by Carey Callahan

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

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

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

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

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

Carey Callahan

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

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

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

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

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

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

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

How do you do this?

The short answer is:

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

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

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

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

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

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