A “gay boy in a girl’s body” desists: Guest post

This is a guest post by long-time 4thWaveNow community member overwhelmed. She is available to respond to your comments and questions in the comments section for this post.

Most trans activists and gender specialists will concede that at least some prepubescent children will grow out of gender dysphoria. (How many? No one knows, but it’s a current hot topic which I’ll be tackling in a post in the near future). But it’s touted as if it were gospel that once puberty hits, if a teen says they’re trans, then they are–case closed. Gender dysphoria at puberty = gender dysphoria for life.

As my own personal story attests, this is simply not always the case. I’ve been hearing from more and more young people who have bucked this supposed hard-and-fast truism. And now we hear from another mom whose daughter has changed her mind.

It has long been known that upwards of 90% of gender dysphoric girls are same-sex attracted, but overwhelmed‘s daughter is one of a growing number of young women who are opposite-sex attracted but who also believe themselves to be transgender.

As I experienced with my own teen, overwhelmed tells us that most of the medical and psychological professionals she encountered–far from being cautious and methodical about handing out a trans diagnosis–rushed to the assumption that her daughter was transgender simply because she claimed to be.

Seeing a pattern, readers?


Another mom listens to her gut

 

by overwhelmed

Earlier this year my daughter revealed that she really was a gay boy trapped in a girl’s body. She had never shown any previous signs of discomfort with her body so I was confused by this belief, especially the urgent desire to medically transition NOW!

I called my pediatrician’s office for a referral to a psychologist for my daughter. The nurse who answered the phone had just attended a transgender educational seminar and felt like she knew all about my daughter, even though she had never met her. This nurse completely dismissed my over 16 years of knowledge of my daughter. Just like that. She told me that my daughter’s pre-existing depression and anxiety were symptoms of her being transgender, not the other way around. I told her that my daughter had been online in Tumblr communities and had watched a lot of YouTube transition videos that had likely influenced her. The newly educated nurse, however, basically told me that I needed to accept that she was transgender, and to start supporting my daughter in being her authentic self.

My daughter’s first psychologist also completely dismissed any knowledge I had about my daughter. At the time I was just relieved to have found someone to talk to my daughter who I was concerned might be suicidal. I was happy that this psychologist had experience working with others who were transgender. I mistakenly believed that she would be able to tell that my daughter wasn’t an authentic trans boy. While traveling to and from her therapy sessions, I shared transgender scientific research with my daughter— that many people identifying as transgender have mental health problems, that the vast majority (80%) of kids outgrow their gender dysphoria, and so forth. I didn’t realize it initially, but my daughter was also sharing this information with the psychologist. And, the psychologist was telling my daughter that the information I was telling her was bogus, made-up information. She mentioned that she had a PhD and knew much more than I. She told her that I shouldn’t believe everything I read online. She told my daughter that she wanted to include parents during the next session so that she could “set me straight” on the facts.

I fired her.

In the meantime, I felt the need to get information out there, so that other parents could benefit from the information I had found. There is such an overwhelming amount of information online touting that gender is unchanging, that transition is the only cure. I know this is wrong. All you have to do is look at the scientific research, or even to the growing number of detransitioners who are speaking out. I started submitting comments to transgender media articles and even on some parenting forums. I am a person who tends to be pretty careful in what I write, never intending to be offensive, but one site I went to banned me immediately because I recommended googling “transgender regret” as a way to get information from a different perspective! I have also had quite a few comments on media articles disappear due to similar recommendations.

Overall, as a parent who did not buy into my daughter needing cross-sex hormones and lopped off breasts, I am ignored when I voice my concerns. I’m silenced. I’m vilified. I’ve been called transphobic and gleefully told that it isinevitable that my daughter will commit suicide due to the lack of support.

Unfortunately, parents concerned about their trans-identifying children face a perfect storm of opposition. They are battered from many directions, told that they are wrong, warned that if they don’t start supporting their child that suicide is a likely outcome. These messages come from their own children, the overwhelming pro-trans voices online, the news and media, medical professionals, government officials, and even school districts.

I admit that there were times when I doubted my gut instincts. But, fortunately I was able to find a group of parents in the same situation (thanks 4thwavenow!) and have greatly benefited from their support. And, fortunately I found another therapist for my daughter who was able to uncover the reasons she felt disconnected to her sex. She had once felt powerless as a female (due to some traumatic experiences) and thought a male identity would be a better fit. Now she no longer identifies as transgender. While still eschewing most things considered conventionally feminine, she has embraced the fact that her presentation and passions don’t make her any less female.

Although I am able to relax about my own daughter’s status, I am still very concerned about the vast majority of parents in this situation. I fear that many won’t find the support system that was so beneficial to me. I fear that they won’t be able to find a mental health professional that will try to uncover their child’s underlying reasons for identifying as trans. I fear that many parents will succumb to the pressure.

It shouldn’t be like this. There shouldn’t be so much pressure against parents who are genuinely concerned about their children’s health.

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Parents, keep listening to your gut—not the gender therapist

A few months ago, my teenage daughter stopped trying to “pass” as male. She dropped the self-defined-as-male uniform, the stereotyped swagger and the fake-deepened voice and just—moved on. Her fervent desire to be seen and treated as a boy faded away, just as other formerly unshakable ideas and urges had in the past. And our relationship has never been better.

Although I’ve allowed myself to exhale, just a little, she will remain at risk, because every sector of society—the media, the government, the schools, medicine and psychology–is now saturated with the message that trans is real; trans is good;  and if you’re a “gender nonconforming” girl–one who prefers the clothing, activities, and hairstyle more typical of the opposite sex– you just might actually be a boy.

What did I, and the other adults who love her, do? It hasn’t been easy. In fact, for a time it was a living hell, a purgatory of slammed doors, stony silence, yelling matches, and mostly—waiting.

There was no magic answer. We rode it out. I learned something about keeping my mouth shut. About saying my piece and then leaving it be.  About living with uncertainty.  We didn’t cater to demands for instant gratification.  We paid for and encouraged activities that would get her out into nature and off the Internet. Mostly, we waited.

We drew a clear line in the sand: There would be no money to pay for a gender therapist, testosterone, or a binder. If she wanted to pursue those things at the age of medical majority, that would be her choice—and it would be on her dime. At the same time, we let her know that her clothing and hairstyle choices were hers to make. Not always successfully, we tried to calmly and sparingly convey the message that however she dressed, whatever interests she pursued, she was a female—perhaps an unusual one, but a young woman nevertheless, who might someday become a role model to show other girls just how amazing and truly expansive a woman can be.

Like many who read this blog, I phoned gender therapists during the weeks after her announcement that she was trans. Without even meeting my child in the flesh, all four of these therapists talked to me like this trans thing was a done deal. I wrote about one of those conversations here. One very friendly therapist, who identifies as FTM and whose website stressed “his” commitment to “informed consent,” assured me that there was no need for my daughter to first experience a sexual or romantic relationship before deciding whether she was trans. “Most of the young people just skip that step now,” the therapist said.

Skip that step? I thought back to my own adolescence. I didn’t even begin to have a clear idea of who I was, as a sexual being, until after I’d had more than one relationship. It took years for me to come to know my body’s nuances and intricacies, its capacity for pleasure, how I might feel in relation to another.

This same therapist signed my kid up for a “trans teen” support group scheduled for the following week—again, without ever having met her. “There’s nothing you or I can do about your daughter being trans,” said another therapist… on the phone, without having met my kid. Yet another therapist refused to talk to me at all; insisted she’d have to have a private appointment with my kid first.

Contrary to the myth promulgated by the transition promoters, at least in the United States, there is no slow and careful assessment of these kids who profess to be trans. The trend is to kick out the gatekeepers, and  move towards a simple model of “informed consent”: If you say you’re trans, you are–no matter how young and no matter when you “realized” you were trans.

All these therapists seemed well meaning enough. They believed they were doing the correct thing. But with each conversation, I felt more and more uneasy. My gut feeling that something wasn’t right led me to research, to question…to put the brakes on. And the more I read, and thought, and understood, the more determined I became to find an alternative. I started this blog out of sheer desperation. I needed to find someone, anyone, who understood what I was going through. I needed other parents to talk to—badly.

My kid never did go to a gender therapist. Never did sit in a room full of “trans teens.” If she had, I feel certain she’d be sporting a beard right now.

When I first started blogging, I got a lot of hate mail. In every anonymous drive-by comment, the hater referred to my “son” who would grow up to hate my guts. “He” would surely commit suicide, and more than one of them wished me a lifetime of misery when that inevitably happened. Even the mildest posts resulted in hostile reblogs from strangers who had not the slightest idea of my family’s situation.

At first, these anonymous barbs stung, but it didn’t take long for me to realize that I could rely on my inner parental compass. Because, see, I know my daughter. I knew, when she suddenly began spouting the gender-policed jargon planted in her head by Tumblr trans activists, that this wasn’t who she really was. This was a girl who, all through childhood, was never “gender conforming” but who was secure in herself because I’d made sure she knew, via my words and my example, that girls could be and do anything.

Most of all, I knew she needed me—not to blindly “support” and give in to her every demand, but to simply BE THERE, even as a limit; a steady place she could push and rail against. It was scary, and painful, being on the receiving end of teen outrage.  Because a teenager does have the right to make some of their own decisions. And because no parent gets it right all the time. (Paradoxically, part of being a halfway decent parent is knowing how imperfect you are at the job.) But one thing became more and more clear to me:  my child did not need a parent who would collaborate in sending her down a road to being a permanent medical patient. In fact, she needed protection from the very same people who were sending me hate mail on Tumblr.

Not so long ago, child and adolescent psychologists—people who actually study the development of young human beings—were frequently cited and quoted. These experts, as well as every other rational adult, were well aware that kids shift identities: try this one on, shed it like a snake skin, try on another. Younger kids go through a long and wonderful period of make believe and magical thinking. They are actually convinced they ARE the identity they try on. And adolescents are renowned for trying on hairstyles, belief systems, clothing styles—only to discard them after a few weeks, months, or maybe even years.

In contrast to today’s transgender-soaked paradigm, when a kid’s announcement that they are the opposite sex is taken at face value, it has been previously acknowledged–for decades–that parents are largely responsible for the inculcation of gender stereotypes into their children’s minds. Children aren’t born hating their sexed bodies. They only grow to reject themselves when someone they look up to promotes the idea that their likes and dislikes in clothing, toys, activities, or other pursuits are seen as incongruent with their natal sex.

 A child’s burgeoning sense of self, or self-concept, is a result of the multitude of ideas, attitudes, behaviors, and beliefs that he or she is exposed to. The information that surrounds the child and which the child internalizes comes to the child within the family arena through parent-child interactions, role modeling, reinforcement for desired behaviors, and parental approval or disapproval (Santrock, 1994). As children move into the larger world of friends and school, many of their ideas and beliefs are reinforced by those around them. A further reinforcement of acceptable and appropriate behavior is shown to children through the media, in particular, television. Through all these socialization agents, children learn gender stereotyped behavior. As children develop, these gender stereotypes become firmly entrenched beliefs and thus, are a part of the child’s self-concept.

… Often, parents give subtle messages regarding gender and what is acceptable for each gender – messages that are internalized by the developing child (Arliss, 1991). Sex role stereotypes are well established in early childhood. Messages about what is appropriate based on gender are so strong that even when children are exposed to different attitudes and experiences, they will revert to stereotyped choices (Haslett, Geis, & Carter, 1992).

But now, we have people like this: the mother of a six-year-old girl who has “transitioned” to male, writing storybooks to indoctrinate kindergartners. To suggest to them that they, too, might really be the opposite sex:

“Can the doctor have made a mistake? Was I supposed to have been born a boy? Am I the only kid in the world like this?”

Deep down, Jo Hirst had been anticipating these questions. And she knew she had to get the answers right.

It was bedtime, and her six-year-old was curled up on her lap. Assigned female at birth, from 18 months of age Hirst’s son* had never wanted to wear female clothing and always played with boys.

I challenge anyone to find me a single account of a “transgender child” which does NOT resort to talking about toys, hairstyle, clothing, or play stereotypes to justify the diagnosis of “trans” in a young child.

Our kids are being cheated of the opportunity, the breathing space, to simply explore who they are without a gaggle of adults jumping in to interfere with the process by “validating” their frequently transient identities. Kids are being encouraged to freeze their sense of self in a moment in time, during the period of life when everything is in flux. And even though key researchers have said over and over again that most gender dysphoric kids “desist” and grow up to be gay or lesbian; even though the latest research denies any such thing as a “male” or “female” brain, parents are encouraged to socially transition their kids, put them on “puberty blockers,” and refer to them by “preferred pronouns.”

For very young children, this cementing of the child’s identity in a period when they most need the freedom to simply play and explore—to “make believe”—is essentially stunting the child’s development.

Young children go through a stage where it is difficult for them to distinguish reality from fantasy.  Among many other things, it’s why we have ratings on films. A young child can’t understand that the monster onscreen is not real.

Research indicates that children begin to learn the difference between fantasy and reality between the ages of 3 and 5 (University of Texas, 2006).  However, in various contexts, situations, or individual circumstances, children may still have difficulty discerning the difference between fantasy and reality as old as age 8 or 9, and even through age 11 or 12. For some children this tendency may be stronger than with others.

Just exactly what is motivating doctors and psychologists to jettison decades of research and clinical practice in favor of a completely unsubstantiated and unproven hypothesis of “transgender from birth”? The glib answer is: suicide. But if a gender nonconforming youth expresses the desire to self harm, encouraging that youth to further dissociate from their whole selves (because the body and mind, contrary to the bleating of trans activists, are not separate units, but a whole) is not a responsible way to support mental health.  As this commenter said in a recent post on GenderTrender:

 Wow. Conservatives aren’t the only ones who suck at science. Brain sex? Seriously? If you’re allegedly born in the wrong body, why doesn’t your brain count as part of the “wrong body”? Your brain is telling the truth but the rest of your body is a liar? Wtf? This shit is as sensible as scientology.

And when it comes to teens,

 Teens often pick up on cues and assimilate ideas presented in movies/films viewed in the movie theater and other sources, (online sources for watching movies now eclipse movie theater viewings or film DVD rentals for teens), and while teens already understand the difference between fantasy and reality, they may still absorb or become attached to ideas that are powerfully presented in films but that have no basis in reality, the teen not having enough experience or knowledge to sort propaganda from fact, fiction from reality. Films, television programs, music and statements from celebrities can [and do] become a part of the thinking and emotional/psychological makeup of teens and children.

This used to be a “duh” thing. Are teens influenced by what they imbibe, what’s in fashion, what celebrities (like Jazz Jennings and “Caitlyn” Jenner and Laverne Cox) are doing,  what their peers are saying and doing? Might socially isolated teens be even more swayed by what they see on social media, while they sit for hours, alone in their rooms?

Facebook depression,” defined as emotional disturbance that develops when preteens and teens spend a great deal of time on social media sites, is now a very real malady. Recent studies have shown that comparisons are the main cause of Facebook depression; the study showed that down-comparison (comparing with inferiors) was just as likely to cause depression as up-comparison (comparing with people better than oneself).

…Other risks of extensive social networking among youth are loss of privacy, sharing too much information, and disconnect from reality.

My daughter, like so many others I’ve now heard about, emerged from months of self-imposed social isolation and YouTube/Reddit binges, to announce, out of the blue, that she was transgender. And simply for questioning this, for refusing to hop aboard the train, I’ve been labeled a “child abuser” of my “son”? Until the last few years, parents who recognized that teens go through phases weren’t considered abusive. They were considered well informed.

Not so long ago, parents and helping professionals neither interfered with nor bolstered a particular identity that a kid was trying on. Everyone understood this was an important part of growing up: to allow our young to experiment, to see what worked and what didn’t. It’s called the development of a self. It takes years. It’s not even complete at 21. The self doesn’t emerge, fully formed and immutable at birth. It develops in response to experience, to love, and to adversity.

Given my own daughter’s desistence from the idea that she is or was ever “transgender,” I feel even more strongly that parents are right to resist the push by every sector of society to identify “gender dysphoric” young people as “trans.”

So you bet I’m going to keep doing what I can to support parents who want to challenge and at least delay an adolescent’s decision to permanently alter body and mind with hormones and surgeries. You bet I’m going to try to save my own kid from what amounts to a cult that won’t let you leave if you change your mind, without serious social consequences. You bet I’m going to continue to protect my daughter and others like her from a lifetime of difficulty, from the rapacious medical industry that is profiting from the regressive resurgence and marketing of gender stereotypes.

You can also bet that I’m going to continue shedding light on the frankly insane practice of labeling very young children as transgender, grooming and conditioning them as preschoolers to believe their own bodies are somehow wrong and alien, that they must undergo teasing and torment from other children, that they must wear prosthetics to amplify or hide their own genitalia to be accepted as they are. Or just as bad: That the entire world must be browbeaten into redefining  biological reality such that “some girls have penises” and “some boys have vaginas.”

And this work is not just about protecting kids. It’s also about supporting family members and friends who are so deeply affected by the transgender narrative.  The trans activists, the media, the doctors and psychiatrists–none of them talk about the terrible damage done to the family system, to the fabric of close relationships, when a child “transitions.”  All the activists have to say is that the skeptical parents and loved ones are “transphobes.” No one talks about the fact that the majority of these dysphoric kids would grow up to be gay or lesbian adults if not interfered with;  adults with healthy, intact bodies, not poisoned by drugs and carved up by surgeons’ knives.

So we have to keep talking about it. We have to keep the lights on in our corner of the Internet, even if only to document this strange medical and cultural fad for future historians.

Thanks to everyone who is traveling this road with me. While I know we often feel swamped and hopeless, we have each other for strength and courage. And for now, that will have to be enough.

Skeptical gender therapist: “A medical doctor is not a candy seller”

candy seller

In yesterday’s post, I focused on the situation in the United Kingdom, where the school system is deeply enmeshed with a trans activist organization which peddles its message to kids as young as 4 years old. And the majority of posts on this blog document the seemingly unstoppable trend to diagnose and treat children as “transgender.” With this overwhelming level of societal and medical support, the issue must be pretty much settled—right?

Not according to the gender specialists themselves, it isn’t.

Hot off the presses, in the October 2015 issue of the Journal of Adolescent Health, a team of Dutch researcher-clinicians report findings from a survey of gender clinics which serve dysphoric children around the world.

Although you’d never know it, judging by the accelerating trend to socially “transition” kids as young as 3, freeze adolescents’ natural puberty with GnRh agonists, and then move on to chemical sterilization via cross-sex hormones thereafter, there is no  consensus amongst gender specialists that this current treatment protocol is the way to go.

The qualitative survey, entitled “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study” was conducted by a group of well-known Dutch researchers/gender specialists who are themselves actively involved in administering puberty blockers and other treatments to “transgender” children. The authors surveyed 17 treatment teams (endocrinologists, psychologists, MDs, psychiatrists, ethicists) regarding their views and experiences.

Many of the parents who contribute to and read this blog agonize about their difficulty finding therapists and doctors critical of the I’m-trans-if-I-say-I-am paradigm. I hope this post gives some measure of hope to those parents. While the skeptical specialists (nearly all of them psychologists or psychiatrists, with most endocrinologists and pediatricians apparently submitting pro-transition comments) are quoted anonymously, at least we know they’re out there. And enough of them exist to tell us that the runaway pediatric transition train may not have completely lost its brake pads—yet.

The journal article can be read in its entirety here, and the abstract summarizes the key findings:

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions…

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived…

CONCLUSIONS:

As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.

Because my aim here is to show that gender specialists are not unanimously aboard the child transition bandwagon, this post will mostly highlight the comments from the more skeptical gender specialists surveyed. Amazingly (to me), the doubters seem to hit nearly all the same points I do in my blog posts.  [Note: Use of boldface to emphasize certain passages is my own, not that of the authors.]

So what is gender dysphoria?

Is GD a normal variation of gender expression, a social construct, a medical disease, or a mental illness? In the DSM-5 and the to-be-released ICD-11, the main challenge in classifying GD has been to find a balance between concerns related to the stigmatization of mental disorders and the need for diagnostic categories that facilitate access to health care, payment by insurance companies, and the communication between diverse professions.

I spend a fair amount of time reading articles and social media posts authored by gender specialists. It’s quite evident that there is currently pressure to completely de-stigmatize the transgender diagnosis…yet still find a way to get the “treatment” paid for by private insurance companies (or the taxpayer via public insurance such as Medicare or Medicaid). This thread from the WPATH public Facebook page [commenter names redacted] is illustrative of the dilemma the survey authors point to in the passage above.

wpath gender incongruence

So, this thread seems to indicate that providers are moving away from gender dysphoria as a disorder; even as an experience which causes distress. But why then would there be a need for medical treatment? This conundrum is addressed by the 17-clinic survey authors:

The interviews and questionnaires show that most informants find it difficult to articulate their thoughts about this aspect. Most see GD as neither a disease nor a social construct, but as a normal, but less frequent variation of gender expression. However, some note that you would not need medical procedures to make the lives of people with GD more satisfying if it were merely a normal variation.

Another thread from the WPATH public Facebook page seems to justify transition services for someone who just wants a “joyful and loving life.”

wpath joyful life

But when it comes to young people, at least one psychiatrist in the survey study gives us a less sanguine view of such quality-of-life justifications for medical transition:

“I find it extremely dangerous to let an adolescent undergo a medical treatment without the existence of a pathophysiology and I consider it just a medical experimentation that does not justify the risk to which adolescents are exposed. Gender dysphoria is the only situation in which medical intervention does not cure a sick body, but healthy organs are mutilated in the process of adapting physical and congruent psychological identity.” –Psychiatrist

I feel certain at least a few of the parents who frequent this blog wish they had the office phone number for this reasonable clinician. Amirite?

On the wisdom of puberty blockers

How many of us have asked, “but what if puberty blockers also inhibit the psychological/neurological maturation that comes with puberty–and beyond?” And, because many kids actually outgrow their gender dysphoria, interrupting puberty would deny them the opportunity to become comfortable in their bodies and avoid a life as a permanent medical patient.

It’s a pleasant surprise to see an acknowledgement of some of these concerns here:

In the literature, the concern is raised that interrupting the development of secondary sex characteristics may disrupt the development of a gender identity during puberty that is congruent with the assigned gender. The interviews and questionnaires show that some treatment teams share this view.

One clinician even talks about lesbian women who would have been misdiagnosed as “trans” children in an earlier time.

I have met gay women who identify as women who would certainly have been diagnosed gender dysphoric as children but who, throughout adolescence, came to accept themselves. This might not have happened on puberty blockers.”–Psychologist

So at least one psychologist who works on a pediatric transition team acknowledges what many, formerly gender dysphoric women, say: that if there had been “gender clinics” for kids in the 1950s, 60s, 70s, or 80s, they would not be happy lesbian adults today, but sterilized “trans men.”

Speaking more broadly, another therapist has this to say:

“I believe that, in adolescence, hypothalamic inhibitors should never be given, because they interfere not only with emotional development, but [also] with the integration process among the various internal and external aspects characterizing the transition to adulthood.” –Psychiatrist

On co-occurring psychological/psychiatric issues

If you read through the part of this blog where most parents congregate and introduce themselves for the first time, some common themes emerge. One is the observation by many parents that their kids have other mental health issues, nearly always predating the (sometimes sudden) announcement that they are transgender.  While most activists insist that transition is the cure for what ails a dysphoric child or teen, the clinicians working in the trenches aren’t so sure.

The risk of co-occurring psychiatric problems in children and adolescents with GD is high. The percentage of children referred for GD who fulfilled DSM criteria of at least one diagnosis other than GD is 52%. The psychiatric comorbidity in adolescents with GD is 32%. Another study shows that 43% of the children and adolescents seen in a gender identity clinic suffer from major psychopathology. To date, the precise mechanisms that link GD and coexisting psychopathology are unknown.

Miscellaneous physical and psychological risks of medical transition

The surveyed clinicians acknowledge many of the concerns discussed regularly on this blog.

The possible consequences of suppressing puberty for cognitive and brain development are unclear and debated at this moment. The normal pubertal increase in bone mineral density may be attenuated by puberty suppression, and it is uncertain if there is complete catch-up after treatment with cross-sex hormones.

While it only merits one sentence (and no direct quotes), the surveyed clinicians appear to view sterilization as an important concern:

In the interviews and questionnaires, the loss of fertility was often mentioned as a major consequence of treatment.

And here’s an additional worry I haven’t seen in writing before: the potential negative impact of puberty blockers on future SRS surgery.

In addition, various informants stressed the importance of the fact that the penis and scrotum should be developed enough to be able to use this tissue to create a vagina later in life. Very early use of puberty suppression impairs penile growth and consequently makes certain surgical techniques impossible.

Will we see this rather thorny issue discussed on an episode of the Jazz Jennings reality show? Will the Tumblr trans activists screaming “now or never” take heed?

On whether kids are mature enough to make these decisions

One informant stated that the decision whether to start with hormones should only be made during adulthood: “We should facilitate his or her process of integration in the society and if he or she would undergo hormone- and surgical treatments he or she could decide [on this] during adulthood.” —Psychiatrist

Influence of the Internet and social media

You know how trans activists scoff at our observations that our kids only started talking about “transition” after binging on YouTube and Reddit?

They speculated that television shows and information on the Internet may have a negative effect and, for example, lead to medicalization of gender-variant behavior.

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

Hello? The Advocate? The Boston Globe? The Washington Post? Anybody?

Furthermore, interviews and questionnaires show that treatment teams feel pressure from parents and adolescents to start with treatment at earlier ages.

Puberty suppression has been adopted as part of the treatment protocol by increasing numbers of originally reluctant treatment teams. More and more treatment teams embrace the Dutch protocol but with a feeling of unease…these professionals also have doubts because of the lack of long-term physical and psychological outcomes.

Hey, journalists. Obscure blogger over here quoting actual gender specialists, so you can’t say it’s just a bunch of nervous Nellie-moms making shit up. Need the link again? Oh, that’s just the abstract, here’s the pre-publication full-text, right here.

Self-harm/suicidal ideation

For several informants, a reason to use puberty suppression was the fear of increased suicidality in untreated adolescents with GD. Research shows that transgender youth are at higher risk of suicidal ideation and suicidal attempts. Nevertheless, caution is needed when interpreting these data because they do not show causality or directionality.

The meaning of that last sentence is crystal clear, and entirely in accord with what I, and other critics of the harmful “transition or suicide” meme that adult trans activists continually propagate, have tried to point out. While no one disputes that there is a higher self-harm and suicidality rate amongst trans-identified young people, there is no evidence that such self-harming behaviors and thoughts are ultimately alleviated by “transition.” Further, as this sentence implies, the “directionality” could be the reverse of what trans activists promote. Having a trans identity and/or facing the monumental prospect of medical transition could be a cause of self harming (in addition to the preexisting or comorbid mental health issues so many of these young people seem to have).

This is not the moment for another flippant call for journalists to take heed. This is deadly serious business: the terrible toll of self harm and suicide among trans-identified youth.  I have not seen a single news treatment of suicide or suicide risk that has even hinted at what these clinicians are stating baldly. Isn’t it time for a more nuanced discussion?


And finally: Leave it to a medical ethicist to point out the huge logical fallacy in the “informed consent” model of treatment now running rampant:

“The fact that somebody wants something badly, does not mean that a health care provider should do it for that reason; a medical doctor is not a candy seller.”— Professor of health care ethics and health law

Imminently sensible. So how is it that “informed consent” and the demonization of “gatekeepers” is more and more the norm? How is it that self identification as trans, even for young children, is fast becoming the only requirement for obtaining treatment? There is something strange going on here. If even some experienced gender specialists  are expressing doubts, why does the media behave as if the issue has been settled?

The positive attitude of many health care providers in giving hypothalamic blockers…is based on the need to conform to international standards, even if they are conscious of a lack of information about medium and long term side effects.” –Psychiatrist

But how can there be “standards” (they are talking about WPATH here) that these providers feel pressure to conform to, if the standards are not based on solid information about risks and benefits? Exactly which cart is pulling this runaway horse?

As still little is known about the etiology of GD and long-term treatment consequences in children and adolescents, there is great need for more systematic interdisciplinary and (worldwide) multicenter research and debate.


Reason for hope?

The article concludes in a way that makes me feel a whisper of hope for the future.

Several professionals mentioned that participation in the study made them think more explicitly about the various themes, and it encouraged them to discuss the issues in their teams. In the Dutch teams, we therefore introduced moral deliberation sessions to talk about these ethical topics. The first reactions of the professionals were positive; the sessions made them rethink essential aspects of the protocol.

Will this “moral deliberation” and “rethinking” result in more caution, or even a desire to put a halt to the pediatric transition train? Time will tell, but it is encouraging that at least the Dutch researchers may be losing some sleep in pondering the incredible power they wield over the lives of children and their families.

At least we know there is controversy. At least we know they are not all marching in lockstep.

And that is something.