The stories we tell: Inspiring resilience in dysphoric children

Lisa Marchiano, LCSW is a psychotherapist and certified Jungian analyst. She blogs on parenting at Big Picture Parenting, and on Jungian topics at www.theJungSoul.com. You can also find her at PSYCHED Magazine and @LisaMarchiano on Twitter. Lisa has contributed previously to 4thWaveNow (see “Layers of Meaning” and “Suicidality in trans-identified youth”).

Lisa is available to interact in the comments section of this post.


In recent years, stories of young children socially transitioning have been increasingly common in the mainstream media.  Frequently, the focus is on the child’s preference for toys, activities, hairstyles, or clothing more typical of the opposite sex. Critics of these articles sometimes insinuate that parents merely need to reinforce that non-stereotypical toy and clothing choices are acceptable, and this will resolve the child’s distress. “Why don’t the parents just buy their son a doll instead of agreeing he is a girl because he doesn’t like trucks?” is a typical critical statement. But it is my belief that in some cases, such criticisms oversimplify the complexity and difficulty of situations in which a young child experiences severe dysphoria.

There are certainly cases where parents hastily infer that a child is transgender and ought to be transitioned based on non-sex-stereotypical choices on the part of the child, and these are troubling indeed. To take but one example, the mom interviewed about her nonbinary child in this BBC story was looking into blockers for her daughter partly on the basis of the child preferring pirates to princesses.

But closer attention to the details in some of these stories reveals a more complicated picture. For example, there are media stories about children who appear to despise their own genitals.  In this account, according to his mother, a little boy attempted to cut off his penis at age 4 with a pair of scissors.

Clearly, a parent facing a situation like this would want to seek out professional help, and might understandably conclude that the child is suffering from intractable dysphoria.  It’s worth noting, though, that the current trend in the US focusing on gender affirmation makes it difficult to consider alternate explanations for such distress in a child, including co-occurring mental health problems—or even more mundane explanations. See, for example, in this piece, the observations of a parent of such a boy, who discovered

…the importance of asking “Why?” Had I asked that when [my son] told me that he wanted to cut off his penis with a pair of scissors, who knows what I would have learned? But I didn’t ask because I thought I knew precisely what he meant. Applying an adult perspective, and my own views on gender, I immediately concluded that that remark was a rejection of his birth gender. But maybe he had a urinary tract infection and his penis was sore. Or maybe he had been wearing a pair of pants that he had outgrown and they were uncomfortable in the crotch. Or maybe having a penis made him feel like he didn’t fit in with his sisters and cousin, and he thought that if he looked more like them then they would all get along better instead of squabbling. Who knows. But we should at least have had the conversation. The same way we would if he had said “I’m sad” or “I’m angry.”

But setting aside for the moment alternative explanations for why a young child might want to mutilate his own genitals, it seems to me that in at least some cases where young children have been transitioned, these kids were experiencing a significant amount of distress over their sex. They may have suffered from a deep feeling of having been born “wrong.” They may have a powerful feeling of really being the other sex. They are likely subjected to significant social stress at school due to not fitting into gender expectations. The pain experienced by these children – and families – is very real and sometimes quite extreme.

I imagine it would be very difficult to be the parent of these children. One would have to bear with so many unknowns. Will the dysphoria resolve itself? If so, when? How? Will my child be subjected to bullying? How can I protect him or her? What if the dysphoria worsens? What will happen at adolescence? What is the right thing to do?

Above all, a parent in this situation would be subjected to the horrible reality of having to watch their child suffer each and every day.

Childhood Transition Solves Some Problems…

Although affirmation and social transition are frequently prescribed in todays’ activist climate, we do not have any good long-term evidence to support social transition among pre-pubertal children. The clinical practice guideline of the Endocrine Society recommends against doing so. The Dutch researchers who developed the use of puberty blockers also recommend against it. Nevertheless, I can certainly understand why social transition would be an attractive option for parents.

First, it would resolve ambiguity. One would know what course their child would be on, and could embrace the new reality and adjust accordingly, rather than have to tolerate the agony of not knowing. Consider for example the following excerpt from a 2013 story from The New Yorker.

One mother in San Francisco, who writes about her family using the pseudonym Sarah Hoffman, told me about her son, “Sam,” a gentle boy who wears his blond hair very long. In preschool, he wore princess dresses—accompanied by a sword. He was now in the later years of elementary school, and had abandoned dresses. He liked Legos and Pokémon, loved opera, and hated sports; his friends were mostly science-nerd girls. He’d never had any trouble calling himself a boy. He was, in short, himself. But Hoffman and her husband—an architect and a children’s-book author who had himself been a fey little boy—felt some pressure to slot their son into the transgender category. Once, when Sam was being harassed by boys at school, the principal told them that Sam needed to choose one gender or the other, because kids could be mean. He could either jettison his pink Crocs and cut his hair or socially transition and come to school as a girl.

Hoffman ignored the principal’s advice. She told me, “Are we going to assume that every boy who doesn’t fit into the gender boxes is trans? Don’t push kids who aren’t going to go there.” Still, as Hoffman’s husband said, “It can be difficult for people to accept a child who is in a place of ambiguity.” A kid with a nameable syndrome who requires a set of specific accommodations at school (recognition of a new name, the right to use the bathroom and locker room he or she wants to) is, in some ways, easier to present to the world than a child who occupies a confusing middle ground.

Above all, it must be extremely compelling as a parent to know that there are simple steps you can take that will resolve your child’s unhappiness in the short term. Many parents in these stories report that their child immediately become happier, more playful, and more joyful as soon as they were allowed to wear dresses full-time, or cut their hair short and choose a new name. It is hard to argue with what looks like success.

…And Creates Others.

While I have a great deal of empathy for parents who, in the face of their child’s overwhelming distress, decide to allow a social transition,  there are serious risks to doing so. As human sexuality researchers point out, every parent in this situation must weigh the immediate suffering that their child is experiencing against potential future suffering of regret or medical complications. There is accumulating evidence that Lupron may have serious side effects. Testosterone and estrogen may increase risks for heart disease, cancer, stroke, and diabetes. And of course, as has been pointed out even by gender specialists themselves, the child will become permanently sterilized if puberty blockers are followed immediately by cross-sex hormones.

What an agonizing choice. Such parents believe they can relieve their children’s distress for at least a while, but there may be real consequences down the road. There is very little evidence to help a parent make this decision. We simply don’t have good criteria for decisively determining which children will persist in a cross sex identification into adulthood. Though some gender therapists claim those who are persistent, insistent, and consistent will benefit from transition, the evidence we do have indicates that this is not a fool-proof criterion.

The second significant risk in facilitating a social transition among pre-pubertal children is that transition almost certainly increases persistence. If a five-year-old boy is “affirmed” that he is the opposite sex, and is addressed by a typically female name and pronouns by the adults around him, it is very likely that the child will be reinforced in his belief that his body is “wrong.”

Moreover, the surge of endogenous hormones at puberty rewires a young person’s brain in complex ways. It is likely these hormones and the changes they bring that in part account for desistance in the roughly 80% of children who grow out of dysphoria and come to feel at home in their natal sex. By blocking these pubertal hormones with Lupron, it is probable that clinicians and parents are setting the child’s cross-sex identification in stone.

The Stories We Tell

Therapists like to remind our clients that there is the thing that happened, then there is the story we tell ourselves about what happened. The stories we tell can make a huge difference in how we feel and respond to events–and the options we have.

For example, if a friend doesn’t call when she said we would, we could tell ourselves any number of stories about that. We might imagine our friend forgot. She’s been busy lately. We might call her instead, or we might move on with other things, intending to catch up with her later.

But what if we tell ourselves a different story? What if we decide that she probably didn’t call because she is angry? Or has decided she doesn’t want to be friends? Then we might find ourselves upset. We may experience a significant amount of unnecessary distress as we react to a situation that is mostly of our imagining. We might even make a choice – such as avoiding or confronting her – that might wind up bringing about the very outcome we feared.

A lot of what therapists do is help people to generate new stories that can maximize the potential for positive outcomes. Roughly speaking, there are two main criteria that make for good, adaptive stories. First, does the story more or less reflect reality? Second, does the story open up new possibilities for response?

Reality

Reality, of course, is sometimes a matter of opinion. It isn’t always possible to judge what is “real.” However, in general, those beliefs that do not line up with objective reality are often not very adaptive. If we believe, for example, that no one ever gets into college without straight A’s, we may feel as though our efforts at obtaining a university education are futile, and we will be more likely to give up.

An exception would be the coping strategy referred to as denial, which can be adaptive if it shields us from realities that are too harsh or painful to tolerate right now. However, even denial can be maladaptive, since it may encourage us to ignore or avoid important realities. Imagine, for example, someone diagnosed with cancer, who decides to forgo the recommended treatment of chemo and use ineffective herbal remedies instead.

Telling—or agreeing with–a child that she is a boy in a girl’s body doesn’t pass the reality test. It may be true that a child strongly feels she is the opposite sex. It may true that she feels very uncomfortable with her body, or the social roles ascribed to her. But to assert that she is really a boy is to deny objective, material reality. It sets a child up to manage massive cognitive dissonance, and to be at odds with her own biology.

We only have one body. Part of being a parent is teaching our children how to accept, love, and care for the one body they will have throughout their life. Believing that there is something fundamentally wrong with our body, such that it might require drugs and/or surgery to be corrected, makes it more difficult to accept and care for ourselves properly.

Options

A good story increases our options. Generally speaking, one story is better than another if it allows us to generate more possible ways to respond. Returning to the example of our friend who doesn’t call, if we believe she didn’t call because she hates us, our one option may be to sit home and feel miserable, sad, and angry. If we believe that she may be busy and perhaps she forgot, we have other options. We can call her right away. We can wait and call her tomorrow. We can decide we are tired of her being forgetful, and decide we aren’t going to call her until she calls us.

Having multiple choices increases our agency, and gives us an internal locus of control. Psychologists believe that developing an internal locus of control is one of the key variables that determines resilience. We experience ourselves as active participants in our lives rather than passive victims.

Affirming that a child is transgender is a story that reduces rather than increases options. If I tell a five-year-old that he is a girl in a boy’s body, then the choices become transition, or be miserable. The internet is quick to tell young people that their choice is to “transition or die.” Many parents who have decided to support social transition report that they believed they would either have “a dead son, or a live daughter.” When there are only two choices and one of those is suicide, then there really is only one choice.

In contrast, if the story we tell our child is that he has gender dysphoria, suddenly a range of possible options becomes available to us. We can support him in managing his distress. We can work to challenge rigid gender expectations. We can try to find him like-minded peers, and adult role models of feminine men. We can teach him self-soothing skills. We can work with the school to reduce bullying. And of course, the option to transition will still be there.

When Pharma Shapes the Story

Influential journalist and author Alan Schwarz convincingly traced the explosion of ADHD diagnoses to Big Pharma’s aggressive marketing of stimulant medications for the condition.

“A.D.H.D. Nation” focuses on an unholy alliance between drug makers, academic psychiatrists, policy makers and celebrity shills like Glenn Beck that Schwarz brands the “A.D.H.D. industrial complex.” The insidious genius of this alliance, he points out, was selling the disorder rather than the drugs, in the guise of promoting A.D.H.D. “awareness.” By bankrolling studies, cultivating mutually beneficial relationships with psychopharmacologists at prestigious universities like Harvard and laundering its marketing messages through trusted agencies like the World Health Organization, the pharmaceutical industry created what Schwarz aptly terms “a self-affirming circle of science, one that quashed all dissent.

Our children look to us, their parents, to help make sense of their experience – to know, in effect, what story they should tell themselves. The marketing messages of pharmaceuticals change the stories we tell ourselves and our children about their suffering.

When our toddler falls and bumps herself, she looks at us to gauge our reaction. If we reassure her that she is okay, she runs off and continues playing. If our face reveals fear and alarm, if we rush to her and ask worriedly whether she is all right, she is likely to burst into loud wails.

Before 2007, when Lupron was first used in the United States to block puberty for gender dysphoric children, kids who experienced even extreme distress over their sex were probably rarely socially transitioned. After all, the physical changes of puberty were inevitable. Before Lupron, there were very few “transgender children.” There were certainly gender dysphoric children, whose parents likely did the best they could to help their child navigate distress.

Lupron is a profitable drug. The drug’s manufacturer AbbVie reported making $826 million on Lupron sales in 2015. New off-label uses for the drug, such as helping kids grow taller or delaying puberty in gender dysphoric kids, have certainly provided new markets. The annual cost for Lupron for a transgender child can be around $15,000. The story that tells us we need to arrest puberty for dysphoric children or risk dire consequences directly benefits the pharmaceutical industry.

The treatments available to us shape how we conceptualize our symptoms. Pharmaceutical companies magnify this influence through marketing and hiring of physicians as consultants. As the image below shows, mentions of the term “transgender children” was nearly nonexistent in published books before 2000 – not long after the Dutch published their studies about using Lupron to block puberty. The mentions rise sharply around 2007 — the year Norman Spack began using Lupron for gender dysphoria at his clinic in Boston. Google’s Ngram had data available only through 2008. We can only imagine what the mentions must be like in recent years.

Marchiano ngram

With the ability to suspend puberty granted by the magic of pharmaceuticals, a whole new treatment pathway has opened. I fear that the temptation to take this route may be strong, even though there is little empirical evidence about where it leads.

Psychotherapists know that often, the answer to dealing with discomfort is to learn to sit with it. It must be excruciating as a parent to watch a child suffer with dysphoria. The temptation to end the suffering with a quick pharmaceutical fix must be immense. But I can’t help but think that at least some of time, it might be better to sit with this discomfort rather than reaching for a drug.

Having a young child with severe dysphoria presents an excruciating dilemma for a parent. I can’t say without any doubt what path I would choose, as I have not been faced with this very difficult decision. I do believe that those supporting these families ought to offer them honest information about what we do and don’t know, both about gender dysphoria, and the effects of transition.

The Lost Generation Strikes Back

by Worriedmom


Dateline: New York, New York, May 6, 2027

 

When you look back at it, what’s most striking is how it seemed like nothing much was happening…and then it happened all at once.  Like watching a thunderstorm roll in over the prairie: the sky strobes with flashes of far-off lightning and the thunder is a barely audible rumble, the clouds mass slowly, the wind picks up bit by bit, but it seems hundreds of miles away; until suddenly it’s right on top of you and pouring down like there’s no tomorrow.

Was it the emergence of PUFF (Parents United For Fairness), the nationwide group of outraged soccer dads and softball moms, who finally rose up as one to demand that girls be included in sports, once every team at every school became comprised exclusively of males and transwomen?  Or was it in 2020, when 57% of all gold medals awarded at the Olympics in women’s events were given to biological men?

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Or was it the simultaneous, highly publicized nationwide demonstrations aimed at the Human Rights Campaign, GLAAD, Lambda Legal and the National Center for Lesbian Rights, by mobs of furious gays and lesbians, chanting “no gay eugenics” and demanding their movement back?  Was it the Oprah episode featuring 15 de-transitioned adults, which made #HowCouldYouDoThisToMeMom the third fastest trending hashtag in Twitter history?  Many thought the death blow came with the sex abuse scandals.  Interpol had been on the trail of “transition porn” for years, and when the Boston Globe blew the lid off in 2023, many thought the writing was on the wall.

But even though all this helped lead to the eventual fall of the once all-powerful “pediatric T lobby,” the day the movement died was when the trial lawyers smelled blood in the water.

Screen Shot 2017-05-06 at 00.40.22The first rumblings came when the hospitals started spinning off their gender clinics into separate corporations and classifying clinic workers as independent contractors.  Medical schools and teaching hospitals started trying to put as much daylight as possible between their own organizations and the gender crew.  Pediatric gender doctors began setting up contingency plans for a hasty exit from the practice and quietly moving assets abroad.  Insurance companies, faced by skyrocketing costs associated with transition, were by then doubly rocked by the realization that transition would only be the starting point for years of expensive treatments for chronic illnesses brought on by those same pricey procedures and drugs.

Managers of “gender clinics” belatedly realized that it might have been better to impose a distinction between transgender political advocacy and medical advice. They started cracking down on therapists and doctors who made policy and pursued professional vendettas on Twitter and Facebook, but thanks to the Wayback Machine, it was a case of too little, too late.  It took a while to weed out the clinicians who advertised primarily on Tumblr and other youth-oriented platforms, although all of that evidence came in handy later on in courtrooms across the United States.  (To this day, the Trial Lawyers of America sends the “Testpocalypse” doctor a bouquet of roses for his birthday.)

By this point, all 50 states had passed legislation that permitted “gender confirmation surgery” and cross-hormone treatment for children as young as six.  But by 2021, the first wave began to emerge of frightened, sick, and miserable adults.  Few of these individuals were counted or helped by the then-ubiquitous gender clinics, and even though their stories were suppressed by every mainstream and QT media outlet, new underground story-telling techniques started to connect them to each other.  The most prominent voice among them was Brayden, a rising star on the once-popular Trans Channel who had begun his transition at age 7 months.  By then the permanently disabled victim of years of unproven drug therapies and repeated (and unsuccessful) surgeries, all of which were televised, Brayden became a crusader for the “lost generation,” as the legions of victims began to call themselves.  Telegenic and appealing, before he passed away Brayden became the “face” of the movement, and achieved what thousands of previous victims could not: attracting sympathetic news coverage from the many outlets that had once been under the sway of the all-powerful T lobby.

Eventually the stories of the lost generation reached the ears of people who had a tremendous financial interest in seeing to it that they received justice, or at least compensation.  The first lawsuits were launched.  How could we forget that moment in 2022 when, right after he filed the first of what became dozens of lawsuits, a key plaintiff’s class-action attorney was interviewed on the steps of the Southern District of New York: “Dude, we brought the cigarette industry down.  You really think this is going to be hard?”

Although there were several tricky legal problems that had to be resolved first, the plaintiff’s bar sat up and took notice when in 2025 a Texas jury delivered the first successful $10,000,000 verdict for “wrongful transition.”

tenmillionThe verdict was later reduced on appeal, but not until discovery had revealed the astronomically high expenses that would be entailed in providing lifetime care for a young person suffering from fragile bones, peeling and broken teeth, severe mood disorder, cardiovascular disease, and, of course, sterility.  It developed that “informed consent” was anything but, since nobody involved with that documentation actually had any idea of what was being consented to.  Although practitioners had hoped this paperwork would shield them from liability, one of the earliest cases in the area established that neither minors nor their parents could provide informed consent to unknown, and unknowable, medical consequences.  The courts also generally affirmed that patients couldn’t “waive” their care providers’ gross negligence: who knew?

After that, it was off to the races, legally speaking.  Everybody left standing got sued (although by then, most of the top “pediatric gender specialists” had re-located or made themselves judgment-proof).  Insurance companies were the first to crumble: faced with virtually unlimited future expenses, they imposed a blanket denial of coverage for any “gender therapies” for under-age 18 patients.  R.I.C.O. (the Racketeer Influenced and Corrupt Organizations Act) proved a remarkably flexible tool for pursuing groups of affiliated health care providers, surgeons, counselors, drug makers, and the advocates who had encouraged and developed a steady stream of patients.

The NIH finally got into the game when in 2025, it began to finance large-scale studies of young people who had received GnRH agonists at a young age, followed by cross-sex hormones.  Unfortunately, there was no shortage of damaged and ill subjects.  At the congressional hearings that started later that year, government “watchdogs” were faced with angry speeches in the form of questions.  What congress-people from both sides of the aisle urgently wanted to know was why the FDA had permitted human experimentation on, and sterilization of, children, in violation not only of medical ethics but the Geneva Conventions.  There was no good answer.

Many of the “transgender reforms” were reversed as quickly as they’d been enacted.  For instance, the mandatory “Might You Be Trans?  No, Think About It … Really, Might You Be?” psychological screening test administered at the start of the school year for all pupils in all grades was abruptly discontinued.  Hormone-suppressing drugs and cross-sex hormones were pulled from the shelves of school infirmaries everywhere.  Congress amended Title IX again, and sports authorities everywhere agreed to pretend that the period from 2015-2027 “just didn’t happen.”

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Few of these developments healed the victims.  However, a portion of the immense liability pay-outs were eventually directed to the establishment of a nationwide fund, from which disbursements could be made to qualified plaintiffs.

As might be expected, no word was ever heard from most in the press.  There was a limited amount of soul-searching in academia (Pediatric Transition and Satanic Panic: Did We Really Get It Wrong Again? was one of the most-downloaded papers on PubMed in 2028) but by and large, the majority of the most vocal trans-proponents in the press simply “moved on,” and wished everyone else would, too.

By far the most enduring impact of the rise and fall of trans-mania, as it came to be called, will be its impact on the culture wars.  The line between “conservatives” and “liberals” became increasingly blurred, as people on both sides began, first, to realize that they indeed had a common interest and, second, that they could work together effectively despite their differences.  People who had once regarded each other with horror and fear learned that they could advocate for the same outcome, and that joining forces made their voices stronger and more credible.  The respect, tolerance and cooperation that pervaded the “trans lib” movement eventually affected social issues beyond trans-mania: working together, it was not difficult to find solutions to other social justice issues that took into account and respected personal rights and religious freedoms.  Life became much easier when one side did not have to lose so the other side could win.  At last, the war over Planned Parenthood was ended when representatives of all viewpoints were able to hammer out compromises that satisfied all (okay, most) concerns.new york trans

Once the culture wars were finally settled, people of all political persuasions realized the tremendous amounts of energy and time that had been wasted in fighting them, and turned, at last, to solving larger and more systemic problems.  Environmental, educational, economic and social problems became much more susceptible to solution once ideology was out of the picture and the goodwill of both sides was assumed.

Even with all these positive changes, I still mourn the victims, and their faces and stories will haunt me forever.  But at least I can sleep at night, knowing that I did what I could, when I could do it.

How about you?


Worriedmom is a mother of four (allegedly) adult children, who lives in the Northeastern part of the United States.  She practiced law for many years and now works in the non-profit area. She is available to interact in the comments section of this post.

Graphics by Lily Maynard


 

A “sinister mental trap”: One man’s journey back to himself

Potentilla is a detransitioned male who spends his days farming, making gardens, practicing herbalism, and reading Carl Jung. He is interested in history, human nature, and the occult, and greatly enjoys giggling with strangers, the utter improbability of life, taking long walks, and making music with friends. He is available to interact in the comments section of this post. Potentilla can also be reached at potentillacinquefoil@gmail.com, where he is happy to discuss these issues privately with concerned parents and people contemplating transition or detransition.


by Potentilla

I was born male and lived for the first five or so years of my life totally OK with that. As I got older and was taught postmodernism, white guilt and misandry, I started to hate my male body and wanted my maleness to be destroyed. I became suicidal and practiced self harm, including towards my genitals. I wanted to magically turn into a girl, and thus be redeemed.

Growing up, it was hard for me to conform to the norms of American masculinity. Part of this is that my dad is a reflective and empathetic man, and so my natural model is someone who himself doesn’t necessarily conform to gender norms. Nevertheless, I was ok with my body until maybe the age of 19, when I realized I’m attracted to other men and am both a “bottom” and somewhat swishy. Around 20 I had multiple crises; I moved to a gay hippie commune, I broke up with my first serious boyfriend, I did too many drugs, became homeless, and had several very confusing sexual relationships with women.

Slowly I came to believe that I was a repressed woman. It is a testament to my credulity that I could honestly assess my own life situation, and yet come to that conclusion. But that is exactly what happened. Trans let me explain away all my problems with a new and compelling narrative. This promise held enormous emotional appeal. At the time, I was living in a trans/genderqueer space where there was a cult-like atmosphere in regard to transitioning. Being trans made you an insider and conferred upon you sympathy, respect, and resources. Being merely gay was frowned upon.

For the past 10 years ago or so, I’ve “lived as a woman.” For the first 8 years of that, I was on cross sex hormones, when I began to use herbs to manage my health.  I had an orchiectomy about 7 years ago. After my surgery, every punk house was open for me to live in. I had become a protected class.

Even though I didn’t pass as a natal female, being trans made my life easier to navigate socially. People seem much more comfortable with a somewhat feminine man becoming a transwoman than a somewhat feminine male owning his maleness. It is fascinating that this is the case, that it was and is scarier for me not to pretend I’m a woman.

So, I had some very compelling reasons to transition, those being:

  1. unprocessed trauma concerning my gender
  2. poor mental health and poor reality testing
  3. social pressure
  4. social rewards
  5. a postmodern ideology that rewards transition

I believe that the trans movement has qualities that make it very similar to a cult. I became trans for the very same reason that people join cults; and similarly to those who escape cults, I’ve found profound healing in my slow path towards detransition.

Now, almost ten years later, it is clear that I am not a woman. In fact, it is obvious that I am still very much a male, but now with breasts and mutilated genitalia. That is an uncomfortable position to be in; not only was I mistaken; everyone knows it. But his uncomfortable reality is still preferable to the intense self-delusion and narcissism that I lived in and with for many years.

The Curse of Trans

While there is a certain temptation to accept all of this as personal failings; while there are certainly many ways that I have been weak and unstable, it doesn’t feel particularly genuine to try to explain my immersion into trans as solely a personal choice and experience. To understand trans sensu lato means understanding the ways it resembles a cult. I transitioned only after heavy indoctrination into genderist ideology. Most pertinent was the pernicious “cis” and “trans” dichotomy.

I believe this binary ideology to be a very profound curse to susceptible individuals. “Cis” is defined as someone who is okay with their body as it is, while “trans” means someone who isn’t okay with their gendered body, regardless if they physically transition or not. Given this definition, most people have at certain points of their lives been functionally trans. This is usually especially pronounced at puberty, and it is horrifyingly predictable that we’re now seeing a trend of trans children, given the intersection of pubescent dysphoria and genderist ideology.

When I encountered this false dichotomy, naturally I put myself on the side of “trans” because I have a long history of hating my gendered body. Once I accepted this as true, I was locked into the certain path of claiming I was a woman. This led to faith-based beliefs that “gender is innate” and “I am a woman,” which in turn led to the blind faith that “hormone replacement therapy will solve my problems” and “I’ll be so much happier after I’m castrated and no longer male.” This was compounded by the widespread belief that transgender feelings grow worse with time and inevitably lead to insanity or suicide if there is not medical intervention.

And away I went, my mind totally taken with genderist ideology, with full faith that transitioning was the only way to save my life.

This is why I consider “trans” to be a curse. I imagine the evil trans witch standing over the gender-nonconforming children lost in the woods, reassuring them that “cis people are comfortable with their bodies and trans people aren’t. I can help you become at home in your own body” as the children follow her deeper into the woods to be transformed. What the children don’t realize is that they must pay for this with a piece of the glowing, golden ball that is in their hearts. Later, only a few become disillusioned and decide to retrieve the piece of their heart that they lost. They wander alone hither and thither in the dark woods for many years to find the sacred springs where they wash off their deception, fear and helplessness, and find that the golden ball never actually left. They are still themselves, only disfigured and disoriented by the deal they made with the evil witch. But they are finally able to leave the dark forest and again become part of the human family.

glowing heart

I’m open to the idea that some individuals need to transition to live their authentic selves. There may very well be folks who genuinely and beautifully find themselves in transition. That being said, though, I believe it is inevitable that these stories of self-discovery through sex change, no matter how true they are or beneficial to the individual, contribute to the destructive myth of the trans/cis binary. I don’t want to generalize too much from my own experience, but I also strongly believe that transition does profound harm, even when it does help. People have the right to transition, but I also believe that the entire gender identity movement has become unfathomably destructive, especially to gender nonconforming young people who, for the most part, would almost certainly otherwise be homosexuals. There are areas of subtlety which I’m not sure how to explore in this regard, and they are beyond the scope of this essay.

Sense of Self

During the time I believed I was a woman, I enjoyed every step of transition, because it gave me an identity. I didn’t know who I was and a transgender narrative gave me a handle to understand myself. Rather than needing to take care of the wounded parts of my self, I created an entirely new persona, and I played that part every moment of every day.

This worked as a great solution for a time; I did a good job playing that part, rather than living as my authentic self, and was thus shielded from the vicissitudes of the world. This is of course textbook narcissism, which makes me wonder if trans is as much a cult of narcissism as a cult of gender.

With time however, my authentic self was nonetheless nurtured by my experiences and I began to become more genuine. This transformation had three parts:

1) Leaving the Trans Cult

After a nasty breakup, I left a queer land project and LGBT community where postmodern Marxist ideology was very dominant. I constantly self-censored to fit in with the group. My own political leanings tend towards Burkean conservatism, so I was more or less lying to myself and others. I attended mandatory sensitivity training which had the feel of a political indoctrination meeting. Almost every day, I ritualistically confessed my guilt as a white person in conversation with my peers, and they did the same with me. Over time I began to feel an actual intense guilt. And with that, I began to wake up to the fact that this sort of politic was bad for my mental health.

So after my nasty breakup, I left this queer community and got a live-in job at a farm. My coworkers there were much more free thinking, and I began to find it easier to think for myself. That year I worked 55-hour weeks and read about 60 books (including Spengler, Odum’s Ecology textbook, Marcus Aurelius, Homer, and more). This study, and the new milieu with new friends, allowed me the opportunity to learn that I’m strong and capable living on my own, and my worldview was massively expanded.

2) Going off Hormones

About 9 months after leaving the trans cult, I stopped taking hormones, and began taking herbs, and studying them, to maintain my health instead. I could pursue a passion that connects me to my inner self while showing me that I’m not dependent on maintaining a trans identity to meet my own health needs.

medicinal herbs

I’ve also developed skills which have helped many other people. In turn, I saw people valuing me for something deeper than my identity. I am very passionate about plants and have been my entire life. I am also open and spiritual in my psychological orientation. This makes the study and practice of herbalism deeply rewarding to my authentic self, and helped me become strong enough to escape from living mostly out of my trans identity.

3) Detransition

After leaving the queer land projects, I fell into several other social milieus where thoughts were heavily policed. By this point I had already stopped believing in the idea of transition, but kept up appearances for social benefit–and that social benefit was huge. Certain people would hire me because I was perceived as trans. I could find places to live with queer folks largely on account of my identity. Living in these environments, which were well stocked with self-appointed thought police, was bad for me, and I began contemplating leaving. Near the end of this time I developed debilitating chemical sensitivities, and decided my best bet was to live with my parents for a time. At that point, the entire trans narrative dissolved, and just as quickly, my chemical sensitivities became very easily manageable.

Some Closing Thoughts

Over the years, I’ve known dozens of trans people. Most had reasons that were less convincing than my own for transition, and as we’ve seen, my own justifications were rather feeble. This leads me to believe that, by and large, trans is a disingenuous ideology that is a current mass hysteria. It is also clearly something of an unintentional eugenics program against gender nonconforming folk. The entire enterprise makes me feel sick. It has become trendy to commit oneself to lifelong hormone therapy and surgical mutilation. I was not able to correctly appraise the situation at the time I became trans and deeply regret the decision now.

Going a little deeper, trans is profoundly sexist and actually creates less diversity in expression. I went from an authentic, studious, awkward, somewhat feminine man to performing full time as a trans woman. Eventually my authentic self reasserted itself, and now I’m slowly moving towards more integration. The trans narrative does much more than merely normalize mental illness; it creates mental illness. I would have never transitioned if I hadn’t been wounded by postmodernism and then given an escape hatch in trans. The narrative made me crazy just as much as my own predisposition made me vulnerable to it.

My sense is that no one wants to hear the voices of detransitioners until it is too late. My sincere hope is that some people who are considering transition, as well as parents with “trans” children, might read my essay and choose a brighter path than that of transition. Please learn from my mistakes and consider other options. Most dysmorphia goes away with time. The entire trans narrative is a sinister mental trap which is profoundly harmful. There are infinitely better ways to deal with the universal experiences of dissatisfaction and desire to be someone else.

“In the absence of solid evidence”: “Innovators” and “thought leaders” promote under-18 transition

by Overwhelmed

 

The University of San Francisco runs one of the most prestigious and well respected programs for “trans kids” in the United States.  Their publication, “Health considerations for gender non-conforming children and transgender adolescents,” written by Johanna Olson-Kennedy, MD, Stephen M. Rosenthal, MD, Jennifer Hastings, MD and Linda Wesp, MSN, consists of detailed guidelines on treatment for gender dysphoric youth. It appears to be written for providers, not laypeople, with specific recommendations for GnRH analogues and hormones—when to start, options for delivery (e.g. injection, patches, gel), dosages, needle gauge sizes, and lab tests for monitoring. Other areas are addressed too, including the induction of amenorrhea in natal females and the importance of discussing infertility. Towards the end of the protocol, there is a section about genital and chest surgeries.

The authors state that current standards of care recommend waiting until patients are 18 years old for genital surgeries. But regardless of this advice, they advocate for underage surgeries in certain cases:

Both the Endocrine Society Guidelines and the World Professional Association of Transgender Health (WPATH) Standards of Care version 7.0 recommend deferring genital surgery for both transmasculine and transfeminine youth until the age of 18 years. As youth are transitioning at increasingly younger ages, genital surgery is being performed on a case-by-case basis more frequently in minors.

One of the authors of the UCSF document, Dr. Johanna Olson, has frequently argued for relaxing the over-18 guidelines on genital surgery, including earlier this year on the WPATH Facebook page.

Here’s what the UCSF guidelines have to say about “chest” surgeries aka mastectomies:

 While increasing numbers of insurance companies are covering the cost of male chest reconstruction, there are often arbitrary barriers to surgery citing that youth need to be at least 18 years of age prior to undergoing this procedure. Providers should participate in appeal processes so that patients can undergo chest surgery. There are currently no available data that report the positive impact of male chest reconstruction in minors, although a study is underway now.

Gender doctors don’t have the data to back up the double mastectomies and chest contouring they are performing on minor children. But regardless, providers are instructed to recommend health insurance coverage for the procedure—including intervening in appeals processes.

Throughout the guidelines, there are a number of times it is admitted that the science of pediatric medical transition is lacking in data:

 “While sparse data exist regarding the impact of puberty suppression and gender-affirming hormones administered during adolescence, there have been promising results from the Netherlands indicating that this approach in adolescents results in improved quality of life and diminished gender dysphoria.”

 “While there still exists uncertainty as to which GNC children will continue into adolescence and adulthood with transgender identities and/or gender dysphoria and which will not, it is been noted in prior studies that increased intensity of gender dysphoria is a predictor of a future transgender identity.”

 “While data are sparse, preliminary results from the Netherlands indicate that behavioral problems and general psychological functioning improve while youth (age 12 and older) are undergoing puberty suppression.”

 “While clinically becoming increasingly common, the impact of GnRH analogues administered to transgender youth in early puberty and <12 years of age has not been published.”

 No consensus exists on the length of time GnRH analogues should continue after youth begin gender-affirming hormones.”

However, regardless of these caveats, the protocol comes across as very thorough. Eighteen different sources are cited for justification. The authors appear to be knowledgeable and capable.

But at the very end, there is this disclaimer:

ucsf-disclaimer

And there you have it. We are relying on the “expert opinions of innovators and thought leaders” in a field that is in its infancy. “In the absence of solid evidence,” children are being given earlier and earlier irreversible medical interventions based on best guesses about the future.

As the guidelines note, though, studies are indeed underway. Olson and other gender specialists have received a $5.7-million NIH grant to study children and teens who are currently undergoing medical transition. But importantly, these studies aren’t recruiting a control group of untreated trans-identified children, and they are only set to run for 5 years. While any information is better than none when it comes to this modern experiment on youth, the long-term medical and psychological outcomes for the people who were subjected to irreversible medical interventions in their youth will remain a mystery for decades to come.

Could social transition increase persistence rates in “trans” kids?

The trend of “socially transitioning” children as young as 2 or 3 years old to endorse the notion they are “born in the wrong body” is a very new phenomenon. But to read about it in the press, you’d think this was a settled area of clinical practice, with proven results and few doubts about its efficacy.

It is no such thing.

In a 2011 journal article,  Dutch clinician-researchers who first pioneered the use of puberty blockers cautioned that early social transitions can be difficult to reverse:

 As for the clinical management in children before the age of 10, we suggest a cautious attitude towards the moment of transitioning. Given our findings that some girls, who were almost (but not even entirely) living as boys in their childhood years, experienced great trouble when they wanted to return to the female gender role, we believe that parents and caregivers should fully realize the unpredictability of their child’s psychosexual outcome. They may help the child to handle their gender variance in a supportive way, but without taking social steps long before puberty, which are hard to reverse.

Even the Endocrine Society, which actively promotes puberty blockers and cross-sex hormones for pubescent children, counseled against social transition in its practice guideline:

endocrine-society

As recently as last year, a 17-clinic qualitative study reported on doubts some clinicans have about aspects of “affirmative” treatments for children:

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

But among many clinicians and activists, social transition (which usually leads to puberty blocking and then to cross sex hormones) is now being actively promoted as completely harmless and “fully reversible.” Not only that: it is being shamelessly peddled as the only way to prevent suicide amongst children and teenagers.

What evidence do we have for these assertions? There is no historical record of desperately dysphoric “trans children” who demanded sex change lest they commit suicide.  The constant media and activist drumbeat that very young children must be socially transitioned ASAP; must be called by the correct pronouns; must have their “wrong bodies” fixed prior to the “wrong puberty”– or they will kill themselves–is the most irresponsible thing the mass media and medical profession could possibly do. It is a form of emotional blackmail which has terrorized countless parents into handing their kids over to gender clinics and activist-run “charities” for transition to the opposite sex. And the media, by running breathless stories implying that the only way to support gender-defiant and gender dysphoric children is to  “transition” them, may be contributing to suicide contagion, a phenomenon that has been well known for decades.

As far as evidence that social transition is “reversible,” which of these children is actually “reversing”? Certainly, the ones who have continued on to puberty blockers are not:

spack-100-persist

Imagine the pressures on any of the myriad trans-kid YouTube stars, or the children who are the subjects of the too-many-to-count fawning media portrayals we see in every major newspaper and magazine. Can a Jazz Jennings really change course?

None of the children who have been identified as “truly transgender” by clinicians like Norman Spack and Johanna Olson are going to get the chance to find out if they would have been just as happy not being socially transitioned. We won’t learn in any systematic way whether social transition and media validation could be creating persistence in children who might otherwise have grown up without medical and psychiatric tampering.  We can’t know, because researchers aren’t studying them; they don’t have control groups of children who claim to be the opposite sex but who are not socially transitioned and subsequently puberty blocked.

What is a truly transgender child? According to activists and some clinicians, the key trait (along with being generally “gender nonconforming” and preferring the clothes, activities, and appearance more typical of the opposite sex) is that these children are more “persistent, consistent, and insistent” in saying they are the opposite sex (vs simply wanting to be, or wishing they were).

But what is the meaning of “persistent, consistent, and insistent” with children who have only been on the planet a short time, as are the many toddlers, preschoolers, and grade schoolers now being labeled as “trans kids”?  Especially when a rather large percentage of these children also exhibit traits of autism—a disorder known to be characterized by rigid thinking, gender nonconformity, and obsessive/restricted patterns of behaviors?

Activists don’t seem troubled by any of this, nor by the decades of research showing most dysphoric children desist and grow up to be lesbian or gay adults.

korte

The recent study most often cited by trans activists is one by Kristina Olson at the University of Washington, which essentially proved that children who preferred the activities and appearance of the opposite sex weren’t just pretending; they  really meant what they said! (Why would anyone question that?)

But even Dr. Olson, whose confirmation-bias-riddled study includes no control group of non-socially transitioned children, admits that no one can know the outcome for this new generation of experimental patients. kristina-olson-does-not-know

These kids are, by any measure, guinea pigs being subjected to social engineering and then (in most cases) experimental medical procedures, the results of which won’t be known for decades. Researchers like Kristina Olson are fully aware of this, but they think it’s worth the cost of some regrets, some detransitions. Because hey–it’s science.

kristina-olson-admits-kids-are-guinea-pigs

A commenter on the above article aptly points out the elephant in the room:

comment-on-olson-article-persistence-caused-by-social-transition

Fortunately, there is reliable data from other clinician-researchers which suggest a more cautious approach is still in order. We have a 2012 study by Devita Singh, which demonstrated that a very high proportion of kids—some 88%–happily desisted from a trans identification as adults.  It’s worth noting that several of these children were “persistent, insistent and consistent” in their formerly intense gender dysphoria.

Dr. Singh shared her views about early transition in a recent, unusually balanced article in The Walrus magazine:

Singh is frustrated that, despite the findings of her study and others like it, there’s now more pressure than ever for doctors and families to affirm a young child’s stated gender. She doesn’t recommend immediate affirmation and instead suggests an approach that involves neither affirming nor denying, but starting with an exploration of how very young children are feeling. Affirmation, she argues, should be a last resort.

These days there can be a high price to pay for treating gender affirmation as a last resort. Dr. Ken Zucker, a  renowned gender dysphoria expert, has approved puberty blockers and cross-sex hormones for many adolescents. Nevertheless, he recognizes that children often change their minds, and takes a careful approach in his clinical practice. For this heresy, he was hounded from his position at CAMH in Toronto by trans activists hellbent on preventing any kind of therapy for dysphoric kids besides “affirmation.”

But Dr. Zucker is still actively publishing,  having co-authored several scholarly journal articles in 2016 alone, and he continues to work with families and young people in his private practice.

In an age when too many believe that children, no matter how young, should be affirmed in their gender identities with no further investigation, clinicians like Zucker are very much needed. Desistance, despite trans activist protestations to the contrary, is a real thing. It’s just not as newsworthy as the latest trans kindergartener coming out story.

This places a heavy burden on parents who aren’t sure who their children are, or who don’t accept the notion that a 5-year-old, even an insistent and strong-willed one, has a set identity in the same way adults do. The current politics leave them behind, because their stories don’t fit neatly into the binary in which trans identities are either accepted or rejected, full stop. There’s no natural political grouping for parents of desisters, because desisting isn’t an identity-politics lodestone in the way persisting is. “We’re quieter,” said Amanda of parents of kids whose gender dysphoria desists. “There are a bunch of us scattered around, and we’re not acting collectively.” As Merry put it, “I feel like sometimes there’s no middle ground. You’re either trans or you’re not, and you can’t be this kid who is just kind of exploring.”

 

Layers of meaning: A Jungian analyst questions the identity model for trans-identified youth

Lisa Marchiano, LCSW, is a Jungian analyst. She blogs at theJungSoul.com (Facebook: https://m.facebook.com/thejungsoul), and can also be found on Twitter @LisaMarchiano.

Lisa’s thoughtful essay stands in stark contrast to the simplistic advice we see from self-declared gender therapists like this one. For the perspective of another therapist skeptical of the “gender affirmative” approach, see this post by Lane Anderson, a former therapist for trans-identified teens who quit her job last year due to ethical concerns.

Lisa would like to thank Miranda Yardley, ThirdWayTrans, and Carey Callahan for their contributions to this post. Though these three individuals were generous in sharing their time and expertise, the views expressed here are Lisa’s own.

Lisa is available to respond to your remarks and questions in the comments section of this post. In addition, Lisa is interested in being in contact with other therapists who share her concerns about the identity therapy model:

If there are other therapists reading this and wanting support to question or work outside of the identity model, please be in touch. Contact me privately on Facebook or Twitter, or ask this blog to put you in touch with me via email. There are lots of us out there. Let’s start talking.


by Lisa Marchiano 

As a social worker and a Jungian analyst, I have become increasingly concerned about the rush to affirm children’s and young people’s transgender self-diagnosis, and then transition them to the opposite sex. I am particularly worried about social and medical transition among teens whose transgender diagnosis arose “out of the blue,” without a significant history of early childhood dysphoria. I fear that, via their well-meaning desire to validate young people in pain, therapists are discarding basic principles of psychotherapeutic care.

My views have been informed by my work with detransitioners, as well as with parents of trans-identifying teens. I have also sought to educate myself further by listening to trans people, parents, clinicians, academics, lesbians, feminists, educators, gays, and others who are writing and speaking about gender. I believe that transition may be a viable and even necessary option for some people. I support the right of adults to choose this option with appropriate therapeutic care and support. I certainly believe that trans people deserve human rights, legal protection, humane care, and respect. However, there are potential physical and psychological dangers of transition, and we need to exercise astute clinical judgment and caution when working with young people who are seeking transition.

I have often seen trans activists and gender specialists promote “social transition” of trans-identifying youth as a positive and “fully reversible” intervention. Social transition refers to a number of steps one can take to present as the opposite sex. These might include making changes to one’s hair style, make-up, name, pronouns, and dress. One might also begin binding breasts or wearing a packer to “present” more convincingly as the opposite sex. Social transition is sometimes described as something that has few if any long-term consequences, and therefore can be recommended with minimal concerns,  even for young children. However, in some significant percentage of cases, social transition leads to medical transition. It appears likely that being conditioned to believe you are the opposite sex creates ever greater pressure to continue to present in this way. Once one has made the investment of coming out to friends and family, having teachers refer to you by a new name and pronouns, will it really be so easy to change back? Children who socially transition at a young age may have little experience living as their natal gender. How easy will it be for them to desist?

At least some of the time, each step taken toward transition creates pressure to continue. Numerous blog posts from detransitioners explore how transition made dysphoria worse, often because the young person became increasingly preoccupied with passing. This further discomfort created pressure to take more steps toward transition in order to present more convincingly as the opposite sex. To take just one example, breast binding may bring relief to some natal females who experience discomfort with their breasts, but binding in itself can be quite painful, restricting breathing and movement—thus creating an incentive to take the next step—“top surgery”/double mastectomy. I have heard one mother of a FtM young person stating that this natal female “got his lungs back” after getting a double mastectomy because he no longer needed to bind. Additionally, anecdotal evidence indicates that it is not uncommon for teens who socially transition to move on to hormones and/or surgery shortly after their 18th birthday. So it’s clear that social transition must be viewed as a treatment that carries with it a significant risk of progressing to medical transition.

Medical transition refers to a number of interventions undertaken to alter one’s body. These can include administration of hormone blockers to children and teens; administration of cross sex hormones; mastectomy; phalloplasty; hysterectomy; body masculinization; orchiectomy; vaginoplasty; facial feminization surgery; and others. All of these procedures can have permanent effects, and most of them carry significant risks. It is unusual (though not unheard of) for minors to have these surgeries. However, it is not uncommon for minors to take hormone blockers and cross sex hormones. And in 100% of the cases reported in the literature, children on puberty blockers went on to cross sex hormones. Top gender clinician Johanna Olson reports that no puberty-blocked children at her clinic in LA Children’s Hospital have ever failed to continue hormone treatment. Therefore, the claim that blockers are “100% reversible” is not accurate in practice. In fact, being on blockers appears to consolidate an investment in a cross sex identification. And although one rarely sees this “side effect” reported in the mainstream media, because gametes do not develop when an adolescent does not undergo natal puberty, hormone blockers followed by cross sex hormones results in permanent, life-long sterility 100% of the time.

Hormone blockers and cross sex hormones are being used off label (that is, they are not FDA-approved for this purpose). We have almost no knowledge about the long-term effects of taking these drugs over the course of decades, as anyone beginning transition as a young person will likely do. According to Madeline Deutsch, clinical director at University of California, San Francisco’s Center of Excellence for Transgender Health, “it scientifically makes sense that if someone is on hormones for decades, it’s highly likely that they’re going to be at higher risk [for certain health issues] than someone who started taking hormones at age 40 or 50.” Even the top pediatric gender doctors admit that there’s a dearth of good data on the long-term health outcomes of transition.

Certainly, there are risks. Cross sex hormones change bodies fairly quickly. Some of these changes are irreversible, such as a deepened voice, facial hair, and baldness for testosterone, and breast growth and, potentially, infertility for estrogen. In addition, use of cross-sex hormones carries with it potential negative side effects. Girls who take testosterone will be at increased risk for developing diabetes, cancer of the endometrium, liver damage, breast cancer, heart attack, and stroke. There may be other adverse effects of which we are not aware at this time, since long-term testosterone use in natal females is a relatively new phenomenon that has not been adequately studied.

I fear that there are young people transitioning – with the ready help of therapists, doctors, and others – who may regret these interventions and need to come to terms with permanent and in some cases drastic changes to their bodies. In fact, I know this is already happening. I have had considerable contact with the growing community of detransitioners. In many cases, the hatred for and disconnection from their bodies that these young people experienced was due to sexual trauma, internalized homophobia, or bullying. In videos and blogs, young women speak about their sadness over their lost voices and breasts. Male detransitioners mourn the loss of their testicles, the loss of their ability to orgasm, in some cases the loss of their fertility. Many have had complications from hormones such as vaginal atrophy, nerve damage, or chronic pain. You can hear some of these stories for yourself here, here, and here, among other places.

I have also spoken with many parents. Their stories are just as heartbreaking. These usually involve a teen who was anxious, depressed, socially isolated, or suffering from PTSD coming to identify as trans after internet binges on social media sites. These parents report that mental health professionals are validating the self-diagnosis of transgender after a handful of therapy sessions, without any exploration of prior mental health issues, trauma, sexual orientation, or history of gender nonconforming behavior. This clearly violates APA recommendations, which urge special caution in treating adolescents who present with sudden onset dysphoria.

All of this comes down to an essential question: When treating someone with gender dysphoria, do we do so using a mental health model, or an identity model?

An identity model is founded on the belief that we ought to be able to define our own experiences for ourselves. It proclaims that each of us has a right to assign our own meaning to our lives, our feelings, and our bodies. We get to decide who we are, and no one has authority over our self-perception. An identity model offers respect and self-determination for every person to define themselves as they would like.

An identity model has a place in psychotherapy. As people, we all self-identify aspects of our personality, values, and experiences in ways that are often very important to us. We might identify as Catholic, or as a Democrat. We might identify as an artist, an introvert, or a lesbian. As therapists, accepting and affirming our clients’ self-identification is important and empowering. As therapists, we can accept and empathize with a client’s story about his or her life experience. We can hold this story as valuable and important whether or not we objectively agree with it. As long as the client’s story does not lead to maladaptive behaviors, we do not need to challenge or attempt to discredit or disprove such a self-identification.

However, an identity model of working with transgender people goes further. An identity model stipulates that it is wrong to explore or question a client’s self-determined identity. Gender dysphoria is seen as evidence that someone is transgender, and merely wondering about underlying psychological reasons for dysphoria or alternative explanations for symptoms is seen as synonymous with denying a person’s identity. Applying our own clinical judgment to someone’s proclaimed self-diagnosis is seen as bigoted and wrong. Our role as therapists becomes limited to enthusiastic affirmation only.

In contrast, when we are working in a mental health model, we understand that clients come to us with symptoms that cause distress, and may interfere with a person’s day-to-day functioning. As therapists, we ought to be interested both in helping to alleviate or manage symptoms, as well as helping to understand the underlying cause of the symptom. If we are psychodynamically oriented, a basic assumption of our work is that every symptom has a meaning beyond its superficial presentation, and a major part of our work is to help our clients gain insight about this meaning.

In opposition to an identity model, then, the main task in mental health therapy with a client experiencing gender dysphoria would be to deeply explore the symptoms without making assumptions about what the symptoms mean. In fact, while identity therapy knows what gender dysphoria means – i.e. that the client is trans – mental health therapy will start with the assumption that we have no idea what the symptom means. We must be open to the meaning that emerges for patients as we explore their experience with them.

Seeking to understand deeply the nature, quality, and etiology of the dysphoria is not at all the same thing as denying the reality or importance of the symptom. When I explore a client’s anxiety – when did it start? What tends to trigger it? How does it feel? – I am not implying that I do not feel that the anxiety is unimportant or illusory. As we come to understand more about a client’s unique experience of a symptom, we may unwrap the meaning behind the suffering so that the problem resolves in a surprising, unexpected way. Or we may simply gain better information about the best course of treatment to alleviate the symptom for that particular person.

An identity model is not an appropriate basis on which to prescribe drastic, permanent medical intervention.

An identity model does not leave room for a therapist to exercise his or her clinical judgment. It disallows the possibility of a thorough assessment and differential diagnosis. According to the identity model, a client’s self-diagnosis is not to be questioned or explored. Therefore, alternative causes of dysphoria cannot be sought. As with many other mental health issues, the symptoms of gender dysphoria can be caused by many different things. Feeling uncomfortable with or disconnected from one’s body can go along with being on the autism spectrum; having experienced trauma; having bipolar disorder; having an eating disorder; or experiencing internalized homophobia. And sadly, it is a normal experience for teen girls, 90% of whom express dissatisfaction with their bodies.

An identity model subverts the normal diagnostic paradigm in which a patient presents with symptoms, and the clinician makes a diagnosis. In an identity model, the diagnosis is the identity. This occludes the focus on symptom resolution and management because the priority becomes affirming the identity. When symptoms are seen as validation of an identity, clinical judgment becomes irrelevant.

Before determining that a young person ought to undergo drastic treatments that may permanently alter their bodies and lead to permanent sterilization, a thorough assessment should be conducted that explores all potential factors contributing to the dysphoria. Unfortunately, because exploration of gender dysphoria is construed by some to be tantamount to “conversion therapy,” this kind of extensive assessment is frequently not performed. Though data is sparse, I personally have had contact with dozens of young people and/or their families who received a transgender diagnosis and a prescription for hormones after one to three appointments with a therapist.  According to this survey of more than 200 detransitioned women, 65% of those who transitioned received no therapy at all, either because they were referred for treatment at their first visit, transitioned through an informed consent clinic, or bought hormones through unofficial sources. (The median age for beginning transition in this survey was 17.) Only 6% of respondents felt they had received adequate counseling about transition. In fact, according to the ideology of gender identity, thorough assessment is seen as inappropriate “gatekeeping.”

An identity model does not allow us to rule out cases of transgenderism where social contagion might be at play. It appears quite likely that the striking increase in trans-identifying teens in recent years is due at least in part to social contagion. There has been a sudden sharp rise in the number of children and teens presenting at gender clinics. The first transgender youth clinic opened in Boston in 2007. Since then, 40 other clinics that cater exclusively to children have opened. Inexplicably, the ratio of natal males to natal females has flipped sharply, with many more natal female teens now presenting. Many of these young people have been presenting with dysphoria “out of the blue” as teens or tweens after extensive social media use without ever having expressed any gender variance before. This now-common presentation was virtually unheard of even a handful of years ago. Thousands of home-made videos on sites such as YouTube chronicle the gender transitions of teenagers. These teens show off their new-found muscles or facial hair. The Tumblr blog Fuck Yeah FTMs  features photo after photo of young FtMs celebrating the changes wrought by testosterone. “I finally have freedom!” posters boast under photographs of their scarred chests post mastectomy. “I’m no longer pre-T!” boasts another under a video of someone injecting testosterone. Almost all of these posters are under 25 years of age. According to Jen Jack Gieseking, a New York academic and researcher who was interviewed by BBC Radio 4 last May, “There really isn’t a trans person I’ve met under the age of 30 who hasn’t been on Tumblr.” There are multiple credible online reports of whole friend groups coming out together as trans.

But correlation isn’t causation. As this brilliant blog post explores, the contagion factor only speaks to the particular way that young people choose to deal with distress. It isn’t that the internet is “causing” the rise in transgenderism. It’s that many young people – particularly young females – are feeling alienated from their bodies due to trauma, porn culture, societal standards of beauty, oppressive gender roles, sexism, homophobia, and so forth. Self-diagnosing as transgender becomes an attractive way to deal with the alienation because it is so validated and even lionized in the culture and the mainstream media. For therapists, an identity therapy model does not allow us to acknowledge the role of social contagion, though contagion has been well-documented in contributing to suicide clusters and other behaviors.

An identity therapy model encourages us not to put safeguards in place to prevent young people from undertaking treatments they may later regret. According to an identity model, self-diagnosis as trans should never be questioned. To do so implies a lack of support and even bigotry. Therefore, the clinician must not stand in the way of transition to the person’s “authentic self.” Because of this, an increasing number of minors are going on hormones and even undergoing surgery that will permanently alter their bodies. Even 18 is probably too young to make such major medical decisions. In cases where the 18-year-old is making medical decisions based on a social transition that she or he began years earlier, it is possibly even more likely that that young person has not carefully considered the consequence of transition. Top gender doctors are hoping to see the recommended age for “bottom surgery” lowered.

In sharp contrast, it’s not easy for non-trans patients to be sterilized before adulthood. For instance, in Massachusetts, a patient must be at least 21 years of age to qualify for sterilizing surgeries under the state’s public health scheme. When such a surgery is undertaken, patients are carefully counseled and must sign a form stating that they understand the permanent nature of the procedure, and that they do not wish to bear or father children. Patients must then wait a minimum of 30 days after signing the form before having the surgery. This procedure has been put in place because surgical sterilization has been shown to come with a high incidence of regret. Why are there not similar safeguards in place for those transgender identifying young people wishing to amputate healthy organs and/or sterilize themselves?

There is a wealth of research about cognitive and emotional development in adolescence. The upshot of it is that teens and young adults are more likely to act impulsively, are unable to assess risks well, and are more emotionally reactive. It is partly for these reasons that we do not allow teens to drink, get tattoos, or use tanning beds without adult consent.

An identity model does not allow us to examine the homophobia that drives some – possibly many — transitions. According to extensive research on desistance, a significant majority of children who identify as the opposite sex will not continue to do so into adulthood. The majority of those who desist will come to identify as lesbian or gay. “Feminine” boys are actually many times more likely to grow up to be gay men rather than transgender women. The same is true for “masculine” girls. Many lesbian bloggers (such as this one and and this one) are very concerned that the current trend to transition young people is disproportionately hurting lesbians and gays, and their fears appear to be well founded. This conservative Christian Texas mother was bothered by her son’s “flamboyant, feminine” behavior. Rather than accepting her son’s gender-defiant presentation, she has decided he is transgender. She now has a very pretty, gender conforming “daughter.”

There is widespread concern in the lesbian community that many young would-be lesbian or bisexual women are finding it easier to become “straight men” due to internalized homophobia. In this article, fourteen-year-old Mason describes how he knew he was transgender. “I’ve always known something was up about how I felt about myself,” says Mason, who as Madelyn had refused to wear pink, or to dress in stereotypically feminine attire. “I thought I was gay or bisexual or something.” In years past, Madelyn most likely would have grown up to be a lesbian or bisexual woman. To paraphrase psychiatrist Ray Blanchard, surely it’s preferable to have an outcome of a reasonably well adjusted lesbian woman, rather than someone who identifies as a trans man who has had many irreversible surgeries and a lifetime of drugs.

An identity model makes us unable to tease out other mental health concerns that may be impacting the desire to transition. There is considerable research that points to a high likelihood of co-occurring disorders in young people who wish to transition. For example, this study from 2015 noted that “severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.” In this study, 68% of the population had first had contact with psychiatric service for reasons other than gender dysphoria. Thirteen percent were being treated for psychotic symptoms.

This study from 2004 found high rates of “comorbidity” in those with gender dysphoria, and noted that this was often not taken into consideration when treatment planning for these patients. “Results: Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders. Conclusions: Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.”

This 2015 study found a link between gender dysphoria and dissociative symptoms secondary to trauma. According to this blogger, trauma and dissociation were a big part of her desire to transition. This was also true for this blogger here. Similar stories from detransitioners with histories of unaddressed trauma abound.

An identity model does not allow us to take into account reports from parents or previous therapists who may not agree with the patient’s self-diagnosis. I have received dozens of distraught emails from parents trying in vain to get gender therapists to listen to them when they share information about their child’s mental health history that ought to be taken into consideration while assessing and treating gender dysphoria. While I cannot share the contents of these emails without violating people’s privacy, I can point to quite a few places online where frustrated parents have shared similar stories. For example, this social work professor states that the gender therapist did not review her daughter’s special education records or speak with the previous therapist before recommending hormones and surgery for this young autistic teen.

Parents I have had contact with have told me about their child having a history of anxiety, panic attacks, depression, trauma, loss, bipolar disorder, anorexia, cutting, borderline personality disorder, and psychosis. In these cases, as soon as the young person brought up their transgender self-diagnosis, the focus of the therapy shifted to this alone. The parents’ fears, concerns, and information about past treatments were disregarded as obstructionist and transphobic. I am not alleging that this is happening in every case. However, it certainly is happening with some degree of regularity.

An identity model does not allow us to question the incoherence of gender identity ideology. While gender dysphoria appears to be a meaningful diagnostic term that describes a set of symptoms – namely intense discomfort with one’s sexed body – it does not follow from this that one is “trapped in the wrong body,” has a “female” or “male” brain, or even a “gender identity” that doesn’t match one’s body. Though the concept of gender identity is currently being enshrined into law, the truth is that we have no meaningful definition of the term. (For an excellent analysis of the incoherence of the term, take a look at Rebecca Reilly Cooper’s work.) When a trans-identified person is asked how they know they are transgender, they are usually unable to answer the questions without reference to sex role stereotypes. For example, a physician who prescribed cross sex hormones to a 12-year-old natal female stated that the child had “never worn a dress.” This was offered as evidence of the child’s being “truly trans,” and therefore needing these hormones. I would strenuously argue that one’s clothing preferences should not be a reason to permanently sterilize a child.

It doesn’t make sense to say that one’s sex organs don’t matter, but then assert a primary, essential difference based on a sexed brain. Sexed brains do not exist. It is absurd to posit that one’s chromosomal sex, genitals, and entire reproductive system are meaningless and irrelevant or a social construct, and then assert that a subjective feeling of being the opposite gender is determinative. There is no robust science behind the notion of gender identity. Journalists have been quick to report on studies that seem to prove brain differences among those who are transgender. However, as the sexology researcher James Cantor has pointed out, these studies actually seem to be documenting brain differences among those who are homosexual.

If you want to see a review of some of the literature out there in support of a biological basis for gender dysphoria, this blog post does a good job. There are some solid studies that seem to indicate that genetics or pre-natal hormone exposure may play some role in the development of gender dysphoria. That isn’t really surprising. Pretty much every diagnosis in the DSM – from depression, to anorexia, to borderline personality disorder – has some genetic component. Gender dysphoria is real. As with other mental health diagnoses, its causes are likely complex and involve genetic, biological, environmental, and psychological factors. But it doesn’t follow from any of this that the sufferer has an inborn “gender identity” that ought to supersede any consideration of one’s objective biological sex. Body dysmorphic disorder is associated with brain differences and appears to have a genetic component, and yet the biological component of the condition does not dictate that we understand the patient’s suffering to reflect objective reality.

Transgender activists assert that “gender is between the ears, not between the legs.” However, this is an ideological, faith-based statement that cannot be scientifically validated. What is “between our ears” — meaning our inner experience of ourselves as a gendered person — is purely subjective. Within this context, asserting that one is transgender is an unfalsifiable statement of belief. In reality, feeling like the other sex does not in any way mean that you are the other sex. Identity is an important aspect of one’s experience. We get to define ourselves subjectively, and I would argue that full-fledged adults ought to be able to modify their bodies in accordance with their sense of themselves. However, subjective identity should not dictate a necessity for medical treatment of any kind, especially body-altering treatments with highly significant side effect profiles for minors or young people

An identity model does not allow us to consider treatment outcomes critically. The research on outcomes post transition is mixed at best. It is well-known that one study showed that 41% of transgender people had experienced suicidal ideation or self harm. It is less well-known that the study gives no indication whether the attempt was before or after receiving transition care. Several large studies show astonishingly high rates of suicide among transgender people who have medically transitioned (see here and here). It has been argued that suicide rates continue to be high after transition due to societal prejudice. While this likely is true some of the time, post-transition transsexuals are more likely to “pass” as the target gender, and therefore ought to be less subject to discrimination. Given the undeniably high rates of suicide in post-transition transsexuals, it is disingenuous to claim that transition is a panacea that will prevent suicide.

While this study showed positive outcomes for early transition, there were only 55 subjects included. Perhaps more importantly, they were last assessed at one-year post sex reassignment surgery. In the survey of detransitioned women, the average length of transition was four years. It seems possible that some of the 55 individuals followed in the first study might go on to have regrets if they were followed for longer. Worryingly, one of the 70 individuals invited to participate in the study was unable to do so because the person died as a result of postsurgical necrotizing fasciitis after undergoing vaginoplasty.

While the media is full of stories of young people becoming happier and more confident after being allowed to transition, there is some evidence that this is not always the case. In addition to the research that documents high suicide rates post transition, I am aware of anecdotal evidence of continued or even increased anxiety and depression, social isolation, psychiatric hospitalization, and poor academic outcomes for those who have transitioned.

An identity model does not allow us to explore other options for dealing with dysphoria. Transition – social and medical — is currently the only treatment commonly prescribed for gender dysphoria. If what we are treating is an acute discomfort with one’s body, it would seem reasonable to offer a range of different treatments before prescribing transition, including anti-depressants, talk therapy, and emotion-regulation skills to help patients manage their distress. However, none of these treatments is routinely prescribed for gender dysphoria. In the survey of 200 detransitioned women, some significant percentage of them stated that they found alternative ways of dealing with dysphoria other than transition. Detransitioner and therapist in training Carey Callahan offers several specific techniques that she has found helpful on her blog. Clinicians and researchers ought to be mining these experiences to find other effective treatments for dysphoria in addition to transition.

whitman-quote-2

An identity model makes some questionable assumptions about the nature of identity and our ability to know ourselves. An identity model is predicated on the notion that identity is immutable, essential, and knowable. This is not my experience of human nature. Identities are useful for approximating something about ourselves. They are constructs that allow us to talk about our experience. But they are not absolute truths, and they rarely say something about our most essential, mysterious, and ultimately unknowable essence. To quote Whitman, “do I contradict myself? Very well, then, I contradict myself. I am large. I contain multitudes.” I have had the good fortune to contradict myself many times in my life – contradict myself on things that at one time felt utterly essential and absolutely true. I believe this is a universal human experience, and yet another reason why making permanent changes to one’s body at a young age ought to be approached with extreme caution.

An identity model makes it impossible for us to acknowledge or discuss the varied reasons why a person might want to transition. The desire to transition likely has many varied causes. Seeing all transitions as an expression of innate gender identity obscures the very real differences between one person’s situation and another, making it impossible to assess and treat people in an individualized way. A late transitioning MtT autogynephile has an experience of gender dysphoria that is vastly different than that of a fifteen-year old lesbian, and the former’s experience ought not in any way to dictate how we understand or treat the latter.

An identity model creates a false dichotomy between affirmation and bigotry. According to the current narrative, the only supportive response to a teen who has self-identified as transgender is to affirm this identity and begin transition immediately. Any other response is quickly labeled transphobic. In reality, there is a huge range between assisting a child in transitioning immediately and affirming that they are and in fact always have been the opposite sex, and denigrating or shaming them for their desire to transition or coercively trying to get them to conform to rigid gender expectations. Parents can communicate their unconditional love and support. Parents can offer solace and warmth as the child struggles with distressing feelings. Parents can seek legitimate psychotherapeutic help to offer space for the young person to explore and understand the desire to transition. Teenagers often develop strong beliefs about what they must do or have, and it is well known that these beliefs and demands are not always sound or rational. Never before have parents of teens been told that they have to accede to the demands of their teenager or risk doing irreparable harm. Parents of teens have always had to step in and set loving limits on behavior that may not be in the young person’s long-term best interest. When dealing with a child who has diagnosed themselves as transgender, parents can do what parents of teenagers always do – set sensible limits and help a child to reflect on the potential consequences of his or her actions. Parents can assure the child of their ongoing love and acceptance if he or she does eventually decide, as a full-fledged adult, to transition.

An identity model offers an inferior kind of therapy to those who identify as transgender. As the blogger Third Way Trans has pointed out, “if someone is a member of a dominant class they receive regular psychotherapy but if they aren’t they receive a special kind of social justice therapy.” Those who come into treatment with gender dysphoria are not given the opportunity to explore deeply their experience, but instead have their self-diagnoses affirmed. There are people who will need to live as the opposite sex in order to have the happiest, fullest life possible. These individuals may need to consider taking hormones or having surgery. Surely these people deserve to have a place to explore these consequential decisions without prejudice in favor of a specific outcome so that a process of careful discernment can take place. If therapists are only cheerleaders for transition, how can someone in this situation get help to make the best decision?

I believe we should offer clients with gender dysphoria high quality mental health therapy. In a guest post on this blog, a woman who considered transitioning several times during her life shared a moment from her own therapy that proved important to her.

“When I started therapy in my early twenties, I revealed to my therapist that I had been raped at 18. It had been four years and I had never told anyone. In the process of uncovering that rape and telling her about it, I stated, during a session, that I wanted to become a man. She nodded, she said she understood, and that it was something we could explore, but in the meantime, we really needed to talk about the rape. I appreciated her approach. She wasn’t directive, judgmental, or reactive, she simply stated it was something to keep talking about, but encouraged me to focus on my experience of being raped and other traumas.”

In providing high quality mental health therapy to all patients, we would communicate unconditional positive regard to our gender dysphoric patients, just as we would with anyone else, and as the therapist in this blog post did. We would greet their announcement that they feel as though they may need to transition with acceptance and curiosity, communicating that we are willing to go there with them, to explore this desire in all of its intricacy, without prematurely coming to a fixed notion of what is right for our patient. We would see the person in front of us in all of their miraculous complexity, and not just as a “gender identity.”

As therapists, we have been trained in assessment. We have been trained to wonder about layers of meaning that may not be visible at first glance. We have been trained in how to recognize and work with trauma. We have been trained to help out clients explore their labyrinthine inner lives. When clients come to me wondering whether to end a relationship with a boyfriend or change careers, we typically spend months considering all of the different facets of such a decision. Don’t we owe at least as considered a process to someone contemplating making permanent changes to his or her body, especially when that person is a teen or young adult?

Announcing a new online survey for detransitioned women

Cari is a 22-year-old detransitioned woman who was interviewed recently on 4thWaveNow about her experiences as a former teen client of Transactive Gender Center in Portland, OR.  Cari wrote to us today to announce an online survey she has created for women who are reclaiming themselves as female.  I’ll let her introduce her work in her own words shortly. But first, if you have not had a chance to watch Cari’s very powerful YouTube video,  please do so. In it, she deftly takes apart a post on trans youth, desistance, and detransition by trans activist MtoF Julia Serano.

Cari is not the only detransitioner talking back to Serano. Several other women have come forward in recent days to eloquently and incisively describe the many facets of the female detransitioned experience, including Maria Catt and crashchaoscats. Transgender Trend also posted an excellent response to Serano.

Now I’ll let Cari introduce her Survey of female detransition and reidentification. Please share widely!


This survey is for anyone female/AFAB who formerly self-described as transgender. This includes women who transitioned, whether socially and/or medically, and have subsequently detransitioned, as well as individuals who still identify as nonbinary or genderfluid, but have desisted from medical or social transition. The purpose of this survey is to provide information about the demographics of those who detransition and reidentification, motivations of individuals to detransition, and survey general attitudes of female detransitioners towards transition.

I’m posting this as a way of getting some data about detransitioned women where none seems to exist, particularly regarding motivation to detransition and the efficacy of managing dysphoria without transition. This survey is short due to surveymonkey’s question limit, and not very scientific, however I may create a longer and more controlled one in the future, should there be interest in that.