the ages of 16-19. A relieved desister, she enjoys tidying, writing, and watching the weather. She lives in the United Kingdom. Sam can be found on Twitter @rainiest_day and is available to interact in the comments section of her article.

Sam joins several other desisters on 4thWaveNow who, along with their parents, have shared their experiences of rapid onset of gender dysphoria (ROGD) in adolescence.


I was not a trans child. I was a gender-conforming little girl, as far as children are ever completely gender-conforming.  I liked pretty clothes but I also jumped in the occasional mud-pit. I didn’t play with Lego very much, because I wasn’t particularly good at it, but who cares? Not I. I felt no discomfort with being a girl. I felt little discomfort with anything, really; I was a bossy, blunt, stubborn little girl with very important opinions about everything.

I was not overjoyed about puberty. I don’t think I’m alone in that! Bras–miserably restrictive. Periods–horrible. Men followed me home from school even when I was twelve and thirteen; I in my uniform was not a very pretty child, but that didn’t seem to be the point. I didn’t like high school because I didn’t understand how I was supposed to act. Being overtly smart, because I was, made people dislike me, so I tried being stupider, but even then, I was still doing it all wrong. I thought I wasn’t on the same wavelength as everyone else, which, of course, is what loads of people feel like. But I didn’t know that. My relationship with my parents wasn’t perfect, but it was good, and we all got on.

When I was in my teens, I got into a disaster of a relationship with a girl. I was no longer in control of myself, of my body, of when I slept and when I ate and where I could be when. Things got very difficult. As the situation became increasingly unhealthy, over a very short space of time I became deeply dysphoric. Suddenly I loathed my female body and its nauseating shapes and its catastrophic frailties with a vehemence I had never known before. I stood in the bathroom and knew I needed to wash but I couldn’t take off my shirt, I couldn’t, because of what was underneath it, so I went out foul. I lost a lot of weight–partly from stress and partly to prove I could still control one aspect of my body. The new flatness of my chest only relieved me, it felt good like nothing else in my life felt good. As my legs got scrawny and the line of my figure straighter I felt only relief. I dressed only in masculine clothing, chopped my hair very short, felt like it made me tough, mean, safe. I still remember the exact moment a man said, “Excuse me, mate” to me as he passed me. It felt so much better than being hit on, even if nothing felt very good anymore.

God, everything hurt. I was desperate, unspeakably desperate to be in control of my own body, in the middle of a situation in which I wasn’t. I wanted to be strong, but I wanted even more to disappear. I wanted everyone in the world to go away. If my body was different, I knew I would have power, to walk away, to STOP IT.

I knew a little about what this was that I was feeling, I’d looked it up online –oh, I’m trans.  I tried to tell my girlfriend that I was trans, that I wasn’t a girl. She carried on as if I had said nothing, wouldn’t humour me by using my new name. I was stung, confused. A friend gave me a binder. I got thinner. I was “he”, or maybe “they”, yes, that was nice, like a cool drink of water; just anyone not called “she”. The “she” I was walking around in felt disgusting to me. “She” was all wrong. Skinny male me, pleasantly mistaken for a boy, felt like a port in the storm, if still not enough. I wanted control, control, of my body, of my life, but not to be me as I had been, because whoever that was far away, getting further away all the time, waiting for all of this to be over. I wanted like hell to be everything I wasn’t, and I didn’t know that other people felt that way too, not just transgender, but apocalyptic, so I was all alone.

The relationship ended. I was in a bad way. I’d made a Tumblr blog, looking, really, for a space that I could have to myself to vent, and I found myself on it a lot more. There is good stuff on that website. But the nasty stuff is so easy to find and so hard to wriggle free of if you’re like I was: lonely, miserable, hollow, and utterly lost, uneasy about everything, because now that she was gone I wasn’t quite so sure about being a boy, but I knew very definitely I couldn’t be a girl. Everything was still all wrong.

It’s difficult to explain what the “nasty stuff” is if you haven’t spent time on there yourself, exactly how pervasive and focused the brainwashing is, how perverse and suffocating and addictive it can be. The convoluted and illogical discourse, the constant shifting of goalposts so you are always on your toes to know what can I say? What am I allowed to think? What does this word mean today? So many lies were told to me about gender, sex, oppression, people, love, health, and happiness. I didn’t get better, and neither did anyone else I spoke to, but we were assured that this way–with our made-up pronouns and our made-up genders and our self-diagnosed illnesses–was the right way. It was a real crabs-in-a-bucket mentality, where any criticism, even of downright abusive behaviour, was transphobic and/or ableist and/or racist. To suggest improving oneself, sorting out your life, was cruelty of the highest order; we were perfect as we were, they  cooed, and anyone saying otherwise hated us and everyone like us. Narcissism ruled supreme.

We copied the writing style everyone else used, and we copied what they said too. They said and then we said we were beautiful. They and then we said we were against the world, the cis world, the hateful world, the world that wasn’t ideologically pure like we were ideologically pure. Nobody suffered like us. We were martyrs, floating high above reproach and deserving, more than anyone, of every good thing in the world: comfort, other people’s money. We deserved to have every rule bent for us, because we were right and they were wrong.

I could go on, describing every argument they used to justify this attitude, but I doubt they’d work on you. A lot of us were young teens, vulnerable in some way, whether abused or ostracised from society or just weak-willed. They gave us a new self, and all the power in the world. We thought so ruthlessly, that people against us didn’t deserve to live, reasoned it out in our mad non-reason –horrible, horrible, icy, inhumanly mechanical thinking that I have never encountered anywhere else since. We didn’t think about what we said, we just repeated what we knew we were supposed to say, and really, truly thought we were expressing our own thoughts.

They told us that we could choose a gender, any gender, out of countless, that we could make up our own and they would be taken seriously; they were, but only ever by others on there. Words on Tumblr ceased to mean the same as in the real world. Words were made up. They said if we wanted to wear make-up, or pink, or feminine clothes, we had to have a label for that, and if we wanted to have short hair, and wear masculine clothes, we had to have a label for that too.

I am not even touching the language around sexual orientation, because that is a whole other article. If we liked to switch how we “presented”, we would have a label to describe that we switched, and we could also change our labels and our pronouns day-to-day to describe how we felt (FELT! That is the crux of all of this nonsense) each day. It is so, so exhausting to be constantly examining every desire, thought, inclination of your shifting, constantly changing adolescent self, trying to find a word to fit, only to question yourself again the next week, or day, or hour. We adjusted our entire sense of self once, again, again, again. Every time, distancing ourselves a bit more from the person we used to be, that we couldn’t bear to be anymore. (I think we knew the old us would be ashamed, so we hid our faces from them.)

The time I wasted! Years on this! The energy! They say “agender” means I don’t have a gender. Do I feel like that? How do I know? How can you “feel” that? They said this was freeing for us, to finally know what to call ourselves, but the boxes they said we had to choose from were so tiny we couldn’t fit, unless we had a hundred, and even then we didn’t feel satisfied. We were forcing ourselves apart into splinters until we weren’t people any more, just words, and words that didn’t mean anything.

Why on earth weren’t we happy? We were children who knew so little about the world, and we believed everything everyone on Tumblr said. They–and then we–all spoke with such perfect arrogance, like we knew everything. We knew we did. There was also an awareness we had–although never, ever voiced, even to ourselves –that if we were just a white, normal, “cis” kid, we couldn’t be part of this club. We were part of it because we were special, and we were special because we were part of the club.

I questioned nothing. I didn’t have one original thought. And I didn’t really feel a thing.

I never looked at myself and thought: girl. That wasn’t right, and what’s more, it was vile. I was something else. I knew it.

Well: my parents knew I was sad. All that I told you about above didn’t fulfil me, although I knew it had to, because I had nothing else. My misery was obvious. One day, I stopped being able to smile. I was so emotionally numb, and that frightened me. I just couldn’t make my face smile. As I spiralled deeper into the trans-cult, my parents & I had arguments over everything. I was snappy, I was mean, I was acting recklessly, I was telling them off for using language that the trans-cult said was bad, I was ignoring all of their eminently sensible and kind advice. I tried to tell them I wasn’t a girl, to use different pronouns when they referred to me.

baptised in fireWhile they weren’t angry, just bemused, and while they really did try, I never felt my parents’ efforts were good enough. It was horribly unfair of me to treat them this way when I myself was always unsure. Even when someone in the real world “validated” me, it didn’t feel as nice as it was supposed to. Why not? I didn’t know. Were they lying? Did they really get it? Why didn’t I feel happy for more than a few minutes, did it mean I was using the wrong words? I crawled back onto my online spaces for further fruitless introspection. Over time, I lost contact with virtually all my old real-life friends – I was no longer invited to anything. I must have been annoying as all hell.

One tiny event in particular– my poor parents, poor me, poor all of us– sticks in my head and makes me feel sick whenever I think of it:

I was in the car. They were driving me to a college lesson because I hadn’t got up in time, because I wasn’t sleeping. I hadn’t washed. Before I got out of the car, my mother gave me a five-pound note.

“It’s the “cheering-up Sam” fund,” she said.

I suppose it sounds silly. But it burns. I’m looking down at that five-pound-note in my hand, and it’s breaking my heart. They knew I was so sad, but what could they do? They loved me so much, but what could they do? What were they supposed to do? How could they possibly help me? I couldn’t hold a civil conversation with them. I was mad, wildly irrational. I knew I was in the wrong but my pride was searing me full of holes. I lost my temper when the conversation became stressful, I walked out of the house and wandered around, alone, sick to my stomach with anger.

I became convinced that T was what I needed. I felt sick at the thought sometimes, but other times I would feel giddily sure, so eventually I summoned up the courage and called a clinic to make an appointment to start testosterone. But before the clinic called me back, something strange happened.

My dysphoria went away. It just went! Why or where it went I can’t say. I was 19 by this time, still clinging to my “trans identity”, insistent I wasn’t “cis”, but the feeling of wrongness about the sex of my body was gone and has stayed gone since. I didn’t love my body in the slightest, but I no longer hated it and think it completely, fundamentally wrong like I had before. I struggled with my weight for a long time then and after, but I began to realise I was female.

My close brush with acquiring testosterone shook me back into my senses somewhat. I was conscious as I came back into my body that I had almost made a huge mistake. The fear of what could have been stayed with me, that as my dysphoria passed I might have been trapped in a body more foreign to me than the original, a body like a boy that my brain no longer actually needed. The irreversible changes that would have occurred weighed on my mind:  the voice no longer mine, the man-face, the dark, thick hair. So anxiously, I thought – that’s not me…

I very slowly, not quite realising it, was distancing myself from the trans-cult and its thinking.

Well, this and that happened, I struggled on, I had a few setbacks, I struggled on a bit more. I got a proper job. This was the kick in the backside, the firework up the arse that I had needed. I was busy. I was tired. I was called “she” – I was too embarrassed to ask for special pronouns. I had to wear work clothes like everyone else. I took my work seriously, but I had to listen to people chatting in such a heretical way! Saying things that I hadn’t dared to even think, for so long! Talking about men being men, and women being women, so casually using language I had forgotten I could use. At some point, I started to agree with them. The hours I worked kept me off Tumblr and Twitter. The real world beamed blinding, hot sunlight into the dark and cold and dusty parts of my world. And one day, I simply deleted all of my social media. I can’t remember why – I just knew I had to. I didn’t stay to say goodbye to anybody I knew, I just wiped it all. I have never missed it since.

My relationship with my parents recovered. It’s a lot better now than it was before, somehow. They know I’m myself– a real, human woman who knows it– again. I started tentatively using the words daughter, woman, girl, sister to describe myself in conversation. Even now when I say those words I feel them in my mouth. I worked, shopped, ate, and I was doing weird things I did before; laughing like a horse, telling off-colour jokes to make my parents snort.

I had spent a lot of time at home, and perhaps the loveliest thing is that I ended up spending much time with my mother, while I was unemployed and recovering. We talked and we argued. But we talked far more than we argued. Sometimes I fell asleep while she was talking; she has a very soothing voice. Sometimes she fell asleep while I was talking – maybe my voice is soothing too. I loved my mother before, but I didn’t know how much I could love her, because I had never tried to understand her. I wonder, if I had breezed through my teens and headed out, unhesitating, into the great beyond, would I talk to her so fondly and treat her so kindly as I do now? Every cloud.

For a long time, I was a shell of myself. But the bossy, blunt, stubborn girl wasn’t all gone. The trauma I went through took time to fade to something I could manage, but I forgave her and I forgave myself. If I met her in the street I really think I could chat with her. I go stretches of days without thinking about it for more than a few seconds. At first my views on, well, everything, flip-flopped wildly. I went to a much wider variety of websites, I read books, I learned about things happening that I had missed, or worse, things where I had believed completely untrue versions of events.

The world had been such a hostile place when everyone was supposedly out to get me, and the only safe space was my Tumblr, where people only ever told me I was right. I learned that people thought a lot of things, had a lot of opinions, and get this: that some people could think one thing I agreed with, as well as another thing I disagreed with. I had been divorced from humanity in the trans-cult, and I was shocked at the empathy I found in myself for people, shocked at all these people, walking around, all with their lives and their feelings and their hearts. The “privileged” people actually suffered; I had believed they couldn’t. There was so much more suffering than I’d known there to be, but there was also so much more goodness. Every morning I realised my horizons were broader than the morning before, only to discover by the evening there was still so much more I hadn’t the faintest clue about.

Turns out, being a woman? You can wear anything you want, and you’re still a woman. You can do what you want, and you’re still a woman. Reality never needs to be validated.

My ability to think critically returned bit by tiny bit. It took time for me to get used to asking questions, checking sources, not believing every little thing I saw or read. I had been taught to believe unquestioningly and I had to wrestle myself out of the habit. Even now, I remind myself I can have opinions and I can disagree with someone, and they can disagree with me, and it doesn’t mean I’m a bad person; it just means that people are people, and I’m a person, and I have to deal with them being people just as they deal with me, because we have a great deal more in common than not. Through it all I have had the support of my parents – we can talk now.

I’m here now. I’ve slowly, quietly rejoined the human race as a woman, knowing it a miracle, holding both the stubborn determination of my childhood and the grateful joy of my young adulthood. The old me I was once so ashamed to face is here, and we are one again, baptised in fire and back fighting.

 

Who’s gaslighting whom? Susan Bradley, youth gender dysphoria expert, weighs in

Child psychiatrist Susan Bradley, MD, FRCP(C), founded the Child and Adolescent Gender Identity clinic at the Toronto Center for Addiction and Mental Health (CAMH), originally the Clarke Institute of Psychiatry, in 1975. She continued to direct that clinic until 1982, when Dr. Kenneth Zucker took over as head of the clinic after joining as a student in 1977. Dr. Bradley was subsequently employed at Toronto Sick Kids Hospital, where she was chief of the department of child psychiatry. She was also head of child and adolescent psychiatry at the University  of Toronto from 1989 until 1999. She is currently professor emerita at University of Toronto, and is writing a book about supporting youth with high functioning Autism Spectrum Disorder.

Dr. Bradley recently wrote an article for the Post-Millennial about the current political and clinical climate surrounding issues of childhood and adolescent gender dysphoria; highly recommended.

We will be posting a lengthy 4thWaveNow interview with Dr. Bradley in the near future. Stay tuned.


Below, Dr. Bradley responds to a recent paper by Damien Riggs (associate professor of social work) and Clare Bartholomaeus (research associate) of Flinders University, Adelaide, Australia entitled “Gaslighting in the context of clinical interactions with parents of transgender children.”

gaslighting author screen cap

The piece is, in essence, an attack on skeptical parents of trans-identified children, in the form of three “fictionalized case studies.” Riggs and Bartholomaeus characterize parents who do not fully affirm their child as transgender as engaging in “identity-related abuse”; they use the term over 30 times in their paper. According to the authors, “abuse” and “gaslighting” include such transgressions as not using preferred pronouns; cancelling appointments; and not agreeing to medical transition on the timetable preferred by Riggs and other providers engaged in pediatric transition.

The authors counsel therapists to try to see a child privately when parents are not sufficiently obsequious. They even refer to non-compliant parents as abuse “perpetrators”:


gaslighting article 5

Authors suggest therapists should find “creative ways” to make private contact with the child


We have included more screen captures from the Riggs article in Dr. Bradley’s response below. However, we will not be deconstructing the entire paper in detail. We strongly encourage readers to examine it closely.

 


by Susan Bradley, MD, FRCP(C), Consultant Child Psychiatrist

 Where is Damien Riggs coming from?

That’s what I had to ask myself when I read his diatribe against parents of youth who have recently expressed their feelings of gender dysphoria. His position seems to be this: Parents who are reluctant to simply buy into his belief that anyone who expresses feelings of gender dysphoria must be “trans” and supported in their transition with no questions asked, are not being adequately supportive of their child; further, he terms this parental skepticism “identity-related abuse.” But it’s natural for any parent of a youth expressing such feelings, particularly if they are of recent onset, to wonder “why?” or “how come now?” Such sudden changes in identity would make anyone question what is really going on inside that person.


gaslighting article 1

Parents are “gaslighters” if they question hormone blockers or want to slow down medical intervention


To be a parent of a child undergoing such a radical change in identity is a very stressful experience, with conflicting feelings of wanting to support their child, but also wanting to be sure that what they want really makes sense. If this child has a previous history of feeling rejected by peers, many parents will be aware of the damage that has been done to their self-esteem, and rightly see them as vulnerable to those who offer acceptance, at whatever cost.

But Damien Riggs, the therapist advising us, seems to see things in black and white terms: if they voice any feelings of being “trans” they must be “trans”. What about those individuals who change their minds? Does the therapist know for sure that my daughter is not going to change her mind? How do we know that this sudden, intense interest is different from other intense interests the child may have had in the past? How do we know what impact interventions such as puberty blockers will have on her future, especially if she changes her mind?


gaslighting article 2

“Cisgenderist” parents who misgender their kids should not be allowed to apologize


These are just some of the questions that would go through the minds of any caring parent in that situation. If the therapist does not address these concerns in a straightforward manner, most parents would then begin to wonder if they are in the right place to help their child. Failing to engage wholeheartedly in the “therapy” would be one way of trying to deal with their uncertainty when they sense that the therapist is not open to a discussion about their concerns.

This hardly qualifies  as “gaslighting,” a term defined in the dictionary as “behavior intended to manipulate someone by psychological means into questioning their own sanity” or behavior that “seeks to sow seeds of doubt” about their reality or beliefs. To the contrary, those parents are behaving as most parents would in a situation where they do not feel heard.

From the description of the process of therapy engaged in by Damien Riggs, there appears to be no attempt to help parents be understood in terms of what most would regard as very normal worries about a process that seems to be moving forward with little thought for the persons involved. There is no evidence of intent to deceive by these parents; only a lack of faith in the person directing their child’s treatment, who after all, has very little prior knowledge of that child, their issues, their vulnerability, or their ability to make a competent decision about life-altering interventions.

I would argue that Damien Riggs’ accusations about the parents “gaslighting” is unethical and lacking in understanding of the relationship between child and parent. Amongst other things it is the parents’ job to protect the interests of their children until they reach an age when they are capable of doing so by themselves.  Riggs appears not to understand the importance of this relationship when he mislabels the rather normal reactions of parents with a rapid onset dysphoric child as “gaslighting”.


gaslighting article 4

Parents who ask for a diagnosis for their trans-identified children are gaslighters.


If Damien Riggs had done a careful assessment of the youth, particularly, the girls with rapid onset gender dysphoria (ROGD), he would have understood that most of these young women had begun to have homoerotic feelings as they moved into adolescence. Experiencing crushes on same-sex peers is not unusual both in individuals who later become lesbian, but also in heterosexual women.

However, if you are a teen who has had social difficulties, it is easy to feel that having these feelings will make you feel more “weird” than you may already feel. Homophobic slurs are common amongst teens, further increasing anxiety about acceptance in these young girls. The process is easy to uncover if you—as a therapist—ask the right questions, in that these young women desperately want friends and someone who accepts them. The internet sites for “trans” individuals are very welcoming of anyone who expresses interest. Because many of these young women are not really skilled at self-reflection, finding a simple solution (“I’m trans!”) that makes them feel accepted seems perfect. Unfortunately, as we all know, life is more complicated and what seems like a simple way of feeling good may not be a good long term solution.

Caring parents take time to understand and accept mental health issues even when they are more common than the belief that one is in the wrong body. Recent onset gender dysphoria is a rather sudden change in how the youth sees herself, and although some of these individuals may eventually decide that transitioning is best for them, many will realize that they are lesbian and can explore that and find acceptance in a same-sex relationship without having to change their bodies. They need time to understand their feelings and explore ways of finding the best solutions for them. Parents can usually participate in being supportive when they understand what their child is struggling with and how they can help.  For Riggs to blame parents for not accepting his approach wholeheartedly is not what those of us in mental health are trained to do.

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

by Brie Jontry

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


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

Tannehill ROGD WPATH post

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

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

karasic retract poster

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

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

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

WPATH jan 5 2018 detrans therapist

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

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

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

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

increase in girls

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

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

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

But you’re not listening to us.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

brie advocate comment

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

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

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

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