Tag Archives: teen transition

The trans-kid honeymoon is sweet—while it lasts

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I recently received comments from two readers (here and here) regarding a 2014 Dutch survey study of 55 young transgender adults (average age 20). The study, which reported overall positive psychological outcomes after medical transition, surveyed youth who had been diagnosed with gender dysphoria, after which they had received puberty blockers, then cross-sex hormone treatments, and finally SRS surgery. The average length of time from first pre-treatment assessment to post-surgery was 6 years.

RESULTS:
After gender reassignment, in young adulthood, the GD was
alleviated and psychological functioning had steadily improved. Well-
being was similar to or better than same-age young adults from
the general population. Improvements in psychological functioning

were positively correlated with postsurgical subjective well-being.

These findings would likely reassure parents and others who have ushered children down the medical transition road. And frankly, anyone who has watched even a few YouTube teen transition vlogs would not find these results particularly surprising. For these kids, it must be an exhilarating experience, to feel they can escape their dissatisfaction with sex-role stereotypes and/or physical characteristics, and embark upon the long-awaited transformation into the opposite sex.  The speed with which the metamorphosis happens—with many young people “passing” as the opposite sex after only a few months of hormone treatment–is  downright magical.

No doubt, at least some of these people will go on to live happy, long lives with no regrets. But it’s likely some will begin to question (at what age? 30? 40? 50? 60?) whether giving up their fertility; permanently altering their bodies; and facing a lifelong regimen of injections and medical monitoring were ultimately worth the price.

Here is one young woman who has begun to raise a few questions. In a recent video entitled “Gender Troubles” (uploaded 6 years after she first decided to “transition,” and after 4 years of videos on her channel that mostly celebrated that choice), she acknowledges what she values about her “transition,” while sharing her realization that things are not quite as simple as they originally seemed to her younger self:

 When I decided to go on hormones…it seemed like the most logical choice for me. I was in a very bad place emotionally…I hated myself a lot. I hated my body. I didn’t identify with it….and I felt very separate from my body. And finding YouTube videos of other people who were transitioning and finding out it was an option to do so kind of deeply affected me. It was very difficult to resist those changes….to resist taking hormones, to see those changes in myself, especially because feeling so disconnected from myself it seemed like the best idea….and you don’t often see other narratives out there, on YouTube, about gender…

…. I struggled with the changes, how I felt about them, how it made me feel and why. At first I accepted them. It was exciting. It was euphoric. It was certainly a ride. And I really liked seeing myself with more muscle, I liked my voice deepening, the hair that was growing…

… My parents were really cool with it. They were not cool with me being a lesbian at all…. [now] they didn’t have to say “I have a lesbian daughter. I have a son who’s straight”….My family was supportive of my transition, so we became a lot closer because of that…

…As time went on, I really felt like…I didn’t identify with the changes I was seeing…I didn’t like the fact that these changes weren’t natural. Part of it felt like I was burying a piece of myself…

…The other night, I cried, because I realized I really want to be able to get pregnant. And I really want to be able to breastfeed. … Maybe it’s me getting older, the internal clock…ultimately I don’t regret getting top surgery…but there are elements where I miss having them….only about 15% of the time. But I can’t deny that this happens…

…There’s a lot more that happens besides achieving a male body or a more masculine body….a lot of things change and you don’t realize it. I don’t think I realized it as much until  …  a year or two off hormones. Things started kind of affecting me…

…When I was transitioning I was really caught up in the thrill of it, the excitement of it, the endorphins that went along with it…[but now]  I’ve been thinking about things I wasn’t before.

Transition regret videos aside, even if we restrict our focus to the 55 subjects in the Dutch research study cited above–young people who (so far) are reporting largely positive benefits from their transition–there is more nuance to this study than first meets the eye. 4thWaveNow contributor fightingunreality delves into some of the study’s unexamined implications in the post below.

As you read fightingunreality’s analysis, consider whether survey studies like this one might be subject to the  “interpersonal expectancy ” of researchers and “supportive” parents. The interpersonal expectancy effect is also known as self-fulfilling prophecy, or the Pygmalian effect, extensively studied by preeminent psychological researcher Robert Rosenthal:

 …the tendency for experimenters to obtain results they expect, not simply because they have correctly anticipated nature’s response, but rather because they have helped to shape that response through their expectations. When behavioral researchers expect certain results from their human or animal subjects, they appear unwittingly to treat them in such a way as to increase the probability that they will respond as expected…

In more recent years….research has been extended from experiments, to teachers, employers, and therapists whose expectations for their…patients might also come to serve as interpersonal self-fulfilling prophecies.

Analysis of the 2014 Dutch study (available in full at the link, and introduced above),

by fightingunreality

Any discussion of the “outcomes” for those children chosen for the experimental use of puberty-blocking drugs would be remiss without first addressing the ethics of what has been done.

First, this study is about young people, many of whom initially presented to the clinic as prepubescent children. Children’s understanding of gender is primarily comprised of the simplistic social stereotypes through which they have learned to perceive the meaning of biological sex, and which they lack the certainty of identity to resist. Developmentally unable to fully comprehend abstract concepts, they have little understanding of the social forces which inform and compel both them and the adults to behave in certain manners deemed to be “appropriate” on the basis of sex. The vast majority of these children were socially transitioned by their parents prior to their arrival at the clinic, thereby disrupting the chance that they may have had to experience a typical childhood.

hormone graph 2

Because 85% of the fathers and 95% of the mothers were supportive of their children’s desire to live as the other gender, and since virtually all of the children were living for all intents and purposes as socially transitioned, we can assume, with little doubt, that these parents subscribed to the idea of sex-based gender roles for their children akin to those we have seen in the plethora of news stories of (mostly) moms citing wrong toys and early color preferences as indications that their children were different.

Since none of these child-transition studies (this Dutch study being no exception) report the extent to which parents enforce traditional gender roles, we have no real sense of the degree of their influence on these children or how much they might affect the kids’ willingness to defy them in order to express their non-traditional likes and dislikes– without the expressed belief that they are in fact, a different sex. Is it only a coincidence that 94% of the males in this study were either same-sex attracted or bisexual (87.9% SSA, 6.1% BI) or that 100% of the females (89.2 SSA, 10.8% BI) had same sex attractions? Are we really expected to believe that social and parental attitudes in regards to homosexuality play no part in either the formation of the children’s understandings of what constitutes “feeling like the other sex,” or, more importantly, the acceptability to parents of what, in effect, becomes medicalized gay conversion therapy?

Since the stated protocol by these researchers is to provide a six-months to a year “diagnostic phase,” this means that prior to the first assessment for this particular study, they had already been living as cross-gendered for at least that amount of time, plus the previously acknowledged but unspecified duration of social transition. During the actual diagnostic phase, all of them “officially transitioned” –including name changes. Since the youngest, at the time just prior to the administration of hormone blockers, was 11.1 years old, that means this child had been living cross-gendered since a minimum age of 10.6 years old –in addition to the time prior to arriving at the clinic. What can such a child actually know about what it means to live as his or her own natal sex?

Given the willingness, as noted in the study, of peers and parents to promote and solidify by reinforcement these children’s sense of being wrong-bodied, it is hard to see how such children could establish a basis by which they could reasonably fully comprehend–let alone reevaluate–their child-based understanding of gender and gender roles. As has been noted in previous posts on this blog, identity formation throughout childhood and adolescence is both malleable and fluid. It is impossible to believe that the interventions by both the parents and the clinicians did not directly interfere with these children’s identity development. How does a child who has basically reordered their family’s lives by their insistence that they are actually the other sex back down from such claims? How do they tell their friends? We are not talking about adults, here, after all. By the time these children reached the point of choosing to delay their puberty, they had been living as the other gender for years –in some instances possibly half of their young lives. By the time it came to choose whether or not to imbibe cross-sex hormones, it is no surprise that none of these children chose to revert to living as their own sex: they had been socialized trans.

It’s interesting to note from the information in this paper that during the time between starting hormone blockers and their choice to be put on cross-sex hormones, these kids –especially the girls –actually experienced greater levels of “gender dysphoria.” I think it’s important to ask ourselves why that is. These kids were not facing the risk of further development of secondary sexual characteristics. They were living as their chosen gender. Why wouldn’t they be at least somewhat relieved of their dysphoria? Since levels of such dysphoria consist of self-assessment, this worsening could merely reflect the child’s desire to fully transition along with the knowledge that admitting a decreasing level of dysphoria might threaten the willingness of the clinicians to advance their transitions. That is one possibility. The other more likely possibility is that living as fully socially transitioned children, their awareness of not physically “matching” their chosen gender while assuming that role actually worsens the sense of being wrong-bodied. In other words, telling someone that you are actually a boy or a girl when you clearly are not increases self-awareness of and discomfort with your actual sex.

As was articulated in a BBC documentary by a gay Iranian who was pressured into transition, prior to transitioning he often heard, “He’s so girly. He’s so feminine.” After the surgery, whenever [he] wanted to feel like a woman or behave like a woman, everybody would say “look, she’s like a man. She’s manly.” This phenomenon can readily be applied to children who may have been considered like the other sex prior to living akin to that sex, but become seemingly less like the other sex when attempting to assume that role. The very fact that they are attempting to live as the other gender may very well increase the dysphoria that assuming such a role is meant to lessen. Is it a wonder that 100% of the children that comprised this cohort chose to go on to cross-sex hormones?

The gender specialists promoting these studies want us to believe that the use of hormone blockers provides extra time without the stressful development of secondary sexual characteristics. They’d like us to believe that the children are being given a sort of “time-out” to consider their choices and become more mature before committing to irreversible changes, but is that really the case? The hormones required for adolescent brain reorganization and development are not released when a child has received GnRh agonists. Physical development typical for teenagers is prevented, setting the children even farther apart from their peers, and sexual and romantic involvements –a key factor in desistance –are avoided.

Ultimately, 100% of the children who chose to utilize hormone blockers in this study went on to fully transition. In fact, virtually all children inducted for such therapy demonstrate 100% persistence rates despite that fact that even today, major proponents of this therapy (such as Johanna Olson-Kennedy and Robert Garofalo, in their 2016 paper detailing research priorities on gender identity development and biopsychosocial outcomes) acknowledge that “Clinically useful information for predicting individual psychosexual development pathways is lacking.” They do not have reliable information on who will or will not desist. Are we really expected to believe that these hormone blocker advocates are exceptionally lucky in their selection process when they themselves profess such uncertainty and bemoan the lack of adequate research? Or should such absolute rates of persistence be setting off alarm bells to those of us concerned with the practice of funneling children into a pipeline that flows in only one direction: towards lifelong medicalization with unknown long-term consequences?

Because of the extraordinary persistence rates of children infused with hormone blockers, it’s obvious that hormone blockers do not allow these children extra time. The choice to participate in this protocol becomes the decision to transition, because it prevents the aspects of maturation necessary for desistance from ever occurring. The one thing it does do, however, is to make it seem safer to interfere with the children’s natural course of development. Parents are assured that the effects of blockers are reversible, and the moral burden of placing young children in the position of making adult decisions is put aside.   As a result, even more children are being swept up by this 21st century version of reparative therapy. Altogether, we will never know the number of children who would have desisted had they been allowed to develop without social and medical intervention. This is a travesty.

As far as the “positive outcomes” this study purports, there are numerous problems. First, in order to understand this study, we must consider the selection process detailed in a previous paper by the same authors.  The 70 children chosen for this study were selected from an original cohort of 111 (out of 196 children arriving at the UV hospital seeking treatment for GD) eligible for hormone blockers, after having been “thoroughly screened after a comprehensive psychological evaluation with many sessions over a longer period of time” and found “eligible for puberty suppression and cross-sex hormones.” It was a group chosen on the basis of their likelihood of coping with the transition process. They had “no psychosocial problems interfering with assessment or treatment,” and “adequate” (in the case of this cohort, very high) “family or other support,” and what the researchers described as “good comprehension of the impact of medical interventions.” (We can only guess what that could mean, given the fact that pre-adolescents and adolescents do not have the frontal lobe development to fully project themselves into the future.) Altogether, they seem very unlike the average children and adolescents who are currently being inducted into this process of life-long medicalization either in regard to screening or support and ongoing therapy, which the study notes was provided to them for an average of 6 years “after first presenting at the clinic.”

Fifteen of the cohort of 55 had “some missing data” which we are assured resulted in “no significant differences” on the pre-treatment tests.   I think, too, that when considering the outcomes of these children, it would be remiss to ignore the 15 members of the original cohort of 70 who did not participate in follow up: six had not met the one year gender reassignment surgery anniversary for this study and were, therefore, excluded. Two refused to complete the assessment, and two did not return their questionnaires. (Why?) Three had health problems which prevented them from undergoing gender reassignment surgery, one “dropped out of care” (no clarification) and 1 died from complications from surgery. (How does one weigh such a loss against “positive outcomes?”)

Given the fact that all of these children had what is in essence a “gender obsession” since childhood and had been socially transitioned for years, it comes as no surprise that they experienced relief at finally accomplishing their goals. The kids as a whole did overall demonstrate better functioning than at their initial assessment –possibly from the counselling and special attention they were getting –but “it cannot be ruled out that it relates instead or as well to the benefits that accrue from being validated and accepted for treatment.” They were getting what they wanted, after all. Research has shown that gender non-conforming children and adolescents are at higher risk for PTSD due to abuse and bullying because of being different, and the prospect of “fitting in” provided by merely initiating action towards this goal certainly provides a degree of psychological relief- regardless of the actual physical changes that have yet to take place. This is evidenced by the “significant quadratic effect” that commences immediately upon initiation of cross-sex hormones, well before significant physiological effects of the hormones could possibly have occurred.

Would body image and psychological well-being have improved in these children had they been allowed to experience a natural childhood and identity formation without medical intervention? It is well known in the field of child development that children go through a period of significant peer gender enforcement which corresponds with their concrete thinking and familial socialization which certainly affects the self-image of those who fail to conform. This rigidity begins to relax at around 8 to 10 years –after some of the children in this study have already been socially transitioned due to the discomfort this rigidity has created. Would they have come to a more nuanced understanding of gender roles had they made it past this stage? We –and they –will never know. Logically, children have been shown to be more accepted by members of the sex with which they share interests, rather than those whose similarities are based solely on sex, and gender enforcement prior to adolescence tends to be enacted by members of the same sex. Is it any wonder that children tend to “identify” with those who seemingly accept them and share common interests? Would a more mature understanding of abstract concepts assist them in accepting their own bodies without conforming to artificial gender roles as it did for many of us who matured without the alluring possibility of appearing to actually change sex?

As adolescence progresses, criticism is most likely directed by male peers who are not known for impulse control or empathy. Certainly those of us who have been on the receiving end of such mockery can attest to the resulting social stigma and humiliations we suffered in light of it due to our vulnerability at that age and the fact that we were insecure in our own identities and lacking the self-assurance that maturity brings. It has been demonstrated that peer and social disapproval for gender non-conformity peaks in the adolescent years and gradually decreases throughout young adulthood and adulthood. Not only do we mature, but the peers responsible for the harassment mature, as well. The insults decrease. As gay rights activists in the past often said, in an attempt to help bullied gay and lesbian children, “it really does get better.”

Unfortunately, none of the children in this study will ever know whether this would have been the case for them, because they left behind in childhood the bodies which they very well may have come to accept in the absence of such criticism. In a study in which there is no viable way to create a control group with which to compare these children, there’s no way of knowing how well they would have fared with just the extensive psychotherapy alone, nor of desistance which may have taken place without these prolonged social and medical interventions which prevented the maturation and social and sexual experience that would have occurred otherwise.

As a gender non-conforming adult, I am occasionally harassed by what are typically groups of two or three teen boys out to impress their friends. Because I am an adult with a fully-formed sense of self, my identity is not threatened as are those of the children who have not yet discovered, through experience and physical development, who they really are or can be. Sadly, the ultimate result of medicalized disruption of identity formation –which would have included their whole selves, bodies included –creates an identity which is dependent upon exogenous substances, conscious gendered performance, and the willingness of others to deny their own perception in order to validate it. As such, the identity is not sustainable without significant degrees of external support, and remains more highly vulnerable to what are perceived as being threats to self when it is not validated.   As a result, they may be “at increased risk for the development of narcissistic disorders…as a consequence of the inevitable difficulties they face in having their cross-gender feelings and identities affirmed by others.” (Note: While the linked study is not specifically of children, it seems to me children subjected to early medical transition would also be at some risk of narcissism, given the confluence of factors brought to bear upon them.)

Perhaps the greatest hindrance to accurately critiquing this study is related to the ages and the timing of this so-called “long-term” study: it was completed after only a minimum of one year after gender reassignment surgery. These now young adults had barely any life-experience living as fully transitioned persons. They were still in the honeymoon phase of what had become a fully supported childhood desire. A significant portion of them were still living at home with their supportive parents and attending school. Their lives as fully transitioned adults were just beginning, and the difficulties of navigating sexual relationships and the hardships that entails for those not of their natal sex were in their infancy. They were many years away from the rise in suicidality noted in a Swedish long-term study of adult transgendered persons, which began to rise around 8-10 years after transition.

Because of the failure of the Dutch authors to denote significant variables among these youths (as I’ve outlined in this post), their study inspires more questions than it provides answers.   Have these children been harmed by the parental and medical reification of childhood fantasy and desire? We have primarily their own self-reports to rely on –the reports of young adults who never were given the opportunity to experience childhood or adolescence as one would experience their own actual sex. They have nothing with which they can compare their current experienced “gender.” They will not know what it’s like to have sex in their natural bodies, nor be loved as such. Certainly, as partially formed adults (remember- maturation takes place concurrently with hormonal action and resulting brain development and theirs was delayed), they had not reached fully adult status at the time of their self-assessment. We do not know how the difficulties of living as transgendered people will affect them. We do not know if the long-term effects of injecting artificial cross-sex hormones will damage them physically (or mentally). We will never know whether they might have resolved their gender dysphoria, as others have, and pressed on through life, because they were never given the chance to find out.

Their childhood fantasies were to become a different sex. What they have been given, instead, is the means of promoting that illusion—and the reality of becoming a life-long medical patient.

 

Blocking puberty–and the right to an identity crisis

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I recently wrote about research findings that gay and lesbian youth are typically older than their heterosexual counterparts when they first act upon and realize their sexual orientation. While same-sex attracted girls, in particular, reach this milestone between 19-early 20s, the current trend is to “socially transition,” then puberty block, and finally move on to cross sex hormones at age 16.

It’s easy to see that many of these teens are being set up to short-circuit the natural discovery of their sexual orientation. But is that the only potential problem with social transition and puberty blocking—the preemptive conversion of likely gay and lesbian youth to transgender?

Not by a longshot. There are so many important things that happen at puberty which are critically important to the maturation necessary to make informed decisions about major life changes (you know–things like sterility, loss of breasts, and a permanently deepened voice) that a developmental psychologist or cognitive scientist could write a doctoral dissertation about the subject.

In fact, many have; the research and clinical literature going back to the mid-20th century is chock-a-block with replicated studies, clinical observations, and meta-analyses. More recently, we have MRI and fMRI studies corroborating earlier observations.

What we don’t have, at least not yet, are the PhD theses showing how the experimental “treatments” currently being implemented by pediatric endocrinologists and gender specialists—many of whom have no professional background in child or adolescent psychology—fly in the face of that large body of literature.

I have spent hundreds of hours poring over the literature on gender dysphoria and pediatric transition. But in all the studies and papers I’ve read, I have not seen mention of the vast body of extant knowledge about child and adolescent psychology. It’s as if these gender specialists just started from scratch.

Erik-Erikson-portrait

Erik Erikson

What exactly are they ignoring? Well, for starters, there’s the work of Erik Erikson, a preeminent child and adolescent psychology expert of the 20th century. You can’t read the scholarly or clinical literature on pediatric psychology without finding a reference to Erikson’s work; in fact, much of the current knowledge in the field is built upon his fundamental insights. A blog post is not adequate to even summarize it, but his bedrock finding about the psychological journey of adolescence is this: Developing an identity takes place in stages, culminating in an integrated adult personality; and “identity work”—including an identity crisis—is critical to healthy adult psychological functioning.

erikson capAdolescent psychology expert James Marcia was another foundational thinker who built upon Erikson’s framework:

… two distinct parts form an adolescent’s identity: crisis (i.e., a time when one’s values and choices are being reevaluated) and commitment. He defined a crisis as a time of upheaval where old values or choices are being reexamined. The end outcome of a crisis leads to a commitment made to a certain role or value.

But we don’t need a study, a theory, or someone with a PhD after their name to prove this to us, do we? Any adult who has lived through that time of life called “adolescence” can attest to the fact that questioning, and trying on and discarding different ways of being, go with the territory. And it’s a rough time. How many adults would willingly relive the fraught and tumultuous days of middle and high school? Every psychologist (until the Age of the Trans Child) has agreed: it’s not supposed to be an easy ride. In fact, without the essential but painful work of adolescence, a person will not reach their adult potential: “unable to achieve an integrated adult identity, either because they have failed to resolve the identity crisis or because they have experienced no crisis. ”

Contrast this long-accepted understanding of adolescence with the approach taken by today’s gender specialists. Instead of helping children weather the natural and not necessarily comfortable process of cognitive and emotional development, they concretize and freeze in place the certainties of childhood, in what should be a time for exploration, not stasis.

It would be one thing if these gender clinics were really in the business of helping a child expand or explore different gender identities, without medical interference. But we know that they support and encourage “transition” from one sex to the other, with all the permanent physical changes that entails. In terms of adolescent psychological development, once these kids have taken the irrevocable step of moving from blockers to cross sex hormones, they have been denied the opportunity to go through an identity crisis.  So, a 16-year-old girl who has lost her fertility and her breasts, and who has already committed to a permanent testosterone-deepened voice and increased body hair — how easy will it be for her to experience James Marcia’s “time of upheaval where old values or choices are being reexamined?” That adolescent girl has been cheated of that stage of life. And when did we, as a society, decide that was a good thing?

The media stories and anecdotes from gender clinics are all the same: The kids are uncomfortable, so they and their parents seek relief. Then, according to everyone, the treatment “works” because the kids are happy. For how long? No one knows.

Be that as it may, an identity crisis isn’t supposed to be resolved in preschool, or kindergarten, or even middle or high school: It is the work and the challenge of adolescence, not complete until late adolescence.

 Adolescence has long been characterized as a time when individuals begin to explore and examine psychological characteristics of the self in order to discover who they really are, and how they fit in the social world in which they live. Especially since Erikson’s (1968) theory of the adolescent identity crisis was introduced, scholars have viewed adolescence as a time of self-exploration. In general, research has supported Erikson’s model, with one important exception: the timetable. It now appears that, at least in contemporary society, the bulk of identity “work” occurs late in adolescence, and perhaps not even until young adulthood.

“Late in adolescence”—after the time when most “trans” youth have moved on from puberty blockers to cross-sex hormones, thus bypassing the period when they would have been able to explore possibilities in their original bodies—including, but not limited to, their sexual orientation and other essential aspects of their identities and personalities.

The insights of the earlier child development experts have been corroborated by advanced visualization technologies, such as MRI and fMRI, which have revolutionized our understanding of the human brain and psychological development. In recent years, we have come to understand that full maturation occurs much later than previously thought.

Recent research has shown that human brain circuitry is not mature until the early 20s (some would add, “if ever”). Among the last connections to be fully established are the links between the prefrontal cortex, seat of judgment and problem-solving, and the emotional centers in the limbic system, especially the amygdala. These links are critical for emotional learning and high-level self-regulation.

Beginning at puberty, the brain is reshaped. Neurons (gray matter) and synapses (junctions between neurons) proliferate in the cerebral cortex and are then gradually pruned throughout adolescence. Eventually, more than 40% of all synapses are eliminated, largely in the frontal lobes. Meanwhile, the white insulating coat of myelin on the axons that carry signals between nerve cells continues to accumulate, gradually improving the precision and efficiency of neuronal communication — a process not completed until the early 20s.

In addition to reading research studies, I spend a fair bit of time reading the blogs, tweets, and social media writings of trans-identified teens. While most teens are pretty self-absorbed, with these kids, I am always struck by the depth of self-involvement, the extreme obsession with looks and appearance, and the constant focus on getting what they want, when they want it.

What is conspicuously absent in the narratives of many of these teens is another key aspect of pubertal maturation: self reflection and awareness. Concrete, literalist thinking is a hallmark of childhood. So a preadolescent frozen at Tanner Stage 2 of pubertal development (when blockers normally begin to be administered) may still think literally and concretely: “I am a boy.” Instead of: “Maybe I think I’m a boy because I like trucks and hate girly clothes. Maybe there’s a reason I think I’m a boy, but I’m really not.” The name for such higher level reflection, or “thinking about thinking,” is metacognition.

So when these young people, frozen at an earlier stage of cognitive development, are asked at age 15 or 16, “Are you SURE you’re really a boy?” why would any of them say “no”? And in fact, in the small number of studies that have looked at kids who have been socially transitioned and puberty blocked, none of them have failed to move on to cross sex hormones. Is this because they are “truly trans” and their clinicians have godlike diagnostic skills, with zero—zero!—false positives? Or is it because the very act of endorsing and reifying their self-proclaimed concretized self-images has helped them persist in those self-perceptions?

 No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.

It’s not just metacognitive and abstract thinking that develops slowly, reaching fruition in late adolescence. As I wrote about in this post, executive function—the ability to make decisions, plan, and think of future consequences (like, “do I want to have children of my own, ever”?) doesn’t begin to consolidate until the mid-20s.

Then there’s social maturity and a more nuanced understanding of how to interact with one’s peers. Who doesn’t remember the awkwardness, the trying-to-fit-in, seasick self-consciousness of adolescence? Social development takes place in concert with one’s peers, along with the slow dawning of self-reflection. A socially transitioned, puberty-blocked 14-year-old who has avoided the rigors of hormone-fueled social issues won’t  understand any of this.  How will that lack of experience inform their decision to continue on to cross sex hormones?

 We previously investigated how the ability to understand social emotional scenarios using mixed emotions varied across puberty in girls aged 9–16 (Burnett et al., 2011). There was a change between early and late puberty in the number of emotional responses that participants gave in social emotion scenarios, with girls in late puberty attributing a wider combination of emotions in social scenarios than their peers in early puberty

… Our findings of puberty-related changes in neural activation, together with those shown in other recent fMRI studies using different ‘social’ tasks as described in the introduction, suggest that aspects of functional brain development in adolescence, like these behavioral changes, may be more closely linked to the physical and hormonal changes of puberty than chronological age.

 As the authors note, social intelligence—a more nuanced understanding of “social emotion” scenarios—develops as a result of the release of hormones, not chronological age. This is so obvious it hardly seems worth studying (or proving on a functional MRI study).  Yet gender specialists talk as if the brain develops separately from the body; as if hormones are only important for secondary sexual characteristics. They are constantly reassuring skeptics that blocking puberty gives these incredibly immature kids the time to figure out if this is really what they want—without the benefit of the cognitive, emotional, and social maturation processes that comes with the secretion of pubertal hormones.

I’ve touched upon only a few facets of adolescent cognitive-emotional development in this post. The literature in this area is vast, still accumulating, and spans decades and millions of pages of writing. Contemporary cognitive scientists like Russell Viner, Sarah-Jayne Blakemore and Jay Giedd are continuing to add to the body of knowledge. But their work on adolescent psychology and brain development is not referenced in the media or in the writings of trans activists or pediatric gender specialists. In point of fact, what little peer-reviewed research there is in the field of “gender identity” is going in the exact opposite direction of the rest of developmental psychology and cognitive science—towards a reification of rigid, unchanging identity and decision-making “agency” for younger and younger children; while the replicated research of developmental psychology and neuroscience is moving toward an understanding of neuroplasticity, the necessity of undergoing an identity crisis, and a later age for brain maturation than was previously thought.

Cognitive scientist Jay Giedd:

One of the most exciting discoveries from recent neuroscience research is how incredibly plastic the human brain is. For a long time, we used to think that the brain, because it’s already 95 percent of adult size by age six, things were largely set in place early in life. … [There was the] saying. “Give me your child, and by the age of five, I can make him a priest or a thief or a scholar.”

[There was] this notion that things were largely set at fairly early ages. And now we realize that isn’t true; that even throughout childhood and even the teen years, there’s enormous capacity for change. We think that this capacity for change is very empowering for teens. …

Instead of respecting this “enormous capacity for change,” gender specialists are tampering with the endocrine system, freezing gender dysphoric children in a state of suspended development—and then expecting these psychologically and emotionally immature children to make permanent decisions about their future as adults. It’s a huge clinical gamble. What it amounts to is hoping for the best.

But is anyone preparing for the worst?

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

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

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

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

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

I drew a clear line in the sand: There would be no money to pay for a gender therapist, testosterone, or a binder. If she wanted to pursue those things at the age of medical majority, that would be her choice—and it would be on her dime. At the same time, I let her know that her clothing and hairstyle choices were hers to make. Further: I purchased the “men’s” clothing (including underwear), paid for the haircuts, supported all the other stuff she wanted to do or wear that is more “male typical.” Not always successfully, I tried to calmly and sparingly convey the message that however she dressed, whatever interests she pursued, she was a female—perhaps an unusual one, but a young woman nevertheless, who might someday become a role model to show other girls just how amazing and truly “gender-expansive” a woman can be.

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

Skip that step? I thought back to my own adolescence. I didn’t even begin to have a clear idea of who I was, as a sexual being, until after I’d had more than one relationship. It took years for me to come to know my body’s nuances and intricacies, its capacity for pleasure, how I might feel in relation to another. [Update: for lesbian youth in particular, this process can be a long one, on average not complete until one’s early 20s]

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

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

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

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

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

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

Most of all, I knew she needed me—not to blindly “support” and give in to her every demand, but to simply BE THERE, even as a limit; a steady place she could push and rail against. It was scary, and painful, being on the receiving end of teen outrage.  Because a teenager does have the right to make some of their own decisions. Later adolescence is a time of individuation, dawning adulthood. Haranguing or lecturing not only gets you nowhere, it isn’t fair. Negotiation is probably the most important parenting skill when it comes to high-school-aged youth. And no parent gets it right all the time. (Paradoxically, part of being a halfway decent parent is knowing how imperfect you are at the job.) But one thing became more and more clear to me:  my child did not need a parent who would collaborate in sending her down a road to being a permanent medical patient. In fact, she needed protection from the very same people who were sending me hate mail on Tumblr.

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

In contrast to today’s social-media-fueled paradigm, when a kid’s announcement that they are the opposite sex is taken at face value by seemingly everyone around them, it was previously understood that adults were largely responsible for the inculcation of gender stereotypes into children’s minds. Children aren’t born hating their sexed bodies. They only grow to reject themselves when someone they look up to promotes the idea that their likes and dislikes in clothing, toys, activities, or other pursuits are seen as incongruent with their natal sex.

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

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

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

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

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

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

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

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

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

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

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

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

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

And when it comes to teens,

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

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

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

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

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

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

Given my own daughter’s desistence from the idea that she is or was ever “transgender,” I feel even more strongly that parents are right to resist the push by every sector of society to identify “gender dysphoric” minors as “trans.” Yes, some of these young people may go on to identify as the opposite sex; some will seek medical transition. But what the current atmosphere has done is rob them of the crucial time they need to figure it all out. Medical transition was once a rare, adult-only decision. I’m in favor of a return to that more reasonable approach to the matter.

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

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

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

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

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

Guest post: Tips for parents on finding a therapist for their trans-identified teen

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So many readers of this blog have agonized over how to find a therapist who won’t immediately jump to the conclusion that their distressed teen is “trans” and in need of “transition” services. I asked Lane, the clinician who wrote the excellent guest post  “Exiles in their own flesh”, if she had any advice to offer. She responded in the comments thread of this recent post. I am reproducing her remarks here for greater visibility. Thank you, Lane!

As a therapist who worked with many teens who came into my office identifying as trans, I want you parents to know I did not automatically support their transitions. Like you, I was struck by the suddenness of this phenomenon of teens thinking they were born into the wrong body. My first concern was for the teen’s mental health, I looked at other causes. It’s interesting: around the time I started noticing an uptick in the number of kids identifying this way, I mentioned my concerns to a psychiatrist and a pediatrician who were both heads of the clinic where I worked. They were both on the brink of retiring, and they did not buy this new “trend” at all. They looked at what was happening as yet another medical fad. But, like I said, they were retiring. They were the old guard. The folks who replaced these dinosaurs (just kidding) had a complete absence of critical thought for the trans-narrative. It was almost as if they wanted to distinguish themselves from those they were replacing by being more open-minded, more patient-oriented.

The two folks who have come in to replace the old guard have a notable lack of developmental psych background. They are somewhat open to learning about it, but in general their work with teens (particularly any group billed as in any way marginalized – trans is pretty much the top of the heap in this regard) tends to be informed by a social-justice paradigm over something more clinical.

So, as far as finding a therapist more critical of the trans-narrative, it might be helpful to find a practitioner who is more classically trained and who is over 50. Also, find someone who is clearly a thinking, intellectual type, rather than someone more prone to falling in with medical fads. I hate to say it, but both of the old dinosaurs were uber smart, male doctors. Perhaps it was their sense of privilege, but these guys were not afraid of stating their opinions and had enough power in the organization to easily hold onto their own sense of reality. The people who embraced the trans-narrative on my team, apparently without a critical thought, were, I hate to say this, all women. So, using this small sample, which admittedly, may be utterly useless, I’d say that finding someone who isn’t as prone to the shifting sands of group-think, who hasn’t been dependent upon being seen by other professionals as “correct,” would help. Have your kid be seen by an arrogant, old man. LOL. Who would have thought I would ever write that!

Then again, I am not an old man, but I am definitely someone who has always valued and prized truth over belonging. I’m weird that way. That could be another way to screen for a trans-critical therapist, someone more old-style intellectual rather than social-justice oriented (not that I’m not down with SJ, but I qualify it when working clinically). Therapists who are critical of trans won’t be able to come out and say they are, so you’ll need to know to look for clues. You could also read their work, if they have any. Some have blogs and websites. If they say something like, well, it seems like your kid has some other mental health concerns, I’d like to focus on those for awhile before exploring their trans issues, that would be a good sign. If they do a thorough history of your family’s mental health, trauma history, that’s a good sign. These histories are an absolute must.

If a therapist is hopping on the trans explanation right out of the gate, that’s a sign they are inexperienced and lacking clinical authority. This is why you probably want your kid to see someone who has been practicing awhile–20 years at least–because, honestly, clinicians were trained so differently in the past. The training was less politicized, more intellectual and critical and I guess a bit more honest as far as research. It wasn’t perfect in the past, obviously there were abuses, but there were general, shared standards of care and it was a bad thing to breach them. There was more personal responsibility, more commitment and investment on the part of the clinicians. Now the vast majority of the clinicians and psychiatrists in the organization where I worked constantly complain about being overworked and exhausted and feel the org is screwing them over. They are too afraid to go into private practice where they could perhaps see fewer people in a day and therefore have more mental space to see each client as an individual. When people are overworked in healthcare, it means the treatment suffers; they don’t have time to look into the background of new therapies. Honestly, none of the folks I worked with had any training in working with transgender kids. They were starting to talk about getting some, but this is just now happening. And I practice in a large, metropolitan city. There are no standards of care or official certification processes yet in place for vetting therapists who work with transgender issues.

These days, training standards for therapists are pretty weak in general. Most good clinicians study for years and years, join institutes and hopefully become critical of a lot of what they learn. The point is, there are no short-cuts; it takes clinicians a really long time to become effective. Younger clinicians tend to be swayed more by current trends because they just don’t have enough experience with seeing loads of different people. Also their training is different, and they have much less clinical confidence.

If I were a parent and my kid were experiencing this issue, I would also just be as honest and loving as you can with them about your concerns, as many of the parents here on this blog have been. It’s hard because you don’t necessarily want to use this situation as the time to explain to your kid that doctors and the medical profession have been co-opted by activists and other folks looking to profit from their distress in some way. There’s so much that needs to fall away in order for you to help your kid. And if your kid is already unstable, it could be frightening to hear mom or dad sounding like they’ve been pulled into a conspiracy theory.

I think the best way to combat becoming reactive (as we do when we feel nobody believes us and yet we feel we must continue to speak since so much is at stake) is to deal with our own grief at being so alone and not being believed. Honestly, this level of self-doubt and invalidation is traumatic for people, particularly people who have in general spent their lives being respected for their measured take on the world (your basic educated liberal parent). I honestly can’t think of anything more hellish than to suddenly find your usual experience of being taken at your word ripped out from beneath you. But this is exactly what is happening to parents who question the trans-narrative. Caring, truly loving parents (not enabling parents necessarily, but good, solid parents) are being made to question their motives. It’s heartbreaking for me as a therapist to see this happening to families. I wish I had more answers for you. It might be best to keep your child away from people who bill themselves as gender specialists.

In order to reach your child, you will absolutely need to find a way to regain your own internal grounding. This blog is obviously helping with this task. You may need to “let go a little,” which it sounds like many of you have done. By this I mean, do not fight your kid on this issue. When we deal with kids with other compulsions, such as eating disorders, we encourage parents to stop talking about food.

Exiles in their own flesh: A psychotherapist speaks

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This is a guest post submitted by Lane Anderson (a pseudonym), a practicing psychotherapist who has worked extensively with “trans teens” and their families. She shares with us her clinical insights into her clients, adolescent psychology, and the impact of the transgender phenomenon on our society as a whole.

If there are other mental health providers reading this post, please consider guest posting or responding in the comments section below the article. See this earlier post featuring Dr. David Schwartz for another critical perspective from a psychotherapist.

I am extremely grateful to Lane and Dr. Schwartz for speaking up. Time is of the essence, since the American Psychological Association recently released new guidelines which will make it even more difficult for clinicians to step forward.

I am a licensed psychotherapist. I’m writing this post on my last day at a teen health clinic, where I’ve seen patients and their families for nearly a decade.

In the past year especially, it’s become increasingly clear to me that I cannot uphold the primary value of my profession, to do no harm, without also seriously jeopardizing my standing in the professional community.  It’s a terrible and unfortunate conflict of interest. I’ve lost much sleep over the fact that, for a significant portion of my clients and their parents, I am unable to provide what they profess to come to me seeking: sound clinical judgment. Increasingly, providing such judgment puts me at risk of violating the emergent trans narrative which–seemingly overnight and without any explanation or push-back of which I am aware–has usurped the traditional mental health narrative.

When I am suddenly and without warning discouraged from exploring the underlying causes and conditions of certain of my patients’ distress (as I was trained to do), and instead forced to put my professional stamp of approval upon a prefab, one-size-fits-all narrative intended to explain the complexity of my patient’s troubles, I feel confused.  It’s as if I am being held hostage. No longer encouraged or permitted to question, consider or discuss the full spectrum of my patient’s mental health concerns, it has occurred to me that I am being used, my meager professional authority commandeered to legitimize a new narrative I may or may not wish to corroborate.

It’s been perilous to simply admit to not fully understanding it all–let alone disagree with the trans narrative.  There was no training or teaching. I was just suddenly told that some of my patients thought they were trapped in the wrong body and that was that.

After much soul searching, I felt I had no choice but to remove myself from this crippling work setting. Being told to exercise my clinical judgment with some clients, while ignoring it with others, made me feel like a fraud.

Throughout my career, I have come to my work with these thoughts in mind: that life is complex, that people are complex. But in one way or another, most people tend to balk at that kind of ambiguity. I try to assist people in flexing a little, try to help them find ways to manage life’s gray areas, and the occasional distress that comes from simply being conscious. But at the end of the day, I couldn’t deny it was a little weird for me to go on believing I could effectively teach others to be less rigid, more free people facing their lives head on, when I myself, their humble guide, was being exploited, tongue-tied by a new party line.

There are so many complex forces, from many different realms, coming into play with this trans wave.  Most people are completely unaware of these intersecting interests.

Unfortunately the culture war has done a number on the concept of critical thinking.  I have considered myself liberal my entire adult life, and I still am. But for a long time I couldn’t find anyone questioning this trans explosion who wasn’t on the far right. It made me feel like only conservatives were allowed to think, to consider this issue, but ultimately their thoughts were rendered meaningless due to their branding by the culture war. It’s essential that left-leaning people model critical thinking for the masses in this regard.

It’s important to link people like us together, who have been silenced, so we can resume contact with our critical thinking skills and reduce our growing sense of self doubt.  Divide and conquer is best accomplished through silencing, through calling into question those who speak out. There is so much of this attached to the trans movement. Even just wondering about a profound concept such as transgender is  labeled transphobic. What I think has happened is that people are now phobic about their own gut responses to life. We are being systematically separated from our own intuition. This is fatal for a civilization, I think. Not that our intuition always tells the truth with a capital T, but it is a critical piece of who we are. Without it, we remain profoundly directionless, and more susceptible to coercion of all types.

What frightens me most about the trans movement is that the establishment has gotten involved and is leading it. I think that’s really weird. Clearly they are benefiting from it financially. So sad. It disturbs me to see how giddy my former medical director is to be part of this growing craze. We used to treat kids with mental health problems, but now it’s all about validating their emergent and shifting identities.  As professionals, if we don’t loudly prioritize their identities as being the most important thing about them (and identities do shift constantly in kids and teens), we risk coming across as unsupportive and even immoral. Identity development has always been a teen task, but in the past it wasn’t necessarily supposed to become a lifestyle, or colonize the entirety of your existence.

Our world is in a profound state of flux. We can’t begin to comprehend what the Internet has done to how we see ourselves. People are looking for ways to belong, ways to understand who they are in place and in time. They are looking to reduce the anxiety that comes when too much change happens all at once. I try and look at trans folks as people who are seeking to answer the new questions that have emerged in this early 21st century.  I have been trying to find a way to understand their urges to detach from their bodies, to undo that feeling of exile they experience in their own flesh.  We all want to get back to ourselves; it is our duty to reconnect with those weighty parts that inevitably sink to the depths of us, the parts too heavy to remain on the surface of our lives.

From what I can see, the age-old human task to reclaim that which has gone missing appears to be manifesting with great prominence in the trans community. The problem is this: we all look for shortcuts to finding the lost treasure. It’s human nature to resist the long and serpentine journey to our own sense of personal truth. In our fear, in our self doubt, we calculate the risk and often decide it is preferable to be shown what another person–a “helping professional” or an activist–bills as a sure thing, a direct path to what we sense we lack. We all, on some level, hold a childlike fantasy that someone else has figured it out and can provide us a direct map to ourselves. And that’s what the trans narrative does. It promises to guide the follower to their essential, authentic self.  But this, unfortunately, doesn’t happen, because the essential self, whatever that is, is not created from another’s road map, but can only be comprised of the trails we forge ourselves.

What saddens me the most is the way children are being trained to think their parents do not love them if mom and dad don’t jump aboard the trans train. To me, this is a brutal aspect of a near-dictatorship being foisted on everyone. The kids are too young to see that there are no other people who will have their backs, throughout life with lasting devotion, in the unique way their families will. They think these new friends they’ve made online understand them perfectly. And in believing this unquestioningly, they find themselves lulled by the frictionless experience delivered most powerfully by group think.

Of course, I’m describing the pull of all cults; that deep human desire to be known through and through and through.The cult experience seeks to end the frustration that naturally comes when we mature and begin to see ourselves as separate beings. In our separateness, we must do the hard work of truly learning to know another. Group think reduces the fear that comes when we are unsure if we will be located by another, when we remain unable to locate ourselves.

Cults and closed narratives neutralize and tame what we see as the unknown. I think somebody needs to put a refresher out there on the cult mindset and group think.  People seem to have forgotten that we are all very easily influenced by each other. Carl Elliot wrote about this in relation to body dysmorphic disorder (people wanting to amputate their own limbs because they disidentify with them) in the Atlantic, “A new way to be mad.”

One common trait I’ve noticed in nearly all the trans kids I’ve met has been their profound sense of being different, and too alone. They often have had little success with making friends, or what I would call contact with “the other.”  Because of their psychic isolation, they are prime targets for group think narratives. But in addition to looking for a way to belong, they are also craving protection and the stamp of legitimacy, perhaps because they feel a profound lack of it.

Now that the government and medical communities are involved in the creation of who trans folks are, this class of individuals have finally found their safe havens. Now, rather than being merely invisible and awkward, they have been transformed into veritable leaders of a revolution. Now, rather than cower in the shadows, they have commandeered the narratives of others into a similar dark and brooding place where they once were. The tables, as they lived and viewed them, have now turned.

It’s got to be dizzying for these formerly “ugly ducklings” to find themselves at the center of a flock of swans. To become a part of the movement, to finally be seen and found as whole, alive, and most importantly, wanted, all they have to do is renounce the very bodies in which they feel they have been imprisoned. In doing so, the promised payoff is very big, for they have finally found a way to render mute all those who once discounted and disbelieved them. Through silencing others who threaten them, they have unearthed a means of silencing their own self hate. Rather than being afraid of themselves, they make others fear what they have become.

Psychologically these interpersonal tactics would once upon a time have been categorized as immature, “primitive” defenses erected by an undifferentiated self that cannot see the self or others as whole creatures.  But as I witness it in my own practice, this is the basic thinking underlying the psychology of the trans narrative. In her recent blog post, “My Disservice to My Transgender Patients,” Dr. Kathy Mandigo talks about feeling threatened by some of her MTF patients.  Many of the trans kids I’ve worked with will joke about how they and their friends are dictators, “masters of the universe!” I find that clinically significant. This is something toddlers do when they are first discovering they are separate from their rulers (parents). Rather than fear the parent, they seek to control the parent, exert their will on the parent and co-opt the parent’s power as their own. In doing this they hide from view their terror at facing their own powerlessness.  Ideally, the child will gradually outgrow this urge to control, will gradually relinquish the dictatorial need to create safety through controlling the external realm. When that happens,  we say it is a sign of maturity. As our own sense of agency grows, we are better able to forfeit the habit of controlling others. We also begin to feel guilt at the idea of controlling others, as we begin to see them as separate from us, 3D human beings instead of mere props on our psychic stage.

Unfortunately some people have a hard time making this shift. They get stuck or addicted to manipulating their external environment, and will continue to create inner safety through the constant and relentless work of controlling others.

Last week in a team meeting, our medical director said he was meeting with a girl who identifies as FTM to discuss top surgery and testosterone treatment.  Apparently, according to the director,  the girl’s mom is slowing down the process of transition.  Bad mom, right? The director added that the girl’s mom told her that 9 out of 9 of her daughter’s friends also identify as FTM.

At this point I couldn’t hold my tongue any longer. I said, “Can we not be honest and see that we are dealing with a trend?” Of course, everyone else  at the table was mute.  Considering I’m leaving my post, I felt bold enough to say that I found it infuriating we couldn’t discuss this topic clinically. More silent colleagues (except their eyes were wide as if they wanted me to keep talking and taking the risk for them). I said that what we were doing as a medical community was potentially very harmful, and made mention of some of the videos I’d watched featuring transmen who decided to go off testosterone.  The medical director prides himself in providing special services for those patients he deems unjustly marginalized by society. But he can’t see how the medical community has become complicit in the oppression he earnestly seeks to remedy.

A large part of the problem comes with the revolution in health care. More and more, we are giving people the power to define their own treatments. This is good in many ways, but the trans movement is using this moment, and is actively recruiting young, psychologically undefined and frightened people to push their agenda through the medical community. It’s clearly not that difficult to do. These kids are just pawns. That’s how it looks to me anyway. The trans community needs more converts so that the narrative becomes more cohesive. I’m guessing the push for this comes from a need to further cohere so they will have more members to fully cement a fragile, constructed reality.

We–people who don’t identify as trans–are the external realm that must be controlled to bring the trans community the inner peace they now lack. But they don’t get that they will never find calm or strength this way. You cannot find yourself through coercing others. You cannot extinguish your fears by turning from them. The trans community must face their own fears, face themselves and their own demons. They can’t wipe out their fear that they are not really transitioning by censoring the thoughts and expressions of others. If they believe they are trans, they shouldn’t need to spend so much effort foisting that belief on others.

The fact that they do dictate to others is to me diagnostic of their very condition. They are uncertain about who and what they are. No sin in that. That’s human.  The transgression comes in refusing to accept this uncertainty, and in sacrificing the lives and consciences of others to nullify your own self doubt.

Teen suicide and the chilling effect on dialogue

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Another teenager who identified as transgender committed suicide yesterday. Blake Brockington, the first trans homecoming king in the nation, jumped off a bridge in Charlotte, NC and died immediately.

Teen suicide is the most horrible thing imaginable, and we all need to do whatever we can to prevent it.  Gender dysphoria—the pain resulting from a sense of dissociation from one’s own body and biological sex—is a very real phenomenon, as anyone who has experienced it will tell you. After one of these tragedies, the dominant message is that suicidal ideation in people who are “gender non-conforming” is solely the result of transphobia and the lack of (usually) parental support for “transition.”  Parents, family members, and anyone else who was not fully on-board with the young person’s desire or efforts to change his or her gender are vilified, often to the point of death threats and stalking.

But maybe, just maybe, some of these young people want to die because 21st century society has given them the message that they cannot live their lives legitimately and happily in the bodies they were born in if they do not conform to gender stereotypes. That if they don’t like “girly” things or are “sissy boys,” or if they identify with and enjoy pursuits and body ornamentation traditionally associated with the opposite sex, they and their families must push for a medical diagnosis that will commit them to a chronic, expensive health condition involving lifelong drug treatment and repeated plastic surgeries; that they will have to live like Type 1 diabetics, requiring treatment for the rest of their lives. How can all of this pressure to conform not contribute to a sense of hopelessness and despair?

When a young person takes his or her own life, we must absolutely ask “why.” But a teen suicide should not shut down an open-minded discussion about root causes and conditions. Blake was out as trans. While Blake faced a lack of family support for “transition,” things seemed to be improving. The high school was open-minded enough to allow Blake to be their homecoming king. Blake was an activist with a purpose, well respected by many, with a long life to look forward to. Is the reason for Blake’s suicide simply that society or family weren’t supportive enough of the dominant transgender paradigm, or could there be a more complex explanation? Is gender therapy the only answer for a gender non-conforming person in pain?

I write this not to trigger hate or anger against any person, no matter how he or she identifies. I write as the parent of a gender non-conforming child whom I love more than anything on earth. Reading about another teen taking their own life is awful. But Blake’s suicide does not make me question gender politics less: it makes me question more.

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I’m a 21 year old lesbian who has watched a number of her friends declare themselves to be ‘genderqueer’ or ftm rather than the seemingly dirty word of lesbian or even woman. I’m gnc and constantly asked what my preferred pronouns are. When I proudly say SHE it is met with derision and a sneer as if I’ll soon grow out of it. This new attack on womanhood is frightening. Thank you for creating this blog and posting the truth.

Keep the faith. It gives me hope and courage just hearing from young women like you. I recommend immersing yourself in some of the lesbian feminist literature and music from the Second Wave: Meg Christian, Cris Williamson, Teresa Trull, and many others. I look forward to more out lesbian performers as we move out of Peak Trans.

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While i certainly don’t think you should allow your daughter to transition at such a young age, you should consider the possibility that she legitimately transsexual and suffers body dysphoria. If she does, only then should she transition. But I am completely 100% in agreement with you on how stupid these new definitions of gender identity are.

But what causes body dysphoria?  Before transgender became a popular, hip thing, there were a relatively small number of people who were so unhappy in their bodies that they chose a sex change operation.  No one was celebrating and pushing them in subReddits and on YouTube and Tumblr. All of these young lesbians who suddenly become keen on “transitioning” seem to acquire the idea that they are dysphoric from watching OTHER lesbians who claim to be dysphoric on YouTube magically changing into straight boys high on testosterone.  I think this especially happens with shy, socially awkward teens who spend most of their time on the web, and who are having trouble with forming strong relationships in real life.  Not to mention that the latest push is to make it even easier to change genders.  In transactivist circles, it’s considered oppressive to have to wait at all, to have to get a letter, to spend time “living as a man.” The trans movement thinks even young teens should be able to get immediate access to hormones and surgery as soon as they want it. They decry the “gatekeepers” who won’t just let them start transitioning NOW.