TMI: Genderqueer 11-year-olds can’t handle too much info about sterilizing treatments–but do get on with those treatments

Posted on April 13, 2021 by 4thwavenow

On April 7, 2021, the UC San Francisco Child and Adolescent Gender Center offered a Zoom “training” entitled “Fertility Issues for Transgender and Nonbinary Youth.” Advertised widely on Facebook, the session was led by well-known gender therapist Diane Ehrensaft and a colleague, and was attended by over 100 people via Zoom. A recording of the session was provided to 4thWaveNow by an attendee. This article will draw on a few excerpts from the session, available for viewing here and here.

There’s a lot to unpack in the nearly two-hour long session, and we hope to address it more fully in future writings. For now, this piece will focus on one key theme explored in the session:

Future reproduction is pretty much foreclosed as a possibility for children who have been puberty-blocked and who subsequently continue on (as nearly all do) to cross sex hormones, but the “benefits outweigh risks” to move the child from, as Ehrensaft puts it, “gender dysphoria to gender euphoria.”

The fertility-wrecking aspect of the blockers>cross-sex hormones regimen isn’t new ground for those of us who’ve been closely following the accelerating trajectory of pediatric transition in the last few years. Indeed, gender clinicians themselves have known and talked about it for years. The issue is that biological reproduction depends on full maturation of gametes (sperm and ova), and gamete maturation depends upon a person completing their natal puberty.

But what may be new to our readers is that Ehrensaft–a developmental psychologist by training– herself recognizes a concern that child-transition skeptics have repeatedly pointed out: tweens and young teens undergoing these treatments are not developmentally mature enough to comprehend the full magnitude of irreversible sterilization. (Interestingly, she also discussed this three years ago at the 2018 WPATH conference in Buenos Aires.)

Although Ehrensaft (as you might guess) continues to recommend these treatments, in her Zoom presentation, she explains in detail that clinicians, parents, and other adults involved in the child’s care shouldn’t overburden a child with “TMI” –too much information—too many details– about the momentous decision to undergo interventions that result in permanent chemical sterilization.

Now is as good a time as any to dispense (again) with a typical reaction expressed when anyone talks about fertility and trans kids. Many trans activists routinely pooh-pooh the idea that people should be concerned about the loss of future fertility in medically-transitioned children. “You just think women should be baby machines! Not everyone wants to have babies!” Again we state (as we have previously): The issue is not whether a child should ever want “genetically related” (to use Ehrensaft’s term) offspring when they reach adulthood. It is that it is a human right to make the decision to reproduce–or not–when one has reached adulthood. Stated more plainly: Sterilizing children is a human rights violation. Until quite recently, these statements would not have been considered remotely controversial—but here we are.

Before delving further into yesterday’s Zoom session, let’s briefly review some of Ehrensaft’s previous remarks on the sterilization of trans kids.

Regular readers and followers of the 4thWaveNow Twitter account will be aware of Ehrensaft’s now-infamous presentation at a 2016 conference in Santa Cruz, CA, perhaps best known for the segment on barrettes and onesies. Less well known perhaps is her opinion, expressed in the same venue, that parents who might want to protect their children’s foundational human right to decide (yea or nay) about reproduction as adults (as opposed to middle school-age) are wrongly interfering with their children’s “dreams” and only balk because of a selfish desire for “genetically related” grandchildren.

“We have to work with parents on—these aren’t your dreams, we have to focus on your child’s dreams, and what they want.”

It appears Ehrensaft has not changed her views much on this in the last 5 years. In the April 7^th 2021 Zoom session, Ehrensaft again appeared to relegate any worries or ethical concerns about sterilizing an 11- or 12-year-old child to nothing more than a self-centered parental desire for grandchildren. Note that in the slide reproduced here, the 11-year-old “assigned female at birth” identifies as “genderqueer.”

Back in 2016, Ehrensaft waxed enthusiastic that many of the puberty-blocked trans kids she has worked with are mature beyond their years, capable of choosing adoption over biological offspring, just as a thoughtful adult might do after careful deliberation. (Interestingly, Ehrensaft seems to have moderated her opinion on this somewhat. In last week’s session, she cautioned clinicians that such pronouncements could possibly be “almost a reflexive response” from some young clients who just want to obtain blockers or hormones, an “overblown altruism”.)

But Ehrensaft’s key point back in 2016 was that puberty blockers and cross-sex hormones are directly analogous to fertility-robbing chemotherapy treatments for children with terminal cancer, since both are “life saving” and urgently required interventions. The message is powerful (whether accurate or not) and more than enough to chasten any loving parent: Denying your middle schooler blockers and hormones is tantamount to letting a child with terminal cancer die for lack of treatment.

We have, of course, heard the life-saving claim many times before: that dysphoric tweens require these treatments for survival, despite risks to not only their future fertility, but also potentially to their sexual function. There is no historical evidence for this claim (in fact, child and youth suicide rates have increased since the advent of pediatric medical transition).(A thorough examination of the flaws in the “suicide or transition” orthodoxy would require another 3000-word article, but for those interested, see here, here, and here for some more reading on the subject.)

Now let’s take a closer look at Ehrensaft’s April 7^th Zoom presentation.

You may have heard that puberty blockers are supposed to “buy time” for the dysphoric child to decide whether to proceed further with medical intervention. Indeed, that was the original intent when puberty blockers were first prescribed to gender dysphoric children in the Netherlands. But there’s a reason why the original Amsterdam clinician-researchers were (and still are) cautious about recommending social transition for younger children: Their goal was to prevent those children who might outgrow their gender dysphoria from embarking on lifelong, unnecessary medicalization; to avoid concretizing what is for some a transient gender confusion. The Dutch engaged in lengthy evaluation and recommended blockers for a carefully assessed cohort of their young patients. Even then, the blockers were meant to buy time.

But Ehrensaft and other “affirmative” clinicians have turned the more cautious “watchful waiting” approach on its head in the last decade or so. No longer is a child encouraged to leave the question open as to whether they will become lifelong medical patients; now they are “affirmed,” often as young as toddlerhood; and at the first sign of puberty, in Ehrensaft’s words, they urgently desire blockers to

“ward off an unwanted puberty that they’ve been thinking and worrying about for years…These kids who have socially transitioned many years prior, they don’t NEED more time to explore their gender. They’ve known from an early age what their authentic gender was…they’ve been living their affirmed gender for many years by the time they reach puberty.”

For these children, blockers (and the cross-sex hormones which nearly inevitably follow provide “continuity of care in gender affirmation and discontinuity in potential capacity to ever create progeny with their own genetic material.”

So common is social transition (in the US at least), Ehrensaft reported on April 7^th, that US researchers have found upwards of 90% of kids requesting pubertal blockade have already socially transitioned. The full ramifications of this increase in social transition (encouraged by affirmative therapists like Ehrensaft) have never been explored in a controlled study. It’s interesting that affirmative clinicians readily follow the Dutch protocol for the use of puberty blockers, while utterly dismissing their cautions about early social transitions.

So if children “affirmed” (and therefore socially transitioned) since early childhood are now justifiably candidates for blockers and then cross hormones, what is the responsibility of clinicians and parents in consenting to these interventions, given that (in her words) “blocking puberty takes away options for fertility for most?”

Ehrensaft acknowledges that a child at Tanner stage 2 (that is, the earliest sign of puberty— “as early as 8 or 9 years old”) is not emotionally or psychologically equipped to understand sex or reproduction, beyond much more than a simple, concrete description of sperm + egg. What’s more, she says, asking a child to consider the mechanics of sex and reproduction at this age may actually be psychologically harmful!

“Fertility considerations about blockers followed by hormones brings on the storm before the lull is over”… So we now have a child who could be as young as 8, 9 who has to think about sex, babies, and future roles rather than games and game playing, which is where we situate development at this period…it’s a developmental stretch and it can create emotional stress.”

She calls this “the disruption”– the “developmental disarray” which could result from informing a child still interested in games and make-believe (and though she doesn’t say it, at an age when some may still believe in Santa Claus or the Easter Bunny):

“So we’re needing to acquire the child’s assent for medical interventions and that requires asking a child prematurely to take on sex and drugs but no rock and roll.”

So what to do if you don’t want to stress out the child with TMI when they are at the “just the facts” stage of development — when you “may get a lot of squirminess about sex or around sex”? Do you talk about how the jaunty boy sperm meets the cute girl ovum (like the slide picture shows) but stay silent on the icky stuff about sex? After all, they’re not ready (and may even be disgusted by) the “rock and roll” older adolescents become intensely interested in with full-on puberty and sexual maturation.

Pretty much, says Ehrensaft. Instead of “giving them more information than they need or can handle,”adults should limit themselves to simplistic explanations about reproduction but not sex.

The question arises: If a child as young as 8 or 9 years old “can’t handle” information about sex, how can they handle deciding whether they are OK with losing the right to reproduce (or not) as an adult, when given “just the facts”?

Ehrensaft buttresses her points by highlighting the developmental framework popularized by the late Erik Erikson (one of the 20^th century’s most respected developmental psychologists), which rests on the notion that successful and healthy maturation and adult identity consolidation occurs in stages. She notes that children being asked to decide about their future fertility are “two or three” stages behind the age when they would be better equipped to comprehend the gravity of that choice.

It’s not surprising she would be familiar with the giants in that field; though best known as a gender therapist, Ehrensaft, as mentioned previously, is a PhD developmental psychologist. (It’s much less widely known that in the 1990s, she also had some involvement, as a psychotherapist, in the widely-discredited “satanic ritual abuse” preschool controversy.)

But very unlike Erikson, Ehrensaft’s analyses & recommendations always stem from an untestable confirmation bias: that “gender identity” is a native, fundamental property of the human brain, present from birth (as she said in that 2016 talk, babies “probably know their gender as early as the beginning of the second year of life…they probably know even earlier but they’re really pre-pre verbal”). In contrast, Erikson’s work made no mention of innate gender. Rather, he emphasized identity development as a long process, involving an essential “crisis” that is often not resolved until one’s 20s. In fact, Erikson posited that a person might not attain healthy adult psychological integration if they did not experience an identity crisis. Another question arises: Could gender dysphoria, for at least some children and adolescents, be something that needs to be struggled with for successful resolution and maturation, instead of ameliorated (short-circuited?) as Ehrensaft and other affirmative clinicians now do via social transition and hormone blockers?

After warning her audience not to burden tweens with TMI, she rather abruptly notes that

“Those of us who provide this care have been accused of sterilizing children. And what I would say is, we are not sterilizing everybody—[quickly revises] anybody.”

Yet this is precisely what Ehrensaft has told her audience affirming clinicians are doing, just with different words (e.g., “they won’t be able to have a genetically related child”): These treatments WILL permanently take the choice to reproduce away from a child who has been puberty-blocked and then moves to cross-sex hormones. A dictionary definition for that is sterilization.

Not missing a beat, she continues:

“I would encourage us to hold this in mind: That when people—when adults—confront medical infertility it is a very very difficult road and there are certainly and people may go through some really hard times but there’s not a high suicidality rate for infertile people facing medical infertility. But we do know there are alarmingly high rates of self harm and suicidality and suicidal thoughts among both adults and youth who experience extreme gender dysphoria. And I will say that one of the things I’ve read recently while reading a research study it struck me one youth talking about fertility preservation. I have to decide between saving myself and holding the option of someday having a child…to me it’s a choice between that potential child and my life.”

What research study? Who conducted it? And why would children believe (or be encouraged to believe) they must make a “Sophie’s Choice” between their own lives and that of potential future offspring?

“But as we communicate the fertility information to youth, hold in mind, not many people become suicidal about medical infertility, but many do about gender dysphoria.”

Where are the references for this statement? Where are the studies comparing the “not many” infertile adults who never become suicidal, with adults who were sterilized at the dawn of puberty? Where is the NIH-funded research looking at how chemically sterilized trans kids subsequently feel at 20, 35, 40 and later (much later for males) about having their reproductive choices foreclosed when they were 10 or 12 years old?

To her credit, Ehrensaft does acknowledge there are real ethical issues to ponder here. She even poses the same question many pediatric transition skeptics regularly do:

“Is a child really able to foresee into the future and foreshorten fertility … And how can a child two or three stages behind Erikson’s stage 7 anticipate what they will feel two or three stages later?”

She provides no answer to her own question; in fact, she simply poses more questions, and says it’s “for us to start [emphasis added] finding out. And we are.”

How can this not be seen as an admission that the entire “affirmative” pediatric-transition enterprise is, in fact, an experiment–with unknown future consequences?

Ehrensaft wraps up this part of the Zoom session with an anecdote she says she heard from another gender clinician, Scott Leibowitz, MD:

“I want to mention one intervention I learned from Scott Leibowitz. Which is, in making these decisions with youth about fertility and their future fertility, once they’ve made the decision, he invites them to write a letter to themselves at age 30, and write their present-age self to their 30-year-old self explaining to them what process they went through to make the decision they did that may have implications for future fertility at age 30 or 25.:

What does Ehrensaft (and Leibowitz, assuming she has represented his views accurately) think this letter-writing exercise will accomplish “after [the child has already] made the decision” that they will never reproduce? Is this meant to serve as an apology of sorts to the regretful adult? That 30-year-old future self, with a 30-year-old brain and all its more nuanced and experience-tempered understanding of the world, its fully developed frontal lobes, will see this letter by his or her child-self and feel — what? Does any 30-year-old look upon the writings or thoughts of their 12-year-old self and see wisdom? They will likely “forgive” their 12-year-old self, but …

Ehrensaft presents this anecdote as if it’s some kind of a solution to the question she posed: How can a child at an early stage of emotional, psychological, and intellectual development make a decision several years before they are equipped to fully comprehend it?

To sum up the 4thWaveNow reaction to the main message imparted in this Zoom “training”: Ehrensaft’s use of (accurate) developmental psychology to justify the impossibility of obtaining informed consent from minors, with only the emotional blackmail of suicidality as a rationale, is nothing short of mind-blowing.

But maybe this is all much ado about nothing. After all, as Ehrensaft’s colleague Jen Hastings, MD told her Zoom audience, maybe none of this will matter in a future when reproductive tech and genetic engineering liberate us from our biological constraints:

“Gametes may soon be irrelevant.”

The complete April 7, 2021 Zoom training can be viewed (in two parts) here and here.

Queering the Student Body

Posted on September 14, 2018 by 4thwavenow

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by Missingdaughter

Missingdaughter is the mother of a young woman who went missing in college. The author is available to interact in the comments section of her article.

How many college students identify as genderqueer, as transgender, as something other than male or female? Short answer: we don’t know.

The Williams Institute of the UCLA School of Law tracks transgender demographics. In 2011, the Williams Institute found that 0.3% of adults identified as transgender. Another analysis from 2016, which utilized data from the CDC’s 2014 Behavioral Risk Factor Surveillance System (BRFSS), showed the number of adults identifying as transgender had risen to 0.6% of the population. What about teenagers? Yet another Williams Institute estimate in January of 2017 suggests that 0.7 percent of youth ages 13 to 17 identify as transgender. Teenagers are a difficult population to survey. Dr. Emily A. Greytek, director of research at G.L.S.E.N. thinks the numbers for teens identifying as transgender could range from 0.5% to 1.5%. Transgender is an umbrella term—this could also account for the fuzzy numbers.

For many reasons, the aforementioned data requires closer examination. For one thing, any statistic based on a generalization across a large population does not capture local variances. There is anecdotal evidence of localized clusters of transgender-identifying young people in much higher proportions than these US-wide statistics would indicate. Escalating evidence suggests an expanding social epidemic, a phenomenon being described as Rapid Onset Gender Dysphoria (ROGD).

Malcolm Gladwell argues in his book, The Tipping Point, that social epidemics germinate, emerge, and grow by specific mechanisms and for specific reasons, ultimately reaching a tipping point, the pivotal threshold at which ideas and behaviors spread uncontrollably throughout larger society. The surveys we have do not record the germination of alternative gender identities on college campuses.

The colleges themselves report only a vague sense of the numbers. In the Spring 2017 Association of American Colleges and Universities journal, a report titled “The Experiences of Incoming Transgender College Students: New Data on Gender Identity” uses data gathered from the 2015 CIRP Freshman Survey. The report follows 678 transgender students from 209 colleges and universities.

On financial matters, the report states, “transgender students receive financial aid at a higher rate than the national sample. More transgender students reported receiving Pell grants (32.8 percent versus 26.6 percent), need-based grants or scholarships (47.8 percent versus 36.6 percent), and work-study funding (35.4 percent versus 20.9 percent). More transgender students also received merit-based aid (60.7 percent versus 51.6 percent), which is especially encouraging given that the average high school academic performance of transgender students was slightly outpaced by the national average.…”

The trans-identified students have self-reported emotional health concerns: “52.1 percent of incoming transgender college students reported their emotional health as either below average or in the lowest 10 percent relative to their peers.” However, “nearly three-quarters of transgender students reported a good chance they would seek counseling (74.6 percent). One reason for this difference is that evaluation and referral by a mental health professional is typically recommended to those seeking or undergoing hormone therapy or gender confirmation procedures.”

Transgender students are a politically and socially engaged group: “Nearly half of the transgender student sample reported having engaged in some type of activism within the year prior to college entry (47.4 percent), which is more than double the percentage of students in the national sample who reported having done so (20.8 percent). Other authors have noted the tendency of transgender students to view their identity through an activist lens, describing the intersection between their gender and activist identities, and the role other identities play at the intersection.” Further, more than two-thirds of incoming transgender college students indicated they were likely to participate in protests on campus (68.7 percent), as compared to about one-third of the national sample (33.1 percent).

Nowhere in this report did it state how many students pursue a medical transition while in college. It is understandable that colleges may not be able to track shifting gender and sexual micro-identities on their campuses. Some of these identities may be a passing whim. But we don’t know anything about how many students arrive at college with a transgender identity, or who adopt a transgender identity while in college, and—more importantly—how many of these students access campus health services for cross-sex hormones or are referred to a nearby off-campus provider for life-changing hormone treatments and/or surgery referrals. Because the students are over 18, FERPA restrictions may prevent a parent from ever learning that his or her young adult child has undergone life-changing medical interventions—even if the child is still covered under the parent’s insurance plan. (True: the student is legally an adult, though not fully in brain function.) Considering the heady atmosphere of trans cheerleading on a college campus and the easy access to medical clinics, a young adult could be more likely to pursue medical transition while away at college.

As noted in the article “Are you sending or losing your teen to college?” published last year on 4thWaveNow, “if it were all just identity exploration, it would be one thing; but many college students are quickly advancing into medical treatments—often with the financial support of the university. Diagnostic testing or even basic counseling are no longer necessary, and college-bound teens have quickly figured this out. ‘Coming out’ as transgender is now treated pretty much the same as a gay or lesbian coming out, not as the gender identity disorder it was considered to be only a short time ago.”

Some students arriving at college without a previous transgender identity will adopt this label in college. How does a coming-of-age journey turn into a coming-of-transgender journey? Why would a young person without previous gender dysphoria adopt this identity? Some would term these new identities as “late harvest apples,” a term used by Diane Ehrensaft to explain unlikely transgender proclamations from older teens and young adults. There are several reasons this identity might bloom in college. One is that gender ideology on most college campuses is an entrenched dogma that manages to unite marginalized and protected identities, tribalism, theory masquerading as science, the queering of curriculum—all these ideas combined form a nebulous all-encompassing groupthink. No one dare question this gender ideology, as this theory involves a protected class of people who are highly triggered by reality.

This new identity could form during O week, which is the week for welcoming new students to a college campus. There are also welcoming queer weeks and Q week. Further, it has become the norm to announce a preferred pronoun to other students and professors, and to be instructed on pronoun etiquette so one does not make a blunder.

From O week introduction icebreakers to the classroom, it is increasingly common to make a preferred pronoun declaration and to be asked to use assorted preferred pronouns for others. The following excerpts on preferred pronoun usage are from a guide created for faculty at Central Connecticut State University:

There are also lots of gender neutral pronouns in use. Here are a few you might hear:

They, them, theirs (Xena ate their food because they were hungry.) This is is a pretty common gender-neutral pronoun…. And yes, it can in fact be used in the singular.

Ze, hir (Xena ate hir food because ze was hungry.) Ze is pronounced like “zee” can also be spelled zie or xe, and replaces she/he/they. Hir is pronounced like “here” and replaces her/hers/him/his/they/theirs.

Just my name please! (Xena ate Xena’s food because Xena was hungry) Some people prefer not to use pronouns at all, using their name as a pronoun instead.

Never, ever refer to a person as “it” or “he-she” (unless they specifically ask you to.) These are offensive slurs used against trans and gender non-conforming individuals.

Why is it important to respect people’s PGPs? You can’t always know what someone’s PGP is by looking at them.

Asking and correctly using someone’s preferred pronoun is one of the most basic ways to show your respect for their gender identity.

When someone is referred to with the wrong pronoun, it can make them feel disrespected, invalidated, dismissed, alienated, or dysphoric (or, often, all of the above.)

It is a privilege to not have to worry about which pronoun someone is going to use for you based on how they perceive your gender. If you have this privilege, yet fail to respect someone else’s gender identity, it is not only disrespectful and hurtful, but also oppressive.

You will be setting an example for your class. If you are consistent about using someone’s preferred pronouns, they will follow your example.

Many of your students will be learning about PGPs for the first time, so this will be a learning opportunity for them that they will keep forever.

Discussing and correctly using PGPs sets a tone of respect and allyship that trans and gender nonconforming students do not take for granted. It can truly make all of the difference, especially for incoming first-year students that may feel particularly vulnerable, friendless, and scared.

Do take care, faculty. It is oppressive to oppressed classes to screw up their pronouns. But it is not oppressive to you to have to learn and use preferred pronouns. Can professors be dismissive of this silliness? No, not if they wish to not be dismissed from their positions. To take one example, a recent article stated that at the University of Minnesota a new draft proposal discloses that not correctly recognizing preferred pronouns could result in “disciplinary action up to and including termination from employment and academic sanctions up to and including academic expulsion.”

Professors at many colleges are compelled to use the student’s “chosen” names, the preferred pronouns–and of course, since we are talking about legal adults, the families may have no idea this is happening with their student: “If you are made aware of a student’s LGBTQ or transgender status do not assume other professors, friends, or family are also aware of the student’s status.” CCSU recommends that faculty read Author Dean Spade’s journal article on working with transgender students. Dean Spade is a professor at the University of Seattle School of Law.

The idea that someone is defined by a gender identity will be promoted, the idea enforced, as soon as the student arrives on campus. If a student has not given gender identity much thought, she or he will now be fully immersed in declaring a gender. What is the effect on one’s identity when forced to declare a gender identity in a classroom or with the weekly RA meeting? Champlain College decided that it would be a good idea to have everyone wear a preferred pronoun button. Imagine declaring other identities on introductions, name tags, etc.: My political party is X, my sexual identity is X, though occasionally Y, my religion is X, my mixed-ethnicity includes V,W,X,Y,Z.

Sexual identities are whirred together with gender identities. It is no wonder that with so many options available that identities often do shift. Resident Advisors often receive LGBTQ training. RAs at UC San Diego are provided with a 74 page training manual on LGBTQ identities. This publication dates from 2007. If there is a more recent update, one would assume it focuses heavily on gender identities and creative sexuality labels.

Here is one item from this 2007 guide under ‘B’:

BDSM: (Bondage, Discipline/Domination, Submission/Sadism, and Masochism ) The terms ‘submission/sadism’ and ‘masochism’ refer to deriving pleasure from inflicting or receiving pain, often in a sexual context. The terms ‘bondage’ and ‘domination’ refer to playing with various power roles, in both sexual and social context. These practices are often misunderstood as abusive, but when practiced in a safe, sane, and consensual manner can be a part of healthy sex life. (Sometimes referred to as ‘leather.’)

Professors are expected to not only practice compelled pronoun speech, but also to queer the curriculum. From Vanderbilt University, we have a comprehensive guide, “Teaching Beyond the Gender Binary in the University Classroom ”:

In this guide we learn the reasons some students may question the non-binary, “Clark, Rand,and Vogt (2003) observe that students may sometimes hold onto their current understanding of gender roles ‘like lifelines in class discussion’ when confronted with information that challenges their existing views.”

Instructors are encouraged to: “integrate non-conforming gender topics into courses that are seemingly unrelated to gender…Instructors might also “discuss medical diagnoses that have emerged in light of intersex patients.” Another recommendation is to “incorporate a class debate about the impact of gender labeling on the development of criteria for diagnosis, drug development and medical treatment.” Lastly, the authors suggest that “instructors might incorporate debates around the research on gender non-conforming brain structures, such as that of the female limbic nucleus neuron counts for male-to-female transsexuals. For some, the latter recommendation may seem problematic given the history of biological sexism and racism in the United States…In engineering classrooms, encouraging students to think about how existing technologies might require modification if one were to consider the needs of gender non-conforming individuals…In biology classrooms, incorporating readings about the variation of gender identity and expression when presenting about sex chromosomes.”

So we can see that gender-related ideologies and pedagogy are no longer confined to the departments of Queer Studies, Women’s Studies, Gender Studies, and the Humanities. The college experience is queered in likely and unlikely places by professors and students alike. Some other examples include:

A professor at Northern Illinois State is concerned that masculine lesbians are viewed as women and not transgender. ‘Zir’ says that “compulsory heterogenderism, participants’ gender identities often went unrecognized, rendering their trans* identities invisible.”

“Queer Ecologies” is a course taught at Eugene Lang College. A partial course description: “Drawing from traditions as diverse as evolutionary biology, LGBTQ+ movements, feminist science studies, and environmental justice…”

If one is stumped for ideas on queering the curriculum, QuERI is a site for courses such as, “Goodgirls, Sluts and Dykes: Heteronormative Policing in Adolescent Girlhood.”

To a young ideological student, it makes sense to insert queer into the Israeli–Palestinian conflict. This honors thesis is from the department of Gender & Sexuality at Davidson College:

The Gender and Sexuality Studies Department provides you with a solid grounding in the interconnected, interdisciplinary fields of gender, sexuality, and queer studies, and engage these fields from a variety of perspectives – religious, economic, political, social, biological, psychological, historical, anthropological, artistic, and literary.

New Mexico Tech promotes non-binary awareness in STEM fields.

It is no surprise that a full immersion into gender ideology on a college campus (that is consistently reinforced) could lead a young person to embrace this identity. Yes, some students arrive to college with a genderqueer or transgender identity. Some do not. If a student adopts this identity, there is no barrier to this identity going medical. A transgender identity, a non-binary identity–both of these stated identities can receive hormones and surgeries. There is a social contagion to this identity; if many other peers are headed to the student clinic for a testosterone shot, why not?

In last year’s college piece, we documented that medical transition services were easily available on college campuses, often with just a single visit to a counselor. The 2017 Campus Pride guide listed 86 colleges that cover medical transition surgeries. Students are often covered under their parent’s insurer, and these young adults can gain access to transgender medical services. We can only assume that insurer coverage will continue to increase. If the campus student health clinic does not provide these services, the student will be sent to a nearby off-campus “informed consent” clinic. Planned Parenthood now plays a large role in transgender health services. As in, young women come to Planned Parenthood for testosterone shots. Ironic, isn’t it? Most people think of Planned Parenthood as a place to obtain birth control–not as a place to obtain an off-label drug that may render these young women sterile, not to mention the many serious and permanent side effects of this drug.

Brown University has a generous student health care plan that provides a full range of sex reassignment surgery (SRS). As stated on Brown’s counseling website: “We partner with Brown Counseling and Psychological Services (CAPS) and University Health Services to collectively provide access, without undue barriers, to medical resources on and off-campus. Brown University health insurance provides trans-inclusive coverage for therapy, hormones, and gender affirmation surgeries for students, staff, and faculty.”

Recently, Brown University has been in the news–no, not for the reason of ranking 14 in U.S. News Best National Universities. Professor Lisa Littman of Brown University recently published a study on ROGD, or Rapid Onset Gender Dysphoria. Her study was posted on the university’s news feed and then quickly taken down when students and other activists protested. A petition was created to support academic freedom and scientific inquiry. Dr. Littman’s study created a wake beyond the research community.

Does this university have conflicts of interest between supporting faculty research, scientific integrity, appeasing activist students and outside political groups–possibly conflicts with competing interests of faculty? Dr. Michelle Forcier is a professor at The Warren Alpert Medical School at Brown University. Dr. Forcier is passionate about transgender medical care: “Should we let them die when we have medicine for diabetes?” she said. “And we’re really talking about the same level of intervention. When gender non-conforming, transgender kids and adults are not supported (and) are stigmatized, then they can’t be healthy.”

Many colleges provide cross-sex hormones for their students. Here is some budgeting advice from Tufts University Health Care:

We recommend that Testosterone be obtained from pharmacies that have special expertise—Health Service commonly works with New Era Pharmacy in Portland Oregon which ships directly to you. At New Era, a 10 ml bottle of Testosterone lasts for 9 months or more depending on your dose, and costs $65 out of pocket, which is much cheaper than using your insurance. Prescriptions for needles and syringes will also be needed. Our nurses will work with you to help you learn to administer your injections. We will also provide you with a small sharps container for safe needle disposal.

Whether through the student health plan, the parent’s medical insurance (unbeknownst to the parents), or with some creative patch funding (as in one of the thousands of accounts on Go Fund Me by young women seeking “top surgery”), college students are a vulnerable population to the social contagion and permanent medical harm of a phenomenon being termed, ROGD or Rapid Onset Gender Dysphoria.

In fall 2018, “The number of students projected to attend American colleges and universities is 19.9 million...Females are expected to account for the majority of college and university students in fall 2018: about 11.2 million females will attend in fall 2018. We don’t know the exact number of college students who are identifying as genderqueer or transgender. Colleges aren’t tracking these students. Let’s choose 1% as a number in the middle, approximating from various surveys.

What could this mean for these young women? This could translate into potentially 100K young women put on a pathway to receiving a mastectomy. No one is tracking these numbers.

Colleges must reveal how many students they refer to transgender medical health services on-campus or off-campus. Colleges and universities have an ethical responsibility to state how many students are receiving cross-sex hormones and even mastectomies due to the colleges affirming and encouraging these interventions, and sending these students to providers that are more than willing to chop off their breasts.

What will become of these young students, their futures? Many, with encouragement from peers and counselors, will estrange themselves from their families.

We will hear from some families, like this one, in a future article:

“the phone call from my daughter in the deepening voice, the phone call to the college dean of students who told me ‘sometimes children do not have the same moral compass as their parents,’ the visit to the same office where they threatened to call security on me, the generic text my husband and I received from our daughter cutting us out of her life”…

Controversy intensifies over Littman ROGD study; petition now signed by 3700, no word from Brown University or PLoS ONE

Posted on September 4, 2018 by 4thwavenow

by Marie Verite

Update: 7 Sept 2018: Petition has now reached 4200 signatures. In addition to the articles linked below, new media coverage includes: NBCNews, which covers the controversy as well as the petition, as does this San Diego Union/New York Daily News story; Ken Miller, biology prof and Brown alum in the Brown Daily Herald ; and Cathy Young in Newsday.

In the six days since the launch of the petition urging Brown University and PLoS One to continue supporting research into the sharp increase in youth—particularly females—who seek medical intervention for gender dysphoria, over 3700 have signed and over 1060 have written comments. The initial signature goal was 1000, which was quickly surpassed in less than 12 hours; the goal has since been continuously raised. As of this writing it stands at 4000.

The signatories include many families affected by rapid onset gender dysphoria (ROGD), medical professionals, therapists, doctors, and academics. You can read them all—and sign the petition, if you have not yet—here. A small sampler of the 1000+ comments:

— Lee Jussim – Chair Psychology Department, Rutgers University “If it’s wrong, let someone produce evidence that it is wrong. Until that time, if the research pisses some people off, who cares? Galileo and Darwin pissed people off too. Brown U should be ashamed of itself for caving to sociopolitical pressure. Science denial, anyone?”

— Richard B. Krueger – Columbia University College of Physicians and Surgeons “Brown University’s actions in its failure to support Dr. Littman’s peer reviewed research are abhorrent.”

— Nicholas H. Wolfinger – Professor, Department of Family and Consumer Studies, University of Utah “It’s extraordinary for a dean to withdraw support for a study, especially one by an untenured researcher. This is inimical to the spirit of open inquiry. The well-being of trans youth & other sexual minorities is best served by more research, not less.”

The petition was emailed to officials at Brown and PLoS ONE editors several days ago when it reached 2000 signatures, along with a personal letter requesting a response. As of this date, no reply email or even an acknowledgement of receipt has been received.

This week, parents who launched the petition will be mailing the hard-copy petition, with its over 3700 signatories and over 1000 comments, to the Brown University and PLoS officials named at the bottom of the petition, as well as to two WPATH officials located in the United States. A response from all recipients is being requested.

In addition to petition signatories, there have been many others who’ve stepped forward to express their concerns about this assault on academic freedom and the attempted muzzling of free and open discussion regarding the surge in new cases of gender dysphoria in youth and young adults. Press coverage of the exploding controversy is increasing.

This week, the US edition of The Economist ran a piece featuring a mother who completed Dr. Littman’s survey and her daughter, now a 21-year-old desister who identified temporarily as trans and demanded medical intervention at the age of 16. The piece also covers Littman’s study and the growing controversy around it. Entitled “Why are so many teen girls appearing in gender clinics?” the article appears online and in this week’s print edition.

The Economist reports that the mother was fine with her daughter’s gender expression but drew the line at medical transition; Rachel and her mother Janette fought “for months.” In the end, Rachel desisted. The article concludes with this paragraph:

Squashing research risks injuring the health of an unknown number of troubled adolescent girls. Rachel, now 21, believes she latched on to a trans identity as a way of coping with on-off depression and being sexually abused as a child. After receiving therapy, her gender dysphoria disappeared. Had her mother affirmed her gender identity as a 16-year-old, as several gender therapists urged, Rachel would have embarked on a medical transition that she turned out not to want after all.

Despite the obvious caring and thoughtfulness demonstrated by the liberal mother and her daughter in the article, Dianne Ehrensaft, Director of Mental Health at the gender clinic associated with UC San Francisco’s Benioff Children’s Hospital and an internationally recognized gender therapist, told the Economist that Littman finding research subjects on sites where skeptical parents like Janette congregate (such as 4thWaveNow)

“would be like recruiting from Klan or alt-right sites to demonstrate that blacks really are an inferior race.”

The Economist article is one of the first to center both the experience of a trans-identified teen who changed her mind and her mother. (Jesse Singal included such stories in his recent Atlantic story; Singal continues to undergo attacks by trans activists for what can only be described as a balanced piece on the matter of youth gender dysphoria).

There has been other prominent news coverage of the Littman controversy. Jeffrey Flier, Harvard University Higginson Professor of Physiology and Medicine at Harvard, and former Dean of Harvard Medical School, first reacted on Twitter to Brown’s removal of the press release of Littman’s’ study, and the university’s failure to support its own researcher:

A few days later, Flier penned a piece for Quillette (an online journal fast becoming one of the most respected outlets for nuanced and incisive writing), taking Brown University to task for its disgraceful treatment of Dr. Littman, an untenured professor, as well as its abdication of responsibility to defend academic freedom via its craven actions in the face of agenda-driven activists. In response, many prominent physicians have retweeted Flier’s piece, as well as Brown faculty members. In Quillette, Flier took no prisoners:

“In all my years in academia, I have never once seen a comparable reaction from a journal within days of publishing a paper that the journal already had subjected to peer review, accepted and published.”

Reactions to the Littman debacle were everywhere on Twitter (for better or worse, the cyber-public square, referred to by some as the “Agora of the 21st Century”), including from other medical professionals, such as Nicholas Christakis, physician, writer, and researcher at Yale.

An article on Medscape on August 28, “Caring for Transgender Kids: Is Clinical Practice Outpacing the Science?” attracted comments from several physicians, most expressing serious concerns about the epidemic of young people identifying as transgender in the last few years. [Note: Some of these physicians signed and commented on the petition calling on Brown and PLoS ONE to support Dr. Littman’s work.]

Many journalists have also weighed in on Twitter, overwhelmingly in support of Littman’s work and also the petition to Brown and PLoS ONE.

Jon Kay, Canadian editor of Quillette opined on Twitter

Tonight, Kay tweeted a letter by a WPATH clinician condemning the ROGD research. Based on WPATH’s previous hostility to any and everything to do with ROGD, we should expect to be hearing more from them in the very near future.

Other coverage of the Littman controversy (recommended) includes Science magazine, Inside Higher Ed, attorney-blogger Jonathan Turley, and the Volokh Conspiracy in Reason magazine.

The intense, swift reaction to the Littman matter–and ROGD–is stunning. Ironically, the pile-on intended to suppress Littman’s work may have had the opposite effect of that desired by activists. As of this writing, Littman’s study has been viewed on the PLOS ONE website nearly 59,000 times (this count would not include, of course, additional views of the paper via email shares of PDFs, etc). Indeed, the Littman affair seems to have not only brought the question of rapid onset of gender dysphoria in adolescence, finally, into the public eye. It has also stimulated a broad group of thinkers, professionals, journalists, and clinicians to start talking about the issues, under the banner of academic freedom and the pursuit of truth over the ideological dictates of one group of activists.

It’s heartening to see that defense of these core values is not dead, after all, in the West. We now have not just parents, but public intellectuals, physicians, and ethical clinicians speaking up who recognize what is occurring for what it is: An assault on scientific inquiry and an attempt to squelch open discussion of a phenomenon which is becoming more obvious by the day, despite every effort by the usual suspects to insist it doesn’t exist.

As of this writing, there has been no further public response from either Brown University or PLoS ONE. The last reaction we are aware of was an obsequious response by PLoS ONE on Twitter to a self-described BDSM trans sex worker who goes by the moniker “SadistHailey”/Hailey Heartless.

As we observed on our Twitter account,

Shriveled raisins: The bitter harvest of “affirmative” care

Posted on January 26, 2017 by 4thwavenow

Note to readers: This is another in an ongoing series of posts which shine a light on the public statements made by gender specialists in various forums. The aim here, as always, is to inform the public, particularly parents, about the actions and self-reported thoughts and plans of individuals who are currently involved in providing hormones and surgeries to minors. All screen captures are from publicly accessible (i.e. not password-protected or otherwise private) websites. We intend to continue to exercise our free-speech right to report on these public statements, as well as publishing our personal opinions on pediatric transition and those who enable and promote it.

To anyone who may object to our work in this area, hear this: The backlash represented by 4thWaveNow, Transgender Trend, Youth Gender Professionals, and the increasing number of individuals and organizations who question the burgeoning increase in child and youth transition is precisely that: a backlash against the decision taken by trans activists and their media handmaidens to relentlessly promote pediatric transition—especially MEDICAL transition.

The final straw, for many of us, has been the shameless and daily attempts by activists, journalists, and some clinicians to misuse self-harm statistics as a weapon to bludgeon parents into submission. A recent article in Spiked Online exposed this immoral and deeply destructive tactic, and we will continue to expose it on 4thWaveNow.

Scattered through the posts on this site, we have discussed the fact that puberty blockers followed by (or used concurrently with) cross-sex hormones to prevent the “wrong puberty” in prepubertal kids results in irreversible sterilization. This is well-recognized fact, openly acknowledged by researchers and top pediatric gender specialists alike [see the bottom of this post for a collection of links on this matter].

The reason is that gametes (sperm and ova) require natural, biological puberty to mature to the point that they are viable for reproduction. It is not currently possible to freeze immature gametes, as it is for those of adult trans people who have been allowed to go through natal puberty.

Our point is not that anyone and everyone should have biological children or that women are only fit to be baby machines (a red herring “argument” that has been used against us by trans activists). It also has nothing to do with the demographics of who will ultimately decide to bear or father children. (I notice none of these activists cavalierly argue for sterilization of disabled or gay people, both of whom have a lower statistical rate of becoming biological parents). The point is that it is a human rights violation to sterilize minors, who by definition cannot consent nor understand what it means to give up that future right. And given that the majority of “persisting” trans kids are same-sex attracted, it is not a stretch to see that prepubescent sterilization of “trans kids” amounts in many cases to a form of proactive anti-gay eugenics—even if that is not the conscious intention. What’s more, as many parents know, the decision to reproduce may come later in life, even if we thought in our youth that we wouldn’t have wanted children. Most young people naturally don’t spend their time thinking about having kids of their own; they have other priorities at that stage of life, as well they should.

But does any of this matter if adult trans people aren’t particularly interested in reproduction?

Well, it turns out that several studies have shown that a majority of trans men and trans women desire to have biological children of their own.

But even setting aside research evidence, all you have to do is look at the increasing number of (sometimes sensationalized) media stories about “pregnant men” to know this is “a thing”.

There are a sufficient number of trans men becoming pregnant and giving birth that the premier midwifery organization in the United States has changed all its literature to be “gender neutral” in an ostensible effort to avoid “triggering” its clients with words like “woman” and “breasts.” Planned Parenthood now campaigns on behalf of “menstruators” and the venerable La Leche League has even scrubbed its language of inconvenient mentions of biological reality, to ensure that trans men who want to “chest feed” won’t feel excluded.

But when it comes to the fertility of trans people, trans activists want to have their cake and eat it too: Celebrate and support adult trans who decide (often unexpectedly) to reproduce, while fiercely lobbying for medical intervention which permanently sterilizes prepubescent children. There is really no way to square this contradiction. They constantly claim that stopping the “wrong puberty” is the only antidote to suicide, yet that “wrong” puberty is the one and only pathway to possible reproduction in the future.

Not to put too fine a point on it, but the very people arguing that the only alternative to these sterilizing pediatric treatments is suicide are very much alive, and quite a fair few of them (notably, several top MTF trans activists) have biological children of their own. “Do as I say, not as I do” is rightly ridiculed as hypocrisy when it comes to any other subject. How on earth did these people survive to adulthood, father children, yet now harangue us that the “wrong” puberty of these children must be stopped?

As to the weaponization of suicidality: There is no record in the history of medicine of children and teenagers killing themselves because they could not medically transition in childhood, or because they were “born in the wrong body.” (Since August when this piece was posted, we’ve been waiting for any evidence to the contrary.) Even the most frequently cited “41%” study of trans adults who have reported suicidal ideation doesn’t assert that medical transition cures suicidality.

Source: Williams Institute, 2014

So, given that

large numbers of adult trans men and women express a desire to have biological children;
no child or pre-adolescent can know for certain whether or not they will eventually want to reproduce;
it is a universally acknowledged human rights violation to sterilize minors;
and there is no evidence that early medical transition will ultimately reduce self harming behaviors,

we must ask: Why do gender specialists continue the reckless practice of promoting sterilizing hormones and surgical interventions on prepubescent children, who, by virtue of their undeveloped powers of reason and judgment, cannot meaningfully consent to such treatments? On what authority does any adult—including these children’s parents—have the right to make a decision for a minor that should solely belong to adults of reproductive age themselves?

Even if it turns out to be true that most of these kids won’t opt for biological reproduction in the future, what of the (already limited) pool of potential life partners they might fall in love with? It’s not at all uncommon for couples to part company over disagreements about whether to have children. And then there’s the issue of what genital surgeries do to sexual response and function. None of this is ever discussed in the glowing portraits of “trans kids” that we see daily in the mainstream media (though it is by the clinicians themselves—as you’ll see shortly).

The gender specialists are fully aware of the irreversible effects of their interventions. Gender clinics detail the risks of infertility and other permanent changes on their consent forms. Research articles, public statements, and news articles capture the admissions by prominent gender specialists (again, see the bottom of this piece for links). Some express reservations (but no accompanying intention to cease and desist or even slow down their caseloads); some mention it in passing. And some, as you’ll see in a moment, appear to lose no sleep at night over what they’re doing, but only express interest in the future market for even more high tech interventions for the young people entrusted to their care.

Last March, Johanna Olson-Kennedy, MD (herself a parent), one of the world’s most successful and best known pediatric gender specialists, posted a call on the publicly accessible WPATH Facebook page for earlier genital surgeries on minors. We wrote about it at the time in this post.

The irony is inescapable: By puberty blocking young people, endocrinologists create a situation where these youth naturally yearn for puberty, as they watch their unblocked peers mature and move on. Olson-Kennedy’s solution? More high-tech, expensive medical intervention; earlier cross-sex hormones, earlier sex reassignment surgery. An iatrogenic problem created in the first place by suppressing the perfectly healthy bodies of young people.

Just a few days ago, Olson’s original post was revived via several new comments supporting her radical idea. This one, by Susan Maasch, founder of the Trans Youth Equality Foundation (TYEF) is particularly striking. ( We wrote about TYEF—a purveyor of free breast binders (secretly to girls with “unsupportive” parents) and youth transition propaganda, last year.)

“Shriveled raisins”: The outcome of years of hormone treatment unnatural to the female body.

Other activists and pediatric gender specialists, including Rixt Luikenaar (ironically, an OB-GYN), Kathie Moelig (founder of TransFamily Support Services), and others acknowledge that sterilization (which their clients may someday regret) will result from early surgeries and hormones, but place their faith in high-tech medicine to find a way around it—eventually.

This unquestioning belief that medical technology will solve the problems created by zealous “affirmative” gender specialists is widely shared. Just a couple of days ago, NPR ran an article acknowledging that immature gametes can’t currently be preserved for future reproduction. But by drawing on fertility preservation research in cancer survivors treated with sterilizing chemotherapy, the pediatric-transition pushers hope that puberty-blocked children’s ova and sperm can eventually be coaxed to reproductive viability in a petri dish.

Both groups — young cancer patients and trans kids hoping to transition early — have a demand for fertility preservation at an age where it has not usually been possible. But researchers say they are drawing closer to a solution with new techniques to freeze, or cryopreserve, immature reproductive cells…

… they started to look for ways to grow that tissue in a petri dish, so it can develop into a mature egg. “We’ve had to borrow knowledge from other disciplines and sort of figure out how that applies to trans people … What can be frustrating sometimes is having to adapt and extrapolate all of this information from work that is not done for trans people.” — Zil Goldstein, Mount Sinai

Brave New World. Puts a whole new spin on “test tube babies.” Not to mention a future boost for the surrogacy industry.

No one in the mainstream media—in this case, NPR– seems willing to point out the obvious: If you let these kids simply mature naturally–as their healthy bodies are desperately fighting to be allowed to do–they can preserve their fertility and decide whether they want to choose hormonal or surgical interventions when they reach adulthood, with mature judgment and reasoning powers. There would be the added benefit of giving kids a chance to desist before it’s too late—as so many were allowed to do before “gender affirmative” treatment was advertised 24 hours a day, 7 days a week. Only a few years ago, this would have been seen as just common sense caution. Adults-only transition was the norm.

There are other ramifications besides infertility resulting from this reckless rush for earlier and earlier surgeries and hormonal treatments. Here, Olson-Kennedy and other commenters analyze the impact of surgeries on sexual function—but disagree on how much should be discussed with the kids themselves about their future orgasm potential after their genitalia have been surgically rejiggered.

At least one “practitioner” seems not to want concerns about orgasm potential to be a “hindrance” to a child achieving their “authentic self”:

Bringing us into 2017, Jenn Burleton, head of Transactive Gender Center, assured the Facebook group on January 18 that orgasm is a discussion topic amongst “caregivers” in Transactive support groups. Good to know parents and other adults feel empowered to make decisions for these kids about their adult sexual function and fertility in their “support groups.”

(Just a thought: how many of these people publicly pontificating about the sexual function of children consider how they’d have felt as teens if adults had been scheming about their orgasm potential, and the impact thereon from a surgeon’s scalpel?)

In January 2017, nearly a year after Olson-Kennedy’s original post calling for the WPATH Standards of Care 8 to support earlier genital surgeries, many clinicians, activists, and parent leaders of trans youth groups remain keenly interested in lowering age of surgeries for youth. From the sounds of it, “many many” surgeons are eager to oblige.

Dan Karasic, MD, director of a gender clinic at UC San Francisco, moderator of the WPATH Facebook page, and a key player in WPATH and the co-chair of the recently formed USPATH, helpfully informs us that a discussion on under-18 surgeries will take place at the inaugural USPATH conference February 5 2017. “Advocacy” to pressure insurance companies to get onboard and pay for genital surgeries on minors is also an important part of the discussion.

This isn’t the first time we’ve seen Dr. Karasic advocating for lowering the age for surgeries. In this post, we discussed his public support for a mother obtaining double mastectomy for her 15-year-old and her attempts to get her insurance company to foot the bill for it.

Again: The people advocating for drastic and irreversible medical interventions on minors have enormous power over the future lives of children. The decisions they have taken with their careers and activism will impact a generation of youth for a lifetime. These adults, trans or not, were allowed to mature without medical interference in the era preceding this Age of the Trans Child.

Some of the people weighing in are trans adults, among them MTFs who have fathered children and had successful careers, who were not subjected to tampering and scheming about their most private and personal bodily functions as children. And as much as the trans activists may claim they’d have welcomed such interventions as children, the fact remains: Somehow they made it to adulthood, fertility and sexual function intact, without killing themselves.

Exactly what authority gives these people the right to advocate for and perform medical experiments on children, “trans” or not? This is a question a lot more people need to be asking.

Meanwhile, the USPATH conference session on surgery in minors is on Sunday, February 5 at 10:15 AM in Los Angeles.

Readers will undoubtedly recognize some of the names on this panel.

For more information about the irreversible sterilizing effects of puberty blockers followed by cross-sex hormones on prepubescent children, see below. Readers contributions are welcome and will be added to this list.

Sahar Sadjadi, The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?

It must be remembered that puberty suppression as the first step to medical transition, if followed by cross-sex hormones, which has been the case for almost all reported cases, leads to infertility due to the permanent immaturity of the gonads and the reproductive tract. The absence of the discussion of sterilization of children as a major ethical challenge in this bioethics article, and many other clinical debates on puberty suppression, is striking. For any other group of children, such an intervention would be discussed extensively with ethics review boards. (What grounds might justify the permanent elimination of the child’s reproductive ability? Should parents be able to make such a decision for the child? Which futures are opened by the treatment and which ones are foreclosed? How might benefits be weighed in relation to the loss of reproductive capacity?) The media would likely react with investigations and questions about the long-term consequences of treatment. These “queer” children’s bodily integrity and reproductive rights should not be any less pressing than other children’s. Needless to say, children are not legally capable of consent, and 9–10 year olds are not capable of understanding all the health consequences of the treatment. Parents are asked to make life decisions on issues as critical as fertility for young children. Can they make an informed decision and evaluate benefits vis a vis risks when confronted with such horrendous forecasts for their children?

Unique ethical and legal implications of fertility preservation research in the pediatric population

Norman Spack, MD, founder of first US pediatric gender clinic:

The biggest challenge is the issue of fertility. When young people halt their puberty before their bodies have developed, and then take cross-hormones for a few years, they’ll probably be infertile. You have to explain to the patients that if they go ahead, they may not be able to have children. When you’re talking to a 12-year-old, that’s a heavy-duty conversation. Does a kid that age really think about fertility? But if you don’t start treatment, they will always have trouble fitting in. And my patients always remind me that what’s most important to them is their identity.

Brill & Pepper, The Transgender Child, 2008, p. 216

“The choice to progress from GnRH inhibitors to estrogen without fully experiencing male puberty should be viewed as giving up one’s fertility, and the family and child should be counseled accordingly”. For girls, sterilization is the outcome too, because “eggs do not mature until the body goes through puberty”

Diane Ehrensaft, video clip from conference. Time stamp: 5:06

“Another thing that’s a show-stopper around [parents] giving consent is the fertility issue. That if the child goes directly from puberty blockers to cross- sex hormones they are pretty much forfeiting their fertility and won’t be able to have a genetically related child.”

Robert Garofolo, PBS.org:

“It’s an imperfect field with regards to decisions we are asking these families to make,” acknowledged Dr. Robert Garofalo, who co-directs the Center for Gender, Sexuality and HIV Prevention at Chicago’s Lurie Children’s Hospital and is also working on the transgender youth study. Garofalo hopes the team will be able to study patients far beyond the current five-year term to address a host of questions that currently have no answers. Does hormone use in trans youth increase breast cancer risk? How well do adults who have transitioned as teens grapple with their loss of fertility? “These are things that are entirely unknown,” Garofalo said.

Too much trust

Posted on November 21, 2016 by 4thwavenow

4thWaveNow contributor Overwhelmed is the mother of a daughter who previously identified as transgender. Her daughter is now comfortable being female even though she chooses to eschew conventionally feminine clothing and sports a short haircut.

Overwhelmed can be found on Twitter: @LavenderVerse

by Overwhelmed

Why does the public seemingly trust that gender doctors know what they are doing? Well, one of the reasons is the frequent media portrayals of trans kids. Children who have recently undergone medical transition are being presented as success stories, even though no one knows the long term consequences of gender-affirming treatments.

I came across this article on the University of California San Francisco website. It covers the transition of three children—two who have puberty blocker implants and one, a natal female named Oliver, whose treatment has included puberty blockers, testosterone, a double mastectomy with chest contouring, a hysterectomy (at 16 years old!) and plans in the near future for the first in a series of phalloplasty surgeries. The article also highlights the involvement of three gender-affirming pioneers—Dr. Ehrensaft, Dr. Rosenthal and Joel Baum—whom I will discuss a little later in this post. But first I will focus on Oliver.

Oliver’s story (which I’ve pulled from three separate articles) starts off as expected—a young child uncomfortable in dresses who likes short hair and playing baseball. When puberty started, it caused a great deal of distress. Suicide was considered. And then:

A few months before his 15th birthday, …stumbled across the word “transgender” online. He read about people who had had medical treatment to align their bodies with their gender identity – their inner sense of who they are.

“Bam, my life changed,” he says. “It lifted a major weight to find out I could do something about all this pressure I had been feeling.”

At first Oliver’s parents, especially his father, didn’t accept that their daughter was really their son.

“It took me a bit to become a really supportive dad,” ….

For months they didn’t speak. But in the end, reading the suicide statistics for transgender teens brought him around.

“My kid’s not going to kill himself,” …. “I don’t care what he is, as long as he’s a productive person in society, and he needs all the support we can give him.”

Oliver was taken to UCSF’s Child and Adolescent Gender Center.

By age 15, Oliver… was on a dual regimen of testosterone, plus puberty blockers to keep his endogenous estrogen from competing with the male hormones.

While he had to endure a second puberty, and he’ll need to take testosterone for the rest of his life, he’s had no second thoughts about transitioning.

The summer after his sophomore year, he had “top” surgery – a double mastectomy and male chest contouring – in San Francisco. To pay for the procedure, which was not covered by insurance, he used earnings from years of showing and selling pigs at the Tuolumne County fair.

“It’s a lot of money for a 15-year-old,” he says of the $8,000 price tag. “But I appreciate it every day.”

His family’s insurance also wouldn’t cover a puberty blocker implant, so… at first chose cheaper but “gnarly” monthly shots. Later, concerned about unknown long-term effects of the blockers, and hating the painful shots, he opted for a hysterectomy at age 16 – performed by the same family doctor who had delivered him.

In June, he’ll undergo the first in a series of “bottom” surgeries to create male genitalia.

His only regret, he says, is not finding UCSF’s Gender Center sooner. “To not go through the wrong puberty, those kids are lucky,” he says. “That’s a team effort. You have to show [gender dysphoria], and parents have to catch it.”

Oliver’s story has been published in at least three media articles, likely reaching a large audience. The teen has also been influential in Oliver’s small town high school where at least four other transgender students have since come out.

An increasing number of children like Oliver are announcing they’re transgender, and families are looking to the experts in the field for guidance. Diane Ehrensaft, PhD, a clinical and developmental psychologist, is one of a number of pediatric gender-affirming pioneers in the San Francisco Bay area. She is Director of Mental Health and founding member of the UCSF Child and Adolescent Gender Center. She is a well-known proponent of the gender affirmative model and has authored two books on the subject. Ehrensaft has a private practice in Oakland and serves on the Board of Directors of Gender Spectrum.

Her credentials seem impressive, but there are concerns that her stance could unnecessarily pressure parents into eventually medically transitioning their children. She’s often quoted in news reports about trans kids. Here she is in the Duluth New Tribune article from above, rationalizing the dramatic increase in trans-identifying kids seeking treatment:

“We have lifted the lid culturally,” said developmental psychologist Diane Ehrensaft, whose Oakland, Calif. practice has seen a fourfold increase in the number of gender-questioning kids in recent years. “These kids have always existed, but they kept it underground.”

She is also quoted in the UCSF article:

“When a child says, ‘I’m not the gender you think I am,’ that can be a showstopper,” says Diane Ehrensaft, PhD, the Gender Center’s director of mental heath as well as a private-practice psychologist in Oakland. “Some parents say, ‘Not on my watch. No way am I signing off on a medical intervention. When they’re 18 they can do what they want.’ I say, ‘You’re absolutely right, you’re the ones minding the shop, but let me share with you the risk factors of holding back.’”

A parent swayed by Ehrensaft’s logic may believe that, contrary to historical records, there were always this many trans kids. This could lead parents to disregard the impacts of social contagion. And she tells parents that being cautious and holding back medical interventions until their child is 18 could lead to serious “risk factors.” Suicide seems to be implied.

Stephen Rosenthal, MD, is another pediatric gender-affirming pioneer in the San Francisco Bay area. He is a founder of the UCSF Child and Adolescent Gender Center and currently serves as its Medical Director. He is also the program director for Pediatric Endocrinology, director of the Endocrine Clinics, and co-director of the Disorders of Sexual Development (DSD) Clinic. Additionally, Rosenthal spends time as a professor of clinical pediatrics at UCSF and conducts research. Currently, he is participating in an NIH-funded study of pediatric medical transition.

He has stated that “these kids have a very high risk of depression, substance abuse, suicidal thoughts and suicide attempts. Not treating is not a neutral option.” He promotes early treatment—puberty blockers, cross-sex hormones and sometimes surgeries—to alleviate these symptoms without any proof of long term relief.

Under his direction, the UCSF Child and Adolescent Gender Center has grown substantially. It opened in 2010. By 2012 there were 75 patients and currently there are over 300 patients with about 10 new referrals a month. Business is booming. Clinics are being added in San Mateo and Oakland. The UCSF Gender Center network isn’t the only place in the San Francisco Bay area offering pediatric gender affirming treatment. Stanford and Kaiser Permanente provide similar services.

What could be driving all of these children to seek treatment? Well, the San Francisco Bay Area has been well-educated by Gender Spectrum, a “national advocacy group for gender expansive youth whose mission is to create a gender sensitive and inclusive environment for all children and teens.” Many schools in the area have hosted training sessions by Gender Spectrum. The goal of gender sensitivity training is to increase acceptance and decrease bullying, but it’s likely that some children get confused by the information, leading to a rise in referrals to gender clinics.

Joel Baum, MS, is an advocate for pediatric gender affirmation. He is the Senior Director of Professional Development and Family Services at Gender Spectrum and is the Director of Education and Advocacy for the UCSF Child and Adolescent Gender Center. He co-wrote Schools in Transition, A Guide for Supporting Transgender Students in K-12 Schools, which I discussed in this blog post. He has spoken in schools, at conferences (mentioned in this 4thWaveNow post) and, according to this article, promotes transgender awareness on radio shows.

Per the article, it was Baum who helped Emily and her husband realize that their son was really their daughter (Kelly).

One day Emily got a call from her husband, who was in his car listening on the radio to Joel Baum, MS, the Gender Center’s director of advocacy as well as the director of education and training for the Oakland-based nonprofit Gender Spectrum. “You’ve got to turn on the radio,” he told her. “I think this is our kid.’”

Emily was horrified to learn about the high rates of harassment, school failure, and suicide among transgender youth. “I couldn’t talk about it without weeping. I kept going to all these images in our culture for transgender people, that they’re on the edge, disenfranchised,” she says. “I was thinking, ‘I can’t lose my kid. I don’t care what her gender is. I’ve got to get on the other side of those statistics.’”

Her path forward, she says, was “unconditional acceptance of my child’s truth.”

The family started regular visits to Gender Center clinics and let Kelly be their guide. She grew her hair long. In third grade, she switched her masculine birth name to a gender-neutral nickname. At age nine, she transitioned socially, becoming “she” to relatives, friends, and classmates.

Intensely private, Kelly wanted no emails to parents, no classroom announcement. Just a quiet switch in pronouns. Her elementary school administrators and teachers – faced with their first transitioning student – were “incredibly supportive,” says Emily, who sought out staff training and put Kelly in a classroom with only one student who knew her from “before”: her best friend.

Now 13, Kelly has a matchstick-sized implant under the skin near her left bicep to suppress the male hormones her body produces. She’s blossomed into a “beautiful, smart, artistic, empathetic, fun kid,” Emily says. “I’m like, ‘Whoo! I hit the jackpot.’ But it was definitely a process and a journey for our family, and our daughter, to come to understand who she was.”

Ehrensaft, Rosenthal and Baum are promoting treatment for gender dysphoric children based on unproven theories, not solid evidence. There has been a dramatic rise in trans-identifying youth, but instead of questioning why, Ehrensaft says that the increase is due to hidden trans kids coming out. Rosenthal seems to believe that pre-emptive treatment (leading children to become permanent medical patients with unknown long term side effects) is worth it to potentially avoid future depression, substance abuse and suicide. Baum doesn’t appear to consider that transgender advocacy can lead some impressionable kids to mistakenly self-diagnose as trans. Or, that it can affect how parents interpret their children, potentially leading their gender defiant kids unnecessarily down the path of transition.

And each uses suicide statistics, flawed as they are, to justify early intervention. I’ve seen many parents in news articles state that the motivation to go along with transition was to avoid suicide. Parents are scared and feel pressured. They want to keep their children alive, no matter what. They don’t feel like they have a real choice. “I can either have a live son or a dead daughter” (or the reverse) is a common saying. When parents trust the advice of gender experts, they will accept puberty blockers, cross-sex hormones, mastectomies, and hysterectomies as necessary. Unfortunately, though, this approach does not guarantee a live child.

Tremendous pressure is being placed on parents to provide gender affirmative “support.” Media articles never quote these pioneers recommending what we do at 4thWaveNow—to support our children in defiance of gender. We allow our children to choose their haircuts, clothing and interests. We accept them as is, without pressuring them to conform to societal expectations. We urge caution and encourage reflection on what it means to be male or female. We consider the long term impacts of medical interventions. We don’t rush into gender affirmation via pronouns or treatments. We want to avoid suicide in our children, but realize that the underlying reasons are more complex than the trans kids media articles portray. And some of us have had success with this approach.

There is a great deal of trust being put in the experts in the field, but we need to remember that they are pioneers in the strictest sense. They are still developing new ways of thinking about and treating gender dysphoric patients. The process is not complete. Gender science is rapidly evolving and changes to treatment protocols are likely. Today’s success stories may not be tomorrow’s success stories. The trust in experts should be viewed from this perspective.

Gender-affirmative therapist: Baby who hates barrettes = trans boy; questioning sterilization of 11-year olds same as denying cancer treatment

Posted on September 29, 2016 by 4thwavenow

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Note: 4thWaveNow frequently features posts (like this one) that focus, often unflatteringly, on the activists and providers involved in pediatric transition. These people aren’t ogres who intend to bring harm to the young people and families under their care and influence. They undoubtedly sincerely believe they are doing the right thing. The purpose here, as ever, is not to demonize, but to shed light on the potential and actual damage done by the practice and ideology of “gender affirmation.” Harms done not only to children and their families, but to the decades of progress achieved by the women’s and LGB liberation movements.

A well known subscriber to the “gender affirmative” approach to trans-identified children is Diane Ehrensaft, PhD., a clinical and developmental psychologist. Dr. Ehrensaft, author of The Gender Creative Child, plays a powerful role in the burgeoning field of pediatric transgenderism. She is director and chief psychologist for the University of California-San Francisco children’s hospital gender clinic, and is also an associate professor of pediatrics at UCSF. She sits on the Board of Directors of Gender Spectrum, a San Francisco Bay area organization which is heavily involved in matters pertaining to trans-identified children and youth.

In February, Dr. Ehrensaft, along with other pediatric transition specialists, including Joel Baum, MS (senior director of professional development and family services at Gender Spectrum), presented at a conference and continuing education event in Santa Cruz, California. The all-day event, attended by over 400 people, was recorded and video is available here.

The 5.5-hour video is well worth watching in its entirety for anyone interested in the current state of “gender affirmative” therapy. This post will touch on only a few highlights from the conference. There is much, much more. (Numbers in square brackets give approximate hour:minute time stamps for each video excerpt.)

Dr. Ehrensaft [1:31] tells the audience that “gender affirmation” differs from the more cautious approach of learning to “live in your own skin” provided by Dr. Ken Zucker in Toronto. Zucker’s clinic was shut down by trans activists a few months ago—reported by Ehrensaft with obvious glee and to the applause of her audience. Gender affirmation also parts company with the “watchful waiting” protocol pioneered by clinician-researchers in the well known Amsterdam gender identity clinic founded by Peggy Cohen-Kettenis. The Dutch have repeatedly counseled caution in social transition and early intervention for gender dysphoric children, given the high rate of desistance and the fact that early social transition has made it more difficult for some young people to change their minds later—and might even increase the likelihood that a child will persist in a trans identity.

Ehrensaft labels “gender affirmative” therapy as “listen and act,” i.e., essentially follow the child’s lead in whether or not to proceed with early interventions like social transition and puberty blockers. According to Ehrensaft, this boils down to whether the child says they ARE (vs. “want to be”) the opposite sex, and how “persistent, insistent, and consistent” they are in asserting their cross-sex identification and gender “expression.”

Ehrensaft denies that gender-affirmative therapists simply “rubber stamp” a child’s gender identity, yet despite her protestations to the contrary, she constantly reifies the idea that gender identity is innate and recognizable even in pre-verbal babies and toddlers (more on that later in the post).

To be fair, in her presentation Ehrensaft does acknowledge the replicated research showing that a large majority of gender dysphoric kids will grow out of it. Yet she strongly believes that she and others like her can reliably distinguish between the “apples” who are truly transgender and the “oranges” who are only exploring.

Even if you believe there is such a thing as a truly transgender child, what is the justification—the evidence— for her hubris, her certainty that she and others like her who peddle the “gender affirmative” approach can predict which children might be happy, decades later, as sterilized, surgically and chemically altered adults? There really isn’t any. Even so, at one point, she claims science is on her side, pointing (without directly citing it) to “research” out of the University of Washington that proves—gender-defiant children really, really, really mean it when they say they prefer the clothes, toys, and lifestyle more typical of the opposite sex.

Let’s take a closer look at the “insistent, consistent, persistent” mantra—droned incessantly by gender experts, with this conference being no exception. While Ehrensaft and Baum take great pains to say they support and even celebrate gender “nonconformity,” when the young trans-identified people (present at the event and on video) talk about their experiences and how they “know” they are trans, we hear the same rationale we always do: they eschew sex-stereotyped behaviors and appearance.

How does Ehrensaft directly instruct us in what it means to be “consistent, persistent, and insistent”? She plays a video clip of a young FtoM who has this to say about why s/he is and has always been trans: [47:00]

We [trans kids] don’t know about much but we know about gender. We know that girls are the ones supposed to be in skirts and dresses and guys in jeans and fight all the time…I think what should have been a sign to my parents was um…I was a quiet child. I didn’t fuss or anything. But whenever my mom would try to dress me up and put lipstick on me and get me all pretty for pictures I would throw a tantrum, I would scream … that should have definitely been a big sign to her that I was not trying to fit into the girl role… The most feminine thing I did as a child was paint my nails—black.

There is knowing laughter from the audience at this last point—as if choosing black (instead of pink or purple?) fingernail polish were a sure sign that this child was, in fact, a boy. A child who was, yes, persistent, consistent, INSISTENT…that she didn’t want to act like a stereotypical girl in a dress wearing lipstick.

If Ehrensaft could respond here, I imagine she might say something like, “oh but it’s more than gender expression!” If it’s more than that, why is the one video excerpt provided to teach us about who is really trans all about stereotypes? Could it be that conforming to stereotypes is the very basis of the definition of a “trans child”?

We hear from another trans-identified teen during the panel discussion, Jordan, a 17-year-old FtoM. We also hear from Jordan’s mom, Heidi, who leads a local support group for trans-identified youth and their families.

Heidi—who at several points mentions her strong church affiliation–talks about some of the childhood experiences that convinced her that her daughter was actually her son, including this [4:37]:

When Jordan was about 2 it became clear to me that Jordan liked boy things—you know trucks, video games, violence…when he was about between 2 and 4 I noticed he would rip off the pretty little dresses I would put on him. Would go screaming through the house and would not leave the house until he had on his brother’s big, holey T-shirts. I just thought he was a tomboy and that it was a phase. He was driving me nuts but it was a phase. During this time I worked for a very large church… We are Christians… We were told by everyone around us to make that kid wear a dress.

Another kid screaming in a dress.

Mom tried to force her kid to wear dresses: check. The kid liked trucks: check. A girl not wanting to wear dresses is ”a phase”: check. Mom didn’t like this (it drove her nuts): check. Mom was involved with a church, whose members wanted her to “make” her child wear a dress.

Could this stuff be any more obvious?

Jordan seems to agree that an aversion to wearing dresses is a key sign of one’s innate gender identity [4:44].

My mom put me in a dress at Easter. [But I] went to church in dirty jeans and a big T-shirt. That was kind of a big signal.

A big signal of what? That Jordan didn’t like dresses, preferred to wear jeans? What is this obsession with dresses that we see in each and every media story about girls who are “really boys?” When did we step into this time machine, returning to the turn of the 20^th century? Even Katherine Hepburn wore pants and eschewed dresses in the 1940s.

Then there’s this from Heidi [4:40]:

[During the elementary school years] I was [putting up] posters of really strong women. You know, like the singer Pink? Oh, this is a real kick-ass girl, you can be like her… when he had a crush on her. It was things like that.

Things like… not wanting a lesbian daughter? This conference took place in 2016, in the San Francisco Bay Area–for decades considered one of the most gay-friendly places in the USA, and the audience tittered at this revelation of Jordan’s same-sex attraction—as if that were a sign Jordan was actually a boy!

Mom goes on to describe how Jordan was diagnosed with a whole “plethora” of mental health issues, from ADD to bipolar to mood disorders, and concludes that it was being trans that was the root of all these other problems; once Jordan transitioned, everything else cleared up: the self hatred, the self harm, the unhappiness.

This is an increasingly common refrain, and in fact, Ehrensaft at several points in her presentation asserts that “gender is the cure” for an array of other mental health issues. What we don’t see, from Ehrensaft or anyone else, is actual evidence that allowing children to “transition” results in improvements in mental health over the long haul. What we are beginning to see in accounts from some people who have detransitioned is that transition essentially put their other issues on hold for a while—only to re-arise when the initial transition exhilaration began to dissipate.

We have evidence from several studies that gender dysphoria often co-presents with other mental health issues. Ehrensaft and others like her are now turning such research on its head, positing that the cause of comorbid mental health problems is a child being somehow thwarted in their gender identity.

Returning to the conference, although Jordan’s “gender expression” is not assumed to be the real reason for transition, it is telling that, as always, it is examples of how a person does or does not conform to sex-stereotyped behaviors that are presented as the evidence for being transgender.

And that goes even for babies, according to Ehrensaft. During the audience Q&A, a man asks how one might tell if a pre-verbal one or two-year-old is transgender. Ehrensaft’s answer, delivered with a knowing and confident smile [Clip for this excerpt is here, starting at approx. 2:05-2:06 in main video]:

[Preverbal children] are very action oriented. This is where mirroring is really important. And listening to actions. So let me give you an example.

I have a colleague who is transgender. There is a video of him as a toddler–he was assigned female at birth–tearing barrettes out of then-her hair. And throwing them on the ground. And sobbing. That’s a gender message.

Ehrensaft miming a significant “gender message:” a toddler ripping barrettes out of her hair

Ehrensaft is a developmental psychologist, and the only reason she can think of that a 2-year-old girl might detest the feel of barrettes in her hair is that the child is really a boy?

Again, I imagine Ehrensaft’s retort: Oh, that was just one thing–there were lots of other signs. Then why does Ehrensaft use this as a seminal example when responding to a question from the audience? And according to Ehrensaft, if the child (consistently, insistently, and persistently?) tore the barrettes from her hair “not once, but twice, three times,” that is the clincher.

Ehrensaft elaborates:

Sometimes kids between 1 and 2, with beginning language, will say, “I BOY!” when you say “girl.” That’s an early verbal message! And sometimes there’s a tendency to say “Well, honey, no you’re a girl because little girls have vaginas, and you have a vagina so you’re a girl…Then when they get a little older [the child] says, “Did you not listen to me? I said I’m a boy with a vagina!”

Believers in gender identity accuse gender skeptics like me of “reducing people to their genitals.” But here we have a developmental psychologist saying in so many words that the only thing that makes a girl a girl….is her vagina. I don’t know about the other parents reading this, but I can say my response to my two-year-old in that scenario would not have been a reference to (one aspect of) her genitals.

What else does Ehrensaft advise for parents who are so concerned about their baby’s “gender identity”?

They can show you about what they want to play with…and if they feel uncomfortable about how you are responding to them and their gender… if you’re misgendering them. So you look for those kinds of actions….like tearing a skirt off. …There was one on that Barbara Walters special, this child wore the little onesie with the snap-ups between the legs. And at age one would unsnap them to make a dress, so the dress would flow. This is a child who was assigned male. That’s a communication, a pre-verbal communication about gender.

Ehrensaft then counsels parents not to try to squelch non-sex-stereotyped behaviors (good advice), but ruins it with a faith-based assertion of innate gender identity:

And children will know [they are transgender] by the second year of life…they probably know before that but that’s pre-pre verbal.

Not to put too fine a point on it but…this is a PhD. developmental psychologist talking here. What is her evidence base for saying babies “know” their gender identity?

…Especially since, at other points in her presentation, Ehrensaft acknowledges that gender identity can be fluid.

So which is it? A baby innately “knows” their gender identity, or it’s mutable? To be logically consistent, Ehrensaft ought to also say that some infants are born (innately) “gender fluid”—an assertion that would be much closer to the truth, given the fact of lifelong neuroplasticity. I wonder when the NIH will fund a study to determine which babies are born “binary” and which “genderqueer”?

What if gender-fluid children transition but change their minds? No harm done, according to Ehrensaft. She breezily asserts [1:50] that there is “no data” that it harms kids to switch back and forth between identities, as long as we “support” them in their “journey”—presumably even if that journey takes them down the road to hormones and surgeries which will alter them forever. She even touts “nonbinary transition” [3:57] as if it is something to be celebrated when youth who define themselves as “agender,” “nonbinary,” or any of the other “genders” (better known as “personalities”) might choose irreversible medical interventions.

Is Ehrensaft aware of cases like this? Would she just chalk it up to this detransitioned woman being “gender fluid” instead of “binary” and the permanent damage done to her body just part of her “gender journey” for which we have “no evidence” of any harm?

My double mastectomy was severely traumatizing. I paid a guy, a guy who does this every day for cash, to drug me to sleep and cut away healthy tissue. I did this because I believed it would heal all of the emotional issues I was blaming on my female body. It didn’t work. Now I’m still all fucked up and I’m missing body parts, too.

Ehrensaft also thinks social media has “been a godsend” [2:08] and a “tremendous boon” for young people to find others like them, with the only real ill effect being the online bullying of trans-identified kids. To be fair, she does throw a bone later to the fact that some kids presenting to clinics may be using a “script” and it’s important to look deeper to see whether it’s “their script”—which is something; although if Ehrensaft was trained in child/adolescent developmental psychology, her cheerleading for nothing but the positive effects of social media is stunning. Has she never heard about online “communities” of teen anorexics and cutters?

Now to touch upon one final topic covered by Ehrensaft and others in the conference: permanent sterilization caused by prepubescent hormone treatment. This “side effect” is rarely mentioned in the countless media stories celebrating trans kids. One usually has to hunt for obscure literature references to find any mention. But during the conference, several providers do acknowledge—repeatedly–that puberty blockers followed by cross-sex hormones always result in permanent infertility. They do so at least three times in the conference: [3:53], [4:18], and [5:06].

During the closing panel discussion, Ehrensaft and Baum devote several minutes to the topic of sterilizing trans kids—but explain it away with a twofer: By equating it to treatments for children with life-threatening cancers, and by stating that parents reluctant to sterilize their 11-year-olds are only concerned because they selfishly want grandchildren.

Actually, it’s a three-fer, because Ehrensaft and Baum manage to squeeze in the usual emotional blackmail: children who have to go through their natal puberty might commit suicide. [5:06].

Ehrensaft:

Another thing that’s a show-stopper around [parents] giving consent is the fertility issue. That if the child goes directly from puberty blockers to cross- sex hormones they are pretty much forfeiting their fertility and won’t be able to have a genetically related child.

There’s a lot of parents who have dreams of becoming grandparents. It’s very hard for them not to imagine those genetically related grandchildren. So we have to work with parents around, these aren’t your dreams. [she laughs]. You have to focus on your child’s dreams. What they want.

Let’s be very clear here: Ehrensaft laughingly implies that parents concerned about their child’s human right to choose or not to choose to reproduce, a decision heretofore seen as inalienable and reserved for mature adults, are really only concerned about future grandchildren, not the bodily integrity or cognitive wherewithal of their prepubescent child. These egocentric parents are denying their children “their dreams.” These thoughtless parents need to be “worked with” by gender specialists.

And that’s not all: Ehrensaft goes on to shame these recalcitrant parents with the implication that puberty-blocked, 11-year-old trans tweens are more socially responsible than their clueless parents:

And what I will say about many of the youth who want puberty blockers is: I have never met such an altruistic group of kids around adoption! Never! “I will adopt because there are so many children who need good homes.” And I think that’s both heartfelt but also they’re trying to tell us the most important thing to me right now is being able to have every opportunity to have my gender affirmation be as complete as possible. Anything else is secondary.

Do we need a PhD in developmental psychology to tell us this? You bet an 11-year-old thinks anything but what they want RIGHT NOW is secondary. I want it, and I want it right now: the motto of youth, of children who are a decade or more away from full development of their reasoning, judgment, and awareness of future consequences.

But wait—perhaps there’s hope. Asks Ehrensaft:

The question is, can an 11-year-old, 12-year-old at that level of development, be really thinking and know what they want at age 30 around infertility?

Can they? Might it be ok to wait and allow this child to mature to adulthood before making such momentous decisions?

The answer to that is: We don’t think twice about instituting treatments for cancers for children that will compromise their fertility. We don’t say, we’re not going to give them the treatment for cancer because it’s going to compromise their fertility.

So here we have a woman who is directly responsible for sterilizing 11 and 12 year old children equating simply waiting–allowing a child to grow up to make their own decisions—with denying cancer treatment. And of course, we know what’s coming next: Transition or suicide.

For some of the youth, having the gender affirmation interventions is as life-saving as the oncology services for children who have cancer.

And they must have these interventions right now!

I wonder: Do Ehrensaft or any of the others here, so very certain of their moral superiority, ever lie awake at night wondering whether these children in their care could just as easily be supported in waiting?

Joel Baum instructs parents to transition their kids–or else.

Joel Baum, head of education for Gender Spectrum doubles down [5:09] to deliver the coup–de–grâce to any parents who might still be hesitating:

I’ll just add one thing here. When we’re working with families, what is the leverage point for that family?…The fact of the matter is at the end of the day, it is their decision and we just hope they’re going to make an informed decision. Just make sure you have all the information you need. Which includes:

Here comes the punchline—the ultimate “leverage point”:

You can either have grandchildren or not have a kid anymore because they’ve ended the relationship with you or in some cases because they’ve chosen a more dangerous path for themselves.

Here, I’ll just let one of my lovely, unpublished commenters translate Joel Baum’s so-very-subtle veiled threat into plain language:

You are a horrible mother and you are abusing your son. You’re the reason trans people kill themselves. I hope one day he escapes from you and your transphobic abuse and never has to see you again.

Never mind that my daughter desisted from trans identity; never mind that our family remains intact despite my “transphobic abuse” i.e., refusal to pay for hormones and top surgery. And never mind, Joel Baum, that there is no evidence that troubled youth will desist from self harm if their parents are terrified into paying for irreversible medical interventions.

At this juncture, let me repeat what I’ve said many times before: A concern about sterilizing children is not a statement about whether a person ought to reproduce or not. It’s about respecting the right of children to mature to adulthood to make the decision for themselves. It’s a basic moral tenet, respected in every other area of human rights law: you don’t sterilize children.

And this, too: There is no evidence, historical or otherwise, that a child prevented from medically transitioning will kill themselves before making their own medical decisions as an adult. That activist-clinicians feel justified in holding this threat over the heads of loving parents—and that journalists, politicians, and pediatric specialists who should know better abet them in wielding this weapon—is deeply shameful and should be exposed to the intense, disinfecting light of public scrutiny as long as necessary; until the purveyors of this immoral strategy are finally forced to answer the difficult questions they have been avoiding for the better part of a decade.

This conference is worth studying for anyone who wants to fully understand how a formerly rare diagnosis, with medical treatment only available for legal adults, has morphed into a pediatric specialty area where doctors, psychologists, and psychiatrists wave away the sterilization, drugging, and permanent medical alteration of children with nary a peep of dissent. And they do it by shamelessly scaring the bejesus out of everyone, by shaming parents into believing that unless they permanently sterilize little Judy or Billy at age 11, unless they agree to irreversible medical interventions for their teenager, they will be colluding in their child’s demise.

Watch the entire 5-hour presentation, even if you have to do it over several sessions. What you’ll be observing is how key movers and shakers on the cutting edge of pediatric transition in the United States are moving inexorably forward. Understand their tactics. Understand their ideology.

Because despite its steady progress so far, the “gender affirmative” pediatric transition juggernaut is only beginning to pick up speed.

[Meanwhile, if you haven’t already, be sure to read this post by a therapist who is skeptical of the “identity model” for trans-identified youth.]

The adolescent trans trend: 10 influences

Posted on July 18, 2016 by 4thwavenow

The below post is written by Overwhelmed, 4thWaveNow contributor and the mother of a teen daughter who insisted she was transgender, but who subsequently changed her mind. Other parents in the same situation have shared their experiences on 4thWaveNow, and a new research study (currently recruiting) is the first to systematically examine the phenomenon of “trans trending” amongst tweens and teens.

Trans activists and gender specialists constantly assure us that puberty blockers are harmless and “fully reversible.” They claim these drugs “buy time” for a young person to decide if they really are trans. But given that social transition + puberty blockers are followed in 100% of reported cases by cross-sex hormones (see here and here), the “buying time” assertion deserves a lot more scrutiny. If there weren’t other forces at work (like social contagion and the conditioning effect of being validated in the idea that you are “really” the opposite sex if you prefer the appearance and lifestyle of that sex), a 100% persistence rate in trans-identification simply wouldn’t be happening.

And when it comes to teens who experience onset of gender dysphoria in adolescence, parents like Overwhelmed, Penny White, and the founder of this website–who have personally observed their teens voluntarily desisting from a trans identity–are the ones who have actually bought time for their kids: precious time to realize that becoming a lifelong patient haunting the offices of endocrinologists and plastic surgeons is not the only way to live a gender-defiant life.

by Overwhelmed

Earlier this year, a Nature article reported on the May 2016 launch of a study aimed at documenting the psychological and medical impacts of delaying the puberty of trans youth:

Funded by the US National Institutes of Health (NIH), the US $5.7-million project will be not only the largest-ever study of transgender youth, but also only the second to track the psychological effects of delaying puberty — and the first to track its medical impacts. It comes as the NIH and others have begun to spend heavily on research related to the health of transgender people, says Robert Garofalo, a paediatrician at Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois, and a leader of the study. “We seem to really be at a tipping point,” he adds.

Garofalo and his colleagues aim to recruit 280 adolescents who identify as transgender, and to follow them for at least five years. One group will receive puberty blockers at the beginning of adolescence, and another, older group will receive cross-sex hormones. Their findings could help clinicians to judge how best to help adolescents who are seeking a transition.

Despite the fact that puberty blockers–followed in nearly every case by cross-sex hormones–have been prescribed for many years for “trans kids,” this study will be the FIRST in the United States to track the impacts of medical transition on this population. It has become increasingly popular for gender doctors to start trans-identified children on puberty blockers. The rationale is to avoid the potential psychological distress and the physical development of secondary sex characteristics associated with the “wrong puberty.” Based on the constant onslaught of celebratory articles about “trans kids” in the media, the public is likely unaware that puberty blockers and cross-sex hormones are not approved by the FDA for this purpose. These drugs are being used off-label and the science isn’t settled by any means. Even the gender doctors confess there is no medical consensus.

I appreciate that the Nature piece is not just another one-sided article touting pro-transition dogma. Although the journalist failed to mention that children who pause their natal puberty, and then directly proceed to cross-sex hormones, have the not-so-insignificant consequence of permanent sterility, she did include viewpoints not often seen in the mainstream media:

“But some scientists worry that putting off puberty in older children may disrupt bone and brain development, reducing bone density and leading to cognitive problems.”

“Because most children who question their gender do not do so past adolescence, many psychologists discourage “socially transitioning” until the teenage years.”

The debate is so heated — and evidence so sparse — that the authors of the American Psychiatric Association’s 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were unable to reach a consensus. “People are making declarations of knowledge that are their belief systems, that aren’t also backed up by empirical research,” says Jack Drescher, a psychiatrist at the William Alanson White Institute in New York City.”

But there is one assertion in the article–touted as settled science—that raises a huge red flag:

“But those who identify as transgender in adolescence almost always do so permanently.”

Many parents who read 4thWaveNow are VERY familiar with this assumption. When their child, out of the blue, with no prior history of gender dysphoria, claims to be transgender, most parents resort to internet searches to become more knowledgeable. They read articles like this one by Irwin Krieger, LCSW, which tells parents it’s pretty much inevitable their teen or young adult child will remain transgender:

…I do acknowledge that most teens who have come out to parents and others as transsexual are truly transsexual so as not to give them any false sense of the likelihood of their child having a change of heart.

Parents are encouraged to just start “supporting” their child by using the correct pronouns, buying new clothes and aiding their child with social (and possibly medical) transition.

Historically (prior to the year 2000), the research data did show that many kids who consistently believed they were the opposite sex during and after puberty held onto this belief into adulthood. But in the last few years, something new has emerged: a wave of post-pubertal, self-diagnosed trans teens. These youth may not fit the historical profile due to relatively recent influences like:

The social contagion phenomenon. Many confused teens and young adults (and increasingly, tweens) seek out answers from strangers online. They say they don’t “fit in,” that they prefer clothing and activities usually associated with the opposite sex. They ask, “Does this mean I’m transgender?” The answers they receive frequently affirm they are and urge them to “Transition NOW!” Places like Tumblr, Reddit, and YouTube (MTF and FTM transition videos) are full of this “wisdom.” The blog Transgender Reality documents some of these conversations.

Sometimes it isn’t an online influence that sparks a newly realized transgender status. There are more students socially and medically transitioning in high schools and universities. On some campuses there are entire friend groups claiming to be transgender, and an impressionable child who is befriended by this group may suddenly decide he/she is trans as well.

The ability to achieve an instant “special” status. There is an appeal for some to identify as transgender in order to receive extra attention or boost their social standing.

If a student announces to school administration that they’re transgender, it’s becoming taboo to question them. More schools are enacting guidelines (like this one co-authored by the National Education Association) that enable children to be treated as the opposite sex, regardless of maturity level or mental health status. And parents don’t need to be in agreement, or even informed, about these accommodations.

Additionally, some children and/or their parents may be enticed by the potential to become celebrities. After all, Jazz Jennings and Caitlyn Jenner have their own TV shows strictly based on their transgender identities.

The reduction in gatekeeping. The current train of thought among gender doctors and therapists is that gender identity is innate, unchangeable, and is often realized at a very young age. If you follow this line of thinking (and assume that no one could possibly be confused or misled into believing they are transgender), then you likely feel it is unjust, and even harmful, to make a child jump through gatekeeping hoops before medical treatment.

As an example of this logic, Dr. Johanna Olson-Kennedy, the medical director of the Center for Transyouth Health and Development at Children’s Hospital in Los Angeles, was recently quoted in this article about Sam who was given puberty blockers, then began testosterone injections and had a double mastectomy all by the age of 14:

“It is pretty well proven that people know their gender by the age of 5,” said the Center for Transyouth Health and Development’s Olson. “If we accept and believe that people know their gender by the age of 5, why not accept that trans kids know their authentic gender?”

Treating young people with gender dysphoria is critical, Olson said, as puberty increases the chances they will harm themselves.

“One of the things that puts trans kids at higher risk is this period of time when they are going through puberty,” she said. “Their body is becoming the adult or permanent version of this body they are not comfortable with.”

The push for transgender identities to be seen as a normal variation of human existence (like homosexuality). It has become more common for doctors and therapists to avoid labeling people who think they are the opposite sex as having a mental disorder. An example from Jack Drescher is in this article about the World Health Organization classification system:

When ICD-11 is published, being transgender will be listed in a different part of the document, potentially under conditions related to sexual health, said Drescher, who is a New York psychiatrist and a professor of psychiatry at New York Medical College. “So they’ll be diagnoses, but they won’t be mental disorder diagnoses.”

The medical community’s process of de-stigmatizing being transgender was also reflected in the last round of updates to the Diagnostic and Statistical Manual of Mental Disorders in 2013. The DSM, which is used by clinicians, replaced the diagnosis of “gender identity disorder” with “gender dysphoria.” The diagnostic class was also separated from sexual dysfunctions.

Identifying as transgender shares some similarities with anorexia nervosa and body dysmorphic disorder for which treatment consists primarily of therapy and possibly medication. But the regimen for gender dysphoric patients often includes medical interventions to physically alter their bodies to better align with their feelings, making this condition treated like no other mind/body disconnect.

The popularity of early social transition. It’s becoming increasingly common to socially transition prepubescent children, to encourage them to live as the gender with which they identify. In the Nature article cited above, psychologist Diane Ehrensaft (a proponent of the gender affirmative model) and transgender rights attorney Asaf Orr comment on this approach:

But encouraging children to live as the gender they identify with is an increasingly popular choice. “There’s been a real sea change,” says Diane Ehrensaft, a psychologist at UCSF. She reports seeing more prepubescent patients recently who have already transitioned socially.

Many transgender-rights activists support this model, and liken any other approach to gay-conversion therapy. “You’re telling a kid, ‘I don’t believe you’,” says Asaf Orr, staff attorney at the National Center for Lesbian Rights in San Francisco. The best strategy, he says, is “to affirm a child’s gender exploration, regardless of what the end result is going to be”.

The gender affirmative model encourages children to “explore” their gender identity through social transition. It is often stated that it’s harmless to do so since no hormones or surgeries are involved. But this doesn’t take into account that children who are treated as the opposite sex are being conditioned to continue in their belief, potentially leading to future medical interventions. Even the Dutch researchers who pioneered the use of puberty blockers to treat transgender youth, do not recommend social transitioning in prepubescent children due to the “high rate of remission.”

6. Transactivism. There is a burgeoning group of people who are out to educate the world about the importance of accepting transgenderism. Their pleas are often presented as anti-bullying or anti-discrimination campaigns. They tend to cite high suicide rates and imply that misgendering someone or questioning their gender identity may contribute to these statistics. Many of these activists are transgender themselves and feel they are the most knowledgeable about their condition. They pass themselves off as experts. Many conduct training sessions in schools, police departments, hospitals, etc. They write books, media articles, blog posts. Host conferences. Just one activist can have considerable influence. And there are so many voices shouting this philosophy that it drowns out opposing viewpoints.

7. Framing transgender acceptance as the new civil rights movement. Personally, I was elated when the US Supreme Court declared same-sex marriage legal. But, after that triumph, organizations like the Human Rights Campaign (HRC), the American Civil Liberties Union (ACLU) and the National Center for Lesbian Rights (NCLR) seem to be focusing more intensely on the transgender rights movement.

It is admirable to oppose discrimination against transgender people in employment, housing and appropriate health care. And I very much condemn violence against them. But there needs to be a balance. It should be acknowledged that some impressionable children, teens and young adults are confused and erroneously self-diagnose as transgender. This vulnerable population needs protection from unnecessary medical interventions. But since these organizations promote the “born this way” dogma, anyone who doesn’t blindly accept and support them as the opposite sex, is called misinformed or even abusive and bigoted.

In a short period of time, the transgender rights movement has made substantial gains. There have been laws passed in the United States and Canada that could be interpreted to mean any therapy that doesn’t affirm a youth’s gender identity is illegal. US schools are being pressured to allow transgender-identifying students into opposite sex bathrooms, locker rooms, and even bedroom assignments on overnight field trips. Overall, there has been a tendency in recent guidelines, legislation and court cases to prioritize gender identity over sex.

The significant growth of the gender industry. There has been a rise in demand for gender clinics, doctors, therapists, endocrinologists, surgeons (and even “packers”—penile prostheses) due to the rapid increase in gender dysphoric children.

Back in January 2016, this pro-transition Cosmopolitan article stated that the first US transgender youth clinic opened in Boston in 2007. And since then 40 more have begun catering—exclusively to children—in the United States.

Surgeons are finding their services are increasingly sought after as well. Dr. Curtis Crane (who performs mastectomies on minors) has commented on how he cannot keep up with the demand for phalloplasties, even though he keeps training more surgeons in the technique:

Crane says he’s one of only a few surgeons in the U.S. performing a high volume of phalloplasties — a booming surgical niche fueled by an increasing number of transgender men seeking to complete their anatomical transition. Even after hiring and training two colleagues to perform the eight-hour surgery, Crane’s patients must wait a year to have it done.

I frequently come across statements from doctors and therapists saying their transgender-based business is flourishing, often with a significant backlog. Due to their expertise, these are the professionals that I wish would speak out about potential over-diagnosis and over-treatment of trans-claiming youth. You have to wonder if they truly see the massive increase in patients as a positive (“more people are finally being treated because they are better informed and there is less stigma”). Or do they see trouble on the horizon (“I’m pretending everything is peachy, but I’m really concerned this may be a disastrous medical trend”)?

Selective media coverage. Many media outlets portray positive “trans kids” stories, but choose to omit information not favorable to the transgender rights movement. Usually there is no discussion of the high desistence rates, or of the significant risks associated with medical treatments. And when facts like these are not included, the public is misinformed.

US media is chock-full of pro-pediatric-transition stories, many of which have been discussed on this site. You can also click on the Transgender Trend blog links below for examples and excellent analysis of biased programming from the UK’s BBC:

The silencing of skeptics. Unfortunately, it is taboo to voice concerns that children, teens and young adults may be at risk of unnecessary medical transitions. This blog is one of the ONLY places online that parents and their allies can speak out, although most choose to do so anonymously to maintain their privacy.

Unfortunately, there are some trans activists, deeply offended by anyone contradicting the transgender narrative, who work to discredit anyone who dares to express opposing viewpoints. To these activists, it is fair game to try to get someone fired from their job or to post pictures of their children with sexually explicit captions (see the Michael Bailey link). Alice Dreger , Michael Bailey and Kenneth Zucker have been recipients of this treatment.

On a positive note, I’ve heard there are a growing number of professionals—doctors, nurses, teachers, journalists—whispering their concerns to each other. But due to the current environment, they’re afraid to speak publicly. Afraid they’ll be called bigots. Afraid they’ll lose their jobs.

We are living in a time when the number of gender dysphoric children is rising exponentially with no sign of a leveling off.

Kids are being medically transitioned regardless of the fact that there’s no medical consensus of what the best treatment options are. No one knows the long term consequences of puberty blockers, cross-sex hormones and surgeries in this population. This may very well be a disastrous fad similar to the false memory and ritual abuse scares of the ‘80s and ‘90s. And to top it all off, there’s significant pressure not to publicly express skepticism.

Mainstream media involvement would be welcome, along with brave professionals speaking up about their concerns. It is essential that the public be informed not only of the pros, but also the cons, of transitioning children.

Instead of focusing solely on treating the burgeoning number of gender dysphoric children, professionals ought to investigate the reasons for the radical shift in this population. Why are so many presenting to gender clinics? Why are there currently so many females vs. males seeking treatment (historically it was the opposite)? Why do so many have co-morbid mental health issues—autism spectrum disorders, OCD, ADHD/ADD, depression, etc.? These are important questions in need of answers. Especially because of the often irreversible nature of medical interventions, and that the patients are children with the rest of their lives ahead of them.

Today’s children are exposed to all kinds of influences that weren’t present until relatively recently. It would make sense to now reject the statement “those who identify as transgender in adolescence almost always do so permanently.” And to re-evaluate treatment protocols so that children, teens and young adults receive the thorough mental health care they need, and avoid any unnecessary medical interventions.

4thWaveNow

A community of people who question the medicalization of gender-atypical youth

Tag Archives: Diane Ehrensaft