Brown University and PLOS ONE: Defend academic freedom and scientific inquiry

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We are urging Brown University and the editors of the peer-reviewed journal PLOS ONE to continue to support the research of Dr. Lisa Littman. Her recently published paper, “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” explores the possibility that social contagion may cause some teens and young adults to incorrectly conclude they are transgender, and thereby undertake irreversible medical interventions that they may eventually regret.

Since its publication, there has been a concerted effort to suppress Dr. Littman’s groundbreaking study. Complete details can be found below. Readers who share our concern about this activist-driven attack on scientific inquiry and academic freedom are strongly encouraged to sign the petition at this link.

In addition,  please consider telephoning and/or writing a personal letter to the following individuals at Brown University and PLOS ONE. What’s at stake: The future of research into the unexplained increase in young people, particularly girls, presenting to gender clinics.

Bess Marcus, Dean of School of Public Health, bess_marcus@brown.edu, 401-863-9858

Christopher Kahler, Chair of Behavioral and Social Sciences, christopher_kahler@brown.edu, 401-863-6651

Brian Clark, Director of News and Editorial Development, brian_clark@brown.edu, 401-863-1638

Joerg Heber, PLOS ONE Editor-in-Chief, jheber@plos.org, 415-624-1200

Petition text

We, the undersigned, are writing in support of Dr. Lisa Littman of Brown University and her study on the topic of rapid onset gender dysphoria (ROGD).

Many of us are parents of teens and young adults who, having never expressed discomfort with their sex during childhood, experienced a sudden onset of gender dysphoria after exposure to the concept through peers and/or websites promoting transition. Some of the signatories to this petition are parents who completed Dr. Littman’s survey. The results of the study support the possibility that social contagion, rather than an innate, immutable sense of incongruence between body and mind, may be at work in some of these cases.

We are grateful that Dr. Littman’s research has been published and that this issue is finally beginning to get the attention it deserves. Although an abrupt adolescent onset of dysphoria has been mentioned previously in the scientific literature[1] , Dr. Littman’s study is the first to explore and document the phenomenon in detail. It describes what appears to be happening to many young people today.

We must be very clear: the parental reports in this study offer important and much-needed preliminary information about a cohort of adolescents, mostly girls, who with no prior history of dysphoria, are requesting irreversible medical interventions, including the potential to impair fertility and future sexual function. In any other group of children, these grave consequences would be seen as human rights violations unless there was significant and overwhelming evidence these procedures would be beneficial long-term.

Across the world in the last few years, researchers and clinicians have noted a sharp uptick in the number of young people, primarily females, who are requesting medical transition services. For example, in the United Kingdom gender clinic referrals have quadruped in the last five years. This constitutes an epidemic. As a leader in public health research, it is incumbent upon Brown University to investigate the causes and conditions leading to this sharp increase, as well as the long term outcomes.

Tavistock-referrals-of-boys-vs-girls-

Referral data from Tavistock GIDS: http://gids.nhs.uk/number-referrals

We are disheartened to see that Brown University has already removed a news release announcing the study from its website and replaced it with a letter to their community that states: “There is an added obligation for vigilance in research design and analysis any time there are implications for the health of the communities at the center of research and study.”

We, the undersigned, many of whom are parents who participated in Littman’s survey, agree wholeheartedly that the “scientific community holds an obligation for vigilance in research design and methodology.” There has yet to be a study that includes a cohort of youth offered mental health care in place of affirmation therapy. The glaring absence of a control group of youth who are supported by their families in their gender exploration but who are not affirmed in “wrong body” beliefs is a failure of the scientific community. As the number of girls and young women who desist from their trans identification grows, we must demand recognition for this cohort as members of the “communities at the center of research and study.”

The university has effectively caved to pressure from activists who claim that Dr. Littman recruited participants from “anti-trans” or “far right” hate sites. Similarly, the moderator of the PLOS One Twitter site promised to “investigate” the published study after trans activists mobbed their account. Trans activists  claim the parents who completed the survey were too transphobic to accept that their children were trans and too disconnected to have noticed that they had been suffering from dysphoria since childhood.

These claims are false in every respect. The three websites referenced are available for all to view, but the vast majority of contributors are secular, engaged, open-minded, mostly liberal-leaning parents.

These sites point to the probability that many kids who are today identifying as trans are in fact experiencing internalized homophobia. In other words, the contributors to these sites are concerned about the wellbeing of gay and lesbian kids, and they want to ensure that their children are not transitioning simply because they are ashamed of their sexual orientation.

Consider the study results:

  • 85.9% support same-sex marriage.
  • 88.2% believe trans people deserve the same rights and protections as everyone else.

Clearly, those who claim the respondents are from the far right are either misinformed or disingenuous.

And what of the claim that the parents were “unsupportive” or too disconnected from their children to recognize they had felt dysphoric during childhood? Dr. Littman acknowledges this possibility in her paper. However, she also notes that “the 200 plus responses appear to have been prepared carefully and were rich in detail, suggesting they were written in good faith and that parents were attentive observers of their children’s lives.”

Littman’s study offers, for the first time, a glimpse into families who hold space for their dysphoric children while also seeking out mental health care that focuses on underlying conditions. Consider some of her findings:

  • 204 out of 256 youth reported on in the study claimed alternative sexualities to their parents prior to coming out as transgender
  • Over 200 youth were supported in changing their presentation in terms of hairstyle and dress
  • 188 had changed their names
  • 175 had changed their pronouns
  • 111 youth told their parents they wanted to see a gender therapist; 92 were taken to see one

Moreover, of Dr. Littman’s respondents, there were only eight cases of estrangement: six by the youths themselves and two “where the estrangement was initiated by the parent because the AYA’s outbursts were affecting younger siblings or there was a threat of violence made by the AYA to the parent.” [AYA = “adolescent or young adult.”]

These are clearly parents who supported their children in their distress and through exploration of identity. Littman’s study also found that 119 youth requested medical interventions at the same time they announced their new gender identity or within the first month of their announcement. Remember, 100% of the youth discussed in her survey did not qualify for a diagnosis of gender dysphoria at any point in their childhood or  prior to coming out. Yet, 17 youth were offered an Rx on their first visit with a clinician. Perhaps even more concerning, “For parents who knew the content of their child’s evaluation, 71.6% reported that the clinician did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria before proceeding and 70.0% report that the clinician did not request any medical records before proceeding.” This is in a cohort of young people of whom 62.5% had been diagnosed with at least one mental health or neurodevelopmental disability prior to the onset of gender dysphoria, which mirrors data from other affirmation-focused clinics.[2]

Another notable criticism of the study is that Dr. Littman sought input only from parents, not from their children. Here again she acknowledges the limitation: “Although this research adds the necessary component of parent observation to our understanding of gender dysphoric adolescents and young adults, future study in this area should include both parent and child input.” We understand that Dr. Littman plans future surveys specifically for dysphoric youth and we cannot emphasize enough how important this research will be for this particular group of young people and their families.

We, the signatories to this letter, overwhelmingly support the rights of transgender people, but we want better diagnostic and mental health care for youth who suddenly demand serious medical interventions, particularly in the absence of a history of dysphoria.  We believe that medical interventions that may benefit some individuals may not help, and may even harm, others, as already evidenced by the growing number of desisters and detransitioners, many of whom have already suffered from irreversible side effects of their earlier medical transition . We support more research to help distinguish between the two groups, and Dr. Littman’s study is an important first step.

We strongly urge Brown University and PLOS ONE to resist ideologically-based attempts to squelch controversial research evidence. Please stand firm for academic freedom and scientific inquiry.  We urge you to support Dr. Littman in this important line of research.

[1] See, for example, Bonfatto, M. & Crasnow, E. (2018) Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service, Journal of Child Psychotherapy, 44:1, 29-46, DOI: 10.1080/0075417X.2018.1443150. Also see Byne, W., Bradley, S. J., Coleman, E., Eyler, A. E., Green, R., Menvielle, E. J., . . . Tompkins, D. A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4), 759-796. doi:10.1007/s10508-012-9975-x.

[2] “In all diagnostic [mental health] categories, prevalence was severalfold higher among TGNC youth than in matched reference groups.” http://pediatrics.aappublications.org/content/early/2018/04/12/peds.2017-3845

 

 

First peer-reviewed study of rapid onset gender dysphoria released today

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The research, conducted by Dr. Lisa Littman, examines parent reports of the heretofore little-studied phenomenon of rapid onset of gender dysphoria in adolescence, also called ROGD.

The full paper can be accessed here (open access):

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202330

Stay tuned for an interview with Dr. Littman here on 4thWaveNow within the next few days.

Research evidence: Gender-atypical tots more likely to become gay or lesbian

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by Michael Biggs

Michael Biggs is Associate Professor of Sociology at the University of Oxford and Fellow of St Cross College. He researches social movements and collective protest.

Transgender activists insist that children who behave in ways more typical of the opposite sex—a boy who likes dressing up as a fairy princess, a girl who enjoys rough-and-tumble play—are ‘transgender’. Such kids, they argue, must be subjected to medical interventions to make them superficially resemble the opposite sex, and these interventions must take place as soon as possible. The British National Health Service gives puberty-blocking hormones to children as young as 10, while in the United States some surgeons will amputate the breasts of 13-year-old girls.

Many of the kids labelled ‘transgender’ would—if left alone—grow up to be lesbian or gay. This observation has been made by many parents, and sometimes their children who desisted or detransitioned, whose stories are gathered on this website. It is also supported by a growing body of scientific research. Developmental Psychology published an important article last year (Li, Kung, and Hines 2017), which 4thWaveNow has previously highlighted. Thanks to the generosity of Gu Li in sharing some of the data, I will try to explicate the results for the general reader.

The article exploits a survey of exceptional quality, from a well-defined population: mothers giving birth in a county in southwestern England in 1991–2. Therefore it avoids the problem of haphazard sampling which undermines so many surveys of sexuality. The survey is large, so the article analyzes 4,597 children. Because they are tracked over time, we can see how the children behaved just before starting school (at 4 years and 9 months), and then how they turned out by the age of 15.

Gendered behavior

The survey asked mothers (or other caregivers) about their children’s behavior. We are interested in the questions on gender which comprise the Preschool Activities Inventory (Golombok and Rust 1993). This is a standard list of two dozen questions covering toys, activities, and characteristics. For example, the interviewer asks how often the child played with toy guns in the last month, from “never” to “very often.” All these questions are condensed into a single scale, so that the child can be placed somewhere on a spectrum from most ‘feminine’ to most ‘masculine’.

The Preschool Activities Inventory predates the emergence of transgenderism as a phenomenon. Yet the questions bear a striking resemblance to the reasons given by parents for diagnosing their kids as transgender, as catalogued by Lily Maynard. Thus, femininity is elicited by questions about playing with dolls, dressing in girls’ clothes, and pretending to be a female character like a princess; masculinity by playing with cars, or joining ball games. Today’s trans kids, in other words, would be drawn from those on the extremes of the Inventory.

Biggs image 1

The first graph plots gendered activities of the children in the survey. The horizontal axis is derived from the Preschool Activities Inventory, ranging from most ‘masculine’ to most ‘feminine’. Clearly there is a large difference, on average, between boys and girls. But there is also a wide variation within each sex. Indeed, the two distributions overlap at the edges. The mid point between the typical (median) girl and the typical boy is indicated by a vertical line. About 6% of girls behaved in ways more typical of boys than of girls, and vice versa for 3% of boys. A few of these kids were extremely atypical for their sex: girls, for example, who preferred even more ‘masculine’ activities than those chosen by the typical boy.

These atypical kids, incidentally, demonstrate the limits of socialization as the sole explanation for gendered behavior. Parents were not encouraging them to deviate from gender norms, and yet this subset of children were becoming more gender-divergent as they grew up (activities were also measured earlier, at the ages of 2½ and 3½) while most of their peers were gravitating towards behavior more typical for their sex. In fact, analysis of this same population shows that the mothers with higher levels of testosterone gave birth to girls who chose more ‘masculine’ activities, though there was no effect on boys (Hines et al. 2002). As the authors note in the abstract, “nonheterosexual individuals appear to diverge from gender norms regardless of social encouragement to conform to gender roles.”

Sexual orientation

Now fast forward ten years to the children at 15 (in 2006–07). They were asked about their sexual orientation, recording their answer confidentially on a computer. For simplicity we will divide orientation into two groups: on one hand, heterosexuals (“100%” or “mainly”) and on the other, homosexuals (“100%” or “mainly” gay or lesbian). A small number of teens identified as bisexual or asexual; they are excluded from the total.

Only 1.1% of boys identified as gay rather than heterosexual, and 0.7% of girls identified as lesbian. These proportions roughly match the total British population, but younger cohorts—like the millennials in this survey—are more likely to call themselves gay or lesbian than older generations. Therefore one suspects that some of those who called themselves heterosexual at 15 would subsequently come out as gay or lesbian in their late teens or early twenties.

Biggs image 2

The second graph uses gendered behavior to predict subsequent sexual orientation for girls. The horizontal axis is the same as in the first graph. The curve shows how girls who had preferred more ‘masculine’ activities were far more likely to identify as lesbians. As the curve extends further to the right, it is based on fewer individuals (shown as points), and so estimation becomes less certain. We can, however, be confident in the following comparison. A girl who was average in gendered activities has a 0.5% chance of becoming lesbian. For a girl who was midway between average girl and average boy, the probability triples to 1.7%.

biggs image 3

The third graph is the equivalent for boys. A boy who was at the average in gendered activities has a 0.6% chance of becoming gay. For a boy who was halfway between the average boy and the average girl, the probability multiplies eight-fold to 4.9%. Again, we cannot give too much credence to the extreme left of the curve, as it derives from only a few individuals. One final point needs emphasis. While kids who behaved in ways more typical of the opposite sex were far more likely to identify as homosexual than those who conformed, nevertheless the majority of them were heterosexual. As noted already, some of them would come out as gay or lesbian later on. Nevertheless, the majority of gender-nonconforming kids are heterosexual.

In sum, then, girls and boys growing up in England in the early 1990s preferred different toys and activities. To what extent this reflected socialization from parents and television, as feminists emphasize, and to what extent innate sexual differences, remains an open question.

It’s crucial is to appreciate variation and overlap as well as differences. Just as some women are naturally taller than some men, so some girls prefer more ‘masculine’ activities than some boys do. Such girls were far more likely to turn out as lesbian. That was the case, at least, in this survey of children coming of age in a society that was relatively tolerant of homosexuality—and before transgender identities were ascendant in social media and schools. We can only speculate how the cohort born ten years later would identify. But we must realize that the characteristics that now diagnose a ‘transgender child’ are the same characteristics that increase the chances of a teenager becoming gay or lesbian.

Note

Predicted probabilities are estimated from logistic regression. Adding a quadratic term or log transforming the Preschool Activities Inventory does not improve the model’s fit. N = 2,382 boys and 2,141 girls. Data kindly supplied by Gu Li.

References

Golombok, Susan, and John Rust. 1993. “The Pre-School Activities Inventory: A Standardized Assessment of Gender Role in Children.” Psychological Assessment, vol. 5, pp. 131–136.

Hines Melissa, Susan Golombok, John Rust, Katie J. Johnston, Jean Golding, and Avon Longitudinal Study of Parents and Children Study Team. 2002. “Testosterone During Pregnancy and Gender Role Behavior of Preschool Children: A Longitudinal, Population Study.” Child Development, vol. 73, pp. 1678–87.

Li, Gu, Karson T. F. Kung, and Melissa Hines. 2017. “Childhood Gender-Typed Behavior and Adolescent Sexual Orientation: A Longitudinal Population-Based Study.” Developmental Psychology, vol. 53, pp. 764–77.

Does prepubertal medical transition impact adult sexual function?

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by Brie J

Brie is a public spokesperson for 4thWaveNow. To learn more about her, read her interview, “Born in the Right Body.” 

All audio clips (click to listen) are from the Gender Odyssey conference in Seattle, Washington, August 2017.

Update September 2021: A portion of this article discusses a Facebook post from 2017 that has been altered.(Click for Archived version from August 2019). Unfortunately, several posters on the Transgender Health Facebook page have since deleted comments. In particular, Dr. Johanna Olson-Kennedy deleted her entire Facebook account sometime after May 26 2021, the last date for which we have documentation.)

A few months ago, I watched a YouTube video made by a young non-binary person who couldn’t orgasm. Born female, their natal sex hormones were suppressed in late puberty and testosterone followed. While I knew “puberty blockers” (a gonadotropin-releasing hormone agonist) followed by cross-sex hormones stops future sexual development in males–and sterilize both sexes–I realized I didn’t know anything about how this process affects females and their future ability to experience sexual pleasure.

GnRH agonists suppress 95% of all sex hormone production. For a “vagina-haver,” low levels of estrogen, LH, and FSH can mean vaginal atrophy, or life with a potentially very dry, possibly itchy, thin-walled vagina that is more prone to bacterial infections, bleeding during sexual activity, and urinary incontinence, among other annoying-to-serious health issues. Estrogen keeps mucous membranes healthy and pelvic floor muscles strong.

I read a number of studies that found  “sexual desire, sexual interest and sexual intercourse were totally annulled” during GnRH use in male cancer patients and repeat sex offenders, and that females, sent into “chemical menopause” after being treated with Lupron for endometriosis, experienced even greater decreases in libido, sexual function, and ability to achieve sexual pleasure than women in natural menopause. This could be because during natural menopause, LH and FSH hormones, which are important to emotional well being and sexual desire, surge, but they are also suppressed by GnRH agonists.

I turned to the Facebook group frequented by members of WPATH, hoping to find more information. Surely members of the World Professional Association for Transgender HEALTH would be concerned with protecting young people’s’ abilities to function sexually as mature adults, right?

My search for “orgasm + blockers” turned up six posts. None about what happens to female bodies. The first and most pertinent post is this one (click to read the whole conversation , written by a therapist who has helped “100s of kids transition” and who is also an aunt to two trans teens. In reading her posts, I usually find this therapist to be thoughtful, with sincere concern for teens’ well being, and I was glad she was the one asking (even though it is concerning she’s helped so many kids down this path yet required a “sophisticated” parent to jolt her into thinking about this question):

sexual function piece arlene 1

None of Arlene’s very, very, smart friends were able to give her much of an answer.

sexual function piece arlene 2 responses

Bummer, even the Dutch don’t know. That’s when Arlene is reminded by her fellow WPATH members that dead people can’t have orgasms.

sexual function piece kelley winters

While Arlene defends the value of difficult questions, one of the busiest pediatric gender docs in the country, Johanna Olson-Kennedy who oversees the care of some 900 plus patients at The Center for Transyouth Health and Development at Children’s Hospital Los Angeles, stops by to share a report about infant and toddler masturbation.

She tells readers that she’d “love it” if everyone could “enjoy” an “amazing article” that talks about how “of these 13 orgasming and masturbating infants and children, 5 were misdiagnosed with seizure, and on anti epileptic meds.”

sexual function piece olson saudi 1

She doesn’t bother to post a link to the full text report published online in Annals of Saudi Medicine (but I will), she just uploads a sideways picture of the first page.

sexual function piece olson saudi 2

It’s a sad read about the sex hormone levels in a sample of thirteen babies and toddlers diagnosed with “gratification disorder” (they masturbate. Often) who were seen at pediatric neurology clinics in Jordan. It wouldn’t be worth mentioning here except that Olson-Kennedy references this study again a year later when she talks about the population of natal males who will be forever stuck with “Tanner II genitals” during her presentation for parents: “Puberty Suppression: What, When, and How,” at the 2017 Seattle Gender Odyssey Conference. Audio of the presentation, which is excerpted below into small clips, is available in full here.

It is unclear what this study has to do with protecting sexual function in males denied natal puberty. At the conference, Olson-Kennedy explains that she “went on a journey to find out if prepubertal kids have orgasms.” But how does the study support her own practice of administering blockers and hormones to prepubescent youth? First and foremost, orgasm is never mentioned in this short report focused on masturbation. The subjects were thirteen children between the ages of 4 and 36 months, not “18 months and nine” years old, as she claims. Moreover, only three of the thirteen young ones studied were male, the group of people Arlene is concerned with in her FB post. “What if “we” get it wrong?” Olson-Kennedy asks towards the end of the anecdote, and laughs.  The “Cis Trajectory” is the problem; conceiving un-medicalized bodies as preferable, according to Olson-Kennedy, is the problem (Olson-Kennedy, Gender Odyssey, 8/25/17 8:41-9:50).

Most of us have known or heard of babies and toddlers who like to fiddle with their bits. No one should deny that even the youngest of infants is capable of pleasurable feelings when they touch sensitive parts of their bodies. Even people with immature genitals and lower levels of sex hormones can experience sexual pleasure but are these early childhood experiences comparable to adult ones? Are they ‘good enough’ for a lifetime? Do you think you’d be bitter, as an adult, if as a minor, doctors took away your potential to ever experience full adult sexual pleasure? I would be, yet it appears Olson-Kennedy is suggesting that since very young children masturbate, parents shouldn’t worry about the potential loss of sexual function that results from GnRH agonists used in early puberty and followed by cross-sex hormones.

We need to talk about this more, even if it is uncomfortable. Our children have a right to grow into bodies capable of experiencing full sexual pleasure. The organs responsible for fertility are also those responsible for sexual function. Locking people into an adulthood with prepubescent sex organs–or a need for genital surgery–should be a focal point in all conversations about the consequences of denying children natal puberty.

These issues are rarely discussed anywhere, unless you’re lucky enough to catch Olson-Kennedy at a gender conference. Olson-Kennedy “gives prescriptions to people to masturbate” because (as she explains at Gender Odyssey conference in Seattle in August 2017),

Blocking is one tool that’s an awesome tool for a lot of people. And what does that mean? Does that mean that trans feminine, trans girls who get blocked in tanner 2 we are we are making the assumption that all of them are going to have genital surgery. Are we doing that? Because we might be doing that. (Laughs) I’m just saying we might be doing that. And so that actually is worthy of a conversation. Because many trans women do not have genital surgery. Love their genitals, enjoy their genitals, like to use them.

That’s fantastic. We love people who love their bodies and use them and enjoy them. That’s a great human place to be. But we have to ask ourselves if you have Tanner II male genitals are you going to be able to use them, are you going to want to be able to use them? Or we are we just assuming that everybody is now going to have to say “Well I either need to go through puberty to get adult sized genitals or I’m going to have these genitals that I have or I’m getting surgery.” Does that make sense?…If we are judging the success of vaginoplasty by post-surgical orgasm how do we know people are having orgasms prior to surgery if we are blocking them at Tanner II? (Olson-Kennedy, Gender Odyssey, 8/25/17, 8:41-9:50)

In another Facebook post, Olson-Kennedy asks:

sexual function post olson 3

Procuring approval for vaginoplasties at younger ages is important because, only guessing here, her patients aren’t happy to “have NON FUNCTIONING genitals because they had the extraordinary opportunity to avoid “male pubertal maturation.”

sexual function post olson 4

Let’s talk about that. Drugs that are successfully used to chemically castrate sex offenders, which have been shown to lower IQ as much as ten points in children taking them for precocious puberty, are now being prescribed off-label to kids in Tanner II who don’t want to suffer what Winters describes as “irreversible disfiguration from incongruent puberty.” How can adolescents or their parents make an informed decision or a balanced cost-benefit analysis about the potential for permanent sexual dysfunction when the language used to describe the natural process of development equates a body capable of ejaculation and orgasm with one that is disfigured?

We’d be reckless not to think that at least some of the bodies acted on with cross-sex hormones before they have a chance to fully develop will, at some point, seem “disfigured” to the adults who live in them and to those who might want to have sex with them. In a recent study, 958 adults aged 18-81, 87.5% said they wouldn’t consider dating a trans person.

However, even among those willing to date trans persons, a pattern of masculine privileging and transfeminine exclusion appeared, such that participants were disproportionately willing to date trans men, but not trans women, even if doing so was counter to their self-identified sexual and gender identity (e.g., a lesbian dating a trans man but not a trans woman).

How much more difficult will it be for some to find partners and sexual pleasure in their altered bodies? Does Olson-Kennedy talk about these challenges with her patients? In her talk at Seattle Gender Odyssey last year, she says she checks in with some about where they’re looking for dates. Online, she says, it’s easier to disclose and find people interested but “you may be someone’s fetish” (Olson-Kennedy, Gender Odyssey, 8/25/17 1:15:23).

I’m stuck once again, wondering how knowing all this, she still claims that her role is to “Do everything in your human power to get them what they need and deserve” (:29 – 1:14)) when they’re eleven years old and what they want may not be in their long-term best interest?

Oh, and natal females, the group that set me off on this research in the first place? According to Olson-Kennedy, suppressing puberty isn’t all that wonderful for them, either. She explains to parents at Gender Odyssey that not only are emotional lability and significant behavioral changes frequent and serious side effects of blockers (29:15) but another reason these kids are “doing so bad” is because blockers put them in menopause. I appreciate her candor,  “Menopause is bad enough when you’re menopause-age, but when you’re fourteen and you’re having hot flashes, memory problems, insomnia, and you feel like crap, it is really terrible. This is really common” she says, of the current treatment protocol. “What happens when you put a fourteen year old in menopause?” she asks the audience. “You’re shutting down their ovaries,” she answers herself (Olson-Kennedy, Gender Odyssey, 8/25/17, 30:25)

Towards the end of her talk, Olson-Kennedy briefly mentions that pelvic pain is common after 18+ months on testosterone, and that she thinks it comes from “the pelvic floor” not an atrophic uterus. She says genital dysphoria usually sets in two-three years after starting on testosterone, which also negatively impacts the health of female sexual organs, causing vaginal, cervical, and uterine atrophy. I can’t help but wonder how GnRH agonists followed by testosterone, a treatment plan that may produce a double whammy of vaginal and pelvic area discomfort, impacts an already dysphoric teen’s feelings about her body, about her sexuality? The potential for vaginal, cervical, and uterine atrophy needs to become a focus in discussions surrounding youth medical transition, and what that means for the sexual becoming of a vagina-cervix-uterus-haver (perhaps still with the shallow vaginal cavity and thinner vaginal walls of a prepubescent child).

So, why? Why, given all the negatives associated with puberty suppression and early medical transition, aren’t mental health tools like dialectical behavioral therapy, which is successful at helping even suicidal people learn to manage distress and discomfort, offered first?

Instead, Olson-Kennedy focuses on getting parents to stifle every protective urge they possess so they’ll sign off on unnecessary and harmful medical interventions for a group of children, at least some of whom sound remarkably like those categorized by Lisa Littman, Susan Bradley, Riittakerttu Kaltiala-Heino, Ray Blanchard, Michael Bailey, Tania Marshall, and 4thWaveNow parents as experiencing ‘rapid onset’ gender dysphoria:

Some present with a prolonged history of gender dysphoria but the absolute hardest are the twelve to fourteen year old trans boys coming out to their parents…they came out like two months ago, and what happens? At nine years old something doesn’t feel right. I’m starting puberty, I’m doing all this work, I’m going online, I found 750,000 YouTube videos “this is me one month on T;” I’m connected to my community; I know I’m trans; I’m twelve years old and I absolutely have to tell my parents and now my parents are here and I’m here [points far away]

And because I’m thirteen you need to get on the ball and this needs to have happened yesterday and because I am here and my parents are here [far away] and the parent desperately wants you, the provider, to close that gap by pushing their kid backwards. But you as a professional know you have to close that gap by pushing them forward and keeping them. You want to keep them because you want them to give consent and be supportive. (Olson-Kennedy, Gender Odyssey, 8/25/17, 48:30-49:50)

I didn’t find all the answers I was looking for because no one has them. There is no medical diagnosis of “wrong” or “incongruent” puberty. Denying a body any stage of sexual development as a first-line of treatment for a non-lethal condition should never be encouraged let alone celebrated. Let’s refocus the discussion on ways to help young people manage their distress that prioritizes their physical and sexual health.

What I wish the Atlantic article hadn’t censored

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by Jenny Cyphers

Jenny Cyphers is a homeschooling parent. She has been writing about that experience for many years, in various online forums. Jenny has been married for 24 yrs to the father of their two children, one adult and one teenager. They all live, work, and create, in Oregon. Jenny and her teen daughter were recently interviewed for an article about gender-dysphoric youth in The Atlantic.

4thWaveNow editorial note: We are grateful for Jesse Singal’s reporting on this complex issue and appreciate that he included the seldom-heard voices of teens who desisted from a trans identity, and their parents, in his article. We are aware that in some circles, the discussions we host on our site are considered transphobic and that we, a loosely-organized group of parents writing on this site, have been defamed as a “hate group” by those on the extreme end of the activist spectrum.

As always, we encourage those interested in the issue to read as widely as possible so they may come to their own conclusions. We contend that by leaving out all mention of 4thWaveNow, The Atlantic not only failed to offer parents the alternative opinions and resources we offer, but they also contributed to an environment that, due to censorship of critical voices, continues to propagate the distorted idea that cautiousness around medical interventions for minors is inherently harmful to trans-identified people in general.

I knew, when I agreed to be interviewed for The Atlantic article “When Children Say They’re Transgender,” that some of my words might be cut, or changed in ways I didn’t intend. But Jesse Singal is a good journalist. He’s personable and honest and willing to take on some really difficult subjects. He digs deep, records, researches, cites sources and ties things together in a nuanced way. Along with editors, he carefully adds and discards words, phrases, sources, quotes, and relevant ideas that lend themselves to the overall picture of what people will read and take away from what they’ve read. That’s what good journalism is.

There are a few things about our story and the way it was presented in The Atlantic that I’d like to clarify. First and foremost, the last-minute editorial decision to unlink the essay “A Careful Step into a Field of Landmines,” I’d written for 4thWaveNow, combined with removal of all mention of the site, needs to be highlighted because in doing so, The Atlantic failed to include important resources created to help parents support their gender dysphoric and nonconforming youth. The result is an article focused on the “situation” of “trans kids” that obscures parent-led examination and support for youth to explore identity without harmful medical interventions, the consequences of which can last a lifetime.

There are more choices for families than to either support their teens’ requests for pharmaceuticals and surgery on the one hand, and disowning or otherwise invalidating their interest in exploring their identity and nonconformity on the other. The Atlantic editors’ choice to remove 4thWaveNow from the discussion in effect denied parents access to important analysis that offers a balanced and middle ground.

Delta pic

The Atlantic photo editor had to dig deep in the several photos we provided to find the pensive one they chose for their article. Here’s one my daughter likes better; she suggested it be included with this post.

Part of my agreeing to contribute to this important debate is helping to create a platform. This website is such a platform. In talking with Jesse, I was upfront about my beliefs, which in part have been informed by 4thWaveNow and the great many array of voices shared here. It isn’t a monolith. Some of us are very liberal, left-leaning people in liberal left-leaning parts of the country, doing liberal left-leaning activities. Some of us are middle-of-the road, a minority of us are conservative, some of us are doctors, therapists, professors, and teachers. Some of us have allowed full social transition to give space to figure things out while still not agreeing to medical transitioning, and some have not. Excluding mention of 4thWaveNow, a site that gets 60K hits a month, fails to tell the whole story. Why do that? Why leave out one of my main sources of information and the ways that information helped me help my child?

Two of the most important aspects of my family’s experience that are not adequately addressed in the Atlantic article, are: 1) my daughter was given a clinical diagnosis of gender dysphoria, so she was just as “truly trans” as the next kid, and 2) it was my insistence that my child wait to medically transition, not her therapist’s. My teen’s therapist, Laura Edwards-Leeper, listened to me and agreed. We were lucky. While there are some cautious, thoughtful providers, the current situation in the US is that there is also no oversight. The most vocal professionals are firmly in the affirmation camp which believes, without any long-term data to validate, that withholding hormonal interventions is tantamount to abuse.

I didn’t know, going into Delta’s first appointment, what the outcome would be. That’s how difficult this is for parents; we have no idea what the outcome will be when we have very “insistent, consistent, and persistent” children requesting immediate medical interventions. It’s a matter of luck to find a therapist who respects parents’ knowledge of their children, who takes parental concerns and insights seriously, and who are not afraid to support slow, cautious progression.

While many transgender activists argue that they understand our children better than we do, there is no evidence to support their claim. Rapid Onset Gender Dysphoria is seen primarily, although not exclusively, in natal females during puberty. It is important to understand that what separates my daughter and many of the kids of 4thWaveNow parents, is this: None of these kids experienced distress over their sexed bodies until they came into contact with the idea that there might be something wrong with them. In other words, the dysphoria is what was “rapid onset,” not necessarily their gender atypicality. These are not kids with “early-onset,” nor do they resemble later in life transitioning people who frequently claim to have always “felt like” a girl but were too afraid or oppressed by family dynamics to admit their feelings. Then, making wide sweeping projections of their own experiences, they mark our children as being in need of the help they believe they should have had. With our kids, as with the group of young people described in Lisa Littman’s survey where ROGD was first named, their dysphoria set in quickly during puberty, often after spending hours online watching/reading others discuss their distress.

Another outlandish claim (made repeatedly by some activists and “affirming” clinicians) is that we simply missed all the signs our children were suffering earlier. I can assure you that, as a homeschooling mom who spent all day every day with my daughter, she never thought she was or wanted to be a boy prior to encountering the idea from transgender kids in her social circle. In fact, between ages 9-11, she was often “misgendered” (referred to as “he” or “him”) and hated it. It saddens me that these activists experienced such awful childhoods. However, their childhoods seem to have been negatively influenced by the religious fundamentalism and/or abusiveness of their parents; their childhoods do not remotely resemble the experiences of my daughter or the many other young people experiencing ROGD whom I’ve met.

atlantic coverTeens and tweens with ROGD often meet all the clinical diagnostic criteria for transitioning. They are often “insistent, persistent, and consistent” for more than six months, or in our case, for two years. Teens with ROGD also typically meet the clinical threshold for gender dysphoria, as mine did. It’s in her medical file. That’s correct, my “never really trans kid” had a clinical diagnosis of gender dysphoria under the DSM-V. This is what we hope others understand: our kids are suffering, they hate their bodies, they want and need help. In many cases, our kids had trouble making friends, experienced some form of earlier trauma, and struggle in other important ways, completely unrelated to gender, that should not be overlooked or seen as secondary to their dysphoria.

I know, because I was in pro-transitioning parent support groups, that parents are going to “gender specialists” and demanding medical interventions for their children without thoroughly considering why their children feel the way they do. I know, because I’ve heard from parents, that some therapists will give the green light to medical pathways without addressing any mental health issues. Dr. Johanna Olson-Kennedy, who treats 900 youth at her LA clinic, is quoted in Singal’s article as saying that she “believes that therapy can be helpful for many TGNC young people, but she opposes mandating mental-health assessments for all kids seeking to transition.” As many 4thWaveNow parents and teens will tell you, this attitude denies young people the opportunity to deeply explore why they want to alter their bodies and shuts down learning about other non-medical means of managing their distress.

When I was approached to do an interview, I needed to carefully consider my motivation for doing so, and if I should agree to discuss my family’s situation at all. Ultimately, I agreed because people need to hear that there are other ways to support trans-identifying kids. Gender dysphoria is very real and it hurts. My child’s life wasn’t easy because of the intense pain of GD. I knew there had to be answers other than what I saw everywhere around me, that suggested agreeing to medical interventions was the loving and kind thing to do, and that these interventions were harmless and helpful. I agreed to be interviewed because I wanted to highlight for other parents that there are other choices: most notably, offering support (buying clothing, getting haircuts, using a new name, finding a decent therapist) while also saying “I don’t think there is anything incongruent about your body/feelings.” The Atlantic axed this part of our story, the part where parents can offer tremendous support for their children without ever setting foot in a gender clinic in search of medical interventions.

I used to be a lot more open to the idea of transitioning children, in part because I know and like many transgender people. It wasn’t until I found that in the US, girls as young as 13 are getting mastectomies, that I began to question gender affirming medicine. In the new genderist language it’s called “chest,” “top,” or “confirmation” surgery. It sounds so much nicer than a double mastectomy, almost positive and pleasant. Cutting healthy body parts off of children should not be a thing. Ever. That was the moment I decided I would never stop talking about this.

My part of the interview with Jesse Singal–although about my daughter–was really more about how to support, in general, a child going through this very difficult experience. It is challenging, if not impossible, to find places to discuss supporting teens as they explore their identity in non-medical ways. 4thWaveNow is the only US-based resource that allows this. We need to talk about how to support gender non-conforming kids; things like buying clothing from the boys’ department if you have a daughter, or buying girl clothing if you have a son. My part of the interview wasn’t aimed at kids, but at parents who really need more and better tools for helping their distressed children than the “transition or die” option. Without choices, how can people really make one? Pick one of the two? No thanks.

Someone asked me the other day why I care. Why can’t I just let people do what they want? The answer is really simple. As humans we are guided to protect our young. If our culture fails to do so, each of us have failed to protect our children. This is why there are laws against abusing children, laws preventing minors from smoking or drinking, laws to keep kids from driving, laws for educating children. We can argue against any one of those things, but the cultural “we” have agreed that this is for the good of protecting children from harm, and for promoting welfare. In the US, unlike in other countries, there are no laws or regulations about transitioning children. Until there are, this is up for debate and I’m weighing in.

The fact that so many parents are left with this narrative that there is only one right way to help a confused kid, is what drives a wedge between the parent and child, leaving children vulnerable to self-proclaimed internet “experts”, like Zinnia Jones, who are more than willing to validate their feelings, further dividing parent and child.

Look, I understand that there are some truly not-very-nice parents out there, but we should not be making policy around them. That’s the sort of thing that creates bad case law. Let’s assume that the vast majority of parents want what’s best for their children, even if they have no idea what that looks like.

I was even more puzzled about the Atlantic‘s last-minute editorial decisions when I saw thaZinnia Jones cheap puberty blockers onlinet, not only was any mention of 4thwavenow scrubbed in the final version of the article, but a statement by Jones and reference to Jones’ website were included. Jones has written multiple screeds denying the existence of the rapid-onset dysphoria in adolescent girls that more and more people (including clinicians) are noticing. Further,  Jones recommends (on Twitter) that young people secretly obtain puberty blockers online if their parents aren’t onboard.

Unfortunately, many therapists, and others invested in the transgender narrative, seem to be heavily influenced by activists like Zack Ford, an opinion writer for the website Think Progress who, in response to Singal’s article, enunciates the activist-notion that parental concern and insight is irrelevant to the discussion. He writes,

“Whether a parent doubts the legitimacy of a child’s transition has zero relevance to whether transitioning is best for their child. Humoring this doubt is exactly what makes the story so harmful.”

Read that quote again. Read it several times to see just how dismissive it is of parents, the very people transgender and gender non-conforming kids rely on for support. You know–the people who would be signing the informed consent paperwork at the doctor’s office, agreeing to allow doctors to prescribe permanent, sometimes sterilizing, experimental off-label use of medications, and body-altering irreversible surgeries.

The collective, cultural “we” cannot dismiss parents as trivial when we are discussing our children, whom we will protect with our lives. This protective mechanism is the prime role of parents and an important part of being human and all the moral and ethical things that come with it. This is not a divide between liberal and conservative. There are too many divisions in this world, and this country, as it is. This is about whether “we” have an ethical imperative to protect our children. Yes, we need to listen to kids. We also need to listen to parents who are not interested in stifling their children’s interests or gender presentation, but who also know their children better than any therapist ever will.

 

Testosterone & young females: What is known about lifelong effects?

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by Kerry Smith, MD

Kerry Smith [a pseudonym], MD, is a board-certified internist in the US who has been practicing since 2004. She is the mother of several children, including a 12-year-old daughter who suddenly developed the notion that she is transgender after being exposed to the idea in her 6th grade classroom. It was this development that led Dr. Smith to research the protocol for medical transition of children. She believes that most physicians are blissfully unaware, as she recently was, of the current standards which aggressively promote unstudied and off-label irreversible medical interventions in children too young to drink, smoke, vote, drive, consent to sex, or even watch an R-rated movie.

Dr. Smith is available to interact in the comments section of her article.

What are the risks of giving testosterone to a female for a lifetime?

As the mother of a girl trying on a trans identity, and as a practicing physician, I need an answer to this question.

I’m not the only one. Every day more of us join this club, as the rate of girls questioning their “gender identity” continues to skyrocket, outstripping boys at a previously unimaginable pace. Surely, those who advocate for the medical interventions known as “transitioning” must have a risk-benefit analysis available for parents and patients, before committing young people to a lifetime of pharmaceutical (and potentially surgical) treatment for a poorly defined psychiatric condition?

As a physician who has sworn to do no harm, that’s what I would have assumed.

As it turns out, the WPATH-inspired standard of care, adopted by the US Endocrine Society, has pushed boldly ahead where no medical society has gone before, promoting radical, irreversible body modifications for adolescents using powerful, off-label hormone regimens in the absence of any longterm data about safety.

They are perfectly open about this choice, stating in the standards:

These recommendations place a high value on avoiding the increasing likelihood of an unsatisfactory physical change when secondary sexual characteristics have become manifest and irreversible, as well as a high value on offering the adolescent the experience of the desired gender. These recommendations place a lower value on avoiding potential harm from early hormone therapy.

I suppose it is considered “transphobic” of parents to persist in the nit-picky demand for actual data about what that “potential harm” might consist of, but so be it. Teenagers have always resisted parental concerns about their risky activities. Last time I checked, that didn’t keep us from trying to stop them from using dangerous drugs. Why should testosterone (a schedule III drug in the same category as Suboxone and ketamine) get a free pass?

Sex hormones have a long and checkered history in the US, having been widely celebrated as the fountain of youth before falling from grace after studies belatedly showed multiple adverse health outcomes. This was most striking when the evidence from huge studies WHI, HERS and HERS II demonstrated that, contrary to what earlier observational studies seemed to show, hormone replacement therapy for postmenopausal women actually increased rather than decreased the risk of heart attack, stroke and cancer.

Testosterone had its day in the sun as well, being prescribed not just for the medical condition of hypogonadism, but gleefully promoted as a panacea for the vitality and wellbeing of aging men, for the supposed diagnosis of “low T.” Recently the serious risks of this approach have been described, including increased heart attack and stroke; the FDA eventually placed a warning on testosterone products, and lawsuits are underway; however the shameless promotion to men continues unabated.

As a physician, my first stop for drug information is usually the evidence-based clinical resource UpToDate, which contains full prescribing information for medications available in the US and Canada including dosing, indications, risks, interactions, and other details. I reviewed the entry on testosterone and found that, to my surprise, there is no mention of any suggested dosing regimens for female to male transsexuals.

In the US, once a drug is FDA approved for one use, it is often used “off-label” for other conditions, which is a generally accepted practice. These common, accepted off-label uses will be listed in resources such as UpToDate along with relevant dosing information and warnings. For example, the entry for modafinil, a stimulant, has dosing information listed for the FDA approved indications of narcolepsy, obstructive sleep apnea, and shift-work sleep disorder, as well as for the off-label indications of ADHD, cancer related fatigue, major depressive disorder, and multiple sclerosis related fatigue.

In contrast, the UpToDate entry for testosterone makes no mention of any approved or off-label use for the treatment of transgenderism or gender dysphoria. The only indication for testosterone in females listed is for the adjuvant treatment of postmenopausal women with metastatic breast cancer.

I then checked the FDA prescribing information for Depo-Testosterone (injection) and Androgel (topical), and found a total lack of any reference to use in females for any purpose whatsoever.

testosterone

Testosterone:  Schedule-III controlled substance. The US FDA doesn’t acknowledge or mention its use, on- or off-label, for FTMs

This absence speaks volumes. While the WPATH Standards of Care would have us believe that “[f]eminizing/masculinizing hormone therapy – the administration of exogenous endocrine agents to induce feminizing or masculinizing changes – is a medically necessary intervention for many transsexual, transgender, and gender nonconforming individuals with gender dysphoria,” the reality is that this treatment is so far out of the mainstream of modern medical standards that it is not yet anywhere reflected in basic prescribing reference materials, even as an off-label use.

Because “transgender medicine” is a new field, there is as yet no meaningful body of data that can definitively answer the question of what risks my daughter might face if she embarks on decades of testosterone injections. Studies promoting this treatment as “safe and effective” are generally limited to a few dozen patients and a year or two of follow up. A review article in the Lancet published in April 2016 touted as providing “an evidence-based overview of the benefits, risks, and effects of testosterone therapy in transgender men” observed that “testosterone decreases HDL cholesterol, increases triglycerides, might increase systolic blood pressure, and might increase the incidence of [type 2] diabetes and metabolic syndrome” but was forced to ultimately conclude that the long term effects are largely unknown due to “a paucity of high-quality data” in this area, a disclaimer found in most articles regarding cross-sex hormone treatment.

The desired effects of testosterone for transgender-identified females are the development of male secondary sex characteristics: hair growth on the face and body, changes in bone structure, increased muscle mass, redistribution/decrease of body fat, deepening of the voice, cessation of menstruation, decreased fertility and clitoral growth are all expected. Of note, even these desired effects may not live up to the hype; clitoral growth can cause pain or numbness and, in some cases, appears to lead to difficulty attaining orgasm; voice changes may not reach the desired pitch, leading some patients to seek out voice deepening surgery; some reports suggest increased muscle mass on a female frame can lead to thoracic outlet syndrome.

Of these effects, the changes to body composition, menstruation and fertility may be reversible (if testosterone is started post-puberty; if administered immediately after puberty blockers, irreversible sterility is the norm). Though testosterone is a known teratogen, there is no shortage of glamorous stories celebrating transmen who manage to conceive and give birth after stopping testosterone. However, changes to voice, bone structure, hair distribution and genitals are usually permanent, even if the hormone is stopped.

Then there are the undesired effects. The most commonly reported one is acne, which is often severe enough to require treatment. Male pattern baldness is also unmasked in those who are genetically predisposed.

More important than cosmetic effects are the changes in markers for cardiovascular disease. Studies tend to show that exogenous testosterone increases LDL (bad cholesterol), lowers HDL (good cholesterol), increases erythrocytes (red blood cells) potentially leading to venous thromboembolism (blood clots) from polycythemia, and increases blood pressure. It has also been shown to increase fluid retention which can contribute to heart failure.

Studies suggest as well that in women (but not men), higher endogenous testosterone levels correlate with insulin resistance and the development of diabetes, and studies suggest that adding testosterone in the form of a drug may increase risk for diabetes.

Even in male patients, studies clearly indicate that testosterone therapy increases the risk of cardiovascular disease including heart attack. One review article notes dryly:

“The effects of testosterone on cardiovascular-related events varied with source of funding. Nevertheless, overall and particularly in trials not funded by the pharmaceutical industry, exogenous testosterone increased the risk of cardiovascular-related events, with corresponding implications for the use of testosterone therapy.” [emphasis added.]

In other words, all studies showed an increase in cardiovascular disease, but this effect was “less prominent” in Big Pharma funded studies. What a surprising coincidence!

Testosterone may cause mood changes. Small studies suggest testosterone treatment in transmen can increase anger, which makes sense, given that abuse of testosterone by bodybuilders is known to sometimes result in “roid rage,” a condition of unchecked anger and aggression. One article reports a case of late onset psychosis associated with testosterone use in a trans-identified female, in whom no other cause could be found.

Testosterone has also been associated with liver damage or tumors, though more often in oral formulations rather than the injectables favored by transgender medicine practitioners. It has been known to impair kidney function. It has been shown to impair mitochondrial function leading to oxidative stress. The list of recommended laboratory tests for monitoring is long.

The effects of testosterone on the ovaries and uterus are not well defined. Early research suggested testosterone administration causes enlarged and cystic ovaries similar to what is seen in polycystic ovary syndrome. While studies in postmenopausal women suggest that testosterone does not stimulate abnormal growth of the endometrium (uterine lining), small studies of young FTM patients suggest that in younger females, testosterone administration does induce proliferative changes in the endometrium, which could theoretically progress to cancer. Cases of ovarian cancer have been noted in females treated with testosterone. These changes to the ovaries and endometrium explain why removal of the uterus and ovaries are often suggested for FTM patients on long term testosterone treatment, though there is no medical consensus on this as there is minimal data.

There is some experience giving testosterone off-label to postmenopausal women for hypoactive sexual desire disorder (HSDD); indeed this treatment is still promoted online and prescribed by some physicians. However, despite promising results for women’s libidos, studies suggest that even low dose testosterone may increase risks for endometrial and breast cancer, and as of yet there is no FDA approval for any form of testosterone for this indication.

So, the state of the art of transgender medicine for a young girl who believes she is a boy is to affirm this belief using hormones and possibly surgery. Current standards promoted by WPATH include puberty suppression using Lupron as young as age 10, followed by cross-sex hormone treatment with testosterone by age 16. It should be noted that in the United States, top gender doctors who see the greatest number of patients often begin cross-sex hormone treatment much earlier (as young as 12 in this recently published study).

We don’t know all the side effects this regimen may produce, but when started before puberty, one effect is certain: permanent sterility.

Aside from that pesky side effect, the expected effects of testosterone treatment include changes in body fat and muscle composition, changes in bone structure, facial/body hair growth and male pattern hair loss, clitoral growth, changes in sexual function, voice deepening, cessation of menstruation, and increased acne.

Likely side effects include adverse changes in cholesterol and blood pressure, leading to increased risk for heart attack and stroke; increased red blood cell mass which increases risks for blood clots; and changes in the ovaries and uterus potentially leading to increased risk of cancer, for which many experts recommend hysterectomy and bilateral salpingo-oophorectomy.

Possible side effects include increased risk of diabetes (another risk factor for heart disease and stroke), possible liver damage, possible kidney damage, risk of mitochondrial damage, and perhaps an increased risk for psychiatric disease.

How significant are these risks? Will they be worth it to a generation of “gender nonconforming” kids as they start their adult lives already committed to a lifetime as chronic medical patients? Will they face premature disability and death?

No one knows. Maybe it will all work out fine. Maybe testosterone really is the fountain of youth, providing strength, energy, vitality and virility to brave young gender outlaws, as they sacrifice their fertility to give birth to their authentic selves with the eager assistance of the medical and pharmaceutical industries.

Maybe.

But medical history is littered with miracle cures gone wrong. Future historians will judge whether the massive increase in girls and young women prescribed testosterone will go down as a triumph of medicine–or an ill-begotten disaster.

 

Why I supported my autistic daughter’s social transition to a man

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by FightingToGetHerBack

FightingToGetHerBack lives in the United States with her husband and 17-year old daughter Zoe. Four years ago, Zoe made the surprise announcement that she was transgender. 

FightingToGetHerBack shares her personal story to illustrate how even smart, educated parents can be emotionally blackmailed into supporting their children’s transition. She is available to interact in the comments section of this post, and can be found on Twitter @FightingToGetHerBack

 For almost a year, I actively supported my daughter’s social transition to appear as a man. I called Zoe by her preferred masculine name and pronouns, and introduced her to others as my son. I was by her side as she marched in a Trans Pride Parade, waving pink and blue flags and dancing to Lady Gaga’s “Born This Way.” I purchased the binder she wore to flatten her breasts.

Outwardly, I appeared as the supportive, loving mother of a transgender child. Inwardly, I was conflicted. Privately, I grieved. Alone, I cried.

As I look back on all I did to affirm Zoe’s mistaken identity as a man, I am mortified.

What caused me to ignore what seems like common sense: that my daughter could not possibly be my son?

Why did I dismiss my initial intuition: that Zoe was caught up in a false identity that was actively promoted at her school and online?

How did I fall for the unsupported scare tactics of “affirmative” gender specialists and the narrative widely promoted by lazy journalism: that Zoe’s mental well-being — and indeed, her life — hinged on my unquestioned support of her sudden self-proclaimed identity as a man?

Like my daughter, I became a victim of transgender ideology: a non-scientific, activist-driven dogma that inexplicably dictates protocol for medical practices, mental health counseling, school policies, media coverage, and an increasing number of laws in the U.S. and abroad.

Let me begin by telling you about Zoe. Throughout her childhood, she preferred feminine clothing and hairstyles, in marked contrast to my own low-maintenance appearance. As a pre-teen, she seemed to embrace the changes brought about by puberty, expressed excitement when her period began, and enjoyed shopping for bras and body-hugging clothes. When she started 7th grade, she begged for permission to shave her legs and wear make-up. Zoe had no stereotypical male interests and shied away from all sports, hating to get dirty or sweaty. There was nothing about her childhood that I would consider boyish, except for one: her difficulty in fitting in with other girls.

Zoe is autistic and highly gifted; socially challenged, yet intellectually precocious. When she was little, she talked to her peers as if they were adults and didn’t understand when they were bored by her academic monologues. Though we invited children to our house for playdates, the invitations were rarely reciprocated. At her annual birthday parties, the other kids ignored her and played mostly with each other. Fortunately, she was oblivious to their social rejection.

But as Zoe grew older, many girls became cliquish and exclusive. They judged each other on their appearances and their fashion choices. They were turned off by my daughter’s social immaturity and her low social status. My intellectual autistic girl had a hard time navigating their complex social cues. She was not aggressively bullied, but she was left out, and she began to realize that she was different.

Around 5th grade, she started to associate more with boys than girls; not because she shared their interests or participated in their rough-and-tumble play, but for their lack of drama. Thankfully, the boys were accepting of her quirky off-putting ways. Hanging out with them was much easier and preferable to being alone. And though the boys accepted her, she still felt disconnected from her peers. “Why doesn’t anyone like me?” she asked me more than once.

So when Zoe suddenly announced that she was transgender at the age of 13, this seemed to come out of nowhere. Zoe was confused, I thought, and had misinterpreted her difficulty in fitting in with the girls as a sign that she was a boy. My disbelief was not a reflexive reaction based on intolerance or prejudice (in fact, I have leaned toward the left side of the political spectrum, and have a career devoted to progressive causes), but based on a lifetime of observations as her attentive mother.

But I was concerned: How could such a smart girl believe she was a boy? What happened to make her believe this so strongly and so suddenly?

I asked Zoe to tell me when it was that she first started thinking she was transgender. She said she got the idea after attending a school presentation. I was appalled. I had no idea this was part of the school curriculum. Zoe also told me about other kids she knew who were transgender. I was stunned to learn that this was so common. Interestingly, all of the “trans” kids that Zoe knew were very similar: highly intelligent and with apparent autistic traits–and with a history of not fitting in.

I asked Zoe, “If you hadn’t known there were other kids who were trans, would you believe you were a boy?” Her answer was telling: “No, because I would not have known it was an option. But I don’t think I am a boy; I am a boy.” She patiently explained to me the differences between gender identity and sex assigned at birth. When I expressed confusion, she told me I wouldn’t understand because I am cis. I had never heard that word before. Clearly, she had been doing some online research.

I began to do some research of my own. But nothing I found confirmed my theory: that my child’s autistic thinking and history of not fitting in made her vulnerable to the false belief that she was transgender. To the contrary, all of my online searches told me that a child’s gender identity was not to be questioned, and that children, no matter their age, know who they are. Still, I held onto my belief that this was likely a phase that would pass.

I decided the best approach was to ignore the gender issue and help Zoe develop her identity based on her interests, not on her feelings. I signed her up for 4H and nature groups. I did everything I could to help her connect to who she really was, and help her find other kids who shared her passions.

isolated girl.jpgOver the course of a year, Zoe’s anger toward me grew. Our once strong, loving relationship deteriorated, and she threatened to leave home many times. She blamed her worsening depression on me and my lack of acceptance of her “true” self. It became clear that this was no simple phase that would fade away on its own, but I didn’t know what to do. Maybe she was really transgender, I wondered. My husband thought Zoe was just being a selfish, belligerent teen. But I decided that I needed someone to help me sort this out, a trained and experienced professional to answer some questions: Is my daughter really transgender? If she is, what should I do? And if she’s not, how do I convince her otherwise? I turned to gender specialists for help.

This was my first big mistake.

I went to the Psychology Today website and contacted ten local therapists who claimed a specialty with transgender issues. After explaining a bit about my daughter’s history, every single therapist responded in a similar manner: “A child would not choose this.” “A child would not make this up.” “Once teens reach puberty, there is no question that their gender identity is set.” They all ignored the fact of Zoe’s autism. “Even autistics know who they are.” They ignored the possibility of social contagion. “It’s becoming more common now because society is more accepting.” They did not see this as a temporary identity crisis, but as an absolute, undeniable truth that was dangerous to question.

Perhaps if I had found just one authoritative professional to confirm my misgivings, I would never have doubted myself.

Instead, I deferred to the apparently unanimous consensus of the experts and decided to work with Dr. Brown [not his real name], a therapist in private practice whose clinical specialties were transgender care and autism, and who was a member of WPATH, an organization that I ignorantly assumed was grounded in a scientifically-based, expert approach to transgender care.

My husband went along with my plan. We both met with Dr. Brown before he met Zoe. Surely, based upon his extensive experience, he could tell us if our daughter was really transgender. After hearing our story, he confirmed that she was. Since it had been over a year since Zoe came out to us, and because she had been “insistent, persistent, and consistent” in her identity, this meant that yes, this was real.

Dr. Brown comforted us by telling us what great parents we were for finding support for our son; that many parents refuse to believe their children are transgender and they become estranged from them. He told us that as a transgender teen, our son is at high risk of suicide and that research shows that the best way to prevent this is parental acceptance. Dr. Brown told us to start slowly by allowing him to transition at home using his preferred name and pronouns, but to wait several months until the summer to start coming out to friends and family, and to wait until the fall to come out at school.

I loved — and love — Zoe unconditionally, fiercely, and deeply. I would do anything to save her life and minimize her suffering. I have always sought the best care for her, no matter the cost. I was — and am — a vulnerable, confused, and scared mother. So I did what Dr. Brown told me I MUST do or my daughter would kill herself. I fell for the “live son” vs “dead daughter” scare tactic.

Though it was hard to hear those words — that my daughter was really transgender and that my actions were critical to preventing her possible suicide —  in a way, it was a relief. Finally, I could stop debating with myself and just work on accepting my daughter as my son. It was easier to put my faith in Dr. Brown and his expertise than to constantly question myself. I rationalized that I had been in denial for the past year, but now I needed to face reality and focus on Zoe’s mental health, our relationship, and keeping her alive.

I began supporting the first step in Zoe’s social transition that evening when I used masculine pronouns and called Zoe by his chosen name, Joe. I told Joe about Dr. Brown and his recommendations. I apologized to Joe for my lack of support over the past year. Joe was overjoyed. Later that night, I sobbed privately while I grieved the loss of my daughter.

Joe started seeing Dr. Brown right away. After each session, Joe did not seem happy or content. He seemed more fixated on transitioning. Despite the original plan to take this slowly, he immediately changed his name and pronouns at school. The school never notified me of this change, nor asked my permission. Since there were already several other “trans” kids at the school, this was seen as a normal request that did not need to involve parents.

Joe’s transition at school, as with the other “trans” students, was met with complete unquestioning acceptance by peers and teachers alike. Trans teens had become so common that no one acted like this was a big deal. And after years of not fitting in, Joe thought he had finally found his tribe.

Though I was upset with the school staff and concerned with how fast things were moving, I said nothing. I needed to support my son and maintain his mental health, so I kept my concerns to myself.

Now that Joe was “out,” I helped with his social transition by taking him to a barber followed by shopping for “boy” clothes. But that wasn’t enough. Joe begged me for a binder. I discussed this with Dr. Brown who told me it was now psychologically necessary for Joe’s social transition to be complete. Dr. Brown assured me that as long as I bought one from a reputable company, there were no dangers. He told me if I didn’t buy one, Joe would just use duct tape, which was very dangerous. Given the alternative, I felt like I had no choice. I complied.

Within one month of seeing Dr. Brown, Joe’s physical transformation was dramatic. His appearance disturbed me in a deep and visceral way. My once curvy 14-year old daughter now resembled a pudgy, unattractive 11-year old boy. I was ashamed of my feelings and felt guilty for caring about his physical appearance. I told myself it was his mental health I should be focused on, but I still found it painful to look at him.

Dr. Brown kept telling me what a good job I was doing, that Joe is so happy now, and that for the first time in his life, he feels like he belongs. Despite Dr. Brown’s assurances of Joe’s happiness, that was not my observation at home. Joe seemed more and more depressed. His periods, which had been non-events until he started seeing the gender therapist, now became a crisis. Joe refused to go to school on those days and became angrier and more depressed. After each step in Joe’s transition process, he became fixated on the next. So after binding his breasts, his new obsession was medically stopping his periods.

During the time that I supported Joe’s social transition, I purposely avoided any news articles on the topic. And when I heard critical voices — which at that time seemed to come only from ultra-conservative gay-bashers  — the unintended consequence of their hurtful words served only to harden my support for my son’s transition and bias my thinking.

As Joe continued to see Dr. Brown, I sensed that his “therapy” was mostly about validating Joe’s conviction that his was trans, while pushing the next step in transitioning. I eavesdropped on one session where I listened to Dr. Brown ask Joe about his week, how much he enjoyed being his authentic self, and about his next plans for transition. I did not hear Dr. Brown ask Joe about his increasing depression, or explore the basis for his growing discomfort with his body.

Despite this, we continued to see Dr. Brown and followed his expert advice. Although I never stopped having fears and doubts, I tried to convince myself that I was just a worried mom lacking objectivity. Meanwhile, my husband was mostly disengaged, refusing to talk with me about my worries, but willing to go along with whatever I decided.

Dr. Brown’s experienced, authoritative, and persuasive voice continued to convince me that my actions were the key to preventing Joe’s suicide. I deferred to his self-proclaimed authority, which was seemingly consistent with the overwhelming majority of the medical and psychological establishment. So when Dr. Brown recommended that I enroll Joe in a therapeutic support group for trans kids, I complied.

This was my second big mistake.

I selected a support group at a well-respected gender clinic, a collaborative practice that included clinicians who specialize in autism, clinical psychology, and adolescent gynecology. Their approach was described as research-based and conservative.

Before Joe started attending the support group, I met privately with the head of the clinic, Dr. Jones, to learn more. He told me that every meeting began with the kids announcing their preferred name, their pronouns, and the gender that they identified with on that particular day. He explained that the goal was to impress upon the kids that their current gender identity was not necessarily fixed. He told me that every child in the group had either been diagnosed with Autism Spectrum Disorder or had symptoms that suggested autism. I was reassured that Joe would fit in well with the other participants.

When I told Dr. Jones that over 5% of the students at Joe’s school thought they were trans, he denied the role of social contagion. He said the increasing numbers were a result of society and schools becoming more tolerant.

I asked Dr. Jones why kids with ASD were more likely to identify as transgender. He told me researchers do not know, but theorized that both transgenderism and ASD were caused by prenatal exposure to an excess of androgens. I asked if gender identity were innate, then why would it appear so suddenly with no signs throughout childhood? Dr. Jones explained that this was probably because ASD prevents children from thinking flexibly about gender until they are older. So although Joe’s gender identity was always that of a boy, Dr. Jones explained, Joe didn’t know his identity until recently because the ASD precluded the flexible thinking required to come to this realization when he was younger.

Privately, I thought all of his explanations seemed far-fetched, but as I had been doing with increasing frequency, I kept my doubts to myself, followed the “expert” advice, and agreed to allow Joe to participate in the program.

The kids in the group had many traits in common besides autism. Their trans identity came on suddenly when they were teens, they seemed really smart, and they were obvious social misfits. All had serious mental health issues. Compared to the other kids, my daughter appeared the most well-adjusted.

Although the clinicians acknowledged that these kids may change their minds, all of the parents were told to put their children on hormone blockers. When I questioned the possibility of side effects, my concerns were arrogantly dismissed. The head clinician told me that blockers were well-studied and perfectly safe, and encouraged me to set up an appointment with the clinic’s gynecologist. He recommended that Joe take blockers for one year, which he euphemistically described as “buying time.” At the end of his year on blockers, Joe would likely be ready to proceed to the next step: testosterone. Unconvinced, I refused to consent.

While Joe was in group, I got to know the other parents. We were all genuinely troubled by our children’s trans identity. We talked about how we lost friends and family members over this issue; how we had become more socially isolated; how our marriages had become strained; how surprised we were when our kids announced they were trans; how there had been no signs of this throughout their childhoods. Like me, these were caring, thoughtful parents who were determined to help their children in any way they could.

Unlike me, all of the other parents consented to medical treatment for their kids. Some were on blockers; others were already on cross-sex hormones. Apparently, I was the only one who had concerns about the medical protocol, and the only one who still harbored doubts about my child’s transgender identity. As the months passed, I felt more disconnected from the other parents. They began to question why I refused medical treatment for my son, told me I was endangering his mental health, and seemed personally offended by my non-compliance. I started to keep my opinions to myself and wondered if there was something wrong with me. Were my doubts and concerns well-founded? Or could I just not accept the reality of having a transgender child? I now believe that if I had met at least one other parent who shared my misgivings, I would have had the courage of my convictions to question the trans narrative much sooner than I did and would have escaped the power of groupthink.

So what finally woke me up? It was when the head of the program, Dr. Jones, the  well-respected “expert” threatened me: “Your choice is between a mental hospital or hormone blockers.” That’s when I finally realized the clinic’s true agenda: not to therapeutically help my child, but to push her on a dangerous path to medically transition under the pretense of it being a psychological necessity.

That night, I turned to the internet to figure out what to do next. That’s when I discovered 4thWaveNow, TransgenderTrend, GenderCriticalDad, and other reasonable gender-critical voices.

I could not stop reading for days. All of my original theories were shared by a group of intelligent, thoughtful, and eloquent parents and therapists.. For the first time since my daughter announced she was my son, I found evidence-based information to support my own ideas. My God, how could I have been so stupid to doubt myself? How did I fall for this? How could I have played along with her ridiculous belief that she is a boy? How did I not see that this sudden increase in trans-identifying teens at her school was part of a psychic epidemic? That these vulnerable children were being medicalized by unscrupulous professionals? That most journalists were singularly focused on portraying transgenderism as a human rights issue, rather than what was obviously a psychological and sociological phenomena?

It has now been over one year since I discovered the online support I needed to realize the truth. But my daughter remains a victim. It is as if she has been brainwashed. And increasingly, it seems as if society has been brainwashed.

Thanks to Zoe’s school, her gender therapists, professional health organizations, the media, and the internet, my daughter is still certain that she is really a boy. She refuses to discuss the topic with me, and refuses to listen to my concerns. She is also convinced that medical transition is necessary for her future happiness, a process she plans to begin when she turns 18 next year. And I will be powerless to stop her.

The only thing I can do is speak the truth and encourage others to do the same.

If you are a doctor or therapist, please don’t reflexively endorse a child’s belief that s/he is the opposite sex. Children need good therapy to explore underlying issues that are likely fueling their discontent.

If you are a member of a professional health organization, please demand that they base their professional guidelines for gender-confused children on science, not politics or ideology. Organizations like the American Academy of Pediatrics, the American Psychological Association, the American Psychiatric Association, and the Endocrine Society will continue to irresponsibly promote ideologically driven protocol as settled science until they are held accountable by their membership.

If you are a college professor, administrator, or counselor: Please speak up about a phenomenon that is becoming increasingly common across college campuses. Although most college students are legal adults, their brains are still developing and they are just as prone to social contagion as young teens. Those with underlying mental issues, often exacerbated by the stress of college life, are especially vulnerable. Many students begin their medical transition services as part of their college health plan — with little or no mental health counseling to explore other underlying factors.

If you are a journalist, please re-think the currently popular mainstream narrative and investigate this issue more deeply. Why are there suddenly so many kids who think they are trapped in the wrong body? Does science really support “an innate gender identity?” Why have the number of gender clinics treating children skyrocketed in the past ten years? What is the source of the millions of dollars that is funding this movement?  Does it really make sense to treat children medically on the basis of a belief which is likely to change over time?

Whoever you are, please speak up. Please help prevent more children’s minds from being poisoned by lies, bodies from being irreversibly altered, and families like mine from being destroyed.

“Intellectual no-platforming”: Ken Zucker pushes back on the latest attempt to discredit desistance-persistence research

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by Marie Verite and Brie J

Dr. Kenneth Zucker, recognized as one of the world’s top experts in childhood gender dysphoria, penned the following paper (released today).

Zucker, K. J. (2018). The myth of persistence: Response to “A Critical Commentary on Follow-Up Studies and “Desistance” Theories about Transgender and Gender Non-Conforming Children” by Temple Newhook et al. (2018). International Journal of Transgenderism. https://doi.org/10.1080/15532739.2018.1468293

Dr. Zucker has offered to provide a PDF of the full-text article if readers contact him via email.

Multiple trans-activist journalists and “affirmative” gender clinicians have (rather successfully) propagated the meme that desistance from a trans identity is a “myth”; that Zucker (former director of the Toronto clinic), Thomas Steensma, Peggy Cohen-Kettenis (of the Amsterdam team which pioneered the use of puberty blockers for gender-dysphoric children), and others have wrongly conflated merely gender nonconforming children with “true trans” kids. Therefore, their entire body of research is essentially worthless. These critics have gone further, accusing some clinicians (like Zucker) of forcing harmful reparative therapy on “trans kids.”

Dr. Zucker’s detailed rebuttal to the Temple-Newhook et al article is well worth reading in its entirety.  Be forewarned: The paper is densely argued and referenced, such that understanding it requires a decent working knowledge of the clinical literature on childhood gender dysphoria, the nuances/changes in the DSM diagnostic classifications (e.g., DSM-IV “gender identity disorder” vs. DSM-V “gender dysphoria”), as well as the trans-activist reactions to all of the above.

In a series of tweets today, Dr. Zucker emphasized one of the key points in his paper.

 “…that pre-pubertal gender social transition is itself a psychosocial treatment, which Temple-Newhook et al ignore.”

The context for this tweet can be found on page 7 of Dr. Zucker’s article:

Thus, I would hypothesize that when more follow-up data of children who socially transition prior to puberty become available, the persistence rate will be extremely high. This is not a value judgment – it is simply an empirical prediction. Just like Temple Newhook et al. (2018) argue that some of the children in the four follow-up studies included those who may have received treatment “to lower the odds” of persistence, I would argue that parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.

And later, on page 10:

Temple Newhook et al. (2018) go on to state that “It is important to acknowledge that discouraging social transition [with reference to the Dutch team’s putative therapeutic approach] is itself an intervention with the potential to impact research findings…” Fair enough. But Temple Newhook et al. (2018) curiously suppress the inverse: encouraging social transition is itself an intervention with the potential to impact findings. I find this omission astonishing.

An astonishing omission, indeed.

As regular readers of this website will know, most parents in the 4thWaveNow community are particularly concerned about the recent increase in teens (particularly females) presenting to gender clinics, with a sudden onset of gender dysphoria around the age of puberty.

Although the characteristics and clinical course of early-onset gender dysphoria (the primary population discussed in Zucker’s paper) are different from that of adolescent-onset, an underlying question pertains to both: Does “affirmative” treatment increase the likelihood that a cross-sex identification will persist?

We must point out here that trans activists consider it “transphobic” for anyone to believe that a child’s desistance from trans-identification would be preferable to persistence. (In fact, this accusation is leveled by Temple Newhook et al in their paper, in so many words. This helps to explain why so many trans activists object to the very idea of studying persistence vs. desistance in the first place.)  Yet, we find it mystifying that a preference for desistance is even controversial.  Surely, if a child can find peace in his or her unaltered body–and happily avoid becoming a sterilized medical patient dependent for life on drugs and surgeries–that is a positive outcome. To leverage an analogy popular with trans activists, many say that “gender affirming” medical treatment is analogous to treatment for children with life-threatening cancers. Yet who would not feel happy for the cancer patient who goes into remission, thus avoiding the ravages of chemo and radiation?

Furthermore, is it not possible to support young people in their gender atypicality,  while at the same time encouraging bodily acceptance?

Central to this discussion is the trans-activist conflation of psychotherapeutic methods with conversion therapy.  Zucker addresses this problem head-on on page 9:

Now, of course, it would not come as a surprise if Temple Newhook et al. (2018) took umbrage at the mere idea of a treatment arm designed to reduce a child’s gender dysphoria via psychotherapeutic methods. They might, for example, offer up the following from the seventh edition of the Standards of Care:

Treatment aimed at trying to change a person’s gender identity…to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964)….Such treatment is no longer considered ethical.” (Coleman et al., 2011, p. 175)

Yet, on the very same page of the Standards, one finds the following: “Psychotherapy should focus on reducing a child’s…distress related to the gender dysphoria…” (p. 175) or “Mental health professionals…. should give ample room for clients to explore different options for gender expression” (p. 175). The lack of internal consistency between the first statement and the second and third statements is rather astonishing.

“Reducing a child’s…distress related to the gender dysphoria” should be the primary goal of all treatment methods. Quite a few 4thWaveNow parents have observed that upon social transition, their children’s dysphoria actually increased. This is another aspect related to the different populations (early-onset vs. adolescent rapid-onset) that needs to be clarified but still remains unknown. Dr. Zucker explains that he “prefers the following summary statements about therapeutics with regard to children with gender dysphoria”:

Different clinical approaches have been advocated for childhood gender discordance….There have been no randomized controlled trials of any treatment….the proposed benefits of treatment to eliminate gender discordance…must be carefully weighed against… possible deleterious effects. (American Academy of Child and Adolescent Psychiatry, 2012, pp. 968–969)

Very few studies have systematically researched any given mode of intervention with respect to an outcome variable in GID and no studies have systematically com- pared results of different interventions….In light of the limited empirical evidence and disagreements…among experts in the field…recommendations supported by the available literature are largely limited to the areas [reviewed] and would be in the form of general suggestions and cautions… (Byne et al., 2012, p. 772)

…because no approach to working with [transgender and gender nonconforming] children has been adequately, empirically validated, consensus does not exist regarding best practice with pre-pubertal children. Lack of consensus about the preferred approach to treatment may be due, in part, to divergent ideas regarding what constitutes optimal treatment outcomes… (American Psychological Association, 2015, p. 842)

Here at 4thWaveNow, we have repeatedly stated that we seek to support—not “eliminate”–our children’s “gender discordance” although we resist the idea that gender atypicality is a sign of bodily incongruence. More than anything, 4thWaveNow parents seek to help our children minimize the discomfort that accompanies their nonconformity to gender norms. Since many of our children only experienced dysphoria upon reaching puberty, we call for (much) more evidence that social and medical transition are better at alleviating dysphoria than psychotherapeutic methods.

And as Dr. Zucker has made clear via his life’s work (and in this paper), the jury is still very much out on that question–despite the many attempts by trans activists to deplatform those who study the matter of persistence and desistance.

zucker intellectual no platforming

 

The Open Society Foundations & the transgender movement

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by Michael Biggs

Michael Biggs is Associate Professor of Sociology at the University of Oxford and Fellow of St Cross College. He researches social movements and collective protest.

The transgender movement has transformed cultural norms and social institutions at breathtaking speed. Most of us, becoming acquainted with the trans issue for the first time, are astonished to discover the extent of the gender revolution. The movement has accomplished in a few years what the movements for women’s and for gay and lesbian rights took many decades to achieve.

Part of the explanation is the amount of money behind transgenderism. The Gender Industrial Complex, as we may call it, has many components. Lucrative sponsorship comes from pharmaceutical companies and medical providers. Charities originally established to fight for homosexual rights (like Human Rights Campaign in the United States and Stonewall in Britain) wield large budgets. Last but not least, three American billionaires have bankrolled the transgender movement on a global scale: Jennifer Pritzker, whose activities were detailed in another blogpost, Jon Stryker, and George Soros.

This blogpost focuses on the Open Society Foundations (OSF), funded by Soros. This is not easy to discuss because he is vilified by right-wingers, whose criticism sometimes degenerates into anti-semitism (Williamson 2018). Therefore those of us who are liberal or progressive tend to react instinctively by dismissing any scrutiny of Soros out of hand. This is unjustified, as I will show by providing some facts about how OSF has funded the transgender movement.

OSF fully supports the objectives of transgender activists. Self-identification is “an essential legal right for trans people” (OSF 2014a). In other words, biological sex must be superseded by subjective gender identity, to include options “outside the binary categories of male and female” (OSF 2014b). Identity should not be “governed by age restrictions” (OSF 2014b). Therefore OSF funds “trans-led or LGBT organizations that promote progressive, rights-based processes for legal gender recognition” (OSF 2014a). It also advocates access to “hormonal therapy, counseling, and gender-affirming surgeries” on demand (OSF 2014a). This includes puberty blockers for youth (OSF 2013).

How much has OSF spent to promote the transgender movement? In 2011–13, it spent $3.19 million, which made it the top funder, followed by Stryker’s Arcus Foundation and Pritzker’s Tawani Foundation (Funders for LBTQ Issues 2015). OSF’s current database includes grants worth $3.07 million for 2016–17 (searching for keywords “trans” and “transgender”). The largest recipients in this current tranche are the International Lesbian, Gay, Bisexual, Trans and Intersex Association ($642,000), Global Action for Trans Equality ($500,000), and Transgender Europe ($500,000).

open society reception areaThree million dollars on trans issues is a tiny fraction of OSF’s total expenditure, merely 0.3% (OSF 2017). Crucially, however, this funding greatly exceeds the resources given to alternative voices. This website, for example, receives no funding. To illustrate the difference that money can make, consider the commemoration of the victims of violence.

As we saw, OSF gave $500,000 to Transgender Europe in the past two years. Transgender Europe also received $1,072,000 from the Arcus Foundation from 2010 to 2017 (Arcus Foundation 2018). The organization’s projects include the Transgender Day of Remembrance, which is underpinned by a comprehensive database of victims throughout the world, Trans Murder Monitoring. This database counted 325 trans victims of violence in year from October 2016 to September 2017 (TMM 2017). The great majority of these occurred in Central and South America. There were only three in Western Europe, and thankfully none in the United Kingdom. Surprisingly, perhaps, the Transgender Day of Remembrance was widely observed in Britain in November 2017. In many universities, for example, candles were lit for each of the victims, the transgender flag was raised, speakers were invited, and services held. Searching university websites (the domain .ac.uk), we find over 2,800 webpages containing the phrase “Transgender Day of Remembrance”.

While no transgender person was murdered in the United Kingdom in 2017, 138 women were killed by men, including murders where a man was the principal suspect (Smith 2018). These data were compiled by Karen Ingala Smith, who receives no funding for this work. She started recording such deaths in 2009, under the rubric of Counting Dead Women. This was developed into the Femicide Census—in partnership with Women’s Aid—with minimal funding and pro-bono support by two legal firms (Femicide Census 2016).

Despite the diligent research over many years, this has left barely a trace in British universities. The equivalent search on their websites yields fewer than a hundred webpages containing the phrases “Femicide Census” or “Counting Dead Women”.

To sum up, more than a hundred women are murdered each year in the United Kingdom at the hands of males, but no day has been set aside to commemorate their deaths. Transgender murders are exceedingly rare—eight in the past decade (Trans Crime UK 2017; Evening Standard 2018)—and yet they have an institutionalized day of remembrance. Even if we consider the homicide rate rather than the number of homicides, Nicola Williams demonstrates that transgender people are no more likely to become victims than are women (Fairplay for Women 2017).

The prominence of transgender victims, compared to the virtual invisibility of female victims, is partly explained by the amount of resources devoted to compiling evidence and promoting commemoration. Thus funding from large American charities like OSF—along with the Arcus and Tawani Foundations—shapes the political climate in Britain and around the world.

References

All but one (indicated by *) have been archived on the Internet Archive.

Arcus Foundation. Grantees in Europe, Focusing on Social Justice, Beginning with T. https://www.arcusfoundation.org/grantees/?_paged=&focus=Social+Justice+Grants&amount=default&_year=default&location=Europe&post_title_start_with=T#scroll-anchor-1

Evening Standard. 2018. ‘Hounslow stabbing’, 22 March 2018. https://www.standard.co.uk/news/crime/tributes-paid-to-victim-found-stabbed-to-death-in-hotel-near-heathrow-a3796261.html *

Fairplay for Women. 2017. How Often Are Transgender People Murdered? https://fairplayforwomen.com/trans-murder-rates/

Femicide Census. 2016. Profiles of Women Killed by Men: Redefining an Isolated Incident. https://1q7dqy2unor827bqjls0c4rn-wpengine.netdna-ssl.com/wp-content/uploads/2017/01/The-Femicide-Census-Jan-2017.pdf

Funders for LBTQ Issues. 2015. TRANSformational Impact: U.S. Foundation Funding for Trans Communities. http://www.lgbtfunders.org/wp-content/uploads/2016/05/TRANSformational_Impact.pdf *

OSF. 2013. Transforming Health: International Rights-Based Advocacy for Trans Health. https://www.opensocietyfoundations.org/sites/default/files/transforming-health-20130213.pdf

OSF 2014a. Explainers: An Essential Legal Right for Trans People. https://www.opensocietyfoundations.org/explainers/essential-legal-right-trans-people

OSF. 2014b. License to Be Yourself: laws and Advocacy for Legal Recognition for Trans People. https://www.opensocietyfoundations.org/sites/default/files/license-to-be-yourself-20140501.pdf

OSF. 2017. Open Society Foundations 2017 Budget Overview. https://www.opensocietyfoundations.org/sites/default/files/open-society-foundations-2017-budget-overview-20170202.pdf

Smith, Karen Ingala. 2018. 2017. https://kareningalasmith.com/2017/02/12/2017/

Trans Crime UK. 2017. Trans Homicides in the UK: A Closer Look at the Numbers. http://transcrimeuk.com/2017/11/16/trans-homicides-in-the-uk-a-closer-look-at-the-numbers/

Trans Murder Monitoring. 2017. TDoR 2017 Update. http://transrespect.org/wp-content/uploads/2017/11/TvT_TMM_TDoR2017_SimpleTable_EN.pdf

Williamson, Kevin D. 2018. “An Epidemic of Dishonesty on the Right.” National Review, Feb. 22. https://www.nationalreview.com/2018/02/parkland-shooting-hoax-latest-right-dishonesty-epidemic/

The project of a lifetime: A therapist’s letter to a trans-identified teen

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Therapist and Jungian analyst Lisa Marchiano received the following email recently. She and the writer of the email agreed that Lisa would address the author’s questions in a public forum, and the author kindly agreed to allow the email to accompany Lisa’s response.

Lisa can be found on Twitter at @LisaMarchiano. She blogs at theJungSoul.com

Please note that this post is intended for educational purposes only and is not meant to replace professional advice.

Email from a trans-identified teen:

Hello. I’m almost 16 years old and recently I have been reading some of your writing on “Rapid Onset Gender Dysphoria.” Currently I identify as transgender and have for almost 2 years, but as a chronic over-thinker, I like to expose myself to viewpoints and ideas that are different from my own. If my parents knew what ROGD was, they would probably argue that I am in that category. I came out to them about a year ago and I hadn’t shown any gender dysphoria in early childhood. To them, it probably seemed a little “out of the blue,” though I had known for a year before that, had begun to transition (cutting my hair and buying from the men’s section), and had been questioning since puberty. I don’t have any mental or physical health problems, and I have a wide social circle of friends, none of whom are transgender or homosexual (though one of my friends is asexual, and my girlfriend is bisexual). I’m almost positive that I’m transgender, but your writing got me thinking and I have a few questions for you.

If what I am experiencing is ROGD, and simply a coping mechanism for something else, what signs could I look for in myself to figure that out? You talked a lot about the parent’s side of the equation, but what can I, as a trans teen do to ensure that I’m not “tricking” myself into believing this?

When do you believe a trans identity is valid? I certainly don’t disagree with you that there are many teenagers in my generation that are “becoming” trans because it is trendy, having no symptoms of gender dysphoria (I know a person like this). But do you think that trans people need to meet certain criteria to be considered trans and be considered for medical transition? If so, what criteria? Do you believe that gender dysphoria can present itself at puberty?

Thank you for reading and hopefully replying. I really appreciate your time.

Lisa Marchiano’s response:

Thank you for writing me such a thoughtful email, and for your willingness to take the answer here in this public forum. First of all, it goes without saying that this letter can’t take the place of therapy. I can’t diagnose from afar. I am, after all, just a stranger on the internet, and this is just my opinion. I believe it is an informed opinion, but it can’t take the place of discussing important issues face to face with someone who knows you well. Looking at these issues with a qualified therapist who can help you ponder your feelings in an open-ended way without prematurely foreclosing exploration can be very helpful. In addition, I hope you might feel comfortable someday discussing this with your parents. There may be a lot they don’t understand, but it is likely that there is no one on the planet who is more steadfastly on your team than they.

As a Jungian, I see psychological health in terms of a movement toward wholeness. Over the course of our lives, we hopefully integrate more and more aspects of ourselves, including parts that may be “feminine,” and parts that may be “masculine.” This life-long growth process means that we become larger and more complex as we become conscious of more aspects of ourselves. I do not believe that it makes sense to think in terms of identity, as this implies a single, fixed “truth” about ourselves – an endpoint that can be decisively known. Rather, I believe we continue to grow and change throughout our lives.

There is no robust evidence for innate gender identity. Our sense of gender appears to be an emergent property that arises out of a complex interplay between our bodies, our minds, and the social world. Though there is almost certainly a biological component to gender dysphoria, it is also likely shaped by our life history. The way we experience ourselves in terms of gender – that is as more or less male or female or both – is shaped by our family, our wider social network including friends and teachers, and the culture, including advertising, YouTube and other social media. Traumatic experiences, such as the loss of someone close, parental divorce, or emotional, physical or sexual abuse can also affect our experience of our gender.

Can gender dysphoria present for the first time at puberty? Clearly, many young people feel dysphoric at adolescence. Nearly all natal females feel discomfort with their bodies at puberty. I wonder if the question you are asking is whether dysphoria at adolescence but not before means that one shouldn’t identify as trans as a result. I think the answer to that is complicated, and I can’t really answer that for you. Again, this would be something to explore with a therapist who could really get to know your unique situation. Let me just say that based upon my reading of the medical literature, dysphoria presenting for the first time at puberty used to be unusual (but not unheard of) until recently.

Rapid onset gender dysphoria appears to be a relatively new phenomenon, and we don’t understand much about it yet. It appears as though the typical presentation of an ROGD teen involves considerable social influence, either online or by peers, as well as psychiatric comorbidities and/or vulnerabilities. Based on anecdotal reports, many ROGD teens first decide they are trans after reading on the internet. There is very little research on this, but the little there is seems to point to a different outcome for those with ROGD traits (no dysphoria in childhood, higher rates of psychiatric comorbidity, social influence) vs those with the more typical presentation of GD. And outcomes matter, because at the end of the day, we want all people to do as well as possible.

People often come to therapy to explore difficult decisions. I’m going to share a little bit about how I help someone explore their options. If you were to find a therapist to have this discussion with, here are some of the things the two of you might consider together.

There is a difference between what we feel, and what we choose to do about those feelings. I have a passionate conviction that all feelings are valid and important. We should be encouraged to feel them, to take them seriously, to honor them, and to be curious about them. We can take our feelings seriously and acknowledge them as valid without that acknowledgement meaning that we need to take a particular course of action as a result of them. For example – if we are very angry at someone, our feelings of anger are valid and deserve to be felt. What we do about that anger – whether we lash out at the person, for example – is another question entirely. When considering what to do about feelings, I am always interested in whether a given course of action is adaptive or maladaptive.

Let me explain more of what I mean by that. When someone comes to me with a question or a problem, I find it very helpful to examine the issue through the lens of pragmatism. I am interested in identifying what works for this particular person. This means that I ask us to set aside – at least for a moment – judgments based on values, morals, or ideology, and just explore whether a given response works.

What do I mean by “works?” In some sense, we all get to define that for ourselves, and one person’s definition might vary greatly from someone else’s. But we need some firm ground to stand on, so I do have a general answer – something works if it helps you to “do your life.” Freud famously said that the cornerstones of a mentally healthy life are the ability to love and to work, and I think that’s a great place to start. To have a life that is fulfilling, we generally need work that we find meaningful, as well as abiding relationships, at least some of which are truly intimate. I would add a third category to these two: . we can consider that a life strategy works if it is protective of our physical health – or at least not inimical to it. In sum, something works and is adaptive if it doesn’t interfere with our ability to work, to love, and to maintain our health.

Whether identifying as transgender for any individual is adaptive of maladaptive will depend on the person’s particular situation. If we are a natal female who has an inner experience of maleness (and I, in fact, believe that all females have masculine traits, and that our experience of the male side of ourselves can be very important psychologically), then identifying as male could be very liberating, exciting, and growth promoting. It could very well enable someone to engage productively in work and relationships. In this case, a transgender identity would be adaptive.

There could also be cases when identifying as transgender may not be adaptive. Whether it is or not will likely depend in part on how we understand what it means to identify as trans. For example, if part of identifying as transgender means that we need to be perceived as male when we are female bodied, we are putting ourselves in a vulnerable position, as we are giving others power over our sense of ourselves. We can’t control how others see us. Positioning ourselves so that we only feel okay when others perceive and validate us as we want to be perceived, rather than focusing on developing self-acceptance and resilience in the face of slights or rejections, is a decision that may promote worse mental health. This in turn could make it more difficult for us to concentrate at work or school. It might cause us to withdraw from friendships or other important relationships. If this were the case, we might say that our trans identification was proving to be maladaptive.

Furthermore, if identifying as transgender means that we understand ourselves to be literally male when our bodies are female, we may experience cognitive dissonance. Cognitive dissonance refers to the inner tension that we feel when important beliefs are contradicted by evidence. It can be quite uncomfortable. Psychologists have studied those whose strong beliefs are challenged by material evidence. (The theory of cognitive dissonance was developed by a psychologist studying a doomsday cult, and what happened to cult members’ beliefs when the world did not in fact end as their leader had predicted.) They note that we have a tendency to “double down” on our false beliefs in order to resolve the internal tension. Our beliefs become more extreme, and we work even harder internally to justify or reconcile with the challenged belief. (This isn’t just true of cult members. It’s true of every one of us.)

Those who identify as transgender can suffer from pangs of cognitive dissonance. This can often make the dysphoria worse. I have heard many stories from desisters and detransitioners that identifying as transgender made them feel worse, because they then had to deal with a constant tension around the fact that their body looked and acted differently than how they thought it should. This can invite obsessive, perseverative thinking, which can be draining and cause increased distress and anxiety. Adopting a belief that contradicts material reality can be a recipe for unhappiness, as we will likely feel the need to strive to become the thing we are not. This is part of the reason many wisdom traditions and psychotherapy schools direct us to cultivate acceptance of those things we cannot change.

The blogger ladyantitheist articulates the above sentiment eloquently in her post about her trans identification and desistance from it:

One of the biggest problems I think with being transgender is it comes out of an unhappiness, and that the impossibility of the accepted solution amplifies the unhappiness. Having short hair doesn’t give you an Adam’s apple, testosterone injections won’t change your bone structure, a phalloplasty won’t let you produce sperm. The closer you get to the real thing, the further the gap between you and being a real male grows. Freeing yourself from the task of climbing a mountain whose peak can never be summited is your only chance of ever actually being happy. I eventually stopped looking for validation as something I would never be, and started the process of loving myself.

If identifying as transgender amplifies our unhappiness with our bodies, if it causes us to perseverate on features of our bodies which we don’t like, then I would say that doing so is probably not adaptive.

There’s one other major conversation to have when considering whether identifying as transgender works, and that is the matter of maintaining our physical health. If identifying as transgender means that we feel compelled to engage in activities that could cause long-term harm to our body, then it may be maladaptive. Binding can result in collapsed lungs, compressed ribs, and back problems, and some report that they continue to suffer ill effects even after they are no longer binding. Mastectomies remove healthy tissue and can result in painful scarring. Testosterone will result in vaginal atrophy and may damage fertility. It can negatively affect one’s lipid profile, bone density, and liver function. It may increase one’s risk of heart attack and diabetes. There are currently 6,000 cases pending in litigation against drug manufacturers having to do with male bodied people who took testosterone, and experienced blood clots, heart attacks, stroke, and sudden death. Phalloplasty is known to have a high complication rate, and these can be serious and debilitating in some circumstances. If a basic measure of whether something “works” is if it helps us to protect and maintain physical well-being, it would appear that medical transition may not do so in many cases.

Could medical transition ever be adaptive? Yes, I think so. There are trans adults who feel that their capacity to love and work has been enhanced by transition. I suspect that those who benefit from transition have had a good process in which they explored their gender; addressed any underlying issues; and had realistic expectations for the outcomes of transition. Since transition compromises physical health, it is important to carefully consider such a step, and be certain that the benefits will outweigh the considerable known and unknown risks.

I would like to offer another rule of thumb when considering whether a particular life strategy is adaptive or maladaptive. All things being equal, it is better to preserve options and maintain flexibility. This is especially true when we are in the first half of life. When in doubt, leave options open. One of my concerns about medical transition for young people is that it shuts down future options. Having a mastectomy will permanently remove the option of nursing. Taking testosterone may render us infertile. Even if we think we never want to become a parent, there is still a value in protecting the future possibility of doing so. And fertility is not the only option to protect. If a person has taken on a significant transition to another gender expression and then has serious questions about it, they may be faced with even more serious challenges than they had before. Freedom of expression may be seriously, and in some cases, profoundly restricted or limited. Transition does have the potential to seriously limit additional life choices.

We really are all works in progress. Our sense of ourselves will continue to change and shift throughout our lives. It may be tempting to strive for certainty in tumultuous times, but I’d be wary of any urgency. You do actually have time on your side. By staying curious – as you clearly are – and trying out different things, you will gather more and better information in order to help you decide what works for you. One of the helpful things about a pragmatic framework for evaluating life strategies is that it leaves room for things to change. Most strategies don’t work forever. For any decision we make, we can ask ourselves, is this working? And then a few months later, is this still working? If the strategy is benefiting us in living our fullest life more than it is hampering us, we know to continue pursuing it. And if the day comes where we realize the balance of the equation has tipped so that the strategy is more costly than beneficial, then we can abandon it. We need not limit ourselves according to rigid beliefs about what is right or wrong.

elephant-blindmenWhile I was working on this letter, I was reading a novel called The Nix by Nathan Hill. The novel is in part the story of a woman named Faye, and it follows her throughout her life as she tries to discover who she truly is. Toward the end of the book, the author makes some comments about how we understand ourselves that I thought were very wise. I’ll let him have the last word.

In the story of the blind men and the elephant, what’s usually ignored is the fact that each man’s description was correct. What Faye won’t understand and may never understand is that there is not one true self hidden by many false ones. Rather, there is one true self hidden by many true ones. Yes, she is the meek and shy and industrious student. Yes, she is the panicky and frightened child. Yes, she is the bold and impulsive seductress. Yes, she is the wife, the mother. And many other things as well. Her belief that only one of these is true obscures the larger truth, which was ultimately the problem with the blind men and the elephant. It wasn’t that they were blind – it’s that they stopped too quickly, and so never knew there was a larger truth to grasp…. Seeing ourselves clearly is the project of a lifetime.