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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
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.
by Marie Verite and Brie J
Dr. Kenneth Zucker, recognized as one of the world’s top experts in childhood gender dysphoria, penned the following paper (released today).
Zucker, K. J. (2018). The myth of persistence: Response to “A Critical Commentary on Follow-Up Studies and “Desistance” Theories about Transgender and Gender Non-Conforming Children” by Temple Newhook et al. (2018). International Journal of Transgenderism. https://doi.org/10.1080/15532739.2018.1468293
Dr. Zucker has offered to provide a PDF of the full-text article if readers contact him via email.
Multiple trans-activist journalists and “affirmative” gender clinicians have (rather successfully) propagated the meme that desistance from a trans identity is a “myth”; that Zucker (former director of the Toronto clinic), Thomas Steensma, Peggy Cohen-Kettenis (of the Amsterdam team which pioneered the use of puberty blockers for gender-dysphoric children), and others have wrongly conflated merely gender nonconforming children with “true trans” kids. Therefore, their entire body of research is essentially worthless. These critics have gone further, accusing some clinicians (like Zucker) of forcing harmful reparative therapy on “trans kids.”
Dr. Zucker’s detailed rebuttal to the Temple-Newhook et al article is well worth reading in its entirety. Be forewarned: The paper is densely argued and referenced, such that understanding it requires a decent working knowledge of the clinical literature on childhood gender dysphoria, the nuances/changes in the DSM diagnostic classifications (e.g., DSM-IV “gender identity disorder” vs. DSM-V “gender dysphoria”), as well as the trans-activist reactions to all of the above.
In a series of tweets today, Dr. Zucker emphasized one of the key points in his paper.
“…that pre-pubertal gender social transition is itself a psychosocial treatment, which Temple-Newhook et al ignore.”
The context for this tweet can be found on page 7 of Dr. Zucker’s article:
Thus, I would hypothesize that when more follow-up data of children who socially transition prior to puberty become available, the persistence rate will be extremely high. This is not a value judgment – it is simply an empirical prediction. Just like Temple Newhook et al. (2018) argue that some of the children in the four follow-up studies included those who may have received treatment “to lower the odds” of persistence, I would argue that parents who support, implement, or encourage a gender social transition (and clinicians who recommend one) are implementing a psychosocial treatment that will increase the odds of long-term persistence.
And later, on page 10:
Temple Newhook et al. (2018) go on to state that “It is important to acknowledge that discouraging social transition [with reference to the Dutch team’s putative therapeutic approach] is itself an intervention with the potential to impact research findings…” Fair enough. But Temple Newhook et al. (2018) curiously suppress the inverse: encouraging social transition is itself an intervention with the potential to impact findings. I find this omission astonishing.
An astonishing omission, indeed.
As regular readers of this website will know, most parents in the 4thWaveNow community are particularly concerned about the recent increase in teens (particularly females) presenting to gender clinics, with a sudden onset of gender dysphoria around the age of puberty.
Although the characteristics and clinical course of early-onset gender dysphoria (the primary population discussed in Zucker’s paper) are different from that of adolescent-onset, an underlying question pertains to both: Does “affirmative” treatment increase the likelihood that a cross-sex identification will persist?
We must point out here that trans activists consider it “transphobic” for anyone to believe that a child’s desistance from trans-identification would be preferable to persistence. (In fact, this accusation is leveled by Temple Newhook et al in their paper, in so many words. This helps to explain why so many trans activists object to the very idea of studying persistence vs. desistance in the first place.) Yet, we find it mystifying that a preference for desistance is even controversial. Surely, if a child can find peace in his or her unaltered body–and happily avoid becoming a sterilized medical patient dependent for life on drugs and surgeries–that is a positive outcome. To leverage an analogy popular with trans activists, many say that “gender affirming” medical treatment is analogous to treatment for children with life-threatening cancers. Yet who would not feel happy for the cancer patient who goes into remission, thus avoiding the ravages of chemo and radiation?
Furthermore, is it not possible to support young people in their gender atypicality, while at the same time encouraging bodily acceptance?
Central to this discussion is the trans-activist conflation of psychotherapeutic methods with conversion therapy. Zucker addresses this problem head-on on page 9:
Now, of course, it would not come as a surprise if Temple Newhook et al. (2018) took umbrage at the mere idea of a treatment arm designed to reduce a child’s gender dysphoria via psychotherapeutic methods. They might, for example, offer up the following from the seventh edition of the Standards of Care:
Treatment aimed at trying to change a person’s gender identity…to become more congruent with sex assigned at birth has been attempted in the past without success (Gelder & Marks, 1969; Greenson, 1964)….Such treatment is no longer considered ethical.” (Coleman et al., 2011, p. 175)
Yet, on the very same page of the Standards, one finds the following: “Psychotherapy should focus on reducing a child’s…distress related to the gender dysphoria…” (p. 175) or “Mental health professionals…. should give ample room for clients to explore different options for gender expression” (p. 175). The lack of internal consistency between the first statement and the second and third statements is rather astonishing.
“Reducing a child’s…distress related to the gender dysphoria” should be the primary goal of all treatment methods. Quite a few 4thWaveNow parents have observed that upon social transition, their children’s dysphoria actually increased. This is another aspect related to the different populations (early-onset vs. adolescent rapid-onset) that needs to be clarified but still remains unknown. Dr. Zucker explains that he “prefers the following summary statements about therapeutics with regard to children with gender dysphoria”:
Different clinical approaches have been advocated for childhood gender discordance….There have been no randomized controlled trials of any treatment….the proposed benefits of treatment to eliminate gender discordance…must be carefully weighed against… possible deleterious effects. (American Academy of Child and Adolescent Psychiatry, 2012, pp. 968–969)
Very few studies have systematically researched any given mode of intervention with respect to an outcome variable in GID and no studies have systematically com- pared results of different interventions….In light of the limited empirical evidence and disagreements…among experts in the field…recommendations supported by the available literature are largely limited to the areas [reviewed] and would be in the form of general suggestions and cautions… (Byne et al., 2012, p. 772)
…because no approach to working with [transgender and gender nonconforming] children has been adequately, empirically validated, consensus does not exist regarding best practice with pre-pubertal children. Lack of consensus about the preferred approach to treatment may be due, in part, to divergent ideas regarding what constitutes optimal treatment outcomes… (American Psychological Association, 2015, p. 842)
Here at 4thWaveNow, we have repeatedly stated that we seek to support—not “eliminate”–our children’s “gender discordance” although we resist the idea that gender atypicality is a sign of bodily incongruence. More than anything, 4thWaveNow parents seek to help our children minimize the discomfort that accompanies their nonconformity to gender norms. Since many of our children only experienced dysphoria upon reaching puberty, we call for (much) more evidence that social and medical transition are better at alleviating dysphoria than psychotherapeutic methods.
And as Dr. Zucker has made clear via his life’s work (and in this paper), the jury is still very much out on that question–despite the many attempts by trans activists to deplatform those who study the matter of persistence and desistance.
Therapist and Jungian analyst Lisa Marchiano received the following email recently. She and the writer of the email agreed that Lisa would address the author’s questions in a public forum, and the author kindly agreed to allow the email to accompany Lisa’s response.
Lisa can be found on Twitter at @LisaMarchiano. She blogs at theJungSoul.com
Please note that this post is intended for educational purposes only and is not meant to replace professional advice.
Email from a trans-identified teen:
Hello. I’m almost 16 years old and recently I have been reading some of your writing on “Rapid Onset Gender Dysphoria.” Currently I identify as transgender and have for almost 2 years, but as a chronic over-thinker, I like to expose myself to viewpoints and ideas that are different from my own. If my parents knew what ROGD was, they would probably argue that I am in that category. I came out to them about a year ago and I hadn’t shown any gender dysphoria in early childhood. To them, it probably seemed a little “out of the blue,” though I had known for a year before that, had begun to transition (cutting my hair and buying from the men’s section), and had been questioning since puberty. I don’t have any mental or physical health problems, and I have a wide social circle of friends, none of whom are transgender or homosexual (though one of my friends is asexual, and my girlfriend is bisexual). I’m almost positive that I’m transgender, but your writing got me thinking and I have a few questions for you.
If what I am experiencing is ROGD, and simply a coping mechanism for something else, what signs could I look for in myself to figure that out? You talked a lot about the parent’s side of the equation, but what can I, as a trans teen do to ensure that I’m not “tricking” myself into believing this?
When do you believe a trans identity is valid? I certainly don’t disagree with you that there are many teenagers in my generation that are “becoming” trans because it is trendy, having no symptoms of gender dysphoria (I know a person like this). But do you think that trans people need to meet certain criteria to be considered trans and be considered for medical transition? If so, what criteria? Do you believe that gender dysphoria can present itself at puberty?
Thank you for reading and hopefully replying. I really appreciate your time.
Lisa Marchiano’s response:
Thank you for writing me such a thoughtful email, and for your willingness to take the answer here in this public forum. First of all, it goes without saying that this letter can’t take the place of therapy. I can’t diagnose from afar. I am, after all, just a stranger on the internet, and this is just my opinion. I believe it is an informed opinion, but it can’t take the place of discussing important issues face to face with someone who knows you well. Looking at these issues with a qualified therapist who can help you ponder your feelings in an open-ended way without prematurely foreclosing exploration can be very helpful. In addition, I hope you might feel comfortable someday discussing this with your parents. There may be a lot they don’t understand, but it is likely that there is no one on the planet who is more steadfastly on your team than they.
As a Jungian, I see psychological health in terms of a movement toward wholeness. Over the course of our lives, we hopefully integrate more and more aspects of ourselves, including parts that may be “feminine,” and parts that may be “masculine.” This life-long growth process means that we become larger and more complex as we become conscious of more aspects of ourselves. I do not believe that it makes sense to think in terms of identity, as this implies a single, fixed “truth” about ourselves – an endpoint that can be decisively known. Rather, I believe we continue to grow and change throughout our lives.
There is no robust evidence for innate gender identity. Our sense of gender appears to be an emergent property that arises out of a complex interplay between our bodies, our minds, and the social world. Though there is almost certainly a biological component to gender dysphoria, it is also likely shaped by our life history. The way we experience ourselves in terms of gender – that is as more or less male or female or both – is shaped by our family, our wider social network including friends and teachers, and the culture, including advertising, YouTube and other social media. Traumatic experiences, such as the loss of someone close, parental divorce, or emotional, physical or sexual abuse can also affect our experience of our gender.
Can gender dysphoria present for the first time at puberty? Clearly, many young people feel dysphoric at adolescence. Nearly all natal females feel discomfort with their bodies at puberty. I wonder if the question you are asking is whether dysphoria at adolescence but not before means that one shouldn’t identify as trans as a result. I think the answer to that is complicated, and I can’t really answer that for you. Again, this would be something to explore with a therapist who could really get to know your unique situation. Let me just say that based upon my reading of the medical literature, dysphoria presenting for the first time at puberty used to be unusual (but not unheard of) until recently.
Rapid onset gender dysphoria appears to be a relatively new phenomenon, and we don’t understand much about it yet. It appears as though the typical presentation of an ROGD teen involves considerable social influence, either online or by peers, as well as psychiatric comorbidities and/or vulnerabilities. Based on anecdotal reports, many ROGD teens first decide they are trans after reading on the internet. There is very little research on this, but the little there is seems to point to a different outcome for those with ROGD traits (no dysphoria in childhood, higher rates of psychiatric comorbidity, social influence) vs those with the more typical presentation of GD. And outcomes matter, because at the end of the day, we want all people to do as well as possible.
People often come to therapy to explore difficult decisions. I’m going to share a little bit about how I help someone explore their options. If you were to find a therapist to have this discussion with, here are some of the things the two of you might consider together.
There is a difference between what we feel, and what we choose to do about those feelings. I have a passionate conviction that all feelings are valid and important. We should be encouraged to feel them, to take them seriously, to honor them, and to be curious about them. We can take our feelings seriously and acknowledge them as valid without that acknowledgement meaning that we need to take a particular course of action as a result of them. For example – if we are very angry at someone, our feelings of anger are valid and deserve to be felt. What we do about that anger – whether we lash out at the person, for example – is another question entirely. When considering what to do about feelings, I am always interested in whether a given course of action is adaptive or maladaptive.
Let me explain more of what I mean by that. When someone comes to me with a question or a problem, I find it very helpful to examine the issue through the lens of pragmatism. I am interested in identifying what works for this particular person. This means that I ask us to set aside – at least for a moment – judgments based on values, morals, or ideology, and just explore whether a given response works.
What do I mean by “works?” In some sense, we all get to define that for ourselves, and one person’s definition might vary greatly from someone else’s. But we need some firm ground to stand on, so I do have a general answer – something works if it helps you to “do your life.” Freud famously said that the cornerstones of a mentally healthy life are the ability to love and to work, and I think that’s a great place to start. To have a life that is fulfilling, we generally need work that we find meaningful, as well as abiding relationships, at least some of which are truly intimate. I would add a third category to these two: . we can consider that a life strategy works if it is protective of our physical health – or at least not inimical to it. In sum, something works and is adaptive if it doesn’t interfere with our ability to work, to love, and to maintain our health.
Whether identifying as transgender for any individual is adaptive of maladaptive will depend on the person’s particular situation. If we are a natal female who has an inner experience of maleness (and I, in fact, believe that all females have masculine traits, and that our experience of the male side of ourselves can be very important psychologically), then identifying as male could be very liberating, exciting, and growth promoting. It could very well enable someone to engage productively in work and relationships. In this case, a transgender identity would be adaptive.
There could also be cases when identifying as transgender may not be adaptive. Whether it is or not will likely depend in part on how we understand what it means to identify as trans. For example, if part of identifying as transgender means that we need to be perceived as male when we are female bodied, we are putting ourselves in a vulnerable position, as we are giving others power over our sense of ourselves. We can’t control how others see us. Positioning ourselves so that we only feel okay when others perceive and validate us as we want to be perceived, rather than focusing on developing self-acceptance and resilience in the face of slights or rejections, is a decision that may promote worse mental health. This in turn could make it more difficult for us to concentrate at work or school. It might cause us to withdraw from friendships or other important relationships. If this were the case, we might say that our trans identification was proving to be maladaptive.
Furthermore, if identifying as transgender means that we understand ourselves to be literally male when our bodies are female, we may experience cognitive dissonance. Cognitive dissonance refers to the inner tension that we feel when important beliefs are contradicted by evidence. It can be quite uncomfortable. Psychologists have studied those whose strong beliefs are challenged by material evidence. (The theory of cognitive dissonance was developed by a psychologist studying a doomsday cult, and what happened to cult members’ beliefs when the world did not in fact end as their leader had predicted.) They note that we have a tendency to “double down” on our false beliefs in order to resolve the internal tension. Our beliefs become more extreme, and we work even harder internally to justify or reconcile with the challenged belief. (This isn’t just true of cult members. It’s true of every one of us.)
Those who identify as transgender can suffer from pangs of cognitive dissonance. This can often make the dysphoria worse. I have heard many stories from desisters and detransitioners that identifying as transgender made them feel worse, because they then had to deal with a constant tension around the fact that their body looked and acted differently than how they thought it should. This can invite obsessive, perseverative thinking, which can be draining and cause increased distress and anxiety. Adopting a belief that contradicts material reality can be a recipe for unhappiness, as we will likely feel the need to strive to become the thing we are not. This is part of the reason many wisdom traditions and psychotherapy schools direct us to cultivate acceptance of those things we cannot change.
The blogger ladyantitheist articulates the above sentiment eloquently in her post about her trans identification and desistance from it:
One of the biggest problems I think with being transgender is it comes out of an unhappiness, and that the impossibility of the accepted solution amplifies the unhappiness. Having short hair doesn’t give you an Adam’s apple, testosterone injections won’t change your bone structure, a phalloplasty won’t let you produce sperm. The closer you get to the real thing, the further the gap between you and being a real male grows. Freeing yourself from the task of climbing a mountain whose peak can never be summited is your only chance of ever actually being happy. I eventually stopped looking for validation as something I would never be, and started the process of loving myself.
If identifying as transgender amplifies our unhappiness with our bodies, if it causes us to perseverate on features of our bodies which we don’t like, then I would say that doing so is probably not adaptive.
There’s one other major conversation to have when considering whether identifying as transgender works, and that is the matter of maintaining our physical health. If identifying as transgender means that we feel compelled to engage in activities that could cause long-term harm to our body, then it may be maladaptive. Binding can result in collapsed lungs, compressed ribs, and back problems, and some report that they continue to suffer ill effects even after they are no longer binding. Mastectomies remove healthy tissue and can result in painful scarring. Testosterone will result in vaginal atrophy and may damage fertility. It can negatively affect one’s lipid profile, bone density, and liver function. It may increase one’s risk of heart attack and diabetes. There are currently 6,000 cases pending in litigation against drug manufacturers having to do with male bodied people who took testosterone, and experienced blood clots, heart attacks, stroke, and sudden death. Phalloplasty is known to have a high complication rate, and these can be serious and debilitating in some circumstances. If a basic measure of whether something “works” is if it helps us to protect and maintain physical well-being, it would appear that medical transition may not do so in many cases.
Could medical transition ever be adaptive? Yes, I think so. There are trans adults who feel that their capacity to love and work has been enhanced by transition. I suspect that those who benefit from transition have had a good process in which they explored their gender; addressed any underlying issues; and had realistic expectations for the outcomes of transition. Since transition compromises physical health, it is important to carefully consider such a step, and be certain that the benefits will outweigh the considerable known and unknown risks.
I would like to offer another rule of thumb when considering whether a particular life strategy is adaptive or maladaptive. All things being equal, it is better to preserve options and maintain flexibility. This is especially true when we are in the first half of life. When in doubt, leave options open. One of my concerns about medical transition for young people is that it shuts down future options. Having a mastectomy will permanently remove the option of nursing. Taking testosterone may render us infertile. Even if we think we never want to become a parent, there is still a value in protecting the future possibility of doing so. And fertility is not the only option to protect. If a person has taken on a significant transition to another gender expression and then has serious questions about it, they may be faced with even more serious challenges than they had before. Freedom of expression may be seriously, and in some cases, profoundly restricted or limited. Transition does have the potential to seriously limit additional life choices.
We really are all works in progress. Our sense of ourselves will continue to change and shift throughout our lives. It may be tempting to strive for certainty in tumultuous times, but I’d be wary of any urgency. You do actually have time on your side. By staying curious – as you clearly are – and trying out different things, you will gather more and better information in order to help you decide what works for you. One of the helpful things about a pragmatic framework for evaluating life strategies is that it leaves room for things to change. Most strategies don’t work forever. For any decision we make, we can ask ourselves, is this working? And then a few months later, is this still working? If the strategy is benefiting us in living our fullest life more than it is hampering us, we know to continue pursuing it. And if the day comes where we realize the balance of the equation has tipped so that the strategy is more costly than beneficial, then we can abandon it. We need not limit ourselves according to rigid beliefs about what is right or wrong.
While I was working on this letter, I was reading a novel called The Nix by Nathan Hill. The novel is in part the story of a woman named Faye, and it follows her throughout her life as she tries to discover who she truly is. Toward the end of the book, the author makes some comments about how we understand ourselves that I thought were very wise. I’ll let him have the last word.
In the story of the blind men and the elephant, what’s usually ignored is the fact that each man’s description was correct. What Faye won’t understand and may never understand is that there is not one true self hidden by many false ones. Rather, there is one true self hidden by many true ones. Yes, she is the meek and shy and industrious student. Yes, she is the panicky and frightened child. Yes, she is the bold and impulsive seductress. Yes, she is the wife, the mother. And many other things as well. Her belief that only one of these is true obscures the larger truth, which was ultimately the problem with the blind men and the elephant. It wasn’t that they were blind – it’s that they stopped too quickly, and so never knew there was a larger truth to grasp…. Seeing ourselves clearly is the project of a lifetime.
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.
A version of the letter contained in this post was sent by the parents of a trans-identifying daughter to the gender clinic where she received transition services. PADad, who is the young woman’s father, would like this letter to serve as a template for other parents, and encourages readers to participate in the letter-writing campaign he describes below. PADad is available to interact in the comments section of this post.
Note to 4thWaveNow readers: The letter as written by PADad has undergone lawyer review. Please see the April 10, 2018 update posted beneath the letter.
by PADad
Like many who congregate on 4thWaveNow, we are the parents of a young person (in our case, a 20-year-old daughter) who has recently and suddenly come out as transgender. And like most here, our daughter had never exhibited any gender dysphoria as a child.
We have been doing a lot of research and planning our steps carefully. We have decided that one thing we must do is to push back against the forces in our society that are encouraging young people to take potentially harmful medications and make irreversible changes to their bodies. We want to help ensure that, before they are given access to medical interventions, young people carefully explore why they believe these changes are needed and how the changes will affect their lives in the future.
The trans activists do not outnumber those of us who are concerned about this trend, and our inactivity is putting our children at risk. Right now, many clinicians prescribe hormones and surgeries for youth with little fear of repercussion. We can change the calculus for these clinicians. We must reveal to them how many parents have the same concerns, as well as our tenacity in calling them to account. We are not going away.
To that end, I have prepared a letter that I will be sending to all of the clinicians who are involved in my daughter’s care. Because she is on our health insurance plan, we have access to her actions and payments, so we know who these people are.
I have drafted a similar letter to send to our health insurance company, putting them on notice that they are complicit in this harmful trend and urging them to change their standards for the treatments and surgeries they will allow and cover. We are also pursuing legal representation to follow up on our letters.
If insurance companies see they may be exposing themselves to liability by covering interventions that may cause more harm than good, they can play an important role in limiting the number of young people who inappropriately undertake medical intervention.
This linked site contains a comprehensive list of gender clinics in the US., organized by state and easy to search. Please consider sending your own letters to no fewer than 10 clinicians on this list, if possible, by registered mail. You may choose to use/customize our letter (below) as a template. Choose the clinics who are closest to you and perhaps add in some at random. We need to get as many out there as we can.
If some of these clinicians and facilities change their ways, others will follow. The risk of lawsuits goes up for them if they allow themselves to be singled out. That can affect the cost of their malpractice insurance. If we act together, we can make a difference.
A Parent’s Letter to a Gender Clinic
You are receiving this letter because our child is a patient at your clinic or a clinic like yours. The purpose of the letter is to make you aware of a concern that many parents, including myself, and a large and growing number of medical professionals, share about the care you are providing for our children. Some of these young people are over the age of 18 and therefore do not have to include us in their health decisions. Regardless of their age, and regardless of whether or not we are involved in discussions between you and our children, you have an obligation to do what is best for their long-term health. We do not believe this is happening.
The increasing rate at which young people, aged 11-21, are coming out as transgender cannot be explained by the fact that the broader transgender movement in western societies is removing the social stigma around coming out. The evidence is very clear at this point, and becoming clearer by the day, that what is going on with at least some of these young people, particularly young women, has elements of a social contagion.
We are including links to multiple pieces of research at the end of this letter to support our statements and to elucidate our concerns. As medical professionals, you should be aware of this research, and you have an obligation to take it seriously. At a minimum, you should be raising the bar and making selection criteria considerably more stringent before prescribing “puberty blockers,” HRT and surgeries. Because these treatments have permanent effects on patients’ bodies and minds, you should be first requiring alternatives to these treatments which are more reversible. Unless social contagion and other underlying and preexisting factors (including other mental health issues) are ruled out, it is insufficient and negligent to place undue emphasis on self-reporting from the youths themselves.
We understand that you may be under the impression that existing law provides protection against future liability for prescribing these dangerous drugs and performing these surgical interventions. We disagree. Moreover, as human beings and responsible medical professionals, you can raise the bar for treatment, reduce future regret rates, and put pressure on your peers to be better informed and to act responsibly.
Be advised that through this letter, we are putting you on notice. So far as we know, the current course of medical transgender treatment for minors has never been tested in the context of medical malpractice liability, and we do not believe that these interventions will be found to meet the standard of care for the treatment of juvenile dysphoria.
If you do not act in the best interests of all of your patients, the day may well come that you will be held accountable. We are planning for that day. Clinics and doctors will be called out by name. We will call you out by name in legal proceedings, and in social and conventional media. You should assume that, particularly given the irreversible and (at least in some cases) unwanted changes that these young people will suffer, damages can reasonably be expected to be substantial.
In addition to the risk of legal action, you should think about your place in history and your reputation. This contagion will pass, as they all do. But due to its size and impact, you should expect this social contagion to be a topic for years to come. It is already large and catastrophic enough to garner significant interest and publication in medical, social and psychological journals. I urge you to think carefully about how your clinic and your name will be mentioned in the course of this crisis, and whether you protected or ultimately harmed young people; whether you acted out of concern for youth or for your profits. You can dismiss any single case or patient as justifiable, but history will be less kind when looking at the body of your work over time.
I would encourage you to read the referenced research and clinical opinion, including the multiple links to additional published research in these articles, and familiarize yourself with it. There is sufficient information there to warrant serious soul-searching in any practitioner involved in the medical transition of minors and young adults.
Update: April 10, 2018. A few trans activists have claimed that the letter as written amounts to issuing (possibly unlawful) threats. For clarity, here are remarks by two lawyers in the 4thWaveNow community. (Caveat: This statement should not to be construed as legal advice for anyone reading this.)
Any communication, such as the letter referenced above, that states “if you engage in X behavior, Y consequences may result” could be termed, in some sense, a “threat.” The issue is not whether “threat” is the correct appellation, the issue is whether that “threat” is actionable (i.e. potentially gives rise to civil or criminal liability). Here, the answer is no.
Start with the understanding that in the United States, there is extremely wide latitude for speech. We enjoy robust First Amendment protections that give us the ability to express our opinions quite freely and widely without government interference, compared to other countries. There are allowable restrictions for such things as defamation or criminal conspiracy, as one would expect, but generally speaking, such restrictions on speech tend to be very narrowly interpreted and difficult to fall within. In the U.S., there simply is no such tort or crime as “hate speech;” our Supreme Court so ruled last summer. Moreover, “hate crimes,” or crimes motivated by animus against a particular group based on group characteristics, are a sentencing enhancement, or an additional penalty that is added on to a pre-existing crime. Other than in a few very select instances that don’t apply here, there is no such thing as a “hate crime” standing alone (an underlying crime such as assault, battery, etc. has to have been committed to give rise to the “hate crime” add-on).
On the “threat” point, first, as to criminal liability. A “threat” only gives rise to criminal liability when it communicates or contains, for instance, the intention to use bodily harm against the recipient, to harm the person’s property (e.g. “terroristic threats”), or to obtain financial advantage by unlawful means specified in an applicable law. An example of the latter would be extortion (“pay me X or I’ll tell your husband you are having an affair”). The “clinic letter” does none of these things, and 4thWaveNow unequivocally and strongly condemns any revision to the letter that would threaten such actions.
Second, as to civil liability. It is generally permissible to threaten to take legal action against someone in order to assert or protect one’s legal rights. Lawyers send “demand letters” (letters that outline why a party should do, or not do, some action, and the legal consequences for refusing to comply) all the time.
Moreover, it is not 4thwavenow that is making any demand in the letter; and the letter, in the form contained on the site, does not identify any recipient.
Summing it up, at the very most the “clinic letter” could be viewed as containing a non-actionable “threat” by the individual at issue (a) that legal remedies may be sought, to the extent such remedies are now, or in the future become, available and appropriate, and (b) to advocate the subject positions with, and exert public pressure upon, medical providers and insurers.
Suggested References
“Evidence for Altered Sex Ratio in Clinic-Referred Adolescents with Gender Dysphoria,” Aitken et al, The Journal of Sexual Medicine, 2015
https://www.ncbi.nlm.nih.gov/pubmed/25612159
Analysis of article here:
The Canadian clinic saw nearly nearly three times as many female teens in the past 8 years as they had seen in the previous thirty. The Dutch clinic saw nearly twice as many female teens in the past 8 years as they had seen in the previous seventeen.
Rapid Onset of Gender Dysphoria in Adolescents and Young Adults: A Descriptive Study. Lisa L. Littman MPH., Journal of Adolescent Health, 2017.
http://www.jahonline.org/article/S1054-139X(16)30765-0/fulltext
Parents online are observed reporting their children experiencing a rapid onset of gender dysphoria appearing for the first time during or after puberty. They describe this development occurring in the context of being part of a peer group where one, multiple, or even all friends have developed gender dysphoria and come out as transgender during the same time frame and/or an increase in social media/internet use. The purpose of this study is to document this observation and describe the resulting presentation of gender dysphoria inconsistent with existing research.
“Medicine must do better on gender,” Margaret McCartney, British Medical Journal, 2018
https://www.bmj.com/content/360/bmj.k1312
A clear rise in referrals of children to specialist gender identity services has been seen in recent years, particularly in teens. Yet the role assigned to medicine can’t be separated from societal attitudes and abilities. The debate on gender occurs in an environment where boys are seen as being boys, and girls as girls, because of how they behave rather than their biological sex…
…Therapists are right to be concerned about overdiagnosis and overtreatment. But this concern can be perceived by parents as a barrier rather than a caring, evidence based response.
Many children with gender dysphoria will grow up without reassignment surgery but will be gay or bisexual. One concern is that gender reassignment makes homosexuality “disappear”: in Iran being gay is illegal, but the rate of gender reassignment surgery is the highest in the world.
“CBC Self-Censorship Part of Frightening Gender Identity Trend,” Susan Bradley, The Post Millennial, 2018.
https://www.thepostmillennial.com/cbc-self-censorship-part-frightening-gender-identity-trend/
In my own practice, I have seen a good many young women displaying the phenomenon known as “rapid onset gender dysphoria,” or ROGD, which overwhelmingly affects girls. Typically, the ROGD teenage girls I see have, wittingly or not, begun to experience homoerotic feelings about which they are conflicted. They tend to be socially isolated, and somewhere “on the spectrum.” They may have histories of eating or self-harm disorders.
They have found companions with the same attributes on Internet sites, which diminishes such adolescents’ sadness over their social isolation, but which can also lead to foreclosure of reflective thinking about their own feelings and situation. Some of these girls are depressed, afflicted with suicidal ideation. Because of the initial euphoria they experience in finally “belonging” to a well-defined kinship group, they tend to embrace the idea of transitioning wholeheartedly as the solution to their other problems.
“Transgenderism and the Social Construction of Diagnosis,” Lisa Marchiano, Quillette, 2018.
http://quillette.com/2018/03/01/transgenderism-social-construction-diagnosis/
Activists and certain clinicians who are sympathetic to the activist movement appear to feel threatened by the idea of rapid onset gender dysphoria because the suggestion that dysphoria might be influenced by social or cultural factors undermines the notions of innateness. If dysphoria isn’t innate, justifying medical intervention becomes more complicated.
“Early Medical Treatment of Children and Adolescents with Gender Dysphoria: An Empirical Ethical Study.” Lieke et al, Journal of Adolescent Health, 2015
https://www.ncbi.nlm.nih.gov/pubmed/26119518
Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits […]As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment.
“The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity” Delay et al, Journal of Youth and Adolescence, 2017
https://link.springer.com/article/10.1007/s10964-017-0749-6
Homophobic name calling emerged as a form of peer influence that changed early adolescent gender identity, such that adolescents in this study appear to have internalized the messages they received from peers and incorporated these messages into their personal views of their own gender identity.
“The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?” Sahar Sadjadi, Journal of Medical Humanities, 2013
https://pdfs.semanticscholar.org/46da/ae7559f1b49d4516b0eee5266ab24a6e739a.pdf
Currently, the health consequences of the treatment are relatively unexplored. The treatment is being implemented, however, under the pressure of the emergency of saving the child from the devastation assumed to follow the onset of puberty. It must be remembered that puberty suppression as the first step to medical transition, if followed by cross-sex hormones, which has been the case for almost all reported cases, leads to infertility due to the permanent immaturity of the gonads and the reproductive tract. The absence of the discussion of sterilization of children as a major ethical challenge in this bioethics article, and many other clinical debates on puberty suppression, is striking. For any other group of children, such an intervention would be discussed extensively with ethics review boards.
The annual number of referrals to the gender dysphoria specialist team at the Astrid Lindgren Children’s Hospital in Stockholm. Referenced article in Swedish:
http://lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2017/02/Kraftig-okning-av-konsdysfori-bland-barn-och-unga/ …
“A Different Stripe”, Renee Sullivan, Psychology Today, 2018
https://www.psychologytoday.com/articles/201803/different-stripe
It’s been four years since I reidentified as a woman. My gender dysphoria was real and often painful, but the way for me to resolve it wasn’t by becoming a man. It was by questioning and rejecting the stories society had told me about what it means to be a woman.
Some charts illustrating the steadily increasing number of natal females presenting to gender clinics, worldwide.
Canada, Netherlands, UK, Finland
Sweden
United Kingdom
New Zealand
Toronto and Amsterdam