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.

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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 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, 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.]