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GuessImAfab is a 22-year-old re-identified female who identified first as nonbinary, and then a transgender man, from the ages of 18-21. She lives in the United States. GuessImAfab was on testosterone for a year and a half and spent a … Continue reading
Interview by Grace Williams
In this interview with Chiara Caignon, one of the co-founders of the Pique Resilience Project (PRP), and her mother, Denise Caignon (aka “Marie Verite”), the founder of 4thWaveNow, the two women tell the story of Chiara’s temporary trans identification and how this inspired the creation of 4thWaveNow. They talk about what life was like for both mother and daughter during the teenage years when Chiara believed she was a man, and Chiara describes the influences that eventually led to her desistance.
You can read Chiara’s personal essay, “Girlhood Interrupted: The Path of Desistance,” written for the Velvet Chronicle.
For several years now, 4thWaveNow has been administered and edited by a small, dedicated group of parents; it’s no longer a one-woman show. In the meantime, Chiara has gone her own way, recently joining forces with three other detransitioned women — Dagny, Helena, and Jesse — to launch the Pique Resilience Project. The purpose of PRP is to offer support to the growing number of young people who have realized that transition was a mistake for them, as well as to young people who are questioning their gender identity but have not yet transitioned. PRP has so far released two videos (here and here) and a podcast. Chiara was also interviewed by Benjamin Boyce about her experiences with trans identification and desistance on Feb. 21, 2019.
Chiara and Denise were previously interviewed (using the pseudonyms Rachel and Janette) for an article by Charlotte McCann in the Sept. 1, 2018, issue of The Economist,
“Why are so many teenage girls appearing in gender clinics?”
Grace Williams conducted this interview with Chiara and Denise via email. “I am one of the thousands of parents who have benefited greatly from 4thWaveNow,” says Grace, “and I’m deeply grateful to Chiara and the other young women of the Pique Resilience Project for their work to help young people like my daughter.”
Chiara, I’ve watched the videos you and the other women of the Pique Resilience Project have made and I’ve been really impressed with how articulate you all are. This is something new: a group of detransitioned/desisted women starting a YouTube channel. Can you tell us a bit about what inspired you to do this and how things are going so far?
I was put in contact with Dagny, Helena, and Jesse a few months ago, and we had our first meetup in January. The initial goal was to create an ongoing multimedia project, focused mainly on raising awareness. All four of us have unique experiences and are committed to sharing those in the hopes of informing others about the dangers of automatic gender affirmation and the influences of social media. We also dive in to other factors that fuel dysphoria, and the importance of exploring those before embarking on medical transition.
We’ve had incredible, overwhelmingly positive feedback so far, as well as a ton of opportunities that have arisen for us to expand our platform. Several parents and young people who are questioning their gender have contacted us for advice, and I personally have helped two so far in the process of self-reflecting and moving toward desisting. I’m very excited about the future for us and this project.
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Denise, what are your thoughts about PRP?
Chiara has always done things her own way. She’s tough and intelligent, so in one sense I’m not surprised that she could pull off something this important. And at the same time, what she and the other three women of PRP have created far surpasses what I could ever have imagined five years ago. Their message is one of strength and hope—not only for their primary audience, young people who are questioning their gender, but for parents whose daughters and sons have pursued and/or desisted from a trans identity. Not every young person will desist or detransition, but these women show and tell what that can be like. By joining together as a group, the PRP women are offering an alternative vision that we haven’t seen in quite this way previously (although there have been some really inspiring detransitioners who’ve been writing and vlogging about their experiences for several years now). I really think their insights and experiences will help many people in the years to come—and that includes not only those who detransition/desist and their families, but also others who continue to live as trans-identified people.
Obviously, it’s been a long and sometimes difficult road for both of you, starting with Chiara’s initial announcement that she was trans in late 2014. Let’s jump into that story, starting from the beginning. First, how did Chiara tell you she thought she was trans?
Chiara told me she was trans soon after her 17th birthday, in a text message consisting solely of a link to an online informed consent clinic that would prescribe testosterone for minors, with parental permission. Medical transition was her goal from the get-go, and pretty much out of the blue. She had never previously said one word about feeling “wrong” as a girl—in fact, quite the opposite. I had thought for quite some time that she was likely a lesbian (which I fully supported), but there had never been any indication that she despised her body or wished she were the opposite sex.
But we had just watched the TV series “Transparent” together, and good liberal that I’ve always been, my initial reaction was “maybe she IS trans.” If she had not abruptly and immediately expressed such an intense interest in testosterone and top surgery, I might not have embarked on a research mission which in rather short order resulted in alarm bells—primarily because I learned the effects of T are mostly irreversible, and I well remembered my own dead-certainties at age 17 that turned out to be mistaken when I got older. Her constant demand for hormones (and later “can I at least have top surgery”?), coupled with my phone calls to some gender therapists, all of whom in so many words told me if she said she was trans, then she was, intensified my skepticism.
When I asked one of the gender therapists how we could know she was trans as opposed to lesbian, she said, “Oh, it is very rare for a trans man to actually be a lesbian. Very, very rare.” Then there was the (very nice) FTM therapist who, when I mentioned Chiara had not had a full-on relationship yet, said, “A lot of trans teens just skip that step” and added “he’d” be welcome at the next trans teen support group that week. I actually did schedule an appointment with this therapist, as well as signed her up for the group, until my crash online course in all things trans made me think better of it and cancel. Not long after, Chiara and I together found a therapist who used a mental-health (vs. “affirmative”) model and agreed to work with Chiara without enabling medical transition.
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Chiara, why do you think you came to believe you were transgender? What forces were acting on you?
At the time, I of course believed that I was “a man trapped in a woman’s body,” and that I would truly not survive if I was not allowed to transition. (I wasn’t constantly or seriously suicidal, though I had ideation at times—it was more that I saw no future for myself as female; the only option in my mind was living as male. Additionally, suicide rates by trans-identified kids are misrepresented and used to threaten and manipulate people into “validating” identities without question.) In hindsight, however, I was struggling to deal with trauma, internalized homophobia, and social isolation. I was at a vulnerable place, and not all that happy being a girl, so I latched onto a trans identity almost as soon as I first heard about it online.
Was there a lot of talk about suicide online? If so, did that influence you in any way?
There was a large amount, the most notable being the case of Leelah Alcorn, an MtF teenager who committed suicide in 2014. Her death affected me, along with many others, as it was sensationalized and widely held up as a warning to parents: “This is what happens when you don’t let your kid transition.” This mantra continues to be repeated online and everywhere, and perpetuates the idea that suicide is the “only way out” for kids whose parents will not accept their gender identity—this is a false statement that should under no circumstance be peddled to impressionable young people.
What made you feel unhappy about being a girl?
I was dealing with trauma, which caused me to want to escape my body. This, in addition to my resistance to accepting my same-sex attraction, resulted in a rejection of being female.
How did your dysphoria manifest itself? What “triggered” it for you?
It came on in the span of a couple months, but was still a fairly gradual process. The main triggers were my increased usage of social media, which facilitated my exposure to trans ideology and activism, as well as my social isolation and beginning to learn about and come to terms with past trauma. My dysphoria caused me to adopt an appearance that was as masculine as possible—I cut my hair short, wore men’s clothes, bound my chest, and packed off and on for over a year. I even used the men’s bathrooms in public, and felt good about myself when I passed successfully.
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Denise, as every parent knows who has experienced something similar, hearing your daughter suddenly declare she is transgender and tell you she needs hormones immediately is very stressful. How did you cope?
Starting the website—which was initially a cry into the wilderness, just hoping to find and speak to other parents who were skeptical of their teen’s desire to embark on medical transition—was crucial in helping me to cope with the situation. I suspect there would have been more arguments and difficult times between Chiara and me if I had not had the outlet of writing and finding others online who were in the same boat.
Pretty much all my “in real life” friends at the time were lifelong liberals/lefties like me, who saw (as I had) everything to do with trans activism as purely and simply the next civil rights movement; they hadn’t had a reason to look into some of the more controversial aspects because their lives hadn’t been touched by the issue. So, for the most part, I couldn’t talk to them openly about what was happening in my family.
This was, of course, a very difficult time for Chiara as well. She wanted desperately to transition. Did you make any concessions to her at the time?
I did. At her request, I bought boxer shorts, “men’s” clothing, “men’s” dress shoes, and repeatedly paid for very short haircuts. I was happy to do this, in part, because being “gender nonconforming” in clothing, hairstyles, etc. doesn’t mean a person is actually the opposite sex. I was well aware, however, that these outward expressions of gender meant to Chiara that she was a man (at the time). I drew the line at hormones or surgery, and I didn’t purchase the binder she asked for. (Whether she ever got a binder herself from one of the websites that offer them free, I don’t know.)
What were conversations between you like at the time?
We pretty much had a communication breakdown. Once we were a few months into it, I began to realize that I needed to say as little as possible, because after all, in just a few months, this was all going to be out of my hands (she was 17). Also, parental lectures—or even attempts at meaningful conversation—were becoming counterproductive (that can be true for any parent and teen in conflict, trans-identified or not!). When I did say something, I tried hard to be succinct, instead of going on and on. I would say things like: “You’re a strong, gender-nonconforming young woman. That doesn’t mean you are literally a man. In fact, you could be a role model for other young women in the same boat.” At the time, this all seemed to fall on deaf ears.
Like many parents in this predicament seem to do, I found and looked up to young, detransitioned women who were writing on Tumblr. I thought they somehow had “the answer.” I now know they don’t, and many—if not most—don’t appreciate parents reaching out for help. Nevertheless, I was fortunate to be able to meet two detransitioners I’d discovered online in person when I attended the Michigan Women’s Music Festival in 2015. They were kind enough to reach out to Chiara (with her and their permission) and I remain grateful to them for their generosity.
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Chiara, what turned things around for you? Was there anything that you read or heard that suddenly helped you realize not only that transition was not right for you but that gender identity as a concept was suspect?
At 17, as soon as I graduated high school, I moved to Florida for nine months for an internship on a horse farm. We had very little internet access, and spent most of each day performing physical labor, so I was forced to focus on something apart from trans ideology. Being disconnected from social media, specifically Tumblr and YouTube, allowed me to slowly begin rediscovering myself and my interests and by the time I returned home, I had matured (emotionally, physically, and mentally) enough to return to these social media sites with a critical eye. I found radical feminist blogs, the messages of which resonated with me, and gradually moved away from my trans identity with the support of this new community.
What appealed to you about the radical feminist blogs? What were they saying that resonated with you?
Radical feminism, being focused on women’s issues and liberation, was a breath of fresh air for me in many ways. The people writing about it online were fiercely protective of women and passionate about enacting change. The main points that appealed to me were their acceptance and celebration of lesbian and bisexual women, and their tendency to think critically and question problematic narratives—specifically prostitution, pornography, and, of course, transgenderism. They opened my eyes to the glaring issues behind trans activism (puberty blockers, misogyny, homophobia, women’s loss of rights, etc.), which allowed me to finally realize that I wanted nothing to do with the movement, and the best way for me to fight it was to simply exist as myself and stand up for other women. I definitely do not agree with every aspect of the ideology, but I believe it is the one of the only movements that truly cares about helping women.
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Denise, are you a radical feminist?
I like to think of myself as a “rational” feminist. Some of the tenets of radical feminism seem more ideological than logical—for example, the notion that humans are essentially “blank slates,” with all gendered behaviors being only social constructs. But there is a large body of replicated, cross-cultural scientific evidence that there is a biological basis to typical sex differences, and even some typical gendered behaviors, many of which are rooted in evolutionary selective pressures. Again, we’re talking about averages; individuals should never be assumed to be average. Being gender-atypical doesn’t mean anyone’s brain is mistakenly stuck in the wrong body. Historically, some of the more interesting, accomplished humans have been atypical for their sex. And, importantly, many—though not all—gender-atypical kids grow up to be lesbian, gay, or bisexual adults. This has long been well understood, though in the last few years, the trans movement has obscured this knowledge. There is a very real (even if unintended) risk that proto-LGB kids will be unnecessarily medicalized before they are old enough to realize and accept their sexuality. We already see many detransitioned lesbians who themselves say their difficulty accepting their sexual orientation contributed to their transient trans identification. (Of the essays I’ve written, I am perhaps most proud of the one I wrote on this subject, “The surgical suite: Modern-day closet for today’s teen lesbian”).
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Chiara, you mentioned that internalized homophobia played a role in your belief that you were trans. Why were you more comfortable identifying as a trans man than a lesbian?
In many ways, it felt easier for me to exist as a gender-conforming, “typical” man, as opposed to a gay, gender-nonconforming woman. As I mentioned in my recent interview, I think a lot of my desire to transition was based on a fantasy version of myself as a man—I was convinced that all discrimination against me would disappear as soon as I became a straight man. I also believe that our society is still largely heteronormative and somewhat homophobic, and gay people are often subjected to judgement, hate crimes, and insults. This is something many young people begin realizing in their teenage years, and it is understandably tempting to want to escape those experiences.
Did you talk to a therapist about your questions about gender identity? Did you find the therapy helpful or counterproductive?
I have been in and out of therapy for many years. It was incredibly helpful for me in many regards, and I strongly believe it should be utilized to determine factors contributing to dysphoria, before medical transition is permitted. The two long-term therapists I’ve had in the last few years have allowed me the space to explore mental health, come to terms with past events, and build the skills necessary to advance my life in the direction that I want. I hope that therapists will begin to educate themselves on both sides of gender ideology, and use this knowledge to encourage critical thinking in anyone who may be questioning a trans identity.
What were the things you think your mom got right in parenting you during the period when you identified as trans, and what do you think she got wrong? What could she have done better?
I am grateful that she never allowed medical transition, as I am sure I would have regretted it. I also appreciate that she put me in contact with a couple of detransitioned women, as well as paying for therapy for me to discuss issues behind my dysphoria.
But there were times in which I felt that my privacy was invaded, and this made it difficult for me to trust her intentions. I also had my phone taken away. While I understand that she truly felt that was for the best, I do not believe that trying to cut me off from the internet was helpful—I had multiple other ways to access it without my phone anyway, so this only caused resentment and anger on my end. I do understand that this was a very stressful time for her, but I believe that she could have been more careful about how she phrased several things, and stepped back to look at how some of her actions would impact me in the future.
Teens and their parents often have a hard time communicating with each other, even when the trans issue isn’t on the table. Were the arguments you had with your mom around this subject always counterproductive, or did she occasionally say things that stuck with you and helped you (eventually) see things differently? Conversely, do you think your mom was eventually able to understand some of what you were going through and trying to tell her?
At the time, most of our arguments did nothing to change my mind or outlook. At that point in my life, I was reluctant to change my opinions and take advice, especially from my mother. I can look back now and agree with a lot of what she expressed to me, and I do think that some things she said stuck with me and helped me to open my mind to the idea that transition was not the right path for me. I believe that she did eventually understand a lot of what I was feeling, but it was an unfamiliar topic to her at first.
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Denise, do you have any regrets? Were there any things that you wished you had done differently?
I do have regrets about how I handled some things. I was not (and am not) a perfect parent, and I think the increased stress we both experienced during that time damaged our relationship. We’d been very close pre-puberty, but along with the other garden-variety issues that arise for parents and teens weathering adolescence, the trans issue turned the stress-volume up to max. One night, when Chiara was screaming about how awful I was not to approve medical intervention, I screamed back that she should just leave. I immediately wished I hadn’t said it. She didn’t leave, and I never took any steps to kick her out, but I know how much that must have hurt and probably still does. I’ve apologized, but I still wish I could take it back because I never meant it.
Monitoring and restricting her social media and (temporarily) confiscating her phone are things I feel more conflicted about. At the time, it seemed to me that she was being inducted into a cult: the obsessive nature of her wanting “the two Ts” (testosterone and top surgery), scripted language, and a seeming refusal to examine or explore what might be underlying this (as well as a general refusal to talk to me about much of anything) resulted in my feeling desperate to know what was going on inside her, and to try to keep her safe in any way I could. Besides the rumination on being trans 24-7, her grades had dropped from As and Bs to Ds and Fs, she nearly dropped out of high school, she had drifted away from all the friends who had previously been important to her, and totally abandoned all her hobbies and interests.
In an ideal world, I would not have invaded her privacy, and I know from my own teen years how such actions feel like a huge betrayal of trust. Something similar happened to me when I myself was 17. I discovered one day that my dad had searched my closet and confiscated a baggie of marijuana I had hidden beside a diary. I still remember the burning outrage. I confronted my father and for many years could not forgive him. Now, of course, I can understand how worried he was about me and the choices I’d been making. But whether what he did was justified, or whether my similar actions with Chiara were justified? I’m not sure.
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Chiara, on the PRP website, you, Dagny, Helena, and Jesse state plainly that you all experienced rapid-onset gender dysphoria (ROGD) as described in the paper published by Dr. Lisa Littman last year, but trans activists have tried to dismiss and discredit Dr. Littman’s research, claiming it is based entirely on the claims of bigoted, transphobic parents. Why do you believe that you experienced ROGD? How would you respond to Dr. Littman’s critics?
I believe that ROGD is a very real phenomenon, because I, myself, and many others only began experiencing dysphoria around our teenage years, seemingly in response to significant changes or struggles. I did not begin to have dysphoria until I was a young teenager, and had no desire to transition until I began hearing about others doing so. I became obsessed with the idea that I was a man, and completely fixated on medical transition as the only viable option for me. Since I can look back now and understand that I would not have been happy long-term with that decision, I am very confident in Littman’s study, and believe that discrediting it as “transphobia” is wildly irresponsible. I find it very strange that trans activists see any inkling of criticism as a direct, “violent” attack.
You mentioned that you had no desire to transition until you heard about others doing so. Did your dysphoria increase the more you learned about gender identity and transition?
Absolutely. The more information I consumed on the topic, the more adamant I was that transition was right for me. Other people’s hormonal and surgical results appealed to me at the time, and I desperately wanted that for myself. It was a vicious circle: the more I watched, the more my dysphoria grew, and the more my dysphoria grew, the more I needed to “escape” in the form of this addictive media.
Why do you think so many young people—especially girls—have come to see themselves as transgender?
In many ways, it is incredibly difficult and often painful to exist as a woman in society. Dealing with harassment and strict gender roles is a daily ordeal, and media often portrays us as infantile, sexualized, and unconditionally available to men. Women are targets of assault and murder simply because of their sex—the idea of escaping that, which transitioning to male promises to provide, is very attractive.
What do you think it will take to wake people up to the harm that’s being done in the name of gender ideology?
Honestly, I think this is already starting to happen. The response to our project alone has been big (over 20K video views in the first two weeks) and overwhelmingly positive, which gives me hope that more and more people are beginning to realize the negative effects of this movement. Also, many of the young people who transitioned when the movement was beginning to really take hold a few years ago are now detransitioning, and their voices are growing in number. I am grateful to be part of a project to raise them up, because I believe those experiences are very important and should be shared in order to educate others.
Trans activists claim that only a tiny percentage of people who transition regret their transitions. Do you think the number is this low?
No, I believe that the percentage is actually fairly high. People claim that less than 3% of trans people detransition, but since detransitioners are routinely silenced and discounted, I am hesitant to accept that number as accurate. Also, this estimate generally fails to account for people who desist–that is, abandon a trans identity before taking hormones or undergoing surgery.
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Denise, do you agree?
Yes. And with organizations like Gender Spectrum promulgating immediate affirmation of youth trans identities, we’re likely to see more in the future. Plus, many who detransition don’t return to their gender therapists/MDs, nor are they being systematically tracked otherwise. And regardless of how many detransitioners there are, they matter. Their voices matter. And it shouldn’t be seen as “transphobic” or even controversial to ask that we try—as a society, as parents, as clinicians, even as trans activists—to minimize the number of people who will later feel they were harmed by believing they were trans; particularly people who were irreversibly harmed by medical intervention they later come to regret.
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Chiara, what would you say to the activists and legislators who are pushing for legislation that would make it illegal for therapists to encourage clients to explore why they feel they must transition?
I think that would be blatant malpractice. The job of a therapist is to help people overcome issues and develop the best life possible, and transition is not always the right way forward. This would also prevent therapists from digging into deeper issues behind dysphoria. If this law were to go into effect, if would only increase the number of young people who would later detransition.
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Denise, why have you decided to “come out” now?
After Chiara and her compatriots launched Pique Resilience, I realized we were in a new phase—both as mother and daughter, as well as in the greater effort to raise awareness about the complex issues to do with youth transition. Until now, it was of utmost importance to me to protect Chiara’s identity and privacy, so very little information about her was ever included in anything I wrote. Her courage in bringing her story to light has inspired me to step forward as well. There’s nothing to be ashamed of, anyway. Many families have had very similar experiences to our own, and the more of us who are able to speak publicly about our lives, the better.
I suspect detractors might claim the only reason Chiara desisted is because of something I’ve done or said to somehow cajole her into doing it; that she’ll “retransition” in the future. Or maybe: 4thWaveNow is the master puppeteer pulling the strings of the Pique Resilience Project. But Chiara is an adult, supporting herself, living on her own, making her own decisions. And I’m pretty sure the other three women in PRP are also very much their own persons! As far as our family situation, I feel quite certain that if Chiara had decided to pursue transition (and she told me she absolutely planned to, as recently as age 18), she’d have gone ahead with it. Then I’d be in the position of coming to terms with that decision, which I know I would have. She’s my child. I’ll love her no matter what she does, whether I agree with it or not.
Trans activists have worked very hard to deny the experiences and observations of families impacted by an abrupt onset of gender dysphoria. Just a couple of days ago, trans activist and writer Julia Serano penned a long Medium article, as well as a tweet thread, in which she paints ROGD as some sort of coordinated, grand conspiracy cooked up by bigoted parents and backwards clinicians. It’s strange that activists like Serano (along with many others) refuse to believe there could be some young people (the majority of them female) who identify as trans due to social contagion and other issues (which Chiara and the other women of Pique Resilience Project have eloquently talked about in their videos and social media postings). Why can’t Serano et al understand that people are talking about their own lived experiences? The fact is, if there’s any mutual effort on the part of those of us who’ve experienced or observed ROGD, it’s simply a “grand conspiracy” to tell the truth.
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Chiara, what would you say to trans activists who might claim your mother has brainwashed you into believing that you’re not trans? (They tend to say that about any parent whose kid desisted.)
Parents are often demonized, called “abusive,” and beaten down by trans activists if they dare to question whether transition is right for their child. Parents are generally not in the habit of brainwashing their children—rather, most want to protect and support them. Asking your child to think critically and consider other factors at play is not abusive, it’s just parenting. Further, I am an adult fully capable of making my own decisions and formulating my own opinions. My decision to desist was mostly due to my own experiences and research, not a result of my mother forcing an ideology.
When did you first learn that your mom was the founder of 4thWaveNow?
Just a few months ago, not long after we started Pique Resilience, and years after I desisted. I was very surprised, mainly because I had no idea that my mom was running a blog at all, let alone one of this size. I completely respect and support all the work that has gone into it; it’s become one of the largest and most-visited sites providing an alternate viewpoint, and I’m grateful for the support it gives to both young people and their parents.
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Denise, do you have anything to say to those who criticize parents when they do not immediately affirm their children’s belief that they are transgender?
One of the most pernicious things trans activists and some gender clinicians do is try to drive a wedge between young trans-identified people and their families. While there are certainly abusive parents, the vast majority of us who have serious reservations about the medicalization of our gender-atypical youth do love and care about our kids and only want the best for them. We do our best, given our own personalities and weaknesses (as well as our strengths). While the time during which Chiara believed she was trans was very difficult for us and brought out the worst in us both, I’m very grateful we have moved toward healing the rifts between us, though we have further to go. Above all, I’m very glad that Chiara and the other three intrepid women of the Pique Resilience Project have started their own effort to help young people like them.
When it comes to how this increase in young (mostly) women who believe they’re men will ultimately play out, no one knows; it’s going to unfold over the next few years and decades. But I can say this: the future of the movement to raise awareness about this issue does not belong to 4thWaveNow, or parents. It belongs to resilient young women like Chiara and her friends and colleagues. They are the ones who will make the world a better place for their generation and the next generation of gender-atypical young people to come.
Sasha Ayad, M. Ed., LPC, is a Licensed Professional Counselor who works in private practice with teens and young adults who are questioning their gender. We interviewed Sasha via email for this post.
She uses an exploration-based approach to seek out underlying issues and help her teen clients move towards self-awareness, resilience, and long-term well being. She also conducts occasional consultations for parents whose teens present with gender issues first emergent around puberty.
In a monthly newsletter, Sasha’s reflects on interesting psychological material, and relates it back to the phenomenon of a sudden presentation of gender dysphoria in adolescence. She also offers advice for parents as they guide and support their gender-questioning teen. Readers can sign up here to receive the newsletter and Sasha’s PDF on how to search for effective therapists and individualized treatment.
Sasha has a full caseload and long waiting list, so is unable to take on new clients. However, Sasha offers a subscription-based Patreon account with videos designed to help parents engage in trusting and productive dialogue with their gender-questioning teen.
Tell us about your background, training, and work as a therapist.
In undergraduate school, I studied psychology and history. My graduate program was focused in counseling psychology, or the clinical practice of therapy. I’ve worked in the field of behavioral therapy and mental health in Houston, Texas since 2005, and in a counseling capacity since 2008. I spent many years working with young children on the autism spectrum through applied behavioral therapy. In the field of domestic and sexual violence, I worked as an individual and group therapist with women and children. I also developed and ran the first counseling program at a state-supported residential facility for adults with intellectual disabilities and concurrent mental illness. In recent years, I worked as a school counselor for underserved populations at a top-ranking charter school.
I am now working in my private practice full-time, based here in Houston. Most of my work is conducted online, and I see teen and young adult clients from all over the country and internationally. I specialize in working with adolescents who are questioning their gender and most of my clients are female. I also conduct occasional consults for families who have children presenting with Rapid Onset Gender Dysphoria, and create content for my monthly newsletter and video series.
I am a Licensed Professional Counselor (LPC) in Texas, and I hold a master’s degree in Education.
What specifically sparked your interest in working with adolescents and adults who have gender identity issues?
My interest in this population developed and grew organically out of my own desire to better understand the growing phenomenon. When I was a young graduate student, my understanding of this issue was limited and I was marginally familiar with the conventional, textbook examples of childhood gender dysphoria: a person, who from a very young age, is completely convinced their body is the “wrong sex.” In these cases, the wrong body self-concept develops, seemingly independent of societal norms and environmental influences. I used to think, “what a strange and troubling experience: to really believe you have the wrong sexed body.”
Even back then, I did hold skepticism about this narrative, with its heavy reliance on gender-atypical preferences and behaviors supplying the “evidence” that the child is actually in the “wrong body,” and therefore needs to socially and medically transition, however outcome data shows some patients may benefit from a medical gender reassignment. Around 2012 I began more deeply investigating this idea of gender identity out of personal interest and professional curiosity. Keep in mind, this was before the huge boom of trans-identified kids in the years to come. I started to wonder how things like socialization, gender norms, or even sexual trauma may play a role in the idea of the “wrong body.” I also became curious about the underlying suppositions of “gender identity”: that one’s “correct” biological sex or “authentic self” is always correlated with feelings of congruence between mind, spirit, and body (i.e. innate gender identity). Couldn’t “cis” also people feel varying degrees of gender/sex incongruity at times?
As time went on, I eventually discovered the work and writings of detransitioned people. I read about how quickly they were “affirmed” and shuttled towards a path of medical intervention, circumventing thorough evaluation or less invasive means of symptom-reduction, which are foundations of ethical therapeutic practice. I became very disturbed by what seemed to be a failure of mental health practitioners, who were responsible for their care, to look at these young people as whole and complex individuals. Were many in our field simply blind to the myriad factors, both social and subconscious, that might contribute to the feeling of being “trapped in the wrong sexed body?” I grew quite baffled that therapists were treating gender identity without any of the thoughtfulness, intuition, or even clinical curiosity typically afforded to other presenting problems – not to mention the care historically mandated by our psychological ethical standards. And looking at the sheer number of young girls suddenly adopting a trans identity around puberty, I became curious about this emergent population of gender dysphoric girls (and some boys).
I eventually stumbled upon this brilliant podcast interview with Lisa Marchiano, and my jaw dropped to hear another professional bravely speaking her mind and echoing some of the same fears I held. I reached out to her immediately and soon got connected with your work at 4thWaveNow, Transgender Trend, and many other resources for parents.
Then in 2015, as a school counselor, I was required to take part in a training on “Supporting Trans and Gender-Diverse Youth.” To my disappointment (but not my surprise) the presenter (who was not a psychologist, but an advocate) completely failed to put forth a nuanced, thoughtful analysis, and even skirted issues when I brought them up during the training. I arranged several meetings with my manager at the time, the head of the counseling program – my goal was to present her with evidence of wider phenomenon and some of the less obvious problems with the unidimensional, non-scientific training we were receiving. She graciously and thoughtfully listened to my concerns but admitted that there was so much she didn’t understand about the changes in the LGBTQAI movement, and she felt it was important to continue developing our counseling program according to the gender identity activists. I believe proponents of this affirmation narrative deliberately use “newspeak” and made-up language to confuse professionals into a state of self-doubt and subsequent willingness to dismiss their own intuition and clinical knowledge. And that’s exactly what might have happened to my manager, who is an incredibly brilliant, experienced, and competent social worker.
At that point I decided I would no longer take part in organizations that are committed to an activist cause rather than individualized, holistic, clinical perspectives on gender dysphoria. Schools are promoting this one-sided view unquestioningly to their mental health staff and to the children they claim to serve. I also realized there is a scarcity of therapists working with these children in a manner that adheres to comprehensive clinical standards. On the other end of the spectrum, some religious therapists seemed to avoid or discourage any type of gender and sexuality exploration, which is also not helpful to the client. So, I decided to build the kind of therapy practice I thought was lacking for trans-identified youth. I started my practice part-time in 2016 and have been working independently in private practice full-time since July 2017.
Do you have a personal interest in this issue? Do you have relatives or friends who are affected by the current wave of transgender identifying children and adolescents?
Not until recently. A few years ago, when I worked as a middle school counselor, there was one child who was especially memorable; I spent much time with her, both as my counseling client and while chaperoning extracurricular activities during my three years at the school.
She stood out from other students in multiple ways. Despite having many brilliant and creative peers, she excelled in so many disparate domains, being a fantastic sketch artist, dancer, writer, and academic learner. She had impeccable grades in every subject and treated her peers with kindness and fairness. She created incredible logos and t-shirt designs for clubs and school events, and played leadership roles in many campus groups: anime, drama, orchestra, art, and more. I have several beautiful pieces of art that she’s created for me over the years, mostly portraits of female characters, reminiscent of Japanese-style manga. Her appearance was also creatively inspired: she experimented with various hair-cuts, styles, and colors, and expressed her own personal fashion sense (and progressive political leanings) through graphic jewelry and buttons on her messenger bag. I always praised her for carving out her own sense of style and individuality.
She identified as bisexual at the time, and she was a great student-leader in my GSA club, showing initiative and often taking responsibility for large portions of our meetings. I was always careful in how we navigated conversations about gender and gender identity and she seemed to be well-grounded in her own unique expression of female identity. She was never particularly feminine, especially as a seventh grader, when there is immense social pressure to look a certain way. She always had lot of friends, was overall quite happy, and she was just one of those kids I never thought I’d have to worry about. I imagined her starting a graphic design company one day, or maybe being a video game software engineer. Really, her options are limitless.
I found out recently that she has come out as trans, and that she wants to transfer to a different school so she can start her new life as a “trans boy.” In my hours and hours of being with her, she never expressed thoughts of gender dysphoria, though I do remember that once she drew a picture of a pensive “non-binary” character and “their” girlfriend.
It feels like our best and brightest, our most creative and unique girls, are suddenly taking a detour as they devote a huge amount of energy and time to questioning their gender. The kids I meet in private practice are first introduced to me in the midst of their gender concerns, but it’s quite profound to have known someone before the identity-change, when they were happy and full of life. To think that she’s now disconnecting from her female-self can feel quite perplexing. It seems that her parents have fully accepted the wrong-body explanation and claim to have “always known she was a boy.”
How would you describe your therapeutic approach?
I’m pretty explicit with my teen clients regarding what to expect in therapy, because I believe truth, honesty and trust are foundational aspects of any successful relationship, counseling included. I tell them something like this: “I’m different from ‘gender therapists’ you might have read about online because I won’t just meet with you one or two times then write you a letter for endocrinology. I believe my job is to help you explore who you are on a much deeper level. First I’ll spend a lot of time just asking questions and listening so I can try to understand what’s going on in your mind, heart, and body. Then we will work together to figure out what your particular experience of gender dysphoria looks like, where it might have come from, and what we can try to reduce your distress. In sessions, I’ll encourage both of us to ‘be curious’ about your experience because the more you can learn about yourself in counseling, the better you’ll be at thinking for yourself and making good decisions about your identity, your body, and your life. Sometimes counseling can be hard but we will work together to gently face the scary or painful stuff and see if you can learn more about yourself and grow bigger in the process. We can also look for ways to loosen the grip that pain or dysphoria has over your life so that you can have more options and be more confident.”
As for the specifics, my approach is highly tailored to the constitution, mindset, resilience, age, history, development, and maturity of each client. I always start with trust and initial bonding, which can be hard with some clients who have been taught that therapists should act as nothing more than GD diagnosis signators for top surgery or hormones. With more open clients, who are less defensive and more conversationally or intellectually predisposed, we might discuss their personal philosophy of gender identity and I give them space to sort through any doubts they might bring to the table. With other clients, who are in a more sensitive or fragile place, I may approach their identity indirectly, focusing instead on the underlying pain that is somehow finding relief in this new self-concept. I also like to pragmatically examine how taking on a trans identity will play out regarding a client’s self-confidence, their ability to exist in the world, how they relate to family, friends, and so on. Sometimes I have to start somewhere very basic, like assessing if the teen even understands what the words “male” and “female” mean, if they know anything about sexuality (age-appropriate understanding), or what they know about their own bodies.
The ideas that influenced my perspective at this point are quite eclectic and not restricted to the field of psychology, though I’m deeply grounded in a back-to-basics, individualized, and holistic approach. I draw from Acceptance and Commitment Therapy, Cognitive Behavioral Therapy, behaviorism, social psychology, anthropology, history, and Taoism. More recently, I’m returning to a deeper exploration of psychoanalysis and Jungian analysis, which I find to be tremendously useful in making both micro- and macro- interpretations of what’s happening with my clients.
I also work closely with parents while respecting the confidentiality of the teen client. Having calls with my caseload parents every six weeks or so has proven to be incredibly important to the therapeutic progress of the teen client. Teen accounts of family dynamics often gives me insights into how parents can deepen their relationship with their teen or engage in more effective communication with them.
I’ve had very good feedback from my teen clients regarding their feelings of safety in session and ability to express themselves. I often hear that teens feel a great amount of pressure from others to “pick a label” and that our sessions are nice because they can explore gender without it needing to be so concrete. At times, a young person’s gender identity may be playing an important role in their ability to exert autonomy or feel successful in social relationships. In cases like these, we might explore the new-found confidence a client has gained and locate it’s source within the client, rather than affixing it to the identity persona. This is just one example of how it’s possible to work with gender identity in a nuanced way that isn’t necessarily challenging or a literal affirmation.
Are you able to work across state lines, or must your clients be in the state of Texas?
Unlike clinical psychologists, LPCs can see clients in other states and outside the country, though I practice based on the regulations in the state of Texas. I make this clear in my initial consent conversations and documentation with new clients.
How has your your practice been going so far? Have you received any hateful or angry pushback? If so, how have you handled that?
Unfortunately there have been two separate attempts to formally attack my license, both of which I have responded to strongly, since they are gross mischaracterizations of my work. When people submit formal complaints to a licensing board about a practicing clinician, it’s most often a client or former client who feels maligned and harmed by a direct personal interaction. In the attacks made against me, however, it was other activist-clinicians who lodged the complaints. One attack is from an activist with whom I’ve never even spoken, from the other side of the country. The other complaint was really shocking since it was submitted by a former colleague of mine with who I felt a strong sense of mutual respect and camaraderie during our time working together. The lack of professionalism and integrity she displayed with this covert act of aggression has been very sobering. When colleagues don’t even attempt to reach out to one another and discuss their concerns, and instead go after someone’s livelihood, the profession itself feels degraded. In addition to these types of serious attacks, of course, common trolling and insulting comments on my social media accounts or blog posts happen occasionally. However, when I speak with people about my practice face-to-face, I am typically met with far more inquiry and curiosity than vitriolic responses. Exceedingly the response I’ve gotten about my work from clinicians and parents has been positive. Therapists indicate that they find my work insightful and that it has helped them better treat their own gender-questioning teen clients. My approach is very much grounded in foundational ethics of clinical practice, so the fact that it’s sometimes called “controversial” should raise a red flag about the novel and unscientific recommendations being pushed by gender identity organizations (and now by the APA).
Do you believe there is such a thing as a “truly transgender” child or adolescent? Why or why not?
It’s hard to answer a question when the terms of each word haven’t even been defined well. There’s no definition for “transgender” that isn’t completely circular in logic. Perhaps a better question is, “are there some children for whom the benefit of social and medical transition outweighs the risks”? Or maybe, “are there some children who, in order to live vital meaningful lives, must live in the gender role of the opposite sex”? To cover all my bases, let me include a question the gender therapist might ask too: “if a child is threatening to kill themselves, isn’t it better to support their transition?”
My answers for adults would look very different, because I do believe that for some, a transgender identity and transition are a means of true individuation and authenticity. For children, however, let me tailor these questions a bit.
1. “Are there some children for whom the benefits of social and medical transition outweigh the risks”?
If by “risk” we mean feelings of body discomfort or incongruence, then trying to prevent that risk seems impossible. Discomfort and biological limitations are ubiquitous and necessary aspects of human experience, and it’s always been true that body discomfort is particularly acute in adolescence. The struggle associated with changing social roles around femininity and masculinity, hormonal and physical changes of the body, independence and safety, social cohesion and isolation, assertiveness and passivity, and every other fundamental human developmental endeavor requires us to grapple with our own pain and limitations. Without that struggle we don’t develop resilience, we don’t learn about ourselves, and we don’t learn anything about living in the real world as it is, materially or socially. With the growing evidence that social contagion plays a role in puberty-onset gender questioning, we should be exceptionally cautious before medicalizing any kind of identity exploration.
That being said, it may be that classic cases of absolute insistence on being the opposite sex from the age a child could walk and talk are a different story. Of the hundreds of families I’ve talked to, only a few of them have kids whose gender dysphoria started in early childhood. Perhaps those families are more comfortable with medically transitioning their children, so they don’t contact me as much. Since I’ve not really worked with those kids, I don’t feel I’m qualified to prescribe their best treatment.
2. “Are there some children who, in order to live vital meaningful lives, must live in the gender role of the opposite sex?”
A “good life” doesn’t come from never experiencing discomfort, or conversely from always being perfectly comfortable, which I addressed in the previous question. But perhaps someone assumes that a girl who prefers or expresses strong masculinity would do better living “as a boy”? Are certain traits or behaviors literally incompatible with being a female in society, or a man in society? Well, what does this say about our capacity to broaden independence and make room for personal preferences? And if someone does take on non-conformist roles, should they not also develop the personal resilience and emotional fortitude to stand firm in their own presentation with strength and individuality? I think there’s something inherently flawed about expecting all of society to completely abandon every aspect of our historically stable gender roles and it’s also flawed to say there’s no room for individuals to choose how to express themselves on the spectrum of femininity and masculinity. I would like to emphasize again that adults should be free to explore a medical gender transition as an option, but may also find it meaningful to consider these interesting questions for themselves.
3. “If a child is threatening to kill themselves, isn’t it better to support their transition?”
If a child is threatening to kill themselves, we should take a huge pause and think of the big picture. The most empathetic thing we can do initially is to listen with care, but we, as adults, also need to determine if this child is thinking clearly. Since when do emotionally unstable, demanding children get to use threats to dictate decisions as important as fertility and surgery? Furthermore, if a child is that disturbed or troubled, then they are clearly in no position to make good choices about their long-term well being. The use of this threat by some advocates is incredibly manipulative and has no precedent whatsoever in the field of psychology. Over the last ten years, I’ve worked with dozens of young people who are actively struggling with self-harm and making suicidal statements (whether related to gender identity or not). These behaviors can serve many functions, not the least of which are expressing psychic pain, gaining attention and care from adults, or trying to manipulate people in power into making a concession of some sort. Children who haven’t developed the emotional or relational tools for self-soothing will use any means necessary to express pain and gain what they are seeking. I don’t mean to deride a child’s methods; she’s doing the best with what she has at the time. But these are reflections we must take very seriously as clinicians. So giving into these types of threats does far more harm than good for the child. We need to instead, conduct thorough risk assessments, create conscientious collaborative safety plans with the child and family, and work through underlying issues if we really care about the child’s safety and well-being (as therapists have always done with suicidal ideation).
In the current atmosphere, professionals who question the current “affirmative” approach to therapy for trans-identified kids may be risking their careers. Do you think the concern is overblown?
This is a touchy area so I want to start by saying that I can understand the pressures therapists feel from their institutions to make politically favorable choices and statements. Many clinicians also have their own family to be responsible for and feel financial pressures to not “rock the boat.” In recent times, some professionals have been demoted or sanctioned for sharing their clinical impressions, which indicates a horrific direction our field is headed down. However, we have all taken vows of high ethical standards and we are responsible for making sure the work we do reflects our professional integrity.
Personally, as I’ve considered this question, I find myself asking: what’s the point of having a career based on helping others if you have to lie every day about harm that’s being done? And what does the collective and cumulative impact of lying and silence about this issue amount to in the long run?
Honestly, I don’t know what is going to happen in the next five, ten, or twenty years. In recent times whenever skeptical, intelligent, and nuanced articles about transgender children appear, there’s often a dangerously aggressive and thoughtless effort to dismiss and diminish important arguments. The way things are going, I would not be surprised if things “get worse before they get better.” That being said, I am not worried about the work I’m doing because I believe it to be the right thing to do. Standing up for ethics is easy until it’s not. I am deeply committed to standing up for individualized treatment, nuanced assessment, and a least-invasive-first approach, even if that means it puts me at some personal/professional risk.
I strongly encourage other clinicians to speak the truth and be honest about what they are seeing in their clinical practice. Complicit silence only makes more room for oversimplified caricatures of our patients, and in the end, the gender-questioning teens will be the ones who suffer from our lack of nuance as professionals.
What will it take for more therapists to come out publicly in offering alternatives to the transgender-affirming approach to therapy?
Clinicians should be thinking more broadly about adolescent psychology, questioning suspicious claims carefully, educating themselves on multiple perspectives, and finally, acting with honesty and courage. Because when I talk with most therapists one-on-one, there’s a deep intrinsic knowing that the field has spiraled out of control with regards to childhood transition, but people are afraid to even think deeply about it, question claims, seek out knowledge, or speak up.
The APA has issued “guidelines” for the treatment of what they term TGNC clients (transgender gender nonconforming). Though not binding, these guidelines are nevertheless considered “best practice.” Do you agree with them? If not, how does an APA member go about recommending changes to them?
I am not an APA member, since I am an LPC (Licensed Professional Counselor), and not a clinical psychologist. However, the APA is a powerful organization and their guidelines are looked to as aspirational principles which have significant impact on how therapy is informed and practiced. I disagree with the guidelines and believe they violate some of the most basic ethical standards, including beneficence, avoidance of maleficence, fidelity and responsibility. I believe the infiltration of political ideology into non-political organizations is the main confounding element in the organization’s ability to adhere to these professional values.
Regarding TGNC, some trans activists have essentially co-opted gender nonconformity under the “trans umbrella.” Who does that leave? No one is 100% “conforming” when it comes typical gender expression. As you know, we at 4thWaveNow support such gender atypicality in our kids, but we strongly resist the notion that this means they are somehow “transgender.”
I agree – even trying to amalgamate “gender non-conforming” people into some semblance of a group is an impossible task since, like you said, no one is 100% “conforming.” We all exhibit traits of masculinity and femininity, and it’s absurd to try and find some line that constitutes “cis” and “trans” – according to some of the definitions of those terms floating around. I believe concept creep is also playing an important role in how the definition of gender dysphoria has been broadened so dramatically in scope.
What are your views on the possible influences of parenting dynamics on children identifying as transgender?
It’s becoming harder and harder for parents to keep their children safe from questionable beliefs about gender, since they have infiltrated our medical and educational institutions. But I do recommend some possible means by which parents can safeguard their kids:
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”…
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,
We are urging Brown University and the editors of the peer-reviewed journal PLOS ONE to continue to support the research of Dr. Lisa Littman. Her recently published paper, “Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports,” explores the possibility that social contagion may cause some teens and young adults to incorrectly conclude they are transgender, and thereby undertake irreversible medical interventions that they may eventually regret.
Since its publication, there has been a concerted effort to suppress Dr. Littman’s groundbreaking study. Complete details can be found below. Readers who share our concern about this activist-driven attack on scientific inquiry and academic freedom are strongly encouraged to sign the petition at this link.
In addition, please consider telephoning and/or writing a personal letter to the following individuals at Brown University and PLOS ONE. What’s at stake: The future of research into the unexplained increase in young people, particularly girls, presenting to gender clinics.
Bess Marcus, Dean of School of Public Health, bess_marcus@brown.edu, 401-863-9858
Christopher Kahler, Chair of Behavioral and Social Sciences, christopher_kahler@brown.edu, 401-863-6651
Brian Clark, Director of News and Editorial Development, brian_clark@brown.edu, 401-863-1638
Joerg Heber, PLOS ONE Editor-in-Chief, jheber@plos.org, 415-624-1200
We, the undersigned, are writing in support of Dr. Lisa Littman of Brown University and her study on the topic of rapid onset gender dysphoria (ROGD).
Many of us are parents of teens and young adults who, having never expressed discomfort with their sex during childhood, experienced a sudden onset of gender dysphoria after exposure to the concept through peers and/or websites promoting transition. Some of the signatories to this petition are parents who completed Dr. Littman’s survey. The results of the study support the possibility that social contagion, rather than an innate, immutable sense of incongruence between body and mind, may be at work in some of these cases.
We are grateful that Dr. Littman’s research has been published and that this issue is finally beginning to get the attention it deserves. Although an abrupt adolescent onset of dysphoria has been mentioned previously in the scientific literature[1] , Dr. Littman’s study is the first to explore and document the phenomenon in detail. It describes what appears to be happening to many young people today.
We must be very clear: the parental reports in this study offer important and much-needed preliminary information about a cohort of adolescents, mostly girls, who with no prior history of dysphoria, are requesting irreversible medical interventions, including the potential to impair fertility and future sexual function. In any other group of children, these grave consequences would be seen as human rights violations unless there was significant and overwhelming evidence these procedures would be beneficial long-term.
Across the world in the last few years, researchers and clinicians have noted a sharp uptick in the number of young people, primarily females, who are requesting medical transition services. For example, in the United Kingdom gender clinic referrals have quadruped in the last five years. This constitutes an epidemic. As a leader in public health research, it is incumbent upon Brown University to investigate the causes and conditions leading to this sharp increase, as well as the long term outcomes.
Referral data from Tavistock GIDS: http://gids.nhs.uk/number-referrals
We are disheartened to see that Brown University has already removed a news release announcing the study from its website and replaced it with a letter to their community that states: “There is an added obligation for vigilance in research design and analysis any time there are implications for the health of the communities at the center of research and study.”
We, the undersigned, many of whom are parents who participated in Littman’s survey, agree wholeheartedly that the “scientific community holds an obligation for vigilance in research design and methodology.” There has yet to be a study that includes a cohort of youth offered mental health care in place of affirmation therapy. The glaring absence of a control group of youth who are supported by their families in their gender exploration but who are not affirmed in “wrong body” beliefs is a failure of the scientific community. As the number of girls and young women who desist from their trans identification grows, we must demand recognition for this cohort as members of the “communities at the center of research and study.”
The university has effectively caved to pressure from activists who claim that Dr. Littman recruited participants from “anti-trans” or “far right” hate sites. Similarly, the moderator of the PLOS One Twitter site promised to “investigate” the published study after trans activists mobbed their account. Trans activists claim the parents who completed the survey were too transphobic to accept that their children were trans and too disconnected to have noticed that they had been suffering from dysphoria since childhood.
These claims are false in every respect. The three websites referenced are available for all to view, but the vast majority of contributors are secular, engaged, open-minded, mostly liberal-leaning parents.
These sites point to the probability that many kids who are today identifying as trans are in fact experiencing internalized homophobia. In other words, the contributors to these sites are concerned about the wellbeing of gay and lesbian kids, and they want to ensure that their children are not transitioning simply because they are ashamed of their sexual orientation.
Consider the study results:
Clearly, those who claim the respondents are from the far right are either misinformed or disingenuous.
And what of the claim that the parents were “unsupportive” or too disconnected from their children to recognize they had felt dysphoric during childhood? Dr. Littman acknowledges this possibility in her paper. However, she also notes that “the 200 plus responses appear to have been prepared carefully and were rich in detail, suggesting they were written in good faith and that parents were attentive observers of their children’s lives.”
Littman’s study offers, for the first time, a glimpse into families who hold space for their dysphoric children while also seeking out mental health care that focuses on underlying conditions. Consider some of her findings:
Moreover, of Dr. Littman’s respondents, there were only eight cases of estrangement: six by the youths themselves and two “where the estrangement was initiated by the parent because the AYA’s outbursts were affecting younger siblings or there was a threat of violence made by the AYA to the parent.” [AYA = “adolescent or young adult.”]
These are clearly parents who supported their children in their distress and through exploration of identity. Littman’s study also found that 119 youth requested medical interventions at the same time they announced their new gender identity or within the first month of their announcement. Remember, 100% of the youth discussed in her survey did not qualify for a diagnosis of gender dysphoria at any point in their childhood or prior to coming out. Yet, 17 youth were offered an Rx on their first visit with a clinician. Perhaps even more concerning, “For parents who knew the content of their child’s evaluation, 71.6% reported that the clinician did not explore issues of mental health, previous trauma, or any alternative causes of gender dysphoria before proceeding and 70.0% report that the clinician did not request any medical records before proceeding.” This is in a cohort of young people of whom 62.5% had been diagnosed with at least one mental health or neurodevelopmental disability prior to the onset of gender dysphoria, which mirrors data from other affirmation-focused clinics.[2]
Another notable criticism of the study is that Dr. Littman sought input only from parents, not from their children. Here again she acknowledges the limitation: “Although this research adds the necessary component of parent observation to our understanding of gender dysphoric adolescents and young adults, future study in this area should include both parent and child input.” We understand that Dr. Littman plans future surveys specifically for dysphoric youth and we cannot emphasize enough how important this research will be for this particular group of young people and their families.
We, the signatories to this letter, overwhelmingly support the rights of transgender people, but we want better diagnostic and mental health care for youth who suddenly demand serious medical interventions, particularly in the absence of a history of dysphoria. We believe that medical interventions that may benefit some individuals may not help, and may even harm, others, as already evidenced by the growing number of desisters and detransitioners, many of whom have already suffered from irreversible side effects of their earlier medical transition . We support more research to help distinguish between the two groups, and Dr. Littman’s study is an important first step.
We strongly urge Brown University and PLOS ONE to resist ideologically-based attempts to squelch controversial research evidence. Please stand firm for academic freedom and scientific inquiry. We urge you to support Dr. Littman in this important line of research.
[1] See, for example, Bonfatto, M. & Crasnow, E. (2018) Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service, Journal of Child Psychotherapy, 44:1, 29-46, DOI: 10.1080/0075417X.2018.1443150. Also see Byne, W., Bradley, S. J., Coleman, E., Eyler, A. E., Green, R., Menvielle, E. J., . . . Tompkins, D. A. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41(4), 759-796. doi:10.1007/s10508-012-9975-x.
[2] “In all diagnostic [mental health] categories, prevalence was severalfold higher among TGNC youth than in matched reference groups.” http://pediatrics.aappublications.org/content/early/2018/04/12/peds.2017-3845
by Jenny Cyphers
Jenny Cyphers is a homeschooling parent. She has been writing about that experience for many years, in various online forums. Jenny has been married for 24 yrs to the father of their two children, one adult and one teenager. They all live, work, and create, in Oregon. Jenny and her teen daughter were recently interviewed for an article about gender-dysphoric youth in The Atlantic.
4thWaveNow editorial note: We are grateful for Jesse Singal’s reporting on this complex issue and appreciate that he included the seldom-heard voices of teens who desisted from a trans identity, and their parents, in his article. We are aware that in some circles, the discussions we host on our site are considered transphobic and that we, a loosely-organized group of parents writing on this site, have been defamed as a “hate group” by those on the extreme end of the activist spectrum.
As always, we encourage those interested in the issue to read as widely as possible so they may come to their own conclusions. We contend that by leaving out all mention of 4thWaveNow, The Atlantic not only failed to offer parents the alternative opinions and resources we offer, but they also contributed to an environment that, due to censorship of critical voices, continues to propagate the distorted idea that cautiousness around medical interventions for minors is inherently harmful to trans-identified people in general.
I knew, when I agreed to be interviewed for The Atlantic article “When Children Say They’re Transgender,” that some of my words might be cut, or changed in ways I didn’t intend. But Jesse Singal is a good journalist. He’s personable and honest and willing to take on some really difficult subjects. He digs deep, records, researches, cites sources and ties things together in a nuanced way. Along with editors, he carefully adds and discards words, phrases, sources, quotes, and relevant ideas that lend themselves to the overall picture of what people will read and take away from what they’ve read. That’s what good journalism is.
There are a few things about our story and the way it was presented in The Atlantic that I’d like to clarify. First and foremost, the last-minute editorial decision to unlink the essay “A Careful Step into a Field of Landmines,” I’d written for 4thWaveNow, combined with removal of all mention of the site, needs to be highlighted because in doing so, The Atlantic failed to include important resources created to help parents support their gender dysphoric and nonconforming youth. The result is an article focused on the “situation” of “trans kids” that obscures parent-led examination and support for youth to explore identity without harmful medical interventions, the consequences of which can last a lifetime.
There are more choices for families than to either support their teens’ requests for pharmaceuticals and surgery on the one hand, and disowning or otherwise invalidating their interest in exploring their identity and nonconformity on the other. The Atlantic editors’ choice to remove 4thWaveNow from the discussion in effect denied parents access to important analysis that offers a balanced and middle ground.
The Atlantic photo editor had to dig deep in the several photos we provided to find the pensive one they chose for their article. Here’s one my daughter likes better; she suggested it be included with this post.
Part of my agreeing to contribute to this important debate is helping to create a platform. This website is such a platform. In talking with Jesse, I was upfront about my beliefs, which in part have been informed by 4thWaveNow and the great many array of voices shared here. It isn’t a monolith. Some of us are very liberal, left-leaning people in liberal left-leaning parts of the country, doing liberal left-leaning activities. Some of us are middle-of-the road, a minority of us are conservative, some of us are doctors, therapists, professors, and teachers. Some of us have allowed full social transition to give space to figure things out while still not agreeing to medical transitioning, and some have not. Excluding mention of 4thWaveNow, a site that gets 60K hits a month, fails to tell the whole story. Why do that? Why leave out one of my main sources of information and the ways that information helped me help my child?
Two of the most important aspects of my family’s experience that are not adequately addressed in the Atlantic article, are: 1) my daughter was given a clinical diagnosis of gender dysphoria, so she was just as “truly trans” as the next kid, and 2) it was my insistence that my child wait to medically transition, not her therapist’s. My teen’s therapist, Laura Edwards-Leeper, listened to me and agreed. We were lucky. While there are some cautious, thoughtful providers, the current situation in the US is that there is also no oversight. The most vocal professionals are firmly in the affirmation camp which believes, without any long-term data to validate, that withholding hormonal interventions is tantamount to abuse.
I didn’t know, going into Delta’s first appointment, what the outcome would be. That’s how difficult this is for parents; we have no idea what the outcome will be when we have very “insistent, consistent, and persistent” children requesting immediate medical interventions. It’s a matter of luck to find a therapist who respects parents’ knowledge of their children, who takes parental concerns and insights seriously, and who are not afraid to support slow, cautious progression.
While many transgender activists argue that they understand our children better than we do, there is no evidence to support their claim. Rapid Onset Gender Dysphoria is seen primarily, although not exclusively, in natal females during puberty. It is important to understand that what separates my daughter and many of the kids of 4thWaveNow parents, is this: None of these kids experienced distress over their sexed bodies until they came into contact with the idea that there might be something wrong with them. In other words, the dysphoria is what was “rapid onset,” not necessarily their gender atypicality. These are not kids with “early-onset,” nor do they resemble later in life transitioning people who frequently claim to have always “felt like” a girl but were too afraid or oppressed by family dynamics to admit their feelings. Then, making wide sweeping projections of their own experiences, they mark our children as being in need of the help they believe they should have had. With our kids, as with the group of young people described in Lisa Littman’s survey where ROGD was first named, their dysphoria set in quickly during puberty, often after spending hours online watching/reading others discuss their distress.
Another outlandish claim (made repeatedly by some activists and “affirming” clinicians) is that we simply missed all the signs our children were suffering earlier. I can assure you that, as a homeschooling mom who spent all day every day with my daughter, she never thought she was or wanted to be a boy prior to encountering the idea from transgender kids in her social circle. In fact, between ages 9-11, she was often “misgendered” (referred to as “he” or “him”) and hated it. It saddens me that these activists experienced such awful childhoods. However, their childhoods seem to have been negatively influenced by the religious fundamentalism and/or abusiveness of their parents; their childhoods do not remotely resemble the experiences of my daughter or the many other young people experiencing ROGD whom I’ve met.
Teens and tweens with ROGD often meet all the clinical diagnostic criteria for transitioning. They are often “insistent, persistent, and consistent” for more than six months, or in our case, for two years. Teens with ROGD also typically meet the clinical threshold for gender dysphoria, as mine did. It’s in her medical file. That’s correct, my “never really trans kid” had a clinical diagnosis of gender dysphoria under the DSM-V. This is what we hope others understand: our kids are suffering, they hate their bodies, they want and need help. In many cases, our kids had trouble making friends, experienced some form of earlier trauma, and struggle in other important ways, completely unrelated to gender, that should not be overlooked or seen as secondary to their dysphoria.
I know, because I was in pro-transitioning parent support groups, that parents are going to “gender specialists” and demanding medical interventions for their children without thoroughly considering why their children feel the way they do. I know, because I’ve heard from parents, that some therapists will give the green light to medical pathways without addressing any mental health issues. Dr. Johanna Olson-Kennedy, who treats 900 youth at her LA clinic, is quoted in Singal’s article as saying that she “believes that therapy can be helpful for many TGNC young people, but she opposes mandating mental-health assessments for all kids seeking to transition.” As many 4thWaveNow parents and teens will tell you, this attitude denies young people the opportunity to deeply explore why they want to alter their bodies and shuts down learning about other non-medical means of managing their distress.
When I was approached to do an interview, I needed to carefully consider my motivation for doing so, and if I should agree to discuss my family’s situation at all. Ultimately, I agreed because people need to hear that there are other ways to support trans-identifying kids. Gender dysphoria is very real and it hurts. My child’s life wasn’t easy because of the intense pain of GD. I knew there had to be answers other than what I saw everywhere around me, that suggested agreeing to medical interventions was the loving and kind thing to do, and that these interventions were harmless and helpful. I agreed to be interviewed because I wanted to highlight for other parents that there are other choices: most notably, offering support (buying clothing, getting haircuts, using a new name, finding a decent therapist) while also saying “I don’t think there is anything incongruent about your body/feelings.” The Atlantic axed this part of our story, the part where parents can offer tremendous support for their children without ever setting foot in a gender clinic in search of medical interventions.
I used to be a lot more open to the idea of transitioning children, in part because I know and like many transgender people. It wasn’t until I found that in the US, girls as young as 13 are getting mastectomies, that I began to question gender affirming medicine. In the new genderist language it’s called “chest,” “top,” or “confirmation” surgery. It sounds so much nicer than a double mastectomy, almost positive and pleasant. Cutting healthy body parts off of children should not be a thing. Ever. That was the moment I decided I would never stop talking about this.
My part of the interview with Jesse Singal–although about my daughter–was really more about how to support, in general, a child going through this very difficult experience. It is challenging, if not impossible, to find places to discuss supporting teens as they explore their identity in non-medical ways. 4thWaveNow is the only US-based resource that allows this. We need to talk about how to support gender non-conforming kids; things like buying clothing from the boys’ department if you have a daughter, or buying girl clothing if you have a son. My part of the interview wasn’t aimed at kids, but at parents who really need more and better tools for helping their distressed children than the “transition or die” option. Without choices, how can people really make one? Pick one of the two? No thanks.
Someone asked me the other day why I care. Why can’t I just let people do what they want? The answer is really simple. As humans we are guided to protect our young. If our culture fails to do so, each of us have failed to protect our children. This is why there are laws against abusing children, laws preventing minors from smoking or drinking, laws to keep kids from driving, laws for educating children. We can argue against any one of those things, but the cultural “we” have agreed that this is for the good of protecting children from harm, and for promoting welfare. In the US, unlike in other countries, there are no laws or regulations about transitioning children. Until there are, this is up for debate and I’m weighing in.
The fact that so many parents are left with this narrative that there is only one right way to help a confused kid, is what drives a wedge between the parent and child, leaving children vulnerable to self-proclaimed internet “experts”, like Zinnia Jones, who are more than willing to validate their feelings, further dividing parent and child.
Look, I understand that there are some truly not-very-nice parents out there, but we should not be making policy around them. That’s the sort of thing that creates bad case law. Let’s assume that the vast majority of parents want what’s best for their children, even if they have no idea what that looks like.
I was even more puzzled about the Atlantic‘s last-minute editorial decisions when I saw tha
t, not only was any mention of 4thwavenow scrubbed in the final version of the article, but a statement by Jones and reference to Jones’ website were included. Jones has written multiple screeds denying the existence of the rapid-onset dysphoria in adolescent girls that more and more people (including clinicians) are noticing. Further, Jones recommends (on Twitter) that young people secretly obtain puberty blockers online if their parents aren’t onboard.
Unfortunately, many therapists, and others invested in the transgender narrative, seem to be heavily influenced by activists like Zack Ford, an opinion writer for the website Think Progress who, in response to Singal’s article, enunciates the activist-notion that parental concern and insight is irrelevant to the discussion. He writes,
“Whether a parent doubts the legitimacy of a child’s transition has zero relevance to whether transitioning is best for their child. Humoring this doubt is exactly what makes the story so harmful.”
Read that quote again. Read it several times to see just how dismissive it is of parents, the very people transgender and gender non-conforming kids rely on for support. You know–the people who would be signing the informed consent paperwork at the doctor’s office, agreeing to allow doctors to prescribe permanent, sometimes sterilizing, experimental off-label use of medications, and body-altering irreversible surgeries.
The collective, cultural “we” cannot dismiss parents as trivial when we are discussing our children, whom we will protect with our lives. This protective mechanism is the prime role of parents and an important part of being human and all the moral and ethical things that come with it. This is not a divide between liberal and conservative. There are too many divisions in this world, and this country, as it is. This is about whether “we” have an ethical imperative to protect our children. Yes, we need to listen to kids. We also need to listen to parents who are not interested in stifling their children’s interests or gender presentation, but who also know their children better than any therapist ever will.
Angus is the pseudonym of a mostly-retired clinical epidemiologist on the faculty of a major health sciences university. We asked Angus to provide a short bio, and this is what he wrote:
“Angus is in his late 50s now, but back in his 40th year of life, his arrogance and folly led him to think it was fine to transgress, wear the dress, and pretend to be a “woman.” He did this for 13 long years, taking the synthetic estrogen drug every day, self-absorbed and entirely content. He was so convinced that he would carry on as a fake “lady” until the day he died, he decided to have some surgery. Not the more drastic option, it’s true, but most men would do anything to avoid the one he got. Quite unexpectedly one morning Angus snapped out of his transfugue trance state and felt compelled to examine his life. He rapidly ceased his masquerading and mimicry and re-engaged with material reality. He has the blog at autogynephiliatruth.wordpress.com but hasn’t put anything up there for a while. Angus can sometimes be observed causing trouble on Twitter @iforgetalready.”
As with all articles submitted by our contributors, the opinions expressed by the author are his own. He is interacting in the comments section of his post under the moniker “Awesome Cat.”
by Angus
The trans industry must concede that rapid onset gender dysphoria is a social contagion and they must cease recruiting efforts among young people.
Girls and young women increasingly make the claim in recent years to have “gender dysphoria,” an inversion of the male-dominant pattern that has been observed over many decades. More than just flipping the chart, this represents a major surge in the rate at which women are inducted into the illusory realm of TransWorld. The trans industry’s nonsensical position is that practically all “cis” people are potentially “trans,” but it’s impossible to know for sure whether anyone is a man, a woman, or some innovation unless they tell you. Even then, you may need to ask again tomorrow.
Clinicians have struggled to explain why there has been such an appalling growth in adolescent “gender dysphoria,” especially in girls and women. One possible explanation, recognized as far back as 2010 and 2012, is the impact of social expectations, including the Internet, on the development of a transgender identity.
And even further back, in 1999, WPATH (formerly called the Harry Benjamin International Gender Dysphoria Association) advised clinicians to proceed with caution when treating adolescents because of the changeability of “gender identity.”
Then, in 2016, a physician named Lisa Littman conducted a study which, in part, investigated whether social contagion could be a contributing cause; in other words, perhaps some kids caught up in this mix do not really have a long-standing discomfort with their sex. It’s possible for many that the trap door could open below their feet, and within a short time, they’d be injecting testosterone. That’s truly how they roll with “affirmative transcare.”
Trans activists raged over the anticipatory invalidation they already felt with this story, as it dramatically undermined their alibi of “born this way” innocence. They seek transrecruits among children and youth, and at least in the USA, have an alarming interest in giving kids hormone drugs and surgeries at the earliest possible ages. Along with academic and clinician running dogs and other personnel getting paid in the trans industry’s multifarious dimensions, they worried that the mainstream public might see through transvested interests of its pseudoscience. They tried to kill this story with fire. Their efforts only made the story better known.***
Let me just say that I don’t believe that anyone on Earth is “transgender,” “transsexual,” trans-anything except perhaps transvestite, because that term is specific to clothes (Latin vestīre). In English the word just means crossdresser, which is accurate in a simplistic way. Nor is anyone “cis.” Evolution would not allow development of a heritable trait cluster or quasi-sub-species in which a woman or man in good physical health would have an insatiable obsessed yearning to mimic the sociocultural sex stereotypes (i.e. “gender”) for appearance and mannerisms of the opposite sex. There is no way that little Johnny likes to play with dolls or that little Jenny likes to play with trucks because as “trans kids,” they are on the spear point of an ancient evolutionary process that manifests at a certain prevalence in a given population. Had there been such genetic innovation back when we roamed the savannahs, folks with those characteristics would have all died out pretty quickly due to the lack of skilled plastic surgeons and endocrinologists. After all, along with voice coaches, such professionals are the only ones who can deliver “the basic health care they need to survive.” Our illustrious forebears in the painted caves would not have been pleased with the maladaptive meltdown and tantrum behaviour that would have emerged in proto-trans people in response to rampant “misgendering,” and excess mortality due to other people declining to play along would have been high. In real life, simpler explanations are more likely to be true, and there are far more compelling approaches to exploring the question of why women and men with healthy bodies might get it into their minds that they are really the opposite sex.
It should be pretty obvious that the “transition” one hears too much about is also a bogus mind-game. No-one “transitions” to anything except a likely-shortened lifestyle with lots more trips to the doctor, massive surgeries, aftercare; complications (some quite filthy), surgical revisions, risk of cardiovascular trouble; and lifelong drugs. Men may look forward to practicing fake voices & mincing walks, incessant “dilation” of the pseudo-“vagina” seeping void space created through flaying & inverting their genitals, heightened risk of multiple sclerosis and still being 100% male. Women may anticipate the potential for luxuriant back hair growth and being rather shocked that after mastectomies and having the organs of their reproductive systems ripped out, they are still as female as the day is long. Also, a greater risk of kidney failure, even if they are vegans.
Men and women who bought into the transprop and believe its lies have paid with their bodily integrity, and many times with their health. They are victims of it themselves, and I wish healing and wholeness for them. In the moment, however, many contribute to transgenderism’s harms.
For nearly 100 years, since doctors began misleading confused men and women to believe that this might be an option, vastly more males than females have desperately demanded to go under the knife and “change sex.” Such “change” is only illusion, but many men and women have fixated on that fraudulent goal in the vain hope to escape the miseries and melodrama of their own real lives. It is thus a matter of tremendous public health concern, indeed it’s a public health emergency, that over the course of a few years the rate of young women and girls who newly claim to be trans has gone through the roof. Doctors in Amsterdam and Toronto reported in 2015 that in their clinics there were now more females than males getting transbees in their bonnets. These women and girls had never previously shown profound dissatisfaction with being female; their “gender dysphoria” seemed to be new. Investigators used their Discussion to propose that among other reasons why women now greatly outpaced men, perhaps more secretly trans heterosexual women were now hopping on board the transwagon. Alternatively, maybe this decade’s grossly overblown propagandizing of all things trans has resulted in an Exodus of silently-suffering transfolk, women and men both, from “cisnormative” agony; women lead the way, enjoying their female privilege, as many already owned a few pairs of blue jeans or had short hair.
Newcomers to the trans industry, Helsinki then piped up to say that in their first two years running a child transing center they were stunned to find that 41 of 46 (87%) of adolescents were girls. Inconveniently for trans industry bigwigs, the Finns continued. It seems that 35/47 (75%) of these youth were already in treatment for serious psychiatric comorbidity unrelated to “gender”; and 12/47 (26%) were on the autism spectrum. The ratio of females to males, autism prevalence and levels of comorbid psychopathology were far higher than had ever previously been reported. Investigators were flummoxed by all of this, pointing out the ways that it contradicted the lying official translore, and could propose no solid explanations; least of all for the massive overrepresentation of girls.
Reports from the United Kingdom of huge spikes in the rate of child referrals to transing centers also show far more girls than ever before. The most recent of these papers from the UK suggests that from 2009-2016, the average year-on-year increase in referrals for children under age 12 was “only” 48.6% for boys, while it was 92.7% for girls; in adolescents the corresponding rates were 54.9% and 88.6%.
Naturally, the new transcenario posed a problem for TransHQ. Most industry clinicians maintained the party line, more or less saying “gee, we didn’t know there were so many transkids.” When two of the more notorious pediatric trans industry doctors were asked about the startlingly high proportions of girls, Johanna Olson-Kennedy seemed taken aback but then acknowledged that it was true, before uttering a few more incoherent half-thoughts. Joshua Safer seemed evasive and glassy-eyed as he answered in terms of both sexes.
None of the researchers reporting this outbreak of “girlpower denied” was apparently able to imagine a possibility that would require coloring outside the lines of the trans cult’s hijacked rainbow; an answer that was much more likely to be true than their mouthfuls of bloated transjargon.
In 2016, however, Dr. Lisa Littman (now at Brown University in Rhode Island, USA) published a summary description of her survey undertaken with parents of youth purporting to have “gender dysphoria.” Results of her survey suggested something pretty obvious: This new type of rapid-onset gender dysphoria (ROGD) is a whole different animal than the usual kind observed in adolescents. It was really sort of a youth craze, exacerbated via social contagion through the influence of peer groups and shady characters who promote trans ideology and recruit adolescents aboard the transwagon. Psychotherapist Lisa Marchiano also wrote eloquently on ROGD in several articles, including this piece from the perspective of Jungian psychology.
The discussion of ROGD came upon trans activists unawares, but as the story continued to gain traction, the transmachine hotly blew up its transmissions, spewing towering tizzies of refutation, torrid pseudoscientific tirades, aggrieved attacks on academic integrity. Many trans industry academics and clinicians who have desperately tried for years to show that “gender identity” is innate now faced the possibility that the public would begin to catch on: “Innate gender identity” was complete garbage. Ice cold embarrassment and waves of sweaty invalidation flew from the ridgetops of their enormous brows. Social media was also transflamed with outrage, scorn, popcorn and flipped wigs.
But what can these trans cult & industry personnel and enablers really say in their dizzy diatribes? They raged against ROGD, called it a “hoax diagnosis,” scoffed at the study design and impugned Dr. Littman’s academic integrity. Yet they knew full well that the entirety of the “affirmative model of care” for people confused about what sex they are has much flimsier underpinnings, in addition to cherry-picking, confirmation bias, same-team replication & review, in-house “bioethicists” and financial or other conflicts of interest. What can they say, when reports from around the world confirm not only an explosion in the rate of children and adolescents getting hooked into TransWorld, but a reversal of the old familiar sex ratio? What can they say when there is in real life no “trans”?
Young people are systematically gaslighted in their indoctrination about all things trans. Like many adults, adolescents are usually overstimulated, sleep-deprived and eating suboptimal food; often somewhat traumatized and fragmented far away from knowing their own wholeness. Trans ideology is now presented to kids in USA schools as truth, “settled science” that helps people to “become their authentic selves,” masquerading through life as the opposite sex. But based on both my personal experience as a former “transwoman” and my ongoing research, trans itself actually doesn’t exist, at least not in material reality. It exists only through mind-games; reversals, inversions & perversions of meaning; language-policing; and bureaucratic paperwork.
All human beings are “valid,” but transgenderism is a cultish ideology that leads to serious harms. Rich countries of the world have fallen grotesquely into error and if there is any justice, the people who promote and take advantage of the transcraze in young people someday will be held accountable.
by Brie J
On February 20, The Advocate, one of the leading LGBT publications in the US, ran an article which attempted to invalidate data collected by physician and researcher Lisa Littman from parents whose children experienced Rapid Onset Gender Dysphoria (ROGD). The author, Brynn Tannehill, immediately posted the article to the WPATH Facebook page.
In the thread, Tannehill (along with Jo Hirst, author of the Gender Fairy), suggested The Journal of Adolescent Health should be asked to retract and/or apologize for publication of Littman’s preliminary findings. UCSF’s Dan Karasic, MD (moderator of the Facebook page and WPATH official) agreed.
Littman’s abstract had been accepted for poster presentation and the poster was presented at the March 2017 Annual Meeting. (The full paper has not been published yet, and we look forward to its availability).
Note: Interestingly, as of this writing, four days after they were written, the last three comments have been deleted from the original thread.
The dismissal of Littman’s work, and the move to suppress it, is unconscionable. For one thing, some young people (like my daughter) who experienced ROGD have already desisted. Others, who were supported in procuring medical intervention, have already experienced regret. Many more desisters and detransitioners are sure to follow.
This trend has not gone unnoticed by at least some in WPATH. For example, veteran WPATH clinician Rachael St. Claire, in a Facebook post on January 5 of this year, made this comment (notice that commenting was turned off immediately after St.Claire posted):
This concern is echoed by UCSF clinical psychologist Erica Anderson, herself a transgender woman, in a recent Washington Post article:
“I think a fair number of kids are getting into it because it’s trendy,” said Anderson, who was married for 30 years and fathered two children before transitioning seven years ago.
I’m often the naysayer at our meetings. I’m not sure it’s always really trans. I think in our haste to be supportive, we’re missing that element. Kids are all about being accepted by their peers. It’s trendy for professionals, too.”
In addition, clinics around the world have noted a sharp increase in the number of girls presenting for treatment in the last few years.
A once-rare condition is now increasingly common. It is surely in the interest of all people who care about gender dysphoric youth to investigate the reasons for the increase, and Littman’s work is an early contribution to this effort.
The ostensible reason given for Karasic et al’s desire to have Littman’s abstract retracted is that the data comes from a self-selected group of parents, culled from websites where such parents gather, in an anonymous survey format, and is thus deemed to be worthless. Yet advocates for pediatric transition constantly promote other survey studies, also culled from “self selected” groups (such as the Williams Institute suicidality survey), as well as research conducted by investigators who only recruit subjects from pro-early transition organizations (such as Kristina Olson’s two studies), with no attempt to broaden their samples to children who are not socially or medically transitioned.
In fact, Littman’s work is the first to study this new presentation of gender dysphoria, and she collected information from the people who know these children and teens better than any transgender advocate, endocrinologist, psychologist, or therapist ever could — their parents.
But you’re not listening to us.
Littman’s study, according to its critics, is contentious for a few reasons, but most notably for using the term “Rapid Onset Gender Dysphoria” as a descriptor for a new kind of trans-identifying youth, primarily natal females, who during or after puberty, begin to feel intense unhappiness about their sexed bodies and what it means to feel/be/present as a woman.
Let me emphasize: What is “rapid onset” in this population is the dysphoria, not the gender atypicality. What distinguishes these young people from the early-onset populations studied previously is that they may have been happily gender nonconforming throughout childhood (though some were more gender typical), but they were not unhappy (which is all “dysphoric” really means), nor did they claim or wish to be the opposite sex. The unhappiness set in suddenly, in nearly every case only after heavy peer influence, either on- or offline.
This phenomenon has only recently been noted by clinicians directly involved in treating gender dysphoric youth, as well as other mental health professionals. While there is no lack of evidence for adolescent emotional and behavioral social “contagions,” Littman’s research is the first to collect data on this phenomenon as it relates to identifying as transgender.
Even though rapid onset gender dysphoria has been noted by other researchers and clinicians who work with these populations, The Advocate and WPATH’s Dan Karasic consider the descriptor “junk science.” In a swift attempt at censorship, Karasic deleted all but one of my comments on the public WPATH Facebook page and then banned me from the group when I asked him to please consider the experiences of young people, like my daughter, for whom gender dysphoria set in hard and fast after being exposed to the idea that her gender nonconformity was in fact a sign of being transgender.
Interestingly, after I was purged, Karasic posted links to both my and my daughter’s stories on 4thWaveNow, and unfounded accusations were leveled against me and 4thWaveNow; since I was banned, I was not able to respond to them.
Interested readers may refer to these Twitter threads should you want more blow-by-blow details:
The subject of the linked article twice, in a public forum, accused 4thWaveNow of "attacking my children" in the writeup. Is there any basis for this claim? https://t.co/qwSqvaFGPX
— 4thWaveNow (@4th_WaveNow) February 22, 2018
https://twitter.com/BJontry/status/966728843649204224
https://twitter.com/BJontry/status/966479677098401792
It is concerning, given Karasic’s reaction to Littman’s research, that he and others evidently leave no room for a teenager to be incorrect about how they are interpreting their feelings, no room for a clinician to be incorrect when recommending transition, and no room for a parent to understand what is going on with their own child. It is narrow minded and short-sighted, especially considering there is no long-term data supporting the benefits of early medical transition for gender dysphoria or consensus from the medical community about best treatment methods.
This lack of consensus, while well known and acknowledged by the international medical community, has been ignored by many transgender advocates, along with the “gender affirmative” recipients of a $5.7 million NIH grant, who, with the help of the mainstream media, have manipulated the public into believing early social transition, pubertal blockade, and early cross-hormone treatment constitute settled science.
To be clear, in “Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study,” a 17-clinic international study published in The Journal of Adolescent Health, the authors explain that:
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 (world- wide) multicenter research and debate. As long as there are only limited long-term data in support of the guidelines, there will be no true consensus on treatment. To advance the ethical debate, we need to continue to discuss the diverse themes based on research data as an addition to merely opinions. Otherwise ideas, assumptions, and theories on GD treatment will diverge even more, which will lead to (even more) inconsistencies between the approaches recommended by health care professionals across different countries. (372)
I am sure some WPATH members, like the treatment teams in Lieke et al., “feel pressure from parents and adolescents to start with treatment at earlier ages.” I know there are others, besides those reported in Lieke et al. who:
[…] wondered in what way the increasing media attention affects the way gender-variant behavior is perceived by the child or adolescent with GD and by the society he or she lives in. 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
It is unconscionable that transgender advocates, and the leading international body concerned with transgender medicine, would seek to quash data that address unsettled and mostly unexplored areas of concern. It is incredibly important that ROGD be included as a research point because the main studies used to justify the use of puberty blockers, cross-sex hormones and surgery in adolescents required “persistent gender dysphoria since childhood” and “no serious comorbid psychiatric disorders that may interfere with the diagnostic assessment” before the patients were eligible for medical intervention. In other words, none of the participants in these treatment studies had adolescent-onset of their gender dysphoria and none of the participants had serious psychiatric issues.
It is a huge leap to assume that an entirely different population of adolescents with a different presentation of symptoms will have the same results as the adolescents in the Amsterdam cohort. An additional gap in the research is that because all the desistence and persistence studies are about adolescents who had childhood onset of gender dysphoria, the persistence and desistence rates for adolescent-onset gender dysphoria are unknown.
In all areas of medicine, best practices come from intense discussion and research into indications and contraindications, and into risks, benefits, and alternatives. Yet, WPATH’s Karasic, along with the trans advocates who have prominent roles in the organization, appear to believe it is in their community’s best interest to shut down all discussion about contraindications, risks and alternatives. This is inappropriate and undermines the very concept of informed consent.
Furthermore, The Advocate article suggests that Littman’s sample is biased because it gathered data from “unsupportive” parents. This framing is both fallacious and dangerous to gender nonconforming and dysphoric youth. It suggests that the only path for gender dysphoric youth, even those with a rapid onset, is full affirmation including fulfillment of requested medical interventions. It also implies that parents aren’t able to be both supportive and cautious.
I have spoken to some of the parents who participated in the study. Few could be described as “unsupportive.” In fact, almost overwhelmingly, these parents supported their children in thinking about their gender identity and helped facilitate their preferences for atypical gender presentation and interests (taking them for haircuts, new clothing, and so forth). Many sought professional mental health consultations and treatment for their children. But what many of these parents did not support for their underage teenagers were hormonal and surgical interventions. This is an important distinction: Littman’s sample were supportive parents who were unsupportive of a particular medical treatment option.
It is entirely possible to be supportive parents invested in our child’s well-being and not agree to unproven medical procedures for which there is no consensus from the medical community of long-term safety or benefit to the majority of dysphoric youth. However, the loudest voices in pediatric transgender medicine often cite Kristina Olson’s descriptive research about early social transition for children which relies on the methods that they decry as “junk” when used in Littman’s research (targeted recruitment and the collection of data from parents). Kristina Olson recruited her sample from support groups and conferences to find parents who have socially transitioned their children, which might consist only of parents who are supportive of early social and medical transition. So is it an acceptable method for both studies, junk for both studies, or are the WPATH activists simply going by whether they like or dislike the findings?
As all parents know, we can tell when our children are suffering. To remain credible, advocates for gender dysphoric youth and the international organization which claims to be concerned with generating best practices in the field of transgender medicine must acknowledge that ROGD exists and there are some trans-identifying youth who arrive at their identity from external social pressures, and at times, internalized homophobia.
Related to this last point, the WPATH Facebook page wasn’t the only place my respectful questions were deleted. In a comment on The Advocate article itself, I asked Tannehill and Advocate readers to consider the recent research into how homophobic name-calling influences (hint: greatly) children’s perceptions of their gender identity.
My comment was swiftly scrubbed from existence. For those interested in reading “The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity?” the full text is here.
Finally, the fact that ROGD is being discussed by the conservative media is not, no matter how many “incriminating” links Tannehill dropped in the Advocate piece, a legitimate reason to discredit the data. The irony is not lost on many 4thWaveNow parents that our stories are covered by media outlets we typically avoid. In this politically charged climate, it is important for researchers, clinicians, and parents to work together to “first do no harm” even when those we otherwise disagree with call for the same cautions.
Clearly, Brynn Tannehill and Dan Karasic do not speak for all members of WPATH. I know for certain that they do not speak for many professionals currently working with gender dysphoric youth who see in their own practices what can only be described as “rapid onset gender dysphoria” in an increasing number of adolescents, particularly girls. Clinicians are aware of the rapidly growing numbers of young people requesting services and the possibility of social contagion; there are those among you who are concerned by the potential for misdiagnosis and the subsequent harm that will come to some of your patients as a result.
It is time for those with concerns to speak out. Please do not allow your ethical and professional concerns to be held hostage by ideology.
by J. Michael Bailey, Ph.D and Ray Blanchard, Ph.D
This is the second in a series of articles authored by Drs. Bailey and Blanchard; see here for their first piece.
Many parents who are part of the 4thWaveNow community have daughters who fit the profile of a sudden onset of gender dysphoria in adolescence. This phenomenon is discussed in detail by the authors after the first two types, in the section “Rapid-onset Gender Dysphoria (Mostly Adolescent and Young Adult Females).” Some 4thWave parents will also find the section “Two Rarer Types of Gender Dysphoria” of particular interest (near the end of the article).
We recognize that regular readers and members of 4thWaveNow will not agree with all of what Bailey and Blanchard have to say, but as always, if you wish to challenge the authors, your comments will be more likely to be published if they are delivered respectfully.
As their time permits, Drs. Bailey and Blanchard will be available to interact in the comments section of this post.
Michael Bailey is Professor of Psychology at Northwestern University. His book The Man Who Would Be Queen provides a readable scientific account of two kinds of gender dysphoria among natal males, and is available as a free download here.
Ray Blanchard received his A.B. in psychology from the University of Pennsylvania in 1967 and his Ph.D. from the University of Illinois in 1973. He was the psychologist in the Adult Gender Identity Clinic of Toronto’s Centre for Addiction and Mental Health (CAMH) from 1980–1995 and the Head of CAMH’s Clinical Sexology Services from 1995–2010.
One problem with the current mainstream narrative regarding gender dysphoria is that it makes no distinctions among apparently very different kinds of persons. For example, Bruce Jenner appeared to be a very masculine man, an Olympic athlete who was married to three different women and had six children with them, before becoming Caitlyn Jenner. In contrast, Jazz Jennings, a natal male, was so feminine that she earned a diagnosis of gender identity disorder at the age of four. She is attracted to males. Jenner and Jennings are so different in their presentation and history that it is surprising to us that anyone thinks they have the same condition. Jenner and Jennings are examples of two very different kinds of gender dysphoria that have been scientifically well studied, and have fundamentally different motivations, clinical presentations, and likely causes.
The failure of so many therapists and activists to acknowledge this distinction is disturbing for at least two reasons. First, it suggests they are either ignorant of relevant scientific evidence or are purposefully ignoring it. Second, failure to make scientifically valid and fundamental distinctions among different kinds of gender dysphoric persons can only prevent progress toward finding the best approach to helping each. Measles, influenza, and strep throat are all associated with fever. But if we had merely lumped them together as “fever,” we would not have effective treatments for them.
Types of Gender Dysphoria
Gender dysphoria isn’t common. But there are at least three distinct types of gender dysphoria that, presently, regularly occur in children and adolescents. We summarize these at length here. Two other kinds of gender dysphoria are much less common in these age groups, and so we address them less fully near the end of this essay. The main three types differ in their age of onset (childhood, adolescence, or adulthood), their speed of onset (gradual or sudden), their associated sexual orientations (members of the same sex or the fantasy of belonging to the opposite sex), and their sex ratio (equally or unequally likely in males and females).
The first type—childhood-onset gender dysphoria—definitely occurs in both biological boys and girls. It is highly correlated with homosexuality–the sexual preference for one’s own biological sex–especially in natal males. (Sexual orientation is usually not apparent until a child reaches adolescence or adulthood, however.) This is the type that Jazz Jennings had before her gender transition. The second type—autogynephilic gender dysphoria—occurs only in males. It is associated with a tendency to be sexually aroused by the thought or image of oneself as a female. This type of gender dysphoria sometimes starts during adolescence and sometimes during adulthood, and its onset is typically gradual. (Onset may appear sudden to family members, however.) Although Caitlyn Jenner has not discussed her feelings openly, we strongly suspect she is autogynephilic. The third type—rapid-onset gender dysphoria—mostly occurs in adolescent girls. This type is primarily characterized by the age and speed of onset rather than the associated sexual orientation, and it may not be limited to one sex, as the second type is. Our impression is that rapid-onset gender dysphoria is especially common among daughters of parents who read 4thWaveNow as well as those who post on the support board at gendercriticalresources.com.
The first two types (childhood-onset gender dysphoria and autogynephilic gender dysphoria) have been well studied, although autogynephilic gender dysphoria has primarily been studied in adults. The third (rapid-onset gender dysphoria) has only recently been noticed, and it is possible that it didn’t occur much until recently.
How do you know which type of gender dysphoria your child has? If there were clear signs well before puberty that your child was gender dysphoric, s/he has child-onset gender dysphoria. (You would certainly have noticed signs at the time; at the very least you would have coded your child as extremely gender nonconforming.) If your child showed signs of gender dysphoria for the first time during adolescence, s/he has one of the other types. Remember, autogynephilic gender dysphoria occurs only in natal males, and it starts either during adolescence or adulthood. (And to a parent, it usually seems sudden.) We describe the three types more thoroughly below.
Childhood-onset Gender Dysphoria (Boys and Girls)
The most obvious feature that distinguishes childhood-onset gender dysphoria from the other types is early appearance of gender nonconformity. Gender nonconformity is a persistent tendency to behave like the other sex in a variety of ways, including preferences of dress and appearance, play style, playmate preferences, and interests and goals. A very gender nonconforming boy may dress up as a girl, play with dolls, dislike rough play, show indifference to team sports or contact sports, prefer girl playmates, try to be around adult women rather than adult men, and be known by other children as a “sissy” (a term generally used to ridicule and shame feminine boys). A very gender nonconforming girl shows an opposite pattern, with the less derogatory word “tomboy” replacing sissy.
Onset of gender nonconformity is childhood cases is very early, typically about as early as gendered behavior can be noticed.
It is important to understand that not all gender nonconforming children (even very gender nonconforming children) have gender dysphoria. Probably most don’t, in fact. But we know of no cases of childhood-onset gender dysphoria without gender nonconformity.
Gender dysphoria in the childhood cases requires that children are unhappy with their birth sex. Furthermore, they typically yearn to be–or even assert that they are–the other sex.
What do we know about childhood-onset gender dysphoria?
Childhood-onset gender dysphoria has been systematically studied by two high quality international research centers (one in Toronto, which was led by Kenneth Zucker, and one in the Netherlands, which was led by Peggy Cohen-Kettenis). Both centers have assessed and followed representative samples of gender dysphoric children seen at their clinics. Reassuringly, results are fairly similar across the two sites. Furthermore, their results are similar to less representative samples studied earlier in the United States.
The published literature shows that at least in the past, 60-90% of children whose gender dysphoria began before puberty adjusted to their birth sex without requiring gender transition. That may be changing, however, due to changes in clinical practice that encourage gender transition. (See below.)
It is important to realize that childhood-onset gender dysphoria is the only kind of gender dysphoria that has been well-studied in children and adolescents. This means, for example, that the persistence and desistance figures we have provided apply only to that type. We do not know comparable figures about autogynephilic or rapid-onset gender dysphoria. Furthermore, most people, when they think of “transgender children and adolescents” have childhood-onset gender dysphoria in mind. (And they think of happy Jazz more than they think of Jazz’s serious medical surgeries and hormonal treatment for life.) But this association is misleading for all cases of gender dysphoria that are not childhood-onset. Autogynephilic and rapid-onset gender dysphoria have very different causes and presentations than childhood-onset gender dysphoria.
Sexuality
Children with childhood-onset gender dysphoria have a much higher likelihood of non-heterosexual (i.e., homosexual or bisexual) adult outcomes compared with typical children. Childhood-onset gender dysphoric boys who desist usually become nonheterosexual men. A smaller percentage have reported that they are heterosexual at follow up. Those who transition become transwomen attracted to men.
Although most childhood-onset gender dysphoric girls who have been followed identify as heterosexual, those who desist have a much higher rate of nonheterosexuality compared with the general population. Among those who transition, most are attracted to women.
We repeat: there is no evidence that parents can change their children’s eventual sexual orientation, and we don’t think they should try.
Risk Factors for Persistence of Childhood-onset Gender Dysphoria
Which childhood-onset gender dysphoric children will persist, and which will desist? Evidence suggests that we can’t distinguish these two groups with high confidence, although we can distinguish them better than chance.
There is some evidence that the severity of gender dysphoria distinguishes these two groups, although it is far from a perfect predictor. Children who not only say they want to be the other sex but who assert that they are the other sex may be especially likely to persist. The reasons why a child’s expressed belief that s/he is the other sex predicts persistence remain unclear, and this variable does not allow even near-perfect prediction. The idea that it is the essential test of “true trans” is an overstatement.
Other empirically supported risk factors include being of lower socioeconomic status and having autistic traits, both of which predict persistence. Why should these factors matter? Researchers have speculated that socioeconomically disadvantaged families are more likely to have problems that prevent them from providing the consistent supportive social environment that may be most likely to help the gender dysphoric child desist. Autistic traits include perseverative and obsessional thinking, both of which may make desistance more difficult. Furthermore, parents of children with autistic traits may be so concerned about other problems that they are permissive about things likely to foster gender transition.
One powerful predictor of persistence is social transition, or a child’s living as the other sex. Until recently this was practically unheard of. Increasingly, however, it is not only known but encouraged by many gender therapists. (Watch an episode of “I am Jazz.”) In the Netherlands social transition has been common longer than in the United States. A recent study found that social transition was the most powerful predictor of persistence among natal males. That is, gender dysphoric boys allowed to live as girls strongly tended to want to become adult women. (The same trend occurred for natal females, but it was less robust.) This is not surprising. If a gender dysphoric child is allowed to live as the other sex, what will change his/her mind? No one disputes that gender dysphoric children really, really would like to change sex.
What should you do?
The necessary studies have not been conducted to be certain. But based on the overall picture, we suggest:
If you want your childhood-onset gender dysphoric child to desist, and if your child is still well below the age of puberty (which varies, but let’s say, younger than 11 years), you should firmly (but kindly and patiently) insist that your child is a member of his/her birth sex. You should consider finding a therapist if this is difficult for you and your child. You should not allow your child to engage in behaviors such as cross dressing and fantasy play as the other sex. Above all else, you should not let your child socially transition to the other sex.
At the same time, you should recognize that despite your best efforts, your child may ultimately need to transition to be happy. If your child’s gender dysphoria persists well into adolescence (again, the ages vary by child, but let’s say age 14 or so), s/he is much more likely to transition. At that point, in our opinion, parents should consider supporting transition.
Autogynephilic Gender Dysphoria (Adolescent Boys and Men)
From a parent’s perspective, autogynephilic gender dysphoria (which occurs only in natal males) often seems to come out of the blue. This is likely to be true whether the onset is during adolescence or adulthood. A teenage boy may suddenly announce that he is actually a woman trapped in a man’s body, or that he is transgender, or that he wants gender transition. Typically, this revelation follows his intensive internet research and participation in internet transgender forums. Importantly, the adolescent showed no clear, consistent signs of either gender nonconformity or gender dysphoria during childhood (that is, before puberty).
There is an important distinction between rapid-onset gender dysphoria and autogynephilic gender dysphoria that happens to have an adolescent onset. Rapid-onset gender dysphoria is suddenly acquired, whereas autogynephilic gender dysphoria may be suddenly revealed, after having grown in secret for a number of years. We will talk more about this later.
Where does autogynephilic gender dysphoria come from? We know a lot about the motivation of this kind of gender dysphoria. Most of our knowledge comes from studies of adults born male who transitioned during adulthood. Some of these adults had gender dysphoria during adolescence, but all of them had the root cause of their condition: autogynephilia.
(Warning: Autogynephilia is about sex. We understand that it is awkward and uncomfortable for any parent to consider their children’s sexual fantasies. But you can’t understand your son with this kind of gender dysphoria without doing so.)
Autogynephilia is a male’s sexual arousal by the fantasy of being a woman. That is, autogynephilic males are turned on by thinking about themselves as women, or behaving like women. The typical heterosexual adolescent boy has sexual fantasies about attractive girls or women. The autogynephilic adolescent boy’s may also have such fantasies, but in addition he fantasizes that he is an attractive, sexy woman. The most common behavior associated with autogynephilia during adolescence is fetishistic cross dressing. In this behavior, the adolescent male wears female clothing (typically, lingerie) in private, looks at himself in the mirror, and masturbates. Some autogynephilic males are not only sexually aroused by cross dressing, but also by the idea of having female body parts. These body-related fantasies are especially likely to be associated with gender dysphoria.
It is important to distinguish between autogynephilia and autogynephilic gender dysphoria. Autogynephilia is basically a sexual orientation, and once present does not go away, although its intensity may wax and wane. Autogynephilic gender dysphoria sometimes follows autogynephilia, and is the strong wish to transition from male to female. A male must have autogynephilia to have autogynephilic gender dysphoria, but just because he is autogynephilic doesn’t mean he will be gender dysphoric. Many autogynephilic males live their lives contented to remain male. Furthermore, sometimes autogynephilic gender dysphoria remits so that a male who wanted to change sex no longer does so.
In general, adolescent boys are unlikely to divulge their sexual fantasies to their parents. This is likely especially true of boys with autogynephilia. Furthermore, many boys who engage in cross dressing feel ashamed for doing so. The fact that autogynephilic fantasies and behaviors are largely private is one reason why autogynephilic gender dysphoria usually seems to emerge from nowhere. Another reason is that autogynephilic males are not naturally very feminine. An adolescent boy with autogynephilia does not give off obvious signals of gender nonconformity or gender dysphoria.
It is likely that most autogynephilic males do not pursue gender reassignment, but this is difficult to know. (We would need to conduct a representative survey of all persons born male, asking about both autogynephilia and gender transition. This has not been done and won’t be done anytime soon.) Many males with autogynephilia are content to cross dress occasionally. Some get married to women and many also have children. Family formation is no guarantee against later transition, although that may slow it up somewhat. In past decades, when autogynephilic males have transitioned, they have most often done so during the ages 30-50, after having married women and fathered children. It is possible that autogynephilic males have recently been attempting transition at younger ages, including adolescence.
The relationship between autogynephilia and (autogynephilic-type) gender dysphoria is uncertain. One view is that gender dysphoria may arise as a complication of autogynephilia, depending perhaps on chance events or environmental factors. Another view is that autogynephiles who become progressively gender dysphoric were somewhat different from simple autogynephiles from the beginning (for example, more obsessional). Because we do not actually know the causes of autogynephilia, it is quite difficult to sort out these various interpretations at present.
Autogynephilia—the central motivation of autogynephilic gender dysphoria—can be considered an unusual sexual orientation. As with other kinds of male sexual orientation, we do not know how to change it, and we shouldn’t try. The dilemma is how to live with autogynephilia in a way that allows the most happiness. For some with autogynephilia, this will mean staying male. For others, it will mean transitioning to female.
What do we know about autogynephilic gender dysphoria?
Much of what we know about autogynephilic gender dysphoria comes from research conducted on adults. Most of the early research was conducted by the scientist who developed the theory of autogynephilia, Ray Blanchard. This work was subsequently confirmed and extended by other researchers, especially Anne Lawrence, Michael Bailey, and Bailey’s students.
Blanchard’s research identified two distinct subtypes of gender dysphoria among adult male gender patients. One type, which he called “homosexual gender dysphoria” is identical to childhood onset male gender dysphoria. Males with this condition are homosexual, in the sense that they are attracted to other biological males. Blanchard provided persuasive evidence that the other male gender patients were autogynephilic. We currently favor the theory that there are only two well established kinds of gender dysphoria among males, because no convincing evidence for any other types has been offered. This could change–we are committed to a scientific open-mindedness. In particular, it is possible that some cases of adolescent-onset gender dysphoria among males are essentially the same as Rapid-onset Gender Dysphoria that occurs among natal females. This will require more research to establish, however.
Autogynephilia is a probably rare, although it is difficult to know for certain. Among males who seek gender transition, however, it is common. In fact, in Western countries in recent years, including the United States, autogynephilia has accounted for at least 75% of cases of male-to-female transsexualism.
Given how important autogynephilia is for understanding gender dysphoria, it may surprise you that you had never heard of it. Autogynephilia remains a largely hidden idea because most people–including journalists, families, and many males with autogynephilia–strongly prefer the standard, though false, narrative: “Transsexualism is about having the mind of one sex in the body of the other sex.” Many people find this narrative both easier to understand and less disturbing than the idea that some males want a sex change because they find that idea strongly erotic.
Although many autogynephilic males find discovery of the idea of autogynephilia to be a positive revelation–autogynephilia has been as puzzling to them as it is to you–some others are enraged at the idea. There are two main reasons why some autogynephilic males are in denial. First, they correctly believe that many people find a sexual explanation of gender dysphoria unappealing–discomfort with sexuality is rampant. Second, they find this explanation of their own feelings less satisfying than the standard “woman trapped in man’s body” explanation. This is because autogynephilia is a male trait, and autogynephilia is about wanting to be female.
It is good to be aware of autogynephilia’s controversial status, because transgender activists are often hostile to the idea. You will not learn more about it from the activists. And if your son has frequented internet discussions, he may also resent the idea. We emphasize that autogynephilia is controversial for social reasons, not for scientific ones. No scientific data have seriously challenged it.
Sexuality
Males with autogynephilia can have a variety of autogynephilic fantasies and interests, from cross dressing to fantasizing about having female bodies to enjoying (for erotic reasons) stereotypical female activities such as knitting to fantasizing about being pregnant or menstruating. One study found that autogynephilic males who fantasize about having female genitalia also tended to be those with the greatest gender dysphoria.
Autogynephilic males sometimes identify as heterosexual (i.e., attracted exclusively to women); sometimes as bisexual (attracted to both men and women), and sometimes as asexual (i.e., attracted to no individuals). Blanchard’s work has shown that autogynephilia can be thought of as a type of male heterosexuality, one that is inwardly directed. Autogynephilia often coexists with outward-directed heterosexuality, and so autogynephilic males usually say they are also attracted to women. Some autogynephilic males enjoy the idea that they are attractive, as women, to other men. They may have sexual fantasies about having sex with men (in the female role); some may even act on these fantasies. This accounts for the bisexual identification among some autogynephilic males. In some others, the intensity of the autogynephilia–which is attraction to an imagined “inner woman”–is so great that there are no erotic feelings left for other people. This accounts for asexual identification. (Asexual autogynephilic males have plenty of sexual fantasies, but these fantasies tend not to involve other people.)
When autogynephilic males receive female hormones as part of their gender transition, they typically experience a noticeable decrease in their sex drive. Some have reported that this has diminished their desire for gender transition as well. Others, however, have reported no change in their desire for transition. (In any case, hormonal therapy is a medical intervention with serious potential side effects, and we do not recommend it as a way to treat gender dysphoria, except in cases in which after very careful consideration, gender transition is pursued.)
Autogynephilia is a paraphilia, meaning an unusual sexual interest nearly exclusively found in males.
We repeat: Autogynephilia is a sexual orientation–to be sure, an unusual orientation that is difficult to understand. There is no evidence that parents can change their children’s sexual orientations. And we don’t think they should try.
What should you do?
Consistent with our values, knowledge, and common sense, we believe that males with autogynephilic gender dysphoria should not pursue gender transition right away, as soon as they first have the idea. Transition ultimately requires serious medical procedures with irreversible consequences. But we are unsure what the right approach to autogynephilic gender dysphoria is. In part, this is because there has been too little outcome research conducted by scientists knowledgeable and open about autogynephilia.
First, we recommend that your son be informed about autogynephilia. The best way to do this is up to you. There is probably no non-awkward way. Consider showing them this blog. People should make important life decisions based upon facts, and for males autogynephilic gender dysphoria, autogynephilia is a fact. The standard “female mind/brain in male body” is a fiction.
Some males become less motivated to pursue gender change when they understand their autogynephilia. However, some do not become less motivated. We know far less about patterns of persistence and desistance of autogynephilic gender dysphoria than we do about childhood onset gender dysphoria.
If an autogynephilic male has become familiar with the scientific evidence, has patiently considered the potential consequences of gender transition over a non-trivial time period, and still wishes to transition, we do not oppose this decision. It is possible that many autogynephilic males are happier after gender transition. But there is no rush for any adolescent to decide.
Rapid-onset Gender Dysphoria (Mostly Adolescent and Young Adult Females)
Rapid-onset gender dysphoria (ROGD) seems to come out of the blue. We think this is because ROGD does come out of the blue. This is not to say that all adolescents with ROGD were happy and mentally healthy before their ROGD began. But importantly, they had no sign of gender dysphoria as young children (before puberty).
The typical case of ROGD involves an adolescent or young adult female whose social world outside the family glorifies transgender phenomena and exaggerates their prevalence. Furthermore, it likely includes a heavy dose of internet involvement. The adolescent female acquires the conviction that she is transgender. (Not uncommonly, others in her peer group acquire the same conviction.) These peer groups encouraged each other to believe that all unhappiness, anxiety, and life problems are likely due to their being transgender, and that gender transition is the only solution. Subsequently, there may be a rush towards gender transition, including hormones. Parental opposition to gender transition often leads to family discord, even estrangement. Suicidal threats are common.*
We believe that ROGD is a socially contagious phenomenon in which a young person–typically a natal female–comes to believe that she has a condition that she does not have. ROGD is not about discovering gender dysphoria that was there all along; rather, it is about falsely coming to believe that one’s problems have been due to gender dysphoria previously hidden (from the self and others). Let us be clear: People with ROGD do have a kind of gender dysphoria, but it is gender dysphoria due to persuasion of those especially vulnerable to a false idea. It is not gender dysphoria due to anything like having the mind/brain of one sex trapped in the body of the other. Those with ROGD do, of course, wish to gender transition, and they often obsess over this prospect.
The subculture that fosters ROGD appears to share aspects with cults. These aspects include expectation of absolute ideological agreement, use of very specific jargon, thinking of the world as “us” versus “them” (even more than typical adolescents do), and encouragement to cut off ties with family and friends who are not “with the program.” It also has uncanny similarities to a very harmful epidemic that occurred a generation ago: the epidemic of false “recovered memories” of childhood sexual abuse and the associated epidemic of multiple personality disorder. We discuss these more below. First, however, we review what little we know about ROGD.
What About Natal Males?
Why do we keep emphasizing natal females versus natal males? There are three reasons. First, the single study that has been conducted on ROGD found substantially higher numbers of females than males (more than 80% female cases). Second, there has been a striking surge in the number of adolescent females identifying as transgender and presenting at gender clinics. Third, there is a different kind of gender dysphoria–Autogynephilic Gender Dysphoria–that likely accounts for most or all of the apparent cases of ROGD in natal males. However, we cannot be completely sure that the smallish number of ROGD cases in natal males are due to autogynephilia. It’s possible, therefore, that what we discuss here applies to some natal males as well.
What Do We Know?
ROGD is such a recent phenomenon that we know little for certain. We have four sources of data. First, an important study of ROGD has been presented by Lisa Littman at the annual meeting of the International Academy of Sex Research. (It has not yet been published, but we suspect it will be soon.) This is the only systematic empirical study to date. Second, we have had numerous conversations with mothers of girls with ROGD. Third, we have read several case studies of the phenomenon. Fourth, we have been in touch with clinicians who work (either as therapists or consultants) with children with ROGD, or their families. Fortunately, the sources have provided convergent findings. We are fairly confident about the following generalizations:
–The large majority of persons with ROGD are female, and the most typical age of onset ranges from high school to college ages.
–Persons with ROGD have a high rate of non-heterosexual identities before the onset of their ROGD.
–Signs of extreme social contagion are typical. For example, this includes multiple peer group members who all began to identify as transgender. Sometimes this occurs after school-sponsored transgender educational programs.
–Persons with ROGD have high rates of certain psychiatric problems, especially aspects related to borderline personality disorder (e.g., non-suicidal self-harm) and mild forms of autism (that used to be called “Asperger Syndrome).
–In general, the mental health and social relationships of children with ROGD get much worse once they adopt transgender identities.
–Parents resisting their children’s ROGD are not “transphobic” or socially intolerant. These are parents who, for example, usually approve of gay marriage and equal rights for transgender persons.
Our Current Take on ROGD
Rapid-onset Gender Dysphoria (ROGD) occurs when a young person (generally an adolescent female) is persuaded that she is transgender, despite strong evidence that the young person had few or no signs associated with established forms of transgender. How and why does this happen?
Despite the very limited available research to date, we have strong intuitions and hunches about what is going on, based on its similarity to similar phenomena in the past: the recovered memories and multiple personality epidemics. We spend considerable effort in this section both explaining these past epidemics and drawing the parallels to the current one that concerns us now: Rapid-onset Gender Dysphoria. We believe that she who forgets (or ignores) the past is doomed to repeat it.
During the 1990s there was an explosion of cases in which women came to believe that they had been sexually molested, usually by their fathers and often repeatedly and brutally. They believed these things even though prior to “recovering” these “memories”–most often during psychotherapy–they did not remember anything like them. They believed in the memories even though the memories were often highly implausible (for example, family members would have noticed). Many women with recovered memories cut off relationships with their families. Some developed symptoms of multiple personality disorder. We know now that the recovered memories were false. And multiple personality disorder doesn’t exist, at least in the way those affected and their therapists believed. We refer to recovered memories and multiple personality disorder, which have similar causes–and also some similar causes to ROGD–as RM/MPD
Here are the main similarities between ROGD and RM/MPD:
Some of the factors that seem to be common in ROGD–and some that are similar between ROGD and RM/MPD–likely encourage the adoption of false beliefs and identities. These include a fragile sense of self (BPD), attention seeking (BPD), social difficulties (BPD and autistic traits), social malleability (BPD, and adolescence), social pressure (adolescence), and strongly held (if irrational and poorly supported) beliefs that make embracing false conclusions especially likely (sociopolitical indoctrination). Adolescents with an actual history of gender nonconformity, or whose sexual orientations are non-heterosexual, may be especially vulnerable to believing that these are signs they have always been transgender. Adolescents whose lives have not been going well may be especially looking for an explanation and may be especially receptive to drastic change.
Based on the aforementioned data sources with which we are familiar, and on our informed hunches, we suspect that many persons with ROGD were usually troubled before they decided they were gender dysphoric and many will lead somewhat troubled lives even after their ROGD (hopefully) dissipates. Of course, ROGD can only make things worse, both for the affected person and her family.
What to do
Because ROGD is such a recent phenomenon, there is very little guidance about helping affected persons. Lisa Marchiano has written two excellent essays abounding with good sense, and we recommend starting with those.
Second, set aside, for now, rapid-onset gender dysphoria. Identify your child’s problems that existed before ROGD and that may have contributed to it. Attending to these problems will be useful for everybody, and perhaps your child will even agree.
Third, with respect to ROGD, do what you can to delay any consideration of gender transition. Of the different kinds of gender dysphoria, ROGD is the type for which gender transition is least justifiable and least researched. Remember, ROGD is based on a false belief acquired through social means. None of the aforementioned factors that have caused your child to embrace this false belief will be corrected by allowing her to transition.
Two Rarer Types of Gender Dysphoria
For the sake of completeness, we include two other kinds of gender dysphoria. We suspect that both are rare, even among persons with gender dysphoria. One of us (Blanchard) has seen cases of the first type, autohomoerotic gender dysphoria, which appears to be an erotically motivated gender dysphoria. In this case, sexually mature natal females (i.e., not biologically still children) become sexually preoccupied with the idea of becoming a gay man and interacting with other gay men. Neither of us has seen someone clearly fitting the second type, gender dysphoria resulting from psychosis. (Our inclusion of this type was motivated in large part by the argument of Dr. Anne Lawrence, an important scholar we both respect.) In this type, a person (either male or female by birth) acquires the delusion that s/he is the other sex, because s/he is suffering from gross thinking deficiencies.
Superficially, both of these conditions have some similarities to some other kinds of gender dysphoria. For example, a female with rapid onset gender dysphoria may be sexually attracted to males and thus strive to become a gay man, similar to autohomoerotic gender dysphoria. The important difference is that the female with rapid onset gender dysphoria is not primarily motivated by an erotic desire to be a gay man. Instead, having the prospect of having sex with gay men is a by-product of her condition, not the main point of it. The female with rapid onset gender dysphoria acquires it via social contagion, broadly speaking (i.e., including cultural signals that gender dysphoria is in some crucial ways desirable). With respect to the other rare subtype, we have both known gender dysphoric persons with psychosis. However, in these cases, the psychosis was not the cause of the gender dysphoria. It was simply an additional problem that the gender dysphoric person had. In the case of gender dysphoria resulting from psychosis, the belief that one is transgender (or the other sex) is clearly a delusion resulting from disordered thinking–and not, for example, from social contagion or autogynephilia.
Autohomoerotic Gender Dysphoria
This rare type of gender dysphoria is limited to females. Published cases have consisted of women whose gender dysphoria began in late adolescence or adulthood. (It is conceivable that it might begin earlier in some cases.) It occurs in (heterosexual) females who are sexually attracted to men, but who wish to undergo sex reassignment so that they can have “homosexual” relations with other men. These females appear to be sexually aroused by the thought or image of themselves as gay men. We have created the label autohomoerotic gender dysphoria to denote this sexual orientation. There are little systematic data on this type of gender dysphoria, although clinical mentions of heterosexual women with strong masculine traits, who say that they feel as if they were homosexual men, and who feel strongly attracted to effeminate men go back over 100 years.
It is well documented that at least a few autohomoerotic gender dysphorics have undergone surgical sex reassignment and were satisfied with their decision to do so. There is no compelling reason to question such self-reports of postoperative satisfaction, although current surgical techniques do not produce fully convincing or functional artificial penises, and it is difficult to imagine that autohomoerotics find it easy to attract gay male partners who can overlook this.
This type of gender dysphoria does not appear to be the female counterpart of autogynephilic gender dysphoria, although the differences might appear subtle. Autogynephilic (male) gender dysphorics are attracted to the idea of having a woman’s body; autohomoerotic (female) gender dysphorics are attracted to the idea of participating in gay male sex. For autogynephiles, becoming a lesbian woman is a secondary goal—the logical consequence of being attracted to women and wanting to become a woman. For autohomoerotics, becoming a gay man appears to be the primary goal or very close to it.
The few available case reports suggest that autohomoerotic gender dysphoria may have ideational or behavioral antecedents in childhood. However, these females are not as conspicuously masculine as girls with (pre-homosexual) Childhood Onset Gender Dysphoria. For this reason, and because it is rare to start with, it is unlikely that many parents will detect this syndrome in daughters. It is conceivable, however, that when they occur, cases of autohomoerotic gender dysphoria may be perceived by others as Rapid Onset Gender Dysphoria. This is not because their gender dysphoria arose suddenly, but rather because their early, atypical erotic fantasies were invisible to their parents.
Gender Dysphoria Caused by Psychotic Delusions
The idea that gender dysphoria can sometimes reflect psychotic delusions is certainly plausible. Delusions in schizophrenia, for example, are often bizarre but compelling to the person who has them. Unfortunately, neither of us (Ray Blanchard or Michael Bailey) has had direct contact with a person clearly meeting this profile, and so we have less confidence in this gender dysphoria category than in the others. Our lack of direct familiarity doesn’t necessarily mean that much. Even if gender dysphoria due to psychosis were fairly common (compared with other forms of gender dysphoria), we wouldn’t have expected to come across it. Persons with severe mental illness have generally been treated for their mental illness and not for gender dysphoria. Until recently, clinics treating persons with gender dysphoria would have screened out patients with severe mental illness, because of concerns that their diagnosis and treatment might be compromised. But we are hesitant to embrace this kind of gender dysphoria as “definitely existing,” because we worry that psychiatrists who have claimed to see it may have been insufficiently trained to notice other kinds of gender dysphoria, such as autogynephilia. Thus, they may have concluded that psychosis caused the gender dysphoria, when in fact, psychosis may have simply occurred with autogynephilia within the same person. One of us (Bailey) has recently been in touch with a mother of a young man who appears to have the profile we would expect for gender dysphoria due to psychotic delusions, and there was no evidence that this young man was autogynephilic. Still, we are least sure about the existence–much less the prevalence–of this kind of gender dysphoria.
Not Just One Type of Gender Dysphoria: Some Implications
It should be clear by now that “gender dysphoria” is not a precise enough term. Parents of gender dysphoric children should know which type of gender dysphoria their child has. To do so it is necessary to learn about all three of the most common types. That is, in order to understand why one’s child is Type X, it is necessary to know why s/he is not Type Y or Type Z. This is not simply academic. There are essential differences between the different types of gender dysphoria.
If knowledge is power, then lack of knowledge is malpractice. The ignorance of some leading gender clinicians regarding all scientific aspects of gender dysphoria is scandalous. To do better, they should start here. We recommend against hiring gender clinicians who are hostile to our typology. Ideally, they would agree with it.
Knowing there are very distinct kinds of gender dysphoria also raises questions–and concerns–about transgender persons of one type using their own experiences to make recommendations for children/adolescents of other types. Nothing in Caitlyn Jenner’s experience allows her to understand what it was like to be Jazz Jennings–and vice versa. Yet a number of vocal transgender activists who have histories typical of autogynephilic gender dysphorics do not hesitate to pressure parents, legislators, and clinicians for acquiescence, laws, and therapies that do not distinguish among types of gender dysphoric children. Moreover, they not infrequently claim inside knowledge based on their own experiences. Yet their experiences are irrelevant to the two types of gender dysphoria that they don’t have. And even with respect to autogynephilia, these transgender activists are nearly all in denial. This means that their public recollections of their experiences are either distorted or outright lies. A notable exception is Dr. Anne Lawrence, who has become an important researcher of gender dysphoria, and who has been honest and open about her autogynephilia. Dr. Lawrence has taken the time to learn the scientific literature regarding different types of gender dysphoria and does not insist that her personal experiences apply to non-autogynephilic gender dysphorics. The biggest victims in the attempts by autogynephiles-in-denial to steer the narrative towards sameness are, in fact, other persons with autogynephilia. These include honest autogynephiles, who frequently contact us but are fearful of public attacks by those in denial. Most relevant to this blog as potential victims are autogynephilic youngsters, who are at risk of being swayed toward decisions they would not otherwise make, on the basis of inaccurate fantasies embraced by those who cannot face the truth of their own condition.
To us, the most tragic group, along with their families, includes those who have acquired rapid-onset gender dysphoria. That condition appears to be the tragic interaction of the current transgender zeitgeist (“It’s everywhere, and it’s great!”) and social media with the vulnerability of troubled adolescents, especially adolescent girls. They are at risk for unnecessary, disfiguring, and unhealthy medical interventions.
*Note. Suicide is tragic and awful, and because of this, we recommend taking seriously your child’s suicidal ideas, threats, and gestures. We have written elsewhere about the risk of suicide among gender dysphoric persons, and we think that this risk is elevated compared with non-gender-dysphoric persons, but still unlikely.